Wireless flow-powered miniature robot capable of traversing tubular structures.

Wireless millimeter-scale robots capable of navigating through fluid-flowing tubular structures hold substantial potential for inspection, maintenance, or repair use in nuclear, industrial, and medical applications. However, prevalent reliance on external powering constrains these robots' operational range and applicable environments. Alternatives with onboard powering must trade off size, functionality, and operation duration. Here, we propose a wireless millimeter-scale wheeled robot capable of using environmental flows to power and actuate its long-distance locomotion through complex pipelines. The flow-powering module can convert flow energy into mechanical energy, achieving an impeller speed of up to 9595 revolutions per minute, accompanied by an output power density of 11.7 watts per cubic meter and an efficiency of 33.7%. A miniature gearbox module can further transmit the converted mechanical energy into the robot's locomotion system, allowing the robot to move against water flow at an average rate of up to 1.05 meters per second. The robot's motion status (moving against/with flow or pausing) can be switched using an external magnetic field or an onboard mechanical regulator, contingent on different proposed control designs. In addition, we designed kirigami-based soft wheels for adaptive locomotion. The robot can move against flows of various substances within pipes featuring complex geometries and diverse materials. Solely powered by flow, the robot can transport cylindrical payloads with a diameter of up to 55% of the pipe's diameter and carry devices such as an endoscopic camera for pipeline inspection, a wireless temperature sensor for environmental temperature monitoring, and a leak-stopper shell for infrastructure maintenance.

The impact of corporate culture on industrial accidents in high-risk industries: a cross-sectional survey.

The rate of industrial accidents in Korea is two to three times higher than those in advanced countries such as Germany. These accidents are mainly concentrated in high-risk industrial areas. Using the ninth wave of the Occupational Safety and Health Company Survey by the Occupational Safety and Health Research Institute (OSHRI), we analyzed the influence of corporate culture on the occurrence of occupational accidents in high-risk industries using negative binomial regression. We found that older workers and foreign workers had a positive effect on the accident rate, while female workers had a negative effect on the accident rate. In addition, it was found that the health and safety management organization also reduced occupational accidents. Corporate culture and workplace environment significantly reduced industrial accidents among workers. This suggests that internal elements of an organization such as corporate culture and working environment can have an impact in reducing the occurrence of industrial accidents.

A Review: Pharmacological Effect of Natural Compounds in Diospyros kaki Leaves from the Perspective of Oxidative Stress.

Oxidative stress is caused by an imbalance between reactive oxygen species and antioxidant levels. Current research suggests that oxidative stress is one of the key factors in the development of many chronic diseases, and it has been a concern for many years. Many natural compounds have been studied for their special free-radical-scavenging properties. The major chemical constituents of the leaves of Diospyros kaki are flavonoids and triterpenoids, both of which are potential antioxidants that can prevent damage caused by reactive oxygen species or reactive nitrogen species and ameliorate diseases associated with oxidative stress. In addition to the major constituents such as flavonoids and triterpenoids, the leaves of Diospyros kaki include compounds such as phenylpropanoids, alkaloids, phenolic acids, and terpenes. Studies have shown these compounds have certain antioxidant and neuroprotective activities. Experiments have shown that flavonoids or the extracts from the leaves of Diospyros kaki have a variety of good pharmacological activities, which could activate oxidative stress and mitochondrial apoptosis, inhibit the proliferation of human prostate cancer cells and induce apoptosis. It also could achieve the effect of anti-cancer cell proliferation and induce apoptosis by regulating oxidative stress. The main chemical substance of the leaves of Diospyros kaki regulating oxidative stress may be these multi-hydroxyl structure compounds. These natural products exhibit significant antioxidant activity and are an important basis for the leaves of Diospyros kaki to treat human diseases by regulating oxidative stress. This review summarizes the structural types of natural products in the leaves of Diospyros kaki and elaborates the mechanism of the leaves of Diospyros kaki in neuroprotection, anti-diabetes, renal protection, retinal degenerative diseases, and anti-cancer from a new perspective of oxidative stress, including how it supplements other pharmacological effects. The chemical constituents and pharmacological effects of the leaves of Diospyros kaki are summarized in this paper. The relationship between the chemical components in the leaves of Diospyros kaki and their pharmacological effects is summarized from the perspective of oxidative stress. This review provides a reference for the study of natural anti-oxidative stress drugs.

Soft-robotic ciliated epidermis for reconfigurable coordinated fluid manipulation.

The fluid manipulation capabilities of current artificial cilia are severely handicapped by the inability to reconfigure near-surface flow on various static or dynamically deforming three-dimensional (3D) substrates. To overcome this challenge, we propose an electrically driven soft-robotic ciliated epidermis with multiple independently controlled polypyrrole bending actuators. The beating kinematics and the coordination of multiple actuators can be dynamically reconfigured to control the strength and direction of fluid transportation. We achieve fluid transportation along and perpendicular to the beating directions of the actuator arrays, and toward or away from the substrate. The ciliated epidermises are bendable and stretchable and can be deployed on various static or dynamically deforming 3D surfaces. They enable previously difficult to obtain fluid manipulation functionalities, such as transporting fluid in tubular structures or enhancing fluid transportation near dynamically bending and expanding surfaces.

Magnetically actuated gearbox for the wireless control of millimeter-scale robots.

The limited force or torque outputs of miniature magnetic actuators constrain the locomotion performances and functionalities of magnetic millimeter-scale robots. Here, we present a magnetically actuated gearbox with a maximum size of 3 millimeters for driving wireless millirobots. The gearbox is assembled using microgears that have reference diameters down to 270 micrometers and are made of aluminum-filled epoxy resins through casting. With a magnetic disk attached to the input shaft, the gearbox can be driven by a rotating external magnetic field, which is not more than 6.8 millitesla, to produce torque of up to 0.182 millinewton meters at 40 hertz. The corresponding torque and power densities are 12.15 micronewton meters per cubic millimeter and 8.93 microwatt per cubic millimeter, respectively. The transmission efficiency of the gearbox in the air is between 25.1 and 29.2% at actuation frequencies ranging from 1 to 40 hertz, and it lowers when the gearbox is actuated in viscous liquids. This miniature gearbox can be accessed wirelessly and integrated with various functional modules to repeatedly generate large actuation forces, strains, and speeds; store energy in elastic components; and lock up mechanical linkages. These characteristics enable us to achieve a peristaltic robot that can crawl on a flat substrate or inside a tube, a jumping robot with a tunable jumping height, a clamping robot that can sample solid objects by grasping, a needle-puncture robot that can take samples from the inside of the target, and a syringe robot that can collect or release liquids.

Cloning and functional characterization of three sesquiterpene synthase genes from Chamaecyparis formosensis Matsumura.

Terpene synthase (TPS) analysis may contribute to a better understanding of terpenoids biosynthesis and the evolution of phylogenetic taxonomy. Chamaecyparis formosensis Matsumura is an endemic and valuable conifer of Taiwan. Its excellent wood quality, fragrance, and durability make it become the five precious conifers in Taiwan. In this study, three sesquiterpene synthase genes that belong to the TPS-d2 clade were isolated and characterized through in vitro reaction of recombinant protein and in vivo reaction of Escherichia coli heterologous expression system. The main product of Cf-GerA was germacrene A using GC/MS analysis, while the product of Cf-Aco and Cf-Gor were identified as acora-4(14),8-diene and (5R,6R,10S)-α-gorgonene by using NMR analysis. These are the first reported enzymes that biosynthesize acora-4(14),8-diene and (5 R,6 R,10 S)-α-gorgonene. Both sesquiterpene synthases may isomerize the farnesyl pyrophosphate substrate to nerolidyl pyrophosphate for further cyclization. Cf-Aco may catalyze 1,6-cyclization of nerolidyl cation while Cf-Gor may catalyze through an uncharged intermediate, isogermacrene A.

Potential of Steroidal Alkaloids in Cancer: Perspective Insight Into Structure-Activity Relationships.

