Direct Extension Research Articles

Evaluation of in-situ stress orientations within the Central Kenyan rift, through analysis of borehole images of wells drilled in Menengai Geothermal field, Kenya

The Menengai Caldera is in a complex structural zone within the Kenyan Central Rift and hosts the Menengai Geothermal Field. In assessing the subsurface characteristics of many geological resources, knowledge of in-situ stress orientations and magnitudes at depth is essential. Acoustic televiewer logging campaigns carried out in Menengai Geothermal Field between 2018 and 2019 in the production zones of three geothermal wells, have provided an on-site assessment of horizontal in-situ stress orientation in an area lacking such data. Data generated from drilling-induced features in the Menengai Geothermal Field revealed that the average SHmax orientation for MW-34 is NW-SE, whereas the average SHmax orientation for MW-20B is NE-SW, and the average SHmax orientation for MW-15A is NNE-SSW. Subsurface variations of in-situ stress orientations are related to large-scale features such as fractures, fissures, and fault architecture in the geothermal field. The NW-SE SHmax in-situ stress orientation around MW-34 agrees with the Molo (TVA) structural orientation, the Menengai pre-caldera shield orientation, and the Aswa shear zone. The NNE-SSW strike direction of the southern Kenyan Rift Valley, which changes orientation at the triple junction, is compatible with the NE-SW and NNE-SSW SHmax orientations of MW-20B and MW-15A. MW-34 is aligned to the Solai TVA/Graben because of its NE-SW Shmin orientation. In addition, the MW-15A's almost E-W Shmin orientations coincide with the Kenyan Rift's extension direction, which corresponds to the orientation of the E-W striking horsetail fracture inside the Menengai caldera. Localized stress perturbations manifest as rotations of BOs or DITFs orientations along the well as a function of depth.

Influence of Inherited Brittle Fabrics on Continental Rifting: Insights From Centrifuge Experimental Modeling and Application to the East African Rift System

AbstractThe presence of pre‐existing fabrics at all lithospheric scales has been proven to be of primary importance in controlling the evolution of continental rifts. Indeed, observations from natural examples show that even in conditions of orthogonal rifting, when extension should result in simple fault patterns dominated by normal faults orthogonal to extension vectors, inherited fabrics induce complex arrangements of differently‐oriented extension‐related structures. This paper explored the influence of inherited fabrics on rift‐related structures by using a series of analog models deformed in a centrifuge. The models reproduced a brittle‐ductile crustal system and considered the presence of pre‐existing discrete fabrics in the brittle crust in conditions of orthogonal narrow rifting. These fabrics were reproduced by cutting the brittle layer at different orientations with respect to the extension direction. Modeling shows pre‐existing fabrics have a significant influence on rift‐related faults, provided that the angle between inherited fabrics and the rift trend is less than 45°. In these conditions, fabrics cause prominent segmentation of rift‐related faults and induce the development of isolated depocenters. Pre‐existing fabrics strongly influence the geometry of extension‐related structures, resulting in curved fault patterns and en‐echelon arrangement of oblique faults. These findings provide insights into the development of continental rift systems in nature: our modeling shows indeed significant similarities (i.e., peculiar fault architecture and geometries) with the faults in different sectors of the East African Rift System (e.g., the Magadi and Bogoria basin, Kenya Rift), testifying that reactivation of inherited fabrics is a paramount process in shaping continental rifts.

Recent tectonic features of Western Anatolia based on half-space modeling of GNSS Data

A new block model including a 111-site GNSS network was computed to determine deformation pattern in Western Anatolia. These GNSS sites serving the block model were observed for at least 16 h within two consecutive days in 3 different years ranging from 2005-2010. The GNSS dataset obtained from this network were processed with GAMIT / GLOBK software and a high-precision Eurasia-fixed velocity field was produced for the Western Anatolia region. The results show that the region moves in the southwest direction with rates of 18–28 mm/yr with respect to Eurasian plate. To study the crustal stretching of the study area, we computed a novel model consisting of 6 blocks and 14 fault segments. Unlike the previously published block models, our preferred model consists of relatively smaller blocks and much more GNSS sites. Most of the block boundaries align almost in E-W direction except for one lying along NE-SW accommodated with İzmir-Balıkesir Transfer Zone that has the highest lateral movement throughout the region. Achieved results highlight the importance of the structural elements in an active crustal stretching setting, with transfer faults approximately parallel to the main extension direction.

