Successful treatment of methemoglobinemia in an elderly couple with severe cyanosis: two case reports

INTRODUCTION: Methemoglobinemia should be considered in all cyanotic patients who remain unresponsive to oxygen therapy. Rapid diagnosis is very important in emergency cases. Here, we present the cases of two patients, a married couple, admitted to our hospital with methemoglobinemia after exposure to sodium nitrite. CASE PRESENTATION: Two patients, a married couple, presented with methemoglobinemia. The 72-year-old Taiwanese man and 68-year-old Taiwanese woman were referred to our hospital with dizziness and tachypnea. On examination, their mucous membranes were cyanotic, and their blood samples showed the classic ‘chocolate brown’ appearance. The man also reported having experienced twitching of his right arm for a few minutes before arrival at the hospital. The symptoms of both patients failed to improve in response to supplemental oxygen delivered via oxygen masks, although the arterial blood gas data of these patients were normal and their pulse oximetry showed oxyhemoglobin levels of approximately 85%. A carbon monoxide-oximeter showed that the man’s methemoglobin concentration was 48.3%, and the woman’s was 36.4%. Methylene blue (100mg) was administered intravenously to both patients, and their symptoms improved dramatically. They were admitted to the intensive care unit and discharged three days later, without neurological sequelae. CONCLUSION: Severe methemoglobinemia is a life-threatening condition and, if untreated, may result in death. Early diagnosis and appropriate antidotal treatment are crucial in treating this emergency situation

Understanding the Mechanism of Deep Learning Frameworks in Lesion Detection for Pathological Images with Breast Cancer

With the advances of scanning sensors and deep learning algorithms, computational pathology has drawn much attention in recent years and started to play an important role in the clinical workflow. Computer-aided detection (CADe) systems have been developed to assist pathologists in slide assessment, increasing diagnosis efficiency and reducing misdetections. In this study, we conducted four experiments to demonstrate that the features learned by deep learning models are interpretable from a pathological perspective. In addition, classifiers such as the support vector machine (SVM) and random forests (RF) were used in experiments to replace the fully connected layers and decompose the end-to-end framework, verifying the validity of feature extraction in the convolutional layers. The experimental results reveal that the features learned from the convolutional layers work as morphological descriptors for specific cells or tissues, in agreement with the diagnostic rules in practice. Most of the properties learned by the deep learning models summarized detection rules that agree with those of experienced pathologists. The interpretability of deep features from a clinical viewpoint not only enhances the reliability of AI systems, enabling them to gain acceptance from medical experts, but also facilitates the development of deep learning frameworks for different tasks in pathological analytics

Arterial blood and end-tidal concentrations of sevoflurane during the emergence from anesthesia in gynecologic patients

OBJECTIVE: The end-tidal concentration of inhalation anesthetics is a clinical indicator for predicting the emergence from anesthesia. This study was conducted to assess the relationship between arterial blood and end-tidal sevoflurane concentrations during emergence. METHODS: Thirty-two female American Society of Anesthesiologists physical status I-II patients receiving general anesthesia for elective gynecologic surgery were included. A fixed dose of 3.5% inspiratory sevoflurane in 6 L min-1 oxygen was maintained until the end of surgery. At 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuing sevoflurane, as well as at the time of eye opening by verbal command, defined as awakening, 1 ml arterial blood was obtained to measure its sevoflurane concentration by gas chromatography. Simultaneous inspiratory and end-tidal concentrations of sevoflurane were detected by an infrared analyzer and tested by Bland-Altman agreement analysis. RESULTS: The arterial blood concentrations of sevoflurane were similar to the simultaneous end-tidal concentrations during emergence: 0.36% (0.10) and 0.36% (0.08) sevoflurane at awakening, respectively. The mean time from discontinuing sevoflurane to eye opening was 15.8 minutes (SD 2.9, range 10-26) and was significantly correlated with the duration of anesthesia (52-192 minutes) (P = 0.006) but not with the body mass index or total fentanyl dose. CONCLUSION: The mean awakening arterial blood concentration of sevoflurane was 0.36%. The time to awakening was prolonged in accordance with the anesthetic duration within 3 hours. With well-assisted ventilation during emergence, the sevoflurane end-tidal concentration was nearly equal to its arterial blood concentration, which could be a feasible predictor for awakening

Duration effect of desflurane anesthesia and its awakening time and arterial concentration in gynecologic patients

