Hemorrhagic Complications Following Ultrasound-Guided Breast Biopsy: A Prospective Patient-Centered Study.

OBJECTIVE: We aimed to evaluate the clinical and imaging factors associated with hemorrhagic complications and patient discomfort following ultrasound (US)-guided breast biopsy. MATERIALS AND METHODS: We prospectively enrolled 94 patients who were referred to our hospital between June 2022 and December 2022 for US-guided breast biopsy. After obtaining informed consent, two breast radiologists independently performed US-guided breast biopsy and evaluated the imaging findings. A hemorrhagic complication was defined as the presence of bleeding or hematoma on US. The patients rated symptoms of pain, febrile sensation, swelling at the biopsy site, and dyspnea immediately, 20 minutes, and 2 weeks after the procedure on a visual analog scale, with 0 for none and 10 for the most severe symptoms. Additional details recorded included those of nausea, vomiting, bleeding, bruising, and overall satisfaction score. We compared the clinical symptoms, imaging characteristics, and procedural features between patients with and those without hemorrhagic complications. RESULTS: Of 94 patients, 7 (7%) developed hemorrhagic complications, while 87 (93%) did not. The complication resolved with 20 minutes of manual compression, and no further intervention was required. Vascularity on Doppler examination (P = 0.008), needle type (P = 0.043), and lesion location (P < 0.001) were significantly different between the groups. Patients with hemorrhagic complications reported more frequent nausea or vomiting than those without hemorrhagic complications (29% [2/7] vs. 2% [2/87], respectively; P = 0.027). The overall satisfaction scores did not differ between the two groups (P = 0.396). After 2 weeks, all symptoms subsided, except bruising (50% 2/4 in the complication group and 25% [16/65] in the no-complication group). CONCLUSION: US-guided breast biopsy is a safe procedure with a low complication rate. Radiologists should be aware of hemorrhagic complications, patient discomfort, and overall satisfaction related to this procedure.

Calf Circumference as an Indicator for Cystatin C Testing in Hospitalized Elderly Male Patients for Detecting Hidden Renal Impairment.

Serum creatinine is used to measure the estimated glomerular filtration rate (eGFR); however, it is influenced by muscle mass and may therefore overestimate renal function in patients with sarcopenia. We examined calf circumference (CC) as a convenient muscle mass evaluation tool that can potentially indicate the need to test for cystatin C instead of creatinine in elderly inpatients. We retrospectively reviewed the electronic health record of 271 inpatients aged 65 or over. CC was determined by measuring the thickest part of the nondominant calf. eGFRcys and eGFRcr were calculated using cystatin C and creatinine levels, respectively. We evaluated optimum CC cutoff values using the eGFRcys/eGFRcr ratio for detecting hidden renal impairment (HRI, defined as eGFRcr ≥ 60 mL/min/1.73 m2 but eGFRcys < 60 mL/min/1.73 m2). CC showed a significant positive correlation with the eGFRcys/eGFRcr ratio in both sexes. The areas under the receiver operating characteristic curve were 0.725 and 0.681 for males and females, respectively. CC cutoffs with a sensitivity or specificity of 90% or 95% might be used to detect HRI in males. In conclusion, utilizing the optimum cutoff, CC could be a cost-effective screening tool for detecting HRI in elderly male patients using cystatin C as an add-on test.

Fabrication of Superhydrophobic Water-Pinning Surfaces through Integration of Silica Colloids into Cellulose Nanocrystals.

