Deep-learning model associating lateral cervical radiographic features with Cormack-Lehane grade 3 or 4 glottic view.

Unanticipated difficult laryngoscopy is associated with serious airway-related complications. We aimed to develop and test a convolutional neural network-based deep-learning model that uses lateral cervical spine radiographs to predict Cormack-Lehane grade 3 or 4 direct laryngoscopy views of the glottis. We analysed the radiographs of 5939 thyroid surgery patients at our hospital, 253 (4%) of whom had grade 3 or 4 glottic views. We used 10 randomly sampled datasets to train a model. We compared the new model with six similar models (VGG, ResNet, Xception, ResNext, DenseNet and SENet). The Brier score (95%CI) of the new model, 0.023 (0.021-0.025), was lower ('better') than the other models: VGG, 0.034 (0.034-0.035); ResNet, 0.033 (0.033-0.035); Xception, 0.032 (0.031-0.033); ResNext, 0.033 (0.032-0.033); DenseNet, 0.030 (0.029-0.032); SENet, 0.031 (0.029-0.032), all p < 0.001. We calculated mean (95%CI) of the new model for: R2 , 0.428 (0.388-0.468); mean squared error, 0.023 (0.021-0.025); mean absolute error, 0.048 (0.046-0.049); balanced accuracy, 0.713 (0.684-0.742); and area under the receiver operating characteristic curve, 0.965 (0.962-0.969). Radiographic features around the hyoid bone, pharynx and cervical spine were associated with grade 3 and 4 glottic views.

Viscosity Prediction of Lubricants by a General Feed-Forward Neural Network.

Modern industrial lubricants are often blended with an assortment of chemical additives to improve the performance of the base stock. Machine learning-based predictive models allow fast and veracious derivation of material properties and facilitate novel and innovative material designs. In this study, we outline the design and training process of a general feed-forward artificial neural network that accurately predicts the dynamic viscosity of oil-based lubricant formulations. The network hyperparameters are systematically optimized by Bayesian optimization, and strongly correlated/collinear features are trimmed from the model. By harnessing domain knowledge in the selection of features, the quantitative structure-property relationship model is built with a relatively simple feature set and is versatile in predicting the dynamic viscosity of lubricant oils with and without enhancement by viscosity modifiers (VMs). Moreover, partial dependency, local-interpretable model-agnostic explanations, and Shapley values consistently show that the eccentricity index, Crippen MR, and Petitjean number are important predictors of viscosity. All in all, the neural model is reasonably accurate in predicting the dynamic viscosity of lubricant solvents and VM-enhanced lubricants with an R2 of 0.980 and 0.963, respectively.

n-3 PUFA and caloric restriction diet alters lipidomic profiles in obese men with metabolic syndrome: a preliminary open study.

PURPOSE: For people with metabolic syndrome (MetS), altering the macronutrient composition of their diets might ameliorate metabolic abnormalities. The common method of clinical assessment only measures total lipid concentrations but ignores the individual species that contribute to these total concentrations. Thus, to predict the amelioration of MetS following caloric restriction (CR) and the intake of fish oil, we used lipidomics to investigate changes in plasma lipids and identify potential lipid metabolites. METHODS: Lipidomics was performed using ultra-high-performance liquid chromatography-tandem mass spectrometry on plasma samples from a clinical trial conducted over 12 weeks. Subjects were randomized into two groups: CR (n = 12) and CR with fish oil (CRF, n = 9). Anthropometric and clinical parameters were measured and correlated with plasma lipidomics data. RESULTS: Compared with baseline, significant differences were observed in body weight, waist circumference, blood pressure and interleukin-6 in both groups, but triglyceride (TG) levels significantly decreased in only the CRF group (all p < 0.05). A total of 138 lipid species were identified. Levels of species containing long-chain polyunsaturated fatty acids were significantly elevated-greater than twofold-following fish oil intake, these included TG (60:9) and phosphatidylcholine (p40:6) (all q < 0.05). TG (60:9) tended to correlate negatively with body weight, body mass index, blood pressure, and HbA1c following fish oil intake. CONCLUSION: CR and fish oil can ameliorate MetS features, including anthropometric parameters, blood pressure, and blood lipid concentrations. The levels of particular lipid species such as TG-containing docosapentaenoic acid were elevated post-intervention and negatively associated with MetS features. TG (60:9) may be proposed as a lipid metabolite to predict amelioration in MetS following the intake of CR and fish oil.

