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Objective: The head-up tilt test (HUTT) is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope (VVS). The present study aims to verify the hypothesis that ambulatory blood pressure (BP) monitoring (ABPM) and the simplistic tilt test may be potential alternatives to the HUTT. Methods: The study consecutively enrolled 360 patients who underwent the HUTT to evaluate VVS. BP), heart rate (HR), and BP/HR ratios derived from ABPM and the simplistic tilt test were evaluated to predict the presence, pattern, and stage of syncope during the HUTT. Results: Mixed response was the commonest pattern, and syncope occurred frequently with infusion of isoproterenol at a rate of 3 μg/min. During the simplistic tilt test, the cardioinhibitory group had higher tilted BP/HR ratios than the vasodepressor group, while the vasodepressor group had a faster tilted HR and a larger HR difference than the cardioinhibitory group. The higher the BP/HR ratio in the tilted position, the higher the isoproterenol dosage needed to induce a positive response. During ABPM, BP/HR ratios were significantly higher in the cardioinhibitory group than in the vasodepressor group. The higher the ABPM-derived BP, the higher the dosage of isoproterenol needed to induce syncope. There were significant correlations in BP/HR ratios between ABPM and the supine position in the vasodepressor group, while significant correlation was found only for the diastolic BP/HR ratio between ABPM and the tilted position in the cardioinhibitory group. The mixed pattern shared correlative features of the other two patterns. Conclusion: ABPM and the simplistic tilt test might be used as promising alternatives to the HUTT in VVS evaluation in clinical settings.

Purpose: Several studies discussed different chemotherapy drugs that have influenced the expression of PD-L1 and CD47 in vitro and in vivo experiments. However, in breast cancer, neoadjuvant chemotherapy (NAC) influence on the changes of PD-L1 and CD47 trends is still controversial. In this study, we retrospectively investigated the effects of NAC on the expression of PD-L1, CD47, and tumor infiltrating lymphocytes (TILs) in breast cancer. The correlation between different immune indicators. As well as its relationship with clinicopathological features and prognosis. Methods: A total of 77 patients with invasive breast cancer who underwent NAC between May 2016 to July 2017 were included. Immunohistochemistry was used to detect the expression of PD-L1, CD47, CD4, and CD8 in breast biopsy tissues before NAC and tumor resected tissues after NAC. Paired Chi-square test was used to analyze the changes of PD-L1, CD47, CD4, and CD8 before and after NAC. The relationship between the expression of PD-L1 and CD47 before NAC and clinicopathological features of patients was evaluated by the Chi-square test. Spearman correlation analysis was used to discuss the correlations in the four indicators and their correlations with chemotherapy efficacy. Disease-free survival (DFS) and overall survival (OS) were compared in each immune indicator before and after NAC. Results: (1) Among 77 patients, a total of 16 cases showed pathological complete response (pCR) after NAC, in which the expression of PD-L1 and CD47 was not counted in the paired Chi-square according to the judgment standard. CD47expression after NAC was lower than before NAC in 61 patients (23.0% vs 55.7%, P 0.05).(2) Before NAC, CD47 expression was correlated with age ( P =0.048) and histological grade ( P =0.015) in breast cancer tissues of the 77 patients. CD47 expression was not associated with ER, PR, Ki-67, HER-2, tumor diameter, grade, lymph node metastasis, molecular subtypes, and pTNM stage ( P >0.05). PD-L1 expression was not correlated with the above clinicopathological features ( P >0.05). (3) CD47 expression was correlated with PD-L1 before NAC( P 0.05). (4) The expression of CD4+T cells and CD8+T cells were positively correlated with non-pCR after NAC ( P =0.002, P =0.005). Other factors showed no relation with therapy efficacy( P >0.05). Before NAC, CD8+T cells expression was associated with DFS ( P =0.0365), while the expression of other factors was not associated with overall survival or DFS ( P > 0.05). Conclusion: NAC could influence the tumor immune microenvironment, such as the expression of CD47 and CD4, but have no effect on PD-L1 and CD8, which suggests that it is better to retest the immune indicators after chemotherapy to prevent negative patients could not benefit from immune therapy. CD47 expression was related to the patient’s age and histological grade before NAC. Innate immune response and adaptive immune response both participate in tumor immune escape procedures in breast cancer. After NAC, CD4+ T cells and CD8+ T cells tend to express more in the tumor. And patients with higher expression of CD8+ T cells are likely to have longer DFS.

