Arecoline induces heart injure via Fas/Fas ligand apoptotic pathway in heart of Sprague-Dawley rat.

Habitual chewing of areca nut increases the risk of cardiovascular disease mortality, but less report demonstrate the toxic mechanism of areca nut on heart. To investigate toxicity of areca nut on cardiomyocytes, we induced the heart injury with arecoline to evaluate the acute damage of areca nut on heart. Different concentrations of are coline (lowdosage: 5 mg/kg/day and high dosage 50 mg/kg/day) were injected into Sprague-Dawley rat via intra-peritoneal method for 21 days to create negative effects of arecoline on cardiomyocyte. Themyocardial architecture of the rat heart was observed. The arecoline-induced apoptotic proteins were analysed via western blotting. The myocardialarchitecture of heart was injured with arecoline and TUNEL stain was also shown are coline-induced cardiac apoptosis. Arecoline promoted the protein expression of both Fas dependent snd mitochondrial dependent apoptosis. In summary, arecoline induces cardiac toxicity and apoptosis by inducing both death receptor and mitochondria-dependent apoptotic pathways on heart.

Prepared Reticulated Nickel Hydroxide for Sensing Urea by Differential Pulse Voltammetry.

A urea sensor base on reticulated nickel hydroxide is prepared by hydrothermal way and operated by differential pulse voltammetry method. The reticulated nickel hydroxide has been successfully synthesized by a hydrothermal method and has been characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Fourier transform infrared spectroscopy (FTIR). The Ni(OH)2 sensor exhibits a higher sensor response (S) of 7.1 than NiO and Au sensing materials to 0.05 M urea concentration at 0.62 V. Various concentration of urea from 0.1 mM to 50 mM are performed on Ni(OH)2, and the sensor response are increased from 1.1 to 7.1 by differential pulse voltammetry (DPV) method. The urea detection limit is measured as 0.1 µM in this system. In addition, the Ni(OH)2 sensor exhibited good reproducibility and short term stability, and the response exhibits no obvious changes after 20 days tests. A possible sensing mechanism of Ni(OH)2 urea sensor is presented.

Structured Routine Use of Styletubation for Oro-Tracheal Intubation in Obese Patients Undergoing Bariatric Surgeries-A Case Series Report.

The aim of this case series report is to provide a new topical view of styletubation (video intubating stylet technique) in obese patients undergoing bariatric surgeries. In contrast to various conventional direct laryngoscopes (DLs), videolaryngoscopes (VLs) have been applied in such obese populations with potentially difficult airway complications. The safety and effectiveness of VLs have been repeatedly studied, and the superiority of VLs has then been observed in and advocated for routine use. In this article, among our vast use experiences with styletubation (more than 54,998 patients since 2016) for first-line routine tracheal intubation, we present the unique experience to apply the styletubation technique in obese patients undergoing bariatric surgery. Consistent with the experiences applied in other patient populations, we found the styletubation technique itself to be swift (the time to intubate from 5 s to 24 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction). The learning curve is steep, but competency can be enhanced if technical pitfalls can be avoided. We, therefore, propose that the styletubation technique can be feasibly and routinely applied as a first-line airway modality in obese patients undergoing bariatric surgery.

An Approach to Improve the Effectiveness of the Video-Assisted Intubating Stylet Technique for Tracheal Intubation: A Case Series Report.

Direct laryngoscopy and videolaryngoscopy are currently the dominant tools for endotracheal intubation. However, the video-assisted intubating stylet, a type of videolaryngoscopy, has been shown to offer some advantages over these tools, such as rapid intubation time, high first-attempt success rates, less airway stimulation, and high subjective satisfaction. On the other hand, this optical intubating technique also has some technical limitations that need to be addressed, including camera lens fogging, airway path disorientation, and obscured visibility due to secretions. In this clinical report, we describe an approach that improves the visibility of the glottis by introducing a suctioning catheter into the nasopharyngeal airway to enhance the efficiency and accuracy of using the intubating stylet technique for tracheal intubation.

Styletubation in Bariatric Surgery: A Case Report.