Chicken PRDX3 is required for proliferation of chicken embryo fibroblast cells.

1. This experiment investigated the influence of chicken PRDX3 on cell proliferation in chick embryo fibroblast cells using PRDX3 knockdown technology.2. A methyl thiazolyl tetrazolium (MTT) assay was performed to assess the effect of chPRDX3 knockdown on fibroblast proliferation. The antioxidant effect was investigated to determine if it directly mediated fibroblast cell proliferation.3. To determine the role of chPRDX3 on cell proliferation, an siRNA mediated knockdown was performed in chick fibroblast cells using an in vitro assay. The proliferation of fibroblast cells transfected with siPRDX3 #3 and siPRDX3 Mix was significantly decreased after 48 h (P < 0.01). In addition, the knockdown of chicken PRDX3 suppressed cell proliferation through an increase in oxidative stress.4. The results demonstrated that chPRDX3 is required for cell proliferation in chicken fibroblast cells. Such findings have important implications for the maintenance of chicken fibroblast cells.

Normative values and factors affecting water-perfused esophageal high-resolution impedance manometry for a Chinese population.

BACKGROUND: Combined esophageal high-resolution impedance manometry (HRIM) measures multiple pressures and bolus transit simultaneously, facilitating detailed assessment of esophageal motility. Currently, normative values for water-perfused HRIM systems for Chinese populations are lacking. METHODS: Healthy volunteers were enrolled for comprehensive anthropometric measures, blood biochemistry tests, and an HRIM study using 22 water-perfused pressure sensors and 12 impedance channels. Ten 5-mL liquid swallows of saline at 30-second intervals were conducted. The following parameters were calculated: distal contractile integral (DCI), distal latency (DL), lower esophageal sphincter (LES) basal pressure, 4-second integrated relaxation pressure (IRP-4s), and complete bolus transit percentage. Normal values were established based on the 5th and 95th percentiles. KEY RESULTS: All 66 participants (34 male, 32 female, aged 21-64 years) completed the study and tolerated the HRIM procedure well. The upper normal limit (95th percentile) of IRP-4 second was 20 mmHg. The 5th-95th percentile range for DCI, DL, and complete bolus transit was 99-2186 mmHg●s●cm, 6.2-11.3 second, and 50%-100%, respectively. Age was negatively correlated with DL. Females had significantly higher upper limits for IRP-4s and median DCI than males. Multivariate analyses confirmed that IRP-4s was higher in females, and that higher body mass index and waist circumference were associated with reduced DL and better bolus transit, respectively. CONCLUSIONS AND INFERENCES: We established normative values for the water-perfused HRIM system for a Chinese population. Gender and anthropometric factors may affect various major HRIM parameters and should be taken into account when interpreting HRIM results in clinical practice.

The incidence and characteristics of 3-month mortality after intraoperative cardiac arrest in adults.

BACKGROUND: There is little information about clinical outcomes after intraoperative cardiac arrest (IOCA). We determined the incidence and characteristics of 3-month mortality after IOCA. METHODS: The electronic medical records of 238,648 adult surgical patients from January 2005 to December 2014 were reviewed retrospectively. Characteristics of IOCA were documented using the Utstein reporting template. RESULTS: IOCA occurred in 50 patients (21/100,000 surgeries). Nineteen patients died in the operating room, and further 12 patients died within 3 months post-arrest (total mortality: 62%). Three survivors at 3 months post-arrest had unfavourable neurological outcome. Finally, 34 patients showed unfavourable clinical outcomes at 3 months post-arrest. The incidences of non-cardiac surgery, emergency, pre-operative intubation state, non-shockable initial cardiac rhythm, hypovolaemic shock, pre-operative complications-induced cardiac arrest, non-anaesthetic cause of cardiac arrest, intra- and post-arrest transfusion, and continuous infusion of inotrope or vasopressor in intensive care unit (ICU) were significantly higher in non-survivors at 3 months post-arrest. Total epinephrine dose administrated during arrest was higher, and the duration of cardiac compressions was longer in non-survivors at 3 months post-arrest. CONCLUSIONS: In this study, the incidence of IOCA was 21/100,000 surgeries and the 3-month mortality rate after IOCA was 62%. Several factors including surgical emergency, non-shockable initial cardiac rhythm, pre-operative complications, surgical complications, long duration of cardiac compressions, high total epinephrine dose, transfusion, and continuous infusion of inotropes or vasopressors in ICU seemed to be risk factors for 3-month mortality after IOCA. These risk factors should be considered in the light of relatively small sample size of this study.

