The adaptability of the Pulsta valve to the diverse main pulmonary artery shape of native right ventricular outflow tract disease.

BACKGROUND: Pulsta valve is increasingly used for percutaneous pulmonary valve implantation (PPVI) in patients with a large native right ventricular outflow tract (RVOT). This study aims to elucidate the outcomes of Pulsta valve implantation within the native RVOT and assess its adaptability to various native main pulmonary artery (PA) anatomies. METHODS: A multicenter retrospective study included 182 patients with moderate to severe pulmonary regurgitation in the native RVOT who underwent PPVI with Pulsta valves® between February 2016 and August 2023 at five Korean and Taiwanese tertiary referral centers. RESULTS: Pulsta valve implantation was successful in 179 out of 182 patients (98.4%) with an average age of 26.7 ± 11.0 years. The median follow-up duration was 29 months. Baseline assessments revealed enlarged right ventricle (RV) volume (mean indexed RV end-diastolic volume: 163.1 (interquartile range, IQR: 152.0-180.3 mL/m²), which significantly decreased to 123.6(IQR: 106.6-137.5 mL/m2  after 1 year. The main PA types were classified as pyramidal (3.8%), straight (38.5%), reverse pyramidal (13.2%), convex (26.4%), and concave (18.1%) shapes. Pulsta valve placement was adapted, with distal main PA for pyramidal shapes and proximal or mid-PA for reverse pyramidal shapes. Two patients experienced Pulsta valve embolization to RV, requiring surgical removal, and one patient encountered valve migration to the distal main PA, necessitating surgical fixation. CONCLUSIONS: Customized valve insertion sites are pivotal in self-expandable PPVI considering diverse native RVOT shape. The rather soft and compact structure of the Pulsta valve has characteristics to are adaptable to diverse native RVOT geometries.

Clinical aspects for differential diagnosis of Kawasaki disease shock syndrome: a case control study.

BACKGROUND: Because of the absence of a specific diagnostic test and pathognomonic clinical features, physicians must rely on the presence of specific clinical criteria and laboratory data that support the diagnosis of KD. To help clinicians distinguish KD, KDSS, septic shock, and TSS earlier, we suggest differential diagnosis and treatment guideline. METHODS: Medical records of immunocompetent patients who were admitted to the pediatric department with a diagnosis of KDSS, septic shock or TSS (SS group) were retrospectively reviewed. In addition, KD patients were selected by seasonal matching to each case of KDSS patient by date of admission (± 2 weeks). RESULTS: There were 13 patients with KDSS, 35 patients with SS group, and 91 patients with KD. In comparison between KDSS and septic shock group, KDSS group had significantly higher rate of coronary aneurysm incidence, and higher left ventricle dysfunction rate. In comparison between KDSS and TSS, patients with KDSS had a significantly higher erythrocyte sedimentation rate (ESR) and significantly lower creatinine. Receiver operation characteristic curve revealed that the optimal ESR cut off value for determining the KDSS was 56.0 (sensitivity 75.0%, specificity of 100.0%) and the optimal creatinine cut off value for determining the TSS was 0.695 (sensitivity 76.9%, specificity 84.6%). CONCLUSIONS: Clinical symptoms, laboratory finding, echocardiography, and culture studies can be used to differentiate KD, KDSS, septic shock and TSS.

Late Recurrence of Wilms Tumor After 17 Years: A Case Report.

Wilms tumor is the most common renal malignancy in children. Most of Wilms tumor recurrences occur within 2 years of the first diagnosis. Relapse after 5 years after the first diagnosis is called "late recurrence" and is rare in Wilms tumor. There are few case reports or small series of late recurrence of Wilms tumor. Because of the rarity of late recurrence of Wilms tumor, there is no clear guideline for its management. We describe a case of late recurrence of Wilms tumor as a remote metastasis in the lung at 18 years after the first diagnosis and 17 years after the second remission, which was achieved by radiotherapy and high-dose chemotherapy with autologous stem cell rescue. After late recurrence, the patient was treated by surgery and adjuvant chemotherapy, and remained disease-free for 11 months. Several very late recurrences of Wilms tumor in the literature are reviewed.

