Endoscopic Ultrasound-Guided Fine Needle Aspiration has High Diagnostic Value in the Diagnosis of Solid Pancreatic Lesions.

Objective: To analyze the potential factors influencing the diagnostic capability of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and provide medication treatment recommendations for patients with pancreatic solid mass lesions. Methods: A retrospective analysis was conducted on clinical data of 92 patients with pancreatic solid mass lesions who underwent EUS-FNA examination after detection by imaging studies. The diagnostic effectiveness of EUS-FNA was evaluated based on cytological or histological examination results. Logistic regression analysis was subsequently performed to analyze the potential factors influencing the diagnostic capability of EUS-FNA in patients with pancreatic solid mass lesions. Results: EUS-FNA was successfully performed in all 92 patients, with a puncture success rate of 100.00%. Only one patient experienced transient hyperamylasemia, which resolved with conservative treatment. No other serious complications were observed. Among the 92 patients, 70 patients obtained a definite diagnosis after EUS-FNA (Group A), while 22 patients did not achieve a definite diagnosis (Group B) after the procedure. Univariate analysis showed that lesion size, dilation of the pancreatic duct or bile duct, negative pressure, and suction method were significantly different between Group A and Group B (P < .05). Multivariate logistic regression analysis revealed that lesion size, dilation of the pancreatic duct or bile duct, negative pressure, and suction method were potential factors influencing the diagnostic ability of EUS-FNA in patients with solid pancreatic lesions (P < .05). Conclusion: EUS-FNA has a high diagnostic value in the evaluation of solid pancreatic lesions. Lesion size, dilation of the pancreatic duct or bile duct, negative pressure, and suction method are potential factors influencing the diagnostic ability of EUS-FNA in patients with solid pancreatic lesions. In terms of medical treatment, specific treatment methods and drug choices should be based on a comprehensive evaluation of the nature of the patient's lesions and the severity of the condition.

Successful treatment of Bowen's Disease in the nipple-areola complex with a combination of photodynamic therapy and cryotherapy-A case report.

Photodynamic therapy (PDT) is a non-invasive, effective treatment for superficial skin conditions, offering superior cosmetic outcomes compared with traditional therapies. Bowen's disease (BD) of the nipple-areola complex (NAC) is rare and thus, lacks a standardized treatment approach. This report details the case of a 48-year-old woman who was successfully treated for BD of the NAC using PDT. Over a follow-up period of 30 months, there was no evidence of disease recurrence, underscoring the potential of PDT as a viable treatment option for this rare manifestation of BD.

Nanowires Framework Supported Porous Lotus-Carbon Anode Boosts Lithium-Ion and Sodium-Ion Batteries.

The novel design of carbon materials with stable nanoarchitecture and optimized electrical properties featuring simultaneous intercalation of lithium ions (Li+ ) and sodium ions (Na+ ) is of great significance for the superb lithium- sodium storage capacities. Biomass-derived carbon materials with affluent porosity have been widely studied as anodes for lithium-ion batteries (LIBs) and sodium-ion batteries (SIBs). However, it remains unexplored to further enhance the stability and utilization of the porous carbon skeleton during cycles. Here, a lotus stems derived porous carbon (LPC) with graphene quantum dots (GQDs) and intrinsic carbon nanowires framework (CNF) is successfully fabricated by a self-template method. The LPC anodes show remarkable Li+ and Na+ storage performance with ultrahigh capacity (738 mA h g-1 for LIBs and 460 mA h g-1 for SIBs at 0.2 C after 300 cycles, 1C≈372 mA h g-1 ) and excellent long-term stability. Structural analysis indicates that the CNFs-supported porous structure and internal GQDs with excellent electrical conductivity contribute significantly to the dominant capacitive storage mechanism in LPC. This work provides new perspectives for developing advanced carbon-based materials for multifunctional batteries with improved stability and utilization of porous carbon frameworks during cycles.

Comparative Analysis Based on Physiological and Transcriptomic Data between Juvenile and Adult Tree Peony (Paeonia delavayi).

