Topology Optimized Prelithiated SiO Anode Materials for Lithium-Ion Batteries.

Silicon monoxide (SiO)-based materials have great potential as high-capacity anode materials for lithium-ion batteries. However, they suffer from a low initial coulombic efficiency (ICE) and poor cycle stability, which prevent their successful implementation into commercial lithium-ion batteries. Despite considerable efforts in recent decades, their low ICE and poor cycle stability cannot be resolved at the same time. Here, it is demonstrated that the topological optimization of the prelithiated SiO materials is highly effective in improving both ICE and capacity retention. Laser-assisted atom probe tomography combined with thermogravimetry and differential scanning calorimetry reveals that two exothermic reactions related to microstructural evolution are key in optimizing the domain size of the Si active phase and Li2 SiO3 buffer phase, and their topological arrangements in prelithiated SiO materials. The optimized prelithiated SiO, heat-treated at 650 °C, shows higher capacity retention of 73.4% and lower thickness changes of 68% after 300 cycles than those treated at other temperatures, with high ICE of ≈90% and reversible capacity of 1164 mAh g-1 . Such excellent electrochemical properties of the prelithiated SiO electrode originate from its optimized topological arrangement of active Si phase and Li2 SiO3 inactive buffer phase.

Lactate dehydrogenase to albumin ratio as a prognostic factor in lower respiratory tract infection patients.

PURPOSE: To verify the role of lactate dehydrogenase to albumin (LDH/ALB) ratio as an independent prognostic factor for mortality due to the lower respiratory tract infection (LRTI) in the emergency department (ED). METHODS: We reviewed the electronic medical records of patients who were admitted to the ED for the management of LRTI between January 2018 and December 2020. Initial vital signs, laboratory data, and patient severity scores in the ED were collected. The LDH/ALB ratio was compared to other albumin-based ratios (blood urea nitrogen to albumin ratio, C-reactive protein to albumin ratio, and lactate to albumin ratio) and severity scales (pneumonia severity index, modified early warning score, CURB-65 scores), which are being used as prognostic factors for in-hospital mortality. Multivariable logistic regression was performed to identify independent risk factors. RESULTS: The LDH/ALB ratio was higher in the non-survivor group than in the survivor group (median [interquartile range]: 217.6 [160.3;312.0] vs. 126.4 [100.3;165.1], p < 0.001). In the comparison of the area under the receiver operating characteristic curve (AUC) for predicting in-hospital mortality, the AUC of the LDH/ALB ratio (0.808, 95% confidence interval: 0.757-0.842, p < 0.001) was wider than other albumin-based ratios and severity scales, except the blood urea nitrogen to albumin ratio. In the multivariable logistic regression analysis, the LDH/ALB ratio independently affected in-hospital mortality. CONCLUSION: The LDH/ALB ratio may serve as an independent prognostic factor for in-hospital mortality in patients with LRTI.

Detection of Testicular Torsion With Preserved Intratesticular Flow By Point of Care Ultrasound in the Emergency Department: A Case Report.

BACKGROUND: Ultrasonography is an effective diagnostic tool for testicular torsion (TT), which is typically characterized by the absence of blood flow in the affected testicle on color Doppler mode. However, there are a few reported cases of TT with symmetrical preserved flow. We report a case of TT with the preserved intratesticular flow on color Doppler ultrasound. CASE REPORT: A 14-year-old boy was admitted due to sudden-onset right scrotal pain. Point-of-care ultrasound (POCUS) revealed that the right testicle was larger than the left. The intratesticular flow in both testicles was preserved. Radiology-performed ultrasound confirmed the preserved intratesticular flow observed on POCUS, but also demonstrated a whirlpool sign of the right spermatic cord. TT was confirmed surgically. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should investigate the presence of intratesticular blood flow and the whirlpool sign of the spermatic cord or other ultrasound features suggestive of TT, even if testicular blood flow is preserved. Suspicion of TT from POCUS findings warrants further evaluation to preserve the patient's fertility.

Successful endotracheal intubation using i-gel supraglottic airway device and ultrasonography in a patient with bedside cervical traction: A case report.

