Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: A multi-institutional observational study

PURPOSE: We aimed to examine the association between contrast extravasation (CE) on initial computed tomography (CT) scan and pseudoaneurysm (PSA) development in pediatric blunt splenic and/or liver injury. METHODS: We conducted a multi-institutional retrospective study in cases of blunt splenic and/or hepatic injury who underwent an initial attempt of nonoperative management. A logistic regression model was used to compare PSA formation and CE on initial CT scan, and the area under the receiver operating characteristic curve (AUC) with and without CE was used to assess the predictive performance of CE for PSA formation. RESULTS: Of 236 cases enrolled from 10 institutions, PSA formation was observed in 17 (7.2%). Multivariate analysis showed a significant association between CE on initial CT scan and increased incidence of PSA formation (odds ratio, 4.96; 95% confidence interval, 1.37-18.0). There was no statistically significant association between the grade of injury and PSA formation. The AUC improved from 0.75 (0.64-0.87) to 0.80 (0.70-0.91) with CE. CONCLUSION: Active CE on initial CT scan was an independent predictor of PSA formation. Selective use of follow-up CT in children who showed CE on initial CT may provide early identification of PSA formation, regardless of injury grade. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Measurement of Residual ^<60>Co Activity Induced by Atomic-bomb Neutrons in Nagasaki and Background Contribution by Environmental Neutrons

Residual ^Co activity in five steel samples induced by neutrons from the Nagasaki atomic bomb has been measured within about 1000 m from the hypocenter. The chemical separation of cobalt and nickel from steel samples was performed, and cobalt-enriched samples were prepared for all samples. Gamma-ray measurements were carried out with a low-background well-type germanium detector. The gamma-ray spectra for five samples were compared with the spectrum of a control sample to ensure that the observed ^Co was actually induced by A-bomb neutrons. The activation of cobalt by environmental neutrons was also investigated. It has been shown that the present ^Co data are consistent with earlier Hashizume\u27s data

Measurement of Residual ^<60>Co Activity Induced by Atomic-bomb Neutrons in Nagasaki and Background Contribution by Environmental Neutrons

Residual ^Co activity in five steel samples induced by neutrons from the Nagasaki atomic bomb has been measured within about 1000 m from the hypocenter. The chemical separation of cobalt and nickel from steel samples was performed, and cobalt-enriched samples were prepared for all samples. Gamma-ray measurements were carried out with a low-background well-type germanium detector. The gamma-ray spectra for five samples were compared with the spectrum of a control sample to ensure that the observed ^Co was actually induced by A-bomb neutrons. The activation of cobalt by environmental neutrons was also investigated. It has been shown that the present ^Co data are consistent with earlier Hashizume's data

Performance of prototype Dual Gain Multilayer Thick GEM with high-intensity heavy-ion beam injections in low-pressure hydrogen gas

A prototype Dual Gain Multilayer Thick Gas Electron Multilyer (DG-M-THGEM) with an active area of 10 cm $\times$ 10 cm was manufactured aiming at the production of a large-volume active-target time projection chamber which can work under the condition of high-intensity heavy-ion beam injections. The DG-M-THGEM has a alternating structure of electrodes and insulators. Effective gas gains of two regions, which are called beam and recoil regions, are separately controlled. Performance of the prototype DG-M-THGEM in hydrogen gas at a pressure of 40 kPa was evaluated. Irradiating a $^{132}$Xe beam, an effective gas gain lower than 100 with a charge resolution of 3% was achieved in the beam region while the effective gas gain of 2000 was maintained in the recoil region. Position distributions of measured charges along the beam axis were investigated in order to evaluate gain uniformity in the high intensity beam injection. The gain shift was estimated by simulations considering space charges in the drift region. The gain shift was suppressed within 3% even at the beam intensity of 2.5 $\times$ 10$^{6}$ particles per second.Comment: 19 pages, 14 figures, 3 table