Channelled versus nonchannelled Macintosh videolaryngoscope blades in patients with a cervical collar: a randomized controlled noninferiority trial.

PURPOSE: Channelled blades have the advantage of avoiding stylet use and potential airway injury during videolaryngoscopic intubation. Nevertheless, the effectiveness of channelled Macintosh-type blades has not yet been fully established. We sought to assess the utility of channelled Macintosh-type blades for videolaryngoscopic intubation under cervical spine immobilization. METHODS: We conducted a randomized controlled noninferiority trial in neurosurgical patients with a difficult airway simulated by a cervical collar. Videolaryngoscopic intubation with a reinforced tracheal tube was performed using a channelled Macintosh-type blade without a stylet (channelled group, n = 130) or a nonchannelled Macintosh-type blade with a stylet (nonchannelled group, n = 131). The primary outcome was intubation success rate. Secondary outcomes included time to intubation and incidence or severity of intubation-related complications (subglottic, lingual, and dental injuries; bleeding; sore throat; and hoarseness). RESULTS: The initial intubation success rate was 98% and 99% in the channelled and nonchannelled groups, respectively, showing the noninferiority of the channelled group (difference in proportions -0.8%; 95% confidence interval [CI], -4.8% to 2.9%; predefined noninferiority margin, -5%; P = 0.62). Fewer participants in the channelled group had subglottic injuries than in the nonchannelled group (32% [32/100] vs 57% [54/95]; difference in proportions, -25%; 95% CI, -39% to -11%; P < 0.001). There were no significant differences between the two groups in the overall intubation success rate, time to intubation, and incidence or severity of other intubation-related complications. CONCLUSIONS: For videolaryngoscopic intubation in patients with a cervical collar, channelled Macintosh-type blades are an alternative to nonchannelled Macintosh-type blades, with a noninferior initial intubation success rate and a lower incidence of subglottic injury. STUDY REGISTRATION: CRIS.nih.go.kr ( KCT0005186 ); first submitted 29 June 2020.

RéSUMé: OBJECTIF: Les lames avec canal ont l'avantage de ne pas nécessiter l'utilisation d'un stylet et d'ainsi éviter les lésions potentielles des voies aériennes lors de l'intubation vidéolaryngoscopique. Néanmoins, l'efficacité des lames avec canal de type Macintosh n'a pas encore été pleinement établie. Nous avons cherché à évaluer l'utilité des lames avec canal de type Macintosh pour l'intubation vidéolaryngoscopique lorsque le rachis cervical était immobilisé. MéTHODE: Nous avons mené une étude randomisée contrôlée de non-infériorité chez des patient·es de neurochirurgie présentant des voies aériennes difficiles simulées par le port d'un collier cervical. L'intubation vidéolaryngoscopique avec une sonde trachéale renforcée a été réalisée à l'aide d'une lame Macintosh avec canal sans stylet (groupe avec canal, n = 130) ou d'une lame Macintosh sans canal avec stylet (groupe sans canal, n = 131). Le critère d'évaluation principal était le taux de réussite de l'intubation. Les critères d'évaluation secondaires comprenaient le temps d'intubation et l'incidence ou la gravité des complications liées à l'intubation (lésions sous-glottiques, linguales et dentaires, saignements, maux de gorge et enrouement). RéSULTATS: Le taux de réussite initial de l'intubation était de 98 % et 99 % dans les groupes avec et sans canal, respectivement, montrant la non-infériorité du groupe lame avec canal (différence de proportions −0,8 %; intervalle de confiance [IC] à 95 %, −4,8 % à 2,9 %; marge de non-infériorité prédéfinie, −5 %; P = 0,62). Les lésions sous-glottiques ont été moins nombreuses dans le groupe avec canal que dans le groupe sans canal (32 % [32/100] vs 57 % [54/95]; différence de proportions, −25 %; IC 95 %, −39 % à −11 %; P < 0,001). Il n'y avait pas de différences significatives entre les deux groupes en matière de taux global de réussite de l'intubation, de temps d'intubation et d'incidence ou de gravité des autres complications liées à l'intubation. CONCLUSION: Pour l'intubation vidéolaryngoscopique des patient·es portant un collier cervical, les lames avec canal de type Macintosh constituent une alternative aux lames sans canal de type Macintosh, avec un taux de réussite d'intubation initial non inférieur et une incidence plus faible de lésions sous-glottiques. ENREGISTREMENT DE L'éTUDE: CRIS.nih.go.kr ( KCT0005186 ); première soumission le 29 juin 2020.

