Untimely surgery for stent-fracture-related death after transjugular intrahepatic portosystemic shunt: a case report.

Transjugular intrahepatic portosystemic shunt (TIPS) is a life-saving procedure for patients with severe portal hypertension and persistent variceal bleeding. Stent fracture is a rare and severe complication; however, its cause and mechanisms remain poorly defined. This case helps understand the factors contributing to its occurrence, complications, and subsequent poor outcomes. A 63-year-old male was presented with ruptured bare stent after a TIPS procedure. The upper edge of the bare stent was ruptured, and its fraction subsequently migrated to the entrance of the right atrium. Meanwhile, a mural thrombus was formed in the inferior vena cava. A surgery for the removal of free fracture was planned for preventing the form of pulmonary embolism. Before the surgery, the fracture was shifted to the right inferior pulmonary artery. Therefore, the surgery was canceled for further evaluation. Then, hematemesis suddenly occurred with a high possibility of variceal bleeding and/or gastric ulcer bleeding. Despite comprehensive treatments, the patient symptoms were still worsened with the development of chest tightness, shortness of breath, severe hypoxia, and heart failure. Finally, the patient succumbed to systemic multiorgan failure and death. Taken together, a ruptured unstable stent should be removed as early as the patient is hemodynamically stable, as it is difficult to balance between hemostasis therapy and anticoagulation treatment in patients with liver-cirrhosis-related severe portal hypertension. Physicians should be on high alert of the potential complications of bare stent rapture after TIPS.

Ruptured TIPS stent with a fatal consequence Unstable stent rupture is a life-threatening complication of TIPS and severely complicates the treatment of gastric ulcer bleeding. Early removal of the ruptured stent is necessary to prevent further complications.

Defected MoS2 Modified by Vanadium-Substituted Keggin-Type Polyoxometalates as Electrocatalysts for Triiodide Reduction in Dye-Sensitized Solar Cells.

The rational design of efficient triiodide reduction reaction catalysts that are dependent on cheap and ample elements on Earth has become a challenge. As an extremely encouraging non-noble metallic catalyst, MoS2 requires effective strategies to improve the site accessibility, inherent conductivity, and structural stability. Here, vanadium-substituted Keggin-type polyoxometalates (POMs) can be used as electron aggregates to modify manganese (Mn)-doped MoS2 through the electrochemical deposition strategy, thereby improving the charge transfer ability of MoS2 to I-/I3- redox pairs and accelerating the reduction of I3-. Additionally, with the increase in the number of vanadium atoms substituted in POMs, the conduction band of POMs and MoS2 can also match better, which effectively reduces the energy loss and is more conducive to charge transfer. Meanwhile, the deposition of POMs can improve the stability of metastable MoS2. When POMs/MoS2 materials are used as the counter electrodes of dye-sensitized solar cells, the power conversion efficiency (PCE) obtained is 7.27%, which is higher than that of platinum (Pt) (6.07%). The PCE can still maintain the initial 96% after 9 days. This work provides a valuable way for the improvement of platinum-free catalysts with minimal expense, basic process, high efficiency, and good stability.

Strategic Design of a Bifunctional NiFeCoW@NC Hybrid to Replace the Noble Platinum for Dye-Sensitized Solar Cells and Hydrogen Evolution Reactions.

High-performance triiodide reduction reaction (IRR) catalysts in dye-sensitized solar cells (DSSCs) and hydrogen evolution reaction (HER) catalysts in electrochemical water splitting are extremely compelling for renewable energy conversion and storage. The best IRR and HER catalysts generally rely on the use of noble metal platinum (Pt), which suffers obstacles in real-world implementation. The rational design of efficient bifunctional IRR and HER catalysts based on inexpensive and earth-abundant elements to replace scarce Pt could enable low-cost photoelectric conversion and hydrogen production but is challenging and rarely reported. Herein, we present a bifunctional NiFeCoW@NC hybrid with the unique architecture of WC loaded on the in situ formed carbon nanotubes embedded with Co-doped FeNi3 nanoparticles based on the anisotropic integration design principle, which operates efficiently for DSSCs and hydrogen evolution. The assembled DSSCs using the designed multimetal-based NiFeCoW@NC counter electrode delivered a high power conversion efficiency of 6.92% and long-term stability superior to bimetal-based NiFe@NC, CoW@NC, and Pt counterparts. It also exhibited eminent hydrogen evolution performance with a low overpotential of 127.8 mV to drive a 10 mA cm-2 current density, a Tafel slope of 60.4 mV dec-1, and satisfactory durable stability in 0.5 M H2SO4. This work provides a design principle for low-cost and highly active bifunctional catalysts to replace Pt for DSSCs and hydrogen evolution.

Heteropoly Blue/Protonation-Defective Graphitic Carbon Nitride Heterojunction for the Photo-Driven Nitrogen Reduction Reaction.

