Pretreatment with remifentanil to prevent withdrawal after rocuronium in children

BACKGROUND

Pain from rocuronium injection is a common side-effect reported to occur in 50-80% of the patients. This randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy of pretreatment with i.v. remifentanil on prevention of withdrawal response during rocuronium injection in paediatric patients.

METHODS

After obtaining parental consents, 70 paediatric patients were randomly allocated into two groups to receive either i.v. remifentanil 1 mug kg(-1) (remifentanil group, n=35) or i.v. saline 5 ml (saline group, n=35). Anaesthesia was induced with thiopental sodium 2.5% (5 mg kg(-1)) and the test drug was injected over 30 s. One minute after the test drug injection, rocuronium 1% (0.6 mg kg(-1)) was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate were recorded on arrival in the operating theatre, before and 1 min after the tracheal intubation.

RESULTS

The overall incidence of withdrawal movements was significantly higher in the saline group (33 patients; 94%) than that in the remifentanil group (8 patients; 23%) (P<0.001). No patient in the remifentanil group showed generalized movement, whereas 51% of patients in the saline group did. Remifentanil prevented significant increase in MAP after intubation.

CONCLUSION

This study demonstrated that pretreatment with remifentanil 1 microg kg(-1) provided a safe and simple method for reducing the incidence of rocuronium-associated withdrawal movement with haemodynamic stability in children.

Determination of the optimal angle for needle insertion during caudal block in children using ultrasound imaging

Using ultrasound imaging, the optimal angle for needle insertion during caudal epidural injection in children was estimated. After general anaesthesia, ultrasonography was performed at the sacral hiatus in 130 children aged 2-84 months positioned in the lateral position. The median [range] values for the intercornual, caudal space depth and the distance from skin to the posterior sacral bony surface were 17.0 [9.6-24] mm, 3.5 [1-8] mm and 21.0 [10-39] mm, respectively. The optimal angle showed no significant correlation with age, weight, height or body surface area. The median [range] calculated optimal angle for the needle was 21.0 [10-38] degrees. We conclude that the needle should be inserted at about 20 degrees to the skin to avoid puncture of the bone and potential intra-osseous injection.

Laboratory-scale analysis of effect of plume spacing of air diffuser system on destratification efficiency

This paper presents a study conducted to develop guidelines for the design of an air bubble destratification system, with particular concern given to plume spacing. To investigate the effect of plume spacing on the destratification efficiency of the system, we first conducted a dimensional analysis that included major variables in bubble hydrodynamics. Then, we conducted laboratory experiments with various plume spacings and water depths under non-linear stratification conditions, and we evaluated the destratification efficiencies. Our results showed that the highest efficiency was obtained with a plume spacing of 0.75 times the water depth. Our study has shown that the overall efficiency of an air diffuser system can be increased by changing the spacing between diffusers and that plume spacing should be a major design parameter for future air diffuser systems.

Nodal staging in genitourinary cancers

In patients with genitourinary cancers nodal staging is an integral part of the pretreatment evaluation. The presence of nodal metastatic disease plays an important role in predicting prognosis and treatment planning. Although some nodal groups can be evaluated clinically, most patients undergo various imaging studies for nodal staging. Each modality has its own unique attributes and applications. This article reviews various imaging modalities, namely, contrast enhanced computerized tomography, magnetic resonance imaging (MRI), and positron emission tomography, used for nodal staging in patients with genitourinary cancers and highlights their strengths and weaknesses. Emerging novel techniques such as lymphotropic nanoparticle enhanced MRI are also highlighted.

The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy

BACKGROUND

Although epidural opioids have excellent analgesic property, their side-effects limit its use in patient-controlled epidural analgesia (PCEA). This study was designed to compare side-effects of epidural sufentanil in ropivacaine with that of morphine in ropivacaine focusing on lower urinary tract function after major abdominal surgery.

METHODS

In total 60 patients undergoing gastrectomy were randomly allocated to receive either sufentanil in ropivacaine (Group S, n=30) or morphine in ropivacaine (Group M, n=30) for their PCEA. Epidural catheter was inserted between the 7th and 8th thoracic spine. Visual analogue pain score and side-effects such as nausea, vomiting, pruritus, hypotension and urinary retention were evaluated during postoperative days (PODs) 1 and 2 in the postanaesthetic care unit.

