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Fibroepithelial tumours are biphasic neoplasms of the breast comprising the common benign fibroadenomas and the less common phyllodes tumours (PTs), which have recurrent potential. PTs are classified into benign, borderline or malignant, based on five histopathological criteria, with malignant PTs having the highest metastatic capability. Accurate diagnosis can be challenging due to the subjective assessment of histopathological parameters. Fibroadenomas bear morphological similarities to benign PTs, while borderline and malignant PTs can sometimes be difficult to distinguish from other spindle cell tumours of the breast. From clonality studies to whole-genome sequencing, much research has been conducted to elucidate the molecular pathogenesis of fibroepithelial tumours, which, in turn, have allowed leveraging the findings for diagnostic applications, including grading of PTs. The most noteworthy discovery was of recurrent MED12 mutations in both fibroadenomas and PTs. Subsequent studies also uncovered relatively frequent genetic mutations in TERT promoter and RARA. A customised panel of 16 most frequently mutated genes in fibroepithelial tissues has been compiled previously and has contributed to resolving a few diagnostic dilemmas. This review will introduce the 16 genes and focus on the top three that are most frequently mutated in fibroepithelial tumours: MED12, TERT, and RARA.

Breast fibroepithelial lesions (FELs) encompass the common fibroadenoma (FA) and relatively rare phyllodes tumour (PT); the latter entity is usually classified as benign, borderline or malignant. Intratumoural heterogeneity is frequently present in these tumours, making accurate histologic evaluation challenging. Despite their rarity, PTs are an important clinical problem due to their propensity for recurrence and, in the case of malignant PT, metastasis. Surgical excision is the mainstay of management. Recent work has uncovered myriad genetic alterations in breast FELs. In this study, exome sequencing was performed on seven cases of morphologically heterogeneous breast FELs, including FAs, PTs of all grades, and a case of metaplastic spindle cell carcinoma arising in PT, in order to elucidate their intratumoural genetic repertoire. Gene mutations identified encompassed cell signalling, tumour suppressor, DNA repair and cell cycle regulating pathways. Mutations common to multiple tumour regions generally showed higher variant allele frequency. Frequent mutations included MED12, TP53, RARA and PIK3CA. Histological observations of increased cellular density and pleomorphism correlated with mutational burden. Phylogenetic analyses revealed disparate pathways of possible tumour progression. In summary, histological heterogeneity correlated with genetic changes in breast FELs.

Abstract Background Cardiac blood cysts are exceedingly rare cardiac tumours usually found on cardiac valves in infants. We report and discuss a rare unique case wherein a giant atrial septal cardiac blood cyst was found in an adult. Case summary A 59-year-old Chinese lady with history of hypertension, hyperlipidemia and transient ischaemic attack presented with atypical chest pain. Her ECG suggested right ventricular strain. Echocardiography revealed a large right atrial intracardiac mass attached to the interatrial septum which prolapsed into the right ventricle during each cardiac cycle with associated dilatation of the right atrium and right ventricle. Computed tomography scans showed no evidence of malignancy or metastasis. Considering our patient’s profile and the characteristics of the mass, it was opined to likely be a cardiac myxoma. After consultation with our cardiothoracic surgeons, she underwent surgical resection of the intracardiac mass. Histology revealed that the intracardiac mass was a cardiac blood cyst. Discussion First described by Elsasser in 1844, cardiac blood cysts are extremely rare benign cardiac tumours very rarely seen in adults. Though benign, they have been associated with outflow tract obstruction, valvular regurgitation and embolization. Symptomatic patients do well with surgical resection, while long-term outcomes in asymptomatic patients followed up with serial echocardiograms are mixed. Due to its rarity, existing literature is limited to case reports and small case series, with a lack of guidelines on management till recently. Our case report serves to highlight this unique presentation of an exceedingly rare intracardiac tumour.

Serious games are motivating and provide a safe environment for students to learn from their mistakes without experiencing any negative consequences from their actions. However, little is known about students' gaming preferences and the types of serious games they like to play for education. This study aims to determine the types of gaming aspects that students would like to play in a pharmacy-related serious game. A cross-sectional study was conducted using a self-administered survey, which obtained students' responses on their preferences regarding various gaming aspects (reward systems, game settings, storylines, viewing perspectives, and gaming styles) and for a hypothetical gaming scenario (authentic simulation or post-apocalyptic fantasy). Descriptive statistics, chi-square, and Fisher's exact tests were used for statistical analyses. Response rate was 72.7% (497/684 undergraduates). The most popular game reward systems were unlocking mechanisms (112/497, 22.5%) and experience points (90/497, 18.1%). Most students preferred fantasy/medieval/mythic (253/497, 50.9%) and modern (117/497, 23.5%) settings, but lower year undergraduates preferred modern settings less than upper year seniors (47/236, 19.9% vs 70/242, 28.9%, P=.022). Almost one-third (147/497, 29.6%) preferred an adventurer storyline or an authentic pharmacy-related plot (119/497, 23.9%), and a collaborative game style was most preferred by the students (182/497, 36.6%). Three-dimensional game perspectives (270/497, 54.3%) were more popular than two-dimensional perspectives (221/497, 44.5%), especially among males than females (126/185, 68.1% vs 142/303, 46.9%, P<.001). In terms of choice for a pharmacy-related serious game, a post-apocalyptic fantasy game (scenario B, 287/497, 57.7%) was more popular than an authentic simulation game (scenario A, 209/497, 42.1%). More males preferred the post-apocalyptic fantasy scenario than females (129/187, 69.0% vs 155/306, 50.7%, P<.001). In general, students want a three-dimensional, fantasy/medieval/mythic post-apocalyptic game, based on an adventurer storyline with an unlocking mechanism reward system. A balance between real-life and fantasy elements needs to be struck in order for the game to cater students towards health care practices.

