[Using Team Resource Management and Situational Simulation to Improve the Resuscitation Performance Completion Rate].

BACKGROUND & PROBLEMS: Cardiopulmonary resuscitation is an important issue in patient safety. After investigation, we identified the causes of the low rate of resuscitation completion in our emergency department as: incomplete utilization of available first-aid equipment, lack of standards related to task allocation, unclear moving line and instrument placement, lack of teamwork, and poor resuscitation-related communications during the COVID-19 pandemic. PURPOSE: The project aimed to improve the resuscitation performance completion rate. RESOLUTION: The project included designing equipment reminder cards and an airway car, designating specific responsibilities for each team member, establishing standard layouts and traffic flows, and providing situational simulation and team resource management training. RESULTS: After the intervention, the resuscitation performance completion rate had risen to 91.6% from the pre-intervention rate of 69.1%. This has since further risen to a relatively constant completion rate of 98.1%. CONCLUSIONS: The implementation of the team resource management and situational simulation training intervention in our ED improved both the resuscitation completion rate and the rate of return of spontaneous circulation (ROSC).

Investigation of a Novel Acoustic Levitation Technique Using the Transition Period Between Acoustic Pulse Trains and Electrical Driving Signals.

Acoustic levitation is considered one of the most effective noncontact particle manipulation methods, along with aerodynamic, ferromagnetic, and optical levitation techniques. It is not restricted by the material properties of the target. However, existing acoustic levitation techniques have some drawbacks that limit their potential applications. Therefore, in this article, an innovative approach is proposed to manipulate objects more intuitively and freely. By taking advantage of the transition periods between the acoustic pulse trains and electrical driving signals, acoustic traps can be created by switching the acoustic focal spots rapidly. Since the high-energy-density points are not formed simultaneously, the computation of the acoustic field distribution with complicated mutual interference can be eliminated. Therefore, compared to the existing approaches that created acoustic traps by solving pressure distributions using iterative methods, the proposed method simplifies the computation of time delay and makes it possible to be solved even with a microcontroller. In this work, three experiments have been demonstrated successfully to prove the capability of the proposed method including lifting a Styrofoam sphere, transportation of a single target, and suspending two objects. Besides, simulations of the distributions of acoustic pressure, radiation force, and Gor'kov potential were conducted to confirm the presence of acoustic traps in the scenarios of lifting one and two objects. The proposed tactic should be considered effective since the results of the practical experiments and simulations support each other.

Renoprotective Effects of Shout Camphor Medicinal Mushroom (Taiwanofungus camphorates, Basidiomycetes) Mycelia on Several Media in Mice with Chronic Kidney Disease.

Taiwanofungus camphoratus has been widely used in Taiwan as a folk medicine to prevent and treat liver diseases, diarrhea, abdominal pain, itchy skin, and hypertension. Recent studies have shown that T. camphoratus mycelia extracts exert anti-inflammatory and antioxidant effects on some types of renal disease, but the effect of T. camphoratus mycelia on chronic kidney disease (CKD) remains unclear. In this study we used the Bioresource Collection and Research Center (BCRC) medium and modified media (e.g., BCRC+A, HKS1, and HKS1+A media) to incubate T. camphorates mycelia and detect the feasible benefits of renal protection in mice with CKD. Five groups of mice with a partial nephrectomy (each mouse weighed approximately 30 g) received a daily administration of different media-treated T. camphoratus mycelia water solutions (3 mg dried mycelia dissolved in 0.3 mL water) by oral gavage for 30 days, while a control group received distilled water. The results show that progressive increased blood urea nitrogen and serum creatinine were significantly inhibited in the HKS1+A group on days 10 and 30. Plasma total protein was effectively increased in the HKS1 and HKS1+A groups. The BCRC and BCRC+A groups exhibited no obvious improvement in renal function. The results suggest that the HKS1+A medium provides the optimal effect in preventing the deterioration of kidney function and might have a renoprotective effect on CKD.

Subungual pleomorphic fibroma.

