Values of optical coherence tomography angiography for diagnosing diabetic retinopathy and evaluating treatment outcomes

PURPOSE

To compare the consistency between fundus fluorescein angiography (FFA) and optical coherence tomography angiography (OCTA) for the diagnosis of diabetic retinopathy (DR).

MATERIALS AND METHODS

Ninety-six diabetic patients (185 eyes) treated from January 2019 to December 2019 underwent OCTA and FFA. The image characteristics of fundus lesions were recorded. Sixty-nine patients (137 eyes) who were diagnosed with DR by both examinations and needed to receive panretinal photocoagulation (PRP) were selected. The retinal nerve fiber layer (RNFL) thickness, macular superficial vascular complex (SVC) and deep vascular complex (DVC) blood flow density, 300μm area surrounding foveal avascular zone (FAZ) (FD300) blood flow density and FAZ parameters were compared.

RESULTS

The Kappa coefficient of FFA and OCTA for diagnosing DR was 0.537 (P=0.000). FFA and OCTA had substantial consistency for detecting retinal microaneurysms and macular edema (Kappa coefficient=0.643/0.616, P=0.000), perfect consistency for detecting retinal neovascularization and retinal non-perfusion area (Kappa coefficient=0.809/0.832, P=0.000), and moderate consistency for detecting structural changes in the macular ring (Kappa coefficient=0.423, P=0.000). The RNFL thickness in the peripapillary and the superior temporal, temporal inferior, inferior nasal and superior nasal regions rose 1 week after PRP but declined 1 year after treatment (P<0.05). The macular SVC, DVC and FD300 blood flow density declined 1 week after PRP but rose 1 year after treatment (P<0.05).

CONCLUSIONS

OCTA shows consistency with FFA for diagnosing DR, which remedies the deficiency of FFA. The reduction in fundus lesions after PRP can be quantified by OCTA.

Chemical signatures of polycyclic aromatic hydrocarbons in the emissions from in situ oil burns

This study characterized the parent and alkylated polycyclic aromatic hydrocarbons (PAHs) in gaseous and particulate emissions from the in situ burning (ISB) of oils. The experimental results indicate that the burning of the heavy oil produced the most PAH emissions because of its longest burning time. In addition, the parent PAHs mainly exist in the particulate phase, while alkylated PAHs mostly accumulate in the gaseous phase. In particular, the diagnostic-ratios of PAHs with great stability in both gaseous and particulate emissions from ISB are identified by comparing the laboratory and field data. The presences of bell-, slope- and V-shaped distribution patterns of alkylated PAHs in the emissions precisely indicate their sources to be petrogenic and pyrogenic processes occurring during ISB. The formation of 2-methylanthracene during ISB is confirmed. The overall findings are expected to provide a prospective protocol to characterize PAH pollution from ISB emissions in case of oil spills.

The fingerprint stability of the biomarker hopanes and steranes in soot emissions from in-situ burning of oil

The behavior of emissions is an important concern of in-situ burning (ISB) of spilled oils. In particular, the heavy soot originated from ISB can negatively impact the atmospheric environment. To track the behavior of ISB soot, the conservative biomarkers, such as hopanes and steranes, can be potentially used. In this study, the stability of chemical fingerprints of hopanes and steranes in the ISB soot were investigated based on the burning of two different types of oils, including one ultra-light condensate (i.e., surrogate Sanchi condensate) and one heavy oil. The results indicate that the chromatographic patterns and diagnostic ratios of hopanes and steranes in the ISB soot emissions almost remain identical to their corresponding source oils, proving the various oil source identification of ISB soot can be realized. This work attempts to provide novel insights into the application of biomarkers in the management of ISB emissions.

Gas-particle partitioning of polycyclic aromatic hydrocarbons from oil combustion involving condensate, diesel and heavy oil

This study focuses on the gas-particle (G-P) partitioning of 16 polycyclic aromatic hydrocarbons (PAHs) from oil combustion, which is one of the important contributors of anthropogenic PAHs but has been rarely studied. The combustions of different types of oils involving ultra-light to heavy oils were investigated, and the PAH partitioning mechanism was determined by the widely used Junge-Pankow adsorption model, K_oa absorption model, and dual sorption model, respectively. The results show that the source-specific diagnostic ratios of Ant/(Ant+Phe) are between 0.09 and 0.24, the estimated regression slopes of G-P partition coefficients (K_P) of the total PAHs on their sub-cooled liquid vapor pressures (P_L^O) are in the range of - 0.34 to - 0.25, and the predicted fractions of PAHs in the particle phase (φ) by K_oa absorption model are close to the measured values, while the log K_Pvalues of the LMW PAHs from the combustions of diesel and heavy oil are better represented by the dual sorption model. Our findings indicate that PAHs are derived from mixed sources that include the unburned original oil and combustion products, and the PAH partitioning mechanism is governed by the process of absorption into organic matter because of the unburned oil, but both adsorption and absorption exist simultaneously in the lighter PAHs from the combustions of heavier oils (i.e., diesel and heavy oil). Based on these findings, the understanding of the fate and transport of PAH emissions and the optimization of the emergency responses to accidents such as marine oil spills would be potentially improved.

