Novel Mode of Near-Infrared Spectroscopy as a Continuous Cerebral Physiological Monitoring Device during Cardiopulmonary Resuscitation: Four Case Reports.

BACKGROUND: NIRO-Pulse is a novel mode of near-infrared spectroscopy that can be used to visually evaluate cerebral perfusion during cardiopulmonary resuscitation (CPR), providing real-time feedback as to the quality of the CPR. The aim of this report was to describe the several representative cases of NIRO-Pulse for physiological monitoring during CPR. METHODS: We present several cases from out-of-hospital cardiac arrest (OHCA) patients for whom NIRO-Pulse was attached to the forehead after hospital arrival. Patients were subjected to continuous brain monitoring during CPR using NIRO-Pulse, which allows for the visualisation of ΔHb (Hb pulsation). NIRO-Pulse is capable of simultaneously measuring and displaying cerebral tissue oxygen saturation (SctO2) and Hb pulsation, providing real-time feedback during CPR in the form of physiological indicators, and assessing changes in SctO2 throughout the CPR procedure by post-mortem analysis. RESULTS: We observed several representative cases that provided the following insights: (1) SctO2 increased after a change in the quality of chest compression, (2) SctO2 decreased during the ventilation phase of synchronised CPR, (3) SctO2 decreased during the interruption of chest compressions for the preparation of defibrillation, and (4) SctO2 gradually and continuously increased after return of spontaneous circulation. CONCLUSION: Displaying Hb pulsation in conjunction with SctO2 during CPR may be helpful for evaluating the quality of and patient responsiveness to CPR. Further studies investigating the association between the use of NIRO-Pulse during CPR and subsequent outcomes should be conducted.

Successful Coil Embolization Using Percutaneous Cardiopulmonary Support in a Patient with Refractory Out-of-hospital Cardiac Arrest Caused by Aneurysmal Subarachnoid Hemorrhage.

In recent years, extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be an effective alternative to conventional CPR for treating patients with reversible causes of cardiac arrest. Nevertheless, the definite indication for ECPR and also surgical interventions during ECPR treatment have not been established, especially in patients with out-of-hospital cardiac arrest (OHCA) caused by subarachnoid hemorrhage (SAH). We treated a comatose 50-year-old woman with refractory cardiac arrest due to aneurysmal SAH-induced takotsubo cardiomyopathy (TCM). The initial cardiac rhythm was ventricular fibrillation. This is the first case report on coil embolization being successfully performed on a patient undergoing ECPR and therapeutic hypothermia (TH) while the patient was still in cardiac arrest, which resulted in complete social rehabilitation. Moreover, the success of this treatment suggests that ECPR and endovascular therapy should be considered for highly selected patients when cardiopulmonary and neurological functions are potentially reversible even in the setting of SAH.

Evaluating Precipitation Features and Rainfall Characteristics in a Multi-Scale Modeling Framework.

Cloud and precipitation systems are simulated with a multi-scale modeling framework (MMF) and compared over the Tropics and Subtropics against the Tropical Rainfall Measuring Mission (TRMM) Radar-defined Precipitation Features (RPFs) product. A methodology, in close analogy to the TRMM RPFs, is developed to produce simulated precipitation features (PFs) from the output of the embedded two-dimensional (2D) cloud-resolving models (CRMs) within an MMF. Despite the limitations of 2D CRMs, the simulated population distribution, horizontal and vertical structure of PFs, and the geographical location and local rainfall contribution of mesoscale convective systems (MCSs) are in good agreement with the TRMM observations. However, some model discrepancies are found and can be identified and quantified within the PF distributions. Using model biases in relative population and rainfall contributions, PFs can be characterized into four size categories: small, medium to large, very large, and extremely large. Four different major mechanisms might account for the model biases in each different category: (1) the two-dimensionality of the CRMs, (2) a positive convection-wind-evaporation feedback loop, (3) an artificial dynamic constraint in a bounded CRM domain with cyclic boundaries, and (4) the limited CRM domain size. The second and fourth mechanisms tend to contribute to the excessive tropical precipitation biases commonly found in most MMFs, whereas the other mechanisms reduce rainfall contributions from small and very large PFs. MMF sensitivity experiments with various CRM domain sizes and grid spacings showed that larger domains (higher resolutions) tend to shift PF populations toward larger (smaller) sizes.

