Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis.

OBJECTIVES: Although airway management is important in pediatric resuscitation, the effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM), such as endotracheal intubation (ETI) and supraglottic airway (SGA) devices, for prehospital resuscitation of pediatric out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to determine the efficacy of AAM during prehospital resuscitation of pediatric OHCA cases. METHODS: We searched four databases from their inception to November 2022 and included randomized controlled trials and observational studies with appropriate adjustments for confounders that evaluated prehospital AAM for OHCA in children aged <18 years in quantitative synthesis. We compared three interventions (BMV, ETI, and SGA) via network meta-analysis using the GRADE Working Group approach. The outcome measures were survival and favorable neurological outcomes at hospital discharge or 1 month after cardiac arrest. RESULTS: Five studies (including one clinical trial and four cohort studies with rigorous confounding adjustment) involving 4852 patients were analyzed in our quantitative synthesis. Compared with ETI, BMV was associated with survival (relative risk [RR] 0.44 [95% confidence intervals (CI) 0.25-0.77]) (very low certainty). There were no significant association with survival in the other comparisons (SGA vs. BMV: RR 0.62 [95% CI 0.33-1.15] [low certainty], ETI vs. SGA: RR 0.71 [95% CI 0.39-1.32] [very low certainty]). There was no significant association with favorable neurological outcomes in any comparison (ETI vs. BMV: RR 0.33 [95% CI 0.11-1.02]; SGA vs. BMV: RR 0.50 [95% CI 0.14-1.80]; ETI vs. SGA: RR 0.66 [95% CI 0.18-2.46]) (all very low certainty). In the ranking analysis, the hierarches for efficacy for survival and favorable neurological outcome were BMV > SGA > ETI. CONCLUSION: Although the available evidence is from observational studies and its certainty is low to very low, prehospital AAM for pediatric OHCA did not improve outcomes.

Probing Structural Perturbation in a Bent Molecular Crystal with Synchrotron Infrared Microspectroscopy and Periodic Density Functional Theory Calculations.

The range of unit cell orientations generated at the kink of a bent single crystal poses unsurmountable challenges with diffraction analysis and limits the insight into the molecular-scale mechanism of bending. On a plastically bent crystal of hexachlorobenzene, it is demonstrated here that spatially resolved microfocus infrared spectroscopy using synchrotron radiation can be applied in conjunction with periodic density functional theory calculations to predict spectral changes or to extract information on structural changes that occur as a consequence of bending. The approach reproduces well the observed trends, such as the wall effects, and provides estimations of the vibrational shifts, unit cell deformations, and intramolecular parameters. Generally, expansion of the lattice induces red-shift while compression induces larger blue-shift of the characteristic ν(C-C) and ν(C-Cl) modes. Uniform or non-uniform expansion or contraction of the unit cell of 0.1 Å results in shifts of several cm-1, whereas deformation of the cell of 0.5° at the unique angle causes shifts of <0.5 cm-1. Since this approach does not include parameters related to the actual stimulus by which the deformation has been induced, it can be generalized and applied to other mechanically, photochemically, or thermally bent crystals.

Effect of Charged Group Spacer Length on Hydration State in Zwitterionic Poly(sulfobetaine) Brushes.

Effect of alkyl chain spacer length between the charged groups (CSL) in zwitterionic poly(sulfobetaine) (PSB) brushes on the hydration state was investigated. PSB brushes with ethyl (PMAES), propyl (PMAPS), or butyl (PMABS) CSL were prepared by surface-initiated atom transfer radical polymerization on silicon wafers. Hydration states of the PSB brushes in aqueous solutions and/or humid vapor were investigated by contact angle measurement, infrared spectroscopy, AFM observation, and neutron reflectivity. The PSB brushes are swollen in humid air and deionized water due to the hydration of the charged groups leading to the reduction of hydrated PSB brushes/water interfacial free energy. The hydrated PSB brushes exhibit clear interface with low interfacial roughness due to networking of the PSB brush chains through association of the SBs. The hydrated PSB brushes produce diffusive swollen layer in the presence of NaCl because of the charge screening followed by SB dissociation by the bound ions. The ionic strength sensitivity in the hydration got more significant with increasing the CSL in SBs because of the augmentation in partial charge by charged group separation.