Chemical fingerprinting and characterization of spilled oils and burnt soot particles - A case study on the Sanchi oil tanker collision in the East China Sea

The condensate spill accident from the Sanchi oil tanker collision in the East China Sea is unique in world history. To date, the spilled and burnt amounts of condensate remain unknown. The present study demonstrates the chemical fingerprints of a surrogate condensate (SC) from the same source, and of the carried heavy fuel oil (HFO) of the Sanchi accident. The evaporative features of the condensate are demonstrated by allowing the SC to naturally volatilize in a dark fume hood. In addition, the combustion emission of the SC is characterized by conducting a laboratory-scale combustion experiment. The evaporation experiment suggests that the volatilization process plays a significant role in the weathering of the condensate. The results show that the SC and HFO can be clearly distinguished based on their chemical fingerprints of C₂₇-C₃₅ hopanes and C₉-C₃₆ n-alkanes, along with priority polycyclic aromatic hydrocarbons (PAHs) and their alkylated derivatives. The compositional data reveal that the lighter component is predominant in the SC, thereby supporting its high volatility and flammability. The greater amounts of heavier components in the HFO indicate its long-term degradation and potential ecological risks to the environment. Further, the trisnorhopane thermal indicator (T_s/T_m) and C₂₉/C₃₀ ratio of hopanes are validated for identification of the SC and the HFO. More importantly, the changes in the hopane ratios of the soot particles are analyzed for the first time in this study, and the results demonstrate the validity of using hopane ratios to fingerprint the condensate soot particles. The diagnostic ratios of 2-MP/1-MP, 9/4-MP/1-MP, and InP/(InP+BghiP) also show decent performance on source identification after the condensate evaporation and combustion processes.

Occurrences, Sources, and Human Health Risk Assessments of Polycyclic Aromatic Hydrocarbons in Marine Organisms From Temperate Coastal Area

The pollution characteristics of 16 polycyclic aromatic hydrocarbons (PAHs) in marine organism species (6 species of fishes and 2 species of crustaceans) from the coastal area of the East China Sea were determined. The concentrations of 16 PAHs in the studied organisms ranged from 29.73 to 87.02 ng/g dw and 2- and 3-ring PAHs were the most abundant compounds in the aquatic organisms. The habitat, diet and predator-prey relationship have posed potential effects on the PAH accumulation in marine organisms. The source identification of PAHs was performed by using the molecular diagnostic ratios and principal component analysis (PCA). The results showed that the main sources of PAHs in the marine organisms were coal combustion, followed by mixture of gasoline combustion, oil combustion, crude oil spill and vehicle emissions. The incremental lifetime cancer risk of human via ingestion process of marine organisms in this sea area was also estimated and the assessment showed that it posed an acceptable but non-negligible risk to human health.

Electrochemical degradation performance and mechanism of dibutyl phthalate with hydrophobic PbO2 electrode

A polytetrafluoroethylene (PTFE) doped PbO₂ anode with a highly hydrophobicity was fabricated by electrodeposition method. In this process, vertically aligned TiO₂ nanotubes (TiO₂NTs) are formed by the anodic oxidation of Ti plates as an intermediate layer for PbO₂ electrodeposition. The characterization of the electrodes indicated that PTFE was successfully introduced to the electrode surface, the TiO₂NTs were completely covered with β-PbO₂ particles and gave it a large surface area, which also limited the growth of its crystal particles. Compared with the conventional Ti/PbO₂ and Ti/TiO₂NTs/PbO₂ electrode, the Ti/TiO₂NTs/PbO₂-PTFE electrode has enhanced surface hydrophobicity, higher oxygen evolution potential, lower electrochemical impedance, with more active sites, and generate more hydroxyl radicals (·OH), which were enhanced by the addition of PTFE nanoparticles. The electrocatalytic performance of the three electrodes were investigated using dibutyl phthalate (DBP) as the model pollutant. The efficiency of the DBP removal of the three electrodes was in the order: Ti/TiO₂NTs/PbO₂-PTFE > Ti/TiO₂NTs/PbO₂ > Ti/PbO₂. The degradation process followed the pseudo-first-order kinetic model well, with rate constants of 0.1326, 0.1266, and 0.1041 h^-1 for the three electrodes, respectively. The lowest energy consumption (6.1 kWh g^-1) was obtained after 8 h of DBP treatment using Ti/TiO₂NTs/PbO₂-PTFE compared to Ti/TiO₂NTs/PbO₂ (6.7 kWh g^-1) and Ti/PbO₂ (7.4 kWh g^-1) electrodes. Moreover, the effects of current density, initial pH and electrolyte concentration were investigated. Finally, the products of the DBP degradation process were verified based on gas chromatography-mass spectrometry analysis, and possible degradation pathways were described.

Application of a fugacity model to estimate emissions and environmental fate of ship stack PAHs in Shanghai, China

The understandings of environmental activities and regional inventory of ship stack PAHs are very limited in Shanghai due, in part, to the lack of source-segregated analysis. To address this, measured PAHs in organic film on ship surfaces were employed to reconstruct concentrations in various compartments through a fugacity model to investigate the level, transport, fate and annual emission of ship stack PAHs in Shanghai. The results revealed that ship stack PAHs results in 11.2-181 ng L^-1 and 71.0-1710 ng g^-1 in water and sediment of Shanghai, respectively. After being released into air, ship stack PAHs mainly concentrated in organic films and sediments while sunk in water and sediment. Crucial mass transfer pathways include deposition of airborne and sediment PAHs. The mass loss of ship stack PAHs was primarily through air advection, followed by degradation in sediment. The ship emissions (53.7 tons annually) accounted for approximate one tenth of the regional total in Shanghai (in 2017). Additionally, shipping was estimated to release 127 tons of PAHs annually into the Shanghai section of Yangtze River. Our results suggest our fugacity-based approach can be used to estimate the regional emissions and inventory of ship stack PAHs in the surrounding environment.

