Difficult airway management in the emergency room using an airway scope

In the emergency room, some cases need adequate airway management. We present a patient whom we intubated using a new device. This device might be an option in airway management but some considerations should also be taken into account

Production of Nitric Oxide Using a Pulsed Arc Discharge

Nitric monoxide (NO) is increasingly being used in medical applications. Currently, a gas cylinder of N/sub 2/ mixed with a high concentration of NO is used. This arrangement is potentially risky due to the possibility of accidental leak of NO from the cylinder. The presence of NO in air leads to the formation of nitric dioxide (NO/sub 2/), which is toxic to the lungs. Therefore, an on-site generation of NO would be very desirable for patients with acute respiratory distress syndrome and other related illnesses. We have recently reported on the production of NO using a pulsed arc discharge. In the present work, the discharge reactor was made simpler and smaller. NO was generated using a pulsed arc discharge in dry air and in mixtures of oxygen and nitrogen. The composition of the gas mixture after treatment with an arc discharge followed by exposure to heated molybdenum was 540 ppm of NO, 48 ppm of NO/sub 2/, and the balance dry air at 0.1 MPa and 300 /spl plusmn/ 3 K. No ozone was detected at the outlet of the system by UV absorption. The density of the brass particles emitted from the electrodes, which had diameters over 0.3 /spl mu/m, was less than 1.39 /spl mu/g/L. A filter could readily capture and thus remove the brass particles

Production of Nitric Monoxide Using Pulsed Discharges for a Medical Application

Nitric monoxide (NO) is widely used in medical treatment of acute respiratory distress syndrome (ARDS). The production of NO is of interest to the medical community. In the present work, NO is generated by pulsed discharges between two rod electrodes in a mixture of nitrogen and oxygen. An arc discharge having a temperature of about 10000K was produced, which was sufficient to generate NO. Some of the important parameters affecting the production of NO have been investigated. These include the percentage of O2 (6-94%) in the mixture of N2 and O2, the energy of the discharge (0.5-12 J/pulse), the pulse repetition rate (0.5-4.5 pps) and the flow rate (1.35-5.4 l/min) of the gas mixture. NO2 produced in the discharge was successfully changed to NO using a heated molybdenum tube. NO2 must be extracted from the gas before clinical inhalation. The concentration of ozone was completely eliminated by bubbling the gas mixture through water. A maximum of NO and a minimum of NO2 concentrations were generated when the proportion of O2 in the gas mixture was in the range of 20-27%. The concentrations of NO and NO2 increased with increasing pulse repetition rate and with decreasing flow rate of the mixture. In all cases, NO2 was effectively removed using a heated molybdenum tube

Stabilization by Fusion to the C-terminus of Hyperthermophile Sulfolobus tokodaii RNase HI: A Possibility of Protein Stabilization Tag

RNase HI from the hyperthermophile Sulfolobus tokodaii (Sto-RNase HI) is stabilized by its C-terminal residues. In this work, the stabilization effect of the Sto-RNase HI C-terminal residues was investigated in detail by thermodynamic measurements of the stability of variants lacking the disulfide bond (C58/145A), or the six C-terminal residues (ΔC6) and by structural analysis of ΔC6. The results showed that the C-terminal does not affect overall structure and stabilization is caused by local interactions of the C-terminal, suggesting that the C-terminal residues could be used as a “stabilization tag.” The Sto-RNase HI C-terminal residues (-IGCIILT) were introduced as a tag on three proteins. Each chimeric protein was more stable than its wild-type protein. These results suggested the possibility of a simple stabilization technique using a stabilization tag such as Sto-RNase HI C-terminal residues

Insights into Land Plant Evolution Garnered from the Marchantia polymorpha Genome.

The evolution of land flora transformed the terrestrial environment. Land plants evolved from an ancestral charophycean alga from which they inherited developmental, biochemical, and cell biological attributes. Additional biochemical and physiological adaptations to land, and a life cycle with an alternation between multicellular haploid and diploid generations that facilitated efficient dispersal of desiccation tolerant spores, evolved in the ancestral land plant. We analyzed the genome of the liverwort Marchantia polymorpha, a member of a basal land plant lineage. Relative to charophycean algae, land plant genomes are characterized by genes encoding novel biochemical pathways, new phytohormone signaling pathways (notably auxin), expanded repertoires of signaling pathways, and increased diversity in some transcription factor families. Compared with other sequenced land plants, M. polymorpha exhibits low genetic redundancy in most regulatory pathways, with this portion of its genome resembling that predicted for the ancestral land plant. PAPERCLIP

Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease

AimsLimited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH.MethodsThis retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death.ResultsThe 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45–13.73; P = .009).ConclusionsThe IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered