[S100A10 promotes proliferation and invasion of lung adenocarcinoma cells by activating the Akt-mTOR signaling pathway]

OBJECTIVE

To investigate the effects of expression levels of S100 calcium-binding protein A10 (S100A10) in lung adenocarcinoma (LUAD) on patient prognosis and the regulatory role of S100A10 in lung cancer cell proliferation and metastasis.

METHODS

Immunohistochemistry was used to detect the expression levels of S100A10 in LUAD and adjacent tissues, and the relationship between S100A10 expression and clinicopathological parameters and prognosis of the patients was statistically analyzed. The lung adenocarcinoma expression dataset in TCGA database was analyzed using gene enrichment analysis (GSEA) to predict the possible regulatory pathways of S100A10 in the development of lung adenocarcinoma. Lactate production and glucose consumption of lung cancer cells with S100A10 knockdown or overexpression were analyzed to assess the level of glycolysis. Western blotting, CCK-8 assay, EdU-594 assay, and Transwell assays were performed to determine the expression level of S100A10 protein, proliferation and invasion ability of lung cancer cells. A549 cells with S100A10 knockdown and H1299 cells with S100A10 overexpression were injected subcutaneously in nude mice, and tumor growth was observed.

RESULTS

The expression level of S100A10 was significantly upregulated in LUAD tissues as compared with the adjacent tissues, and an elevated S100A10 expression level was associated with lymph node metastasis, advanced tumor stage and distant organ metastasis (P < 0.05), but not with tumor differentiation or the patients' age or gender (P > 0.05). Survival analysis showed that elevated S100A10 expressions in the tumor tissue was associated with a poor outcome of the patients (P < 0.001). In the lung cancer cells, S100A10 overexpression significantly promoted cell proliferation and invasion in vitro (P < 0.001). GSEA showed that the gene sets of glucose metabolism, glycolysis and mTOR signaling pathway were significantly enriched in high expressions of S100A10. In the tumor-bearing nude mice, S100A10 overexpression significantly promoted tumor growth, while S100A10 knockdown obviously suppressed tumor cell proliferation (P < 0.001).

CONCLUSION

S100A10 overexpression promotes glycolysis by activating the Akt-mTOR signaling pathway to promote proliferation and invasion of lung adenocarcinoma cells.

[Prevalence and trends of anemia among pregnant women in eight provinces of China from 2016 to 2020]

This study analyzed the anemia status and change trend of 219 835 pregnant women in eight provinces from 2016 to 2020 in the Maternal and Newborn Health Monitoring Program(MNHMP). The results showed that from 2016 to 2020, the anemia rate of pregnant women in eight provinces was 41.27%, and the rates of mild, moderate and severe anemia were 28.56%, 12.59% and 0.12% respectively; the anemia rates in eastern, central and western regions were 41.87%, 36.09% and 44.63% respectively, and the anemia rates in urban and rural areas were 39.87% and 42.23%. From 2016 to 2020, the anemia rate of pregnant women decreased from 44.93% to 38.22%, with an average annual decline of 3.86% (95%CI:-5.84%, -1.85%). The anemia rate among pregnant women of the eastern region (AAPC=-6.16%, 95%CI:-9.79%, -2.38%) fell faster than that among pregnant women of the central region (AAPC=0.71%, 95%CI:-6.59%, 8.57%) and western region (AAPC=-1.53%, 95%CI:-5.19%, 2.28%). From 2016 to 2020, the moderate anemia rate in pregnant women decreased from 14.98% to 10.74%, with an average annual decline of 8.72% (95%CI:-12.90%, -4.34%), with a statistically significant difference (P<0.05); AAPC for mild and severe anemia in pregnant women was 1.56% (95%CI: 3.44%, 0.36%) and 18.86% (95%CI: 39.88%, 9.52%), respectively, without statistically significant difference (P>0.05).

