Search

A 72-year-old woman with hypertension, type 2 diabetes, stage 5 chronic kidney disease (CKD), and a history of left breast cancer presented with decreased urine output, abdominal fullness, and dyspnea. She was admitted with acute on CKD with fluid overload. Hemodialysis was initiated due to worsening oliguria and uremia. An ultrasound incidentally revealed multiple hepatic tumors, cirrhosis, ascites, and splenomegaly. Liver magnetic resonance imaging (MRI) confirmed infiltrative tumors, and a biopsy was scheduled. Post-biopsy, she developed hypotension, desaturation, and acute consciousness disturbance, requiring fluid resuscitation and intubation. In the ICU, she exhibited biopsy wound bleeding, abdominal distension, and anemia. A computed tomography (CT) scan identified hemoperitoneum (Figure 1), so arterial embolization was performed. Despite hemostasis, she remained hemodynamically unstable, with severe abdominal distension and an intra-abdominal pressure (IAP) of 23 mmHg, indicating abdominal compartment syndrome. Paracentesis drained bloody ascites, and continuous venovenous hemofiltration (CVVH) was started. Her hemodynamics was improved dramatically with reduced inotropes and vasopressor support, as well as the correction of lactic acidosis (Figure 2). However, the biopsy confirmed cholangiocarcinoma later. She experienced fluctuating conditions, including intra-abdominal infection, intradialytic hypotension, and refractory ascites. Given her age, underlying conditions, and new malignancy, the family opted for hospice care. She was extubated and passed away 35 days post-admission. Abdominal compartment syndrome is diagnosed with sustained IAP of more than 20 mmHg with new organ dysfunction. Elevated IAP would lead to reduced venous return and decreased chest wall compliance. Impaired cardiac and pulmonary function then multi-organ failure could occur later. Management includes improving abdominal wall compliance, reducing intra-abdominal volume and surgical decompression. High mortality rate to 36 percent in 28 days was mentioned in one prospective cohort study. Timely diagnosis and treatment are important for easily missed recognition. [ABSTRACT FROM AUTHOR]

A simple multispectral differentiation method for the identification of systemically diseased chickens was developed and demonstrated. Color differences between wholesome and systemically diseased chickens were used to select interference filters at 488, 540, 580, and 610 nm for the multispectral imaging system. Over a period of 6 months, 660 chicken images were collected in three batches. An image processing algorithm to locate the region of interest (ROI) was developed in antler to define four classification areas on each image: whole carcass (WC), region of interest (ROI), upper region (UR), and lower region (LR). Three feature types, average intensity (AI), average normalization (AN), and average difference normalization (ADN), were defined using several wavebands for a total of 12 classification features. A decision tree algorithm was used to determine threshold values for each of the 12 classification features in each of the four classification areas. The AI feature type was found to identify wholesome and systemically diseased chickens better than the AN and ADN features types. Classification by AI in the ROI area, using the 540 and 580 nm wavebands, achieved the best accuracies. AI540 achieved 96.3% and 97.1% classification accuracies for wholesome and systemically diseased chickens, respectively. AI580 achieved 96.3% and 98.6% classification accuracies for wholesome and systemically diseased chickens, respectively. This simple differentiation method shows potential for automated on--line chicken inspection. [ABSTRACT FROM AUTHOR]

Previous studies have revealed higher mortality rates in patients with severe influenza who are coinfected with invasive pulmonary aspergillosis (IPA) than in those without IPA coinfection; nonetheless, the clinical impact of IPA on economic burden and risk factors for mortality in critically ill influenza patients remains undefined. The study was retrospectively conducted in three institutes. From 2016 through 2018, all adult patients with severe influenza admitted to an intensive care unit (ICU) were identified. All patients were classified as group 1, patients with concomitant severe influenza and IPA; group 2, severe influenza patients without IPA; and group 3, severe influenza patients without testing for IPA. Overall, there were 201 patients enrolled, including group 1 (n = 40), group 2 (n = 50), and group 3 (n = 111). Group 1 patients had a significantly higher mortality rate (20/40, 50%) than that of group 2 (6/50, 12%) and group 3 (18/11, 16.2%), p < 0.001. The risk factors for IPA occurrence were solid cancer and prolonged corticosteroid use in ICU of >5 days. Group 1 patients had significantly longer hospital stay and higher medical expenditure than the other two groups. The risk factors for mortality in group 1 patients included patients’ Charlson comorbidity index, presenting APACHE II score, and complication of severe acute respiratory distress syndrome. Overall, IPA has a significant adverse impact on the outcome and economic burden of severe influenza patients, who should be promptly managed based on risk host factors for IPA occurrence and mortality risk factors for coinfection with both diseases. [ABSTRACT FROM AUTHOR]

