A comparison of posterior and medial cord stimulation for neurostimulation-guided vertical infraclavicular block: a randomized noninferiority clinical trial.

BACKGROUND: We investigated whether medial cord stimulation is inferior to posterior cord stimulation for vertical infraclavicular block with respect to block success. METHODS: Ninety-six patients scheduled for upper limb surgery were randomly elicited a medial or posterior cord response for infraclavicular block using 40 mL of 0.5% ropivacaine. We assessed block success (complete sensory block of the 5 nerves in the forearm at 50 minutes) as the primary end point and block procedure characteristics and adverse events as secondary end points. RESULTS: The block success rates did not differ significantly between medial and posterior cord stimulation (95.7% [44/46] vs 91.7% [44/48], 95% CI of difference, -7.4% to 15.6%), while the secondary end points were comparable in both groups. CONCLUSIONS: Needle manipulation to elicit medial cord response is noninferior to posterior cord response of block success during neurostimulation-guided vertical infraclavicular block.

Anesthesia management of deep brain stimulation insertion in a patient with generalized idiopathic dystonia: a case report.

Dystonia is a movement disorder in which excessive muscle contractions cause abnormal movement. It is classified according to its clinical manifestations (onset, distribution, temporal and associated features) and etiology (pathology and inheritance). Deep brain stimulation (DBS) is a surgical procedure used to treat medically intractable dystonia. In this study, we aim to share our experience with general anesthesia in systemic idiopathic dystonia that was not controlled by drugs, along with a literature review. A 21-year-old man with generalized idiopathic dystonia and developmental delay was scheduled to undergo deep brain stimulator implantation under general anesthesia. Intubation of the endotracheal tube and fixation of the stereotactic frame were performed in the intensive care unit (ICU) under sedation and neuromuscular blockade before arrival at the operating room. Total intravenous anesthesia was administered. After an uneventful surgery, the patient was discharged to the ICU with an endotracheal tube. As dystonia has a wide clinical spectrum and DBS requires special anesthetic considerations, anesthesiologists should adopt proper anesthetic depth and neuromuscular blockade according to each patient's condition.

Effect of clinical anesthesia preoperative evaluation on the length of preoperative period and total hospitalization of patients undergoing laparoscopic cholecystectomy.

OBJECTIVE: Anesthesia preoperative evaluation clinics (APECs) are currently operating in several South Korean hospitals. While several studies have investigated the impact of APEC operations on the length of total hospital stay (LTHS), few have investigated their impact on the length of preoperative hospital stay (LPHS) for patients. In this study, we aimed to determine whether APEC affected the LPHS and LTHS. METHODS: Data of all patients who underwent surgery at Chungbuk National University Hospital between September 2009 and August 2019 were analyzed retrospectively. All patients who had undergone laparoscopic cholecystectomy over the last 10 years were categorized into two groups: those who visited the APEC (Group A), and those who did not (Group B). The age, sex, American Society of Anesthesiologists physical status score, LPHS, and LTHS of the two groups were compared. RESULTS: The LPHS was 1.03±0.2 days in Group A and 1.61±1.6 days in Group B. The LTHS was 4.77±1.9 days in Group A and 5.63±2.6 days in Group B. The LPHS and LTHS of the two groups differed by 0.58 and 0.9 days, respectively. CONCLUSION: We evaluated the effect of APEC operations on the LPHS and LTHS of inpatients undergoing laparoscopic cholecystectomy and observed a decrease in both the LPHS and LTHS. Understanding and accepting the importance of APEC is significant for physicians and administrators working to improve hospital efficiency and patient outcomes. Further research is needed to investigate the need and benefits of APECs.

A rare case of acute meningitis shortly after lumbar selective nerve root block: a case report.

