Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report

BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.

Risk prediction model for distinguishing Gram-positive from Gramnegative bacteremia based on age and cytokine levels:A retrospective study

BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or Gram-positive(G+).However,there is no risk prediction model for assessing whether bacteremia patients are infected with G-or G+pathogens.AIM To establish a clinical prediction model to distinguish G-from G+infection.METHODS A total of 130 patients with positive blood culture admitted to a single intensive care unit were recruited,and Th1 and Th2 cytokine concentrations,routine blood test results,procalcitonin and C-reactive protein concentrations,liver and kidney function test results and coagulation function were compared between G+and Ggroups.Least absolute shrinkage and selection operator(LASSO)regression analysis was employed to optimize the selection of predictive variables by running cyclic coordinate descent and K-fold cross-validation(K=10).The predictive variables selected by LASSO regression analysis were then included in multivariate logistic regression analysis to establish a prediction model.A nomogram was also constructed based on the prediction model.Calibration chart,receiver operating characteristic curve and decision curve analysis were adopted for validating the prediction model.RESULTS Age,plasma interleukin 6(IL-6)concentration and plasma aspartate aminotransferase concentration were identified from 57 measured variables as potential factors distinguishing G+from G-infection by LASSO regression analysis.Inclusion of these three variables in a multivariate logistic regression model identified age and IL-6 as significant predictors.In receiver operating characteristic curve analysis,age and IL-6 yielded an area under the curve of 0.761 and distinguished G+from G-infection with specificity of 0.756 and sensitivity of 0.692.Serum IL-6 and IL-10 levels were upregulated by more than 10-fold from baseline in the G-bacteremia group but by less than ten-fold in the G+bacteremia group.The calibration curve of the model and Hosmer-Lemeshow test indicated good model fit(P>0.05).When the decision curve analysis curve indicated a risk threshold probability between 0%and 68%,a nomogram could be applied in clinical settings.CONCLUSION A simple prediction model distinguishing G-from G+bacteremia can be constructed based on reciprocal association with age and IL-6 level.

Nedaplatin/Gemcitabine Versus Carboplatin/Gemcitabine in Treatment of Advanced Non-small Cell Lung Cancer: A Randomized Clinical Trial

Objective： To evaluate the efficacy and safety of nedaplatin/gemcitabine （NG） and carboplatin/gemcitabine （CG） in the management of untreated advanced non-small cell lung cancer （NSCLC）. Methods： Sixty-two patients with previously untreated advanced NSCLC were recruited between June 2006 and November 2007. Subjects were randomly assigned to the NG arm （n=30） and the CG arm （n=32）. Only patients （24 and 25 in the NG and CG arms, respectively） who completed 〉2 chemotherapy cycles were included in the data analysis. The primary outcome measure was the objective response rate （ORR）. The secondary outcome measures included progression-free survival （PFS）, overall survival （OS） and adverse events. Results： There were no statistically significant differences in the efficacy measures （ORR, P=0.305; median PFS, P=0.298, median OS, P=0.961） or in the major adverse events （grade 3/4 neutropenia, P=0.666; grade 3/4 anemia, P=0.263; grade 3/4 thrombocytopenia, P=0.222） between the two treatment arms. However, there was a trend towards higher ORR （37.5% vs. 24.0%）, longer PFS （6.0 vs. 5.0 months）, and less adverse events in the NG arm. Conclusion： NG regimen seems to be superior over CG regimen for advance NSCLS, but further investigation is needed to validate this superiority.

Majorana fermions induced fast-and slow-light in a hybrid semiconducting nanowire/superconductor device

We investigate theoretically Rabi-like splitting and Fano resonance in absorption spectra of quantum dots(QDs)based on a hybrid QD-semiconducting nanowire/superconductor(SNW/SC)device mediated by Majorana fermions(MFs).Under the condition of pump on-resonance and off-resonance,the absorption spectrum experiences the conversion from Fano resonance to Rabi-like splitting in different parametric regimes.In addition,the Fano resonances are accompanied by the rapid normal phase dispersion,which will indicate the coherent optical propagation.The results indicate that the group velocity index is tunable with controlling the interaction between the QD and MFs,which can reach the conversion between the fast-and slow-light.Fano resonance will be another method to detect MFs and our research may indicate prospective applications in quantum information processing based on the hybrid QD-SNW/SC devices.

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

BACKGROUND Emphysematous pyelonephritis(EPN)is a rare but fatal necrotic infection of the kidney,which usually leads to septic shock.Therefore,early diagnosis and optimized therapy are of paramount importance.In the past two decades,pointof-care ultrasound(POCUS)has been widely used in clinical practice,especially in emergency and critical care settings,and helps to rapidly identify the source of infection in sepsis.We report a rare case in which a“falls”sign on POCUS played a pivotal role in the early diagnosis of EPN.CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission.He went to the emergency room,and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts.This imaging feature was like a mini waterfall.His blood and urine culture demonstrated Escherichia coli bacteremia,and EPN associated with septic shock was diagnosed.The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed.He subsequently underwent computed tomography-guided percutaneous catheter drainage,and fully recovered.We also review the literature on the sonographic features of POCUS in EPN.CONCLUSION This case indicates that a“falls”sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.

Crowd intelligence in AI 2.0 era

The Internet based cyber-physical world has profoundly changed the information environment for the development of artificial intelligence(AI), bringing a new wave of AI research and promoting it into the new era of AI 2.0. As one of the most prominent characteristics of research in AI 2.0 era, crowd intelligence has attracted much attention from both industry and research communities. Specifically, crowd intelligence provides a novel problem-solving paradigm through gathering the intelligence of crowds to address challenges. In particular, due to the rapid development of the sharing economy, crowd intelligence not only becomes a new approach to solving scientific challenges, but has also been integrated into all kinds of application scenarios in daily life, e.g., online-tooffline(O2O) application, real-time traffic monitoring, and logistics management. In this paper, we survey existing studies of crowd intelligence. First, we describe the concept of crowd intelligence, and explain its relationship to the existing related concepts, e.g., crowdsourcing and human computation. Then, we introduce four categories of representative crowd intelligence platforms. We summarize three core research problems and the state-of-the-art techniques of crowd intelligence. Finally, we discuss promising future research directions of crowd intelligence.

Auxiliary-cavity-assisted vacuum Rabi splitting of a semiconductor quantum dot in a photonic crystal nanocavity

The coherent light-matter interaction has drawn an enormous amount of attention for its fundamental importance in the cavity quantum-electrodynamics (C-QED) field and great potential in quantum information applications. Here, we design a hybrid C-QED system consisting of a quantum dot (QD) driven by two-tone fields implanted in a photonic crystal (PhC) cavity coupled to an auxiliary cavity with a single-mode waveguide and investigate the hybrid system operating in the weak, intermediate, and strong coupling regimes of the light-matter interaction via comparing the QD-photon interaction with the dipole decay rate and the cavity field decay rate.The results indicate that the auxiliary cavity plays a key role in the hybrid system, which affords a quantum channel to influence the absorption of the probe field. By controlling the coupling strength between the auxiliary cavity and the PhC cavity, the phenomenon of the Mollow triplet can appear in the intermediate coupling regime,and even in the weak coupling regime. We further study the strong coupling interaction manifested by vacuum Rabi splitting in the absorption with manipulating the cavity-cavity coupling under different parameter regimes.This study provides a promising platform for understanding the dynamics of QD-C-QED systems and paving the way toward on-chip QD-based nanophotonic devices.

From Semantic Grid to Knowledge Service Cloud

1 Introduction The World Wide Web is a major breakthrough in the history of human communication and information sharing (Bemers-Lee et al.,2006).The Web has brought us a series of revolutionary tools,such as digital libraries,net meetings,e-mails,and data services,which have changed the face of scientific research and publishing.Scientists are increasingly relying on these tools to conduct their daily research,and to collaborate with their colleagues through distant communication and knowledge sharing.Despite all these accomplishments,there are still gaps between what can be done using the current Web and what need to be done in an e-Science environment (Buetow,2005).

Flexible hollow TiO_(2)@CMS/carbon-fiber van der Waals heterostructures for simulated-solar light photocatalysis and photoelectrocatalysis

The recycling technology of photocatalyst powdery has hardly been mature in the photocatalytic oxidation so far.In this work,the hollow TiO_(2)microspheres with an appropriate thickness are confined in carbon microspheres(CMSs)to form hollow TiO_(2)@CMSs,which are physically integrated with carbon-fiber textile by van der Waals(vdW)interactions to generate separable and recyclable hollow TiO_(2)@CMSs/carbon-fiber vdW heterostructures.Such separable and recyclable heterostructures show remarkable oxidation of 2,4-dinitrophenol.From our detailed characterization and density functional theory(DFT)calculations,we found that carbon fiber can trap electrons exerted from the excitation of hollow TiO_(2)@CMSs and creates holes in hollow TiO_(2)microspheres,which endow the carbon fiber with photocatalytic activity through coherent charge injection.This study indicates that our general strategy for the fabrication of hollow TiO_(2)@CMSs/carbon-fiber vdW heterostructures can be used as separable and recyclable photocatalyst and photoelectrocatalyst with potential industrial applications in environmentrelated fields.

National semantic infrastructure for traditional Chinese medicine

1 Introduction Traditional Chinese medicine (TCM) is "the traditional medicine that originated in China,and is characterized by holism and treatment based on pattern identification/syndrome differentiation" (WHO,2007).In China,traditional medicine accounts for around 40％ of all healthcare delivered;in the West,TCM is increasingly adopted by medical practitioners as a form of complementary and altemative medicine (CAM) (WHO,2002).Both in China and in the West,scientists are attempting to bring the ancient heritage of TCM into line with modem standards,through the scientific development of TCM in the direction of evidence-based medicine (Qiu,2007).There is a pressing need for the digital preservation and global access of TCM knowledge assets.

A multi-agent framework for mining semantic relations from Linked Data

Linked data is a decentralized space of interlinked Resource Description Framework(RDF) graphs that are published,accessed,and manipulated by a multitude of Web agents.Here,we present a multi-agent framework for mining hypothetical semantic relations from linked data,in which the discovery,management,and validation of relations can be carried out independently by different agents.These agents collaborate in relation mining by publishing and exchanging inter-dependent knowledge elements,e.g.,hypotheses,evidence,and proofs,giving rise to an evidentiary network that connects and ranks diverse knowledge elements.Simulation results show that the framework is scalable in a multi-agent environment.Real-world applications show that the framework is suitable for interdisciplinary and collaborative relation discovery tasks in social domains.