Steroidal alkaloids contain both steroidal and alkaloid properties in terms of chemical properties and pharmacological activities. Due to outstanding biological activities such as alkaloids and similar pharmacological effects to other steroids, steroidal alkaloids have received special attention in anticancer activity recently. Substituted groups in chemical structure play markedly important roles in biological activities. Therefore, the effective way to obtain lead compounds quickly is structural modification, which is guided by structure-activity relationships (SARs). This review presents the SAR of steroidal alkaloids and anticancer, including pregnane alkaloids, cyclopregnane alkaloids, cholestane alkaloids, C-nor-D-homosteroidal alkaloids, and bis-steroidal pyrazine. A summary of SAR can powerfully help to design and synthesize more lead compounds.

Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination

ObjectiveTo determine whether antibodies against the SARS-CoV-2 spike protein following BNT162B2 (Pfizer-BioNTech) COVID-19 mRNA vaccination cross-react with human syncytin-1 protein, and if BNT162B2 mRNA enters breast milk. MethodsIn this observational cohort study of female front-line workers with no history of COVID-19 infection, we amplified BNT162B2 mRNA in plasma and breast milk and assayed anti-SARS-CoV-2 neutralising antibodies and anti-human syncytin-1 binding antibodies in plasma, at early (1-4 days) and late (4-7 weeks) time points following first-dose vaccination. ResultsFifteen consented participants (mean age 40.4 years, various ethnicities) who received at least one dose of BNT162B2, including five breast-feeding women and two women who were inadvertently vaccinated in early pregnancy, were recruited. BNT162B2 mRNA, detected by amplifying part of the spike-encoding region, was detected in plasma 1-4 days following the first dose (n=13), but not 4-5 weeks later (n=2), nor was the mRNA isolated from aqueous or lipid breast milk fractions collected 0-7 days post-vaccination (n=5). Vaccine recipients demonstrated strong SARS-CoV-2 neutralising activity by at least four weeks after the first dose (n=15), including the two pregnant women. None had placental anti-syncytin-1 binding antibodies at either time-point following vaccination. ConclusionsBNT162B2-vaccinated women did not transmit vaccine mRNA to breast milk, and did not produce a concurrent humoral response to syncytin-1, suggesting that cross-reactivity to syncytin-1 on the developing trophoblast, or other adverse effects in the breast-fed infant from vaccine mRNA ingestion, are unlikely. What are the novel findings of this work?COVID-19 vaccination with BNT162B2 did not elicit a cross-reacting humoral response to human syncytin-1 despite robust neutralising activity to the SARS-CoV2 spike protein, and while vaccine mRNA was isolated from plasma, it was not found in breast milk. What are the clinical implications of this work?Our work directly addresses the fertility and breastfeeding concerns fuelling vaccine hesitancy among reproductive-age women, by suggesting that BNT162B2 vaccination is unlikely to cause adverse effects on the developing trophoblast, via cross-reacting anti-syncytin-1 antibodies, or to the breastfed neonate, via mRNA breast milk transmission.

Rolling-shutter-effect camera-based visible light communication using RGB channel separation and an artificial neural network.

We propose and demonstrate a light-panel and rolling-shutter-effect (RSE) camera-based visible light communication (VLC) system using Z-score normalization, red/green/blue (RGB) color channel separation, and 1-D artificial neural network (ANN). The proposed scheme can mitigate the high inter-symbol interference (ISI) generated by the RSE pattern due to the low pixel-per-bit and high noise-ratio (NR) of the display contents.

Visible light positioning (VLP) system using low-cost organic photovoltaic cell (OPVC) for low illumination environments.

We propose and demonstrate a received-signal-strength (RSS) based visible light positioning (VLP) system using a low-cost organic photovoltaic cell (OPVC) receiver (Rx). The OPVC is a passive device without the need of external power supply. It could detect VLC signal and harvest energy. Our developed OPVC has a high power conversion efficiency (PCE) of 9.8%. The VLP system can be operated at a low illumination of 130 lux. The regression machine learning (ML) algorithm is used to enhance the positioning accuracy.

A novel circular RNA hsa_circ_0008035 contributes to gastric cancer tumorigenesis through targeting the miR-375/YBX1 axis.

Circular RNAs (circRNAs) play an important regulatory role in a variety of human cancers, including gastric cancer. The mechanisms for the circRNAs in gastric cancers are not fully understood. This study aims to uncover the mechanism by which circRNAs regulate gastric cancer tumorigenesis. Among the microarray data, we screened dysregulated circRNAs and identified an up-regulated circRNA, hsa_circ_0008035. Functionally, the hsa_circ_0008035 silencing by the siRNA transfection inhibited the proliferation and invasion of gastric cancer cells. Mechanically, hsa_circ_0008035 acted as a sponge for the miR-375 and absorbed its expression, and miR-375 was found to target YBX1 3'-UTR, constructing a hsa_circ_0008035/miR-375/YBX1 axis. Taken together, these findings are evidence that circRNA hsa_circ_0008035 promotes gastric cancer cell proliferation and invasion by regulating miR-375/YBX1.

Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?

OBJECTIVE: Adult appendicitis (AA) with equivocal computed tomography (CT) findings remains a diagnostic challenge for physicians. Herein we evaluated the diagnostic performance of several clinical scoring systems in adult patients with suspected appendicitis and equivocal CT findings. METHODS: We retrospectively evaluated 189 adult patients with equivocal CT findings. Alvarado, Eskelinen, appendicitis inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and adult appendicitis score (AAS) scores were evaluated, receiver operating characteristic analysis was conducted, and the optimal, low, and high cut-off values were determined for patient classification into three groups: low, intermediate, or high. RESULTS: In total, 61 patients were included in the appendicitis group and 128 in the non-appendicitis group. There were no significant differences between the area under the curve of the clinical scoring systems in the final diagnosis of AA for equivocal appendicitis on CT (Alvarado, 0.698; Eskelinen, 0.710; appendicitis inflammatory response, 0.668; RIPASA, 0.653; AAS, 0.726). A RIPASA score greater than 7.5 had a high positive predictive value (90.9) and an AAS score less than or equal to 5 had a high negative predictive value (91.7) in the diagnosis of AA. CONCLUSION: The accuracy of clinical scoring systems in the diagnosis of AA with equivocal CT findings was moderate. Therefore, a high RIPASA score may assist in the diagnosis of AA in patients with equivocal CT findings, and a low AAS score may be used as a criterion for patient discharge. Most patients presented with intermediate scores. The patients with equivocal CT findings may be considered as a third diagnostic category of AA.

Randomized, noninferiority study between video versus hand ultrasound with wet foam dressing materials to simulate B-lines in lung ultrasound: A CONSORT-compliant article.

BACKGROUND: This study evaluated the efficacy of a teaching method using simulated B-lines of hand ultrasound with a wet foam dressing material. METHODS: This prospective, randomized, noninferiority study was conducted on emergency medical technician students without any relevant training in ultrasound. Following a lecture including simulated (SG) or real video clips (RG) of B-lines, a posttest was conducted and a retention test was performed after 2 months. The test consisted of questions about B-lines in 40 randomly mixed video clips (20 simulated and 20 real videos) with 4 answer scores (R-1 [the correct answer score for the real video clips] vs S-1 [the correct answer score for the simulated video clips] in the posttest, R-2 [the correct answer score for the real video clips] vs S-2 [the correct answer score for the simulated video clips] in the retention test). RESULTS: A total of 77 and 73 volunteers participated in the posttest (RG, 38; SG, 39) and retention test (RG, 36; SG, 37), respectively. There was no significant (P > .05) difference in scores of R-1, S-1, R-2, or S-2 between RG and SG. The mean score differences between RG and SG were -0.6 (95% confidence interval [CI]: -1.49 to 0.11) in R-1, -0.1 (95% CI: -1.04 to 0.86) in S-1, 0 (95% CI: -1.57 to 1.50) in R-2, and -0.2 (95% CI: -1.52 to 0.25) in S-2. The mean differences and 95% CIs for all parameters fell within the noninferiority margin of 2 points (10%). CONCLUSION: Simulated B-lines of hand ultrasound with a wet foam dressing material were not inferior to real B-lines. They were effective for teaching and simulations. TRIAL REGISTRATION: The study was registered with the Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp (KCT0002144).

