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.     

Children's Physiological Indices of Empathy and Their Socioemotional Adjustment: Does Caregivers' Expressivity Matter?

Relations of heart rate and skin conductance reactions to mildly evocative empathy-inducing slides with socioemotional functioning were examined for 154 children (mean age = 9 years, 5 months). In addition, maternal expressivity was tested as a moderator of these relations. Parents and teachers rated children's socioemotional functioning, and a behavioral measure of children's regulation was obtained. Boys who exhibited higher skin conductance and higher heart rate to slides depicting negative emotions were better regulated, less emotionally intense, and better adjusted than their peers. Furthermore, boys' regulation and adjustment were positively related to such physiological responding to negative slides if maternal negative expressivity was relatively low or moderate, but not high. Fewer findings were obtained for girls or for positive slides. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior and movements of Indian meal moths (Plodia interpunctella Hübner) during commodity infestation

A model warehouse with carefully regulated environmental conditions was used to study the behavior of adult Indian meal moths during commodity infestation. Sequences of moth distributions in the warehouse, calculated by spatial analysis, clearly showed the coordinated movements of moth populations from eclosion to death. Many facets of adult behavior in a warehouse were coordinated with the photoperiod. Adult moths emerged at the end of a photophase and fairly rapidly moved to the walls and, to a lesser extent, to the undersides of the commodity pallets. Most females are mated in the first 24 h after emergence, largely during the scotophase. Air circulation within the warehouse probably compromised pheromone-directed guidance of males to females, although pheromones may still have a major role in regulating other aspects of male mating behavior. When mating subsided, many of the males flew upwind to the air circulating unit, but only during the photophases. The females moved to the return air side of the warehouse and then migrated towards the same end as the males, but only during the scotophases. They moved from pallet to pallet largely by walking on the warehouse floor and laid eggs in or on the cups of commodity. Direct oviposition on the commodity during the infestation period was lower than expected, probably because commodity odors were dissipated by air circulation and did not provide appropriate orientation. At 144 h after emergence, 90% of the moth population had died.     

Relating matrix metalloproteinase structure to function: why the "hemopexin" domain?

Matrix metalloproteinases are thought to be key players in the remodelling activity of cells associated with both physiological and pathological processes. They share a relatively conserved structure with a number of identifiable modules linked to their specific functions. The structure of the individual domains of a number of matrix metalloproteinases have now been elucidated. Here we review these data in the light of complementary studies on the behaviour of these enzymes in biological systems. In particular we focus on the C-terminal hemopexin-like domain which has intriguingly specific roles in individual matrix metalloproteinases.     

Noninvasive assessment of the direct action of oral nifedipine and nicardipine on left ventricular contractile state in patients with systemic hypertension: importance of reflex sympathetic responses

BACKGROUND: Alveolar macrophages from patients with sarcoidosis were analyzed for their ability to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin-1-beta (IL-1-beta), and interleukin-6 (IL-6). RESULTS: Constitutive release of all three monokines in these patients was concomitantly increased in the active state of disease in comparison with inactive sarcoidosis or healthy control subjects. Alveolar macrophages from patients with inactive sarcoidosis compared with cells from healthy subjects showed increased spontaneous secretion of TNF-alpha and IL-6 only, whereas the constitutive release of IL-1-beta was similar as in healthy volunteers. In vitro stimulation of alveolar macrophages from healthy control subjects with lipopolysaccharide or pokeweed mitogen led to a time- and dose-dependent enhanced secretion of TNF-alpha, IL-1-beta, and IL-6. In a similar manner, with corresponding cells from patients with sarcoidosis the secretion of all three cytokines could be further increased by stimulation with lipopolysaccharide or pokeweed mitogen. CONCLUSIONS: The data presented indicate that an increased release of TNF-alpha, IL-1-beta, and IL-6 correlates to disease activity and may play a critical part in the pathogenesis of sarcoidosis.     