Variations and characteristics of carbonaceous substances emitted from a heavy fuel oil ship engine under different operating loads

Heavy fuel oil (HFO) accounts for approximately 80% of the fuel consumption of ocean-going ships in the world. Multiple toxic species are found in HFO exhaust, however, carbonaceous substances emitted from low-speed marine engine exhaust at different operating loads have not been thoroughly addressed. Therefore, a bench test for a low-speed marine engine with HFO fuel under different operating modes was carried out in this study. Emission factors and characteristics of CO₂, CO, organic carbon (OC), elemental carbon (EC), as well as OC and EC fragments, organic matters of n-alkanes and polycyclic aromatic hydrocarbons (PAHs) are given and discussed. Combined with the correlation analysis results among the measured species and engine technical parameters, the formation processes and influence factors of carbonaceous components are also inferred in this study. Besides, together with OC to EC ratio, n-alkanes to PAHs ratio, etc., EC1 to soot-EC ratio in PM can be considered as tracer characteristic of high-sulfur-content HFO ship distinguished from diesel fuel ships. Profiles of n-alkanes and PAHs in PM can be used to distinguish shipping emission source from other combustion sources. Moreover, characteristics of carbonaceous components in size-segregated particles are also discussed, including OC, EC, OC and EC fragments, as well as organic matters. Results show that most of the particle mass, OC, EC, and organic matters are concentrated in fine particles with size of less than 1.1 μm, indicating the significance of ultrafine particles. Formation processes of OC and EC fragments, EC1 and soot-EC are also deduced and proved combined with the characteristics of OC and EC fragments, organic matters, and especially PAHs. Besides, the large variations of OC to EC ratios and speciated profiles of n-alkanes and PAHs in different particle size bins indicate that particle size should be considered when they are used as characteristic tracer in source apportionment studies.

[Well differentiated grade 3 gastroenteropancreatic neuroendocrine tumors:new insights into diagnosis and therapeutic strategy]

Gastroenteropancreatic neuroendocrine tumor G3(GEP-NET G3) is a novel subtype of neuroendocrine neoplasms proposed in 2019,which has unique biological behavior characteristics. However,there are still many challenges and controversies in its diagnosis and treatment. There are obvious differences between GEP-NET G3 and neuroendocrine carcinoma (NEC) in genetic alterations and molecular profiles. The most frequently mutated genes in NET G3 are MEN1,DAXX/ATRX,while in NEC,TP53 and Rb are the most frequently mutated genes. Currently,the mainstream view is that NET G3 and NEC are two distinct diseases with different genetic backgrounds,and NET G3 will not develop into NEC. Several clinical and pathological factors should be considered to distinguish GEP-NET G3 and NEC,which including patients' medical history,histopathological morphology of neoplasms,Ki-67 index,immunohistochemical results of TP53,Rb,DAXX/ATRX and other markers. Multidisciplinary treatment,including radical resection,chemotherapy,targeted therapy,peptide receptor radionuclide therapy,immunotherapy should be applied in patients with GEP-NET G3. Overall,given its relatively indolent biological behavior,the therapeutic strategy should be more actively. Although the cure strategy of NET G3 has many similarities with NET G1/2,it is completely different from NEC.

Polycyclic aromatic hydrocarbon contamination along roads based on levels on vehicle window films

Vehicular emissions are known to be major contributors of airborne polycyclic aromatic hydrocarbons (PAHs) in cities. In order to assess the long-term contamination of PAHs along roads, we collected organic films from vehicle windows (26 private cars and 4 buses, in Shanghai, China) and used mathematical models to convert the film-bound PAH concentrations to the airborne PAH concentrations. The field measurements of airborne PAHs revealed that the partitioning and Level III fugacity model was suitable to estimate the airborne concentrations of high and low volatile PAHs (expect for naphthalene), respectively. The total airborne PAH concentrations along roads in Shanghai ranged from 0.83 to 3.37 μg m^-3 and the incremental lifetime cancer risks (ILCR_total) by exposure to PAHs along roads were greater than the USEPA lower guideline of 10^-6, indicating non-negligible carcinogenic risks to drivers and passengers, especially via ingestion processes. This study provided a practicable method to investigate long-term air contamination of PAHs in vehicles and along roads based on film-bound PAH on vehicle windows. In addition, it was also possible to investigate the health risk in vehicles as a result of exposure to PAHs. Comparisons of PAHs between roads and shipping lanes also facilitated the delineation of vehicular and shipping PAH inventories. A capsule that summarizes the main finding of the work: Investigating film-bound PAH on vehicle windows is a practicable pathway to investigate the long-term contamination of PAHs in vehicles and along roads. This method can not only simplify the sampling processes, but the model calculations. The results also enabled investigations into ILCR in vehicles and specified source apportionment of traffic PAHs.

