Factors associated with discharge of children from the emergency department after interfacility transfer

Purpose To investigate the factors associated with discharge of children from the emergency department (ED) after interfacility transfer. Methods We reviewed consecutive children who visited the ED via interfacility transfer from January 2014 to December 2015. The children were divided into two groups according to whether they were discharged from the ED or not (the discharge and admission groups), and their characteristics were compared. Multivariable logistic regression analysis was performed to identify the factors associated with discharge of children from the ED after interfacility transfer. Results Of the 999 transferred children, 426 (42.6%) were discharged. Compared to the admission group, these children showed older age, more frequent transfers from clinics and arrivals between 16 h and 20 h, shorter stay in the ED, and less frequent surgical abdomen. We found that age (3 to 6 years; adjusted odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.6, compared with 0 to 2 years), diagnosis (trauma; OR, 2.4; 95% CI, 1.5-4.0, compared with gastrointestinal diseases), and referring hospital (primary clinic; OR, 5.4; 95% CI, 3.1-9.4, compared with tertiary hospitals) were the factors. Conclusion The children who aged 3 to 6 years, had trauma or underwent transfers from primary clinics were more likely to be discharged at the ED. Considering these factors, we should reduce unnecessary transfers

Bilateral ischemic lumbosacral plexopathy from chronic aortoiliac occlusion presenting with progressive paraplegia

Spinal cord ischemia is rare but causes significant morbidity and mortality. Spinal cord ischemia has been reported after open and endovascular interventions of the thoracic and abdominal aorta, and, rarely, acute occlusion of aorta from in situ thrombosis or acute embolic occlusion. Acute interruption of the critical blood supply to the spinal cord or root contributes to this devastating neurologic deficit. However, gradually worsening lumbosacral plexopathy and consequent paraplegia related to chronic aortic occlusion is extremely rare. We present a case of a 58-year-old man with progressive lower limb paralysis from atherosclerotic aortoiliac occlusion without history of aortic surgery or evidence of thromboembolism

Usefulness of Videofluoroscopic Swallow Study with Mixed Consistency Food for Patients with Stroke or Other Brain Injuries

This study evaluated the feasibility of mixed consistency foods test in patients with dysphagia which developed after stroke or other brain injuries. The findings of a videofluoroscopic swallow study (VFSS) were compared using single versus mixed consistency foods. Forty-nine patients with stroke or other brain injuries who had no significant abnormal findings in the single consistency food VFSS and started regular hospital diet were recruited for this study. Twenty-five (51%) of the 49 patients showed normal findings whereas 24 (49%) patients showed abnormal findings in the mixed consistency food VFSS. Abnormal findings included posterior spillage of liquid prematurely to pyriform sinus (n = 23), laryngeal penetration (n = 6), subglottic aspiration in the oral preparatory phase of swallowing (chewing), solid components (n = 2), and significant (more than 10%) residue in valleculae or pyriform sinus (n = 2). There was an increased risk of abnormal findings in mixed consistency food VFSS such as aspiration and penetration when a patient showed delayed pharyngeal delay time in single consistency food using liquids. In conclusion, VFSS protocols using mixed consistency foods would be useful before starting regular diet for patients after stroke or other brain injuries

Pectinase-treated Panax ginseng ameliorates hydrogen peroxide-induced oxidative stress in GC-2 sperm cells and modulates testicular gene expression in aged rats

AbstractBackgroundTo investigate the effect of pectinase-treated Panax ginseng (GINST) in cellular and male subfertility animal models.MethodsHydrogen peroxide (H2O2)-induced mouse spermatocyte GC-2spd cells were used as an in vitro model. Cell viability was measured using MTT assay. For the in vivo study, GINST (200 mg/kg) mixed with a regular pellet diet was administered orally for 4 mo, and the changes in the mRNA and protein expression level of antioxidative and spermatogenic genes in young and aged control rats were compared using real-time reverse transcription polymerase chain reaction and western blotting.ResultsGINST treatment (50 μg/mL, 100 μg/mL, and 200 μg/mL) significantly (p < 0.05) inhibited the H2O2-induced (200 μM) cytotoxicity in GC-2spd cells. Furthermore, GINST (50 μg/mL and 100 μg/mL) significantly (p < 0.05) ameliorated the H2O2-induced decrease in the expression level of antioxidant enzymes (peroxiredoxin 3 and 4, glutathione S-transferase m5, and glutathione peroxidase 4), spermatogenesis-related protein such as inhibin-α, and specific sex hormone receptors (androgen receptor, luteinizing hormone receptor, and follicle-stimulating hormone receptor) in GC-2spd cells. Similarly, the altered expression level of the above mentioned genes and of spermatogenesis-related nectin-2 and cAMP response element-binding protein in aged rat testes was ameliorated with GINST (200 mg/kg) treatment. Taken together, GINST attenuated H2O2-induced oxidative stress in GC-2 cells and modulated the expression of antioxidant-related genes and of spermatogenic-related proteins and sex hormone receptors in aged rats.ConclusionGINST may be a potential natural agent for the protection against or treatment of oxidative stress-induced male subfertility and aging-induced male subfertility