[Analysis of typing conversion and perinatal outcomes in twins with selective intrauterine growth restriction of different subtypes]

Objective: To retrospectively analyze the clinical data of different types of selective intrauterine growth restriction (sIUGR) pregnant women under expectant management, including the natural evolution, typing conversion and perinatal outcomes. Methods: The clinical data of 153 pregnant women with sIUGR under expected treatment in Women's Hospital, Zhejiang University School of Medicine from January 2014 to December 2018 were collected. Maternal characteristics including maternal age, gravidity, parity, method of conception, pregnancy complication, gestational age at delivery, indication for delivery, birth weight, the rate of intrauterine and neonatal death and neonatal outcomes were recorded. Pregnant women with sIUGR were divided into three types according to end-diastolic umbilical artery flow Doppler ultrasonography, and the differences of typing conversion and perinatal outcomes of sIUGR pregnant women based on the first diagnosis were compared. Results: (1) Clinical characteristics and pregnancy outcomes: among 153 pregnant women with sIUGR, 100 cases (65.3%) were diagnosed with type Ⅰ, 35 cases (22.9%) with type Ⅱ, and 18 cases (11.8%) with type Ⅲ. There were no significant differences in age, conception mode, pregnancy complications, first diagnosis gestational age, characteristics of umbilical cord insertion, delivery indications, fetal intrauterine mortality and neonatal mortality among three types of sIUGR pregnant women (all P>0.05). The average gestational age at delivery of type Ⅰ sIUGR was (33.5±1.9) weeks, which was significantly later than those of type Ⅱ and Ⅲ [(31.3±1.8), (31.2±1.1) weeks, P<0.001]. The percentage disordance in estimated fetal weight (EFW) of type Ⅰ sIUGR was significantly lower than those of type Ⅱ and type Ⅲ (P<0.001). The incidence rate of neonatal intensive care unit (NICU) admission, cerebral leukomalacia and respiratory complications of both fetus and necrotizing enterocolitis of large fetus in type Ⅰ were significantly lower than those in type Ⅱ and type Ⅲ (all P<0.05). (2) Typing conversion: in 100 cases of type Ⅰ sIUGR, 18 cases progressed to type Ⅱ and 10 cases progressed to type Ⅲ. Compared with 72 stable type Ⅰ sIUGR, those with progressed type Ⅰ sIUGR had higher incidence of NICU admission and lung disease in both fetuses, and cerebral leukomalacia and necrotizing enterocolitis in large fetus (all P<0.05). The proportion of inconsistent cord insertion was significantly higher in those type Ⅰ progressed to type Ⅲ (6/10) than in those with stable type Ⅰ (19.4%, 14/72) and type Ⅰ progressed to type Ⅱ sIUGR [0 (0/18), P=0.001]. Four cases of type Ⅱ sIUGR reversed to type Ⅰ and 6 cases reversed to type Ⅲ. Compared with type Ⅱ reversed to type Ⅰ sIUGR, those stable type Ⅱ and type Ⅱ reversed to type Ⅲ sIUGR had a higher incidence of NICU admission in large fetus (P<0.05). Two cases of type Ⅲ sIUGR reversed to type Ⅰ and 6 cases progressed to type Ⅱ. There were no significant differences in fetal serious complications in type Ⅲ sIUGR with or without doppler changes (all P>0.05). Conclusions: The different types of sIUGR could convert to each other. The frequency of ultrasound examinations should be increased for patients with the type Ⅰ sIUGR, especially when the percentage discordance in EFW is substantial or with discordant cord insersion.