Neuroprotective effect of Capsicum annuum var. abbreviatum against hydrogen peroxide-induced oxidative stress in HT22 hippocampus cells.

Phenolic compounds isolated from pepper (Capsicum annum) have been demonstrated to have neuroprotective effects, whereas the physiological properties of Capsicum annuum var. abbreviatum (CAA) have not been studied. Thus, we investigate the chemical composition and neuroprotective activity of CAA extract (CAAE) in HT22 hippocampus cells against H2O2-induced neurotoxicity. CAAE treatment resulted in a significant protection of H2O2-exposed HT22, this protection ultimately occurred through an inhibition of MDA and ROS levels and an induction of SOD activity. Furthermore, CAAE treatment reduced H202-induced apoptosis though decreasing the expression of pro-apoptotic factors (Bax, cytochrome c, and cleaved caspases-3) while increasing the expression of the anti-apoptotic factors (Bcl-2), as well as the accumulation of nucleus-Nrf2-mediated HO-1 signaling. Interestingly, CAAE has a high concentration of unique phenolic compositions (chlrogenic acid, tangeretin, etc.) than other capsicum annum extracts. Altogether, these findings suggest that CAAE can be a useful natural resource for alleviating neurodegenerative diseases.

Diagnostic Accuracy of the Neck Tornado Test as a New Screening Test in Cervical Radiculopathy.

BACKGROUND: The Spurling test, although a highly specific provocative test of the cervical spine in cervical radiculopathy (CR), has low to moderate sensitivity. Thus, we introduced the neck tornado test (NTT) to examine the neck and the cervical spine in CR. OBJECTIVES: The aim of this study was to introduce a new provocative test, the NTT, and compare the diagnostic accuracy with a widely accepted provocative test, the Spurling test. DESIGN: Retrospective study. METHODS: Medical records of 135 subjects with neck pain (CR, n = 67; without CR, n = 68) who had undergone cervical spine magnetic resonance imaging and been referred to the pain clinic between September 2014 and August 2015 were reviewed. Both the Spurling test and NTT were performed in all patients by expert examiners. Sensitivity, specificity, and accuracy were compared for both the Spurling test and the NTT. RESULTS: The sensitivity of the Spurling test and the NTT was 55.22% and 85.07% (P < 0.0001); specificity, 98.53% and 86.76% (P = 0.0026); accuracy, 77.04% and 85.93% (P = 0.0423), respectively. CONCLUSIONS: The NTT is more sensitive with superior diagnostic accuracy for CR diagnosed by magnetic resonance imaging than the Spurling test.

Design of highly efficient RGB top-emitting organic light-emitting diodes using finite element method simulations.

In this paper, we present finite element method simulations of top-emitting organic light-emitting diodes for designing optimized red, green, and blue full-color device structures. The OLED structures in the simulation are used to evaluate the device parameters, such as the outcoupling efficiency, electroluminescence spectra, and angular emission characteristics on organic layers with varying thickness and different cathodes. The numerical study also extracts these parameters for nano-structured devices. By observing the agreement between the simulated and measured data precisely, our simulations show capability of predicting the fabricated device results.

Variations in the distance between the cricoid cartilage and targets of stellate ganglion block in neutral and extended supine positions: an ultrasonographic evaluation.

