Infective Endocarditis Due to High-Level Gentamicin-Resistant Enterococcus faecalis Complicated Multisystemic Complications in an Elderly Patient.

The escalating incidence of infective endocarditis (IE) caused by aminoglycoside-resistant Enterococcus is a growing concern for clinicians. This issue is particularly pronounced in elderly patients, who face an elevated risk of renal damage during antibiotic treatment, thereby limiting available pharmacological options. Furthermore, elderly patients often present with multiple comorbidities, leading to heightened mortality rates. In this article, we present a case involving an elderly male patient who sought medical attention on two separate occasions due to inflammation of the lower extremities and lumbosacral pain. Subsequent diagnosis revealed infective endocarditis (IE) caused by high-level gentamicin-resistant Enterococcus faecalis through blood culture and echocardiography. The patient also experienced peripheral and cerebral arterial embolism, secondary spine infection, and subsequent heart failure, highlighting the severity of the clinical situation. Following an initial 10-day course of vancomycin and ceftriaxone therapy, the patient developed renal impairment, necessitating a switch to bactericidal therapy with ampicillin in combination with ceftriaxone. Additionally, aortic valve replacement was performed during this period. Ultimately, the patient achieved clinical remission. This case underscores the critical importance of prompt and accurate diagnosis, appropriate antibiotic selection, and timely surgical intervention in enhancing the prognosis of elderly patients with IE.

Effects of first-line nucleot(s)ide analogues on lipid profiles in patients with chronic hepatitis B: a network meta-analysis.

INTRODUCTION: Recent studies have found that lipid levels in patients with chronic hepatitis B (CHB) may change during antiviral therapy. OBJECTIVE: To assess the effects of first-line nucleot(s)ide analogues (NAs) on lipid profiles in patients with CHB using network meta-analysis. METHODS: Seven electronic databases (PubMed, Embase, Cochrane Library, and four Chinese databases) were searched for cohort studies on the effect of NA on lipids in patients with CHB up to August 1, 2023. The changes of serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were taken as outcomes. The mean difference (MD) of continuous variables and 95% confidence intervals (CI) were calculated using RevMan 5.4 and Stata 16.0 software, and network meta-analysis was based on a frequentist framework. RESULTS: A total of 4194 patients were included in the study, including patients with CHB treated with entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), as well as patients not receiving antiviral therapy [patients with inactive CHB who were not receiving antiviral therapy (referred as inactive CHB patients) and non-HBV-infected patients]. TDF reduced TC levels compared to the non-antiviral group (TDF vs. inactive CHB patients: MD = - 17.27, 95% CI (- 30.03, - 4.47); TDF vs. non-HBV-infected individuals: MD = - 17.10, 95% CI (- 20.13, - 14.07)). TC changes in the TAF and ETV groups were not statistically different from the non-antiviral group (TAF vs. inactive CHB patients: MD = - 2.69, 95% CI (- 14.42, 9.04); TAF vs. non-HBV-infected individuals: MD = - 2.52, 95% CI (- 8.47, 3.43); ETV vs. inactive CHB patients: MD = - 4.24, 95% CI (- 17.12, 8.64); ETV vs. non-HBV-infected individuals: MD = - 4.07, 95% CI (- 9.90, 1.75)). The ranking of the effects for lowering TC is as follows: CHB patients treated with nucleotide analogues [with varying efficacy: TDF (SUCRA = 99.9) > ETV (SUCRA = 59.3) > TAF (SUCRA = 43.6)] > inactive CHB patients (SUCRA = 27.3) > non-HBV-infected individuals (SUCRA = 19.9). As for secondary outcomes, among the three antiviral drugs, TDF had the most significant effect on lowering TG, LDL-C, and HDL-C, but none of the three drugs was statistically different from the non-antiviral group. Subgroup analysis showed that the lipid-lowering effect of TDF was more pronounced in the elderly (≥ 50 years). CONCLUSION: TDF was effective in lipid reduction, particularly pronounced in the older population. TAF and ETV had a neutral effect to TC, TG, LDL-C, and HDL-C. Despite a relative increase in lipids observed in patients transitioning from TDF to TAF or ETV, these changes remained within acceptable limits.

