Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report.

Introduction-This report illuminates the distinctive features of a successfully managed Retzius space infection arising from a complex perirectal abscess. It adds novel insights to the scientific literature by addressing the rarity of such occurrences, highlighting the diagnostic complexities associated with extraperitoneal spread, and underscoring the crucial role of a nuanced understanding of anatomy in navigating clinical scenarios involving anorectal abscesses. Patient's Main Concerns and Important Clinical Findings-A 68-year-old male presented with dizziness and diffuse lower abdominal pain, accompanied by intermittent perianal pain for one month. Regardless of an initial misdiagnosis as hemorrhoids, the patient presented sepsis status with fever, hypotension, and tachycardia upon admission. Clinical examinations, including a digital rectal examination, laboratory findings, and imaging studies, revealed a substantial perianal abscess extending into the space of Retzius. Primary Diagnoses, Interventions, and Outcomes-The primary diagnosis involved a heterogeneous fluid-filled perianal abscess extending into the Retzius space, confirmed by abdominal contrast-enhanced computed tomography (CT). Immediate initiation of broad-spectrum antibiotics and subsequent incision and drainage in the 8 o'clock region was performed. Post-operatively, the patient experienced rectal bleeding, necessitating suturing ligation. A follow-up CT scan revealed an extraperitoneal abscess around the bladder, leading to CT-guided drainage and identification of microbial pathogens. Antibiotic treatment with piperacillin-tazobactam was administered. With two weeks of antibiotics and post-operative care, the patient's symptoms improved, and he was discharged with no signs of recurrence or complications. Conclusions-This case report emphasizes the importance of early consideration and identification of extraperitoneal abscesses for timely intervention. The complexity of anatomical planes in extraperitoneal spaces poses diagnostic challenges, necessitating a strategic treatment. The successful management of this case underscores the significance of a multidisciplinary approach, including prompt diagnosis, appropriate antibiotic therapy, and timely surgical interventions, ultimately contributing to improved outcomes in cases involving complex anorectal abscesses.

Water can trigger nuclear reaction to produce energy and isotope gases.

This paper reports the discovery that water can trigger a peculiar nuclear reaction and produce energy. Cavitation may induce unusual reactions through implosion of water vapor bubbles. Many of this research has been published formally or informally. We have conducted experiments using two reactor types made from multiple-pipe heat exchanger and found that the heat exchange process of water produces peculiar excess heat and abnormally high pressure leading to rupture of the reactor. Recently, we have tested another eight reactors. Interestingly, these reactors produce non-condensable gas. We suspected that they include 22Ne and CO2. We used a mass spectrometer (MS) to analyze 14 gas samples collected from 8 reactors, including ten samples showing a coefficient of performance COPx > 1.05 (with excess heat) and four having COPx < 1.05 (without excess heat). Several methods were adopted to identify the gas content. For CO2 identification, two methods are employed. For 22Ne identification, three methods are employed. All the results confirm that isotope 22Ne and regular CO2 really exist in the output gas from reactors determined to have excess heat. We conjecture a possible mechanism to produce 22Ne and CO2 and find out that 12C and isotope 17O are the intermediate. They finally form isotope gases containing 17O, including H2O-17 (heavy-oxygen water), isotope O2 (16O-17O), and isotope CO2 (12C-16O-17O). In the excess heat producing reactors, all these gasses were detected by MS in the absence of 20Ne and 21Ne. The observed isotope gases produced from reactors having excess heat verifies that water can trigger a peculiar nuclear reaction and produce energy.

Association between nonalcoholic fatty liver disease and colorectal cancer: A population-based study.

Colorectal cancer (CRC) and nonalcoholic fatty liver disease (NAFLD) have high prevalence rates and place a considerable burden on the health-care industry. The association between both diseases is controversial. Our aim was to examine the association between NAFLD and CRC. Using data extracted from the Taiwan National Health Insurance Research Database (NHIRD) from 2000 to 2015, we enrolled 60 298 patients with NAFLD. Of these, 52,986 met the inclusion criteria. A comparison group was selected using 4-fold propensity score matching by age, sex, and year of index date. The primary outcome was the cumulative incidence of CRC in patients with NAFLD. Over a mean follow-up period of 8.5 years, 160 new cases of CRC were identified. The incidence rate of CRC was higher in the NAFLD group (12.23 per 100,000 person-years) than in the comparison cohort (6.0 per 100,000 person-years). Cox proportional hazards regression analysis revealed that the adjusted hazard ratio (HR) of CRC was 1.259 in the study group (95% confidence interval [CI]: 1.047-1.486, P = .003). Using Kaplan-Meier analysis, we ascertained that the cumulative incidence of CRC was significantly high in the NAFLD group. Patients older than 50 years, with diabetes mellitus (DM), and with chronic liver disease also exhibited a high risk of CRC. NAFLD was associated with a high risk of CRC. CRC occurs more frequently in patients with NAFLD aged between 50 and 59 years and those older than 60 years with comorbidities, including DM and chronic liver disease. Physicians should consider the subsequent risk of CRC when treating patients with NAFLD.

