Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section

Background: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. Aims: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. Study Design: Cross-sectional study. Methods: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. Results: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. Conclusion: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women

Comparıng pulse pressure varıatıon and pleth varıabılıty ındex in the semı-recumbent and trendelenburg posıtıon ın crıtıcally ıll septıc patıents

Introduction. Dynamic tests for predicting fluid responsiveness have generated increased interest in recent years. One of these tests, pulse pressure variation (PPV), is a parameter calculated from respiratory variations of pulse pressure. Another test, pleth variability index (PVI), is based on respiratory variations of the perfusion index and can be measured non-invasively by pulse oximeter. Previous studies have shown that both tests are valuable in determining fluid responsiveness. Methods. In this observational prospective study, our aim was to compare the PVI and PPV in order to identify a convenient tool for determining fluid responsiveness. Our study was performed in a surgical and reanimation intensive care unit. We enrolled one hundred mechanically ventilated adult patients diagnosed with sepsis. Exclusion criteria included brain death, spontaneous breathing, cardiac arrhythmia, and impaired peripheral circulation. We measured the PPV by arterial monitorization and the PVI by using Masimo Radical 7 in the 45° semi-recumbent position (SP) and then 15° Trendelenbug position (TP). We performed correlation and ROC analysis using a >13% fluid responsiveness cut-off value for the PPV and >14% for the PVI. Results. Between the SP and the TP, we did not observe significant decreases in PPV (from 14.17 ± 10.57 to 12.66 ± 9.64; p > 0.05), while we did observe significant decreases in PVI (from 21.91 ± 13.99 to 20.46 ± 14.12; p < 0.05). The PPV fluid responsiveness cut-off value in the SP and TP was 20% (78.95% sensitivity, 77.05% specificity) and 18% (76.67% sensitivity, 72.46% specificity), respectively. The PVI fluid responsiveness cut-off value in the SP and TP was 20% (80.49% sensitivity, 81.03% specificity) and 16% (81.25% sensitivity, 62.69% specificity), respectively. The area under the ROC of the PPV and PVI was 0.843 and 0.858 in the SP, respectively, and 0.760 and 0.747 in the TP, respectively. The PPV and PVI were correlated in the SP (r = 0.578; p = 0.001) and the TP (r = 0.517; p = 0.001). Conclusions. Our results showed that the PPV and PVI were correlated independent of position change in sepsis patients. Both tests appear to be equivalently reliable. However, the ability of the PPV and PVI to predict fluid responsiveness decreased in the TP in our study

CHRONIC ILLNESS, HOSPITALIZATION AND CHILD

Duygusal sorunlar, kronik hastalığa sahip çocuk ve ergenler ve ailelerde evrensel anlam taşımamalarına karşın, araştırmalardan gelen kanıtlar; kronik pediatrik hastalıkların psikolojik bozukluklar için esas bir risk etkeni oluşturduğunu göstermiştir. Kronik hastalıklarla beraber olan psikolojik sorunlarla sıklıkla ruh sağlığı konsultanları yüzleşirler. Bunları tanımlamak için bir yapıya ihtiyaç vardır. Hasta değerlendirilirken, klinisyenler, en azından teorik olarak, psikosomatik komponentin kronik hastalıkların her fazında var olacağını mutlaka hatırlamalıdırlar. Kronik hastalığa tepki, bireysel, gelişimsel ve çevresel etmenlerden etkilenir. Etkin psikiyatrik konsultasyon ve psikolojik yardım kronik hastalıkların tedavisi sırasında daha iyi prognoz ve uyuma yol açabilir. Although emotional disturbances do not mean universal in chronically ill children and adolescents and their families, the evidence from studies indicated that the chronic pediatric illness constitutes a substantial risk factor for psychological disorder. Psychological problems associated with chronic illness frequently confront the mental health consultant, and a framework for conceptualizing them is required. In evaluating a patient, the clinicians must remember that a psychosomatic component is at least theoretical possible in every phase of all chronic disorders. Reacting to the chronic illness is influenced by individual, developmental and environmental factors The effective psychiatric consultation and psychological support can lead to better prognosis and compliance during the treatment of chronic illness

