A rare case of pheochromocytoma in a pregnant woman presenting with chest pain: extraordinary management.

BACKGROUND: Pheochromocytoma is rare in pregnant women. It presents as diverse symptoms, including hypertension and sweating. The symptoms of pregnant women with pheochromocytoma and comorbid hypertension often mimic the clinical manifestations of preeclampsia, and these women are often misdiagnosed with preeclampsia. CASE PRESENTATION: In this case, a pregnant woman presented with chest pain as the primary symptom, and a diagnosis of pheochromocytoma was considered after ruling out myocardial ischemia and aortic dissection with the relevant diagnostic tools. This patient then underwent successful surgical resection using a nontraditional management approach, which resulted in a positive clinical outcome. CONCLUSIONS: It is essential to consider pheochromocytoma as a potential cause of chest pain and myocardial infarction-like electrocardiographic changes in pregnant women, even if they do not have a history of hypertension.

TRD-YOLO: A Real-Time, High-Performance Small Traffic Sign Detection Algorithm.

Traffic sign detection is an important part of environment-aware technology and has great potential in the field of intelligent transportation. In recent years, deep learning has been widely used in the field of traffic sign detection, achieving excellent performance. Due to the complex traffic environment, recognizing and detecting traffic signs is still a challenging project. In this paper, a model with global feature extraction capabilities and a multi-branch lightweight detection head is proposed to increase the detection accuracy of small traffic signs. First, a global feature extraction module is proposed to enhance the ability of extracting features and capturing the correlation within the features through self-attention mechanism. Second, a new, lightweight parallel decoupled detection head is proposed to suppress redundant features and separate the output of the regression task from the classification task. Finally, we employ a series of data enhancements to enrich the context of the dataset and improve the robustness of the network. We conducted a large number of experiments to verify the effectiveness of the proposed algorithm. The accuracy of the proposed algorithm is 86.3%, the recall is 82.1%, the mAP@0.5 is 86.5% and the mAP@0.5:0.95 is 65.6% in TT100K dataset, while the number of frames transmitted per second is stable at 73, which meets the requirement of real-time detection.

A fundamental study on selective extraction of Li+ with dibenzo-14-crown-4 ether: Toward new technology development for lithium recovery from brines.

The present study has proposed a selective Li+ extraction process using a novel extractant of dibenzo-14-crown-4 ether functionalized with an alkyl C16 chain (DB14C4-C16) synthesized based on the ion imprinting technology (IIT). Theoretical analysis of the possible complexes formed by DB14C4-C16 with Li+ and the competing ions of Na+, K+, Ca2+ and Mg2+ was performed through density functional theory (DFT) modeling. The Gibbs free energy change of the complexes of metal ions with DB14C4-C16 and water molecules were calculated to be -125.81 and -166.01 kJ/mol for lithium, -55.73 and -117.77 kJ/mol for sodium, and -196.02 and -291.52 kJ/mol for magnesium, respectively. Furthermore, the solvent extraction experiments were carried out in both single Li+ and multi-ions containing solutions, and the results delivered a good selectivity of DB14C4-C16 towards Li+ over the competing ions, showing separation coefficients of 68.09 for Ca2+-Li+, 24.53 for K+-Li+, 16.32 for Na+-Li+, and 3.99 for Mg2+-Li+ under the optimal conditions. The experimental results are generally in agreement with the theoretical calculations.

The impact of environmental regulation efficiency loss on inclusive growth: Evidence from China.

This study uses panel data from 281 cities in China during the period 2004-2016 and the two-regime spatial Durbin model to investigate the strategic interactions of environmental regulation efficiency loss between cities. It adopts the spatial lag of X model and the mediating effect model to analyze the effect and mechanisms of environmental regulation efficiency loss on inclusive growth. The results show that there are asymmetric strategic interactions in the form of imitative competition and upward competition between geographically neighboring cities, which exacerbates the environmental regulation efficiency loss. The environmental regulation efficiency loss of local and neighboring cities inhibits inclusive growth at both the national and regional levels. At the regional level, the local and neighbor effects are the strongest in the central and western regions. The results also show that the inhibition of the neighbor effect is more obvious within 500 km and is relatively stable after 2007. Revenue decentralization, fiscal autonomy, and promotion pressure have a partial mediating effect, which may be important channels for the environmental regulation efficiency loss to restrain inclusive growth. However, expenditure decentralization plays a masking effect, which mitigates the inhibition of the environmental regulation efficiency loss on inclusive growth. In addition, the robustness test of the informal environmental regulation efficiency loss supports the conclusions of the formal environmental regulation efficiency loss. Moreover, the inhibitions of the two are similar at the national level but are different at the regional level. This study therefore suggests that policymakers should adopt a series of measures to improve environmental regulation efficiency, in addition to increasing environmental regulation intensity.