The water-pinning effect is a phenomenon in which water droplets adhere to a surface and do not roll off, even when the surface is tilted or turned upside down. This effect holds great potential for applications in various areas, such as dew collection in arid regions, anti-drip function for a greenhouse, and liquid transport and control. However, creating surfaces that exhibit this effect poses challenges, necessitating materials with both hydrophobicity and high adhesive force along with a scalable, cost-effective method to produce the essential geometries that have not yet been established. To address these challenges, we propose a straightforward coating approach involving silica nanoparticles (SiO2) and cellulose nanocrystals (CNCs) to fabricate artificial water-pinning surfaces. We assessed the water-pinning ability of the coated surface through measurements of the contact angle, contact radius, and hysteresis. Remarkably, the coated surface exhibited a contact angle of approximately 153.87° and a contact radius of around 0.89 mm when a 10 µL water droplet was applied, demonstrating its resistance to rolling off, even at a tilting angle of 90°. The droplet only began to fall when its volume reached approximately 33 µL, requiring a substantial water pinning force of 323.4 µN. We also investigated the physicochemical characteristics of the SiO2@CNC coating surface, including morphology, chemical composition, and chemical structure, to unravel the underlying mechanism behind its water-pinning ability. Our proposed fabrication method offers a promising avenue for the development of functional biopolymer-based surfaces capable of precisely manipulating water droplets.

A Comparative Study on the Carcass and Meat Chemical Composition, and Lipid-Metabolism-Related Gene Expression in Korean Hanwoo and Brindle Chikso Cattle.

The objective of this study was to elucidate the effect of cattle breed on carcass and meat chemical composition, fatty acid profiles, and lipid-metabolism-related genes. For this study, same-age Hanwoo and Chikso steers (n = 6 per breed) reared under identical conditions were used. Immediately after slaughter, muscle tissues were collected for analysis of mRNA expression. At 24 h post-mortem, the carcasses were assessed for carcass traits (marbling score, meat yield, etc.), and meat quality and fatty acid profiles in the longissimus lumborum (LL) and semimembranosus (SM) muscles. The results showed that no differences in the slaughter weight, dressing rate, back-fat thickness, trimmed fat, and total meat yield occurred between the two breeds (p > 0.05). However, Hanwoo cattle had a higher marbling score, intramuscular fat (IMF) content, and expression level of lipid-metabolism-related genes such as lipoprotein lipase, peroxisome proliferator-activated receptor gamma, and fatty acid binding protein 4, compared with Chikso (p < 0.05). Contrastingly, Chikso had a higher total unsaturated fatty acid content and expression level of stearoyl CoA desaturase 1 (p < 0.05). It may be said that the difference in the expression levels of lipid-metabolism-related genes could be the molecular factors underlying IMF deposition and fatty acid profile differences in the beef from the two breeds.

A Comparative Study on the Meat Quality, Taste and Aroma Related Compounds between Korean Hanwoo and Chikso Cattle.

The aim of this study was to compare the meat quality and taste-and-aroma-related components of beef between breeds. For this purpose, Hanwoo and Chikso steers (n = 7 per breed) raised under identical conditions until 30 months old were used. After 24 h of slaughter, longissimus lumborum (LL) and semimembranosus (SM) muscles were collected and analyzed for technological quality, free amino acids, metabolites, and volatile compounds. The Chikso meat showed lower values for shear force and color traits (lightness, redness, and yellowness) compared to Hanwoo (p < 0.05). The Chikso presented a higher amount of sweetness-related free amino acids (alanine, proline, and threonine) in the LL muscle, while Hanwoo had a higher amount of methionine and glutamine associated with umami taste (p < 0.05). A total of 36 metabolites were identified and quantified in the meat samples; out of them, 7 compounds were affected by breed (p < 0.05). Regarding aroma compounds, a significantly higher amount of fat-derived aldehydes associated with fatty and sweet notes was found in Hanwoo, whereas a higher amount of pyrazines associated with roasty notes was found in Chikso (p < 0.05). Thus, under identical feeding conditions, breed showed a significant effect on the quality and taste-and-aroma-related components that may influence the eating quality of beef between the two breeds studied.

Mask-wearing behavior during the COVID-19 pandemic in Korea: The role of individualism in a collectivistic country.

