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Background To increase the chance of restoring spontaneous circulation, cardiopulmonary resuscitation (CPR) with high-quality chest compressions is needed. We hypothesized that, in a municipal hospital emergency department, the outcome in nontraumatic out-of-hospital cardiac arrest patients treated with standard CPR followed by mechanical chest compression (MeCC) was not inferior to that followed by manual chest compression (MaCC). The purposes of the study were to test our hypothesis and investigate whether the use of MeCC decreased human power demands for CPR. Methods A total of 455 consecutive out-of-hospital cardiac arrest patients of presumed cardiac etiology were divided into two groups according to the chest compressions they received (MaCC or MeCC) in this retrospective review study. Human power demand for CPR was described according to the Basic Life Support/Advanced Cardiovascular Life Support guidelines and the device handbook. The primary endpoint was recovery of spontaneous circulation during resuscitation, and the secondary endpoints were survival to hospital admission and medical human power demands. Results In this study, recovery of spontaneous circulation was achieved in 33.3% of patients in the MeCC group and in 27.1% in the MaCC group (p = 0.154), and the percentages of patients who survived hospitalization were 22.2% and 17.6%, respectively (p = 0.229). A ratio of 2:4 for the human power demand for CPR between the groups was found. Independent predictors of survival to hospitalization were ventricular fibrillation/pulseless ventricular tachycardia as initial rhythm and recovery of spontaneous circulation. Conclusion No difference was found in early survival between standard CPR performed with MeCC and that performed with MaCC. However, the use of the MeCC device appears to promote staff availability without waiving patient care in the human power-demanding emergency departments of Taiwan hospitals.

The target controlled infusion (TCI) of propofol with fentanyl facilitates easy titration of the depth of anesthesia, and thereby may improve the quality of anesthesia. The aim of this study is to investigate if propofol TCI-based anesthesia is practical for anterior cervical discectomy and fusion (ACDF), one of the most common surgical interventions in spine procedures, when compared with sevoflurane-based anesthesia with respect to the quality of anesthesia. Patients were classified into two groups according to the anesthesia regimen of maintenance of anesthesia with fentanyl and either propofol TCI (group FP) or inhalational sevoflurane (group FS), respectively. The primary endpoint was to evaluate quality of anesthesia and extubation time. Secondary endpoints were hemodynamic stability during the operation, operative fentanyl consumption, and postoperative complications. The study results revealed there were comparable results on time to extubation, changes in intraoperative hemodynamic parameters, and the occurrence of postoperative complications between the groups. No differences in average length of intensive care unit (ICU) stay and hospital stay were noticed. However, opioid consumption and blood loss during the operation for patients in group FP were significantly higher than those of patients in group FS (551.28 ± 193.98 vs. 446.86 ± 177.15 μg, p = 0.005; 52.06 ± 58.25 vs. 28.33 ± 40.74 mL, p = 0.019, respectively). In these adult patients undergoing ACDF, propofol TCI-based anesthesia appears to be as efficacious as sevoflurane-based anesthesia but consumed more fentanyl and experienced higher blood loss.

Torque-speed characteristics measurements are essential in the design and manufacture of electric motors. Dynamometers have been widely used in motor characteristics measurements, and the coupling between the motor under test and dynamometer is a critical issue for high-power electric motors. This paper develops a contactless measurement system, which consists of a permanent magnet (PM) coupler and requires no dynamometer. The torque of the PM coupler is transmitted by the eddy-current and controlled by the air gap inside the coupler. An equivalent circuit model of the magnetic coupler is derived theoretically and then verified experimentally under different operating conditions. The capacity of the proposed measurement system can also be determined in order to provide sufficient and accurate measurement information for the tested motors. A 1.5 kW dc motor with a maximum torque of 8.15 N-m was tested as an illustrated example. The experimental results are given to show the effectiveness of the proposed approach.

