The value of the peroneus brevis tendon cross-sectional area in early diagnosing of peroneus brevis tendinitis: The peroneus brevis tendon cross-sectional area.

A thickened peroneus brevis tendon has been considered to be an important morphologic parameter of peroneus brevis tendinitis (PBT). Previous researchers have found that the peroneus brevis tendon thickness (PBTT) is correlated with inflammation of the peroneus brevis tendon. However, inflammatory hypertrophic change is different from simple thickness. Thus, we devised the peroneus brevis tendon cross-sectional area (PBTCSA) as a new diagnostic parameter to analyze the hypertrophy of the whole PBT. We assumed that the PBTCSA is a major morphologic parameter useful for early PBT diagnosis. Peroneus brevis tendon images were collected from 22 patients with PBT and from 22 normal subjects who underwent ankle-magnetic resonance imaging and revealed no evidence of PBT. The T1-weighted axial ankle-magnetic resonance imaging images were evaluated at the ankle level from all participants. The PBTT was measured as the thickest point at the transverse image of the peroneus brevis tendon. The PBTCSA was measured as the cross-sectional ligament whole area of the peroneus brevis tendon that was most hypertrophied in the axial A-MR images. The average PBTT was 2.22 ± 0.29 mm in the normal group and 2.85 ± 0.36 mm in the PBT group. The average PBTCSA was 6.98 ± 1.54 mm2 in the normal group and 13.11 ± 2.45 mm2 in the PBT group. PBT patients had significantly greater PBTT (P < .001) and PBTCSA (P < .001) than the normal group did. A receiver operating characteristic curve analysis revealed that the most suitable cutoff value of the PBTT was 2.51 mm, with 81.8% sensitivity and 81.8% specificity, and an AUC for the score was 0.93. The most suitable cutoff value of the PBTCSA was 10.08 mm2, with 90.9% sensitivity and 90.9% specificity, and AUC for the score was 0.98. Even though the PBTT and PBTCSA were both significantly associated with PBT, the PBTCSA was a more sensitive diagnostic parameter.

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial.

BACKGROUND: A rigid video-stylet intubation device provides safe and accurate access to the trachea by enabling visualization of the airway structures during tracheal intubation. The primary purpose of this study was to examine the effects of glycopyrrolate premedication on tracheal intubation with a rigid video-stylet. METHODS: In this prospective, randomized, double-blinded study, 78 patients were randomly assigned to the control group (n = 39; no glycopyrrolate administration) or the glycopyrrolate group (n = 39; 0.005 mg/kg glycopyrrolate, intramuscular injection). A rigid video-stylet was used for tracheal intubation. The degree of oral secretion observed through the video-stylet monitor was assessed using the OptiScope laryngeal view and graded on a 4-point scale (1, excellent; 2, good; 3, poor; and 4, unacceptable). The time to intubation and hemodynamic variables at baseline and 1, 3, and 5 minutes after intubation were recorded. RESULTS: The OptiScope laryngeal view grades of the glycopyrrolate group (grade 1 = 16 [41.0%], 2 = 17 [43.6%], 3 = 6 [15.4%], and 4 = 0 [0%]) were significantly higher than those of the control group (grade 1 = 9 [23.1%], 2 = 11 [28.2%], 3 = 18 [46.2%], and 4 = 1 [2.6%]; P = .02). The intubation time was shorter in the glycopyrrolate group (18.5 seconds [15.0-22.0]) than the control group (22.0 seconds [17.9-26.4], P = .02). There was no significant difference in the hemodynamic variables between groups. CONCLUSION: Glycopyrrolate facilitated tracheal intubation with a rigid video-stylet by decreasing oral secretions and providing better visualization and faster intubation with hemodynamic stability. TRIAL REGISTRY: www.clinicaltrials.gov; Identifier: NCT03050242.

Does Equi-Minimum Alveolar Concentration Value Ensure Equivalent Analgesic or Hypnotic Potency?: A Comparison between Desflurane and Sevoflurane.

