[Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases].

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.

[Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery].

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery.

BACKGROUND: The optimal analgesia regimen after laparoscopic colorectal cancer surgery is unclear. The aim of the study was to characterize the beneficial effects of continuous transversus abdominis plane (TAP) blocks initiated before operation on outcomes following laparoscopic colorectal cancer surgery. METHODS: Patients undergoing surgery for colorectal cancer were divided randomly into three groups: combined general-TAP anaesthesia (TAP group), combined general-thoracic epidural anaesthesia (TEA group) and standard general anaesthesia (GA group). The primary endpoint was duration of hospital stay. Secondary endpoints included gastrointestinal motility, pain scores and plasma levels of cytokines. RESULTS: In total, 180 patients were randomized and 165 completed the trial. The intention-to-treat analysis showed that duration of hospital stay was significantly longer in the TEA group than in the TAP and GA groups (median 4·1 (95 per cent c.i. 3·8 to 4·3) versus 3·1 (3·0 to 3·3) and versus 3·3 (3·2 to 3·6) days respectively; both P < 0·001). Time to first flatus was earlier in the TAP group (P < 0·001). Visual analogue scale (VAS) scores during coughing were lower in the TAP and TEA groups than the GA group (P < 0·001). Raised plasma levels of vascular endothelial growth factor C, interleukin 6, adrenaline and cortisol were attenuated significantly by continuous TAP block. CONCLUSION: Continuous TAP analgesia not only improved gastrointestinal motility but also shortened duration of hospital stay. A decreased opioid requirement and attenuating surgical stress response may be potential mechanisms. Registration number: ChiCTR-TRC-1800015535 ( http://www.chictr.org.cn).

ANTECEDENTES: El régimen analgésico óptimo para los pacientes tras cirugía laparoscópica del cáncer colorrectal se desconoce. El objetivo de este estudio fue caracterizar los efectos beneficiosos del bloqueo continuo del plano transverso abdominal (transversus abdominis plane, TAP) iniciado preoperatoriamente sobre los resultados después de cirugía laparoscópica del cáncer colorrectal. MÉTODOS: Los pacientes sometidos a cirugía del cáncer colorrectal fueron divididos aleatoriamente en tres grupos: anestesia combinada general-TAP (grupo TAP), anestesia epidural combinada general-torácica (grupo TEA) y anestesia general estándar (grupo GA). El resultado primario fue la duración de la estancia hospitalaria. Los resultados secundarios incluyeron la motilidad gastrointestinal, puntuaciones de dolor y niveles plasmáticos de citocinas. RESULTADOS: En total, 180 pacientes fueron aleatorizados y 165 completaron el ensayo. El análisis por intención de tratar mostró que la duración de la estancia hospitalaria en el grupo TEA fue significativamente más larga que en el grupo TAP y GA respectivamente (4,1 (3,8-4,3) versus 3,1 (3,0-3,3) días, P < 0,001; 4,1 (3,8-4,3) versus 3,3 (3,2-3,6) días, P < 0,001). El tiempo hasta la primera eliminación de gases fue más precoz en el grupo TAP (P < 0,001). Las puntuaciones de la escala analógica visual (visual analogue scale, VAS) durante la tos en el grupo TAP y TEA fueron inferiores (P < 0,01). Los niveles elevados en plasma del factor de crecimiento endotelial C (VEGF-C), interleucina (IL)-6, epinefrina y cortisol fueron atenuados significativamente por el bloque TAP continuo. CONCLUSIÓN: La analgesia TAP continua no solo mejora la motilidad gastrointestinal, sino que también acorta la estancia hospitalaria. Una disminución en los requerimientos de opiáceos y la atenuación de la respuesta al estrés quirúrgico podrían ser mecanismos potenciales de la acción de TAP.

[Surgical treatment for inflammatory myofibroblastic tumor in genito-urinary system: a study of 15 cases].