This paper outlines a method using finite-element analysis (FEA) to model the magnetization process of a small brushless surface-magnet three-phase motor with isotropic ferrite magnets and concentrated windings. This is aimed at allowing in situ magnetization using the three-phase machine winding. Radial magnetization is the nominal manufactured magnetization pattern; however, the in situ method leads to a variation in the magnetization pattern, and the performance is examined using open-circuit simulations. The properties of the magnet material (a ferrite 5 type) are examined in order to simulate the magnetization. Bulk magnetization Hs-sat levels for ferrite type 5 indicate that a 10-kOe field is required. In this paper, localized magnetization is examined using FEA, and it is measured in actual rotors by examination of the surface flux density when removed from the stator. Methods for deriving the approximate back electromotive force from both the FEA and the surface measurements are put forward; these show a reasonable correlation. The use of magnetization functions allows the magnetization pattern to be applied to the simulations. This paper uses a standard manufactured machine to carry these out. Open-circuit experiments are conducted to validate the presented method.

Although post-traumatic cerebral infarction is a known complication of craniocerebral trauma, borderzone infarction (BZI) after multiple traumas in young adults are uncommon and published data on this are extremely scant. We present an unusual occurrence of unilateral borderzone infarction in a 21-year-old male who sustained multiple traumas in a traffic accident, which included mild head injury, blunt cardiac injury, right traumatic hemopneumothorax, and three long bone open fractures. Initial head scan revealed mild brain edema, and the BZI was uncovered by a repeated brain CT scan since the patient had a delayed neurological deficit which was incompatible for the injury severity of the head. Comprehensive work-up was performed and a narrowed right internal carotid artery was disclosed by CT angiography. Although unilateral BZI is extremely rare in young patients, emergency physicians should still keep in mind to warrant serial examinations for BZI and early recognition to provide appropriate treatment.

Background: Recent studies have demonstrated that Rac is a regulator of cell morphology and growth. Rac1 gene appears to have involvement in tumorigenesis and metastatic potential. In our previous study of rac1 gene in 45 human brain tumors, rac1 pseudogene was found. The rac1 pseudogene is an intronless pseudogene and has a similarity of 86% with rac1 nucleotide sequence. The rac1 pseudogene contains 579 nucleotides and only 46 amino acids can be translated. Little is known about the expression of rac1 pseudogene in human tissues or tumors. Materials and Methods: The expression of rac1 gene and rac1 pseudogene in different human tissues and brain tumors was investigated by the use of reverse transcriptase-polymerase chain reaction and Northern blotting. Results: The rac1 gene is apparently expressed in these 8 human tissues. The rac1 pseudogene is also apparently expressed in human tissues except for brain tissue. The overexpression of rac1 gene in brain tumors was 8% (2/25) and the overexpression of rac1 pseudogene was 76.9% (20/26). Only two astrocytomas had overexpression of rac1 gene, compared with normal brain tissues. The overexpression of rac1 pseudogene was 6 of 9 in meningiomas, 7 of 9 in astrocytomas, and 7 of 8 in pituitary adenomas. Conclusions: High frequency of overexpression of rac1 pseudogene was detected in the human brain tumors when compared with that expressed in the normal brain tissues. Our study suggested that the rac1 pseudogene may play an important role of the tumorigenesis of brain.

Aims. Rac1 is a member of the Ras superfamily of small GTPase and plays a fundamental role in cytoskeleton reorganization, regulation of gene expression and cell proliferation, and cellular transformation. Though recent studies point to an involvement of rac1 in tumorigenesis, little is known about the alteration of rac1 gene in human brain tumours. Methods. Reverse transcription-polymerase chain reaction (RT-PCR), TA cloning, and DNA sequencing were performed to detect rac1 gene mutations in the surgical specimens of 45 human brain tumours. Results. Twelve of 45 cases had base changes in the rac1 gene. The frequency of rac1 alterations was seven of 18 meningiomas, three of 14 astrocytomas, one of seven pituitary adenomas, and one of four metastatic brain tumours. No mutation was detected in acoustic neurilemomas. The subtypes of seven meningiomas include three meningotheliomatous, two atypical, one transitional and one angioblastic meningioma. Three astrocytomas had rac1 gene mutation, including one grade II, one grade III, and one grade IV astrocytoma. All of single base changes were transitions, five of them being T to C transitions. Sites of rac1 mutation were found in codons 34, 41 (two cases), 42 (two cases), 43, 44, 46 and 58. These mutations are mainly localized in the putative effector-domain of rac1 gene and may enhance the activity of rac1, which increases the survival of brain tumours. Conclusion. Our results suggest that rac1 gene may play a role in some brain tumours of divergent histogenesis and that the alterations of rac1 gene may contribute to tumorigenesis and/or metastasis.

