Harnessing nitrate over ammonium to sustain soil health during monocropping.

Introduction: In achieving food security and sustainable agricultural development, improving and maintaining soil health is considered as a key driving factor. The improvement based on different forms of nitrogen fertilization has aroused great public interest in improving and restoring monocropping obstacles for specific soil problems. Methods: For this, a short-term cucumber cropping field experiment was conducted in the subtropical region of China under four fertilization treatments: ammonium (AN), nitrate (NN), ammonium with dicyandiamide (AN+DCD), nitrate with dicyandiamide (NN+DCD). In this study, we measured the effects of nitrogen forms addition on plant productivity and soil health in a monocropping system over seven seasons. Results: To systematically evaluate soil health, a wide range of soil environmental factors were measured and incorporated into the soil health index (SHI) by entropy method. Compared with ammonium treatment (SHIAN = 0.059, SHIAN+DCD = 0.081), the positive effect of nitrate was mainly reflected in improving soil health (SHINN = 0.097, SHINN+DCD = 0.094), which was positively correlated with the increase in plant productivity of cucumber after seven seasons of monocropping. The most critical factor affecting SHI is soil ammonium nitrogen content, which was negatively correlated with plant productivity. Discussion: Nitrate promotes soil health and plant productivity by optimizing soil environmental factors. The study thus emphasized the necessity of nitrate input for the sustenance of soil-crop ecosystems, with the consequent possibility of application of the results in planning monoculture obstacle prevention and management measures.

InSb-based saturable absorbers for ultrafast photonic applications.

Sb-related III-V compounds have recently gained great research interest owing to their excellent optical and electrical characteristics, which provide many possibilities in photonics and electronics. This study investigated the application of InSb films in ultrafast photonics. An InSb film was fabricated on the tapered zone of a microfiber, and its saturation intensity, modulation depth, and non-saturable loss were determined as 119.8 MW cm-2, 23.5%, and 27.3%, respectively. The structure of the electronic band and density of states of InSb were theoretically calculated. Notably, mode-locked and Q-switched fiber lasers were realised by incorporating the InSb-microfiber device into two different Er-doped fiber cavities. In the Q-switching state, the narrowest pulse duration was measured as 1.756 µs with a maximum single-pulse energy of 221.95 nJ and a signal-to-noise ratio of 60 dB. In the mode-locking operation, ultrafast lasers with a high signal-to-noise ratio (70 dB), a pulse width as narrow as 265 fs and a repetition rate of 49.51 MHz were acquired. Besides, the second-harmonic mode-locked state was built with an output power of 13.22 mW. In comparison with the reported laser performance with 2D materials as saturable absorbers, the InSb-based mode-locked and Q-switched fiber lasers proposed herein exhibit better comprehensive performance.

Green construction and release mechanism of lignin-based double-layer coated urea.

BACKGROUND: Lignin played an important role in the establishment of coated fertilizers coating material as a substitute for petrochemical raw materials. However, so far, the lignin-based coated fertilizers was limited in only the poor slow-release performance. To achieve good slow-release performance of lignin-based coated fertilizers, hydrophilic of lignin need to be resolved to establish an green and better controllable lignin-based coated fertilizers. RESULTS: In the study, a novel green double layer coating with lignin-based polyurethane (LPU) as the inner coating and epoxy resin (EP) as the outer coating was effectively constructed for coated urea. Fourier transform infrared spectra confirmed that lignin and polycaprolactone diol successfully reacted with Hexamethylene diisocyanate. The loss weight and water contact angle (WCA, 75.6-63.6°) of the LPUs decreased with the increased lignin content. The average particle hardness of the lignin-based double-layer coated urea (LDCU) first increased from 58.1 N (lignin of 30%) to 67.0 N (lignin of 60%), but then decreased to 62.3 N (lignin of 70%). The release longevity of the coated urea was closely related to the preparation parameters of the coating material. The optimal cumulative nutrient release rate (79.4%) of LDCU was obtained (lignin of 50%, -CNO/-OH molar ratios of 1.15, EP of 35%, and coating ratio of 5%). The aggregates of hydrone on the LDCU caused the dissolution and swelling of nutrients, and then the diffusion of nutrients through the concentration gradient. CONCLUSIONS: A though the nutrient release of the LDCUs was affected by many factors, the successful development of the LDCUs will help improve the rapid development of the coated fertilizer industry.

