Cerebral venous sinus thrombosis caused by traumatic brain injury complicating thyroid storm: a case report and discussion.

INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disease with diverse predisposing factors. We report a case of CVST caused by a thyroid storm induced by traumatic brain injury. CASE PRESENTATION: A 29-year-old male patient with a history of Graves' disease with hyperthyroidism presented to our hospital with head trauma of cerebral contusion and laceration in both frontal lobes confirmed by admission CT scan. He received mannitol to lower intracranial pressure, haemostatic therapy, and antiepileptic treatment. Eight days later, he presented with signs of thyroid storms, such as tachycardia, hyperthermia, sweating and irritation, and his thyroid function tests revealed high levels of TPO-Ab, TR-Ab, TG-Ab, FT3 and FT4. Then, he entered a deep coma. His brain CT showed a thrombosis of multiple venous sinuses, along with the opening of peripheral collateral vessels, congestive infarction with haemorrhage and brain swelling. He regained consciousness after treatment with antithyroid drugs, anticoagulants, respiratory support and a regimen of sedation/analgesia. After a half-year follow-up, most of the patient's blocked cerebral venous sinuses had been recanalized, but there were still some sequelae, such as an impaired fine motor performance of the right hand and verbal expression defects. CONCLUSIONS: CVST can be induced by thyroid storms, and trauma-related thyroid storms can develop on the basis of hyperthyroidism. The purpose of this case report is to raise clinicians' awareness and improve their ability to diagnose CVST early in patients with traumatic brain injury complicating thyroid storms to improve the neurological prognosis among similar patients.

Analysis of hypervirulent Klebsiella pneumoniae and classic Klebsiella pneumoniae infections in a Chinese hospital.

AIMS: To evaluate the clinical and genetic virulence characteristics of critically ill patients with hypervirulent Klebsiella pneumoniae (hvKP) and classic KP (cKP) infection. METHODS AND RESULTS: The patients included in this retrospective study (n = 225) were grouped according to their hvKP (n = 114) or cKP (n = 111) status, and their clinical characteristics were analysed and compared. Cox multivariate analysis was conducted to determine the risk factors for hvKP infection. Length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation and 28-day survival rate were similar between the groups. However, the incidence of septic shock was higher in the hvKP group (16.7%) than in the cKP group (8.1%). CONCLUSIONS: There was a high rate of hvKP infection in this population. Compared to patients with cKP infection, those with hvKP infection showed a higher probability of having septic shock; nevertheless, survival and length of hospital stay were similar between the groups. Risk factors for hvKP infection included hospital-acquired infection and renal insufficiency. SIGNIFICANCE AND IMPACT OF THE STUDY: This study presents relevant information on the characteristics of hvKP infection in a Chinese population, and this promotes early diagnosis and supports the view that the prevalence of hvKP is high in China.

Noncentrosymmetric Weyl phase and topological phase transition in bulk MoTe.

Ideal topological materials are those stable materials with less nontrivial band crossing near the Fermi surface and a long Fermi arc. By means of first-principles calculations, here we present that the 3D monochalcogenide molybdenum telluride (Pm-MoTe) without an inversion center shows a type-II Weyl semimetal (WSM) phase which cannot checked by symmetry index method. A total of eight Weyl points (WPs) are found in different quadrants of the Brillouin zone (BZ) of Pm-MoTe, which guarantee a long Fermi arc. The WSM phase is robust against the spin-orbit coupling (SOC) effect because of mirror symmetry and time reversal symmetry. It is also found that a topological phase transition can be tuned by strain. For different types of strain, the number of WPs can be effectively modulated to a minimum number, and their energies could be closer to Fermi level. These findings propose a promising material candidate that partly satisfies the ideal WSM criteria and extends the potential applications of the tunable topological phase.

Optimization of central venous pressure during the perioperative period is associated with improved prognosis of high-risk operation patients.

Background: While central venous pressure (CVP) measurement is used to guide fluid management for high-risk surgical patients during the perioperative period, its relationship to patient prognosis is unknown. Methods: This single-center, retrospective observational study enrolled patients undergoing high-risk surgery from February 1, 2014 to November 31, 2020, who were admitted to the surgical intensive care unit (ICU) directly after surgery. Patients were divided into the following three groups according to the first CVP measurement (CVP1) after admission to the ICU: low, CVP1 <8 mmHg; moderate, 8 mmHg≤ CVP1 ≤ 12 mmHg; and high, CVP1 >12 mmHg. Perioperative fluid balance, 28-day mortality, length of stay in the ICU, and hospitalization and surgical complications were compared across groups. Results: Of the 775 high-risk surgical patients enrolled in the study, 228 were included in the analysis. Median (interquartile range) positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group (low CVP1: 770 [410, 1205] mL; moderate CVP1: 1070 [685, 1500] mL; high CVP1: 1570 [1008, 2000] mL; all P <0.001). The volume of positive fluid balance during the perioperative period was correlated with CVP1 (r=0.336, P <0.001). The partial arterial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2) ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups (low CVP1: 400.0 [299.5, 443.3] mmHg; moderate CVP1: 362.5 [330.0, 434.9] mmHg; high CVP1: 335.3 [254.0, 363.5] mmHg; all P <0.001). The incidence of postoperative acute kidney injury (AKI) was lowest in the moderate CVP1 group (low CVP1: 9.2%; moderate CVP1: 2.7%; high CVP1: 16.0%; P=0.007). The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group (low CVP1: 1.5%; moderate CVP1: 0.9%; high CVP1: 10.0%; P=0.014). Logistic regression analysis showed that intraoperative hypotension and CVP1 >12 mmHg were risk factors for AKI within 72 h after surgery (adjusted odds ratio[aOR]=3.875, 95% confidence interval[CI]: 1.378-10.900, P=0.010 and aOR=1.147, 95%CI: 1.006-1.309, P=0.041). Conclusions: CVP that is either too high or too low increases the incidence of postoperative AKI. Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid. However, CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.

