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Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population.

A small hydrophilic peptide of eight amino acids (AspTyrLysAspAspAspAspLys) was engineered onto the N-terminus of a variety of recombinant lymphokines for the purpose of aiding in their detection and purification from yeast supernatants or E. coli extracts. An antibody specific for the first four amino acids of this sequence was used as a detection reagent and for immunoaffinity purification of products under mild conditions. Because of the small size of the peptide moiety and its hydrophilic nature, the proteins were unaffected by its presence and retained a high level of biological activity. In addition, it was possible to remove the peptide via an enzymatic cleavage procedure using enterokinase.

The relative rates of RNA polymerase biosynthesis in Bacillus subtilis has been examined under steady-state growth conditions. The synthesis of RNA polymerase subunits (a, ß, ß', s) has been followed by subunit fractionation of immunoprecipitated [3H]-labelled samples on SDS-polyacrylamide gels. The stoichiometries of a:ß:ß':s subunits have been determined from cultures pulse-labelled during steady-state growth. The results suggest that an unassembled pool of the a-subunit exists from which the holoenzyme is formed.

The most common indication for employing the fibreoptic technique for intubation is when a difficult intubation is anticipated. It may also be used when intubation unexpectedly proves difficult with a rigid laryngoscope in anaesthetized patients. However, failures with orotracheal fibreoptic intubation have been reported in up to 9.5% of cases, although only two possible equipment related causes of intubation difficulties have been identified. The Berman intubating airway and the Ovassapian intubation airway in fibreoptic orotracheal intubation have been compared in 65 patients. The study was randomized and for fibreoptic endoscopy each patient served as his or her own control. The results indicate that both airways can be used for orotracheal fibreoptic intubation in anaesthetized patients. The Berman airway offers easier visualization of the vocal cords than the Ovassapian airway, provided that the Berman airway is of an adequate size and positioned in the midline. Upon impingement of the intubation tube, completing the tracheal intubation is more difficult with the Berman airway than the Ovassapian airway.

The most common indication for employing the fibreoptic technique for intubation is when a difficult intubation is anticipated. It may also be used when intubation unexpectedly proves difficult with a rigid laryngoscope in anaesthetized patients. However, failures with orotracheal fibreoptic intubation have been reported in up to 9.5% of cases, although only two possible equipment related causes of intubation difficulties have been identified. The Berman intubating airway and the Ovassapian intubation airway in fibreoptic orotracheal intubation have been compared in 65 patients. The study was randomized and for fibreoptic endoscopy each patient served as his or her own control. The results indicate that both airways can be used for orotracheal fibreoptic intubation in anaesthetized patients. The Berman airway offers easier visualization of the vocal cords than the Ovassapian airway, provided that the Berman airway is of an adequate size and positioned in the midline. Upon impingement of the intubation tube, completing the tracheal intubation is more difficult with the Berman airway than the Ovassapian airway.

Summary I-125 seeds were permanently implanted into 25 parasellar-clival meningiomas (median age of patients, 56 y) and 19 globoid meningiomas in the elderly (median age of patients, 77 y) using stereotactic technique and 3-D dose planning. Total dose at the tumour margin was increased during the series from 100 Gy to 150 Gy. The procedure caused no mortality and no serious bleeding, but injury to the III cranial nerve due to puncture occurred in one (4%) of the 25 parasellar-clival meningiomas. In two (4.5%) of the 44 cases the postoperative CT scan showed a misplaced seed, located at the tumour surface. Nonenhancing hypodense rings developed around the seeds (‘hot spots’) with a median diameter of 10.5 mm at 12 months corresponding to a median initial activity of 8.7 mCi. In general, meningiomas responded by slow reduction in volume.

We have studied the haemodynamic changes, QT intervals and catecholamine responses to induction of anaesthesia and tracheal intubation in 24 ASA I patients allocated randomly to receive either propofol 2.5 mg kg-1 or thiopentone 5 mg kg-1 over 60 s. After disappearance of the eyelash reflex, the lungs were ventilated with 100% oxygen for 3 min. The trachea was intubated after administration of vecuronium. With thiopentone, heart rate (HR) was greater than with propofol before intubation (P < 0.05). During induction, systolic (SAP) and diastolic arterial pressure (DAP) decreased more with propofol than with thiopentone. The QT interval was prolonged only during induction with thiopentone. In both groups, HR, SAP, DAP and the QT were increased in response to intubation (P < 0.001). The SAP and QT interval responses to intubation were significantly greater with thiopentone than with propofol (P < 0.05). One patient in the thiopentone group with a significantly prolonged QT interval had episodes of bigeminy and ventricular tachycardia. In both groups, concentrations of noradrenaline in mixed venous plasma increased after intubation (P < 0.001). Concentrations of adrenaline increased after intubation only in the thiopentone group (P < 0.001).

