A report of acute atrial fibrillation induced by misapplication of epinephrine

AbstractUrticaria is a systemic allergic reaction leading to wheal formation with skin itching. Occasionally we come across some intractable cases, in which we may administrate epinephrine infusion besides steroid and anti-histamine. A 19 year-old man suffered from intractable urticaria for 2 days, although anti-histamine and steroids were used. Titration of adrenaline was considered in the treatment of intractable urticaria. He was administrated 1 mg epinephrine intravenous bolus due to mis-dilution by the nurse. Transient atrial fibrillation with cardiac ischemia occurred. After 12.5 mg labetalol i.v., and 11-hour observation in the emergency room, he gradually recovered to normal sinus rhythm without ST-T change. In the past, ventricular tachycardia, hypertension, chest pain, pulmonary edema, the need to intubate, renal failure requiring renal transplant, coronary artery spasm, myocardial ischemia/infarction and hypokalemia have been reported after mis-diluted or excessive doses of epinephrine in treating anaphylaxis. To our knowledge, our case is the first worldwide to describe transient atrial fibrillation after epinephrine overdose, and the patient was successfully resuscitated by 12.5 mg labetalol. It is important to know how to rescue accidental epinephrine intravenous injection patients

Using Large Institutional or National Databases to Evaluate Prostate Cancer Outcomes and Patterns of Care: Possibilities and Limitations

Prostate cancer is the most common non–skin-related cancer in men. With advances in technology, the care and treatment for men with this disease continues to become more complex. Large databases offer researchers a unique opportunity to conduct prostate cancer research in various areas, and provide important information that helps patients and providers determine prognosis after treatment. Furthermore, the studies using these databases may provide information on how side effects from various treatments can affect one's quality of life. Finally, information from these datasets can help to identify factors that determine why patients receive the treatments they do. Despite this, these databases are not without limitations. In this review, we discuss various available, national, multicenter, and institutional databases in the context of prostate cancer research, citing numerous important studies that have impacted on our understanding of prostate cancer outcomes

Microfabrication of Microchannels for Fuel Cell Plates

Portable electronic devices such as notebook computers, PDAs, cellular phones, etc., are being widely used, and they increasingly need cheap, efficient, and lightweight power sources. Fuel cells have been proposed as possible power sources to address issues that involve energy production and the environment. In particular, a small type of fuel-cell system is known to be suitable for portable electronic devices. The development of micro fuel cell systems can be achieved by the application of microchannel technology. In this study, the conventional method of chemical etching and the mechanical machining method of micro end milling were used for the microfabrication of microchannel for fuel cell separators. The two methods were compared in terms of their performance in the fabrication with regards to dimensional errors, flatness, straightness, and surface roughness. Following microchannel fabrication, the powder blasting technique is introduced to improve the coating performance of the catalyst on the surface of the microchannel. Experimental results show that end milling can remarkably increase the fabrication performance and that surface treatment by powder blasting can improve the performance of catalyst coating

Energetics and energy scaling of quasi-monoenergetic protons in laser radiation pressure acceleration

Theoretical and computational studies of the ion energy scaling of the radiation pressure acceleration of an ultra-thin foil by short pulse intense laser irradiation are presented. To obtain a quasi-monoenergetic ion beam with an energy spread of less than 20%, two-dimensional particle-in-cell simulations show that the maximum energy of the quasi-monoenergetic ion beam is limited by self-induced transparency at the density minima caused by the Rayleigh-Taylor instability. For foils of optimal thickness, the time over which Rayleigh-Taylor instability fully develops and transparency occurs is almost independent of the laser amplitude. With a laser power of about one petawatt, quasi-monogenetic protons with 200 MeV and carbon ions with 100 MeV per nucleon can be obtained, suitable for particle therapy applications

Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review

BACKGROUND: During their reproductive years about 10% of women experience some kind of symptoms before menstruation (PMS) in a degree that affects their quality of life (QOL). Acupuncture and herbal medicine has been a recent favorable therapeutic approach. Thus we aimed to review the effects of acupuncture and herbal medicine in the past decade as a preceding research in order to further investigate the most effective Korean Medicine treatment for PMS/PMDD. METHODS: A systematic literature search was conducted using electronic databases on studies published between 2002 and 2012. Our review included randomized controlled clinical trials (RCTs) of acupuncture and herbal medicine for PMS/PMDD. Interventions include acupuncture or herbal medicine. Clinical information including statistical tests was extracted from the articles and summarized in tabular form or in the text. Study outcomes were presented as the rate of improvement (%) and/or end-of-treatment scores. RESULTS: The search yielded 19 studies. In screening the RCTs, 8 studies in acupuncture and 11 studies in herbal medicine that matched the criteria were identified. Different acupuncture techniques including traditional acupuncture, hand acupuncture and moxibustion, and traditional acupuncture technique with auricular points, have been selected for analysis. In herbal medicine, studies on Vitex Agnus castus, Hypericum perforatum, Xiao yao san, Elsholtzia splendens, Cirsium japonicum, and Gingko biloba L. were identified. Experimental groups with Acupuncture and herbal medicine treatment (all herbal medicine except Cirsium japonicum) had significantly improved results regarding PMS/PMDD. CONCLUSIONS: Limited evidence supports the efficacy of alternative medicinal interventions such as acupuncture and herbal medicine in controlling premenstrual syndrome and premenstrual dysphoric disorder. Acupuncture and herbal medicine treatments for premenstrual syndrome and premenstrual dysphoric disorder showed a 50% or better reduction of symptoms compared to the initial state. In both acupuncture and herbal medical interventions, there have been no serious adverse events reported, proving the safety of the interventions while most of the interventions provided over 50% relief of symptoms associated with PMS/PMDD. Stricter diagnostic criteria may have excluded many participants from some studies. Also, depending on the severity of symptoms, the rate of improvement in the outcomes of the studies may have greatly differed

Generation of quasi-monoenergetic protons from thin multi-ion foils by a combination of laser radiation pressure acceleration and shielded Coulomb repulsion

We study theoretically and numerically the acceleration of protons by a combination of laser radiation pressure acceleration and Coulomb repulsion of carbon ions in a multi-ion thin foil made of carbon and hydrogen. The carbon layer helps to delay the proton layer from disruption due to the Rayleigh–Taylor instability, to maintain the quasi-monoenergetic proton layer and to accelerate it by the electron-shielded Coulomb repulsion for much longer duration than the acceleration time using single-ion hydrogen foils. Particle-in-cell simulations with a normalized peak laser amplitude of a_0 = 5 show a resulting quasi-monoenergetic proton energy of about 70 MeV with the foil made of 90% carbon and 10% hydrogen, in contrast to 10 MeV using a single-ion hydrogen foil. An analytical model is presented to explain quantitatively the proton energy evolution; this model is in agreement with the simulation results. The energy dependence of the quasi-monoenergetic proton beam on the concentration of carbon and hydrogen is also studied

Generalized Guidance Scheme for Low-Thrust Orbit Transfer

The authors present an orbital guidance scheme for the satellite with an electrical propulsion system using a Lyapunov feedback control. The construction of a Lyapunov candidate is based on orbital elements, which consist of angular momentum and eccentricity vectors. This approach performs orbit transfers between any two arbitrary elliptic or circular orbits without any singularity issues. These orbital elements uniquely describe a non degenerate Keplerian orbit. The authors improve the reliability of the existing Lyapunov orbital guidance scheme by considering the energy term. Additional improvement is achieved by adding the penalty function. Furthermore, it is shown that the final suggested approach is suitable for the satellite passing the earth’s shadow area