Intraoperative accidental extubation on a known difficult-airway patient requires prompt attention. A good understanding of the steps to re-establish the airway is critical, especially when the ...patient is known to have a difficult airway documented or discovered on induction or acquires a difficult airway secondary to intraoperative events. The situation becomes even more complicated if the case has been handed off to another anesthesiologist, where specific and detailed information may not have been conveyed. This simulation was designed to train first-year clinical anesthesia residents. It was a 50 min encounter that focused on the management of complete loss of an airway during a thyroidectomy on a known difficult-airway patient. The endotracheal tube dislodgement was simulated by deliberate tube manipulation through the cervical access window of the mannequin. Learners received a formative assessment of their performance during the debrief, and most of the residents met the educational objectives. Learners were asked to complete a survey of their experience, and the feedback was positive and constructive. The response rate was 68% (17/25). Our simulation program helped anesthesiology residents develop intraoperative emergency airway management skills in a safe environment, as well as foster communication skills among anesthesiologists and the surgery team.
Metformin is a well-known oral hypoglycaemic agent and has been commonly used, in combination with sulphonylurea, to treat type 2 diabetes. However, the advantageous effect of metformin plus ...sulphonylurea on diabetic macroangiopathy has yet to be clarified. To evaluate whether sulphonylurea or sulphonylurea plus metformin prevent diabetic macroangiopathy, we examined the progression of carotid artery intima-media thickness (IMT) as a surrogate end point.
Subjects with type 2 diabetes were divided into three groups, receiving the following treatments: (i) glibenclamide (n=59); (ii) gliclazide (n=30); and (iii) glibenclamide + metformin (n=29). Maximum IMT and average IMT (the greatest value among 6 average values of each 3 points including greatest thickness) were measured at the beginning and end of the observation period.
For the follow-up period of 3 years, the annual change in average IMT of the glibenclamide plus metformin group (0.003+/-0.048 mm) was smaller than that of the glibenclamide group (0.064+/-0.045 mm) and gliclazide group (0.032+/-0.036 mm) (p<0.0001 and p=0.043 respectively). In the gliclazide group, average IMT increased during the follow-up period, but annual change in average IMT was significantly smaller than that of the glibenclamide group (p=0.005). Glibenclamide + metformin or gliclazide also attenuated the progression of maximum IMT, compared with that of glibenclamide (0.041+/-0.105, 0.044+/-0.106, 0.114+/-0.131 mm/year respectively, p=0.029 and p=0.035 respectively). Multivariable regression analysis implied that administration of metformin or gliclazide significantly and independently (p<0.05) reduces the progression of average IMT, compared with glibenclamide monotherapy.
These data indicate that metformin or gliclazide, rather than glibenclamide, have a potent anti-atherogenic effect in type 2 diabetes.
Endothelial derived nitric oxide synthase ( eNOS) gene polymorphisms affect eNOS activity and are associated with abnormal vasomotility and impaired local blood flow. A decrease in local blood flow ...has been reported to cause insulin resistance. The aim of this study was to examine a possible association of two eNOS polymorphisms, Glu298Asp (G894T) in exon 7 and (-)786T-C mutation with insulin resistance.
Genotypes of both Glu298Asp and (-)786T-C mutation were examined by the PCR-RFLP method. Plasma nitrate and nitrite concentrations were also measured.
The allele frequencies of both polymorphisms showed no considerable differences in 233 non-diabetic subjects and 301 patients with Type II (non-insulin-dependent) diabetes mellitus. Non-diabetic subjects with the (-)786C allele had (p<0.05) higher fasting plasma insulin and homeostasis model assessment of insulin resistance than those with the (-)786T/ (-)786T genotype. Diabetic subjects with (-)786C allele showed higher HbA(1c) than those with the (-)786T/(-)786T genotype. A euglycaemic hyperinsulinemic clamp study done on 71 of the 301 patients showed a lower glucose infusion rate in diabetic patients with the (-)786C allele than those without it. In diabetic patients with the (-)786C allele, plasma nitrate and nitrite concentrations were lower than in subjects without it (p=0.026). No differences were observed between mutant carriers of Glu298Asp and non-carriers among both non-diabetic subjects and Type II diabetic patients.
The (-)786T-C mutation of the eNOS gene is associated with insulin resistance in both Japanese non-diabetic subjects and Type II diabetic patients.
Since charge injection from metals into insulating polymers leads to electrical degradation and failure of various electrical devices, it is essential to clarify the band alignment at the ...metal/insulating polymer interface. However, the electronic structure at the metal/insulating polymer interface has not been studied experimentally. In this contribution, band alignments at the Au/polytetrafluoroethylene (PTFE) and Au/polypropylene (PP) interfaces were determined by first-principles calculations using density functional theory (DFT) and X-ray photoelectron spectroscopy (XPS) measurements. The calculated electronic properties on the Au/PP interface are in agreement with the experimental results, indicating that the vacuum level shift at the interface is slight (below 0.3 eV). On the other hand, in the case of PTFE, even though the computed vacuum level shift for an ideal interface was small (−0.1 eV), the experimental results indicated that the vacuum level shift can be more than 1.7 eV. The results suggest that, in actual systems, the vacuum level shift may be caused by the impurities or defects at the interface. Our work has led us to conclude that the band alignment of the metal/polymer interface depends not only on the combination of material species but also on the way the contact is formed between them.
