Comparison of fiberoptic bronchoscopic intubation using silicone and polyvinyl chloride double-lumen tubes

Background Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. Methods Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. Results A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. Conclusions Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis

Metronidazole-induced encephalopathy in a patient with liver cirrhosis

Encephalopathy is a disorder characterized by altered brain function, which can be attributed to various causes. Encephalopathy associated with metronidazole administration occurs rarely and depends on the cumulative metronidazole dose, and most patients with this condition recover rapidly after discontinuation of therapy. Because metronidazole is metabolized in the liver and can be transported by the cerebrospinal fluid and cross the blood-brain barrier, it may induce encephalopathy even at a low cumulative dose in patients with hepatic dysfunction. We experienced a patient who showed ataxic gait and dysarthric speech after receiving metronidazole for the treatment of hepatic encephalopathy that was not controlled by the administration of lactulose. The patient was diagnosed as metronidazole-induced encephalopathy, and stopping drug administration resulted in a complete recovery from encephalopathy. This case shows that caution should be exercised when administering metronidazole because even a low dose can induce encephalopathy in patients with liver cirrhosis

Bone Morphogenetic Protein Signaling: Implications in Urology

The bone morphogenetic proteins (BMPs), as members of the transforming growth factor-β (TGF-β) superfamily, not only control bone formation, but also regulate multiple key steps during embryonic development and differentiation. Furthermore, BMPs play critical roles in maintaining the homeostasis of the cardiovascular, pulmonary, reproductive, urogenital, and nervous systems in adult life. Like all members of the TGF-β superfamily, BMP signaling is mediated through a heteromeric complex of type I and type II transmembrane serine/threonine kinase receptors. The subsequent signal transduction cascade includes either the canonical Smad-dependent or non-canonical Smad-independent pathways. Reflecting the critical function of BMPs, BMP signaling is tightly regulated at multiple steps by various mechanisms including extracellular endogenous antagonists, neutralizing antibodies/extracellular soluble receptor domains, small molecule inhibitors, cytoplasmic inhibitory Smads, and transcriptional co-repressors. Recently, dorsomorphin, the first small molecule inhibitor of BMP signaling, was identified and suggested as a useful tool for dissecting the mechanisms of signaling pathways and for developing novel therapeutics for diverse human diseases that are related to the BMP signaling pathways. In this article, we discuss various mechanisms involved in regulating BMP signaling pathways and their implications for urology

Prevention of Bradycardia during Spinal Anesthesia under Dexmedetomidine Sedation in Older Adults

Older adults exhibit reduced physiological responses to beta-adrenergic stimulation and parasympathetic inhibition. This study aimed to investigate the effect of reducing the incidence of bradycardia in the atropine and ephedrine pretreatment group compared to the control group in older adults who received spinal anesthesia with intravenous dexmedetomidine. Overall, 102 older adults aged over 65 years were randomly divided into three groups, and saline (control group), atropine at 0.5 mg (atropine group), and ephedrine at 8 mg (ephedrine group) were administered intravenously to each group as pretreatment. Immediately after spinal anesthesia, dexmedetomidine loading and study drug injections were commenced. The primary outcome was the incidence of bradycardia (p = 0.035), and no difference was noted between the atropine and ephedrine groups. Therefore, if ephedrine or atropine is selected and used according to the patient’s condition and clinical situation, it may be helpful in preventing bradycardia during spinal anesthesia using dexmedetomidine in older patients

Synthesis of Enantiomeric omega-Substituted Hydroxy Acids from Terminal Epoxides and Alkenes: Functional Building Blocks for Discrete and Sequence-Defined Polyesters

Polyesters exhibiting a protein-like absolute atomic precision have unlimited potential for application as biomaterials and polymeric materials. Herein, we report the synthesis of enantiomeric omega-hydroxy acids (OHAs) from terminal epoxides and alkenes as starting materials. Our synthetic strategy allows the synthesis of a library of OHAs with a well-defined atomic composition (carbon number), stereochemical configuration, and substituent chemistry. These monomers can serve as building blocks for the preparation of discrete and sequence-defined polyesters, wherein various functional groups can be introduced at specific locations via the cross-convergent method. We demonstrated that the specific locations of the reactive functional groups of the sequence-defined polyester could be utilized to form a concentrically cyclic polymer upon cyclization. Our results provide a facile platform for engineering polyesters with the structural sophistication exhibited only by biopolymers, such as proteins and nucleic acids.N

Automated Segmentation of Individual Tree Structures Using Deep Learning over LiDAR Point Cloud Data

Deep learning techniques have been widely applied to classify tree species and segment tree structures. However, most recent studies have focused on the canopy and trunk segmentation, neglecting the branch segmentation. In this study, we proposed a new approach involving the use of the PointNet++ model for segmenting the canopy, trunk, and branches of trees. We introduced a preprocessing method for training LiDAR point cloud data specific to trees and identified an optimal learning environment for the PointNet++ model. We created two learning environments with varying numbers of representative points (between 2048 and 8192) for the PointNet++ model. To validate the performance of our approach, we empirically evaluated the model using LiDAR point cloud data obtained from 435 tree samples scanned by terrestrial LiDAR. These tree samples comprised Korean red pine, Korean pine, and Japanese larch species. When segmenting the canopy, trunk, and branches using the PointNet++ model, we found that resampling 25,000–30,000 points was suitable. The best performance was achieved when the number of representative points was set to 4096

Synergistically designed antireflective cover for improving wide-angle photovoltaic efficiencies

We demonstrated that a well-designed nanopatterned cover improves photovoltaic efficiency across a wide range of incident angles (θ). A nanopatterned cover was created using an integrated ray-wave optics simulation to maximize the light absorption of the surface-textured Si photovoltaic device. A hexagonally arranged nanocone array with a 300 nm pitch was formed into a polymer using nanoimprinting, and the nanostructured polymer was then attached to a glass cover with an index-matching adhesive. Angle-resolved current density-voltage measurements on Si photovoltaic devices showed that the nanopatterned glass cover yielded a 2–13% enhancement in power conversion efficiency at θ = 0–60°, which accounted for its broadband antireflective feature. We performed all-season-perspective simulations based on the results of the integrated ray-wave optics simulations and solar altitude database of South Korea, which validated the sustainability of the developed nanopatterned cover during significant seasonal fluctuations. © 2022 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement.TRU