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Dental sedation plays a pivotal role in alleviating patient anxiety during various procedures. Remimazolam, a benzodiazepine derivative, stands out for its distinctive attributes, particularly its rapid onset of sedation coupled with a brief duration, making it an invaluable option for dental applications. The patient was admitted for the extraction of impacted third molars via patient-controlled sedation and not only demonstrated stable vital signs but also expressed a high level of satisfaction with the procedure. An in-depth analysis of plasma remimazolam concentrations and changes in the Patient State Index revealed negative correlation patterns, highlighting the inherent potential of remimazolam in achieving effective sedation. This expanded research scope aims to provide a more nuanced understanding of the pharmacological responses to remimazolam in dental sedation scenarios.This case report offers valuable insights into the evolving landscape of dental sedation methodologies and paves the way for a more informed and evidence-based approach to the use of remimazolam in patient-controlled sedation.
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Objective@#: Collateral circulation is associated with the differential treatment effect of endovascular thrombectomy (EVT) in acute ischemic stroke. We aimed to verify the ability of the collateral map to predict futile EVT in patients with acute anterior circulation ischemic stroke. @*Methods@#: This secondary analysis of a prospective observational study included data from participants underwent EVT for acute ischemic stroke due to occlusion of the internal carotid artery and/or the middle cerebral artery within 8 hours of symptom onset. Multiple logistic regression analyses were conducted to identify independent predictors of futile recanalization (modified Rankin scale score at 90 days of 4–6 despite of successful reperfusion). @*Results@#: In a total of 214 participants, older age (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.56 to 3.67; p<0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR, 1.12; 95% CI, 1.04 to 1.21; p=0.004), very poor collateral perfusion grade (OR, 35.09; 95% CI, 3.50 to 351.33; p=0.002), longer door-to-puncture time (OR, 1.08; 95% CI, 1.02 to 1.14; p=0.009), and failed reperfusion (OR, 3.73; 95% CI, 1.30 to 10.76; p=0.015) were associated with unfavorable functional outcomes. In 184 participants who achieved successful reperfusion, older age (OR, 2.30; 95% CI, 1.44 to 3.67; p<0.001), higher baseline NIHSS scores (OR, 1.12; 95% CI, 1.03 to 1.22; p=0.006), very poor collateral perfusion grade (OR, 4.96; 95% CI, 1.42 to 17.37; p=0.012), and longer door-to-reperfusion time (OR, 1.09; 95% CI, 1.03 to 1.15; p=0.003) were associated with unfavorable functional outcomes. @*Conclusion@#: The assessment of collateral perfusion status using the collateral map can predict futile EVT, which may help select ineligible patients for EVT, thereby potentially reducing the rate of futile EVT.
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Purpose@#Moderate-intensity continuous training (MICT) improves exercise capacity with vascular benefits, but time constraints hinder consistent adherence. High-intensity interval training (HIIT) has emerged as a time-efficient alternative, with repeated sprint training (RST) being the shortest format. We hypothesized that RST would be as effective as MICT in improving vascular function and exercise capacity in young adults. @*Methods@#Twenty-three adults (mean age, 26.2±3.8 years) were randomly assigned to either RST or MICT. RST involved 20 sets of 4-second cycling sprints followed by 30-second active recovery, totaling 11 minutes. MICT consisted of 30-minute cycling at 50% to 60% of heart rate reserve. Vascular function evaluated via brachial artery flow-mediated dilation. Exercise capacity (maximum oxygen uptake, total exercise load test time) and anaerobic capacity (maximum power, anaerobic threshold) were measured using maximum exercise tests. These variables were measured befre and after a 6-week training. @*Results@#Both groups showed comparable improvements in flow-mediated dilation (p＜ 0.05). Maximum oxygen intake slightly improved, while total exercise time significantly increased for both (p＜ 0.05). Anaerobic threshold unchanged, while maximum power improved (p＜ 0.05). @*Conclusion@#These findings underscore that RST is a time-efficient exercise strategy, which improves vascular function and exercise capacity as effectively as MICT in young adults.