Characterization of polycyclic aromatic hydrocarbons in the surface sediments around the sunken Sanchi oil tanker

The Sanchi oil tanker collision has attracted worldwide attention for its uniqueness in history. This study investigates the contamination level, spatial distribution, sources, and ecological risk level of polycyclic aromatic hydrocarbons (PAHs) present in the surface sediments collected from around the sunken tanker. The results indicated that the total PAH contents in the study area were in the range of 26.42-226.94 ngˑg^-1, with an average of 106.86 ngˑg^-1. The highest PAH concentration was observed at the station closest to the Sanchi wreckage, indicating potential PAH contamination due to the accident. The PAH ratios and statistical analysis revealed that the PAHs were mainly generated by coal and fuel oil combustion, with certain petrogenic inputs. The ecological risk assessment results suggested that adverse ecological effects to the benthic ecosystem due to PAH contamination was rare. However, long-term monitoring of the local sedimentary environment is highly recommended because of the prominent presence of high molecular weight PAHs.

Improving Cross-cultural "Mind-reading" with Electrical Brain Stimulation

A cross-cultural disadvantage exists when inferring the mental state of others, which may be detrimental for individuals acting in an increasingly globalized world. The dorsomedial prefrontal cortex (dmPFC) is a key hub of the social brain involved in ToM. We explored whether facilitation of dmPFC function by focal high-definition tDCS can improve cross-cultural mind-reading. 52 (26 F/M) Singaporeans performed the Caucasian version of the Reading the Mind in the Eyes Test (RMET) and received HD-tDCS to either the dmPFC or a control site (right temporoparietal junction, rTPJ) in sham-controlled, double-blinded, crossover studies. Contact with Caucasians was determined for the Singaporean cohort as a potential mediator of RMET performance and HD-tDCS response. 52 Caucasians completed the RMET during sham-tDCS and served as a comparison group. A cross-cultural disadvantage on the RMET was confirmed in the Singaporean cohort and this disadvantage was more pronounced in those participants who had less contact with Caucasians. Importantly, HD-tDCS to the dmPFC improved RMET performance in those with less contact. No effect was identified for rTPJ HD-tDCS or for the age/sex control task demonstrating task and site specificity of the stimulation effects. Electrical stimulation of the dmPFC selectively improves the rate of cross-cultural ToM inference from facial cues, effectively removing cross-cultural disadvantage that was found in individuals with lower cross-cultural exposure.

Sedimentary polycyclic aromatic hydrocarbons (PAHs) along the mouth bar of the Yangtze River Estuary: Source, distribution, and potential toxicity

The source, distribution, and potential toxicity of sedimentary polycyclic aromatic hydrocarbons (PAHs) along the mouth bar of the Yangtze River Estuary were investigated. Total concentrations of 17 PAHs in the study area ranged from 34.94 to 580.26 ng/g (mean value 146.31 ng/g). Results of PMF model revealed that mixed vehicle emissions (38.43%), natural gas combustion (24.98%), biomass combustion (20.76%) and coal combustion (15.83%) were sources of these sedimentary PAHs. The ERL/ERM, TEL/PEL and TEC/PEC values showed that the potential toxicity of PAHs was at low to medium level, but the presence of benzo[a]pyrene (BaP) and benzo[e]pyrene (BeP) requires more attention and research. Sedimentary PAHs pollution level in the three shoals (East Nanhui Shoal, Jiuduansha Shoal and Hengsha Shoal) was higher than that of the two passages (South Passage and North Passage), which demonstrates the possibility of restoration of the adjacent shoals by dredged soils in terms of PAHs pollution.

An unusual case of pigmented plaques on the sole

Palmoplantar lichen planus is a rare variant of lichen planus with diverse clinical presentations, making the diagnosis challenging. We present an unusual case of a young patient who presented with asymptomatic non-pruritic flat-topped pigmented plaques on his left sole and no other lesions elsewhere. Histology was consistent with lichen planus. We emphasize a high index of suspicion owing to varied clinical presentation and the necessity of a biopsy for diagnosis.

Transcranial MR Imaging-Guided Focused Ultrasound Interventions Using Deep Learning Synthesized CT

BACKGROUND AND PURPOSE

Transcranial MR imaging-guided focused ultrasound is a promising novel technique to treat multiple disorders and diseases. Planning for transcranial MR imaging-guided focused ultrasound requires both a CT scan for skull density estimation and treatment-planning simulation and an MR imaging for target identification. It is desirable to simplify the clinical workflow of transcranial MR imaging-guided focused ultrasound treatment planning. The purpose of this study was to examine the feasibility of deep learning techniques to convert MR imaging ultrashort TE images directly to synthetic CT of the skull images for use in transcranial MR imaging-guided focused ultrasound treatment planning.

MATERIALS AND METHODS

The U-Net neural network was trained and tested on data obtained from 41 subjects (mean age, 66.4 ± 11.0 years; 15 women). The derived neural network model was evaluated using a k-fold cross-validation method. Derived acoustic properties were verified by comparing the whole skull-density ratio from deep learning synthesized CT of the skull with the reference CT of the skull. In addition, acoustic and temperature simulations were performed using the deep learning CT to predict the target temperature rise during transcranial MR imaging-guided focused ultrasound.

RESULTS

The derived deep learning model generates synthetic CT of the skull images that are highly comparable with the true CT of the skull images. Their intensities in Hounsfield units have a spatial correlation coefficient of 0.80 ± 0.08, a mean absolute error of 104.57 ± 21.33 HU, and a subject-wise correlation coefficient of 0.91. Furthermore, deep learning CT of the skull is reliable in the skull-density ratio estimation (r = 0.96). A simulation study showed that both the peak target temperatures and temperature distribution from deep learning CT are comparable with those of the reference CT.

