Insulin Facilitates the Recovery of Myocardial Contractility and Conduction during Cardiac Compression in Rabbits with Bupivacaine-Induced Cardiovascular Collapse

Bupivacaine inhibits cardiac conduction and contractility. Insulin enhances cardiac repolarization and myocardial contractility. We hypothesizes that insulin therapy would be effective in resuscitating bupivacaine-induced cardiac toxicity in rabbits. Twelve rabbits were tracheally intubated and midline sternotomy was performed under general anesthesia. Cardiovascular collapse (CVC) was induced by an IV bolus injection of bupivacaine 10 mg/kg. The rabbits were treated with either saline (control) or insulin injection, administered as a 2 U/kg bolus. Internal cardiac massage was performed until the return of spontaneous circulation (ROSC) and the time to the return of sinus rhythm (ROSR) was also noted in both groups. Arterial blood pressure, and electrocardiography were continuously monitored for 30 min and plasma bupivacaine concentrations at every 5 min. The ROSC, ROSR and normalization of QRS duration were attained faster in the insulin-treated group than in the control group. At the ROSC, there was a significant difference in bupivacaine concentration between two groups. Insulin facilitates the return of myocardial contractility and conduction from bupivacaine-induced CVC in rabbits. However, recovery of cardiac conduction is dependent mainly on the change of plasma bupivacaine concentrations

Development and Validation of an Arterial Pressure-Based Cardiac Output Algorithm Using a Convolutional Neural Network: Retrospective Study Based on Prospective Registry Data

Background: Arterial pressure-based cardiac output (APCO) is a less invasive method for estimating cardiac output without concerns about complications from the pulmonary artery catheter (PAC). However, inaccuracies of currently available APCO devices have been reported. Improvements to the algorithm by researchers are impossible, as only a subset of the algorithm has been released. Objective: In this study, an open-source algorithm was developed and validated using a convolutional neural network and a transfer learning technique. Methods: A retrospective study was performed using data from a prospective cohort registry of intraoperative bio-signal data from a university hospital. The convolutional neural network model was trained using the arterial pressure waveform as input and the stroke volume (SV) value as the output. The model parameters were pretrained using the SV values from a commercial APCO device (Vigileo or EV1000 with the FloTrac algorithm) and adjusted with a transfer learning technique using SV values from the PAC. The performance of the model was evaluated using absolute error for the PAC on the testing dataset from separate periods. Finally, we compared the performance of the deep learning model and the FloTrac with the SV values from the PAC. Results: A total of 2057 surgical cases (1958 training and 99 testing cases) were used in the registry. In the deep learning model, the absolute errors of SV were 14.5 (SD 13.4) mL (10.2 [SD 8.4] mL in cardiac surgery and 17.4 [SD 15.3] mL in liver transplantation). Compared with FloTrac, the absolute errors of the deep learning model were significantly smaller (16.5 [SD 15.4] and 18.3 [SD 15.1], P<.001). Conclusions: The deep learning-based APCO algorithm showed better performance than the commercial APCO device. Further improvement of the algorithm developed in this study may be helpful for estimating cardiac output accurately in clinical practice and optimizing high-risk patient care. © Hyun-Lim Yang, Chul-Woo Jung, Seong Mi Yang, Min-Soo Kim, Sungho Shim, Kook Hyun Lee, Hyung-Chul Lee. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 16.08.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on https://medinform.jmir.org/, as well as this copyright and license information must be included.1

Determinants of gastric cancer screening attendance in Korea: a multi-level analysis

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Abstract Background We aimed to assess individual and area-level determinants of gastric cancer screening participation. Method Data on gastric cancer screening and individual-level characteristics were obtained from the 2007–2009 Fourth Korea National Health and Nutrition Examination Survey. The area-level variables were collected from the 2005 National Population Census, 2008 Korea Medical Association, and 2010 National Health Insurance Corporation. The data were analyzed using multilevel logistic regression models. Results The estimated participation rate in gastric cancer screening adhered to the Korea National Cancer Screening Program guidelines was 44.0% among 10,658 individuals aged over 40 years who were included in the analysis. Among the individual-level variables, the highest income quartile, a college or higher education level, living with spouse, having a private health insurance, limited general activity, previous history of gastric or duodenal ulcer, and not currently smoking were associated with a higher participation rate in gastric cancer screening. Urbanization showed a significant negative association with gastric cancer screening attendance among the area-level factors (odds ratio (OR) = 0.73; 95% confidence interval (CI) = 0.57-0.93 for the most urbanized quartile vs. least urbanized quartile). Conclusion There are differences in gastric cancer screening attendance according to both individual and regional area characteristics