The establishment of a heterojunction is a crucial strategy to design highly effective nonnoble metal nanocatalysts for the photocatalytic nitrogen reduction reaction (PNRR). Heteropoly blues (r-POMs) can act as electron-transfer mediators in PNRR, but its agglomeration limits the further promotion of PNRR productivity. In this work, we construct a protonation-modified surface of N-vacancy g-C3N4 (HV-C3N4), achieving the high dispersion of r-POMs via the surface modification strategy. Enlightened by the synergy effect of the nitrogenase, r-POMs were anchored onto HV-C3N4 nanosheets through an electrostatic self-assembly method for preparing r-POMs-based protonation-defective graphitic carbonitride (HV-C3N4/r-POMs). As an electron donor, r-PW12 can match with the energy level of HV-C3N4 to build a heterojunction. The electron redistribution of the heterojunction facilitates the optimization of the electronic structure for enhancing the performance of PNRR. HV-C3N4/r-PW12 exhibits the best PNRR efficiency of 171.4 µmol L-1 h-1, which is boosted by 94.39% (HV-C3N4) and 86.98% (r-PW12). The isotope 15NH4+ experiment proves that ammonia is derived from N2, not carbon nitride. This study opens up a crucial view to achieve the high dispersion of r-POMs nanoparticles and develop high-efficiency nonnoble metal photocatalysts for the PNRR.

A COVID-19 risk score combining chest CT radiomics and clinical characteristics to differentiate COVID-19 pneumonia from other viral pneumonias.

With the continued transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the world, identification of highly suspected COVID-19 patients remains an urgent priority. In this study, we developed and validated COVID-19 risk scores to identify patients with COVID-19. In this study, for patient-wise analysis, three signatures, including the risk score using radiomic features only, the risk score using clinical factors only, and the risk score combining radiomic features and clinical variables, show an excellent performance in differentiating COVID-19 from other viral-induced pneumonias in the validation set. For lesion-wise analysis, the risk score using three radiomic features only also achieved an excellent AUC value. In contrast, the performance of 130 radiologists based on the chest CT images alone without the clinical characteristics included was moderate as compared to the risk scores developed. The risk scores depicting the correlation of CT radiomics and clinical factors with COVID-19 could be used to accurately identify patients with COVID-19, which would have clinically translatable diagnostic and therapeutic implications from a precision medicine perspective.

Chest CT of COVID-19 in patients with a negative first RT-PCR test: Comparison with patients with a positive first RT-PCR test.

To compare clinical and imaging features between patients with an initial negative reverse-transcription-polymerase chain-reaction (RT-PCR) test and patients with an initial positive RT-PCR test. CT follow-up analysis in the negative RT-PCR group is also described.Thirty-three patients with SARS-CoV-2 infection confirmed by RT-PCR, with 216 lesions upon CT, were included. Demographic information and chest CT imaging features were collected.The average age in the whole study group was 46.9 ±â€Š11.1 years, with 18 males and 15 females. Patients in the positive RT-PCR test group were more likely to have a fever than patients in the negative RT-PCR test group (85.7% vs 50%, P < .05). Lesions in the positive group were more likely to be located in the peripheral area than lesions in the negative group (83.6% vs 68.2%, P < .05). Regarding the appearance of 216 lesions, ground-glass opacities (GGOs) with consolidation (43.2%) was the most common appearance in the negative group, followed by pure GGOs (31.8%), while in the positive group, pure GGOs (32%) and GGOs with interlobular septal thickening (32.8%) were both most frequent, and the difference between them was evident (P < .05). For the follow-up analysis, the largest short-axis of a lesion was smaller upon follow-up (median size 13.6 mm vs 14 mm), albeit by a smaller margin. Pure GGOs decreased in frequency, from 31.3% to 21.3%, while consolidation increased in frequency, from 7.5% to 12.5%.The manifestations of COVID-19 in patients with a first negative RT-PCR test and patients with a positive first RT-PCR test are different to some extent. The consolidation component may increase after follow-up.

High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages.

PURPOSE: We aimed to compare chest HRCT lung signs identified in scans of differently aged patients with COVID-19 infections. METHODS: Case data of patients diagnosed with COVID-19 infection in Hangzhou City, Zhejiang Province in China were collected, and chest HRCT signs of infected patients in four age groups (<18 years, 18-44 years, 45-59 years, ≥60 years) were compared. RESULTS: Small patchy, ground-glass opacity (GGO), and consolidations were the main HRCT signs in 98 patients with confirmed COVID-19 infections. Patients aged 45-59 years and aged ≥60 years had more bilateral lung, lung lobe, and lung field involvement, and greater lesion numbers than patients <18 years. GGO accompanied with the interlobular septa thickening or a crazy-paving pattern, consolidation, and air bronchogram sign were more common in patients aged 45-59 years, and ≥60 years, than in those aged <18 years, and aged 18-44 years. CONCLUSIONS: Chest HRCT manifestations in patients with COVID-19 are related to patient's age, and HRCT signs may be milder in younger patients.