The behavior of the general public is crucial for an effective COVID-19 response. The Republic of Korea has shown better performance in this regard than many other countries worldwide. Based on the theories of individualism and collectivism, this study analyzes how Korean culture and political preferences influence the mask-wearing behavior of people in Korea. We conducted two online surveys after the first wave and in the middle of the third wave of the pandemic in Korea. The results showed only small partisan differences in the level of mask-wearing behavior in Korea. Additionally, regression analysis results demonstrate that, when demographic variables are controlled, concerns of spreading infection and horizontal individualistic tendencies of younger respondents have a significant positive relation to mask-wearing behavior. Meanwhile, horizontal collectivism had a significant positive relationship with older respondents' mask-wearing behavior, as expected in the collectivistic culture of the Korean people. As a result, horizontal individualism has similar characteristics with horizontal collectivism in Koreans and both have a positive relation to their mask-wearing behavior.

Intraoperative Glycemic Variability and Mean Glucose are Predictors for Postoperative Delirium After Cardiac Surgery: A Retrospective Cohort Study.

PURPOSE: Postoperative delirium (POD) is a common but serious complication after cardiac surgery and is associated with various short- and long-term outcomes. In this study, we investigated the effects of intraoperative glycemic variability (GV) and other glycemic variables on POD after cardiac surgery. PATIENTS AND METHODS: A retrospective single-center cohort analysis was conducted using data from electronic medical record from 2018 to 2020. A total of 705 patients undergoing coronary artery bypass graft surgery and/or valve surgery, and/or aortic replacement surgery were included in the analysis. Intraoperative GV was assessed with a coefficient of variation (CV), which was defined as the standard deviation of five intraoperative blood glucose measurements divided by the mean. POD assessment was performed three times a day in the ICU and twice a day in the ward until discharge by trained medical staff. POD was diagnosed if any of the Confusion Assessment Method for the Intensive Care Unit was positive in the ICU, and the Confusion Assessment Method was positive in the ward. Multivariable logistic regression was used to identify associations between intraoperative GV and POD. RESULTS: POD occurred in 306 (43.4%) patients. When intraoperative glycemic CV was compared as a continuous variable, the delirium group had higher intraoperative glycemic CV than the non-delirium group (22.59 [17.09, 29.68] vs 18.19 [13.00, 23.35], p < 0.001), and when intraoperative glycemic CV was classified as quartiles, the incidence of POD increased as intraoperative glycemic CV quartiles increased (first quartile 29.89%; second quartile 36.67%; third quartile 44.63%; and fourth quartile 62.64%, p < 0.001). In the multivariable logistic regression model, patients in the third quartile of intraoperative glycemic CV were 1.833 times (OR 1.833, 95% CI: 1.132-2.967, p = 0.014), and patients in the fourth quartile of intraoperative glycemic CV were 3.645 times (OR 3.645, 95% CI: 2.235-5.944, p < 0.001) more likely to develop POD than those in the first quartile of intraoperative glycemic CV. CONCLUSION: Intraoperative blood glucose fluctuation, manifested by intraoperative GV, is associated with POD after cardiac surgery. Patients with a higher intraoperative GV have an increased risk of POD.

Public perception of geothermal power plants in Korea following the Pohang earthquake: A social representation theory study.

This study sought to determine how the residents of Pohang, Korea, perceive geothermal plants after the 2017 Pohang earthquake by applying social representation theory through a mixed-method approach incorporating qualitative and quantitative research. The residents' perception of the geothermal plant was largely anchored to their perception of nuclear power plants. At the time of the Gyeongju earthquake in 2016, public discourse on nuclear accidents developed and was thereafter perpetuated by the Pohang earthquake victims via cognitive anchoring. The survey results demonstrated that Pohang residents had a significantly negative opinion on geothermal plants regardless of safety, climate change mitigation, and economic factors. Upon analyzing the respondents' energy preferences through factor analysis, geothermal power plants were found to aggregate in the same category as nuclear power plants. This result statistically confirms that Pohang residents associate geothermal power plants with the risk discourse on nuclear power plants.

Korean mothers' morality in the wake of COVID-19 contact-tracing surveillance.