BACKGROUND: Minimum alveolar concentration (MAC) has traditionally been used to compare the potency of volatile anesthetics. However, as it reflects the spinal mechanism of immobility rather than the cerebral mechanism of analgesia and hypnosis, it is doubtful that equi-MAC connotes equivalent analgesic or hypnotic potency. The level of analgesia and hypnosis can be assessed using surgical pleth index and bispectral index (BIS) values, respectively. This study was designed to compare the surgical pleth index and BIS values produced by equi-MAC of desflurane and sevoflurane in patients undergoing single-agent volatile anesthesia. METHODS: Eighty-nine patients were randomly allocated to two groups receiving either desflurane (n = 44) or sevoflurane (n = 45). Anesthesia was only maintained with assigned volatile anesthetic of age-corrected 1.0 MAC. Surgical pleth index values as an analgesic estimate and BIS values as a hypnotic estimate were obtained under standard tetanic stimulation. RESULTS: Post-stimulation surgical pleth index values (mean ± SD), the primary outcome, were significantly lower for the desflurane group than those for the sevoflurane group (49 ± 10 vs. 64 ± 14, difference, 15 [95% CI, 10 to 20], P < 0.001). The desflurane group showed significantly lower poststimulation BIS values (median [interquartile range]) than the sevoflurane group (36 [31 to 41] vs. 41 [38 to 47], difference, 6 [95% CI, 2 to 9], P = 0.001). CONCLUSIONS: During a steady-state of 1.0 MAC, desflurane and sevoflurane did not cause similar surgical pleth index and BIS values under the standardized nociceptive stimulus. These findings suggest that equi-MAC of desflurane and sevoflurane may not ensure equivalent analgesic or hypnotic potency. VISUAL ABSTRACT: An online visual overview is available for this article at http://links.lww.com/ALN/B726.

Antiallodynic Effects of Bee Venom in an Animal Model of Complex Regional Pain Syndrome Type 1 (CRPS-I).

Neuropathic pain in a chronic post-ischaemic pain (CPIP) model mimics the symptoms of complex regional pain syndrome type I (CRPS I). The administration of bee venom (BV) has been utilized in Eastern medicine to treat chronic inflammatory diseases accompanying pain. However, the analgesic effect of BV in a CPIP model remains unknown. The application of a tight-fitting O-ring around the left ankle for a period of 3 h generated CPIP in C57/Bl6 male adult mice. BV (1 mg/kg ; 1, 2, and 3 times) was administered into the SC layer of the hind paw, and the antiallodynic effects were investigated using the von Frey test and by measuring the expression of neurokinin type 1 (NK-1) receptors in dorsal root ganglia (DRG). The administration of BV dose-dependently reduced the pain withdrawal threshold to mechanical stimuli compared with the pre-administration value and with that of the control group. After the development of the CPIP model, the expression of NK-1 receptors in DRG increased and then decreased following the administration of BV. SC administration of BV results in the attenuation of allodynia in a mouse model of CPIP. The antiallodynic effect was objectively proven through a reduction in the increased expression of NK-1 receptors in DRG.

The effects of etomidate and midazolam on adipose tissue-derived mesenchymal stem cell proliferation.

BACKGROUND: Stem cell therapy using adipose tissue-derived mesenchymal stem cells (ADSCs), which are capable of multipotent differentiation, is currently being investigated in the field of tissue regeneration and the treatment of patients in intensive care units. It is known that type-A γ-aminobutyric acid (GABAA) receptor activity has an influence on stem cell proliferation. Thus, we investigated the effects of the clinically available GABAA receptor agonists, etomidate and midazolam, on ADSC proliferation measured by the cell counting kit-8 assay. METHODS: ADSCs cultured in control medium or adipogenic differentiation medium for 15 days were divided into 5 treatment groups: non-medicated (Control) and 4 groups including treatment with etomidate or midazolam at 1 and 50 µM (n = 3 per group). The cell counting kit-8 assay was performed for determining the cell proliferation in both medium groups at day 0, 3, 6, 9, 12, and 15 in culture. The absorbance values at 450 nm were then measured by enzyme-linked immunosorbent assay reader and statistically compared among groups. RESULTS: There was no significant difference in cell proliferation profiles among the 5 groups at any time point in both control and adipogenic differentiation media. CONCLUSIONS: Etomidate and midazolam did not influence ADSC proliferation under both media when compared to the non-medicated group and there was no dose-dependent effect of etomidate and midazolam on ADSC viability.

miR-34a inhibits differentiation of human adipose tissue-derived stem cells by regulating cell cycle and senescence induction.

MicroRNAs (miRNAs) are critical in the maintenance, differentiation, and lineage commitment of stem cells. Stem cells have the unique property to differentiate into tissue-specific cell types (lineage commitment) during cell division (self-renewal). In this study, we investigated whether miR-34a, a cell cycle-regulating microRNA, could control the stem cell properties of adipose tissue-derived stem cells (ADSCs). First, we found that the expression level of miR-34a was increased as the cell passage number was increased. This finding, however, was inversely correlated with our finding that the overexpression of miR-34a induced the decrease of cell proliferation. In addition, miR-34a overexpression decreased the expression of various cell cycle regulators such as CDKs (-2, -4, -6) and cyclins (-E, -D), but not p21 and p53. The cell cycle analysis showed accumulation of dividing cells at S phase by miR-34a, which was reversible by co-treatment with anti-miR-34a. The potential of adipogenesis and osteogenesis of ADSCs was also decreased by miR-34a overexpression, which was recovered by co-treatment with anti-miR-34a. The surface expression of stem cell markers including CD44 was also down-regulated by miR-34a overexpression as similar to that elicited by cell cycle inhibitors. miR-34a also caused a significant decrease in mRNA expression of stem cell transcription factors as well as STAT-3 expression and phosphorylation. Cytokine profiling revealed that miR-34a significantly modulated IL-6 and -8 production, which was strongly related to cellular senescence. These data suggest the importance of miR-34a for the fate of ADSCs toward senescence rather than differentiation.

A prospective, randomized, double-blind, multicenter trial to evaluate the therapeutic efficacy and safety of palonosetron in the treatment of postoperative nausea and vomiting over a 72-h period.

PURPOSE: We performed a multicenter, randomized, double-blind trial to assess the efficacy and safety of a single, fixed, intravenous dose of palonosetron (0.075 mg) in the treatment of established postoperative nausea and vomiting (PONV). METHODS: Three hundred and eighty-four patients who had at least one risk factors of PONV and underwent surgery under general anesthesia were screened. Those who developed PONV were randomized to receive either 0.075 mg intravenous palonosetron or a placebo. The incidence of nausea and vomiting, severity of nausea, requirements for rescue anti-emetics, and adverse effects at 2, 24, and 72 h after drug administration were evaluated. Complete response (CR) and complete control (CC) rate were compared for 24 and 72 h. RESULTS: Among the 384 patients, 152 (39.6 %) developed PONV and were randomized to either the palonosetron (n = 75) or placebo (n = 77) group. The number of patients with CR at 24 and 72 h was higher in the palonosetron group than the placebo group [0-24 h: n = 49 (68.1 %) vs. n = 30 (40.5 %), p < 0.001; 0-72 h: n = 47 (65.3 %) vs. n = 28 (37.8 %), p < 0.001]. The incidence of PONV at 2, 24, and 72 h periods was lower in the palonosetron group than the placebo group (29.2, 45.8, and 50.0 % in the palonosetron group vs. 50.0, 62.2, and 66.2 % in the placebo group, p = 0.010, 0.048, 0.047, respectively). The incidence of adverse events was not different between the groups. CONCLUSION: A single 0.075 mg IV dose of palonosetron effectively increased the CR rates at 24 and 72 h in these moderate-risk patients with established PONV.

Elevated fasting serum insulin level predicts future development of hypertension.

BACKGROUND: Studies have investigated clinical association between fasting insulin level and hypertension. However, it is still debatable whether elevated fasting insulin actually increases the risk of hypertension with the passage of time. Thus, this study was aimed at investigating the association between baseline fasting insulin level and the development of hypertension. METHODS: 25,062 normotensive, non-diabetic Korean men participating in a medical health check-up program were followed up from 2005 until 2010. They were divided into 4 groups according to baseline fasting insulin levels (first quartile-fourth quartile). The incidence of hypertension was compared among 4 groups, and Cox proportional hazards model was used to determine if hypertension was associated with higher baseline fasting insulin level. RESULTS: The incidence of hypertension increased according to the baseline fasting insulin level (first quartile: 13.3%, second quartile: 15.4%, third quartile: 17.5%, fourth quartile: 23.2%, P<0.001). Even after adjusting for multiple covariates, the HRs (95% CI) for hypertension were higher for the second (1.12; 0.96-1.31), third (1.39; 1.20-1.62) and fourth quartile group (1.75; 1.51-2.03), compared to the first quartile group, respectively (P for trend<0.001). CONCLUSION: The risk of hypertension was in proportion to the baseline fasting insulin level. In addition, hyperinsulinemia was an independent risk factor for the future development of hypertension. These findings suggest the value of fasting insulin level as an early predictor of hypertension.

High-normal albuminuria predicts metabolic syndrome in middle-aged Korean men: a prospective cohort study.