PURPOSE: Anatomic variations complicate surface landmark-guided needle placement, thereby increasing nerve blockade failure rate. However, little is understood about how anatomic distances change under different clinical conditions. As the cricoid cartilage is an easy and accurate landmark, we investigated changes in distance between the sixth or seventh cervical transverse processes (C6TP or C7TP) and the cricoid cartilage in neutral and extended supine positions. METHODS: Forty-two patients (16 men, 26 women) were included in this study. Distances between the cricoid cartilage and C6TP/C7TP were measured using ultrasonography with the patient in neutral and extended supine positions. RESULTS: C6TP and C7TP were caudally located at 6.0 ± 8.1 and 15.1 ± 7.2 mm, respectively, from the cricoid cartilage in the neutral supine position, and at 15.2 ± 8.0 and 25.3 ± 8.0 mm, respectively, in the extended supine position. In the extended supine position, the cricoid cartilage was more cephalad than C6TP and C7TP in all patients. The distance from the cricoid cartilage to C6TP was 12.1 ± 7.6 mm in men and 17.2 ± 7.7 mm in women. CONCLUSION: C6TP and C7TP are located approximately 15 and 25 mm, respectively, caudal to the cricoid cartilage in the extended supine position. Our results highlight the fact that there can be significant anatomic variation between the extended and neutral supine positions used in stellate ganglion block, which should be kept in mind when devising easily identifiable and palpable surface landmarks.

Light outcoupling enhancement from top-emitting organic light-emitting diodes made on a nano-sized stochastic texture surface.

An effective method for enhancing the light outcoupling efficiency from top-emitting organic light-emitting diodes (TEOLEDs) with a nano-sized stochastic texture surface (NSTS) is suggested. The broadly distributed pitch and the randomly sized of islands in the NSTS enable the photons that are otherwise trapped to be emitted over the broad emission wavelength range. The NSTS-embedded TEOLEDs have wide angular-dependent emission characteristics and an enhanced external quantum efficiency (EQE). Theoretical and full-wave optical calculations were performed to understand the mechanisms of the efficiency enhancement. Optimized TEOLEDs achieved a 32% EQE enhancement compared with the reference devices without the NSTS.

Incidence of propofol injection pain and effect of lidocaine pretreatment during upper gastrointestinal endoscopy.

BACKGROUND/AIMS: Propofol has been used in the past for sedation in upper gastrointestinal (GI) endoscopic procedures. This study aimed to measure the incidence of propofol injection pain and evaluate the effect of lidocaine on pain caused during sedative upper GI endoscopic examinations. METHODS: Subjects scheduled to undergo sedative diagnostic upper GI endoscopy were randomly assigned to lidocaine and placebo groups. Pretreatment with a bolus of 1% lidocaine 2 ml or normal saline 2 ml into the largest dorsal vein of the non-dominant hand was followed by propofol administration. Pain intensity was estimated by an examiner blinded to the group assignment using a four-point verbal rating scale. A score of 1-3 was regarded as pain. RESULTS: A total of 121 patients (males, 69; age, 58.6 ± 12.1 years) completed the study; 61 and 60 subjects were randomly assigned to the lidocaine and placebo groups, respectively. The incidence of pain during upper GI endoscopy was 60%. The lidocaine group showed a lower incidence of pain than the placebo group (37.7% vs. 60.0%, P = 0.018). The lidocaine group perceived significantly less pain than the placebo group (median pain score, 0 vs. 1, P = 0.008). Only lidocaine pretreatment was an independently associated factor against pain perception (OR, 0.380; 95% CI, 0.177-0.815; P = 0.013). CONCLUSIONS: Pretreatment using lidocaine was found to be effective in reducing propofol injection-induced pain. However, its usefulness for GI endoscopic procedures in daily clinical practice needs further evaluation because of the low intensity of pain.

Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality.

OBJECTIVE: The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality. METHODS: A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality. RESULTS: The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores. CONCLUSION: We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.

Is cervical cancer a risk factor for colorectal neoplasia? Prevalence of colorectal adenoma in Korean patients with cervical cancer.