Evaluating the Impact of Assimilating Aerosol Optical Depth Observations on Dust Forecasts Over North Africa and the East Atlantic Using Different Data Assimilation Methods.

This study evaluates the impact of assimilating moderate resolution imaging spectroradiometer (MODIS) aerosol optical depth (AOD) data using different data assimilation (DA) methods on dust analyses and forecasts over North Africa and tropical North Atlantic. To do so, seven experiments are conducted using the Weather Research and Forecasting dust model and the Gridpoint Statistical Interpolation analysis system. Six of these experiments differ in whether or not AOD observations are assimilated and the DA method used, the latter of which includes the three-dimensional variational (3D-Var), ensemble square root filter (EnSRF), and hybrid methods. The seventh experiment, which allows us to assess the impact of assimilating deep blue AOD data, assimilates only dark target AOD data using the hybrid method. The assimilation of MODIS AOD data clearly improves AOD analyses and forecasts up to 48 hr in length. Results also show that assimilating deep blue data has a primarily positive effect on AOD analyses and forecasts over and downstream of the major North African source regions. Without assimilating deep blue data (assimilating dark target only), AOD assimilation only improves AOD forecasts for up to 30 hr. Of the three DA methods examined, the hybrid and EnSRF methods produce better AOD analyses and forecasts than the 3D-Var method does. Despite the clear benefit of AOD assimilation for AOD analyses and forecasts, the lack of information regarding the vertical distribution of aerosols in AOD data means that AOD assimilation has very little positive effect on analyzed or forecasted vertical profiles of backscatter.

High-resolution NU-WRF simulations of a deep convective-precipitation system during MC3E: Further improvements and comparisons between Goddard microphysics schemes and observations.

The Goddard microphysics was recently improved by adding a fourth ice class (frozen drops/hail). This new 4ICE scheme was developed and tested in the Goddard Cumulus Ensemble (GCE) model for an intense continental squall line and a moderate, less organized continental case. Simulated peak radar reflectivity profiles were improved in intensity and shape for both cases, as were the overall reflectivity probability distributions versus observations. In this study, the new Goddard 4ICE scheme is implemented into the regional-scale NASA Unified-Weather Research and Forecasting (NU-WRF) model, modified and evaluated for the same intense squall line, which occurred during the Midlatitude Continental Convective Clouds Experiment (MC3E). NU-WRF simulated radar reflectivities, total rainfall, propagation, and convective system structures using the 4ICE scheme modified herein agree as well as or significantly better with observations than the original 4ICE and two previous 3ICE (graupel or hail) versions of the Goddard microphysics. With the modified 4ICE, the bin microphysics-based rain evaporation correction improves propagation and in conjunction with eliminating the unrealistic dry collection of ice/snow by hail can replicate the erect, narrow, and intense convective cores. Revisions to the ice supersaturation, ice number concentration formula, and snow size mapping, including a new snow breakup effect, allow the modified 4ICE to produce a stronger, better organized system, more snow, and mimic the strong aggregation signature in the radar distributions. NU-WRF original 4ICE simulated radar reflectivity distributions are consistent with and generally superior to those using the GCE due to the less restrictive domain and lateral boundaries.

[Evaluation of long-term results in patients who underwent reconstruction of thoracic wall with curved metal plates].

Between 1992 and 2011, 22 patients underwent surgery of reconstruction of thoracic wall with curved metal plates for multiple rib fracture and resection of thoracic wall tumor. They were divided into 2 groups according to original disorders. Twelve cases of group A accepted surgical stabilization of traumatic multiple rib fractures with the metal plates fixed on the fractured ribs as an external brace. Ten patients of group B were suffered from thoracic wall tumors, including 1 fibrous dysplagia, 1 chondroma, 5 invasive lung cancer, 2 rib metastases and 1 primary chest wall cancer. After the resection of tumors, an average of 3.2 ribs were removed, the defects of full thickness chest wall were reconstructed using a combination of a polypropylene mesh and the metal plates. In both groups, there were no displacement of the plates and allergic reaction. Only 2 patients needed removal of the fixed plates due to pyothorax caused by pneumonia after crushing thoracic injuries. The long metal reconstruction plates with many perforations were very useful for reconstruction of chest wall because they were long enough to cover the whole length of widely resected chest defects and moderately soft enough to be appropriately bent or twist by hand at the time of operation. Moreover long-term result of the reconstructed chest wall was safe and satisfactory without severe complication.