Bioinspired Passive Tactile Sensors Enabled by Reversible Polarization of Conjugated Polymers

Tactile perception plays a vital role for the human body and is also highly desired for smart prosthesis and advanced robots.Compared to active sensing devices,passive piezoelectric and triboelectric tactile sensors consume less power,but lack the capability to resolve static stimuli.Here,we address this issue by utilizing the unique polarization chemistry of conjugated polymers for the first time and propose a new type of bioinspired,passive,and bio-friendly tactile sensors for resolving both static and dynamic stimuli.Specifically,to emulate the polarization process of natural sensory cells,conjugated polymers(including poly(3,4-ethylenedioxythiophen e):poly(styrenesulfonate),polyaniline,or polypyrrole)are controllably polarized into two opposite states to create artificial potential differences.The controllable and reversible polarization process of the conjugated polymers is fully in situ characterized.Then,a micro-structured ionic electrolyte is employed to imitate the natural ion channels and to encode external touch stimulations into the variation in potential difference outputs.Compared with the currently existing tactile sensing devices,the developed tactile sensors feature distinct characteristics including fully organic composition,high sensitivity(up to 773 mV N^(−1)),ultralow power consumption(nW),as well as superior bio-friendliness.As demonstrations,both single point tactile perception(surface texture perception and material property perception)and two-dimensional tactile recognitions(shape or profile perception)with high accuracy are successfully realized using self-defined machine learning algorithms.This tactile sensing concept innovation based on the polarization chemistry of conjugated polymers opens up a new path to create robotic tactile sensors and prosthetic electronic skins.

A high entropy stabilized perovskite oxide La_(0.2)Pr_(0.2)Sm_(0.2)Gd_(0.2)Sr_(0.2)Co_(0.8)Fe_(0.2)O_(3−δ)as a promising air electrode for reversible solid oxide cells

Reversible solid oxide cell(RSOC)is a new energy conversion device with significant applications,especially for power grid peaking shaving.However,the reversible conversion process of power generation/energy storage poses challenges for the performance and stability of air electrodes.In this work,a novel high-entropy perovskite oxide La_(0.2)Pr_(0.2)Gd_(0.2)Sm_(0.2)Sr_(0.2)Co_(0.8)Fe_(0.2)O_(3−δ)(HE-LSCF)is proposed and investigated as an air electrode in RSOC.The electrochemical behavior of HE-LSCF was studied as an air electrode in both fuel cell and electrolysis modes.The polarization impedance(Rp)of the HE-LSCF electrode is only 0.25Ω·cm^(2) at 800℃ in an air atmosphere.Notably,at an electrolytic voltage of 2 V and a temperature of 800℃,the current density reaches up to 1.68 A/cm^(2).The HE-LSCF air electrode exhibited excellent reversibility and stability,and its electrochemical performance remains stable after 100 h of reversible operation.With these advantages,HE-LSCF is shown to be an excellent air electrode for RSOC.

Corticosteroids in posterior reversible encephalopathy syndrome:Friend or foe?A systematic review

BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is a complex neurological disorder characterized by symptoms such as headaches,seizures,confusion,and visual disturbances.The pathophysiology of PRES involves endothelial dysfunction,disrupted cerebral autoregulation,and resulting vasogenic edema.Hypertension and other factors that alter cerebral autoregulation are critical in its development.Corticosteroids,widely used for their anti-inflammatory and immunosuppressive properties,play a controversial role in PRES.AIM To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature.Specifically,it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES.By synthesizing case reports and series,this review aims to provide a comprehensive understanding of the mechanisms,clinical presentations,and management strategies associated with corticosteroid-related PRES.METHODS The review was carried out according to the PRISMA guidelines.The databases searched included Science Direct,PubMed,and Hinari.The search strategy encompassed terms related to corticosteroids and PRES.Studies were included if they were peer-reviewed articles examining corticosteroids in PRES,excluding non-English publications,reviews,and editorials.Data on patient demographics,clinical characteristics,imaging findings,corticosteroid regimens,and outcomes were extracted.The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.RESULTS A total of 56 cases of PRES(66.1%women,33.9%men)potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified.Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years,with seizures,headaches,hypertension,and visual disturbances being common clinical sequelae.Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes.High-dose or prolonged corticosteroid therapy was a significant risk factor.On the contrary,in the treatment cases,corticosteroids were associated with positive outcomes,including resolution of vasogenic edema and stabilization of symptoms,particularly in patients with underlying inflammatory or autoimmune diseases.CONCLUSION Corticosteroids have a dual role in PRES,capable of both inducing and treating the condition.The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating.Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation.Corticosteroids may aid in the management of PRES:(1)Enhancing endothelial stability;(2)Antiinflammatory properties;and(3)Improving blood-brain barrier integrity.Mechanisms which may reduce or mitigate vasogenic edema formation.