RESULTS

The incidence of serious to major micturition problem in Group S was lower than that in Group M (P<0.001). The incidence of pruritus, nausea and vomiting was also lower in Group S than in Group M on POD 1.

CONCLUSIONS

The lower incidence of major/serious micturition problem in patients receiving sufentanil in ropivacaine thoracic epidural analgesia suggests that continuation of urinary drainage may not be necessary from POD 1 onwards.

Chilaiditi syndrome caused by Fitz-Hugh-Curtis syndrome: multidetector CT findings

Chilaiditi syndrome is a condition in which the colon or small intestine is interposed temporarily or permanently between the liver and the diaphragm. Usually, it is an asymptomatic and incidental radiographic finding, but it may be a potential source of abdominal problems, ranging from intermittent mild abdominal pain to acute intestinal obstruction. We report multidetector computed tomographic findings of a case of Chilaiditi syndrome presenting as small bowel obstruction due to hepatodiaphragmatic interposition of the ileal loop, which was entrapped by adhesive bands caused by Fitz-Hugh-Curtis syndrome.

Improved search for nu(mu) --> nu(e) oscillation in a long-baseline accelerator experiment

We performed an improved search for nu(mu) --> nu(e) oscillation with the KEK to Kamioka (K2K) long-baseline neutrino oscillation experiment, using the full data sample of 9.2 x 10(19) protons on target. No evidence for a nu(e) appearance signal was found, and we set bounds on the nu(mu) --> nu(e) oscillation parameters. At Deltam(2)=2.8 x 10(-3) eV(2), the best-fit value of the K2Knu(mu) disappearance analysis, we set an upper limit of sin(2)2theta(mue) < 0.13 at a 90% confidence level.

Genetic variation at the perilipin locus is associated with changes in serum free fatty acids and abdominal fat following mild weight loss

OBJECTIVE

Perilipin (PLIN) is a class of protein-coating lipid droplets in adipocytes. We aimed to examine the association between common single-nucleotide polymorphisms (SNPs) at PLIN locus with circulating free fatty acid (FFA) and abdominal fat distribution in response to weight loss.

METHODS

Non-diabetic/overweight-obese Koreans (n=177) participated in a 12-week calorie restriction (-300kcal/day) program. Seven SNPs (6209T>C, 10076C>G, 10171A>T, 11482G>A, 13042A>G, 13048C>T and 14995A>T), abdominal fat areas (visceral/subcutaneous fat areas at 1st lumbar and 4th lumbar levels), serum lipids, glucose, insulin, FFA, oxidized low-density lipoprotein (LDL) and urinary 8-epi-prostaglandin F(2alpha) (PGF(2alpha)) were examined.

RESULTS

Single-nucleotide polymorphisms 10076C>G/10171A>T showed the strongest positive linkage disequilibrium (LD) (D'=0.923, R (2)=0.839, P<0.001) and SNPs11482G>A/14995A>T showed moderate positive LD (D'=0.824, R (2)=0.578, P<0.001). Calorie restriction induced 4.6% weight loss with significant abdominal fat reduction. In response to weight loss, subjects with nCA/nCA haplotypes at SNPs 10076C>G/10171A>T showed greater reduction in FFA levels than those with CA/CA haplotype (CA/CA: C/C at SNP 10076 and A/A at SNP 10171, nCA: non-CA haplotype carrier). On the other hand, subjects with nGA/nGA haplotype at SNPs 11482G>A/14995A>T had increased FFA levels with a rapid loss in abdominal fat, whereas GA/GA haplotype carriers had reduction in FFA levels. These results still remained significant after adjusting for age, gender and BMI. Prostaglandin F(2alpha) and oxidized LDL were also more reduced in GA/GA haplotype carriers than in nGA haplotype carriers. This effect remained significant after adjusting for baseline level, age, gender and BMI. Paradoxically, nGA haplotype carriers had increased levels of urinary PGF(2alpha) after weight reduction.

