Change in peak expiratory flow rate after the head-tilt/chin-lift maneuver among young, healthy, and conscious volunteers

Objective The head-tilt/chin-lift (HT/CL) is a simple, routinely used maneuver to open the upper airway. Changes in the peak expiratory flow rate (PEFR) before and after the HT/CL maneuver have not been evaluated among conscious volunteers who are regarded as a control cohort. Methods Sixty healthy 20-year-old volunteers (30 males and 30 females) were enrolled. The supine position was defined as the position at which the ear-eye line was at a 10° angle to the horizontal. The HT/CL position was defined as the position at which the ear-eye line was at a 25° angle to the horizontal. PEFR was measured using a hand-held device with the subject in the supine position (pre-PEFR) and HT/CL position (post-PEFR), respectively. One set was defined as these two measurements. Five sets of measurements were performed on each subject (300 sets). The set with the maximal and minimal difference between pre-PEFR and post-PEFR were excluded from the analysis. We used a paired t-test to compare the mean pre-PEFR and post-PEFR values for the entire group and subgroups divided by sex, height, body weight, body mass index and response status. Results Overall, 360 measurements (180 sets) were analyzed. The mean pre-PEFR and post-PEFR were 316.1±87.6 and 346.5±94.7 L/min, respectively. Further, significant differences were observed for sex, height, body weight, and body mass index. In 10 subjects, post-PEFR was lower than pre-PEFR. Conclusion PEFR increased by 9.6% after the HT/CL maneuver in young conscious subjects, but some subjects showed decreased PEFR after the HT/CL maneuver

Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding

Objective We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB). Methods We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours. Results Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59–0.73, P=0.004), but not to GBS (0.70, 0.64–0.77, P=0.141) and AIMS65 (0.76, 0.70–0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%. Conclusion The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB

High-Efficiency Organic Photovoltaics with Two-Dimensional Conjugated Benzodithiophene-Based Regioregular Polymers

We synthesized and characterized two kinds of regioregular polymers that were based on thieno[3,4-b]thiophene as an electron-accepting unit and benzo[1,2-b:4,5-b′]dithiophene as the electron-donating unit with different side chain, alkylthio and alkyl thiophenes, named rr-PTBS and rr-PTB7-Th, respectively. Because of the partial introduction of the alkylthio thiophene side chain, rr-PTBS showed red-shifted absorption and a deeper HOMO level compared to those of rr-PTB7-Th. In addition, both rr-PTBS:PC71BM and rr-PTB7-Th:PC71BM blended films showed face-on orientations stronger than those of regiorandom PTB7-Th. However, the rr-PTB7-Th:PC71BM blended film showed a peak in the out-of-plane direction much weaker than those of rr-PTBS:PC71BM and PTB7-Th:PC71BM blended films. Moreover, the rr-PTBS:PC71BM blended film exhibited charge carrier mobility (μe/μh ∼ 1.01) much more balanced than that of the rr-PTB7-Th:PC71BM blended film (μe/μh ∼ 1.23). The bulk-heterojunction organic photovoltaic (OPV) device based on rr-PTBS and the 1,8-diiodooctane additive showed a high power conversion efficiency (PCE) of 8.68%, while the OPV device based on rr-PTB7-Th and the 1,8-diiodooctane additive showed a PCE of 7.04%. Finally, an OPV device using rr-PTBS, the diphenyl ether additive, and Micro Lens Film exhibited a short-circuit current (Jsc) of 19.72 mA/cm2, an open-circuit voltage (Voc) of 0.82 V, and a fill factor (FF) of 63.82%, thus resulting in a PCE of 10.31%. © 2017 American Chemical Society.

Incidence of acute cerebral infarction or space occupying lesion among patients with isolated dizziness and the role of D-dimer.