The Korean government collects and releases sociodemographic information about people infected with COVID-19, their travel histories, and whether or not the patients wore masks. Korean mothers then upload this information on the boards of online groups called "mom cafes." Based upon a digital ethnography of 15 "mom cafes," we examine how Korean mothers understand the travel histories of virus patients and explore the relationships between morality and materiality in the context of infectious disease surveillance. The main findings reveal that mom cafe mothers form moral personhood based on information gathered about artifacts, places, and the mobility of patients. They tie patients' travel histories inextricably to moral identities. Non-maleficence is central to Korean mothers' morality. This morality appears through the material discourses of artifacts, places, and mobility. A face mask becomes one such hallmark of morality. It is a requisite for moral persons. Those who visit crowded places, such as churches, clubs, and room salons, become immoral because they can be easily infected and spread the virus to their families and communities. To mom cafe mothers, mobile patients, such as clubbers, appear less moral than those who self-quarantine due to the high infection rate of COVID-19. We conclude that morality in this context involves the materiality of artifacts, a sense of place, and the spatial mobility of people.

Gratitude Moderates the Mediating Effect of Deliberate Rumination on the Relationship Between Intrusive Rumination and Post-traumatic Growth.

PURPOSE: This study examines the moderating effect of gratitude on the mediating effect of deliberate rumination on the relationship between intrusive rumination and post-traumatic growth (PTG). METHODS: We used self-report questionnaires to collect data from 450 18-68-year-old participants (Mage = 39.73, SD = 13.73) residing in major cities and regions across South Korea. Data that were collected from 411 participants were subjected to analysis. Version 25 of SPSS (Statistical Package for Social Science) and PROCESS macro were used to analyze mediation, moderation, and moderated mediation effects. RESULTS: Deliberate rumination mediated the relationship between intrusive rumination and PTG. Gratitude moderated the effect of deliberate rumination on PTG. Finally, gratitude moderated the mediating effect of deliberate rumination on the relationship between intrusive rumination and PTG. CONCLUSION: Deliberate rumination and gratitude facilitate PTG for traumatized adults. In particular, gratitude reinforces the effect of deliberate rumination on PTG.

Increased serum uric acid levels are associated with digital ulcers in patients with systemic sclerosis.

Endothelial injury/dysfunction is thought to be one of the earliest events in the development of vascular diseases in systemic sclerosis (SSc). Although hyperuricemia is also known to induce endothelial dysfunction and vascular inflammation, the effect of uric acid on the microvascular involvement in SSc has not been well established. We investigated whether increased serum uric acid (SUA) levels are associated with digital ulcers (DUs) in SSc. In this cross-sectional study, we consecutively recruited 71 women with SSc and 349 age- and sex-matched healthy subjects, and SUA levels were measured in all study subjects. SSc patients had significantly higher mean SUA levels than healthy subjects (4.5 ± 1 mg/dL vs 4.2 ± 0.9 mg/dL, p = 0.017), although a significantly lower body mass index (BMI) was observed in SSc patients than in controls. Among 71 SSc patients, 22 (31%) had DUs ever (active DUs, 8; healed DUs, 14). SSc patients presenting with DUs ever showed significantly higher SUA levels than those without this feature (median, 5.2 mg/dL vs 4.1 mg/dL, p = 0.009). In multivariable logistic regression models adjusted for confounders such as BMI and estimated glomerular filtration rate, increased SUA levels were associated with a significantly higher risk for the presence of DUs ever (OR 2.3, 95% CI 1.16-4.57, p = 0.018). Our data revealed that elevated SUA levels are independently associated with the presence of DUs in SSc patients, thereby suggesting the potential role of hyperuricemia in the pathogenesis of SSc vasculopathy.

Serum CCL11 level is associated with radiographic spinal damage in patients with ankylosing spondylitis.

