Effect of remimazolam versus propofol anesthesia on postoperative delirium in neurovascular surgery: study protocol for a randomized controlled, non-inferiority trial.

BACKGROUND: Remimazolam is a short-acting benzodiazepine newly approved for the induction and maintenance of general anesthesia. Remimazolam emerges as an ideal drug for the neurosurgical population due to its rapid emergence, enabling early neurological assessment, and its ability to maintain perfusion pressure, which is crucial for preventing cerebral ischemia. However, the use of benzodiazepine has been associated with an increased risk of postoperative delirium (POD). There is currently limited evidence about the relationship between remimazolam-based total intravenous anesthesia (TIVA) and POD. METHODS: In this double-blind, randomized, non-inferiority trial, we plan to include 696 adult patients with American Society of Anesthesiologists physical status class I to III, undergoing elective neurovascular surgery under general anesthesia. After informed consent, the patients will be randomized to receive either remimazolam or propofol-based TIVA with a 1:1 ratio. The primary outcome is the incidence of POD within 5 days after surgery. Secondary outcomes include subtypes, number of positive assessments and severity of POD, emergence agitation, intraoperative awareness and undesirable patient movement, intraoperative hypotension, and postoperative cognitive function. The data will be analyzed in modified intention to treat. DISCUSSION: This trial will evaluate the effect of remimazolam on the development of POD compared to propofol anesthesia. The results of this trial will provide evidence regarding the choice of optimal anesthetics to minimize the risk of POD in neurosurgical patients. TRIAL REGISTRATION: The study protocol was prospectively registered at the Clinical trials ( https://clinicaltrials.gov , NCT06115031, principal investigator: Jiseon Jeong; date of first registration: November 2, 2023, before the recruitment of the first participant.

Association Between Individual Air Pollution (PM10, PM2.5) Exposure and Adverse Pregnancy Outcomes in Korea: A Multicenter Prospective Cohort, Air Pollution on Pregnancy Outcome (APPO) Study.

BACKGROUND: Prenatal exposure to ambient air pollution is linked to a higher risk of unfavorable pregnancy outcomes. However, the association between pregnancy complications and exposure to indoor air pollution remains unclear. The Air Pollution on Pregnancy Outcomes research is a hospital-based prospective cohort research created to look into the effects of aerodynamically exposed particulate matter (PM)10 and PM2.5 on pregnancy outcomes. METHODS: This prospective multicenter observational cohort study was conducted from January 2021 to June 2023. A total of 662 women with singleton pregnancies enrolled in this study. An AirguardK® air sensor was installed inside the homes of the participants to measure the individual PM10 and PM2.5 levels in the living environment. The time-activity patterns and PM10 and PM2.5, determined as concentrations from the time-weighted average model, were applied to determine the anticipated exposure levels to air pollution of each pregnant woman. The relationship between air pollution exposure and pregnancy outcomes was assessed using logistic and linear regression analyses. RESULTS: Exposure to elevated levels of PM10 throughout the first, second, and third trimesters as well as throughout pregnancy was strongly correlated with the risk of pregnancy problems according to multiple logistic regression models adjusted for variables. Except for in the third trimester of pregnancy, women exposed to high levels of PM2.5 had a high risk of pregnancy complications. During the second trimester and entire pregnancy, the risk of preterm birth (PTB) increased by 24% and 27%, respectively, for each 10 µg/m3 increase in PM10. Exposure to high PM10 levels during the second trimester increased the risk of gestational diabetes mellitus (GDM) by 30%. The risk of GDM increased by 15% for each 5 µg/m3 increase in PM2.5 during the second trimester and overall pregnancy, respectively. Exposure to high PM10 and PM2.5 during the first trimester of pregnancy increased the risk of delivering small for gestational age (SGA) infants by 96% and 26%, respectively. CONCLUSION: Exposure to high concentrations of PM10 and PM2.5 is strongly correlated with the risk of adverse pregnancy outcomes. Exposure to high levels of PM10 and PM2.5 during the second trimester and entire pregnancy, respectively, significantly increased the risk of PTB and GDM. Exposure to high levels of PM10 and PM2.5 during the first trimester of pregnancy considerably increased the risk of having SGA infants. Our findings highlight the need to measure individual particulate levels during pregnancy and the importance of managing air quality in residential environment.

Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases.

To assess the short-term operative and fertility outcomes of single-incision robotic myomectomy. We performed this retrospective cohort study of 286 women who underwent robotic single-site myomectomy using the da Vinci® Xi surgical system (RSSM group, n = 70) or robotic single-port myomectomy using the da Vinci® SP surgical system (RSPM group, n = 216). Data were collected through chart reviews and telephone interviews. Except operating time (94.6 ± 30.1 min in RSSM vs. 81.7 ± 20.1 min in RSPM) and location of the removed fibroids, there were no significant differences in the operative outcomes or characteristics of the removed fibroids between both groups. The proportion of fibroids in the lateral wall in RSPM (13.4%) was approximately twice that in RSSM (6.3%). There was no conversion to laparotomy or multiport access, and none of the women required readmission in either group. No significant difference in the complication rate was noted between groups, and all complications were resolved with conservative treatment. During the approximately 20-month follow-up period, in the RSSM and RSPM groups, the pregnancy rates were 54.5% and 67.4%, respectively, and the abortion rates were 33.3% and 22.6%, respectively. In terms of operative and fertility outcomes, single-site robotic myomectomy appears to be feasible and safe in women with symptomatic fibroids. The da Vinci® SP system is thought to be helpful in reducing operation time and surgically difficult myomectomy.

Nonfamilial VACTERL-H Syndrome in a Dizygotic Twin: Prenatal Ultrasound and Postnatal 3D CT Findings.

Background: VACTERL association is a widely known congenital malformation that includes vertebral, anal, cardiac, tracheoesophageal, renal, and limb anomalies. Patients with VACTERL and hydrocephalus appear to form a distinct group, both genetically and phenotypically, and their condition has been called VACTERL-H syndrome. Most cases of VACTERL-H have been reported postnatally, as VACTER-H syndrome is difficult to diagnose prenatally. Case Presentation: Here, we report a case of VACTERL-H syndrome in a dichorionic and diamniotic twin diagnosed prenatally by ultrasonography and confirmed postnatally by three-dimensional computed tomography (3D CT). A 34-year-old multiparous female was referred to our institution at 31 + 3 weeks gestation for suspected fetal ventriculomegaly. Detailed examinations using two-dimensional and Doppler ultrasounds revealed hydrocephalus, bilateral dysplastic upper arms, radial aplasia, unilateral pulmonary agenesis, dextrocardia with right atrial enlargement, a unilateral hypoplastic ectopic kidney, a single umbilical artery, a tracheoesophageal fistula with a small stomach, polyhydramnios, and anal atresia. Findings from the postnatal 3D CT aligned with the prenatal diagnosis, showing upper-limb agenesis, dextrocardia with pulmonary hypoplasia, tracheoesophageal fistula, imperforate anus, and colon dilatation. The affected 1390-g male twin had an unaffected 1890-g female twin sister and a healthy 6-year-old brother. Conclusions: Upon encountering fetuses with multiple anomalies, including ventriculomegaly, a small stomach with polyhydramnios, an abnormally positioned heart, and upper-limb abnormalities, clinicians should perform systematic ultrasonographic examinations to detect associated anomalies and be aware of VACTERL-H syndrome.

Study on antioxidant activity and cytotoxicity of Aronia melanocarpa leaf tea extracts.

Aronia leaf tea, which is generally discarded after harvesting the fruit, was prepared using three different methods. Water extract from dried Aronia melanocarpa leaf tea (DALT), water extract from steamed Aronia melanocarpa leaf tea (SALT), water extract from roasted Aronia melanocarpa leaf tea (RALT) were manufactured and their functional ingredients were analyzed. The total polyphenol contents in the DALT, SALT, and RALT samples were 33.67 mg GAE/g, 57.79 mg GAE/g, and 53.16 mg GAE/g, respectively. The results from the ABTS radical scavenging activity and FRAP assays showed that there was significantly higher antioxidant activity in SALT and RALT samples than in DALT. The MTT assay revealed that the cytotoxicity of SALT and RALT samples against HeLa cells was higher than that of DALT. These results verified that the phytochemical components of aronia leaves changed based on its tea preparation methods and aronia leaf extracts contain bioactive compounds that have potential health benefits.