Improvement effect of reversible solid solutions Mg_(2)Ni(Cu)/Mg_(2)Ni(Cu)H_(4)on hydrogen storage performance of MgH_(2)

The hydrogen absorption/desorption kinetic properties of MgH_(2)can be effectively enhanced by doping specific catalysts.In this work,MOFs-derived NiCu@C nanoparticles(~15 nm)with regular core-shell structure were successfully prepared and introduced into MgH_(2)(denoted as MgH_(2)-NiCu@C).The onset and peak temperatures of hydrogen desorption of MgH_(2)-11 wt.%NiCu@C are 175.0℃and282.2℃,respectively.The apparent activation energy of dehydrogenated reaction is 77.2±4.5 kJ/mol for MgH_(2)-11 wt.%NiCu@C,which is lower than half of that of the as-milled MgH_(2).Moreover,MgH_(2)-11 wt.%NiCu@C displays great cyclic stability.The strengthening"hydrogen pumping"effect of reversible solid solutions Mg_(2)Ni(Cu)/Mg_(2)Ni(Cu)H_(4)is proposed to explain the remarkable improvement in hydrogen absorption/desorption kinetic properties of MgH_(2).This work offers a novel perspective for the design of bimetallic nanoparticles and beyond for application in hydrogen storage and other energy related fields.

Critical Solvation Structures Arrested Active Molecules for Reversible Zn Electrochemistry

Aqueous Zn-ion batteries(AZIBs)have attracted increasing attention in next-generation energy storage systems due to their high safety and economic.Unfortunately,the side reactions,dendrites and hydrogen evolution effects at the zinc anode interface in aqueous electrolytes seriously hinder the application of aqueous zinc-ion batteries.Here,we report a critical solvation strategy to achieve reversible zinc electrochemistry by introducing a small polar molecule acetonitrile to form a“catcher”to arrest active molecules(bound water molecules).The stable solvation structure of[Zn(H_(2)O)_(6)]^(2+)is capable of maintaining and completely inhibiting free water molecules.When[Zn(H_(2)O)_(6)]^(2+)is partially desolvated in the Helmholtz outer layer,the separated active molecules will be arrested by the“catcher”formed by the strong hydrogen bond N-H bond,ensuring the stable desolvation of Zn^(2+).The Zn||Zn symmetric battery can stably cycle for 2250 h at 1 mAh cm^(-2),Zn||V_(6)O_(13) full battery achieved a capacity retention rate of 99.2%after 10,000 cycles at 10 A g^(-1).This paper proposes a novel critical solvation strategy that paves the route for the construction of high-performance AZIBs.

Rational Design of Ruddlesden-Popper Perovskite Ferrites as Air Electrode for Highly Active and Durable Reversible Protonic Ceramic Cells

Reversible protonic ceramic cells(RePCCs)hold promise for efficient energy storage,but their practicality is hindered by a lack of high-performance air electrode materials.Ruddlesden-Popper perovskite Sr_(3)Fe_(2)O_(7−δ)(SF)exhibits superior proton uptake and rapid ionic conduction,boosting activity.However,excessive proton uptake during RePCC operation degrades SF’s crystal structure,impacting durability.This study introduces a novel A/B-sites co-substitution strategy for modifying air electrodes,incorporating Sr-deficiency and Nb-substitution to create Sr_(2.8)Fe_(1.8)Nb_(0.2)O_(7−δ)(D-SFN).Nb stabilizes SF’s crystal,curbing excessive phase formation,and Sr-deficiency boosts oxygen vacancy concentration,optimizing oxygen transport.The D-SFN electrode demonstrates outstanding activity and durability,achieving a peak power density of 596 mW cm^(−2)in fuel cell mode and a current density of−1.19 A cm^(−2)in electrolysis mode at 1.3 V,650℃,with excellent cycling durability.This approach holds the potential for advancing robust and efficient air electrodes in RePCCs for renewable energy storage.

