Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?

Background. Whether pre-hospital laryngeal mask airway (LMA) use poses a survival benefit and should be approved as routine airway management in non-shockable cardiac arrest is of major concern. The present study examined the effectiveness of LMA, in comparison to other pre-hospital airway management on individuals who have experienced non-shockable cardiac arrest. Methods. Adult patients who experienced non-shockable cardiac arrest with activation of the emergency medical service (EMS) made up our study cohort in Taoyuan, Taiwan. The data were abstracted from EMS records and cardiac arrest registration protocols. Results. Among the 1912 enrolled patients, most received LMA insertion (72.4%), 108 (5.6%) bag-valve-mask (BVM) ventilation, 376 (19.7%) high-flow oxygen non-rebreather facemask, and only 44 (2.3%) received endotracheal tube intubation (ETI). With regard to survival to discharge, no significant differences in prevalence were evident among the groups: 2.8% of oxygen facial mask, 1.1% of BVM, 2.1% of LMA, and 4.5% of the ETI group survived to discharge (p = 0.314). In comparison to oxygen facial mask use, different types of airway management remained unassociated with survival to discharge after adjusting for variables by logistic regression analysis (BVM: 95% confidence interval [CI], 0.079 – 1.639 [p = 0.186]; LMA: 95% CI, 0.220–2.487 [p = 0.627]; ETI: 95% CI, 0.325–17.820 [p = 0.390]). The results of Hosmer-Lemeshow goodness-of-fit test of logistic regression model revealed good calibration. Conclusions. Pre-hospital LMA use was not associated with additional survival to discharge compared with facial oxygen mask, BVM, or ETI following non-shockable cardiac arrest

Giant lipoma arising from deep lobe of the parotid gland

BACKGROUND: Lipomas are common benign soft tissue neoplasms but they are found very rarely in the deep lobe of parotid gland. Surgical intervention in these tumors is challenging because of the proximity of the facial nerve, and thus knowledge of the anatomy and meticulous surgical technique are essential. CASE PRESENTATION: A 71-year-old female presented with a large asymptomatic mass, which had occupied the left facial area for over the past fifteen years, and she requested surgical excision for a cosmetically better facial appearance. The computed tomography (CT) scan showed a well-defined giant lipoma arising from the left deep parotid gland. The lipoma was successfully enucleated after full exposure and mobilization of the overlying facial nerve branches. The surgical specimen measured 9 × 6 cm in size, and histopathology revealed fibrolipoma. The patient experienced an uneventful recovery, with a satisfying facial contour and intact facial nerve function. CONCLUSION: Giant lipomas involving the deep parotid lobe are extremely rare. The high-resolution CT scan provides an accurate and cost-effective preoperative investigative method. Surgical management of deep lobe lipoma should be performed by experienced surgeons due to the need for meticulous dissection of the facial nerve branches. Superficial parotidectomy before deep lobe lipoma removal may be unnecessary in selected cases because preservation of the superficial lobe may contribute to a better aesthetic and functional result

Volumetric intensity-modulated Arc (RapidArc) therapy for primary hepatocellular carcinoma: comparison with intensity-modulated radiotherapy and 3-D conformal radiotherapy

<p>Abstract</p> <p>Background</p> <p>To compare the RapidArc plan for primary hepatocellular carcinoma (HCC) with 3-D conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) plans using dosimetric analysis.</p> <p>Methods</p> <p>Nine patients with unresectable HCC were enrolled in this study. Dosimetric values for RapidArc, IMRT, and 3DCRT were calculated for total doses of 45~50.4 Gy using 1.8 Gy/day. The parameters included the conformal index (CI), homogeneity index (HI), and hot spot (V_107%) for the planned target volume (PTV) as well as the monitor units (MUs) for plan efficiency, the mean dose (D_mean) for the organs at risk (OAR) and the maximal dose at 1% volume (D_1%) for the spinal cord. The percentage of the normal liver volume receiving ≥ 40, > 30, > 20, and > 10 Gy (V_{40 Gy}, V_{30 Gy}, V_{20 Gy}, and V_{10 Gy}) and the normal tissue complication probability (NTCP) were also evaluated to determine liver toxicity.</p> <p>Results</p> <p>All three methods achieved comparable homogeneity for the PTV. RapidArc achieved significantly better CI and V_107%values than IMRT or 3DCRT (<it>p </it>< 0.05). The MUs were significantly lower for RapidArc (323.8 ± 60.7) and 3DCRT (322.3 ± 28.6) than for IMRT (1165.4 ± 170.7) (<it>p </it>< 0.001). IMRT achieved a significantly lower D_meanof the normal liver than did 3DCRT or RapidArc (<it>p </it>= 0.001). 3DCRT had higher V_{40 Gy}and V_{30 Gy}values for the normal liver than did RapidArc or IMRT. Although the V_{10 Gy}to the normal liver was higher with RapidArc (75.8 ± 13.1%) than with 3DCRT or IMRT (60.5 ± 10.2% and 57.2 ± 10.0%, respectively; <it>p </it>< 0.01), the NTCP did not differ significantly between RapidArc (4.38 ± 2.69) and IMRT (3.98 ± 3.00) and both were better than 3DCRT (7.57 ± 4.36) (<it>p </it>= 0.02).</p> <p>Conclusions</p> <p>RapidArc provided favorable tumor coverage compared with IMRT or 3DCRT, but RapidArc is not superior to IMRT in terms of liver protection. Further studies are needed to establish treatment outcome differences between the three approaches.</p