Direct laryngoscopes and videolaryngoscopes are the dominant endotracheal intubation tools. The styletubation technique (using a video-assisted intubating stylet) has shown its advantages in terms of short intubation time, high success rate, less required stimulation, and operator satisfaction. The learning curve can be steep but is easily overcome if technical pitfalls are avoided. Conditions that make styletubation challenging include secretions/blood, short/stiff neck, restricted mouth opening and cervical spine mobility, anatomical abnormalities over head and neck regions, obesity, etc. In this clinical report, we present the effectiveness and efficiency of the routine use of the styletubation for tracheal intubation in a super-super-obese patient (BMI 103 kg/m2) undergoing bariatric surgery with laparoscopic sleeve gastrectomy.

"Altered Short-Term Dynamics of Cardio-Respiratory Interaction during Propofol-Induced Yawning".

"Cardiac and respiratory oscillations have been shown to interact with each other. This interaction could reflect autonomic nervous system functionality. Propofol-induced yawning during anesthesia induction seems to be associated with sympathetic activation. Presumptively, there is high linearity among interaction of different physiologic system behaviors. Recently, investigators used coherence analysis to quantify the existence and strength of linearity between system signals for study of cardio-respiratory interaction under different physiological conditions. In this investigation, we used a method of time-frequency coherence function to analyze ECG and respiration signals to investigate the linearity of cardio-respiratory dynamics in patients undergoing routine propofol induction procedures for elective surgery. In this prospective, observational clinical study, a total of 84 eligible patients were enrolled. The patients were categorized into yawning and no-yawning groups during propofol induction. During induction, both groups demonstrated significant reduction in high frequency coherence (coh-HF) with simultaneously significant increase in very low frequency coherence (coh-VLF) compared to the pre-induction period. As yawning occurred, the yawning group had more significant changes of cardio-respiratory coherences than the no-yawning group at coh-LF and coh-VLF bands. The yawning group also showed loss of linearity at high frequency band (coh-HF > 0.5) as compared with the pre-induction period, and also showed increases in linearity at low (coh-LF > 0.5) and very low (coh-VLF > 0.5) frequency bands compared with the no-yawning group. Propofol-induced yawning alters cardio-respiratory dynamics with changes of linearity between cardio-vascular and respiratory system behaviors."

Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature.

Direct laryngoscopy (DL) and videolaryngoscopy (VL) have been the most commonly used airway management modalities in the last several decades. Meanwhile, various optional airway tools (e.g., supraglottic devices, fiberoptic bronchoscopes) have been used for alternative rescue modalities when anticipated or unexpected difficulties in airway management has occurred. In recent decades, optical stylets and video-assisted intubating stylets have become another option for difficult airway scenarios. In contrast to other approaches, we have adopted the Shikani video-assisted intubating stylet technique (VS) for both routine and difficult airway management scenarios. In this case series report, we present the video-twin technique, combining a videolaryngoscope with a video-assisted intubating stylet in various clinical case scenarios. We propose that such a combination is easy to learn and employ and is particularly beneficial in situations where an expected difficult airway (EDA) is encountered.

The Use of a Video-Assisted Intubating Stylet Technique in a Critically Ill and Contagious COVID-19 Patient.

Tracheal intubation and ventilatory support are among the important treatments in patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) and severe hypoxia. The intubating team often uses video-assisted intubation equipment to ensure a safe and successful tracheal intubation. In this case report, we demonstrate for the first time, the use of the Shikani video-assisted intubating stylet and the Shikani intubating technique as a safe, speedy, and effective way to intubate a critically ill and highly contagious COVID-19 patient. In addition to the conventional consensus guidelines that are currently available for good practice (such as the proper use of personal protection equipment, etc.), we demonstrated that using the Shikani video-assisted intubating stylet is a reliable and proficient technique that is easy to learn while minimizing the risk of COVID-19 exposure of the airway personnel.

Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report.

Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult airways because of an improved laryngeal view, higher frequency of successful intubations, higher frequency of first-attempt intubation, and fewer intubation attempts. In this case series report, we describe the video-assisted intubating stylet technique in five patients with difficult airways. We believe that the intubating stylet is a feasible and safe airway technique for anesthetized tracheal intubation in patients with an anticipated difficult airway.