A long juvenile period limits the breeding process of many woody plants including tree peony. To investigate the physiological and transcriptomic differences between juvenile and adult plants of tree peony and to explore the key SQUAMOSA PROMOTER BINDING PROTEIN-LIKE (SPL) genes, which are vital in age-dependent pathways, 1-year-old and 3-year-old Paeonia delavayi plants were used to compare the relevant physiological parameters and transcriptomic profiles of the leaves in two phases of plants. The results of the physiological parameters showed that the starch content in the leaves of adult plants remained unchanged and that the soluble sugar content significantly increased compared with those in the juvenile plants. In terms of plant hormones, the contents of cytokinin-like hormone (N6-isopentenyladenine (iP)) and jasmonic acid (JA) significantly decreased, whereas the contents of auxin (indole-3-acetic acid, IAA), abscisic acid (ABA), cytokinin-like hormone (N6-isopentenyladenenosine (iPR)), and ethylene precursor (1-aminocyclopropane-1-carboxylic acid, ACC) showed no statistic difference. Transcriptome sequencing results showed that there were 194 differentially expressed genes (DEGs) between juvenile and adult plants, including 171 up-regulated DEGs and 23 down-regulated DEGs. Circadian rhythm, plant hormone signal transduction, and sugar metabolism were closely related to the juvenile-to-adult transition in P. delavayi, involving a total of 12 DEGs. In addition, a total of 13 SPL genes were identified in the transcriptome data, but only PdSPL10 (c71307.graph_c0) was differentially expressed. It was further validated via qRT-PCR analysis, indicating that PdSPL10 might be a key gene regulating the process of juvenile-to-adult in P. delavayi. Based on the above results, a hypothetical transcriptional network regulating juvenile-to-adult transition and flowering in P. delavayi was proposed. These findings provide a reference for understanding the mechanism of juvenile-to-adult transition in tree peony.

CT-based radiomics signature for differentiating pyelocaliceal upper urinary tract urothelial carcinoma from infiltrative renal cell carcinoma.

Objectives: To develop a CT-based radiomics model and a combined model for preoperatively discriminating infiltrative renal cell carcinoma (RCC) and pyelocaliceal upper urinary tract urothelial carcinoma (UTUC), which invades the renal parenchyma. Materials and methods: Eighty patients (37 pathologically proven infiltrative RCCs and 43 pathologically proven pyelocaliceal UTUCs) were retrospectively enrolled and randomly divided into a training set (n = 56) and a testing set (n = 24) at a ratio of 7:3. Traditional CT imaging characteristics in the portal venous phase were collected by two radiologists (SPH and ZXL, who have 4 and 30 years of experience in abdominal radiology, respectively). Patient demographics and traditional CT imaging characteristics were used to construct the clinical model. The radiomics score was calculated based on the radiomics features extracted from the portal venous CT images and the random forest (RF) algorithm to construct the radiomics model. The combined model was constructed using the radiomics score and significant clinical factors according to the multivariate logistic regression. The diagnostic efficacy of the models was evaluated using receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC). Results: The RF score based on the eight validated features extracted from the portal venous CT images was used to build the radiomics model. Painless hematuria as an independent risk factor was used to build the clinical model. The combined model was constructed using the RF score and the selected clinical factor. Both the radiomics model and combined model showed higher efficacy in differentiating infiltrative RCC and pyelocaliceal UTUC in the training and testing cohorts with AUC values of 0.95 and 0.90, respectively, for the radiomics model and 0.99 and 0.90, respectively, for the combined model. The decision curves of the combined model as well as the radiomics model indicated an overall net benefit over the clinical model. Both the radiomics model and the combined model achieved a notable reduction in false-positive and false-negativerates, resulting in significantly higher accuracy compared to the visual assessments in both the training and testing cohorts. Conclusion: The radiomics model and combined model had the potential to accurately differentiate infiltrative RCC and pyelocaliceal UTUC, which invades the renal parenchyma, and provide a new potentially non-invasive method to guide surgery strategies.

Research and application of KABP nursing model in cardiac rehabilitation of patients with acute myocardial infarction after PCI.

OBJECTIVE: To investigate the effect of a nursing protocol based on the KABP (Knowledge, Attitude, Belief and Practice) model in the cardiac rehabilitation (CR) of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). METHODS: In this prospective study, a total of 76 patients with AMI who underwent PCI were selected as the research objects. Through random number table, the participants were divided into 41 cases in the KABP group (cardiac rehabilitation nursing based on KABP model) and 35 cases in the control group (conventional rehabilitation nursing). All patients underwent echocardiography within 48 hours after PCI and 3 months after the postoperative follow-up to determine the improvement of their cardiac function. The risk of falling out of bed for 7 days after surgery, the physical improvement and exercise endurance before and after the intervention, as well as the scores of Coronary Artery Disease Self-Management Scale (CSMS) and China Questionnaire of Quality of Life in Patients with Cardiovascular Diseases (CQQC) were compared between the two groups. RESULTS: Within 48 hours after operation, there was no significant difference in the indicators of cardiac function between the two groups (all P>0.05). After 3 months of postoperative follow-up, the improvement of cardiac function of KABP group including left ventricular ejection fraction, stroke volume, and cardiac index were significantly better than those of the control group (all P<0.05), and NYHA class was also significantly better than that of the control group (P<0.001). On the 7th day after operation, the high risk of falling out of bed in the KABP group (17.07%) was significantly lower than that in the control group (74.29%; P<0.001). The metabolic equivalent, 6-minute walk test scores, and CQQC scores of the KABP group were significantly higher than those of the control group (all P<0.01). The total scores of daily life management, disease medical management, emotional cognitive management and self-management in CSMS were significantly higher than those of the control group (all P<0.01). CONCLUSION: Cardiac rehabilitation care based on the KABP model can improve the recovery of cardiac function of AMI patients after PCI, reduce the risk of falling out of bed, help patients recover their physical status and exercise endurance, and improve their management behavior and postoperative life quality.