CONCLUSIONS

The deep learning method can be used to simplify workflow associated with transcranial MR imaging-guided focused ultrasound.

Polycyclic aromatic hydrocarbon contaminations along shipping lanes and implications of seafarer exposure: Based on PAHs in ship surface films and a film-air-water fugacity model

Polycyclic aromatic hydrocarbons (PAHs) are one of the most toxic compounds in ship tailpipe exhausts. The long-term contamination of PAHs along shipping lanes and ports is difficult to assess using conventional methods such as AIS-EFs-data based (AIS, Automatic identification system; EFs, emission factors) or field sampling methods. To address this, we collected the organic films on ship surfaces and used a modified film-air-water fugacity model to convert the film-bound concentrations to the airborne (gaseous plus particulate) concentrations. Not surprisingly, concentrations of PAHs on organic films on ship surfaces were greater than those measured on films on residential buildings. The airborne total PAH concentrations along shipping lanes in Yangtze River Delta area ranged from 63.3-325 ng m^-3, which were in the same order of magnitude to those in Beijing during haze days. The incremental lifetime cancer risks by exposure to PAHs in ship indoor air were higher than the US EPA lower guideline, indicating considerable carcinogenic risks to seafarers. Our study proposes an alternative method to estimate the long-term contaminations of PAHs along shipping lanes and highlights a notable health risk to seafarers.

Emissions of intermediate volatility organic compound from waste cooking oil biodiesel and marine gas oil on a ship auxiliary engine

Ship auxiliary engines contribute large amounts of air pollutants when at berth. Biodiesel, including that from waste cooking oil (WCO), can favor a reduction in the emission of primary pollutant when used with internal combustion engines. This study investigated the emissions of gaseous intermediate-volatile organic compounds (IVOCs) between WCO biodiesel and marine gas oil (MGO) to further understand the differences in secondary organic aerosol (SOA) production of exhausts. Results revealed that WCO exhaust exhibited similar IVOC composition and volatility distribution to MGO exhaust, despite the differences between fuel contents. While WCO biodiesel could reduce IVOC emissions by 50% as compared to MGO, and thus reduced the SOA production from IVOCs. The compositions and volatility distributions of exhaust IVOCs varied to those of their fuels, implying that fuel-component-based SOA predicting model should be used with more cautions when assessing SOA production of WCO and MGO exhausts. WCO biodiesel is a cleaner fuel comparing to conventional MGO on ship auxiliary engines with regard to the reductions in gaseous IVOC emissions and corresponding SOA productions. Although the tests were conducted on test bench, the results could be considered as representative due to the widely applications of the test engine and MGO fuel on real-world ships.

Emission of intermediate volatility organic compounds from a ship main engine burning heavy fuel oil

Intermediate volatility organic compounds (IVOCs) are crucial precursors of secondary organic aerosol (SOA). In this study, gaseous IVOCs emitted from a ship main engine burning heavy fuel oil (HFO) were investigated on a test bench, which could simulate the real-world operations and emissions of ocean-going ships. The chemical compositions, emission factors (EFs) and volatility distributions of IVOC emissions were investigated. The results showed that the main engine burning HFO emitted a large amount of IVOCs, with average IVOC EFs of 20.2-201 mg/kg-fuel. The IVOCs were mainly comprised of unspeciated compounds. The chemical compositions of exhaust IVOCs were different from that of HFO fuel, especially for polycyclic aromatic compounds and alkylcyclohexanes. The volatility distributions of IVOCs were also different between HFO exhausts and HFO fuel. The distinctions in IVOC emission characteristics between HFO exhausts and HFO fuel should be considered when assessing the IVOC emission and related SOA formation potentials from ocean-going ships burning HFO, especially when using fuel-surrogate models.

Common and unique effects of HD-tDCS to the social brain across cultural groups

Cultural background influences social cognition, however no study has examined brain stimulation differences attributable to cultural background. 104 young adults [52 South-East Asian Singaporeans (SEA); 52 Caucasian Australians (CA)] received anodal high-definition transcranial direct current stimulation (HD-tDCS) to the dorsomedial prefrontal cortex (dmPFC) or the right temporoparietal junction (rTPJ). Participants completed tasks with varying demands on self-other processing including visual perspective taking (VPT)and episodic memory with self and other encoding. At baseline, SEA showed greater self-other integration than CA in the level one (line-of-sight) VPT task as indexed by greater interference from the alternate perspective. Anodal HD-tDCS to the dmPFC resulted in the CA performing closer to the SEA during egocentric perspective judgements. Baseline performance on level two (embodied rotation) VPT task and the self-reference effect (SRE) in episodic memory was comparable between the two groups. In the combined sample, HD-tDCS to the rTPJ decreased the interference from the egocentric perspective during level two VPT and dmPFC HD-tDCS removed the SRE in episodic memory. Stimulation effects were comparable when baseline performance was comparable. When baseline performance differed, stimulation differences were identified. Therefore, social cognitive differences due to cultural background are an important consideration in social brain stimulation studies.