Background: Fibreoptic intubation has been suggested to be the best method to manage a compromised airway. This retrospective study was designed to compare endotracheal intubation with the help of a rigid laryngoscope or a fibrescope in patients with rheumatoid arthritis.

We have compared impingement of the tracheal tube against the larynx using a standard preformed tube, warmed preformed tube or two flexible spiral-wound tracheal tubes with different tip designs, in 100 adult patients undergoing orotracheal fibreoptic intubation under general anaesthesia, in a prospective, randomized study. The rates of impingement were 20 of 30 with the standard tube, 12 of 30 with the warmed standard tube (P=0.07) and eight of 20 with both spiral tubes. However, impingement with the spiral tubes took longer to overcome if a sharp tipped rather than an obtuse tipped tube was used. Manipulations after impaction led to oesophageal intubation on one patient, and in one patient fibreoptic intubation failed. We conclude that resistance to the tracheal tube occurred frequently when the spiral-wound tubes were used.
Key words: intubation tracheal; intubation tracheal, technique; equipment, tubes tracheal

We have compared impingement of the tracheal tube against the larynx using a standard preformed tube, warmed preformed tube or two flexible spiral-wound tracheal tubes with different tip designs, in 100 adult patients undergoing orotracheal fibreoptic intubation under general anaesthesia, in a prospective, randomized study. The rates of impingement were 20 of 30 with the standard tube, 12 of 30 with the warmed standard tube (P = 0.07) and eight of 20 with both spiral tubes. However, impingement with the spiral tubes took longer to overcome if a sharp tipped rather than an obtuse tipped tube was used. Manipulations after impaction led to oesophageal intubation in one patient, and in one patient fibreoptic intubation failed. We conclude that resistance to the tracheal tube occurred frequently when the spiral-wound tubes were used.

We have studied the effect of glycopyrronium on the anaesthetic action and absorption of topical lignocaine in 10 healthy, non-smoking volunteers. Lignocaine 100 mg was sprayed on the oral mucosa 15 min after random administration of glycopyrronium 4 micrograms kg-1 or normal saline i.v. Glycopyrronium decreased the mean analgesia score from 2 to 0.1 (2 = baseline; 0 = anaesthesia) at 4 min compared with a change from 2 to 0.5 after normal saline (P < 0.05). All scores returned to baseline by 40 min and 20 min in the glycopyrronium and control groups, respectively. The mean (SD) peak plasma lignocaine concentration was 0.57 (0.29) microgram ml-1 after glycopyrronium and 0.31 (0.10) microgram ml-1 after saline (P < 0.05) and were attained in 17 min (range 10-40 min) and 29 min (range 8-40 min), respectively. Pretreatment with glycopyrronium enhanced absorption and prolonged the analgesic action of topically administered lignocaine.

Background: In the UK at present, different centres use different insulin regimens for paediatric patients at diagnosis of Type 1 Diabetes. Some centres start all children on basal bolus or multiple dose injection (MDI) regimens, whereas others still use twice daily (BD) mixed insulins in certain age groups, partly because of difficulties in supporting insulin administration in school. Since 2008, all children newly diagnosed with diabetes attending Nottingham Children's Hospital have been started on a MDI regimen, regardless of age. We aimed to assess whether either of these insulin regimens produced better honeymoon HbA1Cs and duration of honeymoon period.Methods: A retrospective analysis of HbA1C and duration of honeymoon period in children started on MDI regimens compared with those started on BD regimens, looking at all children and young people registered with the Nottingham Paediatric Diabetes Service in Dec 2010. Honeymoon was defined using Insulin Dose Adjusted for A1C ie HbA1C+ (4 x total daily dose insulin in units/kg/day) as < 9.Results: There were no differences in sex, age distribution or initial education given between the BD regimen group (n=104) and the MDI group (n=106). At 6 months, 45% of children on the BD regimen were still honeymooning, vs 75% on MDI (p< 0.001). At 12 months, this had dropped to 23% in the BD group vs 42% (p< 0.02) in the MDI.Conclusions: It would appear that MDI regimens from diagnosis give a significantly more prolonged honeymoon period than BD mixed insulins.