Prenatal Diagnosis of Fetal Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) Syndrome.

Background: Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome, also known as Herlyn-Werner-Wunderlich syndrome, is a rare syndrome characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Most cases of OHVIRA have been reported in adolescents or adults. Gartner duct cysts, including those manifesting as vaginal wall cysts, are also rare. Fetal OHVIRA syndrome and Gartner duct cysts are difficult to diagnose. Case Presentation: Here, the authors report a case of combined OHVIRA and Gartner duct cyst diagnosed prenatally by ultrasonography, along with a brief review of the relevant published reports. A 30-year-old nulliparous female was referred to our institution at 32 weeks' gestation for fetal right kidney agenesis. Detailed ultrasonographic examinations using 2D, 3D, and Doppler ultrasounds revealed hydrocolpometra, and uterus didelphys, with a normal anus and right kidney agenesis. Conclusions: When encountering female fetuses with ipsilateral renal agenesis or vaginal cysts, clinicians should be aware of OHVIRA syndrome and Gartner duct cysts and perform systematic ultrasonographic examinations for other genitourinary anomalies.

Prediction of Postoperative Pain and Opioid Consumption Using Intraoperative Surgical Pleth Index After Surgical Incision: An Observational Study.

BACKGROUND: We evaluated whether the surgical pleth index (SPI) following surgical incision was related to postoperative pain and opioid consumption. METHODS: This prospective observational study was performed in 50 patients undergoing laparotomy under sevoflurane-based general anesthesia. We recorded the highest SPI during surgical incision. The postoperative pain with a numerical rating scale (NRS) and opioid consumption during postoperative 24 h were compared in patients who showed SPI over 50 (Group H) or 20-50 (Group L). The relationship between postoperative opioid consumption and SPI values (pre-incision, post-incision SPI value, change of SPI value, and post-incision SPI minus pre-incision SPI) was evaluated using receiver-operating characteristic analysis. RESULTS: The mean of the highest SPI value during surgical incision was 56 (SD, 12; range, 26-85). Twenty-nine (63%) patients were included in Group H and 17 (37%) patients in Group L. There was a significant difference in NRS during recovery room stay and on postoperative 24 h in two groups (5 [5, 6] vs 7 [6, 8], p=0.007 and 3.5 [3, 5] vs 5 [5,6], p=0.006, Group L vs Group H). Group H used higher fentanyl via patient control analgesia during postoperative 24 h (573 (253) µg vs 817 (305) µg, p=0.008). A change of pre-incision and post-incision SPI value of 23, which showed the highest sensitivity (67%) and specificity (68%), was defined post hoc as the cut-off for fentanyl consumption during postoperative 24 h ≥1000 µg. CONCLUSION: Our finding suggests that the SPI response to nociceptive stimuli during surgery is closely related to the degree of patient postoperative pain and opioid requirements. This information may be used to provide proper intraoperative analgesia and individual postoperative pain management.

High-risk human papillomavirus testing as a primary screening for cervical cancer: position statement by the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology.

Based on emerging data and current knowledge regarding high-risk human papillomavirus (hrHPV) testing as a primary screening for cervical cancer, the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology support the following scientific facts: • Compared to cytology, hrHPV screening has higher sensitivity and detects more cases of high-grade cervical intraepithelial neoplasia. • Qualified hrHPV testing can be considered as an alternative primary screening for cervical cancer to the current cytology method. • The starting age of primary hrHPV screening should not be before 25 years because of possible overtreatment in this age, which has a high human papillomavirus (HPV) prevalence but rarely progresses to cancer. The screening interval should be no sooner than every 3 years and no longer than every 5 years. • Before the introduction of hrHPV screening in Korea, research into comparative effectiveness of primary hrHPV screening for cervical cancer should be conducted to determine the appropriate HPV assay, starting age, and screening interval.

