premature stop codon 91 amino acids downstream from the last original amino acid (Ala 227). This mutation resulted in the subsequent generation of a non-functional short polypeptide (318 amino acids) that lacks its intracellular C-terminal region or well in a null allele. In this region, URAT1 directly interacts with PDZK1, a PDZ domain-containing protein that interacts with several membrane proteins through its PDZ motif.11 PDZK1 regulates the functional activity of URAT1-mediated urate transport in the apical membrane of renal proximal tubule. 12 The association of URAT1 with PDZK1 enhances urate transport activities in HEK293 cells (1.4-fold), and the deletion of the patient lacks its PDZ domain. The 680Gins was not present in 240 chromosomes of normal individuals, so it is likely that his abnormal allele represents rare polymorphisms. On the other hand, primary gout phenotype of our patient is not due to this kind of mutation. Our finding that the N-terminus region of the SLC22A12 gene seems to be associated with reduced renal uric acid is worth mentioning.
We report a patient who showed a selective deficit of voluntary saccades and quick phases of nystagmus after cardiac surgery. Voluntary saccades in the horizontal plane were very slow, while vertical saccades, vestibular and optokinetic nystagmus, were absent. However, smooth pursuit, the vestibulo-ocular reflex, and the ability to hold steady eccentric gaze were preserved.
Tracheobronchial ruptures (TBR) rarely complicate surgical procedures under general anesthesia. Seemingly uneventful intubations can result in injury to the trachea, which often manifests as hemoptysis and subcutaneous emphysema. We present 2 patients with postintubation TBR who were treated surgically and discuss considerations in the management of this potentially lethal injury.
The pulse CO-Oximetry allows continuous, noninvasive monitoring of hemoglobin (SpHb). We assessed the impact of increased end-tidal carbon dioxide (EtCO2) on the accuracy and trending ability of SpHb in laparoscopic surgery. Participants (n = 64) were randomly allocated to the low carbon dioxide (CO2) group (EtCO2: 30–35 mmHg) or the high CO2 group (EtCO2: 40–45 mmHg). The SpHb and laboratory hemoglobin (tHb) were obtained during surgery. The correlation coefficient (r) between SpHb and tHb showed greater tendency in the low CO2 group (r = 0.68) than in the high CO2 group (r = 0.43). The bias (precision) was −1.18 (1.09) with a limit of agreement (LOA) of −3.31 to 0.95 in low CO2 group and −1.02 (1.24) with a LOA of −3.45 to 1.42 in high CO2 group; they did not differ significantly between the groups (p = 0.246). The low CO2 group showed a high concordance rate of 95.9% and a moderate correlation between ΔSpHb and ΔtHb (r = 0.53). However, the high CO2 group showed a concordance rate of 77.8% and no correlation between ΔSpHb and ΔtHb (r = 0.11). In conclusion, increased EtCO2 significantly reduced the trending ability of SpHb during laparoscopic surgery. Caution should be executed when interpreting SpHb values during laparoscopic surgery in patients with hypercapnia.
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