Nasal cavity fungus ball discovered accidentally:A case report

BACKGROUND Fungal balls within the nasal cavity are an exceedingly rare clinical entity,typically presenting with nonspecific symptoms or being identified incidentally.CASE SUMMARY This report presents an incidental discovery of a fungal ball in the nasal cavity during routine imaging,with no associated clinical symptoms.CONCLUSION This case underscores the importance of considering the possibility of asympto-matic presentations of nasal fungal balls,which may be detected incidentally during imaging evaluations.

The contribution of gender and age on early and late mortality following ST-segment elevation myocardial infarction： results from the Korean Acute Myocardial Infarction National Registry with Registries

Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction （STEMI）, are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide regis-try. Methods This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early （30 days） and late （12 months） mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women （〈 60 years）, in-hospital [5.8% vs. 2.5%, P 〈 0.001; unadjusted odds ratios （OR）： 2.41, 95% confidence inter-vals （CI）： 1.59-3.66], early （6.2% vs. 2.6%, P 〈 0.001; unadjusted OR： 2.4, 95% CI： 2.12-2.72） and late mortality （7.0% vs. 3.1%, P 〉 0.001; unadjusted OR： 2.33, 95% CI： 2.08-2.61） were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer re-lated to gender in any age groups. Conclusions Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for yotmger women should be performed.

A Multi-Center International Survey Related to the Nutritional Support after Hematopoietic Stem Cell Transplantation Endorsed by the ASIA Pacific Blood and Marrow Transplantation (APBMT)

Background: The nutritional support after hematopoietic stem cell transplantation (HSCT) has not been well established due to the scarcity of clinical trials. To conduct international clinical trials in Asia, we performed the questionnaire survey to investigate the current standard of nutritional support after HSCT. Method: We sent the questionnaire to the physicians nominated by the Asia Pacific Blood and Marrow Transplantation (APBMT) members of each country/ region. Result: We received 15 responses from 7 different countries/regions. The target calorie amount is 1.0 - 1.3 × basal energy expenditure (BEE) in 11 institutes when partial parenteral nutrition is used. When total parenteral nutrition (TPN) is used, the target calorie amount is 1.0 - 1.3 × BEE in 9 institutes and 1.3 - 1.5 × BEE in 4 institutes. Lipid emulsion is routinely used in 12 institutes. Multivitamins and trace elements are routinely added to TPN used in most institutes. It is still uncommon to use the immunonutrition. Blood glucose levels are routinely monitored in all institutes, but the target range varies (<110 in 2 institutes, <150 in 4 institutes, and <200 in 8 institutes). Conclusions: Basic nutritional support is similar in participating institutes. However, the target glucose level varies and the use of immunonutrition is rather rare. These points can be the theme of future clinical trials.

Study protocol of the Asian XELIRI ProjecT(AXEPT):a multinational,randomized,non-inferiority,phase Ⅲ trial of second-line chemotherapy for metastatic colorectal cancer, comparing the eicacy and safety of XELIRI with or without bevacizumab versus FOLFIRI w

