The Effect of Sex on the Remimazolam Dosage Required for Successful i-gel Supraglottic Airway Insertion with Remifentanil in Non-Paralyzed Patients: An Up-and-Down Sequential Allocation Trial.

(1) Background: The physiological and pharmacological variations between men and women are known to influence drug efficacy. The objective of this study was to determine the 50% and 95% effective doses (ED50 and ED95) of remimazolam required for i-gel supraglottic airway (ISA) insertion under remifentanil infusion without neuromuscular blocking agents (NMBAs) in both males and females. (2) Methods: Patients aged 19-65 years, scheduled for general anesthesia using ISA, were enrolled in this study. Patients were divided into two groups based on their sex. The anesthesia process began with a remifentanil infusion targeting an effect-site concentration of 3.0 ng/mL, accompanied by a remimazolam injection. The initial remimazolam dose was 0.25 mg/kg, and it was adjusted with a step size of 0.05 mg/kg based on the outcome of ISA insertion in the preceding patient. (3) Results: The ED50 of remimazolam (mean ± standard error) was 0.28 ± 0.02 mg/kg in the male group and 0.18 ± 0.02 mg/kg in the female group (p < 0.001). Additionally, ED95, which was calculated using the isotonic regression method, was significantly comparable between the male and female groups (male: 0.35 mg/kg, 95% confidence interval [CI] = 0.34-0.35; female: 0.29 mg/kg, 95% CI = 0.25-0.30). (4) Conclusions: This study showed that both the ED50 and the ED95 of remimazolam for successful ISA insertion was higher for men than that for women. Therefore, while using remimazolam alongside remifentanil infusion without NMBAs for ISA insertion, one should consider the patient's sex for appropriate dosing.

The Multi-dimensional Assessment of Suicide Risk in Chronic illness-20 (MASC-20): Development and validation.

BACKGROUND: We developed and tested the psychometric properties of the Multi-dimensional assessment of suicide risk in chronic illness-20 (MASC-20), which assess suicidal behavior (SB), and its associated distress in chronic physical illness (CPI). METHODS: Items were developed by incorporating inputs from patient interviews, a review of existing instruments, and expert consultations. Pilot testing with 109 patients and field testing with 367 patients with renal, cardiovascular, and cerebrovascular diseases were conducted. We analyzed Time (T) 1 data to select items and T2 data to examine psychometric properties. RESULTS: Forty preliminary items were selected through pilot testing; 20 were finalized from field testing. Optimal internal consistency (α = 0.94) and test-retest reliability (Intra class correlation coefficient = 0.92) of the MASC-20 supported reliability. Good fit of the four-factor model (physical distress, psychological distress, social distress, and SB) from exploratory structural equation modeling demonstrated factorial validity. Its correlations with MINI suicidality (r = 0.59) and the Schedule of Attitudes Toward Hastened Death-abbreviated scores (r = 0.62) indicated convergent validity. Higher MASC-20 scores in patients with clinical levels of depression and anxiety and low health status demonstrated known-group validity. The MASC-20 distress score predicted SB beyond known SB risk factors, supporting incremental validity. A cutoff score of 16 was optimal for identifying suicide risk. The area under the curve was within a moderately accurate range. The sum of sensitivity and specificity (1.66) indicated diagnostic utility. LIMITATIONS: MASC-20's applicability to other patient populations and its sensitivity to change requires testing. CONCLUSIONS: The MASC-20 appears to be a reliable and valid tool for assessing SB in CPI.

The longitudinal effects of chronotype on chemotherapy-induced nausea and vomiting in patients with breast cancer receiving neoadjuvant chemotherapy.

OBJECTIVE: The object of this longitudinal cohort study was to investigate whether chronotype affects the incidence of chemotherapy-induced nausea and vomiting (CINV) among patients with breast cancer. METHODS: The study included a total of 203 breast cancer patients who received neoadjuvant chemotherapy using a regimen of doxorubicin and cyclophosphamide with high emetogenicity. Patients received four cycles of chemotherapy in approximately three months. Patients completed questionnaires including the Munich Chronotype Questionnaire (MCTQ) before the first chemotherapy and the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) after each of the four chemotherapy sessions. To confirm the effect of chronotype on CINV during the four cycles, we performed statistical analyses using a generalized estimating equation (GEE). RESULTS: CINV occurred in 108 (53.2%), 112 (55.2%), 102 (50.3%), and 62 (30.5%) patients during four cycles of treatment. In the GEE approach, late and early chronotypes (vs. intermediate chronotype) were associated with an increased risk of CINV (late chronotype: odds ratio [OR], 2.06; 95% confidence interval [CI], 1.41-2.99; p < 0.001, early chronotype: OR, 1.84; CI, 1.25-2.73; p = 0.002), which remained significant even after adjusting for age, BMI, antiemetic treatment, history of nausea and vomiting, anxiety, and sleep quality. CONCLUSION: Chronotype affected CINV across the four cycles of neoadjuvant chemotherapy in patients with breast cancer, suggesting the need to consider chronotype in predicting and managing CINV.