Does the use of bedside ultrasonography reduce emergency department length of stay for patients with renal colic?: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the effect of adding bedside ultrasonography to the diagnostic algorithm for nephrolithiasis on emergency department (ED) length of stay. METHODS: A prospective, randomized, controlled pilot study was conducted from October 2014 to December 2014 with patients with acute flank pain. In the non-ultrasonography group (NUSG), non-contrast computed tomography was selected based on clinical features and hematuria in the urinalysis. In the ultrasonography group (USG), non-contrast computed tomography was selected based on clinical features and hydronephrosis on bedside ultrasonography. The primary outcome was ED length of stay. The secondary outcomes were radiation exposure, amount of analgesics, proportion of patients with diseases other than ureteral calculus, and proportion of patients with unexpected ED revisits within 7 days from the index visit. RESULTS: A total of 103 patients were enrolled (NUSG, 51; USG, 52). The ED length of stay for the USG (89.0 minutes) was significantly shorter than that for the NUSG (163.0 minutes, P<0.001). There were no significant differences between the two groups in the radiation exposure dose (5.29 and 5.08 mSv, respectively; P=0.392), amount of analgesics (P=0.341), proportion of patients with diseases other than ureteral calculus (13.0% and 6.8%, respectively; P=0.486), and proportion of patients with unexpected ED revisits within 7 days from the index visit (7.8% and 9.6%, respectively; P=1.000). CONCLUSION: The use of early bedside ultrasonography for patients with acute flank pain could reduce the ED length of stay without increasing unexpected ED revisits.

Fosinopril Prevents the Development of Tactile Allodynia in a Streptozotocin-Induced Diabetic Rat Model.

The aim of this study was to evaluate fosinopril-induced changes in hemodynamic parameters and tactile allodynia in a rat model of diabetes. Diabetes was induced by streptozotocin (STZ; 50 mg/kg, i.p.) in male Wistar rats. STZ produced hyperglycemia, weight loss, polydipsia, polyphagia, and polyuria as well as long-term arterial hypotension, bradycardia, and tactile allodynia at 10-12 weeks. Daily administration of the angiotensin converting enzyme inhibitor, fosinopril (25 mg/kg, p.o., for 11 weeks) partially reduced the loss of body weight, decreased hyperglycemia, and systolic blood pressure in diabetic rats. Likewise, systemic administration of fosinopril prevented the development and maintenance of tactile allodynia in STZ-induced diabetic rats. These data suggest that fosinopril may have a role in the pharmacotherapy of diabetic neuropathic pain.

Evaluation of a novel simulation method of teaching B-lines: hand ultrasound with a wet foam dressing material.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of teaching A- and B-lines, and lung sliding with a novel simulation methods using hand ultrasound. METHODS: All subjects enrolled were medical school students who were novices in lung ultrasound. All subjects attended a 20-minute lecture about lung ultrasound using simulated video clips of A-lines, B-lines, and lung sliding; and then a 20-minute post-test was administered. The post-test included questions on the presence or absence of A-lines, B-lines, and lung sliding using a random mixture of 20 real video clips and 20 simulated video clips created by using hand ultrasound with or without foam dressing materials. A Wilcoxon signed rank test was used to compare the scores of A-lines, B-lines, and lung sliding between the real images (RG) and simulated models (SG). RESULTS: There was a statistically significant difference in the median score of the correct answers for A-lines (RG, 18; SG, 17; P=0.037). Correct answers for B-line were significantly different between RG and SG group (RG, 18; SG, 17; P=0.008). There was a statistically significant difference in the median score of the correct answers for lung sliding (RG, 16; SG, 18; P<0.001). CONCLUSION: We found this novel B-line teaching model by using a hand ultrasound with a wet foam dressing material is effective for beginners who are less experienced with lung ultrasound and pulmonary interstitial syndrome.

