Cardiac myxomas as great imitators: A rare case series and review of the literature.

Myxoma is the most common type of primary cardiac tumors, accounting for 50%-80% of them. Cardiac myxomas are difficult to detect due to the lack of specific signs and symptoms and even benign tumors can cause serious consequences. Cardiac failure, atrio-ventricular valve obstruction or the embolization phenomenon can quietly occur in patients with cardiac myxomas. Here, we report three extraordinary cases, each of which vary in the first symptom. One case involved a 66-year-old man who had no underlying heart disease but suddenly developed chest tightness and got out of breath after exercising. One case was a 36-year-old young woman with a two-year history of low blood pressure but suddenly suffered a stroke. The third case was a 42-year-old middle-aged woman who accidentally discovered a cardiac myxoma during the diagnosis and treatment of acute pancreatitis. Echocardiography revealed huge masses floating in their atriums. Under general anesthesia, all the patients underwent open-heart surgery and hematoxylin and eosin-stained sections of the samples confirmed myxomas. Although most patients with cardiac myxomas lack of specific systemic symptoms, typical myxomas are relatively easy to diagnose. There are currently no effective medical therapeutic to inhibit tumor growth and surgical resection is the mainstay of treatment, which prevents a dreaded complication resulted from systemic and pulmonary embolisms.

Effects of thinning and understory removal on the soil water-holding capacity in Pinus massoniana plantations.

Forest management practices play an important role in regulating the soil water-holding capacity of plantation. However, most studies focus on soil water dynamics present during large-scale forest loss and afforestation events, while little is known about how soil water under different forest management practices responds to rainfall events and which factors mainly regulate soil water-holding capacity. In this study, a stable hydrogen isotope was used to explore the contribution of three natural rainfall events (8.9, 13.3 and 67.7 mm) to soil water (CRSW) in a Pinus massoniana plantation under four forest management practices (no thinning (NTN), understory removal (USR), light-intensity thinning (LIT) and heavy-intensity thinning (HIT)) in the Three Gorges Reservoir Area of the Yangtze River Basin in China. Furthermore, a structural equation model was employed to determine the effects of vegetation biomass and soil properties on the CRSW. The results showed that plantation soil under different forest management practices exhibited different water-holding capacities. Following light (8.9 mm) and moderate (13.3 mm) rainfall events, the CRSW in the HIT stand was slightly higher than that in the other stands. Following heavy (66.7 mm) rainfall event, the CRSW of most layers in USR stand was not different from the other three stands, while the CRSW in the LIT and NTN stands was significantly higher than that in the HIT stand in the 0-100 cm soil layers, suggesting that soil in the LIT and NTN stands had a greater water-holding capacity than that in the HIT stand. In addition, soil properties were the main factors directly affecting the CRSW, explaining 60% and 37% of the variation in the CRSW on the first and seventh days after heavy rainfall, respectively. Overall, compared to the HIT stand, the LIT and NTN stands showed greater capacity in retaining rainwater. Therefore, under expected global changes with frequent occurrences of extreme precipitation events, methods involving light-intensity and no thinning should be employed to build up soil and water conservation functions, which will be critical for keeping water-holding capacity and moderating floods.

Primary gastroduodenal tuberculosis complicated with acute pancreatitis: a rare case report and literature review.

BACKGROUND: Tuberculosis (TB) is a major health problem worldwide. Even in highly prevalent countries, primary gastroduodenal tuberculosis is a rare manifestation of extrapulmonary tuberculosis. In recent years, as the incidence of tuberculosis has increased year by year, the occur of gastroduodenal tuberculosis has also increased. Endoscopy is an important tool for diagnosing gastroduodenal tuberculosis. The performance of gastroduodenal tuberculosis under endoscopy is often non-specific, which may imitate other benign or malignant gastroduodenal diseases. Diagnosis of gastroduodenal tuberculosis relies on a combination of endoscopy and guided biopsy. CASE PRESENTATION: Here, we report a rare and interesting case of gastroduodenal tuberculosis with acute pancreatitis. The case initially mimicked gastroduodenal ulcers in morphology and appeared in a middle-aged person with normal immunity but with prolonged fever and abdominal pain. The disease was diagnosed through endoscopy and guided biopsy, and it responded well to antituberculosis drugs. CONCLUSIONS: Clinicians must remember that even in the absence of immunodeficiency, as in this case, tuberculosis can affect any part of the gastrointestinal tract.

