Gadolinium retention in rat abdominal organs after administration of gadoxetic acid disodium compared to gadodiamide and gadobutrol.

PURPOSE: To compare gadolinium retention in the abdominal organs after administration of gadoxetic acid disodium, a liver-specific contrast agent, compared to gadodiamide and gadobutrol. METHODS: Three types of gadolinium-based contrast agents (GBCAs) were administered to rats. A single (gadodiamide and gadobutrol, 0.1 mmol/kg; gadoxetic acid disodium, 0.025 mmol/kg) or double label-recommended dose was intravenously administered once (Group 1), a single dose was administered 4 times (Group 2) and a single dose with or without a chelating agent (intraperitoneal injection immediately after each GBCA administration) was administered (Group 3). Rats were sacrificed after 1, 4, and 12 weeks and gadolinium concentrations in the liver, spleen, kidney, muscle, and bone were measured by inductively coupled plasma mass spectrometry. P values less than 0.05 were considered statistically significant. RESULTS: More gadolinium was retained with a double dose compared to a single dose, but there was no observed significant difference in gadolinium retention after a double dose compared to a single dose (P > .05). Gadodiamide was retained the most in all tissues followed by gadobutrol and gadoxetic acid disodium. Residual gadolinium was significantly less at 4 weeks compared to 1 week (P < .05), but no further decrease was observed after 4 weeks (P > .05). The presence of the chelating agent did not significantly decrease the concentration of residual gadolinium (P > .05). CONCLUSION: Gadolinium was retained the least in abdominal organs after gadoxetic acid disodium was administered and most of the residual gadolinium was excreted 4 weeks after GBCA administration when a label-recommended dose was administered. A commercially available chelation therapy agent could not reduce gadolinium retention.

The protective effect of klotho against contrast-associated acute kidney injury via the antioxidative effect.

As oxidative stress is one major factor behind contrast-associated acute kidney injury (CA-AKI), we investigated the protective effect of klotho against CA-AKI via the antioxidative effect. In in vitro experiments, cells (NRK-52E) were divided into the following three groups: control, iopamidol, or iopamidol + recombinant klotho (rKL) groups. Moreover, cell viability was measured with the Cell Counting Kit-8 assay, and oxidative stress was examined with 2',7'-dichlorodihydrofluorescein diacetate fluorescence intensity. RT-PCR and Western blot analysis were performed to assess propidium iodide klotho expression, and Bax-to-Bcl-2 and apoptosis ratios were evaluated with annexin V/Hoechst 33342 staining. Furthermore, we knocked down the klotho gene using siRNA to verify the endogenous effect of klotho. In our in vivo experiments, oxidative stress was evaluated with the thiobarbituric acid-reactive substance assay, and apoptosis was evaluated with the Bax-to-Bcl-2 ratio and cleaved caspase-3 immunohistochemistry. Additionally, cell and tissue morphology were investigated with transmission electron microscopy. In both in vitro and in vivo experiments, mRNA and protein expression of klotho significantly decreased in CA-AKI mice compared with control mice, whereas oxidative stress and apoptosis markers were significantly increased in CA-AKI mice. However, rKL supplementation mitigated the elevated apoptotic markers and oxidative stress in the CA-AKI mouse model and improved cell viability. In contrast, oxidative stress and apoptotic markers were more aggravated when the klotho gene was knocked down. Moreover, we found more cytoplasmic vacuoles in the CA-AKI mouse model using transmission electron microscopy but fewer cytoplasmic vacuoles in rKL-supplemented cells. The present study shows that klotho in proximal tubular cells can protect against CA-AKI via an antioxidative effect.

The effects of occupation-centered activity program on fall-related factors and quality of life in patients with dementia.