PEGylated niosomes-mediated drug delivery systems for Paeonol: preparation, pharmacokinetics studies and synergistic anti-tumor effects with 5-FU.

This work describes the preparation of a PEGylated niosomes-mediated drug delivery systems for Paeonol, thereby improving the bioavailability and chemical stability of Paeonol, prolonging its cellular uptake and enhancing its synergistic anti-cancer effects with 5-Fu. PEGylated niosomes, which are prepared from biocompatible nonionic surfactant of Spans 60 and cholesterol, and modified with PEG-SA. Pae-PEG-NISVs were evaluated in vitro and in vivo. The cytotoxicity of Pae-PEG-NISVs was investigated against HepG2 cells. Fluorescence microscope was used to detect the apoptotic morphological changes. Growth inhibition assays were carried out to investigate whether Pae-PEG-NISVs could enhance the antiproliferative effects of Pae co-treated with 5-FU on HepG2 cells. The optimized Pae-PEG-NISVs had mean diameters of approximately 166 nm and entrapment efficiency (EE) of 61.8%. Furthermore, the in vitro release study of Paeonol from PEGylated niosomes exhibited a relatively prolonged release profile for 12 h. Pharmacokinetic studies in rats after i.v. injection showed that Pae-PEG-NISVs had increased elimination half-lives (t1/2, 87.5 versus 17.0 min) and increased area under the concentration-time curve (AUC0-t, 38.0 versus 19.48 µg/ml*min) compared to Paeonol solution. Formulated Paeonol had superior cytotoxicity versus the free drug with IC50 values of 22.47 and 85.16 µg/mL at 24 h on HepG2 cells, respectively, and we found that low concentration of Pae-PEG-NISVs and 5-Fu in conjunction had obviously synergistic effect. Our results indicate that the PEG-NISVs system has the potential to serve as an efficient carrier for Paeonol by effectively solubilizing, stabilizing and delivering the drug to the cancer cells.

The Progress of Polymer Composites Protecting Safe Li Metal Batteries: Solid-/Quasi-Solid Electrolytes and Electrolyte Additives.

The impressive theoretical capacity and low electrode potential render Li metal anodes the most promising candidate for next-generation Li-based batteries. However, uncontrolled growth of Li dendrites and associated parasitic reactions have impeded their cycling stability and raised safety concerns regarding future commercialization. The uncontrolled growth of Li dendrites and associated parasitic reactions, however, pose challenges to the cycling stability and safety concerns for future commercialization. To tackle these challenges and enhance safety, a range of polymers have demonstrated promising potential owing to their distinctive electrochemical, physical, and mechanical properties. This review provides a comprehensive discussion on the utilization of polymers in rechargeable Li-metal batteries, encompassing solid polymer electrolytes, quasi-solid electrolytes, and electrolyte polymer additives. Furthermore, it conducts an analysis of the benefits and challenges associated with employing polymers in various applications. Lastly, this review puts forward future development directions and proposes potential strategies for integrating polymers into Li metal anodes.

Surgery for bronchiectasis-destroyed lung: feasibility of video-assisted thoracoscopic surgery, and surgical outcomes.

OBJECTIVES: To provide the experience of surgical treatment for bronchiectasis-destroyed lung (BDL) and evaluate the feasibility of video-assisted thoracoscopic surgery (VATS). METHODS: BDL patients underwent surgical treatment between January 2013 and June 2018 were included. Logistic regression was performed to assess factors for major complications, and Cox's regression was performed to assess factors affected symptomatic outcome. RESULTS: Totally, 143 patients were treated by VATS (n = 64) and thoracotomy (n = 79). Nine (14.1%) cases scheduled for VATS were converted to thoracotomy for dense adhesions (n = 6) and frozen hilum (n = 3). The VATS group had a median chest tube duration, hospitalization and a time of returning to full activity of 4 days, 5 days and 1.5 months, respectively. Major complications occurred in 28 (19.6%) of all patients, 50.0% after pneumonectomy and 13.4% after lobectomy/extensive lobectomy. Multivariable analysis identified pneumonectomy [odds ratio, 3.64; 95% confidence interval (CI), 1.18-11.21] as a significant predictor for major complications. Overall, 141 (98.6%) patients benefitted from surgery (completely asymptomatic, n = 109; acceptable alleviation, n = 32). Thirty-four patients experienced relapse of the disease, including 13 with productive cough, 11 with haemoptysis and 10 with recurrent infections. Pseudomonas aeruginosa infection [hazard ratio (HR), 3.07; 95% CI, 1.38-6.83] and extent of remanent bronchiectatic areas (HR, 1.03; 95% CI, 1.00-1.05) were independent risk factors for shorter relapse free interval. CONCLUSIONS: VATS for BDL is feasible in well-selected patients. Pneumonectomy increased the risk of postoperative major complications. Removing all BDL lesions contributed to satisfactory prognosis.

Identifying optimal surgical approach among T1N2-3M0 non-small cell lung cancer patients: a population-based analysis.

Background: Whether stage T1N2-3M0 non-small cell lung cancer (NSCLC) patients could benefit from surgery and the optimal surgical procedure have remained controversial and unclear. This study aimed to investigate whether stage T1N2-3M0 NSCLC can benefit from different surgery types and develop a tool for survival prediction. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients diagnosed with stage T1N2-3M0 NSCLC between 2000 and 2015. A 1:1 propensity score-matched (PSM) analysis was used to balance the distribution of clinical characteristics. Survival analyses were performed by using the Kaplan-Meier (KM) curves and Cox proportional hazards regression. All patients were randomly split at a ratio of 7:3 into training and validation cohorts. The nomogram was constructed by integrating all independent predictors for overall survival (OS) and cancer-specific survival (CSS). The model's performance was evaluated by discrimination, calibration ability, and risk stratification ability. Results: A total of 4,671 patients were enrolled. After 1:1 PSM, the distribution proportions of clinical characteristics in 1,146 patients were balanced (all P>0.05). The non-surgical approach was associated with worse survival compared with sublobectomy and lobectomy in the unmatched and matched cohorts. The multivariate Cox analysis showed that sublobectomy and lobectomy were both related to better OS and CSS rates compared with no surgery (P<0.001). Moreover, the results of subgroup analyses based on age, N stage, and radiotherapy or chemotherapy strategy were consistent. A total of 801 patients were included in the training cohort and 345 cases constituted the validation cohort. The nomogram constructed for the 1-, 3-, and 5-year OS and CSS prediction showed good discrimination, performance, and calibration both in the training and validation sets. Significant distinctions in survival curves between different risk groups stratified by prognostic scores were also observed (all P<0.001). Conclusions: Stage T1N2-3M0 NSCLC patients could benefit from sublobectomy or lobectomy, and lobectomy provides better survival benefits. We developed and validated nomograms, which could offer clinicians instructions for strategy making.

Single- versus multi-port video-assisted thoracic surgery for pulmonary aspergilloma: a propensity-matched study.

OBJECTIVES: The utilization of single-port video-assisted thoracic surgery for pulmonary aspergilloma (PA) has not been well studied. The study was performed to evaluate the safety and feasibility of it for PA compared with multi-port video thoracic-assisted surgery. METHODS: From August 2007 to December 2019, consecutive PA patients receiving surgeries at Shanghai Pulmonary Hospital were enrolled retrospectively. Propensity score matching based on preoperative clinical variables was utilized to compare perioperative and long-term outcomes. RESULTS: In all 358 patients, a total of 63 patients underwent single-port video-assisted thoracic surgery, and 63 out of 145 patients for multi-port surgeries were paired with the single-port video-assisted thoracic surgery recipients. The median follow-up period was 40 months (range, 2-140 months). Patients receiving single-port video-assisted thoracic surgery showed a similar operation time, intraoperative blood loss, drainage duration and drainage volume to those of multi-port video-assisted thoracic surgery recipients (P > 0.05). Patients undergoing lobectomy by single-port approach experienced a shorter postoperative hospital stay {4.9 [standard deviation (SD): 2.0] vs 5.9 (SD: 2.3), P = 0.014}. The average postoperative pain scores [day 0: 2.6 (SD: 0.7) vs 3.1 (SD: 0.8), day 3: 4.0 (SD: 0.9) vs 4.8 (SD: 3.9), day 7: 2.2 (SD: 0.5) vs 3.1 (SD: 0.8), P < 0.001] and the number of days that patients required analgesic agents [3.0 (SD: 2.2) vs 4.8 (SD: 2.1), P < 0.001] were also decreased in the single-port video-assisted thoracic surgery group. CONCLUSIONS: Single-port video-assisted thoracic surgery is a safe and feasible alternative to multi-port video-assisted thoracic surgery for simple PA and selected complex ones, with a potential advantage of reduced postoperative pain.

