Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite

Objective Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)—a new indicator for immature granulocytes—for DIC diagnosis. Methods This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite. Results Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P<0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P<0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI’s receiver operating characteristic curve was 0.724. Conclusion DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department

The usefulness of serum delta neutrophil index for differentiating bacterial and viral meningitis in the emergency department

Objective When managing patients with acute meningitis in an emergency department (ED), early diagnosis of the type of infection (bacterial or viral) considerably affects the clinical course and treatment because of the high mortality and morbidity associated with bacterial meningitis (BM). The serum delta neutrophil index (DNI), a new inflammatory marker, reflects the fraction of circulating immature granulocytes and is elevated in cases of bacterial infection. The objective of this study was to evaluate whether serum DNI can be used to differentiate between BM and viral meningitis (VM) in the ED. Methods This retrospective, observational study included 104 consecutive patients (aged &gt;18 years) diagnosed with acute meningitis from January 2012 to November 2014 in a regional emergency center. White blood cell and neutrophil counts, C-reactive protein level, and DNI were evaluated regarding their usefulness for differentiating BM and VM. Results Serum DNI was not significantly higher in the BM group (n=12) than in the VM group (n=92) (0 [interquartile range, 0% to 2.73%] vs. 0 [interquartile range, 0 to 0%], P=0.057). However, the white blood cell count and C-reactive protein level were statistically higher in the BM group (P=0.034 and P=0.026, respectively). Serum DNI was not found to be a statistically useful differential diagnostic parameter (area under the curve, 0.628; 95% confidence interval, 0.438 to 0.818). Conclusion Currently, there is no evidence that the serum DNI aids in differentiating acute BM from acute VM in the ED. Keyword

Validation of the Korean criteria for trauma team activation

Objective We conducted a study to validate the effectiveness of the Korean criteria for trauma team activation (TTA) and compared its results with a two-tiered system. Methods This observational study was based on data from the Korean Trauma Data Bank. Within the study period, 1,628 trauma patients visited our emergency department, and 739 satisfied the criteria for TTA. The rates of overtriage and undertriage in the Korean one-tiered system were compared with the two-tiered system recommended by the American College of Surgery-Committee on Trauma. Results Most of the patient’s physiologic factors reflected trauma severity levels, but anatomical factors and mechanism of injury did not show consistent results. In addition, while the rate of overtriage (64.4%) was above the recommended range according to the Korean criteria, the rate of undertriage (4.0%) was within the recommended range. In the simulated two-tiered system, the rate of overtriage was reduced by 5.5%, while undertriage was increased by 1.8% compared to the Korean activation system. Conclusion The Korean criteria for TTA showed higher rates of overtriage and similar undertriage rates compared to the simulated two-tier system. Modification of the current criteria to a two-tier system with special considerations would be more effective for providing optimum patient care and medical resource utilization

Relationship between Vitamin D, Parathyroid Hormone, and Bone Mineral Density in Elderly Koreans

There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged ≤ 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism

The 5p15.33 Locus Is Associated with Risk of Lung Adenocarcinoma in Never-Smoking Females in Asia

Genome-wide association studies of lung cancer reported in populations of European background have identified three regions on chromosomes 5p15.33, 6p21.33, and 15q25 that have achieved genome-wide significance with p-values of 10−7 or lower. These studies have been performed primarily in cigarette smokers, raising the possibility that the observed associations could be related to tobacco use, lung carcinogenesis, or both. Since most women in Asia do not smoke, we conducted a genome-wide association study of lung adenocarcinoma in never-smoking females (584 cases, 585 controls) among Han Chinese in Taiwan and found that the most significant association was for rs2736100 on chromosome 5p15.33 (p = 1.30×10−11). This finding was independently replicated in seven studies from East Asia totaling 1,164 lung adenocarcinomas and 1,736 controls (p = 5.38×10−11). A pooled analysis achieved genome-wide significance for rs2736100. This SNP marker localizes to the CLPTM1L-TERT locus on chromosome 5p15.33 (p = 2.60×10−20, allelic risk = 1.54, 95% Confidence Interval (CI) 1.41–1.68). Risks for heterozygote and homozygote carriers of the minor allele were 1.62 (95% CI; 1.40–1.87), and 2.35 (95% CI: 1.95–2.83), respectively. In summary, our results show that genetic variation in the CLPTM1L-TERT locus of chromosome 5p15.33 is directly associated with the risk of lung cancer, most notably adenocarcinoma

Current Development of Automotive Powertrain Components for Low Friction and Wear Reduction through Coating and Heat Treatment Technology

Recent findings of R&D for powertrain components concerning friction and wear reduction are described in this chapter. These are realized through lubrication technology of coating and heat treatment, which are fit for this book. In the first part, nano-complex coatings for parts of future mobility are presented with their friction and wear behavior. The application of an alloying target was proposed to promote the commercial use of nanocomposite coatings. In the second part, the importance on pre-treatments-related silicon oxide-diamond-like carbon (SiO-DLC) coating for the smallest part of fuel system is described. The optimization of cleaning for the balls before coating was resulted: The best cleaning performance presented the addition of acetone cleaning, water boiling, and then acetone cleaning, confirmed by fluorescence analyzers. The third part of this work was developing low-temperature vacuum carburizing and pre-treatment for parts of injector, stopper (SUS303), and position ring (1.4305) with high wear resistance. The difference between two steels led to the result: high molybdenum of 1.4305 formed Mo-oxides on the surface during acid etching. These Mo-oxides resolved quickly by hydrogen during carburizing and then enabled activated carburizing. The 1.4305 was appropriate for the carburizing and was chosen for stopper

Effects of Silica Shell Encapsulated Nanocrystals on Active χ-Fe₅C₂ Phase and Fischer–Tropsch Synthesis

Among various iron carbide phases, χ-Fe5C2, a highly active phase in Fischer–Tropsch synthesis, was directly synthesized using a wet-chemical route, which makes a pre-activation step unnecessary. In addition, χ-Fe5C2 nanoparticles were encapsulated with mesoporous silica for protection from deactivation. Further structural analysis showed that the protective silica shell had a partially ordered mesoporous structure with a short range. According to the XRD result, the sintering of χ-Fe5C2 crystals did not seem to be significant, which was believed to be the beneficial effect of the protective shell providing restrictive geometrical space for nanoparticles. More interestingly, the protective silica shell was also found to be effective in maintaining the phase of χ-Fe5C2 against re-oxidation and transformation to other iron carbide phases. Fischer–Tropsch activity of χ-Fe5C2 in this study was comparable to or higher than those from previous reports. In addition, CO2 selectivity was found to be very low after stabilization

Left ventricle segmentation in transesophageal echocardiography images using a deep neural network.

PurposeThere has been little progress in research on the best anatomical position for effective chest compressions and cardiac function during cardiopulmonary resuscitation (CPR). This study aimed to divide the left ventricle (LV) into segments to determine the best position for effective chest compressions using the LV systolic function seen during CPR.MethodsWe used transesophageal echocardiography images acquired during CPR. A deep neural network with an attention mechanism and a residual feature aggregation module were applied to the images to segment the LV. The results were compared between the proposed model and U-Net.ResultsThe results of the proposed model showed higher performance in most metrics when compared to U-Net: dice coefficient (0.899±0.017 vs. 0.792±0.027, p0.05). There was a significant difference between the proposed model and U-Net.ConclusionCompared to U-Net, the proposed model showed better performance for all metrics. This model would allow us to evaluate the systolic function of the heart during CPR in greater detail by segmenting the LV more accurately