BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC...BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC)lesions,they are benign.As such,it is important to develop methods to distinguish between FNH-like lesions and HCC.AIM To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC.METHODS We studied pathologically confirmed FNH-like lesions in 13 patients with alco-holic cirrhosis[10 men and 3 women;mean age:54.5±12.5(33-72)years]who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography(CT)and magnetic resonance imaging(MRI),including superparamagnetic iron oxide(SPIO)and/or gadoxetic acid-enhanced MRI.Seven patients also underwent angiography-assisted CT.RESULTS The evaluated lesion features included arterial enhancement pattern,washout appearance(low density compared with that of surrounding liver parenchyma),signal intensity on T1-weighted image(T1WI)and T2-weighted image(T2WI),central scar presence,chemical shift on in-and out-of-phase images,and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI.Eleven patients had multiple small lesions(<1.5 cm).Radiological features of FNH-like lesions included hypervascularity despite small lesions,lack of“corona-like”enhancement in the late phase on CT during hepatic angiography(CTHA),high-intensity on T1WI,slightly high-or iso-intensity on T2WI,no signal decrease in out-of-phase images,and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid.Pathologically,similar to HCC,FNH-like lesions showed many unpaired arteries and sinusoidal capillarization.CONCLUSION Overall,the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis.Specifically,SPIO-and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.展开更多
This study systematically investigated the effects of graphite nodule parameters,including count,average diameter,and nodularity,on microstructure and mechanical properties of austempered ductile irons(ADIs).The ADI s...This study systematically investigated the effects of graphite nodule parameters,including count,average diameter,and nodularity,on microstructure and mechanical properties of austempered ductile irons(ADIs).The ADI specimens with graphite nodule counts of 212±11 mm^(-2),308±9 mm^(-2),415±10 mm^(-2),and 589±13 mm^(-2) were designated as G-200,G-300,G-400,and G-600,respectively.Results indicate a progressive refinement of graphite with an increase in nodule counts.Specifically,the average nodule diameter decreases from 33.3±1.3μm for G-200 to 17.0±0.7μm for G-600.The nodularity of all samples is above 90%.Furthermore,the nodularity exhibits a corresponding increasing trend with the rise of graphite nodule count in ADIs.Additionally,the volume fraction of the austenite phase in ADIs decreases with an increase in graphite nodule count.The graphite nodule count changes the tensile strength and elongation of ADIs.The specimen G-400 exhibits the ultimate tensile strength of 897±11 MPa and an elongation of 9.8%±0.6%,representing 5.3%and 44.1%improvements respectively compared to G-200.To explore the wear resistance of ADIs with different graphite nodule counts,dry sliding friction and wear test of different samples was carried out at room temperature.At a high load of 25 N,G-400 exhibits superior wear resistance,achieving a 42%reduction in worn volume compared to G-200.Worn micromorphology identifies three primary wear mechanisms:microcutting-dominated abrasive wear,adhesive wear,and fatigue wear.展开更多
In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute ...In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.展开更多
Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable...Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable depending on the organ involved and type of protein. Amyloidosis can be classified based on quantity, type, and location of these proteins. Amyloid light-chain amyloidosis develops in the bone marrow, producing abnormal forms of light-chain proteins, which cannot be broken down. These proteins transform into amyloid fibrils and form amyloid deposits in different organs. Pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis;however, it may present as localised pulmonary disease. Localized pulmonary Amyloidosis can present as nodular, cystic, or tracheobronchial amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. This is a case of a 47-year-old female with background history of interstitial lung disease presenting with progressive shortness of breath. Computed tomography scan revealed bilateral pulmonary nodules. The patient was referred to our thoracic surgery team with the suspicion of bronchogenic malignancy with metastasis. Diagnostic video assisted wedge resection was performed for this patient, and histology confirmed pulmonary amyloidosis of nodular type. Amyloid deposition simulates both inflammatory and neoplastic conditions. Definitive diagnosis requires biopsy confirmation therefore early detection and commencing the patient on appropriate treatment pathway may help in symptomatic relief and better outcome.展开更多
The nodular cast iron samples were prepared with the normal nodularizing process, in which the important antinodularizing elements Pb, Bi and Al were added respectively in order to research the influence of them on th...The nodular cast iron samples were prepared with the normal nodularizing process, in which the important antinodularizing elements Pb, Bi and Al were added respectively in order to research the influence of them on the nodularization of the graphites. The nodular graphites were extracted from the nodular cast iron by the electrolytic technique. The distribution of trace elements in nodular and deformed graphite were measured by Scanning Proton Microprobe (SPM). Most of the adding elements Pb, Bi and Al existed in matrix as impurities, a part of them intruded into the nodular graphites. A new suggestion of Ti antinodularizing properties had been proposed. The influence of Pb, Bi and Al on the nodularization was indirectly performed through Ti. Therefore, Ti is one of the most important antinodularizing elements.展开更多
