Correlative study between modified mallampati score with Cormack Lehane and POGO scoring

Background: Assessing the difficulty level of the airway for intubation is extremely important in anaesthetic practice to avoid delays in intubation and resulting adverse consequences. Multiple grading systems are used by anaesthesiologists across the globe to aid in classifying the airways, but the number of studies assessing the level of agreement between various methods is scarce. Hence, the current study was conducted with an objective of assessing the level of agreement of Modified Mallampatti score (MMS) with Cormack –Lehane scoring and POGO Scoring. Materials and methods: The study was a cross sectional study, conducted in the Department of Anesthesiology, Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu on adults aged between 18 to 65 years, belonging to ASA grade 1 and 2, scheduled for elective and emergency surgery under general anaesthesia. Patients with apparent restriction of mouth opening due to pain, with fresh facial injuries and dental abnormalities were excluded from the study. The airway of each subject was assessed by the trained anesthetist, in charge of the procedure. The agreement between the different methods of grading was assessed by kappa Statistic along with its standard error and P value. P value < 0.05 was considered as statistically significant. Results: A total of 236 subjects were included in the study. Among the study population, 74 (31.36%) had mallampatti grade I. The number of mallampatti grade II, III, and IV was 140 (59.32%), 21 (8.90%) and 1 (0.42%) respectively. Among the study population, 143 (60.59%) had Cormack Lehane grade I. The number of Cormack Lehane grade II, and III was 84 (35.59%), and 9 (3.81%) respectively. Among the study population, 170 (72.03%) had POGO grade 1. The number of POGO grade 2, 3 and 4 was 42 (17.80%), 15 (6.36%), and 9 (3.81%) respectively. The measure of agreement was very poor between Mallampatti grading with Cormack Lehane grading. (kappa statistics value - K. Murugesan, Arunachalam R, Rajarajan N. Correlative study between modified mallampati score with Cormack Lehane and POGO scoring. IAIM, 2018; 5(4): 119-125. Page 120 0.103, P value 0.032). The measure of agreement was also very poor between Mallampatti grading and POGO grade. (kappa statistics value was 0.105, P value 0.004). The measure of agreement was fair between Cormack Lehane grading and Mallampatti grading. (kappa statistics value was 0.327, P value <0.001). Conclusions: When compared to POGO score, Cormack Lehane grading had shown a better level of agreement with Mallampatti grading. But the level of agreement between any of the two methods was too low to rely on them interchangeably in clinical practice.

Comparative Evaluation of two Polishing Systems on the Surface Texture of an aesthetic material (nano-composite): A Profilometric Study.

Composites have revolutionized the concept in asthetic dentistry. Proper finishing and polishing of composites are important aspects of clinical restorative procedures that enhance both asthetics and the longevity of the restoration. A number of finishing and polishing devices are available, but to decide the efficacy of various materials is still a challenge to the dentists or clinicians. Hence the study was undertaken to determine the effectiveness of two polishing systems Sof-Lex and PoGo on Filtek Z350 by evaluating surface roughness using a Profilometer. The study concluded that Sof-Lex is a better polishing system than PoGo.

Absence Expression of Heat Shock Protein 25 in the Cerebellum of Ataxic Mutant Pogo Mouse / 대한해부학회지

Heat shock proteins (Hsps) are generally known to be induced in response to a range of stressful stimuli such as hyperthermia, immobilization, UV radiation, arsenite, various chemicals, and drugs. In addition, these proteins have been suggested to have roles in protecting cells against apoptotic cell death. The ataxic mutant Pogo (pogo/pogo) mouse is a novel neurological ataxic mutant, which is derived from Korean wild type mouse (KJR/Mskist) strain. Pogo mutation is considered as an alleles of alpha subunit of P/Q-type calcium channel mutants such as rolling mouse Nagoya (RMN), tottering, and leaner. We investigated the topographical Hsp25 expression using immunohistochemistry and western blot analysis in several ataxic mutant mice: RMN, tottering, leaner, Pogo and Korean wild mouse. In the cerebellum of the RMN, tottering, leaner, and normal mouse including Balb/C, C57BL/6 and ICR mouse, Hsp25 was expressed in a subset of Purkinje cells that form parasagittal stripes. The Hsp25 expression is largely restricted to specific cerebellar lobules: VI /VII (the central zone: CZ), and IX/X (the nodular zone: NZ). Surprisingly, no Hsp25-immunoreactive Purkinje cells were seen in CZ and NZ of the cerebellum of Pogo (pogo/pogo), heterozygotes Pogo (pogo/+), and Korean wild mouse. Moreover, in western blot analysis, there was no cerebellar Hsp25 expression in ataxic Pogo mouse including Korean wild mouse. These data suggest that cerebellar Hsp25 expression was irrelevant with the development of ataxia in Pogo mouse.

