Spontaneous Pneumocephalus: A Case Report with a Literature Review.

BACKGROUND: Pneumocephalus is defined as gas in the intracranial space. Common causes include head trauma, surgery, and diagnostic/therapeutic procedures resulting from the direct disruption of the dura. Spontaneous or nontraumatic pneumocephalus is an uncommon condition, often caused by infection, either due to insidious disruption of the dura or gas-forming pathogens. CASE REPORT: Herein, we report a rare case of spontaneous pneumocephalus associated with meningitis in a patient who received conservative treatment without surgical intervention. Blood culture revealed group A streptococcus. The pneumocephalus subsided gradually with antibiotic treatment, and no neurological deficits remained. A follow-up brain computed tomography scan showed the absence of pneumocephalus, but it showed progressive hydrocephalus. The patient was discharged on the 21st day of hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous pneumocephalus associated with meningitis is rare. It should always raise the suspicion of meningitis and prompt suitable treatment. Emergency physicians should always be vigilant for this particular possibility on brain computed tomography.

The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients.

STUDY OBJECTIVE: The coronavirus disease 2019 (COVID-19) outbreak has caused a severe burden on medical professionals, as the rapid disposition of patients is important. Therefore, we aimed to develop a new clinical assessment tool based on the shock index (SI) and age-shock index (ASI). We proposed the hypoxia-age-shock index (HASI) and determined the usability of triage for COVID-19 infected patients in the first scene. METHODS: The predictive power for three indexes on mortality, intensive care unit (ICU) admission, and endotracheal intubation rate was evaluated using the receiver operating curve (ROC). We used DeLong's method for comparing the ROCs. RESULTS: The area under the curve (AUC) for ROC on mortality for SI, ASI, and HASI were 0.546, 0.771, and 0.773, respectively. The AUC on ICU admission mortality for SI, ASI, and HASI were 0.581, 0.700, and 0.743, respectively. The AUC for intubation for SI, ASI, and HASI were 0.592, 0.708, and 0.757, respectively. The AUC differences between HASI and SI showed statistically significant (P = 0.001) results on mortality, ICU admission, and intubation. Additionally, statistically significant results were found for the AUC difference between the HASI and ASI on ICU admission and intubation (P = 0.001 and P = 0.004, respectively). CONCLUSION: HASI can provide a better prediction compared to ASI on ICU admission and endotracheal intubation. HASI was more sensitive in mortality, ICU admission, and intubation prediction than the ASI.

Contrast Agent Pooling (C.A.P.) sign and imminent cardiac arrest: a retrospective study.

BACKGROUND: The sign of contrast agent pooling (C.A.P.) in dependent part of the venous system were reported in some case reports, which happened in the patients before sudden cardiac arrest. Until now, there is no solid evidence enough to address the importance of the sign. This study aimed to assess the accuracy of the C.A.P. sign in predicting imminent cardiac arrest and the association of the C.A.P. sign with patient's survival. METHODS: This is a retrospective cohort study. The study included all patients who visited the emergency department, who received contrast computed tomography (CT) scan and then experienced cardiac arrest at the emergency department (from January 1, 2016 to December 31, 2018). We evaluated the occurrence of the C.A.P. sign on the chest or abdominal CT scan, patients with ECMO were excluded. With positive C.A.P. sign, the primary outcome is whether in-hospital cardiac arrest happens within an hour; the accuracy of C.A.P. sign was calculated. The secondary outcome is survival to discharge. RESULTS: In the study, 128 patients were included. 8.6% (N = 11) patients had positive C.A.P. sign and 91.4% (N = 117) patients did not. The accuracy of C.A.P. sign in predicting cardiac arrest within 1 h was 85.94%. The C.A.P. sign had a positive association with IHCA within 1 h after the CT scan (adjusted odds ratio 7.35, 95% confidence interval [CI] 1.27 - 42.69). The relative risk (RR) of survival to discharge was 0.90 with positive C.A.P. sign (95% CI 0.85 - 0.96). CONCLUSIONS: The C.A.P. sign can be considered as an alarm for imminent cardiac arrest and poor prognosis. The patients with positive C.A.P. sign were more likely to experience imminent cardiac arrest; in contrast, less likely to survive. TRIAL REGISTRATION: IRB No.108107-E.

Hiccups as the Presenting Manifestation of Cardiac Tamponade: A Case Report.

BACKGROUND: Cardiac tamponade is a life-threatening disease with a high mortality rate. Its clinical manifestations depend on the length of time over which pericardial effusion accumulates. Among those, hiccups are rarely reported. CASE REPORT: We present a 48-year-old man who came in with a chief complaint of persistent hiccups and later had hypotension and dyspnea at the emergency department. Electrocardiogram revealed diffuse ST elevation with mildly elevated cardiac enzymes. Echocardiography showed massive pericardial effusion, implying cardiac tamponade. Catheter pericardiocentesis was performed and massive pericardial effusion was drained. Hiccups subsided after the procedure and the patient recovered uneventfully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To the best of our knowledge, this is the first case of cardiac tamponade with the presenting manifestation of persistent hiccups. Emergency physicians should stay vigilant when approaching those patients with unexplainable prolonged hiccups.

