Gold nanoparticles-doped MXene heterostructure for ultrasensitive electrochemical detection of fumonisin B1 and ampicillin.

Early transition metal carbides (MXene) hybridized by precious metals open a door for innovative electrochemical biosensing device design. Herein, we present a facile one-pot synthesis of gold nanoparticles (AuNPs)-doped two-dimensional (2D) titanium carbide MXene nanoflakes (Ti3C2Tx/Au). Ti3C2Tx MXene exhibits high electrical conductivity and yields synergistic signal amplification in conjunction with AuNPs leading to excellent electrochemical performance. Thus Ti3C2Tx/Au hybrid nanostructure can be used as an electrode platform for the electrochemical analysis of various targets. We used screen-printed electrodes modified with the Ti3C2Tx/Au electrode and functionalized with different biorecognition elements to detect and quantify an antibiotic, ampicillin (AMP), and a mycotoxin, fumonisin B1 (FB1). The ultralow limits of detection of 2.284 pM and 1.617 pg.mL-1, which we achieved respectively for AMP and FB1 are far lower than their corresponding maximum residue limits of 2.8 nM in milk and 2 to 4 mg kg-1 in corn products for human consumption set by the United States Food and Drug Administration. Additionally, the linear range of detection and quantification of AMP and FB1 were, respectively, 10 pM to 500 nM and 10 pg mL-1 to 1 µg mL-1. The unique structure and excellent electrochemical performance of Ti3C2Tx/Au nanocomposite suggest that it is highly suitable for anchoring biorecognition entities such as antibodies and oligonucleotides for monitoring various deleterious contaminants in agri-food products.

Fibrolamellar Hepatocellular Carcinoma (FLHCC) in a Young Patient Presenting With Nausea and Vomiting After a Greasy Meal.

Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare and distinct subtype of liver cancer, predominantly affecting younger patients without underlying liver diseases. This case report discusses a unique presentation of FLHCC in a 38-year-old male with a past medical history of a well-controlled seizure disorder. The patient presented with nausea, vomiting, and abdominal pain following a fatty meal. Laboratory tests revealed elevated liver enzymes and anemia, and imaging showed a large hepatic lesion. Initial management included a septic workup and broad-spectrum antibiotics. However, a liver biopsy performed subsequently revealed the presence of FLHCC. The patient underwent a successful open right hepatectomy and was managed postoperatively with consideration of his seizure disorder. Follow-up at six months showed a stable postoperative condition without any evidence of recurrence. The diagnosis of FLHCC is challenging due to its rarity and nonspecific presentation. The case emphasizes the importance of considering FLHCC in the differential diagnosis of hepatic lesions, particularly in young patients. Surgical resection remains the primary treatment modality. This case underscores the importance of a thorough evaluation of hepatic lesions, especially in younger patients. It also illustrates the complexities in managing patients with FLHCC, requiring a multidisciplinary approach for optimal outcomes. Further research is necessary to better understand the pathogenesis of FLHCC and to develop more effective treatment strategies.

Atypical Clostridium difficile Infection in a Pregnant Patient: A Case Study on Non-Diarrheal Presentation and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Complication.

Clostridium difficile (C. difficile) is a Gram-positive, spore-producing bacterium that often leads to pseudomembranous colitis, typically manifesting as watery diarrhea. The risk factors for C. difficile infection (CDI) include exposure to broad-spectrum antibiotics, immunocompromised states, advanced age, usage of proton pump inhibitors (PPI), and comorbid conditions such as chronic kidney disease (CKD). This report details a case involving a 23-year-old pregnant woman who presented with symptoms of abdominal pain and constipation. She was diagnosed with a urinary tract infection (UTI) and treated with ceftriaxone. During her hospitalization, she was administered opioid pain relievers and underwent an intensive bowel regimen. Despite these measures, her constipation and abdominal discomfort persisted, and magnetic resonance imaging (MRI) of the abdomen revealed significant dilatation of the large bowel. The patient, discovered to have hyponatremia, underwent further evaluation. This revealed elevated urine osmolality and decreased blood plasma osmolality, indicative of a syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient received treatment with hypertonic saline. Later in her hospital stay, she tested positive for CDI through stool analysis and was treated with oral vancomycin. This case underscores the importance of considering CDI as a differential diagnosis in cases of ileus, abdominal pain, and constipation, especially in patients with notable risk factors for CDI. It highlights that the presence of diarrhea or watery bowel movements is not a necessary symptom for CDI testing.

