A Comparative Study of the Effectiveness of Pharmacopuncture Therapy for Chronic Neck Pain: A Pragmatic, Randomized, Controlled Trial

Background: This two-arm, parallel, pragmatic, multicenter, clinical randomized, controlled trial with a 12-week follow-up period aimed to compare the effectiveness of pharmacopuncture therapy and physical therapy strategies for chronic neck pain. Methods: Eight sessions of pharmacopuncture therapy or physical therapy were administered within 2 weeks. The primary outcome was the visual analogue scale (VAS) score for neck pain. The secondary outcomes were the scores of the Northwick Park questionnaire (NPQ), VAS score for radiating arm pain, numeric rating scale (NRS) for neck and arm bothersomeness, neck disability index (NDI), patient global impression of change (PGIC), 12-item short form health survey (SF-12), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. The protocol was registered with Clinicaltrials.gov (NCT04035018) and CRIS (KCT0004243). Results: We randomly allocated 101 participants with chronic neck pain to the pharmacopuncture therapy (n = 50) or physical therapy group (n = 51). At the primary endpoint (week 5) the pharmacopuncture therapy group showed significantly superior effects regarding VAS score for neck pain and arm bothersomeness, NRS for neck pain, NDI, NPQ, and PGIC compared with the physical therapy group. These effects were sustained up to 12 weeks after follow-up. Conclusion: Compared with physical therapy, pharmacopuncture therapy had superior effects on the pain and functional recovery of patients with chronic neck pain.

Kidney Transplantation Using Expanded-Criteria Deceased Donors: A Comparison With Ideal Deceased Donors and Non-Expanded-Criteria Deceased Donors

PURPOSE

The use of expanded-criteria deceased-donor (ECD) kidneys must be evaluated within the objective perspective of critical organ shortage and graft function and survival. In this study, we aimed to compare the clinical outcomes of ECD reliance with concurrent use of ideal-criteria deceased donors (IDDs) and non-ECDs in adult renal transplantation.

METHODS

Between February 2000 and December 2015, we analyzed 405 deceased-donor renal transplants, specifically 129 grafts (31.9%) from ECDs, 233 grafts (57.5%) from non-ECDs, and 43 grafts (10.6%) from IDDs. ECDs were classified according to the United Network for Organ Sharing guidelines, while an IDD was defined as a younger person (10-39 years of age) with no medical risk factors who died from a traumatic head injury. Donor and recipient risk factors were separately analyzed and correlated with recipient graft function, and survival was evaluated.

RESULTS

ECDs were older (56.8 ± 6.3 years); showed increased incidence of hypertension, diabetes, and cerebrovascular brain death; and had a higher pre-retrieval serum creatinine level than the other groups. ECD kidney recipients were also older (50.6 ± 9.8 years), had a shorter waiting time (P = .031), and demonstrated a low frequency of re-transplantation (P = .028). Long-term renal function followed longitudinally was lower in ECD kidney recipients until five years after transplantation, while the glomerular filtration rate (GFR) level at 7 and 10 years did not differ significantly among the groups (P = .074 and .262, respectively). There were no significant differences in terms of graft survival (P = .394) or patient survival (P = .737) among the groups.

CONCLUSIONS

Although the long-term renal function followed longitudinally was lower in ECD kidney recipients, the use of renal grafts from ECDs is an acceptable method to resolve the disparity of critical organ shortage. However, the classification of the high-risk group should be updated with consideration given to differences in regional characteristics.

Sorption of Nitro Explosives to Polymer/Biomass-Derived Biochar

Factors affecting the sorptive removal of nitro explosives (2,4,6-trinitrotoluene [TNT] and hexahydro-1,3,5-trinitro-1,3,5-triazine [RDX]) to polymer/biomass-derived biochar were investigated through batch experiments. Compared with that of rice ( L.) straw (RS)-derived biochar, the sorption of TNT and RDX to polymer/RS-derived biochar was greatly enhanced by >2.5 and 4 times, respectively. The type and amount of polymer did not significantly affect the sorption of nitro explosives to polymer/RS-derived biochar. Pyrolysis temperature did not affect the sorption capacity. Surface treatment with acid or an oxidant did not significantly change the sorption capacity, suggesting that polymer residues may be strongly responsible for the enhancement. Possible polymer residues were identified via gas chromatography mass spectrometry analysis. The toxicity characteristic leaching procedure and Microtox bioassay analyses indicated that polymer/RS-derived biochar did not show possible harmful effects. Our results suggest that polymer/RS-derived biochar can be effectively used as a sorbent to remove nitro explosives both in the natural environment and engineered systems.

Genetic parameters of carcass and meat quality traits in different muscles (longissimus dorsi and semimembranosus) of Hanwoo (Korean cattle)