BACKGROUND: Pleomorphic fibroma is a benign fibroblastic tumor characterized by pleomorphic, hyperchromatic cells or giant multinucleated cells embedded in a collagenous stroma. These cytologic features may lead to an incorrect diagnosis of malignancy. Most cases reported in the literature are located on trunk or extremities; the presentation as a subungual mass is rare. METHODS: We report an unusual case of a subungual pleomorphic fibroma in 66-year-old woman. Clinical information was obtained. Histologic examination and immunohistochemical studies were performed. RESULTS: A 66-year-old woman presented with a longstanding (40 years), subungual mass that deformed the nail of the left middle finger. Microscopic examination revealed a paucicellular tumor composed of hyperchromatic spindled, pleomorphic, floret-like giant cells embedded in haphazardly arranged collagen bundles in the dermis. No mitotic figures were seen. The tumor cells were vimentin-positive but did not stain with antibodies to S-100, cytokeratin, smooth muscle actin, factor XIIIa or CD34 negative. The diagnosis of a pleomorphic fibroma was made. Follow-up shows no evidence of tumor, 36 months after excision. CONCLUSION: Pleomorphic fibroma of the subungual region is an unusual cutaneous tumor with histologic features that may cause confusion with true sarcomas. This is only the second case reported of a subungual pleomorphic fibroma. Pleomorphic fibroma should be considered in the differential diagnosis of pleomorphic subungual tumors.

Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli.

BACKGROUND: Cutaneous tuberculosis is especially difficult to distinguish from other granulomatous dermatoses. We used polymerase chain reaction (PCR) to evaluate the incidence of cutaneous tuberculosis and atypical mycobacterial infection in formalin-fixed, paraffin-embedded tissues with unspecified granulomatous inflammation and negative results for acid-fast bacilli (AFB), and analyzed the pattern of cutaneous tuberculosis in this group of patients. METHODS: A total of 38 specimens which had been collected from 36 patients and fulfilled the criteria for tissues described above were used in this study. Two different primer pairs targeting the gene encoding for 16S ribosomal RNA (common to all mycobacteria) and the insertion sequence IS6110 (specific for M. tuberculosis complex) were used in the PCR assays. The clinical characteristics, histopathologic findings, and culture results of the patients were also analyzed. RESULTS: Four specimens were excluded from the analysis due to the lack of internal control testing. Of the remaining 34 specimens, 22 were PCR positive for the 16S rRNA gene. Among them, 18 specimens were PCR positive for both the 16S rRNA gene and IS6110. Cutaneous tuberculosis could be diagnosed in these 18 cases (56.2%). Out of the 18 cases, there were 8 women and 10 men. The age range was 15-77 years (mean: 44.2 years). After reviewing their clinical presentation, 11 cases were considered as tuberculosis verrucosa cutis, 6 cases as lupus vulgaris, and 1 case as erythema induratum. The remaining 4 cases (12.5%) positive only for 16S rRNA gene were considered as possible atypical mycobacteria infection. CONCLUSIONS: These results show that in paucibacillary form of cutaneous tuberculosis with unclassical clinical and histological presentation, this PCR system provides rapid and sensitive detection of M. tuberculosis DNA in formalin-fixed, paraffin-embedded specimens. Cutaneous tuberculosis represents a significant proportion in specimens showing granulomatous inflammation. In areas like Taiwan, where prevalence of pulmonary tuberculosis is still high, tuberculosis verrucosa cutis and lupus vulgaris are common forms of cutaneous tuberculosis and are seen more frequently than atypical mycobacterial infection.

A surgical approach to ingrown nail: partial matricectomy using CO2 laser.

BACKGROUND: Ingrown nail is a deformity characterized by a transverse overcurvature of the lateral nail plate that causes nail fold inflammation. Currently recommended surgical procedures vary considerably. OBJECTIVE: We report our experience with a modified partial matricectomy and nail edge excision with CO2 laser. METHODS: A total of 116 ingrown nail edges in 77 patients were treated with the procedure. RESULTS: The incidence of recurrence was 2 of 76 cases (2.6%). CONCLUSION: This new surgical approach was found to be effective and is presented as an alternative treatment technique.