BACKGROUND/AIMS: The relationship between colorectal neoplasia and cervical cancer has not been evaluated. This study aimed to assess the prevalence of colorectal adenoma in patients with cervical cancer and compare it with that of control subjects. METHODOLOGY: Between January 2005 and December 2009, the medical records of patients diagnosed with cervical cancer were retrospectively reviewed. Patients undergoing sigmoidoscopy or colonoscopy for the preoperative evaluation of the colon were enrolled in this study. Age-matched female healthy subjects who underwent colonoscopy for screening purposes were included as control subjects. We compared demographic and clinicopathological characteristics between the groups. RESULTS: Overall, 285 patients with cervical cancer and 284 healthy subjects were included (age, 56.93±11.92 vs. 56.10±9.31 years). The mean body weight, body mass index (BMI), the incidence of diabetes mellitus and impaired fasting glucose were not statistically different between the 2 groups. The prevalence of colorectal adenoma was not different between the patient and control groups, regardless of examination extent. Multivariate analysis showed that age and BMI were significant independent risk factors for colorectal adenomatous polyps (age, p<0.001; BMI, p=0.002). CONCLUSION: There might not be any significant association between cervical cancer and colorectal adenomatous polyps.

A Pt/TiO(2)/Ti Schottky-type selection diode for alleviating the sneak current in resistance switching memory arrays.

This study examined the properties of Schottky-type diodes composed of Pt/TiO(2)/Ti, where the Pt/TiO(2) and TiO(2)/Ti junctions correspond to the blocking and ohmic contacts, respectively, as the selection device for a resistive switching cross-bar array. An extremely high forward-to-reverse current ratio of approximately 10(9) was achieved at 1 V when the TiO(2) film thickness was 19 nm. TiO(2) film was grown by atomic layer deposition at a substrate temperature of 250 degrees C. Conductive atomic force microscopy revealed that the forward current flew locally, which limits the maximum forward current density to < 10 A cm(-2) for a large electrode (an area of approximately 60 000 microm(2)). However, the local current measurement showed a local forward current density as high as approximately 10(5) A cm(-2). Therefore, it is expected that this type of Schottky diode effectively suppresses the sneak current without adverse interference effects in a nano-scale resistive switching cross-bar array with high block density.

Evaluation of a hybrid constructed wetland for treating domestic sewage from individual housing units surrounding agricultural villages in South Korea.

The treatment efficiency of 2- and 3-stage constructed wetlands (CWs) was evaluated for treating domestic sewage from houses surrounding agricultural villages. The optimum depth of filter media was 90 cm. The optimum volume ratio of vertical flow (VF) and horizontal flow (HF) beds was 1:2, and the optimum filter medium was broken stone in the VF-HF 2-stage hybrid CWs. Based on the above optimum conditions, removal efficiency of biochemical oxygen demand (BOD), chemical oxygen demand (COD), suspended solids (SS), total nitrogen (T-N), and total phosphorus (T-P) were 99, 98, 99, 68, and 72%, respectively. However to utilize constructed wetlands (CWs) for treating domestic sewage for an individual house, would require downsizing of the 2-stage hybrid CWs. In addition, the low removal efficiency of T-N and T-P in 2-stage hybrid CWs would require improvements necessary to meet acceptable water quality discharge standards. Thus, to reduce the CWs' area and improve the T-N and T-P removal efficiencies, VF-HF 2-stage hybrid CW was modified into VF/HF(I)-HF(II) and VF/HF(I)-HF(III) 3-stage hybrid CW. The optimum reduced size of 3-stage hybrid CW was the VF/HF(I)-HF(II) configuration which also increased T-N removal. Using this system, removal efficiency of BOD, COD, SS, T-N, and T-P were 99, 98, 99, 83, and 75%, respectively. In VF/HF(I)-HF(II) CW, the removal velocity of BOD, COD and SS was rapid on the order of VF (1st stage) >> HF(II) (3rd stage) > or = HF(I) (2nd stage), VF (1st stage) >> HF(II) (3rd stage) > HF(I) (2nd stage) and VF (1st stage) >> HF(I) (2nd stage) > HF(II) (3rd stage), respectively. The removal velocity of T-N and T-P in VF/HF(I)-HF(II) CWs was rapid on the order of HF(I) (2nd stage) > HF(II) (3rd stage) > or = VF (1st stage) and VF (1st stage) > HF(I) (2nd stage) > HF(II) (3rd stage), respectively.