BACKGROUND Focal nodular hyperplasia(FNH)commonly occurs in women;it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma(HCC).CASE SUMMARY A large space-occupying lesion in t...BACKGROUND Focal nodular hyperplasia(FNH)commonly occurs in women;it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma(HCC).CASE SUMMARY A large space-occupying lesion in the right lobe of the liver was incidentally detected in an adult man and diagnosed as HCC.Transcatheter arterial chemoembolization was applied once monthly for 2 years,but the lesion did not decrease in size.It was revealed by biopsy to be FNH.Eleven years later,the patient underwent liver resection due to hemorrhage and the pathological examination confirmed FNH.CONCLUSION For a space-occupying lesion,it is prerequisite to pathologically confirm the diagnosis and the corresponding intervention can be effective.展开更多
The static drill rooted nodular pile is a new type of pile foundation consisting of precast nodular pile and the surrounding cemented soil.This composite pile has a relatively high bearing capacity and the mud polluti...The static drill rooted nodular pile is a new type of pile foundation consisting of precast nodular pile and the surrounding cemented soil.This composite pile has a relatively high bearing capacity and the mud pollution will be largely reduced during the construction process by using this type of pile.In order to investigate the bearing capacity and load transfer mechanism of this pile,a group of experiments were conducted to provide a comparison between this new pile and the bored pile.The axial force of a precast nodular pile was also measured by the strain gauges installed on the pile to analyze the distribution of the axial force of the nodular pile and the skin friction supported by the surrounding soil,then 3D models were built by using the ABAQUS finite element program to investigate the load transfer mechanism of this composite pile in detail.By combining the results of field tests and the finite element method,the outcome showed that the bearing capacity of a static drill rooted nodular pile is higher than the bored pile,and that this composite pile will form a double stress dispersion system which will not only confirm the strength of the pile,but also make the skin friction to be fully mobilized.The settlement of this composite pile is mainly controlled by the precast nodular pile;meanwhile,the nodular pile and the surrounding cemented soil can be considered as deformation compatibility during the loading process.The nodes on the nodular pile play an important role during the load transfer process,the shear strength of the interface between the cemented soil and the soil of the static drill rooted pile is larger than that of the bored pile.展开更多
BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associate...BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associated with significant symptoms, more frequently they are discovered incidentally on physical examination or the work-up of unrelated symptoms. Since its nature and pathogenesis are still controversial, accurate diagnosis of FNH based on clinical presentation and radiographic studies is difficult. The purpose of this study was to explore the diagnosis and treatment of FNH. METHODS: Eighty-six FNH patients confirmed pathologically were treated at the Liver Cancer Institute in our hospital from 1996 to 2006. Their clinical manifestions, imaging presentation, pathological findings, and surgical results were analyzed retrospectively. RESULTS: Of the 86 patients with 99 foci, 54 were male and 32 female, with a mean age of 37 years. Eighty patients had a single solitary focus and 6 had multiple foci. Tumor diameter was less than 5 cm in 69 patients, 5-10 cm in 15, and more than 10 cm in 2. The overall rate of correct preoperative diagnosis was 59.3% (51/86) including 32.9% (26/79) by color Doppler flow imaging (CDFI), 60.3% (35/58) by CT, and 77.4% (24/31) by MRI. All the 86 patients underwent resection with good curative effect. CONCLUSIONS: CT and MRI are important diagnostic methods for FNH but it is difficult to make a definite preoperative diagnosis for partial classical and all non-classical FNH patients. We suggest that patients with clinical symptoms or with indefinite diagnosis should accept surgical removal.展开更多
Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrh...Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrhotic portal hypertension.There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series.NRH may develop via autoimmune,hematological,infectious,neoplastic,or drug-related causes.The disease is usually asymptomatic,slowly or nonprogressive unless complications of portal hypertension develop.Accurate diagnosis is made by histopathology,which demonstrates diffuse micronodular transformation without fibrous septa.Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver.While the initial treatment is to address the underlying disease,ultimately the therapy is directed to the management of portal hypertension.The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension.In this review we detail the epidemiology,pathogenesis,diagnosis,management,and prognosis of NRH.展开更多
Reactive nodular fibrous pseudotumor(RNFP), which presents abdominal clinical manifestations and malignant radiographic results, usually requires radical resection as the treatment. However, RNFP has been recently des...Reactive nodular fibrous pseudotumor(RNFP), which presents abdominal clinical manifestations and malignant radiographic results, usually requires radical resection as the treatment. However, RNFP has been recently described as an extremely rare benign postinflammatory lesion of a reactive nature, which typically arises from the sub-serosal layer of the digestive tract or within the surrounding mesentery in association with local injury or inflammation. In addition, a postoperative diagnosis is necessary to differentiate it from the other reactive processes of the abdomen. Furthermore, RNFP shows a good prognosis without signs of recurrence or metastasis. A 16-year-old girl presented with a 3-mo history of epigastric discomfort, and auxiliary examinations suggested a malignant tumor originating from the stomach; postoperative pathology confirmed RNFP, and after a 2-year follow-up period, the patient did not display any signs of recurrence. This case highlights the importance of preoperative pathology for surgeons who may encounter similar cases.展开更多