GFNet: Global Filter Networks for Visual Recognition

Recent advances in self-attention and pure multi-layer perceptrons (MLP) models for vision have shown great potential in achieving promising performance with fewer inductive biases. These models are generally based on learning interaction among spatial locations from raw data. The complexity of self-attention and MLP grows quadratically as the image size increases, which makes these models hard to scale up when high-resolution features are required. In this paper, we present the Global Filter Network (GFNet), a conceptually simple yet computationally efficient architecture, that learns long-term spatial dependencies in the frequency domain with log-linear complexity. Our architecture replaces the self-attention layer in vision Transformers with three key operations: a 2D discrete Fourier transform, an element- wise multiplication between frequency-domain features and learnable global filters, and a 2D inverse Fourier transform. Based on this basic design, we develop a series of isotropic models with a Transformer-style simple architecture and CNN-style hierarchical models with better performance. Isotropic GFNet models exhibit favorable accuracy/complexity trade-offs compared to recent vision Transformers and pure MLP models. Hierarchical GFNet models can inherit successful designs in CNNs and be easily scaled up with larger model sizes and more training data, showing strong performance on both image classification (e.g., 85.0% top-1 accuracy on ImageNet-1 k without any extra data or supervision, and 87.4% accuracy with ImageNet-21 k pre-training) and dense prediction tasks (e.g., 54.3 mIoU on ADE20 k val). Our results demonstrate that GFNet can be a very competitive alternative to Transformer-based models and CNNs in terms of efficiency, generalization ability and robustness. Code is available at https://github.com/raoyongming/GFNet.

Dynamic Spatial Sparsification for Efficient Vision Transformers and Convolutional Neural Networks

In this paper, we present a new approach for model acceleration by exploiting spatial sparsity in visual data. We observe that the final prediction in vision Transformers is only based on a subset of the most informative regions, which is sufficient for accurate image recognition. Based on this observation, we propose a dynamic token sparsification framework to prune redundant tokens progressively and dynamically based on the input to accelerate vision Transformers. Specifically, we devise a lightweight prediction module to estimate the importance of each token given the current features. The module is added to different layers to prune redundant tokens hierarchically. While the framework is inspired by our observation of the sparse attention in vision Transformers, we find that the idea of adaptive and asymmetric computation can be a general solution for accelerating various architectures. We extend our method to hierarchical models including CNNs and hierarchical vision Transformers as well as more complex dense prediction tasks. To handle structured feature maps, we formulate a generic dynamic spatial sparsification framework with progressive sparsification and asymmetric computation for different spatial locations. By applying lightweight fast paths to less informative features and expressive slow paths to important locations, we can maintain the complete structure of feature maps while significantly reducing the overall computations. Extensive experiments on diverse modern architectures and different visual tasks demonstrate the effectiveness of our proposed framework. By hierarchically pruning 66% of the input tokens, our method greatly reduces 31%  ∼  35% FLOPs and improves the throughput by over 40% while the drop of accuracy is within 0.5% for various vision Transformers. By introducing asymmetric computation, a similar acceleration can be achieved on modern CNNs and Swin Transformers. Moreover, our method achieves promising results on more complex tasks including semantic segmentation and object detection. Our results clearly demonstrate that dynamic spatial sparsification offers a new and more effective dimension for model acceleration. Code is available at https://github.com/raoyongming/DynamicViT.

EVALUATION OF PRE-ABLATION NLR AND LMR AS PREDICTORS OF DISTANT METASTASES IN PATIENTS WITH DIFFERENTIATED THYROID CANCER

Objective

This research aim was to evaluates the role of the pre-ablation neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) as predictors of distant metastases in patients with differentiated thyroid cancer (DTC).

Methods

A retrospective analysis was given to 140 patients with DTC who received 131I remnant ablation after surgery. The patients were divided into two groups based on the existence of distant metastasis.

Results

The two groups showed no significant difference in age, gender, WBCs, neutrophils, monocytes, eosinophils, basophils and whether the tumor was multifocal. In the univariate analysis, significant differences were found in tumor size (p=0.021), lymphocyte (p=0.012), NLR (p=0.027), and LMR (p=0.007). According to the ROC curves, NLR had an AUC of 0.612 ± 0.097 with a cut-off value of 1.845, sensitivity of 60.0%, and specificity of 66.2% (p=0.027). LMR had an AUC of 0.638 ± 0.095 with a cut-off value of 4.630, sensitivity of 84.6%, and specificity of 35.4% (p=0.007). In the multivariate analysis, larger tumor size (OR=5.246, 95% CI 1.269-10.907, p=0.009) and higher NLR (OR=2.087, 95% CI 0.977-4.459, p=0.034) were statistically significant for distant metastases.

