Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique.

BACKGROUND: An interscalene brachial plexus block is a commonly conducted nerve block for anesthesia and analgesia in shoulder surgery. Due to its proximity to the targeted nerve, the phrenic nerve, which innervates the diaphragm, is typically inadvertently blocked by ventral spread of the local anesthetic. Although hemidiaphragmatic paresis is tolerable in healthy patients, it would be an irreversible risk to patients with compromised lung reserve. OBJECTIVES: To investigate the effect of interscalene brachial plexus block on hemidiaphragmatic paresis by comparing the conventional local anesthetic volume with a reduced experimental volume at a more specific position using an ultrasound-guided 2-point injection technique. STUDY DESIGN: Prospective, randomized controlled study registered with the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp. KCT0005575. 04/11/2020). SETTING: This study was conducted at a single hospital affiliated with an academic institution between April and December 2020. METHODS: Patients undergoing brisement manipulation and arthroscopic shoulder surgery were randomized to the experimental (10 mL of ropivacaine 0.5%) and control groups (15 mL of ropivacaine 0.5%). Fifty-two patients who received an interscalene brachial plexus block for anesthesia and analgesia in the shoulder region. The interscalene block was performed using a 2-point injection and  observing the spread pattern of the local anesthetic. The primary outcome was the incidence of hemidiaphragmatic paresis, estimated by the thickening fraction of the diaphragm. The secondary outcomes included oxygen saturation, presence of dyspnea, resting pain score, and handgrip strength score. RESULTS: Thickening fraction was significantly decreased in the control group compared with the experimental group (median [interquartile range], 13.9 [10.0-18.5] versus 28.5 [14.5-38.8], P < 0.001). The incidence of hemidiaphragmatic paresis was significantly higher in the control group than in the experimental group (92.3% versus 53.8%, P = 0.004). Handgrip strength was significantly reduced in the control group compared with the experimental group (P = 0.029). LIMITATIONS: We did not perform a phrenic nerve conduction study, as it is rarely performed in routine clinical operations. We did not formally assess the distance and spatial relationship of the phrenic nerve to the targeted nerve. Outcome variables including pain assessment were limited to the immediate postoperative period. CONCLUSIONS: Reducing the local anesthetic volume by selective injection and observing the spread pattern resulted in a decreased incidence of hemidiaphragmatic paresis and preserved handgrip strength after interscalene block.

Correction to: Mitral regurgitation detected during the intraoperative period after atrial septal defect closure: a case report.

The original article [1] contained a typo in author, Joo Hyun Jun's name. This has now been corrected.

Mitral regurgitation detected during the intraoperative period after atrial septal defect closure: a case report.

BACKGROUND: Atrial septal defect (ASD) is a congenital cardiac defect often diagnosed in adult patients. Mitral regurgitation (MR) observed in ASD patients mostly improves after ASD closure. However, a subset of adult ASD patients present new-onset MR or aggravation of preexisting MR after ASD closure. Intraoperative MR aggravation after surgical ASD closure is a rare occurrence which has not been reported in the literature to date. CASE PRESENTATION: A 54-year-old woman was referred to our center due to large secundum ASD with a diameter of 17 mm which was incidentally detected on pre-operative echocardiography at a local clinic. Surgical repair of ASD under mini-thoracotomy was performed. After completion of the operation, intra-operative transesophageal echocardiography showed newly developed Grade II MR which subsequently deteriorated to severe level on postoperative day 3. Because the patient was asymptomatic, we decided to observe closely and treat conservatively with diuretics. Thereafter, echocardiography was evaluated on postoperative day 10 and MR disappeared to trivial level. CONCLUSIONS: Intraoperative MR aggravation is a rare complication following ASD closure. The possibility of MR aggravation should be evaluated in all ASD patients prior to surgery. This case highlights the importance of mitral leaflet examination after ASD closure for early detection of MR.

Dihydrotanshinone-Induced NOX5 Activation Inhibits Breast Cancer Stem Cell through the ROS/Stat3 Signaling Pathway.

Cancer stem cells (CSCs) are known to mediate metastasis and recurrence and are therefore a promising therapeutic target. In this study, we found that dihydrotanshinone (DHTS) inhibits CSC formation. DHTS inhibited mammosphere formation in a dose-dependent manner and showed significant tumor growth inhibition in a xenograft model. This compound reduced the CD44high/CD24low- and aldehyde dehydrogenase- (ALDH-) expressing cell population and the self-renewal-related genes Nanog, SOX2, OCT4, C-Myc, and CD44. DHTS induced NOX5 activation by increasing calcium, and NOX5 activation induced reactive oxygen species (ROS) production. ROS production reduced the nuclear phosphorylation levels of Stat3 and secreted IL-6 levels in the mammospheres. DHTS deregulated the dynamic equilibrium from non-stem cancer cells to CSCs by dephosphorylating Stat3 and decreasing IL-6 secretion and inhibiting CSC formation. These novel findings showed that DHTS-induced ROS deregulated the Stat3/IL-6 pathway and induced CSC death. NOX5 activation by DHTS inhibits CSC formation through ROS/Stat3/IL-6 signaling, and DHTS may be a promising potential therapeutic agent against breast CSCs.

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon.

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

An Assay of Measuring Platelet Reactivity Using Monoclonal Antibody against Activated Platelet Glycoprotein IIb/IIIa in Patients Taking Clopidogrel.