[Purpose] The purpose of this study was to investigate the effects of an occupation-centered activity program for dementia patients living in a local community, and examined the effects of the occupation-centered activity program on their cognitive functions, fall-related factors, and quality of life. [Subjects and Methods] Thirty subjects were divided into two groups: the experiment group (n=15) and the control group (n=15). The occupation-centered activity program was then applied to dementia patients for 60 minutes, 5 times/week for 12 weeks. To identify their cognitive functions before and after the intervention occupation-centered activity program, Mini-Mental State Examination-Korea (MMSE-K) and the Global Deterioration Scale (GDS) were used. To assess fall-related factors, Korean Falls Efficacy Scale for the Elderly (FES-K) was used and leg strength, agility, and balance of the participants was measured. To examine quality of life, the Korean version of Quality of Life-Alzheimer's Disease Scale (KQOL-AD) was used. [Results] The results of the intervention showed that although cognitive function improved in both the experimental and control groups, fall-related factors and the quality of life significantly improved only in the experimental group. [Conclusion] This indicates that the occupation-centered activity program had a positive effect on dementia patients' cognitive functions, fall-related factors, and quality of life.

The effects a respiration rehabilitation program on IADL, satisfaction with leisure, and quality of sleep of patients with chronic obstructive pulmonary disease.

[Purpose] This study was designed to determine the effect of a respiration rehabilitation program on daily activities, satisfaction with leisure, and quality of sleep of patients with chronic obstructive pulmonary disease. [Subjects and Methods] The program was conducted three times a week for 12 weeks (a total of 36 times) with 20 patients aged between 50 and 70 years old. The Frenchay Activity Index was used to determine the instrumental activities of daily living before and after the intervention. The Korean scale of satisfaction with leisure was employed to determine the satisfaction with leisure, and the Korean version of the Pittsburgh Sleep Quality Index was used to measure the quality of sleep. [Results] The total score of all three instruments (instrumental activities of daily living (IADL), satisfaction with leisure, and quality of sleep) improved significantly after the intervention. [Conclusion] In conclusion, the scores of all three instruments (IADL, satisfaction with leisure, and quality of sleep) improved significantly after the intervention, indicating that the respiration rehabilitation program was effective at improving the overall quality of life for patients with chronic obstructive pulmonary disease.

Competence Judgments Based on Facial Appearance Are Better Predictors of American Elections Than of Korean Elections.

Competence judgments based on facial appearance predict election results in Western countries, which indicates that these inferences contribute to decisions with social and political consequence. Because trait inferences are less pronounced in Asian cultures, such competence judgments should predict Asian election results less accurately than they do Western elections. In the study reported here, we compared Koreans' and Americans' competence judgments from face-to-trait inferences for candidates in U.S. Senate and state gubernatorial elections and Korean Assembly elections. Perceived competence was a far better predictor of the outcomes of real elections held in the United States than of elections held in Korea. When deciding which of two candidates to vote for in hypothetical elections, however, Koreans and Americans both voted on the basis of perceived competence inferred from facial appearance. Combining actual and hypothetical election results, we conclude that for Koreans, competence judgments from face-to-trait inferences are critical in voting only when other information is unavailable. However, in the United States, such competence judgments are substantially important, even in the presence of other information.

Comparison of central venous catheterization techniques in pediatric patients: needle vs angiocath.

BACKGROUND: A needle or an angiocath has been generally used as a route for inserting a guide wire during central venous catheterization. We compared the needle with the angiocath for ultrasound-guided central venous catheterization in pediatric patients concerning accuracy and easiness. METHODS: One hundred and thirty-two patients aged between 1 day and 5 years were randomized into the needle and the angiocath groups. The study was separately carried out in two age groups: newborns vs infants and children. The primary outcome was time to successful insertion of the guide wire. Secondary outcomes including other time variables (time to 1st successful puncture of the vein, time between 1st successful puncture of the vein and successful insertion of the guide wire, total time to successful central venous catheterization), frequency variables (number of the puncture attempts, number of the guide wire insertion attempts), success rates (1st successful puncture rate, 1st successful guide wire insertion rate), and complications. RESULTS: There were no statistically significant differences in time and frequency variables, success rates, and complications between both the age groups. Time to 1st successful puncture of the vein (36.8 ± 31.7 vs 19.8 ± 27.1 s; 95% CI of mean difference 2.2-31.8; P = 0.03) and number of puncture attempts (1.6 ± 0.7 vs 1.3 ± 0.8; P = 0.02) were significantly greater in newborns with the needle, whereas with the angiocath, the number of puncture attempts was larger in newborns than in infants and children (1.7 ± 1.2 vs 1.2 ± 0.7; P = 0.02). CONCLUSION: The angiocath showed no superiority over the needle for ultrasound-guided central venous catheterization in pediatric patients. Regardless of the needle or the angiocath, puncture of the vein was more difficult in newborns than in infants and children.