Clinical application of cap-assisted endoscopic nylon loop ligation (C-ENLL) on gastric fundus submucosal tumors / 中国内镜杂志

Objective To evaluate the feasibility and safety of cap-assisted endoscopic nylon loop ligation (C-ENLL) as a new and simple method on gastric fundus submucosal tumors. Methods 74 cases with small gastric fundus submucosal tumors ≤2.00 cm in diameter were reviewed between January 2015 and June 2016. All cases were treated by C-ENLL. The clinical efficacy was analyzed. Results All the 74 patients underwent endoscopic ultrasonography before operation, 70 cases originated from the muscularis propria, 3 cases originated from the muscularis mucosae, 1 case originated from the submucosa. The average diameter of the lesions ranged 0.50 ～ 1.80 cm. C-ENLL achieved an en bloc resection rate of 100.0％, with a mean total procedure time of 26 min. Two patients developed delayed perforation, were treated with nylon rope and metal clip purse suture wound. All of whom were managed successfully. There was no delayed bleeding after operation. Pathological examination showed that 66.2％ (49/74) of the tumors were gastrointestinal stromal tumors. No tumor recurrence was observed during the follow-up. Conclusion The C-ENLL may be a feasible and safe method for the treatment of small gastric fundus submucosal tumors.

Heterogeneity of competition at decameter scale: patches of high canopy leaf area in a shade-intolerant larch stand transpire less yet are more sensitive to drought.

Small differences in the sensitivity of stomatal conductance to light intensity on leaf surfaces may lead to large differences in total canopy transpiration (EC) with increasing canopy leaf area (L). Typically, the increase of L would more than compensate for the decrease of transpiration per unit of leaf area (EL), resulting in concurrent increase of EC. However, highly shade-intolerant species, such as Larix principis-rupprechtii Mayr., may be so sensitive to increased shading that such compensation is not complete. We hypothesized that in such a stand, windfall-induced spatial variation at a decameter scale would result in greatly reduced EL in patches of high L leading to lower EC than low competition patches of sparse canopy. We further hypothesized that quicker extraction of soil moisture in patches of lower competition will result in earlier onset of drought symptoms in these patches. Thus, patches of low L will transition from light to soil moisture as the factor dominating EL. This process should progressively homogenize EC in the stand even as the variation of soil moisture is increasing. We tested the hypotheses utilizing sap flux of nine trees, and associated environmental and stand variables. The results were consistent with only some of the expectations. Under non-limiting soil moisture, EL was very sensitive to the spatial variation of L, decreasing sharply with increasing L and associated decrease of mean light intensity on leaf surfaces. Thus, under the conditions of ample soil moisture maximum EC decreased with increasing patch-scale L. Annual EC and biomass production also decreased with L, albeit more weakly. Furthermore, variation of EC among patches decreased as average stand soil moisture declined between rain events. However, contrary to expectation, high L plots which transpired less showed a greater EL sensitivity to decreasing stand-scale soil moisture, suggesting a different mechanism than simple control by decreasing soil moisture. We offer potential explanations to the observed phenomenon. Our results demonstrate that spatial variation of L at decameter scale, even within relatively homogeneous, single-species, even-aged stands, can produce large variation of transpiration, soil moisture and biomass production and should be considered in 1-D soil-plant-atmosphere models.

Cytochrome c release from oridonin-treated apoptotic A375-S2 cells is dependent on p53 and extracellular signal-regulated kinase activation.

We have reported that oridonin isolated from Rabdosia rubescens induces apoptosis of human melanoma A375-S2 cells within 12 h. In this study, TUNEL assay and flow cytometric analysis also indicate that one of the causes of A375-S2 cell death induced by oridonin was apoptosis. The cell death was preceded by the release of cytochrome c from the mitochondria. Twelve hours after treatment with oridonin, the ratio of Bax/Bcl-xL protein expression was increased and release of cytochrome c was decreased by an extracellular signal-regulated kinase (ERK) MAPK inhibitor (PD98059) and a phosphoinositide 3-kinases (PI3-K) inhibitor (wortmannin). A mitochondrial permeability transition (MPT) inhibitor, decylubiquinone, suppressed the release of cytochrome c without affecting Bax expression. The activation of p53 by oridonin was also blocked by wortmannin. In addtion, PD98059 and wortmannin significantly decreased oridonin-induced DNA fragmentation, but the p38 MAPK inhibitor (SB203580) did not after DNA fragmentation. Oridonin induced A375-S2 cell apoptosis by activating parallel p53 and ERK pathways, increasing the ratio of Bax/Bcl-xL protein expression, and promoting the release of cytochrome c into the cytosol, resulting in apoptotic cell death.