Illustration of a number of atypical computed tomography manifestations of active pulmonary tuberculosis.

Tuberculosis is a serious public health challenge facing mankind and one of the top ten causes of death. Diagnostic imaging plays an important role, particularly for the diagnosis and treatment planning of tuberculosis patients with negative microbiology results. This article illustrates a number of atypical computed tomography (CT) appearances of pulmonary tuberculosis (PTB), including (I) clustered micronodules (CMNs) sign; (II) reversed halo sign (RHS); (III) tuberculous pneumatocele; (IV) hematogenously disseminated PTB with predominantly diffuse ground glass opacity manifestation; (V) hematogenously disseminated PTB with randomly distributed non-miliary nodules; (VI) PTB changes occur on the background of emphysema or honeycomb changes of interstitial pneumonia; and (VII) PTB manifesting as organizing pneumonia. While the overall incidence of PTB is decreasing globally, the incidence of atypical manifestations of tuberculosis is increasing. A good understanding of the atypical CT imaging changes of active PTB shall help the diagnosis and differential diagnosis of PTB in clinical practice.

Clinical value of the detection of EGFR gene mutations in pleural effusion cell blocks among patients with non-small-cell lung cancer.

OBJECTIVE: To evaluate the clinical value of epidermal growth factor receptor (EGFR) detection in pleural effusion cell blocks among patients with non-small-cell lung cancer (NSCLC). METHODS: From July 2016 to September 2018, EGFR gene mutations in 40 lung tumor tissue samples and pleural fluid samples from NSCLC patients in Jinhua Municipal Central Hospital were assessed by the amplification refractory mutation system method. The EGFR results of the two types of samples were compared using the paired Chi-square test, and the mutation positive rates in EGFR exons 18, 19, 20 and 21 were compared between the two types of specimens using the four-grid Chi-square test. RESULTS: Among the 40 tissue samples and pleural effusion samples, 21 and 18 cases of EGFR mutations were detected, respectively, and the mutation positive rates were 52.5% and 45%, respectively. The κ value of the consistency test of the two specimens was 0.851. There were no significant differences in the mutation positive rates in EGFR exons 18, 19, 20, and 21 between the two types of specimens. CONCLUSION: The EGFR results of pleural fluid and tissue samples were in good agreement. Therefore, we can use pleural fluid samples to detect EGFR mutations to guide tyrosine kinase inhibitor treatment for NSCLC patients in whom tumor tissue samples cannot be obtained.

Primary mediastinal yolk sac tumor: a case report and literature review.

Primary mediastinal yolk sac tumors (YSTs) are rare and have a high degree of malignancy. This article reports a 42-year-old man with a primary mediastinal YST. The patient presented with chest tightness and shortness of breath. Using a contrast-enhanced computer tomography (CT) scan, the mediastinal space was found to be occupied by a mass shadow, about 10 cm × 8 cm with a clear boundary and low density. Serum alpha-fetoprotein (AFP) was elevated to 7169.66 ng/ml. The 5th day after hospitalization, a percutaneous biopsy of the mediastinal mass was performed. Malignant tumor cells were found by cytologic examination. According to the pathological morphology and immunohistochemical results, the tumor was diagnosed as primary mediastinal YST. Subsequently, the patient underwent five cycles of adjuvant chemotherapy including bleomycin, etoposide, and cisplatin (BEP) and surgical tumor removal. One month after operation, AFP was elevated to 252.96 ng/ml. CT examination showed that the tumor recurred. As of September 12, 2020, the patient has undergone four cycles of VIP (etoposide, ifosfamide, cisplatin) chemotherapy after relapse, and the patient's condition is currently in partial remission.