The surface of nodular cast iron （NCI） with a ferrite substrate was rapidly remelted and solidified by plasma transferred arc （PTA） to induce a chilled structure with high hardness and favorable wear resistance. T...The surface of nodular cast iron （NCI） with a ferrite substrate was rapidly remelted and solidified by plasma transferred arc （PTA） to induce a chilled structure with high hardness and favorable wear resistance. The effect of scanning speed on the microstructure, micro-hardness distribution, and wear properties of PTA-remelted specimens was systematically investigated. Microstructural characterization in-dicated that the PTA remelting treatment could dissolve most graphite nodules and that the crystallized primary austenite dendrites were transformed into cementite, martensite, an interdendritic network of ledeburite eutectic, and certain residual austenite during rapid solidifica-tion. The dimensions of the remelted zone and its dendrites increase with decreased scanning speed. The microhardness of the remelted zone varied in the range of 650 HV0.2 to 820 HV0.2, which is approximately 2.3-3.1 times higher than the hardness of the substrate. The wear re-sistance of NCI was also significantly improved after the PTA remelting treatment.展开更多
We report three rare cases of sclerosing angiomatoid nodular transformation(SANT) in the spleen.We compared the conventional and contrast-enhanced ultrasonographic appearance.The conventional sonographic examinations ...We report three rare cases of sclerosing angiomatoid nodular transformation(SANT) in the spleen.We compared the conventional and contrast-enhanced ultrasonographic appearance.The conventional sonographic examinations exhibited solitary lesions without common respects,while contrast-enhanced ultrasonography(CEUS) revealed nodular appearance mimicking its pathologic characteristics.It suggests that CEUS can provide morphologic information for diagnosing SANT.展开更多
AIM:To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia(FNH) in children on dynamic contrast-enhanced multi-slice computed tomography(MSCT) and computed tomography angiography(CTA) ima...AIM:To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia(FNH) in children on dynamic contrast-enhanced multi-slice computed tomography(MSCT) and computed tomography angiography(CTA) images.METHODS:From September 1999 to April 2012,a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University,including 12 cases(5.5%) of FNH in children(age ≤ 18 years old).All the 12 pediatric patients underwent MSCT.We retrospectively analyzed the imaging features of FNH lesions,including the number,location,size,margin,density of FNH demonstrated on pre-contrast and contrastenhanced computed tomography(CT) scanning,central scar,fibrous septa,pseudocapsule,the morphology of the feeding arteries and the presence of draining vessels(portal vein or hepatic vein).RESULTS:All the 12 pediatric cases of FNH had solitary lesion.The maximum diameter of the lesions was 4.0-12.9 cm,with an average diameter of 5.5 ± 2.5 cm.The majority of the FNH lesions(10/12,83.3%) had well-defined margins.Central scar(10/12,83.3%) and fibrous septa(11/12,91.7%) were commonly found in children with FNH.Central scar was either isodense(n = 7) or hypodense(n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase.Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases.Pseudocapsule was very rare(1/12,8.3%) in pediatric FNH.With the exception of central scars and fibrous septa within the lesions,all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images,significantly hyperdense in the arterial phase(12/12,100.0%),and isodense in the portal venous phase(7/12,58.3%) and equilibrium phase(11/12,91.7%).Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH,whereas no neovascularization of malignant tumors was noted.In 9 cases(75.0%),there was a spoke-wheel shaped centrifugal blood supply inside the tumors.The draining hepatic vein was detected in 8 cases of pediatric FNH.However,the draining vessels in the other 4 cases could not be detected.No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.CONCLUSION:The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH.Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.展开更多
Focal nodular hyperplasia （FNH） is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple Iocalizations have also been described. The association of FNH with other hepatic...Focal nodular hyperplasia （FNH） is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple Iocalizations have also been described. The association of FNH with other hepatic lesions, such as adenomas and haemangiomas has been reported by various authors. We herein report a case of a hepatocellular carcinoma arising within a large focal nodular hyperplasia, in a young female patient.展开更多
BACKGROUND Focal nodular hyperplasia(FNH)has very low potential risk,and a tendency to spontaneously resolve.Hepatocellular adenoma(HCA)has a certain malignant tendency,and its prognosis is significantly different fro...BACKGROUND Focal nodular hyperplasia(FNH)has very low potential risk,and a tendency to spontaneously resolve.Hepatocellular adenoma(HCA)has a certain malignant tendency,and its prognosis is significantly different from FNH.Accurate identification of HCA and FNH is critical for clinical treatment.AIM To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.METHODS Thirty-one patients with HCA were included in the HCA group.Fifty patients with FNH were included in the FNH group.The clinical data were collected and recorded in the two groups.Conventional ultrasound,shear wave elastography,and contrast-enhanced ultrasound were performed,and the lesion location,lesion echo,Young’s modulus(YM)value,YM ratio,and changes of time intense curve(TIC)were recorded.Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH.A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH.The value of the combined indicators for distinguishing HCA and FNH were explored.RESULTS Multivariate logistic regression analysis showed that lesion echo(P=0.000),YM value(P=0.000)and TIC decreasing slope(P=0.000)were the potential indicators identifying HCA and FNH.In the ROC curve analysis,the accuracy of the YM value distinguishing HCA and FNH was the highest(AUC=0.891),which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope(P<0.05).The accuracy of the combined diagnosis was the highest(AUC=0.938),which was significantly higher than the AUC of the indicators diagnosing HCA individually(P<0.05).This sensitivity was 91.23%,and the specificity was 83.33%.CONCLUSION The combination of lesion echo,YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.展开更多