A Novel Case of a Massive Amebic Liver Abscess in the Setting of Uncontrolled Diabetes Mellitus and Concurrent Pulmonary Embolism.

Amebic liver abscesses (ALAs), one of the most common extraintestinal manifestations of invasive amebiasis, pose diagnostic challenges due to their various clinical presentations and difficulty in distinguishing them from pyogenic abscesses. This case presentation highlights the intricacy of determining the source of an unusually large liver abscess that had an even rare occurrence of a coinciding pulmonary embolus without any evidence of a deep vein thrombosis. This unusual combination underscores the challenges in identifying and managing atypical cases of ALA and emphasizes the need for more comprehensive data to enhance our understanding of such occurrences.

Understand the Chinese Z Generation consumers' Green hotel visit intention: An Extended Theory of Planned Behavior Model.

In the context of growing environmental concerns and a shift towards sustainable tourism, understanding the behaviors of younger generations, particularly Generation Z, becomes crucial for the hotel industry. This study investigates the intentions of Chinese Generation Z consumers to visit green hotels, using an extended Theory of Planned Behavior (TPB) model incorporating multi-dimensional green perceived value. A questionnaire survey with 436 participants was conducted, and structural equation modeling was employed for data analysis. The study reveals that Functional value significantly shapes the inclination towards green hotels among Chinese Generation Z. Emotional value and Subjective norms also positively influence visit intentions, whereas social value, although not a significant driver, provides insights into the distinct nature of green consumption behaviors. This study's findings offer strategic insights for green hotel operators and policymakers to attract this demographic segment, emphasizing Chinese Generation Z consumers' unique preferences and values.

Acupuncture is an effective therapy for macular damage: A case report.

RATIONALE: Many factors can contribute to the development of macular injury, which results in vision loss as a result of a disease. Heredity, age, underlying eye illness, internal eye surgery, or eye trauma can all cause it. A safer alternative to current therapies for macular degeneration is urgently needed since they all induce ocular irritation and postoperative recurrence as well as a host of other adverse effects. PATIENT CONCERNS: A 12-year-old girl was the patient. A laser pen burnt her right eye. There was a spot and a shadow in the middle of her right eye's visual field. DIAGNOSES: Macular degeneration. INTERVENTIONS: Given the patient's age, we opted out of medicine and instead used acupuncture as a symptomatic treatment. OUTCOMES: Two months after therapy concluded, optical coherence tomography result report indicate that the macula region of the right eye is better than it was previously. The corrected visual acuity of the right eye recovered from 0.25 to 1.0, and the clinical accompanying symptoms of the right eye disappeared. LESSONS: No additional medication or surgical procedure was employed in this instance. We treated the macular damage with acupuncture, which relieved the patient's clinical symptoms and had no adverse effects. This demonstrates that acupuncture may be beneficial in treating ophthalmopathy in this direction.

Outcomes of Acute Pancreatitis in Hospitalized Patients With Generalized Anxiety Disorder.