Objective: To present 15 cases of inflammatory myofibroblastic tumor (IMT) in genitor-urinary system, and analyze the characteristics, diagnosis and treatment of the disease. Methods: The diagnostic and therapeutic process of 15 confirmed cases admitted to Sun Yat-sen University Cancer Center between March 2009 and September 2017 were retrospectively analyzed. Of the total cases, 11 cases were diagnosed with cystic IMT with a maximum diameter of 1.0-4.5 cm, 8 cases underwent transurethral resection of bladder tumor(TURBT)and 4 of them underwent partial cystectomy after TURBT and 3 underwent partial cystectomy directly. Two cases were renal IMT with a maximum diameter of 4.0-9.0 cm, one underwent partial nephrectomy and the other accepted radical nephrectomy. One case who was diagnosed with prostatic IMT with a maximum diameter of 3.4 cm underwent transurethral resection of the prostate (TURP) and postoperative radiotherapy. One case who was diagnosed with perineal IMT with a maximum diameter of 2.1 cm underwent tumor resection. Results: The patients were followed up for 10-32 months with a median time of 27 months. No cases relapsed during the follow-up. Conclusion: Surgery is the preferred method for treating IMT in genitor-urinary system. Retrospective study shows a good prognosis in IMT patients, but a long-term follow-up is still required.

Risk factors for early implant-related surgical site infection.

PURPOSE: To identify the risk factors and microbes associated with early implant-related surgical site infection (SSI). METHODS: Records of 193 implant-related SSIs secondary to primary orthopaedic surgery were reviewed. Early and late SSI was defined as infection diagnosed within and after 3 months of surgery, respectively. RESULTS: Of the 193 implant-related SSIs, 29 were superficial incisional, 127 were deep incisional, and 37 were organ/space-related. 144 (90%) out of 160 SSIs used cefazolin in their prophylactic antibiotic regimen. In univariate analysis, early SSI was associated with diabetes mellitus, American Society of Anesthesiologists (ASA) score of >2, emergency procedures, and lack of antibiotic prophylaxis. In multivariable analysis, early SSI was associated with an ASA score of >2 (p=0.016). CONCLUSION: It is important to cross-check ASA score with co-morbidities to reduce early SSIs. Peri-operative optimisation and antibiotic prophylaxis should be administered prior to surgery. Appropriate modification of antibiotic prophylaxis should be considered.

Effects of anaesthesia on proliferation, invasion and apoptosis of LoVo colon cancer cells in vitro.

Tumour cell proliferation, invasion and apoptosis are crucial steps in tumour metastasis. We evaluated the effect of serum from patients undergoing colon cancer surgery receiving thoracic epidural and propofol anaesthesia on colon cancer cell biology. Patients were randomly assigned to receive propofol anaesthesia with a concomitant thoracic epidural (PEA, n = 20) or sevoflurane anaesthesia with opioid analgesia (SGA, n = 20). Venous blood was obtained before induction of anaesthesia and 24 hours postoperatively. The LoVo colon cancer cells were cultured with patient serum from both groups and the effects on proliferation, invasion and apoptosis were measured. Twenty-four hours after surgery, the absorbance value of LoVo cells at 10% serum concentration from PEA was decreased when compared with SGA (0.302 (0.026) vs 0.391 (0.066), p = 0.005). The inhibitory rate of LoVo cells at 10% serum concentration from PEA was higher than that from SGA (p = 0.004) 24 h after surgery. The number of invasive LoVo cells at 10% serum concentration from PEA was reduced when compared with SGA (44 (4) vs 62 (4), p < 0.001). Exposure of LoVo cells to postoperative serum from patients receiving PEA led to a higher luminescence ratio (apoptosis) than those receiving SGA (0.36 (0.04) vs 0.27 (0.05), p < 0.001). Serum from patients receiving PEA for colon cancer surgery inhibited proliferation and invasion of LoVo cells and induced apoptosis in vitro more than that from patients receiving SGA. Anaesthetic technique might influence the serum milieu in a way that affects cancer cell biology and, thereby, tumour metastastasis.