The clinical significance of C-C motif chemokine11 (CCL11) in bone metabolism in ankylosing spondylitis (AS) is not clearly elucidated. Thus, this cross-sectional study aimed to compare serum levels of CCL11 between patients with AS and healthy controls and to investigate the relationship between serum levels of CCL11 and radiographic spinal damage in patients with AS. We consecutively recruited 55 male patients with AS and 26 age- and sex-matched healthy controls. Serum levels of CCL11, tumor necrosis factor-α (TNF-α), interleukin-17, and Dickkopf-1 (DKK-1) were measured with commercially available enzyme-linked immunosorbent assay kits. Radiographs were scored according to the modified Stoke ankylosing spondylitis spine score (mSASSS), and syndesmophytes were defined as mSASSS ≥ 2. The serum levels of CCL11 in AS patients with syndesmophytes were significantly higher than those in AS patients without syndesmophytes (p = 0.007) and healthy controls (p = 0.006). In AS patients, the serum levels of CCL11 were significantly and positively correlated with mSASSS (p = 0.006), number of syndesmophytes (p = 0.029). After adjusting for confounding factors, elevated serum levels of CCL11 were associated with increased mSASSS (ß = 0.007, p = 0.03) and higher risk for the presence of syndesmophytes (OR 2.34 per 50 pg/ml increase, p = 0.012) in AS patients. We found that the serum level of CCL11 was associated with structural damage in patients with AS, suggesting that CCL11 may serve as a promising biomarker for new bone formation in AS.

Primary Sjogren syndrome diagnosed simultaneously with localized amyloidosis of the lacrimal gland: A case report.

INTRODUCTION: Amyloidosis accompanied by Sjögren's syndrome (SS) has been reported to occur primarily in the skin, lungs, tongue, and mammary gland. However, SS in association with secondary amyloidosis is rarely reported, and knowledge of its relevance is inadequate. Here we report a case of primary SS diagnosed simultaneously with localized amyloidosis of the lacrimal gland. CASE PRESENTATION: A 45-year-old woman complaining of a left eyelid mass was referred to the hospital and was diagnosed with localized amyloidosis after excisional biopsy. She was then referred to the rheumatology department for additional evaluation for amyloidosis. Subsequently, her diagnosis was primary SS based on the presented symptoms and results of the Schirmer test, serologic testing, and minor salivary gland biopsy. Pilocarpine (10 mg/d) and hydroxychloroquine (200 mg/d) were initiated for the treatment of SS. Six months after the initial diagnosis, the dry eyes and mouth did not worsen and no masses suggestive of localized amyloidosis were reported. CONCLUSION: This is a rare case of amyloidosis, localized to the lacrimal gland, with SS. Therefore, despite its rarity, physicians should be aware of the potential coexistence of secondary amyloidosis, even in the localized form, in patients with SS.

Successful introduction of an underutilized elderly pneumococcal vaccine in a national immunization program by integrating the pre-existing public health infrastructure.

BACKGROUND: Although pneumococcal vaccines had been recommended for the elderly population in South Korea for a considerable period of time, the coverage has been well below the optimal level. To increase the vaccination rate with integrating the pre-existing public health infrastructure and governmental funding, the Korean government introduced an elderly pneumococcal vaccination into the national immunization program with a 23-valent pneumococcal polysaccharide vaccine in May 2013. OBJECTIVE: The aim of this study was to assess the performance of the program in increasing the vaccine coverage rate and maintaining stable vaccine supply and safe vaccination during the 20 months of the program. METHODS: We qualitatively and quantitatively analyzed the process of introducing and the outcomes of the program in terms of the systematic organization, efficiency, and stability at the national level. RESULTS: A staggered introduction during the first year utilizing the public sector, with a target coverage of 60%, was implemented based on the public demand for an elderly pneumococcal vaccination, vaccine supply capacity, vaccine delivery capacity, safety, and sustainability. During the 20-month program period, the pneumococcal vaccine coverage rate among the population aged ≥65 years increased from 5.0% to 57.3% without a noticeable vaccine shortage or safety issues. A web-based integrated immunization information system, which includes the immunization registry, vaccine supply chain management, and surveillance of adverse events following immunization, reduced programmatic errors and harmonized the overall performance of the program. CONCLUSION: Introduction of an elderly pneumococcal vaccination in the national immunization program based on strong government commitment, meticulous preparation, financial support, and the pre-existing public health infrastructure resulted in an efficient, stable, and sustainable increase in vaccination coverage.