Conclusion

This research reveals that pre-ablation NLR and tumor size are significantly statistically correlated with distant metastases in patients with DTC.

[Morphology of the esophagus of ferrets and expression profile of molecular markers]

OBJECTIVE

To examine the morphological characteristics and the expression profile of molecular markers of ferret esophagus and assess the feasibility of using ferrets as animal models for studying human esophageal diseases.

METHODS

Frozen sections and paraffin- embedded specimens of the esophageal tissues were obtained from adult ferrets (aged 6 to 8 months) and ferrets aged 1 day, 3 days, 5 days, 1 week and 2 weeks. HE staining and periodic acid-Schiff (PAS) staining were used for morphological analysis of the esophageal submucosal glands (SMGs) of adult ferrets, and the expressions of MUC5B and MUC5AC were tested using Mucin staining; The expressions of cytokeratins (CK4, CK5, CK7, CK8, CK14, CK17, CK18, CK19, and CK20) in adult ferret esophagus were examined using HE staining and immunofluorescence assay. The expressions of LEF1 in the esophageal epithelium and SMGs were detected with immunofluorescence assay.

RESULTS

In adult ferrets, the esophageal SMGs were connective tissues below the muscularis mucosa of the esophagus with secretory functions. Cytokeratins were expressed differentially in different esophageal cells: CK4, CK8 and CK20 were expressed mainly in the mucous cells, ductal cells and epithelial cells, respectively, while the mucous cells expressed the largest variety of cytokeratins. Mucin staining showed positive MUC5B and MUC5AC expression in the cytoplasm and lumen of adult ferret esophageal glands. Lectin from DBA, ECL, GSLI, GSL Ⅱ, SBA, Tacalin bioylated, ULEX, WGA, GSL Ⅰ and GSL Ⅱ were expressed on ductal cell membrane, and ECL, PNA and WGA were detected on epithelial cell membrane. Lectin with ConA, PHA-E and PHA-L were expressed on serous cell membrane. Immunofluorescence assay showed that LEF1 in the developing glands were visible from 3 days to 1 week of age and then disappeared as the glands matured. The intensity of LEF1 expression in the esophageal glands differed significantly between ferrets aged 1 to 7 days and those aged two weeks.

CONCLUSION

Ferrets and human share similar esophageal tissue structures and some common molecular markers, suggesting the possibility of using ferrets as animal models of human esophageal diseases.

All-fiber-device-coupled compact, transportable ultra-stable laser

In response to the demand for operation in non-laboratory environments, there has been a trend toward the development of compact, transportable ultra-stable lasers. This paper reports on this sort of laser system assembled in a cabinet. The whole optical part utilizes fiber-coupled devices to simplify the integration. In addition, spatial beam collimation and alignment into the high-finesse cavity are realized by a five-axis positioner and a focus-adjustable fiber collimator, which significantly relax the alignment and adjustment. A theoretical analysis is performed on how the collimator adjusts the beam profile and coupling efficiency. The support structure of the system is specially designed as well so that it features robustness and transportation without performance degradation. The observed linewidth is 1.4 Hz within a duration of 1 s. After subtracting the linear drift of 70 mHz/s, the fractional frequency instability is better than 4 × 10^-15, for the averaging time ranging from 1 to 100 s, which is close to the thermal noise limit of the high-finesse cavity.