OBJECTIVE: High-normal albuminuria has recently been associated with an elevated risk of cardiovascular disease. However, it is uncertain whether high-normal albuminuria is associated with metabolic syndrome (MetS). The objective of this prospective cohort study was to investigate whether a temporal relationship exists between a high-normal urine albumin-to-creatinine ratio (UACR) and the development of MetS. STUDY DESIGN: A total of 4338 healthy Korean men who had their UACRs and MetS components assessed in 2005 were enrolled in the study. A MetS-free cohort of 1364 individuals, who did not have any conditions that would have excluded them from the study, was followed up until 2010. MAIN OUTCOME MEASURE: MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. RESULTS: Cox proportional hazards models were used to estimate the hazard ratio (HR) associated with normal UACR values stratified into following tertiles: <3.12 µg/mg, ≥3.12, <4.87 µg/mg, and ≥4.87 µg/mg. The UACR was categorised into the following tertiles. During 4470.6 person-years of follow-up, 247 incident cases of MetS developed between 2006 and 2010. The third UACR tertile was associated with the development of MetS after adjusting for multiple baseline covariates (HR 1.57; 95% confidence interval: 1.14-2.18). CONCLUSIONS: On the basis of our 5-year follow-up study, a high-normal UACR predicts the development of MetS in Korean men.

Does single-port laparoscopic surgery reduce postoperative pain in women with benign gynecologic disease?

BACKGROUND: Reduced postoperative pain, one of the potential benefits of single-port laparoscopic surgery (SP-LS), has clinically significant importance. The objectives of this study are to compare postoperative pain between SP-LS and conventional laparoscopic surgery (conventional-LS) and to evaluate the difference in postoperative pain between the SP-LS group and the conventional-LS group based on whether a hysterectomy was performed. SUBJECTS AND METHODS: We performed a prospective case-control study among women who underwent SP-LS (n=116) and conventional-LS (n=283) for benign gynecologic disease. We evaluated postoperative pain with a visual analog scale for pain score and the requirement for additional analgesics at 2, 4, 6, 12, 24, 48, and 72 hours after surgery. RESULTS: The pain score was significantly lower in the SP-LS group compared with the conventional-LS group only at 2 hours after surgery (5.70 ± 2.33 compared with 6.38 ± 2.13, P=.005). However, at all assessment times (2, 4, 6, 12, 24, 48, and 72 hours) after surgery including a hysterectomy (n=188) and all assessment times except 2 hours after surgery that did not include a hysterectomy (n=211), there were no differences in pain score when comparing the SP-LS or conventional-LS groups. CONCLUSIONS: Single-port laparoscopy had no effect on postoperative pain except in the immediate postoperative state (2 hours following surgery) in women who underwent surgery that did not include a hysterectomy.

Effect of preoperative anxiety on spectral entropy during induction with propofol.

BACKGROUND: Anxiety influences brain wave activity. E-Entropy module-derived spectral entropy is an electroencephalographic derivative used to monitor the depth of sedation. This study assessed the effect of preoperative anxiety on the spectral entropy parameters of response entrophy (RE) and state entrophy (SE). METHODS: Trait anxiety was measured in 92 American Society of Anesthesiologists physical status I-II patients with the Spielberger State-Trait Anxiety Inventory (STAI) form X2 and state anxiety with STAI-X1 just before anesthesia. RE, SE, blood pressure and heart rate were measured before induction. Propofol was infused via a target controlled infusion pump. At loss of consciousness (LOC), the effect-site concentration (Ce), RE, SE and total amount of propofol were recorded. Patients were stratified into three groups based on their state and trait anxiety scores to evaluate the effect of anxiety level on entropy values. RESULTS: STAI-X1 was significantly correlated with RE and SE for LOC (ρ = 0.230, P = 0.028 and ρ = 0.308, P = 0.003, respectively) and also with STAI-X2 (ρ = 0.411, P = 0.001, respectively). SE was higher in the high state anxiety group than in the low state anxiety group (P = 0.017). The other measured variables were not correlated with any anxiety scales. CONCLUSIONS: The state of anxiety increases RE and SE values at LOC induced with propofol. High state anxiety is associated with higher SE than apparent at low state anxiety. When determining the propofol-induced LOC by spectral entropy, anxiety levels should be considered.

The effectiveness of postoperative neutrophils to lymphocytes ratio in predicting long-term recurrence after stomach cancer surgery.

