A huge traumatic pulmonary pseudocyst

AbstractTraumatic pulmonary pseudocyst (TPP) is a rare complication following blunt trauma. We report a 26-year-old male patient who presented to the emergency room with internal bleeding and shock. Huge TPP (14 cm in diameter) was seen on whole-body computed tomography scan and complicated with bronchial bleeding. He deteriorated to respiratory failure soon after arriving at the emergency room. TPPs imply high-energy impact on the chest region and frequently complicated with pulmonary contusions, hemo- and pneumo-thorax, multiple rib fractures, flail chest, and concurrent with abdominal injuries. Emergency physicians should be aware of such rare entity and manage correctly

Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm

Objectives: This in vitro study investigated the effects of silver diamine fluoride (SDF) on dentine carious lesion with cariogenic biofilm. Study Design: Thirty human dentine blocks were inoculated with Streptococcus mutans and Lactobacillus acidophilus dual-species biofilm to create carious lesion. They were equally divided into test and control group to receive topical application of SDF and water. After incubation anaerobically using micro-well plate at 37oC for 7 days, the biofilms were evaluated for kinetics, morphology and viability by colony forming units (CFU), scanning electron microscopy (SEM), and confocal microscopy (CLSM), respectively. The carious lesion underwent crystal characteristics analysis, evaluation of the changes in chemical structure and density of collagen fibrils using x-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and immune-labeling. Results: The log CFU of S. mutans and L. acidophilus in the test group was significantly lower than control group. SEM and CLSM showed confluent biofilm in control group, but not in test group. XRD showed the loss of crystallinity of dentine due to the dissolution of hydroxyapatite crystal structure in test group was less than control group. FTIR showed that log [Amide I: HPO4 2-] for test vs. control group was 0.31±0.10 vs. 0.57±0.13 (p<0.05). The goldlabeling density in test vs. control group was 8.54±2.44/ìm2 vs. 12.91±4.24/ìm2 (p=0.04). Conclusions: SDF had antimicrobial activity against the cariogenic biofilms and reduced demineralization of dentine

Critical Factors of Adopting Enterprise Application Integration Technology: An Empirical Study on Larger Hospitals

As hospitals extend their service scope, they adopt more information systems. These systems are implemented in different timelines and the interfaces of databases become varied. Frequently, the exchange of information between various systems requires additional coordination or even manual input for unifying data. To embrace automation, the solution is to adopt enterprise application integration (EAI) technology, the middleware, to convert data from among various information systems to enable an efficient flow of data in the hospital. In this paper, we discuss and verify the impact factors on the integration levels of EAI by surveying larger hospitals above the regional level in Taiwan and testing a proposed research model. The findings of this study show that information technology infrastructure, hospital size, external pressure, internal pressure, and external support significantly affect the EAI level

The Guardian, April 9, 1982

Eight page issue of The Guardian, the official student-run newspaper for Wright State University. The Guardian has been published regularly since March of 1965.https://corescholar.libraries.wright.edu/guardian/1998/thumbnail.jp

Well-differentiated gall bladder hepatoid carcinoma producing alpha-fetoprotein: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gall bladder carcinoma is rare, and metastatic gall bladder carcinoma from hepatocellular carcinoma has been reported in only a few patients.</p> <p>Case presentation</p> <p>We present a 73-year-old man with a history of hepatitis B virus-related liver cirrhosis and hepatocellular carcinoma. He received transcatheter arterial chemoembolization, and was diagnosed to have an alpha-fetoprotein producing gall bladder tumor with intraluminal growth. Open cholecystectomy was performed. Pathologic examination of the lesion revealed a well-differentiated hepatoid carcinoma. The lesion was thought most likely to be a metastatic lesion from previous hepatocellular carcinoma. His alpha-fetoprotein level dropped to normal levels five months after the surgery.</p> <p>Conclusion</p> <p>This unusual intraluminal growing tumor proved to be a well-differentiated hepatoid carcinoma, most likely a metastatic lesion from previous hepatocellular carcinoma. This case reminds clinicians that in looking for likely hepatocellular carcinoma recurrence, when no detectable hepatic lesion can account for an elevated alpha-fetoprotein level, the gall bladder should be included in the search for the site of metastasis.</p

Intra-Arterial Urokinase for Acute Superior Mesenteric Artery Occlusion: A Retrospective 12-Year Report of 13 Cases

