Chemical and isotopic compositions of bottled waters sold in Korea: chemical enrichment and isotopic fractionation by desalination

A total of 54 Korean bottled waters were investigated to characterize their origins and types using elemental and isotopic composition, as well as to identify elemental and isotopic changes in desalinated marine water that arise due to desalination. The different types of bottled water displayed a wide pH range (3.42 to 7.21). The elemental compositions of still and sparkling waters were quite similar, whereas desalinated marine water was clearly distinguished by its high concentrations of Ca, Mg, B, and Cl. In addition, desalinated marine water had much higher isotope ratios of oxygen and hydrogen (-0.5 and -2‰, respectively) than still and sparkling waters (-8.4 and -57‰). The elemental composition of desalinated marine water was adjusted through post-treatment procedures; in particular, boron was greatly enriched during desalination processes. The carbon isotope compositions of dissolved inorganic carbon (δ(13)C(DIC) values) varied widely according to the origins of the bottled waters (-25.6 to -13.6‰ for still water, -31.2 to -26.7‰ for sparkling water, and -24.1 to -6.3‰ for desalinated marine water). This indicates that carbon isotopes in dissolved inorganic carbon are significantly fractionated by desalination processes and re-modified through post-treatment procedures. The results suggest that combined elemental and stable isotopic tracers are useful for identifying the origin of bottled water, verifying elemental and isotopic modifications during desalination processes, and characterizing various water types of bottled waters.

Does stroke volume variation predict intraoperative blood loss in living right donor hepatectomy?

BACKGROUND

Although stroke volume variation (SVV) is a valuable index of preload responsiveness, there is limited information about the association between low SVV and increased hepatectomy-related bleeding. We therefore evaluated whether SVV predicts blood loss during living donor hepatectomy.

METHODS

We evaluated 93 adult liver donors undergoing right hepatectomy for transplantation. Arterial blood pressure, heart rate, body temperature, central venous pressure, SVV, cardiac output, and systemic vascular resistance were measured. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine independent factors and optimal cutoff values of hemodynamic parameters for predicting intraoperative blood loss ≥ 700 mL.

RESULTS

Of these 93 donors, 36 (38.7%) had blood loss ≥ 700 mL. Univariate logistic regression analysis showed that factors associated with blood loss ≥ 700 mL included heart rate, SVV, cardiac output, and systemic vascular resistance. Multivariate logistic regression analysis revealed that only SVV was an independent predictor of blood loss ≥ 700 mL. ROC curve analysis showed that the optimal cutoff value for SVV predicting blood loss ≥ 700 mL was 6% (area under the curve = 0.64).

CONCLUSIONS

SVV is a significant independent predictor of blood loss ≥ 700 mL during donor hepatectomy, suggesting that low SVV may provide useful information on intraoperative bleeding in donors undergoing right hepatectomy.

Evaluation of intraoperative brain natriuretic peptide as a predictor of 1-year mortality after liver transplantation

BACKGROUND

Although brain natriuretic peptide (BNP), a marker of cardiac dysfunction, has been known to predict postoperative mortality, little is known about the postoperative prognostic ability of BNP in liver transplantation (OLT) recipients. We aimed to determine whether intraoperative BNP level can predict 1-year all-cause mortality after OLT.

METHODS

We retrospectively investigated 525 OLT recipients. BNP and hemodynamic parameters were simultaneously measured 1 hour after induction of anesthesia. Cox regression analysis and receiver operating characteristic curve analysis were performed to determine clinical predictors and optimal cutoff values of post-OLT mortality.

RESULTS

The 1-year all-cause mortality rate was 9.7% (51/525). Median BNP concentration was significantly higher in nonsurvivors than in survivors (114 vs 56 pg/mL, P < .001). Significant factors in univariate Cox regression analysis were Child-Pugh score, model for end-stage liver disease (MELD) score, logBNP, hemoglobin, creatinine, heart rate, systolic pulmonary arterial pressure, and central venous pressure. In multivariate Cox regression analysis, independent predictors of posttransplant mortality were MELD score and logBNP. However, simultaneously measured hemodynamic parameters did not remain predictors. BNP levels greater than a cutoff of 136 pg/mL (specificity = 83.5%, negative predictive value = 93.6%) were associated with increased post-OLT mortality (log-rank test P < .001).