[Clinicopathologic and molecular features of cribriform morular variant of papillary thyroid carcinoma]

Objective: To investigate the clinicopathologic and molecular features of the rare cribriform morular variant of papillary thyroid carcinoma (CMV-PTC). Methods: The clinicopathologic data of 10 patients with CMV-PTC were retrospectively reviewed. Immunohistochemical (IHC) staining was done using LSAB method. DNA sequencing for APC were applied using Sanger method. BRAF V600E mutation was examined using ARMS method. The cytological, morphological, IHC and molecular features were analyzed. Results: All patients were female at an average age of 27 years old. The tumors were mostly located in the right lobe of thyroid. Fine needle aspiration cytology was performed in three patients; two were diagnosed as suspicious for PTC and one as PTC. Nine tumors presented as solitary nodule and two as multiple nodules in both lobes. Infiltration was demonstrated in three cases. The average size was 2.6 cm. The neoplastic cells were arranged in papillary, cribriform, solid and glandular patterns, with rare or without colloid inside the lumen. The number of morula varied, ranging from zero to many. The neoplastic cells were variably enlarged, showing round, oval or spindle shape. Nuclear irregularity was identified as irregular membrane, nuclear grooves or pseudoinclusion, but no typical ground glass feature. Peculiar nuclear clearing could be observed in the morular cells. IHC staining showed the neoplastic cells were negative for thyroglobulin and p63, but positive for TTF1, cytokeratin 19 and estrogen receptor. Diffuse staining with cytokeratin was seen in the neoplastic cells and the morula. Specific cytoplasmic and nuclear staining of β-catenin was seen in the neoplastic cells but not the morula. Ki-67 proliferation index was 1%-30%. No recurrence or metastasis was observed. One patient was demonstrated to harbor both somatic and germline mutations of the APC gene, who was found to have adenomatous polyposis and her mother died of colonic carcinoma. No BRAF V600E mutation was detected. Conclusions: CMV-PTC is rare and shows atypical cytological and clinicopathological features, and it is easily misdiagnosed.TG, TTF1, ER and β-catenin are specific IHC markers for CMV-PTC. The morula is negative for cytokeratin 19, in contrast to squamous metaplasia. Although CMV-PTC has indolent clinical behavior, a definite diagnosis is necessary to rule out the possibility of APC gene mutation and related extra-thyroidal neoplasm, such as FAP and Gardner syndrome.

[Clinicopathologic characteristics of head and neck carcinoma showing thymus-like element]

Objective: To investigate clinicopathological features of carcinoma showing thymus-like elements (CASTLE) in the head and neck regions. Methods: Clinicopathological data of 7 patients with CASTLE in the head and neck regions were retrospectively reviewed.Immunohistochemical staining and in situ hybridization for EBER were performed. BRAF(V600E) mutation was examined by ARMS method in 6 cases. Results: There were 5 females and 2 males with age between 49 and 78 years (average of 65.6 years). All tumors were solitary nodular lesions with an infiltrative border, including 6 intrathyroid tumors and 1 extrathyroid tumor in the laryngeal pharynx.The tumors were 1.7-4.1 cm in diameter (average of 3.0 cm). Four cases demonstrated lymph node metastasis.All patients were alive without metastasis during follow-up, except one consultation case (with FNA sample) developed recurrence at the primary site. The cases showed different immunoreaction to CD5, diffuse immunoreaction with p63, CK5/6 and CD117, but negative staining for TTF1, TG and calcitonin. One case showed positive immunoreaction with Synin less than 30% tumor cells. The Ki-67 labeling index was between 3% and 90%. No BRAF(V600E) mutation and EB virus infection were detected. Conclusions: Extrathyroid CASTLE involving laryngeal pharynx shows the similar morphological and immunohistochemical features with intrathyroid CASTLE.Immunohistochemical markers of CD5 and CD117 are helpful in the diagnosis. Ki-67 labeling index can be high in CASTLE, especially in lymphoepithelioma type. CD5-negative CASTLE may have neuroendocrine differentiation. BRAF(V600E) mutation and EB virus may not be involved in the carcinogenesis of CASTLE.

Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China

BACKGROUND

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

METHODS

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

RESULTS

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

CONCLUSIONS

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

The use of Masson's trichrome staining, second harmonic imaging and two-photon excited fluorescence of collagen in distinguishing intestinal tuberculosis from Crohn's disease

AIM

Differentiation between Crohn's disease (CD) and intestinal tuberculosis (ITB) continues to be difficult. The present study investigated the collagen fibre characteristics of CD and ITB using Masson's trichrome staining, second harmonic generation (SHG) imaging and two-photon excited fluorescence (TPEF) imaging with the aim of distinguishing between them.

METHOD

The characteristics of collagen fibres in intestinal specimens from patients with CD, ITB and healthy controls were compared using Masson's trichrome staining and SHG and TPEF imaging.

RESULTS

Masson's trichrome staining showed that the content of collagen fibre (540.92 [139.61-1681.93] vs 236.17 [72.94-1108.32], P < 0.05) and fibre deposits (888.92 [315.89-3172.9] vs 498.98 [38.82-5802.31], P < 0.05) were both higher in ITB than in CD. The content of collagen fibre (594.677 [139.61-1681.93] vs 107.425 [4.66-988.7], P < 0.05) and fibre deposits (1118.4661 [315.89-5802.31] vs 340.575 [29.62-1188.87], P < 0.05) were significantly higher in lesions with granulomata than in those without. The SHG/TPEF images demonstrated that the percentage of fibrosis in ITB was also significantly higher than in CD (P < 0.05), in both surgical (13.363% ± 5.303% vs 8.322% ± 5.078%, P = 0.044) and endoscopic specimens (mean rank 13.5 vs 7.5, P = 0.023). The SHG/TPEF imaging described different distribution patterns of collagen between CD and ITB; in the former this was irregular in clumps while in ITB the collagen was arranged around caseating granulomata.