Background: Capecitabine and irinotecan combination therapy(XELIRI) has been examined at various dose levels to treat metastatic colorectal cancer(m CRC). Recently, in the Association of Medical Oncology of the German Cancer Society(AIO) 0604 trial, tri?weekly XELIRI plus bevacizumab, with reduced doses of irinotecan(200 mg/m^2 on day 1) and capecitabine(1600 mg/m^2 on days 1–14), repeated every 3 weeks, has shown favorable tolerability and eicacy which were comparable to those of capecitabine and oxaliplatin(XELOX) plus bevacizumab. The doses of capecit?abine and irinotecan in the AIO trial are considered optimal. In a phase I/II study, XELIRI plus bevacizumab(BIX) as second?line chemotherapy was well tolerated and had promising eicacy in Japanese patients.Methods: The Asian XELIRI Projec T(AXEPT) is an East Asian collaborative, open?labelled, randomized, phase Ⅲ clinical trial which was designed to demonstrate the non?inferiority of XELIRI with or without bevacizumab versus standard FOLFIRI(5?fluorouracil, leucovorin, and irinotecan combination) with or without bevacizumab as second?line chemo?therapy for patients with m CRC. Patients with 20 years of age or older, histologically conirmed m CRC, Eastern Coop?erative Oncology Group performance status 0–2, adequate organ function, and disease progression or intolerance of the irst?line regimen will be eligible. Patients will be randomized(1:1) to receive standard FOLFIRI with or with?out bevacizumab(5 mg/kg on day 1), repeated every 2 weeks(FOLIRI arm) or XELIRI with or without bevacizumab(7.5 mg/kg on day 1), repeated every 3 weeks(XELIRI arm). A total of 464 events were estimated as necessary to show non?inferiority with a power of 80% at a one?sided α of 0.025, requiring a target sample size of 600 patients. The 95% conidence interval(CI) upper limit of the hazard ratio was pre?speciied as less than 1.3.Conclusion: The Asian XELIRI Projec T is a multinational phase III trial being conducted to provide evidence for XELIRI with or without bevacizumab as a second?line treatment option of mCRC.

Construction of a High‑Performance Composite Solid Electrolyte Through In‑Situ Polymerization within a Self‑Supported Porous Garnet Framework

Composite solid electrolytes(CSEs)have emerged as promising candidates for safe and high-energy–density solid-state lithium metal batteries(SSLMBs).However,concurrently achieving exceptional ionic conductivity and interface compatibility between the electrolyte and electrode presents a significant challenge in the development of high-performance CSEs for SSLMBs.To overcome these challenges,we present a method involving the in-situ polymerization of a monomer within a self-supported porous Li_(6.4)La_(3)Zr_(1.4)Ta_(0.6)O_(12)(LLZT)to produce the CSE.The synergy of the continuous conductive LLZT network,well-organized polymer,and their interface can enhance the ionic conductivity of the CSE at room temperature.Furthermore,the in-situ polymerization process can also con-struct the integration and compatibility of the solid electrolyte–solid electrode interface.The synthesized CSE exhibited a high ionic conductivity of 1.117 mS cm^(-1),a significant lithium transference number of 0.627,and exhibited electrochemical stability up to 5.06 V vs.Li/Li+at 30℃.Moreover,the Li|CSE|LiNi_(0.8)Co_(0.1)Mn_(0.1)O_(2) cell delivered a discharge capacity of 105.1 mAh g^(-1) after 400 cycles at 0.5 C and 30℃,corresponding to a capacity retention of 61%.This methodology could be extended to a variety of ceramic,polymer electrolytes,or battery systems,thereby offering a viable strategy to improve the electrochemical properties of CSEs for high-energy–density SSLMBs.

Understanding the spectrum of non-motor symptoms in multiple sclerosis:insights from animal models

Multiple sclerosis is a chronic autoimmune disease of the central nervous system and is generally considered to be a non-traumatic,physically debilitating neurological disorder.In addition to experiencing motor disability,patients with multiple sclerosis also experience a variety of nonmotor symptoms,including cognitive deficits,anxiety,depression,sensory impairments,and pain.However,the pathogenesis and treatment of such non-motor symptoms in multiple scle rosis are still under research.Preclinical studies for multiple sclerosis benefit from the use of disease-appropriate animal models,including experimental autoimmune encephalomyelitis.Prior to understanding the pathophysiology and developing treatments for non-motor symptoms,it is critical to chara cterize the animal model in terms of its ability to replicate certain non-motor features of multiple sclerosis.As such,no single animal model can mimic the entire spectrum of symptoms.This review focuses on the non-motor symptoms that have been investigated in animal models of multiple sclerosis as well as possible underlying mechanisms.Further,we highlighted gaps in the literature to explain the nonmotor aspects of multiple sclerosis in expe rimental animal models,which will serve as the basis for future studies.

