Challenging anticoagulation therapy for multiple primary malignant tumors combined with thrombosis:A case report and review of literature

BACKGROUND Venous thromboembolism significantly contributes to patient deterioration and mortality.Management of its etiology and anticoagulation treatment is intricate,necessitating a comprehensive consideration of various factors,including the bleeding risk,dosage,specific anticoagulant medications,and duration of therapy.Herein,a case of lower extremity thrombosis with multiple primary malignant tumors and high risk of bleeding was reviewed to summarize the shortcomings of treatment and prudent anticoagulation experience.CASE SUMMARY An 83-year-old female patient was admitted to the hospital due to a 2-wk history of left lower extremity edema that had worsened over 2 d.Considering her medical history and relevant post-admission investigations,it was determined that the development of left lower extremity venous thrombosis and pulmonary embolism in this case could be attributed to a combination of factors,including multiple primary malignant tumors,iliac venous compression syndrome,previous novel coronavirus infection,and inadequate treatment for prior thrombotic events.However,the selection of appropriate anticoagulant medications,determination of optimal drug dosages,and establishment of an appropriate duration of anticoagulation therapy were important because of concurrent thrombocytopenia,decreased quantitative fibrinogen levels,and renal insufficiency.CONCLUSION Anticoagulant prophylaxis should be promptly initiated in cases of high-risk thrombosis.Individualized anticoagulation therapy is required for complex thrombosis.

Exogenous insulin autoimmune syndrome:A case report and review of literature

BACKGROUND Insulin autoimmune syndrome(IAS)is a severe manifestation of spontaneous hypoglycemia.It is characterized by elevated levels of immune-reactive insulin and highly potent insulin autoantibodies(IAAs),which are induced by endogenous insulin circulating in the bloodstream.It is distinguished by recurring instances of spontaneous hypoglycemia,the presence of IAA within the body,a substantial elevation in serum insulin levels,and an absence of prior exogenous insulin administration.Nevertheless,recent studies show that both conventional insulin and its analogs can induce IAS episodes,giving rise to the notion of nonclassical IAS.Therefore,more attention should be paid to these diseases.CASE SUMMARY In this case report,we present a rare case of non-classical IAS in an 83-year-old male patient who present with symptoms of a psychiatric disorder.Upon symptom onset,the patient exhibited Whipple's triad(including hypoglycemia,blood glucose level less than 2.8 mmol/L during onset,and rapid relief of hypoglycemic symptoms after glucose administration).Concurrently,his serum insulin level was significantly elevated,which contradicted his C-peptide levels.After a comprehensive examination,the patient was diagnosed with exogenous insulin autoimmune syndrome.Considering that the patient had type 2 diabetes mellitus and a history of exogenous insulin use before disease onset,it was presumed that non classical IAS was induced by this condition.The PubMed database was used to search for previous cases of IAS and non-classical IAS to analyze their characteristics and treatment approaches.CONCLUSION The occurrence of non-classical IAS is associated with exogenous insulin or its analogs,as well as with sulfhydryl drugs.Symptoms can be effectively alleviated through the discontinuation of relevant medications,administration of hormones or immunosuppressants,plasma exchange,and lifestyle adjustments.

Model-based deep learning for fiber bundle infrared image restoration

As the representative of flexibility in optical imaging media,in recent years,fiber bundles have emerged as a promising architecture in the development of compact visual systems.Dedicated to tackling the problems of universal honeycomb artifacts and low signal-to-noise ratio(SNR)imaging in fiber bundles,the iterative super-resolution reconstruction network based on a physical model is proposed.Under the constraint of solving the two subproblems of data fidelity and prior regularization term alternately,the network can efficiently“regenerate”the lost spatial resolution with deep learning.By building and calibrating a dual-path imaging system,the real-world dataset where paired low-resolution(LR)-high-resolution(HR)images on the same scene can be generated simultaneously.Numerical results on both the United States Air Force(USAF)resolution target and complex target objects demonstrate that the algorithm can restore high-contrast images without pixilated noise.On the basis of super-resolution reconstruction,compound eye image composition based on fiber bundle is also embedded in this paper for the actual imaging requirements.The proposed work is the first to apply a physical model-based deep learning network to fiber bundle imaging in the infrared band,effectively promoting the engineering application of thermal radiation detection.