CONCLUSIONS

Intraoperative BNP level is an independent predictor of 1-year all-cause mortality after OLT with a high negative predictive value, suggesting that its measurement appears useful in identifying patients at low risk of post-OLT mortality.

A multianalytical approach for determining the geographical origin of ginseng using strontium isotopes, multielements, and 1H NMR analysis

Asian ginseng (Panax ginseng C.A. Meyer) is widely used as an Oriental medicine in the East Asian regions, particularly Korea and China. In the study, the strontium isotope ratios ((87)Sr/(86)Sr), multielements, and metabolite profiles of 35 ginseng samples collected from Korea and China were examined in an attempt to develop a method to distinguish the origin of ginsengs from the two countries. A multivariate statistical approach was performed to analyze the multielements and the (1)H nuclear magnetic resonance (NMR) data. Results of a t-test for Mg, Fe, Al, and Sc showed significant variation between Korean and Chinese ginsengs, indicating potential tracers for discriminating them. Discriminating between the ginsengs from the two countries was generally successful when both the (87)Sr/(86)Sr ratios and rare earth element (REE) contents were used together. Moreover, principal component analysis (PCA) derived from the (1)H NMR data revealed a significant separation between the ginsengs originating from the two countries. The major metabolites responsible for differentiation were sugars such as glucose, xylose, and sucrose. The results suggest that this multiplatform approach offers a comprehensive method to distinguish the origin of ginsengs.

Carbon isotope fractionation of benzene and toluene by progressive evaporation

Evaporation is one of the key attenuation processes for near-surface volatile organic compounds (VOCs) in the upper soil zone. Evaporation experiments were performed to investigate the carbon isotope fractionation of benzene and toluene during progressive and non-equilibrium evaporation at room temperature. Considerable carbon isotope fractionation occurred during evaporative enrichment of benzene and toluene. The carbon isotope compositions of residual compounds increased exponentially with increasing evaporation. Thus, the remaining liquids become isotopically heavier, and the process follows a Rayleigh trend. This result is compatible with the direction of isotopic changes associated with both microbial degradation and volatilization of hydrocarbons previously observed in soil columns, but shows exactly the opposite behavior to previous equilibrium volatilization findings.

Comparison of stroke volume variations derived from radial and femoral arterial pressure waveforms during liver transplantation

BACKGROUND

Stroke volume variation (SVV) is being increasingly used to predict fluid responsiveness. Since radial arterial pressure (RAP) and femoral arterial pressure (FAP) frequently showing discrepancies during liver transplantation (LT), we sought to investigate the effect of differing arterial waveforms on SVV and cardiac output (CO) derived from the Vigileo device, by comparing SVV and CO values derived from RAP (SVV(RAP), CO(RAP)) and FAP (SVV(FAP), CO(FAP)) during LT.

METHODS

The linear associations and agreements between SVV(RAP) and SVV(FAP) and between CO(RAP) and CO(FAP) were assessed during LT. Hemodynamic variables were measured at nine predefined time points in all 32 recipients, resulting in 288 data pairs.

RESULTS

Correlations were observed between SVV(RAP) and SVV(FAP) (r = .961) and between CO(RAP) and CO(FAP) (r = .848) at all time points. These correlations between SVV(RAP) and SVV(FAP) (r = .923) and between CO(RAP) and CO(FAP) (r = .902) existed even during the period when mean RAP and FAP values differed (10 minutes after reperfusion). Bland-Altman analysis for SVV(RAP) versus SVV(FAP) and for CO(RAP) versus CO(FAP) showed weak biases (-0.2% and -0.5 L/min) and reasonable limits of agreement (-2.2 to 1.8% and -1.9 to 0.9 L/min). The percentage errors for SVV and CO values were 27.0% and 22.2%.

CONCLUSIONS

There was no significant difference between SVV(RAP) and SVV(FAP) when measured using the Vigileo device during LT. This finding indicated that SVV obtained using the Vigileo device offered relatively consistent information regardless of the catheterization site.