The sensory power of cameras and noise meters for protest surveillance in South Korea.

This article analyzes sensory aspects of material politics in social movements, focusing on two police tools: evidence-collecting cameras and noise meters for protest surveillance. Through interviews with Korean political activists, this article examines the relationship between power and the senses in the material culture of Korean protests and asks why cameras and noise meters appeared in order to control contemporary peaceful protests in the 2000s. The use of cameras and noise meters in contemporary peaceful protests evidences the exercise of what Michel Foucault calls 'micro-power'. Building on material culture studies, this article also compares the visual power of cameras with the sonic power of noise meters, in terms of a wide variety of issues: the control of things versus words, impacts on protest size, differential effects on organizers and participants, and differences in timing regarding surveillance and punishment.

A prospective randomized controlled trial of the laryngeal mask airway versus the endotracheal intubation in the thyroid surgery: evaluation of postoperative voice, and laryngopharyngeal symptom.

BACKGROUND: The present study was performed to determine whether thyroidectomy patients undergoing general anesthesia provided with a laryngeal mask airway (LMA) have a lower risk of voice-related complications and laryngopharyngeal symptoms than those undergoing endotracheal intubation (ETI). MATERIALS AND METHODS: In a prospective, double-blinded, randomized clinical trial, we studied 64 patients undergoing elective thyroid lobectomy between July 2013 and February 2014. Acoustic analyses were performed preoperatively and at 48 h and 2 weeks postoperatively. The voice handicap index (VHI), M.D. Anderson dysphagia index (MDADI), and laryngopharyngeal symptom score (LPS) were determined preoperatively and at 24 h, 48 h, 1 week, and 2 weeks post-thyroidectomy. RESULTS: In acoustic analysis, jitter, shimmer and noise-to-harmonic ratio showed significantly better results in the LMA group than the ETI group 48 h after surgery, but there was no difference at 2 weeks. The incidence of postoperative lower-pitched voice in the LMA group was also significantly lower than that in the ETI group. In the LMA group, the VHI, MDADI, and LPS were better compared to those in the ETI group at 24 h postoperatively, and improved to the preoperative state within 1 week. However, those in the ETI group remained poorer than the preoperative values 1 week after surgery. CONCLUSIONS: Use of the LMA in general anesthesia for thyroid surgery has advantages over the ETI in decreasing patients' subjective and objective voice symptoms, reducing the duration of symptoms, and relieving the laryngopharyngeal symptoms.

Comparison of the size 3 and size 4 ProSeal™ laryngeal mask airway in anesthetized, non-paralyzed women: a randomized controlled trial.

PURPOSE: Based on experimental results, various authors have advocated a size 4 ProSeal™ laryngeal mask airway (PLMA) in preference to a size 3 PLMA for women given a neuromuscular blocking agent because the larger size provided a better airway seal. However, spontaneously breathing patients may be ventilated adequately with a lower seal pressure than that needed for mechanical ventilation. Therefore, a smaller size might be preferable as its reduced bulk possibly induces less mucosal damage in non-paralyzed patients. METHODS: A total of 152 females undergoing general anesthesia for short outpatient gynecological surgeries were randomly allocated in equal numbers to insertion of a size 3 or 4 PLMA. The insertion time, success rate, seal pressure, hemodynamic variables, and complications, such as blood staining and sore throat, were evaluated. RESULTS: The incidence of blood staining was lower with the size 3 PLMA compared to the size 4 PLMA (18 vs. 36 %; P = 0.028). Compared with the size 3 LMA, the size 4 PLMA resulted in higher fluctuations in both blood pressure (P = 0.003) and heart rate (P = 0.01). The insertion time was shorter with the size 3 PLMA (9 vs. 16 s; P < 0.001). The airway seal pressure with the size 3 PLMA, although lower than that of the size 4 PLMA (23 vs. 28 cmH2O; P = 0.001), was sufficient for spontaneous ventilation. CONCLUSIONS: Due to the reduced incidence of mucosal injury and greater hemodynamic stability, the size 3 PLMA may be preferable to the size 4 PLMA for non-paralyzed females.