MB-DECTNet: a model-based unrolling network for accurate 3D dual-energy CT reconstruction from clinically acquired helical scans.

Objective.Over the past several decades, dual-energy CT (DECT) imaging has seen significant advancements due to its ability to distinguish between materials. DECT statistical iterative reconstruction (SIR) has exhibited potential for noise reduction and enhanced accuracy. However, its slow convergence and substantial computational demands render the elapsed time for 3D DECT SIR often clinically unacceptable. The objective of this study is to accelerate 3D DECT SIR while maintaining subpercentage or near-subpercentage accuracy.Approach.We incorporate DECT SIR into a deep-learning model-based unrolling network for 3D DECT reconstruction (MB-DECTNet), which can be trained end-to-end. This deep learning-based approach is designed to learn shortcuts between initial conditions and the stationary points of iterative algorithms while preserving the unbiased estimation property of model-based algorithms. MB-DECTNet comprises multiple stacked update blocks, each containing a data consistency layer (DC) and a spatial mixer layer, with the DC layer functioning as a one-step update from any traditional iterative algorithm.Main results.The quantitative results indicate that our proposed MB-DECTNet surpasses both the traditional image-domain technique (MB-DECTNet reduces average bias by a factor of 10) and a pure deep learning method (MB-DECTNet reduces average bias by a factor of 8.8), offering the potential for accurate attenuation coefficient estimation, akin to traditional statistical algorithms, but with considerably reduced computational costs. This approach achieves 0.13% bias and 1.92% mean absolute error and reconstructs a full image of a head in less than 12 min. Additionally, we show that the MB-DECTNet output can serve as an initializer for DECT SIR, leading to further improvements in results.Significance.This study presents a model-based deep unrolling network for accurate 3D DECT reconstruction, achieving subpercentage error in estimating virtual monoenergetic images for a full head at 60 and 150 keV in 30 min, representing a 40-fold speedup compared to traditional approaches. These findings have significant implications for accelerating DECT SIR and making it more clinically feasible.

Anti-Fouling and Anti-Biofilm Performance of Self-Polishing Waterborne Polyurethane with Gemini Quaternary Ammonium Salts.

Biofilms are known to be difficult to eradicate and control, complicating human infections and marine biofouling. In this study, self-polishing and anti-fouling waterborne polyurethane coatings synthesized from gemini quaternary ammonium salts (GQAS), polyethylene glycol (PEG), and polycaprolactone diol (PCL) demonstrate excellent antibiofilm efficacy. Their anti-fouling and anti-biofilm performance was confirmed by a culture-based method in broth media, with the biofilm formation factor against Gram-positive (S. aureus) and Gram-negative bacterial strains (E. coli) for 2 days. The results indicate that polyurethane coatings have excellent anti-biofilm activity when the content of GQAS reached 8.5 wt% against S. aureus, and 15.8 wt% against E. coli. The resulting waterborne polyurethane coatings demonstrate both hydrolytic and enzymatic degradation, and the surface erosion enzymatic degradation mechanism enables them with good self-polishing capability. The extracts cyto-toxicity of these polyurethane coatings and degradation liquids was also systematically studied; they could be degraded to non-toxic or low toxic compositions. This study shows the possibility to achieve potent self-polishing and anti-biofilm efficacy by integrating antibacterial GQAS, PEG, and PCL into waterborne polyurethane coatings.

Motion-compensated scheme for sequential scanned statistical iterative dual-energy CT reconstruction.