Prevalence and associated factors of basilar artery dolichosis in patients with acute cerebral infarction.

Introduction: Little attention has been given to the factors associated with basilar artery (BA) dolichosis. This study aims to elucidate the prevalence and associated factors of BA dolichosis in patients with acute cerebral infarction (ACI). Methods: We collected the clinical and laboratory data of 719 patients with ACI admitted to our department. Magnetic resonance angiography was used to evaluate the geometric parameters of the BA and intracranial vertebral arteries (VAs). A BA curve length > 29.5 mm or bending length (BL) > 10 mm was identified as BA dolichosis. Univariate and multivariate logistic regression were performed to determine the factors associated with BA dolichosis. Results: Among 719 patients with ACI, 238 (33.1%) demonstrated BA dolichosis, including 226 (31.4%) with simple BA dolichosis and 12 (1.7%) with basilar artery dolichoectasia (BADE). Pearson correlation analyses showed that BA curve length was positively correlated with BL (r = 0.605). Multivariate logistic regression analysis demonstrated that current smoking (OR = 1.50, 95% CI: 1.02-2.21, p = 0.039), diabetes mellitus (OR = 1.66, 95% CI: 1.14-2.41, p = 0.008), BA diameter (OR = 3.04, 95% CI: 2.23-4.13, p < 0.001), BA bending (OR = 4.24, 95% CI: 2.91-6.17, p < 0.001) and BL (OR = 1.45, 95% CI: 1.36-1.55, p < 0.001) were significantly associated with BA dolichosis. Conclusion: This study suggests that BA dolichosis was common in patients with ACI, and the morphological parameters of the vertebrobasilar artery and acquired risk factors (including smoking and diabetes) were risk factors for BA dolichosis.

Reduced nutrient release and greenhouse gas emissions of lignin-based coated urea by synergy of carbon black and polysiloxane.

An advanced hydrophobic lignin-based polyurethane coated urea (HLPCU) was successfully developed by synergy of carbon black (CB) and polysiloxane. In this work, CB and polysiloxane were employed to modify the liquefied lignin-based polyurethane (LLPU) and improve it's the hydrophobicity. The effects of polysiloxane contents and coating rates on the nutrient release of HLPCU were thoroughly investigated. The lignin was degraded into polyol with a low molecular weight. FT-IR, XPS and EDX results confirmed that polysiloxane was grafted to the LLPU. The water contact angle (WCA) of the HLPUs (89.39°-98.68°) gradually increased as the polysiloxane content rose (5 %-15 %). However, when the polysiloxane content further increased to 20 %, the WCA of the HLPUs rapidly declined (90.82°). A proper amount of polysiloxane molecules could increase thermo-physical properties of LLPU. The almost no pores were observed on the section micrograph of the HLPCU obtained by synergy of CB and polysiloxane. Synergy between CB and polysiloxane could significantly improve hydrophobicity and then enhance N release longevity of HLPCU (polysiloxane content of 15 %, coating rates of 7 %) up to 44 days. Compared to traditional urea, HLPCU could improve total N use efficiency the cabbage. The HLPCU and HLPCU85 treatments (15 % weight loss with fertilization) reduced the greenhouse effect of N2O, CO2 and CH4 and finally reduced GWP, especially for HLPCU85 treatment. This work will supply an advanced approach and process technology for progress of HLPCU and sustainable agriculture.

GaSb Film is a Saturable Absorber for Dissipative Soliton Generation in a Fiber Laser.

