The Articulated Oral Airway as an aid to mask ventilation: a prospective, randomized, interventional, non-inferiority study.

BACKGROUND: Oropharyngeal airways are used both to facilitate airway patency during mask ventilation as well as conduits for flexible scope intubation, though none excel at both. A novel device, the Articulated Oral Airway (AOA), is designed to facilitate flexible scope intubation by active displacement of the tongue. Whether this active tongue displacement also facilitates mask ventilation, thus adding dual functionality, is unknown. This study compared the AOA to the Guedel Oral Airway (GOA) in regards to efficacy of mask ventilation of patients with factors predictive of difficult mask ventilation. The hypothesis was that the AOA would be non-inferior to the GOA in terms of expiratory tidal volumes by a margin of 1 ml/kg, thus demonstrating dual functionality. METHODS: In this randomized controlled clinical trial, fifty-eight patients with factors predictive of difficult mask ventilation were mask ventilated with both the GOA and the AOA. Video of the anesthetic monitors were evaluated by a blinded member of the research team, noting inspiratory and expiratory tidal volumes and expiratory CO2 waveforms. RESULTS: The AOA was found to be non-inferior to the GOA at a margin of 1 ml/kg with a mean weight-standardized expiratory tidal measurement 0.45 ml/kg lower (CI: 0.34-0.57) and inspiratory tidal measurement 0.109 lower (CI: - 0.26-0.04). There was no significant difference in expiratory waveforms (p = 0.2639). CONCLUSIONS: The AOA was non-inferior to the GOA for mask ventilation of patients with predictors of difficult mask ventilation and there was no significant difference in EtCO2 waveforms between the groups. These results were consistent in the subset of patients who were initially difficult to mask ventilate. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03144089 , May 2017.

Osteoarthritis-Like Changes in Bardet-Biedl Syndrome Mutant Ciliopathy Mice (Bbs1M390R/M390R): Evidence for a Role of Primary Cilia in Cartilage Homeostasis and Regulation of Inflammation.

Osteoarthritis (OA) is a debilitating inflammation related disease characterized by joint pain and effusion, loss of mobility, and deformity that may result in functional joint failure and significant impact on quality of life. Once thought of as a simple "wear and tear" disease, it is now widely recognized that OA has a considerable metabolic component and is related to chronic inflammation. Defects associated with primary cilia have been shown to be cause OA-like changes in Bardet-Biedl mice. We examined the role of dysfunctional primary cilia in OA in mice through the regulation of the previously identified degradative and pro-inflammatory molecular pathways common to OA. We observed an increase in the presence of pro-inflammatory markers TGFß-1 and HTRA1 as well as cartilage destructive protease MMP-13 but a decrease in DDR-2. We observed a morphological difference in cartilage thickness in Bbs1 M390R/M390R mice compared to wild type (WT). We did not observe any difference in OARSI or Mankin scores between WT and Bbs1M390R/M390R mice. Primary cilia appear to be involved in the upregulation of biomarkers, including pro-inflammatory markers common to OA.

Epidemiology of Sports-Related Eye Injuries in the United States.

IMPORTANCE: Ocular trauma can lead to lifelong sequelae, and sports-related ocular injuries have been shown to disproportionately affect the young. Studies quantifying and characterizing the incidence and type of injuries seen with sports-related ocular trauma may be useful for resource utilization, training, and prevention efforts. OBJECTIVE: To examine the emergency department (ED) burden of sports-related ocular trauma in the United States. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, cross-sectional study examined the Nationwide Emergency Department Sample, containing data from approximately 30 million ED visits annually at more than 900 hospitals nationwide, from January 1, 2010, to December 31, 2013, to determine factors associated with sports-related ocular trauma. MAIN OUTCOMES AND MEASURES: Annual incidence of sports-related ocular trauma, broken down by age, sex, mechanism of injury, and related activity, as well as factors associated with short-term impaired vision. RESULTS: During the study period, 120 847 individuals (mean age, 22.3 years [95% CI, 21.9-22.7]; 96 872 males, 23 963 females, and 12 with missing data) presented with sports-related ocular trauma, which was the primary diagnosis in 85 961 patients. Injuries occurred most commonly among males (69 849 [81.3%]; 95% CI, 80.6%-81.9%) and occurred most frequently as a result of playing basketball (22.6%; 95% CI, 21.7%-23.6%), playing baseball or softball (14.3%; 95% CI, 13.7%-14.9%), and shooting an air gun (11.8%; 95% CI, 10.8%-12.8%). Odds of presentation to the ED with impaired vision were greatest for paintball and air gun injuries relative to football-related injuries (odds ratio, 4.75; 95% CI, 2.21-10.19 and 3.71; 95% CI, 2.34-5.88, respectively; P < .001). CONCLUSIONS AND RELEVANCE: In our study, approximately 30 000 individuals presented annually to EDs in the United States with sports-related eye injuries; in more than 70% of these cases, eye injuries were the primary diagnosis. Activities involving projectiles pose the greatest risk for visual impairment in the short term, although long-term outcomes were unavailable.

Epidemiologic Trends of Chemical Ocular Burns in the United States.

IMPORTANCE: Determining the national epidemiologic trends of chemical ocular burns can assist physicians and policy makers in appropriate allocation of resources for treatment and prevention. OBJECTIVE: To describe the epidemiologic trends and risk factors for chemical burns of the eye. DESIGN, SETTING, AND PARTICIPANTS: Between August 1, 2015, and April 25, 2016, data from the Nationwide Emergency Department Sample were analyzed from January 1, 2010, through December 31, 2013. A sample of 900 emergency departments (EDs) across the United States was used. Patients presenting to EDs with a diagnosis of alkali or acid ocular burn, chemical conjunctivitis, or a combination of nonspecific ocular chemical burn and chemical poisoning or toxic effects were eligible for inclusion. Injured patients' age, sex, primary health care insurance, income quartile, and other demographics were described. A subset consisting of those injuries identified as alkaline or acidic burns was further characterized. MAIN OUTCOMES AND MEASURES: Age-specific rates of ED presentation for chemical ocular burn injuries, independent factors associated with all, alkali, and acid injuries, and total ED-associated charges. RESULTS: From January 1, 2010, through December 31, 2013, a total of 144 149 chemical ocular burns were diagnosed at EDs nationwide. Men represented 56.6% of all cases (n = 81 496). Median age was 32 years, with female patients presenting at a younger age than male patients (median of 32 vs 34 years; P < .001). Injury rates were highest among children aged 1 to 2 years (28.61 and 23.49 injuries per 100 000 population, respectively). Adults aged between 18 and 64 years also have these injuries at an increased rate, although this rate was half that of infants (mean, 13.28 per 100 000 population). Alkali injuries were more common than acid injuries (53.6% [n = 9137; 95% CI, 51.6%-56.0%] vs 46.4% [n = 7909; 95% CI, 44.0%-48.9%]), and all chemical eye injuries most commonly occur in residential locations (10.3% [n = 14 772]; 95% CI, 9.6%-10.9%) and among individuals in the first and second (lowest and second-lowest) income quartiles (≤$48 749) (56.0% [n = 80 691]; 95% CI, 54.4%-57.7%). Injuries most commonly occurred among those who had private health care insurance (31.9% [n = 45 900]; 95% CI, 30.9%-32.9%), and occurred more in the South (36.8% [n = 53 008]; 95% CI, 34.6%-39.1%). Emergency department charges due to these injuries totaled $106.7 million. CONCLUSIONS AND RELEVANCE: Young children represent the single highest-risk group for ocular chemical injuries. Education and other interventions concerned with preventing these injuries will be most effective if used accordingly.