Reversible Semi-Fragile Watermarking Technique for Integrity Control of Relational Database

Reversible watermarking schemes for relational database are usually classified into two groups: robust schemes and fragile schemes. The main limitation of existing reversible fragile methods is that they cannot differentiate between legal and malicious modifications. In this paper, we introduce a novel lossless semi-fragile scheme based on prediction-error expansion for content protection of relational database. In the proposed method, all attributes in a database relation are first classified according to their sensitivity to legitimate updates. Then, the watermark is embedded by expanding the prediction error of the two least significant digits of securely selected attributes. At watermark extraction, the proposed method has the ability to fully restore the original data while detecting and localizing tampering. The applicability of our method is demonstrated theoretically and experimentally.

Giant reversible barocaloric effects with high thermal cycle stability in epoxybonded(MnCoGe)_(0.96)(CuCoSn)_(0.04) composite

Hexagonal MnMX-based(M=Co or Ni,X=Si or Ge)alloys exhibit giant reversible barocaloric effects.However,giant volume expansion would result in the as-cast MnMX ingots fragmenting into powders,and inevitably bring the deterioration of mechanical properties and formability.Grain fragmentation can bring degradation of structural transformation entropy change during cyclic application and removal of pressure.In this paper,giant reversible barocaloric effects with high thermal cycle stability can be achieved in the epoxy bonded(MnCoGe)0.96(CuCoSn)0.04 composite.Giant reversible isothermal entropy change of 43.0 J·kg^(−1)·K^(−1) and adiabatic temperature change from barocaloric effects(ΔT_(BCE))of 15.6 K can be obtained within a wide temperature span of 30 K at 360 MPa,which is mainly attributed to the integration of the change in the transition temperature driven by pressure of−101 K·GPa^(−1) and suitable thermal hysteresis of 11.1 K.Further,the variation of reversibleΔ_(TBCE) against the applied hydrostatic pressure reaches up to 43 K·GPa^(−1),which is at the highest level among the other reported giant barocaloric compounds.More importantly,after 60 thermal cycles,the composite does not break and the calorimetric curves coincide well,demonstrating good thermal cycle stability.

Surviving winter on the Qinghai-Xizang Plateau:Extensive reversible protein phosphorylation plays a dominant role in regulating hypometabolism in hibernating Nanorana parkeri

Changes in protein abundance and reversible protein phosphorylation(RPP)play important roles in regulating hypometabolism but have never been documented in overwintering frogs at high altitudes.To test the hypothesis that protein abundance and phosphorylation change in response to winter hibernation,we conducted a comprehensive and quantitative proteomic and phosphoproteomic analysis of the liver of the Xizang plateau frog,Nanorana parkeri,living on the Qinghai-Xizang Plateau.In total,5170 proteins and 5695 phosphorylation sites in 1938 proteins were quantified.Based on proteomic analysis,674 differentially expressed proteins(438 up-regulated,236 down-regulated)were screened in hibernating N.parkeri versus summer individuals.Functional enrichment analysis revealed that higher expressed proteins in winter were significantly enriched in immune-related signaling pathways,whereas lower expressed proteins were mainly involved in metabolic processes.A total of 4251 modified sites(4147 up-regulated,104 down-regulated)belonging to 1638 phosphoproteins(1555 up-regulated,83 down-regulated)were significantly changed in the liver.During hibernation,RPP regulated a diverse array of proteins involved in multiple functions,including metabolic enzymatic activity,ion transport,protein turnover,signal transduction,and alternative splicing.These changes contribute to enhancing protection,suppressing energy-consuming processes,and inducing metabolic depression.Moreover,the activities of phosphofructokinase,glutamate dehydrogenase,and ATPase were all significantly lower in winter compared to summer.In conclusion,our results support the hypothesis and demonstrate the importance of RPP as a regulatory mechanism when animals transition into a hypometabolic state.

