Effects of head-elevated position on tracheal intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway: a prospective randomized crossover study.

BACKGROUND: The head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway. METHODS: Sixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack-Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation. RESULTS: The mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P <  0.0001). MCL grade 1 or 2a was achieved in 56 (85.9%) and 28 (43.7%) of patients in the head-elevated and head-flat positions, respectively (P <  0.0001). Optimization maneuvers for intubation were required in 7 (21.9%) and 17 (53.1%) patients in the head-elevated and head-flat positions, respectively (P <  0.0001). The IDS scores and time to intubation did not differ significantly between the two positions. CONCLUSION: In the head-elevated position, aligning the AM-S in the horizontal plane consistently improved laryngeal visualization without worsening the view when the McGrath MAC videolaryngoscope was used in patients with simulated difficult airways. It also improved the ease of intubation, which reduced the need for optimization maneuvers. TRIAL REGISTRATION: This trial was registered with www. CLINICALTRIALS: gov , NCT04716218 , on 20/01/2021.

Stochastic Particle Approach Electrochemistry (SPAE): Estimating Size, Drift Velocity, and Electric Force of Insulating Particles.

Stochastic particle impact electrochemistry (SPIE) is considered one of the most important electro-analytical methods to understand the physicochemical properties of single entities. SPIE of individual insulating particles (IPs) has been particularly crucial for analyses of bioparticles. In this article, we introduce stochastic particle approach electrochemistry (SPAE) for electrochemical analyses of IPs, which is the advanced version of SPIE; SPAE is analogous to SPIE but focuses on deciphering a sudden current drop (SCD) by an IP-approach toward the edge of an ultramicroelectrode (UME). Polystyrene particles (PSPs) with and without different surface functionalities (-COOH and - NH3) as well as fixed human platelets (F-HPs) were used as model IPs. From theory based on finite element analysis, a sudden current drop (SCD) induced by an IP during electro-oxidation (or reduction) of a redox mediator on a UME can represent the rapid approach of an IP toward an edge of a UME, where a strong electric field is generated. It is also found that the amount of current drop, idrop, of an SCD depends strongly on both the size of an IP and the concentration of redox electrolyte. From simulations based on the SPAE model that fit the experimentally obtained SCDs of three types of PSPs or F-HP dispersed in solutions with two redox electrolytes, their size distribution histograms are estimated, from which their average radii determined by SPAE are compared to those from scanning electron microscopic images. In addition, the drift velocity and corresponding electric force of the PSPs and F-HPs during their approach toward an edge of a Pt UME are estimated, which cannot be addressed currently with SPIE. We further learned that the estimated drift velocity and the corresponding electric force could provide a relative order of the number of excess surface charges on the IPs.

Comparison of Pentax Airway Scope and Macintosh laryngoscope for orotracheal intubation in children: A randomised non-inferiority trial.

BACKGROUND: Pentax Airway Scope (AWS) is a recently developed videolaryngoscope for use in both normal and difficult airways, yet its use in paediatric patients has not been established. The purpose of this study was to evaluate the efficacy of the Pentax AWS regarding intubation time, laryngeal view and ease of intubation in paediatric patients with normal airway, compared to Macintosh laryngoscope. METHOD: A total of 136 paediatric patients aged 1-10 with American Society of Anaesthesiologists physical status I or II undergoing general anaesthesia were randomly allocated into two groups: Macintosh laryngoscope (n = 68) and Pentax Airway Scope (n = 68). Primary outcome was intubation time. Cormack-Lehane laryngeal view grade, application of optimal laryngeal external manipulation, intubation difficulty scale, intubation failure rate and adverse events were also measured. RESULT: No significant difference was observed between the two groups regarding intubation time (P = 0.713). As for the laryngeal view grade, the Pentax group resulted in lower graded cases compared to the Macintosh group (P = 0.000). No optimal laryngeal external manipulation application was required in the Pentax group. Intubation difficulty scale resulted in lower values for Pentax group (P = 0.001). Failure rate was not different between the two groups (P = 0.619). There were significantly more teeth injury cases in the Pentax group than Macintosh group (P = 0.042). CONCLUSION: Pentax Airway Scope provided similar intubation time and success rate, while improving laryngeal view, compared to Macintosh laryngoscopy in children with normal airway. When using Pentax AWS in children, however, the risk of teeth injury may increase.

A Novel IVS2-1G>A mutation causes aberrant splicing of the HRPT2 gene in a family with hyperparathyroidism-jaw tumor syndrome.