Decreased Calbindin-immunoreactive Renshaw Cells (RCs) in the Lumbar Spinal Cord of the Ataxic Pogo Mice / 대한해부학회지

Calbindin D-28K (CALB) is one of the calcium-binding proteins which is assumed to be buffering, transport of Ca2+, and regulation of various enzyme systems. In the spinal cord, a subpopulation of calbindin-immunoreactive neurons located in the ventral portion of lamina VII, medial to the motoneuron column, has recently been proposed to be Renshaw cells (RCs), that mediate recurrent inhibition of spinal alpha-motoneurons, based on the anatomical location. In this study, we have performed to investigate the correlation between RCs containing high levels of CALB and motoneurons in the ventral horn of lumbar spinal cord of the ataxic pogo mice, that characterized by a failures of interlimb coordination, and prolonged excessive tone of hindlimb extensor muscles. We have shown that CALB immunoreactive RCs was significantly decreased in the ventral horn of lumbar spinal cord of the ataxic pogo mice (p.0.05), when compared with the control mice. Whereas, CALB immunoreactivity expression levels were no difference in the dorsal horn. Furthermore, CALB protein was significantly decreased in the lumbar spinal cord of the ataxic pogo mice (p.0.01). However, there were no difference in the cervical and thoracic spinal cord of the between control and pogo mice. These results suggest that motoneurons of ventral horn of the lumbar spinal cord might be more excited state, results in the decreased CALB immunoreactive RCs have not mediated a motoneuron excitability, in the atxic mice, pogo.

A Comparison-study of the Effects of Conventional and Video Laryngoscopic Intubation on Heart Rate and Blood Pressure / 대한마취과학회지

BACKGROUND: Glidescope(R) is a video-assisted intubation device.It offers a clear view and is easy to use, giving it several advantages over conventional intubation devises.This study was designed to compare the hemodynamic effects and POGO scores between conventional and video laryngoscopic intubation. METHODS: Sixty adult patients with ASA 1 or 2 were randomly allocated into two groups; Glidescope(R) (group G) or Macintosh (group M).Anesthesia was induced with propofol and remifentanil.Blood pressure and heart rate were recorded just prior to intubation and 1, 3, and 5 minutes after intubation.POGO scores, intubation time and the severity of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, POGO score, intubation time and the severity of sore throat between two groups. CONCLUSIONS: The POGO scores and hemodynamic changes associated with tracheal intubation using the Glidescope(R) were almost the same as that of the Macintosh group.

Voltage-dependent Calcium Channel (VDCC) alpha(1A) Subunit Expression in the Ataxic Mutant, Pogo Mice Cerebellum / 대한해부학회지

The pogo mouse is a new ataxic mutant derived from a Korean wild mouse. The pogo mutation is inherited as an autosomal recessive trait on chromosome 8. Mutations in gene coding for the alpha(1A)subunit of voltagegated P/Q-type Ca(2+) channel have been shown to cause phenotypes in humans and mice, i.e., tottering, leaner, rolling mouse mouse Nagoya. Using immunohistochemistry, the expression of the alpha(1A)subunit of voltage-gated P/Q-type Ca(2+) channel was examined in pogo mice cerebellum including deep cerebellar nuclei (DCN). We observed alpha(1A)immunoreactivity in the cerebellar cortex (Purkinje cell and granule cell) and DCN of ataxic pogo mice and heterozygote control mice. There was no difference in cerebellar cortical alpha(1A)immunoreactivity between ataxic pogo mice and heterozygous littermate controls (pogo/+). However, we observed alpha(1A)immunoreactivity in the Purkinje cells of control and ataxic pogo mice cerebellum and DCN. We found a significant difference between pogo and heterozygous controls in terms of alpha(1A)immunoreactivities in the DCN. alpha(1A)immunoreactivity in this nucleus in pogo was much higher than in heterozygous littermate controls. No significant differences were observed in the interposed nucleus between pogo and heterozygous controls, but we found that the alpha(1A)subunits were clearer and more abundant in the lateral and medial regions of pogo than in control mice in these regions, where only weak immunoreactivity was observed. This elevated expression of the alpha(1A)subunit in deep cerebellar neurons of pogo might be a compensation for the altered function of P/Q type calcium channel and be related with the induction of the ataxic phenotype in pogo mice.