Nanotechnology is at the forefront of scientific research and offers great prospects for the development of technology. As a type of III-V semiconductor, GaSb materials exhibit numerous outstanding optical and electrical characteristics that are very promising for nonlinear optical device applications. In this study, the electronic band structures of GaSb are theoretically calculated, and its application in dissipative soliton fiber lasers is validated. A GaSb thin film is deposited on a microfiber using magnetron sputtering deposition, and the morphology, chemical composition, structure, and nonlinear optical characteristics of the proposed microfiber-GaSb device are investigated. After incorporating it into an Er-doped fiber laser, dissipative soliton laser pulses are readily obtained with a fundamental frequency of 43.5 MHz. With increasing pump power, the fiber laser could work in the fundamental frequency mode-locking state. At a pump power of 570 mW, the pulse width and the output power are measured to be 917 fs and 49.75 mW, separately. These results reveal that GaSb can be used as an efficient saturable absorber, which will have potential applications in ultrafast optics.

Environmentally friendly preparation of lignin/paraffin/epoxy resin composite-coated urea and evaluation for nitrogen efficiency in lettuce.

Novel lignin/paraffin/epoxy resin composite coated urea (LPECCU) was successfully prepared. Paraffin and epoxy resin (ER) were used to improve the slow-release properties of the lignin-based polyurethane (LPU) coated urea. The relationships among the N release characteristics, liquid-solid rate, -CNO/-OH molar rate and film formation rate in the coating material of LPECCU were investigated. The results showed that the water contact angle (WCA) of the LPU-paraffin increased with the rate of liquid-solid rate (73.61-88.19°) and -CNO/-OH molar rate (65.17-82.24°) increased. The average particle hardness of LPECCU decreased with the increased of liquid-solid rate (57.10-66.80 N) and the reduced of -CNO/-OH molar rate (48.11-63.00 N). The LPECCU emerged compact micro-structure, low sustained release and high compressive resistance by adding paraffin and ER. The coating material of LPECCU appeared excellent biodegradability in the soil. The optimal N cumulative release rate (72.49 %) of LPECCU was obtained (liquid-solid rate of 1.43, -CNO/-OH molar rate of 2, and the film formation rate of 6.66 %). The lettuce growth study was conducted to further evaluate the pot application of the LPECCU. In comparison to conventional urea, LPECCU could improve the total dry matter accumulation and N use efficiency of the lettuce.

Effects of water cooling on laser-induced thermal damage in rat hepatectomy.

PURPOSE: High-powered lasers are commonly used for tissue resection in surgeries, including liver resection, medically known as hepatectomy; however, such lasers inevitably induce thermal damage that causes postoperative complications. This study aims to explore the effects of water cooling and different laser output modes on laser-induced thermal damage during hepatectomy. METHODS: To avoid the influence of superposition, a 980-nm diode laser was used for a single-point hepatectomy. Eighteen Sprague-Dawley rats were used to explore the effects of water cooling and different laser output modes. A constant energy 10-J laser was used to cut the liver tissue with a power of 10 W and time of 1 second. The rats were randomly divided into six groups. The first three groups were assigned as test subjects for different laser output modes. Group 1 was operated with a continuous laser output for a duration of 1 second. Groups 2 and 3 were operated with a pulsed laser output for a duration of 1 second and a pulse width of 0.5 and 0.25 seconds, respectively. Groups 4, 5, and 6 were assigned for the water cooling test. Water cooling was performed based on the parameters of the first three groups. Medical saline (0.9% NaCl) was used for water cooling. The main observation indicators were resection efficiency and thermal damage, including the area of the thermal damage zone. Resection efficiency is calculated by dividing the resection area by the total thermal damage area. RESULTS: In the three water cooling groups, the area of the resection, carbonized, sub-boiling coagulated, and total thermal damage zones were 0.0677, 0.00, 1.7293, and 2.2982 mm2 in Group 4; 0.0465, 0.00, 1.3205, and 1.8414 mm2 in Group 5; and 0.0565, 0.00, 1.4301, and 1.9650 mm2 in Group 6, respectively. Compared with the first three groups, the water cooling groups exhibited significantly reduced thermal damage areas of in the carbonized, sub-boiling coagulated, and total thermal damage zones (p < 0.001 for all). In addition, there was no statistical difference in the resection area, vacuolated area, and resection efficiency. Furthermore, there was no statistical difference in the area of each thermal damage zone between the continuous and pulsed output groups. The resection efficiencies were 4.82%, 3.34%, 3.73%, 3.93%, 3.36%, and 3.01% in Groups 1 to 6, respectively. Moreover, there was no statistical difference (p > 0.05) in the resection efficiencies. CONCLUSION: Water cooling can reduce the total laser-induced thermal damage area and prevent tissue carbonization. Therefore, this cooling method can be used as a simple and safe strategy for controlling thermal damage during hepatectomy.