Introduction Acute pancreatitis (AP) is a common cause of hospitalization in the United States. There is evidence that chronic stress increases the risk for more severe AP episodes. One common form of chronic stress is generalized anxiety disorder (GAD). The purpose of this research was to investigate the impact of GAD on the outcomes of adult patients admitted to the hospital with AP. Methods Utilizing the 2014 National Inpatient Sample database and International Classification of Diseases, Ninth Edition Revision (ICD) codes, AP patients were selected. Common inpatient outcomes of AP patients with and without GAD were examined. The outcomes studied were acute renal failure, acute respiratory failure, sepsis, acute deep vein thrombosis, myocardial infarction, intestinal perforation, and inpatient mortality. A multivariate logistic regression analysis was conducted to assess if GAD was an independent predictor for these outcomes. Results Among 82,156 adult patients hospitalized for AP during the 2014 year, 10,611 of them had coexisting GAD. AP patients with comorbid GAD were found to have an increased likelihood of acute renal failure (aOR = 1.19, 95% confidence interval (CI) = 1.11-1.28, p < 0.001), sepsis (aOR = 1.09, 95% CI = 1.01 -1.19, p = 0.037), acute deep vein thrombosis (aOR = 1.63, 95% CI = 1.06-2.50, p = 0.025), and inpatient mortality (aOR = 1.62, 95% C = I 1.27-2.08, p < 0.001). There was no statistically significant difference found between the two cohorts for the outcomes of myocardial infarction and intestinal perforation. Conclusion In patients hospitalized with AP, those with coexisting GAD were found to have an increased risk of developing acute renal failure, sepsis, acute deep vein thrombosis, and inpatient mortality. There may be benefits to identifying AP patients with comorbid GAD at the time of admission and monitoring them more carefully during their hospitalization to help identify early signs of complications or prevent the negative outcomes seen in this study.

Nanozymatic degradation and simultaneous colorimetric detection of tetracycline.

Tetracycline (TC) is a broad-spectrum antibiotic that can enter and accumulate in the human body via the food chain. Even in small concentrations, TC can cause several malignant health effects. We developed a system to simultaneously degrade the presence of TC in food matrices using titanium carbide MXene (FL-Ti3C2Tx). The FL-Ti3C2Tx exhibited biocatalytic property that activates hydrogen peroxide (H2O2) molecules in 3, 3', 5, 5'-tetramethylbenzidine (TMB environment. During the FL-Ti3C2Tx reaction, the catalytic products released turn the color of the H2O2/TMB system bluish-green. However, when TC is present, the bluish-green color does not appear. Via quadrupole time-of-flight mass spectrometry, we found that the TC is degraded by FL-Ti3C2Tx / H2O2 in preference to H2O2/TMB redox reaction, which intervenes in the color change. Hence, we developed a colorimetric assay to detect TC with a LOD of 615.38 nM and proposed two TC degradation pathways that facilitate the highly sensitive colorimetric bioassay.

Outcomes of Gastroparesis in Hospitalized Patients With Generalized Anxiety Disorder.

Background   Gastroparesis is a common gastrointestinal pathology that has been increasing in prevalence and represents a significant cost to the United States healthcare system. Gastroparesis is associated with psychological dysfunction, including generalized anxiety disorder (GAD). GAD is known to be a prevalent and chronic manifestation of anxiety, which has been increasing in prevalence since the year 2020. Despite the association between gastroparesis and GAD, there has been limited research on the possible impact GAD may have on the morbidity and mortality of patients hospitalized for gastroparesis, which is further evaluated in this study.   Methods   Using the Nationwide Inpatient Sample from the year 2014, a retrospective study was conducted to assess the outcomes of hospitalized gastroparesis patients with and without a history of GAD. In this study, the analyzed outcomes included acute kidney injury (AKI), acute respiratory failure, sepsis, acute deep vein thrombosis, myocardial infarction, intestinal obstruction, and inpatient mortality. To assess whether GAD is an independent risk factor for the outcomes, a multivariate logistic regression analysis was used.   Results   There were 22,150 patients with gastroparesis assessed in this study; GAD was found to be a comorbid diagnosis in 4,196 of those patients. In the GAD cohort, there was an elevated risk for AKI (adjusted odds ratio 1.24, p < 0.001). The adjusted odds ratios for acute respiratory failure, sepsis, acute deep vein thrombosis, myocardial infarction, intestinal obstruction, and inpatient mortality did not meet the threshold for statistical significance.   Conclusion   In hospitalized gastroparesis patients, GAD is a risk factor for AKI. This finding may be attributed to prerenal azotemia due to an increased risk of nausea and vomiting associated with GAD, as well as the medications used to treat GAD such as escitalopram and duloxetine. In addition, the dual inflammatory states caused by the co-existence of both GAD and gastroparesis may also have a role in increasing the risk for AKI. The results of this study may become increasingly relevant given the increasing prevalence of GAD. .