Uniformly Distributed Graphene Domain Grows on Standing Copper via Low-Pressure Chemical Vapor Deposition

Uniformly distributed graphene domains were synthesized on standing copper foil by a low-pressure chemical vapor deposition system. This method improved the distribution of the graphene domains at different positions on the same piece of copper foil along the forward direction of the gas flow. Scanning electron microscopy (SEM) showed the average size of the graphene domains to be about ~20 m. This results show that the sheet resistance of monolayer graphene on a polyethylene terephthalate (PET) substrate is about ~359 /□ whereas that of the four-layer graphene films is about ~178 /□, with a transmittance value of 88.86% at the 550 nm wavelength. Furthermore, the sheet resistance can be reduced with the addition of HNO3 resulting in a value of 84 /□. These values meet the absolute standard for touch sensor applications, so we believe that this method can be a candidate for some transparent conductive electrode applications

Changes in plasma C1q, apelin and adropin concentrations in older adults after descending and ascending stair walking intervention

This study compared changes in plasma complement component 1q (C1q), apelin and adropin concentrations in older obese women after descending (DSW) and ascending stair walking (ASW) training (n = 15/group) performed twice a week for 12 weeks, with gradual increases in exercise time from 5 to 60 min. Fasting blood samples were collected 3 days before the first and 4 days after the last training session. The improvements in the maximal voluntary isometric contraction (MVIC) strength of the knee extensors, functional physical fitness [e.g., 30-s chair stand (CS) performance], resting systolic blood pressure (SBP), insulin sensitivity [e.g., oral glucose tolerance test (OGTT)] and blood lipid profiles [e.g., total cholesterol (TC)] were greater (p \u3c 0.05) in the DSW than ASW group. Plasma C1q decreased (− 51 ± 30%), and apelin (23 ± 15%) and adropin (127 ± 106%) increased (p ≤ .0.05) only after DSW. Significant (p ≤ 0.01) partial correlations were found between the pre- to post-DSW changes in C1q, apelin or adropin and changes in outcome measures [e.g., C1q and MVIC (r = − 0.837), apelin and SBP (r = − 0.854), and andropin and OGTT (r = − 0.729)]. These results showed that greater decreases in plasma C1q and greater increases in apelin and adropin concentrations were associated with greater improvements in outcome measures after DSW than after ASW

The Effect of Annealing on Nanothick Indium Tin Oxide Transparent Conductive Films for Touch Sensors

This study aims to discuss the sheet resistance of ultrathin indium tin oxide (ITO) transparent conductive films during the postannealing treatment. The thickness of the ultrathin ITO films is 20 nm. They are prepared on B270 glass substrates at room temperature by a direct-current pulsed magnetron sputtering system. Ultrathin ITO films with high sheet resistance are commonly used for touch panel applications. As the annealing temperature is increased, the structure of the ultrathin ITO film changes from amorphous to polycrystalline. The crystalline of ultrathin ITO films becomes stronger with an increase of annealing temperature, which further leads to the effect of enhanced Hall mobility. A postannealing treatment in an atmosphere can enhance the optical transmittance owing to the filling of oxygen vacancies, but the sheet resistance rises sharply. However, a higher annealing temperature, above 250°C, results in a decrease in the sheet resistance of ultrathin ITO films, because more Sn ions become an effective dopant. An optimum sheet resistance of 336 Ω/sqr was obtained for ultrathin ITO films at 400°C with an average optical transmittance of 86.8% for touch sensor applications

Association of Chinese Herbal Medicine use with the depression risk among the long-term breast cancer survivors: A longitudinal follow-up study

Background Breast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation(CHM) into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors. Methods A cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received (n = 1,450) and did not receive (n = 1,450) CHM treatment were enrolled. The incidence rate and hazard ratio citation(HR) for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression. Results During the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation(PYs)], and the adjusted HR remained significant at 0.74 (95% CI 0.58–0.94) in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year. Conclusion Finding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials