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Delayed pneumocephalus activated by recurring percutaneous hope right after vertebrae surgery: A case statement as well as literature evaluate.
BACKGROUND Ischaemic tissue injury caused by tissue hypoperfusion is one of the major consequences of sepsis. Phosphate concentrations are elevated in ischaemic tissue injury. This study was performed to investigate the association of phosphate concentrations with mortality in patients with sepsis. METHODS This was a retrospective cohort study of patients with sepsis conducted at an urban, tertiary care emergency department (ED) in Korea. Patients with sepsis arriving between March 2010 and April 2017 were stratified into four groups according to the initial phosphate concentration at presentation to the ED group I (hypophosphataemia, phosphate less then 2 mg/dL), group II (normophosphataemia, phosphate 2-4 mg/dL), group III (mild hyperphosphataemia, phosphate 4-6 mg/dL), group IV (moderate to severe hyperphosphataemia, phosphate ≥6 mg/dL). Multivariable Cox proportional hazard regression analyses were performed to evaluate the independent association of initial phosphate concentration with 28-day mortality. RESULTS Of the 3034 participants in the study, the overall mortality rate was 21.9%. The 28-day mortality rates were group I (hypophosphataemia) 14.6%, group II 17.4% (normophosphataemia), group III (mild hyperphosphataemia) 29.2% and group IV (moderate to severe hyperphosphataemia) 51.4%, respectively (p less then 0.001). learn more In the multivariable analyses, patients with severe hyperphosphataemia had a significantly higher risk of death than those with normal phosphate levels (HR 1.59; 95% CI 1.23 to 2.05). Mortality in the other groups was not significantly different from mortality in patients with normophosphataemia. CONCLUSIONS Moderate to severe hyperphosphataemia was associated with 28-day mortality in patients with sepsis. Phosphate level could be used as a prognostic indicator in sepsis. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China. This short report is a narrative review of our tertiary paediatric emergency department (ED) perspective and experience managing the evolving outbreak situation. Logistic considerations included the segregation of the ED into physically separate high-risk, intermediate-risk and low-risk areas, with risk-adapted use of personal protective equipment (PPE) for healthcare personnel in each ED area. Workflow considerations included the progressive introduction of outpatient COVID-19 testing in the ED for enhanced surveillance; adapting the admissions process particularly for high-risk and intermediate-risk cases; and the management of unwell accompanying adult caregivers. Manpower considerations included the reorganisation of medical manpower into modular teams to mitigate the risk of hospital transmission of COVID-19. Future plans for a tiered isolation facility should include structural modifications for the permanent isolation facility such as anterooms for PPE donning/doffing; replication of key ED functions in the tent facility such as a separate resuscitation room and portable X-ray room; and refresher PPE training. Dynamic reassessment of ED workflow processes, in conjunction with the hospital and national public health response, may help in managing this novel disease entity. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.A simple and low cost alternative which is able to identify thermal and fast neutrons in a clinical environment of radiotherapy is presented. CR-39 and LR-115 Solid State Nuclear Track Detectors (SSNTDs) were used, estimating their viability. In order to register alpha tracks due to thermal neutrons, natural boric acid tablets were placed in close contact to the detector, whereas in order to detect epithermal neutrons, some were additionally covered in a thin cadmium layer. Different configurations were assembled, changing the position of the converter with respect to the detector and the incident neutron fluence, which was evaluated in different positions of a radiotherapy table. The contribution due to environmental 222Rn and its daughters to the track density registered by the detector during the measurements was found to be negligible. It is concluded that the designed experimental set up constitutes a trustworthy and affordable method to carry out neutron measurements with the recommended configurations provided for the CR-39 detector, and not with LR-115. Present work concerns polymer pencil-lead graphite (PPLG) and the potential use of these in elucidating irradiation-driven structural alterations. The study provides detailed analysis of radiation-induced structural interaction changes and the associated luminescence that originates from the energy absorption. Thermally stimulated emission from the different occupied defect energy levels reflects the received radiation dose, different for the different diameter PPLGs. The PPLG samples have been exposed to photon irradiation, specifically x-ray doses ranging from 1 to 10 Gy, extended to 30-200 Gy through use of a60Co gamma-ray source. Trapping parameters such as order of kinetics, activation energy and frequency factor are estimated using Chen's peak-shape method for a fixed-dose of 30 Gy. X-ray diffractometry was used to characterize the crystal structure of the PPLG, the aim being to identify the degree of structural order, atomic spacing and lattice constants of the various irradiated PPLG samples. The mean atomic spacing and degree of structural order for the different diameter PPLG are found to be 0.3332 nm and 26.6° respectively. Photoluminescence spectra from PPLG arising from diode laser excitation at 532 nm consist of two adjacent peaks, 602 nm (absorption) and 1074 nm (emission), with mean energy band gap values within the range 1.113-1.133 eV. The results of measuring the gamma background radiation in Lab 5 of the underground facility in the Pyhäsalmi Mine at a depth of 1410 m are presented. The background integral count rate per kg of germanium of the HPGe-detector was 0.028 s-1 × kg-1. After purging the measuring chamber with nitrogen gas at a rate of 0.15 L/h the count rate was reduced to 0.021 s-1 × kg-1.
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