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.     

Flaw density examinations of a clad boiling water reactor pressure vessel segment

As part of the Oak Ridge National Laboratory's Heavy-Section Steel Technology Program, studies have been conducted to determine flaw density in a section of reactor pressure vessel cut from the Hope Creek Unit 2 vessel. This boiling water reactor vessel was never in service. One objective was to evaluate the approximate 0.7- by 3-m (2- by 10-ft) segment of the vessel provided using ultrasonic flaw detection methods performed with both ASME Code techniques and supplemental ultrasonic methods. A second objective was to evaluate the inner surface stainless steel cladding for cracks with a high sensitivity penetrant examination. Both objectives were successfully completed. Five Code-recordable indications were detected ultrasonically; however, all were found to be anomalies associated with the cladding. One flaw was detected by the supplemental ultrasonic tests, and it was analyzed destructively. This flaw was pipelike indication, about 20 mm (0.8 in.) long extending along the length of the longitudinal weld in which it was located and was about 20 mm below the cladding surface. The flaw had a through-wall dimension (or length) of about 6 mm (0.24 in.) for an approximate 3-mm (0.1-in.) distance along the 20-mm major length. No flaws were detected by the penetrant examination of the cladding surface.     

Structure of metal site in Cd-substituted His117Gly mutant of azurin with and without addition of imidazole derivatives

The present work uses 111mCd-perturbed angular correlations of gamma-rays (PAC) to investigate the structure of the metal site of the His117Gly mutant of Pseudomonas aeruginosa azurin in aqueous solution and the effect on the structure upon addition of the following exogenous ligands: imidazole, 4-methyl imidazole, 1-methyl imidazole, 2-methyl imidazole and histidine. The nuclear quadrupole interaction of cadmium bound to the mutant without addition of exogenous ligands shows a strong pH dependence with three different nuclear quadrupole interactions consistent with two pKa values at about 7.2 and 8.6 at 2 degrees C. Addition of the imidazole derivatives resulted in a significant change in the PAC spectrum showing that they coordinate. This is in accordance with observations by EPR for the same mutant with copper at the metal site [den Blaauwen, T. & Canters, G. W. (1993) J. Am. Chem. Soc. 115, 1121-1129]. However, whereas EPR and ultraviolet/visual absorption show that the characteristics of the wild-type copper protein are regained by addition of the imidazole derivatives with the exception of the possible bidentates (histidine and histamine), the comparison of the PAC results to model calculations shows that the cadmium ion must be fourfold coordinated in most cases, probably binding an additional water or hydroxide ligand. A fourfold coordination is in contrast to cadmium-substituted wild-type azurin where PAC data inferred a threefold coordination by a Cys and two His residues [Danielsen, E. Bauer, R., Hemmingsen, L., Andersen. M., Bjerrum, M. J., Butz, T., Tr?ger, W., Canters, G. W., Hoitink, C. W. G., Karlsson, G., Hansson, O. & Messerschmidt, A. (1995) J. Biol. Chem. 270, 573-580]     

Ein Überblick zur digitalen Bildverarbeitung in der Lebensmittelwissenschaft 1. Mitt. Bestimmung geometrischer Merkmale an isolierten Objekten

I. Fromhold-Treu und W. Kozerke: A survey on digital picture processing in food science. Part 1. Determination of geometrical properties of isolated objects The aim of this series of articles is a summary of procedures and methods of the digital picture processing with the point of view of their special application in the science of nutrition and food. After a short introduction to the fundamentals of the digital picture processing some effective procedures of the recognition of isolated objects in binary pictures are given. Furthermore there are defined geometrical properties for these objects.     

INTERACTION OF HIGH-STRAIN AND HIGH-CYCLE FATIGUE IN TURBINE MATERIALS

Abstract— An investigation has been conducted to examine the interaction between high-strain and high-cycle fatigue under combined cycling conditions on 2% NiCrMoV and a 12% CrNiMo alloy. The results reveal that the application of high-strain fatigue cycles prior to low-strain high-cycle fatigue is significantly less damaging than the equivalent number of single high-strain cycles applied between periods of high-cycle fatigue, indicating a much greater damaging interactive effect under the combined cycling condition. A damage summation, based on high-strain and high-cycle fatigue initiation curves and calculated at various endurances, was found to approach zero under combined cycling conditions indicating that a prediction of damage using the Palmgren-Miner linear damage rule is inapplicable. Cumulative damage curves, based on an assessment of hypothetical crack growth behaviour under high-strain and high-cycle fatigue conditions, can be constructed to explain the large departure from the Palmgren-Miner prediction of unity. Such curves, however, fail to predict the more damaging interactive effect observed under combined cycling conditions. The apparent contradiction between experimental results and theoretical assessment is discussed and a mechanism proposed to account for the observed interactive effect.     

Influence of curing at different relative humidities upon compound reactions and porosity in Portland cement paste

The reduction in relative humidity within drying concrete depends mainly on the depth from the exposed surface, exposure duration, temperature and environmental humidity; this limits hydration and coarsens pore structure, thus impairing durability. OPC paste, of 0.59 water/cement ratio, was cured for 2 days and then exposed to controlled relative humidity environments. After 14 and 90 days exposure, hydration of the individual compounds was measured using quantitative X-ray diffraction and thermogravimetry. Methanol adsorption was used to monitor porosity and gel formation. Even a small drop in relative humidity below 95% r.h. significantly limited cement hydration. Gel porosity increased with amount of hydration and, for a given level of hydration, decreased with drying. Curing below 80% r.h. produced a coarsened pore structure with a large-diameter porosity three times greater than that obtained with saturated curing.     

REM sleep deprivation potentiates the effects of imipramine and desipramine but not that of clomipramine in the forced swimming test

The human amnestic syndrome associated with lesions of the hippocampus and amygdala is characterized by a selective impairment of recent (explicit, episodic) memory. Benzodiazepine (BZ) treated normal subjects demonstrate similar, marked impairments in episodic memory, but in addition, BZ also induces sedation and inattention. Thus, the amnestic effects of BZ may be secondary to drug-induced sedation. However, when subjects were pretreated with the specific BZ receptor antagonist, flumazenil, the sedative and attentional effects of diazepam were blocked, but a marked impairment in episodic memory still occurred. This demonstrates that, using neuropharmacological methods, it is possible to produce a dissociation of memory impairment from inattention and sedation. Such distinct patterns of cognitive dysfunction may serve as models for clinical cognitive syndromes.     

Evaluation of accuracy of measuring intraocular pressure by handheld non-contact applanation tonometer

PURPOSE: To evaluate the accuracy of measuring intraocular pressure by handheld non-contact applanation tonometer. METHOD: 58 patients' (113 eyes) intraocular pressure were measured by Keeler, non-contact tonometer and R 900 Goldmann applanation tonometer and the results of measurement of intraocular pressure by the two kinds of tonometers were compared. RESULT: The mean intraocular pressure measured by non-contact is 16.31 +/- 5.59 mmHg and 17.49 +/- 6.13 mmHg (1 mmHg = 0.1333 kPa) by Goldmann applanation tonometer, respectively. There was no statistical significance to be found (P > 0.05) between the two methods. By linear correlation and regression analysis, a positive correlation was found between the two methods (r = 0.8942, b = 0.8154). CONCLUSION: The handheld non-contact tonometer has the same accuracy and reliability of measurement of intraocular pressure comparing with Goldmann applanation tonometer, and it can be used in glaucoma clinic and screening.