Non-centrosymmetric Weyl semimetal state and strain effect in the twisted-brick phase transition metal monochalcogenides.

Weyl semimetals are a class of gapless electronic excitation topological quantum materials upon breaking time-reversal or inversion symmetry. Here, we demonstrate the existence of the Weyl semimetal state in the non-centrosymmetric twisted-brick phase MoTe theoretically. The topological properties and strain effects of MoTe have been systematically studied based on first-principles calculations and the Wannier-based tight-binding method. In the absence of spin-orbit coupling (SOC), MoTe exhibits gapless nodal loop states related to the mirror reflection symmetry. When the SOC is turned on, the two nodal loops split into 22 pairs of Weyl points (WPs) with opposite chirality. When the effect of uniaxial (εz) strain is taken into account, the Weyl semimetal phase of MoTe shows great robustness and striking tunable topological strength. In particular, the total number of WPs changes significantly under strain. MoTe under +4% and +8% uniaxial strains have only four pairs of WPs with a relatively large separation in momentum space. These results show that MoTe under weak strain is a promising partly ideal type I Weyl semimetal candidate, while the isolog structure WTe both opens a direct gap with and without SOC, showing a compensated semimetal state.

Fat embolism syndrome with cerebral fat embolism through a patent foramen ovale: A case report.

RATIONALE: Fat embolism syndrome with cerebral fat embolism, rarely observed at our neurology department, is often associated with long bone fractures. Its diagnosis is based on medical history and supportive imaging data and is usually not difficult. However, its pathogenesis remains poorly understood. PATIENT CONCERNS: A 46-year-old woman was urgently presented to a nearby hospital because of a femur fracture caused by an accident. She rapidly developed somnolence and was suspected to have fat embolism syndrome. DIAGNOSES: Due to patients history of trauma and supportive imaging data, she was diagnosed with fat embolism syndrome obviously. However, severe brain damage confused our understanding of the pathogenesis. The subsequent diagnosis of fat embolism syndrome with patent foramen ovale provided a reasonable explanation. INTERVENTIONS: Initially, we did not consider the fact that the patient had developed fat embolism syndrome and thus designed a comprehensive treatment program for fat embolism syndrome. Then the routine cardiac and vascular ultrasound screening were followed up, but patent foramen ovale was diagnosed unexpectedly, which led to a more aggressive treatment of brain injury. OUTCOMES: After relevant symptomatic treatment continued for nearly 3 months, an overall improvement was observed. Patients consciousness was restored but language disorders were left. LESSONS: Clinicians should consider patent foramen ovale as the embolization pathway, particularly in young and middle-aged patients with cerebral embolism because it is often mistaken for a rare situation.

A type of novel Weyl semimetal candidate: layered transition metal monochalcogenides Mo2XY (X, Y = S, Se, Te, X ≠ Y).

Based on ab initio calculations and the Wannier-based tight-binding method, we studied the topological electronic properties and strain modulation of transition metal monochalcogenides (TMM) Mo2XY (X, Y = S, Se, Te, X ≠ Y). These materials are nodal line semimetals in the absence of spin-orbit coupling (SOC). The presence of SOC turns them into Weyl semimetals with 24 Weyl nodes located in the kz≠ 0 planes and related by time-reversal, rotation C3z, and mirror symmetries. The maximal separation between two neighboring Weyl points with opposite chirality is of the order of magnitude of 0.10 Å-1, which can be readily accessed by angle-resolved photoemission spectroscopy (ARPES). The Weyl semimetal phase shows great robustness and demonstrates different responses under uniaxial and biaxial strain. Intriguingly, the location of the Weyl point changes significantly, resulting in a striking modulation of topological properties under in-plane biaxial strain. Our finding provides a realistic and promising platform for studying and manipulating the behavior of Weyl fermions in experiments.

Multicenter Study of Tetanus Patients in Fujian Province of China: A Retrospective Review of 95 Cases.