We report a case of successful endotracheal intubation using i-gel and ultrasonography without a laryngoscope in a patient with a bedside cervical traction device. A 57-year-old man was referred to the emergency department because of quadriparesis following a motor vehicle accident, who was confirmed to have cervical dislocation with spinal cord compression. For ventilation support, the i-gel rescue airway device was placed to secure the patient airway temporarily. Then, an endotracheal tube was passed through the stem of the i-gel while observing the optimal tube position with ultrasonography. This case showed that ultrasonography can be used for early confirmation of endotracheal tube placement into the trachea via the i-gel.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea.

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Comparison of cosmetic appearances after facial lacerations repaired by junior residents and experts.

PURPOSE: The technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training. METHODS: Wound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5-10 days following suturing. RESULTS: Sixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2-4) and 5 (4-5), respectively (p = 0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p < 0.001). CONCLUSIONS: There were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement.

Reversible Acute Blindness in Suspected Metformin-Associated Lactic Acidosis.

BACKGROUND: Metformin is commonly used for the treatment of type 2 diabetes mellitus. Renal insufficiency is one of the contraindications for its use. Inadvertent prescription in patients with renal insufficiency may lead to metformin-associated lactic acidosis (MALA), which is associated with a high risk of mortality. Consequently, the early recognition and management of MALA is essential. CASE REPORT: We present the case of a 68-year-old man who had reversible blindness resulting from severe lactic acidosis. On presentation, he was alert, oriented, and had no complaints except mild abdominal discomfort and blindness. He denied any history of trauma or drug abuse. The results of the laboratory studies showed severe metabolic acidosis with a high anion gap and increased levels of serum creatinine. There were no predisposing ocular or neurologic lesions that could have induced the blindness. Although the blood levels of methanol, ethanol, and metformin were not estimated, correction of acidosis and hemodialysis led to a complete recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Rarely, transient blindness may occur in patients with fatal severe metabolic acidosis. Evaluation for the presence of metabolic acidosis and a detailed medical history are essential in the management of acute blindness in such patients.

Usefulness of new method of central venous catheter securement using a continuous suture.

INTRODUCTION: To reduce the time required for suture closure for central venous catheterization, a new procedure was developed using a continuous suture technique. The present study was conducted to investigate the usefulness of this method. METHOD: The study was conducted with 90 volunteers among the doctors in the university hospital. Preliminary training (using video) on the two fixation methods was given to the participants prior to the experiment. After applying the central vein of the pig skin, a suture up to the butterfly seal was prepared, and the participant was allowed to fix the suture using the classic method and the new method. The time required for suturing was measured in seconds, and the tension was determined using a tension measuring device after suturing. RESULT: When using the new "one-time method," the time required was shortened by about 20.50s on average compared with the conventional method (P<0.001). The median and quartile of the tension of the thread for the one-time method was 1.10kg (1.00-1.20kg) and of the conventional method was 1.10kg (1.00-1.20kg), which showed no statistically significant difference between the two groups (P=0.476). CONCLUSION: We found that the new one-time method provided faster and more convenient central catheterization and catheter securement than the conventional methods.

Extracorporeal cardiopulmonary resuscitation in bedside echocardiography-diagnosed massive pulmonary embolism.

Acute pulmonary embolism (PE) is one of the major causes of inhospital cardiac arrest as well as out-of-hospital cardiac arrest. Bedside diagnosis of acute PE in the emergency department (ED) can be challenging, especially in a cardiac arrest setting. Even if the early diagnosis of an acute massive PE had been made, hemodynamic instability may be worsened unless obstructive shock gets resolved. We present a case of a 46-year-old woman who developed pulseless electrical activity (PEA) after complaining of weakness and dyspnea in an ambulance, presumptively diagnosed as acute PE by bedside focused echocardiography. She received thrombolytic therapy and was rescued by extracorporeal cardiopulmonary resuscitation for recurrent PEA arrest in the ED. Focused bedside echocardiography provides a rapid diagnostic adjunct, and extracorporeal cardiopulmonary resuscitation can be a valuable rescue therapy for PEA arrest from massive PE.