The thermal fatigue cracking behavior of high Si-Mo nodular cast iron （NCI） is investigated by means of optical microscope （OM）, scanning electron microscope （SEM） and energy dispersive spectroscope （EDS）, in ...The thermal fatigue cracking behavior of high Si-Mo nodular cast iron （NCI） is investigated by means of optical microscope （OM）, scanning electron microscope （SEM） and energy dispersive spectroscope （EDS）, in order to find a new material used in exhaust manifolds in First Automotive Works （FAW） .Nodular cast irons with silicon content about 4.7% , in combination with up to 1.1% molybdenum , were produced by Jilin University and FAW. The repeated heating / cooling test was performed under cyclic heating at various maximum heating temperatures （Tmax） ranging from 800to 900℃.Experimental results indicate that the thermal fatigue cracking resistance of high Si-Mo NCI decreases with increasing the maximum heating temperature.The periods for crack initiation are 24-36 , 40-50and 70-90times associated with heating temperature of 900 , 850and 800℃ , respectively , when the holding time is about 10min at Tmax.When thermal fatigue cracking occurs , the cracking always initiates at the bigger surface of specimen.The major positions of cracks propagation are generally at the eutectic oxide boundary region and the region of the graphite disappearance.At the same time , the oxidation may accelerate crack initiation and propagation.On the other hand , micro-crack number varied from large to little because of shielding effect.As exhaust manifolds , the reasonable working temperature of high Si-Mo NCI is no more than 840℃ by test and analysis.展开更多
The microstructure and mechanical properties of nodular cast iron produced by the melted metal die forging process （MMDF for short） were experimentally researched.The main obtained results are ： the nodular cast ir...The microstructure and mechanical properties of nodular cast iron produced by the melted metal die forging process （MMDF for short） were experimentally researched.The main obtained results are ： the nodular cast iron produced by this process can be machined as easy as traditional one only if holding at the remained temperature for 4 h ; its strength and plasticity are obviously higher than those of traditional ones ; the graphite size arrived at grade 8 , and the graphite spheroidizing arrived at grade 1 or 2 , but a streamline molded distribution of the graphite slightly appeared.Both of the strength and plasticity increased with the pressure when the pressure holding time was larger than its critical value.A new way to produce high properties nodular cast iron was provided.展开更多
Focal nodular hyperplasia(FNH) of the liver is a benign lesion occurring in 0.6%-3% of the general population that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Most lesions...Focal nodular hyperplasia(FNH) of the liver is a benign lesion occurring in 0.6%-3% of the general population that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Most lesions are diagnosed incidentally and the natural history of the disease remains largely unknown. It has been shown that most FNH remain stable, or even regress, over a long follow-up period. We present a patient with FNH of the liver who was followed up for 7 years. A 26-yearold woman with a 5-year history of oral contraceptive use was referred to our hospital in February 2005 for further examination of a liver tumour. The diagnosis of FNH was made using magnetic resonance(MR) imaging with hepatospecific contrast media; this technique allows a correct diagnosis, in particular distinguishing FNH from hepatic adenoma, avoiding an invasive procedure such as the lesion biopsy. After 7-year from the diagnosis, we observed the complete spontaneous regression of the lesion by enhanced MR scanning. In this patient, discontinuation of oral contraceptive use and two childbirths may have influenced the natural history of FNH. To our knowledge, in the English literature there is no report illustrating a complete regression of giant FNH but only studies of decreasing in size. The present case suggests that a young patient with giant FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression.展开更多
AIM： To describe the clinical and histological characteristics of a group of adults with small-bowel nodular lymphoid hyperplasia （NLH）. METHODS： Patients were searched for five years in pathology records of our i...AIM： To describe the clinical and histological characteristics of a group of adults with small-bowel nodular lymphoid hyperplasia （NLH）. METHODS： Patients were searched for five years in pathology records of our institution. The biopsy material was reassessed using strict histopathological criteria. Clinical data were obtained from medical records. RESULTS： Small-bowel NLH was diagnosed in 18 cases. The female： male ratio was 2 ： 1. The most frequent symptoms were diarrhea （72%）, involuntary weight loss （72%） and abdominal pain （61%）. Nine patients （50%） had immunodeficiency. Small-bowel bacterial overgrowth was found in three （17%） cases. At small-bowel NLH diagnosis, three （17%） had associated lymphoma： two intestinal and one extra-intestinal lymphomas. In two patients with villous atrophy and anti-endomysial antibodies the diagnosis of celiac disease was established. Giardia larnblia infection was found in only one patient with hypogammaglobulinemia （Herman＇s syndrome）. CONCLUSIONS： NLH is uncommon in adult patients. Associated diseases are immunodeficiency and lymphoid tissue malignancies.展开更多
Glycogen storage disease type Ia (GSD-Ia; also called von Gierke disease) is an autosomal recessive disorder of carbohydrate metabolism caused by glucose-6-phosphatase deficiency. There have been many reports describi...Glycogen storage disease type Ia (GSD-Ia; also called von Gierke disease) is an autosomal recessive disorder of carbohydrate metabolism caused by glucose-6-phosphatase deficiency. There have been many reports describing hepatic tumors in GSD patients; however, most of these reports were of hepatocellular adenomas, whereas there are only few reports describing focal nodular hyperplasia (FNH) or hepatocellular carcinoma (HCC). We report a case with GSD-Ia who had undergone a partial resection of the liver for FNH at 18 years of age and in whom moderately differentiated HCC had developed. Preoperative imaging studies, including ultrasonography, dynamic computer tomography (CT) and magnetic resonance imaging, revealed benign and malignant features. In particular, fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT revealed the atypical findings that FDG accumulated at high levels in the non-tumorous hepatic parenchyma and low levels in the tumor. Right hemihepatectomy was performed. During the perioperative period, high-dose glucose and sodium bicarbonate were administered to control metabolic acidosis. He had multiple recurrences of HCC at 10 mo after surgery and was followed-up with transcatheter arterial chemoembolization. The tumor was already highly advanced when it was found by chance; therefore, a careful follow-up should be mandatory for GSD-I patients as they are at a high risk for HCC, similar to hepatitis patients.展开更多
文摘BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC)lesions,they are benign.As such,it is important to develop methods to distinguish between FNH-like lesions and HCC.AIM To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC.METHODS We studied pathologically confirmed FNH-like lesions in 13 patients with alco-holic cirrhosis[10 men and 3 women;mean age:54.5±12.5(33-72)years]who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography(CT)and magnetic resonance imaging(MRI),including superparamagnetic iron oxide(SPIO)and/or gadoxetic acid-enhanced MRI.Seven patients also underwent angiography-assisted CT.RESULTS The evaluated lesion features included arterial enhancement pattern,washout appearance(low density compared with that of surrounding liver parenchyma),signal intensity on T1-weighted image(T1WI)and T2-weighted image(T2WI),central scar presence,chemical shift on in-and out-of-phase images,and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI.Eleven patients had multiple small lesions(<1.5 cm).Radiological features of FNH-like lesions included hypervascularity despite small lesions,lack of“corona-like”enhancement in the late phase on CT during hepatic angiography(CTHA),high-intensity on T1WI,slightly high-or iso-intensity on T2WI,no signal decrease in out-of-phase images,and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid.Pathologically,similar to HCC,FNH-like lesions showed many unpaired arteries and sinusoidal capillarization.CONCLUSION Overall,the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis.Specifically,SPIO-and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.
基金supported by the Science and Technology Project of Hebei Education Department(Grant No.BJK2023075)the Science and Technology Project of Tianjin Education Department(Grant No.2022K1087)the Chunhui Project Foundation of the Education Department of China(Grant No.HZKY20220264).
文摘This study systematically investigated the effects of graphite nodule parameters,including count,average diameter,and nodularity,on microstructure and mechanical properties of austempered ductile irons(ADIs).The ADI specimens with graphite nodule counts of 212±11 mm^(-2),308±9 mm^(-2),415±10 mm^(-2),and 589±13 mm^(-2) were designated as G-200,G-300,G-400,and G-600,respectively.Results indicate a progressive refinement of graphite with an increase in nodule counts.Specifically,the average nodule diameter decreases from 33.3±1.3μm for G-200 to 17.0±0.7μm for G-600.The nodularity of all samples is above 90%.Furthermore,the nodularity exhibits a corresponding increasing trend with the rise of graphite nodule count in ADIs.Additionally,the volume fraction of the austenite phase in ADIs decreases with an increase in graphite nodule count.The graphite nodule count changes the tensile strength and elongation of ADIs.The specimen G-400 exhibits the ultimate tensile strength of 897±11 MPa and an elongation of 9.8%±0.6%,representing 5.3%and 44.1%improvements respectively compared to G-200.To explore the wear resistance of ADIs with different graphite nodule counts,dry sliding friction and wear test of different samples was carried out at room temperature.At a high load of 25 N,G-400 exhibits superior wear resistance,achieving a 42%reduction in worn volume compared to G-200.Worn micromorphology identifies three primary wear mechanisms:microcutting-dominated abrasive wear,adhesive wear,and fatigue wear.
文摘In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.
文摘Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable depending on the organ involved and type of protein. Amyloidosis can be classified based on quantity, type, and location of these proteins. Amyloid light-chain amyloidosis develops in the bone marrow, producing abnormal forms of light-chain proteins, which cannot be broken down. These proteins transform into amyloid fibrils and form amyloid deposits in different organs. Pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis;however, it may present as localised pulmonary disease. Localized pulmonary Amyloidosis can present as nodular, cystic, or tracheobronchial amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. This is a case of a 47-year-old female with background history of interstitial lung disease presenting with progressive shortness of breath. Computed tomography scan revealed bilateral pulmonary nodules. The patient was referred to our thoracic surgery team with the suspicion of bronchogenic malignancy with metastasis. Diagnostic video assisted wedge resection was performed for this patient, and histology confirmed pulmonary amyloidosis of nodular type. Amyloid deposition simulates both inflammatory and neoplastic conditions. Definitive diagnosis requires biopsy confirmation therefore early detection and commencing the patient on appropriate treatment pathway may help in symptomatic relief and better outcome.