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Purpose@#Isometric handgrip exercise (IHE) has a favorable cardiovascular effect and improves hemodynamic responses. Whether IHE attenuates stress-related hemodynamic reactivity assessed during a sympathetic challenge remains unexplored. We tested the hypothesis that an acute bout of IHE would improve carotid arterial function and attenuate cardiovascular vasoreactivity response to sympathetic stress in healthy adults. @*Methods@#In a randomized cross-over design, sixteen healthy adults (aged 21.8±3.1 years) were enrolled. Participants completed two testing sessions, separated by 1 week. Trials were either a control trial or performed IHE for two sets of 2 minutes at 30% of maximal voluntary contraction for each hand. The participant’s hand was immersed in an ice water bath (4 ℃ ) up to the wrist for 2 minutes. Carotid artery diameter, β-stiffness index, and compliance using ultrasound machine and brachial blood pressure (BP), heart rate (HR) were measured as indices of vasoreactivity at baseline, during, and recovery from cold pressor testing (CPT). @*Results@#The BP, HR, carotid artery diameter, and β-stiffness index increased similarly during CPT in both trials (p＜ 0.001), without any interaction effect. Compared with the IHE trial, arterial compliance decreased in the control groups at 120 seconds during recovery with a significant interaction effect (p=0.02). @*Conclusion@#These findings suggest that an acute IHE did not attenuate BP, HR, carotid artery diameter and β-stiffness index vasoreactivity, but improved carotid artery compliance to sympathetic activation in healthy young adults.
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Background@#While the importance of mental health is well-recognized in the field of occupational health, implementation of effective strategies in the workplace has been limited by gaps in infrastructure, program comprehensiveness, coverage, and adherence. The authors developed a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model based occupational mental health intervention, and implemented in a web-based format with a smartphone application. @*Methods@#The SBIRT-based intervention was developed by a multidisciplinary team, including occupational health physicians, nurses, psychiatrists, and software developers. The following mental health areas were included, based on outcomes of an epidemiological survey conducted: insomnia, depression, anxiety, problematic alcohol use, and suicidal risk. The viability of the two-step evaluation process utilizing a combination of the brief version and the full-length version of the questionnaire was examined using responses from the survey. The intervention was adjusted according to the survey results and expert opinions. @*Results@#The epidemiological survey included 346 employees who completed the long-form version of mental health scales. These data were the used to confirm the diagnostic value of using a combination of short-form and long-form version of the scales for screening in the SBIRT model. The model uses a smartphone application for screening, provision of psychoeducation, and for surveillance. The universal methods of the model ensure it can be implemented by all occupational managers, regardless of their specialization in mental health. In addition to the two-step screening procedure to identify employees at-risk for mental health problems, the model includes a stepped care approach, based on risk stratification, to promote mental health education, management, and follow-up for continuous care. @*Conclusion@#The SBIRT model-based intervention provides an easy-to-implement approach for the management of mental health in the workplace. Further studies are required to examine the effectiveness and feasibility of the model.
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Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an “L” shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (Polar TM , Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case.
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Purpose@#Regular aerobic exercise improves exercise capacity and quality of life in children with congenital heart disease (CHD), but it remains unclear whether aerobic exercise would improve vascular function in children with CHD. We tested the hypothesis that acute bout of virtual reality (VR) exergame would improve vascular function in children with CHD. @*Methods@#In a single-arm study, eight children (age, 9±1 years; five males) with CHD participated in VR exergame (30 minutes at 40% of heart rate reserve) using a stationary cycle ergometer with a head mount display. Endothelial function and arterial stiffness as surrogate markers of vascular function were assessed via reactive hyperemia index (RHI) and augmentation index (AIx) using peripheral arterial tonometry at baseline and 30 minutes after VR exergame. @*Results@#Compared to baseline, VR exergame improved in RHI (1.08 [0.96–1.30] to 1.16 [1.09–1.36], p＜ 0.05) and natural log transformed RHI (0.07 [−0.04–0.26] to 0.15 [0.09–0.31], p＜ 0.05). However, no significant changes were observed for decrease AIx (−1.00 [−9.00–9.50] to −7.00 [−14.00–8.75], p=0.547) and AIx@75 (−6.50 [9.75–3.50] to −4.50 [−13.00–4.50], p=0.735) (all index values are reported as median [interquartile range]). @*Conclusion@#These findings suggest that a single bout of VR exergame has the potential to improve vascular endothelial function in children with CHD.
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Purpose@#Numerous studies have reported the effects of interrupting prolonged sitting with aerobic exercise on vascular and postprandial function, but the effects of resistance exercise for interrupting prolonged sitting remain unclear. We tested the hypothesis that intermittent resistance activity breaks would attenuate prolonged sittinginduced vascular and postprandial metabolic dysfunction. @*Methods@#Fourteen healthy adults (age, 24±2 years; body mass index, 22.0±2.4 kg/m2 ) completed two trials in a randomized cross-over design. During a 4-hour sitting after a high-fat meal, the participants underwent either resistance activity (RA) with 10 repetitions of five exercises every hour or uninterrupted sitting as a control trial (SIT). Plasma glucose, triglycerides, and brachial artery blood pressure, along with blood flow and shear rate in the superficial femoral artery and carotid artery were measured at baseline and every hour during the 4-hour sitting period. Brachial artery flow-mediated dilation (FMD) was measured at baseline, 2 hours, and 4 hours after the start of the sitting. @*Results@#Plasma glucose and triglycerides increased after a high-fat meal in both RA and SIT groups without a significant interaction effect. In addition, while SIT group decreased brachial artery FMD (7.2%±2.0% to 6.5%±2.7% to 5.1%±2.6%), RA did not attenuate a decrease in FMD (7.6%±3.4% to 7.3%±3.1% to 6.7%±2.7%, interaction p=0.581). @*Conclusion@#Our findings indicate that interrupting prolonged sitting with intermittent RA did not attenuate the negative effects of sitting on vascular function and postprandial metabolism in young healthy adults.
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Purpose@#This study was conducted to update nursing practice guidelines for intravenous infusion published in 2017. @*Methods@#The guideline update process was carried out using 22 steps developed by NICE and SIGN. It was agreed to update domains related to central venous infusion therapy. Contents related to peripheral infusion would be updated later. @*Results@#Updated guidelines for central venous infusion therapy consisted of 6 domains and 195 recommendations. The number of recommendations by domain was 11 for general instruction, 14 for central vascular access devices (CVAD) and add-on devices, 13 for nursing management before insertion of CVAD, 30 for management during insertion of CVAD, 51 for management after insertion of CVAD, and 76 for complications. A grade was 29 (14.9%), B grade was 87 (44.6%), and C grade was 79 (40.5%) in the strength of recommendations. A total of 37 (19.0%) recommendations were newly developed and 23 (12.3%) previous recommendations have been modified. The newly developed recommendations were mainly related to the infection control methods. @*Conclusion@#The updated guideline is focused on safe maintenance of central venous infusion therapy. Through this guideline, it is hoped to minimize the occurrence of complications and improve the standardization and efficiency of nursing practice.
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Purpose@#Although chronotropic incompetence (CI) is common in patients with complex congenital heart disease (CHD) and is associated with adverse cardiovascular outcomes, few data are available regarding modifiable predictors of CI in this escalating patient population. We tested the hypothesis that higher levels of physical activity (PA) are associated with a lower prevalence of CI in patients with complex CHD and evaluated the receiver operating characteristic curve to identify the PA level that best predicted CI. @*Methods@#We evaluated 111 adolescents with complex CHD. CI was defined as the failure to achieve 80% of the chronotropic response index during peak cardiopulmonary exercise test. Self-reported habitual activity was obtained using a global PA questionnaire. @*Results@#CI was identified in 45 of the 111 cases (40.5%). After adjusting for potential confounding variables, the high PA group demonstrated a lower odds ratio for having CI (odds ratios, 0.25; 95% confidence interval, 0.06‒0.99) compared with the low PA group. The most accurate cut-point for PA to predict the prevalence of CI was 15 metabolic equivalents (METs)-hours/week (areas under the curve, 0.71; 95% confidence interval, 0.61‒0.81; sensitivity, 71%; specificity, 69%). @*Conclusion@#Our findings demonstrate that higher levels of PA are associated with a lower prevalence of CI, independent of potential confounders, and that 15 METs-hours/week of PA provides a cut-point for accurately predicting the presence of CI in adolescents with complex CHD.