Physical Health Literacy and Health-related Behaviors in Patients with Psychosis.

OBJECTIVE: : This study compared the levels of knowledge of physical illnesses and patterns of health behaviors between patients with psychosis and the general population. METHODS: : A total of 712 participants were included in the study; 292 patients with a schizophrenia spectrum disorder and 420 healthy controls matched for age and gender. Questionnaires were administered to study participants to determine the level of knowledge of chronic physical illnesses such as cancer, hypertension, and diabetes mellitus and health-related behavior. Results from the two study groups were compared to identify differences in knowledge of physical illness and health-related behaviors. RESULTS: : Compared with healthy controls, patients with psychosis were less likely to undergo regular medical check-ups and engage in exercise. Patients with psychosis had poorer knowledge of physical illnesses, and were more likely to smoke, be overweight, or have diabetes. Patients with psychosis were significantly less likely to acknowledge the importance of early detection of cancer and controlling hypertension and diabetes, independent of education and type of medical insurance. Patients who smoked were significantly less likely to agree with the statement on the relationship between smoking and physical illnesses. Patients not undergoing regular medical check-ups were significantly less likely to agree with statements concerning the need for cancer screening. CONCLUSION: : Patients with psychosis demonstrated lower levels of knowledge of physical illnesses and a lack of understanding of preventive behaviors. Low levels of knowledge were associated with poor health-related behaviors. Education of physical health should be provided to patients with psychosis.

Sonographic estimation of needle depth for cervical epidural blocks.

BACKGROUND: Cervical epidural steroid injections are often used to treat acute and chronic pain syndromes involving the face, neck, and upper extremities. Ultrasound has evolved as a valuable tool for performing neuraxial blocks, providing useful prepuncture information on the structure. Our goal was to evaluate the accuracy and precision of ultrasound by comparing skin to dura distance from ultrasound with the actual skin to epidural depth. METHODS: We enrolled 50 patients undergoing cervical epidural blocks at the pain clinic. Ultrasound images with transverse and longitudinal median views of the C6/7 area were taken. The epidural needle was inserted, reproducing the direction of the ultrasound beam on the longitudinal median view. Measured distances from skin to dura on each ultrasound view were compared with the actual needle depth. Additionally, we examined ultrasound visibility, the number of puncture attempts, and any complications related to the procedure. RESULTS: Concordance correlation coefficients between the measured distances on ultrasound and actual needle depth were 0.9272 and 0.9268 on transverse and longitudinal median view, respectively. The cervical epidural block was successfully performed on 48 patients (96%). There were two incidents (4%) of dural puncture. No bloody taps, postprocedure complications, or hemodynamic instability related to cervical epidural blocks occurred. CONCLUSIONS: Ultrasound provides very accurate information on the skin to dura distance for epidural blocks in the cervical spine. Knowledge of skin to dura distance and a preview of spinal anatomy before puncture can more safely identify the epidural space.

Optimal dose of combined rocuronium and cisatracurium during minor surgery: A randomized trial.

