Objective: To investigate the accuracy of using the ratio of pre-epiglottis space distance (Pre-E) and the distance between the epiglottis and the vocal folds (Pre-E/E-VF) measured by the ultrasound to predict potential difficult airway in the Chinese population. Design: A prospective clinical study. Setting: The pre-operative assessment service clinic of Tuen Mun Hospital. Patients: Patients with age of 18 years or above, who were scheduled for elective surgery requiring general anesthesia with direct laryngoscopy and tracheal intubation. Results: A total of 113 patients with direct laryngoscopic assessment during elective operations were included. Thirty-nine (34.5%) patients had potential difficult airway which was defined as documented Cormack-Lehane classification grade 2b, 3, or 4 by the anesthetists. Measurement of the distance from the epiglottis to the anterior vocal folds (Pre-E/aVF) ratio had better inter-rater reliability and accuracy comparing to the measurements of the distances from the epiglottis to the midpoint between the vocal folds and to the posterior vocal folds. The performance of using the Pre-E/aVF ratio to predict potential difficult airway was compared with other clinical tests (the Mallampati classification, the thyromental distance and the neck circumference to thyromental distance ratio). By using the Pre-E/aVF ratio of 1, the sensitivity and specificity to predict a potential difficult airway were 79.5% and 39.2%, respectively (p = 0.044). The ultrasound assessment method had a comparable predictive value as the Mallampati classification (the area under the receiver operator characteristic curves 0.648 vs 0.687). The negative likelihood ratio of the ultrasound assessment method was the lowest among all the other airway assessment methods.

Objective: To describe our clinical experience of using combination of fluorescent iodized emulsion, indocyanine green & lipiodol, and hook-wire in pre-operative CT localization of patients with subsolid lung lesions prior to video-assisted thoracoscopic surgery (VATS). Methods: A retrospective review between June 2018 and July 2019 of consecutive Chinese patients whom underwent VATS for subsolid lung lesions with pre-operative CT localization done with combination of fluorescent iodized emulsion and hook-wire technique in a tertiary hospital (Tuen Mun Hospital, Hong Kong SAR). The duration and complications related to the localization procedure were recorded The clinical records, operative findings and pathology reports were retrieved from the hospital electronic clinical management system. Results: Combination fluorescent iodized emulsion with hook-wire enabled accurate localization and resection of all subsolid lung lesions in VATS. No major complications were reported. Conclusion: Combination of fluorescent iodized emulsion and hook-wire placement under CT guidance is a simple, safe and cost- effective procedure that enabled accurate localization and resection of subsolid nodule in VATS. Advances in knowledge: VATS has been the mainstay for indeterminate pulmonary nodules for diagnostic and/or curative purpose. The main problem that surgeons may encounter during operation is the difficulty in locating the target lesion particularly for subsolid lesions. Many pre-operative localization methods have been developed in this regard. With the novel technique that we described, we were able to overcome disadvantages of most described methods.

A 76-year-old patient with history of diabetes mellitus (DM), hypertension, and hyperlipidemia presented to the Emergency Department for fever and malaise. The patient's spot blood glucose was 40.8 mmol/L. The preliminary blood culture result showed Gram-negative bacilli.