OBJECTIVES: To determine the awakening arterial blood concentration of desflurane and its relationship with the end-tidal concentration during emergence from various durations of general anesthesia. METHOD: In total, 42 American Society of Anesthesiologists physical status class I-II female patients undergoing elective gynecologic surgery were enrolled. General anesthesia was maintained with fixed 6% inspiratory desflurane in 6 l min-1 oxygen until shutoff of the vaporizer at the end of surgery. One milliliter of arterial blood was obtained for desflurane concentration determination by gas chromatography at 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after the discontinuation of desflurane and at the time of eye opening upon verbal command, defined as awakening. Concentrations of inspiratory and end-tidal desflurane were simultaneously detected by an infrared analyzer. RESULTS: The mean arterial blood concentration of desflurane was 1.20% at awakening, which correlated with the awakening end-tidal concentration of 0.96%. The mean time from the discontinuation of desflurane to eye opening was 5.2 minutes (SD = 1.6, range 3-10), which was not associated with the duration of anesthesia (60-256 minutes), total fentanyl dose, or body mass index (BMI). CONCLUSIONS: The mean awakening arterial blood concentration of desflurane was 1.20%. The time to awakening was independent of anesthetic duration within four hours. Using well-assisted ventilation, the end-tidal concentration of desflurane was proven to represent the arterial blood concentration during elimination and could be a clinically feasible predictor of emergence from general anesthesia

Near-Infrared H2 and Continuum Survey of Extended Green Objects

The Spitzer GLIMPSE survey has revealed a number of "Extended Green Objects" (EGOs) which display extended emission at 4.5 micron. These EGOs are potential candidates for high mass protostellar outflows. We have used high resolution (< 1") H2 1-0 S(1) line, K, and H-band images from the United Kingdom Infrared Telescope to study 34 EGOs to investigate their nature. We found that 12 EGOs exhibit H2 outflows (two with chains of H2 knotty structures; five with extended H2 bipolar structures; three with extended H2 lobes; two with pairs of H2 knots). In the 12 EGOs with H2 outflows, three of them exhibit similar morphologies between the 4.5 micron and H2 emission. However, the remaining 9 EGOs show that the H2 features are more extended than the continuum features, and the H2 emission is seldom associated with continuum emission. Furthermore, the morphologies of the near-infrared continuum and 4.5 micron emission are similar to each other for those EGOs with K-band emission, implying that at least a part of the IRAC-band continuum emission of EGOs comes from scattered light from the embedded YSOs.Comment: accepted for publication in ApJ

The effect of exercise on the risk of metabolic syndrome associated with sleep insufficiency: a cross-sectional study

IntroductionSleep disturbance and insufficient sleep have been linked to metabolic syndrome, increasing cardiovascular disease and mortality risk. However, few studies investigate the joint effect of sleep and exercise on metabolic syndrome. We hypothesized that regular exercise can mitigate the exacerbation of metabolic syndrome by sleep insufficiency.ObjectiveThe aim of this study was to investigate whether exercise can attenuate or eliminate the relationship between sleep insufficiency and metabolic syndrome.MethodA total of 6,289 adults (mean age = 33.96 years; women: 74.81%) were included in the study, a cross-sectional study conducted based on the results of employee health screening questionnaires and databases from a large healthcare system in central Taiwan. Participants reported sleep insufficiency or not. Self-reported exercise habits were classified into 3 levels: no exercise, exercise &lt;150 min/week, and exercise ≧150 min/week. Multiple logistic regression and sensitivity analyses were conducted to understand the joint associations of sleep patterns and exercise with metabolic syndrome with exposure variables combining sleep duration/disturbances and PA.ResultsCompared with the reference group (sufficient sleep), individuals with sleep insufficiency had a higher risk for metabolic syndrome [adjusted odds ratio (AOR) = 1.40, 95% confidence interval (95% CI): 1.01–1.94, p &lt; 0.05] in females aged 40–64 years, but not in other populations. Sleep insufficiency was not associated with the risk of metabolic syndrome among individuals achieving an exercise level of &lt;150 min/week, and in particular among those achieving ≧150 min/week in all populations in our study.ConclusionSleep insufficiency was related to a higher risk of metabolic syndrome in female healthcare staff aged 40–64 years. Being physically active with exercise habits in these individuals, the risk of metabolic syndrome was no longer significant

Near-infrared H2 and continuum survey of extended green objects. II. Complete census for the northern Galactic plane