Multimodality imaging of diseases of the vagina.

Pathologies of the vagina are important causes of symptoms related to the genital tract in women. They can be missed on transabdominal ultrasonography (USG), which is the baseline modality used for evaluation of gynaecological complaints. Transperineal USG and MRI are the imaging modalities of choice for evaluation of the vagina. Diseases of the vagina can be grouped depending upon the age group in which they occur. In children and young adults, congenital anomalies like longitudinal or transverse vaginal septum, imperforate hymen, vaginal aplasia or atresia, and rectovaginal fistula can be seen. Malignant tumours can rarely occur in children, rhabdomyosarcoma being the most common one. Common diseases affecting adults include benign lesions like epidermoid, Gartner duct, and Bartholin cysts, and urogenital fistulas involving the vagina. Endometriosis and other benign tumours of vagina including leiomyoma, fibroepithelial polyp, and angiomyxoma are occasionally seen. Malignant tumours can be primary, the most common one being squamous cell carcinoma, or secondary, due to direct extension from cancers involving the adjacent organs. Characteristic morphological changes occur in the vagina after radiotherapy, which can be identified on imaging. Knowledge about the imaging appearances of these diseases is crucial in guiding appropriate management.

Effects of Cystic Duct Margin Involvement on the Survival Rates of Patients With Gallbladder Cancer: A Propensity Score-Matched Case-Control Study.

Background In gallbladder cancer (GBC), extrahepatic bile duct (EHBD) resection is selectively performed if gross direct extension or microscopic involvement of the cystic duct margin (CDM) is detected. Although CDMis usually sent for frozen biopsy intraoperatively in most centers, there are no studies regarding the routine use of CDM frozen biopsy irrespective of the tumor location and paucity of literature regarding the impact ofCDM status on recurrence-free and overall survival inGBC. The presence of obstructive jaundice in GBC usually indicates the involvement of EHBD or cystic duct-bile duct junction. The present study aimed to analyze the necessity of routineCDM frozen biopsy inpatients with resectable GBC withoutjaundice, regardless of the tumor location. The impact of positive CDM on survival was also evaluated. Methods This retrospective observational case-control study was conducted from May 2009 to March 2021 and included 105 patients with resectable GBC without macroscopic EHBD infiltration andjaundice. Patients were divided into CDM-negative (n=91) and CDM-positive (n=14) groups. Propensity score matchingwas performed for variables such asperformance status, tumor size, tumor-node-metastasis (TNM) stage, and adjuvant chemotherapy. After propensity score matching, 27 patients (CDM-negative=13, CDM-positive=14) were included. The primary outcome was to analyze the role of routine CDM frozen biopsy regardless of tumor location, and secondary outcomes were to study the impact of positive CDM status on survival andevaluate predictive factors for CDM positivity. A subgroup analysis was conducted to assess clinicopathologic characteristics and outcomes of the anatomical location of the tumor. Results Of 105 patients, 91 had negative CDM, and 14 had positive CDM. Among 14 patients with positive CDM, only one patient had a tumor in the fundus/body, and the remaining had a tumor involving the neck. All CDM-positive patients underwent bile duct excision with hepaticojejunostomy. Common bile duct (CBD) involvement was present in 50% of patients with positive CDM in the final histopathological examination. In the matched population, patients with positive CDM had a significantly higher rate of neck tumors (p=0.001). Recurrence-free survival (24 vs. 12 months, p=0.30) and overall survival (24.5 vs. 20 months, p=0.417) were comparable between CDM-negative and CDM-positive groups, respectively. On multivariate analysis, preoperative and intraoperative tumor location were independent predictive factors for CDM positivity. On subgroup analysis, 30 patients had tumor involving the neck of the gallbladder, and the remaining 75 had at the fundus and body of the gallbladder. Neck tumors had inferior recurrence-free survival (17 vs. 30 months, p=0.012) and overall survival (24 vs. 36 months, p=0.048) compared to non-neck tumors. Conclusions Routine use of CDM frozen analysis in patients with resectable GBC without jaundice, regardless of tumor location, can be avoided. Itcan be selectively preferred in patients with GBC involving the neck since tumor location is found to be an independent predictive factorfor CDM positivity. Positive CDM has comparable survival outcomes to negative CDM, providing a similarR0 resection rate and tumor stage.However, neck tumors have aworse prognosis than non-neck tumors.

