Evaluation of a Diagnostic and Management Algorithm for Adult Caustic Ingestion: New Concept of Severity Stratification and Patient Categorization

Background: Caustic ingestion has gained increasing attention worldwide. However, the insight into whether to use esophagogastroduodenoscopy (EGD) or computed tomography (CT) for first-line investigation remains controversial. This study aimed to evaluate a diagnostic and management algorithm that combines EGD and CT for rapid triage. Methods: We established an algorithm for our hospital in 2013, aiming to maximize the benefits and minimize the limitations of EGD and CT. Then, we retrospectively analyzed the 163 enrolled patients treated between 2014 and 2019 and categorized them into 4 groups: A = 3 (1.8%): with perforation signs and directly confirmed by CT, B = 10 (6.1%): clinically suspected perforation but not initially proven by CT, C = 91 (55.8%): initial perforation less favored but with EGD grade ≥ 2b or GI/systemic complications, and D = 59 (36.2%): clinically stable with EGD grade ≤ 2a, according to initial signs/symptoms and EGD/CT grading. The morbidity and mortality of each group were analyzed. The predictive values of EGD and CT were examined by logistic regression analyses and receiver operating characteristic (ROC) curves. Results: The outcomes of such algorithm were reported. CT was imperative for patients with toxic signs and suspected perforation. For non-emergent operations, additional EGD was safe and helpful in identifying surgical necessity. For patients with an initially low perforation risk, EGD alone sufficiently determined admission necessity. Among inpatients, EGD provided excellent discrimination for predicting the risk for signs/symptoms’ deterioration. Routine additional CT was only beneficial for those with deteriorating signs/symptoms. Conclusions: According to the analyses, initial signs/symptoms help to choose EGD or CT as the first-line investigative tool in caustic patients. CT is necessary for seriously injured patients, but it cannot replace EGD for moderate/mild injuries. The severity stratification and patient categorization help to simplify complex scenarios, accelerate decision-making, and prevent unnecessary intervention/therapy. External validation in a larger sample size is further indicated for this algorithm

Glucose-Dependent Insulinotropic Polypeptide Mitigates 6-OHDA-Induced Behavioral Impairments in Parkinsonian Rats

In the present study, the effectiveness of glucose-dependent insulinotropic polypeptide (GIP) was evaluated by behavioral tests in 6-hydroxydopamine (6-OHDA) hemi-parkinsonian (PD) rats. Pharmacokinetic measurements of GIP were carried out at the same dose studied behaviorally, as well as at a lower dose used previously. GIP was delivered by subcutaneous administration (s.c.) using implanted ALZET micro-osmotic pumps. After two days of pre-treatment, male Sprague Dawley rats received a single unilateral injection of 6-OHDA into the medial forebrain bundle (MFB). The neuroprotective effects of GIP were evaluated by apomorphine-induced contralateral rotations, as well as by locomotor and anxiety-like behaviors in open-field tests. Concentrations of human active and total GIP were measured in plasma during a five-day treatment period by ELISA and were found to be within a clinically translatable range. GIP pretreatment reduced behavioral abnormalities induced by the unilateral nigrostriatal dopamine (DA) lesion produced by 6-OHDA, and thus may be a novel target for PD therapeutic development

Effect of prior antiplatelet therapy on major adverse cardiac events in patients diagnosed with infective endocarditis: Population-based retrospective cohort study

Background: Infective endocarditis (IE) occurs with an incidence of about 3–10 per 100,000 person-years globally. Those with infective endocarditis complicated embolic events have worse outcomes. However, whether antiplatelet therapy could prevent the development of ischemic stroke and myocardial infarction remained unknown. Materials and Methods: We conducted a retrospective cohort study using Taiwan National Health Insurance Research Database to access the effect of prior antiplatelet therapy on major adverse cardiac events in patients diagnosed with infective endocarditis. Results: The clinical characteristics and the risk of subsequent major adverse cardiac events in 901 patients with infective endocarditis with prior antiplatelet therapy and a matched cohort without antiplatelet therapy were retrospectively analyzed. The majority (63%) of the patients with prior antiplatelet therapy were male and 568 (57.7%) had a high (≥3) Charlson Cormorbidity Index score. There was no significant difference in the risk of myocardial infarction, ischemic stroke, and major bleeding between the two groups. The tests of interaction showed the risk of myocardial infarction was contingent on heart failure. Conclusions: Prior antiplatelet therapy did not prevent the cerebral and myocardial infarction in those with infective endocarditis. Neither did them increase the risk of major bleeding in patients with infective endocarditis