PURPOSE: Immunosuppression is a characteristic of cancer recurrence after curative resection. The neutrophil-to-lymphocyte ratio (NL ratio) in peripheral blood is associated with immune function. However, it is not clear whether the postoperative NL ratio is a predictor for cancer relapse after resection. Thus, we investigated the effectiveness of the short-term postoperative NL ratio in the prediction of disease recurrence within 5 years after stomach cancer surgery by a retrospective chart review. METHODS: Ninety-three patients with stomach cancer were enrolled. Significant risk factors for cancer recurrence were determined by multivariate Cox regression. Independent variables to increase the NL ratio to >7.7 by postoperative day (POD) 3 were examined by multivariate logistic regression analysis. RESULTS: The 5-year risk of cancer recurrence after gastrectomy was 4.2 times higher for patients with a POD3 NL ratio of >7.7 (P = 0.005), 3.4 times higher for normal-weight patients compared with overweight patients (P = 0.008), and 20 times higher for stage III compared with stage 0 according to the tumor-node-metastasis cancer staging system (P = 0.003). The surgical duration (hours) increased the chance of high NL ratio >7.7 (odds ratio, 2.5; P = 0.006). CONCLUSION: The postoperative NL ratio, especially the POD3 NL ratio, predicts long-term recurrence after stomach cancer surgery.

Preventive role of propofol in hypoxia/reoxygenation-induced apoptotic H9c2 rat cardiac myoblast cell death.

Reperfusion of ischaemic myocardium is accompanied by cardiomyocyte apoptosis. Although a protective role of propofol in this process has been suggested, the exact mechanism of propofol activity remains to be elucidated. Here, we report that propofol protects cardiac H9c2 cells from hypoxia/reoxygenation-induced cell death by attenuating the phosphorylation of extracellular signal-regulated kinases (ERKs) and by up-regulating heme oxygenase 1 (HO-1) expression levels. Treatment with 25 µM propofol significantly protected against hypoxia/reoxygenation-induced cell death, as determined by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and Western blot analysis using anti-apoptotic signal proteins, such as apoptotic protease activating factor 1 and caspase 9. Propofol furthermore suppressed the ERK signaling pathway in cardiac H9c2 cells subjected to hypoxia/reoxygenation. The up-regulation of anti-oxidant enzymes such as HO-1, manganese superoxide dismutase (MnSOD) and catalase is also associated with the protective effect of propofol on hypoxia/reoxygenation-induced cell death. Taken together, the results reveal a new mechanism by which propofol inhibits hypoxia/reoxygenation-induced cell death in cardiac H9c2 cells, supporting a potential application of propofol as a preemptive cardioprotectant.

Recurrent unilateral lung ventilation disorder in a patient that experienced rocuronium-induced anaphylactic bronchospasm during laparoscopic rectal surgery -A case report-.

Rocuronium is the anesthetic agent most likely to cause anaphylaxis. Immediately after intravenous rocuronium administration, the authors experienced ventilatory impairment due to unilateral bronchospasm (left lung), which was relieved by emergency treatment. However, 80 minutes after beginning laparoscopic surgery for rectal cancer, the left lung suddenly re-collapsed under pneumoperitoneum in the Trendelenburg position. A postoperative intradermal test revealed that rocuronium, vecuronium, atracurium, succinylcholine, or thiopental could induce anaphylaxis in this patient, but it was not established whether the second incident during surgery was due to endobronchial intubation or anaphylactic bronchospasm. This case cautions that under pneumoperitoneum in the Trendelenburg position, patients suspected of being prone to anaphylactic bronchospasm should also be considered at risk of endobronchial intubation.

Patient repositioning and the amelioration of airway obstruction by an anterior mediastinal tumor during general anesthesia -A case report-.

An 18-year-old male with huge anterior mediastinum mass was scheduled for thoracotomic incisional biopsy under general anesthesia after failed fluoroscopy-guided percutaneous needle biopsy. Under propofol and succinylcholine anesthesia, intubation was successfully achieved using a Univent tube. However, when we changed the patient's position from supine to right lateral decubitus, oxygen saturation declined. He was then positioned supine, but hypoxemia did not improve. Because the tumor expanded toward the left thoracic field, we considered that the left lateral decubitus position might help relieve the mass effect on the main bronchus. His position was changed accordingly and soon after, hypoxemia improved and surgery was undertaken under cardiopulmonary bypass (CPB). The biopsy was successfully performed under CPB without complication.

The use of chest band to prevent CO(2) subcutaneous emphysema expansion -Two case reports-.

CO(2) subcutaneous emphysema is one of the complications of laparoscopic surgery using CO(2) gas. During laparoscopic surgery, CO(2) gas can spread to the entire body surface through the subcutaneous tissue layer. Extensive CO(2) subcutaneous emphysema results in hypercarbia and acute respiratory acidosis. Hypercarbia and acidosis can lead to decreased cardiac contractility and arrhythmia. A cloth band, 5 cm in width and 120 cm in length, was made with Velcro tape at both tips, and placed on the patient's xyphoid process level and inframammary fold to prevent CO(2) subcutaneous emphysema. This report describes two successful cases using a chest band to prevent the expansion of CO(2) subcutaneous emphysema.