Objective.Dual-energy computed tomography (DECT) has been widely used to reconstruct numerous types of images due its ability to better discriminate tissue properties. Sequential scanning is a popular dual-energy data acquisition method as it requires no specialized hardware. However, patient motion between two sequential scans may lead to severe motion artifacts in DECT statistical iterative reconstructions (SIR) images. The objective is to reduce the motion artifacts in such reconstructions.Approach.We propose a motion-compensation scheme that incorporates a deformation vector field into any DECT SIR. The deformation vector field is estimated via the multi-modality symmetric deformable registration method. The precalculated registration mapping and its inverse or adjoint are then embedded into each iteration of the iterative DECT algorithm.Main results.Results from a simulated and clinical case show that the proposed framework is capable of reducing motion artifacts in DECT SIRs. Percentage mean square errors in regions of interest in the simulated and clinical cases were reduced from 4.6% to 0.5% and 6.8% to 0.8%, respectively. A perturbation analysis was then performed to determine errors in approximating the continuous deformation by using the deformation field and interpolation. Our findings show that errors in our method are mostly propagated through the target image and amplified by the inverse matrix of the combination of the Fisher information and Hessian of the penalty term.Significance.We have proposed a novel motion-compensation scheme to incorporate a 3D registration method into the joint statistical iterative DECT algorithm in order to reduce motion artifacts caused by inter-scan motion, and successfully demonstrate that interscan motion corrections can be integrated into the DECT SIR process, enabling accurate imaging of radiological quantities on conventional SECT scanners, without significant loss of either computational efficiency or accuracy.

Trace elements in red swamp crayfish (Procambarus clarkii) in China: Spatiotemporal variation and human health implications.

The enrichment and health risk assessment of trace elements in crayfish on a national scale are significant for food safety due to the rapidly expanding crayfish consumption in China. In the present study, 4709 samples were extracted from databases to explore the spatiotemporal variation characteristics of trace elements in crayfish. Due to the variance in the background value of trace elements, the level of trace elements varies by region. Additionally, levels of As and Cr in crayfish increased with the promotion of intensive rice-crayfish coculture in China. Health risk assessment results revealed that trace elements may cause non-carcinogenic risk for crayfish consumption for adults and children from the mid-lower reaches of the Yangtze River, and the main risk was from As and Hg. The cancer risk values of As for children and adults in Zhejiang, Anhui, Heilongjiang, Hubei, Hunan, Jiangsu, Jiangxi and Shandong provinces were above the allowable value. There is concern about the non-carcinogenic and carcinogenic risk of consuming crayfish containing trace elements in some areas in China. Therefore, the results can serve as a critical reference for policy purposes in China. In addition, it is recommended that further research and assessment on crayfish consumption are required.

Does environmental regulation dividends inequality impact inclusive growth? Evidence from China.

Based on the panel data of 281 city level in China for the period of 2004-2016, this study uses the Cobb-Douglas production function to investigate the distribution of environmental regulation dividends and further adopts the threshold model to explore the impact of environmental regulation dividends inequality (ERDI) on inclusive growth (IG). Results indicate that the distribution structure of the environmental regulation dividends has improved, but the inequality between urban-rural residents is still apparent. Environmental regulation dividends inequality has a non-linear threshold effect on inclusive growth, which turns from a significant inhibition to a slight promotion after exceeding the threshold value. Grouping tests show that environmental regulation dividends inequality has a heterogeneous effect on cities with different resource endowments and leading industries and still inhibits inclusive growth of non-resource-based cities even if the inequality is higher than the threshold value. Mechanism analysis reveals that primary distribution and redistribution are the main channels through which environmental regulation dividends inequality inhibits and promotes inclusive growth when the inequality is below and above the threshold value, respectively. These conclusions have important implications for enhancing and distributing environmental regulation dividends to promote inclusive growth.

A Multi-Medium Analysis of Human Health Risk of Toxic Elements in Rice-Crayfish System: A Case Study from Middle Reach of Yangtze River, China.

Rice-crayfish system has been extensively promoted in China in recent years. However, the presence of toxic elements in soil may threaten the quality of agricultural products. In this study, eight toxic elements were determined in multi-medium including soil, rice, and crayfish from the rice-crayfish system (RCS) and conventional rice culture (CRC) area. Crayfish obtained a low level of toxic element content, and mercury (Hg) in rice from RCS showed the highest bioavailability and mobility. Health risk assessment, coupled with Monte Carlo simulation, revealed that the dietary exposure to arsenic (As) and Hg from rice and crayfish consumption was the primary factor for non-carcinogenic risk, while Cd and As were the dominant contributors to the high carcinogenic risk of rice intake for adults and children, respectively. Based on the estimated probability distribution, the probabilities of the total cancer risk (TCR) of rice intake for children from RCS were lower than that from CRC.

Surgical Options for Resectable Lung Adenosquamous Carcinoma: A Propensity Score-Matched Analysis.