HRPT2, the gene associated with hyperparathyroidism-jaw tumor (HPT-JT) syndrome, was previously mapped to 1q24-q32. It was recently cloned, and several germline mutations were found to predispose to HPT-JT syndrome. We sequenced the complete HRPT2 coding sequence and splice-junctional regions in a Korean family with HPT-JT syndrome and identified a novel germline mutation, IVS2-1G>A in intron 2, that caused the autosomal dominant trait of HPT-JT syndrome in this family. RT-PCR and sequencing of the transcripts revealed that this splicing mutation generated alternative splicing errors leading to the formation of two different transcripts, one with exon 3 deleted, the other lacking the first 23 bp of exon 3 due to the use of an internal splice acceptor in exon 3. Translation of both transcripts results in premature termination. In addition, we detected two novel somatic mutations of HRPT2 in malignant parathyroid tumors from the affected individuals. One, 85delG, causes premature termination; the other, an 18 bp in-frame deletion of 13_30delCTTAGCGTCCTGCGACAG, suggests that this region may be important in the development of the parathyroid carcinomas in HPT-JT syndrome. These findings provide further evidence that mutation of HRPT2 is associated with the formation of parathyroid tumors in HPT-JT syndrome.

Unliganded estrogen receptor α stimulates bone sialoprotein gene expression.

Estrogen is one of the steroid hormones essential for skeletal development. The estrogen receptor (ER) is a transcription factor and a member of the steroid receptor superfamily. There are two different forms of the ER, usually referred to as α and ß, each encoded by a separate gene. Hormone-activated ERs form dimers, since the two forms are coexpressed in many cell types. Bone sialoprotein (BSP) is a tissue-specific acidic glycoprotein that is expressed by differentiated osteoblasts, odontoblasts and cementoblasts during the initial formation of mineralized tissue. To determine the molecular basis of the tissue-specific expression of BSP and its regulation by estrogen and the ER, we have analyzed the effects of ß-estradiol and ERα on BSP gene transcription. ERα protein levels were increased after ERα overexpression in ROS17/2.8 cells. While BSP mRNA levels were increased by ERα overexpression, the endogenous and overexpressed BSP mRNA levels were not changed by ß-estradiol (10(-8)M, 24 h). Luciferase activities of different sized BSP promoter constructs (pLUC3~6) were increased by ERα overexpression, whereas basal and induced luciferase activities by ERα overexpression were not influenced by ß-estradiol. Effects of ERα overexpression were abrogated by 2 bp mutations in either the cAMP response element (CRE) or activator protein 1 (AP1)/glucocorticoid response element (GRE). Gel shift analyses showed that ERα overexpression increased binding to the CRE and AP1/GRE elements. Notably, the CRE-protein complexes were disrupted by ERα, CREB and phospho-CREB antibodies. The AP1/GRE-protein complexes were supershifted by the c-Fos antibody. These studies demonstrate that ERα stimulates BSP gene transcription in a ligand-independent manner by targeting the CRE and AP1/GRE elements in the rat BSP gene promoter.

Turn-on fluorescence detection of apoptotic cells using a zinc(II)-dipicolylamine-functionalized poly(diacetylene) liposome.

A liposome-based fluorescence sensing system for apoptotic cells has been developed from stimuli-responsive poly(diacetylene)-liposomes for the first time. The combination of the liposome components, a phosphatidylserine-binding Zn(II)-dipicolylamine component and an alcohol-terminated component in the ratio of 2:1, has led to an efficient detection system for apoptotic cells, as demonstrated by confocal fluorescence microscopy and FACS analysis. The liposome shows a color change from blue to reddish purple and emits fluorescence in the turn-on mode upon interaction with phosphatidylserine. The present system thus avoids the washing steps required for "always-on"-type sensing systems.

Zinc(II)-dipicolylamine-functionalized polydiacetylene-liposome microarray: a selective and sensitive sensing platform for pyrophosphate ions.

A microarray-chip assay system for the fluorescence detection of phosphate-containing analytes in aqueous media has been constructed from stimuli-responsive polymerized poly(diacetylene)-liposomes for the first time. Proper combination of the liposome components (Zn(II)-dipicolylamine for phosphate binding and an amine-terminated component for anchoring the liposome onto an aldehyde-derivatized glass plate), has led to a microarray chip that selectively detects pyrophosphate, an important biomarker, over competing anions, such as phosphate and adenosine triphosphate, with nanomolar sensitivity. The chip-based assay shows advantages, such as high specificity and sensitivity, over solution-based assays that use the same liposomes, and over known homogeneous molecular sensing systems.