Antioxidation and anti-inflammatory effects of gamma-irradiated silk sericin and fibroin in H 2O2-induced HaCaT Cell

Oxidative stress in skin cells can induce the formation of reactive oxygen species (ROS), which are critical for pathogenic processes such as immunosuppression, inflammation, and skin aging. In this study, we confirmed improvements from gamma-irradiated silk sericin (I-sericin) and gamma-irradiated silk fibroin (I-fibroin) to skin cells damaged by oxidative stress. We found that I-sericin and I-fibroin effectively attenuated oxidative stress-induced ROS generation and decreased oxidative stress-induced inflammatory factors COX-2, iNOS, tumor necrosis factor-α, and interleukin-1β compared to the use of non-irradiated sericin or fibroin. I-sericin and Ifibroin effects were balanced by competition with skin regenerative protein factors reacting to oxidative stress. Taken together, our results indicated that, compared to non-irradiated sericin or fibroin, I-sericin, and I-fibroin had anti-oxidation and antiinflammation activity and protective effects against skin cell damage from oxidative stress. Therefore, gamma-irradiation may be useful in the development of cosmetics to maintain skin health.

Bean extract-based gargle for efficient diagnosing COVID-19 at early-stage using rapid antigen tests: a clinical, prospective, diagnostic study

ImportanceThe antigen-based rapid diagnostic test (Ag-RDT), using saliva specimens, is fast, non-invasive and suitable for SARS-CoV-2 self-testing, unlike nasopharyngeal swab (NPS) testing. ObjectiveTo assess the diagnostic sensitivity of a novel Beanguard gargle (BG)-based virus detection method for early diagnosis of COVID-19. DesignThis clinical trial was conducted at Gunsan Medical Center, Namwon Medical Center, and Jeonbuk National University Hospital, between May 7 and July 7, 2021. SettingPaired NPS and BG-based saliva specimens collected from COVID-19 patients and healthy individuals were analyzed using NPS-RT-PCR, BG-RT-PCR, and BG-Ag-RDTs. ParticipantsThe study comprised 102 COVID-19-positive patients hospitalized after governmental screening process and 100 healthy individuals. Forty-five COVID-19 patients were sampled within 6 days of illness and 57 within 7-15 days; 27 were categorized as asymptomatic and 75, as symptomatic. Eight and 2 patients carried the SARS-CoV-2 Alpha and Delta variants, respectively. InterventionThe diagnostic performances of BG-Ag-RDT, BG-RT-PCR, and NPS-RT-PCR for detecting SARS-CoV-2 were compared. Main outcomesThe sensitivities of BG-Ag-RDT and BG-RT-PCR towards salivary viral detection were highly concordant, with no discrimination between symptomatic, asymptomatic, or SARS-CoV-2 variant cases. ResultsAmong total participants (mean age, 43.7 years), 51% were women. BG-Ag-RDTs showed high sensitivity (97.8%, [95% CI, 88.4% to 99.6%]) and specificity (100%, [95% CI, 96.3% to 100%) in 45 patients within 6 days of illness and could detect all cases of SARS-CoV-2 Alpha and Delta variants. In 11 asymptomatic early-stage cases, both BG-Ag-RDTs and BG-RT-PCR showed excellent sensitivity and specificity of 100% (95% CI, 74.1% to 100% and 95% CI, 20.7% to 100%, respectively). The interaction between SARS-CoV-2 spike proteins and truncated canavalin, an active ingredient from bean extract (BE) and the ultrastructural features of SARS-CoV-2 particles coated with BE were observed. The detachment of the SARS-CoV-2 receptor-binding domain from hACE2 increased as the BE concentration increased, allowing the release of the virus from hACE2 for early diagnosis. Conclusions and RelevanceUsing BG-based saliva remarkably enhances the Ag-RDT diagnostic performance as an alternative to NPS and enables rapid and accurate COVID-19 self-testing and mass screening, supporting efficient COVID-19 management. Trial RegistrationKCT0006438 Key PointsO_ST_ABSQuestionC_ST_ABSHow can we collect SARS-CoV-2 from oral cavity to improve the sensitivity of antigen-based rapid diagnostic test (Ag-RDT)? FindingsIn this clinical study involving 102 hospitalized COVID-19 patients, the Ag-RDT test using Beanguard gargle-based saliva specimens showed significantly enhanced sensitivity and specificity towards detection of SARS-CoV-2 along with Alpha and Delta variants in all patients tested within 6 days of illness. MeaningOur self-testing method represents an attractive alternative to nasopharyngeal swab RT-PCR for the early diagnosis of symptomatic and asymptomatic COVID-19 cases.

Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study

Background@#Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. @*Methods@#This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. @*Results@#Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. @*Conclusions@#The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

Analysis of the Injuries of Korean Professional Basketball Players during the 2019–2020 Regular Season / 대한스포츠의학회지

Purpose@#This study aimed to provide the descriptive statistics regarding the injury epidemiology of Korean professional basketball players. @*Methods@#In this study, athlete exposures (AEs) and time exposures (TEs) were collected from the 38 basketball players (17 women) who participated in the 2019–2020 regular season. Injury rate (IR) and 95% confidence interval (CI) were calculated. @*Results@#A total of 35 injuries were reported. The overall rate of injury was 5.65 per 1,000 AEs and 0.06 per 1,000 TEs. Approximately 65.7% of all the injuries occurred during the official games, with lower limb injuries accounting for about 57.1% of all the injuries. Ankle was the most frequently injured body area (25.7%) with a IR of 1.45 per 1,000 AEs. Sprain accounted for the largest portion with 54.3% overall, followed by strain, contusion and cartilage damage. The most common cause of injuries was contact with another athletes (37.2%), and the recurrence of past injuries (20.0%) also accounted for a high proportion. @*Conclusion@#Korean professional basketball players experience a high rate of injuries occurring during official games.Ankle sprains were the most common ones. Contact-caused injuries accounted for the highest portion.

The Factors Influencing the Accuracy of Head PositionDuring Canalith Reposition Procedure Using 9 AxisInertial Sensor / 대한이비인후과학회지

Background and Objectives@#The canalith reposition procedure (CRP) is used for the treatment of benign paroxysmal positional vertigo (BPPV) where the accuracy of position may affect the therapeutic efficacy. We investigate the accuracy of head position in CRP and its influencing factors during the procedure by measuring the position using inertial sensors and three dimensional remodeling.Subjects and Method We included 28 patients who were diagnosed as BPPV. To evaluate the accuracy of the CRP, we used the inertial sensor on the patient’s goggle used for videonystagmography. We evaluated the accuracy of the treatment compared to the textual treatment used during CRP. We also evaluated patient factors that affected the accuracy of head position as well as analyzing the correlation between the error rate and the successful treatment rate. @*Results@#While the average error rate was 12.6±5.8% for the PSCC group, it was 10.2±5.2% for the lateral semicircular canal (LSCC) group. For the posterior semicircular canal (PSCC) the group with body mass index (BMI), less than 25 patients had the lower error rate than the group with BMI greater than 25. There was no significant differences regarding the error rate according to BMI or age in the PSCC group. There is no significant differences regarding the error rate between those treated within 1 week and those over 1 week. For the LSCC delayed treatment group, there was no significant differences of error rate between the 1st and 2nd maneuver at each position. @*Conclusion@#For the Epley maneuver, the error rate of patients with high BMI is higher than those with low BMI. When the repeated barbeque maneuver was conducted, patients could have a more accurate position due to the learning effect. Care should be taken to ensure accurate CRP by considering various factors.

Associations of Spiritual Well-being, Attitude toward Death and Quality of Life among Alcoholics Anonymous / 정신간호학회지

PURPOSE: The aim of the study was to investigate associations of spiritual well-being, attitude toward death, and quality of life among Alcoholics Anonymous (AA). METHODS: This study was cross-sectional and descriptive in design. The data was collected from August to September 2018 with 133 AA members drawn from two provinces of South Korea. The data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA with Turkey tests, Pearson's correlation coefficients, and hierarchical multiple linear regression analyses using SPSS/WIN 20.0 program. RESULTS: The existential spiritual well-being (β=.52, p<.001), attitude toward death (β=.24, p<.001), dual diagnosis (β=−.17, p=.003), occupation (β=.12, p=.035) of the participants were significant factors, which explained 63.7% of the variance of quality of life. CONCLUSION: The study findings highlight the need to develop psychological nursing strategies to enhance the spiritual well-being and improve a positive attitude toward death based on the job and dual diagnosis among AA members to improve their better quality of life.

The Efficacy of Miniaturized Repetitive Transcranial Magnetic Stimulation in Patients with Depression

OBJECTIVE: The present study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) at a high frequency using a miniaturized device compared to standard rTMS and sham rTMS for the treatment of depression. METHODS: Fifty-four patients with depression were randomly assigned to either 15 days of miniaturized, standard, or sham rTMS. The stimulation consisted of 60 trains of 5 seconds at 10 Hz for 30 minutes. Clinical measures were assessed at baseline and on the final day of the stimulation. RESULTS: A repeated-measures analysis of variance revealed a significant main effect of time and a time by group interaction on Hamilton Rating Scale for Depression scores. There were no significant correlations between individual motor thresholds and changes of clinical outcomes. Our results revealed a significant reduction in the Hamilton Rating Scale for Depression in the miniaturized and standard groups compared to the sham group. CONCLUSION: The antidepressant utility of miniaturized rTMS using subthreshold stimulation was comparable to that of standard stimulation.