Treatment of wound infections linked to neurosurgical implants.

As neurosurgery has advanced technologically, more and more neurosurgical implants are being employed on an aging patient population with several comorbidities. As a result, there is a steady increase in the frequency of infections linked to neurosurgical implants, which causes serious morbidity and mortality as well as abnormalities of the skull and inadequate brain protection. We discuss infections linked to internal and external ventricular and lumbar cerebrospinal fluid drainages, neurostimulators, craniotomies, and cranioplasty in this article. Biofilms, which are challenging to remove, are involved in all implant-associated illnesses. It takes a small quantity of microorganisms to create a biofilm on the implant surface. Skin flora bacteria are implicated in the majority of illnesses. Microorganisms that cause disruptions in wound healing make their way to the implant either during or right after surgery. In about two thirds of patients, implant-associated infections manifest early (within the first month after surgery), whereas the remaining infections present later as a result of low-grade infections or by direct extension from adjacent infections (per continuitatem) to the implants due to soft tissue damage. Except for ventriculo-atrial cerebrospinal fluid shunts, neurosurgical implants are rarely infected by the haematogenous route. This research examines established and clinically validated principles that are applicable to a range of surgical specialties using implants to treat biofilm-associated infections in orthopaedic and trauma cases. Nevertheless, there is little evidence and no evaluation in sizable patient populations to support the success of this extrapolation to neurosurgical patients. An optimal microbiological diagnostic, which includes sonicating removed implants and extending culture incubation times, is necessary for a positive result. Additionally, a strategy combining surgical and antibiotic therapy is needed. Surgical procedures involve a suitable debridement along with implant replacement or exchange, contingent on the biofilm's age and the state of the soft tissue. A protracted biofilm-active therapy is a component of antimicrobial treatment, usually lasting 4-12 weeks. This idea is appealing because it allows implants to be changed or kept in place for a single surgical procedure in a subset of patients. This not only enhances quality of life but also lowers morbidity because each additional neurosurgical procedure increases the risk of secondary complications like intracerebral bleeding or ischemia.

Mechanical properties of fracture-grouted prefabricated sandstone after thermal-acid coupling treatment: An experimental study

Grouting reinforcement is an efficient approach to increase the stability of engineered fractured rock masses that may be subjected to high temperatures and acidic groundwater in complex geological environments. To reveal the mechanical properties and failure characteristics of the grout-reinforced fractured rock masses under thermal-acid coupling conditions, prefabricated fractured red sandstone specimens with different inclination angles (IAs) were firstly grouted using a new high-strength fast anchoring agent (HSFAA). Then, the grout-reinforced specimens (GRSs) were then immersed in hydrochloric acid (HCl) solutions with different temperatures (varying from 25 to 300 °C). Finally, the macroscopic mechanical properties, microscopic morphology, and crack evolution characteristics of the GRSs after thermal and acid solution treatments were investigated by the uniaxial compression test, X-ray computed tomography (CT) and scanning electron microscopes (SEM). The results confirmed that the HSFAA featured with high fluidity, rapid setting, excellent early strength, and micro-expansion, was an ideal grouted reinforcement material for fractured rock masses. The compressive and tensile strengths of the HSFAA material at a 1-day curing were 2.01 and 1.64 times those of the ordinary Portland cement 42.5 (P.O 42.5), respectively. The fractured IA, thermal-acid coupling method and temperature affected the mass loss, strength parameters, and failure modes of the GRSs to different degrees. The thermal-acid coupling treatment affected the initiation location and extension direction of cracks within the GRSs. The increasing temperature led to the larger and more varied internal cracks, as well as the more complex 3D spatial morphology within the GRSs.

Well–posedness of the three–dimensional NLS equation with sphere–concentrated nonlinearity

We discuss strong local and global well–posedness for the three–dimensional NLS equation with nonlinearity concentrated on . Precisely, local well–posedness is proved for any C 2 power–nonlinearity, while global well–posedness is obtained either for small data or in the defocusing case under some growth assumptions. With respect to point–concentrated NLS models, widely studied in the literature, here the dimension of the support of the nonlinearity does not allow a direct extension of the known techniques and calls for new ideas.

A Comprehensive Survey on Graph Anomaly Detection With Deep Learning

Anomalies represent rare observations (e.g., data records or events) that deviate significantly from others. Over several decades, research on anomaly mining has received increasing interests due to the implications of these occurrences in a wide range of disciplines. Anomaly detection, which aims to identify rare observations, is among the most vital tasks in the world, and has shown its power in preventing detrimental events, such as financial fraud, network intrusion, and social spam. The detection task is typically solved by identifying outlying data points in the feature space and inherently overlooks the relational information in real-world data. Graphs have been prevalently used to represent the structural information, which raises the graph anomaly detection problem - identifying anomalous graph objects (i.e., nodes, edges and sub-graphs) in a single graph, or anomalous graphs in a database/set of graphs. However, conventional anomaly detection techniques cannot tackle this problem well because of the complexity of graph data. For the advent of deep learning, graph anomaly detection with deep learning has received a growing attention recently. In this survey, we aim to provide a systematic and comprehensive review of the contemporary deep learning techniques for graph anomaly detection. We compile open-sourced implementations, public datasets, and commonly-used evaluation metrics to provide affluent resources for future studies. More importantly, we highlight twelve extensive future research directions according to our survey results covering unsolved and emerging research problems and real-world applications. With this survey, our goal is to create a "one-stop-shop" that provides a unified understanding of the problem categories and existing approaches, publicly available hands-on resources, and high-impact open challenges for graph anomaly detection using deep learning.

Studies of oil product pollution in the aeration zone by mathematical modelling

Formulation of the problem. The article presents the results of a study to assess the pollution of the aeration zone due to the leakage of oil products as a result of the destruction of the «Amik» oil depot during the military operations in the town of Borodyanka. The destruction of the tanks resulted in an immediate leakage of light oil products onto the soil of the surrounding area. The result was a technogenic environmental situation that required immediate determination of the mechanisms of accidental penetration of pollutants into the soil and groundwater, determination of the area of contamination and scientifically sound methods of soil remediation of oil products. The article highlights the issues of organising mathematical modeling of various data for solving applied problems using Google Earth data. Materials and methods. In order to assess the contamination area and determine the mechanism of accidental penetration of oil products into the soil and groundwater, the existing models of pollutant penetration in case of accidental oil spill were analysed and mathematical spatial models of geomorphological, hydrogeological, engineering-geological and experimental filtration data were created using interpolation, mathematical approximation and gradient analysis. The latter made it possible to identify the directions of surface and groundwater flow both in the local area of the oil depot and in adjacent areas. Using the investigation and filtration parameters obtained during the field work, hydraulic gradients and soil filtration coefficients were calculated, and a spatial mathematical model of the local subterranean gradient of groundwater flow was created. Results. It was shown that the direction of the underground flow is controlled by a zone of local depression, which is expressed by a decrease in the absolute height of the natural lithological layer with a height difference of about 0.4 m or the maximum values of the height of the contamination lens. The direction of extension of this zone has been determined to be from north to south. This zone can be considered the zone of maximum accumulation of liquid with oil products. Based on the survey results, the thickness of the contamination lens was calculated to be 0.3 m on average. Using this indicator, the area of contamination is 4169 m2, the volume of contamination is 1250.7 m3, which corresponds to the claimed damage. However, taking into account the anisotropy of the filtration properties of the lithological types in different directions within the aeration zone, the presence of dissolved water due to dispersion and the presence of local accumulation depressions in the lithological strata, options with other indicators (0.5 m / 0.1 m) are also acceptable. The calculation of the contamination areas was carried out taking into account the power variations. The approximate total areas of oil product distribution in the aeration zone were plotted with reference to Google Earth imagery. Conclusions. The research enabled practical recommendations to be made for cleaning up the area of oil products and preventing the spread of the pollutant by pumping oil products out of the modelled and actually confirmed pollution lens. In accordance with the recommendations, 140 wells were drilled to a depth of 5.2 m, with a diameter of 0.11‑0.168 m and a total length of 710 m, which made it possible to prevent the spread of the contaminant by pumping out the oil products and reusing them after clean-up.

Study on solvent effect and coordination characteristics of two different types of Cu(II) salamo-salen-salamo-hybrid complexes

Based on the condensation reaction of a containg-formyl asymmetric salamo-based ligand with ethylenediamine, a salamo-salen-salamo-hybrid multi-compartment ligand possessing both salen and salamo structural moieties was prepared, and its different types (Cu(II): H2L)2−) of copper(II) complexes, confirmed as [Cu(H2L)]2·4EtOH (1) and [Cu2(H2L)2]·2MeOH·(Me)2CO (2), have been synthesized and elucidated structurally. In the complexes, Cu(II) ion is sited at the salen's N2O2 cavity, while the salamo structural moieties do not participate in coordination. This coordination characteristic indicates that the coordination ability of salen and salamo structural moieties in salamo-salen-salamo-hybrid ligand varies, with salen having relatively stronger coordination ability, which may be due to the incorporation of more electronegative multiple O atoms on C=N bonds, resulting in a decrease in the electron cloud density on the N atoms of the multi-oxime groups and a decrease in the coordination ability. Thus, Salen structural moiety on the hybrid ligand has stronger coordination ability than salamo structural moieties. In addition, due to the solvent effect, the extension direction of the single salamo long chain is different, and the configurations of the complexes are also different. Through X-ray diffraction analysis and DFT theoretical computations of the ligand and the complexes, the weak intramolecular and intermolecular interactions of the complexes, as well as the intermolecular C-H···π & π···π interactions of the complexes, were discussed. The ligand and the copper(II) complexes were analyzed for their MESP, as well as to show the mobile regions of the molecules in the complex molecules. Due to the solvent effect, the spatial orientation of the long chain of salamo has undergone significant changes, changing the region where the complex molecules move in a specific space.

Rethinking the dynamic of global production networks: Integrate the influence of suppliers and towards a flexible strategy making causal mechanism

AbstractThe global production network (GPN) 2.0 framework mainly considers the organizational capabilities of lead firms, neglecting the influence of supplier capabilities on the strategic making of lead firms. I argue that the GPN 2.0 framework must integrate the influence of supplier capabilities (both industrial and individual firm levels) to better explain the organization of the global economy. Industrial‐level capability determines the possible strategic choices that firms may make under certain dynamic combinations, whereas the individual firm level determines the geographic extension direction of GPNs. Therefore, this study incorporates the influence of suppliers and builds a more flexible strategy‐making causal mechanism other than the definitive and limiting causal mechanism in GPN 2.0. I hope this article can promote the further development of GPN 2.0 and convey some valuable concepts to make it perform better in deconstructing the organization of the global economy in the real world.