CONCLUSION

The evaluation of fibrosis in CD and ITB by Masson's trichrome staining and SHG and TPEF imaging appears to distinguish between these two diseases.

Diversity of killer cell immunoglobulin-like receptor genes in Drung Chinese

Killer cell immunoglobulin-like receptor (KIR) genes are variably distributed among populations from distinct geographic areas and ethnic origins. We describe, for the first time, KIR gene diversity in 152 unrelated and healthy Drung individuals, as measured by sequence-specific polymerase chain reaction. All 16 known KIR genes were detected. Of these, the framework genes KIR2DL4, 3DL2, 3DL3, and 3DP1 were present in all individuals as expected, along with the non-framework genes KIR2DL1, 2DL3, and 2DP1. In contrast, KIR2DL2, 2DS2, and 2DS5 were unusually rare, suggesting that KIR gene distribution was relatively concentrated. Ten different KIR genotypes were found, of which the most common consisted of nine genes (KIR2DL1, 2DL3, 2DL4, 2DS4, 3DL1, 3DL2, 3DL3, 2DP1, and 3DP1) and accounted for 66.4% of participants. There were eight different haplotypes present, of which the A haplotype was the most common (81.9%). Principal components and dendrogram analysis confirmed that the Drung Chinese are most closely related to the Japanese, the Zhejiang Han, and the Yunnan Han. In conclusion, distinctive frequencies of KIR genes, haplotypes, and genotypes are observed in Chinese Drung.

A novel HLA-DRB1 allele, HLA-DRB1*12:48

HLA-DRB1*12:48 differs from DRB1*12:09, by a single synonymous nucleotide at position 266.

A novel HLA-B allele, HLA-B*35:269

HLA-B*35:269 differs from HLA-B*35:01:01:01, by a single synonymous nucleotide at position 103.

A novel HLA-A allele, HLA-A*02:544

The novel allele HLA-A*02:544 has two nucleotide changes from its most closely related allele, HLA-A*02:148. Firstly at nucleotide 255 where C → T (codon 60 GAC → GAT), resulting in a non-coding change as GAC and GAT both code for the same amino acid aspartic acid. Secondly at nucleotide 368 where T → G (codon 98 TTT → TGT) resulting in a coding change, 98 phenylalanine is changed to cysteine.

Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies

The objective of the study was to assess the relationship between hypertension and risk of depression. The relationship between hypertension and depression has been discussed for a long time, but the results are controversial. Studies were searched from PubMed and Cochrane up to 24 March 2014. Any prospective cohort study, which possibly reported the relationship between hypertension and depression, was included. The random effect model was used to calculate the pooled relative risk (RR). Finally, five prospective cohort studies were included for analysis, with a total of 9647 participants involved. Our meta-analysis does not support that hypertension is probably a risk factor of depression. The pooled RR was 1.16 (95% confidence interval: 0.91, 1.42) when those exposed to hypertension were compared with those who were not. Subgroup analysis, sensitivity analysis and publication bias test suggested that the overall result of this analysis was robust. Further studies are needed to exclude the effects of other confounding factors.

Prevalence and impact of premature ejaculation in outpatients complaining of ejaculating prematurely: using the instruments of intravaginal ejaculatory latency time and patient-reported outcome measures

This study was designed to assess the impact of premature ejaculation (PE) on a large population of men and their female partners using the instruments of intravaginal ejaculatory latency time (IELT) and patient-reported outcome (PRO) measures. A non-interventional, observational and cross-sectional field survey enrolled 2704 men with self-reported PE and their female partners from January 2010 to January 2012. PE was diagnosed by the International Society for Sexual Medicine (ISSM) criterion. IELT and sexual dysfunction were measured using a stopwatch and PRO measures, respectively. The incidence of PE in this study was 19.27%. PE negatively impacted on subjects and their partners, including reduced ejaculatory control and sexual satisfaction, and increased personal distress and interpersonal difficulty (P<0.001 for all). The severity of PE was considered worse by subjects than by their female partners (P<0.001). Reduced ejaculatory control and sexual satisfaction were considered the central themes of PE. Furthermore, a correlation was observed among the outcomes of IELT and PRO measures for subjects and their partners (absolute correlation coefficient ranged from 0.33 to 0.67). This in-depth qualitative study provides valuable insight into the PE status in Chinese men. Further research is needed to confirm and extend these results.

Application of high-frequency ultrasound in esophageal atresia with distal fistula

The present study was designed to evaluate the accuracy of preoperative ultrasonography (US) in depicting the structure of esophageal atresia with distal fistula (EA-DF) and to determine its role in planning the surgical strategy by digitally measuring the interpouch distance (ID). Thirty-six neonates (20 males and 16 females) born with EA-DF were included in this study. After obtaining chest radiographs of the neonates with a coiled nasogastric tube in the upper esophageal pouch, longitudinal esophageal high-frequency US was performed. The esophageal structures were displayed, and the IDs measured on US images were compared with the surgical findings. With the use of US, the structure of EA-DF was accurately depicted, and the ID detected by US correlated well with the surgical findings. Statistical analysis demonstrated no significant difference in the ID as assessed by US and surgery (R = 0.99, P < 0.001).). US findings were crucial for planning the surgical strategy in 9 (25.0%) patients. Preoperative US could provide more accurate information on the structure of EA-DF and play a crucial role in planning the surgical strategy.