Mediating effects of social support and self-concept on depressive symptoms in adults with spinal cord injury.

STUDY DESIGN: Cross-sectional, correlational design. OBJECTIVES: To examine the effects of individual demographics, activities of daily living, social support, and self-concept on depressive symptoms in people with spinal cord injury (SCI). SETTING: A convenience sample of 135 adults with SCI was recruited from medical and rehabilitation centres in Taiwan. METHODS: Face-to-face, structured interviews were employed to collect information. Study questionnaires included a demographic sheet, the Barthel scale, the modified Social Support Inventory, the Huang self-concept scale and the Beck Depression Inventory. Data were analysed by structural equation modelling (SEM). RESULTS: The average age of the participants was 43.3 years (±11.98), the mean duration of injury was 114 months (±93.78), and most were males. Emotional support (r=-0.173, P<0.05) and appraisal support (r=-0.261, P<0.01) were negatively correlated with depressive symptoms. The best fitted SEM model included individual demographics and physical function, social support and self-concept as significant predictors of depressive symptoms, with self-concept acting as a mediator in this relationship. Participants' characteristics and social support both contributed substantial indirect effects on depressive symptoms via self-concept. Self-concept also mediated the relationship between education, income, physical functioning and participants' depressive symptoms. CONCLUSION: For this sample, the more negative that individuals perceived themselves, the more likely they were to report worsening depressive symptoms. The more social support that individuals have, the more likely they were to report less depressive symptoms. Further longitudinal research will help clarify the direction of these relationships.

Predicting cancer risks from dental computed tomography.

Dental computed tomography (CT) has become a common tool when carrying out dental implants, yet there is little information available on its associated cancer risk. The objective of this study was to estimate the lifetime-attributable risk (LAR) of cancer incidence that is associated with the radiation dose from dental CT scans and to evaluate the effect of scan position, sex, and age on the cancer risk. This retrospective cohort study involved 505 participants who underwent CT scans. The mean effective doses for male and female patients in the maxilla group were 408 and 389 µSv (P = 0.055), respectively, whereas the mean effective doses for male and female patients in the mandible groups were 475 and 450 µSv (P < 0.001), respectively. The LAR for cancer incidence after mandible CT scanning varied from 1 in 16,196 for a 30-y-old woman to 1 in 114,680 for a 70-y-old man. The organ-specific cancer risks for thyroid cancer, other cancers, leukemia, and lung cancer account for 99% of the LAR. Among patients of all ages, the estimated LAR of a mandible scan was higher than that of a maxilla scan. Furthermore, the LAR for female thyroid cancer had a peak before age 45 y. The risk for a woman aged 30 y is roughly 8 times higher than that of a woman aged 50 y. After undergoing a dental CT scan, the possible cancer risks related to sex and age across various different anatomical regions are not similar. The greatest risk due to a dental CT scan is for a mandible scan when the woman is younger than 45 y. Given the limits of the sample size, machine parameters, and the retrospective nature of this study, the results need to be interpreted within the context of this patient population. Future studies will be of value to corroborate these findings.

Mediating effects on health-related quality of life in adults with osteoporosis: a structural equation modeling.

