Efficacy and Safety of Sugammadex for the Reversal of Rocuronium-Induced Neuromuscular Blockade in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

Background and Objectives: Sugammadex is widely used in anesthesia to reverse rocuronium-induced neuromuscular blockade (NMB). In patients with compromised kidney function, most drugs show alteration of their pharmacokinetic profile with reduced clearance. The purpose of this article is to examine the efficacy, pharmacokinetics, and safety of sugammadex in end-stage renal disease (ESRD) patients receiving general anesthesia, using a systematic review. Materials and Methods: The databases of PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched for studies comparing the efficacy or safety outcomes of sugammadex administration for the reversal of rocuronium-induced NMB, in ESRD patients (group R) or in those with normal renal function (group N) undergoing surgery under general anesthesia. Results: We identified nine studies with 655 patients-six prospective, case-control studies with 179 patients (89 and 90 in groups R and N) and three retrospective observational studies with 476 ESRD patients. In the six prospective studies, the times taken to reach a train-of-four ratio ≥0.9, 0.8, and 0.7 were significantly longer in group R than in group N (weighted mean difference [95% confidence interval] [min]: 1.14 [0.29 to 2.00], 0.9 [0.24 to 1.57], 0.89 [0.20 to 1.57], respectively). The total plasma clearance of sugammadex was significantly lower in group R than in group N. There was no significant difference in the incidence of NMB recurrence and prolonged time to recovery between the groups. In the three retrospective studies, the possibility of sugammadex-related adverse events appears to be insignificant. Conclusions: Sugammadex may effectively and safely reverse rocuronium-induced NMB in patients with ESRD, although the recovery to a TOF ratio of 0.9 may be prolonged compared to patients with normal renal function. Further studies are needed, considering the small number of studies included and the high heterogeneity of some of the results.

Coherent beam combination using self-phase locked stimulated Brillouin scattering phase conjugate mirrors with a rotating wedge for high power laser generation.

The self-phase locking of a stimulated Brillouin scattering-phase conjugate mirror (SBS-PCM) allows a simple and scalable coherent beam combination of existing lasers. We propose a simple optical system composed of a rotating wedge and a concave mirror to overcome the power limit of the SBS-PCM. Its phase locking ability and the usefulness on the beam-combination laser are demonstrated experimentally. A four-beam combination is demonstrated using this SBS-PCM scheme. The relative phases between the beams were measured to be less than λ/24.7.

Complete and Incomplete Alcohol Sclerotherapy for Treatment of Symptomatic Hepatic Cysts: Comparison of Volume Reduction and Clinical Outcomes.

Background: The purpose of this study was to compare the efficacy of incomplete alcohol sclerotherapy with complete treatment for hepatic cysts. Methods: From 2005 to 2021, a total of 80 patients (19 males, 61 females; median age 65 years; age range, 42-86 years) who underwent alcohol sclerotherapy for symptomatic benign hepatic cysts were enrolled and retrospectively reviewed. Complete treatment was defined as injecting 25-33% of the aspirated cyst volume with alcohol in 2-3 cycles, with a maximum of 100 mL per cycle. The overall volume reduction rate was compared between the complete and incomplete treatment groups. The response, based on cystic volume reduction, was classified as a complete regression (CR), near-complete regression (NCR), partial regression (PR), or no response (NR). CR and NCR were considered objective responses. Among 80 patients with 85 hepatic cysts, 26 patients with 29 hepatic cysts received incomplete treatment. Results: The overall volume reduction rate was not significantly different between the complete and incomplete treatment groups (94.39% vs. 95.47%, respectively, p = 0.623). The CR and NCR groups showed a significantly higher rate of symptom improvement than the PR and NR groups (p = 0.043). Conclusions: In conclusion, the efficacy of incomplete alcohol sclerotherapy was not inferior to that of complete treatment.

Role of Portosystemic Shunt and Portal Vein Stent in Managing Portal Hypertension Due to Hematological Diseases.