We estimated heritability () and genetic and phenotypic correlations for carcass and meat quality traits of longissimus dorsi (LD) and semimembranosus (SM) muscles in 30-mo-old Hanwoo steers. Variance and covariance components were estimated using REML procedures under univariate and bivariate models. The mean carcass weight (CWT), eye muscle area (EMA), back fat thickness (BFT), and marbling score (MS) were 428.20 ± 46.30 kg, 87.38 ± 8.54 cm2, 13.00 ± 5.14 mm, and 5.21 ± 1.56, respectively. The mean CIE reflectance of meat lightness (L*), redness (a*), and yellowness (b*) were 40.01 ± 2.73, 22.37 ± 2.18, and 10.35 ± 1.46, respectively, in LD muscles and 36.33 ± 2.44, 22.91 ± 2.43, and 10.25 ± 1.65, respectively, in SM muscles. The mean Warner-Bratzler shear force (WBSF), intramuscular fat content (IMF), water-holding capacity (WHC), and protein and ash content in LD and SM muscles were 3.84 ± 0.96 and 6.52 ± 1.21 kg, 15.91 ± 4.39 and 5.10 ± 1.94%, 62.07 ± 3.38 and 71.61 ± 2.06%, 20.01 ± 1.39 and 21.34 ± 0.89%, and 0.80 ± 0.10 and 0.93 ± 0.07, respectively. The estimates of CWT, EMA, BFT, and MS were 0.51 ± 0.13, 0.45 ± 0.13, 0.29 ± 0.09, and 0.22 ± 0.08, respectively. The estimates were moderate for meat quality traits and were 0.37 ± 0.12, 0.40 ± 0.12, 0.33 ± 0.10, 0.33 ± 0.10, 0.30 ± 0.11, and 0.24 ± 0.09 for L*, WBSF, IMF, WHC, and protein and ash content, respectively, in LD muscle; estimates from SM muscle were comparatively low (0.08 ± 0.06 to 0.25 ± 0.09). Estimates of for a* and b* were also low (0.08 ± 0.06 to 0.13 ± 0.07). Carcass weight had a moderate, positive genetic correlation with EMA (0.60 ± 0.13) and a weak correlation with MS and BFT. The genetic correlations among the 3 colorimeter variants were strong and positive within and between muscles. Intramuscular fat content had moderate to strong and negative genetic correlations with WBSF (-0.49 ± 0.18), WHC (-0.99 ± 0.01), and protein (-0.93 ± 0.04) and ash content (-0.98 ± 0.06) in LD muscle, whereas the associations were less pronounced in SM muscle. In general, CWT and EMA had low genetic and phenotypic correlations with meat quality traits, which suggests that the traits are independent and have distinct genetic contributions in each muscle. Conversely, with few exceptions, meat quality traits had genetic and phenotypic correlations with MS and BFT. In conclusion, the estimated genetic parameters for carcass and meat quality traits could be used for genetic evaluation and breeding programs in Korean Hanwoo cattle populations.

Injury to the blood-testis barrier after low-dose-rate chronic radiation exposure in mice

Exposure to ionising radiation induces male infertility, accompanied by increasing permeability of the blood-testis barrier. However, the effect on male fertility by low-dose-rate chronic radiation has not been investigated. In this study, the effects of low-dose-rate chronic radiation on male mice were investigated by measuring the levels of tight-junction-associated proteins (ZO-1 and occludin-1), Niemann-Pick disease type 2 protein (NPC-2) and antisperm antibody (AsAb) in serum. BALB/c mice were exposed to low-dose-rate radiation (3.49 mGy h(-1)) for total exposures of 0.02 (6 h), 0.17 (2 d) and 1.7 Gy (21 d). Based on histological examination, the diameter and epithelial depth of seminiferous tubules were significantly decreased in 1.7-Gy-irradiated mice. Compared with those of the non-irradiated group, 1.7-Gy-irradiated mice showed significantly decreased ZO-1, occludin-1 and NPC-2 protein levels, accompanied with increased serum AsAb levels. These results suggest potential blood-testis barrier injury and immune infertility in male mice exposed to low-dose-rate chronic radiation.

MacroH2A1 downregulation enhances the stem-like properties of bladder cancer cells by transactivation of Lin28B

The histone variant, macroH2A1, has an important role in embryonic stem cell differentiation and tumor progression in various types of tumors. However, the regulatory roles of macroH2A1 on bladder cancer progression have not been fully elucidated. Here, we show that macroH2A1 knockdown promotes stem-like properties of bladder cancer cells. The knockdown of macroH2A1 in bladder cancer cells increased tumorigenicity, radioresistance, degeneration of reactive oxygen species, increased sphere formation capability and an increase in the proportion of side populations. We found that macroH2A1 is required for the suppression of Lin28B identified as a novel downstream target of macroH2A1 in bladder cancer. Loss of macroH2A1 expression significantly correlated with the elevated levels of Lin28B expression and subsequently inhibited the mature let-7 microRNA expression. Furthermore, the stable overexpression of Lin28B enhances the several phenotypes, including tumorigenicity and sphere-forming ability, which are induced by macroH2A1 depletion. Importantly, Lin28B expression was regulated by macroH2A1-mediated reciprocal binding of p300 and EZH2/SUV39H1. Our results suggest that Lin28B/let-7 pathway is tightly regulated by macroH2A1 and its cofactors, and have a pivotal role in the bladder tumor progression and the regulation of stem-like characteristics of bladder cancer cells.

The clinical experience of computed tomographic-guided navigation system in c1-2 spine instrumentation surgery

Objective

To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports.

Methods

Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach.

Results

Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases.

Conclusion

Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.

The early protective effect of glutamine pretreatment and ischemia preconditioning in renal ischemia-reperfusion injury of rat

BACKGROUND

Heat shock proteins (HSP) play an important role in protecting cells against stress.

METHODS

Using a rat model, we tested the hypothesis that pretreatment with glutamine (Gln) and ischemia preconditioning (IPC) increase the expression of HSP resulting in attenuation of renal ischemia/reperfusion (I/R) injury. Sprague-Dawley rats were randomized into 4 groups [group I, Gln injection (+), IPC (+); group II, Gln injection (+), IPC (-); group III, saline injection (+), IPC (+); group IV, saline injection (+), IPC (-)]. Renal HSP70 expression was determined by Western blotting and kidney function was assessed by blood urea nitrogen and serum creatinine. Renal cross-sections were microscopically examined for tubular necrosis, exfoliation of tubular epithelial cells, cast formation, and monocyte infiltration.

RESULTS

Gln pretreatment increased intrarenal HSP expression (P = .031). In group I, tubulointerstitial abnormalities were clearly slighter compared with the other groups (P < .001).

CONCLUSION

Our experiments suggest that (1) a single dose of Gln could induce HSP expression and (2) IPC could relieve renal I/R injury. In addition, IPC combined with Gln pretreatment had a synergic protective effect against renal I/R injury.