The role of interferon-stimulated gene 15 in the occurence and progression of cervical squamous cell carcinoma

To identify molecular markers for early diagnosis and new targets for treatment of cervical squamous cell carcinoma. Our study involved 52 carcinoma tissues that were confirmed pathologically as cervical squamous cell carcinoma (CSCC) at the Fourth Hospital of Hebei Medical University in 2021. We obtained 36 control specimens from patients who had undergone hysterectomy for benign uterine diseases in 2021, with no cervical lesions as confirmed by pathology. Total RNA was extracted from all the samples. Reverse transcription and quantitative real-time PCR were performed. Immunohistochemical staining for interferon-stimulated gene 15 (ISG15) protein was performed. Descriptive analyses including mean and standard deviation were used to compare different groups. For data that do not conform to normal distribution, we use Wilcox rank sum test to make statistics to compare different groups with the median and interquartile. Mann Whitney U test was used to compare non-parametric continuous data, and categorical variables were analyzed using chi-square test. Receiver operating characteristic (ROC) curve was used to evaluate the possibility of using ISG15 as a new biomarker for cervical squamous cell carcinoma. Compared with normal cervical tissues, mRNA expression of ISG15 in cervical cancer tissues was significantly lower (P<0.01); mRNA expression was significantly lower in patients with nerve invasion (P<0.05). Difference in ISG15 protein expression was statistically significant (no expression/low expression) in the cancer samples compared to normal tissues (P<0.01). The area under ROC curve was 0.810 (P<0.001) and the sensitivity and specificity were 75% and 54%, respectively. Spearman's correlation analysis showed that ISG15 mRNA was positively correlated with protein expression (r=0.358, P=0.001). Deficiency of ISG15 may be associated with the occurrence and progression of CSCC. It could be used as a potential tumor marker in research and treatment of CSCC.

The role of interferon-stimulated gene 15 in the occurence and progression of cervical squamous cell carcinoma

To identify molecular markers for early diagnosis and new targets for treatment of cervical squamous cell carcinoma. Our study involved 52 carcinoma tissues that were confirmed pathologically as cervical squamous cell carcinoma (CSCC) at the Fourth Hospital of Hebei Medical University in 2021. We obtained 36 control specimens from patients who had undergone hysterectomy for benign uterine diseases in 2021, with no cervical lesions as confirmed by pathology. Total RNA was extracted from all the samples. Reverse transcription and quantitative real-time PCR were performed. Immunohistochemical staining for interferon-stimulated gene 15 (ISG15) protein was performed. Descriptive analyses including mean and standard deviation were used to compare different groups. For data that do not conform to normal distribution, we use Wilcox rank sum test to make statistics to compare different groups with the median and interquartile. Mann Whitney U test was used to compare non-parametric continuous data, and categorical variables were analyzed using chi-square test. Receiver operating characteristic (ROC) curve was used to evaluate the possibility of using ISG15 as a new biomarker for cervical squamous cell carcinoma. Compared with normal cervical tissues, mRNA expression of ISG15 in cervical cancer tissues was significantly lower (P<0.01); mRNA expression was significantly lower in patients with nerve invasion (P<0.05). Difference in ISG15 protein expression was statistically significant (no expression/low expression) in the cancer samples compared to normal tissues (P<0.01). The area under ROC curve was 0.810 (P<0.001) and the sensitivity and specificity were 75% and 54%, respectively. Spearman's correlation analysis showed that ISG15 mRNA was positively correlated with protein expression (r=0.358, P=0.001). Deficiency of ISG15 may be associated with the occurrence and progression of CSCC. It could be used as a potential tumor marker in research and treatment of CSCC.

[Investigation for pathological interpretation criteria and its prognostic value for P53 expression in Chinese diffuse large B-cell lymphoma]