Oral analgesic for musculoskeletal injuries in children: A systematic review and network meta-analysis.

OBJECTIVE: Pain in pediatric musculoskeletal (MSK) injuries can lead to increased anxiety, fear, and avoidance of medical care, making analgesic management critical. Therefore, we evaluated analgesic efficacy and adverse effects to select the optimal analgesic agent in pediatric patients with MSK injuries. METHODS: Four databases were searched from inception to March 2023 for peer-reviewed, open randomized controlled trials (RCTs). Inclusion criteria were: (1) trials with RCT design, (2) children aged 1 month-18 years with MSK injury, (3) outpatient setting, (4) interventions and control, (5) primary outcome of pain score at 60 and 120 min and secondary outcome of adverse effects, and (6) full-text and peer-reviewed articles. Two reviewers screened, extracted data, and assessed the risk of bias. A frequentist random-effects network meta-analysis (NMA) was performed. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation working group approach. RESULTS: We included eight trials comprising 1645 children. Ibuprofen was significantly associated with pain reduction at 120 min, compared with acetaminophen (SMD 0.31 [95% CI 0.11-0.51]; moderate certainty) and opioids (SMD 0.34 [95% CI 0.20-0.48]; moderate certainty). Compared with opioids alone, ibuprofen-opioid combination was significantly associated with pain reduction at 120 min (SMD 0.19 [95% CI 0.03-0.35]). No significant differences were found in pain interventions at 60 min. Ibuprofen had statistically fewer adverse events than opioids (RR, 0.54 [95% CI 0.33-0.90]; moderate certainty) and ibuprofen with opioids (RR 0.47 [95% CI 0.25-0.89]; moderate certainty). In terms of limitations, the eight RCTs included had relatively small sample sizes; only two were high-quality RCTs. CONCLUSIONS: Our NMA found ibuprofen to be the most effective and least adverse analgesic in pediatric patients with MSK injuries.

Excellent capture of N2O functioning at RT and lower pressure by utilizing an NaCaA-85 zeolite.

We have found an efficient adsorption feature provided by an NaCaA-85 zeolite for N2O even at 298 K and at lower pressures: N2O adsorption capacities of 1.33 mmol g-1 and 4.69 mmol g-1 under respective pressures of 0.3 and at 100 Torr, respectively, indicating the best performance among adsorbent materials so far reported. These adsorption peculiarities will pave a new way for developing excellent materials working for adsorption/separation processes of N2O.

Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure.

CONTEXT: Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers. OBJECTIVES: We aimed to assess the benefits of NPD to medical providers. DATA SOURCES: We searched 5 databases for relevant articles. STUDY SELECTION: Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included. DATA EXTRACTION: Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy. RESULTS: We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff. CONCLUSIONS: Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.

Optical conductivity measurement of a dimer Mott-insulator to charge-order phase transition in a two-dimensional quarter-filled organic salt compound.

We report a novel insulator-insulator transition arising from the internal charge degrees of freedom in the two-dimensional quarter-filled organic salt ß-(meso-DMBEDT-TTF)2PF6. The optical conductivity spectra above Tc=70 K display a prominent feature of the dimer Mott insulator, characterized by a substantial growth of a dimer peak near 0.6 eV with decreasing temperature. The dimer peak growth is rapidly quenched as soon as a peak of the charge order appears below Tc, indicating a competition between the two insulating phases. Our infrared imaging spectroscopy has further revealed a spatially competitive electronic phase far below Tc, suggesting a nature of quantum phase transition driven by material-parameter variations.

Spreading and structuring of water on superhydrophilic polyelectrolyte brush surfaces.

The wetting behavior of superhydrophilic polyelectrolyte brushes was investigated. Reflection interference contrast microscopy demonstrated that the contact angles of water on the polyelectrolyte brushes were extremely low but remained finite in the range of <3°. The presence of water molecules was evident, even outside the macroscopic water droplet. These water molecules were confined to the thin brush layers and contained a highly ordered hydrogen bond network, which was identified as structural water. The presence of the thin film and the structural water changed the surface energies, which prevented the complete wetting of the surface.

Forensic Discrimination of Drug Powder Based on Drug Mixing Condition Determined Using Micro Fourier Transform Infrared Spectroscopy.

