The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation

Objectives:

To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups.

Methods:

Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpaşa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded.

Results:

The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar.

Conclusion:

Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA.Laryngeal mask airways (LMA) represent a good alternative to endotracheal intubation in suitable cases. The LMAs are used to provide ventilation, or to ease the insertion of an endotracheal tube (TT) in difficult airways, but they are also becoming more frequently used to reduce TT associated complications.1 In particular, the recently developed models of LMAs, which include a gastric tube, have become more commonly preferred in anesthesia applications.2 The I-gel (I-gel) (Intersurgical Ltd, Workingham, UK) has a latex-free, non-inflatable, gel-like, thermoplastic elastomeric cuff that provides easy coverage by properly fitting the anatomy of the supraglottic region and also involves a gastric tube; therefore, it has become more frequently used in patients under general anesthesia and receiving positive pressure ventilation.3 It has been reported that the single-use, inflatable cuff-free I-gel can be inserted more easily and has a reduced morbidity rate.4,5 It is recommended in emergency cases requiring intubation, and particularly in airway management of cases experiencing cardiopulmonary arrest.6 Another supraglottic airway device that enables gastric aspiration is the LMA ProSeal (Laryngeal Mask Company Ltd, Berkshire, UK). Since it is a semi-rigid device with an inflatable cuff, it has been reported to cause mucosa and nerve damage in the supraglottic region, sore throat, and hoarseness due to the cuff pressure.7The present study aimed to compare the I-gel and the LMA ProSeal (P-LMA) with respect to the duration of insertion, ease of insertion, airway pressure leakage, gastric tube insertion success ratio, and complications.     

Hopanoid lipids compose the Frankia vesicle envelope, presumptive barrier of oxygen diffusion to nitrogenase

Biological nitrogen fixation in aerobic organisms requires a mechanism for excluding oxygen from the site of nitrogenase activity. Oxygen exclusion in Frankia spp., members of an actinomycetal genus that forms nitrogen-fixing root-nodule symbioses in a wide range of woody Angiosperms, is accomplished within specialized structures termed vesicles, where nitrogen fixation is localized. The lipidic vesicle envelope is apparently a functional analogue of the cyanobacterial heterocyst envelope, forming an external gas-diffusion barrier around the nitrogen-fixing cells. We report here that purified vesicle envelopes consist primarily of two hopanoid lipids, rather than of glycolipids, as is the case in cyanobacteria. One envelope hopanoid, bacteriohopanetetrol phenylacetate monoester, is vesicle-specific. The Frankia vesicle envelope thus represents a layer specific to the locus of nitrogen fixation that is biosynthetically uniquely derived.     

Assessments of the associations of thrombus localization with accompanying disorders,risk factors,D-dimer levels,and the red cell distribution width in pulmonary embolism

OBJECTIVE:

Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism.

MATERIAL AND METHODS:

In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841.

RESULTS:

The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches.

CONCLUSION:

Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.     

Size and location of thyroid gland in the fetal period

Purpose

The present study’s purpose was to examine the size and location of the thyroid gland using anatomic dissection methods on fetal cadavers.

Methods

This study was performed on 200 spontaneously aborted human fetuses (100 males and 100 females) aged between 9 and 40 weeks of gestation. Fetuses without any external and internal pathology or anomaly were included in this study. Fetuses were divided into four groups based on gestational ages as follows: first group 9–12 weeks (first trimester), second group 13–25 weeks (second trimester), third group 26–37 weeks (third trimester) and fourth group 38–40 weeks (full term). The fetuses were also grouped into monthly cohorts as follows: 9–12 weeks, 3rd month; 13–16 weeks, 4th month; 17–20 weeks, 5th month; 21–24 weeks, 6th month; 25–28 weeks, 7th month; 29–32 weeks, 8th month; 33–36 weeks, 9th month; and 37–40 weeks, 10th month. The anterior necks of fetuses were dissected and the thyroid glands exposed. Vertebral and laryngeal levels and the dimensions (width, length, thickness and weight) of the fetal thyroid glands were determined by anatomical dissection methods. The dimensions and ratios of the fetal thyroid gland (weight/fetal body weight) were evaluated.

Results

The mean values and standard deviations of all parameters by gestational weeks, months, and trimesters were calculated. It was found that all parameters increased with gestational age. No significant differences were observed between genders in all parameters (P > 0.05). There were no significant differences between the right and the left sides for parameters of the thyroid glands. The levels of the superior poles of the thyroid lobes were located at the cervical (C) C1–C3 vertebral bodies. The levels of the inferior poles of the thyroid lobes were located at C4–C5 vertebral bodies. The levels of the superior poles of thyroid lobes were located between the upper ½ and lower ½ of the thyroid cartilage or cricoid cartilage. The levels of the inferior poles of the thyroid lobes were located between the second and sixth tracheal rings. The distance between the superior poles of the thyroid gland and the hyoid bone increased throughout the fetal period. The dimensions of fetal thyroid glands increased with gestational age. The ratio between thyroid gland weights and fetal body weights was unchanged during the fetal period.