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Background@#People with special needs tend to require diverse behavioral management in dentistry. They may feel anxious or uncomfortable or may not respond to any communication with the dentists. Patients with medical, physical, or psychological disorders may not cooperate and therefore require sedation (SED) or general anesthesia (GA) to receive dental treatment. Using the healthcare big data in Korea, this study aimed to analyze the trends of SED and GA in special needs patients undergoing dental treatment. It is believed that these data can be used as reference material for hospitals and for preparation of guidelines and related policy decisions of associations or governments for special needs patients in dentistry. @*Methods@#The study used selected health information data provided by the Korean National Health Insurance Service. Patients with a record of use of one of the eight selected drugs used in dental SED between January 2007 and September 2019, those with International Classification of Diseases-10 codes for attention deficit hyperactivity disorder (ADHD), phobia, brain disease, cerebral palsy, epilepsy, genetic disease, autism, mental disorder, mental retardation, and dementia were selected. The insurance claims data were analyzed for age, sex, sedative use, GA, year, and institution. @*Results@#The number of special needs patients who received dental treatment under SED or GA from January 2007 to September 2019 was 116,623. Number of SED cases was 136,018, performed on 69,265 patients, and the number of GA cases was 56,308, implemented on 47,257 patients. In 2007, 3100 special needs patients received dental treatment under SED while in 2018 the number of cases increased 6 times to 18,528 SED cases. In dentistry, ADHD was the most common disability for SED cases while phobia was the most common cause of disability for GA. The male-to-female ratio with respect to SED cases was higher for males (M : F = 64.36% : 35.64%). @*Conclusion@#The application of the SED method and GA for patients with special needs in dentistry is increasing rapidly; thus, preparing guidelines and reinforcing the education and system are necessary.
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Background@#The purpose of this study is to investigate the effect of liquefied digestive medicines on the composite resin surface. @*Methods@#Three types of liquefied digestive medicines (Gashwalmyeongsu, Wicheongsu, and Saengrokcheon) were selected as experimental groups, Samdasoo and Chamisul as negative controls, and Trevi as positive controls were selected to measure pH and titratable acidity. The samples filled with resin at acrylic were made total 300, 50 per group. To evaluate the erosion risk of the composite resin, the specimens were immersed in a liquefied medicine for 1, 3, 5, 15, and 30 minutes, and then the surface microhardness was measured using the Vickers Hardness Number, and the surface change was observed with scanning electron microscope (SEM). @*Results@#The average pH of the three liquefied medicine was 3.75±0.30, the Saengrokcheon was the lowest at 3.45±0.01, and the Trevi was 4.66 and Samdasoo and Chamisul were 7.40 and 8.58, respectively. The amount of NaOH reaching pH 5.5 and 7.0 was the lowest in the order of Trevi, Gashwalmyeongsu, Wicheongsu, and Saengrokcheon. The largest surface hardness reduction value was shown in Gashwalmyeongsu (−11.85±3.73), followed by Saengrokcheon (−9.79±3.11) and Wicheongsu (−8.28±2.83), and Samdasoo (−0.84±1.56) and Chamisul (−6.24±0.42) had relatively low surface hardness reduction values. However, Trevi (−16.67±5.41), a positive control group containing carbonic acid, showed a higher decrease in surface hardness than the experimental group. As a result of observation with SEM, experimental group and positive control group, showed rough surfaces and irregular cracks, and negative control groups showed smooth patterns similar to before immersion. @*Conclusion@#The liquefied digestive medicine with low pH could weaken the composite resin surface, and the carbonic acid component could more effect on the physical properties of the composite resin than pH.
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Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In head and neck cancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.
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Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.
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Hemophilia A is a hemorrhagic disease caused by coagulation factor VIII deficiency. In head and neck cancer surgery, especially during a reconstructive one, complications can occur. These include hematomas due to bleeding which can then lead to flap ischemia, necrosis, and impaired wound healing. There are fewer cases of reconstructive surgery in patients with hemophilia A. Here in we report, a reconstructive surgery that involved mass resection, partial glossectomy (right), selective neck dissection (right, Levels I, II, III, IV), and reconstruction at the lateral arm free flap (left) in a 25-year-old man with hemophilia A. The surgery was successfully performed without any complications after pretreatment with Factor VIII concentrate, which has not been reported earlier.
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Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.
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Background/Aims@#This study aimed to investigate whether everolimus (EVR) affects long-term survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). @*Methods@#The data from 303 consecutive patients with HCC who had undergone LT from January 2012 to July 2018 were retrospectively reviewed. The patients were divided into two groups: 1) patients treated with EVR in combination with calcineurin inhibitors (CNIs) (EVR group; n=114) and 2) patients treated with CNI-based therapy without EVR (non-EVR group; n=189). Time to recurrence (TTR) and overall survival (OS) after propensity score (PS) matching were compared between the groups, and prognostic factors for TTR and OS were evaluated. @*Results@#The EVR group exhibited more aggressive tumor biology than the non-EVR group, such as a higher number of tumors (P=0.003), a higher prevalence of microscopic vascular invasion (P=0.017) and exceeding Milan criteria (P=0.029). Compared with the PS-matched non-EVR group, the PS-matched EVR group had significantly better TTR (P<0.001) and OS (P<0.001). In multivariable analysis, EVR was identified as an independent prognostic factor for TTR (hazard ratio [HR], 0.248; P=0.001) and OS (HR, 0.145; P<0.001). @*Conclusions@#Combined with CNIs, EVR has the potential to prolong long-term survival in patients undergoing LT for HCC. These findings warrant further investigation in a well-designed prospective study.