Aggressive nature killer (NK)-cell neoplasm includes aggressive NK-cell leukemia (ANKL) and extranodal NK/T-cell lymphoma (ENKTL), nasal type. ANKL is rare and is characterized by a systemic neoplastic proliferation of NK-cells, usually with a leukemic presentation. ENKTL is a predominantly extranodal lymphoma, occurring mainly in the upper aerodigestive tract. Both are aggressive neoplasms strongly associated with Epstein-Barr virus (EBV). Here we report two patients with aggressive NK-cells neoplasms localized in the bone marrow (BM) who presented as prolonged fever, anemia, and thrombocytopenia. Both were treated initially as infectious disease. Imaging studies revealed splenomegaly without any nodular lesion or lymphadenopathy. BM examination revealed extensive involvement by EBV-positive NK-cells in both cases. Staging workup including nasal examination/biopsy was negative. Both patients passed away in a month. One case showed gains of chromosomes 4q and 9p by array comparative genomic hybridization. Both tumors were diagnostically challenging due to the unusual clinical presentation and absence of leukemic change, tumor mass or lymphadenopathy. Our cases demonstrate that lymphoma should be considered in patients with fever of unknown origin and bone marrow aspiration/biopsy should be performed as early diagnosis and novel therapeutic regimens may benefit these patients. [ABSTRACT FROM AUTHOR]

Aggressive nature killer (NK)-cell neoplasm includes aggressive NK-cell leukemia (ANKL) and extranodal NK/T-cell lymphoma (ENKTL), nasal type. ANKL is rare and is characterized by a systemic neoplastic proliferation of NK-cells, usually with a leukemic presentation. ENKTL is a predominantly extranodal lymphoma, occurring mainly in the upper aerodigestive tract. Both are aggressive neoplasms strongly associated with Epstein-Barr virus (EBV). Here we report two patients with aggressive NK-cells neoplasms localized in the bone marrow (BM) who presented as prolonged fever, anemia, and thrombocytopenia. Both were treated initially as infectious disease. Imaging studies revealed splenomegaly without any nodular lesion or lymphadenopathy. BM examination revealed extensive involvement by EBV-positive NK-cells in both cases. Staging workup including nasal examination/biopsy was negative. Both patients passed away in a month. One case showed gains of chromosomes 4q and 9p by array comparative genomic hybridization. Both tumors were diagnostically challenging due to the unusual clinical presentation and absence of leukemic change, tumor mass or lymphadenopathy. Our cases demonstrate that lymphoma should be considered in patients with fever of unknown origin and bone marrow aspiration/biopsy should be performed as early diagnosis and novel therapeutic regimens may benefit these patients. [ABSTRACT FROM AUTHOR]

This study applies CF4 plasma pretreatment to a buffer oxide layer to improve the performance of low-temperature polysilicon thin-film transistors (LTPS TFTs). Results show that the fluorine atoms piled up at the interface between the bulk channel and buffer oxide layer and accumulated in the bulk channel. The reduction of the trap states density by fluorine passivation can improve the electrical characteristics of the LTPS TFTs. It is found that the threshold voltage reduced from 4.32 to 3.03 V and the field-effect mobility increased from 29.71 to 45.65 cm2 V[?]1 S[?]1. In addition, the on current degradation and threshold voltage shift after stressing were significantly improved about 31% and 70%, respectively. We believe that the proposed CF4 plasma pretreatment on the buffer oxide layer can passivate the trap states and avoid the plasma induced damage on the polysilicon channel surface, resulting in the improvement in performance and reliability for LTPS-TFT mass production application on AMOLED displays with critical reliability requirement. [ABSTRACT FROM AUTHOR]

High speed networks and rapidly improving microprocessor performance make the network of workstations an extremely important tool for parallel computing in order to speedup the execution of scientific applications. Shared memory is an attractive programming model for designing parallel and distributed applications, where the programmer can focus on algorithmic development rather than data partition and communication. Based on this important characteristic, the design of systems to provide the shared memory abstraction on physically distributed memory machines has been developed, known as Distributed Shared Memory (DSM). DSM is built using specific software to combine a number of computer hardware resources into one computing environment. Such an environment not only provides an easy way to execute parallel applications, but also combines available computational resources with the purpose of speeding up execution of these applications. DSM systems need to maintain data consistency in memory, which usually leads to communication overhead. Therefore, there exists a number of strategies that can be used to overcome this overhead issue and improve overall performance. Strategies as prefetching have been proven to show great performance in DSM systems, since they can reduce data access communication latencies from remote nodes. On the other hand, these strategies also transfer unnecessary prefetching pages to remote nodes. In this research paper, we focus on the access pattern during execution of a parallel application, and then analyze the data type and behavior of parallel applications. We propose an adaptive data classification scheme to improve prefetching strategy with the goal to improve overall performance. Adaptive data classification scheme classifies data according to the accessing sequence of pages, so that the home node uses past history access patterns of remote nodes to decide whether it needs to transfer related pages to remote nodes. From experimental results, we can observe that our proposed method can increase the accuracy of data access in effective prefetch strategy by reducing the number of page faults and misprefetching. Experimental results using our proposed classification scheme show a performance improvement of about 9–25% over the same benchmark applications running on top of an original JIAJIA DSM system. [ABSTRACT FROM AUTHOR]