Contrast-enhanced magnetic resonance angiography in the early period after kidney transplantation

Our objective was to evaluate the usefulness of three-dimensional (3-D) contrast-enhanced (CE) magnetic resonance angiography (MRA) to assess renal parenchyma, arterial inflow stenosis, and peritransplant fluid collections in the early period after kidney transplantation (KT). Between January 2010 and April 2011, we examined a consecutive series of 144 renal transplants using 3-D CE MRA at 14 days after KT. MRA showed parenchyma infarctions (n = 17, 11.8%), arterial inflow stenoses (n = 23, 16%), lymphoceles (n = 14, 9.7%), and hematomas (n = 6, 4.2%). The degree of renal transplant artery inflow stenosis was graded qualitatively based on diameter criterion; <50% = mild, 50% to 70% = moderate, and >70% = severe in 10 (6.9%), 5 (3.5%), and 8 (5.6%) subjects, respectively. The study recipients were divided into 3 groups according to the degree of renal artery inflow stenosis (group I: normal; group II: mild and moderate, <70%; group III: severe, >70%). Among group III patients who underwent digital subtraction angiography, 5 had percutaneous transluminal angioplasty or stenting performed after 1 month. Their mean resume creatinine levels at 1, 6, and 12 months after transplantation were not significantly different from those in the other groups (P = .391, .447, .110). The prevalence of graft loss (n = 2) was high in group III (P = .012), although the frequency of acute rejection episodes was not different among the groups (P = .890). The incidences of renal parenchyma infarction, peritransplant fluid collection and arterial inflow stenosis were unexpectedly high in the early period after KT. Thus, 3-D CE MRA provided a rapid global assessment of the renal parenchyma, transplant arterial system, and peritransplant fluid collection that can be helpful to detect or exclude many causes of renal transplant dysfunction.

Human health risks associated with dietary exposure to persistent organic pollutants (POPs) in river water in Korea

Because of their persistence, bioaccumulation tendency, and toxicity, organochlorine pesticides (OCPs) were banned several decades ago. However, they are still detected in natural water and pose a serious risk to human health and the environment. In the present study, seven OCPs were measured in river water collected from 28 sampling sites between 2010 and 2011 in the Yeongsan (YS) and Seomjin (SJ) Rivers, Korea. Gas chromatography/high-resolution mass spectrometry (HRMS) was used for the chemical analysis. The potential health risks of consuming OCPs in fish were assessed in the monitoring region (YS and SJ River basins) by measuring the residual level of OCPs. The human health risks were characterized by considering both the exposure level and the corresponding cancer slope factors; we incorporated both deterministic and probabilistic approaches. The risks were calculated using the probabilistic Maximum Likelihood Estimation (MLE) method. Risk uncertainty and sensitivity were calculated by performing a Monte Carlo analysis. Of the six OCPs, dieldrin, heptachlor epoxide, and hexachlorobenzene exceeded the acceptable risk level in the heavy and light fish consumer groups. The cancer risks associated with these OCPs were 2.99×10(-6), 5.81×10(-6) and 3.72×10(-6), respectively, using the deterministic approach and 1.64×10(-5), 3.36×10(-2) and 5.52×10(-5), respectively, at the 95th percentile using the probabilistic approach. Because there is a high cancer risk associated with these three OCPs, individuals who consume large amounts of freshwater fish may be subject to a high risk of cancer. However, the calculations may have over- or underestimated the risk because of the uncertainty of the environmental concentration and fish intake rate or the use of left-censored monitoring data.

Ginsenoside-Rp1 inhibits platelet activation and thrombus formation via impaired glycoprotein VI signalling pathway, tyrosine phosphorylation and MAPK activation

BACKGROUND AND PURPOSE

Ginsenosides are the main constituents for the pharmacological effects of Panax ginseng. Such effects of ginsenosides including cardioprotective and anti-platelet activities have shown stability and bioavailability limitations. However, information on the anti-platelet activity of ginsenoside-Rp1 (G-Rp1), a stable derivative of ginsenoside-Rg3, is scarce. We examined the ability of G-Rp1 to modulate agonist-induced platelet activation.

EXPERIMENTAL APPROACH

G-Rp1 in vitro and ex vivo effects on agonist-induced platelet-aggregation, granule-secretion, [Ca(2+) ](i) mobilization, integrin-α(IIb) β(3) activation were examined. Vasodilator-stimulated phosphoprotein (VASP) and MAPK expressions and levels of tyrosine phosphorylation of the glycoprotein VI (GPVI) signalling pathway components were also studied. G-Rp1 effects on arteriovenous shunt thrombus formation in rats or tail bleeding time and ex vivo coagulation time in mice were determined. KEY RESULT: G-Rp1 markedly inhibited platelet aggregation induced by collagen, thrombin or ADP. While G-Rp1 elevated cAMP levels, it dose-dependently suppressed collagen-induced ATP-release, thromboxane secretion, p-selectin expression, [Ca(2+) ](i) mobilization and α(IIb) β(3) activation and attenuated p38(MAPK) and ERK2 activation. Furthermore, G-Rp1 inhibited tyrosine phosphorylation of multiple components (Fyn, Lyn, Syk, LAT, PI3K and PLCγ2) of the GPVI signalling pathway. G-Rp1 inhibited in vivo thrombus formation and ex vivo platelet aggregation and ATP secretion without affecting tail bleeding time and coagulation time, respectively.

CONCLUSION AND IMPLICATIONS

G-Rp1 inhibits collagen-induced platelet activation and thrombus formation through modulation of early GPVI signalling events, and this effect involves VASP stimulation, and ERK2 and p38(-MAPK) inhibition. These data suggest that G-Rp1 may have therapeutic potential for the treatment of cardiovascular diseases involving aberrant platelet activation.

Does donor kidney to recipient body weight ratio influence long-term outcomes of living-donor kidney transplantation?

This study evaluated the effect of the donor kidney to recipient body weight (Kw/Rw) ratio on long-term graft function and survival. We investigated retrospectively whether there was any association between Kw/Rw ratio and long-term graft survival and function after a follow-up of >10 years. We studied a consecutive series of 123 adult-to-adult living kidney transplants. According to the Kw/Rw ratio, patients were divided into 3 groups: "low" (Kw/Rw <2.85; n = 29), "medium" (2.85 ≤ Kw/Rw < 4.04; n = 63), and "high" (≥4.04; n = 31). Among the 3 groups, the mean serum creatinine levels at 1 and 6 months as well as 1 year after transplantation were significantly lower among patients with a high Kw/Rw ratio than in those with a medium or low ratio, but serum creatinine levels at 3 and 5 years did not differ significantly (P = .394 and 0.620, respectively). Graft survival rates at 5 and 10 years after transplantation were significantly lower in the "low" group. We observed a significant association between Kw/Rw ratio and graft survival (P = .018). The Kw/Rw ratio is an important factor for long-term graft survival and early graft function. However, it did not significantly affect subsequent renal function.