The quantitative evaluation of the drug mixing condition was conducted for application in the forensic discrimination of drug powders using micro Fourier transform infrared (FT-IR) spectroscopy. Bromhexine hydrochloride (BHCl) and p-hydroxybenzoic acid (PHBA) were used as the simulated drug and additive, respectively. Equal masses of two chemicals were (1) simply mixed, (2) homogenized using agate mortar, or (3) dissolved in methanol and dried, and then (4) homogenized using agate mortar. The mixed powders dispersed on BaF2 plates were subjected to mapping analysis of micro FT-IR spectroscopy using synchrotron radiation (SR) or globar light in transmission mode with aperture sizes of 2.5 x 2.5 and 10 x 10µm2, and x-y scanning steps of 2.5 and 10 µm, respectively. The areas of the vibration bands specific to BHCl (C-N bending) and PHBA (C=O stretching) were converted to the molar contents (CBHCl, CPHBA), and the relative content ratio (RCR: CPHBA/[CBHCl + CPHBA]) was used as one mixing parameter. The resulting two-dimensional distribution map provided the relative spatial localizations of the two species, and frequency histograms with a horizontal axis of RCR were plotted to evaluate the RCR distribution. The percentage frequency of the extreme value in which RCR was 0 or 1 (%EV) was used as one mixing index. After excluding the extreme values, the coefficient of variation (CV) of the RCR distribution was used as another mixing index. The differentiation among four mixing modes could be evaluated from the standpoint of %EV and CV, and the discrimination capacity by SR instrument was superior to that by globe light instrument.

Infrared Spectra and Hydrogen-Bond Configurations of Water Molecules at the Interface of Water-Insoluble Polymers under Humidified Conditions.

Elucidating the state of interfacial water, especially the hydrogen-bond configurations, is considered to be key for a better understanding of the functions of polymers that are exhibited in the presence of water. Here, an analysis in this direction is conducted for two water-insoluble biocompatible polymers, poly(2-methoxyethyl acrylate) and cyclic(poly(2-methoxyethyl acrylate)), and a non-biocompatible polymer, poly(n-butyl acrylate), by measuring their IR spectra under humidified conditions and by carrying out theoretical calculations on model complex systems. It is found that the OH stretching bands of water are decomposed into four components, and while the higher-frequency components (with peaks at ∼3610 and ∼3540 cm-1) behave in parallel with the C═O and C-O-C stretching and CH deformation bands of the polymers, the lower-frequency components (with peaks at ∼3430 and ∼3260 cm-1) become pronounced to a greater extent with increasing humidity. From the theoretical calculations, it is shown that the OH stretching frequency that is distributed from ∼3650 to ∼3200 cm-1 is correlated to the hydrogen-bond configurations and is mainly controlled by the electric field that is sensed by the vibrating H atom. By combining these observed and calculated results, the configurations of water at the interface of the polymers are discussed.

Electronic state of a conducting single molecule magnet based on Mn-salen type and Ni-dithiolene complexes.

The electrochemical oxidation of an acetone solution containing [Mn(III) (5-MeOsaltmen)(H(2)O)](2)(PF(6))(2) (5-MeOsaltmen(2-) = N,N'-(1,1,2,2-tetramethylethylene)bis(5-methoxysalicylideneiminate)) and (NBu(4))[Ni(dmit)(2)] (dmit(2-) = 2-thioxo-1,3-dithiole-4,5-dithiolate) afforded a hybrid material, [Mn(5-MeOsaltmen)(acetone)](2)[Ni(dmit)(2)](6) (1), in which [Mn(2)](2+) single-molecule magnets (SMMs) with an S(T) = 4 ground state and [Ni(dmit)(2)](n-) molecules in a charge-ordered state (n = 0 or 1) are assembled in a layer-by-layer structure. Compound 1 crystallizes in the triclinic space group P1 with an inversion center at the midpoint of the Mn···Mn dimer. The [Mn(2)](2+) unit has a typical nonplanar Mn(III) dimeric core and is structurally consistent with previously reported [Mn(2)] SMMs. The six [Ni(dmit)(2)](n-) (n = 0 or 1) units have a square-planar coordination geometry, and the charge ordering among them was assigned on the basis of ν(C═C) in IR reflectance spectra (1386, 1356, 1327, and 1296 cm(-1)). The [Mn(2)](2+) SMM and [Ni(dmit)(2)](n-) units aggregate independently to form hybrid frames. Electronic conductivity measurements revealed that 1 behaved as a semiconductor (ρ(rt) = 2.1 × 10(-1) Ω·cm(-1), E(a) = 97 meV) at ambient pressure and as an insulator at 1.7 GPa (ρ(1.7GPa) = 4.5 Ω·cm(-1), E(a) = 76 meV). Magnetic measurements indicated that the [Mn(2)](2+) units in 1 behaved as S(T) = 4 SMMs at low temperatures.