BACKGROUND: Tetanus is a life-threatening disease in developing countries and is accompanied by a high mortality rate. Although China is the world's largest developing country, there have been few clinical studies on tetanus in China. The purpose of this study was to investigate the epidemiology, incidence, and management of tetanus in Fujian Province and to understand the current treatment and prognosis of tetanus patients. METHODS: This was a retrospective, multicenter observational study of patients who presented with a clinical diagnosis of tetanus at 5 general hospitals in Fujian from January 2008 to December 2018. Data were analyzed using a computer software system. RESULTS: A total of 95 patients were recruited, including 6 newborns. The average age of the adult tetanus patients was 55.53 ± 15.39 years old. None of the patients knew their previous history of tetanus immunization. The rate of having received human tetanus immunoglobulin (HTIG) was 9.47%. A total of 73 (76.84%) patients were cured, 17 (17.89%) patients had an unknown prognosis, and 5 (5.26%) patients died. Age, severity of illness, and complications all increased the total duration of hospitalization. Compared with endotracheal intubation, tracheotomy increased the length of stay in the ICU (Intensive Care Unit) but did not affect the total hospital length of stay for mechanical ventilation. CONCLUSIONS: With the promotion of nationwide immunization against tetanus and the development of critical care medicine, morbidity and mortality rates of tetanus in Fujian are low. It is important to increase awareness among local physicians and staff in charge of tetanus immunization programs and with regard to neonatal tetanus and drug-induced tetanus. The prevention and treatment of tetanus in developing countries should arouse widespread concern in society.

A type of robust superlattice type-I Weyl semimetal with four Weyl nodes.

We investigate the topological properties of the Janus superlattices WTeS and WTeSe by first-principles methods and Wannier-based tight-binding Hamiltonians. The thermal stability of the Janus structures is checked by first-principles molecular dynamics. The topological properties are identified through node chirality, surface states and surface Fermi arcs. Our calculations reveal that both WTeS and WTeSe are Type-I Weyl semimetals with only four Weyl nodes in the Brillouin zone, which is a minimal number in a time reversal symmetry system. This small number of Weyl nodes makes them an excellent platform to study their topological properties experimentally. The Weyl nodes are located in four different quadrants of the Brillouin zone and consequently the separation of Weyl points in reciprocal space, and the length of Fermi arc, is of the order of the magnitude of the reciprocal lattice vector |Gz| as might be easily observed in experiment. The Weyl nodes have approximately the same energy below the Fermi level and are hence accessible by conventional ARPES. In addition, under external strain, the Weyl semimetal state is more robust than the sister compounds Td-WTe2/MoTe2. Our findings are important to explore Weyl fermion physics and useful for realizing possible applications of Weyl semimetal materials in future topological electronic devices.

Correlation effect on the electronic properties of pair-checkerboard AFM monolayer FeSe: a first-principles study.

We presented a study of the influence of on-site Coulomb correlation U and Hund coupling J on the electronic properties of monolayer FeSe in a pair-checkerboard antiferromagnetic (PAFM) state based on Hubbard-corrected density functional theory (DFT + U). The results demonstrated the Hubbard-U have a strong influence on the electronic bands and lattice structure of monolayer FeSe in PAFM state. The in-plane lattice constant changes under U > 1.85 eV has been identified under full structure optimization. Furthermore, the Hund coupling J has significant influence on the electronic bands and exhibits a remarkable orbital selective behavior at U = 0. Additionally, our results also demonstrated the Hund coupling J has a weaker effect on electronic properties of FeSe when U gets larger. These results are useful for elucidating the possible role of correlation strength on the electronics band and magnetic ground state of monolayer FeSe.

Pulse-reverse electrodeposition of transparent nickel phosphide film with porous nanospheres as a cost-effective counter electrode for dye-sensitized solar cells.

A Ni2P nanolayer with porous nanospheres was directly coated on fluorine-doped tin oxide glass by pulse-reverse deposition as a low-cost counter electrode catalyst for dye-sensitized solar cells, and the photoelectron conversion efficiency of the cell was increased to 7.32% by using a porous nanosphere catalyst due to the significantly improved ion transport.

Identification of crucial yeast inhibitors in bio-ethanol and improvement of fermentation at high pH and high total solids.

Compounds inhibitory to enzymatic hydrolysis and fermentation are generated from neutral steam exploded corn stover in the process of producing bio-ethanol. In this study, weak acids were identified as main yeast inhibitors, while phenols and aldehyde contribute to the inhibition to a lower degree. Main weak acids in hydrolysates are acetic acid and formic acid, for which critical levels for yeast inhibition are 6 and 4g/L, respectively. The inhibitory effect of these compounds can be greatly overcome by increasing pH of hydrolysates to 6.0-9.0, but there is a risk of bacterial contamination when fermenting at high pH. The relationship of pH, total solids of hydrolysates, fermentation and contamination was studied in detail. Results indicate that the contamination by bacteria when fermenting at high pH can be prevented effectively using hydrolysates with total solids of more than 20%. Meanwhile, ethanol yield is improved significantly.