Genetic factors contributing to the development of IgA nephropathy remain to be elucidated.
The present multicenter cross-sectional case-control study measured genotype frequencies of 65 ...atherosclerotic disease-related gene polymorphisms in 230 Japanese patients with IgA nephropathy and 262 apparently healthy volunteers with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) and negative or trace proteinuria and hematuria by dipstick test non-chronic kidney disease (CKD) participants. Clinical characteristics at kidney biopsy of patients with IgA nephropathy and those at the study recruitment of non-CKD participants were included as covariates in multivariate logistic regression models.
Among 31 gene polymorphisms with ≥5% of minor genotype in non-CKD participants, methionine synthase MTR A2756G (D919G) was significantly associated with IgA nephropathy using χ(2) test even after controlling for family-wise error rate by the method of Bonferroni (P = 0.044). A multivariate nonconditional logistic regression model identified MTR A2756G as a significant contributor of IgA nephropathy 2756AG and GG versus AA, odds ratio 0.42 (95% confidence interval 0.25-0.69) and 0.21 (95% confidence interval 0.06-0.68), P(trend) < 0.001. After each patient with IgA nephropathy was randomly matched to a non-CKD participant on age (±5 years), gender, mean arterial pressure (±5 mmHg) and eGFR (±5 mL/min/1.73 m(2)), a multivariate conditional logistic regression model also verified their significant association odds ratio 0.42 (95% confidence interval 0.18-1.00) and odds ratio 0.09 (95% confidence interval 0.01-0.73), P(trend) = 0.004. MTR A2756G was not associated with slope of eGFR (mL/min/1.73 m(2)/year) in 230 patients with IgA nephropathy.
MTR A2756G was associated with the development, but not progression, of IgA nephropathy.
Since charge injection from metal into dielectrics leads to electrical degradation and failure of various electrical and power devices, it is essential to reveal the band alignment of the ...metal/dielectric interface. However, the band alignment of the metal/dielectric interface remains theoretically unexplored and has not been experimentally obtained. This study reveals the band alignment at the Pt/polytetrafluoroethylene (PTFE) interface by X-ray photoelectron spectroscopy (XPS) measurements and first-principles calculations using density functional theory (DFT). Experiments reveal that the electron and hole injection barriers are 5.5 eV and 2.9 eV, respectively. The calculated results agree with the experimental results, indicating that the vacuum level shift at the interface is slight. Therefore, the band alignment at the Pt/PTFE interface is similar to that before contact.
The neuraminidase‐producing ability of bacteria from coastal fish intestines and their environments was determined using a fluorogenic substrate, 2′‐(4‐methylumbelliferyl)‐α‐d‐N‐acetylneuraminic ...acid. Of 836 isolates examined, 758 (90·7%) produced little or no neuraminidase (< 0·0002 U ml⁻¹) while 78 (9·3%) produced ≥ 0·0002 U neuraminidase ml⁻¹. Of note, 10% of vibrios from fish intestines could produce neuraminidases, and 9% did it efficiently. This result suggests that the vibrios capable of producing neuraminidases are able to colonize and establish in the intestinal tract of coastal fish to some extent. Additionally, as many as 58% of the Vibrio isolates with high abilities were tentatively identified as Vibrio damsela.
OBJECTIVE:--The binding of advanced glycation end products (AGEs) to their receptor (RAGE) plays an important role in the development of diabetic vascular complications. In the present study, we ...examined circulating endogenous secretory RAGE (esRAGE) levels in subjects with type 1 diabetes and explored the possible association between esRAGE levels and the severity of diabetic vascular complications. RESEARCH DESIGN AND METHODS--Circulating esRAGE levels in serum were examined in 67 Japanese type 1 diabetic patients (22 men and 45 women, age 24.0 ± 4.4 years means ± SD) and 23 age-matched healthy nondiabetic subjects (10 men and 13 women aged 24.9 ± 1.4 years). Daily urinary albumin excretion, the presence of retinopathy, and intima-media thickness (IMT) of the carotid artery were also evaluated. We further explored the association between esRAGE levels and severity of diabetic vascular complications. RESULTS:--Circulating esRAGE levels were significantly lower in subjects with type 1 diabetes than in nondiabetic subjects (0.266 ± 0.089 vs. 0.436 ± 0.121 ng/ml, respectively, P < 0.0001) and was inversely correlated with HbAsubscript 1c (A1C) levels (r = -0.614, P < 0.0001). In addition, multivariate regression analysis demonstrated that A1C was an independent risk factor for a low esRAGE value. Furthermore, circulating esRAGE levels were inversely correlated with carotid IMT (r = -0.325, P = 0.0017) and was one of the independent risk factors for IMT thickening. Furthermore, there was a significant difference (P = 0.0124) in esRAGE levels between patients without retinopathy (0.286 ± 0.092 ng/ml) and those with retinopathy (0.230 ± 0.074 ng/ml). CONCLUSIONS:--Circulating esRAGE levels were significantly lower in type 1 diabetic patients than in nondiabetic subjects and were inversely associated with the severity of some diabetic vascular complications.
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