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Background/Aims@#This study aimed to investigate whether everolimus (EVR) affects long-term survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). @*Methods@#The data from 303 consecutive patients with HCC who had undergone LT from January 2012 to July 2018 were retrospectively reviewed. The patients were divided into two groups: 1) patients treated with EVR in combination with calcineurin inhibitors (CNIs) (EVR group; n=114) and 2) patients treated with CNI-based therapy without EVR (non-EVR group; n=189). Time to recurrence (TTR) and overall survival (OS) after propensity score (PS) matching were compared between the groups, and prognostic factors for TTR and OS were evaluated. @*Results@#The EVR group exhibited more aggressive tumor biology than the non-EVR group, such as a higher number of tumors (P=0.003), a higher prevalence of microscopic vascular invasion (P=0.017) and exceeding Milan criteria (P=0.029). Compared with the PS-matched non-EVR group, the PS-matched EVR group had significantly better TTR (P<0.001) and OS (P<0.001). In multivariable analysis, EVR was identified as an independent prognostic factor for TTR (hazard ratio [HR], 0.248; P=0.001) and OS (HR, 0.145; P<0.001). @*Conclusions@#Combined with CNIs, EVR has the potential to prolong long-term survival in patients undergoing LT for HCC. These findings warrant further investigation in a well-designed prospective study.
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Nonalcoholic fatty liver disease (NAFLD) is a major public health problem and the most common form of chronic liver disease, affecting 25% of the global population. Although NAFLD is closely linked with obesity, insulin resistance, and type 2 diabetes mellitus, knowledge on its pathogenesis remains incomplete. Emerging data have underscored the importance of Rho-kinase (Rho-associated coiled-coil-containing kinase [ROCK]) action in the maintenance of normal hepatic lipid homeostasis. In particular, pharmacological blockade of ROCK in hepatocytes or hepatic stellate cells prevents the progression of liver diseases such as NAFLD and fibrosis. Moreover, mice lacking hepatic ROCK1 are protected against obesity-induced fatty liver diseases by suppressing hepatic de novo lipogenesis. Here we review the roles of ROCK as an indispensable regulator of obesity-induced fatty liver disease and highlight the key cellular pathway governing hepatic lipid accumulation, with focus on de novo lipogenesis and its impact on therapeutic potential. Consequently, a comprehensive understanding of the metabolic milieu linking to liver dysfunction triggered by ROCK activation may help identify new targets for treating fatty liver diseases such as NAFLD.
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Purpose@#Recovery from exercise is a vulnerable phase that has been linked to increased susceptibility to sudden cardiovascular events. Cigarette smoking increases the risk of cardiovascular mortality and morbidity. We tested the hypothesis that postexercise cigarette smoking would attenuate hemodynamics and vascular function during recovery from exercise in young men. @*Methods@#Thirteen habitual smokers (age, 22±3 years; body mass index, 25.1±3.6 kg/m 2 ) participated in (1) cigarette smoking (0.6 mg nicotine) and (2) sham smoking (SHAM) immediately postexercise (30 minutes on a treadmill;40% to 60% of heart rate [HR] reserve) in a randomized order. Assessments were hemodynamics (HR, rate-pressure product [RPP], brachial and central artery blood pressures) and vascular function (arterial stiffness via carotid-femoral pulse wave velocity [PWV]; conduit vessel function via brachial artery flow-mediated dilation [FMD]). All variables were assessed at baseline, 10 minutes, and 30 minutes postexercise, except for FMD (baseline and 30 minutes postexercise). @*Results@#Compared with the SHAM trial, cigarette smoking increased HR, RPP, and brachial and central blood pressures postexercise (interaction, p＜ 0.05). PWV reduced and FMD increased postexercise in the SHAM trial, while cigarette smoking attenuated exercise-induced improvements (interaction, p＜ 0.05). @*Conclusion@#Cigarette smoking attenuated hemodynamic recovery and an improvement in arterial stiffness and conduit vessel function in young habitual smokers, thereby providing evidence for the negative effects of cigarette smoking during recovery from exercise.