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The Respiratory Adjusted Shock Index at Admission Is a Valuable Predictor of In-Hospital Outcomes for Elderly Emergency Patients with Medical Diseases at a Japanese Community General Hospital
Get PDFBackground: The respiratory adjusted shock index (RASI) is a risk score whose usefulness in patients with sepsis and trauma has previously been reported. However, its relevance in elderly emergency patients with medical diseases is yet to be clarified. This study assessed the usefulness of the RASI, which can be evaluated without requiring special equipment, to provide objective and rapid emergency responses. Methods: In this retrospective study, we recruited patients with medical diseases, aged 65 years or older, who were transported to the emergency room from Tokushima Prefectural Kaifu Hospital and underwent arterial blood gas testing from 1 January 2022 to 31 December 2023. We investigated the association of the RASI with other indices, including the lactate level, National Early Warning Score 2 (NEWS2), Shock Index (SI), Sequential Organ Failure Assessment (SOFA) score, quick SOFA (qSOFA) score, and systemic inflammatory response syndrome (SIRS). Results: In this study, we included 260 patients (mean age, 86 years), of whom 234 were admitted to the hospital; 27 and 49 patients died within 7 and 30 days of admission, respectively. The RASI was positively correlated with the lactate level, NEWS2, SI, and increase in the SOFA score (p < 0.001). The RASI was higher in patients with a SIRS or qSOFA score ≥ 2 than in those without (p < 0.001). It predicted death within 7 and 30 days of admission with an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.73–0.87), sensitivity of 96.3%, and specificity of 53.6% when the cutoff value was set to 1.58 and with an AUC of 0.73 (95% CI: 0.66–0.81), sensitivity of 69.4%, and specificity of 70.6% when the cutoff value was set to 1.83, respectively. Conclusions: The RASI is a simple indicator that can be used for predicting in-hospital outcomes in elderly emergency patients with medical diseases. Larger prospective studies based on this study are needed.journal articl
Discrimination between Toxoplasmic Encephalitis and Central Nervous System Lymphoma : An Updated Review
Get PDFVarious opportunistic infections, such as human immunodeficiency virus infections, develop in compromised hosts. The treatment options for Malignant Lymphoma (ML) and Toxoplasmic Encephalitis (TE) are completely different; therefore, discriminating between them is critical. Currently, imaging techniques such as magnetic resonance imaging, 201Tl-single photon emission computed tomography, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography and laboratory techniques such as PCR and antibody assays are used. Moreover, there are options for pathological examination using brain biopsy. However, discriminating between ML and TE remains challenging. Here, we describe an update of the discrimination methods between TE and ML.journal articl
Anesthetic management of a patient with mandibular hypoplasia, deafness, progeroid features, lipodystrophy syndrome : a case report
Get PDFBackground: Mandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a rare autosomal dominant disorder that presents unique challenges for anesthetic management due to its multisystemic manifestations. This report outlines the anesthetic considerations for MDPL patients based on our case experience.
Case presentation: A 15-year-old male with MDPL syndrome underwent testicular extraction under general anesthesia. Insertion of a peripheral venous catheter was challenging due to scleroderma-like skin. Although the facial features of MDPL syndrome suggested a difficult airway, intubation with a McGrath™ Mac video laryngoscope was successful. Despite MDPL syndrome’s association with hypertriglyceridemia due to lipodystrophy, this patient’s triglyceride levels were normal. Thiamylal and sevoflurane were used without issues such as delayed emergence from anesthesia.