Surface engineering of ZnO electrocatalyst by N doping towards electrochemical CO_(2) reduction

The discovery of efficient,selective,and stable electrocatalysts can be a key point to produce the largescale chemical fuels via electrochemical CO_(2) reduction(ECR).In this study,an earth-abundant and nontoxic ZnO-based electrocatalyst was developed for use in gas-diffusion electrodes(GDE),and the effect of nitrogen(N)doping on the ECR activity of ZnO electrocatalysts was investigated.Initially,a ZnO nanosheet was prepared via the hydrothermal method,and nitridation was performed at different times to control the N-doping content.With an increase in the N-doping content,the morphological properties of the nanosheet changed significantly,namely,the 2D nanosheets transformed into irregularly shaped nanoparticles.Furthermore,the ECR performance of Zn O electrocatalysts with different N-doping content was assessed in 1.0 M KHCO_(3) electrolyte using a gas-diffusion electrode-based ECR cell.While the ECR activity increased after a small amount of N doping,it decreased for higher N doping content.Among them,the N:ZnO-1 h electrocatalysts showed the best CO selectivity,with a faradaic efficiency(FE_(CO))of 92.7%at-0.73 V vs.reversible hydrogen electrode(RHE),which was greater than that of an undoped Zn O electrocatalyst(FE_(CO)of 63.4%at-0.78 V_(RHE)).Also,the N:ZnO-1 h electrocatalyst exhibited outstanding durability for 16 h,with a partial current density of-92.1 mA cm^(-2).This improvement of N:ZnO-1 h electrocatalyst can be explained by density functional theory calculations,demonstrating that this improvement of N:ZnO-1 h electrocatalyst comes from(ⅰ)the optimized active sites lowering the free energy barrier for the rate-determining step(RDS),and(ⅱ)the modification of electronic structure enhancing the electron transfer rate by N doping.

The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest

The global incidence rates of in-hospital cardiac arrest(IHCA)range from1.2 to 9.0 per1,000 hospitalized patients,as per the National Cardiac Arrest Database.[1] While IHCAs tend to exhibit superior 30-day survival rates relative to out-of-hospital cardiac arrests (OHCA) due to situational advantages,such as immediate access to medical personnel and treatments.

Abnormal State Detection in Lithium-ion Battery Using Dynamic Frequency Memory and Correlation Attention LSTM Autoencoder

This paper addresses the challenge of identifying abnormal states in Lithium-ion Battery(LiB)time series data.As the energy sector increasingly focuses on integrating distributed energy resources,Virtual Power Plants(VPP)have become a vital new framework for energy management.LiBs are key in this context,owing to their high-efficiency energy storage capabilities essential for VPP operations.However,LiBs are prone to various abnormal states like overcharging,over-discharging,and internal short circuits,which impede power transmission efficiency.Traditional methods for detecting such abnormalities in LiB are too broad and lack precision for the dynamic and irregular nature of LiB data.In response,we introduce an innovative method:a Long Short-Term Memory(LSTM)autoencoder based on Dynamic Frequency Memory and Correlation Attention(DFMCA-LSTM-AE).This unsupervised,end-to-end approach is specifically designed for dynamically monitoring abnormal states in LiB data.The method starts with a Dynamic Frequency Fourier Transform module,which dynamically captures the frequency characteristics of time series data across three scales,incorporating a memory mechanism to reduce overgeneralization of abnormal frequencies.This is followed by integrating LSTM into both the encoder and decoder,enabling the model to effectively encode and decode the temporal relationships in the time series.Empirical tests on a real-world LiB dataset demonstrate that DFMCA-LSTM-AE outperforms existing models,achieving an average Area Under the Curve(AUC)of 90.73%and an F1 score of 83.83%.These results mark significant improvements over existing models,ranging from 2.4%–45.3%for AUC and 1.6%–28.9%for F1 score,showcasing the model’s enhanced accuracy and reliability in detecting abnormal states in LiB data.

