Multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

Obesity paradox in patients with community-acquired pneumonia:Have you fully considered the confounding factors?

There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.

Modeling,Analysis and Validation of Friendship Paradox in Evolving Networks

Friendship paradox states that individuals are likely to have fewer friends than their friends do,on average.Despite of its wide existence and appealing applications in real social networks,the mathematical understanding of friendship paradox is very limited.Only few works provide theoretical evidence of single-step and multi-step friendship paradoxes,given that the neighbors of interest are onehop and multi-hop away from the target node.However,they consider non-evolving networks,as opposed to the topology of real social networks that are constantly growing over time.We are thus motivated to present a first look into friendship paradox in evolving networks,where newly added nodes preferentially attach themselves to those with higher degrees.Our analytical verification of both single-step and multistep friendship paradoxes in evolving networks,along with comparison to the non-evolving counterparts,discloses that“friendship paradox is even more paradoxical in evolving networks”,primarily from three aspects:1)we demonstrate a strengthened effect of single-step friendship paradox in evolving networks,with a larger probability(more than 0.8)of a random node’s neighbors having higher average degree than the random node itself;2)we unravel higher effectiveness of multi-step friendship paradox in seeking for influential nodes in evolving networks,as the rate of reaching the max degree node can be improved by a factor of at least Θ(t^(2/3))with t being the network size;3)we empirically verify our findings through both synthetic and real datasets,which suggest high agreements of results and consolidate the reasonability of evolving model for real social networks.

What would Hippocrates have sworn upon witnessing the COVID-19 mandates and mortality paradox

For the first time in human history,hundreds of millions of people all over the world have been subjected to compulsory vaccination with a new type of nucleic acid based vaccines in order to keep their jobs or be able to travel due to some notorious coronavirus disease 2019(COVID-19)mandates.The vast majority of African countries were either initially deprived of these vaccines,or later,a majority of the population was too skeptical to receive them and preferred a safe early treatment pharmacological approach.Yet,Africa had the lowest COVID-19 mortality rate compared to those countries that adopted mass vaccination.This letter to the editor adds African insights that should be helpful in future pandemics to save millions of precious lives.

Paradoxical embolus straddling patent foramen ovale demonstrated by computed tomographic pulmonary angiography

An elderly gentleman presented to the emergency department with a recent history of dyspnoea, collapse and transient neurological symptoms. He was noted to be hypoxic with a significantly elevated D Dimer. A computer tomography pulmonary angiogram demonstrated a large embolus with a further filling defects within the left and the right atria, abutting the interatrial septum. Suspicion of a paradoxical pulmonary embolus was raised and the patient subsequently underwent echocardiography which confirmed a patent foramen ovale(PFO). He was commenced on warfarin therapy. In patients with elevated right heart pressure, a PFO can be unmasked and give rise to cerebral emboli. Clinical suspicion should be raised in patients with pulmonary emboli or deep venous thrombosis if there is a concomitant history of focal neurological symptoms.

Ischemic Stroke Due to Paradoxical Embolism in a Patient with Patent Foramen Ovale, Bilateral Distal Deep Vein Thrombosis and Platypnea-Orthodeoxia Syndrome: A Case Report

Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization, a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome). These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.

The Satirical Paradox of Feminism in the novel Forrest Gump and the Fate of Feminism Campaign

Women were depicted as characters that were eager to break away from convention in many novels.However,the subject role of women was never improved during the turbulent feminism movement.Paradox between public conception and reality got stronger and stronger.The genre of the literature represents such a change.The novels that can be demonstrated,in order to support this view,is the Forrest Gump by Winston Groom.

The seeming paradox of adenosine receptors as targets for the treatment of Alzheimer's disease: agonists or antagonists?

Alzheimer＇s disease （AD） is the most common neurodegenerative disorder, and its incidence is relatively high among elderly people, affecting about 1-2% of the population between 60-65 years old and rising dramatically （about 30%） in people aged 80 years or older （Selkoe, 2002）. Nowadays, considering the increasing mean lifespan of populations in developed countries, the disease is becoming more and more a health concern, and the search for an effective cure has turned into＂a real need＂.