We discuss 94 Extended Green Objects (EGOs) in the northern Galactic plane cataloged by Cyganowski et al., based on near-infrared narrow H2 (2.122 μm) and continuum observations from the United Kingdom Infrared Telescope. This data set is three times larger than the one in our previous study and is unbiased by preselection. As discussed in the previous paper, the morphologies of the 4.5 μm emission generally resemble those of the near-infrared continuum, but are different from those of the H2 emission. Of our sample, only 28% of EGOs with H2 emission show similar morphologies between 4.5 μm and H2 emission. These results suggest that the 4.5 μm emission mainly comes from scattered continuum from the embedded young stellar objects, and partially from H2 emission. About half of EGOs are associated with H2 outflows, if the H 2 outflow incompleteness is considered. The H2 outflow detection rate for EGOs with K-band detections (61%) is significantly higher than for those without K-band detections (36%). This difference may be due to the fact that both H2 and K-band emissions are associated with outflows, i.e., H2 emission and K-band continuum are associated with shocks and outflow cavities, respectively. We also compared the correlation between the H2 outflows and Class I 44 GHz methanol masers from the literature. The methanol masers can be located upstream or downstream of the H2 outflows and some bright H2 spots or outflows are not associated with methanol masers, suggesting that methanol masers and H 2 emission trace different excitation conditions. © 2013. The American Astronomical Society. All rights reserved.

Application of social vulnerability indicators to climate change for the southwest coastal areas of Taiwan

The impact of climate change on the coastal zones of Taiwan not only affects the marine environment, ecology, and human communities whose economies rely heavily on marine activities, but also the sustainable development of national economics. The southwest coast is known as the area most vulnerable to climate change; therefore, this study aims to develop indicators to assess social vulnerability in this area of Taiwan using the three dimensions of susceptibility, resistance, and resilience. The modified Delphi method was used to develop nine criteria and 26 indexes in the evaluation, and the analytic hierarchy process method was employed to evaluate the weight of each indicator based on the perspectives of experts collected through questionnaire surveys. The results provide important information pertaining to the vulnerability of the most susceptive regions, the lowest-resistance areas, and the least resilient townships on the southwest coast. The most socially vulnerable areas are plotted based on the present analysis. Experts can consider the vulnerability map provided here when developing adaptation policies. It should be kept in mind that improving the capacities of resistance and resilience is more important than reducing susceptibility in Taiwan

The LEGUE Input Catalogue for Dark Night Observing in the LAMOST Pilot Survey

We outline the design of the dark nights portion of the LAMOST Pilot Survey, which began observations in October 2011. In particular, we focus on Milky Way stellar candidates that are targeted for the LEGUE (LAMOST Experiment for Galactic Understanding and Exploration) survey. We discuss the regions of sky in which spectroscopic candidates were selected, and the motivations for selecting each of these sky areas. Some limitations due to the unique design of the telescope are discussed, including the requirement that a bright (V < 8) star be placed at the center of each plate for wavefront sensing and active optics corrections. The target selection categories and scientific goals motivating them are briefly discussed, followed by a detailed overview of how these selection functions were realized. We illustrate the difference between the overall input catalog - Sloan Digital Sky Survey (SDSS) photometry - and the final targets selected for LAMOST observation.Comment: 11 pages, 7 figures, accepted for publication in RA

Using the computer-based feedback (CBF) system to investigate the juniorphysicians’s and clinical-instructors perceptions for the benefits of general medicine clinical-instructors training program

Background: The purpose of this study is to examine the clinical-instructors and junior-physicians (residents and interns) perceptions for the general-medicine training program by using bi-directional interactive and self-assessments computer-based feedback (CBF) and paper-based multisource feedback assessment (PBMFA) systems for the efficiency and benefit evaluation.Methods: Between 2011 January to 2013 December, junior-physicians and their clinical-instructors in the same medical team were enrolled consecutively for monitoring the CBF scores gave by each other after each clinical course. A total of 321 residents, 298 interns and 110 clinical-instructors who participated in the core competency general-medicine training program in 6-months period were included in the study. The CBF and PBMFA evaluations are undergone paralleled to gather the suggested information in different levels of Kirkpatrick evolutional theory.Results: The results showed that lecturers, being 5-10 years as attending physicians, internal medicine sub-specialty clinical-instructors are most benefit from the general medicine training program. Accordingly, the CBF scores of junior-physicians was positively correlated with the times (&gt; 3-times) of exposure to the medical teams that leaded by qualified clinical-instructors. Both clinical-instructors and junior-physicians have positive attitude to the value of the general-medicine training program. Interestingly, a good consistency was existed between residents CBF scores and PBMFA grades for their core-competency performance. Comparatively, the overall perception of clinical-instructors and junior-physicians for the general-medicine training was very positive.Conclusions: Clinical-instructors and junior-physicians had positive perception of CBF and PBMFA systems which could give us different information to improve and strength the further core-competency general-medicine training program by appropriate utilization