BACKGROUND: Combined rocuronium and cisatracurium have synergistic effects. We investigated whether reduced doses are effective during coadministration, by monitoring neuromuscular relaxation during surgery. METHODS: This randomized, controlled clinical trial was registered at http://clinicaltrials.gov (registration number NCT02495038). The participants were 81 patients scheduled for elective mastoidectomy and tympanoplasty. Participants were assigned to groups, including the intubating dose group (Group I, n = 27; combined ED95 rocuronium and ED95 cisatracurium), the small reduction group (Group S, n = 27; dose reduced by 10% of each ED95), or the large reduction group (Group L, n = 27; dose reduced by 20% of each ED95). Drugs were administered to patients and a timer was started using TOF-Watch monitoring. TOF (train-of-four) was monitored at the ulnar nerve, at a setting of 2 Hz/12 s. We recorded the time to TOF ratio = 0 (onset), time to first TOF ratio > 25% (duration 25%), and TOF 25-75% (recovery index) under total intravenous anesthesia. One-way analysis of variance was used for statistical analyses (α = 0.05, ß = 0.2). RESULTS: There were no significant demographic differences between groups. Group L had a longer duration to onset (mean ±â€Šstandard deviation, 399.3 ±â€Š147.8 seconds) and shorter duration 25% (39.4 ±â€Š6.8 minutes) compared to Group I (212.8 ±â€Š56.0 s and 51.3 ±â€Š8.47 minutes, respectively) and Group S (230.7 ±â€Š60.6 s and 47.9 ±â€Š10.7 minutes, respectively). There were no other significant differences between groups. CONCLUSION: Our findings contribute to determining clinically effective combinations of rocuronium and cisatracurium, as well as to predicting the pharmacokinetic characteristics of the synergistic effects. We suggest that reducing doses of both drugs by approximately 10% of their respective ED95 values is sufficient to maintain neuromuscular relaxation during minor surgery.

Latent Iron Deficiency as a Marker of Negative Symptoms in Patients with First-Episode Schizophrenia Spectrum Disorder.

Iron deficiency may alter dopaminergic transmission in the brain. This study investigated whether iron metabolism is associated with negative symptoms in patients with first-episode psychosis. The study enrolled 121 patients with first-episode schizophrenia spectrum disorder, whose duration of treatment was 2 months or less. Negative symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) and Clinician-Rated Dimensions of Psychosis Symptom Severity (Dimensional) scale of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Prominent negative symptoms were defined as moderate or severe negative symptoms on the Dimensional scale of the DSM-5. Iron deficiency was defined as a serum ferritin ≤ 20 ng/mL. Patients with iron deficiency were significantly more likely to have prominent negative symptoms (45.2 vs. 22.2%; p = 0.014) and a higher PANSS negative symptoms score (p = 0.046) than those with normal ferritin levels. Patients with prominent negative symptoms had significantly lower ferritin levels (p = 0.025). The significance of these results remained after controlling for the duration of illness and other confounding variables. Our finding of an independent association between iron deficiency and negative symptoms in patients at the very early stage of illness implies that iron dysregulation has an effect on negative symptoms in patients with schizophrenia. The possibility of therapeutic intervention with iron should be further investigated.

Effects of Combined Rocuronium and Cisatracurium in Laparoscopic Cholecystectomy.

BACKGROUND: Laparoscopic upper abdominal surgery can cause spontaneous respiration due to diaphragmatic stimulation and intra-abdominal CO2 inflation. Therefore, sufficient muscle relaxation is necessary for a safe surgical environment. METHODS: We investigated if the combination of rocuronium and cisatracurium can counteract the delayed onset of cisatracurium's action and delayed recovery of muscle relaxation and whether the dosage of rocuronium, which is metabolized hepatically, can be reduced. A total of 75 patients scheduled for laparoscopic cholecystectomy with an American Society of Anesthesiology physical status I-II, in the age range of 20-60 years, and with a 20-30 kg/m2 body mass index were included in the study. RESULTS: The patients were divided into the following groups: combination group (Group RC, rocuronium 0.3 mg/kg and cisatracurium 0.05 mg/kg), rocuronium group (Group R, rocuronium 0.6 mg/kg), and cisatracurium group (Group C, cisatracurium 0.1 mg/kg), and the onset, 25% duration, recovery index, and addition/time ratio were measured. Patients in Group RC exhibited a significantly different addition/time ratio compared with patients in the other two groups (p = 0.003). CONCLUSION: During laparoscopic cholecystectomy, the 95% effective dose of rocuronium in combination with cisatracurium is expected to provide a sufficient muscle relaxant effect.