Conclusions: MDPL syndrome requires careful preoperative assessment and tailored anesthetic management due to potential airway challenges arising from its distinctive facial features and the possibility of altered anesthetic pharmacokinetics associated with lipodystrophy.journal articl
Review of the analytical prediction method of surf-riding threshold in following sea, and its relation to IMO Second-Generation Intact Stability Criteria
Get PDFHigh-speed ship operations have a significant risk of the broaching phenomenon when navigating in following/quartering seas. The occurrence of this phenomenon can result in a violent yaw motion, regardless of the steering effort. Centrifugal forces due to the yaw motion could cause large roll motion and even capsizing in some cases. A necessary condition for the occurrence of broaching is the surf-riding phenomenon. Therefore, the International Maritime Organization (IMO) has set up criteria to include theoretical formulas for estimating the occurrence of surf-riding phenomena. The theoretical equation used in the IMO Second-Generation Intact Stability criteria (SGISC) to estimate the surf-riding threshold is based on the authors' method, and in its derivation process, Melnikov's method. is utilized. This paper deals with nonlinear equations describing the surge motions of a ship. However, such equations cannot be directly solved; therefore, prior researchers and authors have proposed various approximate methods to predict the surf-riding threshold, including the methods based on Meknikov's method. In this paper, first, the authors describe the mechanism of the surfing phenomenon. Then, the authors explain in detail the derivation of the estimation methods for the surf-riding phenomenon that have been proposed by the prior researchers and the authors. Finally, the authors show the relationship between the theoretical prediction method of the surf-riding threshold based on Melnikov's method and the IMO SGISC.journal articl
Waves causing undesired heat pattern detected via ultrasound-excited active thermography
No full textUndesired heat patterns detected via ultrasound-excited active thermography are observed and their origin is determined based on ultrasound propagation. Waves generated during the inspection of strip- and hollow cylindrical-shaped objects are investigated via experiments and numerical studies. The results show that the dominant waves propagating in the strip- and cylindrical-shaped objects are A0-mode Lamb waves and flexural-mode guided waves, respectively, and that the heat patterns are caused by standing waves generated by the propagation of the guided waves. The findings of this study should be fundamental knowledge to distinguish the temperature abnormalities caused by defects from undesired heat patterns and to improve the defect detection capability of ultrasound-excited thermography.journal articl
Comparative evaluation of two dose-volume histogram prediction tools for treatment planning : Treatment planning quality and dose verification accuracy
Get PDFPurpose: This study aims to compare treatment plans created using RapidPlan and PlanIQ for twelve patients with prostate cancer, focusing on dose uniformity, dose reduction to organs at risk (OARs), plan complexity, and dose verification accuracy. The goal is to identify the tool that demonstrates superior performance in achieving uniform target dose distribution and reducing OAR dose, while ensuring accurate dose verification.
Methods: Dose uniformity in the planning target volume, excluding the rectum, and dose reduction in the OARs (the rectum and bladder) were assessed. The validation included point-dose measurements with an ionization chamber dosimeter and gamma analysis of dose distributions. Monitor units were calculated to evaluate plan complexity.
Results: PlanIQ provided superior dose uniformity, with improvements in the dose homogeneity index compared with RapidPlan. RapidPlan was more effective in reducing OAR doses, particularly in the rectum, with significant reductions at various dose levels. Dose verification showed no significant differences between the two tools. However, PlanIQ showed a smaller mean difference between the calculated and measured doses and a slightly better dose distribution match with less variability than RapidPlan.
Conclusions: RapidPlan was more effective at reducing OAR doses, whereas PlanIQ achieved better dose uniformity and lower plan complexity. Both tools performed similarly in terms of dose verification accuracy, with PlanIQ showing a slight advantage in dose-distribution matching. The choice of planning tool depends on the primary treatment goal, whether it is to reduce the OAR doses or improve the target dose uniformity.journal articl
Frequency-dependent characteristics of osteoblast calcium signaling responses to microvibrational stimulation
Get PDFThe metabolism of bone tissue is regulated by mechanical stimuli. It has been reported that low-intensity, high-frequency vibratory stimuli can activate bone tissue metabolism. Identifying effective vibration conditions that enhance bone formation could potentially be exploited to prevent the onset and progression of osteoporosis, thereby improving quality of life in an aging society. Experiments using model animals have investigated the effects of various frequencies of vibratory stimuli, but there remains no consensus on the most effective frequency. In this study, we used a simple cell culture system to evaluate the calcium signaling response of osteoblasts subjected to micro-vibratory stimuli at different frequencies. Using a custom-developed vibration device, we applied vibratory stimuli to osteoblasts under microscopic observation and evaluated the calcium signaling response using a fluorescent calcium indicator. The vibratory stimuli were applied from 45 to 120 Hz in 15 Hz increments and from 120 to 45 Hz in 15 Hz decrements. The results of the experiment showed that the highest response rate was obtained at 60 Hz in the 45 to 120 Hz group, and at 105 Hz in the 120 to 45 Hz group. These results suggest that in an experimental system where the frequency is swept, the cells respond at the beginning of stimulation, and that habituation may contribute significantly thereafter.journal articl