Pesticide poisonings in South Korea: findings from the National Hospital Discharge Survey 2004-2006

OBJECTIVES

Pesticide poisoning stands as a major public health issue worldwide. The objective of this study was to examine the epidemiologic characteristics of pesticide-related hospitalizations in South Korea.

METHODS

Data from the Korea National Hospital Discharge Survey were analyzed to describe the epidemiologic characteristics of pesticide poisoning among hospitalized patients from 2004 through 2006. Pesticide-related hospitalizations were identified using the International Classification of Diseases, Tenth Revision codes. National estimates of pesticide-related hospitalizations were calculated using sampling weights for number of hospitalizations.

RESULTS

A total of 25,982 pesticide-related hospitalizations were estimated during the years 2004-2006, yielding an average annual pesticide-related hospitalization rate of 17.8 per 100,000 population in South Korea. Age-specific rates for pesticide-related hospitalization increased with age, with the highest rate noted among those aged 70 or above. The majority of pesticide-related hospitalization was cases of intentional poisoning in rural areas. Seasonal variation in the rate was observed, with summer being the highest among both men and women.

CONCLUSIONS

Pesticide-related hospitalization is prevalent and demonstrates demographic and seasonal and regional variations. More effective strategies to reduce pesticide-related hospitalizations are required in South Korea.

Biodegradation of estrogen conjugates by bacteria isolated from river sediments

The objective of this study was to investigate the ability of E. coli in river sediments to degrade estrogen conjugates. Biodegradation experiments on glucuronide estrogens (E1-GLU, E2-GLU and E3-GLU) using E. coli, non-E. coli bacteria as well as sediment crude extracts were carried out in batch mode. A pure identified E. coli strain (KCTC 2571) was used for comparison of enzyme activity. The results showed that the degradation rate of estrogen conjugates by KCTC 2571 and E. coli isolated from sediments followed a similar trend. Fecal bacteria showed a high ability to deconjugate glucuronided estrogens. Approximately 50% of glucuronide moieties were cleaved within 4 h of contact time in experiments using pure E. coli. The degradation rate was slower in experiments using crude extracts of sediments, and conjugated estrogens were not completely degraded even after 12 h of reaction. These results provide a clear understanding of the fate and behavior of estrogen by bacteria in the environment.

Role of arachidonic acid-derived metabolites in the control of pulmonary arterial pressure and hypoxic pulmonary vasoconstriction in rats

BACKGROUND

The roles of arachidonic acid (AA) metabolites in hypoxia-induced pulmonary vasoconstriction (HPV), a critical physiological mechanism that prevents ventilation/perfusion mismatch, are still incompletely understood.

METHODS

Pulmonary arterial pressure was measured in ventilated/perfused rat lungs. Isometric tones of rat intralobar pulmonary arteries were also measured, using a myograph.

RESULTS

Hypoxia (Po₂, 3%)-induced pulmonary arterial pressure increases (ΔPAP(hypox)) were stable with blood-mixed perfusate, but decayed spontaneously. ΔPAP(hypox) was inhibited by 29%, 16%, and 28% by the thromboxane A₂ (TXA₂) antagonist SQ-29548, the 5-lipoxygenase inhibitor, MK886, and the leukotriene D₄ antagonist, LY-171883, respectively. The prostacyclin synthase inhibitor tranylcypromine augmented ΔPAP(hypox) by 5%, whereas inhibition of cytochrome P450 did not affect ΔPAP(hypox). Consistently, the TXA₂ analogue U46619 increased ΔPAP(hypox) whereas prostacyclin abolished ΔPAP(hypox). However, leukotriene D₄ had no direct effect on ΔPAP(hypox). In the isolated pulmonary arteries, pretreatment with U46619 was essential to demonstrate hypoxia-induced contraction.

CONCLUSIONS

The above results suggest that TXA₂ and cysteinyl leukotrienes, other than leukotriene D₄, are endogenous factors that facilitate HPV in rats. The indispensable role of TXA₂-induced pretone in the HPV of isolated pulmonary arteries indicates that the signal from thromboxane receptors might be a critical component of oxygen sensation mechanisms.

Pseudomonas stutzeri YPL-1 Genetic Transformation and Antifungal Mechanism against Fusarium solani, an Agent of Plant Root Rot

An actively antagonistic bacterium that could be used as a biocontrol agent against Fusarium solani, which causes root rots with considerable losses in many important crops, was isolated from a ginseng rhizosphere and identified as a strain of Pseudomonas stutzeri. In several biochemical tests with culture filtrates of P. stutzeri YPL-1 and in mutational analyses of antifungal activities of reinforced or defective mutants, we found that the anti-F. solani mechanism of the bacterium may involve a lytic enzyme rather than a toxic substance or antibiotic. P. stutzeri YPL-1 produced extracellular chitinase and laminarinase when grown on different polymers such as chitin, laminarin, or F. solani mycelium. These lytic extracellular enzymes markedly inhibited mycelial growth rather than spore germination and also caused lysis of F. solani mycelia and germ tubes. Scanning electron microscopy revealed degradation of the F. solani mycelium. Abnormal hyphal swelling and retreating were caused by the lysing agents from P. stutzeri YPL-1, and a penetration hole was formed on the hyphae in the region of interaction with the bacterium; the walls of this region were rapidly lysed, causing leakage of protoplasm. Genetically bred P. stutzeri YPL-1 was obtained by transformation of the bacterium with a broad-host-range vector, pKT230. Also, the best conditions for the transformation were investigated.