Usefulness of the compression-adjusted ventilation for adequate ventilation rate during cardiopulmonary resuscitation.

BACKGROUND: To perform high-quality cardiopulmonary resuscitation (CPR), high-quality chest compression and ventilation support should be performed. However, many providers still have not maintained an adequate ventilation rate but hyperventilated during CPR. Thus, this study was conducted to verify that the compression-adjusted ventilation (CAV) would be a more accurate ventilation method compared with the conventional ventilation (CV). METHODS: Volunteer medical students and emergency medical services personnel were recruited. They were randomly divided into either the CV group or the CAV group. In the CV group, participants performed ventilation with estimation of the rate of 8 to 10 per minute (1 ventilation/6-8 seconds). In the CAV group, the ventilation rate was adjusted in line with the compression rate (compression:ventilation, 12:1). In each group, 2-rescuer adult CPR was performed on a manikin, which was intubated with an endotracheal tube, during a period of 8 minutes. The compression rate and the ventilation rate were recorded during CPR. RESULTS: Data on 56 medical students and 41 emergency medical services personnel were analyzed. No significant difference was observed in compression rate (P =.817); however, median (interquartile range) ventilation rate differed significantly between the CV and CAV groups (8.79 [2.19] per minute vs 9.25 [1.07] per minute, P = .016). In addition, compared with the CV group, adequacy of ventilation rate was better in the CAV group (47.9% vs 85.7%, P < .001). CONCLUSION: In comparison with the CV, the CAV is a more accurate method for maintenance of an adequate ventilation rate.

Electrochemical behavior of elemental alloy anodes in solid-state batteries.

Lithium alloy anodes in the form of dense foils offer significant potential advantages over lithium metal and particulate alloy anodes for solid-state batteries (SSBs). However, the reaction and degradation mechanisms of dense alloy anodes remain largely unexplored. Here, we investigate the electrochemical lithiation/delithiation behavior of 12 elemental alloy anodes in SSBs with Li6PS5Cl solid-state electrolyte (SSE), enabling direct behavioral comparisons. The materials show highly divergent first-cycle Coulombic efficiency, ranging from 99.3% for indium to ∼20% for antimony. Through microstructural imaging and electrochemical testing, we identify lithium trapping within the foil during delithiation as the principal reason for low Coulombic efficiency in most materials. The exceptional Coulombic efficiency of indium is found to be due to unique delithiation reaction front morphology evolution in which the high-diffusivity LiIn phase remains at the SSE interface. This study links composition to reaction behavior for alloy anodes and thus provides guidance toward better SSBs.

Synergistic Evolution of Alloy Nanoparticles and Carbon in Solid-State Lithium Metal Anode Composites at Low Stack Pressure.

Solid-state batteries with Li metal anodes can offer increased energy density compared to Li-ion batteries. However, the performance of pure Li anodes has been limited by morphological instabilities at the interface between Li and the solid-state electrolyte (SSE). Composites of Li metal with other materials such as carbon and Li alloys have exhibited improved cycling stability, but the mechanisms associated with this enhanced performance are not clear, especially at the low stack pressures needed for practical viability. Here, we investigate the structural evolution and correlated electrochemical behavior of Li metal composites containing reduced graphene oxide (rGO) and Li-Ag alloy particles. The nanoscale carbon scaffold maintains homogeneous contact with the SSE during stripping and facilitates Li transport to the interface; these effects largely prevent interfacial disconnection even at low stack pressure. The Li-Ag is needed to ensure cyclic refilling of the rGO scaffold with Li during plating, and the solid-solution character of Li-Ag improves cycling stability compared to other materials that form intermetallic compounds. Full cells with sulfur cathodes were tested at relatively low stack pressure, achieving 100 stable cycles with 79% capacity retention.

Comparison of modified quick sequential organ failure assessment models as triage tools for febrile patients.