Tracing the geographical origin of beefs being circulated in Korean markets based on stable isotopes

We have examined the carbon, nitrogen and oxygen isotopic compositions of American, Mexican, Australian, New Zealand and Korean beefs, which are currently being circulated in Korean markets, to check whether stable isotope ratios can identify their country of origin. Each beef exhibited statistically distinct isotopic compositions, especially in oxygen and carbon, because of the different isotopic compositions of their water and cattle feeds. Nevertheless, their isotopic compositions still showed some overlap, especially among USA, Australian, and Korean beefs, which sometimes resulted in significant misidentification when a single isotope was considered. However, the discrimination was generally successful when both the carbon and the oxygen isotopes were used.

Comparison of the oxygen and hydrogen isotopes in the juices of fast-growing vegetables and slow-growing fruits

We have analyzed the oxygen and hydrogen isotopic composition of juices from fruits and vegetables collected from a small orchard in order to investigate the differences in isotopic enrichment and evaporation intensity between fast-growing vegetables and slow-growing fruits grown under the same climatic conditions. The oxygen and hydrogen isotope levels were much higher in the juices of the fruits and vegetables than in the source waters in which they grew because of evaporation effects. According to our data, fast-growing vegetables are subject to greater evaporation than slow-growing fruits. An evaporation experiment using the source water showed that the oxygen and hydrogen isotopic composition of the 60-80% residual fraction was similar to that of the isotopically enriched grape juice, whereas those of the plume and tomato juices were very close to that of the 80-90% residual fraction, thus proving the effect of evaporation.

Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage

We evaluated whether a thermosoftening treatment with warm saline of a nasotracheal preformed tube can improve navigability through the nasal passageways and reduce epistaxis and nasal damage. A total of 150 patients were randomly allocated to three groups: Group I (untreated tube group, n = 50), Group II (35 degrees C treated tube group, n = 50), and Group III (45 degrees C treated tube group, n = 50). In Groups II and III, the tubes were softened at 35 +/- 2 degrees C and 45 +/- 2 degrees C with warm saline, respectively. In Group I the tube was prepared at room temperature (25 +/- 2 degrees C). The incidence of epistaxis and nasal damage in Groups II and III was significantly less than that of Group I (P: < 0.05). Despite the more frequent incidence of smooth passage in Group III, no statistical difference was found among the groups. Logistic regression analysis also confirmed that epistaxis was more likely to be reduced when the tube had been thermosoftened (odds ratio = 1.46, 95% confidence interval = 1.02, 2.11). We conclude that simple thermosoftening treatment of the nasotracheal tube with warm saline helps to reduce epistaxis and nasal damage.

IMPLICATIONS

Thermosoftening treatment of a nasotracheal tube with warm saline before intubation can effectively reduce epistaxis and nasal damage. This technique is safe, easy, and suitable for all types of tubes and does not require additional implements.

Cisatracurium neuromuscular block at the adductor pollicis and the laryngeal adductor muscles in humans

We have compared the dose-response relationship (n = 30) and time course of neuromuscular block (n = 20) of cisatracurium at the laryngeal adductor and the adductor pollicis muscles. ED95 values for cisatracurium were 66.8 (95% confidence interval 61.3-72.3) micrograms kg-1 at the larynx and 45.2 (42.1-48.3) micrograms kg-1 at the adductor pollicis muscle (P < 0.0001). After administration of cisatracurium 0.1 mg kg-1, onset time was 2.7 (2.2-3.2) min at the larynx and 3.9 (3.0-4.8) min at the adductor pollicis (P < 0.0001). Time to 95% recovery of the first twitch of the TOF was 26.9 (20.1-33.7) min and 45.6 (39.7-51.5) min, respectively (P < 0.0001). We found that the laryngeal adductors were more resistant to the action of cisatracurium than the adductor pollicis muscle, but onset and recovery were faster at the larynx.

Deposition of eosinophil-granule major basic protein and expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in the mucosa of the small intestine in infants with cow's milk-sensitive enteropathy

BACKGROUND

Cow's milk-sensitive enteropathy (CMSE) is an important cause of chronic diarrhea and failure to thrive in infancy. The immunopathology of the mucosal lesion associated with CMSE has not yet been described.

