Search

Background: Temporary ventricular‑assisted device (VAD) provides timely organ perfusion in patients with cardiogenic shock and serves as a bridge to heart transplant. Intravenous levosimendan could provide pharmacologic inotropic support. Aim: We aimed to investigate the adjuvant efficacy of levosimendan in patients with temporary VAD, especially for VAD weaning. Methods: We retrospectively reviewed the medical records of patients receiving temporary VAD for cardiogenic shock between January 2017 and May 2019 in a medical center in Taiwan. Patients were divided into the levosimendan (n = 9, administered levosimendan immediately after VAD), and control groups (n = 20, no levosimendan administered). The biochemistry of systemic perfusion was compared at 1 and 3 days after VAD. After 2 months, the cardiac function of the patients with successful VAD weaning was evaluated by echocardiography. At 6 months follow‑up, survival outcome and Kaplan–Meier survival curves were presented. Results: In total, 29 patients receiving temporary VAD for cardiogenic shock were enrolled, including 9 patients treated with levosimendan infusion. In the levosimendan group, both mean arterial pressure and lactate level decreased significantly (P = 0.037 and 0.023, respectively), and the ratio of arterial oxygen partial pressure to fractional inspired oxygen improved significantly (P = 0.048). No difference in inotropes tapering, consciousness, systemic perfusion biochemistry, and cardiac enzymes. Echocardiography showed significantly improved systolic function and pulmonary artery pressure 2 months later (P = 0.043 and 0.046, respectively) in patients with successful weaning. The levosimendan group had a better weaning rate (P = 0.013) and lower mortality rate (P = 0.571) at 6‑month follow‑up. Conclusion: The levosimendan group showed a better weaning rate and lower mortality rate. [ABSTRACT FROM AUTHOR]

Background and Aims: During coronary artery bypass graft (CABG) surgery, the residual hemostasis procedures, from weaning cardiopulmonary bypass to closing sternotomy, are always completed by residents and supervised by attending surgeons. We want to evaluate the teaching effectiveness for residents under the supervision of attending surgeons with different levels of seniority.Materials and Methods: Between January 1st 2001 and December 31st 2010, 2279 consecutive CABG surgeries were performed in our medical center. In total, 83 patients underwent a reexploration for postoperative bleeding. All causes of bleeding were identified and recorded. Competent attending surgeons were defined as having >3 years' experience and young attending surgeons with ≦3 years' experience. We compared the reexploration rate and aimed to identify the common sources of bleeding by the two groups. We also assessed the impact of attending experience on the outcomes and major complications after reexploration.Results: There were 36 surgical bleeding and 17 non-surgical bleeding in the young group and 16 surgical bleeding and 14 non-surgical bleeding in the competent group. The young group experienced more mediastinal drainage before a reexploration and a longer time interval to a reexploration. However, both are without statistical significance. Furthermore, the young group has a significant longer hospital stay. The most common intra-pericardium surgical bleeding included two-stage cannulation, side branch of the left internal mammary artery (LIMA), and side branch of vein grafts. The most common extra-pericardium surgical bleeding included a puncture hole by sternal wires, LIMA bed, and fragile sternum.Conclusion: Young attending surgeons indeed had both higher incidence of reexploration and surgical bleeding after a CABG. However, the supervisor experience only impacted hospital stay, not major complications or mortality after a reexploration. This might imply the competent attending surgeons provide higher teaching effectiveness for the hemostasis procedure after CABG. [ABSTRACT FROM AUTHOR]

Grateloupia huangiae S.-M. Lin & H.-Y. Liang sp. nov. was previously recorded as G. okamurae Yamada [currently recognized as Polyopes lancifolius (Harvey) Kawaguchi & H.W. Wang] in Taiwan. Molecular phylogenetic analysis shows that G. huangiae is unrelated to P. lancifolius but is closely related to Grateloupia taiwanensis S.-M. Lin & H.-Y. Liang. Although G. huangiae superficially resembles P. Iancifolius in having a leafy thallus and short proliferations borne on the thallus surface, the structure of the auxiliary-cell ampulla is very different. The auxiliary-cell ampulla of G. huangiae is composed of three orders of unbranched filaments before diploidization, each of which is 11-13 cells long. The auxiliary cell is the first cell of the third-order ampullar filament, which is cut off from the first cell of the second-order ampullar filament. This type of auxiliary-cell ampulla is the same as that found in G. taiwanensis. On the other hand, P. lancifolius has a more complex auxiliary-cell ampulla in which the ampullar filaments may bear up to five to six orders of branches before diploidization. A detailed study of the development of auxiliary-cell ampullae before and after diploidization is needed in other species and genera within the Halymeniaceae to better delineate generic concepts in the family. [ABSTRACT FROM AUTHOR]

Taipei Metro adopted the diode-grounded scheme for stray current collection in construction of its cross rail network. During operation of the network, a high rail-to-earth potential (Vrail) has been observed at the east end of the Blue Line (i.e., stations BL13-BL16). To find effective countermeasures, a series of field tests in a step-by-step development nature was conducted from 1999-2000, which led to the decision of disconnecting the impedance bond at Gil of the tie line so that the negative return current of the Blue Line cannot flow to the rails of the Red-Green Line, and vice versa (detailed in Sections 111-A and V-C). This decision was implemented through contract-out work in 2003. Since then, the Vrail has been lowered by almost half before disconnection. To gain the insight characteristic before the contract-out, numerical simulations were also conducted by simulating the multi-train and multisection features of the cross transportation network. The simulation results (for Vrail and stray current, or Istray) were consistent with the field-test results. This paper presents the design of these field tests and their test results in comparison with the simulation results, based on which the countermeasures for reducing Vrail and the present status after Vrail reduction at Taipei Metro are presented. [ABSTRACT FROM AUTHOR]

Hand-foot-mouth disease (HFMD) is the most common and widespread infectious disease in the People's Republic of China. Although there has been a substantial increase of HFMD in many parts of the country in recent years, its spatial dynamics and determinants remain unclear. When we collected and analysed weekly data on HFMD cases from 1,456 counties and the corresponding meteorological factors from 1 May 2008 to 27 March 2009, it was found that HFMD was spatially dispersed across the country in the summer and winter, while clustered in the spring and autumn. The spatial variation of HFMD was found to be affected by a combination of climate variables, while its spatio-temporal transmission was largely driven by temperature variations with a 7-week lag implying that (i) the dispersal of the disease can be anticipated based on the variation of the temperature and other climate variables; and (ii) the spatial dynamics of HFMD can be robustly predicted 7 weeks ahead of time using temperature data only. The findings reported allow prompt preparation and implementation of appropriate public health interventions to control and prevent disease outbreaks.