Combination of Fluorine-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography (¹8F-FDG PET/CT) and Tumor Markers to Diagnose Lymph Node Metastasis in Non-Small Cell Lung Cancer (NSCLC): A Retrospective and Prospective Study.

BACKGROUND The early diagnosis of lymph node (LN) metastasis is crucial for patients with non-small cell lung cancer (NSCLC). However, the diagnosis of LN metastasis mainly dependent on ¹8F-FDG PET/CT (fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography) which exhibited high false positive/negative rate. MATERIAL AND METHODS In retrospective analysis, 135 patients with NSCLC from February 2014 to March 2017 were enrolled. Based on the pathological examination, 71 patients were distributed to the LN Metastasis Group while 64 patients were distributed to the No LN Metastasis Group. Data from ¹8F-FDG PET/CT and tumor marker (TM) examination were collected to establish a logistic model. The receiver operating characteristic (ROC) curve analysis set the threshold of diagnostic factors. Finally, the diagnostic values of these factors were verified in a prospective analysis that included 78 patients with NSCLC from July 2017 to April 2019. RESULTS In our retrospective analysis, compared with the No LN Metastasis Group, the maximum standardized uptake value (SUVmax)/size of primary lesion, the CT value/SUVmax/short diameter of LN, the level of TM were all significantly different than the LN Metastasis Group (All P<0.05). Our logistic model showed that SUVmax of primary lesion (odds ratio [OR]=1.491), short diameter of LN (OR=1.310) and grade of TM (OR=2.927) were significant variables. The ROC curve analysis showed the specificity and sensitivity of our logistic model was 90.6% and 90.1%, respectively. In our prospective analysis, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic model were calculated as 85.7%, 90.9%, 87.2%, 96.0%, and 71.4%, respectively. CONCLUSIONS Our study found that combining ¹8F-FDG PET/CT data and TM to establish a logistic model performed better in the diagnosis of LN metastasis with low false positive/negative rates in patients with NSCLC.

Surfactant-free emulsions stabilized by tempo-oxidized bacterial cellulose.

In order to seek a safe, biodegradable, and sustainable solid stabilizer for food, topical and pharmaceutical emulsions, individualized cellulose nanofibers were prepared by oxidizing bacterial cellulose (BC) in a Tempo-mediated system; their ability to stabilize oil/water interface was investigated. Significant amounts of C6 carboxylate groups were selectively formed on each cellulose microfibril surface, so that the hydrophilicity was strengthened, leading to lower contact angles. Meanwhile, both the length and width of fibrils were decreased significantly, by partial cleavage of numerous numbers of inter- and intra-fibrillar hydrogen bonds. Tempo-oxidized BC (TOBC) was more effective than BC in stabilizing oil-water interface, attributing to the much smaller size. Fibril dosage and oxidation degree exerted a great influence on the stability and particle size distribution of emulsion samples. When the fibril dosage was 0.7wt.%, the sample was so stable that it did not experience creaming and coalescence over 8 months. The 2-TOBC coated droplets showed the greatest stability, although both the zeta potential and the electric repulsion were the largest for the 10-TOBC analogue, which was manipulated by the wettability of fibrils. In addition, the stability of samples was analyzed from the viewpoint of particle size distribution. Consequently, fibril size and wettability are two counterbalanced factors influencing the stability of TOBC-stabilized emulsions; a combination of suitable wettability and size imparts TOBC-stabilized emulsion high stability. As a kind of biomass-based particle stabilizer, TOBC showed great potential applications in food, topical and pharmaceutical formulations.

Asthma COPD Overlap Syndrome on CT Densitometry: A Distinct Phenotype from COPD.

Patients with asthma COPD overlap syndrome (ACOS) are an important but poorly characterized group. This study sought to explore the distinct characteristics of ACOS on CT densitometry. The study population was randomly selected from communities via questionnaires. All participants underwent low-dose volumetric chest CT both before and after bronchodilator administration. Each CT scan was performed at full-inspiration and full-expiration for CT densitometry. Emphysema index (EI), air trapping (AT), mean lung density (MLD) and total lung volume (TLV) were measured and compared between the ACOS and COPD groups. The distributions of both EI and AT were compared between patients with ACOS and COPD. The variations between the pre- and post-BD measurements observed in patients with ACOS were compared with those in patients with COPD. A total of 71 patients completed the study, including 32 patients with COPD and 39 patients with ACOS. The patients with ACOS exhibited lower EI and more upper-zone-predominant EI distributions, compared with the patients with COPD. No significant differences were exhibited in AT and its distribution. Following bronchodilator administration, the variations in AT and expiratory MLD were greater in patients with ACOS than in patients with COPD. No differences were observed in the variations of EI and inspiratory MLD. Our results indicate that patients with ACOS have lower extent of emphysema and different emphysema distribution, as well as greater post-BD variations in air trapping, compared with patients with COPD. These findings suggest that CT densitometry characterizes ACOS as a distinct phenotype from COPD.