Study of defects produced in tungsten by 800-MeV protons using field-ion microscopy

Defects produced in tungsten by 800 MeV proton bombardment have been studied on the atomic scale with a Field Ion Microscope. The material was subjected to a fluence, as measured by radiochemistry, of 10/sup 22/ pm/sup -2/ (approx. 0.1 displacements per atom) at a temperature of 300K. A vacancy concentration of 10/sup -3/ was observed (calculated thermal equilibrium vacancy concentration is approx. 10/sup -56/ at a calculated temperature of 300K). No vacancies were observed in the unirradiated samples. Since vacancies are essentially immobile (D/sub v/ approx. 10/sup -57/ cm/sup 2//sec) at the irradiation temperature used in this study, it is believed that the observed concentrations are those of the radiation produced vacancies that did not spontaneously recombine. The observed interstitial concentration was lower than the vacancy concentration consistent with a higher diffusion rate for interstitials. Additionally, a depleted zone was observed consisting of approximately 300 vacancies. This void volume lies along a (121) pole and has an elongated shape. It is postulated that this damaged region was caused by a recoiling W atom after it had undergone an internuclear cascade after collision with an incident proton. This type of defect may be the nucleus for subsequent void growth when the irradiation is carried out in the void-growth temperature regime

Circulating endothelial cell-derived extracellular vesicles mediate the acute phase response and sickness behaviour associated with CNS inflammation.

Brain injury elicits a systemic acute-phase response (APR), which is responsible for co-ordinating the peripheral immunological response to injury. To date, the mechanisms responsible for signalling the presence of injury or disease to selectively activate responses in distant organs were unclear. Circulating endogenous extracellular vesicles (EVs) are increased after brain injury and have the potential to carry targeted injury signals around the body. Here, we examined the potential of EVs, isolated from rats after focal inflammatory brain lesions using IL-1β, to activate a systemic APR in recipient naïve rats, as well as the behavioural consequences of EV transfer. Focal brain lesions increased EV release, and, following isolation and transfer, the EVs were sequestered by the liver where they initiated an APR. Transfer of blood-borne EVs from brain-injured animals was also enough to suppress exploratory behaviours in recipient naïve animals. EVs derived from brain endothelial cell cultures treated with IL-1β also activated an APR and altered behaviour in recipient animals. These experiments reveal that inflammation-induced circulating EVs derived from endothelial cells are able to initiate the APR to brain injury and are sufficient to generate the associated sickness behaviours, and are the first demonstration that EVs are capable of modifying behavioural responses

Water stable molecular n-doping produces organic electrochemical transistors with high transconductance and record stability.

From established to emergent technologies, doping plays a crucial role in all semiconducting devices. Doping could, theoretically, be an excellent technique for improving repressively low transconductances in n-type organic electrochemical transistors - critical for advancing logic circuits for bioelectronic and neuromorphic technologies. However, the technical challenge is extreme: n-doped polymers are unstable in electrochemical transistor operating environments, air and water (electrolyte). Here, the first demonstration of doping in electron transporting organic electrochemical transistors is reported. The ammonium salt tetra-n-butylammonium fluoride is simply admixed with the conjugated polymer poly(N,N'-bis(7-glycol)-naphthalene-1,4,5,8-bis(dicarboximide)-co-2,2'-bithiophene-co-N,N'-bis(2-octyldodecyl)-naphthalene-1,4,5,8-bis(dicarboximide), and found to act as a simultaneous molecular dopant and morphology-additive. The combined effects enhance the n-type transconductance with improved channel capacitance and mobility. Furthermore, operational and shelf-life stability measurements showcase the first example of water-stable n-doping in a polymer. Overall, the results set a precedent for doping/additives to impact organic electrochemical transistors as powerfully as they have in other semiconducting devices