Posttraumatic Symptoms and Change of Complicated Grief among Bereaved Families of the Sewol Ferry Disaster: One Year Follow-up Study

BACKGROUND: The objective of this study was to determine whether severity and severity change of coexisting psychiatric symptoms might affect change of complicated grief (CG) regarding the Sewol ferry disaster. METHODS: Data from a cross-sectional survey were obtained 18 months (Time 1) and 30 months (Time 2) after the disaster. We ascertained sociodemographic variables and variables obtained from self-reporting questionnaires (i.e., CG, depression, anxiety, post-traumatic stress disorder [PTSD], insomnia, embitterment, and suicidal risk) among 56 bereaved family members. RESULTS: Severity of other psychiatric symptoms at Time 1 had no effect on change of CG at Time 2. However, changes in severity of PTSD over a year affected change of CG. CONCLUSION: It is important to evaluate changes in severity of PTSD and its treatment during management of CG, especially when it involves bereaved families experiencing a traumatic accident.

Frontal Alpha Asymmetry, Heart Rate Variability, and Positive Resources in Bereaved Family Members with Suicidal Ideation after the Sewol Ferry Disaster

OBJECTIVE: After the Sewol ferry disaster, bereavement with suicidal ideation was a critical mental health problem that was accompanied by various neuropsychological symptoms. This study examined the frontal alpha asymmetry (FAA), heart rate variability (HRV), and several psychological symptoms in bereaved family members (BFM) after the Sewol ferry disaster. METHODS: Eighty-three BFM after the Sewol ferry disaster were recruited. We assessed FAA, HRV, and psychological symptoms, including depression, post-traumatic stress, post-traumatic growth factor, anxiety, grief, and positive resources, between BFM with the presence and absence of current suicidal ideation. RESULTS: Compared to BFM without suicidal ideation, BFM with suicidal ideation showed a higher FAA with right dominance. Significant differences in psychological symptoms were observed between the groups. In BFM with suicidal ideation, the low: high frequency (LF:HF) ratio correlated with social resources and support. CONCLUSION: The FAA and LF:HF ratio may be biomarkers that represent the pathological conditions of BFM with suicidal ideation. If researched further, they may shed light on the interaction between bereavement with suicidal ideation and social resources for therapeutic intervention.

Identification of Cystoisospora ohioensis in a Diarrheal Dog in Korea

A 3-month-old female Maltese puppy was hospitalized with persistent diarrhea in a local veterinary clinic. Blood chemistry and hematology profile were analyzed and fecal smear was examined. Diarrheal stools were examined in a diagnostic laboratory, using multiplex real-time polymerase chain reaction (PCR) against 23 diarrheal pathogens. Sequence analysis was performed using nested PCR amplicon of 18S ribosomal RNA. Coccidian oocysts were identified in the fecal smear. Although multiplex real-time PCR was positive for Cyclospora cayetanensis, the final diagnosis was Cystoisospora ohioensis infection, confirmed by phylogenetic analysis of 18S rRNA. To our knowledge, this the first case report of C. ohioensis in Korea, using microscopic examination and phylogenetic analysis.

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

Vestibular System Research Based on Electrophysiology / 대한이비인후과학회지

Electrophysiological research has improved the understandings of various neural controls on motion and their functional connectivity in the central nervous system. Unlike medical imaging techniques, the electrophysiological approach can provide the neural signal processing between two or more specific regions and their temporal transmission of neural information. Using its unique advantages, the vestibular system has been also studied for more than 100 years. However, it is a recent finding that various higher functions, such as cognition, memory, learning, and even spatial navigation, are constructed partially by the vestibular neural information in the human brain. It is caused by the historical underestimation on the vestibular system and its supporting position to the main neural flow. Here, we seek for a new research theme with various approaches in the vestibular system by reviewing electrophysiological researches on the vestibular system and their experimental results.