Dialectical Thermodynamics’Solution to the Conceptual Imbroglio That Is the Reversible Path

According to the second law of thermodynamics, as currently understood, any given transit of a system along the reversible path proceeds with a total entropy change equal to zero. The fact that this condition is also the identifier of thermodynamic equilibrium, makes each and every point along the reversible path a state of equilibrium, and the reversible path, as expressed by a noted thermodynamic author, “a dense succession of equilibrium states”. The difficulties with these notions are plural. The fact, for example, that systems need to be forced out of equilibrium via the expenditure of work, would make any spontaneous reversible process a consumer of work, this in opposition to common thermodynamic wisdom that makes spontaneous reversible processes the most efficient transformers of work-producing-potential into actual work. The solution to this and other related impasses is provided by Dialectical Thermodynamics via its previously proved notion assigning a negative entropy change to the energy upgrading process represented by the transformation of heat into work. The said solution is here exemplified with the ideal-gas phase isomerization of butane into isobutane.

Adrenaline in pulp capping treatment of reversible pulpitis

BACKGROUND The role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis is not clear.AIM To explore the role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis.METHODS A total of 100 patients with reversible pulpitis who were treated in Anhui Jieshou People's Hospital from January 2020 to December 2021 were included in the study.They were categorized into an observation group(n=50;treatment with adrenaline)and a control group(n=50;treatment with zinc oxide eugenol paste).The 24-h postoperative pain,regression time of gingival congestion and redness,clinical efficacy,and incidence of adverse reactions were compared between the groups.Patients were further categorized into the ineffective and effective treatment groups based on clinical efficacy.Logistic multiple regression analysis explored factors affecting the efficacy of pulp capping treatment.RESULTS A significant difference in 24-h postoperative pain was observed between the groups(P<0.05),with a higher proportion of grade I pain noted in the observation group than in the control group(P<0.01).The regression time of gingival congestion and swelling was lower in the observation group(2.61±1.44 d and 2.73±1.36 d,respectively)than in the control group(3.85±1.47 d and 4.28±1.61 d,respectively)(P<0.05).The 2-wk postoperative total effective rate was lower in the control group(80.00%)than in the observation group(94.00%)(P<0.05).The incidence of adverse reactions was not significantly different between the control(14.00%)and observation(12.00%)groups(P>0.05).The proportion of adrenaline usage was lower(P<0.05)and that of anaerobic digestion by Streptococcus and Fusobacterium nucleatum was higher in the ineffective treatment group than in the effective treatment group(P<0.05).Logistic multiple regression analysis revealed adrenaline as a protective factor(P<0.05)and anaerobic digestion by Streptococcus and F.nucleatum as risk factors for pulp capping in reversible pulpitis(P<0.05).CONCLUSION Adrenaline demonstrated therapeutic efficacy in pulp capping treatment for reversible pulpitis,reducing pain and improving clinical symptoms safely.It is a protective factor for pulp capping,whereas Streptococcus and F.nucleatum are risk factors.Targeted measures can be implemented to improve clinical efficacy.

Phase engineering of a donor-doped air electrode for reversible protonic ceramic electrochemical cells

Reversible protonic ceramic electrochemical cells(R-PCECs)demonstrate great feasibility for efficient energy storage and conversion.One critical challenge for the development of R-PCECs is the design of novel air electrodes with the characteristics of high catalytic activity and acceptable durability.Here,we report a donor doping of Hf into the B-site of a cobalt-based double perovskite with a nominal formula of PrBa_(0.8)Ca_(0.2)Co_(1.9)Hf_(0.1)O_(5tδ)(PBCCHf_(0.1)),which is naturally reconfigured to a double perovskite PrBa_(0.8-x)Ca_(0.2)Co_(1.9)Hf_(0.1)-xO5tδ(PBCCHf_(0.1)-x)backbone and nano-sized BaHfO3(BHO)on the surface of PBCCHf_(0.1)x.The air electrode demonstrates enhanced catalytic activity and durability(a stable polarization resistance of 0.269Ωcm2 for~100 h at 600℃),due likely to the fast surface exchange process and bulk diffusion process.When employed as an air electrode of R-PCECs,a cell with PBCCHf_(0.1) air electrode demonstrates encouraging performances in modes of the fuel cell(FC)and electrolysis(EL)at 600℃:a peak power density of 0.998 W cm^(-2)and a current density of1.613 A cm^(-2)at 1.3 V(with acceptable Faradaic efficiencies).More importantly,the single-cell with PBCCHf_(0.1) air electrode demonstrates good cycling stability,switching back and forth from FC mode to EL mode0.5 A cm^(-2)for 200 h and 50 cycles.