The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility.

Among all the proposed predictors of difficult intubation defined by the intubation difficulty scale, head and neck movement (motility) stands out and plays as a crucial factor in determining the success rate and the degree of ease on endotracheal intubation. Aside from other airway tools (e.g., supraglottic airway devices), optical devices have been developed and applied for more than two decades and have shown their superiority to conventional direct laryngoscopes in many clinical scenarios and settings. Although awake/asleep flexible fiberoptic bronchoscopy is still the gold standard in patients with unstable cervical spines immobilized with a rigid cervical collar or a halo neck brace, videolaryngoscopy has been repeatedly demonstrated to be advantageous. In this brief report, for the first time, we present our clinical experience on the routine use of the Shikani video-assisted intubating stylet technique in patients with traumatic cervical spine injuries immobilized with a cervical stabilizer and in a patient with a stereotactic headframe for neurosurgery. Some trouble-shooting strategies for this technique are discussed. This paper demonstrates that the video-assisted intubating stylet technique is an acceptable alternative airway management method in patients with restricted or confined neck motility.

Video-Assisted Stylet Intubation with a Plastic Sheet Barrier, a Safe and Simple Technique for Tracheal Intubation of COVID-19 Patients.

As the COVID-19 pandemic evolves, infection with the Omicron variants has become a serious risk to global public health. Anesthesia providers are often called upon for endotracheal intubations for COVID patients. Expedite and safe intubation can save patient's life, while minimizing the virus exposure to the anesthesia provider and personnel involved during airway intervention is very important to protect healthcare workers and conserve the medical work force. In this paper, we share clinical experience of using a video-assisted intubating stylet technique combined with a simple plastic sheet barrier placed over the patients' mouth for tracheal intubation during the Omicron crisis in Taiwan. We demonstrated that the use of an intubating stylet combined with plastic sheet barrier is swift, safe, and accurate in securing the airway in patients with COVID-19.

Arecoline induces cardiotoxicity by upregulating and activating cardiac hypertrophy-related pathways in Sprague-Dawley rats.

Habitual chewing of the areca nut increases the risk of mortality owing to cardiovascular disease, but few reports have revealed the cardiotoxicity mechanism of the areca nut. Arecoline has been reported to be the primary toxic constituent in the areca nut. In order to study the acute cardiotoxicity of the areca nut in the development of pathologic heart hypertrophy, we induced heart injury in rats using arecoline. Arecoline at a low dosage (5 mg/kg/day) or a high dosage (50 mg/kg/day) was intraperitoneally injected to Sprague-Dawley rats for 21 days. The change of heart function and biochemical pathways were investigated with echocardiography and Western blot. The results were presented that heart functions were weakened by arecoline stimulation, and western blotting analysis revealed an elevation in BNP levels in the heart after arecoline exposure. Arecoline induced IL-6-mediated activation of the MEK5/ERK5 and JAK2/STAT3 pathways, as well as mitogen-activated protein kinase signaling cascades. Further, arecoline increased the calcineurin and NFATc3 levels in the heart. In summary, our results suggest that arecoline causes significantly cardiotoxicity and heart damage by inducing several hypertrophy-related signaling pathways, including IL-6-induced MEK5/ERK5, JAK2/STAT3, mitogen-activated protein kinases, and calcineurin signaling pathways. The study elucidated, for the first time, the possible cardiac hypertrophy mechanisms underlying the cardiotoxicity of the areca nut.

Fast detection of local anesthetic levobupivacaine by impedance method on PPy/SWCNT.

Fast response electrochemical impedance (EI) method was developed to detect concentrations of local anesthetic Levobupivacaine. It revealed the EI method possessed fast response and recovery times and the lowest detected concentration was 1 ppm. Pyrrole was electrochemically polymerized to polypyrrole and made a composite with single walled carbon nanotubes coated over gold electrodes for sensing studies. Ppy and Ppy/SWCNT composite materials were coated upon Au electrodes and characterized by UV/Vis, Fourier Transform Infrared (FTIR), Cyclic Voltammetry (CV) and Transmission Electron Microscope (TEM). Various concentrations of levobupivacaine in the range, 1 to 500 ppm were prepared in medically significant saline solution of 0.9% NaCI as test samples. A 10-kHz frequency was used for the calibration curve, and the short response and recovery time were tested as 5 s and 3 s, respectively. The Ppy/SWCNT material with R2 as 0.9971 showed better linearity than Ppy material. Using molecular dynamic simulation studies exothermic adsorption energies and bond lengths have been calculated and explained the fast response time and lower impedance of Ppy/SWCNT than Ppy.

