Hypervirulent Klebsiella pneumoniae Mediated Hepatic Infarction Septic Shock After Rectal Cancer Surgery: A Case Report.

The liver receives blood from both the hepatic artery and portal vein. Hepatic infarction is rare in clinical practice as both the hepatic artery and portal vein can supply blood to the liver. Here, we reported a case of a 75-year-old man who underwent radical laparoscopic surgery for rectal cancer and subsequently developed hepatic infarction. The patient experienced severe infection, as well as circulatory and respiratory failure on the third day after surgery. The patient presented with high fever, chest tightness, shortness of breath, decreased blood oxygen saturation and blood pressure. The leukocyte count decreased from 8.10 × 10^9/L to 1.75 × 10^9/L. Procalcitonin (PCT) levels increased from 1.02 ng/mL to 67.14 ng/mL, and eventually reaching levels over 200 ng/mL. Enhanced abdominal computed tomography (CT) confirmed the presence of hepatic infarction, but no thrombosis was observed in the hepatic artery or portal vein. Metagenomic next-generation sequencing (mNGS) identified hypervirulent Klebsiella pneumoniae (hvKp) in the patient's blood and ascites, one day earlier than the detection results using traditional culture methods. The patient was diagnosed with hepatic infarction combined with septic shock caused by hvKp. This case emphasizes that in the high-risk group of thrombosis, infection can trigger exacerbated hepatic infarction events, particularly in cases after surgical procedures. For severely ill patients with infectious diseases who are admitted to the ICU with worsening symptoms, it is important to collect appropriate samples and send them for pathogen detection using mNGS in a timely manner. This may aid in early intervention and improve clinical outcomes.

Disseminated Histoplasmosis Infection Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report.

Histoplasmosis is an endemic disease caused by Histoplasma capsulatum. This systemic disease can affect various organs beyond the lungs, such as the liver, spleen, adrenal gland, and lymph nodes. The clinical symptoms can range from asymptomatic to severe, life-threatening conditions, depending on the state of the patient's immune system. This report describes a 40-year-old male who presented with reports of weight loss, low back pain, and progressively worsening movement disorder of the bilateral lower extremities for months. Computed tomography (CT) examination showed multiple lytic lesions of vertebral bodies, bilateral ribs, and pelvic bone, histopathological examination and tumor-related serum markers exclude tumors. mNGS was employed to identify H. capsulatum var. capsulatum as the etiological agent of the lesions in the bone biopsy. Through phylogenetic tree analysis, Histoplasma capsulatum var. Capsulatum (Hcc) was the main responsible pathogen, rarely reported in bone lesions. The patient underwent spinal surgery and was successfully treated with liposomal amphotericin B and itraconazole. Based on the diagnosis and treatment of this case, we discuss the epidemiologic status, clinical presentations, diagnostic criteria, and treatment guidelines of histoplasmosis to provide additional information about this disease. mNGS is utilized in this case, and it appears to be a reliable method for early and accurate diagnosis of this disease.

Can the implementation of household waste classification mitigate greenhouse gas emissions in Beijing? A comprehensive analysis of recent trends and future scenarios.

Household waste contributes significantly to global greenhouse gas (GHG) emissions, and waste classification is crucial for reducing emissions. This study focuses on Beijing and utilizes life cycle assessment (LCA) and material flow analysis (MFA) to calculate GHG emissions in waste management systems and quantify emission reduction potential of different measures. The results show that net emissions from the classification system in 2021 are 116.77 kg CO2-eq/t waste, reducing 61.82 % compared to the traditional mixed collection and transportation system. Waste volume, classification efficiency, and treatment strategies are the primary factors affecting emissions in classification systems. Recycling is identified as effective treatment methods. Three scenarios are designed to explore emission pathway of the system toward 2060. In the business-as-usual (BAU) Scenario, emissions will continue to grow to 108.57 × 104 t CO2-eq/yr in 2060. In the Classification Efficiency Scenario and the Comprehensive Scenario, emissions in 2060 will be cut to -177.26 × 104 t CO2-eq/yr and -702.00 × 104 t CO2-eq/yr, respectively. These results underscore the critical role of waste classification and recycling in mitigating the negative impacts of increasing waste volume. By 2060, combining waste classification with recycling can offset emissions by 803.51 × 104 t CO2-eq/yr, contributing 99 % to emission reduction potential. Improving classification efficiency and recycling ratio are key measures for achieving this reduction goal. Meanwhile, treatment methods and technologies should prioritize classification and recycling. Aiming at carbon neutrality, the study proposes several recommendations to improve classification systems, including enhancing classification efficiency, optimizing treatment facilities and strategies, and establishing recycling and utilization systems, etc.

Investigation of internal damage evolution in gneiss considering water softening.

In soft rock tunnels, there are often large deformations during construction, especially when the groundwater seepage and softens the surrounding rock. For achieving the purpose of studying the softening effect of water immersion on strength and stability of surrounding rock, 15 rock samples were selected for physical and mechanical tests under 5 conditions: natural state and free immersion for 1, 3, 6, and 9 months, and nuclear magnetic resonance technology(NMR) was also adopted to test the internal pore structure of specimens with different immersion durations, thus the micro structure features of the gneiss, such as the NMR relaxation time T2 spectrum distribution, porosity, and pore volume ratio of different pore sizes under water softening were then obtained. The NMR results shows that the longer the free immersion duration of the rock sample, the greater the porosity; at the same time, the number of micropores in the rock gradually decreases under the interaction of water and rock, and the mesopores increase slightly first and then decrease all the time. The number of macropores is gradually increasing. When the immersion duration is 6 months, the number of macropores begins to increase significantly, and the mechanical properties of the specimens begin to drop significantly. By 9 months, the proportion of macropores in the rock has reached 57.6%. The results showed that the number growth of macropores is the root cause of the macroscopic failure of rock sample. The study results have significance for on-site construction in water-rich areas.

Investigation on the Properties of Gneiss under Different Ground Stresses.

Initial geostress has great influence on the properties of gneiss. The physical and mechanical properties of gneiss vary considerably due to different initial geostresses, which exert a huge effect on the stability of underground engineering. In order to explore the influence of initial ground stress on the properties of gneiss. Changes in the physical properties (e.g., P-wave velocity and volumetric weight), mechanical properties (e.g., compressive strength, elastic modulus, and residual strength) and failure mode of gneiss are analyzed by conducting physical and mechanical tests on gneiss in different ground stress areas. The results show that high geostress can improve the pre-peak mechanical properties of gneiss, and weaken its post-peak mechanical properties. When the initial geostress is greater, the pre-peak mechanical properties are better, and the post-peak mechanical properties are worse. The failure mode of gneiss under high ground stress is primarily brittle failure. When the initial ground stress is greater, brittleness is stronger. According to the research results of this paper, it can provide the basis for the optimization and improvement of underground engineering support in gneiss strata with high geostress. The research results have important reference value and guiding significance for underground engineering construction in high geostress gneiss areas.

Case report: an unusual unilateral pterygium - a secondary pterygium caused by parasitosis in the scleral fistula.

BACKGROUND: Ocular parasitosis can cause eye damage, which contribute to eye symptoms such as burning, itching and even blindness. It is uncommon to see the parasitosis lying in the sclera layer, neither it causing pterygium. Here, we present an unusual case of a secondary pterygium caused by intrascleral worm. CASE PRESENTATION: A 52-year-old women complained about discomfort in right eye for 6 years. Slit-lamp examination indicated a thickened triangular layers of conjunctiva extending from the nasal edge to the cornea. The diagnosis was pterygium in the right eye. To our surprise, after scleral of nasal side exposed, we could see a tiny fistula right in the sclera which lied right under the pterygium, with an alive and motile worm inside. An intrascleral fistula was noted. Then the worm was removed by forceps from the fistula, which was creamy white, thread-like and 1 cm long. DISCUSSION AND CONCLUSIONS: As far as we known, it is the first case of an intrascleral worm hidden beneath the conjunctiva which caused the secondary pterygium. It is hard to know the etiology of the secondary pterygium which caused by parasitosis in the scleral fistula untill excision surgery. It is hard to imagine the worm was living in the sclera of the patient for a long-time.

Risk Evaluation Model of Highway Tunnel Portal Construction Based on BP Fuzzy Neural Network.

Risk assessment for tunnel portals in the construction stage has been widely recognized as one of the most critical phases in tunnel construction as it easily causes accident than the overall length of a tunnel. However, the risk in tunnel portal construction is complicated and uncertain which has made such a neural network very attractive to the construction projects. This paper presents a risk evaluation model, which is obtained from historical data of 50 tunnels, by combining the fuzzy method and BP neural network. The proposed model is used for the risk assessment of the Tiefodian tunnel. The results show that the risk evaluation level is IV, slope instability is the greatest impact index among four risk events, and the major risk factors are confirmed. According to the evaluation results, corresponding risk control measures are suggested and implemented. Finally, numerical simulation is carried out before and after the implementation of risk measures, respectively. The rationality of the proposed risk evaluation model is proved by comparing the numerical simulation results.

Electrocatalysis of oxygen at hemoglobin-Au colloid-1,4-benzenedimethanethiol modified electrode.

A novel renewable O2 sensor based on the direct electron transfer of hemoglobin (Hb) is proposed. Hb was immobilized on a gold nanoparticles (GNP) associated with a 1,4-benzenedimethanethiol (BDT) monolayer which were modified the electrode. The direct electrochemistry of Hb was investigated by electrochemical methods and cyclic voltammetric showing a pair of redox peaks of Hb. The high efficiency of the Hb/GNP/BDT modified gold electrode towards the catalytic electro-reduction of oxygen has been observed and the potential application of Hb/GNP/BDT modified gold electrode as biosensors to monitor O2 is proposed. The electrocatalytic response showed a linear dependence on the O2 concentration ranging from 2.0 to 40.0 micromol/L.

Electrocatalytical oxidation of hydroquinone with ferrocene covalently bound to L-cysteine self-assembled monolayers on a gold electrode.

The preparation of a gold electrode modified by ferrocenecarboxylic acid (FcA) covalently bound to L-cysteine self-assembled monolayer (FcA-SAM) is described. The modified electrode shows an excellent electrocatalytic activity for the oxidation of hydroquinone (QH2) and accelerates the electron transfer rate. The anodic overpotential is reduced by ca. 290 mV compared to those obtained at bare gold electrodes. The charge transfer coefficient and the apparent surface electron transfer rate constant for the redox couple of Q/QH2 at the modified electrode are found to be 0.425 and 0.96 s(-1), respectively. The catalytic current response of DPV increases linearly with the QH2 concentration from 5.7 x 10(-7) to 3.2 x 10(-4) M. The estimation of QH2 in a simulative sample is satisfactory. The method is simple, quick, and sensitive.