High-risk human papillomavirus testing as a primary screening for cervical cancer: position statement by the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology.

Based on emerging data and current knowledge regarding high-risk human papillomavirus (hrHPV) testing as a primary screening for cervical cancer, the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology support the following scientific facts: • Compared to cytology, hrHPV screening has higher sensitivity and detects more cases of high-grade cervical intraepithelial neoplasia. • Qualified hrHPV testing can be considered as an alternative primary screening for cervical cancer to the current cytology method. • The starting age of primary hrHPV screening should not be before 25 years because of possible overtreatment in this age, which has a high human papillomavirus (HPV) prevalence but rarely progresses to cancer. The screening interval should be no sooner than every 3 years and no longer than every 5 years. • Before the introduction of hrHPV screening in Korea, research into comparative effectiveness of primary hrHPV screening for cervical cancer should be conducted to determine the appropriate HPV assay, starting age, and screening interval.

Therapeutic effects of three human-derived materials in a mouse corneal alkali burn model.

Purpose: To compare the therapeutic effects of human derivatives in a mouse alkali burn model. Methods: The right eyes of mice were injured using NaOH. After alkali injury, one of the following agents was topically administered for 7 d: human amniotic membrane (hAM) suspension, human umbilical cord serum (hUCS), and human peripheral blood serum (hPBS), or saline. The epithelial defect areas on days 1, 2, and 3 degrees of opacity on days 2, 3, and 7, and corneal neovascularization (NV) areas on day 7 were evaluated. Histologic examination and mRNA expression levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, MMP-8, and MMP-9 were also evaluated on day 7. Results: The epithelial defect areas in the hUCS group were smaller than those in the control and hPBS groups on day 3 (p < .05, respectively). The epithelial defect areas in the hAM suspension group showed smaller than those in the control and hPBS groups on days 1 and 2 (p < .05, respectively). The degrees of opacity were lower in all treatment groups than that of the saline control group on day 7 (p < .05, respectively). Corneal NV areas were not different among groups on day 7 (p = 0.20). The expression levels of TNF-α, IL-6, MMP-8, and MMP-9 mRNA and the infiltration of the inflammatory cells in all treatment groups were lesser than those in the control group on day 7 (p< .05, respectively). Conclusions: All treatments reduced inflammatory reactions and corneal opacity development. Corneal reepithelialization was faster in the hUCS group.

Bilateral salpingectomy to reduce the risk of ovarian/fallopian/peritoneal cancer in women at average risk: a position statement of the Korean Society of Obstetrics and Gynecology (KSOG).

Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations: • Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy. • Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve. • Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended. • Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.

Smoking Exposure in Early Pregnancy and Adverse Pregnancy Outcomes: Usefulness of Urinary Tobacco-Specific Nitrosamine Metabolite 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol Levels.

OBJECTIVES: The aim was to investigate the effect of -maternal smoking exposure assessed by urinary tobacco-specific nitrosamine metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-a1-butanol (NNAL) with adverse pregnancy outcomes. METHODS: A total of 251 pregnant women were recruited. Urinary cotinine and NNAL were measured. Participants' sociodemographics were obtained by questionnaire and pregnancy outcomes were collected by charts review after delivery. RESULTS: The prevalence of smoking was 8.4% (21 of 249), 1.2% (3 of 241), and 3.7% (9 of 241) in pregnant women according to questionnaire, cotinine, and NNAL, respectively. As compared with questionnaire positivity and cotinine levels, women with positive NNAL were independent determinants for spontaneous abortion (adjusted OR 12.357, 95% CI 2.053-74.368), preterm birth (adjusted OR 22.239, 95% CI 3.737-132.357), and small for gestational age (adjusted OR 6.915, 95% CI 1.385-34.524). CONCLUSIONS: Urinary NNAL might be a useful biomarker in detection of maternal smoking status in association with adverse pregnancy outcomes. Use of this marker in preconception and pregnancy counselling before planning pregnancy may allow prevention of several adverse pregnancy outcomes.