基金The project was supported by Academia Sinica and Joint Opcn Laboratc y of Nuclear Analytical Technuiques ,Acadcmis Sinica
文摘The nodular cast iron samples were prepared with the normal nodularizing process, in which the important antinodularizing elements Pb, Bi and Al were added respectively in order to research the influence of them on the nodularization of the graphites. The nodular graphites were extracted from the nodular cast iron by the electrolytic technique. The distribution of trace elements in nodular and deformed graphite were measured by Scanning Proton Microprobe (SPM). Most of the adding elements Pb, Bi and Al existed in matrix as impurities, a part of them intruded into the nodular graphites. A new suggestion of Ti antinodularizing properties had been proposed. The influence of Pb, Bi and Al on the nodularization was indirectly performed through Ti. Therefore, Ti is one of the most important antinodularizing elements.
文摘BACKGROUND Focal nodular hyperplasia(FNH)commonly occurs in women;it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma(HCC).CASE SUMMARY A large space-occupying lesion in the right lobe of the liver was incidentally detected in an adult man and diagnosed as HCC.Transcatheter arterial chemoembolization was applied once monthly for 2 years,but the lesion did not decrease in size.It was revealed by biopsy to be FNH.Eleven years later,the patient underwent liver resection due to hemorrhage and the pathological examination confirmed FNH.CONCLUSION For a space-occupying lesion,it is prerequisite to pathologically confirm the diagnosis and the corresponding intervention can be effective.
文摘The static drill rooted nodular pile is a new type of pile foundation consisting of precast nodular pile and the surrounding cemented soil.This composite pile has a relatively high bearing capacity and the mud pollution will be largely reduced during the construction process by using this type of pile.In order to investigate the bearing capacity and load transfer mechanism of this pile,a group of experiments were conducted to provide a comparison between this new pile and the bored pile.The axial force of a precast nodular pile was also measured by the strain gauges installed on the pile to analyze the distribution of the axial force of the nodular pile and the skin friction supported by the surrounding soil,then 3D models were built by using the ABAQUS finite element program to investigate the load transfer mechanism of this composite pile in detail.By combining the results of field tests and the finite element method,the outcome showed that the bearing capacity of a static drill rooted nodular pile is higher than the bored pile,and that this composite pile will form a double stress dispersion system which will not only confirm the strength of the pile,but also make the skin friction to be fully mobilized.The settlement of this composite pile is mainly controlled by the precast nodular pile;meanwhile,the nodular pile and the surrounding cemented soil can be considered as deformation compatibility during the loading process.The nodes on the nodular pile play an important role during the load transfer process,the shear strength of the interface between the cemented soil and the soil of the static drill rooted pile is larger than that of the bored pile.
文摘BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associated with significant symptoms, more frequently they are discovered incidentally on physical examination or the work-up of unrelated symptoms. Since its nature and pathogenesis are still controversial, accurate diagnosis of FNH based on clinical presentation and radiographic studies is difficult. The purpose of this study was to explore the diagnosis and treatment of FNH. METHODS: Eighty-six FNH patients confirmed pathologically were treated at the Liver Cancer Institute in our hospital from 1996 to 2006. Their clinical manifestions, imaging presentation, pathological findings, and surgical results were analyzed retrospectively. RESULTS: Of the 86 patients with 99 foci, 54 were male and 32 female, with a mean age of 37 years. Eighty patients had a single solitary focus and 6 had multiple foci. Tumor diameter was less than 5 cm in 69 patients, 5-10 cm in 15, and more than 10 cm in 2. The overall rate of correct preoperative diagnosis was 59.3% (51/86) including 32.9% (26/79) by color Doppler flow imaging (CDFI), 60.3% (35/58) by CT, and 77.4% (24/31) by MRI. All the 86 patients underwent resection with good curative effect. CONCLUSIONS: CT and MRI are important diagnostic methods for FNH but it is difficult to make a definite preoperative diagnosis for partial classical and all non-classical FNH patients. We suggest that patients with clinical symptoms or with indefinite diagnosis should accept surgical removal.
文摘Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrhotic portal hypertension.There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series.NRH may develop via autoimmune,hematological,infectious,neoplastic,or drug-related causes.The disease is usually asymptomatic,slowly or nonprogressive unless complications of portal hypertension develop.Accurate diagnosis is made by histopathology,which demonstrates diffuse micronodular transformation without fibrous septa.Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver.While the initial treatment is to address the underlying disease,ultimately the therapy is directed to the management of portal hypertension.The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension.In this review we detail the epidemiology,pathogenesis,diagnosis,management,and prognosis of NRH.
文摘Reactive nodular fibrous pseudotumor(RNFP), which presents abdominal clinical manifestations and malignant radiographic results, usually requires radical resection as the treatment. However, RNFP has been recently described as an extremely rare benign postinflammatory lesion of a reactive nature, which typically arises from the sub-serosal layer of the digestive tract or within the surrounding mesentery in association with local injury or inflammation. In addition, a postoperative diagnosis is necessary to differentiate it from the other reactive processes of the abdomen. Furthermore, RNFP shows a good prognosis without signs of recurrence or metastasis. A 16-year-old girl presented with a 3-mo history of epigastric discomfort, and auxiliary examinations suggested a malignant tumor originating from the stomach; postoperative pathology confirmed RNFP, and after a 2-year follow-up period, the patient did not display any signs of recurrence. This case highlights the importance of preoperative pathology for surgeons who may encounter similar cases.