Roles of conducting filament and non-filament regions in the Ta2O5 and HfO2 resistive switching memory for switching reliability.

The endurance of switching cycles, which is a critical measure of device reliability, in an ultra-thin (1.5 nm) Ta2O5 and HfO2 resistive random access (ReRAM) memory cell with a 28 nm lateral dimension was studied using current-voltage (I-V) sweep and closed-loop pulse switching (CLPS) tests. The two devices showed the typical oxygen-deficient conducting-filament (CF)-mediated bipolar resistance switching behaviour, which was induced by the asymmetric electrode configuration: Ta as the oxygen vacancy (VO) source/reservoir and TiN as the inert electrode. In these device geometries, the CF is supposed to initiate at the oxide/TiN interface and to grow towards the Ta electrode during the switch-on process, while the switch-off process was induced by the contraction of the CF from the Ta/oxide interface. Both devices, however, showed inversion (anomalous SET; switching from the off- to on-state) behaviour in the RESET (switching from the on- to off-state) process, which can be explained by the authors' previous model of the hourglass-shaped CF. In this model, once the CF is ruptured, the RESET polarity bias makes the lower portion of the CF regrow to slightly reconnect such a CF through the accelerated migration of VO from the upper-portion CF to the lower-portion CF, which induces switching performance degradation. In the I-V sweeps, the on- and off-states of the devices showed an overall conductance difference approximately corresponding to the integer multiple values of quantum point contact (G0), but there were arbitrary 0.25 and 0.125G0 differences in the conductance values of the on-state for the Ta2O5 and HfO2 devices, respectively. This suggests that these are the minimal units of conductance variation even for a given CF with a standard G0. Although the precise reason for the emergence of such an abnormal conductance unit is not yet understood, its implication for the reliability is critical. Reliable resistive switching was achieved only for the cases where the minimum point conductance was retained even in the off-state; in the other cases, over-SET and over-RESET were induced, which eventually degraded the device reliability. The detailed quantitative analysis of the device failure revealed that the increasing concentration of VO within the non-CF region in the cell decreased the resistance values of that region, which eventually resulted in the over-SET and over-RESET behaviours during the CLPS tests.

Suxamethonium induces a prompt increase in the bispectral index.

Upon inducting general anesthesia in the operating room, we have observed a prompt increase in the bispectral index (BIS) after the intravenous injection of suxamethonium. We hypothesized that the cause of this BIS increase is muscle hyperactivity owing to fasciculation. However, no reports have been published regarding this abrupt increase in the BIS upon the induction of general anesthesia by suxamethonium. To investigate the degree of change in the BIS in patients receiving anesthesia with suxamethonium, we performed a prospective observational study of 63 participants who underwent closed reduction for nasal bone fracture. Anesthesia was induced by the total intravenous administration of anesthetics and 1.5 mg kg of suxamethonium was injected intravenously upon achieving BIS between 45 and 55. Intubation was performed after fasciculation. Electromyograms and BIS values were recorded from the induction of suxamethonium until 15 minutes after intubation. The mean BIS values were 95.4, 48.5, and 69.3 before induction, before the intravenous injection of suxamethonium, and immediately after fasciculation, respectively. The BIS value immediately after fasciculation (69.3 ±â€Š10.6) was significantly higher than the cutoff BIS value of 60 (P < .001). Although fasciculation after the intravenous injection of suxamethonium resulted in the prompt increase of the BIS to values over 60, none of the participants was awake during surgery. In conclusion, the administration of suxamethonium resulted in the postfasciculation increase of the BIS to an average value of 69.3 without affecting the patient's state of consciousness.