Clinical trial of a new lightwand device (Trachlight) to intubate the trachea

BACKGROUND: Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique. A newly designed lightwand (Trachlight) incorporates modifications to improve the brightness of the light source as well as flexibility. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients. METHODS: Healthy surgical patients were studied. Patients with known or potential problems with intubation were excluded. During general anesthesia, the tracheas were intubated randomly using either the Trachlight or the laryngoscope. Failure to intubate was defined as lack of successful intubation after three attempts. The duration of each attempt was recorded as the time from insertion of the device into the oropharynx to the time of its removal. The total time to intubation (TTI), an overall measure of the ease of intubation, was defined as the sum of the durations of all (as many as three) intubation attempts. Complications, such as mucosal bleeding, lacerations, dental injury, and sore throat, were recorded. RESULTS: Nine hundred fifty patients (479 in the Trachlight group and 471 in the laryngoscope group) were studied. There was a 1% failure rate with the Trachlight, and 92% of intubations were successful on the first attempt, compared with a 3% failure rate and an 89% success rate on the first attempt with the laryngoscope (P not significant). All failures were followed by successful intubation using the alternate device. The TTI was significantly less with the Trachlight compared with the laryngoscope (15.7 +/- 10.8 vs. 19.6 +/- 23.7 s). For laryngoscopic intubation, the TTI was longer for patients with limited mandibular protrusion and mentohyoid distance, with a larger circumference of the neck, and with a high classification according to Mallampatti et al. However, there was no relation between the TTI and any of the airway parameters for Trachlight. There were significantly fewer traumatic events in the Trachlight group than in the laryngoscope group (10 vs. 37). More patients complained of sore throat in the laryngoscope group than in the Trachlight group (25.3% vs. 17.1%). CONCLUSIONS: In contrast to laryngoscopy, the ease of intubation using the Trachlight does not appear to be influenced by anatomic variations of the upper airway. Intubation occasionally failed with the Trachlight but in all cases was resolved with direct laryngoscopy. The failures of direct laryngoscopy were resolved with Trachlight. Thus the combined technique was 100% successful in intubating the tracheas of all patients.     

Embedded micromachined fiber-optic Fabry-Perot pressure sensors in aerodynamics applications

Small size, high bandwidth pressure sensors are required for instrumentation of probes and test models in aerodynamic studies of complex unsteady flows. Optical-fiber pressure sensors promise potential advantages of small size and low cost in comparison with their electrical counterparts. We describe miniature Fabry-Perot cavity pressure sensors constructed by micromachining techniques in a turbine test application. The sensor bodies are 500 /spl mu/m squared, 300 /spl mu/m deep with a /spl sim/2 /spl mu/m-thick copper diaphragm electroplated on one face. The sensor cavity is formed between the diaphragm and the cleaved end of a single mode fiber sealed to the sensor by epoxy. Each sensor is addressed interferometrically in reflection by three wavelengths simultaneously, giving an unambiguous phase determination; a pressure sensitivity of 1.6 radbar/sup -1/ was measured, with a typical range of vacuum to 600 kPa. Five sensors were embedded in the trailing edge of a nozzle guide vane installed upstream of a rotor in a full-scale turbine stage transient test facility. Pressure signals in the trailing edge flow show marked structure at the 8 kHz blade passing frequency. To our knowledge, this is the first report of sensors located at the trailing edge of a normal-sized turbine blade.     

Experimental study of a bi-periodic magnetoinductive waveguide: comparison with theory

Magnetoinductive waves propagating along a line consisting of two kinds of metamaterial elements are studied. Both elements are made up by the same metallic loop but are loaded by different capacitors resulting in different resonant frequencies. The dispersion characteristics are derived from phase and amplitude measurements for the cases when the line consists of (i) identical elements and (ii) of alternating elements. Both planar (elements in the same plane as the axis of the line) and axial (elements perpendicular to the axis of the line) configurations are investigated. It is shown that in the bi-periodic arrangement of the elements, the dispersion curves have a forward wave in the lower frequency branch and a backward wave in the upper frequency branch independent of the configuration whether it is planar or axial. Comparisons between theoretical and experimental results show good agreement     

Smoking Withdrawal Dynamics: III. Correlates of Withdrawal Heterogeneity.