CPAP of 10 cmH2O during cardiopulmonary bypass followed by an alveolar recruitment manoeuvre does not improve post-bypass oxygenation compared to a recruitment manoeuvre alone in children

This randomised controlled study assessed whether continuous positive airway pressure (CPAP) of 10 cmH2O during cardiopulmonary bypass improves post-bypass oxygenation in children compared with no CPAP during bypass. We studied children with a ventricular septal defect. CPAP of 10 cmH2O was applied during bypass in the CPAP group (n=24), whereas the lungs were left deflated in the control group (n=20). In both groups, an alveolar recruitment maneuver was performed by applying positive pressure of 30 to 40 cmH2O for five seconds before weaning from bypass. Postoperative ventilation had the peak inflation pressure set to produce an expired tidal volume of 8 ml/kg with positive end expiratory pressure of 5 cmH2O. Arterial blood gas and haemodynamic measurements were performed at skin incision, five minutes after weaning from bypass, five minutes after chest closure and four hours after arrival in the intensive care unit. In four children CPAP was discontinued because it adversely affected the operating field. There was no difference in demographic characteristics, haemodynamic data, bypass time and operation time. No difference was observed between the groups with respect to pH, PaO2, P(A-a) DO2, PaCO2, and ETCO2 at each time. Variability in the data was greater than expected, leading to a decrease in the expected power of the study. CPAP at 10 cmH2O during bypass was not found to improve the post-bypass oxygenation as compared with leaving the lung deflated during bypass in children undergoing ventricular septal defect repair who had an alveolar recruitment maneuver at the end of bypass.

Computed tomography angiography, perfusion computed tomography, and a drug-eluting stent for the treatment of in-stent restenosis of the middle cerebral artery

The authors report a case of in-stent restenosis (ISR) of the middle cerebral artery (MCA) following bare-metal stent (BMS) deployment and subsequent treatment using a drug-eluting stent (DES). This 65-year-old woman presented with frequent transient ischemic attacks. Initial studies revealed occlusion of the left internal carotid artery and severe stenosis of the right MCA with decreased cerebral perfusion in the bilateral MCA territories. Stent-assisted angioplasty of the right MCA was performed using a BMS, and satisfactory results were obtained with no complications. Six months after the procedure the patient presented with recurrent symptoms, and workups revealed ISR with decreased cerebral perfusion. A DES was successfully placed without complications. Follow-up studies at 3 and 8 months after retreatment showed sustained luminal integrity and cerebral perfusion. A combination of CT angiography and perfusion CT exhibited the anatomical results and hemodynamic status of the stenotic lesion, and these findings coincided with the patient's clinical symptoms and the results of conventional cerebral angiography. In-stent restenosis of the MCA after placement of a BMS can be treated using a DES. A combination of CT angiography and perfusion CT can be an alternative to conventional angiography. Low-profile devices with an amelioration of trackability are essential for the further incorporation of the DES into the field of endovascular neurosurgery. More clinical experiences and long-term follow-ups are mandatory to evaluate the safety, efficacy, and durability of the DES.

Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients

BACKGROUND

Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.

METHODS

Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as 'Point I'. The sternal head of the right clavicle was called 'Point A' and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called 'Point B'. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.

RESULTS

The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients' age, height, and weight.

CONCLUSIONS

The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.

Toxicity of artificial runoff fostered with dry deposition particulates from industrial, commercial, and highway area in Gwangju, Korea

The adverse effects of rainwater and artificial urban runoff (an imitation of urban runoff during rainfall event) were investigated using a battery of bioassays employing three test species. Urban dusts were collected at three representative sites; commercial, industrial and highway areas. The water quality parameters of rainwater and artificial runoff revealed low hardness (23.4 approximately 34.2 mg*L(-1) as CaCO(3)) and alkalinity (7.0 approximately 34.2 mg*L(-1) as CaCO(3)). High toxicities were observed in the bioassays for the artificial runoffs. The average toxic units for D. magna, S. capricornutum, and O. latipes were 1.26(+/-0.84), 1.34(+/-1.10) and 2.05(+/-1.08), respectively. Of these species, O. latipes revealed significantly higher toxicity compared to D. magna and S. capricornutum (p < 0.05). Embryo lesions were observed with 6.25% treatments, and these significantly increased at 12.5% treatments (p < 0.05). The EC(50) values for each artificial runoff were 22.5, 22.6 and 25.4% for commercial, industrial and highway areas, respectively. With 12.5% treatment, significant delays in hatching times were observed (p < 0.05); all embryos tested did not hatched at 100% treatment. Similarly, a significant decrease in hatching success was observed at every sampling point from 25% treatment (p < 0.05). The adverse effects of artificial runoff on the three test species suggests that urban surface runoff can cause significant impairment in aquatic ecosystems.

Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved.

To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

GlideScope video laryngoscope: a randomized clinical trial in 203 paediatric patients

BACKGROUND

The GlideScope intubating device has been reported to provide a comparable or superior laryngoscopic view compared with direct laryngoscopy in adults. This study compared the use of the GlideScope with direct laryngoscopy for the laryngoscopic view and intubation time in children.

METHODS

The laryngoscopic view in 203 children was scored using both the Macintosh laryngoscope and the GlideScope using Cormack and Lehane (C&L) grades. After scoring each laryngoscopic view with and without BURP, the patients were randomly allocated to two groups. The trachea was intubated using direct laryngoscopy (Group DL, n=100) or the GlideScope (Group GS, n=103). We compared C&L grades for the two views in the same patient, and also the time to intubate for each group.

RESULTS

The GlideScope improved the view without BURP in the patients with C&L grade 2 (16/26, P<0.01) and with C&L grades 3 and 4 (7/11, P<0.05). The view with BURP was also improved by the GlideScope in C&L grade 2 (4/9, P<0.05) and with C&L grades 3 and 4 (4/5, P=0.059). The mean time for tracheal intubation was 36.0 (17.9) s in the GS group and 23.8 (13.9) s in the DL group (P<0.001).

CONCLUSIONS

In children, the GlideScope provided a laryngoscopic view equal to or better than that of direct laryngoscopy but required a longer time for intubation.