Analysis of the sol and gel structures of potato starch over a wide spatial scale.

We analyzed edible potato starch and observed the interaction between its granular structure and water molecules. We studied the changes caused by gelatinization during heating and stirring using microscopy, micro-FT-IR spectroscopy, and X-ray scattering techniques. A wide range of spatial scales was revealed using these various techniques. The rate of gelatinization varied significantly and was dependent on the starch concentration. The process of adsorption of water on starch molecules was studied using the humidity-controlled FT-IR spectroscopy technique. Furthermore, by comparing the X-ray scattering profiles of dry and wet granules, the 9-nm repeat "cluster" structure was studied. A gradual collapse of the granules occurred during the processes of heating and stirring. A clustered smectic structure and a smectic-like structure were observed in the opaque gel after gelatinization. Upon further heating, a transparent gel was obtained after the melting of the cluster.

Release of Ceramide Molecules from Ceramide-Containing UV-curable Acrylic Adhesive Gel Sheet Affixed to Human Skin.

Ceramide, an intercellular lipid of the stratum corneum, plays an essential role in making the skin barrier. One problem with the use of medical adhesive tape or sheets for skin is that their repeated attachment and detachment may cause some damage to the skin. An attempt has been made to eliminate this problem by mixing ceramide into the adhesive of sheets, and has delivered excellent clinical results. This study aimed to investigate whether ceramide is transferred from the adhesive with added ceramide to the skin. An adhesive sheet was prepared by adding synthetic ceramide (CER) to UV-curable acrylic adhesive gel. After affixing the adhesive sheet to human skin for a certain period, it was peeled off and cut perpendicular to the adhesive surface. Synchrotron micro-infrared spectroscopy of the sectioned samples showed that the ceramide concentration in the gel sheet decreases as the application time to human skin increases. This is thought to be due to the release of CER from the gel sheet.

The secondary structural difference between Lewy body and glial cytoplasmic inclusion in autopsy brain with synchrotron FTIR micro-spectroscopy.

Lewy bodies (LBs) and glial cytoplasmic inclusions (GCIs) are specific aggregates found in Parkinson's disease (PD) and multiple system atrophy (MSA), respectively. These aggregates mainly consist of α-synuclein (α-syn) and have been reported to propagate in the brain. In animal experiments, the fibrils of α-syn propagate similarly to prions but there is still insufficient evidence to establish this finding in humans. Here, we analysed the protein structure of these aggregates in the autopsy brains of patients by synchrotron Fourier-transform infrared micro-spectroscopy (FTIRM) analysis without extracting or artificially amplifying the aggregates. As a result, we found that the content of the ß-sheet structure in LBs in patients with PD was significantly higher than that in GCIs in patients with MSA (52.6 ± 1.9% in PD vs. 38.1 ± 0.9% in MSA, P < 0.001). These structural differences may provide clues to the differences in phenotypes of PD and MSA.

Synchrotron FTIR Micro-spectroscopy Studies Demonstrate the Release of Ceramide Molecules from a Ceramide-containing UV-curable Acrylic Adhesive Resin.

A recent study has shown that the addition of ceramide to adhesive materials of medical sheets or tapes improves or maintains skin barrier functions despite the irritation and damage caused by the repeated removal of the sheet or tape. This fact may imply that ceramide molecules are released from the adhesive material and penetrate the skin. In this study, we investigated whether ceramide molecules are released from a UV-curable acrylic adhesive resin (acResin®) sheet containing ceramide molecules attached to a cultured skin sample by estimating the local ceramide concentration from the data obtained by synchrotron Fourier transform infrared micro-spectroscopy analysis. Since section samples of uniform thickness could not be prepared, the intensity data of the amide I peak originating from ceramide were normalized by using the intensity data of the ester peak originating from the resin matrix. This analysis enabled the quantification of the change in local ceramide concentrations in the sheet samples. This result indicates that ceramide molecules were released from the acResin® sheet attached to the cultured skin sheet.