Primary Extracranial Meningioma Presenting as a Cheek Mass

Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma

Limits on the Superconducting Order Parameter in NdFeAsO1−x_{1-x}Fy_y from Scanning SQUID Microscopy

Identifying the symmetry of the superconducting order parameter in the recently-discovered ferro-oxypnictide family of superconductors, RFeAsO$_{1-x}$F$_{y}$, where $R$ is a rare earth, is a high priority. Many of the proposed order parameters have internal $\pi$ phase shifts, like the d-wave order found in the cuprates, which would result in direction-dependent phase shifts in tunnelling. In dense polycrystalline samples, these phase shifts in turn would result in spontaneous orbital currents and magnetization in the superconducting state. We perform scanning SQUID microscopy on a dense polycrystalline sample of \NdFeAsO$_{0.94}$F$_{0.06}$ with $T_c=48$ K and find no such spontaneous currents, ruling out many of the proposed order parameters.Comment: 10 pages, 5 figures; to appear in JPS

Superconductivity at the Border of Electron Localization and Itinerancy

The superconducting state of iron pnictides and chalcogenides exists at the border of antiferromagnetic order. Consequently, these materials could provide clues about the relationship between magnetism and unconventional superconductivity. One explanation, motivated by the so-called bad-metal behaviour of these materials, proposes that magnetism and superconductivity develop out of quasi-localized magnetic moments which are generated by strong electron-electron correlations. Another suggests that these phenomena are the result of weakly interacting electron states that lie on nested Fermi surfaces. Here we address the issue by comparing the newly discovered alkaline iron selenide superconductors, which exhibit no Fermi-surface nesting, to their iron pnictide counterparts. We show that the strong-coupling approach leads to similar pairing amplitudes in these materials, despite their different Fermi surfaces. We also find that the pairing amplitudes are largest at the boundary between electronic localization and itinerancy, suggesting that new superconductors might be found in materials with similar characteristics.Comment: Version of the published manuscript prior to final journal-editting. Main text (23 pages, 4 figures) + Supplementary Information (14 pages, 7 figures, 3 tables). Calculation on the single-layer FeSe is added. Enhancement of the pairing amplitude in the vicinity of the Mott transition is highlighted. Published version is at http://www.nature.com/ncomms/2013/131115/ncomms3783/full/ncomms3783.htm

Controlled Orientation of Active Sites in a Nanostructured Multienzyme Complex

Multistep cascade reactions in nature maximize reaction efficiency by co-assembling related enzymes. Such organization facilitates the processing of intermediates by downstream enzymes. Previously, the studies on multienzyme nanocomplexes assembled on DNA scaffolds demonstrated that closer interenzyme distance enhances the overall reaction efficiency. However, it remains unknown how the active site orientation controlled at nanoscale can have an effect on multienzyme reaction. Here, we show that controlled alignment of active sites promotes the multienzyme reaction efficiency. By genetic incorporation of a non-natural amino acid and two compatible bioorthogonal chemistries, we conjugated mannitol dehydrogenase to formate dehydrogenase with the defined active site arrangement with the residue-level accuracy. The study revealed that the multienzyme complex with the active sites directed towards each other exhibits four-fold higher relative efficiency enhancement in the cascade reaction and produces 60% more D-mannitol than the other complex with active sites directed away from each other.ope

High‐Color‐Purity Subtractive Color Filters with a Wide Viewing Angle Based on Plasmonic Perfect Absorbers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110824/1/adom201400533.pd