Pain Assessment Using the Analgesia Nociception Index (ANI) in Patients Undergoing General Anesthesia: A Systematic Review and Meta-Analysis.

The analgesia nociception index (ANI) has emerged as a potential measurement for objective pain assessment during general anesthesia. This systematic review and meta-analysis aimed to evaluate the accuracy and effectiveness of ANI in assessing intra- and post-operative pain in patients undergoing general anesthesia. We conducted a comprehensive search of Ovid-MEDLINE, Ovid-EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, public clinical trial databases (ClinicalTrials and Clinical Research Information Service), and OpenSIGLE to identify relevant studies published prior to May 2023 and included studies that evaluated the accuracy and effectiveness of ANI for intra- or post-operative pain assessment during general anesthesia. Among the 962 studies identified, 30 met the eligibility criteria and were included in the systematic review, and 17 were included in the meta-analysis. For predicting intra-operative pain, pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under curve of ANI were 0.81 (95% confidence interval [CI] = 0.79-0.83; I2 = 68.2%), 0.93 (95% CI = 0.92-0.93; I2 = 99.8%), 2.32 (95% CI = 1.33-3.30; I2 = 61.7%), and 0.77 (95% CI = 0.76-0.78; I2 = 87.4%), respectively. ANI values and changes in intra-operative hemodynamic variables showed statistically significant correlations. For predicting post-operative pain, pooled sensitivity, specificity, and DOR of ANI were 0.90 (95% CI = 0.87-0.93; I2 = 58.7%), 0.51 (95% CI = 0.49-0.52; I2 = 99.9%), and 3.38 (95% CI = 2.87-3.88; I2 = 81.2%), respectively. ANI monitoring in patients undergoing surgery under general anesthesia is a valuable measurement for predicting intra- and post-operative pain. It reduces the use of intra-operative opioids and aids in pain management throughout the perioperative period.

Effect of Combined Soil Amendment on Immobilization of Bioavailable As and Pb in Paddy Soil.

Heavy metal pollution in soil can have detrimental effects on soil ecosystems and human health. In situ remediation techniques are widely used to reduce the bioavailable fractions of heavy metals in soil. The main objective of this study was to examine the reduction of the bioavailable fractions of As and Pb in paddy soil with artificial lightweight material (ALM) manufactured from recycled materials. A total of four treatments, including a control (no amendment), ALM10 (10% of ALM in soil), ALM10+L (10% ALM combined with 0.5% lime), and ALM10+FeO (10% ALM combined with 0.5% FeO), were applied to paddy fields, and rice (Oryza sativa L.) was cultivated after 32 weeks. The highest reduction efficiencies for the bioavailable fractions of As and Pb in soil were observed in the ALM10+FeO (52.8%) and ALM10+L treatments (65.7%), respectively. The uptake of As decreased by 52.1% when ALM10+FeO was applied to paddy soil, and that of Pb decreased by 79.7% when ALM10+L was applied. Correlation analysis between bioavailable heavy metals in soil and soil chemical properties showed that soil pH, electrical conductivity (EC), P2O5, and soil organic matter (SOM) were the main factors controlling the mobility and bioavailability of As and Pb. Overall, the efficiencies of As and Pb reduction increased synergistically in both soil and plants when FeO and lime were combined with the ALM. In future studies, long-term monitoring is necessary to examine the longevity of soil amendments.

Biologically produced sulfur as a novel adsorbent to remove Cd2+ from aqueous solutions.

