Intubation without muscle relaxation for suspension laryngoscopy: A randomized, controlled study

Objective and Aim: The objective of the following study is to examine the effectiveness and safety of suspension laryngoscopy under intubation with propofol and remifentanil alone for vocal fold nodule (VFN) excision.Materials and Methods: A total of 40 patients were equally and randomly assigned to elective VFN excision using suspension laryngoscopy under intubation with propofol and remifentanil alone (Group A) or with  supplementary cisatracurium (Group B).Results: Intubation time was significantly longer in Group A than in Group B (300.0 } 30.0 s vs. 265.2 } 38.7 s, P = 0.003). The two groups showed similar Cormack.Lehane classifications, intubation conditions and ease ofsuspension laryngoscopy. Both groups showed favorable cardiopulmonary safety profiles. Post.anesthesia recovery was significantly more rapid in Group A than in Group B, in terms of times to spontaneous breathing return (7.2 } 1.4 min vs. 10.9 } 1.6 min, P < 0.001), consciousness return (7.4 } 1.5 min vs. 12.3 } 1.8 min, P < 0.001), removal of tracheal intubation (8.1 } 1.5 min vs. 13.2 } 1.7 min, P < 0.001) and operating room discharge (12.7 } 1.4 min vs. 22.1 } 1.3 min, P < 0.001).Conclusion: Use of propofol and remifentanil alone provides favorable intubation and anesthesia conditions for suspension laryngoscopic VFN excision and accelerates post.anesthesia recovery.Key words: Endotracheal intubation, muscle relaxant, propofol,  randomized controlled study, remifentanil, suspension laryngoscopy, vocal fold nodul

A Novel Test Rig for the Basic Nonlinear Characterization of Bolted Joints

The paper aims at performing a comprehensive experimental study on the peculiar properties of a bolted joint, and investigates the damping induced at different interfaces (between flanges, bolt head/nut and flange, threads) during vibrations. A novel, simplified, single-bolt system joining a two-beam structure is designed and tested. Experimental results under different boundary conditions are presented, and the influence of the harmonic excitation force, as well as the bolt tension, is investigated. The test results show how the contact interface between the clamped flanges plays an important role in terms of frictional damping provided to the system during vibration, while the contact interfaces between the head/nut and flange, and secondarily between the threads, affect the system response at a less, but not negligible, extent. The test setup and test procedure can provide a database to validate single bolt contact models to be included in a more complex structure

Bone Activity Biomarkers and Bone Mineral Density in Children with Chronic Kidney Disease

Introduction: Chronic kidney disease - mineral and bone disorder (CKD-MBD) is a spectrum of bone minerals changes that range from high turnover lesions of secondary hyperparathyroidism to the low turnover lesions of adynamic bone disease. Bone biopsy is the gold standard for the diagnosis, but it is not routinely performed because it is invasive technique. Methods: Fifteen CKD children on regular hemodialysis (group I) and 15 CKD children on conservative management (group II) were selected from the nephrology clinics of Zagazig University Hospitals along with 15 age and sex-matched healthy controls. Participants were subjected to biochemical assessment that included osteocalcin (OC), total and bone-specific alkaline phosphatase (tALP and bALP), isomerized beta form of type I collagen cross-linked telopeptide (β-Crosslaps) and intact parathyroid hormone (iPTH) levels. Patients with CKD also had their bone mineral density (BMD) measured using dual energy X-ray absorptiometry (DEXA) at lumbar spine and femoral neck. Results: Serum β-Crosslaps, OC and bALP were significantly higher in patient groups than controls and in group I compared to group II .There was a negative significant correlation between mean Z-score at lumbar spines and bALP, OC and iPTH in group I and with β-Crosslaps in both patient groups. The mean Z-score at femoral neck correlated negatively with bALP in group I, with OC in group II and with iPTH and β-Crosslaps in both groups. Conclusion: Biochemical bone markers and assessment of BMD in patients with CKD may have a role in the early detection of CDK-MBD. Keywords: chronic kidney disease; bone mineral density; bone biomarker

FasL expression on human nucleus pulposus cells contributes to the immune privilege of intervertebral disc by interacting with immunocytes

The mechanisms of immune privilege in human nucleus pulposus (NP) remain unclear. Accumulating evidence indicates that Fas ligand (FasL) might play an important role in the immune privilege of the disc. We aimed for addressing the role of FasL expression in human intervertebral disc degeneration (IDD) and immune privilege in terms of the interaction between NP cells and immunocytes via the FasL-Fas machinery. We collected NP specimens from 20 patients with IDD as degenerative group and 8 normal cadaveric donors as control. FasL expression was detected by qRT-PCR, western blotting and flow cytometry (FCM). We also collected macrophages and CD8(+) T cells from the peripheral blood of patients with IDD for co-cultures with NP cells. And macrophages and CD8(+) T cells were harvested for apoptosis analysis by FCM after 2 days of co-cultures. We found that FasL expression in mRNA, protein and cellular resolutions demonstrated a significant decrease in degenerative group compared with normal control (p<0.05). FCM analysis found that human NP cells with increased FasL expression resulted in significantly increased apoptosis ratio of macrophages and CD8(+) T cells. Our study demonstrated that FasL expression tends to decrease in degenerated discs and FasL plays an important role in human disc immune privilege, which might provide a novel target for the treatment strategies for IDD.published_or_final_versio

