Out-of-hospital Cardiac Arrest in the Elderly

SummaryBackgroundTo investigate the characteristics of out-of-hospital cardiac arrest (OHCA) in the elderly, we retrospectively studied a 6-month series of cases in an emergency department (ED) of a medical center in northern Taiwan.MethodsThere were 145 OHCA cases sent to our ED from January 1, 2007 to June 30, 2007. Of these, 28 traumarelated and five pediatric cases were excluded, and 112 cases were eventually enrolled into our study. The 112 cases were divided into an elderly group (≥ 65 years) of 81 cases and a non-elderly group of 31 cases. There were 64 males and 48 females (male/female ratio, 1.33:1) aged 24–99 years. We collected the laboratory data and made comparisons between the elderly and non-elderly group in arterial blood gas, hemoglobin, potassium, glucose, and troponin I. We used the statistical software SPSS version 11.5.0 (SPSS Inc., Chicago, IL, USA) with t test analysis. The clinical significance was set at p < 0.05.ResultsReturn of spontaneous circulation (ROSC) occurred in 46 cases (41%) after standard resuscitation by advanced cardiac life support. The elderly group had a higher ROSC rate than the non-elderly group, but this was not significant (44% vs. 32%; p = 0.335). The elderly group had less acidosis, less hypercapnia, less hyperkalemia, less hyperglycemia and a higher rate of elevated troponin I than the non-elderly group, but the differences were not significant. The elderly group had significantly lower hemoglobin levels than the non-elderly group (10.52 ± 3.04 vs. 12.6 ± 3.32g/dL; p = 0.003). The glucose levels of the ROSC group were significantly higher than the non-ROSC group in the elderly (230.14 ± 130.4 vs. 195.1 ± 147.7mg/dL; p = 0.049). In the group of acute coronary syndrome (ACS)-related OHCA, the ROSC rate in the elderly group was significantly higher than that of the non-elderly (54.2% vs. 40%; p = 0.014). The elderly group had a slightly lower rate of survival than the non-elderly group (7.4% vs. 9.7%; p = 0.159).ConclusionThe elderly OHCA cases had an anemic status. The elderly had a higher ROSC rate in cases with relative hyperglycemia and ACS-related OHCA. This finding provides us with the theory of trialing administration of glucose water during resuscitation in OHCA cases

On the Existence of H1H^1 solutions for Stationary Linearized Boltzmann Equations in a Small Convex Domain

In this article, we investigate the incoming boundary value problem for the stationary linearized Boltzmann equations in $\Omega \subseteq \mathbb{R}^{3}$. For a $C^2$ bounded domain with boundary of positive Gaussian curvature, the existence theory is established in $H^{1}(\Omega \times \mathbb{R}^{3})$ provided that the diameter of the domain $\Omega$ is small enough.Comment: 19 pages, 1 figur

Ruptured Aortic Aneurysm Presenting as a Stridor

SummaryStridor is an abnormal, high-pitched, whining breathing sound caused by a blockage in the throat or larynx that is usually heard in children. We describe an unusual case of an 81-year-old man brought to our emergency department with sudden onset of dyspnea and shortness of breath. Stridor could be heard without a stethoscope. We found a huge mass over the left upper chest on chest radiography, suggesting an aortic aneurysm. We believed that these symptoms were caused by a huge thoracic aortic aneurysm with trachea/bronchi compression. Chest computed tomography confirmed the diagnosis

Scutellaria baicalensis decreases ritonavir-induced nausea

BACKGROUND: Protease inhibitors, particularly ritonavir, causes significant gastrointestinal disturbances such as nausea, even at low doses. This ritonavir-induced nausea could be related to its oxidative stress in the gut. Alleviation of drug-induced nausea is important in effectively increasing patients' compliance and improving their quality of life. Conventional anti-emetic drugs can only partially abate the symptoms in these patients, and their cost has also been a concern. Rats respond to nausea-producing emetic stimuli by increasing consumption of non-nutritive substances like kaolin or clay, a phenomenon known as pica. In this study, we used this rat pica model to evaluate the effects of Scutellaria baicalensis, a commonly used oriental herbal medicine, on ritonavir-induced nausea. RESULTS: Rats treated with 20 mg/kg ritonavir significant caused increases of kaolin consumption at 24 to 48 hr (P < 0.01). Pretreatment with 0.3 and 3 mg/kg Scutellaria baicalensis extract significantly decreased ritonavir-induced kaolin intake in a dose-related manner (P < 0.01). Compared to vehicle treatment, the extract completely prevented ritonavir-induced kaolin consumption at dose 3 mg/kg. The area under the curves (AUC) for kaolin intake from time 0 to 120 hr for vehicle only, ritonavir only, SbE 0.3 mg/kg plus ritonavir, and SbE 3 mg/kg plus ritonavir were 27.3 g•hr, 146.7 g•hr, 123.2 g•hr, and 32.7 g•hr, respectively. The reduction in area under the curves of kaolin intake from time 0 to 120 hr between ritonavir only and SbE 0.3 mg/kg plus ritonavir, ritonavir only and SbE 3 mg/kg plus ritonavir were 16.0% and 77.7%, respectively. CONCLUSION: Scutellaria baicalensis significantly attenuated ritonavir-induced pica, and demonstrated a potential in treating ritonavir-induced nausea

Protease inhibitor-induced nausea and vomiting is attenuated by a peripherally acting, opioid-receptor antagonist in a rat model

<p>Abstract</p> <p>Background</p> <p>Protease inhibitors such as ritonavir can cause nausea and vomiting which is the most common reason for discontinuation. Rats react to nauseous and emetic stimuli by increasing their oral intake of non-nutritive substances like kaolin, known as pica behavior. In this study, we evaluated the effects of methylnaltrexone, a peripherally acting <it>mu</it>-opioid receptor antagonist that does not affect analgesia, on ritonavir-induced nausea and vomiting in a rat pica model.</p> <p>Results</p> <p>We observed that 24 to 48 hr after administration of oral ritonavir 20 mg/kg, kaolin consumption increased significantly in rats (<it>P </it>< 0.01). This increase was attenuated by pretreatment with an intraperitoneal injection of methylnaltrexone (0.3–3.0 mg/kg) in a dose dependent manner (<it>P </it>< 0.01) and also with naloxone (0.1–0.3 mg/kg) (<it>P </it>< 0.01). The areas under the curve for kaolin intake from time 0 to 120 hr were significantly reduced after administration of the opioid antagonists. Food intake was not significantly affected. Plasma naltrexone levels were measured after methylnaltrexone injection, and no detectable levels were found, indicating that methylnaltrexone was not demethylated in our experimental paradigm.</p> <p>Conclusion</p> <p>These results suggest that methylnaltrexone may have potential clinical utility in reducing nausea and vomiting in HIV patients who take ritonavir.</p

地下水引發自由端順向坡土體滑動特性分析

Retrogressive sliding can be observed in groundwater-induced landslides. The major inducing factor of this phenomenon is the fluidization in the down-hillslope and the soil of the bottom-layers. Moreover, when the water content in the area around the groundwater input pipe surpasses 29%, sag in the upper soil layer can also occur. As the groundwater discharge increases in experiments with the same slope, the equilibrium time needed to achieve landslide equilibrium gets shorter and the durations of landslides also decrease. As the slope in experiments with the same level of groundwater discharge increases, the equilibrium time required to achieve landslide equilibrium gets shorter, the landsliding area in a specific time period gets larger and the total landsliding area also decreases.由地下水誘發自由端邊坡滑動現象，崩塌型態屬於後退型崩塌。主要誘發因子為滲透水分造成下層土壤流動化及地下水輸入管鄰近區域因土壤土體底層水分飽和度超過29%而產生土壤下陷現象。在相同坡度的邊坡滑動實驗中，地下水量越增加，達到邊坡滑動平衡的時間越短且發生滑動次數越少；而在相同輸入地下水量的邊坡滑動實驗中，坡度越增加則達邊坡滑動平衡時間越短、有越高比例的滑動面積集中在特定時段，且總滑動面積也會因此減少

Tempcore Process Simulator to Analyze Microstructural Evolution of Quenched and Tempered Rebar

Featured Application Proposed process simulator can be widely applied to parameter design of industrial Tempcore process with reduced cost and time. Abstract Tempcore process simulator (TPS) has been developed in this study to analyze the microstructural evolution of quenched and tempered rebar. There has been an increasing need to relate the complex microstructures to the resulting properties of quenched and tempered rebar. However, information on such relationships typically requires precise thermal histories imposed on the workpiece. Therefore, TPS, capable of simulating the Tempcore process, has been developed to produce high-fidelity data. TPS mainly consists of a vacuum induction furnace, pilot rolling mill, box furnace, and cooling unit to simulate shop floor operations. A series of experimental tests were successfully carried out with various parameters, such as reheating temperature, water flow, water pressure, and cooling time. The effects of chemical compositions and cooling time on the microstructural evolution and mechanical properties of quenched and tempered rebar have been analyzed to validate the performance of TPS. The results show that TPS can simulate the Tempcore process with a high degree of fidelity and reliability.11Ysciescopu