基金financially supported by the Key Project of China National Erzhong Group Co.(No.2012zx04010-081)
文摘The surface of nodular cast iron （NCI） with a ferrite substrate was rapidly remelted and solidified by plasma transferred arc （PTA） to induce a chilled structure with high hardness and favorable wear resistance. The effect of scanning speed on the microstructure, micro-hardness distribution, and wear properties of PTA-remelted specimens was systematically investigated. Microstructural characterization in-dicated that the PTA remelting treatment could dissolve most graphite nodules and that the crystallized primary austenite dendrites were transformed into cementite, martensite, an interdendritic network of ledeburite eutectic, and certain residual austenite during rapid solidifica-tion. The dimensions of the remelted zone and its dendrites increase with decreased scanning speed. The microhardness of the remelted zone varied in the range of 650 HV0.2 to 820 HV0.2, which is approximately 2.3-3.1 times higher than the hardness of the substrate. The wear re-sistance of NCI was also significantly improved after the PTA remelting treatment.
文摘We report three rare cases of sclerosing angiomatoid nodular transformation(SANT) in the spleen.We compared the conventional and contrast-enhanced ultrasonographic appearance.The conventional sonographic examinations exhibited solitary lesions without common respects,while contrast-enhanced ultrasonography(CEUS) revealed nodular appearance mimicking its pathologic characteristics.It suggests that CEUS can provide morphologic information for diagnosing SANT.
文摘AIM:To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia(FNH) in children on dynamic contrast-enhanced multi-slice computed tomography(MSCT) and computed tomography angiography(CTA) images.METHODS:From September 1999 to April 2012,a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University,including 12 cases(5.5%) of FNH in children(age ≤ 18 years old).All the 12 pediatric patients underwent MSCT.We retrospectively analyzed the imaging features of FNH lesions,including the number,location,size,margin,density of FNH demonstrated on pre-contrast and contrastenhanced computed tomography(CT) scanning,central scar,fibrous septa,pseudocapsule,the morphology of the feeding arteries and the presence of draining vessels(portal vein or hepatic vein).RESULTS:All the 12 pediatric cases of FNH had solitary lesion.The maximum diameter of the lesions was 4.0-12.9 cm,with an average diameter of 5.5 ± 2.5 cm.The majority of the FNH lesions(10/12,83.3%) had well-defined margins.Central scar(10/12,83.3%) and fibrous septa(11/12,91.7%) were commonly found in children with FNH.Central scar was either isodense(n = 7) or hypodense(n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase.Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases.Pseudocapsule was very rare(1/12,8.3%) in pediatric FNH.With the exception of central scars and fibrous septa within the lesions,all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images,significantly hyperdense in the arterial phase(12/12,100.0%),and isodense in the portal venous phase(7/12,58.3%) and equilibrium phase(11/12,91.7%).Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH,whereas no neovascularization of malignant tumors was noted.In 9 cases(75.0%),there was a spoke-wheel shaped centrifugal blood supply inside the tumors.The draining hepatic vein was detected in 8 cases of pediatric FNH.However,the draining vessels in the other 4 cases could not be detected.No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.CONCLUSION:The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH.Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.
文摘Focal nodular hyperplasia （FNH） is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple Iocalizations have also been described. The association of FNH with other hepatic lesions, such as adenomas and haemangiomas has been reported by various authors. We herein report a case of a hepatocellular carcinoma arising within a large focal nodular hyperplasia, in a young female patient.
基金Supported by Zhejiang Natural Science Foundation,NO.LY16H160004Ningbo Yinzhou District Agricultural and Social Development Science and Technology Project,NO.Yinke 2018-74
文摘BACKGROUND Focal nodular hyperplasia(FNH)has very low potential risk,and a tendency to spontaneously resolve.Hepatocellular adenoma(HCA)has a certain malignant tendency,and its prognosis is significantly different from FNH.Accurate identification of HCA and FNH is critical for clinical treatment.AIM To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.METHODS Thirty-one patients with HCA were included in the HCA group.Fifty patients with FNH were included in the FNH group.The clinical data were collected and recorded in the two groups.Conventional ultrasound,shear wave elastography,and contrast-enhanced ultrasound were performed,and the lesion location,lesion echo,Young’s modulus(YM)value,YM ratio,and changes of time intense curve(TIC)were recorded.Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH.A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH.The value of the combined indicators for distinguishing HCA and FNH were explored.RESULTS Multivariate logistic regression analysis showed that lesion echo(P=0.000),YM value(P=0.000)and TIC decreasing slope(P=0.000)were the potential indicators identifying HCA and FNH.In the ROC curve analysis,the accuracy of the YM value distinguishing HCA and FNH was the highest(AUC=0.891),which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope(P<0.05).The accuracy of the combined diagnosis was the highest(AUC=0.938),which was significantly higher than the AUC of the indicators diagnosing HCA individually(P<0.05).This sensitivity was 91.23%,and the specificity was 83.33%.CONCLUSION The combination of lesion echo,YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.