Antioxidant and Anti-Inflammatory Activity and Cytotoxicity of Ethanol Extracts from Rhynchosia nulubilis Cultivated with Ganoderma lucidum Mycelium.

In this study, in order to verify the use of mycelium as a new functional material, Rhynchosia nulubilis was cultivated with Ganoderma lucidum mycelium, and the biological activity of the culture extract was evaluated. Measurements of the 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt radical scavenging activity showed that the ethanol extract from Rhynchosia nulubilis cultivated with Ganoderma lucidum mycelium (RNGM) had significantly higher radical scavenging activity compared to the ethanol extract from Rhynchosia nulubilis (RN). The growth inhibition rate of RNGM against HeLa cells was 93.93% at 400 µg/mL in the 3-(4,5-dimethylthiazol-2-yl)-2,5-dimethyl tetrazolium assay. RNGM effectively decreased nitric oxide production in lipopolysaccharide-treated RAW264.7 macrophage cells. The total polyphenol, total flavonoid, and the ß-glucan contents of RNGM were higher than those of RN. These results demonstrated that increased total polyphenols, flavonoids, and ß-glucan of Rhynchosia nulubilis during cultivation with the Ganoderma lucidum mycelium could increase the antioxidant and anti-inflammatory activity and cytotoxicity of cancer cells.

Clinical Risk Scoring Models for Prediction of Acute Kidney Injury after Living Donor Liver Transplantation: A Retrospective Observational Study.

Acute kidney injury (AKI) is a frequent complication of liver transplantation and is associated with increased mortality. We identified the incidence and modifiable risk factors for AKI after living-donor liver transplantation (LDLT) and constructed risk scoring models for AKI prediction. We retrospectively reviewed 538 cases of LDLT. Multivariate logistic regression analysis was used to evaluate risk factors for the prediction of AKI as defined by the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage). Three risk scoring models were developed in the retrospective cohort by including all variables that were significant in univariate analysis, or variables that were significant in multivariate analysis by backward or forward stepwise variable selection. The risk models were validated by way of cross-validation. The incidence of AKI was 27.3% (147/538) and 6.3% (34/538) required postoperative renal replacement therapy. Independent risk factors for AKI by multivariate analysis of forward stepwise variable selection included: body-mass index >27.5 kg/m2 [odds ratio (OR) 2.46, 95% confidence interval (CI) 1.32-4.55], serum albumin <3.5 mg/dl (OR 1.76, 95%CI 1.05-2.94), MELD (model for end-stage liver disease) score >20 (OR 2.01, 95%CI 1.17-3.44), operation time >600 min (OR 1.81, 95%CI 1.07-3.06), warm ischemic time >40 min (OR 2.61, 95%CI 1.55-4.38), postreperfusion syndrome (OR 2.96, 95%CI 1.55-4.38), mean blood glucose during the day of surgery >150 mg/dl (OR 1.66, 95%CI 1.01-2.70), cryoprecipitate > 6 units (OR 4.96, 95%CI 2.84-8.64), blood loss/body weight >60 ml/kg (OR 4.05, 95%CI 2.28-7.21), and calcineurin inhibitor use without combined mycophenolate mofetil (OR 1.87, 95%CI 1.14-3.06). Our risk models performed better than did a previously reported score by Utsumi et al. in our study cohort. Doses of calcineurin inhibitor should be reduced by combined use of mycophenolate mofetil to decrease postoperative AKI. Prospective randomized trials are required to address whether artificial modification of hypoalbuminemia, hyperglycemia and postreperfusion syndrome would decrease postoperative AKI in LDLT.

Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study.