Combining ultrasound and lactobacilli treatment for high-fat-diet-induced obesity in mice.

Chronic systemic lipopolysaccharide-induced inflammation can cause obesity. In animal experiments, lactobacilli have been shown to inhibit obesity by modifying the gut microbiota, controlling inflammation and influencing the associated gene expression. A previous study found that high-fat-diet-induced (HFD) obesity was suppressed by lactobacilli ingestion in rats via the inhibition of parasympathetic nerve activity. This study explored the combined use of lactobacilli ingestion and ultrasound (US) to control body weight and body fat deposition in HFD mice over an 8-week experimental period. Male C57BL/6J mice received an HFD during treatment and were randomly divided into four groups: (i) control group (H), (ii) lactobacilli alone (HB), (iii) US alone (HU) and (iv) lactobacilli combined with US (HUB). The US was targeted at the inguinal portion of the epididymal fat pad on the right side. At the 8th week, body weight had decreased significantly in the HUB group (15.56 ± 1.18%, mean ± SD) group compared with the HU (26.63 ± 0.96%) and H (32.62 ± 5.03%) groups (p < 0.05). High-resolution microcomputed tomography (micro-CT) scans revealed that the reduction in total body fat volume was significantly greater in the HUB group (69%) than in the other two experimental groups (HB, 52%; HU, 37%; p < 0.05). The reductions in the thickness of the subcutaneous epididymal fat pads were significantly greater in the HUB group (final thickness: 340 ± 7 µm) than in the H (final thickness: 1150 ± 21 µm), HB (final thickness: 1060 ± 18 µm) and HU (final thickness: 370 ± 5 µm) groups (all p < 0.05). Combination therapy with lactobacilli and US appears to enhance the reduction in body weight, total and local body fat deposition, adipocyte size and plasma lipid levels over an 8-week period over that achieved with lactobacilli or US alone in HFD mice. These results indicate that US treatment alone can reduce hyperlipidemia in HFD mice.

The influence of sexual harassment on mental health among female military personnel of the Republic of Korea Armed Forces.

INTRODUCTION: Reports of sexual harassment are becoming more frequent in Republic of Korea (ROK) Armed Forces. This study aimed to analyse the impact of sexual harassment on mental health among female military personnel of the ROK Armed Forces. METHODS: Data from the 2014 Military Health Survey were used. Instances of sexual harassment were recorded as 'yes' or 'no'. Analysis of variance (ANOVA) was carried out to compare Kessler Psychological Distress Scale 10 (K-10) scores. Multiple logistic regression analysis was performed to identify associations between sexual harassment and K-10 scores. RESULTS: Among 228 female military personnel, 13 (5.7%) individuals experienced sexual harassment. Multiple logistic regression analysis revealed that sexual harassment had a significantly negative impact on K-10 scores (3.486, p<0.04). Higher K-10 scores among individuals experiencing sexual harassment were identified in the unmarried (including never-married) group (6.761, p<0.04), the short-term military service group (12.014, p<0.03) and the group whose length of service was <2 years (11.067, p<0.02). CONCLUSIONS: Sexual harassment has a negative impact on mental health. Factors associated with worse mental health scores included service classification and length of service. The results provide helpful information with which to develop measures for minimising the negative psychological effects from sexual harassment and promoting sexual harassment prevention policy.

Pulse Oximeter-Derived Pleth Variability Index is a Reliable Indicator of Cardiac Preload in Patients Undergoing Liver Transplantation.