UNLABELLED: Participants with physical limitation and high degree of pain had poor mental and physical health-related quality of life. In addition, the more support and exercise that the participants had, the more likely they were to report better health-related quality of life. INTRODUCTION: Osteoporosis is a public health threat worldwide. The aim of this study is to examine the effects of individual demographics, disease characteristics, and social support on health-related quality of life (HrQoL) of adults with osteoporosis. Most psychosocial studies focused on the relationships but not the specific construct of social support on HrQoL. METHODS: In a correlational design, face-to-face, structured interviews were employed to collect information. Study questionnaires included a demographic sheet, the modified Social Support Inventory, and the Short-Form 36 scales on a convenience sample of 161 individuals recruited from four outpatient centers. Using the structural equation modeling approach, all relationships among factors, mediators, and HrQoL were analyzed. RESULTS: The mean duration of osteoporosis was longer than 5 years. Participants who exercised more than three times per week had greater HrQoL than individuals who exercised less frequently. Participants with physical limitation and high degree of pain had poor mental and physical HrQoL. The more support that the participants perceived, the more likely they were to report better HrQoL. The best fitted structural equation modeling (SEM) model included individual demographics and physical function, and social support as significant predictors on HrQoL, with informational support and physical function acting as mediators in those relationships. Moreover, this structural model explained 35, 42, and 40 % of the variance on activity of daily living (ADL), physical, and mental health-related quality of life. CONCLUSIONS: The more informational support that individuals have, the more likely they were to report better HrQoL. Individuals with osteoporosis who have lower pain and more exercise are considered having better HrQoL. Further longitudinal research will help clarify the direction of these relationships.

Effect of thoracic epidural anaesthesia on serum vascular endothelial growth factor C and cytokines in patients undergoing anaesthesia and surgery for colon cancer.

BACKGROUND: Serum vascular endothelial growth factor-C (VEGF-C), transforming growth factor-ß (TGF-ß), and interleukin (IL)-6 promote angiogenesis and metastases in colon cancer. We hypothesized that patients who received propofol-epidural anaesthesia (PEA) would exhibit decreases in VEGF-C, TGF-ß, and IL-6 and an increase in IL-10 compared with patients who received general anaesthesia (GA). METHODS: Colon cancer surgery patients were randomly assigned to the PEA (n=20) or GA (n=20) group. Serum VEGF-C, TGF-ß, IL-6, and IL-10 levels before surgery and 24 h after surgery were measured. RESULTS: Patients who received PEA showed decreases in VEGF-C [526 (261) vs 834 (304) pg ml(-1), P=0.001], TGF-ß (P=0.027), and IL-6 (P=0.007) and an increase in IL-10 (P=0.001) 24 h after surgery compared with patients subjected to GA. The visual analogue scale scores at rest and during coughing at 2 and 24 h after operation were significantly lower in PEA patients (P<0.05). CONCLUSIONS: PEA reduces serum concentrations of factors associated with angiogenesis during colon cancer surgery. CLINICAL TRIAL REGISTRATION: ChiCTR-TRC-13003146 (www.chictr.org).

Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

BACKGROUND: Primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when door-to-balloon (D2B) time is < 90 min. We sought to minimize preventable delays by instituting an on-site cardiology team-based approach in the emergency department (ED). METHODS: The on-site group comprised 146 consecutive patients with STEMI undergoing primary PCI after implementation of the on-site strategy. This new patient care model was compared with the conventional care administered before instituting the on-site cardiology team-based strategy in ED, which included 90 patients (interim group) receiving primary PCI at a catheterization room in the same building as the ED, and 147 patients (pre-on-site group) undergoing primary PCI at a catheterization room two blocks away from the ED. RESULTS: Median D2B time decreased from 107 min in the pre-on-site group to 72 min in the interim group, and to 47 min in the on-site group, respectively (p < 0.001). The percentage of D2B times < 90 min increased from 34% to 78% and 96%, respectively among the three groups (p < 0.001). Hospitalization costs were significantly reduced in the on-site and interim vs. pre-on-site groups ($5944, $5999, and $6581, respectively; p = 0.008). In-hospital mortality did not differ significantly among the three groups (4.8%, 2.2%, and 6.1%, respectively; p = 0.387). CONCLUSIONS: Institution of an on-site cardiology team-based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.

Hand warmer related corrosive injury.

