Machine learning analysis with population data for the associations of preterm birth with temporomandibular disorder and gastrointestinal diseases.

This study employs machine learning analysis with population data for the associations of preterm birth (PTB) with temporomandibular disorder (TMD) and gastrointestinal diseases. The source of the population-based retrospective cohort was Korea National Health Insurance claims for 489,893 primiparous women with delivery at the age of 25-40 in 2017. The dependent variable was PTB in 2017. Twenty-one predictors were included, i.e., demographic, socioeconomic, disease and medication information during 2002-2016. Random forest variable importance was derived for finding important predictors of PTB and evaluating its associations with the predictors including TMD and gastroesophageal reflux disease (GERD). Shapley Additive Explanation (SHAP) values were calculated to analyze the directions of these associations. The random forest with oversampling registered a much higher area under the receiver-operating-characteristic curve compared to logistic regression with oversampling, i.e., 79.3% vs. 53.1%. According to random forest variable importance values and rankings, PTB has strong associations with low socioeconomic status, GERD, age, infertility, irritable bowel syndrome, diabetes, TMD, salivary gland disease, hypertension, tricyclic antidepressant and benzodiazepine. In terms of max SHAP values, these associations were positive, e.g., low socioeconomic status (0.29), age (0.21), GERD (0.27) and TMD (0.23). The inclusion of low socioeconomic status, age, GERD or TMD into the random forest will increase the probability of PTB by 0.29, 0.21, 0.27 or 0.23. A cutting-edge approach of explainable artificial intelligence highlights the strong associations of preterm birth with temporomandibular disorder, gastrointestinal diseases and antidepressant medication. Close surveillance is needed for pregnant women regarding these multiple risks at the same time.

Immediate retrograde amnesia induced by midazolam: a prospective, nonrandomized cohort study.

BACKGROUND: Midazolam, a short-acting benzodiazepine, has sedative, anxiolytic, amnestic, and anticonvulsant effect. Given its advantages of rapid onset, short duration, and low toxicity, midazolam is optimal for any procedural sedation. Midazolam is known to cause anterograde amnesia; however, the possibility of retrograde amnesia has also been raised. This prospective cohort, nonrandomized study evaluated the presence and extent of retrograde amnesia induced by midazolam during cesarean delivery. METHODS: One-hundred parturients scheduled for elective cesarean delivery under spinal anesthesia were enrolled. As soon as giving birth, 6 picture cards were shown to the patients in one min intervals, and then midazolam (0.1 mg/kg) was given or not according to the patients' preference. This overall retrograde recall rate of six cards was the primary outcome of our study, which was asked by a blinded investigator. RESULTS: The overall retrograde card recall rate was lower in the midazolam group compared to the control group (77.0 ± 13.4 vs. 87.7 ± 3.9%, p <0.001), especially at one min before midazolam administration (58 vs. 88%, p <0.001). Decreased memory trend was observed as time progressed toward midazolam administration in the midazolam group (p = 0.035). More patients answered 'yes' to the factitious event in the midazolam group than in the control group (26% vs. 4%, p = 0.004). CONCLUSION: Intravenous midazolam could cause a brief-period retrograde amnesia in visual and event memory. Moreover, there were more spurious reports of intraoperative factitious events in the midazolam group, implying that episodic memories were also affected by midazolam.

Immediate retrograde amnesia induced by midazolam: A prospective, non-randomised cohort study.