Cost of effort in benchmarking: exploration and applications

The literature on incentives suggests that the cost of effort is a key determinant of production, as an agent’s utility is dependent on both consumption and the cost of effort. However, the benchmarking literature has neglected to consider the cost of effort in performance improvement, as it primarily focuses on selecting best-practice benchmarks for underperforming agents. This paper aims to bridge these two literatures by examining the cost of effort in benchmarking and its applications. Our approach is a direct extension of the rational inefficiency hypothesis. We use the information of slacks regarding technology to make inference about the cost of effort in benchmarking. Importantly, we show that inference about the cost of effort gives new sights into activity planning, incentive provision, and employee layoffs. Our analysis provides a new explanation for benchmarking failure in business practices. It also contributes to the rational inefficiency hypothesis by revealing that inefficiency can be beneficial in benchmarking since it can be regarded as a form of fringe reimbursement provided to stakeholders to offset the cost of effort.

Partial Order Multiway Search

Partial order multiway search(POMS) is a fundamental problem that finds applications in crowdsourcing, distributed file systems, software testing, and more. This problem involves an interaction between an algorithm 𝒜 and an oracle, conducted on a directed acyclic graph 𝒢 known to both parties. Initially, the oracle selects a vertextin 𝒢 called thetarget. Subsequently, 𝒜 must identify the target vertex by probing reachability. In eachprobe, 𝒜 selects a setQof vertices in 𝒢, the number of which is limited by a pre-agreed valuek. The oracle then reveals, for each vertexq∈Q, whetherqcan reach the target in 𝒢. The objective of 𝒜 is to minimize the number of probes. We propose an algorithm to solve POMS in\(O(\log _{1+k} n + \frac{d}{k} \log _{1+d} n)\)probes, wherenrepresents the number of vertices in 𝒢, andddenotes the largest out-degree of the vertices in 𝒢. The probing complexity is asymptotically optimal. Our study also explores two new POMS variants: The first one, namedtaciturn POMS, is similar to classical POMS but assumes a weaker oracle, and the second one, namedEM POMS, is a direct extension of classical POMS to theexternal memory(EM) model. For both variants, we introduce algorithms whose performance matches or nearly matches the corresponding theoretical lower bounds.

Deformation bands and alteration in porous glass-rich volcaniclastics: Insights from Milos, Greece

Deformation bands in porous volcaniclastics are little studied structural heterogeneities despite their relevance for constraining the modalities of deformation development and related fluid-rock interactions in volcanic areas.We document a dense network of normal-sense Deformation Bands (Normal-sense Compactional Shear Bands (NCSBs) affecting upper Pliocene felsic glassy tuffites in Milos, Greece. NCSBs probably formed between 300 and 500 m of burial depth, in response to NE-SW directed extension which is related to volcanic rift development in the area. They accommodate mm-to m-shear-offsets, trend either N105 ± 10° or N070 ± 10°, and show mutual cross-cutting relations. The NCSB fault rock is made of ultracataclasite in which the cataclastic mechanisms have affected both the mineral fraction and the volcanic glass. Minerals are fractured along their cleavages whereas pumices are interestingly fractured along their vesicles.The development of chemical alteration (dissolution and cementation) essentially into the ultracataclasite is expressed through glass-hosted corrosion gulfs and smectites filling the intergranular porosity. These observations support that NCSBs preferentially retained water, have been the seat of greater fluid flow, and are the locus of ongoing phyllosilicate self-sealing in the vadose zone. A significant decrease (up to one order of magnitude) in porosity is measured within the studied NCSBs.

Abstract 14138: A Rare Encounter With Unusual Metastasis: Metastatic Right Ventricular Tumor Secondary to Cervical Cancer