INTRODUCTION: Patients with hematological diseases experience complications related to portal hypertension, including life-threatening complications such as variceal bleeding. METHODS: We analyzed the prognosis of patients with hematological diseases and portal hypertension treated with transjugular intrahepatic portosystemic shunts (TIPS) or portal vein stents. We retrospectively assessed patients with hematological diseases and portal hypertension who had variceal bleeding. We evaluated the characteristics and prognosis of the enrolled patients. A total of 11 patients with hematological diseases who underwent TIPS, or portal vein stenting, were evaluated. RESULTS: The median follow-up period was 420 days. Of the 11 patients, eight showed resolution of portal hypertension and its complications following TIPS, or stent insertion. One patient experienced rebleeding due to incomplete resolution of portal hypertension, and two other patients also experienced rebleeding because they underwent TIPS closure or revision due to repetitive hepatic encephalopathy. CONCLUSION: Portosystemic shunt and stent installation are effective treatment options for portal hypertension due to hematological diseases.

Comparative Analysis of Lenvatinib and Hepatic Arterial Infusion Chemotherapy in Unresectable Hepatocellular Carcinoma: A Multi-Center, Propensity Score Study.

The comparative efficacy and safety between lenvatinib and hepatic artery infusion chemotherapy (HAIC) in patients with unresectable hepatocellular carcinoma (HCC) is still unclear. This multicenter historical cohort study enrolled 244 patients who were treated with HAIC (n = 173) or lenvatinib (n = 71) between 2012 and 2020. Propensity score matching (PSM) was performed, and 52 patients were selected per group. Clinical outcomes and safety were compared. Objective response rate (ORR) was not different between the two groups (26.0% vs. 23.1%, p = 0.736). Before PSM, the HAIC group had a higher proportion of Child-Pugh B and portal vein tumor, whereas the lenvatinib group had more patients with extrahepatic metastases, which was adjusted after PSM. There were no differences in progression-free survival (PFS) and overall survival (OS) after PSM (HAIC vs. lenvatinib, median PFS, 3.6 vs. 4.0 months, p = 0.706; median OS 10.8 vs. 7.9 months, p = 0.106). Multivariate Cox-regression showed that alpha-fetoprotein ≤1000 ng/mL was only an associated factor for OS after PSM in all patients (hazard ratio = 0.421, p = 0.011). Subgroup analysis for patients with a high tumor burden beyond the REFLECT eligibility criteria revealed that the HAIC group (n = 29) had a significantly longer OS than did the lenvatinib group (n = 30) (10.0 vs. 5.4 months, p = 0.004). More patients in the HAIC group achieved better liver function than those in the lenvatinib group at the time of best responses. There was no difference in the incidence of grade 3 and 4 adverse events between the two groups. Therefore, lenvatinib is comparable to HAIC in terms of ORR and OS in unresectable HCC meeting REFLECT eligibility criteria.

Distribution of natural and anthropogenic radionuclides in northwest Mediterranean coastal sediments.

The distribution of radionuclides in NW Mediterranean coastal sediments, and the processes controlling their abundance were investigated in three cores taken near the island of Porquerolles and one offshore Monaco. The sediments collected near Porquerolles were strongly anoxic due to diagenetic processes involved in the decomposition of organic matter, whereas they transitioned from oxic to anoxic at a depth of 4 cm beneath the seawater interface at Monaco. Organic carbon (OC) was more abundant in sediments at Porquerolles (by about a factor of 3-5) than at Monaco and elsewhere in the coastal NW Mediterranean. Sediment cores collected NE of Porquerolles also possessed elevated uranium concentrations that correlated with high OC content and strong reducing conditions. The 239,240Pu and 241Am activities in surficial sediments ranged from 1 to 5.7 Bq kg-1 and 0.3 to 1 Bq kg-1, respectively, while the 137Cs activity ranged from 0.3 to 6.2 Bq kg-1. The mean activity ratios of 241Am/239,240Pu and 238Pu/239,240Pu in Porquerolles and Monaco sediments were similar to the global fallout ratios. Sediment inventories of global fallout 239,240Pu (430-800 Bq m-2) and 241Am (150-285 Bq m-2) were by about a factor of 5-10 higher at Porquerolles, whereas the inventory of 137Cs (430-1000 Bq m-2) was substantially lower at the investigated stations than have been reported elsewhere at similar latitudes. Specific local conditions characterised by high OC sediment loads due to the growth and mortality of Posidonia oceanica have been responsible for deposition of large amounts of seagrass tissues at the NE corner of Porquerolles, which have had a profound effect on the distribution of radionuclides in the sediments.