基金Item Sponsored by Science and Technology Supporting Project of Jilin Province of China (2007301)
文摘The thermal fatigue cracking behavior of high Si-Mo nodular cast iron （NCI） is investigated by means of optical microscope （OM）, scanning electron microscope （SEM） and energy dispersive spectroscope （EDS）, in order to find a new material used in exhaust manifolds in First Automotive Works （FAW） .Nodular cast irons with silicon content about 4.7% , in combination with up to 1.1% molybdenum , were produced by Jilin University and FAW. The repeated heating / cooling test was performed under cyclic heating at various maximum heating temperatures （Tmax） ranging from 800to 900℃.Experimental results indicate that the thermal fatigue cracking resistance of high Si-Mo NCI decreases with increasing the maximum heating temperature.The periods for crack initiation are 24-36 , 40-50and 70-90times associated with heating temperature of 900 , 850and 800℃ , respectively , when the holding time is about 10min at Tmax.When thermal fatigue cracking occurs , the cracking always initiates at the bigger surface of specimen.The major positions of cracks propagation are generally at the eutectic oxide boundary region and the region of the graphite disappearance.At the same time , the oxidation may accelerate crack initiation and propagation.On the other hand , micro-crack number varied from large to little because of shielding effect.As exhaust manifolds , the reasonable working temperature of high Si-Mo NCI is no more than 840℃ by test and analysis.
基金Item Sponsored by National Natural Science Foundation of China ( 51275031 )Innovation Fund for Technology Based Firms of China ( 11C26211304055 )
文摘The microstructure and mechanical properties of nodular cast iron produced by the melted metal die forging process （MMDF for short） were experimentally researched.The main obtained results are ： the nodular cast iron produced by this process can be machined as easy as traditional one only if holding at the remained temperature for 4 h ; its strength and plasticity are obviously higher than those of traditional ones ; the graphite size arrived at grade 8 , and the graphite spheroidizing arrived at grade 1 or 2 , but a streamline molded distribution of the graphite slightly appeared.Both of the strength and plasticity increased with the pressure when the pressure holding time was larger than its critical value.A new way to produce high properties nodular cast iron was provided.
文摘Focal nodular hyperplasia(FNH) of the liver is a benign lesion occurring in 0.6%-3% of the general population that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Most lesions are diagnosed incidentally and the natural history of the disease remains largely unknown. It has been shown that most FNH remain stable, or even regress, over a long follow-up period. We present a patient with FNH of the liver who was followed up for 7 years. A 26-yearold woman with a 5-year history of oral contraceptive use was referred to our hospital in February 2005 for further examination of a liver tumour. The diagnosis of FNH was made using magnetic resonance(MR) imaging with hepatospecific contrast media; this technique allows a correct diagnosis, in particular distinguishing FNH from hepatic adenoma, avoiding an invasive procedure such as the lesion biopsy. After 7-year from the diagnosis, we observed the complete spontaneous regression of the lesion by enhanced MR scanning. In this patient, discontinuation of oral contraceptive use and two childbirths may have influenced the natural history of FNH. To our knowledge, in the English literature there is no report illustrating a complete regression of giant FNH but only studies of decreasing in size. The present case suggests that a young patient with giant FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression.
文摘AIM： To describe the clinical and histological characteristics of a group of adults with small-bowel nodular lymphoid hyperplasia （NLH）. METHODS： Patients were searched for five years in pathology records of our institution. The biopsy material was reassessed using strict histopathological criteria. Clinical data were obtained from medical records. RESULTS： Small-bowel NLH was diagnosed in 18 cases. The female： male ratio was 2 ： 1. The most frequent symptoms were diarrhea （72%）, involuntary weight loss （72%） and abdominal pain （61%）. Nine patients （50%） had immunodeficiency. Small-bowel bacterial overgrowth was found in three （17%） cases. At small-bowel NLH diagnosis, three （17%） had associated lymphoma： two intestinal and one extra-intestinal lymphomas. In two patients with villous atrophy and anti-endomysial antibodies the diagnosis of celiac disease was established. Giardia larnblia infection was found in only one patient with hypogammaglobulinemia （Herman＇s syndrome）. CONCLUSIONS： NLH is uncommon in adult patients. Associated diseases are immunodeficiency and lymphoid tissue malignancies.
文摘Glycogen storage disease type Ia (GSD-Ia; also called von Gierke disease) is an autosomal recessive disorder of carbohydrate metabolism caused by glucose-6-phosphatase deficiency. There have been many reports describing hepatic tumors in GSD patients; however, most of these reports were of hepatocellular adenomas, whereas there are only few reports describing focal nodular hyperplasia (FNH) or hepatocellular carcinoma (HCC). We report a case with GSD-Ia who had undergone a partial resection of the liver for FNH at 18 years of age and in whom moderately differentiated HCC had developed. Preoperative imaging studies, including ultrasonography, dynamic computer tomography (CT) and magnetic resonance imaging, revealed benign and malignant features. In particular, fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT revealed the atypical findings that FDG accumulated at high levels in the non-tumorous hepatic parenchyma and low levels in the tumor. Right hemihepatectomy was performed. During the perioperative period, high-dose glucose and sodium bicarbonate were administered to control metabolic acidosis. He had multiple recurrences of HCC at 10 mo after surgery and was followed-up with transcatheter arterial chemoembolization. The tumor was already highly advanced when it was found by chance; therefore, a careful follow-up should be mandatory for GSD-I patients as they are at a high risk for HCC, similar to hepatitis patients.