Adhesive anastomosis for organ transplantation.

The recent development of tough tissue adhesives has stimulated intense interests among material scientists and medical doctors. However, these adhesives have seldom been tested in clinically demanding surgeries. Here we demonstrate adhesive anastomosis in organ transplantation. Anastomosis is commonly conducted by dense sutures and takes a long time, during which all the vessels are occluded. Prolonged occlusion may damage organs and even cause death. We formulate a tough, biocompatible, bioabsorbable adhesive that can sustain tissue tension and pressurized flow. We expose the endothelial surface of vessels onto a gasket, press two endothelial surfaces to the adhesive using a pair of magnetic rings, and reopen the bloodstream immediately. The time for adhesive anastomosis is shortened compared to the time for sutured anastomosis. We have achieved adhesive anastomosis of a great vein in transplanting the liver of a pig. After the surgery, the adhesive is absorbed, the vein heals, and the pig lives for over one month.

Near-infrared fluorescence imaging with indocyanine green for assessment of donor livers in a rat model of ischemia-reperfusion.

BACKGROUND: Although marginal donor livers expand the donor pool, an ideal method for quantitatively evaluating the quality of donor livers has not been developed. This study aimed to explore the feasibility of indocyanine green (ICG) fluorescence imaging for estimating liver function in an ischemia-reperfusion model. METHODS: Forty-eight rats were randomly and evenly divided into 8 groups: the control group and the experimental groups (I-VII). The portal vein blocking period was 0 min, 10 min, 20 min, 30 min, 40 min, 50 min and 60 min. After blood flow was reestablished and the hemodynamics stabilized, ICG was injected through the dorsal penile vein as a bolus, and the fluorescence signal was recorded for 30 min in real time. The fluorescence intensity (FI) curve of the liver was fitted with an asymptotic regression model. Fresh liver tissues and serum were obtained from the middle lobe of the liver on postoperative day (POD) 1 and POD 7 for histopathological evaluation and liver function tests. RESULTS: The growth rate of the FI curve, parameter b3, decreased from groups I to VII. According to the two sudden changes in b3 (20 min, 50 min), the experimental groups could be classified into 3 groups (A, B and C). Hepatocytes in groups I-II showed slight edema, group III began to show obvious hepatocyte edema and vacuolar degeneration, and in groups VI-VII, severe hepatocyte degeneration, necrosis and large inflammatory cell infiltration were observed. Suzuki's scores in the 3 groups were also significantly different (P < 0.01). At the same time, the serum liver function in the experimental groups showed a significant increase on POD 1 and a decrease on POD 7. The alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels of groups A, B, and C were significantly different on POD 1 (P < 0.05), and the ALT and direct bilirubin (DB) levels were significantly different on POD 7 (P < 0.05); the lactic dehydrogenase (LDH) level of the group C was significantly higher than that of the groups A and B on POD 1 and POD 7. Meanwhile, the 7-day survival rate of the rats in group C was poor compared to that of the rats in groups A and B (58.3% vs. 100% vs. 100%). CONCLUSION: ICG fluorescence imaging is effective for estimating the degree of liver damage and grading in an ischemia-reperfusion model. It probably has the potential for use in assessing the quality of the donor liver in liver transplantation.

Magnetic-assisted laparoscopic liver transplantation in swine.