Performance of intubation with 4 different airway devices by unskilled rescuers: manikin study.

INTRODUCTION: This study was designed to compare the performances of 4 airway devices in achieving successful ventilation. METHODS: A randomized crossover trial was conducted to evaluate 4 airway devices: laryngeal mask airway (LMA), i-gel (iGEL), PENTAX Airway Scope (AWS), and Macintosh laryngoscope (MCL). Thirty-eight unskilled rescuers performed intubation on a manikin during chest compressions in normal and difficult airway scenarios. The time to ventilation, intubation success rate, and difficulty of intubation were measured. RESULTS: The time to ventilation of the airway devices in the normal scenario had a median value of 8.8 seconds (interquartile range, 7.3-10.5 seconds) for iGEL, 16.1 seconds (13.9-19.3 seconds) for LMA, 30.6 seconds (24.6-37.6 seconds) for AWS, and 35.0 seconds (29.5-45.9 seconds) for MCL. In the difficult airway scenario, the respective time to ventilation was 8.6 seconds (7.8-10.0 seconds), 15.3 seconds (14.3-20.2 seconds), 29.4 seconds (25.7-36.3 seconds) and 59.0 seconds (46.1-103.3 seconds). The success rates were 100% and 100% for LMA, 100% and 100% for iGEL, 97.4% and 94.7% for AWS, and 78.9% and 47.4% for MCL in the normal and difficult airway scenarios. The difficulties of intubation expressed as numerical rating scale were 2.0 and 2.0 (median values) for LMA, 1.0 and 2.0 for iGEL, 3.0 and 3.0 for AWS, and 4.0 and 5.0 for MCL in the normal and difficult airway scenarios, respectively. CONCLUSION: With novice intubators who were unfamiliar with the airway devices, the LMA, iGEL, and AWS were superior to the MCL for establishing an airway without interruption of chest compressions in a manikin study. Intubation with the iGEL was faster and easier than with the other airway devices.

Research on the relationship between Parkinson's disease and Helicobacter pylori infection in middle-aged and elderly people / 中华老年医学杂志

Objective To investigate the prevalence of Helicobacter pylori (HP) infection in patients with Parkinson's disease (PD), and analyze the relationship of HP infection with the symptoms, disease progression and motor complications of PD.Methods 72 PD outpatients were randomly selected, and 100 gender and age-matched subjects who took health physical examination were considered as healthy controls.Basic data were collected and estimated by Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage, the 39-item Parkinson' s Disease Questionnaire (PDQ-39), Activity of Daily Living Scale (ADL), Minimum Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA).All subjects underwent 13C-urea breath test to determine Helicobacter pylori infection status.Results There was no significant difference in H P infection rate between PD and control groups [37.5 ％ (27 cases)vs.32.0％ (32 cases), P=0.45].According to the initial symptoms, PD patients were divided into two groups: bradykinesia/ rigidity group and tremor group.The HP infection rate was higher in bradykinesia/rigidity group than in tremor group [52.2％ (12 cases) vs.30.6％ (15 cases)], but had no significant difference (P=0.08).The mean HY stage was higher in the HP-infected patient group than in the non-infected group [(2.6±0.7) vs.(2.2±0.9), P=0.03].The HP infection rate was higher in patients with HY stage ≥2 than with HY stage ＜2 [46.4％ (26 cases) vs.6.3％ (1 case),P=0.003].There were no correlations of HP infection with gender, age, age of onset, UPDRS, UPDRS-Ⅲ, PDQ-39, the course of the disease, wearing-off phenomenon, and dyskinesias.Conclusions The PD patients with HP infection are mainly at middle-and late-stage.HP infection may be related with the progress of the disease.It needs further study and validation by expanding the sample to investigate whether HP infection affects the motor complications.

Feasibility of optic nerve sheath diameter measured on initial brain computed tomography as an early neurologic outcome predictor after cardiac arrest.