BACKGROUND: Midazolam, a short-acting benzodiazepine, has sedative, anxiolytic, amnestic and anticonvulsant effects. Given its advantages of rapid onset, short duration and low toxicity, midazolam is optimal for any procedural sedation. Midazolam is known to cause anterograde amnesia; however, the possibility of retrograde amnesia has also been raised. This prospective cohort, non-randomised study evaluated the presence and extent of retrograde amnesia induced by midazolam during caesarean delivery. METHODS: One hundred parturients scheduled for elective caesarean delivery under spinal anaesthesia were enrolled. As soon as giving birth, six picture cards were shown to the patients in 1-min intervals, and then midazolam (0.1 mg/kg) was given or not according to the patients' preference. This overall retrograde recall rate of six cards was the primary outcome of our study, which was asked by a blinded investigator. RESULTS: The overall retrograde card recall rate was lower in the midazolam group compared with the control group (77.0 ± 13.4 vs. 87.7 ± 3.9%, P < .001), especially at 1 minute before midazolam administration (58% vs. 88%, P < .001). Decreased memory trend was observed as time progressed towards midazolam administration in the midazolam group (P = .035). More patients answered 'yes' to the factitious event in the midazolam group than in the control group (26% vs. 4%, P = .004). CONCLUSION: Intravenous midazolam could cause a brief-period retrograde amnesia in visual and event memory. Moreover, there were more spurious reports of intraoperative factitious events in the midazolam group, implying that episodic memories were also affected by midazolam.

Association of neuromuscular reversal by sugammadex and neostigmine with 90-day mortality after non-cardiac surgery.

BACKGROUND: Reversing a neuromuscular blockade agent with sugammadex is known to lessen postoperative complications by reducing postoperative residual curarization. However, its effects on 90-day mortality are unknown. Therefore, this study aimed to compare the effects of sugammadex and neostigmine in terms of 90-day mortality after non-cardiac surgery. METHODS: This retrospective cohort study analyzed the medical records of adult patients aged 18 years or older who underwent non-cardiac surgery at a single tertiary care hospital between 2011 and 2016. Propensity score matching and Cox regression analysis were used to investigate the effectiveness of sugammadex and neostigmine in lowering 90-day mortality after non-cardiac surgery. RESULTS: A total of 65,702 patients were included in the analysis (mean age: 52.3 years, standard deviation: 15.7), and 23,532 of these patients (35.8%) received general surgery. After propensity score matching, 14,179 patients (3906 patients from the sugammadex group and 10,273 patients from the neostigmine group) were included in the final analysis. Cox regression analysis in the propensity score-matched cohort showed that the risk of 90-day mortality was 40% lower in the sugammadex group than in the neostigmine group (hazard ratio: 0.60, 95% confidence interval: 0.37, 0.98; P = 0.042). These results were similar in the multivariable Cox regression analysis of the entire cohort (hazard ratio: 0.62, 95% confidence interval: 0.39, 0.96; P = 0.036). CONCLUSIONS: This retrospective cohort study suggested that reversing rocuronium with sugammadex might be associated with lower 90-day mortality after non-cardiac surgery compared to neostigmine. However, since this study did not evaluate quantitative neuromuscular function in the postoperative period due to its retrospective design, the results should be interpreted carefully. Future prospective studies with quantitative neuromuscular monitoring in the postoperative period should be performed to confirm these results.

Effects of deep neuromuscular blockade on the stress response during laparoscopic gastrectomy Randomized controlled trials.

Maintaining deep neuromuscular block during surgery improves surgical space conditions. However, its effects on patient outcomes have not been well documented. We examined whether maintaining deep neuromuscular blockade during surgery could decrease the stress response compared to moderate neuromuscular blockade. Patients undergoing laparoscopic gastrectomy were randomly allocated to either the moderate (train-of-four counts of 1-2) or deep (post-tetanic counts of 1-2) neuromuscular blockade group. The primary outcome variable was the postoperative blood level of interleukin-6, and the secondary outcome variables were intraoperative or postoperative blood levels of tumor necrosis factor-α, interleukin-1ß, interleukin-8, and C-reactive protein. A total of 96 patients were recruited and 88 (44 in each group) were included in the analyses. The levels of tumor necrosis factor-α and interleukin-1ß measured at the end of surgery, interleukin-6 and interleukin-8 measured at 2 h postoperatively, and C-reactive protein measured at 48 h postoperatively were all significantly increased compared to the preoperative values, but there were no differences between the moderate and deep neuromuscular block groups. We found no differences in surgical stress response measured using determining levels of interleukin-6 and other mediators released between the moderate and deep neuromuscular blockade groups in patients undergoing laparoscopic gastrectomy.