INTRODUCTION: Corrosive injury of the esophagus and stomach is never been reported after intoxication of hand warmers. Herein we reported a case that had grade IIA corrosive injury found by endoscopic examination. CASE REPORT: An 84 year-old woman with a history of dementia ingested the contents of hand warmers. She had radiopaque patches in the stomach and duodenum. Upper endooscopic examination revealed corrosive injury of the esophagus and stomach. She recovered with the use of deferoxamine and proton pump inhibitor (PPI). DISCUSSION: The hand warmer contains activated charcoal, salt, and vermiculite, and 50% of iron powder. In previous literature, ingestions of one hand warmer packet or less are considered less toxic. But in our case, corrosive injury of the esophagus and stomach is obvious. CONCLUSION: It appears that significant toxicity will occur after ingestion of one hand warmer packet. Appropriate gastrointestinal decontamination and aggressive management are needed for all patients who are hand warmers intoxicated.

Antibacterial effect of electrolysed acid water on the nasal discharge from patients with chronic rhinosinusitis.

This study was conducted to determine whether electrolysed acid water (EAW) increased the antibacterial effect of irrigating solution used in the management of chronic rhinosinusitis (CRS). One hundred CRS patients were recruited from April 2008 to February 2009. Four swab specimens were taken from the ipsilateral middle meatus of each patient and one was placed in a Thanswab tube, while the other three were each placed randomly in one of three glass tubes containing either 5 ml of EAW, distilled water or 70% alcohol. They were immediately sent to the laboratory for aerobic and anaerobic cultures. Bacteria grew from 36 specimens when they were placed in a Thanswab tube, from four when placed in a tube with EAW, 30 when placed in distilled water and two when placed in alcohol. The culture rate was significantly lower when the specimens were placed in a tube with EAW as compared with distilled water or in a Thanswab tube, but was not different compared with alcohol. The bacteria that grew from four specimens after first being processed by EAW were all anaerobes. This study showed that EAW exhibited an increased antibacterial effect on bacteria grown from the nasal discharge of CRS patients.

The structural and optical properties of InN nanodots grown with various V/III ratios by metal-organic chemical vapor deposition.

Self-assembled InN nanodots have been prepared at 650 degrees C with various V/III ratios from 500 to 30 000 by metal-organic chemical vapor deposition (MOCVD). It is found that the dot density and morphological size as well as the optical properties all display drastic changes at V/III = 12 000. Generally, denser and smaller InN nanodots with higher emission energy and narrower linewidth were obtained when growth was conducted at V/III ratios slightly lower than 12 000 as compared to those at higher V/III ratios. The physical properties of our MOCVD-grown InN nanodots are sensitive to the surface structure and the morphology is very similar to molecular beam epitaxially grown GaN and InN films, which may be used as a guide to optimize the InN growth.

Cost analysis of management in acute appendicitis with CT scanning under a hospital global budgeting scheme.

BACKGROUND: CT scanning of the abdomen is a highly accurate diagnostic tool for acute appendicitis. However, it is still relatively expensive in Taiwan, especially in hospitals which have adopted a global budgeting scheme. The purpose of this study was to analyse the cost of the management of this disease with and without CT scanning. METHOD: A retrospective observational study was undertaken from 1 January to 30 June 2005. Patients with a working diagnosis of "acute appendicitis", "acute appendicitis should be ruled out" and "differential diagnosis including acute appendicitis" were enrolled in the study. Patient demographic data, chief complaints, working diagnoses, laboratory data, CT reports, surgical findings and costs in the emergency department (ED) and ward were collected. RESULT: A total of 266 patients were admitted to an ED with symptoms suggesting acute appendicitis. Of these, 207 underwent an emergency appendectomy. An abdominal CT scan was performed in 71% of patients with a diagnosis of "differential diagnosis including acute appendicitis", which was higher than in the other two diagnostic groups (18% and 60%). Patient age, high sensitivity C-reactive protein (hsCRP) concentration, ED stay, ED expenses and hospital stay were lower in the group that did not have a CT scan than in those who did. The net cost per patient with acute appendicitis in the group who underwent CT scanning was New Taiwan dollar (NT$)40,728, which was nearly equal to the net cost per patient in the group without CT scanning (NT$39,192). CONCLUSION: Routine CT scanning in patients with possible appendicitis is not necessary. History taking and physical examination combined with laboratory tests are still useful and cost-effective methods of diagnosing acute appendicitis.

Impact of enhanced infection control procedures on clinical outcome following resuscitation attempts.

The impact of infection control measures (ICMs) on emergency resuscitation during an outbreak is unclear. The purpose of this retrospective observational study was to investigate the outcomes of emergency resuscitation after implementation of ICMs. Data were collected for the period 1 January to 4 July in 2003 from a 1732-bed tertiary care hospital in central Taiwan. Non-trauma patients who required emergency resuscitation were classified into two groups: before (period 1), and after (period 2), the date on which strict ICMs were implemented. The analysis variables included demographic data of patients, place of resuscitation, number of participating resuscitators, response time and duration of resuscitation, fever, pneumonia status and results of resuscitation. The response time was unchanged but the number of patient resuscitations without an emergency intubation, rapid sequence intubation or a 'do not resuscitate' order increased from 88 (24.4%), 23 (6.4%) and 16 (4.4%) in period 1 to 103 (33.0%), 32 (10.3%) and 29 (9.3%) in period 2, respectively. The failure rate of resuscitation was significantly higher in period 2 (odds ratio: 1.59, 95% confidence interval: 1.17-2.16). The number of emergency resuscitations in patients with fever or pneumonia was not significantly different between these two periods. In conclusion, strict ICM implementation appeared to play a role in the increased failure rate in emergency resuscitation. Normal provision of healthcare to patients and adequate protection of healthcare workers during emergency resuscitation will be of paramount importance during the next outbreak of a highly contagious disease.

Optical properties and carrier dynamics of self-assembled GaN/Al(0.11)Ga(0.89)N quantum dots.

GaN quantum dots were grown on an Al(0.11)Ga(0.89)N buffer layer by using flow rate modulation epitaxy. The Stranski-Krastanov growth mode was identified by an atomic force microscopy study. The thickness of the wetting layer is about 7.2 monolayers. The temperature dependent photoluminescence studies showed that at low temperature the localization energy, which accounts for de-trapping of excitons, decreases with the reducing dot size. The decrease in emission efficiency at high temperature is attributed to the activation of carriers from the GaN dot to the nitrogen vacancy (V(N)) state of the Al(0.11)Ga(0.89)N barrier layer. The activation energy decreases with reducing dot size.

A CRH1 antagonist into the amygdala of mice prevents defeat-induced defensive behavior.

Corticotropin-releasing hormone (CRH) is believed to play an important role in the regulation of behavioral responses to stress. CRH(1) receptor antagonists may reduce stress responsivity. Stress increases CRH in the amygdala, important in memory consolidation. We hypothesized that infusion of a CRH(1) antagonist into the amygdala following social defeat would prevent the development of generalized fear responses. Acute social defeat in mice increases defense towards intruders, even nonaggressive intruders, placed within their home cage. We infused the CRH(1) antagonist antalarmin (0.25 microg/125 nl) bilaterally into the amygdala of mice immediately after defeat and measured their response to a nonaggressive intruder stimulus mouse placed within their home cage 24 h after defeat. Defeated mice that received vehicle displayed high levels of crouch defensive posture and numerous flights from intruders, relative to nondefeated mice that received vehicle. Defeated mice that received antalarmin into the amygdala exhibited significantly less defensive posture than did vehicle-treated defeated mice. Display of defensive posture in antalarmin-treated mice approached that of vehicle-treated nondefeated mice. These findings support a role for CRH in the amygdala to promote consolidation of emotional memory and indicate that antagonism of CRH(1) receptors in the amygdala may prevent the development of exaggerated fear responses in stressed mice.

Seroprevalence of hepatitis C virus infection and its association with natural infection of hepatitis B virus among preschool children in Taiwan.

Taiwan is a hyperendemic area of hepatitis B virus (HBV) infection where chronic hepatitis B is the most important cause of liver cirrhosis and hepatoma. Since, diagnostic kit for detecting hepatitis C virus (HCV) infection has been developed, HCV was found to be another important etiology of chronic liver disease. In order to study the seroprevalence of HCV infection among preschool children after mass hepatitis B vaccination program in Taiwan, a community-based survey was carried out in 54 kindergartens in 10 urban areas, 10 rural areas, and two aboriginal areas randomly selected through stratified sampling. Serum specimens of 2538 preschool children were screened for the HCV antibodies (anti-HCV) by a commercially available third-generation microparticle enzyme immunoassay and for HBV markers by radioimmunoassay methods. The multivariate-adjusted odd ratios (ORm) with their 95% confidence intervals (CI) were estimated through the multiple logistic regression analysis. A total of 58 children were anti-HCV seropositive, giving a prevalence of 2.3%. The prevalence of anti-HCV was 1.0% (5 of 484) among aboriginal children, a significantly decreased seroprevalence compared with those among other ethnic groups after multivariate adjustment. Boys had a higher anti-HCV seroprevalence, but not statistically significantly different from girls (ORm: 1.6; 95% CI: 0.9-2.8; p = 0.08). The seroprevalence of the age group of 3-4 years was lower than that of the age group of 5-6 years (ORm: 2.2; 95% CI: 1.1-4.2; p = 0.02). After multivariate adjustment, preschool children with natural HBV infection had a higher anti-HCV seroprevalence, but not statistically significantly different from those without natural HBV-infection (ORm: 2.6; 95% CI: 0.9-7.4; p = 0.08 for HBV-infected vs. uninfected). HCV infection varies with gender, residential area, and natural HBV infection. HCV and HBV might share common transmission routes in Taiwan.

Objective evidence of decreased salivary function in patients with autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis).

Impaired salivary flow is found in Sjögren's syndrome, which is a common, chronic, autoimmune, inflammatory connective tissue disease, mainly affecting the exocrine glands. Histopathologically, lymphocytic infiltrations of the salivary glands are found in Sjögren's syndrome that are similar to those of the thyroid gland in autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis). To test this hypothesis by Daniels et al ., salivary function was measured by quantitative salivary scintigraphy in autoimmune thyroiditis patients, as well as in age- and sex-matched controls. Forty patients, each with a history of autoimmune thyroiditis of over 10 years, and 61 healthy controls were enrolled in the study. All of the 40 autoimmune thyroiditis patients had good blood sugar control. None presented autonomic neuropathy. They were separated into two subgroups: patient group 1, 20 patients with xerostomia; patient group 2, 20 patients without xerostomia. Two control groups of healthy subjects were included for comparison: control group 1, 36 subjects without xerostomia; control group 2, 25 subjects with xerostomia. After intravenous injection of 5 mCi (99m)Tc-pertechnetate, sequential images at 1 min per frame were acquired for 30 min. The first and 15th minute uptake ratios (URs) were calculated from the tracer uptakes in the four major salivary glands relative to the background regions of interest (ROIs). Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer. The maximal excretion ratios (ERs) of the four major salivary glands after sialagogue stimulation were calculated. Impaired salivary function, represented by significantly decreased UR and ER values, in autoimmune thyroiditis patients with xerostomia was demonstrated in this study. Significantly poorer salivary function was found in autoimmune thyroiditis patients with xerostomia, when compared with autoimmune thyroiditis patients without xerostomia and healthy controls with or without xerostomia, via objective and quantitative salivary scintigraphy. However, a larger series of autoimmune thyroiditis patients is necessary to confirm our findings.