Related to severe hyponatremia, various symptoms, such as confusion, vomiting, changes in mental state, status epilepticus, and a variety of conscious disturbances are sometimes seen in the emergency department (ED) but seldom recognized as water intoxication in the early stages. Status epilepticus is an emergent and life-threatening condition if not diagnosed and managed promptly and efficiently. The authors reported a case of a 31-year-old woman with history of schizophrenia with poor drug compliance. The compulsive drinking of more than 15,000 mL of water per day for 4 days resulted in intermittent episodes of vomiting and seizures and she was sent to our ED by ambulance. Water intoxication with severe hyponatremia ([Na + ] = 112 mEq/L) was diagnosed and hypertonic sodium supplements and airway protection were then offered. Detailed history taking and early detection of hyponatremia is crucial to prevent fatal complications of water intoxication. Emergency physicians should be suspicious of hyponatremia from water intoxication in psychiatric patients with neurologic symptoms during the observation period in the ED.

Chun-Hung Chiang was a pioneer in the academic field of mechanism and machine design in Taiwan. His major research contribution was in the study of spherical mechanisms. While associated with numerical computing methods going back to the 1970s, he introduced body guidance, path generation, and function generation to the classical spherical mechanisms, and he developed concise research in regard to spherical mechanisms. Furthermore, he founded the committee/society of mechanism and machine theory in Taiwan and led the group to join IFToMM in 1983.

This paper outlines a method using finite element analysis to model the magnetization process of a small brushless surface-magnet 3-phase motor with isotropic ferrite magnets and concentrated windings. This is aimed at allowing in-situ magnetization using the 3-phase machine winding. Radial magnetization is the nominal manufactured magnetization pattern; however, the in-situ method leads to a variation in the magnetization pattern and the performance is examined using open-circuit simulations. The properties of the magnet material (a ferrite 5 type) are examined in order to simulate the magnetization. Bulk magnetization H s-sat levels for ferrite type 5 indicate a 10 kOe; however, in this paper localized magnetization is examined using finite element analysis. The use of magnetization functions allows the magnetization pattern to be applied to the simulations. This paper uses a standard manufactured machine to carry these out. Open circuit experiments are conducted to validate the presented method.

While the pole method has been applied for problems of synthesizing planar and spherical four-bar function generators in previous investigations, we are extending the method to the synthesis of planar geared five-bar function generators, by means of an inversion linkage concept. For spherical geared five-bar function generators, we make use of the equations and formulas previously derived for body guidance as these are already available. However, we shall use the location of the relative poles for the orientation of the coordinate system to simplify the synthesis equations. Numerical examples are given.

Nine patients, 16 years of age or younger with primary spinal cord tumors, diagnosed between 1991 and 2003 at The Kaohsiung University Hospital, were reviewed retrospectively. There were 2 female and 7 male patients. Two tumors were located primarily in the cervical cord (1 meningioma, 1 neurofibroma), five were predominantly thoracic (1 lymphoma, 1 meningioma, 1 astrocytoma, 1 fibrosarcoma and 1 osteoblastoma), one lumbar (ependymoma), and one sacral (Ewing's sarcoma). The most common clinical presentation was limb weakness (100%) followed by back pain (44.4%). All the patients underwent laminectomy for removal of their tumors. Five children with benign tumors improved postoperatively. At discharge, these 5 children could walk without assistance and have remained stable with long-term of follow-up. Radical surgery should be considered in benign primary spinal cord tumors. As would be expected, patients diagnosed and treated early and in whom a total resection was achieved had a better prognosis.