Esophagomediastinal Fistula Closed Endoscopically in a Young Patient With Tuberculosis and Human Immunodeficiency Virus.

Tuberculosis is a primary lung disease that can spread to the lymph nodes, vertebrae, and gastrointestinal tract. The esophagus can be affected by mediastinal lymphadenitis, mostly in immunocompromised patients, leading to the formation of esophagomediastinal fistulas. They can cause dysphagia, pleuritic chest pain, and choking coughs from recurrent aspiration. The treatment is surgery but endoscopic interventions using over-the-scope endoclips, stents, medical adhesives, and sutures are successful alternatives. We present a case of an esophagomediastinal fistula in a patient with tuberculosis and human immunodeficiency virus that was successfully treated with through-the-scope endoclips.

Levofloxacin-Induced Hepatotoxicity in Patients With Legionnaires' Disease: Implications and Management.

Legionnaires' disease (LD), caused by the Legionella bacterium, primarily manifests as pneumonia and could result in a spectrum of clinical severity. As treatment necessitates the use of antibiotics, levofloxacin, a fluoroquinolone, is a commonly preferred option due to its broad-spectrum activity. However, the potential side effects of levofloxacin, including rare instances of hepatotoxicity, introduce a therapeutic challenge. This case report explores the association between levofloxacin and hepatotoxicity and its implications for treating LD.

MXene-Based Nucleic Acid Biosensors for Agricultural and Food Systems.

MXene is a two-dimensional (2D) nanomaterial that exhibits several superior properties suitable for fabricating biosensors. Likewise, the nucleic acid (NA) in oligomerization forms possesses highly specific biorecognition ability and other features amenable to biosensing. Hence the combined use of MXene and NA is becoming increasingly common in biosensor design and development. In this review, MXene- and NA-based biosensors are discussed in terms of their sensing mechanisms and fabrication details. MXenes are introduced from their definition and synthesis process to their characterization followed by their use in NA-mediated biosensor fabrication. The emphasis is placed on the detection of various targets relevant to agricultural and food systems, including microbial pathogens, chemical toxicants, heavy metals, organic pollutants, etc. Finally, current challenges and future perspectives are presented with an eye toward the development of advanced biosensors with improved detection performance.

Unique Case of a Refractory Esophageal Peptic Stricture in an Uncontrolled Diabetic.

Esophageal strictures can lead to the narrowing of the esophagus and dysphagia. They are termed peptic strictures when caused by acid reflux and usually measure less than two centimeters in the lower esophagus. Peptic strictures can be treated with proton pump inhibitors, endoscopic dilation, and esophagectomy. We present a unique case of a young diabetic who developed progressive dysphagia and was found to have a 5-centimeter esophageal peptic stricture refractory to treatment. His symptoms were secondary to gastroparesis and acid reflux from uncontrolled diabetes. Since diabetics are more likely to develop such complications, an important part of the management of peptic strictures should be focused on diabetes control.

Oxygen-terminated few-layered Ti3C2Tx MXene nanosheets as peroxidase-mimic nanozyme for colorimetric detection of kanamycin.

