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OBJECTIVEIncreased intracranial pressure (ICP) results in enlarged optic nerve sheath diameter (ONSD). In this study the authors aimed to assess the association of ONSD and ICP in severe traumatic brain injury (TBI) after decompressive craniotomy (DC).METHODSONSDs were measured by ocular ultrasonography in 40 healthy control adults. ICPs were monitored invasively with a microsensor at 6 hours and 24 hours after DC operation in 35 TBI patients. ONSDs were measured at the same time in these patients. Patients were assigned to 3 groups according to ICP levels, including normal (ICP ≤ 13 mm Hg), mildly elevated (ICP = 14–22 mm Hg), and severely elevated (ICP > 22 mm Hg) groups. ONSDs were compared between healthy control adults and TBI cases with DC. Then, the association of ONSD with ICP was analyzed using Pearson’s correlation coefficient, linear regression analysis, and receiver operator characteristic curves.RESULTSSeventy ICP measurements were obtained among 35 TBI patients after DC, including 25, 27, and 18 measurements in the normal, mildly elevated, and severely elevated ICP groups, respectively. Mean ONSDs were 4.09 ± 0.38 mm in the control group and 4.92 ± 0.37, 5.77 ± 0.41, and 6.52 ± 0.44 mm in the normal, mildly elevated, and severely elevated ICP groups, respectively (p < 0.001). A significant linear correlation was found between ONSD and ICP (r = 0.771, p < 0.0001). Enlarged ONSD was a robust predictor of elevated ICP. With an ONSD cutoff of 5.48 mm (ICP > 13 mm Hg), sensitivity and specificity were 91.1% and 88.0%, respectively; a cutoff of 5.83 mm (ICP > 22 mm Hg) yielded sensitivity and specificity of 94.4% and 81.0%, respectively.CONCLUSIONSUltrasonographic ONSD is strongly correlated with invasive ICP measurements and may serve as a sensitive and noninvasive method for detecting elevated ICP in TBI patients after DC.

Background Preoperative localization of the perforators allows precise planning of the flap design and improves surgical efficiency. Recently, infrared thermography is introduced as a reliable alternative, where the perforator corresponds to the “hot spot” on the thermogram. This study aims to compare the application of color Doppler ultrasound (CDU) and infrared thermography in preoperative perforator mapping of the anterolateral thigh (ALT) perforator flap. Patients and Methods From September 2017 to January 2019, CDU and infrared thermography were both applied on 20 patients to locate the perforators originated from lateral circumflex femoral artery preoperatively. The perforators identified using each modality were marked on the anterolateral thigh region. The accuracy of both mapping methods was analyzed according to the intraoperative findings. The relation between location bias and the thickness of subcutaneous tissue was analyzed. Results A total of 20 ALT flaps were included. Fifty-three perforators were detected by CDU, and 51 “hot spots” were identified by infrared thermography, in which 50 “hot spots” corresponded to CDU, and the consistency test showed that the κ index was 0.712 (P < 0.05), representing high consistency. The infrared thermography has a sensitivity of 94.3% and a specificity of 85.7% compared with CDU. The deviation between thermal imaging and CDU was positively correlated with the thickness of the subcutaneous tissue. The Pearson correlation coefficient was 0.84 (R = 0.84). Forty-four perforators marked by CDU were selected for designing the flap. Anatomical findings showed that the accuracy rate of CDU and infrared thermal was 93.2% (41 of 44) and 86.3% (38 of 44), respectively. There was no statistical difference (P > 0.05). Conclusions Compared with CDU, infrared thermography can be used to locate perforators, in this case, the ALT perforators, with a high degree of consistency. It is portable, economical, noninvasive, and easy to operate. It has higher accuracy in patients with thinner subcutaneous tissue. We believe that infrared thermography can be a useful technique for perforator mapping, especially in patients where the subcutaneous tissue is thinner.

Intermittent distributed generators (IDGs), such as distributed wind turbine generator (WTG) and photovoltaic generator (PVG), have been developing rapidly in recent years. The output power of WTG and PVG highly depends on the wind speed and illumination intensity, respectively. There always exist correlations among the wind speed, illumination intensity, and bus load, which could have significant influence on the determination of siting and sizing of IDGs in distribution system. Given this background, a chance‐constrained‐programming‐based IDGs planning model, which can take into account the correlations, is developed in this paper. Latin hypercube sampling technique and Cholesky decomposition are introduced to handle the correlations. A Monte Carlo simulation‐embedded multi‐population differential evolution algorithm is employed to solve the developed model. Case studies carried out on the Baran & Wu 33‐bus distribution system verify the feasibility of the developed model and effectiveness of the proposed solving methodology. © 2015 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.

Ultraviolet (UV)-protective textiles have attracted significant attention because of their wide applicability. However, the anti-UV coatings of such textiles have an adverse effect on their wearing comfort, and other properties related to luster, softness and handle were also ignored. In this study, TiO2-coated silk fabric with controllable UV-protection properties was successfully fabricated via atomic layer deposition (ALD). The luster, bending properties, crease recovery, mechanical properties, air permeability and anti-UV properties of the TiO2-coated silk fabric were investigated. The results showed that the thickness, whiteness, bendability, tensile strength and anti-UV properties of the silk fabric increased progressively while its air permeability, wet crease recovery angle and dry crease recovery angle decreased with an increase in the thickness of the TiO2 coating. However, the coating did not have a negative effect on the usability of the fabric. Thus, the proposed ALD method is a promising one for modifying the surfaces of elastic textile materials in order to accord them with UV-protection properties.

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Rationale: Cranial arterial air embolism is a rare but potentially fatal complication after computed tomography (CT)-guided pulmonary interventions. Patient concerns: A 64-year-old man was diagnosed with a pulmonary nodule (diameter: approximately 1 cm) in the right lower lobe. The patient developed convulsions after CT-guided hook-wire localization. Diagnosis: Cranial CT revealed arborizing/linearly distributed gas in the territory of the right middle cerebral artery. Interventions: The patient was administered hyperbaric oxygen, antiplatelet aggregation therapy, and dehydration treatment. Outcomes: Clinical death occurred 55 hours after air embolism. Lessons: Systemic air embolism is a serious complication of lung puncture. Clinicians should improve their understanding of this complication and remain vigilant against air embolism.

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