Intraoperative Nefopam Reduces Acute Postoperative Pain after Laparoscopic Gastrectomy: a Prospective, Randomized Study.

BACKGROUND: We assessed whether intraoperative nefopam would reduce opioid consumption and relieve postoperative pain in patients undergoing laparoscopic gastrectomy. METHODS: The 60 enrolled patients were randomly assigned to the control (n = 32) or nefopam (n = 28) group. All patients were blinded to their group assignment. We administered 100 ml of normal saline only (control group) or 20 mg of nefopam mixed in 100 ml normal saline (nefopam group) after anesthesia induction and at the end of surgery. The cumulative amount of fentanyl via intravenous patient-controlled analgesia (PCA), incidence of rescue analgesic medication, and numerical rating scale (NRS) for postoperative pain were evaluated along with the total remifentanil consumption. RESULTS: The mean infusion rate of remifentanil was significantly lower in the nefopam group (0.08 ± 0.05 µg/kg/min) than in the control group (0.13 ± 0.06 µg/kg/min) (P < 0.001). Patients in the nefopam group required less fentanyl via intravenous PCA than those in the control group during the first 6 h after surgery (323.8 ± 119.3 µg vs. 421.2 ± 151.6 µg, P = 0.009). Additionally, fewer patients in the nefopam group than in the control group received a rescue analgesic during the initial 6 h postoperatively (78.6 vs. 96.9%, P = 0.028). The NRS measured while patients were in the post-anesthetic care unit was significantly lower in the nefopam group than in the control group (3.8 ± 1.1 vs. 4.8 ± 1.4, P = 0.012). The subsequent NRS obtained after patients had been transferred to the general ward was comparable between the two groups during the following postoperative period. CONCLUSIONS: Intraoperative nefopam decreased postoperative pain and opioid consumption in the acute postoperative period after laparoscopic gastrectomy. Hence, nefopam may be considered as a component of multimodal analgesia after laparoscopic gastrectomy.

Magnesium sulphate improves pulmonary function after video-assisted thoracoscopic surgery: A randomised double-blind placebo-controlled study.

BACKGROUND: Reduced lung volumes are unavoidable after lung resection surgery. Magnesium sulphate (MgSO4) administration has been reported to reduce the requirement for neuromuscular blocking drugs and postoperative analgesics in surgical patients. OBJECTIVE: To investigate the effect of MgSO4 on pulmonary function after video-assisted thoracoscopic surgery (VATS). DESIGN: A randomised, double-blind, placebo-controlled trial. SETTING: A university tertiary care centre. PATIENTS: Sixty-six patients scheduled for pulmonary lobectomy or segmentectomy via VATS. INTERVENTION: Patients were allocated to one of two groups: the Mg (MgSO4 50 mg kg intravenously for 10 min, followed by a continuous infusion of 15 mg kg h during surgery) or the control (same volume of 0.9% saline). MAIN OUTCOME MEASURES: Pulmonary function tests [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate] were measured before surgery and at three time points after surgery (2, 24 and 48 h postoperatively) using a portable spirometer. Twelve months after surgery, pulmonary function test values were repeated at a regular outpatient follow-up visit. RESULTS: FEV1 at 24 (1.7 ±â€Š0.6 vs. 1.3 ±â€Š0.5 l, P = 0.033) and 48 h (1.7 ±â€Š0.6 vs. 1.4 ±â€Š0.5 l, P = 0.021) and FVC at 24 (2.0 ±â€Š0.8 vs. 1.6 ±â€Š0.6 l, P = 0.038) and 48 h (2.2 ±â€Š0.8 vs. 1.7 ±â€Š0.7 l, P = 0.008) after surgery were significantly greater in the Mg group. Patients in the Mg group required less rocuronium than those in the control group (64.2 ±â€Š19.9 vs. 74.9 ±â€Š20.3 mg, respectively; P = 0.041). Consumption of postoperative patient-controlled analgesia was also significantly less at 24 and 48 h after surgery in the Mg group (P = 0.022 and 0.015, respectively), although pain scores and rescue analgesics were comparable. Five patients in the control group were diagnosed with postoperative pneumonia using clinical and radiological criteria before discharge. FEV1 and FVC at 12 months after surgery were not different between the two groups. CONCLUSION: Intraoperative administration of MgSO4 improved pulmonary function and reduced the need for rocuronium and postoperative analgesics in patients who underwent VATS. TRIAL REGISTRATION: cris.nih.go.kr identifier: KCT0001410.