OBJECTIVES: Few parameters are available to predict neurologic outcome of post-cardiac arrest patients in the early stage of treatment. Optic nerve sheath diameter (ONSD) has been used to indirectly assess intracranial pressure. This study evaluated whether ONSD, an additional parameter in initial brain computed tomography (CT) scans, can be an early predictor of neurologic outcome in post-cardiac arrest patients. METHODS: A total of 112 cardiac arrest patients between November 2012 and October 2013 were identified. Ninety-eight comatose cardiac arrest patients were evaluated with brain CT. Of these patients, after exclusion of patients whose brain CT scans were done too late or with poor baseline neurology (Cerebral Performance Category [CPC] ≥ 3), 91 patients were included for this study. The parameters of initial brain CT, i.e., gray matter-to-white matter ratio (GWR) and ONSD, were measured after clinical care as part of a retrospective reanalysis of images. ONSD on brain CT was bilaterally measured 3 mm behind the eyeball at fixed window width and level and averaged to yield the mean value. The performance of ONSD to predict poor neurologic outcome (CPC = 3 to 5) was analyzed using multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and cross-tabulations. RESULTS: Twenty-three patients showed good neurologic outcomes at hospital discharge. Mean (±SD) ONSD was 5.6 (±0.3) mm in the good outcome group versus 6.3 (±0.5) mm in the poor outcome group (p < 0.001). After basic clinical covariates were controlled for, i.e., age, Glasgow Coma Scale (GCS) score (3 vs. 4-15), and time from collapse to return of spontaneous circulation (ROSC), ONSD (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.1 to 3.9) and GWR (OR = 0.6; 95% CI = 0.4 to 0.9) were found to be significant factors for predicting poor neurologic outcome. ROC curve analysis showed that ONSD and GWR had areas under the ROC curve of 0.931 (95% CI = 0.87 to 0.98) and 0.922 (95% CI = 0.86 to 0.97), respectively. Combining the cutoff values of ONSD (6.21 mm, sensitivity = 56%; 95% CI = 43% to 68%) and GWR (1.23, sensitivity = 84%; 95% CI = 73% to 92%) to have 100% specificities, the sensitivity was improved to 92% (95% CI = 84% to 98%). Intrarater and interrater intraclass correlation coefficients between the investigators measuring ONSD were 0.888 and 0.833, respectively. CONCLUSIONS: Optic nerve sheath diameter on initial brain CT correlated closely with the neurologic outcome of hypoxic ischemic encephalopathy and had good reliability. Additional prospective work may be justified evaluating the standardization and diagnostic performance in real time use as a predictive tool for neurologic outcome following cardiac arrest.

Early hyperoxemia may not increase mortality after cardiac arrest: a pilot study.

OBJECTIVE: International Liaison Committee on Resuscitation guidelines advocate an arterial saturation of 94% to 96% after return of spontaneous circulation (ROSC). However, a few clinical trials have investigated the impact of postresuscitative O2 therapy after cardiac arrest. We studied whether early hyperoxemia is associated with a poor post-ROSC outcome after in-hospital cardiac arrest. METHODS: We retrospectively reviewed patients who experienced an in-hospital cardiac arrest from January 2005 to January 2011. Based on the results of the first arterial blood gas analysis (ABGA) within 10 minutes and a second ABGA from 60 to 120 minutes after ROSC, patients were classified into three groups: hyperoxemia (PaO2 ≥ 300 mmHg), normoxemia (300 mmHg > PaO2 ≥ 60 mmHg), and hypoxemia (PaO2 < 60 mmHg or ratio of PaO2 to fraction of inspired oxygen < 300). We examined whether early hyperoxemia was associated with survival and neurological outcome. RESULTS: There were 792 patients who met the inclusion criteria: 638 (80.6%) in the hypoxemia group, 62 (7.8%) in the normoxemia group, and 92 (11.6%) in the hyperoxemia group. Multiple logistic regression analysis showed that hyperoxemia was not associated with survival (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.30 to 3.84) or neurological outcome (OR, 1.03; 95% CI, 0.31 to 3.40). CONCLUSION: Postresuscitation hyperoxemia was not associated with survival or neurological outcome in patients with ROSC after in-hospital cardiac arrest.