A Man with Severe, Left Lower Quadrant Abdominal Pain.

CASE PRESENTATION: An 84-year-old man presented to the emergency department with sudden, left lower quadrant cramping pain. Because critical hypotension was noted, point-of-care ultrasonography (POCUS) was performed immediately. The study revealed a pulsatile flow extravasating from the left common iliac artery into the left psoas muscle with hypoechoic para-aortic fluid collection. DISCUSSION: Common iliac artery rupture is rare and has nonspecific clinical presentations. A quick disposition can be made with a combination of clinical manifestations and POCUS results.

Association of dipeptidyl peptidase-4 inhibitor use and the risk of asthma development among type 2 diabetes patients.

BACKGROUND: Numerous studies have shown that dipeptidyl peptidase-4 inhibitors (DPP-4i) may regulate immunological pathways implicated in asthma. The association between DPP-4i use and risk of asthma development is limited, however. AIM: We aimed to evaluate if DPP-4i treatment in individuals with type 2 diabetes mellitus (T2DM) is associated with a lower risk and severity of asthma. METHODS: We performed a population-based retrospective cohort study using the Longitudinal National Health Insurance Research database between 2008 and 2015. After one-to-four propensity score matching from 1,914,201 patients with defined criteria, we enrolled 3001 patients who were on DPP-4i (DPP-4i group) for a diagnosis of T2DM but without a diagnosis of asthma for further analysis. Cox proportional hazards regression analysis was performed to estimate and compare the risk of developing and severity of asthma, including no acute exacerbations event (No-AE), acute exacerbations (AEs), status asthmaticus (Status), and required endotracheal intubation (ET-tube intubated), between the two groups. RESULTS: The participants had a mean age of 66.05 ± 17.23 years and the mean follow-up time was 4.96 ± 4.39 years. The risk of asthma development was significantly lower in the DPP-4i group than in the non-DPP-4i group [adjusted hazard ratio (HR) = 0.65; 95% confidence interval (CI) = 0.29-0.83; p < 0.001], with a class effect. This trend was observed for severity of asthma as No-AE (HR = 0.55; 95% CI = 0.24-0.70; p < 0.001), AE (HR = 0.57; 95% CI = 0.26-0.73; p < 0.001), and Status (HR = 0.78; 95% CI = 0.35-0.99; p = 0.047), but not in ET-tube intubated cases (HR = 0.96; 95% CI = 0.43-1.22; p = 0.258). CONCLUSION: The use of DPP-4i decreased the risk and severity of asthma with a class effect among No-AE, AE, status of asthma events, but not in ET-tube intubated events. Our report suggests that DPP-4i may play a role in attenuating the impact of asthma on incidence in the future and on more severe forms of disease exacerbation in T2DM patients.

Unusual bilateral kidney and duodenal plasmablastic lymphoma presentation in an elderly patient: A case report.

The present report described the case of a 71-year-old man who was admitted to the emergency department with a 7-day history of progressive left flank pain and tarry stool. Bedside point-of-care ultrasound of the left kidney showed lobulated ill-defined hypoechoic foci in the perirenal spaces with mild hydronephrosis. Subsequent contrast-enhanced abdominal computed tomography revealed lobulated low-density lesions in the bilateral perirenal space and paraaortic space. The patient was subsequently admitted to the internal medicine department of the hospital. Renal and duodenal biopsies were arranged, and pathology reports were consistent with the findings of plasmablastic lymphoma (PBL). This unusual presentation of flank pain and tarry stool caused by recurrent PBL highlighted that genitourinary or gastrointestinal manifestations could occur in cases of PBL recurrence. The patient received intensive chemotherapy regimens comprising a combination of etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin hydrochloride for aggressive non-Hodgkin's lymphoma to achieve a good response.

Extremely rapid self-reaction of the simplest Criegee intermediate CH2OO and its implications in atmospheric chemistry.

Criegee intermediates, which are carbonyl oxides produced when ozone reacts with unsaturated hydrocarbons, play an important role in the formation of OH and organic acids in the atmosphere, but they have eluded direct detection until recently. Reactions that involve Criegee intermediates are not understood fully because data based on their direct observation are limited. We used transient infrared absorption spectroscopy to probe directly the decay kinetics of formaldehyde oxide (CH2OO) and found that it reacts with itself extremely rapidly. This fast self-reaction is a result of its zwitterionic character. According to our quantum-chemical calculations, a cyclic dimeric intermediate that has the terminal O atom of one CH2OO bonded to the C atom of the other CH2OO is formed with large exothermicity before further decomposition to 2H2CO + O2((1)Δg). We suggest that the inclusion of this previously overlooked rapid reaction in models may affect the interpretation of previous laboratory experiments that involve Criegee intermediates.

Infrared absorption spectrum of the simplest Criegee intermediate CH2OO.

The Criegee intermediates are carbonyl oxides postulated to play key roles in the reactions of ozone with unsaturated hydrocarbons; these reactions constitute an important mechanism for the removal of unsaturated hydrocarbons and for the production of OH in the atmosphere. Here, we report the transient infrared (IR) absorption spectrum of the simplest Criegee intermediate CH2OO, produced from CH2I + O2 in a flow reactor, using a step-scan Fourier-transform spectrometer. The five observed bands provide definitive identification of this intermediate. The observed vibrational frequencies are more consistent with a zwitterion rather than a diradical structure of CH2OO. The direct IR detection of CH2OO should prove useful for kinetic and mechanistic investigations of the Criegee mechanism.

Walking motion generation, synthesis, and control for biped robot by using PGRL, LPI, and fuzzy logic.

This paper proposes the implementation of fuzzy motion control based on reinforcement learning (RL) and Lagrange polynomial interpolation (LPI) for gait synthesis of biped robots. First, the procedure of a walking gait is redefined into three states, and the parameters of this designed walking gait are determined. Then, the machine learning approach applied to adjusting the walking parameters is policy gradient RL (PGRL), which can execute real-time performance and directly modify the policy without calculating the dynamic function. Given a parameterized walking motion designed for biped robots, the PGRL algorithm automatically searches the set of possible parameters and finds the fastest possible walking motion. The reward function mainly considered is first the walking speed, which can be estimated from the vision system. However, the experiment illustrates that there are some stability problems in this kind of learning process. To solve these problems, the desired zero moment point trajectory is added to the reward function. The results show that the robot not only has more stable walking but also increases its walking speed after learning. This is more effective and attractive than manual trial-and-error tuning. LPI, moreover, is employed to transform the existing motions to the motion which has a revised angle determined by the fuzzy motion controller. Then, the biped robot can continuously walk in any desired direction through this fuzzy motion control. Finally, the fuzzy-based gait synthesis control is demonstrated by tasks and point- and line-target tracking. The experiments show the feasibility and effectiveness of gait learning with PGRL and the practicability of the proposed fuzzy motion control scheme.