Background: Surgery is the primary treatment option for Lung adenosquamous carcinoma (ASC) patients. However, no study compares the benefits of lobectomy and sublobar resection in ASC patients. Methods: A total of 1379 patients in the Surveillance, epidemiology, and End Results (SEER) database and 466 patients in Shanghai Pulmonary Hospital (SPH) were enrolled. Survival benefits were evaluated after possible confounders were eliminated by propensity score matching (PSM). Results: After 1:3 PSM, 463 SEER database patients and 244 SPH patients were enrolled. Lobectomy was associated with better overall survival (OS) and disease-free survival (DFS) than sublobar resection for ASC patients (5-year OS of SEER: 46.9% vs. 33.3%, P =0.017; 5-year OS of SPH: 35.0% vs. 16.4%, P =0.002; 5-year DFS of SPH: 29.5% vs. 14.8%, P =0.002). Similar results were observed in stage I patients. Univariate and multivariate Cox regression analyses showed that sublobar resection was an adverse prognostic factor independently (SEER: HR: 1.40, 95%CI: 1.08-1.81, P =0.012; SPH: HR: 1.73, 95%CI: 1.11-2.70, P =0.015). Subgroup analysis showed that all of the ASC patient subtypes tended to benefit more from lobectomy than sublobar resection. Conclusions: Lobectomy remains the primary option for ASC patients compared to sublobar resection, including stage I.

The role of surgery in older patients with T1-2N0M0 small cell lung cancer: A propensity score matching analysis.

Background: Surgical resection could improve the survival of patients with early-stage small cell lung cancer (SCLC). However, there is a lack of dedicated studies concentrating on surgical treatment in older patients with T1-2N0M0 SCLC. Thus, we performed this population-based study to investigate whether older patients with T1-2N0M0 SCLC could benefit from surgery. Methods: We collected the data of patients with SCLC between 2000 and 2015 from the Surveillance, Epidemiology, and End Results Program database. Older patients (≥ 65 years) with T1-2N0M0 SCLC were included, and we converted the staging information into those of the eighth edition. The propensity score matching (PSM) was used to balance the distribution of clinical characteristics between surgery and no-surgery groups. Results: Before PSM, the distribution proportions of clinical characteristics in 1,229 patients were unbalanced. The Kaplan-Meier curves of overall survival (OS) and cancer-specific survival (CSS) showed that the patients in the surgery group were better than those in the non-surgery group (all P < 0.001). After 1:2 PSM, the distribution proportions of clinical characteristics in 683 patients were balanced (all P > 0.05). The OS and CSS of patients in the surgery group were still better than that of patients in the no-surgery group (all P < 0.001), and subgroup analysis showed that the surgery was a protective factor for OS and CSS in all clinical characteristics subgroups (almost P < 0.001). The multivariate Cox analysis further confirmed this result (OS: HR, 0.33; 95% CI, 0.27-0.39; P < 0.001; CSS: HR, 0.29; 95% CI, 0.23-0.36; P < 0.001). The result of subgroup analysis based on age, T stage, and adjuvant therapy showed that surgery was related to better OS and CSS compared with non-surgery group (almost P < 0.001) and that lobectomy exhibited the longer survival than sublobectomy. Age, sex, and race were the independent prognostic factors for OS in patients undergoing surgery, whereas only the factor of age affects the CSS in patients with surgery. Conclusions: Older patients with T1-2N0M0 SCLC can benefit significantly from surgical treatment, and lobectomy provides better prognosis than sublobectomy.

A rare cause of abdominal pain managed unconventionally: acute renal infarction caused by atrial fibrillation: a case report.