A preliminary study for the development of reference material using oyster for determination of (137)Cs, (90)Sr and plutonium isotopes.

A new reference material for the determination of (137)Cs, (90)Sr and Pu isotopes ((238)Pu and (239,240)Pu) is being developed using dried oyster matrix by Korea Research Institute of Standards and Science (KRISS). The oyster was collected from Tongyoung harbour, southern part of Korea and the artificial radionuclides ((137)Cs, (90)Sr, (238)Pu and (239,240)Pu) were spiked into the material. After pretreatment and processing, the material was tested for homogeneity and massic activities were determined by measuring (137)Cs, (90)Sr, (238)Pu and (239,240)Pu. The reference value and extended uncertainty for those isotopes will be reported later.

Evaluation of three electrodeposition procedures for uranium, plutonium and americium.

While both mass spectrometry and alpha-particle spectrometry have been widely used for measuring alpha activities, the former is preferred since many laboratories are not equipped with ICP-MS and MC-ICP-MS systems. In this study, three electrodeposition techniques using ammonium chloride, ammonium oxalate and ammonium sulphate as electrolyte solutions were applied and evaluated for the preparation of uranium, plutonium and americium sources for alpha-particle spectrometry. Changes in pH and temperature throughout the electrodeposition process were measured every 15 min, together with percentage deposition every 30 min. The percentage deposition in each method was checked at 300, 400 and 500 mA, and the optimised time and current were determined.

Atmospheric input of ¹³7Cs and 239,240Pu isotopes in Korea after the Fukushima nuclear power plant accident.

Caesium isotopes ((134)Cs and (137)Cs) and (239,240)Pu in rainwater and dry deposition have been analyzed by Korea Research Institute of Standards and Science (KRISS) since the Fukushima nuclear power plant (NPP) accident in March 2011. The concentrations of (239,240)Pu and (137)Cs in the rainwater are 2.6±1.0 to 15±3 µBq/kg and 0.01 to 0.36 mBq/kg, respectively. The concentrations are concordant to those observed before the Fukushima NPP accident, on the other hand, the monthly depositional flux of (239,240)Pu and (137)Cs are much lower than the amounts observed after Fukushima NPP accident and in Monaco in 1998-2001. This confirms that the Fukushima NPP accident caused no significant impact in Korea.

Accumulation of COGEMA-La Hague-derived reprocessing wastes in French salt marsh sediments.

Over the past five decades, authorized low-level discharges from coastal nuclear facilities have released significant quantities of artificial radionuclides into the marine environment. In northwest Europe, the majority of the total discharge has derived from nuclear reprocessing activities at Sellafield in the United Kingdom and COGEMA-La Hague in France. At the Sellafield site, a significant amount of the discharges has been trapped in offshore fine sediment deposits, and notably in local coastal and estuarine sediments, and much research has been focused on understanding the distribution, accumulation, and reworking of long-lived radionuclides in these deposits. In contrast, there are few high-resolution published data on the vertical distribution of radionuclides in fine-grained estuarine sediments near, and downstream of, COGEMA-La Hague. This paper therefore examines the vertical distribution of a range of anthropogenic radionuclides in dated salt marsh cores from two estuaries, one adjacent to, and the other downstream of, the COGEMA-La Hague discharge point (the Havre de Carteret at Barneville-Carteret and the Baie de Somme, respectively). The radionuclides examined show a vertical distribution which predominantly reflects variations in input from COGEMA-La Hague (albeit much more clearly at Barneville-Carteret than at the Baie de Somme site), and Pu isotopic ratios are consistent with a La Hague, rather than weapons' fallout, source. Because of sediment mixing, the marshes apparently retain an integrated record of the La Hague discharges, rather than an exact reproduction of the discharge history. Sorption of radionuclides increases in the order 90Sr < 137Cs < 60Co < 239,240Pu, which is consistent with Kd values reported in the literature. In general, the radionuclide activities observed at the sites studied are low (particularly in comparison with salt marsh sediments near the Sellafield facility), but are similar to those found in areas of fine sedimentation in the central Channel. These marshes are not major sinks for discharged reprocessing wastes.