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关键词： Endoscopic submucosal dissection   Esophageal   Squamous cell carcinoma   Next-generation sequencing   Gastroesophageal reflux   TP53   DISEASE   CANCER   ASSOCIATION   MORTALITY   LESIONS   HEAD  

摘要： Background Cigarette smoking, alcohol consumption, and Lugol-voiding lesions (LVLs) are the major causative risk factors of esophageal squamous cell carcinoma (ESCC); however, reports on ESCC cases unrelated to these risk factors are very limited. Here, we investigated the clinicopathological features and etiology of such cases. Methods We retrospectively analyzed 704 consecutive superficial ESCC tumors of 512 patients who were treated with endoscopic submucosal dissection. The enrolled patients were divided into two groups-the very low-risk (VLR)-group and risk (R)-group-based on the presence of the abovementioned risks. Clinical, endoscopic, and pathological characteristics and genetic findings were assessed in both groups. Results The VLR-group consisted of 21 (4.1%) patients, who were characteristically female. Patients in the VLR-group presented gastroesophageal reflux disease (GERD), hiatal hernia, and non-open-type atrophic gastritis, and were negative for Helicobacter pylori. We found unique endoscopic features-frequently observed in the posterior wall of the middle thoracic esophagus-with a linear shape that closely resembled the erosion-like form of GERD. Additionally, histopathological examination showed that these tumors presented atypical nuclei limited to the basal and parabasal layer, sequential to the surrounding changes that presented pathological chronic inflammation of esophagitis. Evaluation of somatic mutations in cancer-related genes using next-generation sequencing revealed that the positive carcinogenic potential (TP53 mutation) of the tumors was relatively frequent in the VLR-group. Conclusions Our study suggests that ESCC without major causative factors is related to GERD, with no remarkable oncogenic difference.

关键词： High-frequency ultrasound   Basal cell carcinoma   Dermatology   HIGH-RESOLUTION ULTRASOUND   HISTOLOGIC SUBTYPES   PUNCH BIOPSY   MANAGEMENT  

摘要： The purpose of the study was to evaluate the value of high-frequency ultrasound (HFUS) for differentiating invasive basal cell carcinomas (BCCs) from non-invasive BCCs. We established a prediction model based on ultrasound features and validated it further. One hundred patients in the pilot cohort and another 43 in the validation cohort were evaluated. All patients underwent HFUS examinations by the same radiologist, and then were divided on the basis of pathology into invasive and non-invasive types. With respect to growth pattern, 60.5% of invasive BCCs had an irregular pattern, whereas 89.5% of non-invasive BCCs had a nodular or crawling pattern (p < 0.001). As for the layers involved, the more invasive BCCs broke through the dermis compared with non-invasive BCCs (23.3% vs. 1.8%) (p < 0.001). With respect to intralesional hyperechoic spot distribution, invasive and non-invasive BCCs tended to be clustered and absent/scattered-like, respectively (55.8% vs. 91.2%) (p < 0.001). On the basis of the aforementioned features, a prediction model was established with accuracies of 84.0% and 76.7%, respectively, in the pilot and validation cohorts. HFUS holds promise for the differentiation of the invasiveness of BCCs and is helpful in its clinical management. (C) 2021 Published by Elsevier Inc. on behalf of World Federation for Ultrasound in Medicine & Biology.

关键词： D816V MUTATION ANALYSIS   ACUTE MYELOID-LEUKEMIA   PROTOONCOGENE C-KIT   SYSTEMIC MASTOCYTOSIS   TYROSINE KINASE   PEDIATRIC MASTOCYTOSIS   EXTRACELLULAR DOMAIN   INDUCED ANAPHYLAXIS   SPANISH NETWORK   RECEPTOR  

摘要： Objective: Mast cell (MC) activation (MCA) defines the mechanism by which certain patients have symptoms owing to the effect of a wide range of mediators released from MCs upon their activation, when triggered by dif-ferent stimuli. When these symptoms are severe and recurrent, the diagnosis of MCA syndrome (MCAS) might be considered. Here, we review the relevant aspects related to the pathogenesis of MCAS, with special emphasis on the prevalence and diagnostic relevance of KIT mutations. Data Sources: PubMed was searched between 1980 and 2021 using the following terms: mast cell activation syndromes, mast cell activation, anaphylaxis, KIT mutations, KIT D816V, indolent systemic mastocytosis, bone marrow mastocytosis, cutaneous mastocytosis, IgE anaphylaxis, and idiopathic anaphylaxis. Study Selections: Only articles published in English were selected based on their relevance to MCAS or severe and recurrent anaphylaxis. Results: MCAS can be classified as clonal MCAS and nonclonal MCAS depending on the presence vs absence of an underlying KIT mutation (mostly KIT D816V), respectively. In contrast to clonal MCAS in which MCA is associated with a primary MC disorder (ie, primary MCAS) such as mastocytosis or monoclonal MCAS, nonclonal MCAS can be secondary to known or unidentified triggers (ie, secondary and idiopathic MCAS, respectively). Conclusion: The clinical heterogeneity and complexity of the molecular assays needed for the study of patients with MCAS might lead to misdiagnosis, particularly when patients are evaluated at nonspecialized centers. Thus, referral of patients having clinical manifestations suggestive of MCAS to reference centers on mastocytosis and MC diseases is strongly recommended. (c) 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