BACKGROUND: Atrial fibrillation is one of the most common arrhythmias. The main thrombotic complication of arterial fibrillation is ischemic stroke, but it can also cause acute renal infarction from embolization. The low incidence and nonspecific clinical manifestations of acute renal infarction make it difficult to diagnose, often leading to either delayed diagnosis or misdiagnosis. Due to its rarity, more efficient treatment guidelines are helpful for the management of acute renal infarction related to the thromboembolic complication of arterial fibrillation. CASE REPORTS: We report a case of acute renal infarction due to underlying arterial fibrillation, where a novel interventional therapeutic method was used. A 66-year-old Chinese man with arterial fibrillation, not on anticoagulation due to the patient's preference, and coronary artery disease post-percutaneous coronary intervention to left anterior descending artery about 1 year ago, was currently on dual antiplatelet therapy. He suddenly developed intermittent and sharp left-sided abdominal pain and was found to have an acute left renal infarction on computed tomography scan. Angiogram showed acute occlusion of the left renal artery due to thromboembolism. For this patient, a combination method of local thrombus aspiration, angioplasty, and infusion of nitroglycerin and diltiazem were used, restoring blood flow to the left kidney. After recovery, the patient was discharged on aspirin, clopidogrel, and warfarin. At 6 months follow-up, there was no residual kidney dysfunction. CONCLUSIONS: Acute renal infarction from thromboembolism is a rare but serious complication of arterial fibrillation. More efficient and different options for intervention methods will benefit the treatment of this disease. Here, we report a combination therapeutic method that has not been used in acute renal infarction associated with arterial fibrillation, and which restored renal perfusion and prevented long-term kidney injury.

Combining impregnation and co-pyrolysis to reduce the environmental risk of biochar derived from sewage sludge.

Sewage sludge derived biochar has great potential for agricultural application, whereas the risk of heavy metals in sewage sludge is a key challenge for utilization. This study investigated the synergetic effect of co-pyrolysis and ZnCl2 impregnation treatment on the surface characteristics and potential ecological risk of heavy metals in sewage sludge derived biochar. It was concluded that ZnCl2 impregnation led to an increase in biochar yield, O and S content, but decrease the ash content and pH. Additionally, the thermal stability of ZnCl2-added biochar was decreased. Semi-quantitive specific functional groups analysis suggested that ZnCl2 impregnation had a negative effect on the content of CO and C-O, while promoted the formation of aromatic CC. And the functional group of CO was retained in biochar by co-pyrolysis with Camellia oleifera shell due to its high content of potassium. For heavy metal passivation, ZnCl2 impregnation decreased total content of heavy metals by chlorination, while the oxidizable fraction (F3) of heavy metals showed an increasing tendency. Results of potential ecological risk assessment indicated that combining ZnCl2 impregnation and co-pyrolysis had great potential to reduce the ecological risk of heavy metals in sewage sludge derived biochar.

Development and validation of nomogram prognostic model for early-stage T1-2N0M0 small cell lung cancer: A population-based analysis.

Background: Survival outcomes of early-stage T1-2N0M0 small cell lung cancer (SCLC) patients differ widely, and the existing Veterans Administration Lung Study Group (VALSG) or TNM staging system is inefficient at predicting individual prognoses. In our study, we developed and validated nomograms for individually predicting overall survival (OS) and lung cancer-specific survival (LCSS) in this special subset of patients. Methods: Data on patients diagnosed with T1-2N0M0 SCLC between 2000 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All enrolled patients were split into a training cohort and a validation cohort according to the year of diagnosis. Using multivariable Cox regression, significant prognostic factors were identified and integrated to develop nomograms for 1-, 3-, and 5-year OS and LCSS prediction. The prognostic performance of our new model was measured by the concordance index (C-index) and calibration curve. We compared our latest model and the 8th AJCC staging system using decision curve analyses (DCA). Kaplan-Meier survival analyses were applied to test the application of the risk stratification system. Results: A total of 1,147 patients diagnosed from 2000 to 2011 were assigned to the training cohort, and 498 cases that were diagnosed from 2012 to 2015 comprised the validation cohort. Age, surgery, lymph node removal (LNR), and chemotherapy were independent predictors of LCSS. The variables of sex, age, surgery, LNR, and chemotherapy were identified as independent predictors of OS. The above-mentioned prognostic factors were entered into the nomogram construction of OS and LCSS. The C-index of this model in the training cohort was 0.663, 0.702, 0.733, and 0.658, 0.702, 0.733 for predicting 1-, 3-, and 5-year OS and LCSS, respectively. Additionally, in the validation cohort, there were 0.706, 0.707, 0.718 and 0.712, 0.691, 0.692. The calibration curve showed accepted prediction accuracy between nomogram-predicted survival and actual observed survival, regardless of OS or LCSS. In addition, there were significant distinctions in the survival curves of OS and LCSS between different risk groups stratified by prognostic scores. Compared with the 8th AJCC staging system, our new model also improved net benefits. Conclusions: We developed and validated novel nomograms for individual prediction of OS and LCSS, integrating the characteristics of patients and tumors. The model showed superior reliability and may help clinicians make treatment strategies and survival predictions for early-stage T1-2N0M0 SCLC patients.