Clinical outcomes after unplanned extubation in a surgical intensive care population.

BACKGROUND: Clinical outcome after unplanned extubation (UE) in patients admitted to the surgical intensive care unit (SICU) has not been fully investigated. In this study we assessed in-hospital mortality of patients with UE and determined whether UE is a predictor of in-hospital mortality. Finally, we sought to identify predictors of reintubation after UE in mechanically ventilated patients in the SICU. METHODS: Medical charts of patients (n = 4,407) admitted to the SICU between October 2007 and December 2011 were reviewed retrospectively. RESULTS: Eighty-five episodes of UE occurred in 81 patients. Patients with UE required emergency surgery more frequently and had higher ICU and hospital mortality rates, reintubation rate, and APACHE II scores and longer mechanical ventilation (MV) and ICU stay than patients without UE (P < 0.05 for all associations). Multivariate analysis revealed that reintubation (odds ratio [95 % confidence interval]: 4.14 [2.58-6.67]; P < 0.001), APACHE II scores (1.14 [1.12-1.17]; P < 0.001), emergency surgery (1.73 [1.18-2.53]; P = 0.005), and chronic neurologic disease (2.11 [1.30-3.41]; P = 0.002) were associated with hospital mortality. Reintubation was necessary in 17 patients. On multivariate analysis, a score on the Richmond Agitation-Sedation Scale (RASS, 0.48 [0.31-0.76]; P = 0.001), PaO2/FiO2 ratio (0.99 [0.99-1.00]; P = 0.048), and MV duration before UE (1.46 [1.08-1.98]; P = 0.014) were independently associated with reintubation after UE. CONCLUSIONS: Our results indicated that although patients with UE had high in-hospital mortality, UE was not directly associated with in-hospital mortality. Reintubation, chronic neurologic disease, emergency operation, and higher APACHE II score were related to increased in-hospital mortality. A low RASS score, a low PaO2/FiO2 ratio, and long MV duration before UE were related to reintubation after UE.

Preoperative Frailty Is an Independent Risk Factor for Postinduction Hypotension in Older Patients Undergoing Noncardiac Surgery: A Retrospective Cohort Study.

BACKGROUND: Intraoperative hypotension is a risk factor for perioperative adverse outcomes and is highly prevalent in older patients. Frailty has been associated with hemodynamic instability but its impact on postinduction hypotension is unclear. Therefore, we assessed the association between frailty and postinduction hypotension in older patients. METHODS: We retrospectively evaluated electronic medical records of patients aged ≥65 years who were assessed for preoperative frailty and underwent noncardiac surgery under general anesthesia. Reported Edmonton Frail Scale (REFS) scores were used to stratify patients into a nonfrail (REFS scores 0-5), prefrail (6-7), and frail (8-18) groups. Postinduction hypotension was defined as a mean blood pressure below 65 mmHg or 20% from baseline occurring within the first 20 minutes after anesthesia induction and evaluated using multivariate logistic regression analysis. RESULTS: Independent factors related to postinduction hypotension in our sample (421 patients) were status of frail (REFS score ≥8) compared to nonfrail (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.44-5.18; p = .002), lower baseline mean blood pressure in the operating room (OR, 0.98; 95% CI, 0.96-0.999; p = .034) and at the presurgical center (OR, 0.96; 95% CI, 0.94-0.99; p = .003), and orthopedic (compared to urologic) surgery (OR, 2.22; 95% CI, 1.14-4.30; p = .019). CONCLUSION: Preoperative frail status based on REFS scores is associated with postinduction hypotension. Frailty screening tool for older patients may enhance traditional risk calculators and improve patient selection for noncardiac surgery under general anesthesia.