CONCLUSION

Fasting plasma FFA changes following a modest weight loss in overweight-obese subjects are influenced by the genetic variability at the PLIN locus. Furthermore, circulating FFA changes rather than body fat itself may determine changes in lipid peroxides such as urinary PGF(2alpha) and oxidized LDL.

Determination of biodegradation potential by two culture-independent methods in PAH-contaminated soils

Biodegradation potentials of polycyclic aromatic hydrocarbons (PAHs) were determined with soil samples collected from various depths of a PAH-contaminated site and of a site nearby where PAHs were not found. Putative dioxygenase genes were amplified by a primer set specific for initial dioxygenases and identified by web-based database homology search. They were further categorized into several groups of which four dioxygenases were selected as probes for DNA hybridization. The hybridization signals according to the presence of putative dioxygenases were positively related to the extent of PAH contamination. However, the signal intensities varied depending on the probes hybridized and moreover were not consistent with PAH biodegradation activities determined by CO2 evolution. Despite widely accepted advantages of molecular biodegradation assessment, our data clearly present the variations of assessment results depending on the genetic information used and suggest that the methodology may tend to underestimate the real biodegradation capacity of a site probably due to the limited dioxygenase database available at the moment. Therefore, the molecular assessment of biodegradation potential should involve a very careful primer and probe design and an extensive microbiological examination of a site of interest to accurately delineate the biodegradation potential of the site.

Weight loss effect on inflammation and LDL oxidation in metabolically healthy but obese (MHO) individuals: low inflammation and LDL oxidation in MHO women

OBJECTIVE

Recently, a subtype of obesity characterized as a metabolically healthy but obese (MHO) individual has been identified. However, limited data are available on these MHO individuals' metabolic and inflammatory profiles, and the effect of weight loss on these profiles. We investigated metabolic and inflammatory markers in MHO women to determine the effects of a 12-week weight loss on those markers.

SUBJECTS

One hundred and twenty-nine overweight-obese Korean women participated for 12 weeks in a clinical intervention study involving a 300 kcal/day intake reduction. The subjects were divided into two groups: MHO and metabolically abnormal obese (MAO) individuals.

METHODS

Computed tomography was performed. C-reactive protein (CRP), interkeukin-6 (IL-6) and oxidized low-density lipoprotein (LDL), as well as blood lipids, glucose and insulin concentrations were determined at baseline and after weight loss.

RESULTS

At baseline, plasma CRP (P<0.001), IL-6 (P<0.05) and oxidized LDL (P<0.001) levels were significantly lower in the MHO group than in the MAO group. Visceral fat at L1 (P<0.005) and visceral fat at L4 (P<0.001) were significantly lower in the MHO group than in the MAO group. The treatment induced weight loss averaging 3.11% of initial body weight, and the degree of weight loss between the two groups was similar. Visceral fat at L1 and L4 was reduced from its initial values by 3.2 and 5.4%, respectively, after weight loss. The levels of CRP (P<0.05) and oxidized LDL (P<0.01) were significantly reduced in the MAO group after the 12-week weight loss, whereas these effects were not seen in the MHO group.

CONCLUSIONS

Our results showed that MHO individuals exhibited lower visceral fat accumulation and more favorable metabolic and inflammatory states than MAO individuals. After a 12-week weight loss program, significant reductions in blood lipids, CRP and oxidized LDL levels were observed in MAO individuals. However, there was no measurable effect of weight loss on lipid profiles and inflammation in MHO individuals, indicating differing effects of weight loss on these markers between MAO and MHO groups.