Probable targets and mechanism of ginsenoside Rg1 for non-alcoholic fatty liver disease: a study integrating network pharmacology, molecular docking, and molecular dynamics simulation.

Ginsenoside Rg1 (GRg1), a key bioactive component of medicinal herbs, has shown beneficial effects on non-alcoholic fatty liver disease (NAFLD) and numerous other conditions. Nevertheless, the specific targets that are actively involved and the potential mechanisms underlying NAFLD treatment remain unclear. This study aimed to elucidate the therapeutic effects and mechanism of GRg1 in alleviating NAFLD using a combined approach of network pharmacology and molecular biology validation. The analysis yielded 294 targets for GRg1 and 1293 associated with NAFLD, resulting in 89 overlapping targets. Through protein-protein interactions (PPI) network topology analysis, 10 key targets were identified. Upon evaluating the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) analysis, GRg1 may exert therapeutic effects on NAFLD by negatively regulating the apoptotic process, insulin and endocrine resistance, the AGE-RAGE signaling pathway in diabetic complications, and the Estrogen, PI3K/Akt, and MAPK pathways. The three differential gene targets for Akt1, EGFR, and IGF1 were identified through the compound-target network in conjunction with the aforementioned methods. The molecular docking and molecular dynamics (MD) simulations showed that AKT1 and EGFR had a strong binding affinity with GRg1. Overall, our findings point to a novel therapeutic strategy involving NAFLD, with further in vivo and in vitro studies promising to deepen our comprehension and validate its potential advantages.Communicated by Ramaswamy H. Sarma.

All-temperature area battery application mechanism, performance, and strategies.

Further applications of electric vehicles (EVs) and energy storage stations are limited because of the thermal sensitivity, volatility, and poor durability of lithium-ion batteries (LIBs), especially given the urgent requirements for all-climate utilization and fast charging. This study comprehensively reviews the thermal characteristics and management of LIBs in an all-temperature area based on the performance, mechanism, and thermal management strategy levels. At the performance level, the external features of the batteries were analyzed and compared in cold and hot environments. At the mechanism level, the heat generation principles and thermal features of LIBs under different temperature conditions were summarized from the perspectives of thermal and electrothermal mechanisms. At the strategy level, to maintain the temperature/thermal consistency and prevent poor subzero temperature performance and local/global overheating, conventional and novel battery thermal management systems (BTMSs) are discussed from the perspective of temperature control, thermal consistency, and power cost. Moreover, future countermeasures to enhance the performance of all-climate areas at the material, cell, and system levels are discussed. This study provides insights and methodologies to guarantee the performance and safety of LIBs used in EVs and energy storage stations.

A Super Uniform Hydrophobic Gas Diffusion Layer for a Proton Exchange Membrane Fuel Cell.

The design and optimization of the gas diffusion layer (GDL) play a crucial role in the improvement of proton exchange membrane fuel cell performance. Hydrophobic treatment of a GDL is an important method for facilitating mass transfer, while conventional Teflon treatment is not uniform and leads to an increase in ohmic and heat resistance. Herein, a homogeneous molecular hydrophobic GDL was prepared by liquid phase synthesis, and a two-dimensional non-isothermal model was developed to investigate the transfer mechanism. The peak power density of cells with the GDL described above was improved by 46% compared to that of the conventional GDL. The ohmic and mass transport resistance decreased by 15% and 52%, respectively, under a current density of 1 A cm-2 using the uniform hydrophobic GDL. The simulation results proved that the uniform hydrophobic GDL eliminates the hydrophilic dots, which prevents the formation of water pools and reduces the resistance to gas flow. The water saturation of the conventional GDL reaches 0.19 at a current density of 1 A cm-2, and the saturation of a modified GDL under the same conditions is only 0.13. A dimensionless parameter, Tf, is proposed to characterize the resistance of oxygen diffusion. In conclusion, molecular-level uniform hydrophobic treatment can effectively reduce the ohmic and mass transfer resistance of a GDL and effectively improve the performance of fuel cells.

