• High-intensity focused ultrasound (HIFU) is a new minimally invasive therapeutic technique. • HIFU ablation may be safe and effective for treatment of submucosal fibroids • Treatment is minimally invasive and repeatable. • Vaginal expulsion of necrotic tissue is common after treatment.

Background and purpose Three-dimensional pseudo-continuous arterial spin labeling (3D pCASL) with multiple post-labeling delays (PLDs) has been used to assess cerebral blood flow (CBF). We used this modality to estimate antegrade and collateral flow in patients with unilateral middle cerebral artery (MCA) stenosis. Methods Consecutive patients with unilateral MCA 50% to 99% stenosis at two centers underwent pCASL with a PLD of 1.5s and 2.5s. Mean CBF of bilateral MCA territory at the PLD 1.5s and 2.5s were measured. Early-arriving flow proportion was defined as [CBF 1.5s at lesion side/CBF 2.5s at normal side] × 100%. Late-arriving retrograde flow proportion was defined as [(CBF 2.5s minus CBF 1.5s) at lesion side minus (CBF 2.5s minus CBF 1.5s) at normal side]/CBF 2.5s at normal side × 100%. Antegrade and collateral scales were evaluated in patients with conventional angiography. Spearman correlation coefficients were calculated between early-arriving flow and late-arriving retrograde flow proportions on ASL and antegrade and collateral scales on conventional angiography, respectively. Results Forty-one patients (46.0±12.0 years) were enrolled. The mean early-arriving flow proportion was 78.3%±14.9%. The mean late-arriving retrograde flow proportion was 16.1%±10.2%. In 21 patients with conventional angiography, Spearman correlation coefficient was 0.53 (95%CI 0.11–0.79) between antegrade grade and early-arriving flow proportion (p=0.01) and 0.81 (95%CI 0.56–0.92) between collateral grade and late-arriving retrograde flow proportion (p<0.0001). Conclusion Three-dimensional pCASL with two-PLD may provide an empirical approach for estimating antegrade and collateral flow in patients with unilateral MCA stenosis.

Measurement of cell-free fetal DNA (cffDNA) is an indispensable process for non-invasive prenatal screening (NIPS). According to recent studies, cffDNA in maternal plasma can be enriched for various lengths of fragments, and a sufficient amount of cffDNA can effectively eliminate background interference on the part of maternal DNA. Therefore, we developed a simple and effective separation method, improved NIPS (iNIPS), that enriches the fetal fraction and improves the accuracy of NIPS for fetal aneuploid detection. We adopted a novel strategy to achieve enrichment of 125–135 bp cell-free DNA (cfDNA) by e-gel electrophoresis. To evaluate clinical performance, we compared NIPS and iNIPS results from 2153 retrospective clinical samples. Of the 22 samples with NIPS results of “no call”, 17 samples were reclassified as “unaffected” (9 cases of chr13, 5 cases of chr18, and 3 cases of chr21); 2 samples remained classified as “no call” (1 case of chr18 and 1 case of chr21); and 3 samples were identified as T21 by iNIPS. The average increase in abundance of cfDNA fragments of 125–135 bp was 2.5 times, and the average decrease in maternal background interference was 1.3 times. On this basis, the detection of fetal aneuploidy was highly improved with the fetal fraction as low as 2%; iNIPS achieved 100% sensitivity and 99.90% specificity in retrospective samples.

Ischemic stroke is one of the major leading causes for long-term disability and mortality. Collateral vessels provide an alternative pathway to protect the brain against ischemic injury after arterial occlusion. Aiming at visualizing the collaterals occurring during acute ischemic stroke, an integrin α β -specific Fe O -Arg-Gly-Asp (RGD) nanoprobe is prepared for magnetic resonance imaging (MRI) of the collaterals. Rat models are constructed by occluding the middle cerebral artery for imaging studies of cerebral ischemia and ischemia-reperfusion on 7.0 Tesla MRI using susceptibility-weighted imaging sequence. To show the binding specificity to the collaterals, the imaging results acquired with the Fe O -RGD nanoprobe and the Fe O mother nanoparticles, respectively, are carefully compared. In addition, an RGD blocking experiment is also carried out to support the excellent binding specificity of the Fe O -RGD nanoprobe. Following the above experiments, cerebral ischemia-reperfusion studies show the collateral dynamics upon reperfusion, which is very important for the prognosis of various revascularization therapies in the clinic. The current study has, for the first time, enabled the direct observation of collaterals in a quasi-real time fashion and further disclosed that the antegrade flow upon reperfusion dominates the blood supply of primary ischemic tissue during the early stage of infarction, which is significantly meaningful for clinical treatment of stroke.