A novel open drum shaped cavity (ODSC) is employed to estimate the variation of the dielectric and magnetic properties of materials. Compared with the conventional resonant mode excited by normal multipoles, it has the following remarkable property, i.e., concentrating energy. Almost all time-varying electric and magnetic fields are confined inside the ODSC and has high quality factor Q = 573.3. The resonant frequency is ultrasensitive to permittivity and permeability perturbations. The sensitivity is as high as 400 MHz, which is much higher than that in the published literatures. The properties of the target material are estimated by the amount of frequency shift of reflection coefficient S 11. The operation principle of the proposed sensor is initially illustrated by simulations, and then, measurements are performed to show the validity of the proposed procedure. This ultrasensitive sensor can be applied in accurate monitoring variations of permittivity or permeability of liquids, gases, and solids, such as avoiding overuse of cooking oil and qualified dried milk composition.

Background Multiple sclerosis (MS) is an autoimmune disease characterized by a loss of myelin, limb disabilities and dysregulation of gene expression. Unfortunately, there still is no treatment to cure MS. Objectives To explore a novel way to treat MS using currently available antifungal drugs. Material and methods We built an experimental autoimmune encephalomyelitis (EAE) model to mimic MS and tested the effect of an antifungal drug - itraconazole - on EAE by comparing it with a phosphate-buffered saline (PBS) control group. We assessed the animal limb deficits with Weaver's scoring and used histology staining (including luxol fast blue (LFB) and hematoxylin & eosin (H&E) methods) to determine the demyelination in the spinal tissues. We also performed western blotting to quantify the expression changes of proteins related to endoplasmic reticulum (ER) stress response and apoptosis. Results The limb disabilities were greatly diminished and the demyelination in the spinal tissues of the EAE mice was mostly reduced following itraconazole treatment. The hyperactivation of the ER stress response and apoptosis pathway in EAE was also significantly diminished by the itraconazole treatment. In addition, the AMPK pathway was downregulated in EAE, its expression level bi-directionally affected the activity of the ER stress response, and its downregulation removed the beneficial effect of itraconazole. Conclusions Our study revealed a new method for treating MS using currently approved antifungal drugs.

Background and ObjectivesTo characterize the clinical and neuroimaging phenotypes of patients with autoantibodies to γ-aminobutyric acid type A receptor (GABAAR).MethodsTen patients with autoantibodies against GABAAR from Huashan Hospital Autoimmune Encephalitis cohort were identified. We used MRI assessments and clinical examinations to summarize major clinical profile and visualize and quantify lesion distribution features. The relationship between clinical features, neuroimaging phenotypes, and topology of GABAAR expression were further investigated.ResultsThe median age at onset of 10 patients (8 male patients and 2 female patients) with anti-GABAAR encephalitis was 41.5 years (range: 17–73 years). All patients had prominent seizures and multifocal spotted or confluent lesions involved in limbic, frontal, and temporal lobes on brain MRI. Bilateral but asymmetric lesions in cingulate gyri were observed in all patients. These involved lesions could change dynamically with immunotherapies and relapse. Distribution of patients' brain MRI lesions was positively correlated with gene expression level of β3 subunit–containing GABAAR (Spearman ρ = 0.864, p = 0.001), the main target of autoantibodies. According to topology of lesions, patients with anti-GABAAR encephalitis could be classified into 2 clinical-radiological types: confluent type with bilateral confluent lesions involved in almost all limbic, frontal, and temporal lobes and spotted type with multiple scattered small-to-medium patchy lesions. Patients with confluent type exhibited worse clinical presentations and outcomes when compared with those with spotted type (maximum modified Rankin scale [mRS]: 5 [5–5] vs 3.5 [3–4], respectively, p = 0.008; follow-up mRS: 4 [2–6] vs 0.5 [0–1], respectively, p = 0.016).DiscussionAnti-GABAAR encephalitis has distinctive neuroimaging phenotype. Cingulate gyri were frequently involved in this disorder. The topology of lesions might be associated with the distribution of β3 subunit–containing GABAAR and reflected patients' disease severity and outcomes.

A unique case of eyelid metastasis from nasopharyngeal chondroid chordoma in a 63-year-old woman was reported. Chordomas are rare tumors of the bone deriving from remnants of the embryonic notochord. Histologically, the tumor showed lobulated structure and concludes two types of cells: liquid drop cell and small round/cubic cell. Immunohistochemically, AE1/AE3, epithelial membrane antigene (EMA), and S100 showed a uniform and strong positivity. It has a great capacity for recurrence and malignant transformation, despite their slow-growing nature. The most common sites of metastases are liver, lungs, and bones. The eyelid metastasis from chordoma is an extremely rare finding, which may suggest a poor prognosis for the patient. Its significant clinicopathological characteristic could prompt us to take it into consideration when assessing the patient's prognosis.