Early botulinum toxin injection reduces pain after hemorrhoidectomy: a pilot study.

BACKGROUND: Hemorrhoidectomy is the standard procedure for treating high-grade hemorrhoids. However, postoperative pain usually causes patients to delay or refuse surgical treatment. Because maximal resting pressure in the internal anal sphincter plays a major role in post-hemorrhoidectomy pain, Botulinum toxin injections have been proposed to reduce it. However, the optimal timing of Botulinum toxin injections is still unclear. The aim of the present study was to compare the effectiveness of early and intraoperative Botulinum toxin injections for postoperative pain control. METHODS: In this pilot study, we enrolled patients who had grade III or IV hemorrhoids and underwent Ferguson hemorrhoidectomy at a single tertiary care center from October 1, 2018 to November 30, 2020. The experimental group received 50 U Botulinum toxin injections to the internal anal sphincter 1 week before the operation, and the control group received injections intraoperatively. The primary endpoint was the daily maximal and resting visual analogue scale (VAS) score recorded from postoperative days 0-6. The secondary endpoints were analgesia requirements, number of bowel movements per day, healing time, and postoperative length of stay. Power of the daily resting VAS score is at least 93%, but the power of the daily maximal VAS is a little lower (71%) (calculated by G*Power 3.1.9.2). RESULTS: Sixty-two patients (male: female = 27:35; mean age = 47.6 ± 13.1 years) were randomized to the experimental group (n = 31) or control group (n = 31). The experimental group  (n = 31) showed significantly shorter postoperative hospital stay than the controls (n = 31; p = 0.019). A generalized estimating equations model revealed that the group that received Botulinum toxin  yielded a significantly lower maximal (OR 0.4, 95% CI 0.2-1.0, p = 0.041) and resting (OR 0.4, 95% CI 0.2-0.7, p < 0.001) VAS compared to controls at all time points. The Botulinum toxin group also had significantly less resting pain from postoperative days 1-5, and lower maximal subjective pain scores on postoperative days 1 (p = 0.024) and 4 (p = 0.044). Similar trends were observed on other days. CONCLUSIONS: Early Botulinum toxin injection produced shorter hospital stays, and less reported pain after hemorrhoidectomy than intraoperative injections, especially for pain at rest. TRIAL REGISTRATION: Identifier: NCT04485780 on ClinicalTrials.gov (retrospectively registered).

Using Comorbidity Pattern Analysis to Detect Reliable Methylated Genes in Colorectal Cancer Verified by Stool DNA Test.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide in 2020. Colonoscopy and the fecal immunochemical test (FIT) are commonly used as CRC screening tests, but both types of tests possess different limitations. Recently, liquid biopsy-based DNA methylation test has become a powerful tool for cancer screening, and the detection of abnormal DNA methylation in stool specimens is considered as an effective approach for CRC screening. The aim of this study was to develop a novel approach in biomarker selection based on integrating primary biomarkers from genome-wide methylation profiles and secondary biomarkers from CRC comorbidity analytics. A total of 125 differential methylated probes (DMPs) were identified as primary biomarkers from 352 genome-wide methylation profiles. Among them, 51 biomarkers, including 48 hypermethylated DMPs and 3 hypomethylated DMPs, were considered as suitable DMP candidates for CRC screening tests. After comparing with commercial kits, three genes (ADHFE1, SDC2, and PPP2R5C) were selected as candidate epigenetic biomarkers for CRC screening tests. Methylation levels of these three biomarkers were significantly higher for patients with CRC than normal subjects. The sensitivity and specificity of integrating methylated ADHFE1, SDC2, and PPP2R5C for CRC detection achieved 84.6% and 92.3%, respectively. Through an integrated approach using genome-wide DNA methylation profiles and electronic medical records, we could design a biomarker panel that allows for early and accurate noninvasive detection of CRC using stool samples.

Atomic-Layer Controlled Interfacial Band Engineering at Two-Dimensional Layered PtSe2/Si Heterojunctions for Efficient Photoelectrochemical Hydrogen Production.