Reversed charge transfer induced by nickel in Fe-Ni/Mo_(2)C@nitrogen-doped carbon nanobox for promoted reversible oxygen electrocatalysis

The interaction between metal and support is critical in oxygen catalysis as it governs the charge transfer between these two entities,influences the electronic structures of the supported metal,affects the adsorption energies of reaction intermediates,and ultimately impacts the catalytic performance.In this study,we discovered a unique charge transfer reversal phenomenon in a metal/carbon nanohybrid system.Specifically,electrons were transferred from the metal-based species to N-doped carbon,while the carbon support reciprocally donated electrons to the metal domain upon the introduction of nickel.This led to the exceptional electrocatalytic performances of the resulting Ni-Fe/Mo_(2)C@nitrogen-doped carbon catalyst,with a half-wave potential of 0.91 V towards oxygen reduction reaction(ORR)and a low overpotential of 290 m V at 10 mA cm^(-2)towards oxygen evolution reaction(OER)under alkaline conditions.Additionally,the Fe-Ni/Mo_(2)C@carbon heterojunction catalyst demonstrated high specific capacity(794 mA h g_(Zn)~(-1))and excellent cycling stability(200 h)in a Zn-air battery.Theoretical calculations revealed that Mo_(2)C effectively inhibited charge transfer from Fe to the support,while secondary doping of Ni induced a charge transfer reversal,resulting in electron accumulation in the Fe-Ni alloy region.This local electronic structure modulation significantly reduced energy barriers in the oxygen catalysis process,enhancing the catalytic efficiency of both ORR and OER.Consequently,our findings underscore the potential of manipulating charge transfer reversal between the metal and support as a promising strategy for developing highly-active and durable bi-functional oxygen electrodes.

A Dual Domain Robust Reversible Watermarking Algorithm for Frame Grouping Videos Using Scene Smoothness

The proposed robust reversible watermarking algorithm addresses the compatibility challenges between robustness and reversibility in existing video watermarking techniques by leveraging scene smoothness for frame grouping videos.Grounded in the H.264 video coding standard,the algorithm first employs traditional robust watermark stitching technology to embed watermark information in the low-frequency coefficient domain of the U channel.Subsequently,it utilizes histogram migration techniques in the high-frequency coefficient domain of the U channel to embed auxiliary information,enabling successful watermark extraction and lossless recovery of the original video content.Experimental results demonstrate the algorithm’s strong imperceptibility,with each embedded frame in the experimental videos achieving a mean peak signal-to-noise ratio of 49.3830 dB and a mean structural similarity of 0.9996.Compared with the three comparison algorithms,the performance of the two experimental indexes is improved by 7.59%and 0.4%on average.At the same time,the proposed algorithm has strong robustness to both offline and online attacks:In the face of offline attacks,the average normalized correlation coefficient between the extracted watermark and the original watermark is 0.9989,and the average bit error rate is 0.0089.In the face of online attacks,the normalized correlation coefficient between the extracted watermark and the original watermark is 0.8840,and the mean bit error rate is 0.2269.Compared with the three comparison algorithms,the performance of the two experimental indexes is improved by 1.27%and 18.16%on average,highlighting the algorithm’s robustness.Furthermore,the algorithm exhibits low computational complexity,with the mean encoding and the mean decoding time differentials during experimental video processing being 3.934 and 2.273 s,respectively,underscoring its practical utility.

Reversible Data Hiding Algorithm in Encrypted Images Based on Adaptive Median Edge Detection and Ciphertext-Policy Attribute-Based Encryption