AtBAG6, a novel calmodulin-binding protein, induces programmed cell death in yeast and plants

Calmodulin (CaM) influences many cellular processes by interacting with various proteins. Here, we isolated AtBAG6, an Arabidopsis CaM-binding protein that contains a central BCL-2-associated athanogene (BAG) domain. In yeast and plants, overexpression of AtBAG6 induced cell death phenotypes consistent with programmed cell death (PCD). Recombinant AtBAG6 had higher affinity for CaM in the absence of free Ca2 + than in its presence. An IQ motif (IQXXXRGXXXR, where X denotes any amino-acid) was required for Ca2 +-independent CaM complex formation and single amino-acid changes within this motif abrogated both AtBAG6-activated CaM-binding and cell death in yeast and plants. A 134-amino-acid stretch, encompassing both the IQ motif and BAG domain, was sufficient to induce cell death. Agents generating oxygen radicals, which are known to be involved in plant PCD, specifically induced the AtBAG6 transcript. Collectively, these results suggest that AtBAG6 is a stress-upregulated CaM-binding protein involved in plant PCD.

Mitochondrial DNA content is decreased in autosomal dominant optic atrophy

BACKGROUND

Autosomal dominant optic atrophy (ADOA) is the commonest form of inherited optic neuropathy. Mutations in the OPA1 gene encoding a dynamin-related mitochondrial protein underlie ADOA and may perturb the biogenesis and maintenance of mitochondria.

OBJECTIVE

To investigate the mutation spectrum of the OPA1 gene and assess alterations in mitochondrial content caused by OPA1 mutations.

METHODS

Sixteen Korean patients with clinically suspected ADOA were studied. The mutation spectrum of the OPA1 gene was analyzed by PCR single-strand conformation polymorphism and sequencing, and mitochondrial DNA (mtDNA) content was quantified by real-time PCR.

RESULTS

Eight different mutations were found, including five novel mutations. Quantitative real-time PCR analysis showed excellent linearity and precision for the determination of mtDNA copy numbers. The number of mtDNA copies per cell in patients with OPA1 gene mutations (ages 7 to 40) was significantly lower than those in all normal control subjects (p = 0.037), particularly lower than in normal control subjects ages 10 to 39 (p = 0.022).

CONCLUSION

The mutation spectrum of the OPA1 gene disclosed marked genetic heterogeneity and the mitochondrial DNA content was found to be lower in autosomal dominant optic neuropathy, which provides direct evidence for a pathogenetic role of mutations of the OPA1 gene.

Surgical treatment for congenital arteriovenous malformation: 10 years' experience

OBJECTIVES

We report our 10 years experience of the surgical treatment of congenital arteriovenous malformation (AVM).

METHODS

We retrospectively reviewed the medical records of 145 patients with AVM who visited Samsung Medical Center in Korea from 1994 to 2003. Among the 145 patients, 21 patients were operated on. Preoperative embolo/sclerotherapy was done in 20 out of the 21 patients.

RESULTS

The surgically treated AVMs were 13 cases of head and neck lesions, four cases of upper extremity lesions, one case each of back lesion, uterus lesion, lower extremity lesion and multiple site lesions. There were 10 patients with the extratruncular infiltrating type, nine patients with the extratruncular limited type, one patient with a truncular superficial AV fistula and one patient with a mixed type. Fourteen cases were operated on for cosmetic reasons and since they had localized lesions, and five cases were operated on for tissue necrosis. Fourteen cases were cured by a single operation, yet seven cases needed several sessions of operation to cure the AVM or to promote wound healing after surgery.

CONCLUSION

The surgical treatment of AVM is a challenging issue for vascular surgeons. To minimise the complications related to surgery, a multidisciplinary team approach should be considered.

Effect of leptin on insulin resistance of muscle – direct or indirect?

We examined the effect of leptin on the insulin resistance in skeletal muscles by measuring glucose transport. Male Wistar rats were fed rat chow or high-fat diets for 30 days. Before sacrifice, rats fed high-fat diet were subcutaneously injected with leptin (1 mg/kg b.w.) for 3 days. The glucose transport in epitrochlearis and soleus muscles did not differ in the experimental groups under basal conditions, however these values decreased significantly in the rats fed high-fat diet under insulin stimulation (p<0.01). Leptin treatment recovered the decreased glucose transport in epitrochlearis (p<0.05) and soleus muscles (p=0.08). Triglyceride concentrations in soleus muscles were increased significantly in the rats fed high-fat diet as compared to rats fed chow diet (p<0.01), and were decreased significantly by leptin treatment (p<0.01). The glucose transport was measured under basal conditions and after 60 microU/ml of insulin treatment with or without 50 ng/ml of leptin. Leptin had no direct stimulatory effect on glucose transport under both basal and insulin-stimulated conditions in vitro. These results demonstrate that leptin injection to rats fed high-fat diet recovered impaired insulin responsiveness of skeletal muscles and muscle triglyceride concentrations. However, there was no direct stimulatory effect of leptin on insulin sensitivity of skeletal muscles in vitro.