Perioperative risk factors were identified for acute kidney injury (AKI) defined by the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage) after surgery on the thoracic aorta with cardiopulmonary bypass (CPB) in this case-control study. A retrospective review was completed for 702 patients who underwent surgery on the thoracic aorta with CPB. A total of 183 patients with AKI were matched 1:1 with patients without AKI by a propensity score. Matched variables included age, gender, body-mass index, preoperative creatinine levels, estimated glomerular filtration rate, a history of hypertension, diabetes mellitus, cerebrovascular accident, smoking history, or chronic obstructive pulmonary disease to exclude the influence of patient demographics, preoperative medical status, and baseline renal function. Multivariate logistic regression analysis was used to evaluate for independent risk factors in the matched sample of 366 patients. The incidence of AKI was 28.6% and 5.9% of patients from the entire sample required renal replacement therapy. AKI was associated with a prolonged postoperative hospital stay and a higher one-month and one-year mortality both in the entire and matched sample set. Independent risk factors for AKI were a left ventricular ejection fraction <55%, preoperative hemoglobin level <10 g/dL, albumin <4.0 g/dL, diagnosis of dissection, operation time >7 hours, deep hypothermic circulatory arrest (DHCA) time >30 min, pRBC transfusion >1000 mL, and FFP transfusion >500 mL. Although the incidence of poor glucose control (blood glucose >180 mg/dL) was higher in patients with AKI in matched sample, it was not an independent risk factor.AKI was still associated with a poor clinical outcome in the matched sample. Potentially modifiable risk factors included preoperative anemia and hypoalbuminemia. Efforts to minimize operation time and DHCA time along with transfusion amount may protect patients undergoing aortic surgery against AKI.

A comparison among infusion of lidocaine and dexmedetomidine alone and in combination in subjects undergoing coronary artery bypass graft: a randomized trial.

BACKGROUND: Previous studies have reported the cardioprotective effect of dexmedetomidine and lidocaine. We compared the effect of lidocaine and dexmedetomidine infusion during off-pump coronary artery bypass graft (OPCAB). METHODS: 153 patients undergoing OPCAB were enrolled. The lidocaine group (n=36, Group LIDO) received an infusion of lidocaine 2 mg/kg/h after bolus 1.5 mg/kg; the dexmedetomidine group (n=40, Group DEX) received dexmedetomidine 0.3-0.7 µg/kg/h; the combined group (n=39, Group Combined) received infusion of both drugs; and the control group (n=38) received nothing. We measured serum creatinine kinase-myocardial band (CK-MB) and cardiac troponin I (cTnI) concentration before and immediately after the surgery, postoperative day (POD)#1 and #2. The complication rate and clinical outcomes were compared. RESULTS: The concentration of cTnI was significantly lower in the Group LIDO and Group Combined than the control group on POD#2. The concentration of CK-MB was significantly lower in the Group LIDO and Group Combined compared to the control group on POD#1 and #2 [CK-MB on POD#1: 7.67 (5.78-11.92) vs. 7.18 (5.01-11.72) vs. 13.19 (6.85-23.87) in the Group LIDO, combined and control, respectively, Group LIDO vs. control: p=0.003, Group Combined vs. control: p=0.015]. The AUC of CK-MB was significantly lower in the Group LIDO and Group Combined than the control group. However, clinical variables including complication rate, ICU stay and one-year mortality were not different. CONCLUSIONS: Lidocaine infused at 2 mg/kg/h, but not dexmedetomidine infused at 0.3-0.7 µg/kg/h reduced postoperative myocardial injury marker levels compared with the control group. However, no other clinical benefits were observed.

Isolated congenital hereditary cataract in a dizygotic twin: prenatal ultrasonographic diagnosis.

Cataract, defined as opacity of the lens in one or both eyes, is a major cause of blindness throughout the world, and not uncommon, particularly in the elderly population. However, congenital cataracts are rare and occur with a frequency of 30 cases in 100,000 births. About one-third of the cases fall into the group inherited without systemic abnormality. Importantly, congenital cataracts produce deprivation amblyopia, refractive amblyopia, and retinal detachment, leading to lifelong visual impairment. Successful management is dependent on early diagnosis and referral for surgery when indicated. Here we present a case of hereditary bilateral cataracts in a dizygotic twin detected on prenatal ultrasound examinations and postnatally confirmed as congenital cataracts associated with posterior lenticonus.

