MRI Findings and Diagnostic Significance of Soft Tissue Schwannomas in the Extremities

Objective:To analyze the MRI features and rare manifestations of schwannomas of the extremities to improve diagnosis.Methods:Retrospective analysis of 23 cases of schwannomas in the extremities confirmed by surgical pathology,summarizing its signs,signal characteristics and MRI enhancement.Results:Among the 23 cases,20 were single lesions,and 3 were multiple lesions,resulting in a total of 28 lesions.The distribution of these lesions included 7 in the thigh,9 in the calves,4 in the armpits,3 in the hips,and 4 each in the upper arms and forearms.Additionally,there was one lesion located in the groin.On T1-weighted imaging(T1WI),the lesions showed iso-intensity or hypo-intensity.On T2-weighted imaging(T2WI),they appeared slightly hyperintense or hyper-intense.Some lesions exhibited multiple small vesicle-like higher signals,cystic changes,and fiber spacing on T2WI.Furthermore,one lesion showed a liquid-liquid plane.The“target sign”was observed in 18 lesions(64.3%)and“neuropathic signs”were present in six lesions(21.4%).Finally,it was noted that on MRI enhancement,the lesions demonstrated uniform or uneven enhancement.The lesions were uniformly or unevenly enhanced on MRI enhancement.Conclusions:The MRI findings of schwannoma in the extremities exhibit specific characteristics.The cystic changes on T2WI also display distinct features.Recognition of rare MRI findings,such as cystic changes,liquid-liquid plane and septum,should be emphasized to enhance the accuracy of pre-diagnosing schwannomas.

Competitive oxidation behavior of Ni-based superalloy GH4738 at extreme temperature

A high thrust-to-weight ratio poses challenges to the high-temperature performance of Ni-based superalloys. The oxidation behavior of GH4738 at extreme temperatures has been investigated by isothermal and non-isothermal experiments. As a result of the competitive diffusion of alloying elements, the oxide scale included an outermost porous oxide layer (OOL), an inner relatively dense oxide layer (IOL), and an internal oxide zone (IOZ), depending on the temperature and time. A high temperature led to the formation of large voids at the IOL/IOZ interface. At 1200℃, the continuity of the Cr-rich oxide layer in the IOL was destroyed, and thus, spallation occurred. Extension of oxidation time contributed to the size of Al-rich oxide particles with the increase in the IOZ. Based on this finding,the oxidation kinetics of GH4738 was discussed, and the corresponding oxidation behavior at 900-1100℃ was predicted.

Implications of the extremely hot summer of 2022 on urban ozone control in China

Frequent occurrences of extreme heat are causing severe ozone pollution over China.This study examined the driving factors of urban ozone pollution in China during the extremely hot summer of 2022 and the impact of emission control strategies using surface measurements and the GEOS-Chem model.The results show that ozone pollution was extremely severe in summer 2022,with a significant rebound by 12-15 ppbv in the North China Plain(NCP),Yangtze River Delta(YRD),and Sichuan basin(SCB),compared to 2021.Especially over the NCP,the MDA8(maximum daily 8-hourly average)ozone exceeded 160 ppbv,and the number of ozone exceedances was over 42 days.Based on an IPR(integrated process rate)analysis,the authors found that the net chemical production was the dominant factor contributing to the strong ozone increase in summer 2022.For example,in June over the NCP,the net chemical production resulted in an increase by 3.08 Gg d^(−1)(∼270%)in ozone mass change.Sensitivity simulations showed that both NO_(x)(nitrogen oxides)and VOC(volatile organic compound)reductions were important over the NCP,and NO_(x)reductions were more important than VOCs over southern China.To keep the ozone of 2022 at the same level as 2021,a joint reduction of NO_(x)and VOCs by at least 50%-60%would have been required.This study highlights the urgency to develop effective ozone management since extreme heat will become more frequent.

Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature

BACKGROUND Sarcoidosis is a granulomatous disease of unknown etiology that most often impacts the lungs.Cutaneous manifestations of sarcoidosis are seen among 9%- 37% of patients.Subcutaneous sarcoidosis is a rare presentation of cutaneous sarcoidosis with estimates of frequency ranging from 1.4%-16%.To date,very few articles and case reports have been written about this subject.In this paper,we describe a case of subcutaneous sarcoidosis and perform a review of the literature to determine if there are commonalities among patients who present with subcutaneous sarcoidosis.CASE SUMMARY A 38-year-old female,with a past medical history of arthritis and recurrent nephrolithiasis,presents with an 8-mo history of 4 firm,asymptomatic,skincolored nodules on her left and right upper extremities and neck.Needle biopsy and post-excisional pathology report both revealed well-formed,dense,noncaseating granulomas localized to the subcutaneous tissue.Chest computed tomography revealed mild mediastinal lymphadenopathy.A diagnosis of subcutaneous sarcoidosis was made,and the lesions were surgically removed.CONCLUSION Commonalities among patients presenting with subcutaneous sarcoidosis include: middle-aged female,lesions localizing to the upper or lower limbs,lymphadenopathy or pulmonary infiltration on chest imaging,elevated serum angiotensin-converting enzyme.

Magnetic resonance imaging of soft-tissue tumors of the extremities: A practical approach

Diagnosis of extremity soft-tissue tumors can be challenging.Characteristics of tumor margins can help precisely identify locally aggressive or non-aggressive behavior for surgical planning,but cannot differentiate benign from malignant lesions.Most malignant tumors can have inhomogeneous signals on T2-weighted images.Although a uniform signal on T2-weighted images can be a reliable indication of a benign lesion,a well-defined mass with homogeneous internal signal intensity does not definitively identify a benign lesion.Some common and distinctive soft-tissue lesions can have specific clinical and imaging features allowing a diagnosis without biopsy.These are known as determinate lesions.This illustrative report presents a diagnostic guide for extremity soft-tissue tumors based on tissue signal and morphological characteristics on magnetic resonance images.It is important for clinicians to be familiar with the imaging characteristics of common determinate lesions.

Evaluation and Projection of Population Exposure to Temperature Extremes over the Beijing−Tianjin−Hebei Region Using a High-Resolution Regional Climate Model RegCM4 Ensemble

Temperature extremes over rapidly urbanizing regions with high population densities have been scrutinized due to their severe impacts on human safety and economics.First of all,the performance of the regional climate model RegCM4 with a hydrostatic or non-hydrostatic dynamic core in simulating seasonal temperature and temperature extremes was evaluated over the historical period of 1991–99 at a 12-km spatial resolution over China and a 3-km resolution over the Beijing−Tianjin−Hebei(JJJ)region,a typical urban agglomeration of China.Simulations of spatial distributions of temperature extremes over the JJJ region using RegCM4 with hydrostatic and non-hydrostatic cores showed high spatial correlations of more than 0.8 with the observations.Under a warming climate,temperature extremes of annual maximum daily temperature(TXx)and summer days(SU)in China and the JJJ region showed obvious increases by the end of the 21st century while there was a general reduction in frost days(FD).The ensemble of RegCM4 with different land surface components was used to examine population exposure to temperature extremes over the JJJ region.Population exposure to temperature extremes was found to decrease in 2091−99 relative to 1991−99 over the majority of the JJJ region due to the joint impacts of increases in temperature extremes over the JJJ and population decreases over the JJJ region,except for downtown areas.Furthermore,changes in population exposure to temperature extremes were mainly dominated by future population changes.Finally,we quantified changes in exposure to temperature extremes with temperature increase over the JJJ region.This study helps to provide relevant policies to respond future climate risks over the JJJ region.

Increased population exposures to extreme precipitation in Central Asia under 1.5℃ and 2℃ global warming scenarios

The increase in extreme precipitation(EP)may pose a serious threat to the health and safety of population in arid and semi-arid regions.The current research on the impact of EP on population in Central Asia(CA)is insufficient and there is an urgent need for a comprehensive assessment.Hence,we opted for precipitation and temperature data under two Shared Socioeconomic Pathways(SSP2-4.5 and SSP5-8.5)from ten Global Climate Models(GCMs),which were obtained from the NASA Earth Exchange Global Daily Downscaled Projections(NEX-GDDP-CMIP6).By integrating population data in 2020 and 2050(SSP2 and SSP5),we investigated the future changes in EP and population exposure in CA under 1.5℃and 2℃global warming scenarios(GWSs).Our analysis indicates that EP in CA is projected to increase with global warming.Under the SSP5-8.5,the maximum daily precipitation(Rx1day)exhibits an average response rate to global warming of 3.58%/K(1.99-4.06%/K).With rising temperatures,an increasing number of areas and populations in CA will be impacted by EP,especially in the Fergana valley.Approximately 25%of the population(land area)in CA is exposed to Rx1day with increases of more than 8.31%(9.32%)under 1.5℃GWS and 14.18%(13.25%)under 2℃GWS.Controlling temperature rise can be effective in reducing population exposures to EP.For instance,limiting the temperature increase to 1.5℃instead of 2℃results in a 2.79%(1.75%-4.59%)reduction in population exposure to Rx1day.Finally,we found that climate change serves as the predominant factor influencing the population exposure to EP,while the role of population redistribution,although relatively minor,should not be disregarded.Particularly for prolonged drought,the role of population redistribution manifests negatively.

The Extreme Machine Learning Actuarial Intelligent Agricultural Insurance Based Automated Underwriting Model

The paper presents an innovative approach towards agricultural insurance underwriting and risk pricing through the development of an Extreme Machine Learning (ELM) Actuarial Intelligent Model. This model integrates diverse datasets, including climate change scenarios, crop types, farm sizes, and various risk factors, to automate underwriting decisions and estimate loss reserves in agricultural insurance. The study conducts extensive exploratory data analysis, model building, feature engineering, and validation to demonstrate the effectiveness of the proposed approach. Additionally, the paper discusses the application of robust tests, stress tests, and scenario tests to assess the model’s resilience and adaptability to changing market conditions. Overall, the research contributes to advancing actuarial science in agricultural insurance by leveraging advanced machine learning techniques for enhanced risk management and decision-making.

Coastal hypoxia response to the coupling of catastrophic flood,extreme marine heatwave and typhoon:a case study off the Changjiang River Estuary in summer 2020

Massive bodies of low-oxygen bottom waters are found in coastal areas worldwide,which are detrimental to coastal ecosystems.In summer 2020,the response of coastal hypoxia to extreme weather events,including a catastrophic flooding,an extreme marine heatwave,and Typhoon Bavi,is investigated based on multiple satellite,four cruises,and mooring observations.The extensive fan-shaped hypoxia zone presents significant northward extension during July-September 2020,and is estimated as large as 13 000 km^(2) with rather low oxygen minimum(0.42 mg/L) during its peak in 28-30 August.This severe hypoxia is attributed to the persistent strong stratification,which is indicated by flood-induced larger amount of riverine freshwater input and subsequent marine heatwave off the Changjiang River Estuary.Moreover,the Typhoon Bavi has limited effect on the marine heatwave and coastal hypoxia in summer 2020.