Desorption characteristics of H₂O and CO₂ from alumina F200 under different feed/purge pressure ratios and regeneration temperatures

Air pre-purification is an important process for industrial air separation with cryogenic distillation method. This process is typically realized by pressure swing adsorption or temperature swing adsorption. H₂O and CO₂ are the two major components to be removed among the contaminants. In this paper, we establish a mathematical model describing the mass and heat balances in the adsorption bed, and the double-component adsorption/desorption equilibriums of H₂O/CO₂ on alumina F200. To conduct desorption performance analysis, a one-cycle process consisting of feed, blowdown, and purge step under different operating conditions, such as feed/purge pressure ratio and regeneration temperature, is numerically studied. The effect of heat on the desorption performance of H₂O and CO₂ is investigated by changing the purge gas temperature within 30–200 °C under feed/purge pressure ratios of 6:1.1 and 10:1.1, respectively. Detailed results of the H₂O and CO₂ adsorption/desorption behaviors in the bed are demonstrated. The mass and heat transfer characteristics during desorption are also analyzed. Suggestions on the optimization of the heating temperature and duration of purge gas are also proposed

Macroscopic invisibility cloaking of visible light

Invisibility cloaks, which used to be confined to the realm of fiction, have now been turned into a scientific reality thanks to the enabling theoretical tools of transformation optics and conformal mapping. Inspired by those theoretical works, the experimental realization of electromagnetic invisibility cloaks has been reported at various electromagnetic frequencies. All the invisibility cloaks demonstrated thus far, however, have relied on nano- or micro-fabricated artificial composite materials with spatially varying electromagnetic properties, which limit the size of the cloaked region to a few wavelengths. Here, we report the first realization of a macroscopic volumetric invisibility cloak constructed from natural birefringent crystals. The cloak operates at visible frequencies and is capable of hiding, for a specific light polarization, three-dimensional objects of the scale of centimetres and millimetres. Our work opens avenues for future applications with macroscopic cloaking devices

Regulatory role of miR-142-3p on the functional hepatic cancer stem cell marker CD133

Tumor relapse after therapy typifies hepatocellular carcinoma (HCC) and is believed to be attributable to residual cancer stem cells (CSCs) that survive treatment. We have previously identified a CSC population derived from HCC that is characterized by CD133. Despite our growing knowledge of the importance of this subset of cells in driving HCC, the regulatory mechanism of CD133 is not known. Epigenetic changes are believed to be essential in the control of cancer and stem cells. Here, we report the epigenetic regulation of CD133 by miR-142-3p. The interaction between CD133 and miR-142-3p was identified by in silico prediction and substantiated by luciferase reporter analysis. Expression of CD133 was found to be inversely correlated with miR-142-3p in HCC clinical samples as well as in cell lines. Importantly, lower miR-142-3p expression in HCC was significantly associated with worst survival. Functional studies with miR-142-3p stably transduced in HCC cells demonstrated a diminished ability to self-renew, initiate tumor growth, invade, migrate, induce angiogenesis and resist chemotherapy. Rescue experiments whereby CD133 and miR-142-3p is simultaneously overexpressed compensated the deregulated ability of the cells to confer these features. Thus, miR-142-3p directly targets CD133 to regulate its ability to confer cancer and stem cell-like features in HCC.published_or_final_versio

Physicians Infrequently Adhere to Hepatitis Vaccination Guidelines for Chronic Liver Disease

Background and Goals:Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines.Methods:We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview.Results:HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30-98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority.Conclusions:Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines. © 2013 Thudi et al

Postnatal expression of myostain (MSTN) and myogenin (MYoG) genes in Hu sheep of China

The study of candidate genes is an important tool to identify genes associated with economic traits. Skeletal muscle development is an important physiological process in meat animals, and it directly affects meat production. The expression of myostain (MSTN) and myogenin (MYoG) genes in longissimus dorsi, during the early growth stage of Hu sheep, was studied by semi-quantitative Reverse transcription polymerase chain reaction (RT-PCR). The results demonstrate that age and gender were playing a very important role in the expression of sheep muscle. MSTN and MYOG genes showed similar variation pattern for the male and female. The expression level of the MSTN and MYoG genes all showed a positive correlation with live weight, carcass weight and meat percentage, but only showed a significant relationship with meat percentage. MSTN gene showed an extreme significant positive relationship with MYoG.Key words: Sheep, myostain (MSTN), myogenin (MYoG), gene expression, muscle trait