Platinum diselenide (PtSe2) is a group-10 two-dimensional (2D) transition metal dichalcogenide that exhibits the most prominent atomic-layer-dependent electronic behavior of "semiconductor-to-semimetal" transition when going from monolayer to bulk form. This work demonstrates an efficient photoelectrochemical (PEC) conversion for direct solar-to-hydrogen (H2) production based on 2D layered PtSe2/Si heterojunction photocathodes. By systematically controlling the number of atomic layers of wafer-scale 2D PtSe2 films through chemical vapor deposition (CVD), the interfacial band alignments at the 2D layered PtSe2/Si heterojunctions can be appropriately engineered. The 2D PtSe2/p-Si heterojunction photocathode consisting of a PtSe2 thin film with a thickness of 2.2 nm (or 3 atomic layers) exhibits the optimized band alignment and delivers the best PEC performance for hydrogen production with a photocurrent density of -32.4 mA cm-2 at 0 V and an onset potential of 1 mA cm-2 at 0.29 V versus a reversible hydrogen electrode (RHE) after post-treatment. The wafer-scale atomic-layer controlled band engineering of 2D PtSe2 thin-film catalysts integrated with the Si light absorber provides an effective way in the renewable energy application for direct solar-to-hydrogen production.

Preferential lattice expansion of polypropylene in a trilayer polypropylene/polyethylene/polypropylene microporous separator in Li-ion batteries.

The abnormal lattice expansion of commercial polypropylene (PP)/polyethylene (PE)/polypropylene (PP) separator in lithium-ion battery under different charging current densities was observed by in-situ X-ray diffraction. Significant lattice changes of both PP and PE were found during the low current density charging. The capacity fading and the resistance value of the cell measured at 0.025 C (5th retention, 92%) is unexpectedly larger than that at 1.0 C (5th retention, 97.3%) from the electrochemical impedance spectroscopic data. High-resolution scanning electron microscopy is employed to witness the pore changes of the trilayered membrane. Density functional theory calculations were used to investigate the mechanism responsible for the irregular results. The calculations revealed that the insertion of Li-ion and EC molecule into PP or PE are thermodynamically favourable process which might explain the anomalous significant lattice expansion during the low current density charging. Therefore, designing a new separator material with a more compact crystalline structure or surface modification to reduce the Li insertion during the battery operation is desirable.

Two-Person Colonoscopy as a Training Approach to Non-sedation Colonoscopy.

BACKGROUND: Reported learning curves of colonoscopy vary from 94 to 275 cases and focus on one-person colonoscopy. Our aim was to evaluate the learning curve of two-person non-sedation colonoscopy for trainees in a single tertiary care hospital. PATIENTS AND METHODS: We conducted a retrospective study in 1264 patients who underwent diagnostic or screening colonoscopies in a single institution from August 2012 to January 2013. Most of the patients (1174/1264) did not receive sedation during the procedure. All procedures were performed under two-person control. Two third-year residents who received previous colonoscopic training via a plastic model were the trainees. RESULTS: In comparison to the performance of 5 staff members, the colonoscopic outcomes showed no significant differences in the completion rates (77.2% vs. 79.8%, P = .382), average polyp numbers (.9 ± 1.7 vs. 1.0 ± 1.8, P = .453), polyp detection rates (43.5% vs. 46.3%, P = .434), or intubation lengths (96.4 ± 29.3 vs. 96.3 ± 26.7 cm, P = .939). The total procedure times for the 2 groups were 17.2 ± 10.6 minutes (trainees) and 12.9 ± 7.8 minutes (staff) (P < .001). CONCLUSION: Trainees achieved acceptable outcomes over an 81-97 case learning curve under a two-person non-sedation colonoscopy technique, an approach with potential as a transition to single-operator colonoscopy.

Extraordinarily high efficiency improvement for OLEDs with high surface-charge polymeric nanodots.

The efficiency of highly efficient blue, green, red, and white organic light-emitting diodes (OLEDs) has been substantially advanced through the use of high surface-charge nanodots embedded in a nonemissive layer. For example, the blue OLED's markedly high initial power efficiency of 18.0 lm W(-1) at 100 cd m(-2) was doubled to 35.8 lm W(-1) when an amino-functionalized polymeric nanodot was employed. At high luminance, such as 1000 cd m(-2) used for illumination applications, the efficiency was improved from 12.4 to 21.2 lm W(-1), showing a significant enhancement of 71%. The incorporated highly charged nanodots are capable of effectively modulating the transportation of holes via a blocking or trapping mechanism, preventing excessive holes from entering the emissive layer and the resulting carrier-injection imbalance. Furthermore, in the presence of a high-repelling or dragging field arising from the highly charged nanodots, only those holes with sufficient energy are able to overcome the included barriers, causing them to penetrate deeper into the emissive layer. This penetration leads to carrier recombination over a wider region and results in a brighter emission and, therefore, higher efficiency.