IoT-based green-smart photovoltaic system under extreme climatic conditions for sustainable energy development

To realize carbon neutrality,there is an urgent need to develop sustainable,green energy systems(especially solar energy systems)owing to the environmental friendliness of solar energy,given the substantial greenhouse gas emissions from fossil fuel-based power sources.When it comes to the evolution of intelligent green energy systems,Internet of Things(IoT)-based green-smart photovoltaic(PV)systems have been brought into the spotlight owing to their cutting-edge sensing and data-processing technologies.This review is focused on three critical segments of IoT-based green-smart PV systems.First,the climatic parameters and sensing technologies for IoT-based PV systems under extreme weather conditions are presented.Second,the methods for processing data from smart sensors are discussed,in order to realize health monitoring of PV systems under extreme environmental conditions.Third,the smart materials applied to sensors and the insulation materials used in PV backsheets are susceptible to aging,and these materials and their aging phenomena are highlighted in this review.This review also offers new perspectives for optimizing the current international standards for green energy systems using big data from IoT-based smart sensors.

Extreme Responses of An Integrated System with A Semi-Submersible Wind Turbine and Four Torus-Shaped Wave Energy Converters in Different Survival Modes

Offshore wind power is a kind of important clean renewable energy and has attracted increasing attention due to the rapid consumption of non-renewable energy.To reduce the high cost of energy,a possible try is to utilize the combination of wind and wave energy considering their natural correlation.A combined concept consisting of a semi-submersible wind turbine and four torus-shaped wave energy converters was proposed and numerically studied under normal operating conditions.However,the dynamic behavior of the integrated system under extreme sea conditions has not been studied yet.In the present work,extreme responses of the integrated system under two different survival modes are evaluated.Fully coupled time-domain simulations with consideration of interactions between the semi-submersible wind turbine and the torus-shaped wave energy converters are performed to investigate dynamic responses of the integrated system,including mooring tensions,tower bending moments,end stop forces,and contact forces at the Column-Torus interface.It is found that the addition of four tori will reduce the mean motions of the yaw,pitch and surge.When the tori are locked at the still water line,the whole integrated system is more suitable for the survival modes.

A Novel Sensing Imaging Equipment Under Extremely Dim Light for Blast Furnace Burden Surface:Starlight High-Temperature Industrial Endoscope

Blast furnace(BF)burden surface contains the most abundant,intuitive and credible smelting information and acquiring high-definition and high-brightness optical images of which is essential to realize precise material charging control,optimize gas flow distribution and improve ironmaking efficiency.It has been challengeable to obtain high-quality optical burden surface images under high-temperature,high-dust,and extremelydim(less than 0.001 Lux)environment.Based on a novel endoscopic sensing detection idea,a reverse telephoto structure starlight imaging system with large field of view and large aperture is designed.Combined with a water-air dual cooling intelligent self-maintenance protection device and the imaging system,a starlight high-temperature industrial endoscope is developed to obtain clear optical burden surface images stably under the harsh environment.Based on an endoscope imaging area model,a material flow trajectory model and a gas-dust coupling distribution model,an optimal installation position and posture configuration method for the endoscope is proposed,which maximizes the effective imaging area and ensures large-area,safe and stable imaging of the device in a confined space.Industrial experiments and applications indicate that the proposed method obtains clear and reliable large-area optical burden surface images and reveals new BF conditions,providing key data support for green iron smelting.

Spatial Variation and Trend of Extreme Precipitation in Africa during 1981-2019 and Its Projected Changes at the End of 21st Century

This study comprehensively examines the patterns and regional variation of severe rainfall across the African continent, employing a suite of eight extreme precipitation indices. The analysis extends to the assessment of projected changes in precipitation extremes using five General Circulation Models (GCMs) from Coupled Model Intercomparison Project Phase 6 (CMIP6) under four Shared Socioeconomic Pathways (SSPs) scenarios at the long-term period (2081-2100) of the 21st century. Furthermore, the study investigates potential mechanisms influencing precipitation extremes by correlating extreme precipitation indices with oceanic system indices, specifically Ni?o 3.4 for El Ni?o-Southern Oscillation (ENSO) and Dipole Mode Index (DMI) for the Indian Ocean Dipole (IOD). The findings revealed distinct spatial distributions in mean trends of extreme precipitation indices, indicating a tendency toward decreased extreme precipitation in North Africa, Sahel region, Central Africa and the Western part of South Africa. Conversely, West Africa, East Africa and the Eastern part of South Africa exhibit an inclination toward increased extreme precipitation. The changes in precipitation extreme indices indicate a general rise in both the severity and occurrence of extreme precipitation events under all scenarios by the end of the 21st century. Notably, our analysis projects a decrease in consecutive wet days (CWD) in the far-future. Additionally, correlation analysis highlights significant correlation between above or below threshold rainfall fluctuation in East Africa and South Africa with oceanic systems, particularly ENSO and the IOD. Central Africa abnormal precipitation variability is also linked to ENSO with a significant negative correlation. These insights contribute valuable information for understanding and projecting the dynamics of precipitation extreme in Africa, providing a foundation for climate adaptation and mitigation efforts in the region.