Transposition of the Left Renal Vein in Nutcracker Syndrome

Mesoaortic compression of left renal vein produces left renal vein hypertension resulting in left flank pain, hematuria and pelvic-ureteral varices. This is called the nutcracker syndrome. The nutcracker syndrome has been treated in various ways. We recently experienced two cases of patients with nutcracker syndrome. We treated the patients with transposition of their left renal vein.

Chimerism and mosaicism are important causes of ABO phenotype and genotype discrepancies

Discrepancies between blood group genotype and RBC phenotype are important to recognize when implementing DNA-based blood grouping techniques. This report describes two such cases involving the ABO blood group in the Korean population. Propositus #1 was a 22-year-old healthy man undergoing pretransfusion testing for minor surgery. Propositus #2 was a 23- year-old male blood donor. RBCs from both propositi were determined to be group AB and demonstrated unusual agglutination patterns on forward typing, which were inconsistent with their ABO genotype determined by allele-specific (AS) PCR. RBCs from propositus #1 demonstrated mixed field agglutination with both anti-A and -B, while RBCs from propositus #2 demonstrated mixed field only with anti-A reagents. Both had B/O genotypes by AS-PCR. Cloning and sequencing of ABO exons 6 and 7 revealed three alleles in both propositi: propositus #1: A102/B101/O04; propositus #2: A102/B101/O01. A panel of nine short-tandem repeat (STR) loci was tested on DNA extracted from blood, buccal mucosal cells, and hair from the propositi and on DNA isolated from their parents' blood. In all tissues tested from propositus #1, three loci demonstrated a double paternal and a single maternal DNA contribution, indicating that he was a chimera or a mosaic; in those from propositus # 2, one STR locus demonstrated a double paternal DNA contribution, indicating that he was a tetragametic chimera. Chimerism and mosaicism are uncommon but important causes of ABO genotype and phenotype discrepancies. The evaluation of patients and donors with unusual or unexpected serology in pretransfusion testing and consensus ABO alleles may include the evaluation of STR loci to detect these phenomena.

Search for coherent charged pion production in neutrino-carbon interactions

We report the result from a search for charged-current coherent pion production induced by muon neutrinos with a mean energy of 1.3 GeV. The data are collected with a fully active scintillator detector in the K2K long-baseline neutrino oscillation experiment. No evidence for coherent pion production is observed, and an upper limit of is set on the cross section ratio of coherent pion production to the total charged-current interaction at 90% confidence level. This is the first experimental limit for coherent charged pion production in the energy region of a few GeV.

Comparative effect of seeds of Rhynchosia volubilis and soybean on MG-63 human osteoblastic cell proliferation and estrogenicity

The seeds of Rhynchosia volubilis (SRV) (Leguminosae) and soybean have been used in oriental folk medicine to prevent postmenopausal osteoporosis. Their beneficial effects are caused by a high content of isoflavone, which function as partial agonists or antagonists of estrogen. To compare the estrogenic effects of SRV and soybean on the MG-63 osteoblastic cell proliferation, 70% methanol extracts of SRV or soybean were treated on MG-63 cells. Although biphasic over a concentration range of 0.001 mg/ml-0.1 mg/ml, both SRV and soybean extracts increased MG-63 cell proliferation. However SRV was more effective at increasing the cell proliferation that paralleled with the greater estrogenic effects as determined by estrogen receptor alpha (ERalpha) expression, an estrogenic response element (ERE)-luciferase activity and the selective expression of insulin-like growth factor-I (IGF-I). SRV-induced IGF-I expression resulted from increases in the mRNA levels. Despite the increased expression of ERbeta, ERE activity and IGF-I expression by soybean were lower than those by SRV. Furthermore, the comparable estrogenic effects between SRV and the combined treatment of genistein and daidzein standards at 0.5 x 10(-8) M, which is a concentration of these two isoflavones similar to that of SRV at 0.001 mg/ml, demonstrate that the greater estrogenicity of SRV for MG-63 cell proliferation is mediated by the synergism of low levels of isoflavones for the selective expression of IGF-I.