The Machine Learning Ensemble for Analyzing Internet of Things Networks:Botnet Detection and Device Identification

The rapid proliferation of Internet of Things(IoT)technology has facilitated automation across various sectors.Nevertheless,this advancement has also resulted in a notable surge in cyberattacks,notably botnets.As a result,research on network analysis has become vital.Machine learning-based techniques for network analysis provide a more extensive and adaptable approach in comparison to traditional rule-based methods.In this paper,we propose a framework for analyzing communications between IoT devices using supervised learning and ensemble techniques and present experimental results that validate the efficacy of the proposed framework.The results indicate that using the proposed ensemble techniques improves accuracy by up to 1.7%compared to single-algorithm approaches.These results also suggest that the proposed framework can flexibly adapt to general IoT network analysis scenarios.Unlike existing frameworks,which only exhibit high performance in specific situations,the proposed framework can serve as a fundamental approach for addressing a wide range of issues.

Combined Insights from Leachate Structure and Microstructure Characteristics for Eating Quality of Convenience Rice Processed by Super-Heated and Pressurized Steam Technologies

Convenience rice has become widely popular due to its easy availability for cooking. This study investigated the starch structure and composition of leachate and the microstructure of reheated convenience rice using novel processing technologies: super-heated steaming(SHS), auto-electric cooking(AEC), and pressurized-steam cooking(PSC). Additionally, the effect of two different target water contents(58% and 63%) was also evaluated. The PSC_63% sample had the highest total solids and amylopectin amount in the leachate. The amylopectin amount in the leachate differed significantly based on the targeted water content. Morphological characterization revealed that the swelling of starch and the coated layer on the surface of rice grains were most pronounced in the PSC_63% sample due to the pressure processing. The textural hardness of the AEC_58% sample was much higher than that of the other samples. The PSC_63% sample had the highest textural adhesiveness value, which can be attributed to the highest amylopectin amount in the leachate. Sensory characterization showed that the PSC_63% sample had the highest glossiness, whiteness, moistness, and overall acceptability. The principal component analysis score plots presented substantial differences in the leachate and textural and sensory characteristics of reheated convenience rice among the different processing technologies.

Ruptured venous aneurysm associated with a dural arteriovenous fistula:Two case reports

BACKGROUND In general,venous aneurysm associated with dural arteriovenous fistula(dAVF)is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself.However,discrete saccular shaped venous aneurysm without angiographic evidence of venous hypertension arising from the draining vein,like cerebral arterial aneurysm,is quite rare and its pathomechanism remains unclear in patients with dAVF.CASE SUMMARY In this report,we present two cases of ruptured saccular venous aneurysms associated with dAVF without venous hypertension or venous ectasia.In both cases,significant curve or stenosis is observed in draining vein,which is located in just distal portion of the venous aneurysms.These aneurysms were successfully treated with a transarterial embolization.Underlying mechanism of venous aneurysms in these cases is discussed.CONCLUSION Although there is little doubt that hemodynamic stress has a critical role in the development of venous aneurysms in patients with dAVF,preceding venous hypertension or venous ectasia is not necessary for development and enlargement of venous aneurysms.Considering the significant risk of rupture,a careful review of draining vein features including tortuosity or stenosis is needed,especially in venous aneurysms without evidence of venous hypertension.

Recipient artery dissection during extracranial-intracranial bypass surgery:Two case reports

BACKGROUND Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is a valuable treatment for preventing ischemia and hemorrhage in occlusive cerebrovascular disease.Anastomosis site dissection is rarely reported among the various bypass-related complications.CASE SUMMARY In this case report,we describe two patients,who were 63-and 59-years-old with middle cerebral artery occlusion treated by STA-MCA bypass.During bypass surgery,the recipient M4 artery intima was dissected.We sacrificed the dissecting portion,and no complications occurred during the follow-up period.Postoperative brain imaging revealed improved brain perfusion.We report rare cases of recipient artery dissection located in the extracranial to intracranial bypass site,and we suggest atherosclerotic changes in the recipient artery and insufficient puncture as the causes.CONCLUSION Appropriate recipient artery selection is critical,and if dissection occurs,it is essential to sacrifice the dissecting portion quickly.