BACKGROUND AND OBJECTIVES: Residual platelet reactivity in patients who are taking clopidogrel is commonly measured with VerifyNow assay, which is based on the principle of light transmission aggregometry. However, to evaluate the residual platelet reactivity, it would be more accurate if the reactivity of platelet glycoprotein (GP) IIb/IIIa is directly monitored. In this study, PAC1, a monoclonal antibody against activated platelet GP IIb/IIIa, was used to measure the residual platelet reactivity. SUBJECTS AND METHODS: Twenty seven patients with coronary artery disease taking clopidogrel were enrolled. Platelets in whole blood were stained with fluorescein isothiocyanate (FITC)-conjugated PAC1. Mean fluorescence intensity (MFI) and % positive platelets (PP) were measured with flow cytometry, and the binding index (BI; MFI × %PP/100) was calculated. P2Y12 reaction unit (PRU) and % inhibition of VerifyNow assay were also measured in the usual manner. RESULTS: PRU of VerifyNow assay correlated significantly with MFI, %PP, and BI at 10 µM (r=0.59, 0.73, and 0.60, respectively, all p<0.005) and 20 µM of adenosine diphosphate (ADP; r=0.61, 0.75, and 0.63, respectively, all p<0.005). The % inhibition also correlated significantly with MFI, %PP, and BI at 10 µM (r=-0.60, -0.69, and -0.59, respectively, all p<0.005) and 20 µM of ADP (r=-0.63, -0.71, and -0.62, respectively, all p<0.005). CONCLUSION: Direct measurements of the reactivity of platelet GP IIb/IIIa were feasible using PAC1 and flow cytometry in patients taking clopidogrel. Further clinical studies are required to determine the cut-off values which would define high residual platelet reactivity in patients on this treatment protocol.

Fabrication of line-shaped embossing structure by holographic lithography and its application to electronic device.

Holographic lithography has been an efficient and versatile method to fabricate nanosize patterned devices during past several years. This technique is based on the interference of UV-laser beams for patterning regular arrays of fine features without the use of mask as used in conventional lithography. Simple gratings and two-dimensional dot arrays has been fabricated by using the interference principle. Using this technique, we fabricated line-shaped embossing gold (Au) structure on silicon substrates. Towards the characterization of fabricated line-shaped Au nano-structure Field Effect Scanning Electron Microscopy (FE-SEM) is used and our results clearly show the fine structure of fabricated Au lines. Further characterization towards our patterned substrates we used Atomic Force Microscopy (AFM) for analysis of Au patterned lines. A bioelectronic device consisting of cysteine modified azurin was fabricated where the protein was covalently immobilized on the nano-patterned substrate and we investigated the electrochemical property of the device by Cyclic Voltammetry (CV) experiments comparing with that of a normal flat Au substrate. We think these nano-patterned Au substrates can be applied as potentially usable elements for the development of biosensor and other bioelectronic devices.

Effect of poly(ethylene oxide) on the release behaviors of poly(epsilon-caprolactone) microcapsules containing erythromycin.

The biodegradable poly(epsilon-caprolactone) (PCL)/poly(ethylene oxide) (PEO) microcapsules and the analyzing of form and features for the manufacturing conditions were investigated in a prospective drug delivery systems (DDS) through drug release. The effects of emulsifier, emulsifier concentration, and stirring rate on the diameter and form of the microcapsules were examined using image analyzer (IA) and scanning electron microscope (SEM). The role of interfacial adhesion between PCL/PEO and drug was determined by contact angle measurements, and the drug release rate of the microcapsules was characterized by UV-vis spectroscopy. As a result, the microcapsules were made in spherical forms with a mean particle size of 170 nm approximately 68 microm. And the work of adhesion between water and PCL/PEO was increased with increasing the PEO content, which is due to higher hydrophilicity of PEO. The drug release rate of the microcapsules was significantly increased as the PEO content increased, which could be attributed to the increasing of the hydrophilic groups or the degree of adhesion at the interfaces.

5-Fluorouracil and Cisplatin (FP) with Concurrent Radiotherapy for Locally Advanced Head and Neck Cancer.

PURPOSE: The combination of chemotherapy and radiotherapy is emerging as the new standard modality for the treatment of locally advanced head and neck cancer, due to the inherent functional and cosmetic sequelae associated with its surgical management. Combination chemotherapy with 5-fluorouracil and cisplatin (FP) is one of the most active regimens for the head and neck cancer. Furthermore, both agents are known to act as radiosensitizer. This study was conducted to determine the efficacy, feasibility, and the toxicities of concurrent FP chemotherapy with radiotherapy. MATERIALS AND METHODS: Patients with histologically proven locally advanced head and neck cancer (T3-4 or node positive) were enrolled in the study. Patients received 5-fluorouracil, 1,000 mg/m2/day, continuously for 4 days, and cisplatin, 75 mg/m2, on day 1. This regimen was given every four weeks. The radiotherapy (45 Gy) was started on day 1 of the first cycle, and administered in 25 fractions. Following a three-week interval, the radiotherapy was resumed on day 1 of the third cycle of chemotherapy, and administered in 15 fractions (27 Gy). RESULTS: Of the 31 eligible patients included, 28 were able to be evaluated for the tumor response. The response rate for the 28 patients was 93% (16 complete responses, 10 partial responses). Disease free survival for the 16 complete responders was 37 months (median, 1 ~41 months), with a median follow-up time of 31 months. The 1-, 2-, and 3-year survival rates were 82%, 69%, and 63%, respectively. Regarding the feasibility of this treatments, only nineteen patients (61%) received the complete courses of scheduled treatments. The median duration of admission for all patients was 39 days. Grade 3 or 4 stomatitis were observed in 25 patients (83%) and appeared as the dose limiting toxicity of this regimen. CONCLUSION: Although FP chemotherapy with concurrent radiotherapy is toxic, it is an effective and relatively feasible treatment for locally advanced head and neck cancer. The majority of patients experienced severe stomatitis, which appeared as the dose limiting toxicity of this regimen.