A Case of Spontaneous Mediastinal and Subcutaneous Emphysema in a Patient with HIV-Infected Pneumonia.

BACKGROUND: Acquired immunodeficiency syndrome is a chronic infectious disease with high mortality and is caused by the Human Immunodeficiency Virus (HIV). Pneumonia caused by HIV is common, but it rarely causes spontaneous mediastinal and subcutaneous emphysema. CASE PRESENTATION: A 21-year-old man with severe pneumonia was hospitalized owing to dyspnea that had been persisting for 1 day; blood test results confirmed HIV infection. Initial chest Computed Tomography (CT) did not reveal mediastinal or subcutaneous emphysema. However, after 21 days of treatment, the patient experienced discomfort in the neck region and experienced the feeling of snowflakes on applying pressure. Chest CT showed mediastinal and subcutaneous emphysema, located in the bilateral cervical roots, anterior upper chest wall, left axillary chest wall, mediastinum, and other parts. Metagenomic Next Generation Sequencing (mNGS) of the sputum and blood samples suggested multiple pathogenic infections. Antiinfection treatment was initiated, and changes in the patient's condition were monitored. The patient's subcutaneous emphysema improved during the follow-up. CONCLUSION: In HIV-infected patients with sudden mediastinal and subcutaneous emphysema, mNGS can be used to determine the etiological agent during symptomatic treatment. Targeted antipathogen therapy is helpful in improving the condition of patients with subcutaneous emphysema.

Data-driven capacity estimation of commercial lithium-ion batteries from voltage relaxation.

Accurate capacity estimation is crucial for the reliable and safe operation of lithium-ion batteries. In particular, exploiting the relaxation voltage curve features could enable battery capacity estimation without additional cycling information. Here, we report the study of three datasets comprising 130 commercial lithium-ion cells cycled under various conditions to evaluate the capacity estimation approach. One dataset is collected for model building from batteries with LiNi0.86Co0.11Al0.03O2-based positive electrodes. The other two datasets, used for validation, are obtained from batteries with LiNi0.83Co0.11Mn0.07O2-based positive electrodes and batteries with the blend of Li(NiCoMn)O2 - Li(NiCoAl)O2 positive electrodes. Base models that use machine learning methods are employed to estimate the battery capacity using features derived from the relaxation voltage profiles. The best model achieves a root-mean-square error of 1.1% for the dataset used for the model building. A transfer learning model is then developed by adding a featured linear transformation to the base model. This extended model achieves a root-mean-square error of less than 1.7% on the datasets used for the model validation, indicating the successful applicability of the capacity estimation approach utilizing cell voltage relaxation.

Voltammetric and galvanostatic methods for measuring hydrogen crossover in fuel cell.

Hydrogen crossover rate is an important indicator for characterizing the membrane degradation and failure in proton exchange membrane fuel cell. Several electrochemical methods have been applied to quantify it. But most of established methods are too rough to support follow-up applications. In this paper, a systematic and consistent theoretical foundation for electrochemical measurements of hydrogen crossover is established for the first time. Different electrochemical processes occurring throughout the courses of applying potentiostatic or galvanostatic excitations on fuel cell are clarified, and the linear current-voltage behavior observed in the steady-state voltammogram is reinterpreted. On this basis, we propose a modified galvanostatic charging method with high practicality to achieve accurate electrochemical measurement of hydrogen crossover, and the validity of this method is fully verified. This research provides an explicit framework for implementation of galvanostatic charging method and offers deeper insights into the principles of electrochemical methods for measuring hydrogen crossover.

Investigating the critical characteristics of thermal runaway process for LiFePO4/graphite batteries by a ceased segmented method.