Persistent perioperative tachycardia and hypertension diagnosed as thyroid storm induced by a hydatidiform mole: a case report.

Thyroid storm is a critical complication of molar pregnancy. However, early diagnosis of it is difficult because it is a rare complication and usually presents nonspecific findings. In this case report, we present a woman with molar pregnancy who had persistent tachycardia and hypertension. She was diagnosed initially with preeclampsia and sepsis as complications of molar pregnancy. During dilation and curettage under general anesthesia with sevoflurane and remifentanil, tachycardia and hypertension remained even with continuous infusion of labetalol. The patient was subsequently diagnosed with thyroid storm associated with molar pregnancy. She was restored to a clinically euthyroid state 1 day after the operation, and her thyroid function test and ß-hCG values were normal 3 months later. The anesthesiologists should bear in mind the possibility of thyroid storm in patients with molar pregnancies who show persistent tachycardia and hypertension.

The effect of milrinone on induced hypotension in elderly patients during spinal surgery: a randomized controlled trial.

BACKGROUND CONTEXT: Induced hypotension is widely used intraoperatively to reduce blood loss and to improve the surgical field during spinal surgery. PURPOSE: To determine the effect of milrinone on induced hypotension during spinal surgery in elderly patients. STUDY DESIGN/SETTING: Prospective randomized clinical trial. PATIENT SAMPLE: Forty patients, 60 to 70 years old, ASA I-II, who underwent elective lumbar fusion surgery. OUTCOME MEASURES: Intraoperative hemodynamics, blood loss, hourly urine output, and grade of surgical field. METHODS: All patients were randomized to group M or N. The study drug was infused after perivertebral muscle retraction until complete interbody fusion. In group M, 50 µg/kg/min of milrinone was infused over 10 minutes as a loading dose followed by 0.6 µg/kg/min of milrinone as a continuous dose. In group N, an identical volume of normal saline was infused in the same fashion. This study was not funded by commercial or other sponsorship and the authors confirm no conflicts of interest, financial or otherwise. RESULTS: During infusion of the study drug, the systolic and mean blood pressures were maintained within adequate limits of induced hypotension in group M. Intraoperative blood loss was 445.0±226.5 mL in group M and 765.0±339.2 mL in group N (p=.001). Hourly urine output was 1.4±0.6 mL in group M and 0.8±0.2 mL in group N (p<.001). The grade of the surgical field was better in group M than in group N (p=.004). CONCLUSIONS: We conclude that milrinone is useful for induced hypotension in elderly patients during spinal surgery.

The kinase Btk negatively regulates the production of reactive oxygen species and stimulation-induced apoptosis in human neutrophils.

The function of the kinase Btk in neutrophil activation is largely unexplored. Here we found that Btk-deficient neutrophils had more production of reactive oxygen species (ROS) after engagement of Toll-like receptors (TLRs) or receptors for tumor-necrosis factor (TNF), which was associated with more apoptosis and was reversed by transduction of recombinant Btk. Btk-deficient neutrophils in the resting state showed hyperphosphorylation and activation of phosphatidylinositol-3-OH kinase (PI(3)K) and protein tyrosine kinases (PTKs) and were in a 'primed' state with plasma membrane-associated GTPase Rac2. In the absence of Btk, the adaptor Mal was associated with PI(3)K and PTKs at the plasma membrane, whereas in control resting neutrophils, Btk interacted with and confined Mal in the cytoplasm. Our data identify Btk as a critical gatekeeper of neutrophil responses.