Objective: To explore the feasibility of predicting TP53 mutation risk by immunohistochemical staining (IHC) pattern of P53 in Chinese diffuse large B-cell lymphoma (DLBCL) and its correlation with a prognostic difference. Methods: Between January 2021 and December 2021, 51 DLBCL cases at Beijing Boren Hospital were gathered. These cases had both IHC and next-generation sequencing (NGS) results. IHC classified the P53 protein expression pattern into a loss (<1% ) , diffuse (>80% ) , and heterogeneous (1% -80% ) . The sensitivity and specificity of the predicting TP53 mutation by IHC were assessed by comparing the results of the NGS, and the TP53 high mutation risk group included both loss and diffuse expression of P53. From June 2016 to September 2019, Peking University Cancer Hospital collected 131 DLBCL cases with thorough clinicopathological and follow-up data. From their tumor blocks, tissue microarray blocks were made for IHC evaluation of P53 expression pattern, and prognosis effect of P53 studies. Results: Among 51 cases with both IHC and NGS results, 23 cases were classified as TP53 high mutation risk (7 cases loss and 16 cases diffuse) , 22/23 cases were proved with mutated TP53 by NGS. Only 1 of the 28 cases classified as TP53 low mutation risk was proved with mutated TP53 by NGS. IHC had a sensitivity and specificity of 95.7% and 96.4% for predicting TP53 mutation. NGS identified a total of 26 TP53 mutations with a mutation frequency of 61.57% (13.41% -86.25% ) . In the diffuse group, 16 missense mutations and 2 splice mutations were detected; 6 truncating mutations and 1 splice mutation were detected in the loss group; 1 truncating mutation was detected in the heterogeneous group. Multivariate analysis demonstrated that TP53 cases with high mutation risk have impartial adverse significance for the 131 patients included in survival analysis (HR=2.612, 95% CI 1.145-5.956, P=0.022) . Conclusion: IHC of P53 exhibiting loss (<1% ) or diffuse (>80% ) pattern indicated TP53 high mutation risk, IHC can predict TP53 mutation with high specificity and sensitivity. TP53 high mutation risk is an independent predictor for adverse survival.

[Clinical application of laparoscopic sentinel lymph node mapping in early staged cervical cancer]

Objective: To investigate the application of sentinel lymph node biopsy (SLNB) in early-staged cervical cancer by laparoscopy. Methods: It was a prospective, single-arm, single-center clinical study. Seventy-eight cases of cervical cancer patients were collected from July 2015 to December 2018 at the Fourth Hospital of Hebei Medical University. All the patients were injected with tracer into the disease-free block of cervical tissue after anesthesia by the same surgeon who learned sentinel lymph node (SLN) mapping technique in Memorial Sloan-Kettering Cancer Center, and underwent SLN mapping followed by complete pelvic lymphadenectomy. Moreover, all the dissected lymph nodes were stained with hematoxylin eosin staining (HE) pathological examination. Besides, the negative SLN on hematoxylin-eosin staining were detected by immunohistochemistry cytokeratin staining micro-metastasis. To analyze the distribution, detection rate, false negative rate the sensitivity and negative predictive value of the SLN in early-staged cervical cancer by laparoscopy, and explore the value of SLN mapping in predicting the lymph nodes metastasis in early-staged cervical cancer. Results: The overall detection rate of SLN in cervical cancer was 99% (77/78), bilateral detection rate was 87% (68/78). The average of 12.4 lymph node (LN) and 3.6 SLN were dissected for each patients each side. SLN of cervical cancer were mainly distributed in the obturator space (61.5%, 343/558), followed by external iliac (23.5%, 131/558), common iliac (7.3%, 41/558), para-uterine (3.8%, 21/558), internal iliac (2.2%, 12/558), para abdominal aorta (1.1%, 6/558), and anterior sacral lymphatic drainage area (0.7%, 4/558). Fourteen cases of LN metastasis were found among all 78 cases. There were a total of 38 positive LN, including 26 SLN metastasis and 12 none sentinel LN metastasis. Through immunohistochemical staining and pathological ultra-staging, 1 SLN was found to be isolated tumor cells (ITC), and 5 SLNs were found to be micro-metastases (MIC), accounting for 23% (6/26) of positive SLN. SLN mapping with pathological ultra-staging improved the prediction of LN metastasis in cervical cancer (2/14). Metastatic SLN mainly distributed in the obturator space (65%, 17/26), peri-uterine region (12%, 3/26), common iliac region (15%, 4/26), and external iliac region (8%, 2/26). The consistency of the diagnosis of lymph node metastasis by SLN biopsy and postoperative retroperitoneal lymph node metastasis showed that the Kappa value was 1.000 (P<0.001), indicated that the metastasis status of SLN and retroperitoneal lymph node were completely consistent. The sensitivity, specificity, accuracy, false-negative rate, and negative predictive value of SLN biopsy in the diagnosis of lymph node metastasis were 100%, 100%, 100%, 0, and 100%, respectively. Conclusions: SLN in early-staged cervical cancer patients were mainly distributed in the obturator and external iliac space, pathalogical ultra-staging of SLN could improve the prediction of LN metastasis. Intraoperative SLN mapping is safe, feasible and could predict the state of retroperitoneal LN metastasis in early-staged cervical cancer. SLNB may replace systemic pelvic lymphadenectomy.