A 57-year-old man underwent lumbar selective nerve root block (SNRB) for low back pain and lower radiating pain caused by left-sided L4 disc herniation. He presented to the emergency department with fever, headache and aggravated low back pain approximately 3 hours after the procedure. Infection was suspected; hence, blood tests, cerebrospinal fluid (CSF) tests, lumbar magnetic resonance imaging, and brain computed tomography were performed. Imaging findings were not suggestive of infection. The CSF was turbid and yellowish with pleiocytosis; however, the CSF culture was negative. Based on these findings, the patient was diagnosed with acute meningitis. Broad-spectrum antibiotics and steroid therapy were initiated considering the patient's age and general condition. From hospital day (HD) 2, fever and headache were reduced and disappeared completely by HD 5. At the last follow-up, 1 month after discharge, the patient had no symptoms. Acute meningitis is associated with a high mortality and neurologic deficits. Hence, timely tests, diagnosis, and treatment are critical for positive outcomes. Symptoms of meningitis following a nerve block generally occur within 24-48 hours after the procedure. This case is notable, as it involved a quicker and more sudden onset of symptoms; meningitis occurred only a few hours after lumbar selective nerve root block.

Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: A propensity score-matching analysis.

BACKGROUND: We investigated the impact of postreperfusion syndrome (PRS) on hyperglycemia occurrence and connecting (C) peptide release, which acts as a surrogate marker for insulin resistance, during the intraoperative period after graft reperfusion in patients undergoing living donor liver transplantation (LDLT) using propensity score (PS)-matching analysis. PATIENTS AND METHODS: Medical records from 324 adult patients who underwent elective LDLT were retrospectively reviewed, and their data were analyzed according to PRS occurrence (PRS vs. non-PRS groups) using the PS-matching method. Intraoperative levels of blood glucose and C-peptide were measured through the arterial or venous line at each surgical phase. Hyperglycemia was defined as a peak glucose level >200 mg/dL, and normal plasma concentrations of C-peptide in the fasting state were taken to range between 0.5 and 2.0 ng/mL. RESULTS: After PS matching, there were no significant differences in pre- and intra-operative recipient findings and donor-graft findings between groups. Although glucose and C-peptide levels continuously increased through the surgical phases in both groups, glucose and C-peptide levels during the neohepatic phase were significantly higher in the PRS group than in the non-PRS group, and larger changes in levels were observed between the preanhepatic and neohepatic phases. There were higher incidences of C-peptide levels >2.0 ng/mL and peak glucose levels >200 mg/dL in the neohepatic phase in patients with PRS than in those without. PRS adjusted for PS with or without exogenous insulin infusion was significantly associated with hyperglycemia occurrence during the neohepatic phase. CONCLUSIONS: Elucidating the association between PRS and hyperglycemia occurrence will help with establishing a standard protocol for intraoperative glycemic control in patients undergoing LDLT.

Anodic WO3 mesosponge @ carbon: a novel binder-less electrode for advanced energy storage devices.

A novel design for an anodic WO3 mesosponge @ carbon has been introduced as a highly stable and long cyclic life Li-ion battery electrode. The nanocomposite was successfully synthesized via single-step electrochemical anodization and subsequent heat treatment in an acetylene and argon gas environment. Morphological and compositional characterization of the resultant materials revealed that the composite consisted of a three-dimensional interconnected network of WO3 mesosponge layers conformally coated with a 5 nm thick carbon layer and grown directly on top of tungsten metal. The results demonstrated that the carbon-coated mesosponge WO3 layers exhibit a capacity retention of 87% after completion of 100 charge/discharge cycles, which is significantly higher than the values of 25% for the crystalline (without carbon coating) or 40% for the as-prepared mesosponge WO3 layers. The improved electrochemical response was attributed to the higher stability and enhanced electrical conductivity offered by the carbon coating layer.

Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000.

BACKGROUND: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. METHODS: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. RESULTS: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs. FMS, 35.4℃, P = 0.122). CONCLUSIONS: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.

Comparative electrochemical analysis of crystalline and amorphous anodized iron oxide nanotube layers as negative electrode for LIB.