Nanomaterials-based bioinspired enzyme mimics are gaining increased attention as alternatives to biocatalysts. Herein, we report synthesizing oxygen-terminated few-layered titanium-based MXene nanosheets (OFL-Ti-MN). OFL-Ti-MN possesses horseradish peroxidase (HRP) activity in catalyzing the oxidation of colorless 3,3',5,5'-tetramethylbenzidine (TMB) in the presence of hydrogen peroxide (H2O2), which turns the solution color bluish-green. The solution color fades quickly when kanamycin (KAN) is added to this system. This reaction indicates that KAN can prevent color change in the OFL-Ti-MN/TMB-H2O2 system. Based on this strategy, we developed an OFL-Ti-MN-based colorimetric sensor to detect and quantify KAN. The sensor exhibited a dynamic range from 15.28 nM to 46.14 µM and a calculated limit of detection (LOD) of 15.28 nM. From the insight gained from the peroxidase-mimic property of OFL-Ti-MN, we proposed a mechanism for the inhibition effect of KAN on peroxidase and peroxidase-mimic enzymes. The proposed mechanism can potentially help elucidate the reasons for the antibacterial function of KAN and its side effects in humans.

Exploration of Strategies for Organic Integration of Labor Education and Occupational Therapy for College Students.

This paper analyzes the actual functions of the labor education and occupational therapy phase through an in-depth study of labor education and occupational therapy for college students and explores the strategies of organic integration of labor education and occupational therapy for college students. This paper carries out a holistic theoretical construction of labor education in schools and systematically analyzes the components of labor education objectives in colleges and universities, labor education contents in schools, labor education implementation in schools, and labor education evaluation in schools. The main goal of labor education in colleges and universities is to guide students in establishing a scientific concept of labor and constructing a labor education resource system. It focuses on strengthening the construction and improvement of the labor education theoretical system, promoting the construction of labor education disciplines and professional courses, and attaching importance to the training of labor education teachers in the new era to contribute to the perfection of labor education. The system of labor education practice should be innovated. Of course, the labor practice activities based on institutionalization should be implemented. The cycle of labor activities based on the principle of continuity should be strengthened, and the effectiveness of labor education should be improved totally from explicit and implicit instructions. The core of occupational therapy is to help college students adapt to social work, give full play to their self-worth, obtain economic resources, and improve self-confidence. The organic integration of labor education and occupational therapy shows that it can help students ease their social adaptability and adapt to social functions, improve the reemployment rate, and improve students' overall health. Therefore, the practical research on labor education and occupational therapy should be strengthened.

Rare Jejunal Large B-cell Lymphoma Mimicking a Crohn's Disease Without Terminal Ileum Involvement.

This case describes a 49-year-old man who presented with a several-month history of melena, and unintentional weight loss. Prior esophagogastroduodenoscopy and colonoscopy were unrevealing. Further evaluation with capsule endoscopy showed patchy erythematous mucosa in the jejunum creating suspicion for Crohn's Disease. Subsequent push enteroscopy found nodular and congested patchy mucosa of jejunum, and stigmata of bleeding in the proximal and mid-jejunum. Repeat colonoscopy showed a diffuse area of erythematous mucosa in the recto-sigmoid colon, and moderately congested mucosa in the ascending colon, but a normal terminal ileum. A small bowel biopsy eventually revealed large B-cell lymphoma. This is one of the first seven reported cases of small bowel lymphoma mimicking Crohn's Disease and the first to not have any ileal involvement.

The construction of preclinical evidence for the treatment of liver fibrosis with quercetin: A systematic review and meta-analysis.

Quercetin (3,3',4',5,7-pentahydroxyflavone), a flavonoid, is widely found in fruits and vegetables and exerts broad-spectrum pharmacological effects in the liver. Many studies have explored the bioactivity of quercetin in the treatment of liver fibrosis. Hence, through a systematic review and biological mechanism evaluation, this study aimed to construct a body of preclinical evidence for the treatment of liver fibrosis using quercetin. The literature used in this study was mainly obtained from four databases, and the SYRCLE list (10 items) was used to evaluate the quality of the included literature. A meta-analysis of HA, LN, and other indicators was performed via STATA 15.0 software. Subgroup analyses based on animal species and model protocol were performed to further obtain detailed results. Moreover, the therapeutic mechanism of quercetin was summarized in a directed network form based on a comprehensive search of the literature. After screening, a total of 14 articles (comprising 15 studies) involving 254 animals were included. The results from the analysis showed that the corresponding liver function indexes, such as the levels of HA and LN, were significantly improved in the quercetin group compared with the model group, and liver function, such as the levels of AST and ALT, were also improved in the quercetin group. The species- and model-based subgroup analyses of AST and ALT revealed that quercetin exerts a significant effect. The therapeutic mechanism of quercetin was shown to be related to multiple pathways involving anti-inflammatory and antioxidant activities and lipid accumulation, including regulation of the TGF-ß, α-SMA, ROS, and P-AMPK pathways. The results showed that quercetin exerts an obvious effect on liver fibrosis, and more prominent improvement effects on liver function and liver fibrosis indicators were obtained with a dose of 5-200 mg during a treatment course ranging from 4 to 8 weeks. Quercetin might be a promising therapeutic for liver fibrosis.