Square Column Structure of High Efficiency, Reliable, Uniformly Flexible LED Devices

This study demonstrates that flexible white LEDs, doped with diffusion particles and with a square column structure, have excellent luminosity, uniformity, and bending reliability. This large area (5 cm × 5 cm) square column flexible device had a smaller thickness (2 mm), and enhancements in both luminous efficiency (29.5%) and uniformity (44.6%) compared to the characteristics of the 6 mm reference sample. Optimization of the reflective layer coating for the square column, flexible white LED was achieved with a higher luminous efficiency (171 lm/w) and uniformity (92%). We designed a novel lightning bolt electrode to improve reliability and bendability. After the bending test, the blue flexible LED had a lower bending diameter (10 mm) but more bending circles (increased to 2000 times

The Impact of Surgical Experience on Major Intraoperative Aneurysm Rupture and Their Consequences on Outcome: A Multivariate Analysis of 538 Microsurgical Clipping Cases

<div><p>The incidence and associated mortality of major intraoperative rupture (MIOR) in intracranial aneurysm surgery is diverse. One possible reason is that many studies failed to consider and properly adjust the factor of surgical experience in the context. We conducted this study to clarify the role of surgical experience on MIOR and associated outcome. 538 consecutive intracranial aneurysm surgeries performed on 501 patients were enrolled in this study. Various potential predictors of MIOR were evaluated with stratified analysis and multivariate logistic regression. The impact of surgical experience and MIOR on outcome was further studied in a logistic regression model with adjustment of each other. The outcome was evaluated using the Glasgow Outcome Scale one year after the surgery. Surgical experience and preoperative Glasgow Coma Scale (GCS) were identified as independent predictors of MIOR. Experienced neurovascular surgeons encountered fewer cases of MIOR compared to novice neurosurgeons (MIOR, 18/225, 8.0% vs. 50/313, 16.0%, P = 0.009). Inexperience and MIOR were both associated with a worse outcome. Compared to experienced neurovascular surgeons, inexperienced neurosurgeons had a 1.90-fold risk of poor outcome. On the other hand, MIOR resulted in a 3.21-fold risk of unfavorable outcome compared to those without it. Those MIOR cases managed by experienced neurovascular surgeons had a better prognosis compared with those managed by inexperienced neurosurgeons (poor outcome, 4/18, 22% vs. 30/50, 60%, P = 0.013).</p></div

Further Education Provision and Learning for Social Transformation. A case study of the experience of introducing a social change agenda into further education programmes within Vocational Education Committees

Further Education refers to education and training that occurs after second level schooling but is not part o f the third level system. (Ireland, 1995; Department of Education and Science, 2004b). It encompasses a complex and diverse range of provision involving a range o f players. Vocational Education Committees are the main providers of further education under the remit of the Department of Education and Science. Further education is situated within the european and national policy context for adult education, which demonstrates commitment to lifelong learning and social inclusion. The White Paper on Adult Education (Ireland, 2000) sets out a number o f priorities that together promote individual advancement and collective empowerment and promote an active role for all in shaping the direction of society. But the manner in which resources are allocated tells another story as the bulk of state funding is provided for programmes that meet employability and labour market objectives. This study explored the tensions explored experience by those working with and within VECs in inserting a social change agenda into further education programmes given the priority focus on economic competitiveness. It considered this against the transformative learning espoused by Freire, Mezirow and Habermas. The main research consisted of one-to-one interviews and a group interview using qualitative interviewing to draw out peoples’ feelings, thoughts and meanings. These were supported by a review of relevant literature and documents. The main research found a lack of consensus on concepts and meanings in relation to anything other than meeting labour market needs. The role of further education, educators and institutions was contested with respect to other functions such as promoting community action and social change. In conclusion, it suggests that VEC and community and voluntary interests need to reflect on their practice and how they can work towards a philosophical vision for further education that goes beyond meeting the labour market agenda. It especially calls for the implementation of structures promised in the White Paper on Adult Education to support the co-ordinated development of policy

Univariate analysis for risk factors of MIOR.

<p>Univariate analysis for risk factors of MIOR.</p

The risk of MIOR and associated poor outcome between different surgical experience groups.

<p>The risk of MIOR (total bars) from inexperienced neurosurgeons doubled those from experienced neurovascular surgeons (16% vs 8%, P = 0.009). The risk of poor outcome with MIOR (black bars) was 60% in the inexperienced neurosurgeon group, and 22% in the experienced neurovascular surgeon group (P = 0.013).</p