Object: Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the qSOFA score. Methods: We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC). Results: Through multivariable analysis, the identified factors were age (A), male sex (M), SpO2 (S), and lactate levels (L). The AUROCs of ASqSOFA (for in-hospital mortality: 0.812; 95% CI: 0.789-0.835, for ICU admission: 0.794; 95% CI: 0.771-0.817), which included age and SpO2 with qSOFA, were simple and not inferior to other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the modified early warning score and Korean triage and acuity scale. The optimal cut-off score of ASqSOFA for the outcome was 2 and the score for redistribution to a lower-level emergency department was 0. Conclusion: We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It may also be applicable in pre-hospital settings for febrile patient triage.

Comparison of overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants.

OBJECTIVES: The aim of this manikin study was to compare the efficiency between overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants. METHODS: The study conducted from December 2010 to August 2011 involved 48 volunteers who were students in the emergency medical technician course. The authors let volunteers practice OP and AP as a crossover design. The authors monitored the simulated mean arterial pressure (MAP) generated during a 5-min chest compression. The fatigue level of the volunteers after the chest compression was evaluated with the Likert scale. RESULTS: There were no significant differences in MAP between the dominant hand and the non-dominant hand as the lower thumb of OP. Significant differences were observed in simulated systolic blood pressure, MAP and simulated pulse pressure between OP and AP at 1, 2, 3, 4 and 5 min. There were no significant differences among the changes in heart rate, respiratory rate and end-tidal CO(2) during a 5-min chest compression by OP and AP. The Likert scale scores (1 no fatigue to 5 = extreme fatigue) during the 5-min chest compressions were higher in AP than in OP at 2, 3 and 5 min. CONCLUSION: Higher intrathoracic pressures were achieved by OP in this study. However, further studies are needed to validate these effects of overlapping thumbs technique in infant cardiopulmonary resuscitation, not manikin.

Tailored versus conventional surgical debridement in complex facial lacerations in emergency department: A retrospective study.

Surgical debridement is an essential step in treating complex facial lacerations (CFL). As the CFL severity increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient. Because the severity and shape of each CFL vary, it is necessary to tailor the customized pre-excisional design, that is, tailored surgical debridement (TSD), for each case before performing surgical debridement. The use of TSD can enable effective debridement of CFL with higher severity. This study aimed to compare the cosmetic outcomes and complication incidence of CSD versus TSD according to CFL severity. In this retrospective observational study, eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded as Grades I and II. The outcomes of CSD and TSD were compared using the scar cosmesis assessment and rating (SCAR) scale, wherein a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcomes between the 2 groups was compared. The SCAR score and percentage of good cosmetic outcomes between the 2 groups were compared overall and by severity. For analyzing complication incidence, asymmetry, infection, and dehiscence incidence were compared. In total, 252 patients were enrolled [121 (48.0%) CSD and 131 (52.0%) TSD]. The median SCAR scores were 3 (1-5) and 1 (0-2) in all enrolled patients (P < .001), 2 (0-4), and 1 (0-1) in Grade I patients (P < .01), and 5 (4-6) and 1 (1-2) in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The percentage of good cosmetic outcomes was 46.3% and 84.0% overall (P < .001), 59.6% and 85.0% in Grade I patients (P < .01), and 9.4% and 83.5% in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The incidence of complications was significantly higher in the CSD group than in the TSD group, but this was limited to asymmetry. No significant difference was noted in infection or dehiscence. Compared with CSD, TSD can lead to an objectively good cosmetic prognosis at higher CFL severity and can reduce facial asymmetry occurrence.

Endothermic Dehydrogenation-Driven Preventive Magnesiation of SiO for High-Performance Lithium Storage Materials.

Silicon monoxide (SiO)-based materials have gained much attention as high-capacity lithium storage materials based on their high capacity and stable capacity retention. However, low initial Coulombic efficiency associated with the irreversible electrochemical reaction of the amorphous SiO2 phase in SiO inhibits the wide usage of SiO-based anode materials for lithium-ion batteries. Magnesiation of SiO is one of the most promising solutions to improve the initial efficiency of SiO-based anode materials. Herein, we demonstrate that endothermic dehydrogenation-driven magnesiation of SiO employing MgH2 enhanced the initial Coulombic efficiency of 89.5% with much improved long-term cycle performance over 300 cycles compared to the homologue prepared by magnesiation of SiO with Mg and pristine SiO. High-resolution transmission electron microscopy with thermogravimetry-differential scanning calorimetry revealed that the endothermic dehydrogenation of MgH2 suppressed the sudden temperature rise during magnesiation of SiO, thereby inhibiting the coarsening of the active Si phase in the resulting Si/Mg2SiO4 nanocomposite.