Foreign body ingestions are a frequent occurrence, a common presentation at emergency departments, but long, pointed-end metallic spoon swallowing is an uncommon occurrence. Unlike most cases of foreign-body ingestion, there have been no cases of spontaneous passage reported. Consequently, prompt removal is recommended before complications develop. We report a case of accidental ingestion of a long, pointed metallic spoon which failed to pass through the gastrointestinal tract and be excreted. This patient was managed successfully with gastrotomy to remove the object. We recommend this approach for the removal of long pointed foreign bodies to avoid complications developing.

Out-of-hospital cardiopulmonary arrest has a dismal prognosis. Successful resuscitation of these patients depends on the "chain of survival". In Taiwan, the emergency medical services (EMS) system is under development and the links of "chain of survival" are weak and frequently broken. A 2-year retrospective study was conducted from January, 1999, to December, 2000 to evaluate the factors of successful cardiopulmonary resuscitation (CPR) in non-traumatic DOA patients in ED. Of 175 studied patients, 51 patients (29.1%) were successfully resuscitated with return of spontaneous circulation (ROSC), but only 7 patients (4%) survived to hospital discharge. Most successfully resuscitated patients (84.3%) regained their vital signs within 30 minutes. There were no significant differences in age, sex, vehicle of transportation, administration of prehospital CPR or not, EMS response interval, on-scene duration, and scene-to-hospital interval between patients with ROSC and without ROSC. Compared with asystole cardiac rhythm, patients with pulseless electrical activity (PEA) had a higher successful resuscitation rate (p = 0.001), but no significant differences existed between patients with ventricular fibrillation/ventricular tachycardia (VF/VT) and PEA or VF/VT and asystole. However, there were no significant differences in the survival discharge rate among patients with different initial cardiac rhythms in ED.

Background Anterior cervical discectomy and fusion is one of the most common surgical interventions performed by spine surgeons. As efforts are made to control healthcare spending because of the limited or capped resources offered by the National Health Insurance, surgeons are faced with the challenge of offering high-level patient care while minimizing associated healthcare expenditures. Routine ordering of postoperative hematologic tests and observational intensive care unit (ICU) stay might be areas of potential cost containment. This study was designed to determine the necessity of routine postoperative hematologic tests and ICU stay for patients undergoing elective anterior cervical discectomy and fusion and to investigate whether the elimination of unnecessary postoperative laboratory blood studies and ICU stay inhibits patient care. Methods The necessity for postoperative blood tests was determined if there were needs for a postoperative blood transfusion and hospital readmission within 1 month after surgery. The necessity for postoperative ICU observation was decided if immediate surgical intervention was required when any kind of complications occurred during the ICU stay. Results There were 168 patients collected in the study. Among them, all had routine preoperative and postoperative blood tests and were transferred to ICU for observation. No need for blood transfusion was observed, and no patient required immediate surgical intervention when the complications occurred during the ICU stay. Conclusion Cost savings per admission amounted to approximately 10% of the hospitalization cost by the elimination of unnecessary postoperative routine laboratory blood studies and observational ICU stay without waiving patient care in the current volatile, cost-conscious healthcare environment in Taiwan.

Subdural hematomas in infants are uncommon but usually result from non-accidental trauma or from trauma associated with motor vehicle accidents. This report describes the case of an infant with a traumatic acute subdural hematoma that resolved within 65 hours. A 23-month-old boy fell from a height of approximately 10 m. Brain computed tomography disclosed a left subdural hematoma with midline shift. The associated clots resolved spontaneously within 65 hours of the injury. Although they may mimic more clinically significant subdural hematomas, such collections of clots are likely to be located at least partly within the subarachnoid space. Their recognition may influence decisions regarding both surgical evacuation and the likelihood of non-accidental injury. Clinical and radiographic features distinguishing these “disappearing subdural hematomas” from more typical subdural hematomas are discussed.