The haemodynamic effects of propranolol and atenolol medication on dobutamine infusion in patients with coronary artery obstructive disease

We compared the haemodynamic effects of beta-blockers on dobutamine infusion in 60 patients undergoing coronary artery bypass graft surgery. All patients had been taking propranolol (n = 30) or atenolol (n = 30) pre-operatively for at least 1 month. After sternotomy, dobutamine was infused at 2 microg/kg per min, and the dose increased to 4 microg/kg per min and then 8 microg/kg per min, at 15-min intervals. In both groups, dobutamine infusion did not increase the cardiac index or the heart rate, but was associated with an increase in mean arterial pressure, systemic vascular resistance index and mean pulmonary arterial pressure in a dose-dependent manner. The haemodynamic responses to dobutamine infusion were similar in the two groups. We conclude that pre-operative medication with beta-blockers reduced the inotropic and chronotropic effects of dobutamine infusion. There was no difference between the modification produced by propranolol, a non-selective beta-blocker, and that produced by atenolol, a selective beta1-blocker, however.

Bovine and canine transferrin inhibit the growth of Malassezia pachydermatis in vitro

Transferrin, an iron-binding beta-globulin protein that transports iron to mammalian cells, may contribute to innate immunity to fungal pathogens, primarily by limiting microbial access to iron. We investigated whether unsaturated (apo) canine and bovine transferrin had an inhibitory effect in vitro on Malassezia pachydermatis, an important opportunistic cutaneous yeast pathogen of dogs. M. pachydermatis strains were grown at 32 degrees C in 96-well culture plates using Sabouraud's liquid medium containing canine or bovine apo-transferrin at concentrations ranging from 10.6 to 0.7 mg/ml. Optical densities (OD492) in the treated and control wells were measured and then compared between treatments. Bovine and canine transferrin inhibited (P < 0.01) yeast growth at all concentrations tested after five and six days of incubation; inhibition by 5.3 mg/ml exceeded (P < 0.05) that of 0.7 mg/ml on day six. Unsaturated and saturated bovine transferrin had comparable inhibitory effects on the growth of four strains, indicating that the inhibitory effects of transferrin on M. pachydermatis are not dependent upon iron depletion. These studies suggest that transferrin may contribute to innate immunity to M. pachydermatis in dogs and cattle.

Changes in jugular bulb oxygen saturation during off-pump coronary artery bypass graft surgery

BACKGROUND

The effect of haemodynamic derangement during coronary artery anastomosis in off-pump coronary artery bypass surgery on cerebral blood flow has not been elucidated. Jugular bulb oxygen saturation is a useful indicator of cerebral blood flow provided that the cerebral metabolic rate is constant. This study was designed to evaluate the changes in jugular bulb oxygen saturation during off-pump coronary artery bypass surgery.

METHODS

With IRB approval, 48 patients were included. After anaesthesia, an 18-G catheter was introduced into the jugular bulb. Haemodynamic variables and oxygen profiles from gas analysis of jugular bulb blood and arterial blood were obtained: after sternotomy (baseline); at 5 min after the beginning of the anastomosis of the left anterior descending artery, obtuse marginal artery, and right coronary artery; and after sternal closure.

RESULTS

Cardiac index and mixed venous oxygen saturation decreased significantly during anastomosis of all three arteries compared to the baseline value. Although the changes in jugular bulb oxygen saturation during anastomosis were statistically significant compared to its baseline value, jugular bulb oxygen saturation remained within normal limit throughout the study.

CONCLUSIONS

Jugular bulb oxygen saturation, which represents the global cerebral oxygenation, was well maintained during the anastomosis of all coronary arteries despite significant haemodynamic changes during off-pump coronary artery bypass (OPCAB).