BACKGROUND: Although laparoscopic technology has achieved rapid development in the surgical field, it has not been applied to liver transplantation, primarily because of difficulties associated with laparoscopic vascular anastomosis. In this study, we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs. METHODS: Two sets of magnetic vascular anastomosis rings (MVARs) with different diameters were developed. One set was used for anastomosis of the suprahepatic vena cava (SHVC) and the other set was used for anastomosis of the infrahepatic vena cava (IHVC) and portal vein (PV). Six laparoscopic orthotopic liver transplantations were performed in pigs. Donor liver was obtained via open surgery. Hepatectomy was performed in the recipients through laparoscopic surgery. Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis, and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance. RESULTS: Liver transplants were successfully performed in five of the six cases. Postoperative ultrasonographic examination showed that the portal inflow was smooth. However, PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other. The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13 ± 5 vs. 5 ± 1 min (P < 0.01) and 10 ± 2 vs. 4 ± 1 min (P < 0.05), respectively. The durations of MVAR anastomosis in the laparoscope group and manual assistance group for IHVC and PV were 5 ± 1 vs. 1 ± 1 min (P < 0.01), and 5 ± 1 vs. 1 ± 1 min (P < 0.01), respectively. The anhepatic phase was 43 ± 4 min in the laparoscope group and 23 ± 2 min in the manual assistance group (P < 0.01). CONCLUSIONS: Our study showed that magnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.

One-stage CNN detector-based benthonic organisms detection with limited training dataset.

In this paper, focusing on the challenges in unique shape dimension and limited training dataset of benthonic organisms, an one-stage CNN detector-based benthonic organisms detection (OSCD-BOD) scheme is proposed. Main contributions are as follows: (1) The regression loss between the predicted bounding box and ground truth box is innovatively measured by the generalized intersection over union (GIoU), such that localization accuracy of benthonic organisms is dramatically enhanced. (2) By devising K-means-based dimension clustering, multiple benthonic organisms anchor boxes (BOAB) sufficiently exploring a priori dimension information can be finely derived from limited training dataset, and thereby significantly promoting the recall ability. (3) Geometric and color transformations (GCT)-based data augmentation technique is further resorted to not only efficiently prevent over-fitting training but also to significantly enhance detection generalization in complex and changeable underwater environments. (4) The OSCD-BOD scheme is eventually established in a modular manner by integrating GIoU, BOAB and GCT functionals. Comprehensive experiments and comparisons sufficiently demonstrate that the proposed OSCD-BOD scheme outperforms typical approaches including Faster R-CNN, SSD, YOLOv2, YOLOv3 and CenterNet in terms of mean average precision by 6.88%, 10.92%, 12.44%, 3.05% and 1.09%, respectively.

Ultrafast Photonics of Ternary RexNb(1-x)S2 in Fiber Lasers.

Two-dimensional (2D) transition metal chalcogenides (TMCs) become more attractive upon addition of a third element owing to their unique structure and remarkable physical and chemical properties, which endow these materials with considerable potential for applications in nanoscale devices. In this work, a RexNb(1-x)S2-based saturable absorber (SA) device for ultrafast photonics applications is studied. The device is assembled by placing RexNb(1-x)S2 nanosheets with a thickness of 1-3 nm onto a microfiber to increase their compatibility with an all-fiber laser cavity. The prepared RexNb(1-x)S2-based device exhibits a modulation depth of 24.3%, a saturation intensity of 10.1 MW/cm2, and a nonsaturable loss of 28.5%. Furthermore, the RexNb(1-x)S2-based device is used to generate ultrashort pulses in an erbium-doped fiber (EDF) laser cavity. At a pump power of 260 mW, the EDF laser operates in a conventional soliton mode-locked region. The pulse width is 285 fs, and the repetition frequency is 61.993 MHz. In particular, the bound-state soliton mode-locking operation is successfully obtained in a pump power range of 300-900 mW. The bound-state pulses are formed by doubling identical solitons with a temporal interval of 0.8 ps. The output power is as high as 47.9 mW, and the repetition frequency is 123.61 MHz. These results indicate that the proposed RexNb(1-x)S2-based SAs have comparable properties to currently used 2D SAs and provide a basis for their application in the field of ultrafast photonics.

[Design and Feasibility Study of Tracheal Intubation Device Based on Magnetic Navigation Technology].