[Significance of P504s in distinction between solid pseudopapillary tumor of pancreas and pancreatic neuroendocrine tumors].

OBJECTIVE: To study the significance of P504s in differential diagnosis between solid pseudopapillary tumor of the pancreas (SPTP) and pancreatic neuroendocrine tumors (PanNET). METHODS: Forty-three patients with SPTP and 41 patients with PanNET encountered during the period from 2007 to 2014 were recruited. Immunohistochemical study for vimentin, CD10, chromogranin A, synaptophysin, beta-catenin, CD99 and P504s in SPTP and PanNET was performed. The diagnostic value of P504s in differentiating SPTP from PanNET was analyzed. RESULTS: Immunohistochemical study showed that vimentin, CD10, chromogranin A, synaptophysin and CD99 were expressed both in SPTP and PanNET. All cases of SPTP showed granular cytoplasmic expression of P504s, whereas those of PanNET were negative. CONCLUSION: P504s is a sensitive and useful marker for SPTP and can be used in the distinction between SPTP and PanNET.

[Quantitative comparison of idiopathic interstitial pneumonias on high-resolution computed tomographic findings].

OBJECTIVE: To analyze the high-resolution computed tomographic (HRCT) findings of IPF (interstitial pulmonary fibrosis), NSIP (nonspecific interstitial pneumonia) and COP (cryptogenic organizing pneumonia) retrospectively through quantification methods and to explore their distinguishing features. METHODS: Observers with no prior knowledge of the diagnosis evaluated the frequency, extent and distribution of various thin-section CT findings in 29 males and 17 females. The mean age was 50 ± 10 years old (range: 25 - 76). They had a histological diagnosis of IPF (n = 19), nonspecific interstitial pneumonia (NSIP) (n = 14) and cryptogenic organizing pneumonia (COP) (n = 13). RESULTS: Ground-glass opacity, thickening of bronchovascular bundles and interlobular septal thickening were frequent features of IPF and NSIP. The frequency and extent of honeycombing and bronchiolectasis were more found in IPF than in NSIP and COP (P < 0.05). The frequency and extent of air space consolidation were more found in COP than IPF (P < 0.05). There were more number of segments with traction bronchiectasis and less extent of air space consolidation in IPF than NSIP and COP. The number of segments with traction bronchiectasis was less in NSIP than that of IPF and COP. CONCLUSION: The various subtypes of idiopathic interstitial pneumonias often have the distinguishing characteristics easily identified on HRCT. Bronchiolectasis and honeycombing are valuable features for IPF; air space consolidation is a valuable feature for COP. The features of NSIP are also found in both IPF and COP so that additional features are required for both.

Clinical features of pneumonia caused by 2009 influenza A(H1N1) virus in Beijing, China.

BACKGROUND: Data on symptoms and radiographic changes in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) pneumonia during convalescence have not been reported. METHODS: During October 26, 2009, and January 23, 2010, adult patients with pneumonia with laboratory-confirmed or clinically suspected A(H1N1) infections were observed for clinical characteristics, high-resolution chest CT scan, and lung function test changes during acute and 3-month convalescent phases. RESULTS: Of the 65 case subjects, the median age was 41 (interquartile range [IQR], 28-57) years, 60.0% were men, and 55.4% had at least one underlying medical condition. Sixty-two patients started oseltamivir therapy within a median of 5 (IQR, 4-6) days from the onset of illness, and 31 received IV corticosteroids. ARDS developed in 33 patients, and 24 were treated initially with noninvasive positive pressure ventilation (NPPV). In this group, NPPV was successful in 13 patients (54.2%). Nine patients died at a median of 16 (IQR, 10-24) days after onset of illness. Multivariate Cox regression identified two independent risk factors for death: progressive dyspnea after resolution of fever (relative risk, 5.852; 95% CI, 1.395-24.541; P = .016) and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score on presentation (relative risk for each point, 1.312; 95% CI, 1.140-1.511; P < .001). At 3-month follow-up of survivors with A(H1N1), ground-glass opacities were still present, although diminished, in 85.7%, and diffusing capacity for carbon monoxide was mildly reduced in 61.5%. CONCLUSIONS: Ground-glass opacities and decreased diffusing capacity were the main abnormalities observed at 3-month follow-up of survivors of A(H1N1).