Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery

Recent concern regarding lidocaine neurotoxicity has prompted efforts to find alternatives to lidocaine spinal anesthesia. Small-dose dilute bupivacaine spinal anesthesia yields a comparably rapid recovery profile but may provide insufficient anesthesia. By exploiting the synergism between intrathecal opioids and local anesthetics, it may be possible to augment the spinal anesthesia without prolonging recovery. Fifty patients undergoing ambulatory surgical arthroscopy were randomized into two groups receiving spinal anesthesia with 3 ml 0.17% bupivacaine in 2.66% dextrose without (Group I) or with (Group II) the addition of 10 microg fentanyl. Median block levels reached T7 and T8, respectively (P = not significant [NS]). Mean times to two-segment regression, S2 regression, time out of bed, time to urination, and time to discharge were 53 vs 67 min (P < 0.01), 120 vs 146 min (P < 0.05), 146 vs 163 min (P = NS), 169 vs 177 min (P = NS), and 187 vs 195 min (P = NS) respectively. Motor blockade was similar between groups, but sensory blockade was significantly more intense in Group II (P < 0.01). Six of 25 blocks failed in Group I, whereas none failed in Group II. The addition of 10 microg fentanyl to spinal anesthesia with dilute small-dose bupivacaine intensifies and increases the duration of sensory blockade without increasing the intensity of motor blockade or prolonging recovery to micturition or street fitness. IMPLICATIONS: Concerns about the neurotoxicity of lidocaine have prompted efforts to find alternatives to lidocaine spinal anesthesia. We studied 50 patients undergoing ambulatory surgical arthroscopy and found that although small-dose bupivacaine alone is inadequate for this procedure, the addition of fentanyl makes it reliable.     

Effect of pressure gradient on MHD boundary layer over a flat plate

Summary The magnetohydrodynamic (MHD) boundary layer flow over a flat plate is examined here for two cases, viz. a uniform free-stream velocity and a uniform hydrostatic pressure. The nonlinear boundary layer equations are solved using a reliable finite-difference method. The boundary layer physical parameters such as skin-friction coefficient, displacement, momentum and energy thicknesses of the boundary layer are determined. It is found that the normal surface velocity gradient decreases with the local magnetic interaction parameter for the cases of a uniform hydrostatic pressure, whereas in the case of a uniform free-stream volocity it increases with the interaction parameter.     

Hong Kong''s eastern and western medical history

BACKGROUND: Some clinical studies suggest that a combination of an H1- and H2-antagonist may be effective in the prophylaxis of allergic reactions. OBJECTIVE: The efficacy of pretreatment with an H1/H2-antagonist combination, H1-antagonist alone, or placebo in the prophylaxis of local and systemic adverse reactions to specific immunotherapy with Hymenoptera venom was compared. METHODS: In a prospective, randomized, double-blind, placebo-controlled study, 121 patients with Hymenoptera venom allergy were treated with rush immunotherapy and pretreatment with one of the following: 120 mg of terfenadine plus 300 mg of ranitidine, 120 mg of terfenadine alone, or placebo. The incidence of unwanted systemic adverse and local reactions was recorded for up to 50 weeks. RESULTS: In seven patients (6%), six in the placebo group and one in the terfenadine group, systemic side effects required cessation of therapy (p = 0.005). Subjective symptoms occurred in four patients (10%) in the terfenadine plus ranitidine group and in three patients (7%) in the terfenadine group. Regarding local reactions, significantly fewer patients treated with a combination of terfenadine and ranitidine and with terfenadine alone as compared with placebo had severe local symptoms of erythema (29%, 29%, and 49%), edema (24%, 18%, and 41%), and pruritus (13%, 11%, and 31%) at week 1 (p < 0.05). This therapeutic benefit was limited to the first 4 weeks of treatment. Treatment with a combination of terfenadine and ranitidine was not superior to treatment with terfenadine alone. CONCLUSIONS: Pretreatment with H1-antihistamines with or without H2-antihistamines significantly reduced local and systemic adverse reactions to immunotherapy with Hymenoptera venom and may therefore be helpful in the management of immunotherapy.     

Cytoplasmic tail deletion of T cell receptor (TCR) beta-chain results in its surface expression as glycosylphosphatidylinositol-anchored polypeptide on mature T cells in the absence of TCR-alpha

Surface expression of the T cell antigen receptor (TCR) in mature T cells requires the association of a variable heterodimer (alpha.beta or gamma.delta) with six invariant CD3 polypeptides (gamma, delta, epsilon-epsilon, zeta-zeta, or zeta-eta). We described here that deletion of the cytoplasmic tail polypeptide sequence (Lys-Lys-Lys-Asn-Ser) of TCR beta-chain (beta CT) results in expression of the truncated beta-chain on the surface of a mature T cell hybridoma line, in the absence of TCR-alpha, as a glycophosphatidylinositol (GPI)-anchored monomeric polypeptide. The GPI-anchored TCR-beta CT is not associated with CD3-epsilon and is incapable of conventional signal transduction. Association with TCR-alpha prevents beta CT from GPI-linkage formation. The alpha beta CT heterodimer binds the CD3 polypeptides, and the resultant TCR alpha beta CT/CD3 complex is capable of signal transduction. Our data show that a signal sequence for GPI-linkage formation is present in TCR-beta, and this alternative membrane anchoring mechanism can be utilized by beta-chain polypeptide lacking the CT sequence. We conclude therefore that in the absence of TCR-alpha expression, the beta-chain CT sequence plays an essential function in hindering GPI-linkage formation, thereby preventing escape of incompletely assembled TCR beta-chain to the cell surface of mature T cells.     