Elevated Serotonin-immunoreactive Neurons in the Raphe Nucleus of the Ataxic Mutant Mouse, Pogo / 대한해부학회지

This study was carried out to investigate the distribution of serotonin-immunoreactive neruons in the raphe nucleus of the ataxic pogo (pogo/pogo) mice derived from a Korean wild mice. Using by immunohistochemistry, we undertook to elucidate any correlation between the serotonin expression and behavior ataxia including abnormal hindlimb extension in the ataxic pogo mice. The present study has two important findings. First, serotonin immunoreactivity was increased in the raphe nucleus of the ataxic pogo mice. Second, serotonin immunoreactivity was different with the region of raphe nucleus. In the dorsal part of dorsal raphe nucleus (DRD), ventrolateral part of dorsal raphe nucleus (DRVL) and median raphe nucleus (MR), serotonin immunoreactivity was increased, whereas the ventral part of dorsal raphe nucleus (DRV) and interfascicular part of dorsal raphe nucleus (DRI) was similar with the control mice. Therefore, elevated expression of the serotonin in the raphe nucleus of ataxic pogo mice might be a source of behavior ataxia and may be related with the induction of the ataxic phenotype including abnormal hindlimb movements.

Distribution of Calretinin-immunoreactive Unipolar Brush Cells in Ataxic Mutant Pogo Mice Cerebellum / 대한해부학회지

Unipolar brush cells (UBCs) are a class of putative interneurons found in the granular layer of mammalian cerebellum and dorsal cochlear nucleus. The unipolar brush cells (UBCs), as with granular cells, which receives afferent synaptic input from extrinsic mossy fiber and whose axons branch in the granular layer and establish a system of cortex-intrinsic mossy fibers, which synapse with granule cells and other UBCs. In general, UBCs have been identified most readily by their expression of the calcium-binding protein, calretinin. The purpose of this study was to provide information about UBCs distributions of the new ataxic animal model, pogo mouse cerebellum using anti-calretinin immunohistochemistry, immunofluorescence and its effect on calcium homeostasis. Through the examination of calretinin immunohistochemistry and immunofluorescence, we observed that many calretinin immunoreactive UBCs were distributed widely throughout the lobules IX and X of the granular layer of both group. But, we found the number of calretinin immunoreactive UBCs of ataxic pogo (pogo/pogo) mouse was decreased and distribution pattern was altered, compared to control mouse. This result also suggest that reduced calretinin expression may effect on cerebellar Ca2+/-homeostasis, and it may in turn, explain the impaired motor coordination found in the ataxic pogo mice.

Abnormal Expression of Neuropeptide Y in the Cerebellar Purkinje Cells of the Ataxic Mutant Mice, Pogo / 체질인류학회지

The pogo mouse is an autosomal recessive ataxic mutant that arose spontaneously in the inbred KJR/MsKist strain derived originally from Korean wild mice. The ataxic phenotype is characterized by difficulty in maintaining posture and the consequent inability to walk straight. In our previous study about pogo mice cerebellum, we reported the Purkinje cell abnormalities and ectopic expression of tyrosine hydroxylase (TH) in Purkinje cell. In this study, we have provided an abnormal expression of NPY in ataxic mutant pogo mice for the first time. There was increased immunoreactivity for NPY in Purkinje cell of ataxic pogo (pogo/pogo) mice compared to those of heterozygote non-ataxic pogo mice (pogo/+, control group). In our previous study, TH is also expressed abnormally in Purkinje cells of ataxic mutant pogo (pogo/pogo) mouse cerebellum. To compare the expression patterns of TH and NPY within some Purkinje cell using double immunofluorescence, most of NPY-immunoreactive Purkinje cells in the ataxic pogo mice are TH-immunoreactive Purkinje cells. However, all of TH-immunoreactive Purkinje cells are not express the NPY. These data reveal that abnormal NPY-immunoreactivity in the ataxic pogo (pogo/pogo) cerebellum is restricted to a subset of cells within the ectopic TH-immunoreactive Purkinje cell subset. These results further suggest that Purkinje cell abnormalities contribute to motor ataxia in the ataxic pogo mouse.