Background: Metastasis of cervical carcinoma to the heart is a rare and uncommon phenomenon. Cervical cancer most commonly metastasizes to the lungs, liver, bones, and lymph nodes in four ways: 1) hematogenous spread, 2) lymphatic spread, 3) transvenous extension, and 4) direct extension. We present a case of a patient with cardiac metastasis from cervical cancer who initially suffered nonspecific symptoms thought to be secondary to a pulmonary embolism. Case presentation: A 41-year-old African American woman with a history of stage IIIB squamous cell carcinoma (SCC) of the cervix was being evaluated in the hospital for exertional dyspnea and chest pain. She was tachycardic and lung auscultation revealed decreased breath sounds bilaterally. Laboratory results were unremarkable. Initially, there was concern for pulmonary embolism (PE), computed tomography angiography with contrast demonstrated no evidence of PE but a hypoenhancing defect within the right ventricle (RV) with multiple diffuse bilateral pulmonary nodules. Echocardiography revealed RV mass vs thrombus. A cardiac MRI revealed a large infiltrative irregular mass. These findings favored evidence of a tumor rather than a thrombus. Imaging findings are illustrated in Figure 1. The patient subsequently underwent a biopsy of the right lower lobe lung nodule. The biopsy revealed metastatic SCC positive for p16, p40, and PD-L1. The patient was being treated but the prognosis was poor. Conclusion: Metastasis from cardiac tumors with primary cervical cancer is uncommon with a poor prognosis and average life expectancy of less than 6 months when diagnosed. Only 4% of cases of cardiac metastasis from cervical cancer are diagnosed as antemortem. A multimodality approach with prompt diagnosis is necessary for improving prognosis.

Abstract 14850: Streptococcus Constellatus: A Rare Cause of Cardiac Tamponade and Constrictive Pericarditis

Introduction: Cardiac tamponade is an emergency medical condition referring to the buildup of fluid in the pericardial sac, which can compress the heart and lead to hemodynamic instability. Streptococcus constellatus, a member of the Streptococcus viridans group, has been implicated as a rare cause of cardiac tamponade with only 3 cases reported in the medical literature. We present a unique case of Streptococcus constellatus (S. constellatus) induced purulent pericarditis leading to cardiac tamponade and constrictive pericarditis. Case presentation: A 56-year-old female with no significant past medical history presented with intermittent fever, non-productive cough, and worsening shortness of breath for 2 weeks. She initially went to Convenient Care a week ago for a sore throat with a low-grade fever and was sent home with oral antibiotics. Initial vitals revealed hypotension, high-grade fever, and tachycardia. Physical examination was remarkable for elevated jugular venous pressure and muffled heart sounds. Lab work showed significant leukocytosis. EKG was remarkable for diffuse ST-elevation, low QRS voltage, and electrical alterans. A transthoracic echocardiogram (TTE) revealed severe pericardial effusion. Emergent pericardiocentesis was performed draining 370 ml of purulent fluid and post-operative TTE revealed trace pericardial effusion. Blood and pericardial fluid cultures came back positive for S. constellatus. Another trans-esophageal echocardiogram (TEE) was performed during the hospital stay that was negative for any vegetation however, revealed thickened pericardium with septal bounce suggesting constrictive pericarditis. Cardiothoracic surgery recommended repeat TTE in 3 months for possible pericardiectomy if pericardial changes persist. The patient was discharged on oral antibiotics and colchicine in stable condition. Discussion: S. constellatus is typically part of oral, respiratory, and gastrointestinal flora. It can reach the pericardial space through hematogenous spread or direct extension from nearby infections. Our case highlights prompt identification and appropriate treatment which are crucial for managing this potentially life-threatening and unique condition.

Technological issues in shale oil development using horizontal wells in Ordos Basin, China