Lithium-ion batteries (LIBs) are widely used as the energy carrier in our daily life. However, the higher energy density of LIBs results in poor safety performance. Thermal runaway (TR) is the critical problem which hinders the further application of LIBs. Clarifying the mechanism of TR evolution is beneficial to safer cell design and safety management. In this paper, liquid nitrogen spray is proved to be an effective way to stop the violent reaction of LIBs during the TR process. Based on extended-volume accelerating rate calorimetry, the liquid nitrogen ceasing combined with non-atmospheric exposure analysis is used to investigate the TR evolution about LiFePO4/graphite batteries at critical temperature. Specifically, the geometrical shape, voltage, and impedance change are monitored during the TR process on the cell level. The morphologies/constitution of electrodes and separators are presented on the component level. Utilizing the gas analysis, the failure mechanism of the prismatic LiFePO4/graphite battery is studied comprehensively.

Comprehensive Investigation of a Slight Overcharge on Degradation and Thermal Runaway Behavior of Lithium-Ion Batteries.

Overcharge is a hazardous abuse condition that has dominant influences on cell performance and safety. This work, for the first time, comprehensively investigates the impact of different overcharge degrees on degradation and thermal runaway behavior of lithium-ion batteries. The results indicate that single overcharge has little influence on cell capacity, while it severely degrades thermal stability. Degradation mechanisms are investigated by utilizing the incremental capacity-differential voltage and relaxation voltage analyses. During the slight overcharge process, the conductivity loss and the loss of lithium inventory always occur; the loss of active material starts happening only when the cell is overcharged to a certain degree. Lithium plating is the major cause for the loss of lithium inventory, and an interesting phenomenon that the arrival time of the dV/dt peak decreases linearly with the increase of the overcharge degree is found. The cells with different degrees of overcharge exhibit a similar behavior during adiabatic thermal runaway. Meanwhile, the relationship between sudden voltage drop and thermal runaway is further established. More importantly, the characteristic temperature of thermal runaway, especially the self-heating temperature (T1), decreases severely along with overcharging, which means that a slight overcharge severely decreases the cell thermal stability. Further, post-mortem analysis is conducted to investigate the degradation mechanisms. The mechanism of the side reactions caused by a slight overcharge on the degradation performance and thermal runaway characteristics is revealed.

A case report of traumatic osteoarthritis associated with LARS artificial ligament use in anterior cruciate ligament reconstruction.

BACKGROUND: A ligament advanced reinforcement system (LARS) artificial ligament has been proposed for use in anterior cruciate ligament (ACL) reconstruction, and many reports have shown its success in ACL reconstruction. However, there are great concerns about the potential risk of complications, which might prevent its extensive use. Late failure may occur due to serious complications. CASE PRESENTATION: We report a rare case of serious osteoarthritis that occurred 2 years postoperatively in a 51-year-old man who underwent reconstruction with an LARS artificial ligament. In X-rays, the tibial tunnel was placed too posteriorly. MRI showed that the tibial tunnel was enlarged, and there was a large effusion in the knee joint. The LARS device was rough and worn. Histologically, a large number of fibroblasts and a few multinucleated giant cells infiltrated the graft fibres. CONCLUSION: Our findings remind surgeons that an LARS device should be with great caution in ACL reconstruction.

Multiplicative measurement noise can facilitate consensus of multiagent networks.

Measurement noise may have an important impact on the collective motion. Here, we investigate the consensus problem of multiagent networks with multiplicative measurement noise. Based on the stability theory of stochastic differential equations and the algebra graph theory, we obtain sufficient conditions for the consensus and nonconsensus. Both of our analytical and numerical results show that the multiplicative measurement noise can facilitate the emergence of the consensus: the convergence rate increases with respect to the noise intensity if the topologies of the underlying networks satisfy some conditions. Our results provide a better understanding of the constructive role of noise. We also report that the convergence rate of multiagent networks is strongly affected by the network topology and the group size.

[Effect of salmon calcitonin on postoperative humeral head replacement in elderly patients].

