Zbrinjavanje otežanog dišnog puta fiberoptičkom intubacijom Bonfilsom u hitnom slučaju: akutni abdomen s ileusom

This clinical report describes an emergency case of a 49-year-old man, ASA E III status, with clinical symptoms of acute abdomen and ileus, who was scheduled for urgent surgery. Predictors of difficult intubation (Mallampati test Class III , short thyro-mental (<6 cm) and sterno-mental distance (<10 cm) with limited mouth opening (inter-incisor gap <3 cm) were associated with significant comorbidity (rheumatoid arthritis, heart disease, obesity (body mass index 32.6 kg m-2), cervical spine mobility and generalized vascular disease). A specialist experienced in airway management decided on one attempt of Bonfils fiberoptic intubation as primary intervention and urgent tracheotomy, if needed, as secondary intervention. Immediately after assuming supine position on the operating table, the patient lost consciousness and cardiac arrest developed. Successful intubation with oxygenation was followed by cardiopulmonary resuscitation. Upon stabilization of the patient’s vital functions, urgent surgery was performed. In the emergency case presented, we succeeded quickly to secure the airway with Bonfils fiberoptic intubation, which allowed for appropriate oxygenation and starting resuscitation. The high risk of the possible aspiration was avoided by timely provision of airway in the experienced anesthetist’s hands.Opisuje se hitan slučaj 49-godišnjeg bolesnika statusa ASA E III s jasnim kliničkim simptomima akutnog abdomena i ileusa, koji je bio predviđen za hitan kirurški zahvat. Uza začajan komorbiditet (reumatoidni artritis, bolesti srca, pretilost (indeks tjelesne mase 32.6 kg m-2), deformitet vratne kralježnice te generaliziranu aterosklerozu) kliničkim pregledom otkriveni su i prediktori teške intubacije (Mallampati test klasa III ., kratka tiro-mentalna (<6 cm) i sterno-mentalna udaljenost (<10 cm) s ograničenim otvaranjem usta (razmak između sjekutića <3 cm). Iskusni anesteziolog u zbrinjavanju dišnog puta primarno se odlučio za fiberoptičku intubaciju Bonfilsom, odnosno sekundarnu hitnu traheotomiju ako se intubacija Bonfilsom ne uspije učiniti iz prvoga pokušaja. Neposredno nakon premještaja bolesnika na operacijski stol te njegovog namještanja u leđni položaj bolesnik gubi svijest uz razvoj asistolije srca. Odmah je izvedena uspješna intubacija, omogućena oksigenacija bolesnika praćena kardiopulmonalnom reanimacijom. Nakon stabilizacije vitalnih funkcija bolesnika uspješno je dovršen i hitan kirurški zahvat. U prikazanom hitnom slučaju smo fiberoptičkom intubacijom uz Bonfils uspješno i brzo osigurali dišni put te time osigurali dostatnu oksigenaciju i brz početak reanimacije. U ovom slučaju je pravodobna intubacija u rukama iskusnog anesteziologa bila presudna za zaštitu dišnoga puta bolesnika od prijeteće aspiracije uz prisutan ileus

Microglial inclusions and neurofilament light chain release follow neuronal α-synuclein lesions in long-term brain slice cultures.

BACKGROUND: Proteopathic brain lesions are a hallmark of many age-related neurodegenerative diseases including synucleinopathies and develop at least a decade before the onset of clinical symptoms. Thus, understanding of the initiation and propagation of such lesions is key for developing therapeutics to delay or halt disease progression. METHODS: Alpha-synuclein (αS) inclusions were induced in long-term murine and human slice cultures by seeded aggregation. An αS seed-recognizing human antibody was tested for blocking seeding and/or spreading of the αS lesions. Release of neurofilament light chain (NfL) into the culture medium was assessed. RESULTS: To study initial stages of α-synucleinopathies, we induced αS inclusions in murine hippocampal slice cultures by seeded aggregation. Induction of αS inclusions in neurons was apparent as early as 1week post-seeding, followed by the occurrence of microglial inclusions in vicinity of the neuronal lesions at 2-3 weeks. The amount of αS inclusions was dependent on the type of αS seed and on the culture's genetic background (wildtype vs A53T-αS genotype). Formation of αS inclusions could be monitored by neurofilament light chain protein release into the culture medium, a fluid biomarker of neurodegeneration commonly used in clinical settings. Local microinjection of αS seeds resulted in spreading of αS inclusions to neuronally connected hippocampal subregions, and seeding and spreading could be inhibited by an αS seed-recognizing human antibody. We then applied parameters of the murine cultures to surgical resection-derived adult human long-term neocortical slice cultures from 22 to 61-year-old donors. Similarly, in these human slice cultures, proof-of-principle induction of αS lesions was achieved at 1week post-seeding in combination with viral A53T-αS expressions. CONCLUSION: The successful translation of these brain cultures from mouse to human with the first reported induction of human αS lesions in a true adult human brain environment underlines the potential of this model to study proteopathic lesions in intact mouse and now even aged human brain environments

Analysis of structural brain asymmetries in attention-deficit/hyperactivity disorder in 39 datasets

Objective Some studies have suggested alterations of structural brain asymmetry in attention-deficit/hyperactivity disorder (ADHD), but findings have been contradictory and based on small samples. Here, we performed the largest ever analysis of brain left-right asymmetry in ADHD, using 39 datasets of the ENIGMA consortium. Methods We analyzed asymmetry of subcortical and cerebral cortical structures in up to 1,933 people with ADHD and 1,829 unaffected controls. Asymmetry Indexes (AIs) were calculated per participant for each bilaterally paired measure, and linear mixed effects modeling was applied separately in children, adolescents, adults, and the total sample, to test exhaustively for potential associations of ADHD with structural brain asymmetries. Results There was no evidence for altered caudate nucleus asymmetry in ADHD, in contrast to prior literature. In children, there was less rightward asymmetry of the total hemispheric surface area compared to controls (t = 2.1, p = .04). Lower rightward asymmetry of medial orbitofrontal cortex surface area in ADHD (t = 2.7, p = .01) was similar to a recent finding for autism spectrum disorder. There were also some differences in cortical thickness asymmetry across age groups. In adults with ADHD, globus pallidus asymmetry was altered compared to those without ADHD. However, all effects were small (Cohen’s d from −0.18 to 0.18) and would not survive study-wide correction for multiple testing. Conclusion Prior studies of altered structural brain asymmetry in ADHD were likely underpowered to detect the small effects reported here. Altered structural asymmetry is unlikely to provide a useful biomarker for ADHD, but may provide neurobiological insights into the trait

The assessment of electrospun scaffolds fabricated from polycaprolactone with the addition of L-arginine

Polycaprolactone (PCL) was electrospun with the addition of arginine (Arg), an α-amino acid that accelerates the haeling process. The efficient needleless electrospinning technique was used for the fabrication of the nanofibrous layers. The materials produced consisted mainly of fibers with diameters of between 200 and 400 nm. Moreover, both microfibers and beads were present within the layers. Higher bead sized were observed with the increased addition of arginine

Conversion of Synthetic Aβ to In Vivo Active Seeds and Amyloid Plaque Formation in a Hippocampal Slice Culture Model

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