This work is a comparative study of the electrochemical performance of crystalline and amorphous anodic iron oxide nanotube layers. These nanotube layers were grown directly on top of an iron current collector with a vertical orientation via a simple one-step synthesis. The crystalline structures were obtained by heat treating the as-prepared (amorphous) iron oxide nanotube layers in ambient air environment. A detailed morphological and compositional characterization of the resultant materials was performed via transmission electron microscopy (TEM), field-emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), and Raman spectroscopy. The XRD patterns were further analyzed using Rietveld refinements to gain in-depth information on their quantitative phase and crystal structures after heat treatment. The results demonstrated that the crystalline iron oxide nanotube layers exhibit better electrochemical properties than the amorphous iron oxide nanotube layers when evaluated in terms of the areal capacity, rate capability, and cycling performance. Such an improved electrochemical response was attributed to the morphology and three-dimensional framework of the crystalline nanotube layers offering short, multidirectional transport lengths, which favor rapid Li(+) ions diffusivity and electron transport.

Effects of Aromatherapy on Stress, Sleep, Nausea and Vomiting during Patient Controlled Analgesia Treatment of Patients with Hysterectomy.

PURPOSE: The purpose of study was to examine effects of aromatherapy on stress, sleep, nausea and vomiting of women after laparoscopic hysterectomy. METHODS: The participants were 60 women who had laparoscopic hysterectomy: experiment group for aromatherapy (n=30) and control group for routine care (n=30). The experimental group received inhalation aromatherapy for 5 minutes, twice; the first was done right after the operation, the second was at 9 pm before sleep on the same day--while the control group had no inhalation. Data were collected from July to September, 2012 at G hospital. RESULTS: The degree of psychological stress was not significantly different between two groups (t=-1.96, p= .054). Yet, there were significant differences between two groups for degree of physiological stress (t=-3.20, p= .002), the level of cortisol (t=-2.01, p= .049), the score of sleep status (t=2.47, p= .016), the score of sleep satisfaction (t=2.43, p= .018), and the score for nausea and vomiting (t=-2.58, p= .012). CONCLUSION: Inhalation aromatherapy using the mixed oil of lavender, mandarin, and marjoram was effective in decreasing the level of physiological stress, cortisol, and the score for nausea and vomiting, and also allowed the participants to have a better sleep. Therefore, inhalation aromatherapy could be effective in improving the quality of life of these women during recovery.

The state of CD4+ T cell activation is a major factor for determining the kinetics and location of T cell responses to oral antigen.

Current models suggest that inductive immune responses to enteric Ag are initiated in Peyer's patches (PP) and mesenteric lymph nodes (MLN) followed by migration of activated, memory-like CD4(+) T cells to extralymphoid sites in the intestinal lamina propria (LP). The resultant immune system contains both naive and activated T cells. To examine the differential responses of naive and memory-like T cells to oral Ag, bone marrow chimeras (BMC) were generated. Irradiated BALB/c hosts were reconstituted with a mix of DO11.10 x RAG-1(-/-) and BALB/c bone marrow. In unprimed DO11.10 and BMC models, LP and PP DO11.10 T cells responded to oral Ag with similar kinetics. Responses of activated, memory-like T cells to oral Ag were examined in thymectomized BMC 60 days after i.p. immunization with OVA peptide in Freund's adjuvant (OVA(323-339)/CFA). Results indicate that i.p. OVA(323-339)/CFA generated a high proportion of memory-like CD45RB(low) DO11.10 T cells in peripheral lymphoid (40%) and intestinal LP (70%) tissue. Previously activated DO11.10 T cells in the LP responded to oral Ag earlier and at 50% higher levels compared with memory CD4(+) T cells localized to PP tissue. These data indicate that responses to oral Ag in antigenically naive animals are initiated in PP whereas in Ag-experienced animals LP T cells respond earlier and more vigorously than cells in PP. Taken together, these data suggest that previous activation alters the hierarchy of T cell responses to oral Ag by enhancing the efficiency of LP T cell activation.

Increased levels of IgG to cytokeratin 19 in sera of patients with toluene diisocyanate-induced asthma.