PDMS shielding 을 이용한 크랙 기반 습도 제어 및 신축성 인장 센서 개발

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AN IN-VITRO WEAR STUDY OF DENTAL PORCELAINS AND HUMAN ENAMEL

Dental porcelain is one of the materials of choice for restoration where esthetics is of concern, but has a considerable potentials of wear. The wear of enamel is variable when opposed by different porcelain systems and surface conditions, and the exposed dentine and opaque porcelain due to clinical failure is expected to have high potentials of wear. The purpose of this study was to investigate the wear effects of self-glazed, polished incisal porcelain. polished dentine and opaque porcelain against human enamel in the laboratory by use of a pin-on-disk type wear tester. 4 types of dental porcelain(, Ceramco-II, Vintage powder of In-Ceram system) and type IV gold alloy as cotrol group were used for test specimens. Intact buccal cusps of maxillary premolar were used for enamel specimens, and the cusp converged to a point and was devoid of visible abrasion, caries, decalcification. The upper part was the cusp of a maxillary premolar and the lower part was a porcelain specimen. The enamel wear was deter-mined by weighing the cusp before and after each test. Surface profilometer was used to quantitate wear of the porcelain specimens. Vicker's hardness tester was used to evaluate the surface hardness of test specimens. The SEM was used to evaluate the wear surfaces. The results were as follows : 1 Self-glazed porcelain produced more enamel wear than polished porcelain, especially the enamel wear of self-glazed porcelain was 3.2 times more than that of other groups. 2. Opaque porcelain produced least porcelain wear, self-glazed porcelain produce greatest porcelain wear, but there was no statistically significant difference between the groups(p>0.05). 3. The enamel wear of dentine porcelain was 3.8 times more than that of polished inisal porcelain(p0.05) 4. Overglazed porcelain produced less enamel wear than self-glazed porcelain, and more enamel wear than polished porcelain, but there was no statistically significant difference between the groups(P>0.05). 5. The hardness number of dentine and Ceramco-II opaque porcelain was larger, but that of Vintage dentine and self-glazed porcelain was similar to other groups. 6. Examination of SEM photographs revealed that overglazed porcelain had smoother surface than self-glazed porcelain, and self-glazed porcelain had smoother surface than polished porcelain. Much polishing scratches and larger porosities were observed on the opaque porcelain specimen, and much polishing scratchess and small porosities were observed on the dentine porcelain specimen

A retrospective analysis of incidence and its associated risk factors of upper urinary tract recurrence following radical cystectomy for bladder cancer with transitional cell carcinoma: the significance of local pelvic recurrence and positive lymph node.

OBJECTIVE: The aim of this study is to examine the incidence and risk factors of upper urinary tract recurrence (UUTR) following radical cystectomy (RC) in bladder cancer and to evaluate its relationship with neobladder (Neo) or ileal conduit (IC). MATERIALS AND METHODS: All clinicopathologic parameters and perioperative parameters of 311 patients who underwent RC with either Neo or IC by a single surgeon from 1999 to 2012 were retrospectively included in this study. Patients with a history of renal surgery, concomitant UUTR, or a histopathology of non-transitional cell carcinoma were excluded. For statistical analyses of predictive risk factors of UUTR, a multivariate analysis was performed with known risk factors of UUTR, including type of urinary diversion with significance defined as P < 0.05. RESULTS: During the median follow-up period of 53 months, 143 (46.0%) IC and 168 (54.0%) Neo were performed, resulting in 11 (3.5%) cases of UUTR (Neo 7 and IC 4) after RC and all patients then underwent nephroureterectomy. No significant differences in incidence and overall survival in UUTR were observed according different types of urinary diversion (p = 483), and the prognosis for survival of Neo was insignificantly better than that of IC (5-year overall survival 78% vs 74%, respectively, p>0.05). Higher number of positive lymph nodes (HR 9.03) and the presence of pelvic local recurrence (HR 7286.08) were significant predictive factors of UUTR (p<0.05). CONCLUSION: This study reports a UUTR rate of 3.5%, and positive lymph nodes and presence of local recurrence at the pelvis as important risk factors. No significant differences in incidence and survival were observed between Neo and IC