TRAUMATIC “ANGIOEDEMA”: EXTENSIVE SUBCUTANEOUS EMPHYSEMA MASQUERADING AS ANGIOEDEMA

Introduction

COVID 19 pandemic related precautions have resulted in suboptimal physical examination of the patients which may have affected the patient care and training of medical professionals. We present a case of a patient whose subcutaneous emphysema was misdiagnosed as angioedema.

Case Description

25 years old female with cerebral palsy and developmental delay presented to hospital in June, 2020 with asymmetric left facial and periorbital swelling which developed an hour after her regular Depo-Provera injection. She had elevated blood pressure readings with tachycardia without hives, respiratory or gastrointestinal symptoms. Facial swelling did not improve after IM epinephrine, IV steroids and antihistamines. Flexible laryngoscopy noted mild edema of lingual surface of the epiglottis. Allergy service was consulted to evaluate for drug-induced anaphylaxis. Our physical examination revealed significant asymmetric periorbital edema, neck and chest swelling with distant breath sounds and distinct palpable crepitus. Serum Trytpase and C1-Estrase inhibitor levels were normal at 3.2ug/L and 28 mg/dl, respectively. Emergent imaging was recommended, which demonstrated multiple rib fractures, pneumomediastinum with extensive chest wall subcutaneous emphysema tracking to extra-cranial soft tissue. Patient was intubated and chest tube was placed due to concerns for airway compromise. She stayed in ICU for one week before being discharged to home.

Discussion

Facial edema, concerning for angioedema, is potentially life threatening condition and an allergic reaction should be higher on the differential diagnoses. Our case represents a learning opportunity regarding other potentially life threatening conditions that can mimic angioedema, requiring higher index of clinical suspicion and thorough physical examination.

How Does Topography Affect the Value of Ecosystem Services? An Empirical Study from the Qihe Watershed

Topographic position indices (TPIs) measure essential impacts on ecosystem service supply capacity. The identification of changes in ecosystem services and value metrics under varying TPIs has become a topical subject of global change research. Multidimensional changes in spatiotemporal and geographical aspects of ecosystem service values (ESVs) are assessed in this article using land cover/use data from 2000-2015. Effects of land-use/cover changes and topographic indices on ESVs are explored using the Chinese terrestrial unit area ecosystem service value equivalence table combined with topographic factors. A sensitivity index is introduced to quantify the robustness of total ESV to land-use/cover and topographic indices. The results show that: (1) The total ESV in the Qihe watershed declined with a change in land-use/cover during the period 2000-2015. The maximum ESV was CNY 1.984 billion in 2005 and the minimum was CNY 1.940 billion in 2010; (2) The response of ESV to land/use cover varied greatly across TPIs, with the most significant change in ESV occurring in the 0.6-0.8 TPI range and the greatest change in a single ecosystem service occurred in water areas; (3) The sensitivity indices of ESVs are all less than 1. The sensitivity indices of unused land and water tended to zero. Woodland sensitivity indices were the highest at 0.53, followed by those of arable land and grassland, owing to the large proportion of arable land and grassland areas in the overall area of land-use categories.