Characteristics of diagnosis and therapy of adolescent malignant ovarian tumors

BACKGROUND

To improve the early diagnosis rate of adolescent malignant ovarian tumors, avoid misdiagnosis, select proper therapy, avoid excessive therapy, and render therapy more tolerable.

MATERIALS AND METHODS

A comprehensive review of adolescent malignant ovarian tumors, such as types, difficulties of early diagnosis, therapeutic principles, prognosis, fertility preserving through the authors' clinical experience, with reference to Chinese and international literatures.

RESULTS AND CONCLUSION

The majority of adolescent malignant tumors are malignant germ cell, the malignancy is high and it is difficult to diagnose in the early stage, likely to be ignored. Their diagnosis is therefore fundamental, while selecting the most appropriate therapeutic approach that also considers fertility-sparing without compromising prognosis and avoiding over-treatment.

Efficacy of confocal laser endomicroscopy for discriminating colorectal neoplasms from non-neoplasms: a systematic review and meta-analysis

AIM

Confocal laser endomicroscopy (CLE) has evolved to allow in vivo real-time biopsy for the classification of colorectal lesions. The primary aim of this study was to assess the effectiveness of CLE for discriminating colorectal neoplasms from non-neoplasms and its contributing factors. The secondary aim was to compare the efficacy of endomicroscopy and chromoendoscopy for diagnosing colorectal neoplasms.

METHOD

A systematic review of the literature published between 2000 and 2012 was conducted. Pooled sensitivity and specificity were compared using univariate regression analysis according to prespecified subgroups. Pooled relative risk was computed to compare the accuracy of endomicroscopy and chromoendoscopy.

RESULTS

Fifteen studies involving 719 patients and 2290 specimens were analysed. The pooled sensitivity of all studies was 0.94 [95% confidence intervals (CI): 0.88-0.97], and pooled specificity was 0.95 (95% CI: 0.89-0.97). Real-time CLE yielded higher sensitivity (0.96 vs 0.85, P < 0.001) and specificity (0.97 vs 0.82, P < 0.001) than blinded CLE. For real-time CLE, endoscopy-based systems had better sensitivity (0.96 vs 0.89, P < 0.001) and specificity (0.99 vs 0.82, P < 0.0001) than probe-based systems. CLE yielded equivalent accuracy compared with magnifying virtual chromoendoscopy and magnifying pigment chromoendoscopy (P > 0.05).

CONCLUSION

CLE is comparable to colonoscopic histopathology in diagnosing colorectal neoplasms, and is better in conjunction with conventional endoscopy. An endoscopy-based rather than a probe-based modality would be optimal in the application of CLE.

Cloning of arctic lamprey Lethenteron camtschaticum cd9 with roles in the immune response

In this study, the cd9 gene, a member of the tetraspanin superfamily and involved in various cellular processes, was cloned from Lethenteron camtschaticum. Both real-time PCR and immunohistochemical assays showed broad distribution of cd9 in various L. camtschaticum tissues. In addition, expression levels of Cd9 mRNA were up-regulated in the liver and heart after stimulation by lipopolysaccharide. Flow cytometric analyses demonstrated that cd9 was detected on the leukocytes and that the expression level was higher on granulocytes than on lymphocytes, which implied that cd9 was mainly involved in innate immunity.

Under Bump Metallization Development For High Sn Solders

Several under bump metallisation (UBM) schemes using Ni or CuNi alloys as the solderable layer were investigated. Cr or Ti was used as the adhesion layer. The UBM pads of different compositions were sputter deposited on silicon wafers and patterned using standard photolithographic processes. Eutectic Sn-Pb solder balls were reflowed on top of the pads. The resulting interfacial microstructures were examined by SEMIEDX analysis of cross-sectioned samples. The integrity of the UBMIsolder interface was characterized by micromechanical shear testing of flip chip test samples. Growth of intermetallic layers was found to be significantly slower in Ni and CuNi schemes compared to pure Cu. The joints on Ni and CuNi had also a better adhesion at the UBM/solder interface, and in the shear tests the fracture occurred through the solder

Single-electron effects in non-overlapped multiple-gate silicon-on-insulator metal-oxide-semiconductor field-effect transistors

This paper systematically presents controlled single-electron effects in multiple-gate silicon-on-insulator (SOI) metal-oxide-semiconductor field-effect transistors (MOSFETs) with various gate lengths, fin widths, gate bias and temperature. Our study indicates that using the non-overlapped gate to source/drain structure as an approach to the single-electron transistor (SET) in MOSFETs is promising. Combining the advantage of gate control and the constriction of high source/drain resistances, single-electron effects are further enhanced using the multiple-gate architecture. From the presented results, downsizing multiple-gate SOI MOSFETs is needed for future room-temperature SET applications. Besides, the tunnel barriers and access resistances may need to be further optimized. Since the Coulomb blockade oscillation can be achieved in state-of-the-art complementary metal-oxide-semiconductor (CMOS) devices, it is beneficial to build SETs in low-power CMOS circuits for ultra-high-density purposes.