Five parameters of postcessation smoking withdrawal variability derived from clinical data (T. M. Piasecki, D. E. Jorenby, S. S. Smith, M. C. Fiore, & T. B. Baker, 2003a, 2003b) were predicted from baseline measures and pharmacotherapy assignment. Smokers who were more dependent, older, and high in negative affect reported more severe withdrawal. Women, heavier smokers, and those with a history of depression reported more variable symptoms. Smokers treated with nicotine patch, bupropion, or both reported less severe withdrawal than did those given placebo, but medication did not affect the slope of symptoms over time, day-to-day variability of symptoms, or the size of acute changes in symptoms associated with lapses to smoking. Prior research has shown that these symptom facets predict later relapse: thus, current pharmacotherapies may aid cessation by diminishing withdrawal severity, but they do not affect all clinically important aspects of withdrawal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of hydroxide gel drying on the characteristics of co-precipitated zirconia-hafnia powders

Mixed zirconia-hafnia (Hf_0.25Zr_0.75O₂) powders of fine particle size and narrow particle-size distribution can be prepared via co-precipitation routes using mixed zirconium and hafnium salts as the starting materials. The characteristics of the resultant zirconia-hafnia powders are dependent strongly on the dehydration route by which the co-precipitated hydroxide gels are dried. Zirconium-hafnium hydroxide gels are formed when zirconium and hafnium oxynitrates are co-precipitated in an ammonia solution of pH 10.5. The co-precipitated hydrous gels were dried by three very different routes including organic solvent dehydration, microwave drying, and conventional infrared heating lamp drying. The dried hydroxides were then calcined at various temperatures in the temperature range 550–1150 °C, followed by ball milling to remove large soft-particle agglomerates. The resultant zirconia-hafnia powders were characterized for crystallite size, particle size, particle-size distribution, particle morphology, and the degree of powder agglomeration, using experimental techniques such as X-ray diffraction, BET surface area, differential thermal analysis, thermo-gravimetric analysis, sedigraph, scanning and transmission electron microscopy. Hard particle aggregates, which cannot be effectively eliminated using ball milling, occur in the zirconia-hafnia powders processed via either the microwave drying or conventional infrared heating lamp drying routes. In contrast, the organic solvent dehydration route resulted in an almost aggregate-free powder of fine crystallite and particle sizes. Therefore, the zirconia-hafnia powder processed via the organic solvent dehydration route exhibited high sinterability on sintering at 1300 °C.     

Structure of tetrameric human phenylalanine hydroxylase and its implications for phenylketonuria

Phenylalanine hydroxylase (PheOH) catalyzes the conversion of L-phenylalanine to L-tyrosine, the rate-limiting step in the oxidative degradation of phenylalanine. Mutations in the human PheOH gene cause phenylketonuria, a common autosomal recessive metabolic disorder that in untreated patients often results in varying degrees of mental retardation. We have determined the crystal structure of human PheOH (residues 118-452). The enzyme crystallizes as a tetramer with each monomer consisting of a catalytic and a tetramerization domain. The tetramerization domain is characterized by the presence of a domain swapping arm that interacts with the other monomers forming an antiparallel coiled-coil. The structure is the first report of a tetrameric PheOH and displays an overall architecture similar to that of the functionally related tyrosine hydroxylase. In contrast to the tyrosine hydroxylase tetramer structure, a very pronounced asymmetry is observed in the phenylalanine hydroxylase, caused by the occurrence of two alternate conformations in the hinge region that leads to the coiled-coil helix. Examination of the mutations causing PKU shows that some of the most frequent mutations are located at the interface of the catalytic and tetramerization domains. Their effects on the structural and cellular stability of the enzyme are discussed.     

Class sigma glutathione transferase unfolds via a dimeric and a monomeric intermediate: impact of subunit interface on conformational stability in the superfamily

Solvent-induced equilibrium unfolding of a homodimeric class sigma glutathione transferase (GSTS1-1, EC 2.5.1.18) was characterized by tryptophan fluorescence, anisotropy, enzyme activity, 8-anilino-1-naphthalenesulfonate (ANS) binding, and circular dichroism. Urea induces a triphasic unfolding transition with evidence for two well-populated thermodynamically stable intermediate states of GSTS1-1. The first unfolding transition is protein concentration independent and involves a change in the subunit tertiary structure yielding a partially active dimeric intermediate (i.e., N2 left and right arrow I2). This is followed by a protein concentration dependent step in which I2 dissociates into compact inactive monomers (M) displaying enhanced hydrophobicity. The third unfolding transition, which is protein concentration independent, involves the complete unfolding of the monomeric state. Increasing NaCl concentrations destabilize N2 and appear to shift the equilibrium toward I2 whereas the stability of the monomeric intermediate M is enhanced. The binding of substrate or product analogue (i.e., glutathione or S-hexylglutathione) to the protein's active site stabilizes the native dimeric state (N2), causing the first two unfolding transitions to shift toward higher urea concentrations. The stability of M was not affected. The data implicate a region at/near the active site in domain I (most likely alpha-helix 2) as being highly unstable/flexible which undergoes local unfolding, resulting initially in I2 formation followed by a disruption in quaternary structure to a monomeric intermediate. The unfolding/refolding pathway is compared with those observed for other cytosolic GSTs and discussed in light of the different structural features at the subunit interfaces, as well as the evolutionary selection of this GST as a lens crystallin.     

Just a matter of time

As Midwestern foodservice directors & dietitians recently discovered when an earthquake alert was sounded in their area, it's never too early to review & update emergency plans. Herein is a compendium of tips that can be used by any foodservice professional working in an area at risk of disaster, whether it be earthquake, tornado, hurricane, blackout or flood.