Endonuclease V (EndoV) plays the important role of nucleotide excision repair (NER) in the maintenance of genomic stability. Highly sensitive detection of EndoV was achieved through an oligonucleotides sensitizing Tb3+ luminescent technique. We found that although both guanine-rich (G-rich) single-stranded DNA and dGMP could enhance the time-resolved luminescence of Tb3+, their efficiencies of enhancement were considerably different. Employing such interesting phenomenon, a label-free and time-resolved luminescent strategy for the sensitive detection of EndoV activity was developed based on DNA-enhanced time-resolved luminescence (TRL) of Tb3+. The EndoV was used to cut off the deoxyinosine site (dI) and convert the 3'-protruding termini to a recessed end, and Exonuclease III (Exo III) was used to enhance the signal contrast via digestion of G-rich DNA to dNTP. Combining with the natural advantages of the TRL, the proposed method exhibited a good linear response to EndoV ranging from 0.005 to 0.4 U/mL, with a low limit of detection of 0.005 U/mL.

Polypropylene (PP)-based polymers are environmentally friendly and degradable materials that make them attractive alternatives to polyethylene for the electrical insulation systems of power cables in the future. To enhance the insulation performance of PP and to impede leakage currents through the material, different admixtures are utilized. In this paper, the effect of nano-fillers on charge transport characteristics in PP composites under DC electric fields is investigated by using a bipolar charge transport model accounting for mobile and trapped electrons and holes as well as ionic species. The model was validated by comparing the numerical results with the experimental data. The dynamic distributions of space charge densities and electric field in PP with and without nano-fillers are analyzed and compared. The numerical results confirmed that 0.5 phr ZnO nano-fillers can significantly improve the electric field distribution in PP nanocomposites and suppress the bulk current by reducing the charge generation rate and mobilities of charge carriers, thus resulting in a decrease in the volume conductivity. The obtained results provide a theoretical background for tailoring PP-based composites for specific applications by controlling nano-fillers.

A new spiral antenna is proposed in this paper. The developed antenna has improved axial ratio (AR) and shorted arm length. The formula of the new spiral is given. The developed spiral antenna combines the low frequency characteristic of power spiral antenna and high frequency characteristic of Archimedean spiral antenna. The growth rate of radial distance at large winding angle is close to power spiral for improved AR in low frequencies, and the growth rate at small winding angle is close to Archimedean spiral for good AR in high frequencies. The results reveal that the developed spiral antenna has noticeable improved axial ratio at low frequencies compared with Archimedean spiral antenna, and the problem of axial ratio degradation of power spiral antenna is also solved. The arm length is shorted by 46.4% compared to conventional Archimedean spiral antenna, and 63.5% compared to power spiral antenna.

Endonuclease V (EndoV) plays the important role of nucleotide excision repair (NER) in the maintenance of genomic stability. Highly sensitive detection of EndoV was achieved through an oligonucleotides sensitizing Tb

To study the clinicopathologic features, immunophenotype and prognosis of matrix-producing metaplastic carcinoma (MPC).Sixteen cases of MPC diagnosed between 2002 and 2012 in West China Hospital were identified. The clinicopathologic features were analyzed. Immunohistochemistry for E-cadherin, S-100 protein, CK5/6, HCK, PCK, CK7, CK8, p63, SMA, EMA, CD99, MSA, CK14, EGFR, ER, PR, HER2 and Ki-67 was performed with EnVision method. The clinical outcome was evaluated and compared to matched controls of invasive ductal carcinoma.All patients were women and ranged in age from 29 to 69 years (median age 48 years). The median size of primary tumor was 4 cm. Most of the tumors were well-circumscribed with expansile and multinodular appearance. Histology showed invasive carcinoma with a direct transition from carcinoma to cartilaginous/chondromyxoid matrix without an intervening spindle cell component. Tumor distribution was either nodular or diffuse. The matrix component accounted for 10%-80% of the tumor volume. All the tumors were strongly positive for S-100 protein and basal-like cytokeratin with triple negative phenotype (ER, PR and HER2 negative). Alcian blue stain was positive for the cartilaginous/chondromyxoid matrix. Compared with invasive ductal carcinoma, patients with MPC had increased locoregional recurrence (P = 0.010), increased distant recurrence (P = 0.011) and shorter disease-free survival (P = 0.017).MPC is a rare variant of mammary metaplastic carcinoma with unique characteristics of morphology and immunohistochemical staining pattern. This subtype seems to have aggressive biologic behavior.