Biological desulfurization processes of landfill gas yield an enormous amount of biologically produced S (BPS) as a byproduct. Capability of BPS to remove Cd2+ from aqueous solutions was tested and its removal efficiency was compared to that of granular activated carbon (GAC). Kinetics of Cd2+ removal by BPS was a two-stage process with an initial rapid adsorption showing 45% of initial Cd2+ was removed within 5 min, followed by a slower adsorption. Cadmium adsorption onto the BPS fitted the Langmuir isotherm model and maximum adsorption capacity of the BPS (63.3 mg g-1) was 1.8 times higher than that of GAC (36.1 mg g-1). Thermodynamic parameters showed that Cd2+ adsorption by BPS was favorable and endothermic. Data from XPS proved the main adsorption mechanism to be complexation of Cd2+ with sulfides in the BPS. Results demonstrated that BPS can be recycled as a novel adsorbent for Cd2+ removal from wastewater.

Bottom Ash Modification via Sintering Process for Its Use as a Potential Heavy Metal Adsorbent: Sorption Kinetics and Mechanism.

Heavy metal pollution in the environment is a critical issue, engendering ecosystem deterioration and adverse effects on human health. The main objective of this study was to evaluate heavy metal adsorbents by modifying industrial byproducts. The bottom ash was sintered and evaluated for Cd and Pb sorption. Three adsorbents (bottom ash, sintered bottom ash (SBA), and SBA mixed with microorganisms (SBMA)) were tested to evaluate the sorption kinetics and mechanism using a lab-scale batch experiment. The results showed that the highest sorption efficiency was observed for Cd (98.16%) and Pb (98.41%) with 10% SBA. The pseudo-second-order kinetic model (R2 > 0.99) represented the sorption kinetics better than the pseudo-first-order kinetic model for the SBA and SBMA, indicating that chemical precipitation could be the dominant sorption mechanism. This result is supported by X-ray photoelectron spectroscopy analysis, demonstrating that -OH, -CO3, -O, and -S complexation was formed at the surface of the sintered materials as Cd(OH)2 and CdCO3 for Cd and PbO, and PbS for Pb. Overall, SBA could be utilized for heavy metal sorption. Further research is necessary to enhance the sorption capacity and longevity of modified industrial byproducts.

Effect of chemical amendments on remediation of potentially toxic trace elements (PTEs) and soil quality improvement in paddy fields.

Remediation of potentially toxic trace elements (PTEs) in paddy fields is fundamental for crop safety. In situ application of chemical amendments has been widely adapted because of its cost-effectiveness and environmental safety. The main purpose of this research was to (1) evaluate the reduction in dissolved concentrations of cadmium (Cd) and arsenic (As) with the application of chemical amendments and (2) monitor microbial activity in the soil to determine the remediation efficiency. Three different chemical amendments, lime stone, steel slag, and acid mine drainage sludge, were applied to paddy fields, and rice (Oryza sativa L. Milyang 23) was cultivated. The application of chemical amendments immobilized both Cd and As in soil. Between the two PTEs, As reduction was significant (p < 0.05) with the addition of chemical amendments, whereas no significant reduction was observed for Cd than that for the control. Among six soil-related variables, PTE concentration showed a negative correlation with soil pH (r = -0.70 for As and r = -0.54 for Cd) and soil respiration (SR) (r = -0.88 for As and r = -0.45 for Cd). This result indicated that immobilization of PTEs in soil is dependent on soil pH and reduces PTE toxicity. Overall, the application of chemical amendments could be utilized for decreasing PTE (As and Cd) bioavailability and increasing microbial activity in the soil.

Highly selective electrocatalytic conversion of CO2 to CO at -0.57 V (NHE) by carbon monoxide dehydrogenase from Moorella thermoacetica.

We found that CODH is a fascinating enzyme for the electrochemical conversion of CO2 to CO. It could reduce CO2 to CO at -0.57 V vs NHE with approximately 100% current efficiency in 0.1 M phosphate buffer (pH 6.3). Nature's unique structure of C-cluster in CODH would be responsible for the low overpotential and the selective and fast conversion of CO2. The turnover number per C-cluster is 700 h-1, and the pH optimum is 6.3.