With the rapid advancement of cloud computing technology,reversible data hiding algorithms in encrypted images(RDH-EI)have developed into an important field of study concentrated on safeguarding privacy in distributed cloud environments.However,existing algorithms often suffer from low embedding capacities and are inadequate for complex data access scenarios.To address these challenges,this paper proposes a novel reversible data hiding algorithm in encrypted images based on adaptive median edge detection(AMED)and ciphertext-policy attributebased encryption(CP-ABE).This proposed algorithm enhances the conventional median edge detection(MED)by incorporating dynamic variables to improve pixel prediction accuracy.The carrier image is subsequently reconstructed using the Huffman coding technique.Encrypted image generation is then achieved by encrypting the image based on system user attributes and data access rights,with the hierarchical embedding of the group’s secret data seamlessly integrated during the encryption process using the CP-ABE scheme.Ultimately,the encrypted image is transmitted to the data hider,enabling independent embedding of the secret data and resulting in the creation of the marked encrypted image.This approach allows only the receiver to extract the authorized group’s secret data,thereby enabling fine-grained,controlled access.Test results indicate that,in contrast to current algorithms,the method introduced here considerably improves the embedding rate while preserving lossless image recovery.Specifically,the average maximum embedding rates for the(3,4)-threshold and(6,6)-threshold schemes reach 5.7853 bits per pixel(bpp)and 7.7781 bpp,respectively,across the BOSSbase,BOW-2,and USD databases.Furthermore,the algorithm facilitates permission-granting and joint-decryption capabilities.Additionally,this paper conducts a comprehensive examination of the algorithm’s robustness using metrics such as image correlation,information entropy,and number of pixel change rate(NPCR),confirming its high level of security.Overall,the algorithm can be applied in a multi-user and multi-level cloud service environment to realize the secure storage of carrier images and secret data.

Calcineurin inhibitors-related posterior reversible encephalopathy syndrome in liver transplant recipients: Three case reports and review of literature

BACKGROUND Posterior reversible encephalopathy syndrome(PRES),characterized by acute neurological deterioration and extensive white matter lesions on T2-fluid attenuated inversion recovery magnetic resonance imaging(MRI),is increasingly associated with calcineurin inhibitors(CNI)-related neurotoxicity.Prompt diagnosis is crucial,as early intervention,including the modification or discontinuation of CNI therapy,strict blood pressure management,corticosteroid treatment,and supportive care can significantly improve patient outcomes and prognosis.The growing clinical recognition of CNI-related PRES underscores the importance of identifying and managing this condition in patients presenting with acute neurological symptoms.CASE SUMMARY This report describes three cases of liver transplant recipients who developed PRES.The first case involves a 60-year-old woman who experienced seizures,aphasia,and hemiplegia on postoperative day(POD)9,with MRI revealing ischemic foci followed by extensive white matter lesions.After replacing tacrolimus,her symptoms improved,and no significant MRI abnormalities were observed after three years of follow-up.The second case concerns a 54-year-old woman with autoimmune hepatitis who developed headaches,seizures,and extensive white matter demyelination on MRI on POD24.Following the switch to rapamycin and the initiation of corticosteroids,her symptoms resolved,and she was discharged on POD95.The third case details a 60-year-old woman with hepatocellular carcinoma who developed PRES,evidenced by brain MRI abnormal-ities on POD11.Transitioning to rapamycin and corticosteroid therapy led to her full recovery,and she was discharged on POD22.These cases highlight the critical importance of early diagnosis,CNI modification,and stringent management in improving outcomes for liver transplant recipients with CNI related PRES.CONCLUSION Clinical manifestations,combined with characteristic MRI findings,are crucial in diagnosing PRES among organ transplant recipients.However,when standard treatments are ineffective or MRI results are atypical,alternative diagnoses should be taken into considered.

Tacrolimus-induced posterior reversible encephalopathy syndrome following liver transplantation

In this editorial,we talk about a compelling case focusing on posterior reversible encephalopathy syndrome(PRES)as a complication in patients undergoing liver transplantation and treated with Tacrolimus.Tacrolimus(FK 506),derived from Streptomyces tsukubaensis,is a potent immunosuppressive macrolide.It inhibits Tcell transcription by binding to FK-binding protein,and is able to amplify glucocorticoid and progesterone effects.Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES.PRES presents with various neurological symptoms alongside elevated blood pressure,and is primarily characterized by vasogenic edema on neuroimaging.While computed tomography detects initial lesions,magnetic resonance imaging,especially the Fluid-Attenuated Inversion Recovery sequence,is superior for diagnosing cortical and subcortical edema.Our discussion centers on the incidence of PRES in solid organ transplant recipients,which ranges between 0.5 to 5+ACU-,with varying presentations,from seizures to visual disturbances.The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES.Radiographically evident in the parietal and occipital lobes,PRES underlines the need for heightened vigilance among healthcare providers.This editorial emphasizes the importance of early recognition,accurate diagnosis,and effective management of PRES to optimize outcomes in liver transplant patients.The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks,underlining the necessity for careful monitoring and intervention strategies in this patient population.