The PetroChina Changqing Oilfield Company has successfully achieved large-scale economical development of continental low-pressure freshwater lake interlayer shale oil in the Ordos Basin, China, targeting the gravity-flow sandstone thin interlayers in the organically rich mud shale formation of the seventh member of Yanchang Formation (Chang 7 Member) of Triassic,. Their significant discovery of the 1-billion-ton-level Qingcheng shale oil field, with a proven reserve of 1.052 × 109 t, has marked the establishment of China's first million-ton shale oil development zone. However, the extensive growth in production and construction has brought attention to notable challenges, including geological variances, low initial production, rapid decline, low recovery rates, and high development costs. Based on extensive field experience, this paper identifies several technological issues in shale oil development and offers comprehensive recommendations through systematic analysis. The encounter rate of horizontal shale oil wells, crucial for enhancing individual well productivity, can be improved both vertically and horizontally by prioritizing the extension direction of high-quality reservoirs during the deployment of horizontal wells. The contribution of fracturing fluid elasticity to the recovery rate is relatively low. Reservoir modification should not overemphasize large sand volume, fluid volume, or discharge. Additionally, optimizing parameters such as well spacing, vertical interlayer distribution, and fracture development is essential for maximizing the efficiency of fracturing scale, operation discharge, and other parameters. Variability in hydrocarbon source rock quality and the strength of diagenesis significantly impact oil saturation in sand bodies, affecting the selection of favorable areas and the distribution of high-quality reservoirs. Furthermore, the utilization of pre-fracturing with CO2 proves to be an effective approach in reducing viscosity and increasing the ultimate recovery rate. To ensure the efficient development of shale oil in the Changqing Oilfield, this paper emphasizes the necessity of deepening integrated geological studies, clarifying the main controlling factors of shale oil heterogeneous accumulation, and meticulously depicting three-dimensional sweet spots while exploring more effective development methodologies.

Cervix uterine Cancer with Axillary and Neck Lymph Node Metastasis: An Unusual Finding

Background: Cervix uterii cancer is the fourth most common female malignancy. It commonly spreads by direct extension or lymphatic dissemination within the pelvis into the regional lymph nodes. Distant lymph node metastasis remains exeptionnal. To our knowledge, synchronous cervical and axillary lymph node metastasis from cervix cancer have never been reported. Here we report a case of cervical and axillary lymph node metastasis from cervix uterii cancer. Case presentation: A 51-year-old woman diagnosed with cervix uterii cancer and treated with cocomitant chemoradiotherapy, presented 8 months after the initial diagnosis multiple round masses located at the left side of her neck. F-18 FDG PET/CT revealed pathological axillary and neck lymph nodes. Histopathology and immunohistochemistry confirmed the metastatic nature of the lymph nodes. the patient underwent lymph node dissection before undergoing chemotherapy, followed by radiotherapy to the affected cervical and axillary lymph nodes. Conclusions: Metastases from the uterine cervix to the neck lymph nodes are extremely uncommon. Lymphatic drainage and the lymph node jump phenomenon can explain the possible mode of cervical cancer tumor cell spread to the neck area. The mechanism of axillary lymph node metastasis from cervix uterii cancer can be explained by the communication between neck lymph nodes and axillary lymph nodes due to the alteration of the centripetal flow causing a retrograd spread. Distant lymph node metastasis in cervix uterii cancer are associated with a poor prognosis.

Arthrodesis of the interphalangeal joints of the hand by two-dimensional intraosseous wiring

BackgroundNumerous techniques for arthrodesis have been described to fix interphalangeal (IP) joints, and the fixation method should be considered on a case-by-case basis. This study aimed to investigate the availability of IP joint arthrodesis of the hand, using a two-dimensional intraosseous wiring (two-DIOW) method.MethodsA total of 43 joints (19 thumb IP joints, 9 proximal finger interphalangeal (PIP) joints and 15 distal interphalangeal (DIP) joints in 29 patients with a mean age of 66 years (range, 24–85 y) were retrospectively analyzed. All operations were performed with two-DIOW method. We evaluated the bone union rate, correction loss, presence of any surgical complications, and oral steroid use in cases of joint fixation using the two-DIOW method.ResultsOf these 43 digits, 42 achieved bone union (97.7%). Non-union was seen in a thumb IP joint of mutilans rheumatoid arthritis. Mean correction loss of deviation was 1.0°, and flexion or extension angulation was 1.6° in the direction of extension. Surgical complications included mild nail deformity in 2 digits and wire irritation necessitating wire removal in 2 digits. Oral steroids were used for 18 of the 43 digits, including 2 digits complicated by nail deformities. There was no infection and skin necrosis in all digits with or without steroid use.ConclusionsThe two-DIOW method appears to offer an effective method of IP joint fixation, but caution should be exercised in digits of severe joint destruction and in the treatment of wire knot.