The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate: A prospective observational study using rotational thromboelastometry.

Although endoscopic transurethral resection of the prostate (TURP) is a well-established procedure as a treatment for benign prostatic hyperplasia, its complications remain a concern. Among these, coagulopathy may be caused by the absorption of irrigating fluid. This study aimed to evaluate such phenomenon using a rotational thromboelastometry (ROTEM).A total of 20 patients undergoing TURP participated in this study. A mixture of 2.7% sorbitol-0.54% mannitol solution and 1% ethanol was used as an irrigating fluid, and fluid absorption was measured via the ethanol concentration in expired breath. The effects on coagulation were assessed by pre- and postoperative laboratory blood tests, including hemoglobin, hematocrit, platelet count, international normalized ratio of prothrombin time (PT-INR), activated partial thromboplastin time, electrolyte, and ROTEM.INTEM-clotting time (INTEM-CT) was significantly lengthened by 14% (P = 0.001). INTEM-α-angle was significantly decreased by 3% (P = 0.011). EXTEM-clot formation time was significantly prolonged by 18% (P = 0.008), and EXTEM-maximum clot firmness (EXTEM-MCF) was significantly decreased by 4% (P = 0.010). FIBTEM-MCF was also significantly decreased by 13% (P = 0.015). Moreover, hemoglobin (P < 0.001), hematocrit (P < 0.001), platelet counts (P < 0.001), potassium (P = 0.024), and ionized calcium (P = 0.004) were significantly decreased, while PT-INR (P = 0.001) was significantly increased after surgery. The amount of irrigating fluid absorbed was significantly associated with the weight of resected prostatic tissue (P = 0.001) and change of INTEM-CT (P < 0.001).As shown by the ROTEM analysis, the irrigating fluid absorbed during TURP impaired the blood coagulation cascade by creating a disruption in the coagulation factor activity or by lowering the coagulation factor concentration via dilution.

Lactococcus chungangensis sp. nov., a lactic acid bacterium isolated from activated sludge foam.

The taxonomic position of a Gram-positive coccus, designated strain CAU 28T, isolated from activated sludge foam was determined by using a polyphasic approach. Based on its cellular morphology and the results of biochemical tests, strain CAU 28T was identified tentatively as a member of the genus Lactococcus. Comparative 16S rRNA gene sequence analysis showed that levels of similarity between strain CAU 28T and the type strains of recognized Lactococcus species ranged from 90.4 to 97.2 %. DNA-DNA hybridization studies showed that strain CAU 28T displayed less than 26.1 % relatedness to the type strains of recognized Lactococcus species. The rep-PCR fingerprints revealed that strain CAU 28T was well separated from reference Lactococcus species. The combined genotypic and phenotypic data indicate that strain CAU 28T represents a novel species of the genus Lactococcus, for which the name Lactococcus chungangensis sp. nov. is proposed. The type strain is CAU 28T (=KCTC 13185T =CCUG 55099T).

Glycosyltransferase: a specific marker for the discrimination of Bacillus anthracis from the Bacillus cereus group.