Parrondo's paradox for chaos control and anticontrol of fractional-order systems

We present the generalized forms of Parrondo＇s paradox existing in fractional-order nonlinear systems. The gener- alization is implemented by applying a parameter switching （PS） algorithm to the corresponding initial value problems associated with the fractional-order nonlinear systems. The PS algorithm switches a system parameter within a specific set of N 〉 2 values when solving the system with some numerical integration method. It is proven that any attractor of the concerned system can be approximated numerically. By replacing the words ＂winning＂ and ＂loosing＂ in the classical Parrondo＇s paradox with ＂order＂ and ＂chaos＂, respectively, the PS algorithm leads to the generalized Parrondo＇s paradox： chaos1 ＋ chaos2 ＋..- ＋ chaosN = order and order1 ＋ order2 ＋.-. ＋ orderN = chaos. Finally, the concept is well demon- strated with the results based on the fractional-order Chen system.

Paradoxical roles of inhibitory autapse and excitatory synapse in formation of counterintuitive anticipated synchronization

Different from the common delayed synchronization(DS)in which response appears after stimulation,anticipated synchronization(AS)in unidirectionally coupled neurons denotes a counterintuitive phenomenon in which response of the receiver neuron appears before stimulation of the sender neuron,showing an interesting function of brain to anticipate the future.The dynamical mechanism for the AS remains unclear due to complex dynamics of inhibitory and excitatory modulations.In this article,the paradoxical roles of excitatory synapse and inhibitory autapse in the formation of AS are acquired.Firstly,in addition to the common roles such that inhibitory modulation delays and excitatory modulation advances spike,paradoxical roles of excitatory stimulation to delay spike via type-II phase response and of inhibitory autapse to advance spike are obtained in suitable parameter regions,extending the dynamics and functions of the excitatory and inhibitory modulations.Secondly,AS is related to the paradoxical roles of the excitatory and inhibitory modulations,presenting deep understandings to the AS.Inhibitory autapse induces spike of the receiver neuron advanced to appear before that of the sender neuron at first,and then excitatory synapse plays a delay role to prevent the spike further advanced,resulting in the AS as the advance and delay effects realize a dynamic balance.Lastly,inhibitory autapse with strong advance,middle advance,and weak advance and delay effects induce phase drift(spike of the receiver neuron advances continuously),AS,and DS,respectively,presenting comprehensive relationships between AS and other behaviors.The results present potential measures to modulate AS related to brain function.

Relativistic Paradox Characteristic for Belt Transmission with the Bell-Effect

Several contradictions inherent for relativistic dynamics get evident in the case of mechanical systems of cyclic type. In the present paper a version of situation taking place in the moving belt transmission is examined. It is shown that non-Euclidean intrinsic geometry, appearing during acceleration, does not abolish the real paradox in this mechanism. An unavoidable discrepancy between Special and General relativities is established. So, the very existence of wormholes becomes a moot point.

Relativistic Paradox of a Uniformly Charged Sphere Moving with Constant Velocity

A magneto-electric field appearing in a laboratory due to moving charges has unusual properties. In particular, such a field of kinematical origin does not obey the wave equation with a non-relativistic velocity instead of light speed;so, its movement resembles that of a rigid body. In this paper the field of a uniformly charged sphere moving at constant velocity is considered. Relativistic axiom, implicitly used in the derivation of formulas describing a kinematic deformation for the proper spherical field from the point of view of a fixed observer, is revealed. A discrepancy was found between the generally accepted idea of the configuration of a deformed field and its real geometry. It is shown that the correct interpretation of known formulas leads to a logical contradiction, which cannot be eliminated within the framework of the theory of relativity. A scheme of a decisive experiment is proposed.

A Simple Explanation of the Information Paradox by the Information Model of a Black Hole

The information paradox first surfaced in the early 1970s when Stephen Hawking of Cambridge University suggested that black holes are not totally black. Hawking showed that particle-antiparticle pairs generated at the event horizon—the outer periphery of a black hole—would be separated. One particle would fall into the black hole while the other would escape, making the black hole a radiating body. Characteristics of the emission and absorption of usual substance by a black hole can be described by information models. Estimation of the volume of information in black holes is necessary for generation of restrictions for their formation, development and interconversion. Information is an integral part of the Universe. By its physical essence information is heterogeneity of matter and energy. Therefore information is inseparably connected with matter and energy. An information approach along with a physical one allows to obtain new, sometimes more general data in relation to data obtained on the ground of physical rules only. The author’s works, testify about the practicality of information laws usage simultaneously with physical rules for cognition of the Universe. The results presented in this paper show the effectiveness of informational approach for studying the black holes. The article discusses the following questions: The volume of information in the black hole;Information model of a black hole;Characteristics of the emission and absorption of usual substance by a black hole describes the information model of a black hole;The information paradox;A simple explanation of the information paradox by the information model of a black hole.