Surgical treatment of metastatic bone disease of the distal extremities

Metastatic bone disease of the distal extremities,also known as acrometastasis,is very rare.Thus,there is very limited information regarding the clinical manifestations and methods of surgical treatment.The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival.As metastatic bone disease is generally uncurable,the goal of surgical treatment is to provide the patient with good function with as few complications as possible.In this article,we discuss the clinical manifestation of acrometastases,the methods of surgical intervention,and the expected clinical outcome.Non-surgically managed pathological fractures generally remain ununited;therefore,conservative treatment is reserved for patients with poor general condition or dismal prognosis.The current evidence suggests that in lesions of the lower arm and leg,osteosynthesis(plate and screw fixation or intramedullary nail)is the most common method of reconstruction,whereas local excision or amputation are more commonly used in cases of more distal lesions(such as ankle,foot and hand).Following surgery most patients receive adjuvant radiotherapy,even though its role is poorly documented.Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome.Further studies are needed in order to provide stronger clinical evidence and improve decision-making,in an effort to optimize the patients’quality of life and avoid the need for revision surgery.

Statistical Modelling of Extreme Precipitation Indices Supporting Urban Spatial Planning Processes

In this paper,we analyze how statistical modelling of extreme precipitation indices can support urban planners in the analysis and classification of the level of climate sensitivity of the territory and in the subsequent definition of sustainable adaptive planning and design choices.These activities are part of a research project that addresses the issue of climate change from the urban planning perspective to identify solutions to current and future environmental challenges,increasing the climate resilience of infrastructures and communities in urban,rural and coastal areas.These research activities are based on the desire to promote integration between the approaches commonly adopted by urban planners and climate specialists to plan adequate joint risk reduction strategies.As part of this study,the focus will be on the risks produced by the greater frequency and intensity of floods,assessed by the IPCC(Intergovernmental Panel on Climate Change)as one of the key risks for Europe.Specifically,our attention focuses on pluvial flooding,proposing the definition of a statistical modelling of indices related to extreme precipitation and its application to the context of the Calabria Region,in Italy.The indices are recommended by the ETCCDI(Expert Team on Climate Change Detection and Indices)and elaborated starting from official historical data recorded by 146 telemetry active rain gauges,disseminated in the experimentation context.

Clinical Value of Predictive Nursing Intervention on Deep Venous Thrombosis of Lower Extremities after Cesarean Section

[Objectives]To explore the clinical nursing value of predictive nursing intervention in patients with deep venous thrombosis of lower extremities after cesarean section.[Methods]From December 2022 to April 2023,105 pregnant and lying-in women who were hospitalized in the Gynecology Department of Pingquan Hospital and underwent cesarean section and met the inclusion criteria were included as the study objects.According to the medical records,they were divided into observation group(n=52 cases)and control group(n=53 cases).The clinical experimental subjects were divided into two groups.One group was the control group with routine nursing,and the other group was the observation group with predictive nursing intervention.The number of cases of deep venous thrombosis of lower extremities in the two groups was recorded to evaluate the clinical value.[Results]The incidence of deep venous thrombosis of lower extremities in the two groups after cesarean section was compared,and it was suggested that the incidence of the observation group was lower than that of the control group(P<0.05).[Conclusions]Special predictive nursing intervention can greatly reduce the incidence of deep venous thrombosis of lower extremities after cesarean section,improve nursing satisfaction,and improve clinical efficacy,which is worthy of recommendation.