[The value of MR diffusion tensor imaging in assessing white matter changes in short-term methamphetamine withdrawal]

Objective: To explore the value of MRI diffusion tensor imaging (DTI) in the white matter changes of short-term methamphetamine (MA) abstinence. Methods: The data of DTI, demographics features, general information of addiction and impulsivity scale eleven (BIS-11) of 55 short-term MA addicts who were from Changsha, Zhuzhou and Yueyang compulsory detoxification centers in Hunan province, including 40 males and 15 females, aged 14-45 (37.24±7.31) years old, and 52 healthy controls, including 40 males and 12 females aged 18-59 (40.3±9.1) years were collected prospectively from August 2017 to December 2018. The differences of DTI indicators between the two groups were compared by tract-based spatial statistics (TBSS), and then the correlation between the different indicators and the age of first MA use, time of MA use, daily dose used, BIS-11 score were performed. Results: There were significant differences in BIS total score(P<0.001), BIS motivational impulsivity(P<0.001) and BIS attentional impulsivity(P=0.003) between MA group and healthy control group in short-term withdrawal. And compared with the healthy control group, the fractional anisotropy (FA) (0.58±0.02 vs 0.56±0.02,0.77±0.02 vs 0.75±0.04,0.79±0.04 vs 0.76±0.06; all P<0.05), axial diffusivity (AD) (0.57±0.01 vs 0.56±0.02,P=0.001) and mean diffusivity (MD) (0.66±0.02 vs 0.65±0.02,0.52±0.07 vs 0.51±0.06; both P<0.05)values in the MA group were all increased (P<0.05), but there was no significant difference in the radial diffusivity (RD) value (P>0.05). The white matter areas with increased FA value were located in the knee and body of corpus callosum, bilateral anterior corona radiata and left superior corona radiata; the areas with increased AD value were located in the knee, body and pressure of corpus callosum, bilateral anterior limb of internal capsule, posterior limb of internal capsule, anterior, superior and posterior corona radiata, external capsule and superior longitudinal fasciculus; and the areas with increased MD value were mainly located in the right superior longitudinal fasciculus, anterior and posterior limb of internal capsule. The corpus callosum, where there was a difference in FA between the two groups, was positively correlated with the daily dose of MA (r=0.301, P=0.026). Conclusion: MA addicted individuals with short-term withdrawal have white matter edema and damage, and the degree of corpus callosum damage is positively correlated with the daily dose of MA,which is helpful to understand the pathophysiological process of white matter damage in the nervous system and the potential mechanism of neuropsychiatric symptoms in short-term withdrawal MA addicted individuals.

VideoABC: A Real-World Video Dataset for Abductive Visual Reasoning

In this paper, we investigate the problem of abductive visual reasoning (AVR), which requires vision systems to infer the most plausible explanation for visual observations. Unlike previous work which performs visual reasoning on static images or synthesized scenes, we exploit long-term reasoning from instructional videos that contain a wealth of detailed information about the physical world. We conceptualize two tasks for this emerging and challenging topic. The primary task is AVR, which is based on the initial configuration and desired goal from an instructional video, and the model is expected to figure out what is the most plausible sequence of steps to achieve the goal. In order to avoid trivial solutions based on appearance information rather than reasoning, the second task called AVR++ is constructed, which requires the model to answer why the unselected options are less plausible. We introduce a new dataset called VideoABC, which consists of 46,354 unique steps derived from 11,827 instructional videos, formulated as 13,526 abductive reasoning questions with an average reasoning duration of 51 seconds. Through an adversarial hard hypothesis mining algorithm, non-trivial and high-quality problems are generated efficiently and effectively. To achieve human-level reasoning, we propose a Hierarchical Dual Reasoning Network (HDRNet) to capture the long-term dependencies among steps and observations. We establish a benchmark for abductive visual reasoning, and our method set state-of-the-arts on AVR (  ∼ 74 %) and AVR++ (  ∼ 45 %), and humans can easily achieve over 90% accuracy on these two tasks. The large performance gap reveals the limitation of current video understanding models on temporal reasoning and leaves substantial room for future research on this challenging problem. Our dataset and code are available at https://github.com/wl-zhao/VideoABC.