Biomonitoring recycled water in the Santa Ana River Basin in southern California

The Santa Ana River (SAR) is the primary source of groundwater recharge for the Orange County Groundwater Basin in coastal southern California. Approximately 85% base flow in the SAR originates from wastewater treatment plants operated by three dischargers. An on-line, flow-through bioassay using Japanese medaka (Oryzias latipes) as a means of judging potential public health impacts was employed to evaluate the water quality of the surface water and shallow groundwater originating from the SAR. Three chronic (3-4.5 mo) exposures using orange-red (outbred, OR) and see-through (color mutant, ST-II) Japanese medaka as bioindicators were conducted to evaluate endocrinologic, reproductive, and morphologic endpoints. No statistically significant differences in gross morphological endpoints, mortality, gender ratios, and vitellogenin induction were observed in fish from SAR groundwater treatment compared to the group tested in solute reconstituted reverse osmosis-treated or granular activated carbon (GAC)-treated control waters. Significant differences were observed in egg reproduction and the time to hatch in SAR groundwater; however, total hatchability was not significantly lower. To evaluate the estrogenic activity of the surfacewater source of the groundwater, SAR surface water was evaluated for vitellogenin and gonadal histopathology in juvenile medaka with no effects observed. These results demonstrate that OR Japanese medaka may be a sensitive strain as an on-line monitor to predict potential impacts of water quality, but further studies are needed to elicit causative agents within the water mixture.

Alternative method for predicting optimal insertion depth of the laryngeal tube in children

BACKGROUND

Little information is available about the accuracy of the teeth mark on the laryngeal tube (LT) as a guide to correct placement in children. The aim of this crossover study was to evaluate three methods for optimal insertion depth of the size (#) 2 tube in children weighing 12-25 kg.

METHOD

In 24 children, the LT #2 was consecutively inserted by three different methods: (A) until the thick teeth mark on the tube was aligned with the upper incisors, (B) until resistance was felt, and (C) by inserting to a depth, previously measured, of the curved distance between the cricoid cartilage and the upper incisor. In each case, the depth of insertion, the degree of effective ventilation, the presence of leakage, and the fibreoptic view were assessed.

RESULTS

Insertion based on the teeth mark led to a shorter insertion depth and a greater incidence of inadequate ventilation compared with the other two methods. There was no difference in the adequacy of ventilation between methods B and C. The vocal cords were more easily identified with methods B (62.5%) and C (75%) than with method A (12.5%).

CONCLUSIONS

Insertion of the LT #2 aligned with the teeth mark can result in a shallow insertion depth and inadequate ventilation. The measured distance from the cricoid cartilage to the upper incisor offers alternative guidance for correct LT insertion.

Long term results from percutaneous radiofrequency neurotomy on posterior primary ramus in patients with chronic low back pain

PURPOSE

We report on our experience of percutaneous radiofrequency neurotomy (PRN) on the posterior primary ramus (PPR) with at least two years follow-up.

METHODS

228 patients underwent PRN on the PPR for refractory low back pain. 128 patients met the inclusion criteria of facetal originated pain (group II), while 100 patients did not (group I). Radiofrequency (RF) procedures were applied in the usual manner. Pain relief was assessed at 1 week, 1 month, 6 months and 2 years using visual analog scale (VAS).

FINDINGS

Positive responders were 56% at 1 week, 46% at 1 month, 18% at 6 months, and 13% at 2 years after PRN in group I, and 78.9% at 1 week, 75.4% at 1 month, 62.5% at 6 months, and 54.7% at 2 years in group II. Prominent local tenderness, percussion tenderness, pain on getting up, extension and transitional movement, radiating pain on buttock and/or posterior thigh, and good immediate response were found to be significantly related to good outcome.

CONCLUSION

PRN on the PPR has long-term beneficial effects. Long-term good results can be achieved after proper selection of patients with facet joint related low back pain.

Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique

✓ The authors report two cases of stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms.

This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.

A new and simple transection knife for study of neurodegeneration and neuroregeneration in animal model

BACKGROUND

The purpose of this study was to design and make a simple, inexpensive brain knife that could produce consistent results following transection in animal model.

MATERIALS AND METHODS

After testing various materials including commercially available products, microelectrode recording needles as used in deep brain stimulation (DBS) surgery were selected as ideal candidates. They were modified to serve as type of wire-knife for the purposes of study. For this study, the major pathway for dopaminergic neuron from substantia nigra to striatum was selected for transection. A total of 40 Sprague-Dawley rats were assigned to 8 groups; normal, 1-4, 6, 8, and 10 weeks post-transection. Degree of cell death was determined and surviving neurons were counted by means of fluorescent microscopic examination, immunohistochemistry involving tyrosine hydroxylase (TH)-immunoreactive staining, and mapping to verify complete transection.

RESULTS

Compared to control, percentage of remaining neurons in each group was 61.3, 36.8, 29.9, 5.1, 5.9, 7.0%, respectively. Completeness of lesion was correlated with the absence of TH-immunoreactivity in the striatum.

CONCLUSION

Our model seems to provide complete cell death in early period after transection with consistent results. Thus, this type of brain knife can be very handy, without any extra cost, in any research model involving transection of fiber bundle for studies on neurodegeneration and neuroregeneration.

Fungal biodegradation of carbofuran and carbofuran phenol by the fungus Mucor ramannianus: identification of metabolites

The fungus Mucor ramannianus was tested to elucidate the biological fate of a class of N-methyl carbamate pesticide carbofuran and its hydrolysed form carbofuran phenol. The elution profile obtained from analysis by high-pressure liquid chromatography equipped with a reverse-phase C-18 column showed that two peaks occurred after incubation of M. ramannianus with which 1 mM carbofuran was combined as a final concentration. In culture of M. ramannianus with 1 mM carbofuran phenol, it produced two other metabolites compared to metabolites of carbofuran. LC/MS analysis suggested that two of the metabolites produced from carbofuran phenol were most likely to be 2-hydoxy-3-(3-methylpropan-2-ol)phenol or 7a-(hydroxymethyl)-2,2-dimethylhexahydro-6H-furo[2,3-b]pyran-6-one and 3-hydroxycarbofuran-7-phenol.

Rapid and comprehensive indicator for evaluation of performance of treatment processes and of river waters

Naturally occurring UV active compounds, commonly present in almost all source waters, can be rapidly monitored by their ultraviolet absorbance at 260 nm (E260). Herein, the extent of correlation between the E260 and the removal efficiency of the hazardous contaminants, endocrine disrupters and dioxins, were investigated using various treatment and river source waters. The detection of various types of hazardous contaminants using sophisticated analytical methods, such as high resolution gas chromatography (HRGC)/high resolution mass spectrometry (HRMS) and high performance liquid chromatography (HPLC)/inductively coupled plasma (ICP)/mass spectrometry (MS), as well as various short-term bioassays, can require hours or even days for results to be obtained. The removal of the E260 correlated well with those of individual contaminants, such as endocrine disruptor chemicals and dioxins, with the various treatment processes employed. In the plots of the endocrine disrupters against the DOC/E260, a correlation was found with the endocrine activity of the Korean/Japanese river waters employed in this study.

Depth of a central venous catheter tip: length of insertion guideline for pediatric patients

BACKGROUND

In pediatric patients, several studies have been undertaken to establish central venous catheter (CVC) tip optimal depth. Assessments of catheter tip position using chest radiographs may be misleading, whereas transesophageal echocardiography (TEE) has been shown to accurately monitor catheter tip placement at the superior vena cava-right atrial (SVC-RA) junction. The aim of this study was to issue a guideline for ideal catheter insertion depth, from the right internal jugular vein (IJV) using TEE to confirm the position of the catheter tip at the SVC-RA junction.

METHODS

Over a 6-month period, we studied 60 right internal jugular vein catheterizations in infants and children undergoing surgery for congenital heart disease. Positions of CVC tips were confirmed to be at the SVC-RA junction by TEE. Distance from the skin puncture site to the SVC-RA junction, height, weight, and age were recorded.

RESULTS

Distances measured were found to be highly correlated with patient height. The following guideline allows the CVC tip to be positioned above the RA in 97.5% of patients with an accuracy of 95%: optimal depth of insertion (cm) = 1.7 + (0.07 x height) in patients whose height is between 40 and 140 cm.

CONCLUSION

The model proposed for the insertion of the CVC tip in pediatric patients could be used to prevent inadvertent catheter tip placement into the atrium.

Dissimilatory Fe(III) reduction by an electrochemically active lactic acid bacterium phylogenetically related to Enterococcus gallinarum isolated from submerged soil

AIMS

The isolation and identification of a glucose-oxidizing Fe(III)-reducing bacteria (FRB) with electrochemical activity from an anoxic environment, and characterization of the role of Fe(III) in its metabolism.

METHODS AND RESULTS

A Gram-positive (Firmicutes), nonmotile, coccoid and facultative anaerobic FRB was isolated based on its ability to reduce Fe(III). Using the Vitek Gram-positive identification card kit and 16S rRNA gene sequence analysis, the isolate was identified as Enterococcus gallinarum, designated strain MG25. On glucose this isolate produced lactate plus small amounts of acetate, formate and CO2 and its growth rates were similar in the presence and absence of Fe(O)OH. These results suggest that MG25 can couple glucose oxidation to Fe(III) reduction, but without conservation of energy to support growth. Cyclic voltammetry showed that strain MG25 was electrochemically active.

CONCLUSIONS

An electrochemically active and FRB, E. gallinarum MG25, was isolated from submerged soil. Fe(III) is used in the bacterial metabolism as an electron sink.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report concerning the electrochemical activity of glucose-oxidizing FRB, E. gallinarum. This organism and others like it could be used as new biocatalysts to improve the performance of a mediator-less microbial fuel cell.

Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients † †Presented, in part, at the 2005 Annual Meeting of European Society of Anaesthesiologists, Vienna, Austria

BACKGROUND

Several reports have proposed radiographic landmarks for the proper positioning of central venous catheters (CVC). The carina is one of the proposed landmarks in adults. Here, we evaluate the possibility of using the carina as a radiographic landmark for the identification of proper positioning of the CVC tip in paediatric patients.

METHODS

We studied 57 right internal jugular vein catheterizations in infants and children undergoing surgery for the treatment of congenital heart disease. After placing the CVC tip at the junction of the superior vena cava and the right atrium (SVC-RA junction) via intraoperative transoesophageal echocardiography, and by taking postoperative anterior-posterior chest radiographs, we measured the longitudinal distance from the carina to the SVC-RA junction, using the Picture Archiving and Communicating System.

RESULTS

The average distance between the carina and the SVC-RA junction was 1.5 cm (95% CI 1.3-1.8 cm). No catheter tip was above the carina. Although there was no particular relationship between this distance and the patient's age, height, or weight, the distance between the carina and the SVC-RA junction tended to be more variable in younger and smaller children.

CONCLUSIONS

The carina can be used as a radiographic landmark for the proper CVC tip placement in paediatric patients. If the tip of the CVC is not distal to the carina the chances are minute that it is in the right atrium.

New immobilization method for immunoaffinity biosensors by using thiolated proteins

A new immobilization method for immunoaffinity (IA) biosensors that ensures the high surface density and the stability of the IA layer was developed. For the immobilization of biomolecules, the molecular recognition protein was first thiolated by covalent conjugation of mercaptopropionic acid, and then the thiolated protein was attached on the gold surface of the transducer. In this work, horseradish peroxidase (HRP) and its antibody were used as a model antigen-antibody, and the following properties of the IA layer prepared by thiolated protein were estimated: (i) biological integrity of HRP after the immobilization process by using activity assay, (ii) charge transfer resistance by immobilization, (iii) mass loading by the surface plasmon resonance (SPR) biosensor, (iv) number of binding sites, and (v) feasibility test for the measurement of capacitive change by the antigen-antibody interaction. Based on these parameters, the immobilization method by using thiolated protein was determined to be feasible for application to IA biosensors.

Bioleaching of cadmium and nickel from synthetic sediments by Acidithiobacillus ferrooxidans

The microbial leaching process was evaluated for the treatment of synthetic sediments contaminated with cadmium and nickel sulfides. A series of batch leaching experiments was conducted to compare metal solubilization in sediment inoculated with Acidithiobacillus ferrooxidans -inoculated sediments to that in sterile control sediment. The rate and extent of metal solubilization were significantly higher in A. ferrooxidans -inoculated reactors than in acidified sterile reactors. The efficiency of cadmium (Cd) solubilization (80) in the bioleaching process was higher than that of nickel (Ni) solubilization (60). The performance of leaching reactors containing only culture supernatants was comparable to that of A. ferrooxidans -inoculated reactors, indicating that indirect non-contact leaching by the products of microbial metabolism is the predominant mechanism for metal solubilization rather than direct microbial sulfide oxidation. Moreover, the similar (60-75%) extents of Cd(2+) leaching with A. ferrooxidans , cell-free filtrate, and Fe(3+) suggest that abiotic oxidation of CdS by Fe(3+) controls the overall leaching rate, and the role of A. ferrooxidans is most likely not to oxidize CdS mineral directly but to regenerate Fe(3+) as an oxidant.

