ドクター ヘリ シュツドウ ニヨリ ショキ チリョウ オ ソウキ ニ カイシ シエタ ジュウショウ タハツ ガイショウ ノ イチレイ

There was a hotline that a 79-year-old man crashed from a height of 3m. The helicopter emergency medical service （HEMS） dispatched immediately. Flight doctors were in contact with the patient 14 minutes after hotline, and performed tracheal intubation and intravenous ensure path in the field. They came back to our hospital 44 minutes later. Emergency left thoracotomy was performed because the patient experienced cardiac arrest, due to the heart compression caused by the anterior mediastinal hematoma. The patient returned to spontaneous circulation. However, the patient condition was unstable due to bleeding from concurrent right hemothorax. We performed clamshell thoracotomy to stop bleeding, but the patient died by blood loss. Quick start of the primary care is very important to the improvement of the survival rate in severe trauma cases. Our hospital introduced HEMS last year, and had been able to improve the quickness in response by promoting cooperation of ER trauma team and operation room. With this system, we could provide primary care and transportation for the patient before he went into the cardiac arrest. Further evaluation of this system would improve the survival rate in the severe trauma cases

Enhanced boiling surface with hydrophobic circle spots evaporator of looped thermosiphon

Heat transfer characteristic of a closed two-phase thermosiphon with enhanced boiling surface is studied and compared with that of a copper mirror surface. Two-phase cooling improves heat transfer coefficient (HTC) a lot compared to singlephase liquid cooling. The evaporator surfaces coated with a pattern of hydrophobic circle spots (non-electroplating, 0.5 2 mm in diameter and 1.5 3 mm in pitch) achieve very high heat transfer coefficient and lower the incipience temperature overshoot using water as the working fluid. Sub-atmospheric boiling on the hydrophobic spot-coated surface shows a much better heat transfer performance. Tests with heat loads (30 W to 260 W) revealed the optimum thermosiphon performance. Hydrophobic circle spots coated surface with diameter 1 mm, pitch 1.5 mm achieves the maximum heat transfer enhancement with the boiling thermal resistance as low as 0.03 K/W.Papers presented at the 13th International Conference on Heat Transfer, Fluid Mechanics and Thermodynamics, Portoroz, Slovenia on 17-19 July 2017 .International centre for heat and mass transfer.American society of thermal and fluids engineers

The effect of nutritional support on the immune function in the acute postoperative period after esophageal cancer surgery : total parenteral nutrition versus enteral nutrition

Background : Enteral nutrition (EN) is now used more frequently than total parenteral nutrition (TPN) for nutritional support after resection for esophageal cancer. But consensus regarding which type of nutrition should be used does not exist. We studied the effect of TPN and EN on patients’ nutritional status and immune function in the immediate postoperative period after esophageal cancer resection. Methods : We enrolled 30 patients (27 men and 3 women) who underwent subtotal esophagectomy. The patients were randomly assigned to TPN or EN group. Either TPN or EN was begun on postoperative day 1. On postoperative days 1, 3, and 7, three endpoints were measured : albumin, C-reactive protein, and Th1/Th2 balance. Results : All patients completed the study. Anastomotic leaks occurred in 6 patients in the TPN group and 7 patients in the EN group. Albumin, Th1/Th2 balance, and C-reactive protein did not differ between the groups. Th1/Th2 balance was not different regardless of the preoperative treatment or complications. Conclusions. No differences in immune function, nutritional state, or inflammatory response were seen between patients supported with TPN and those supported with EN. The results of our study suggest that perioperative nutritional support can be safely performed either with TPN or EN

The Hydrogen Burning Turn-off of RS Ophiuchi 2006

We report a coordinated multi-band photometry of the RS Oph 2006 outburst and highlight the emission line free y-band photometry that shows a mid-plateau phase at y ~ 10.2 mag from day 40 to day 75 after the discovery followed by a sharp drop of the final decline. Such mid-plateau phases are observed in other two recurrent novae, U Sco and CI Aql, and are interpreted as a bright disk irradiated by the white dwarf. We have calculated theoretical light curves based on the optically thick wind theory and have reproduced the observed light curves including the mid-plateau phase and the final sharp decline. This final decline is identified with the end of steady hydrogen shell-burning, which turned out the day ~80. This turnoff date is consistent with the end of a supersoft X-ray phase observed with Swift. Our model suggests a white dwarf mass of 1.35 \pm 0.01 M_\sun, which indicates that RS Oph is a progenitor of Type Ia supernovae. We strongly recommend the y-filter observation of novae to detect both the presence of a disk and the hydrogen burning turn-off.Comment: to appear in ApJL, 4 pages including 4 figure

心血管イベント予測のための上腕動脈収縮期血圧左右差の最適なカットオフ値の開発と検証

Background: An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. Methods: From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. Results: During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, p = 0.005). The receiver operating characteristic curve revealed that 5 mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p < 0.001). In the validation cohort, the presence of a large IAD (IAD ≥ 5 mmHg) was significantly associated with the primary endpoint (p = 0.021). Conclusions: IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5 mmHg

トウカ ニオケル ダイチョウ センコウ 83レイ ノ リンショウテキ ケントウ

Introduction : Colon perforation easily causes septic shock and multiple organ failure, mortality rate is high. We studied prognostic factors with colon perforation. From January１９９９to December ２００８, ８３ patients with colon perforation underwent emergency surgery in this department. Methods : Subjects were retrospectively divided into survivors（n＝６７）and nonsurvivors（n＝１６）. We studied their clinical factors and compared mortality for each factors. Results : Overall mortality was１９％ １６／８３）. The mean age was７４years, and significantly higher mortality over ８０years. The cause perforation was idiopathic in２５cases, cancer in２１cases, diverticulitis in１９ cases, iatrogenic in８cases, trauma in２cases, others in８cases. The perforation site was the most sigmoid colon. Patients with SOFA score at least five points before surgery and preoperative shock and leucopenia and older than２４hours before surgery was significantly higher mortality. Each was no difference in complications before surgery. PMX-DHP was performed in ３９ cases １３％ mortality. Discussion : In patients with colon perforation, preoperative assessment SOFA score was trusted to reflect the outcome

イガン サイハツゴ ノ テイアルブミン ケッショウ ト ナンジセイ オウト ニ ハロペリドール ガ ユウコウ デアッタ イチショウレイ

The patient was an 83-year-old woman who underwent laparoscopy-assisted distal gastrectomy for gastric cancer on February 25, 201X. S‐1 and UFT were performed, but metastatic liver cancer was seen on a CT scan on September 2. S‐1 was restarted on October 2６ but discontinued on January 18, 201X＋1 and best supportive care was adopted. She was hospitalized on April 15 for loss of appetite and anasarca. The patient had intractable vomiting and treatment resistance to metoclopramide and domperidone. ALB had decreased to 1．3 g/dl on April 22. A decrease in gastrointestinal motility from ascites retention was seen on a CT scan on April 25. Continuous subcutaneous infusion with haloperidol was started on April 25. The frequency of vomiting significantly decreased immediately afterward, and daily caloric intake significantly increased. Her ascites and anasarca were markedly improved on a CT scan on May 11. ALB had risen to 2．7 g/dlon June 14. Continuous subcutaneous infusion of haloperidol was effective for hypoalbuminemia and intractable vomiting after gastric cancer recurrence