BACKGROUND:To determine the incidence of acute cerebral infarction or space occupying lesion (SOL) among patients with isolated vertigo or dizziness (IVD) and to evaluate the role of cerebellar function test (CFT) and D-dimer to discriminate ACI/SOL and non-ACI/SOL. METHODS:A retrospective study of consecutive emergency department (ED) patients with IVD during one year was conducted. ACI was based on the diffusion-weighted magnetic resonance imaging (DW-MRI), and SOL was based on the concurrent MRI sequences. A sensitivity analysis of CFT and D-dimer was also performed. RESULTS:Among the 468 patients enrolled, 13 patients (2.8%) had ACI, 11 at cerebellum, 1 at occipital lobe, and 1 at centrum semiovale. Twenty-five patients (5.3%) had SOL. Aneurysm is most frequent (n = 7), followed by meningioma (n = 4) and venous anomaly (n = 4). In total, ACI/SOL was found in 8.1% (n = 38). Abnormal findings in finger-to-nose (FN), heel-to-shin (HTS), and rapid alternative movement (RAM) tests were significantly higher in ACI or ACI/SOL group, while gait disturbance, tandem gait abnormality, and Romberg's test were not. CFT sensitivities were low for ACI as well as for ACI/SOL, but specificities were high for ACI and ACI/SOL. D-dimer level showed a sensitivity of 100% at >0.18 mg/L for ACI and >0.15 mg/L for ACI/SOL. However, specificity was low at corresponding D-dimer level. Among the subgroup (n = 411) who did not show any abnormality in CFT, 9 patients (2.2%) had ACI, and 33 patients (8.0%) had ACI/SOL. CONCLUSION:The present study reports a clinically significant incidence of ACI/SOL among ED patients with IVD. D-dimer showed high sensitive and low specificity, while CFT showed low sensitivity and high specificity

Synergistic Effects of Terpolymer Regioregularity on the Performance of All-Polymer Solar Cells

Random terpolymers with three different monomer units can provide broader light absorption than the most widely used donor-acceptor (D-A) alternating copolymers, but their electrical properties are often sacrificed by the randomly distributed monomers in the polymeric backbone that prevent efficient intermolecular π- π interactions. Here, we report the development of a regioregular terpolymer and demonstrate its importance in enhancing the power conversion efficiency (PCE) of all-polymer solar cells (all-PSCs). To investigate the impact of the monomer sequence and regioregularity in the terpolymer, we designed and synthesized two terpolymers (Ra-(D1-A-D2-A) random terpolymer and RR-(D1-A-D2-A) regioregular terpolymer) consisting of two electron-donating benzodithiophene (BDT) units with different side chains and one electron-withdrawing fluorinated thieno[3,4-b]thiophene (TT-F) unit. As a reference polymer, we also synthesized the D1-A alternating copolymer. The RR-(D1-A-D2-A) film exhibited stronger π- π stacking and a larger crystallite size than the D1-A and Ra-(D1-A-D2-A) films, resulting in 1 order of magnitude higher hole mobility than those of the other polymers. When blended with the P(NDI2HD-DTAN) polymer acceptor, the RR-(D1-A-D2-A)-based all-PSC yielded an outstanding PCE of 6.13%, which was superior to those of the D1-A-based all-PSCs (4.81%) and Ra-(D1-A-D2-A)-based all-PSCs (4.93%). These findings indicate that the synthesis of the regioregular terpolymer is a promising design strategy for the development of high-performance all-PSCs with improved optical and electrical properties. © 2019 American Chemical Society.1

The prognostic value of platelet-to-lymphocyte ratio on in-hospital mortality in admitted adult traffic accident patients.

BackgroundThe predictive value of platelet-to-lymphocyte ratio (PLR) in acute illness is well known, but further evaluation is needed in traffic accident patients.MethodsThis retrospective observational study enrolled consecutive adult patients involved in traffic accidents who were admitted to the study hospital's emergency department during 1 year. The initial platelet and lymphocyte counts after arrival at the emergency department were the variables of interest. The primary outcome was in-hospital mortality. Data on baseline characteristics, comorbidities, and physiological and laboratory variables were collected. Multivariate Cox proportional hazard modelings were used to identify the variables independently associated with the outcome.ResultsA total of 1,522 traffic accident patient were screened, and 488 patients were enrolled. In all, 43 (8.8%) patients died in the hospital. The median PLR was 115.3 (interquartile range 71.3;181.8). The in-hospital mortality rate of the 1st tertile of PLR (21.5%) was significantly higher than the rates of the 2nd (2.5%) and 3rd (2.5%) tertiles. The area under the receiver operating characteristic curve of PLR for in-hospital survival was 0.82 (95% confidential interval [CI], 0.74-0.89), which was greater than that of lymphocyte count (0.72; 95% CI 0.63-0.81) and platelet count (0.67; 95% CI 0.57-0.76). The Kaplan-Meier curves showed a significant difference in survival between the tertiles (pConclusionPLR was significantly associated with an increased risk of in-hospital mortality in admitted adult traffic accident patients

A novel random terpolymer for high-efficiency bulk-heterojunction polymer solar cells