BACKGROUND: Accurate estimation of cardiac preload during liver transplantation is essential. The right ventricular end-diastolic volume index (RVEDVI) is recognized as a good preload indicator in patients undergoing liver transplantation. Recently, dynamic variation parameters including pleth variability index (PVI) have been used as predictors of fluid responsiveness. However, the correlation between PVI and preload status has not been well studied. We evaluated the relationship between PVI and RVEDVI during liver transplantation. METHODS: Eighteen patients undergoing liver transplantation were enrolled in this study. Data of hemodynamic parameters including PVI derived by Masimo Rainbow SET Pulse CO-Oximeter, central venous pressure (CVP), pulmonary arterial occlusion pressure (PAOP), and RVEDI were obtained at 10 defined time points throughout liver transplantation. The correlation between RVEDVI and CVP, PAOP, and PVI was analyzed using Spearman rank test. We also investigated the ability of PVI to accurately differentiate RVEDVI <123 or >142 mL/m(2) using receiver operating characteristic (ROC) analysis. RESULTS: There was fair to good correlation between PVI and RVEDVI (correlation coefficient = -0.492, P < .001). The correlation coefficient between CVP, PAOP, and RVEDVI was 0.345 and 0.463, respectively. A 13.5% cutoff value of PVI estimated the RVEDVI <123 mL/m(2) (area under the curve [AUC] = 0.762). A 12.5% cutoff value of PVI estimated the RVEDVI >142 mL/m(2) (AUC = 0.745). CONCLUSIONS: PVI presented as a reliable estimate of preload status and may be a useful predictor of fluid responsiveness in patients undergoing liver transplantation.

Characterization of MUDENG, a novel anti-apoptotic protein.

MUDENG (Mu-2-related death-inducing gene, MuD) is revealed to be involved in cell death signaling. Astrocytes, the major glial cell type in the central nervous system, are a source of brain tumors. In this study, we examined MuD expression and function in human astroglioma cells. Stimulation of U251-MG cells with tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resulted in a 40% decrease in cell viability and a 33% decrease in MuD protein levels, although not in MuD mRNA levels. To study the functional relevance of MuD expression, stable transfectants expressing high levels of MuD were generated. Stimulation of these transfectants with TRAIL resulted in enhanced cell survival (77% for stable and 46% for control transfectants). Depletion of MuD led to a marked reduction upon TRAIL stimulation in cell viability (22% in MuD-depleted cells and 54% in control cells). In addition, we observed that MuD depletion increased the susceptibility of the cells to TRAIL by enhancing the cleavage of caspase-3/-9 and BH3-interacting domain death agonist (Bid). A unique 25-kDa fragment of B-cell lymphoma 2 (Bcl-2) lacking BH4 was observed 60-180 min post TRAIL treatment in MuD-depleted cells, suggesting that Bcl-2 is converted from its anti-apoptotic form to the truncated pro-apoptotic form. Importantly, the TRAIL-mediated decrease in cell viability in MuD-depleted cells was abrogated upon Bid depletion, indicating that the role of MuD in apoptotic signaling takes place at the Bid and Bcl-2 junction. MuD localizes predominantly in the endoplasmic reticulum and partly in the mitochondria and its amounts are reduced 6 h post TRAIL stimulation, presumably via caspase-3-mediated MuD cleavage. Collectively, these results suggest that MuD, a novel signaling protein, not only possesses an anti-apoptotic function but may also constitute an important target for the design of ideal candidates for combinatorial treatment strategies for glioma cells.

A Comparison of the Effects of Sevoflurane and Desflurane on Corrected QT Interval Prolongation in Patients Undergoing Living Donor Liver Transplantation: A Prospective Observational Study.

BACKGROUND: QT interval prolongation has frequently been observed in patients with advanced liver disease. We investigated the influence of inhalation anesthetics on the corrected QT (QTc) interval prolongation during surgery in patients undergoing living-donor liver transplantation. METHODS: Our study included 43 patients who were assigned to 2 groups: sevoflurane (n = 22) or desflurane anesthesia (n = 21). QTc intervals were measured at perioperative determined time points and calculated using Fridericia's formula. RESULTS: Intraoperative QTc intervals increased during the peri-intubation period versus baseline (P = .003) and were prolonged during the peri-reperfusion period (P < .001). However, there was no significant difference in intraoperative QTc interval changes between patients given sevoflurane or desflurane (P = .59). CONCLUSIONS: In this prospective observational study, there was no significant difference in QTc intervals between sevoflurane and desflurane. QTc intervals increased during intubation and reperfusion relative to preoperative values in patients given either sevoflurane or desflurane.

