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Abstract Background Nivolumab, an anti-programmed cell death protein 1 antibody, is commonly used as an immune checkpoint inhibitor in various cancers. Various adverse events are associated with these therapies, including hepatitis, dermatitis, and myocarditis. Myocarditis is a relatively rare but potentially fatal immune-mediated adverse reaction. Case presentation We report a case of colon cancer in a 56-year-old Chinese patient with lung and liver metastasis who developed fulminant myocarditis by nivolumab and survived with the support of extracorporeal membrane oxygenation. After six cycles (within 3 months) of nivolumab treatment, the patient developed chest tightness and was hospitalized. A diagnosis of fulminant myocarditis associated with immunotherapy was confirmed based on the clinical manifestations and laboratory examinations. He recovered well and was discharged on day 45 after management with extracorporeal membrane oxygenation, intravenous methylprednisolone, and immunoglobulin. Conclusions This case illustrates a severe cardiovascular complication of immunotherapy, strongly suggesting the necessity of close monitoring for outpatient usage of nivolumab. Additionally, our experience provided an efficient management strategy of extracorporeal membrane oxygenation in terms of life-threatening conditions.

In this paper, a novel physical layer security based on two-level encryption is proposed for orthogonal frequency division multiplexing (OFDM) visible light communication (VLC) systems. In the two-level encryption scheme, the bit signal, which is generated from image data, is first scrambled by a chaotic sequence. After the encrypted bit signal is mapped into 16 QAM symbols, the real and imaginary components of the resulting symbols are encrypted again by two separate chaotic sequences, respectively. A mathematical model is established to securely transmit images in OFDM-based VLC systems based on encryption. Based on the established mathematic model, the bit error rate (BER) formula to securely transmit OFDM-VLC is derived over the dispersive visible light communication (VLC) channel. A theoretical analysis shows that the encryption does not degrade the BER performance of the systems. Additionally, the validity of the BER formula obtained is verified by computer simulation. Theoretical and simulation results both show that the encryption operation has no effect on the BER of the proposed system. However, encryption is helpful for reducing the peak-to-average power ratio (PAPR) of the image-based OFDM. The simulation results show that the security of the image-based OFDM is enhanced and the PAPR is reduced.

The molecular composition, stable carbon and hydrogen isotopes, and light hydrocarbons of the Lower Paleozoic natural gas in the Daniudi gas field in the Ordos Basin were investigated to study the geochemical characteristics. The Lower Paleozoic gas in the Daniudi gas field displays methane contents of 87.41–93.34%, dryness coefficients (C 1 /C 1–5 ) ranging from 0.886 to 0.978, δ 13 C 1 and δ 13 C 2 values ranging from −40.3 to −36.4‰, with an average of −38.3‰, and from −33.6 to −24.2‰, with an average of −28.4‰, respectively, and δD 1 values ranging from −197 to −160‰. The alkane gas generally displays positive carbon and hydrogen isotopic series, and the C 7 and C 5–7 light hydrocarbons of the Lower Paleozoic gas are dominated by methylcyclohexane and iso-alkanes, respectively. The Lower Paleozoic gas in the Daniudi gas field is mixed from coal-derived and oil-associated gases, similar to that observed in the Jingbian gas field. The oil-associated gas in the Lower Paleozoic gas is secondary oil cracking gas and displays a lower cracking extent than that in the Jingbian gas field. The coal-derived gas in the Lower Paleozoic gas in the Daniudi gas field migrated from the Upper Paleozoic gas through the window area where the iron–aluminum mudstone caprocks in the Upper Carboniferous Benxi Formation were missing. The oil-associated gas in the Lower Paleozoic gas in the Daniudi gas field was probably derived from presalt source rocks in the Lower Ordovician Majiagou Formation rather than the limestone in the Upper Carboniferous Taiyuan Formation. It seems unlikely that the marlstone in the Upper Ordovician Beiguoshan Formation and shale in the Middle Ordovician Pingliang Formation on the western and southwestern margins of the Ordos Basin contributed to the oil-associated gas in the Lower Paleozoic gas in the Daniudi gas field.

A plasma source is presented that is capable of generating overdense plasma below the whole quartz plate while exciting surface plasmon polaritons (SPPs) by using a subwavelength diffraction grating. The wavelength of surface wave is calculated and the operation mechanism of plasma heating is attributed to the resonant excitation of SPPs and its dissipation in plasma.

Previous field studies show that surgery residents and medical students have difficulty recognizing appropriate anatomic cues during laparoscopic surgery, causing delays in procedures and errors. Such observations led to the development of an anatomy recognition training intervention, specifically the use of an ordered set of video clips that show the main steps of a laparoscopic procedure. Each procedural step is shown several times in succession, with each repetition coming from a different surgery, thus exposing the learner to varied anatomy and crucial maneuvers. A factorial experiment with 30 medical students showed that the group using these ordered, perceptual learning modules had a significant increase in scores on questions assessing perceptual knowledge and procedural knowledge, with no corresponding Increase for the control group who watched the videos from the same cases but in an unstructured format for the same amount of time (p <0.05). Neither group showed improvement on strategic or declarative knowledge tests. The study suggests that ordered perceptual learning modules an a potential means for training perceptual and procedural knowledge in an effective, safe, and efficient manner, serving as a complement to other types of training methods that teach physical dexterity, strategic and declarative knowledge. [ABSTRACT FROM AUTHOR]