Safety of Administering Intravenous CT Contrast Agents Repeatedly or Using Both CT and MRI Contrast Agents on the Same Day: An Animal Study.

OBJECTIVE: To investigate molecular and functional consequences of additional exposures to iodine- or gadolinium-based contrast agents within 24 hours from the initial intravenous administration of iodine-based contrast agents through an animal study. MATERIALS AND METHODS: Fifty-six Sprague-Dawley male rats were equally divided into eight groups: negative control, positive control (PC) with single-dose administration of CT contrast agent, and additional administration of either CT or MR contrast agents 2, 4, or 24 hours from initial CT contrast agent injection. A 12 µL/g of iodinated contrast agent or a 0.47 µL/g of gadolinium-based contrast agent were injected into the tail vein. Serum levels of blood urea nitrogen, creatinine, cystatin C (Cys C), and malondialdehyde (MDA) were measured. mRNA and protein levels of kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) were evaluated. RESULTS: Levels of serum creatinine (SCr) were significantly higher in repeated CT contrast agent injection groups than in PC (0.21 ± 0.02 mg/dL for PC; 0.40 ± 0.02, 0.34 ± 0.03, and 0.41 ± 0.10 mg/dL for 2-, 4-, and 24-hour interval groups, respectively; P < 0.001). There was no significant difference in the average Cys C and MDA levels between PC and repeated CT contrast agent injection groups (Cys C, P = 0.256-0.362; MDA, P > 0.99). Additional doses of MR contrast agent did not make significant changes compared to PC in SCr (P > 0.99), Cys C (P = 0.262), and MDA (P = 0.139-0.771) levels. mRNA and protein levels of KIM-1 and NGAL were not significantly different among additional CT or MR contrast agent groups (P > 0.05). CONCLUSION: A sufficient time interval, probably more than 24 hours, between repeated contrast-enhanced CT examinations may be necessary to avoid deterioration in renal function. However, conducting contrast-enhanced MRI on the same day as contrast-enhanced CT may not induce clinically significant kidney injury.

Delivery of recombinant sestrin2 ameliorates oxidative stress, mitochondrial damage and renal dysfunction in contrast-induced acute kidney injury.

Although the use of iodinated contrast agents is sometimes unavoidable for accurate diagnosis, contrast-induced acute kidney injury (CI-AKI) is a possible complication of its administration. The pathogenesis of CI-AKI has not been fully elucidated, but oxidative stress is thought to be a major factor. Sestrin2 plays an important role in cellular and mitochondrial homeostasis by regulating oxidative stress. In this study, we aimed to investigate whether recombinant adenovirus containing sestrin2 (RS) can attenuate CI-AKI by reducing oxidative stress in a CI-AKI mice model. Our results showed that RS decreases oxidative stress, pro-inflammatory cytokines (TNF-α, IL-1α, IL-1ß and IL-6) and apoptosis (Bax/Bcl2 and cleaved caspase-3) in the CI-AKI model. Additionally, RS alleviated mitochondrial damage, as evidenced by morphological changes, are restored ATP synthesis. Furthermore, RS administration resulted in a decrease in mitochondrial fission marker (Drp1) that was increased in the CI-AKI model, while the mitochondrial fusion marker (Mfn2) increased, indicating a restoration of mitochondrial dynamics. Decreased relative blood volume, as evaluated on computed tomography (CT), significantly increased compared to the CI-AKI group after RS administration. Finally, renal injury markers such as Kim-1, Ngal, IL-18 also decreased and kidney function was preserved with RS. These results suggested that RS can mitigate the deterioration of renal function in CI-AKI model.

The Effect of Super-Repressor IkB-Loaded Exosomes (Exo-srIκBs) in Chronic Post-Ischemia Pain (CPIP) Models.