Paradoxical herniation associated with hyperbaric oxygen therapy after decompressive craniectomy: A case report

BACKGROUND Whether hyperbaric oxygen therapy(HBOT)can cause paradoxical herniation is still unclear.CASE SUMMARY A 65-year-old patient who was comatose due to brain trauma underwent decompressive craniotomy and gradually regained consciousness after surgery.HBOT was administered 22 d after surgery due to speech impairment.Paradoxical herniation appeared on the second day after treatment,and the patient’s condition worsened after receiving mannitol treatment at the rehabilitation hospital.After timely skull repair,the paradoxical herniation was resolved,and the patient regained consciousness and had a good recovery as observed at the follow-up visit.CONCLUSION Paradoxical herniation is rare and may be caused by HBOT.However,the underlying mechanism is unknown,and the understanding of this phenomenon is insufficient.The use of mannitol may worsen this condition.Timely skull repair can treat paradoxical herniation and prevent serious complications.

Probability Distributions Arising in Connection with the Inspection Paradox for Bernoulli Trials

In renewal theory, the Inspection Paradox refers to the fact that an interarrival period in a renewal process which contains a fixed inspection time tends to be longer than one for the corresponding uninspected process. We focus on the paradox for Bernoulli trials. Probability distributions and moments for the lengths of the interarrival periods are derived for the inspected process, and we compare them to those for the uninspected case.

THE VON NEUMANN PARADOX FOR THE EULER EQUATIONS

The reflection of a weak shock wave is considered using a shock polar. We present a sufficient condition under which the von Neumann paradox appears for the Euler equations.In an attempt to resolve the von Neumann paradox for the Euler equations, two new types of reflection configuration, one called the von Neumann reflection(vNR) and the other called the Guderley reflection(GR), are observed in numerical calculations. Finally, we obtain that GR is a reasonable configuration and vNR is an unreasonable configuration to resolve the von Neumann paradox.

Probability Distributions Arising in Connection with the Inspection Paradox for the Poisson Process

The Inspection Paradox refers to the fact that in a Renewal Process, the length of the interarrival period which contains a fixed time is stochastically larger than the length of a typical interarrival period. To provide a more complete understanding of this phenomenon, conditioning arguments are used to obtain the distributions and moments of the lengths of the interarrival periods other than the one containing this fixed time for the case of the time-homogeneous Poisson Process. Distributions of the waiting times for events that occur both before and after this fixed time are derived. This provides a fairly complete probabilistic analysis of the Inspection Paradox.

Resolving the Information Paradox with Probabilistic Spacetime

It has been 50 years since Hawking described the black hole (BH) information paradox. The combination of BH radiation and subsequent BH evaporation was found to take trapped information into oblivion contrary to the law of conservation of quantum information. Numerous attempts have been made since to resolve this paradox. A brief review herein documents how all these attempts have significant shortcomings, meaning the paradox is still unresolved. A relatively new cosmological theory offers a resolution despite not being developed for that purpose. The theory, entitled the probabilistic spacetime theory (PST), starts with an alteration in one basic assumption compared to all current cosmological theories. Spacetime, instead of being seen as a void or container of other entities, is viewed as the most fundamental entity in the universe, composed of energy fragments, and (in keeping with the conservation principle) impermeable to destruction. The potential contribution of the PST in resolving the information paradox is delineated, with the finding that the single change in the conceptualization of spacetime results in the disappearance of the paradox and not information.

Globalization： The Paradox of Political Governance in Kenya： Domestic, Global, and Historical Forces

This essay is an historical, global, and intellectually oriented analytical commentary on 2013 general and quinquennial presidential election in Kenya and the factors that contributed to its outcome. The analysis and its interpretive conclusion have been informed via the reading of professor Sagini＇s two books

If Quantum “Wave” of the Universe Then Quantum “Particle” of the Universe: A Resolution of the Dark Energy Question and the Black Hole Information Paradox

We start from a minimal number of generally accepted premises, in particular Hartle-Hawking quantum wave of the universe and von Neumann-Connes’ pointless and self referential spacetime geometry. We then proceed from there to show, using Dvoretzky’s theorem of measure concentration, that the total energy of the universe is divided into two parts, an ordinary energy very small part which we can measure while most of the energy is concentrated as the second part at the boundary of the holographic boundary which we cannot measure in a direct way. Finally the results are shown to imply a resolution of the black hole information paradox without violating the fundamental laws of physics. In this way the main thrust of the two opposing arguments and views, namely that of Hawking on the one side and Susskind as well as tHooft on the other side, is brought to a consistent and compatible coherent unit.