I-Health: SDN-Based Fog Architecture for IIoT Applications in Healthcare.

The Industrial Internet of Things (IIoT) has been introduced in an era of increasingly broad potentials in the medical industry. In recent years, IIoT-based healthcare applications have grown in popularity, with the majority of them relying on Wireless Body Area Network (WBAN) for flexibility. There have been a few recent works that have investigated SDN-based fog architecture for constructing smart healthcare systems. However, the best fog node from the fog layer must be identified and limit the transmission of unnecessary data. To address this issue, the Intelligent Software-defined Fog Architecture (i-Health) is developed in this work. Based on the prior data pattern of each patient, the controller will decide whether to send the data to the fog layer. Furthermore, we introduced the Fog Ranking Service (FRS) and Fog Probing Service (FPS) to select the best fog node. The performance comparison reveals that the proposed i-Health outperforms existing benchmark approaches.

A Rare Case of an Incidental Near-Complete Gastric Band Erosion Without Perforation.

Laparoscopic gastric banding has been favored for the treatment of morbid obesity because it is minimally invasive, effective, and reversible. One of the complications is gastric band erosion which can cause abdominal pain, hematemesis, and hematochezia. Erosions can be partial and can lead to intra-abdominal free air, peritonitis, and sepsis. Endoscopic removal of the gastric band can be done safely and effectively using a wire and a mechanical lithotripter. We describe a patient with a rare case of an incidental near-complete gastric band erosion without perforation and subsequent endoscopic removal.

Malnutrition Is Associated With Worse Outcomes of Inpatient Endoscopic Retrograde Cholangiopancreatography.

Objectives Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used to manage pancreaticobiliary disorders in an inpatient setting. Malnutrition is prevalent among hospitalized patients, and it is generally associated with poor clinical outcomes. However, there is a lack of studies on how malnutrition affects the outcomes of inpatient ERCP. Thus, we investigated the outcomes of inpatient ERCP among patients with malnutrition. Methods Adult patients who underwent ERCP from the 2014 National Inpatient Sample database were selected to conduct retrospective analysis. Patient demographics and outcomes of ERCP were compared between the groups with and without malnutrition. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, and ERCP complications, including pancreatitis, cholecystitis, cholangitis, sepsis, hemorrhage, and intestinal perforation. Results Patients with malnutrition had longer length of stay (15.5 days vs. 6.7 days, p < 0.05) and higher total hospital charge ($149,699 vs. $71,723, p < 0.05). Malnutrition was an independent risk factor for inpatient mortality (adjusted odds ratio (aOR) 2.54, 95% confidence interval (CI): 1.70-3.82, p < 0.05), sepsis (aOR 2.20, 95% CI: 1.82-2.65, p < 0.05), hemorrhage (aOR 1.64, 95% CI: 1.05-2.56, p < 0.05), and intestinal perforation (aOR 4.29, 95% Cl:1.61-11.46, p < 0.05). Conclusions Our study indicates that patients with malnutrition are more likely to have worse outcomes, such as increased inpatient mortality, sepsis, hemorrhage, and intestinal perforation. Understanding the nutrition status of patients undergoing ERCP can be a useful approach for risk stratification and determining if closer surveillance of the complications is warranted.