Complex regional pain syndrome (CRPS) is a condition associated with neuropathic pain that causes significant impairment of daily activities and functioning. Nuclear factor kappa B (NFκB) is thought to play an important role in the mechanism of CRPS. Recently, exosomes loaded with super-repressor inhibitory kappa B (Exo-srIκB, IκB; inhibitor of NFκB) have been shown to have potential anti-inflammatory effects in various inflammatory disease models. We investigated the therapeutic effect of Exo-srIκB on a rodent model with chronic post-ischemia pain (CPIP), a representative animal model of Type I CRPS. After intraperitoneal injection of a vehicle, Exo-srIκB, and pregabalin, the paw withdrawal threshold (PWT) was evaluated up to 48 h. Administration of Exo-srIκB increased PWT compared to the vehicle and pregabalin, and the relative densities of p-IκB and IκB showed significant changes compared to the vehicle 24 h after Exo-srIκB injection. The levels of several cytokines and chemokines were reduced by the administration of Exo-srIκB in mice with CPIP. In conclusion, our results showed more specifically the role of NFκB in the pathogenesis of CRPS and provided a theoretical background for novel treatment options for CRPS.

Strategy to Reduce Hypercapnia in Robot-Assisted Radical Prostatectomy Using Transcutaneous Carbon Dioxide Monitoring: A Prospective Observational Study.

Purpose: Monitoring end-tidal carbon dioxide partial pressure (PETCO2) is a noninvasive, continuous method, but its accuracy is reduced by prolonged capnoperitoneum and the steep Trendelenburg position in robot-assisted radical prostatectomy (RARP). Transcutaneous carbon dioxide partial pressure (PTCCO2) monitoring, which is not affected by ventilator-perfusion mismatch, has been suggested as a suitable alternative. We compared the agreement of noninvasive measurements with the arterial carbon dioxide partial pressure (PaCO2) over a long period of capnoperitoneum, and investigated its sensitivity and predictive power for detecting hypercapnia. Patients and Methods: The patients who underwent RARP were enrolled in this study prospectively. Intraoperative measurements of PETCO2, PTCCO2, and PaCO2 were analyzed. The primary outcome was the agreement of noninvasive monitoring with PaCO2 during prolonged capnoperitoneum. Bias and precision between noninvasive measurements and PaCO2 were assessed using Bland-Altman analysis. The bias and mean absolute difference were compared using a two-tailed Wilcoxon signed-rank test for pairs. The secondary outcome was the sensitivity and predictive power for detecting hypercapnia. To assess this, the Yates corrected chi-square test and the area under the receiver operating characteristic curve were used. Results: The study analyzed 219 datasets from 46 patients. Compared with PETCO2, PTCCO2 had lower bias, greater precision, and better agreement with PaCO2 throughout the RARP. The mean absolute difference in PETCO2 and PaCO2 was larger than that of PTCCO2 and PaCO2, and continued to exceed the clinically acceptable range of 5 mmHg after 1 hour of capnoperitoneum. The sensitivity during capnoperitoneum and overall predictive power of PTCCO2 for detecting hypercapnia were significantly higher than those of PETCO2, suggesting a greater contribution to ventilator adjustment, to treat hypercapnia. Conclusion: PTCCO2 monitoring measured PaCO2 more accurately than PETCO2 monitoring during RARP requiring prolonged capnoperitoneum and a steep Trendelenburg position. PTCCO2 monitoring also provides more sensitive measurements for ventilator adjustment and detects hypercapnia more effectively than PETCO2 monitoring.

Glycyrrhizin ameliorating sterile inflammation induced by low-dose radiation exposure.