Evaluation of Serum Volume Losses During Long-Term Storage

Aliquots of serum collected in a large case-control study of cervical cancer were stored at −70°C for up to 4 years during implementation of the study. When 500 μL serum aliquots were thawed in preparation for carotenoid and vitamin A assays, volumes were noticeably variable and fell below 500 μL in the majority of the samples. We were concerned about evaporation/sublimation during storage of the samples because loss of water would concentrate the analytes of interest. We evaluated the use of density and sodium ion concentration measurements to confirm its occurrence. We found that serum density was an unreliable indicator of extent of volume loss since the anticipated increases in density due to evaporation were of the same magnitude as inter-individual variation in serum density. In contrast, Na⁺ concentration is tightly regulated and would rise if water had been lost from the samples. In a representative sample of serum aliquots from the case-control study, 24 of 25 vials contained less than 500 μL of serum. The mean sodium ion concentration (138.1 ± 3.6 mmol/L) was within the normal range for human serum of 136–145 mmol/L, and no correlation was observed between serum volume and Na⁺ concentration. These results strongly suggest that the observed low volumes were not due to evaporative losses. Instead, the variably low volumes of serum aliquots were probably due to pipetting errors in the initial aliquotting resulting from the use of air-displacement pipettes.     

Rate of seasonal spread of respiratory syncytial virus in a pediatric hospital

The rate of nosocomial respiratory syncytial virus (RSV) infection was measured in a large pediatric hospital using an incidence density method. The at-risk days for nosocomial RSV were summed during a defined winter period in which there were 54 admissions with community-acquired RSV infection giving a rate of 2.9 cases per 1,000 at-risk days (95% confidence interval, 0.3-5.4 per 1,000).     

Familiarity and plausibility in conceptual combination: Reply to Gagné and Spalding (2006).

E. J. Wisniewski and G. L. Murphy (see record 2004-22496-015) suggested that the apparent effects of relation frequency in C. L. Gagné and E. J. Shoben's (1997; see record 1997-02349-004) conceptual combination experiments could be explained by differences between the familiarity and plausibility of their stimuli (noun-noun phrases). However, C. L. Gagné and T. L. Spalding (see record 2006-20573-017) argued that Wisniewski and Murphy's measures of plausibility and frequency are both sensitive to relation frequency. They also suggested that the stimuli were mostly novel, such that differences in familiarity could not explain Gagné and Shoben's findings. The current authors focus on the theoretical rationale for the plausibility and familiarity variables, arguing that the original interpretation of their findings is correct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The variability of urinary cotinine levels in young children: implications for measuring ETS exposure.

This study examined the within-subject variability of urinary cotinine levels in young children (aged = 0.6-7.2 years) of smoking parents to determine the number of urine samples needed to provide accurate estimates of exposure to environmental tobacco smoke (ETS) for different time intervals. Secondary analyses were conducted of five independent studies (N = 376), in which multiple urinary cotinine measures had been collected over time periods up to 13 months. Over measurement periods of 4-15 days, the within-subject cotinine levels varied 3-5 times more than would be expected based on measurement error alone. Over 7-13 months, the within-subject variability was 10-20 times higher than would be expected based on the measurement error. Findings indicated that cotinine measures from single urine samples provided highly accurate estimates of only recent exposure (i.e., 2-3 days; rho = 0.99). To achieve similarly precise estimates of the mean cotinine level of an individual child over 4-15 days, up to nine urine samples may be necessary. Up to 12 urine samples may be required to achieve similarly precise estimates of ETS exposure over a 4- to 13-month period. Epidemiologic and clinical research on ETS exposure in children can benefit from multiple urine samples (a) to accurately measure average exposure at the level of the individual child, (b) to describe temporal patterns, (c) to detect incidences of peak exposure that would remain underrecognized if monitoring is limited to a single time point, and (d) to establish stable baseline levels and endpoints based on urine samples collected over clinically relevant time periods.