A model for prediction of spontaneous preterm birth in asymptomatic women.

BACKGROUND: Preterm birth is a complex health problem with social, environmental, behavioral, and genetic determinants of an individual's risk and remains a major challenge in obstetrics. Recent research has caused improvements in predicting preterm birth; however, there is still controversy about the prediction of preterm birth in asymptomatic women. The purpose of this study was to determine if Bayesian filtering can be used in a clinical setting to predict spontaneous preterm birth in asymptomatic women. METHODS: A model of predicting spontaneous preterm birth using PopBayes based on a Bayesian filtering algorithm was developed using a previously collected dataset, then applied to a prospectively collected cohort of asymptomatic women who delivered singleton live newborns at or after 24 weeks of gestation. Cases complicated with major congenital malformations were excluded. RESULTS: The proportion of patients with spontaneous preterm birth was 18.4% (96 of 522) at <37 weeks gestation, 5.4% (28 of 522) at <34 weeks gestation, and 2.7% (14 of 522) at <32 weeks gestation. The match rates with the combination of demographic, clinical, and genetic factors using a Bayesian filtering method (PopBayes) were higher than the match rates using demographic and clinical factors only, including maternal age, maternal body mass index (BMI), prior preterm birth, education, occupation, income, and active and passive smoking. The match rates in preterm delivery before 32 weeks of gestation were higher than the match rates in preterm delivery before 37 and 34 weeks of gestation (94.3% vs. 84.7% and 82.0%, respectively). The negative predictive values for demographic, clinical, and genetic factors in predicting preterm delivery using PopBayes were consistently >90%. CONCLUSIONS: We suggest that Bayesian filtering (PopBayes) is a customizable and useful tool in establishing a model for the prediction of preterm birth.

Manassantin A and B from Saururus chinensis inhibit interleukin-6-induced signal transducer and activator of transcription 3 activation in Hep3B cells.

Inhibition of interleukin-6 (IL-6) has been postulated to be an effective therapy in the pathogenesis of several inflammatory diseases. The current study was performed to examine potential effects of manassantin A and B isolated from Saururus chinensis on the IL-6-induced response to human hepatoma cells. We found that manassantin A and B inhibit signal transducer and activator of transcription 3 (Stat3) activity stimulated by IL-6. We also found that both compounds decreased IL-6-induced Stat3 phosphorylation and nuclear translocation. Both compounds blocked suppressor of cytokine signaling 3 (SOCS-3)-mRNA expression induced by IL-6. In addition, we found that Stat3 inhibitory effects of these compounds could be related to protein tyrosine phosphatase. These findings suggest that manassantin A and B could be useful remedies for treatment of inflammatory diseases by inhibiting IL-6 action.

Effect of hypoxia on endothelial nitric oxide synthase, NO production, intracellular survival signaling (p-ERK1/2 and p-AKT) and apoptosis in human term trophoblast.

PROBLEM: Hypoxia is commonly associated with complicated pregnancies such as intrauterine growth restriction. We evaluated the effects of hypoxia on phospho (p)-eNOS, p-ERK, p-AKT and apoptosis in human trophoblast. METHOD OF STUDY: Isolated trophoblast were cultured in 21% oxygen or 2% oxygen for 24, 48 and 72 hr. p-eNOS, p-ERK and p-AKT protein were assessed by Western blot and apoptosis by TUNEL assay. NOx was determined in the culture media. RESULTS: Compared to controls, hypoxia-exposed CT showed the following: (1) decreased eNOS at 48 and 72 hr, (2) increased p-eNOS at 48 hr, (3) no differences in total NOx production, (4) increased p-ERK at 24, 48 and 72 hr, (5) increased p-AKT at 24 hr (P < 0.05) and (6) increased apoptosis at 48 hr. CONCLUSION: Hypoxia increases activation of p-ERK and induces apoptosis of cultured trophoblast. Hypoxia decreases overall total eNOS but increases p-eNOS, which may allow for NO production to be maintained in trophoblast cells.