Meningioma originating from the superior petrosal vein without dural attachment:A case report

BACKGROUND Meningioma in the cerebellopontine angle(CPA)without dural attachment is extremely rare.We report a unique case of meningioma derived from the superior petrosal vein without dural attachment.CASE SUMMARY A 44-year-old right-handed woman presented with a two-month history of headache and tinnitus.Brain magnetic resonance imaging showed a well-defined contrast-enhancing lesion in the right CPA without a dural tail sign.Tumor resection was performed using a right retro sigmoid approach.A dural attachment was not seen at the tentorium or posterior surface of the petrous pyramid.The tumor was firmly adherent to the superior petrosal vein.The origin site was cauterized and resected with the preservation of the superior petrosal vein.A diagnosis of meningothelial meningioma was made.The patient’s headache and tinnitus gradually disappeared,and a recurrence was not observed five years after the surgery.CONCLUSION The rare occurrence of meningioma without dural attachment makes it difficult to determine dural attachment before surgery.The absence of dural attachment makes it easy to completely resect such tumors.Vessels related to tumors should be removed carefully,considering the possible presence of tumor stem cells in the microvessels.

Safety-Constrained Multi-Agent Reinforcement Learning for Power Quality Control in Distributed Renewable Energy Networks

This paper examines the difficulties of managing distributed power systems,notably due to the increasing use of renewable energy sources,and focuses on voltage control challenges exacerbated by their variable nature in modern power grids.To tackle the unique challenges of voltage control in distributed renewable energy networks,researchers are increasingly turning towards multi-agent reinforcement learning(MARL).However,MARL raises safety concerns due to the unpredictability in agent actions during their exploration phase.This unpredictability can lead to unsafe control measures.To mitigate these safety concerns in MARL-based voltage control,our study introduces a novel approach:Safety-ConstrainedMulti-Agent Reinforcement Learning(SC-MARL).This approach incorporates a specialized safety constraint module specifically designed for voltage control within the MARL framework.This module ensures that the MARL agents carry out voltage control actions safely.The experiments demonstrate that,in the 33-buses,141-buses,and 322-buses power systems,employing SC-MARL for voltage control resulted in a reduction of the Voltage Out of Control Rate(%V.out)from0.43,0.24,and 2.95 to 0,0.01,and 0.03,respectively.Additionally,the Reactive Power Loss(Q loss)decreased from 0.095,0.547,and 0.017 to 0.062,0.452,and 0.016 in the corresponding systems.

SUMS OF DUAL TOEPLITZ PRODUCTS ON THE ORTHOGONAL COMPLEMENTS OF FOCK-SOBOLEV SPACES

We consider dual Toeplitz operators on the orthogonal complements of the FockSobolev spaces of all nonnegative real orders.First,for symbols in a certain class containing all bounded functions,we study the problem of when an operator which is finite sums of the dual Toeplitz products is compact or zero.Next,for bounded symbols,we construct a symbol map and exhibit a short exact sequence associated with the C^(*)-algebra generated by all dual Toeplitz operators with bounded symbols.

Endoscopic ultrasound-guided tissue sampling induced pancreatic duct leak resolved by the placement of a pancreatic stent:A case report