Thermochemiluminescent peroxide crystals.

Chemiluminescence, a process of transduction of energy stored within chemical bonds of ground-state reactants into light via high-energy excited intermediates, is known in solution, but has remained undetected in macroscopic crystalline solids. By detecting thermally induced chemiluminescence from centimeter-size crystals of an organic peroxide here we demonstrate direct transduction of heat into light by thermochemiluminescence of bulk crystals. Heating of crystals of lophine hydroperoxide to ~115 °C results in detectable emission of blue-green light with maximum at 530 nm with low chemiluminescent quantum yield [(2.1 ± 0.1) × 10‒7 E mol‒1]. Spectral comparison of the thermochemiluminescence in the solid state and in solution revealed that the solid-state thermochemiluminescence of lophine peroxide is due to emission from deprotonated lophine. With selected 1,2-dioxetane, endoperoxide and aroyl peroxide we also establish that the thermochemiluminescence is common for crystalline peroxides, with the color of the emitted light varying from blue to green to red.

Normal early development in siblings with novel compound heterozygous variants in ASPM.

Autosomal recessive primary microcephaly 5 (MCPH5) is caused by pathogenic variants in ASPM. Using whole-exome sequencing, we diagnosed two siblings with MCPH5. A known pathogenic variant (NM_018136.4: c.9697C > T, p.(Arg3233*)) and a novel pathogenic variant (c.1402_1406del, p.(Asn468Serfs*2)) of ASPM were identified in affected siblings with normal intelligence. Their pathogenic variants were not located in the critical regions of ASPM, but the relationship between the genotypes and their normal intelligence was unclear.

Mechanically interlocked architecture aids an ultra-stiff and ultra-hard elastically bendable cocrystal.

Molecular crystals are not known to be as stiff as metals, composites and ceramics. Here we report an exceptional mechanical stiffness and high hardness in a known elastically bendable organic cocrystal [caffeine (CAF), 4-chloro-3-nitrobenzoic acid (CNB) and methanol (1:1:1)] which is comparable to certain low-density metals. Spatially resolved atomic level studies reveal that the mechanically interlocked weak hydrogen bond networks which are separated by dispersive interactions give rise to these mechanical properties. Upon bending, the crystals significantly conserve the overall energy by efficient redistribution of stress while perturbations in hydrogen bonds are compensated by strengthened π-stacking. Furthermore we report a remarkable stiffening and hardening in the elastically bent crystal. Hence, mechanically interlocked architectures provide an unexplored route to reach new mechanical limits and adaptability in organic crystals. This proof of concept inspires the design of light-weight, stiff crystalline organics with potential to rival certain inorganics, which currently seem inconceivable.

Optical evidence for the spin-state disorder in LaCo1-x Rh x O3.

We have measured the infrared reflectivity of single-crystalline samples of LaCo1-x Rh x O3 (x = 0, 0.05 and 0.10) from 10 to 300 K from 0.05 to 0.15 eV. We find that the optical phonons of the Co-O stretching mode depend on temperature and the Rh content. Analysis with three Lorentz oscillators reveals that the spin state of Co3+ in LaCo1-x Rh x O3 can be understood in terms of a solid solution of low-spin- and high-spin-state Co3+ ions, and the substituted Rh ion retains some fraction of the high-spin Co3+ ions down to low temperature.

Charge and Lattice Fluctuations in Molecule-Based Spin Liquids.

Spin liquid (SL) systems have been the subject of much attention recently, as they have been theoretically predicted to not freeze, even at 0 K. Despite extensive searches being made for such a system, only a few candidates have been found. All of these candidates share geometrical frustrations that are based on triangular lattices. We applied vibrational spectroscopy to one of the candidates of a molecule-based SL system, and we compared its results against three antiferromagnetic compounds and four charge-ordered compounds. All of their structural motifs belong to triangular lattices. The C=C stretching modes in the SL state indicated that there were charge and lattice fluctuations. These fluctuations were suppressed but non-negligible in the AF compounds. This finding is potentially significant, as it indicates that a hidden lattice and charge fluctuation are the driving force of a geometrical frustration, which eventually leads to a SL state.