Climate change gains more from nuclear substitution than from conservation

We show the massive reduction achievable, in both emissions and climate change impact, from enhanced nuclear energy use on the forecasts of future world energy use and its associated environmental impacts. A range encompassing the major scenarios for the World's energy demand have been analyzed using the latest version of the climate-modeling MAGICC/SCENGEN software (Version 4.1). We have updated and predicted the impacts of 80% substitution with CO₂-free sources (likely predominantly nuclear) for coal-fired electricity (by 2030) and for transportation fuel (by 2040). For transportation, hydrogen produced by CO₂-free sources would replace gasoline and diesel fuels. In this paper, to bracket the range of futures, we simply focus on two scenarios from the Intergovernmental Panel on Climate Change's (IPCC), one (A1FI) that is energy-profligate and one (B2) that is energy-conserving.The results show that, interestingly, projected average global temperatures for all scenarios are fairly similar until about 2035 (a further rise beyond the 1990 average temperature of +0.75 ± 0.1 K) regardless of energy usage and its sources. However, by 2050, the different IPCC scenarios diverge markedly. Understandably, A1FI is projected to have noticeably stronger effects than B2 on average global temperatures (about 0.3 K more in 2050) but the effect is much stronger over land at mid and high latitudes (up to almost 1 K more). What is most striking is that the substitution of CO₂-free sources gives projected average temperature rises in 2050 over key land areas (North America and China) that are very similar for the two energy-use scenarios—typically 1–1.5 K because A1FI's additional energy is predominantly supplied by nuclear. In contrast, projected rises with the unaltered cases are markedly different being about 2.5 K for A1FI and 1.5–2 K for B2. The projected changes in rainfall distribution show similar patterns, especially for the expected increases in higher latitudes.With the assumption of no additional policies for substitution of energy sources beyond 2040, temperature divergence between the two scenarios of relative energy profligacy or conservation grows in the latter half of the 21st century, even with substitution. However, the early substitution of nuclear energy and hydrogen appears to buy time and is not crucially dependent on severe, near-term curtailment of energy use. Near-term curtailment is too difficult to implement at a time of rapid industrialization of major emerging economies. Of course, proportionately larger deployments of CO₂-free energy sources are needed for more energy-intensive scenarios.Nuclear power must dominate as the source of CO₂-free energy since it is proven, dependable, available on a large scale, and economic. Social objections to nuclear energy in some countries and quarters are seen as well-meaning but misguided distractions from solving the energy and environmental crises that are now facing world sustainability. The time for real technical, social and political action is now.     

Learning spreadsheets: human instruction vs. computer-based instruction

The increasing need to instruct students in the use of personal computer software, especially electronic spreadsheets, is placing greater demands on the already full university curriculum. A potential help in meeting these demands is the readily available computer-based software tutorials. In order to explore the feasibility of computer-based instruction as an alternative to human instruction, this research compares two modes of instruction, computer-based and human. An experiment was conducted with groups of business student subjects. The research results indicate no difference in students' attitude towards computer-based instruction and human instruction of spreadsheets. Students' short-term recall of the software syntax being taught is as strong with computer-based instruction as with human instruction. These results were not affected by the level of personal computer experience that students had prior to the experiment. However, the ability to comprehend and immediately apply the software to a task is greater with human instruction than with computer-aided instruction. This advantage holds true for students instructed by experienced and inexperienced instructors.     

A design advisor for the optimal inspection of circularity tolerance

In the wake of growing importance for quality and the need to reduce inspection costs simultaneously, the need for a scientific method of selecting an optimum inspection strategy for coordinate measuring machine (CMM) based inspection has become very important. The inspection error resulting from CMM inspection is greatly affected by the profile irregularities and the sampling strategy, which includes sample size, sampling methods, and algorithms used for form evaluation. This paper describes a system that can recommend an optimal inspection plan based on the needs of the user. A design of experiments (DOE) based approach is used to relate the inspection error with sampling strategies. Surface irregularities are included in the form of lobes formed on the profile. A new two-way model is proposed that works in both directions between the sampling strategy and the performance metrics. The results indicate that the number of lobes and the sampling method used have little impact on the inspection error, while the sample size and form evaluation algorithms have a significant influence. An inspection plan advisor is presented, which provides an inspection plan based on the estimated shape and acceptable measurement error.     

Transient behavior of subthreshold characteristics of fullydepleted SOI MOSFETs

It has been found that the subthreshold currents of fully depleted silicon-on-insulator (SOI) MOSFETs show a transient behavior under certain front-gate and back-gate voltage conditions. The cause of this anomaly is explained, and applications for the phenomenon are pointed out. Particularly, a simple way to measure the silicon film thickness is suggested     

On the use of confidence levels in risk management

A framework for incorporating uncertainty in risk management is developed and applied to two aspects of decision making: meeting standards or safety goals, and cost-benefit criteria. The framework is applied to several case studies including toxic chemicals in water, failure of civil engineering structures and nuclear power plants. The framework proposes that decisions be based on a level of confidence, in addition to comparing best estimate or point values with standards and goals.