Eosinophilic gastroenteritis with intestinal obstruction after ingesting raw yellow tail fish and oyster

Eosinophilic gastroenteritis is a rare disease in which the symptoms are associated with eosinophilic infiltration in various layers of the gastrointestinal tract. A 56-year-old man complained of severe abdominal pain after eating yellow tail fish and oyster. There was no peripheral blood eosinophilia in the initial laboratory test. Abdominal computed tomography demonstrated circumferential wall thickening and dilatation of small intestine with ascites. An emergency laparotomy accompanied by segmental resection of the ileum and end-to-end anastomosis was performed. Histologically, there was a dense infiltration of eosinophils throughout the entire layers of ileal wall, through which this case could be diagnosed as eosinophilic enteritis. We did not prescribe systemic glucocorticosteroid, but asked him to avoid fish and oyster. He did not complain of recurrent gastrointestinal symptoms anymore after discharge. This is the case of eosinophilic gastroenteritis with intestinal obstruction requiring emergency surgery, which was developed or aggravated after ingestion of yellow tail fish and oyster that were suspected to be culprit foods. In patients with eosinophilic gastroenteritis, foods which are related to this abnormal condition should be identified and avoided to control this disease and prevent from aggravation or flare-up.

The Linear Transmission of the Vestibular Neural Information by Galvanic Vestibular Stimulation / 대한평형의학회지

OBJECTIVE: Growing hypotheses indicate the galvanic vestibular stimulation (GVS) as an alternative method to manage the symptoms of parkinson's disease (PD). GVS is easy and safe for use, and non-invasive. However, it is elusive how the neural information caused by GVS is transmitted in the central nervous system and relieves PD symptoms. To answer this question, we investigated the transmission of neural information by GVS in the central vestibular system, focused on vestibular nucleus (VN). METHODS: Twenty guinea pigs were used for this study for the extracellular neuronal recordings in the VN. The neuronal responses to rotation and GVS were analyzed by curve-fitting, and the numerical responding features, amplitudes and baselines, were computed. The effects of stimuli were examined by comparing these features. RESULTS: Twenty six vestibular neurons (15 regular and 11 irregular neurons) were recorded. Comparing the difference of baselines, we found the neural information was linearly transmitted with a reduced sensitivity (0.75). The linearity in the neural transmission was stronger in the neuronal groups with regular (correlation coefficient [Cor. Coef.]=0.91) and low sensitive units (Cor. Coef.=0.93), compared with those with irregular (Cor. Coef.=0.86) and high-sensitive neurons (Cor. Coef.=0.77). CONCLUSION: The neural information by GVS was linearly transmitted no matter what the neuronal characteristics were.

Snapshot of degenerative aging of porcine intervertebral disc: a model to unravel the molecular mechanisms

Larger animal models, such as porcine, have been validated as appropriate models of the human disc with respect to biomechanics and biochemistry. They are advantageous for research as the models are relatively straightforward to prepare and easily obtainable for research to perform surgical techniques. The intention of this study was to quantitatively analyze gene expression for collagen and proteoglycan components of the extracellular matrix and for collagenase (MMP-1) in porcine discs of varying ages (Newborn; 2-3weeks, Mature; 6-9 month, Older; 2-3 years). In this study, we observed that the cell number and GAG (glycosaminoglycan) formation dramatically decreased with aging. Also, gene expression in the annulus fibrosus (AF) and nucleus pulposus (NP) cells changed with aging. The level of MMP-1 mRNA increased with age and both type I, II collagens decreased with age. The level of aggrecan mRNA was highest in the mature group and decreased significantly with aging. In the mature group, MMP-1 expression was minimal compared to the newborn group. In AF cells, type II collagen was expressed at a high level in the mature group with a higher level of aggrecan, when aged NP showed a decrease in type II collagen. The model of IVD degeneration in the porcine disc shows many changes in gene expression with age that have been previously documented for human and may serve as a model for studying changes in IVD metabolism with age. We concluded that the porcine model is excellent to test hypotheses related to disc degeneration while permitting time-course study in biologically active systems.

Three-dimensional Computer-aided Reconstruction of the Temporal Bone in Mongolian Gerbil / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The natural progress of experimentally induced diseases of the temporal bone can be more precisely observed using the 3-dimensional reconstructive technique. We therefore established a method by generating three-dimensional images of the temporal bone with histologic specimen, and measured the structures in the temporal bone of mongolian gerbil in three dimensions. MATERIALS AND METHOD: One mongolian gerbil(Meriones unguiculatus) of 5 weeks old was studied. Temporal bone specimen was processed for histologic study and reference marks were made in each paraffin block to permit accurate alignment. The embedded specimen was horizontally sectioned at 10 micrometer interval. Each histology section was digitalized and a total of 450 image data were entered to the computer software by tracing each region of interest with digitizer. RESULTS: We reconstructed 3-dimensional images of the cochlea, semicircular canals, and facial nerve. For the semicircular canals, we measured the width and height of each canal and angles between canals. For the cochlea, we measured the diameter of each turn and the volume. For the facial nerve, we measured the length of each segment and the angles between neighboring segments. CONCLUSION: In our study, we successfully reconstructed 3-dimensional images of the inner ear structures and facial nerve, and carried out a quantitative analysis of those structures. Applying this 3-dimensional reconstructive technique to disease-induced animal model, we would evaluate the progress of specific disease and the efficacy of treatment more accurately.

Cardiac Output Measurement / 대한마취과학회지

Maintaining tissue perfusion, thus, obtaining optimal oxygen delivery to the tissue is the final goal of hemodynamic monitoring. Cardiac output is the most valuable parameter among the hemodynamic variables. Although there is no true reference for the cardiac output monitoring, thermodilution cardiac output remains the current clinical standard for measuring cardiac output. New cardiac output techniques are compared with thermodilution method in accuracy and relevance, although thermodilution cardiac output monitoring has been shown to increase the morbidity and mortality, and be inaccurate in several clinical settings. New techniques of cardiac output monitoring have been introduced to increase the safety, convenience, accuracy and reproducibility. Especially, to decrease the time-delay of therapeutic intervention, continuous monitoring is preferred. Among these, partial CO2 rebreathing technique based on Fick principle and esophageal Doppler technique are optimal for intraoperative and intensive care settings during mechanical ventilation. They are non- or minimally invasive methods and don't need that much extra training to operate the machines. Esophageal Doppler monitoring provides further data on preload and contractility, but partial CO2 rebreathing technique does not. In case of cardiac or pulmonary dysfunction, cardiac output monitoring technique which could give more information about preload is beneficial. In cardiac surgery, transesophageal echocardiogram is getting to substitute for pulmonary artery catheter for cardiac output monitoring. For cardiac output monitoring, less invasive, more accurate, and continuous technique is preferred, but it should be chosen according to the clinical setting such as type of operation and cardiac and/or pulmonary function of the patient.

Clinical Experience of the Anesthetic Management of Mucopolysaccharidosis / 대한마취과학회지

Mucopolysaccharidosis is characterized by the progressive accumulation of glycosaminoglycans in multiple organs. Valve and coronary involvement, upper airway obstructive disease, joint stiffness, and mental retardation are associated perioperative anesthetic risks. Nineteen patients and 23 anesthetic cases were presented for elective surgery. The mean patient age was 10.8 years. General anesthesia was administered in 21 cases and intubation was failed in two. Mask ventilation without intubation was performed in two cases in day surgery unit. In one case, spinal anesthesia was performed. Otolaryngologic procedures, i.e., tonsillectomy and adenoidectomy, and ventilation tube insertion were most common. Percutaneous endoscopic gastrostomy and herniorrhaphy were also frequent. Dexamethasone was given to all intubated cases and all patients were extubated in the postanesthesia care unit or in the intensive care unit. There was no perioperative mortality. Cautious airway management until intubation is recommended and mask ventilation with short-acting inhalation or intravenous anesthetics is enough to manage relatively short procedures. For herniorrhaphy, a spinal block could be used.

Comparison of the Cervical Spine Motion during Endotracheal Intubation with Lightwands and Macintosh Laryngoscopes / 대한마취과학회지

BACKGROUND: Endotracheal intubation with direct laryngoscope requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomical reasons or because of cervical spine injury. The lightwand requires less neck flexion and head extension than the conventional laryngoscope. The purpose of this study was to compare the extension of cervical spine obtained with lightwand and Macintosh laryngoscope. METHODS: Twenty patients requiring general anesthesia with endotracheal intubation were studied. Patients were placed on the operating table and anesthesia was induced. Intubation were performed on two occasions: with lightwands and Macintosh #3 laryngoscopes. Cricoid pressure was not applied. To determine cervical spine extension, five radiographs were taken in each patient (before induction, during mask ventilation, during intubation with lightwand, during laryngoscopy with the Macintosh blade: in the best glottic view or during intubation). RESULTS: Of 20 cases, we excluded 2 cases due to the technical error. Significant reduction of radiographic cervical spine extension were found in the lightwand compared to Macintosh blade at all cervical level. Mean atlantooccipital extension angles were 6.2o and 11.7o for the lightwand and Macintosh, respectively. There were no significant differences between mask ventilation and intubation with lightwand. CONCLUSIONS: Lightwand may be better than the conventional intubation in patients whose cervical spine movement is limited or undesirable, especially in the patients in whom awake intubation is not available.

The Radiological Measurement of Cervical Spine Extension during Bullard or Direct Laryngoscopy / 대한마취과학회지

Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.