Glutamate and GABA concentrations in the cerebellum of novel ataxic mutant Pogo mice

The Pogo mouse is an autosomal recessive ataxic mutant that arose spontaneously in the inbred KJR/MsKist strain derived originally from Korean wild mice. The ataxic phenotype is characterized by difficulty in maintaining posture and side to side stability, faulty coordination between limbs and trunk, and the consequent inability to walk straight. In the present study, the cerebellar concentrations of glutamate and GABA were analyzed, since glutamate is a most prevalent excitatory neurotransmitter whereas gammar-aminobutyric acid (GABA) is one of the most abundant inhibitory neurotransmitters, which may be the main neurotransmitters related with the ataxia and epilepsy. The concentration of glutamate of cerebellum decreased significantly in ataxic mutant Pogo mouse compared to those of control mouse. However, GABA concentration was not decrease. These results suggested that the decrease in glutamate concentration may contribute to ataxia in mutant Pogo mouse.

Surface roughness of universal composites after polishing procedures / 대한치과보존학회지

The aim of this study was to evaluate the effect of two polishing methods and chemical conditioning on the surface of hybrid composites. Ninety cylindrical specimens (diameter: 8 mm, depth: 2 mm) were made with three hybrid composites - Filtek Z250, Tetric Ceram, DenFil. Specimens for each composite were randomly divided into three treatment subgroups - Mylar strip (no treatment), Sof-Lex XT system, PoGo system. Average surface roughness(Ra) was taken using a surface profilometer at the time of setting and after immersion into 0.02N lactic acid for 1 week and 1 month. Representative specimens were examined by scanning electron microscopy. The data were analyzed using ANOVA and Scheffe's tests at 0.05% significance level. The results were as follows: 1. Mylar strip resulted in smoother surface than PoGo and Sof-Lex system(p<0.001). Sof-Lex system gave the worst results. 2. Tetric Ceram was smoother than DenFil and Z250 when cured under only mylar strip. However, it was significantly rougher than other materials when polished with PoGo system. 3. All materials showed rough surface after storage in 0.02N lactic acid, except groups polished with a PoGo system. The PoGo system gave a superior polish than Sof-Lex system for the three composites. However, the correlation to clinical practice may be limited, since there are several processes, such as abrasive, fatigue, and corrosive mechanisms. Thus, further studies are needed for polishing technique under in vivo conditions.

Differences of Zebrin II Expression Pattern Between Normal Balb/C and Ataxic Pogo Mouse Cerebellum / 대한해부학회지

The purpose of this study is to identify the differences of zebrin II expression between ataxic pogo and normal Balb/C mouse cerebellum. Zebrin II is expressed by subsets of Purkinje cells that form an array of parasagittal bands that extend rostrocaudally throughout the cerebellar cortex, separated by similar bands of Purkinje cells that do not express zebrin II. Zebrin II immunoreactivity was localized in the perikarya of Purkinje cells, and the dendrites. Distribution of zebrin II-immunoreactive Purkinje cells were very similar pattern in pogo and Balb/C mouse cerebellum. But, in the lobule III, distribution of zebrin II expression was different between pogo and Balb/C mouse cerebellum. In lobule III of Balb/c mouse cerebellum, 10~15 zebrin II-immunoreactive Purkinje cells were observed and clustered to form a parasagittal bands. On the other hand, zebrin II expressions of lobule III in pogo mouse cerebellum showed a little different patterns. In lobule III of pogo mouse cerebellum, three bilateral zebrin II immunoreactive parasagittal band were observed. P1 band was almost same with lobule III of Balb/C mouse cerebellum. But, P2 bands were composed of 50~60 Purkinje cells which were immunoreactive with zebrin II. These kind of thickening in zebrin II expression of pogo mouse cerebellum may be due to the genetical difference. Furthermore, these results may provide useful information with further ataxic pogo mice cerebellum studies.