Psychiatric symptoms mediate the effect of resilience on health-related quality of life in patients with breast cancer: Longitudinal examination.

OBJECTIVE: Patients with breast cancer receiving neoadjuvant chemotherapy are at increased risk of poor health-related quality of life (HRQOL). This study examined clinical caseness on depression and anxiety mediate the relationship between resilience and HRQOL in patients with breast cancer. METHODS: A total of 193 patients with breast cancer undergoing neoadjuvant chemotherapy completed questionnaires including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-Breast before the first session (T0), before the start of the last session (T1), and 6 months after the end (T2) of chemotherapy. Mediation analyses using a bootstrapping method was performed. RESULTS: The indirect effect (IE) through T1 depression was significant (IE through depression = 0.043, 95% confidence interval [CI] [0.002-0.090]), while IE through T1 anxiety was not significant (IE through anxiety = 0.037, 95% CI [-0.010-0.097]) in the association between T0 resilience and T2 HRQOL. CONCLUSIONS: Clinical caseness on HADS depression subscale during chemotherapy was a mediating factor of the relationship between resilience before chemotherapy and HRQOL after chemotherapy in patients with breast cancer receiving neoadjuvant chemotherapy. Depression during chemotherapy in patients with breast cancer may be a target symptom of screening and intervention to maintain the HRQOL after chemotherapy. Also, patients with low resilience are more likely to develop depression during chemotherapy, and clinicians should carefully monitor whether depression occurs in these patients with low resilience.

The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study.

BACKGROUND: Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). METHODS: To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. RESULTS: Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). CONCLUSIONS: In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

Prevalence and comorbidities of adult adhd in male military conscripts in korea: Results of an epidemiological survey of mental health in korean military service.

We assessed the prevalence/comorbidities of attention deficit hyperactivity disorder (ADHD) in Korean servicemen using the Epidemiological Survey of Mental Health in Military Service in Korea. A total of 3,441 participants were assessed for adult ADHD, depression, social anxiety, generalized anxiety, somatization, insomnia, suicidality, cigarette dependence, and alcohol dependence using a self-report scale. Participants were also asked to rank their perception of their career prospects, health status, and quality of life on a Likert scale. Participants were classified as ADHD according to the WHO A-ADHD self-report scale. Firth multiple logistic regression and Cochran-Armitage trend tests were used to identify the risks of comorbidities and trends of self-perception between the two groups. ADHD (prevalence: 2.8%) was significantly associated with social anxiety (OR, 40.52; 95% CI 25.14-65.74), generalized anxiety (OR, 28.21; 95% CI 17.37-45.69), depression (OR, 16.36; 95% CI 10.50-25.52), somatization (OR, 14.47; 95% CI 9.21-22.76), suicidality (OR, 11.03; 95% CI 6.67-17.86), and insomnia (OR, 5.92; 95% CI 3.68-9.35). Servicemen with ADHD had negative perceptions (p <0.001) of their career prospects, health status, and quality of life compared to servicemen without ADHD. It is essential to revise the enlistment criteria for individuals with ADHD or to develop management programs for servicemen with ADHD.

The effect of perceived social support on chemotherapy-related symptoms in patients with breast cancer: A prospective observational study.

OBJECTIVE: Few studies have examined the effect of perceived social support (PSS) on chemotherapy-related symptoms (CRS). This study examined the effect of PSS on CRS in 184 patients with breast cancer. METHODS: Participants were consecutively enrolled from a tertiary general hospital in Seoul, South Korea. CRS were assessed eight times, from before the first neoadjuvant chemotherapy to six months after the end of neoadjuvant chemotherapy, with the MD Anderson Symptom Inventory. PSS was evaluated once, before the first neoadjuvant chemotherapy session, using the Multidimensional Scale of Perceived Social Support (MSPSS). Two groups were formed based on MSPSS scores: the low PSS group (n = 62) and the moderate-to-high PSS group (n = 122). Linear mixed model analyses were used to compare the change in CRS severity between the two groups during chemotherapy. RESULTS: Results indicated a significant group-by-time (low PSS or moderate-to-high PSS; 8 periods of chemotherapy) interaction for pain (p = .005), nausea (p = .033), insomnia (p < .001), distress (p = .003), dyspnea (p = .014), memory loss (p = .021), vomiting (p = .016), and numbness (p = .008) in which the moderate-to-high PSS group showed significantly lower levels of increase in those symptoms during chemotherapy. Moreover, the effect of PSS on CRS differed depending on the sources of PSS. CONCLUSION: Patients with moderate-to-high PSS experience less severe CRS compared with patients with low PSS during chemotherapy. The current findings indicate the potential benefits of providing social support in the management of CRS.