This retrospective study aimed to evaluate the outcomes of 13 patients with acute superior mesenteric artery (SMA) occlusion who underwent intra-arterial urokinase thrombolysis between 2008 and 2020. On angiography, seven presented with complete SMA occlusion versus six with incomplete occlusion. The median time from abdominal pain to attempting urokinase thrombolysis was 15.0 h (interquartile range, 6.0 h). After urokinase therapy, bowel perfusion was restored with bowel preservation in six patients; however, treatment failed in the other seven patients. The degree of SMA occlusion (complete vs. incomplete, p = 0.002), degree of recanalisation (p = 0.012), and length of stay (p = 0.032) differed significantly between groups. Of the seven patients with complete SMA occlusion, six underwent bowel resection, of whom three died, and the remaining patient died of shock due to delayed surgery. Among the six patients with incomplete SMA occlusion, no bowel resection was performed. In our experience, intra-arterial urokinase thrombolysis may serve as an adjunctive treatment modality, being a potential replacement for open thrombectomy that is able to preserve the bowel and obviate surgery in cases of incomplete SMA occlusion; however, its use is unsuitable in cases of complete SMA occlusion, for which surgery is warranted

Measuring patient's expectation and the perception of quality in LASIK services

<p>Abstract</p> <p>Background</p> <p>LASIK is the use of excimer lasers to treat therapeutic and refractive visual disorders, ranging from superficial scars to nearsightedness (myopia), and from astigmatism to farsightedness (hyperopia). The purposes of this study are to checking the applicability and psychometric properties of the SERVQUAL on Lasik surgery population. Second, use SEM methods to investigate the loyalty, perceptions and expectations relationship on LASIK surgery.</p> <p>Methods</p> <p>The method with which this study was conducted was questionnaire development. A total of 463 consecutive patients, attending LASIK surgery affiliated with Chung Shan Medical University Eye Center, enrolled in this study. All participants were asked to complete revised SERVQUAL questionnaires. Student t test, correlation test, and ANOVA and factor analyses were used to identify the characters and factors of service quality. Paired t test were used to test the gap between expectation and perception scores and structural equation modeling was used to examine relationships among satisfaction components.</p> <p>Results</p> <p>The effective response rate was 97.3%. Validity was verified by several methods and internal reliability Cronbach's alpha was > 0.958. The results from patient's scores were very high with an overall score of 6.41(0.66), expectations at 6.68(0.47), and perceptions at 6.51(0.57). The gap between expectations and perceptions was significant, however, (t = 6.08). Furthermore, there were significant differences in the expectation scores among the different jobs. Also, the results showed that the higher the education of the patient, the lower their perception score (r = -0.10). The factor loading results of factor analysis showed 5 factors of the 22 items of the SERVQUAL model. The 5 factors of perception explained 72.94% of the total variance there; and on expectations it explained 77.12% of the total variance of satisfaction scores.</p> <p>The goodness-of-fit summary, of structure equation modeling, showed trends in concept on expectations, perceptions, and loyalty.</p> <p>Conclusion</p> <p>The results of this research appear to show that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in LASIK service, and enabling staff to identify where improvements are needed, from the patients' perspective. There were service quality gaps in the reliability, assurance, and empathy. This study suggested that physicians should increase their discussions with patients; which has, of course, already been proven to be an effective way to increase patient's satisfaction with medical care, regardless of the procedure received.</p

Made in Amsterdam : a 1771 cittern by Benoit Joseph Boussu

Cittern-family instruments enjoyed popularity in the second half of the 18th century, most notably in the British Isles and France. Many such instruments from these countries have survived in museums and private collections. This ‘guittar’ fashion also took root in the Netherlands, although very few Dutch-made, late 18th-century citterns have survived. The recent rediscovery of an Amsterdam-made cittern by Benoit Joseph Boussu, previously only known about from written sources, adds another example to this small but important group of Dutch-made instruments. In this article, the Boussu cittern is comprehensively described, based on visual observations, endoscopy and CT-scanning, techniques that also enable a detailed analysis of its inner construction. The instrument’s provenance and the biography of its maker are also discussed. These analyses lead to the conclusion that a cittern, of equal quality and appearance to British and French instruments, had already been built in the Netherlands as early as 1771, and included in its design an innovative watch-key tuning mechanism