OBJECTIVE: In the context of coronavirus disease 2019 (COVID-19) pandemic, the subject was designed to develop a new tracheal intubation device based on magnetic navigation technology to improve the success rate of tracheal intubation and reduce the risk of occupational exposure of medical staff. METHODS: The new tracheal intubation device was designed with the uniqueness of the magnetic field environment and magnetic steering of magnetic navigation technology. And preliminary magnetic navigation tracheal intubation experiments were performed on the tracheal intubation simulator. RESULTS: Magnetic navigation tracheal intubation can successfully implement tracheal intubation, and the time required is lower than that of traditional laryngoscopy. CONCLUSIONS: The tracheal intubation based on magnetic navigation technology is feasible, with high efficiency and easy operation. That is expected to be widely used for tracheal intubation during treatment of patients outside the hospital in the future. At the same time, magnetic navigation endotracheal intubation technology will be the key technology for the development of endotracheal intubation robots.

Vanadium disulfide for ultrafast photonic application.

The investigation of two-dimensional (2D) nonlinear optical materials offers a promising way to construct the high-performance optical devices in fundamental and industrial applications because of their rich distinct optoelectronic properties. Herein, by utilizing the liquid exfoliation method, vanadium disulfide (VS2) nanosheets are prepared and the thickness is measured to be 3.16 nm. In addition, we have fabricated the VS2-based optical device and the nonlinear optical property is characterized with modulation depth of 23.97%. By using VS2 as saturable absorber, a high stable passively mode-locking Er-doped fiber laser is obtained with pulse duration of 169 fs and the largest average output power of 70.5 mW. The slope efficiency is up to 7.9%. In comparison to recent results of mode-locking fiber lasers with 2D materials, the VS2-based fiber laser demonstrates better performance. To the best of our knowledge, this is the first example of using VS2 for generating femtosecond mode-locked laser pulse. Our experimental results not only reveal VS2 ultrafast photonics application, but also advance the high-performance applications for information science and nonlinear optics.

Fungal endocarditis with heart valve replacement and atrial fibrillation posing a treatment challenge: A case report.

RATIONALE: Fungal endocarditis (FE) is a rare disease, in which antifungal treatment is necessary. When FE is complicated with prosthetic heart valve and/or atrial fibrillation, the coadministration of antifungal agents and warfarin is inevitable. We report a case of rheumatic heart disease with atrial fibrillation who developed FE following prosthetic heart valve replacement. The international normalized ratio (INR) increased significantly during the antifungal treatment with fluconazole. A discussion of the antifungal strategy in FE patients with prosthetic heart valves and/or atrial fibrillation and the interaction between antifungal agents and warfarin was performed. PATIENT CONCERNS: A 54-year-old Chinese woman experienced intermittent fevers, aphemia, and weakness in her right extremities. Her temperature was 38.7°C, and there was atrial fibrillation with heart rate 110 times/min. Neurological examination revealed that she had drowsiness, Broca aphasia, right central facial paralysis, and hemiplegia (Medical Research Council scale, upper limb grade 0, lower limb grade II). DIAGNOSES: Multiple infarction on magnetic resonance imaging and the occlusion of left middle cerebral artery suggested the occurrence of cerebral embolism. The presence of Candida parapsilosis in the results of 4 blood cultures and the existence of valve vegetation in the reexamination of echocardiogram supported the diagnosis of FE. INTERVENTIONS: The patient was given antifungal therapy with fluconazol. The INR increased dramatically on the 9th day of antifungal treatment, and subcutaneous bruising occurred at the intravenous infusion site. The antagonist of vitamin K1 was used and warfarin was reduced to a smaller dosage. The antifungal agent was replaced with caspofungin. OUTCOMES: Her speech improved significantly, and the muscle strength of her paralyzed side reached the Medical Research Council scale of grade IV. She continued to receive caspofungin for antifungal treatment with relatively stable INR and waited for heart valve surgery. LESSONS: The choice of antifungal agents is often a big challenge for FE patients, especially when they need warfarin for anticoagulation. It is better to administer a low dose of warfarin while carefully monitoring the INR or choose the antifungal drugs with little or no effect on warfarin.

A novel compound heterozygous KCNJ1 gene mutation presenting as late-onset Bartter syndrome: Case report.

RATIONALE: Bartter syndrome is an autosomal-recessive inherited disease in which patients present with hypokalemia and metabolic alkalosis. We present 1 case with Bartter syndrome, due to a novel compound heterozygous mutation in the KCNJ1 gene encoding the ATP-sensitive inward rectifier potassium channel in the thick ascending limb of the loop of Henle. PATIENT CONCERNS: A patient was admitted to our hospital because of weakness, polyuria, and polydipsia. At presentation to our hospital, the female Chinese patient was 34 years old and her physical examination was normal. Laboratory studies revealed hypokalemia, metabolic alkalosis, hypercalciuria, hyperparathyroidemia, and hyper-reninemia. In addition, urinary potassium was obviously higher. Computer tomography scan confirmed the patient had the bilateral medullary nephrocalcinosis. DIAGNOSIS: Blood samples were received from the patient and her parents, and deoxyribonucleic acid was extracted. The genetic analysis of SLC12A1, SLC12A3, KCNJ1, CLCNKB, BSND, and CASR was performed. The compound heterozygous KCNJ1 gene mutation was validated using conventional Sanger sequencing methods. INTERVENTIONS: The patient was treated with potassium supplementation. Her blood and urine chemistries improved over the next week. Serum potassium normalized with improvement in polyuria and polydipsia over the next month. OUTCOMES: Our patient was compound heterozygous for Thr234Ile and Thr71Met in the KCNJ1 gene. The c.701C>T variant predicted a change from a threonine codon to an isoleucine codon (p.Thr234Ile). The c.212C>T variant predicted a change from a threonine codon to a methionine codon (p.Thr71Met). The unaffected mother was heterozygous for the Thr234Ile mutation, whereas unaffected father was heterozygous for the Thr71Met mutation. LESSONS: The phenotypes of the patient were similar to other patients with Bartter syndrome. The phenotypes of the patient could eventually be explained by the presence of the novel compound heterozygous p.Thr234Ile/p.Thr71Met variants in the KCNJ1 gene.

Atypical "nine" syndrome in bilateral pontine infarction: A case report.

RATIONALE: "Nine" syndrome, that is "eight-and-a-half" syndrome associated with hemiplegia and hemidysesthesia, is a rare disorder. This study aimed to report a Chinese patient with acute bilateral pontine infarction manifesting as eight-and-a-half syndrome plus hemiplegia (atypical nine syndrome), and also the clinical and neuroimaging findings were explained and discussed with review of the literature. PATIENT CONCERNS: A 79-year-old woman experienced sudden vertigo, nausea, vomiting, and weakness at her left arm and leg. The neurological examination disclosed her right horizontal gaze palsy, internuclear ophtalmoplegia (INO), and right-sided peripheral facial paralysis combined with slight left-sided hemiplegia, which were consistent with atypical nine syndrome. DIAGNOSES: Cranial magnetic resonance imaging (MRI) displayed acute multiple ischemic infarction, involving bilateral pontine tegmentum, basilar part of right paramedian pontine, and left cerebellar hemisphere. Intracranial MR angiography (MRA) revealed right middle cerebral artery occlusion, no clear visualization of bilateral vertebral arteries, and basilar artery hypoplasia with stenotic segments. INTERVENTIONS: Thrombolysis could not be performed due to the time window. The patient was given low molecular weight heparin for anticoagulation because of posterior circulation and progressive stroke. OUTCOMES: The vertigo disappeared, and a notable improvement with minimal restriction in the right horizontal gaze and partial relief of her facial paralysis were found at discharge, while her left hemiparesis was fully resolved. No recurrence of cerebral infarction was observed during follow-up as well. LESSONS: This case report with atypical nine syndrome is fairly rare. Nine syndrome may refer to the lesion located in unilateral tegmentum of the caudal pontine plus paramedian pontine, with an important localization value.