Lung Point-of-Care Ultrasound for Unexpected Hypoxemia during Anesthesia.

This is a case report showing acute hypoxemia during anesthesia. Immediate differentiation using lung POCUS (point-of-care ultrasound), in addition to physical examination and portable chest radiography, was made. This is the first case report of sputum impaction due to pneumonia causing hypoxemia that has been detected by lung POCUS during anesthesia.

Application of Plastic Sheet Barrier and Video Intubating Stylet to Protect Tracheal Intubators During Coronavirus Disease 2019 Pandemic: A Taiwan Experience.

Since its outbreak in China, the Coronavirus disease 2019 (COVID-19) pandemic has caused worldwide disaster. Globally, there have been 71,581,532 confirmed cases of COVID-19, including 1,618,374 deaths, reported to World Health Organization (data retrieved on December 16, 2020). Currently, no treatment modalities for COVID-19 (e.g., vaccines or antiviral drugs) with confirmed efficacy and safety are available. Although the possibilities and relevant challenges of some alternatives (e.g., use of stem cells as immunomodulators) have been proposed, the personal protective equipment is still the only way to protect and lower infection rates of COVID-19 among healthcare workers and airway managers (intubators). In this article, we described the combined use of a plastic sheet as a barrier with the intubating stylet for tracheal intubation in patients needing mechanical ventilation. Although conventional or video-assisted laryngoscopy is more popular and familiar to other groups around the world, we believe that the video-assisted intubating stylet technique is much easier to learn and master. Advantages of the video stylet include the creation of greater working distance between intubator and patient, less airway stimulation, and less pharyngeal space needed for endotracheal tube advancement. All the above features make this technique reliable and superior to other devices, especially when a difficult airway is encountered in COVID scenario. Meanwhile, we proposed the use of a flexible and transparent plastic sheet to serve as a barrier against aerosol and droplet spread during airway management. We demonstrated that the use of a plastic sheet would not interfere or hinder the intubator's maneuvers during endotracheal intubation. Moreover, we demonstrated that the plastic sheet was effective in preventing the spread of mist and water spray in simulation models with a mannequin. In our experience, we found that this technique most effectively protected the intubator and other operating room personnel from infection during the COVID-19 pandemic.

Hyperglycemia-Induced Cardiac Damage Is Alleviated by Heat-Inactivated Lactobacillus reuteri GMNL-263 via Activation of the IGF1R Survival Pathway.

Diabetes-induced cardiomyocyte apoptosis is one of the major causes of mortality in patients with diabetes. Numerous studies have indicated the beneficial effects of Lactobacillus reuteri GMNL-263. However, the protective effect of Lactobacillus reuteri GMNL-263 in cardiac damage associated with diabetes remains poorly understood. In this study, we aimed to investigate the protective effect of Lactobacillus reuteri GMNL-263 on cardiomyocytes in diabetic rats. Five-week-old male Wistar rats were categorized into normal control group, diabetes group (55 mg/kgw STZ-induced diabetes via intraperitoneal injection), and diabetic animals treated with Lactobacillus reuteri GMNL-263 (109 CFU/rat/day, oral administration for 4 weeks). The results were presented that oral administration of a high dose of Lactobacillus reuteri GMNL-263 in diabetic rats activated IGF1R cell survival pathways to decrease the Fas-dependent and mitochondrial-dependent apoptotic pathways induced by hyperglycemia. We found that GMNL-263 significantly attenuated cell apoptosis via the IGF1R survival pathway in diabetic rats. The findings of this study suggest that GMNL-263 treatment maybe an effective therapeutic approach for the prevention of cardiac apoptosis in patients with diabetes.