BACKGROUND Pancreatic ductal leaks complicated by endoscopic ultrasonography-guided tissue sampling(EUS-TS)can manifest as acute pancreatitis.CASE SUMMARY A 63-year-old man presented with persistent abdominal pain and weight loss.Diagnosis:Laboratory findings revealed elevated carbohydrate antigen 19-9(5920 U/mL)and carcinoembryonic antigen(23.7 ng/mL)levels.Magnetic resonance imaging of the pancreas revealed an approximately 3 cm ill-defined space-occupying lesion in the inferior aspect of the head,with severe encasement of the superior mesenteric artery.Pancreatic ductal adenocarcinoma was confirmed after pathological examination of specimens obtained by EUS-TS using the fanning method.Interventions and outcomes:The following day,the patient experienced severe abdominal pain with high amylase(265 U/L)and lipase(1173 U/L)levels.Computed tomography of the abdomen revealed edematous wall thickening of the second portion of the duodenum with adjacent fluid collections and a suspicious leak from either the distal common bile duct or the main pancreatic duct in the head.Endoscopic retrograde cholangiopancreatography revealed dye leakage in the head of the main pancreatic duct.Therefore,a 5F 7 cm linear plastic stent was deployed into the pancreatic duct to divert the pancreatic juice.The patient’s abdominal pain improved immediately after pancreatic stent insertion,and amylase and lipase levels normalized within a week.Neoadjuvant chemotherapy was then initiated.CONCLUSION Using the fanning method in EUS-TS can inadvertently cause damage to the pancreatic duct and may lead to clinically significant pancreatitis.Placing a pancreatic stent may immediately resolve acute pancreatitis and shorten the waiting time for curative therapy.When using the fanning method during EUSTS,ductal structures should be excluded to prevent pancreatic ductal leakage.

The sex-specific associations between suicidality and post-traumatic stress disorder in patients with physical injuries

To theeditor:Post-traumatic stress disorder(PTSD)arises after traumatic experiences,presenting with symptoms like reliving trauma,avoidance of reminders,mood changes and increased arousal,significantly affecting life quality and daily functioning.1 A severe complication of PTSD is suicidality,notably contributing to the higher mortality among PTSD sufferers.

Cathode nanoarchitectonics with Na_(3)VFe_(0.5)Ti_(0.5)(PO_(4))_(3): Overcoming the energy barriers of multielectron reactions for sodium-ion batteries

High electrochemical stability and safety make Na+superionic conductor(NASICON)-class cathodes highly desirable for Na-ion batteries(SIBs).However,their practical capacity is limited,leading to low specific energy.Furthermore,the low electrical conductivity combined with a decline in capacity upon prolonged cycling(>1000 cycles)related to the loss of active material-carbon conducting contact regions contributes to moderate rate performance and cycling stability.The need for high specific energy cathodes that meet practical electrochemical requirements has prompted a search for new materials.Herein,we introduce a new carbon-coated Na_(3)VFe_(0.5)Ti_(0.5)(PO_(4))_(3)(NVFTP/C)material as a promising candidate in the NASICON family of cathodes for SIBs.With a high specific energy of∼457 Wh kg^(-1) and a high Na+insertion voltage of 3.0 V versus Na^(+)/Na,this cathode can undergo a reversible single-phase solid-solution and two-phase(de)sodiation evolution at 28 C(1 C=174.7 mAh g^(-1))for up to 10,000 cycles.This study highlights the potential of utilizing low-cost and highly efficient cathodes made from Earth-abundant and harmless materials(Fe and Ti)with enriched Na^(+)-storage properties in practical SIBs.

Development of immature ovarian teratoma after mature teratoma in a girl with familial ovarian teratoma:A case report

BACKGROUND Immature ovarian teratoma is a rare and aggressive neoplasm that affects young women.This report is the first to describe the development of immature teratoma after ovarian cystectomy for mature teratoma of the ovary in an adolescent female with a family history of ovarian teratoma.CASE SUMMARY A 16-year-old girl who had undergone bilateral ovarian cystectomy for mature teratomas 3 years ago showed bilateral adnexal tumors during her regular ultrasonography follow-up every 6 months.She received laparoscopic bilateral ovarian cystectomy,and final histopathology showed grade-1 immature teratoma of the left ovary and mature teratoma of the right ovary.Laparoscopic left salpingo-oophorectomy and staging procedures were performed again.Her mother,maternal aunt,and maternal grandmother had also received surgeries for mature ovarian teratomas.CONCLUSION It is important to have guidance on management of patient and family members with familial ovarian teratomas.