关键词： Primary adenosquamous carcinoma of the liver   Small cell carcinoma   Chemotherapy  

摘要： Primary adenosquamous carcinoma (ASC) of the liver is a rare subtype of cholangiocarcinoma that comprises both adenocarcinoma and squamous cell carcinoma components. We report a 48-year-old woman with advanced primary ASC and small cell carcinoma of the liver who had extrahepatic metastasis and received multiple chemotherapy regimens. After first presenting with upper abdominal pain, imaging revealed a 10.2 x 9.5 cm mass in the right lobe of the liver with lymph node and lung metastases. A liver tumor biopsy revealed adenocarcinoma and squamous cell carcinoma components, leading to a diagnosis of advanced primary ASC of the liver. The tumor shrank with gemcitabine/cisplatin therapy; however, neuron-specific enolase (NSE) and CYFRA levels were increased and the tumor grew. Next, hepatic arterial infusion chemotherapy using 5-fluorouracil and cisplatin decreased NSE and CYFRA levels and suppressed tumor growth. However, due to tumor growth, she died 14 months post-initial diagnosis. Post-autopsy pathology revealed a mixture of CD56- and synaptophysin-positive small cell carcinoma component in addition to ASC. We report a rare advanced primary ASC with small cell carcinoma of the liver diagnosed at autopsy.

关键词： Activation mapping   Catheter ablation   Pacemapping   Premature ventricular complexes   Radiofrequency ablation   SPATIAL-RESOLUTION   CONTRACTIONS   EFFICACY  

摘要： BACKGROUND Pacemapping (PM) is a useful maneuver for aiding premature ventricular complex (PVC) ablation. Its standalone clinical value is still to be defined. OBJECTIVES The purpose of this study was to analyze the efficacy of a predefined PM protocol for low-burden PVC ablation, regardless of their site of origin (SOO) and the presence of structural heart disease. METHODS This was a prospective, nonrandomized, multicenter study. The PM protocol was performed when,1 PVC/min was found. The "target area" was delimited by the 3 best matching points.94% correlation, and 3 radiofreqency (RF) applications were delivered. RESULTS Of 185 patients, 105 (57%) underwent activation mapping, 60 (32%) were PM-guided, and 20 (11%) were canceled due to absence of PVCs. Baseline QRS, PVC burden, and outflow tract origin were independent predictors of PM-guided ablation. A higher proportion of right ventricular outflow tract SOO in the PM group (52% vs 40%; P =.03) was observed. Mean target area was 0.6 +/- 0.9 cm(2). Mean 10-ms isochronal area in local activation time (LAT)-guided procedures was higher (1.7 +/- 2.3 cm(2); P <.001). Mean number of PM matching points acquired was 39 +/- 21 (range 6-98). Mean mapping and RF times were similar in both groups. However, significantly shorter procedural (53 +/- 24 vs 61 +/- 26 minutes; P =.04) as well as RF times (111 6 51 vs 149 6 149 seconds; P 5.05) were needed in the PM group using the proposed protocol. Global clinical success reached 87% for the PM group and 90% (P 5.58) the for LAT mapping group. CONCLUSION When LAT mapping is precluded, application of a PMguided ablation protocol directed to.94% matching correlation target area is a more efficient alternative with comparable clinical results.

关键词： NONMELANOMA SKIN-CANCER   MUTATIONS   ANGIOGENESIS   CONSENSUS   PROMOTES   INVASION   GENOME  

摘要： Little is known regarding the molecular differences between basal cell carcinoma (BCC) subtypes, despite clearly distinct phenotypes and clinical outcomes. In particular, infiltrative BCCs have poorer clinical outcomes in terms of response to therapy and propensity for dissemination. In this project, we aimed to use exome sequencing and RNA sequencing to identify somatic mutations and molecular pathways leading to infiltrative BCCs. Using whole-exome sequencing of 36 BCC samples (eight infiltrative) combined with previously reported exome data (58 samples), we determine that infiltrative BCCs do not contain a distinct somatic variant profile and carry classical UV-induced mutational signatures. RNA sequencing on both datasets revealed key differentially expressed genes, such as POSTN and WISP1, suggesting increased integrin and Wnt signaling. Immunostaining for periostin and WISP1 clearly distinguished infiltrative BCCs, and nuclear beta-catenin staining patterns further validated the resulting increase in Wnt signaling in infiltrative BCCs. Of significant interest, in BCCs with mixed morphology, infiltrative areas expressed WISP1, whereas nodular areas did not, supporting a continuum between subtypes. In conclusion, infiltrative BCCs do not differ in their genomic alteration in terms of initiating mutations. They display a specific type of interaction with the extracellular matrix environment regulating Wnt signaling.

关键词： Shear stress   Cilium   Nrf2   Elastase   FGF-2   Endothelial cells   FIBROBLAST-GROWTH-FACTOR   TRANSCRIPTION FACTOR NRF2   NITRIC-OXIDE SYNTHASE   MULTIDRUG-RESISTANCE PROTEIN-1   HUMAN NEUTROPHIL ELASTASE   LOW-DENSITY-LIPOPROTEIN   SENSITIVE ION-CHANNEL   SMOOTH-MUSCLE-CELLS   FACTOR-KAPPA-B   FACTOR-I IGF-1  

摘要： Endothelial cells are sensitive to mechanical stress and respond differently to oscillatory flow versus unidirectional flow. This review highlights the mechanisms by which a wide range of unidirectional laminar shear stress induces activation of the redox sensitive antioxidant transcription factor nuclear factor-E2-related factor 2 (Nrf2) in cultured endothelial cells. We propose that fibroblast growth factor-2 (FGF-2), brain-derived neurotrophic factor (BDNF) and 15-Deoxy-Delta 12,14-prostaglandin J2 (15d-PGJ2) are potential Nrf2 activators induced by laminar shear stress. Shear stress-dependent secretion of FGF-2 and its receptor-mediated signaling is tightly controlled, requiring neutrophil elastase released by shear stress, alpha v beta 3 integrin and the cell surface glycocalyx. We speculate that primary cilia respond to low laminar shear stress ( 10 dyn/cm2), resulting in secretion of insulin-like growth factor 1 (IGF-1), which facilitates alpha v beta 3 integrin-dependent FGF-2 secretion. Shear stress induces generation of heparan-binding epidermal growth factor-like growth factor (HB-EGF), which contributes to FGF-2 secretion and gene expression. Furthermore, HB-EGF signaling modulates FGF-2-mediated NADPH oxidase 1 activation that favors casein kinase 2 (CK2)-mediated phosphorylation/activation of Nrf2 associated with caveolin 1 in caveolae. Higher shear stress ( 15 dyn/cm2) induces vesicular exocytosis of BDNF from endothelial cells, and we propose that BDNF via the p75NTR receptor could induce CK2-mediated Nrf2 activation. Unidirectional laminar shear stress upregulates gene expression of FGF-2 and BDNF and generation of 15d-PGJ2, which cooperate in sustaining Nrf2 activation to protect endothelial cells against oxidative damage.

关键词： Automatic modulation classification   Cascading network architecture   Deep learning   SNR   Wireless communication   NEURAL-NETWORK   RECOGNITION   IDENTIFICATION  

摘要： BACKGROUND: Automatic modulation classification (AMC) plays a crucial role in cognitive radio, such as industrial automation, transmitter identification, and spectrum resource allocation. Recently, deep learning (DL) as a new machine learning (ML) methodology has achieved considerable implementation in AMC missions. However, few studies have examined the robustness of DL models under varying signal-tonoise ratio (SNR) environments. OBJECTIVE: The primary objective of this paper is to design a robust DL-based AMC model to adapt to noise changes. METHODS: The AMC task is divided into two sub-problems: SNR environment perception and modulation classification in sub-environments. A deep cascading network architecture (DCNA) is proposed to solve these two problems. DCNA is composed of an SNR estimator network (SEN) and a modulation recognition cluster network (MRCN). SEN is designed to identify the SNR levels of samples, and MRCN is composed of several subnetworks for further modulation recognition under diverse SNR settings. In addition, a label-smoothing method is proposed to promote the integration between SEN and MRCN. An auxiliary data-segmenting method is also presented to deal with the contrasting data requirements of DCNA. Note that DCNA does not utilize a specific network structure and can be generalized to various deep learning models with advanced improvements. RESULTS: Experimental results on dataset RML2016.10b show that our proposed DCNA can enhance the recognition performance of different network structures on AMC tasks. In particular, a combination of DCNA and convolutional long short-term deep neural network (CLDNN) can achieve a classification accuracy of 91.0%, outperforming the previous research. CONCLUSION: The performance of the cascading network demonstrates the significant performance advantage and application feasibility of DCNA. (c) 2021 Elsevier B.V. All rights reserved.

关键词： 伸缩缝技术   市政路桥   施工   应用  

摘要： 在社会经济的持续发展与进步之下,城市化发展速率不断提高,城市之中的各项公共设施建设也逐渐完备.其中,道路与桥梁作为城市化发展体系中重要构成,对于整个城市都具有较大影响作用.我国地域辽阔,地形复杂,城市建设也必须考量所处环境的自然情况与后续发展.市政路桥工程通常需要横跨河流、山地等障碍物,施工环境复杂,工程难度较大,为了有效确保路桥工程质量,必须引入与落实全新技术与有效技术,其中,伸缩缝技术就是有效提升路桥质量的技术手段之一,基于此,笔者将会对于伸缩缝技术在路桥工程中的应用展开分析,希望可以为相应工作人员提供建议.