Background. Dexmedetomidine (DEX) has been shown to provide good perioperative haemodynamic stability with decreased intraoperative opioid requirements. It may have neural protective effects, and thus may be a suitable anaesthetic adjuvant to neurosurgical anaesthesia. Methods. Fifty-four patients scheduled for elective surgery of supratentorial brain tumour were randomized to receive in a double-blind manner a continuous DEX infusion (plasma target concentration 0.2 or 0.4 ng ml−1) or placebo, beginning 20 min before anaesthesia and continuing until the start of skin closure. The DEX groups received fentanyl 2 μg kg−1 at the induction of anaesthesia and before the start of operation, the placebo group 4 μg kg−1, respectively. Anaesthesia was maintained with nitrous oxide in oxygen and isoflurane. Results. The median times from the termination of N2O to extubation were 6 (3–27), 3 (0–20) and 4 (0–13) min in placebo, DEX-0.2 and DEX-0.4 groups, respectively (P<0.05 anova all-over effect). The median percentage of time points when systolic blood pressure was within more or less than 20% of the intraoperative mean was 72, 77 and 85, respectively (P<0.01), DEX-0.4 group differed significantly from the other groups. DEX blunted the tachycardic response to intubation (P<0.01) and the hypertensive response to extubation (P<0.01). DEX-0.4 group differed in the heart rate variability from placebo (93 vs 82%, P<0.01). Conclusions. DEX increased perioperative haemodynamic stability in patients undergoing brain tumour surgery. Compared with fentanyl, the trachea was intubated faster without respiratory depression.

Using the criterion of early morning urinary specific gravity (SPGR) of 1.008 or less to define the presence of polyuria, we identified 26 of 72 male (36 percent) and 14 of 31 female (45 percent) institutionalized chronically psychotic patients as polyuric during a comprehensive survey of one of the chronic care units at a State mental hospital. Factors including diagnosis, sex, age, weight, and serum sodium did not distinguish the polyuric from the nonpolyuric patients. For men, administration of lithium was associated with polyuria. Urinary creatinine concentration (UCR) correlated well with SPGR, and UCR may provide an alternate index to separate polyuric from nonpolyuric patients. The clinical implications of our findings are discussed.

We have compared four methods of topical anaesthesia of the nostril for fibreoptic airway endoscopy in a randomized study with 31 unpre-medicated volunteers, each serving as his or her own control. Lignocaine spray, EMLA cream, three cotton swabs soaked in 4% lignocaine solution, or 2 % lignocaine gel was applied in a nostril for 3 min. Application of lignocaine spray was rated as the most unpleasant and EMLA cream the least unpleasant. Spray and gel caused an increase in arterial pressure. Anaesthesia of the mucosa, tested by passing a bronchoscope through the nose to the oropharynx was best with lignocaine spray or gel. Gel or EMLA, but not the local anaesthetic applied with swabs, obscured vision. When slight obscurity of vision is not a problem, local anaesthetic gel is recommended for anaesthesia of the nasal mucosa. Premedication or sedation is recommended for all the methods described here.

The effects of the new, highly selective alpha2-adrenergic agonist, dexmedetomidine, were studied in a randomized, placebo-controlled, double-blind trial in 24 ASA I patients. Dexmedetomidine 0.6 μg kg−1 or saline was given i.v. 10 min before induction of anaesthesia. The required dose of thiopentone was significantly (P < 0.001) smaller in the dexmedetomidine group (mean 4.4 (SD 0.9) mg kg−1) than in the control group (6.9 (1.6) mg kg−1), and the drug attenuated the cardiovascular responses to laryngoscopy and tracheal intubation. The concentration of noradrenaline in mixed venous plasma was smaller in the dexmedetomidine group during all phases of induction (P < 0.01). During surgery, fentanyl was required in a dose of 0.5 (0.6) mg kg−1 and2.8 (2.6) mg kg−1 in the dexmedetomidine and control groups, respectively (P < 0.001). During 2h postoperative follow-up, oxycodone 0.06 (0.06) mg kg−1 and 0.16 (0.1) mg kg−1 (P < 0.05) was given to the two groups respectively.