Brown-Séquard syndrome: a rare manifestation of decompression sickness.

Neurological decompression sickness (DCS) is a rare condition that commonly leads to spinal cord injury. We report the case of a 30-year-old man who developed left-sided weakness and numbness after diving to a maximum depth of 15 m with a total dive time of 205min (10 repetitive dives). To the best of our knowledge, only six cases diagnosed as Brown-Séquard syndrome caused by DCS have been reported in the literature. Divers should be aware of the risk factors of DCS before diving and clinicians should make the diagnosis of spinal cord DCS based primarily on clinical symptoms, not on magnetic resonance imaging findings.

Risk of new-onset type II diabetes after appendicectomy.

BACKGROUND: Altered immune function after appendicectomy has been associated with autoimmune disease, even though the mechanisms are not clearly elucidated. This study aimed to investigate whether the frequency of new-onset type II diabetes was increased after appendicectomy in a case-control study. METHODS: This was a retrospective cohort study from the Taiwan Longitudinal Health Insurance Database 2000. The relative risk was compared with that in the general population using population-based data. Each patient was tracked for a 3-year interval to identify those who developed type II diabetes. Cox proportional hazard regression analysis was used to assess the risk of type II diabetes during follow-up. RESULTS: A total of 31,512 patients were included in the study, of whom 5252 had an appendicectomy (study cohort) and 26,260 were matched for comparison. Some 714 patients (2.3 per cent) developed type II diabetes during the 3-year follow-up, 161 in the study cohort (3.1 per cent) and 553 in the comparison cohort (2.1 per cent). The adjusted hazard ratio (HR) for type II diabetes in the study cohort was 1.45 (95 per cent c.i. 1.22 to 1.74). This increased risk was most pronounced in men (adjusted HR 1.47, 1.16 to 1.88) and in those with a perforated appendix (adjusted HR 2.28, 1.71 to 3.03), and applied only to patients younger than 65 years of age. CONCLUSION: An increased risk of new-onset type II diabetes within 3 years after appendicectomy was found in patients aged less than 65 years. The risk was highest in men and in those with complicated appendicitis.

A calorie-restriction diet supplemented with fish oil and high-protein powder is associated with reduced severity of metabolic syndrome in obese women.

BACKGROUND/OBJECTIVES: The prevalence of metabolic syndrome (MetS) and obesity has increased worldwide, as well as in Taiwan, particularly in women aged>40 years. The purpose of this study was to elucidate the effects of a calorie-restriction diet (CR) supplemented with protein and n-3 polyunsaturated fatty acids (PUFAs) on women with MetS. SUBJECTS/METHODS: A total of 143 eligible female participants were recruited and assigned to four dietary interventions such as 1500-kcal CR, calorie-restriction meal-replacement diet (CRMR), calorie-restriction diet with fish oil supplementation (CRF) and calorie-restriction meal-replacement diet with fish oil supplementation (CRMRF). The changes in anthropometric measures, metabolic profiles, inflammatory response and the Z-score of severity of MetS were evaluated. RESULTS: Among 143 female MetS patients enrolled, 136 patients completed the 12-week study. After the 12-week dietary interventions, we observed reductions in body weight (BW), body mass index (BMI) and waist circumference (WC) in all groups. BMI and triglyceride (TG) levels decreased significantly in the CRMR, CRF and CRMRF groups, but not in the CR group. The homeostasis model assessment of insulin resistance (HOMA-IR) had significantly improved in all four groups, and the levels of interleukin-6 (IL-6) and C-reactive protein (CRP) had significantly decreased in the CRF and CRMRF groups. Following the interventions, the changes in waist circumference (WC), mean arterial pressure (MAP), fasting blood glucose (FBG), TGs, HOMA-IR, CRP and IL-6 significantly correlated with the reductions in Z-score of MetS severity. CONCLUSIONS: Our study results indicate that a calorie-restriction dietary intervention combined with various macronutrients can reduce the severity of MetS in women and increase recovery from MetS by almost twofold in comparison with a CR alone.

When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention?

UNLABELLED: Experts reviewed the literature to determine whether partially whey hydrolysed formulas (HF) offer benefits in the dietary management of frequent gastrointestinal symptoms and allergy prevention. Compared with standard cow's milk-based formulas, partially whey HF confer a limited protective effect against allergic disease in high-risk infants, particularly atopic dermatitis, but not respiratory allergies. No randomised clinical trials have been published on partially whey HF in infants with colicky symptoms. The group did not find sufficient evidence to support the use of partially whey HF in regurgitation, although recent data suggest that a thickened partially whey HF may be more effective. Partially whey HF, fortified with prebiotics and/or probiotics, with high levels of sn-2 palmitate in the fat blend or without palm oil, provide some benefit in functional constipation. CONCLUSION: Overall, partially whey HF may offer a useful alternative to intact protein in the dietary management of common functional gastrointestinal symptoms.

Value of procalcitonin in differentiating pulmonary tuberculosis from other pulmonary infections: a meta-analysis.

OBJECTIVES: To systematically and quantitatively summarise the current evidence on the utility of the procalcitonin test (PCT) in discriminating pulmonary tuberculosis (TB) from other pulmonary infections. METHODS: We searched MEDLINE, EMBASE and the Cochrane database up to August 2013 for studies that reported the performance of PCT alone or compared with other biomarkers in diagnosing pulmonary TB. We summarised PCT using forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. RESULTS: We found nine qualifying studies covering 951 episodes of suspected TB along with 426 confirmed TB cases. The bivariate pooled sensitivity and specificity of PCT to distinguish TB from non-TB were respectively 42% (95%CI 30-56) and 87% (95%CI 63-96). The bivariate pooled sensitivity and specificity for PCT in distinguishing TB from bacterial pneumonia were respectively 78% (95%CI 67-86) and 85% (95%CI 78-90). Low heterogeneity was noted in studies comparing TB with bacterial pneumonia patients. CONCLUSION: The results suggest consistently acceptable sensitivity and specificity of the PCT test in distinguishing TB from bacterial pneumonia. However, given the imperfect sensitivity and specificity of the test, medical decisions should be based on both the PCT test results as well as on clinical findings.

Effect of palonosetron on the QTc interval in patients undergoing sevoflurane anaesthesia.

BACKGROUND: Palonosetron is a recently introduced 5-HT3 receptor antagonist for postoperative nausea and vomiting. Detailed standardized evaluation of corrected QT (QTc) interval change by palonosetron under sevoflurane anaesthesia is lacking. We evaluated QTc intervals in patients who are undergoing surgery with sevoflurane anaesthesia and receive palonosetron. METHODS: Our study included 100 patients who were undergoing elective surgery under sevoflurane anaesthesia. The patients were randomly assigned to two groups: those who received an i.v. injection of palonosetron 0.075 mg immediately before induction of anaesthesia (pre-surgery group, n=50) and those who received it after surgery in the recovery room (post-surgery group, n=50). QTc intervals were measured before operation, intraoperatively (baseline, immediately after tracheal intubation, and at 2, 10, 15, 30, 60, and 90 min after administration of palonosetron or placebo), and after operation (before and at 3, and 10 min after administration of palonosetron or placebo). QTc intervals were calculated using Fridericia's, Bazett's, or Hodges formulas. RESULTS: The perioperative QTc intervals were significantly increased from the baseline values, but were not affected by the pre- or post-surgical timing of palonosetron administration. CONCLUSIONS: There was no significant difference in the QTc intervals during the perioperative period, whether 0.075 mg of palonosetron is administered before or after sevoflurane anaesthesia. Palonosetron may be safe in terms of QTc intervals during sevoflurane anaesthesia. Clinical trial registration ClinicalTrials.gov: NCT01650961.

Higher operating tables provide better laryngeal views for tracheal intubation.

BACKGROUND: The present study was conducted to investigate the influence of different operating table heights on the quality of laryngeal view and the discomfort of the anaesthetist during enodotracheal intubation. METHODS: Eight anaesthetists participated, to each of whom 20 patients were allocated. Before induction of anaesthesia, the height of the operating table was adjusted to place the patient's forehead at one of four landmarks on the anaesthetist's body (the order being determined by block randomization with eight blocks): umbilicus (Group U), lowest rib margin (Group R), xiphoid process (Group X), and nipple (Group N). Next, the anaesthetist began the laryngoscopy and evaluated the grade of laryngeal view. For this 'initial posture', the anaesthetist was not allowed to adjust his or her posture (flexion or extension of the neck, lower back, knee, and ankle). This laryngeal view was then re-graded after these constraints were relaxed. At each posture, the anaesthetist's joint movements and discomfort during mask ventilation or intubation were evaluated. RESULTS: The laryngeal view before postural changes was better in Group N than in Group U (P=0.003). The objective and subjective measurements of neck or lower back flexion during intubation were higher in Group U than in Groups X and N (P<0.01 for each). The improvement of laryngeal view resulting from postural changes correlated with the anaesthetist's discomfort score before the postural change (P<0.01). CONCLUSIONS: Higher operating tables (at the xiphoid process and nipple level of the anaesthetist) can provide better laryngeal views with less discomfort during tracheal intubation. TRIAL REGISTRY NUMBER: NCT01649973 (clinicaltrials.gov).

Rapid identification of Salmonella using Hektoen enteric agar and 16s ribosomal DNA probe-gold nanoparticle immunochromatography assay in clinical faecal specimens.

UNLABELLED: A rapid identification of Salmonella, one of the most common foodborne pathogens worldwide, in clinical patients can enable better rational managements and prevent further outbreaks. The traditional immunochromatography using antibody-gold nanoparticles (Ab-AuNPs), such as the home pregnancy test, has been used for the Salmonella detection. In this study, we developed a new and rapid method using DNA probe-AuNPs for the detection of 16s ribosomal DNA of Salmonella. To evaluate the proposed method in clinical specimens, we performed a clinical test by identifying 159 stool samples on Hektoen agar containing black or crystalloid colonies using the method and the VITEK 2 system for confirmation. Eighty of the isolates were correctly identified as Salmonella to achieve 100% sensitivity. Seventy-five samples were correctly identified as non-Salmonella spp., but four were incorrectly identified as Salmonella. The specificity was 94·93%. The assay time is about 30 min after the DNA purification. The time-consuming and labour-intense biochemical tests can be replaced. We demonstrated that this assay is a rapid, convenient and cost-effective tool for Salmonella identification of clinical faecal samples, which is worth for further promotion and clinical use. This is the first application of using 16s ribosomal DNA probe-Au-NPs and immunochromatography on clinical samples. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first application of using 16s ribosomal DNA probe-gold nanoparticles and immunochromatography method on clinical samples with sensitivity 100% and specificity 94·93%. The assay time is about 30 min after the DNA purification. We find this assay a rapid, convenient, sensitive and inexpensive tool for Salmonella identification of clinical faecal samples, which is worth further promotion and clinical use and can replace the traditional time-consuming and labour-intense biochemical tests. The potential benefit of this approach is to develop a rapid point-of-care test that provides results while the patient is still at the doctors' office.

Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials.

BACKGROUND: Laparoscopic total extraperitoneal (TEP) inguinal hernioplasty is significantly less painful than open repair, but it is not completely painless. Local anesthetics are thought to decrease postoperative pain when placed at the surgical site. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of extraperitoneal bupivacaine treatment during laparoscopic inguinal hernia repair for the reduction of postoperative pain. METHODS: We conducted a systematic review and meta-analysis of RCTs that investigated the outcomes of extraperitoneal bupivacaine analgesia versus control in laparoscopic TEP hernia repair. Pain was assessed using a visual analog scale at 4-6 h and at 24 h following the surgery. The secondary outcomes included complications and analgesia consumption. RESULTS: We reviewed eight trials that included a total of 373 patients. We found no difference between the groups in postoperative pain reduction following laparoscopic TEP inguinal hernia repair. The intensity of pain was not significantly different between the bupivacaine treatment group and the control group. The pooled mean differences in pain scores were -0.26 (95% CI -0.72 to 0.21) at 4-6 h and -0.47 (95% CI -1.24 to 0.29) at 24 h. No bupivacaine-related complications were reported. CONCLUSION: Extraperitoneal bupivacaine treatment during laparoscopic TEP inguinal hernioplasty is not more efficacious for the reduction of postoperative pain than placebo.