OBJECTIVES

This study investigated the eosinophil activation and the role of adhesion molecules in the pathogenesis of intestinal mucosal damage associated with CMSE.

METHODS

Twenty-one patients with chronic diarrhea and abnormal mucosa on duodenal biopsy specimens were included. The patients had negative responses to skin prick tests and RASTs with milk. Fourteen patients were diagnosed with CMSE by milk challenge test and were designated as the CMSE group. Seven patients with no milk intolerance were defined as the non-CMSE group. Four infants with frequent vomiting and no mucosal abnormalities were also studied as the control group. Immunohistochemical stains for eosinophil major basic protein (MBP), vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 on endoscopic duodenal biopsy specimens were performed.

RESULTS

The degree of eosinophil degranulation, as evidenced by localization of extracellular MBP, was significantly greater in the CMSE group compared with the non-CMSE and control groups (P <.05). Expression of VCAM-1 on mononuclear cells was higher in the CMSE group compared with the non-CMSE and control groups (P <.05). The severity of villous atrophy was positively correlated with the deposition of MBP (r = 0.79, P <.001).

CONCLUSION

These results strongly suggest eosinophils and VCAM-1 are implicated in the pathogenesis of mucosal damage associated with CMSE.

Paroxysmal tachycardia and hypertension with or without ventricular fibrillation during laparoscopic adrenalectomy: two case reports in patients with noncatecholamine-secreting adrenocortical adenomas

We present two cases of sudden unanticipated cardiovascular complications in patients with noncatecholamine-secreting adrenocortical adenomas during laparoscopic adrenalectomy. In the first case, the patient developed paroxysmal tachycardia and hypertension followed by ventricular fibrillation shortly after clipping of the adrenal vein. In the second case, the patient suffered hypertension and bigeminy during manipulation of the adrenal gland just around the adrenal vein. Awareness of such complications during either conventional or laparoscopic adrenalectomy is important even if the operation is performed in a patient with an apparently noncatecholamine-secreting adrenocortical adenoma.

Neuromuscular interactions between mivacurium and esmolol in rabbits

We compared the dose-response relationship and the neuromuscular blocking effects of mivacurium during infusions of esmolol in 40 anaesthetised rabbits. Train-of-four stimuli were applied every 10 s to the common peroneal nerve and the force of contraction of the tibialis anterior muscle was measured. Plasma cholinesterase activity decreased by 13% after esmolol infusion. The ED95 of mivacurium increased significantly from 29 (4.8) micrograms.kg-1 with placebo to 61 (9.8) micrograms.kg-1 during esmolol 100 micrograms.kg-1.min-1, 49 (8.2) micrograms.kg-1 during esmolol 300 micrograms.kg-1.min-1 and 54 (7.3) micrograms.kg-1 during esmolol 500 micrograms.kg-1.min-1, respectively (p < 0.001). The duration of neuromuscular block with mivacurium 0.16 mg.kg-1 was prolonged by 30% with esmolol due to diminished plasma cholinesterase activity (p < 0.05). Heart rate and mean arterial blood pressure decreased by 15% with esmolol (p < 0.05). The results of this study show that, in rabbits, esmolol decreased plasma cholinesterase activity, antagonised the neuromuscular blocking potency of mivacurium and prolonged its neuromuscular blocking effect.

Influence of pig embryos on uterine growth

The influence of embryos on growth of the uterus was determined by comparing uterine length, weight and diameter between gravid and nongravid horns within unilaterally pregnant gilts. Eighty-two prepubertal gilts were ovariectomized unilaterally at 5 mo of age, and the ipsilateral uterine horn was ligated near the junction of the uterine horns. Gilts were mated and were assigned randomly for examination on either d 9, 12, 15, 18, 21, 24 or 27 of gestation. Absolute differences and ratios in length, weight and diameter between gravid and nongravid horns of unilaterally pregnant gilts were analyzed. The gravid horn was 40% longer than the nongravid horn from d 18 to 27. Uterine horns with embryos increased linearly in weight and diameter (P less than .01) between d 15 and 27. Embryos, or the signals that they might give, apparently caused increases in length, weight and diameter of the uterine horn by d 18, but not before.