BACKGROUND: Inhaled isocyanate binds with cytokeratin (CK) of the epithelial cells, which could induce immune responses. OBJECTIVE: To elucidate the possible existence of an isocyanate-induced, asthma-associated autoantigen from the bronchial epithelial cells, which may be associated with toluene diisocyanate (TDI)-induced asthma development. METHODS: We cultured bronchial epithelial cells with incubation of TDI-human serum albumin (HSA) conjugate. Gene expression profiles of cultured epithelial cells were analyzed using a microarray technique. CK19 protein expression within the epithelial cells was confirmed by IgG immunoblot using monoclonal antibody to CK19. Serum IgG to CK19 and specific IgG and IgE antibodies to TDI-HSA conjugate were detected by enzyme-linked immunosorbent assay in 68 TDI asthma patients (group 1) and compared with 40 allergic asthma patients (group 2) and 80 unexposed healthy controls (group 3). RESULTS: After TDI exposure, increased expression of CK19 and CK14 genes from the culture bronchial epithelial cells was noted using microarray analysis. IgG immunoblot analysis confirmed increased expression of CK19 after the TDI exposure. The levels of serum IgG to CK19 were significantly higher in the TDI asthma group than in groups 2 and 3 (P=.008). The prevalence of IgG to CK19 was significantly higher in group 1 (38.2%) than group 2 (22.5%) or group 3 (1.3%) (P=.008). Significant associations were noted between IgG to CK19 and specific IgG to TDI-HSA conjugate and transglutaminase (P=.02) but not with specific IgE to TDI-HSA conjugate. CONCLUSION: We suggest that TDI exposure can augment CK19 expression from the bronchial epithelial cell, which may involve immune responses as an autoantigen to induce airway inflammation in TDI-induced asthma.

Two-spotted spider mite allergy: immunoglobulin E sensitization and characterization of allergenic components.

BACKGROUND AND OBJECTIVE: Previous investigations demonstrated that two-spotted spider mite (TSM) inhalation causes allergic asthma in agricultural workers. This work investigates whether TSM causes similar problems in the urban population. We determined the sensitization rate to TSM. We also identified immunoglobulin (Ig)E-binding components and evaluated their relationship with house-dust mite (HDM) allergens. METHODS: We carried out skin prick test (SPT) with TSM in 1,806 respiratory allergy patients over 1 year. TSM-IgE was detected by enzyme-linked immunoadsorbent assay (ELISA). TSM-sensitized patients were classified into two groups: patients who were skin test-positive to both TSM and HDM were included in group A and patients who were skin test-positive to TSM only were included in group B. ELISA inhibition test using sera from group A and B were conducted. IgE-immunoblotting was used to identify major allergens. These were purified by 2-dimensional electrophoresis and blotted onto polyvinylidene difluoride, and N-terminal sequences were identified. RESULTS: SPT (> or = 2+ of allergen/histamine) was positive in 358 (19.8%) patients. Twelve (6.6%) showed positive response to TSM only, and 54.5% had positive specific IgE. ELISA inhibition test using sera from two groups showed significant inhibition by TSM with minimal inhibition by HDM. Amino acid sequence of three major allergens was not homologous with any previously characterized allergens. CONCLUSION: IgE-sensitization rate to TSM was 19.8% in respiratory allergy patients. Eleven IgE-binding components and three major allergens were identified. The pIs and amino acid sequences of the major allergens were determined.

Generation and analysis of end sequence database for T-DNA tagging lines in rice.

We analyzed 6749 lines tagged by the gene trap vector pGA2707. This resulted in the isolation of 3793 genomic sequences flanking the T-DNA. Among the insertions, 1846 T-DNAs were integrated into genic regions, and 1864 were located in intergenic regions. Frequencies were also higher at the beginning and end of the coding regions and upstream near the ATG start codon. The overall GC content at the insertion sites was close to that measured from the entire rice (Oryza sativa) genome. Functional classification of these 1846 tagged genes showed a distribution similar to that observed for all the genes in the rice chromosomes. This indicates that T-DNA insertion is not biased toward a particular class of genes. There were 764, 327, and 346 T-DNA insertions in chromosomes 1, 4 and 10, respectively. Insertions were not evenly distributed; frequencies were higher at the ends of the chromosomes and lower near the centromere. At certain sites, the frequency was higher than in the surrounding regions. This sequence database will be valuable in identifying knockout mutants for elucidating gene function in rice. This resource is available to the scientific community at http://www.postech.ac.kr/life/pfg/risd.