Glycyrrhizin (GL) is a direct inhibitor of HMGB1 which acts as an alarmin when excreted into the extracellular space. High-dose radiation in radiotherapy induces collateral damage to the normal tissue, which can be mitigated by GL inhibiting HMGB1. The purpose of this study was to assess changes in HMGB1 and pro-inflammatory cytokines and to evaluate the protective effect of GL after low-dose radiation exposure. BALB/c mice were irradiated with 0.1 Gy (n = 10) and 1 Gy (n = 10) with GL being administered to half of the mice (n = 5, respectively) before irradiation. Blood and spleen samples were harvested and assessed for oxidative stress, HMGB1, pro-inflammatory cytokines, and cell viability. HMGB1 and pro-inflammatory cytokines increased and cell viability decreased after irradiation in a dose-dependent manner. Oxidative stress also increased after irradiation, but did not differ between 0.1 Gy and 1 Gy. With the pretreatment of GL, oxidative stress, HMGB1, and all of the pro-inflammatory cytokines decreased while cell viability was preserved. Our findings indicate that even low-dose radiation can induce sterile inflammation by increasing serum HMGB1 and pro-inflammatory cytokines and that GL can ameliorate the sterile inflammatory process by inhibiting HMGB1 to preserve cell viability.

Quantitative Analysis of Microperfusion in Contrast-Induced Nephropathy Using Contrast-Enhanced Ultrasound: An Animal Study.

OBJECTIVE: To investigate imaging biomarkers of microperfusion in contrast-induced nephropathy (CIN) using contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS: The CIN model was fabricated by administering indomethacin (10 mg/kg), L-NAME (15 mg/kg), and iopamidol (10 mL/kg) to Sprague-Dawley rats. After 24 hours, CEUS was performed on CIN (n = 6) and control (n = 6) rats with sulphur hexafluoride microbubbles (SonoVue). From time-intensity curves obtained from the kidney arriving time (AT), acceleration time (AC), time to peak (TTP), and peak enhancement (PE) were measured and compared between the groups. After CEUS, the rats were sacrificed, and cell apoptosis markers were evaluated to confirm the development of CIN. RESULTS: Among CEUS parameters, AT (7.8 ± 1.6 vs. 4.2 ± 0.5 s, p = 0.002), AC (4.7 ± 1.4 vs. 2.0 ± 0.4 s, p = 0.002), and TTP (12.5 ± 2.9 vs. 6.2 ± 0.6 s, p = 0.002) were significantly prolonged in the CIN group compared to controls. PE was significantly higher in the control group than in the CIN group (17.1 ± 1.9 vs. 12.2 ± 2.0 dB, p = 0.004). In kidney tissue, mRNA and protein levels of the apoptotic makers were significantly higher in the CIN group than in the control group (p = 0.003 and p = 0.002). CONCLUSION: CEUS parameters can be used as imaging biomarkers for microperfusion in CIN. In rats with CIN, AT, AC, and TTP were significantly prolonged, while PE was significantly lower compared to controls.

Protective effect of glycyrrhizin, a direct HMGB1 inhibitor, on post-contrast acute kidney injury.

Post contrast-acute kidney injury (PC-AKI) is defined as the deterioration of renal function after administration of iodinated contrast media. HMGB1 is known to play an important role in the development of acute kidney injury. The purpose of this study was to investigate the association between HMGB1 and PC-AKI and the protective effect of glycyrrhizin, a direct inhibitor of HMGB1, in rats. Rats were divided into three groups: control, PC-AKI and PC-AKI with glycyrrhizin. Oxidative stress was measured with MDA levels and H2DCFDA fluorescence intensity. The mRNA expressions of pro-inflammatory cytokines (IL-1α, IL-1ß, IL-6 and TNF-α) and kidney injury markers (KIM-1, NGAL and IL-18) were assessed using RT-PCR and ELISA in kidney tissue. In addition, the serum and intracellular protein levels of HMGB1were analyzed with the enzyme-linked immunosorbent assay (ELISA) and western blotting. Histologic changes were assessed with H&E staining using the transmission electron microscope (TEM). Moreover, serum creatinine (SCr), blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) levels were assessed. Oxidative stress, pro-inflammatory cytokines, kidney injury markers and LDH were significantly higher in PC-AKI compared to the controls, but were lower in PC-AKI with glycyrrhizin. Intracellular and serum HMGB1 levels significantly increased after contrast media exposure, whereas they markedly decreased after glycyrrhizin pretreatment. SCr and BUN also decreased in PC-AKI with glycyrrhizin compared to PC-AKI. In PC-AKI, we could frequently observe tubular dilatation with H&E staining and cytoplasmic vacuoles on TEM, whereas these findings were attenuated in PC-AKI with glycyrrhizin. Our findings indicate that HMGB1 plays an important role in the development of PC-AKI and that glycyrrhizin has a protective effect against renal injury and dysfunction by inhibiting HMGB1 and reducing oxidative stress.