Bacillus anthracis, the aetiological agent of anthrax, has been taxonomically classified with the Bacillus cereus group, which comprises B. cereus, Bacillus thuringiensis, Bacillus mycoides, Bacillus pseudomycoides and Bacillus weihenstephanensis. Although the pathogenesis and ecological manifestations may be different, B. anthracis shares a high degree of DNA sequence similarity with its group member species. As a result, the discrimination of B. anthracis from its close relatives in the B. cereus group is still quite difficult. Suppression subtractive hybridization (SSH) was performed to search for genomic differences between a B. anthracis Korean isolate CR and the most closely related B. cereus type strain KCTC 3624(T). Two-hundred and five B. anthracis CR clones obtained by SSH underwent Southern hybridization, and comparative sequences were analysed using the blast program from the National Center for Biotechnology Information (NCBI). Subsequently, primer sets based on the glycosyltransferase group 1 family protein gene specific to B. anthracis were designed from the sequences of subtracted clones, and their specificities were evaluated using eight B. anthracis, 33 B. cereus, 10 B. thuringiensis, six B. mycoides, one B. pseudomycoides, one B. weihenstephanensis and 19 strains from 11 other representative Bacillus species. PCR primers specific for the glycosyltransferase group 1 family protein gene did not amplify the desired products from any of the Bacillus strains under examination, except B. anthracis alone. These findings may be useful in the future development of efficient diagnostic tools for the rapid identification of B. anthracis from other members of the B. cereus group.

Sphingosinicella soli sp. nov., isolated from an alkaline soil in Korea.

A Gram-negative, motile, rod-shaped bacterial strain, KSL-125(T), was isolated from an alkaline soil from Kwangchun, Korea, and its taxonomic position was investigated in a polyphasic study. Strain KSL-125(T) grew optimally at 30 degrees C, at pH 7.5-8.0 and in the presence of 0.5% (w/v) NaCl. A neighbour-joining phylogenetic tree based on 16S rRNA gene sequences showed that strain KSL-125(T) joins the cluster comprising the two Sphingosinicella species at a bootstrap resampling value of 100%. The values for similarity between the 16S rRNA gene sequence of strain KSL-125(T) and those of the type strains of the two Sphingosinicella species were 98.9-99.0%. Strain KSL-125(T) contained Q-10 as the predominant ubiquinone and C(17:1)omega6c, C(16:1)omega7c and/or iso-C(15:0) 2-OH and C(18:1)omega7c as the major fatty acids. The major polar lipids were sphingoglycolipid, diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylmonomethylethanolamine and an unidentified phospholipid. The DNA G+C content was 65.1 mol%. Strain KSL-125(T) was distinguishable from the two recognized Sphingosinicella species on the basis of differential phenotypic properties, DNA-DNA relatedness data and repetitive-sequence-based PCR genomic fingerprinting patterns. The phenotypic, phylogenetic and genetic data showed that strain KSL-125(T) represents a novel species of the genus Sphingosinicella, for which the name Sphingosinicella soli sp. nov. is proposed. The type strain is KSL-125(T) (=KCTC 12482(T) =DSM 17328(T)).

Detection of unusual rotavirus genotypes G8P[8] and G12P[6] in South Korea.