Potential application of ultrasound-guided thermal ablation in rare liver tumors

Background: With the advances of imaging techniques, the detection rate of rare liver tumor is increased. However, the therapeutic strategies of the rare liver tumors remain limited. Methods: We analyzed twelve pathologically confirmed rare liver tumors in 8 patients. All of the patients underwent ultrasound(US) guided biopsy and subsequent thermal ablation. The tumors were ablated according to the preoperative plans and monitored by real-time US. CT/MRI fused with contrast enhanced US(CEUS) or three-dimensional(3 D) US-CEUS images were used to guide and assess the ablation zone more accurately during thermal ablation. The rate of technical efficacy was assessed based on the contrast-enhance CT/MRI(CECT/MRI) results one month after ablation. Local tumor progression(LTP), recurrence and complications were followed up and recorded. Results: Among these twelve nodules, nine were subject to US-guided thermal ablation, whereas the other three inconspicuous nodules were subject to CEUS-guided thermal ablation. Intra-procedure CT/MRI-CEUS or 3 D US-CEUS fusion imaging assessments demonstrated that the ablation zone sufficiently covered the original tumor, and no immediate supplementary ablation was required. Additionally, no major complications were observed during the follow-up period. The postoperative CECT/MRI confirmed that the technique success rate was 100%. Within the surveillance period of 13 months, no LTP or recurrence was noted. Conclusions: US-guided thermal ablation was feasible and safe for rare liver tumors. The use of fusion imaging technique might make US-guided thermal ablation as effective as surgical resection, and this technique might serve as a potential therapeutic modality for rare liver tumors in the future.

Thermal analysis and tests of W/Cu brazing for primary collimator scraper in CSNS/RCS

To the transverse beam collimation system in a rapid cycling synchrotron,an important component is the primary collimator,which improves emittance of the beam halo particles such that the particles outside the predefined trajectory can be absorbed by the secondary collimators.Given the material properties and power deposition distribution,the beam scraper of the primary collimator is a0.17 mm tungsten foil on a double face-wedged copper block of 121.5 mm x 20 mm.The heat is transferred to the outside by a φ34 mm copper rod.In this paper,for minimizing brazing thermal stress,we report our theoretical analysis and tests on brazing the tungsten and copper materials which differ greatly in size.We show that the thermal stress effect can be controlled effectively by creating stress relief grooves on the copper block and inserting a tungsten transition layer into the copper block.This innovation contributes to the successful R&D of the primary collimator.And this study may be of help for working out a brazing plan of similar structures.

The neuroprotective effect of Cassia o btusifolial extract in rats following TBI

Objective:To observe the effect of Cassia o btusifolial extract on rats of traumatic brain injury.Methods:The rats were randomly divided into 4 groups,traumatic brain injur(TBI)group,sham operation group(SHAM)group,(COB-H20 g/kg、COB-L10 g/kg)of Cassia extract groups,They were subjected to the modified Feeney's weight-drop model.sham group fake open skull window only,Cassia o btusifolial extract were given by intragastric administration and the rats were given distilled water instead as TBI and SHAM.The behavioral test was performed by Balance beam,TNF-αand IL-6 level was detected by ELASA method in serum on rats of TBI,The NSE positive cells near the region of injury was ascertainde by measuring in rats of TBI,and Western blot was used to detect the expressions of PI3K in rat brain tissues.Results:Both of Cassia extract groups and TBI traversed the beam significantly quicker than sham group at 3 time points before and after injury(P<0.01),and both of COB groups traversed the beam significantly shorter than TBI(P<0.05).The serum TNF-αand IL-6 content in TBI and Both of COB groups were significantly higher than sham group at 6,24,60h(P<0.01),To compare with the TBI group,the serum TNF-αand IL-6 content in the both of COB groups were significantly decreased respectively at the time 6,24 and 60 hours,The overall level gradually decreased at 24 h,but increased slightly at 60 h.Immunohistochemical method revealed that NSE was lowered dramaticly in sham and both of COB groups(P<0.05),but it was more efficient in both of COB groups compared to TBI group(P<0.05).the expressions of PI3 protein of the TBI group was decreased observbly than sham group(P<0.05),but COB-H group was inecreased significantly than TBI group same as sham group(P<0.05).Conclusion:Cassia o btusifolial extract can improve neurol function,increasing NSE positive cells and the expressions of PI3 protein lever.

Lithium-induced graphene layer containing Li_(3)P alloy phase to achieve ultra-stable electrode interface for lithium metal anode

Uncontrolled growth of lithium dendrite will lead to low Coulombic efficiency and poor cycle stability,which hinders the commercialization of lithium metal batteries.Herein,a novel modified lithium anode with reduced graphene oxide conductive network containing trace lithiophilic phosphorus(P-rGO/Cu)is prepared by electrospraying technique combined with heat treatment process.The rGO layer has a concave and undulating conductive structure,which can significantly improve the effective electrical contact between lithium metal and the current collector,speed up the kinetics of interfacial electron transport and reaction,and improve the resistance of the negative electrode to the internal stress caused by volume change of the lithium,which is advantageous for the stability of the SEI film.The extremely small and uniformly distributed red phosphorus element avoids the volume change caused by lithiation to the maximum extent.Lithiophilic two-phase compound Li_(3)P obtained by alloying P with Li can directionally induce the homogeneous nucleation and dense deposition of lithium metal,address the issue of lithium dendrites and extend the cycle life of the batteries.The obtained P-rGO/Cu exhibits excellent electrochemical performance with an average Coulombic efficiency(CE)of 98%at a current density of 1 mA·cm^(−2) for 400 cycles,and the capacity retention rate of the full cell matched with lithium iron phosphate(LFP)is 83%after 400 cycles at 1C.