The worldwide growth of megaprojects has triggered an increasing number of academic publications in the past few decades. However, there are few studies drawing the whole picture of construction megaproject management. This study aims to investigate the status and identify research implications of construction megaproject management by conducting a systematic review. A total of 155 journal articles in 2007-2018 were identified and analysed, mainly using a bibliographic analysis on annual circulation, major journals, research origins, and categories of research interests. Results indicated that IJPM, JME, PMJ, FEM, JCEM, Sustainability, PICE-MPL and ECAM are the major journals, and developed regions/countries such as the United Kingdom rather than developing regions/countries such as mainland China are the dominant contributors in this field. Ten categories of research interests on megaproject management were also displayed and respectively discussed in depth. Moreover, three implications for future research, namely, 'construction megaproject research in developing areas', 'human factors in construction megaproject research' and 'external complexity in construction megaproject research', were proposed. The clear picture of existing literature might provide insights for academic research into megaproject management. Besides, the frontiers of megaproject research could equip practitioners with updated problem-solving strategies and then facilitate faster development in megaproject management.

According to Lenke classification of adolescent idiopathic scoliosis (AIS), patients with type 5 curve in which the structural major curve is thoracolumbar or lumbar curve with nonstructural proximal thoracic and main thoracic curves, could be surgically treated with selective anterior thoracolumbar or lumbar (TL/L) fusion. This study retrospectively analyzed the radiographies of selective anterior TL/L fusion in 35 cases of AIS with Lenke type 5 curve. Segmental fixation with a single rigid rod through anterior thoracoabdominal approach was applied in all patients. Measurements of scoliosis curve in preoperative, immediate postoperative and follow-up radiographies were analyzed. The average follow up time was 36 months (24-42 months). The average preoperative Cobb angle of the TL/L curve was 45.6°and improved into 9.7°immediate postoperatively, with 79.7% curve correction. In addition, the minor thoracic curve decreased from 29.7°preopera-tively to 17.6°postoperatively, with a spontaneous correction of 41.5%. During the follow-up, a loss of 4.6°c orrection was found and the average Cobb angle of TL/L increased to 14.4°. Also, the minor thoracic curve increased to average 20.1°with a loss of 2.4°correction. Trunk shift deteriorated slightly immediate postoperatively and improved at the follow-up. The lowest instrumented vertebra (LIV) tilt was improved significantly and maintained its results at the follow-up. During the follow-up, the coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) aggravated, while the sagittal contours of T5-T12 and T10-L2 were well maintained. The lumbar lordosis of L1-S1 and the sagittal Cobb angle of the instrumented segments were reduced slightly postoperatively and at the follow-up. There were no major complications or pseudarthrosis. The outcomes of this study show that selective anterior thoracolumbar or lumbar fusion with solid rod instrumentation is effective for surgical correction of AIS with Lenke type 5 curve. The TL/L curve, minor thoracic curve, and LIV title can be improved significantly, with good maintenance of sagittal contour. However, the UIVDA and LIVDA aggravate postoperatively when the trunk rebalances itself during follow-up. The degeneration of LIV disc warrants longer-term follow-up.

OBJECTIVES:To explore the effects of a discrepancy between actual and preferred living arrangements on the relationship between living arrangements and life satisfaction among the elderly in China.METHODS:Secondary analysis of the 2005 dataset of the Chinese Longitudinal Healthy Longevity Survey was performed. A binary logistic regression model was used to analyze the relationship between life satisfaction and living arrangements.RESULTS:Among those with concordant actual and preferred living arrangements, living in a nursing home increased the likelihood of life satisfaction, whereas living alone and living with a spouse decreased the likelihood of life satisfaction compared to living with the next generation and a spouse. Among those with discordant living arrangements, there were no differences in life satisfaction between the various living arrangements, except that living with a spouse increased life satisfaction compared to living with the next generation and a spouse.CONCLUSIONS:A discrepancy between actual and preferred living arrangements modifies the relationship between life satisfaction and actual living arrangement. Living in a nursing home is a good option for Chinese elder care only if the older individual emotionally accepts it. Living alone or with a spouse is not a good arrangement for elder care, even though it is often preferred by the elderly. Those with discordant living arrangements are more satisfied living with their spouses.

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