Five hundred four fecal specimens, collected between 2004 and 2006 from young children with acute diarrhea, were screened for rotavirus by ELISA with VP6-specific antibody. Of these samples, 394 (78.2%) were confirmed as group A rotavirus and they underwent G- and P typing using a combination of ELISA, RT-PCR, and sequence analysis methods. The dominant circulating G serotype was G1 (35.6%) followed by G3 (26.4%), G4 (14.7%), and G2 (11.9%). There was a low prevalence of G9 (1.0%) and of unusual G type rotavirus, in particular, G12 (0.5%) and G8 (0.3%). Of the P genotype rotavirus in circulation, P[8] (53.0%) was most common followed by P[6] (15.5%), P[4] (15.2%), and P[9] (2.3%). Determination of G- and P type combinations revealed that G1P[8] strains were most prevalent (25.4%), amid G3P[8] (16.8%), G2P[4] (6.3%), and G4P[6] (6.1%) strains. Unusual or rare combinations such as G2P[6], G2P[8], G3P[4], G2P[9], G1P[9], G3P[9], G12P[6], G1P[4], G3P[6], and G8P[8] were also found. Owing to the recent emergence of G8 and G12 rotavirus, the findings from this study are important since they provide new information concerning the local and global spread of rotavirus genotypes.

Nesterenkonia jeotgali sp. nov., isolated from jeotgal, a traditional Korean fermented seafood.

A Gram-positive, non-motile, slightly halophilic actinomycete, strain JG-241T, was isolated from jeotgal, a traditional Korean fermented seafood, and its taxonomic position was investigated by using a polyphasic approach. Strain JG-241T grew optimally at 25-30 degrees C and in the presence of 2-5% (w/v) NaCl. The physiological and biochemical properties of strain JG-241T were distinguishable from those of recognized Nesterenkonia species. Strain JG-241T had a peptidoglycan type based on L-lys-gly-D-Asp. It contained MK-7, MK-8 and MK-9 as the predominant menaquinones and anteiso-C15:0) and anteiso-C17:0 as the major fatty acids. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylinositol and an unidentified glycolipid. The DNA G+C content was 68.0 mol%. Comparative 16S rRNA gene sequence analysis showed that strain JG-241T falls within the radiation of the cluster comprising Nesterenkonia species. Similarity values between the 16S rRNA gene sequence of strain JG-241T and those of the type strains of Nesterenkonia species ranged from 96.7 to 99.7%. DNA-DNA relatedness data and repetitive extragenic palindromic DNA-PCR genomic fingerprinting patterns showed that strain JG-241T differs genetically from recognized Nesterenkonia species. On the basis of its phenotypic properties and phylogenetic and genetic distinctiveness, strain JG-241T represents a novel species of the genus Nesterenkonia, for which the name Nesterenkonia jeotgali sp. nov. is proposed. The type strain is JG-241T (=KCTC 19053T=JCM 12610T).

Tsukamurella pseudospumae sp. nov., a novel actinomycete isolated from activated sludge foam.

The taxonomic position of two Tsukamurella strains isolated from activated sludge foam was clarified. The organisms, isolates JC85 and N1176T, were found to have chemical and morphological properties typical of members of the genus Tsukamurella. DNA-DNA relatedness studies showed that the strains formed a distinct genomic species that was most closely related to Tsukamurella spumae. The two isolates also share a range of phenotypic properties that distinguishes them from representatives of all species of Tsukamurella with validly published names. It is evident from the data that the two organisms should be classified as a novel Tsukamurella species, Tsukamurella pseudospumae sp. nov. The type strain is N1176T (=DSM 44118T=NCIMB 13963T).

Tsukamurella spumae sp. nov., a novel actinomycete associated with foaming in activated sludge plants.

A polyphasic taxonomic study was undertaken to establish the taxonomic position of six representative strains isolated from activated sewage sludge foam. The organisms were found to have chemical and morphological properties consistent with their assignment to the genus Tsukamurella. DNA:DNA relatedness studies showed that five out of the six isolates formed a distinct genomic species, the remaining strain was most closely associated with this taxon. The five isolates had a unique phenotypic profile that served to distinguish them from representatives of the validly described species of Tsukamurella. The combination of the genotypic and phenotypic data indicated that the five strains should be classified as a new species in the genus Tsukamurella. The name proposed for this taxon is Tsukamurella spumae, the type strain is N1171T (= DSM 44.113T = NCIMB 13947T). It was also shown that some of the reference strains were misclassified as Tsukamurella paurometabola.