Oxidation of NO x Using Hydrogen Peroxide Vapor over Mo/TiO2.

xMo/TiO2 catalysts (x = 1, 2, 3, and 4%) were prepared using the coprecipitation method in the present study. The coprecipitation method was used in the thermal catalytic decomposition of H2O2 steam to treat NO x at a low temperature range (80-160 °C). Several characterization techniques have been employed, such as X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Brunauer-Emmett-Teller measurements, transmission electron microscopy (TEM), scanning electron microscopy and energy-dispersive X-ray spectrometry (SEM-EDXS), and Fourier transform infrared spectroscopy. The activity tests showed that the incorporation of molybdenum into TiO2 led to a significant increase in the catalytic oxidation of NO, and under the condition of H2O2/NO = 6:1 (molar ratio), the NO x removal rate of 2% Mo/TiO2 is the highest, reaching 92.56%. XRD, TEM, and SEM-EDXS analyses showed that Mo was well dispersed on the surface of an anatase-phase TiO2. XPS analysis indicated that Mo mixed with slag mainly existed in the form of Mo6+. Moreover, in comparison with the mostly reported SCO catalysts, used for the elimination of NO, the prepared Mo/TiO2 catalyst showed excellent stability and sulfur resistance.

Mid-infrared and near-infrared spectroscopy for rapid detection of Gardeniae Fructus by a liquid-liquid extraction process.

Gardeniae Fructus is widely used in the pharmaceutical industry, and many studies have confirmed its medical and economic value. In this study, samples collected from different liquid-liquid extraction batches of Gardeniae Fructus were detected by mid-infrared (MIR) and near-infrared (NIR) spectroscopy. Seven analytes, neochlorogenic acid (5-CQA), cryptochlorogenic acid (4-CQA), chlorogenic acid (3-CQA), geniposidic acid (GEA), deacetyl-asperulosidic acid methyl ester (DAAME), genipin-gentiobioside (GGB), and gardenoside (GA), were chosen as quality property indexes of Gardeniae Fructus. The two kinds of spectra were each used to build models by single partial least squares (PLS). Additionally, both spectral data were combined and modeled by multiblock PLS. For single spectroscopy modeling results, NIR had a better prediction for high-concentration analytes (3-CQA, DAAME, GGB, and GA) whereas MIR performed better for low-concentration analytes (5-CQA, 4-CQA, and GEA). The multiblock methodology was found to be better compared to single spectroscopy models for all seven analytes. Specifically, the coefficients of determination (R2) of the NIR, MIR, and multiblock PLS calibration models of all seven components were higher than 0.95. Relative standard errors of prediction (RSEP) were all less than 7%, except for models of GGB, which were 10.36%, 13.24%, and 8.15% for the NIR-PLS, MIR-PLS, and multiblock models, respectively. These results indicate that MIR and NIR spectrographic techniques could provide a new choice for quality control in industrial production of Gardeniae Fructus.

[On-line detection of concentration process of Ganmaoling granules by near infrared spectroscopy combined with automatic control system].

Our research was designed for on-line detection of multi-index in the concentration process of Ganmaoling granules by integration of near infrared spectroscopy and automatic control system. First, on-line detection system was set up in the concentration tank for Ganmaoling granules production. Spectra were scanned and values of chlorogenic acid, linarin, solid content and relative density were measured. Models of partial least squares regression were built and imported into near infrared workstation. By connecting the control system, real-time multi-index values were determined automatically in the concentration process. Results showed that correlation coefficients of chlorogenic acid, linarin, solid content and relative density models were 0.963, 0.989, 0.993 and 0.918, respectively. Relative standard errors of prediction were 3.71%, 4.28%, 4.17% and 0.24%, respectively, indicating a good performance and high accuracy of the models. Real-time data collection during the whole process was measured by the near infrared detecting system in the control system. In conclusion, the near infrared detection system is able to perform real-time automatic determination of multiindex in the concentration process of Ganmaoling granules with significant advantages.

Vehicular emissions in China in 2006 and 2010.

Vehicular emissions in China in 2006 and 2010 were calculated at a high spatial resolution based on the data released by the National Bureau of Statistics, by taking the emission standards into consideration. China's vehicular emissions of carbon monoxide (CO), nitrogen oxides (NOx), volatile organic compounds (VOCs), ammonia (NH3), fine particulate matters (PM2.5), inhalable particulate matters (PM10), black carbon (BC), and organic carbon (OC) were 30,113.9, 4593.7, 6838.0, 20.9, 400.2, 430.5, 285.6, and 105.1Gg, respectively, in 2006 and 34,175.2, 5167.5, 7029.4, 74.0, 386.4, 417.1, 270.9, and 106.2Gg, respectively, in 2010. CO, VOCs, and NH3 emissions were mainly from motorcycles and light-duty gasoline vehicles, whereas NOX, PM2.5, PM10, and BC emissions were mainly from rural vehicles and heavy-duty diesel trucks. OC emissions were mainly from motorcycles and heavy-duty diesel trucks. Vehicles of pre-China I (vehicular emission standard of China before phase I) and China I (vehicular emission standard of China in phase I) were the primary contributors to all of the pollutant emissions except NH3, which was mainly from China III and China IV gasoline vehicles. The total emissions of all the pollutants except NH3 changed little from 2006 to 2010. This finding can be attributed to the implementation of strict emission standards and to improvements in oil quality.