Perineural dexamethasone reduces rebound pain after ropivacaine single injection interscalene block for arthroscopic shoulder surgery: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: A single injection interscalene block (ISB) is a common regional analgesic technique in patients undergoing arthroscopic shoulder surgery. However, rebound pain after ISB resolution may reduce its overall benefit. Our primary aim was to assess whether perineural dexamethasone reduces the intensity and incidence of rebound pain in patients undergoing arthroscopic shoulder surgery under general anesthesia combined with a preoperative single injection ISB. METHODS: The patients were randomly assigned to receive single injection ISB using either 0.5% ropivacaine (control) or 0.5% ropivacaine containing 5 mg of dexamethasone. The primary outcomes were the pain score difference before and after ISB resolution, and the incidence of rebound pain. The secondary outcomes were the onset and duration of rebound pain, the presence of sleep disturbances due to postoperative pain, the first time when an analgesic was requested, and pain scores at various predefined time points. RESULTS: Pain increase following ISB resolution was lower in the dexamethasone group compared with the control group (4.5±2.4 and 6.9±2.2, respectively, p<0.001). The incidence of rebound pain was significantly lower in the dexamethasone group compared with the control group (37.1% and 82.9%, respectively, p<0.001). The controls experienced greater sleep disturbance during the postoperative period compared with those who received ISB with perineural dexamethasone. CONCLUSIONS: Perineural dexamethasone added to ISB using ropivacaine led to a much smoother resolution of ISB, reflected in a significantly smaller increase in pain after block resolution, a lower incidence of rebound pain and a lower sleep disturbance during the first postoperative week. TRIAL REGISTRATION NUMBER: Clinical Trial Registry of Korea (KCT0004418).

Characteristics of sourdough bread fermented with Pediococcus pentosaceus and Saccharomyces cerevisiae and its bio-preservative effect against Aspergillus flavus.

Six lactic acid bacteria (LAB) and four yeast strains were isolated from Pyeongchang spontaneous sourdough. In combination with the segregated Saccharomycopsis fibuligera and Saccharomyces cerevisiae, Pediococcus pentosaceus was employed for sourdough bread starters because of its antifungal action against Aspergillus flavus. The sourdough bread fermented with P. pentosaceus and S. cerevisiae displayed 56.4% ± 5.5% antifungal movement counter to A. flavus expansion at 96 h. The concentration of lactic and acetic acids in the sourdough bread was 4.5- and 1.6-folds above the control bread, respectively, contributing to the balanced sensory properties with a fermentation quotient (FQ) of 2.08-2.86. SPME- GC/MS newly distinguished twenty-two volatile compounds including six aldehydes, five alcohols, one phenol, three ketones, one acid, and six esters. The results suggest the P. pentosaceus and S. cerevisiae combination as promising sourdough starters for making enhanced quality bread free of preservatives.

Risk Factors for Perioperative Respiratory Adverse Events in Children with Recent Upper Respiratory Tract Infection: A Single-Center-Based Retrospective Study.