OBJECTIVE: To observe the effect of anti-osteoporosis drugs on the curative effect of femoral head replacement in the elderly patients with proximal humerus fracture. METHODS: From November 2012 to June 2016, 38 patients with proximal humeral fractures received humeral head replacement were divided into the treatment group and the control group according to whether the anti-osteoporosis drugs were used after the operation. The treatment group included 19 cases, of which 11 cases were three part fractures, 18 cases were four part fractures, and bone density was(0.58±0.14) g/cm²; the control group involved 19 cases, of which 10 cases were the three part fractures, 9 cases were four part fractures, and bone density was(0.58±0.11) g/cm². Periprosthetic bone mineral density(BMD) was measured at 4, 8, 12, 24 and 48 weeks after operation, and visual analogue scale(VAS) was used to evaluate the pain and Neer score was used to evaluate the function of the shoulder joint. RESULTS: The incisions of all patients were healed with grade A and no complications occurred. Thirty-five patients were followed up for 1 year. The bone density around the prosthesis of treatment group was higher than that of control group, the difference was statistically significant(P<0.05);VAS in two groups had no statistical significance(P>0.05). The total score and functional score of Neer in the treatment group were better than those in the control group, the difference was statistically significant(P<0.05), and there was no significant difference in pain and activity score between the two groups(P>0.05). According to the Neer score, the results of treatment group was excellent in 10 cases, good in 5 cases, fair in 3 cases;in the control group, 3 cases were excellent, 9 cases were good, and 5 cases were fair;the difference between the two groups was statistically significant(P<0.05). CONCLUSIONS: Artificial humeral head replacement combined with anti-osteoporosis drugs in the treatment of proximal humeral fractures in elderly patients can effectively improve the bone density around the prosthesis and restore shoulder function. The early clinical effect is satisfactory.

Fascin-1 Contributes to Neuropathic Pain by Promoting Inflammation in Rat Spinal Cord.

Neuropathic pain is a complicated clinical syndrome caused by heterogeneous etiology. Despite the fact that the underlying mechanisms remain elusive, it is well accepted that neuroinflammation plays a critical role in the development of neuropathic pain. Fascin-1, an actin-bundling protein, has been proved to be involved in the processing of diverse biological events including cellular development, immunity, and tumor invasion etc. Recent studies have shown that Fascin-1 participates in antigen presentation and the regulation of pro-inflammatory agents. However, whether Fascin-1 is involved in neuropathic pain has not been reported. In the present study we examined the potential role of Fascin-1 by using a rodent model of chronic constriction injury (CCI). Our results showed that Fascin-1 increased rapidly in dorsal root ganglions (DRG) and spinal cord (SC) after CCI. The increased Fascin-1 widely expressed in DRG, however, it localized predominantly in microglia, seldom in neuron, and hardly in astrocyte in the SC. Intrathecal injection of Fascin-1 siRNA not only suppressed the activation of microglia and the release of pro-inflammatory mediators, but also attenuated the mechanical allodynia and thermal hyperalgesia induced by CCI.

Manganese exposure facilitates microglial JAK2-STAT3 signaling and consequent secretion of TNF-a and IL-1ß to promote neuronal death.

Chronic manganese (Mn) exposure can lead to neuroinflammation and neurological deficit, which resemble idiopathic Parkinson's disease (IPD). However, the precise mechanisms underlying Mn exposure-induced neurotoxicity remain incompletely understood. Microglia can become hyperactivated and plays a vital role in neuroinflammation and consequent neurodegeneration in response to pro-inflammatory stimuli. In the present study, we found that HAPI microglial cells exhibited increased secretion of pro-inflammatory TNF-α and IL-1ß following Mn exposure in dose- and time-dependent manners. In addition, we showed that Mn exposure could trigger the activation of JAK2/STAT3 signaling pathway in microglia. Notably, Mn-induced secretion of TNF-α and IL-1ß was significantly attenuated by the treatment of JAK2 inhibitor. Finally, through incubating PC12 neuronal cells with Mn-treated microglial conditioned medium, we demonstrated that Mn-induced secretion of microglial TNF-α and IL-1ß facilitated neuronal apoptosis. Thus, we speculate that Mn exposure might trigger JAK2-STAT3 signal pathway in microglia, leading to resultant neuroinflammation and neuronal loss.

Insulin-like Growth Factor Binding Protein6 Associated with Neuronal Apoptosis Following Intracerebral Hemorrhage in Rats.