A Novel Co3O4-BiPO4 Nanoarchitectonics Material Preparation for the Electrocatalytic Detection of Epinephrine.

A novel sensing material of cobalt oxide-bismuth phosphate (Co3O4-BiPO4) was prepared by the hydrothermal method. Thus prepared sensing material was characterized by X-ray diffraction analysis (XRD) and transmission electron microscopy (TEM). The sensor was used for the determination of epinephrine by using modified Co3O4-BiPO4 on glassy carbon electrode (GCE). The cyclic voltammetry (CV) and differential pulse voltammetry (DPV) methods showed a wide linear response to a concentration range, from 1.71 to 55.00 µM, and the epinephrine detection limit for this sensing system was found to be 1.334 µM. The Co3O4-BiPO4 electrode has very high selectivity towards the detection of epinephrine supported by an interference test. The epinephrine sensor seems very advantageous for future clinical health and medical sectors.

Increased risk of strokes in patients with chronic low back pain (CLBP): A nationwide population-based cohort study.

OBJECTIVES: There have not been any longitudinal studies reported that chronic low back pain (CLBP) patients are at risk for stroke. Thus, in this study, we explored the association between CLBP and strokes. PATIENTS AND METHODS: Data (2000∼2010) from the Taiwan National Health Insurance database were analyzed. We matched 10,308 CLBP patients with 20,616 propensity score-matched non-low back pain (NLBP) patients according to age, gender, index year and comorbidities. Covariates of age, gender, comorbidities, and usage of non-steroidal anti-inflammatory drugs (NSAIDs) were adjusted and analyzed. RESULTS: The mean follow-up duration was 8 years. CLBP patients had higher risks of all stroke, hemorrhagic stroke, and ischemic stroke. The adjusted hazard ratios (aHRs) were 2.35 (95 % confidence interval (CI): 2.14-2.57, p < 0.001), 1.55 (95 % CI: 1.16-2.06, p = 0.003), and 2.41 (95 % CI: 2.18-2.66, p < 0.001), respectively. After adjusting and analyzing the NSAIDs used for the varied duration in the CLBP patients, we did not observe any impacts of such NSAIDs used on the association of CLBP with strokes. The association between CLBP and ischemic stroke was most prominent in the patients less than 50 years old with aHR: 3.56 (CI: 2.74∼4.61, p < 0.001). CONCLUSION: CLBP was associated with increased risk of strokes, especially ischemic stroke, and the association was most prominent in patients less than 50 years old. Further large prospective studies on detailed lifestyle-related factors and qualitative pain assessment are needed to clarify the causal relationship between CLBP and stroke.

Clinical assessment of propofol-induced yawning with heart rate variability: a pilot study.

STUDY OBJECTIVES: To investigate the proportion of propofol-induced yawning and sympathovagal balance during propofol-induced yawning. DESIGN: Prospective, observational, clinical study. SETTING: University hospital and 2400-bed tertiary medical center. PATIENTS: 546 ASA physical status I and II patients undergoing elective surgery with general anesthesia. INTERVENTIONS: Standard induction of anesthesia was performed with intravenous (IV) propofol two to four mg/kg (group P), or pretreatment with atropine 0.1 mg/kg (group AP) or with fentanyl 1 to 3 microg/kg (group FP) before propofol. Continuous standard electrocardiogram for heart rate variability (HRV) was performed in another 20 patients to investigate sympathovagal balance during propofol-induced yawning. MEASUREMENTS AND MAIN RESULTS: The proportions of yawning were 53.5% (207/386), 61.1% (55/90), and 0% (0/50) in the P, AP, and FP groups, respectively. Propofol-induced yawning could be dramatically decreased by pretreatment with IV fentanyl (P < 0.001, chi2 test). Significant increased ratio of low-frequency/high-frequency power was detected during HRV monitoring in 9 patients with yawning in comparison with 11 patients without yawning (P < 0.05, Wilcoxon signed-rank test). CONCLUSIONS: Pretreatment with fentanyl may inhibit propofol-induced yawning. Fluctuations in autonomic function have been noted during propofol-induced yawning.