Lactate dehydrogenase to albumin ratio as a prognostic factor for patients with severe infection requiring intensive care.

ABSTRACT: This study was performed to verify whether lactate dehydrogenase to albumin (LDH/ALB) ratio could be used as an independent prognostic factor in patients with severe infection requiring intensive care.We reviewed electronic medical records of patients hospitalized to the intensive care unit via the emergency department with a diagnosis of infection between January 2014 and December 2019. From the collected data, ALB-based ratios (LDH/ALB, blood urea nitrogen to albumin, C-reactive protein to albumin, and lactate to albumin ratios) and some severity scores (modified early warning score, mortality in emergency department sepsis score [MEDS], and Acute Physiology And Chronic Health Evaluation II [APACHE II] score) were calculated. LDH/ALB ratio for predicting the in-hospital mortality was compared with other ALB-based ratios and severity scales by univariable and receiver-operating characteristics curve analysis. Modified severity scores by LDH/ALB ratio and multivariable logistic regression were used to verify the independence and usefulness of the LDH/ALB ratio.The median LDH/ALB ratio was higher in non-survivors than survivors (166.9 [interquartile range: 127.2-233.1] vs 214.7 [interquartile range: 160.2-309.7], P < .001). The area under the receiver-operating characteristics curve of the LDH/ALB ratio (0.642, 95% confidence interval: 0.602-0.681, P < .001) was not lower than that of other ALB-based ratios and severity scores. From multivariable logistic regression, LDH/ALB ratio was independently associated with in-hospital mortality (odds ratio = 1.001, 95% confidence interval: 1.000-1.002, P = .047). Area under the receiver-operating characteristics curves of MEDS and APACHE II scores were improved by modification with LDH/ALB ratio (MEDS: 0.643 vs 0.680, P < .001; APACHE II score: 0.675 vs 0.700, P = .003).LDH/ALB ratio may be useful as the prognostic factor in patients with severe infection requiring intensive care.

Cerebrospinal Fluid Volume Proportion Using Magnetic Resonance Imaging as a Predictor of Poor Neurological Outcome in Survivors of Out-of-Hospital Cardiac Arrest.

We aimed to investigate the prognostic performance of the proportion of cerebrospinal fluid volume (pCSV) using brain apparent diffusion coefficient-magnetic resonance imaging (ADC-MRI) in cardiac arrest (CA) survivors. This retrospective single-cohort study comprised adult comatose CA survivors who underwent brain MRI and targeted temperature management (TTM) from March 2018 to October 2019. We calculated pCSV (pCSV0 and pCSV72 within 6 and 72 hours after return of spontaneous circulation, respectively) using an automated quantitative analysis program. The difference between pCSV0 and pCSV72 was defined as the pCSVd. Neurologic outcome 3 months after CA was assessed with the Cerebral Performance Category scale and dichotomized as good (1 or 2) or poor (3-5). Of the 73 patients included, 44 (60.3%) had a poor neurological outcome. Patients with poor outcome had significantly lower pCSV at baseline and at 72 hours, and a negative change in pCSV over time. The prognostic performance of pCSV72 and pCSVd was significantly higher compared with pCSV0 (all p < 0.001). The pCSVd showed excellent area under the curve values (0.96; 95% confidence interval 0.85-0.99) and highest sensitivity (95%) at 100% specificity. pCSV on brain ADC-MRI was associated with 3-month neurologic outcome in CA survivors. The pCSVd is a highly predictive and sensitive marker of 3-month poor neurological outcome in CA survivors treated with TTM. Multicenter prospective studies are required to determine the generalizability of these results.