The insulin-like growth factor (IGF) system is linked to CNS pathological states. The functions of IGFs are modulated by a family of binding proteins termed insulin-like growth factor binding proteins (IGFBPs). Here, we demonstrate that IGFBP-6 may be associated with neuronal apoptosis in the processes of intracerebral hemorrhage (ICH). We obtained a significant upregulation of IGFBP-6 in neurons adjacent to the hematoma following ICH with the results of Western blot, immunohistochemistry, and immunofluorescence. Increasing IGFBP-6 level was found to be accompanied by the upregulation of Bax, Bcl-2, and active caspase-3. Besides, IGFBP-6 co-localized well with active caspase-3 in neurons, indicating its potential role in neuronal apoptosis. Knocking down IGFBP-6 by RNA-interference in PC12 cells reduced active caspase-3 expression. Thus, IGFBP-6 may play a role in promoting the brain secondary damage following ICH.

Transferrin modified PEG-PLA-resveratrol conjugates: in vitro and in vivo studies for glioma.

Glioblastoma is one of the most malignant brain tumors with a poor prognosis. In this study, we examined the effects of transferrin (Tf)-modified poly ethyleneglycol-poly lactic acid (PEG-PLA) nanoparticles conjugated with resveratrol (Tf-PEG-PLA-RSV) to glioma therapy in vitro and in vivo. The cell viability of Tf-PEG-PLA-RSV on C6 and U87 glioma cells was determined by the MTT assay. In vivo biodistribution and antitumor activity were investigated in Brain glioma bearing rat model of C6 glioma by i.p. administration of RSV-polymer conjugates. We found that the average diameter of each Tf-PEG-PLA-RSV is around 150 nm with 32 molecules of Tf on surface. In vitro cytotoxicity of PEG-PLA-RSV against C6 and U87 cells was higher than that of free RSV, and further the modification of Tf enhanced the cytotoxicity of the RSV-polymer conjugates as a result of the increased cellular uptake of the RSV-modified conjugates by glioma cells. In comparison with free RSV, RSV conjugates could significantly decrease tumor volume and accumulate in brain tumor, which resulted in prolonging the survival of C6 glioma-bearing rats. These results suggest that Tf-NP-RSV had a potential of therapeutic effect to glioma both in vitro and in vivo and might be a potential candidate for targeted therapy of glioma and worthy of further investigation.

[Comparison of navelbine plus ifosfamide and cisplatin versus ifosfamide plus cisplatin in the treatment of advanced non small cell lung cancer].

BACKGROUND: To observe the efficacy and safety of navelbine (NVB) combined with ifosfamide (IFO) and cisplatin (DDP) (NIP regimen) and IFO plus DDP (IP regimen) for advanced non-small cell lung cancer (NSCLC). METHODS: One hundred and twenty patients with advanced NSCLC pathologically proved were randomly divided into group A (NIP regimen, n=60) and group B (IP regimen, n=60). RESULTS: In group A, 58 patients were evaluable. The response rates were 58.62%(34/58), 65.58%(17/26) and 53.12% (17/32) in whole group, untreated patients, and retreated patients, respectively. The median duration of survival was 11.3 months. One-year survival rate was 40.0%. In group B, 59 patients could be evaluated. The response rates were 40.68%(24/59), 63.33%(19/30) and 17.24%(5/29) in whole group, untreated patients, and retreated patients, respectively. The median duration of survival was 9 months and 1-year survival rate was 36.7%. There was no significant difference in objective response rate among all the patients and the patients with no prior treatment between the two groups ( P > 0.05, P > 0.05). However, among retreated patients, the response rate in group A was remarkably higher than that in group B ( P < 0.05). The main dose limiting toxicity was myelosuppression. Leukopenia at grade III+IV was significantly higher in the NIP arm than in the IP arm ( P < 0.05). CONCLUSIONS: NIP yields a higher response rate than IP does in retreated patients, with acceptable toxicity, which can be the first line regimen in the retreatment of advanced NSCLC. IP regimen showes a similar response rate and less toxicity in initial patients, compared with NIP regimen, so it might be considered a relevant regimen in initial patients with advanced NSCLC.