Based on the combination of materials science and mechanical engineering, hot press forming process of the vehicle high strength steels was analyzed. The hot forming process included: heating alloys rapidly to austenite microstructures, stamping and cooling timely, maintaining pressure and quenching. The results showed that most of austenite microstructure was changed into uniform martensite by the hot press forming while the samples were heated at 900 °C and quenched. The optimal tensile strength and yield strength were up to 1530 MPa and 1000 MPa, respectively, and the shape deformation reached about 23%. And springback defect did not happen in the samples.

A one-step sintering process of bauxite raw material from direct mining was completed, and the kinetics of this process was analyzed thoroughly. The results show that the sintering kinetics of bauxite raw material exhibits the liquid-phase sintering behavior. A small portion of impurities existed in the raw material act as a liquid phase. After X-ray diffraction analyses, scanning electron microscopy observations, and kinetics calculations, sintering temperature and heating duration were determined as the two major factors contributing to the sintering process and densification of bauxite ore. An elevated heating temperature and longer duration favor the densification process. The major obstacle for the densification of bauxite material is attributed to the formation of the enclosed blowhole during liquid-phase sintering.

A one-step sintering process of bauxite raw material from direct mining was completed, and the kinetics of this process was analyzed thoroughly. The results show that the sintering kinetics of bauxite raw material exhibits the liquid-phase sintering behavior. A small portion of impurities existed in the raw material act as a liquid phase. After X-ray diffraction analyses, scanning electron microscopy observations, and kinetics calculations, sintering temperature and heating duration were determined as the two major factors contributing to the sintering process and densification of bauxite ore. An elevated heating temperature and longer duration favor the densification process. The major obstacle for the densification of bauxite material is attributed to the formation of the enclosed blowhole during liquid-phase sintering.

Limited information is available regarding long-term effects of air pollution on blood pressure (BP) and hypertension. We studied whether 1-year exposures to particulate matter (PM) and nitrogen oxides (NOx) were correlated with BP and hypertension in the elderly. We analyzed cross-sectional data from 27,752 Taipei City residents > 65 years of age who participated in a health examination program in 2009. Land-use regression models were used to estimate participants' 1-year exposures to particulate matter with aerodynamic diameter ≤ 10 μm (PM10), coarse particles (PM2.5-10), fine particles (≤ 2.5 μm; PM2.5), PM2.5 absorbance, NOx, and nitrogen dioxide (NO2). Generalized linear regressions and logistic regressions were used to examine the association between air pollution and BP and hypertension, respectively. Diastolic BP was associated with 1-year exposures to air pollution, with estimates of 0.73 [95% confidence interval (CI): 0.44, 1.03], 0.46 (95% CI: 0.30, 0.63), 0.62 (95% CI: 0.24, 0.99), 0.34 (95% CI: 0.19, 0.50), and 0.65 (95% CI: 0.44, 0.85) mmHg for PM10 (10 μg/m3), PM2.5-10 (5 μg/m3), PM2.5 absorbance (10-5/m), NOx (20 μg/m3), and NO2 (10 μg/m3), respectively. PM2.5 was not associated with diastolic BP, and none of the air pollutants was associated with systolic BP. Associations of diastolic BP with PM10 and PM2.5 absorbance were stronger among participants with hypertension, diabetes, or a body mass index ≥ 25 kg/m2 than among participants without these conditions. One-year air pollution exposures were not associated with hypertension. One-year exposures to PM10, PM2.5-10, PM2.5 absorbance, and NOx were associated with higher diastolic BP in elderly residents of Taipei.

Background Gastric cancer (GC) is the fourth most common cause of cancer death and has the fifth highest incidence of cancer worldwide. Circular RNAs (circRNAs) have emerged as essential regulators of tumorigenesis and cancer progression. However, the underlying regulatory mechanisms and their roles as diagnostic biomarkers have yet to be well elucidated in GC. Methods In this study, we implemented genome-wide sequencing to identify circRNAs whose expression in plasma extracellular vesicles (EVs) significantly changed. Functional experiments were performed to assess its effect on the proliferation, viability, migration and apoptosis of GC cell lines. Luciferase reporter and RNA pull-down assays were used to validate their combinations. Finally, RNA-Seq and RT-qPCR were used to identify the downstream regulatory pathway involved. Results We found that the circRNA of MORC family CW-type zinc finger 1 gene (circMORC1) was decreased in the plasma EVs of GC patients but increase in GC cells. In vivo, circMORC1 promoted proliferation, viability, and migration and inhibited apoptosis in AGS and SGC-7901 GC cell lines. CircMORC1 was found to bind to miR-103a-1-5p, which is essential for the regulation of phenotypes. In addition, the Wnt pathway was found to be the downstream regulatory pathway of circMORC1 through a miR-103a-1-5p sponge. Conclusions Our results shed light on circMORC1 promotes the proliferation of gastric cancer cells, as a RNA sponge of miR-103a-1-5p and counteracted the down-regulation of Wnt signaling function of miR-103a-1-5p. Revealed a novel mechanism by which circMORC1 regulates tumorigenesis in gastric cancer and provided a new biomarker for GC diagnosis and prognosis.

Purpose: Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan.Methods: From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors.Results: In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention.Conclusion: This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.