The Relationship between Extreme Precipitation Events in East Africa during the Short Rainy Season and Indian Ocean Sea Surface Temperature

The East African short rainy season (October-November-December) is one of the major flood seasons in the East African region. The amount of rainfall during the short rainy season is closely related to the lives of the people and the socio-economic development of the area. By using precipitation data and sea surface temperature data, this study reveals the spatial and temporal variation patterns of extreme precipitation during the East African short rainy season. Key findings include significant rainfall variability, with Tanzania experiencing the highest amounts in December due to the southward shift of the Intertropical Convergence Zone (ITCZ), while other regions receive less than 100 mm. Extreme rainfall events (90th percentiles) are evenly distributed, averaging 2 to 10 days annually. Historical data shows maximum seasonal rainfall often peaks at 15 mm, with frequent occurrences of daily rainfall exceeding 10 mm during OND. Additionally, a positive correlation (0.48) between OND precipitation extremes and Indian Ocean Dipole (IOD) anomalies is statistically significant. These findings highlight the climatic variability and potential trends in extreme rainfall events in East Africa, providing valuable insights for regional climate adaptation strategies.

Analysis of the Effect of Problem-Oriented Nursing Intervention on Patients with Lower Extremity Arteriosclerosis Obliterans in Vascular Surgery

Objective: To analyze the effect of problem-oriented nursing intervention on patients with lower extremity arteriosclerosis obliterans (ASO) in vascular surgery. Methods: The clinical data of 128 patients with lower extremity ASO in vascular surgery were selected and randomly divided into groups A and B, with 64 cases each. Group A is the control group, and Group B is the observation group. Group A received the routine nursing intervention, and Group B received the problem-oriented nursing intervention. The compliance, self-care ability, psychological state, quality of life, and nursing satisfaction of the two groups of patients were evaluated based on various indicators. Results: After the intervention, the evaluation of self-care ability (ESCA) score of the patients in Group B was higher than that of Group A, and the symptom checklist-90 (SCL-90) score was lower than that of Group A. The differences were significant (t = 10.019, t = 3.118, P < 0.01). After the intervention, the World Health Organization Quality of Life Brief (WHOQOL-BREF) index scores of the two groups increased and the increase in Group B was significantly higher than Group A (P < 0.001). The compliance rate of Group B (62/ 96.88%) was higher than that of Group A (52/ 81.25%), and the difference was extremely significant (χ2 = 8.020, P < 0.01). Conclusion: Problem-oriented nursing intervention for patients with lower extremity ASO in vascular surgery improved the patient’s self-care ability, and quality of life, reduced the patient’s negative emotions, and enhanced their overall satisfaction.

Ongoing Blood Pressure Change in Both Upper Extremities: An Unusual Presentation of Aortic Dissection

Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of presenting symptoms and features, it is a challenge to identify this condition, and patients are frequently misdiagnosed. The potentially critical course of aortic dissection can result in tragedy. We present the case of a 46-year-old woman who initially presented with a light headache and sensory loss in her right upper limb. She had a medical history of hypertension without regular medication, and her blood pressure (BP) was 110/67 mmHg on arrival. Four days later, she was sent to the emergency department again because she experienced transient loss of consciousness lasting for a few minutes. Her BP was 94/57 mmHg in the right arm and 89/54 in the left arm. She was admitted to the hospital, and the pulses in both upper limbs were impalpable on the following day. Chest magnetic resonance imaging (MRI) was arranged, and subsequently, aortic dissection was diagnosed. The case presented with unusual characteristics, which increased the difficulty in immediate correct diagnosis.

Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.