PURPOSE: In pediatric patients, the most common reason for delaying surgical intervention is an upper respiratory tract infection (URI). To date, there has been no consensus regarding the optimal timeframe for deferring surgery in children with URI. We conducted this study to evaluate whether a URI symptom-free period and other risk factors affect the incidence of perioperative respiratory adverse events (RAEs). PATIENTS AND METHODS: The study population included 267 pediatric patients (aged 0 to 13 years) with a recent URI episode who underwent surgery under general anesthesia. Following a retrospective review of medical records, several risk factors including a URI symptom-free period for intra- and postoperative RAEs were analyzed using univariate and multivariate logistic regression analyses. RESULTS: RAEs occurred in 23 of 267 patients (8.6%). Univariate analysis revealed that abnormal preoperative chest images (odds ratio [OR], 7.48; 95% confidence interval [CI], 2.46-22.68, p < 0.001) and emergency operations (OR, 2.84; 95% CI, 1.03-7.81, p = 0.04) were associated with RAEs. Four variables (abnormal preoperative chest images, emergency operations, age under 1 year and symptom-free period of 7-13 days) with a significance of <0.20 in the univariate logistic regression analysis were selected as candidate risk factors for the multivariate model. Among the four variables, abnormalities in preoperative chest images (OR, 7.60; 95% CI, 2.28-25.3, p = 0.001) and a symptom-free period of 7-13 days (OR, 0.13; 95% CI, 0.02-0.88, p = 0.04) were independently associated with RAEs in multivariate logistic regression analysis. CONCLUSION: For pediatric patients who require surgery and have a recent history of URI, procedures should be performed after a URI symptom-free period of at least 1-2 weeks. Confirming the absence of abnormalities in preoperative chest images can reduce the incidence of perioperative RAEs.

Effect of Perioperative Low-Dose Dexmedetomidine on Postoperative Delirium After Living-Donor Liver Transplantation: A Randomized Controlled Trial.

BACKGROUND: Postoperative delirium after liver transplantation (LT) is associated with increased hospital length of stay and higher morbidity and mortality. Dexmedetomidine is a recommended and widely used sedative in critically ill patients with reports of potential for delirium prevention. METHODS: A randomized controlled clinical trial was performed to investigate whether perioperative low-dose dexmedetomidine infusion would decrease delirium after living-donor LT. Dexmedetomidine (0.1 mcg/kg/hour) was administered during anesthesia and through postoperative day 2 for patients in the dexmedetomidine group, whereas 0.9% saline was administered at the same rate for the same duration for patients in the control group. The incidence of delirium after LT was compared between the 2 groups. Delirium duration, mechanical ventilation duration, intensive care unit (ICU) and hospital length of stay, and in-hospital and 3-month mortality were also compared. RESULTS: There was no significant difference in delirium incidence in the dexmedetomidine group compared to the control group (9% vs 5.9%; P = .44). Duration of delirium and mechanical ventilation, ICU and hospital length of stay, and in-hospital and 3-month mortality were comparable between the 2 groups. CONCLUSIONS: Perioperative low-dose dexmedetomidine infusion did not reduce the incidence of delirium in living-donor LT.

Data Driven Investigation of Bispectral Index Algorithm.

Bispectral index (BIS), a useful marker of anaesthetic depth, is calculated by a statistical multivariate model using nonlinear functions of electroencephalography-based subparameters. However, only a portion of the proprietary algorithm has been identified. We investigated the BIS algorithm using clinical big data and machine learning techniques. Retrospective data from 5,427 patients who underwent BIS monitoring during general anaesthesia were used, of which 80% and 20% were used as training datasets and test datasets, respectively. A histogram of data points was plotted to define five BIS ranges representing the depth of anaesthesia. Decision tree analysis was performed to determine the electroencephalography subparameters and their thresholds for classifying five BIS ranges. Random sample consensus regression analyses were performed using the subparameters to derive multiple linear regression models of BIS calculation in five BIS ranges. The performance of the decision tree and regression models was externally validated with positive predictive value and median absolute error, respectively. A four-level depth decision tree was built with four subparameters such as burst suppression ratio, power of electromyogram, 95% spectral edge frequency, and relative beta ratio. Positive predictive values were 100%, 80%, 80%, 85% and 89% in the order of increasing BIS in the five BIS ranges. The average of median absolute errors of regression models was 4.1 as BIS value. A data driven BIS calculation algorithm using multiple electroencephalography subparameters with different weights depending on BIS ranges has been proposed. The results may help the anaesthesiologists interpret the erroneous BIS values observed during clinical practice.