A Delicate Diagnostic of Posterior Reversible Encephalopathy Syndrome (PRES) Revealed by Repetitive Convulsions in a 14-Year-Old Child: A Case Report and Review of the Literature

Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occurs in various conditions such as collagenosis or vasculitis of the central nervous system, electrolytic disorders and the use of cytotoxics or immunosuppressive treatment. It is responsible for non-specific neurological manifestations such as confusion, coma, convulsions or visual disturbances. The diagnosis is suggested by brain magnetic resonance imaging (MRI). The lesions correspond to vasogenic edema and are therefore generally reversible after etiologic treatment and control of blood pressure. Aim: This clinical case aims to show the diagnostic complexity of rare pathologies in the intensive care unit. Case presentation: We present a case of a 14-year-old child received in the pediatrics department for generalized tonic-clonic convulsions with tongue biting in a febrile context. Malaria was negative, with hyperleukocytosis, slightly elevated C-reactive protein, anemia and hypokliemia, lumbar puncture was performed and all cerebrospinal fluid examinations revealed nothing. The seizures were controlled by titrated cumulative doses of diazepam with a total of 12mg, antibiotic therapy with ceftriaxone, corticotherapy with dexamethasone 12mg and blood transfusion without any improvement in his condition. He was then transferred to intensive care where the clinical and paraclinical assessment highlighted a neurological deficit Glasgow coma scale of 12/15 and biological hyponatremia. Brain CT-scan was normal. Hydroelectrolytic equilibration was undertaken, antibiotics continued, anti-comital prophylaxis and general resuscitation measures were provided. He regained consciousness on the 3rd day. On the 4th day, he presented high blood pressure and on the 5th, a resumption of convulsions without any obvious biological disorder, cerebrospinal fluid control was once more non-pathological. An MRI was performed and revealed Posterior-reversible encephalopathy syndrome. Conclusion: Posterior-reversible encephalopathy syndrome is a rare disease. It is necessary to keep rare diseases in mind.

Laparoscopic intracorporeal anastomosis vs open anastomosis for ileostomy reversal in Crohn's disease:A single center retrospective study

BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques.However,research on its application for small bowel stoma reversal in patients with Crohn's disease(CD)is limited.Therefore,in this study,we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal(LIIR)and open ileostomy reversal(OIR).AIM To compare the safety,feasibility,bowel function recovery,and short-and longterm LIIR and OIR outcomes in patients with CD.METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution.The baseline data,postoperative recovery,and complication indicators were retrospectively analyzed.Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.RESULTS Notably,15 of the 45 patients in this study underwent OIR,and the remaining 30 received LIIR.Notably,no statistically significant differences were found between the two groups regarding clinical baseline characteristics,operation time,intraoperative hemorrhage,anastomotic site,enterolysis range,first postoperative flatus,postoperative complications,reoperation rate,or incidence of postoperative enteral nutrition intolerance.Compared with the OIR group,the LIIR group had a shorter postoperative hospital stay(P=0.045),lower incidence of enteral nutrition intolerance symptoms(P=0.019),and earlier postoperative total enteral nutrition initiation(P=0.033);however,it incurred higher total hospital costs(P=0.038).Furthermore,multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance(P<0.05).CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible.Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.

Effect of stacking fault energy on mechanical properties of ultrafine-grain Cu and Cu-Al alloy processed by cold-rolling

Cu,Cu-2.2%Al and Cu-4.5%Al with stacking fault energies（SFE） of 78,35 and 7 mJ/m2 respectively were processed by cold-rolling（CR） at liquid nitrogen temperature（77 K） after hot-rolling.X-ray diffraction measurements indicate that a decrease in SFE leads to a decrease in crystallite size but increase in microstrain,dislocation and twin densities of the CR processed samples.Tensile tests at room temperature indicate that as the stacking fault energy decreases,the strength and ductility increase.The results indicate that decreasing stacking fault energy is an optimum method to improve the ductility without loss of strength.