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A male patient in his 50s presented to the emergency department with a three-day history of shortness of breath, New York Heart Association class IV, and oxygen desaturation. His physical examination revealed a large volume radial pulse with bibasal crepitation in the lungs and a soft diastolic murmur in the aortic area on auscultation of his heart. He was managed on the line of decompensated heart failure. Transthoracic echocardiography showed a dissection flap in the ascending aorta with acute severe aortic regurgitation. A subsequent urgent CT angiography of the whole aorta confirmed a complex type A aortic dissection with an aneurysmal ascending aorta. An emergency type A aortic dissection repair (modified Bentall's procedure) was done. The patient made a good recovery, was discharged successfully 2 weeks after the procedure and was doing well on postoperative follow-up.

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The world faces several problems related to natural gas resource rents and energy production from renewable sources. One of the main problems is the influence of energy imports, manufacturing exports, and alternative energy sources on natural gas and electricity production from renewable sources. Energy imports, manufacturing exports, and alternative energy sources can impact natural gas and electricity production. This paper examines natural gas resource rents and electricity production from renewable sources nexus from 1971 to 2021, using energy imports, manufacturer's exports, and alternative energy sources in China. Electricity production from renewable sources and manufacturing exports are negatively associated with natural gas resource rents. Energy imports and alternative energy sources positively relate to natural gas resource rents in China. These results suggest that the energy sector in China is highly interconnected and that policies that seek to promote renewable energy sources and other alternatives can positively affect natural gas resource rents. China needs to develop an energy policy considering the policy implications of energy imports and natural gas resource rents. Such a policy should focus on increasing domestic production, reducing energy imports, and ensuring adequate revenue from natural gas resource rents. Additionally, regulations could be implemented that support the development of alternative energy sources, such as requiring utilities to purchase a certain percentage of their power from renewable sources.

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China's energy supply and energy use are closely linked to environmental degradation. The country's heavy reliance on coal, oil, and natural gas, as well as its rapidly growing demand for energy, have contributed to air and water pollution, soil erosion, and other environmental problems. To address these issues, China must transition to cleaner and more sustainable forms of energy and implement policies to reduce energy demand and promote conservation. This paper explores the impacts of total primary energy supply and energy use on environmental degradation in China, using international trade and economic growth as moderating variables from 1971 to 2019. The results indicate that the total primary energy supply is significant at a 1% significance level, which suggests that it strongly impacts the ecological footprint. Energy use and international trade are significant at a 5% level, indicating that they also influence ecological footprint, albeit to a lesser extent. Economic growth is significant at a 1% significance level, suggesting a strong positive association with the ecological footprint. Energy supply improves the environment in China, whereas energy use degrades the environment. Policymakers should focus on promoting energy efficiency in the industrial and transportation sectors. This can be achieved through the implementation of energy-saving technologies, the promotion of public transportation, and the development of low-carbon transportation systems.

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On-farm sorting and transportation of postharvest fruit include sorting out defective products, grading them into categories based on quality, distributing them into bins, and carrying bins to field collecting stations. Advances in artificial intelligence (AI) can speed up on-farm sorting and transportation with high accuracy and robustness and significantly reduce postharvest losses. The primary objective of this literature review is to provide an overview to present a critical analysis and identify the challenges and opportunities of AI applications for on-farm sorting and transportation, with a focus on fruit. The challenges of on-farm sorting and transportation were discussed to specify the role of AI. Sensors and techniques for data acquisition were investigated to illustrate the tasks that AI models have addressed for on-farm sorting and transportation. AI models proposed in previous studies were compared to investigate the adequate approaches for on-farm sorting and transportation. Finally, the advantages and limitations of utilizing AI have been discussed, and in-depth analysis has been provided to identify future research directions. We anticipate that this survey will pave the way for further studies on the implementation of automated systems for on-farm fruit sorting and transportation.

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F18-FDG PET-CT (Fluorodeoxyglucose Positron Emission Computed Tomography) scanning has a proven role in the staging of various cancers;the physiological distribution of F18-FDG must be understood thoroughly in order to improve the accuracy of image interpretation. We describe the case of a 2 year old child with Langerhans cell histiocytosis, who cried at the time of cannulation before undergoing F18-FDG PET-CT scanning.

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BACKGROUND: The aim of this study was to see the efficacy of different surgical procedures performed for the salvage of failing arteriovenous fistulas. Study design: Prospective observational study. Study was conducted at Department of Vascular surgery, CMH Rawalpindi from 1st August 2017 to 31st December 2018. METHODS: Those surgical procedures were included which were done for the AVFs that failed to mature due to stealing veins or developed complications like thrombosis, hematoma, pseudo or true aneurysm, steal syndrome, stenosis and venous hypertension. The procedures like stealing vein ligation, hematoma evacuation, thrombectomies, redo-anastomosis, pseudo aneurysm excision, aneurysmorrhaphies, excision of stenotic segment, RUDI for steal syndrome and central veno venous bypasses for central vein occlusion were assessed for their efficacy. RESULTS: Sixty-two patients were included. 21 stealing veins were ligated, 15 for fistula maturation and 6 for venous hypertension. Twelve out of these 15 non-maturing AVFs, matured after ligation of stealing vein (80%). In case of reverse vein ligation for venous hypertension all the 6 patients showed reduction in their limb swelling (100%). Nine thrombectomies were performed, 7 were successful (78%). Nine patients presented with stenosis. In 3 patients with stenosis near the anastomotic site, a proximal AVF was formed. In 2 patients the stenotic segment was excised and end to end anastomosis was done. In 1 patient an interposing vein graft was used. In 3 patients, the flow was redirected to basilic vein. All the patients had patent AVF on follow up (100%). In 8 non-infected pseudo aneurysms, excision and end to end anastomosis was done in 3, aneurysmorrhaphies in 2 and revision of the anastomosis in 3 cases. Seven out of 8 (87.5%) had good patency on follow up. In 7 patients with true aneurysm and 3 with bleeding from needle prick site sinus, aneurysmorrhaphies were performed. Two wound site hematomas were evacuated. Two patients presented with severe limb swelling due to central venous occlusion for whom a veno venous cross over bypass was done with good results. In 1 patient with steal syndrome, RUDI was done with acceptable results. CONCLUSIONS: Failing arteriovenous fistula can be salvaged by a variety of techniques provided that it is picked up in time..

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