Synovial sarcoma originating in the liver is extremely rare, and thus far only 3 cases have been reported in the English literature. Herein, we report a primary hepatic synovial sarcoma in a 13-year-old Chinese boy. This patient present with a 10-day right upper quadrant pain, and a heterogeneous mass was documented in the right hepatic lobe by computed tomography. Subsequently, the patient underwent right hepatectomy. Histologically, the tumor exhibited classic features of monophasic synovial sarcoma. The diagnosis was confirmed by the presence of SS18 gene rearrangement and identification of SS18-SSX1 fusion transcript. Unfortunately, a relapsing mass was detected 11 months after the surgery. To the best of our knowledge, the current case is the 1st published example in the pediatric population.

To explore the role of IL-21 in the pathogenesis of myasthenia gravis (MG) and its influence on the the class switch of anti-AChR antibodies.Blood was taken from 26 patients and 18 healthy controls, and the expression of IL-21R mRNA in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR. The expression of IL-21R on B lymphocytes was measured by flow cytometry, while the concentrations of serum IL-21 and the levels of anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3) were tested by ELISA.The serum concentration of IL-21 in the MG group was higher than that in the control group (31.686±8.499 pg/mL, 15.147±6.366 pg/mL) and the difference was significant (P0.01). IL-21R mRNA expressed on PBMCs in the MG group was higher than that in the control group (0.139±0.052, 0.101±0.022), and the difference was significant (P0.05). There was no difference between ocular MG and generalized MG subgroup (P0.05). Compared with the control group, the expression of IL-21R on B lymphocytes also increased in the MG group (P0.05). In the anti-AChR-Ab positive MG group, the serum concentration of IL-21 showed positive correlation with anti-AChR-IgG(P0.05),but no correlation with its isotype IgG(1), IgG(2), and IgG(3), respectively(P0.05). Expression of IL-21R mRNA in the PBMCs showed no correlation with the level of serum anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3), respectively(P0.05); however the expression of IL-21R in B lymphocytes showed positive correlation with anti-AChR-IgG and it's isotype IgG(1) and IgG(3) (P0.05,P0.01,P0.05), but no correlation with IgG(2) (P0.05).IL-21 might induce the class switch of anti-AChR antibodies to IgG(1) and IgG(3) isotype through IL-21R on B lymphocytes which promotes the pathogenesis of the MG.

A MIM thin film diode (TFD) with Ta-Ta 2 O 5 -Ta symmetrical structure for active-matrix liquid crystal display (AM-LCD) was prepared. The Ta 2 O 5 insulator layer as a key to the MIM thin film diode was got by anodizing sputtered tantalum oxide film (sputtering/anodization two-step process), and was heat-treated by vacuum/atmosphere two-step heat-treatment with different process parameter. The microstructure of tantalum oxide film was analyzed by Atomic Force Microscope(AFM) and Transmitting Electron Microscope(TEM), respectively. The I-V characteristics of the MIM thin film diode were also measured. The influence of heat-treatment on microstructure of Ta 2 O 5 insulator film and the I-V characteristics of the MIM thin film diode were investigated. The relationship between the I-V characteristics of the MIM thin film diode and microstructure of Ta 2 O 5 film was also indicated. The results showed that the Ta 2 O 5 film sample with vacuum/330°C atmosphere two-step heat-treatment had uniform and dense amorphous microstructure, and had a good stability, a high switching-on/off ratio (105), and excellent symmetric I-V characteristics with the positive and negative threshold voltages 7V and 6.6V, respectively, and little relative errors (< 6%). The properties of this MIM-TFD can meet the needs of AM-LCD.

A Ta-Ta2O5-Ta MIM thin film diode for active-matrix LCD is described. The Ta2O5 thin film insulator layer of the MIM thin film diode were formed by anodizing sputtered tantalum oxide films (sputtering/anodization two- step process). Experimental results showed that the MIM diode using the two-step oxidized sputtered/anodized tantalum oxide films had the threshold voltage as low as 5 V, the switching-on/off ratio about 105, and a more symmetrical I-V characteristic.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.