A new random terpolymer, coded LGC-D013, based on N-alkylthieno[3,4-c]pyrrole-4,6-dione (TPD) as the acceptor and benzodithiophene (BDT) and terthiophene as the donor units, has been synthesized and characterized as a donor material in bulk-heterojunction (BHJ) organic photovoltaic (OPV) applications. The thermal, optical, and electrochemical properties of the LGC-D013 were characterized. The polymer has a deep highest occupied molecular orbital (HOMO) level of −5.56 eV and an optical band gap of 1.84 eV in film. The OPV based on LGC-D013:PC71BM blend film demonstrated a power conversion efficiency (PCE) of 6.09%, with a relatively high fill factor (FF) of 72.55%. After 1,8-diiodooctane (DIO) treatment with a 3% volume ratio, the short circuit current density (Jsc) was improved from 9.48 to 11.29 mA cm−2, and FF was improved from 72.55 to 73.13%, resulting in PCE improvement from 6.09 to 7.22%. The BHJ OPV using LGC-D013 as the donor polymer based on TPD and BDT with terthiophene showed an improved fill factor as high as 72%, which is higher than those of conventional TPD-BDT based polymers. © The Royal Society of Chemistry.1

Changes in peak expiratory flow rates using two head-tilt/chin-lift maneuver angles in young healthy conscious volunteers.

BACKGROUND:The head-tilt/chin-lift (HT/CL) maneuver is simple and routinely used to open a closed upper airway. OBJECTIVES:It has yet to be determined whether increasing the HT/CL angle further would be beneficial. METHODS:We enrolled 60 (30 males) 20-year-old conscious participants. Pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were defined as positions in which the angle between the ear-eye line and the horizontal line was 80°, 65°, and 50°, respectively. Peak exploratory flow rates (PEFRs) pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were recorded continuously at 1-minute intervals (one set). Five sets of measurements were performed (total, 15 measurements for each participant). RESULTS:We analysed 900 measurements (180 sets). The mean PEFRs pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were 348.4 ± 96.9, 366.4 ± 104.9, and 378.8 ± 111.2 L/min (percentage change compared to pre-HT/CL, 5.2% and 8.7%), respectively. Significant differences were observed among pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions in all participants, as well as in subgroup classified according to sex, and medians of height, body weight, and body mass index. CONCLUSION:Our findings suggest that a greater HT/CL angle would be beneficial, as the PEFR increased gradually. The decreasing manner in the PEFR increase with the HT/CL angle implies the existence of an angle threshold beyond which there were no further benefits in airflow, indicating a minimum in airway resistance. A HT/CL maneuver may be appropriate until locking the atlanto-occipital and cervical spine joints in extension occurs and the chest (sternal notch) begins to rise

Regioregular Low Bandgap Polymer with Controlled Thieno[3,4-b]thiophene Orientation for High-Efficiency Polymer Solar Cells

The regioregular p-type copolymer PBDTTT-C-T composed of TT-BDT-TT-BDT repeating units (TT = thieno[3,4-b]thiophene, BDT = benzo[1,2-b:4,5-b']dithoiphene) and perfectly controlled TT orientation was synthesized. The optical, thermal, and electrochemical properties of the regioregular PBDTTT-C-T were characterized and compared with the random PBDTTT-C-T without structural regioregularity. The regioregular PBDTTT-C-T showed lower optical bandgap (1.55 eV) and higher degree of crystallinity compared to the random PBDTTT-C-T. The inverted bulk heterojunction PSCs based on the regioregular PBDTTT-C-T exhibited a power conversion efficiency as high as 7.79%, which is 19% higher than the random PBDTTT-C-T-based PSCs. It was found that the improved photoabsorption and increase in charge carrier mobility due to high regioregularity of conjugated polymer backbones and effective ordering between polymer chains are the most likely reasons for enhancement of power conversion efficiency in PSCs. © 2015 American Chemical Society.

Dopant-free polymeric hole transport materials for highly efficient and stable perovskite solar cells

We report a dopant-free polymeric hole transport material (HTM) that is based on benzo[1,2-b:4,5:b']-dithiophene and 2,1,3-benzothiadiazole, which results in highly efficient and stable perovskite solar cells (similar to 17.3% for over 1400 h at 75% humidity). The HTM comprises a random copolymer (RCP), which is characterized using UV-vis absorption spectroscopy, cyclic voltammetry, space-charge-limited current, and grazing-incidence wide-angle X-ray scattering. The RCP-based perovskite solar cell exhibits the highest efficiency (17.3%) in the absence of dopants [lithium bis (trifluoromethanesulfonyl) imide and tert-butylpyridine]. The observed efficiency is attributed to a deep HOMO energy level and high hole mobility. In addition, the long-term stability of the device is dramatically improved by avoiding deliquescent or hygroscopic dopants and by introducing a hydrophobic polymer layer. RCP devices maintain their initial efficiency for over 1400 h at 75% humidity, whereas devices made of HTMs with additives fail after 900 h.1111678Nsciescopu