Conclusions

We believe that the results obtained from this study will be useful in monitoring thyroid glands in the intrauterine period as well as recognizing early diagnosis and treatment of thyroid anomalies. It will also contribute to future studies in obstetrics, perinatology, and fetopathology.     

A noble bimetal oxysulfide CuVOS catalyst for highly efficient catalytic reduction of 4-nitrophenol and organic dyes

A novel copper–vanadium bimetallic oxysulfide (CuVOS) nanoparticle catalyst was successfully synthesized by a facile method. The samples were characterized by X-ray photoelectron spectrometry (XPS), X-ray diffractometry (XRD), field-emission scanning electron microscopy (FE-SEM), UV-Vis diffuse spectroscopy (DRS), Fourier transform infrared spectroscopy (FTIR), and N₂ adsorption–desorption isotherms. In order to check the catalytic efficiencies toward reduction reaction, 4-nitrophenol (4-NP) and other organic dyes such as rhodamine-B (RhB), methylene blue (MB), and methyl orange (MO) were used. The results showed that the CuVOS prepared in the presence of a suitable amount of N₂H₄ during the synthesis of the nanoparticles exhibited the fastest reduction capabilities by using NaBH₄ as a reducing agent. It was demonstrated that a 100 mL 4-NP (20 ppm) solution was completely reduced by 5 mg CuVOS-3 within 2 min. Moreover, the complete reduction of 100 mL of MO, RhB, and MB solutions of 100 ppm was also achieved by 5 mg CuVOS-3 within 2 min, 6 min, and 5 min, respectively. Hence, the CuVOS is an efficient catalyst for reducing 4-NP and organic dyes and can have great potential for industrial application.

A novel CuVOS catalyst was successfully synthesized by a facile method. The CuVOS with optimum amount of N₂H₄ had higher catalytic activity.     

The planarian Schmidtea mediterranea as a model system for the discovery and characterization of cell‐penetrating peptides and bioportides

The general utility of the planarian Schmidtea mediterranea, an organism with remarkable regenerative capacity, was investigated as a convenient three‐dimensional model to analyse the import of cell‐penetrating peptides (CPPs) and bioportides (bioactive CPPs) into complex tissues. The unpigmented planarian blastema, 3 days post head amputation, is a robust platform to assess the penetration of red‐fluorescent CPPs into epithelial cells and deeper tissues. Three planarian proteins, Ovo, ZicA and Djeya, which collectively control head remodelling and eye regeneration following decapitation, are a convenient source of novel cationic CPP vectors. One example, Djeya1 (RKLAFRYRRIKELYNSYR), is a particularly efficient and seemingly inert CPP vector that could be further developed to assist the delivery of bioactive payloads across the plasma membrane of eukaryotic cells. Eye regeneration, following head amputation, was utilized in an effort to identify bioportides capable of influencing stem cell‐dependent morphogenesis. These investigations identified the tetradecapeptide mastoparan (INLKALAALAKKIL) as a bioportide able to influence the gross morphology of head development. We conclude that, compared with cellular monolayers, the S. mediterranea system provides many advantages and will support the identification of bioportides able to selectively modify the biology of totipotent neoblasts and, presumably, other mammalian stem cell types.     

D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study

Background

Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.

Methods

In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.

Results

In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p < 0.001), CRP [45(13-98) vs 12(5–28), p < 0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF < 50%, vegetation size of > 10 mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p < 0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p = 0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2 mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.

Conclusion

Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2 mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.     

Use of knee height for the estimation of stature in elderly Turkish people and their relationship with cardiometabolic risk factors

The determination of the approximately truest value in height measurement is important in many fields, but it is difficult to perform true measurements, especially in the elderly individuals. We planned to investigate the following items in geriatric Turkish population: to calculate the decrease in height with advancing age by using the standing height measurement and estimated height derived from the knee height; to evaluate the significance of difference between the two measurement methods in the calculation of body mass index (BMI) and waist/height ratio (WHtR); to determine the cut-off value of WHtR according to estimated height in elderly individuals. We studied 551 cases aged between 19 and 97 years. Knee height was measured using a sliding caliper in a sitting position. Linear regression analysis was carried out to derive predictive equations for the estimation of stature with adults (≤50 years of age) according to the gender. This equation was then used to estimate height among elderly subjects. Of the cases, 60.3% were <60 years (mean: 48.75 ± 7.50); 39.7% of the cases were >60 years (mean: 69.51 ± 7.12). Estimated BMI (EBMI) measurements in the females and males >60 years were in average 1.23 kg/m² and 0.92 kg/m² higher than their real BMIs, respectively. EBMI measurements in the females <60 years were 0.32 kg/m² higher than their real BMIs (p < 0.01). There is a statistically significant difference between WHtR in the females of both age groups, and in the males >60 years, as compared to our estimated WHtR (EWHtR) measurements (p < 0.01). The cut-off point of WHtR was 0.61 and 0.58 in the female and male cases of >60 years in our study, respectively. WHtR seemed to be a better anthropometric index that could predict most cardiometabolic risk factors in our study. EWHtR emerged to be a better cardiometabolic risk index especially in the elderly group.