Correlation of bispectral index with end-tidal sevoflurane concentration and age in infants and children

BACKGROUND

The bispectral index (BIS) has been evaluated as a tool for measuring depth of anaesthesia, but the use of BIS in a paediatric population is still controversial. This study was designed to evaluate the correlation of BIS with end-tidal sevoflurane concentration and age in infants and children.

METHODS

Eighty-one patients undergoing elective urology surgery were allocated into three age groups; 6 months to 2 yr (n=28), 3-7 yr (n=33), and 8-12 yr (n=20). Sevoflurane was administered to achieve steady-state end-tidal sevoflurane concentrations (ET(sevo)) of 2.0, 3.0, and 4.0%; these were achieved consecutively either from the lowest or from the highest concentration. The BIS (version XP) was monitored continuously.

RESULTS

In all three groups, BIS decreased significantly when ET(sevo) increased from 2.0 to 3.0% but there was a paradoxical increase in BIS values when ET(sevo) increased from 3.0 to 4.0%. The non-linear regression analysis showed a significant correlation between BIS and age at each ET(sevo). The younger patients showed the higher BIS values.

CONCLUSIONS

In children aged 6 months to 12 yr, the BIS increased paradoxically as ET(sevo) increased from 3.0 to 4.0%. BIS values showed a wide variation in the same ET(sevo) and the age itself was considered to be a factor affecting the BIS values.

Thoracic subpial intramedullary schwannoma involving a ventral nerve root: a case report and review of the literature

BACKGROUND

Subpial intramedullary schwannoma of the spine is a rare tumor. A few case reports have revealed that the tumor originates from around the ventral nerve exit zone, with only one case confirming involvement of the ventral root.

CASE DESCRIPTION

A 72-year-old female with a 10-month history of Brown-Sequard-type monoparesis is described. On neurological examination, the left leg motor function was grade 3 or 4/5, and dysthesia with low pinprick sensation at the right side below the T8 and T9 dermatome was identified. There were no signs of multiple neurofibromatosis. Magnetic resonance imaging demonstrated a well-demarcated round mass with high enhancement and moderate peritumoral edema, but no combined syrinx. The mass (1.5 x 1 x 1.5 cm) was located at the anterior part of the spinal canal on the left of the midline of the T8 and T9 space. A left-sided unilateral approach was performed with osteoplastic laminotomy of T8 and T9 vertebrae, and radical removal of a subpial tumor was achieved. Pathological examination revealed subpial intramedullary schwannoma. The patient improved postoperatively and at discharge was able to walk without any support.

CONCLUSION

The authors emphasize that the differential diagnosis of intramedullary schwannoma should be included when peritumoral edema is moderately present to provide appropriate preoperative preparations, even if a tumor is seemingly located in the intradural extramedullary space.

Technical advantages of an ultrasonic bone curette in spinal surgery

Object. The authors discuss the safety and efficacy of an ultrasonic bone curette in various spinal surgeries and report its advantages in clinical application.

Methods. Between April 2002 and September 2003, 76 patients with various spinal diseases (29 cervical, five thoracic, 40 lumbosacral, and two foramen magnum regions) were treated microsurgically by using a Sonopet ultrasonic bone curette with longitudinal and torsional tips and lightweight handpieces. The operations were performed successfully and the device was easy to handle. There were no instrument-related complications or -induced damage to any structure even when removing osseous spurs or ossified lesions near the dura mater, nerves, and vessels.

Conclusions. The ultrasonic curette is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat production or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed drills or other tools.

Transfusion for a patient of cis-AB blood type undergoing a redo cardiac operation

cis-AB, a rare ABO genotype, is the result of a mutated gene resulting in dual specific hybrid enzymes. A single-point mutation reverses the specificity of human blood group B synthesizing galactosyltransferase. This may lead to misclassification in ABO grouping and adverse transfusion reactions. Recently, the authors experienced a case of a patient with cis-AB blood type undergoing pulmonary valve replacement and tricuspid valvuloplasty. We transfused the patient with Rh+ A packed red blood cell, fresh frozen plasma and platelet concentrates without any clinically significant transfusion reactions.

Early and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children

This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch, rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1+/-0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1+/-8.8 min and the recovery index (time between T25 and T75) 19.9+/-9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.

Comparison of Central Venous Catheterization Sites in Infants

This study aimed to compare the rates of success and complications between different sites of central venous catheterization in infants. A total of 272 infants were randomized to four groups: right subclavian group (G-RSCV), right internal jugular group (G-RIJV), left subclavian group (G-LSCV) and left internal jugular vein group (G-LIJV). In 77.2% of the patients, we successfully introduced a catheter at the first attempt. The rate of successful catheter placement was highest in the RIJV (RIJV 89.7%, LIJV 79.4%, RSCV 66.2% and LSCV 55.9%). With regard to complications, the rate of arterial puncture, guide wire advancement failure and malpositioning of the catheter were all significantly more frequent during SCV catheterization (SCV versus IJV: 10.1% versus 2.1%, 12.4% versus 0% and 13.4% versus 0.6%, respectively). Our results imply that IJV, especially RIJV, should be the first choice for central venous catheterization in infants.

Ion channels of Fasciola hepatica incorporated into planar lipid bilayers

Ion channels are important target sites of anthelmintics, but little is known about those in Fasciola hepatica. In this work, we applied a planar lipid bilayer technique to characterize the properties of single ion channels in F. hepatica. Under a 200/40 mM KCl gradient, a large conductance channel of 251 pS was observed in 18% of the membranes studied. The channel was selective to K(+) over Cl(-) with a permeability ratio of K(+) to Cl(-) (PK/PCl) of 4.9. Open state probability (Po) of the channel was less than 0.5 and dependent on voltage (-60 to approximately +40 mV) and Ca(2+) (approximately 100 microM). The other two types of single channels observed in 11 and 5% of membranes, respectively, were a K(+)-permeable channel of 80 pS (PK/PCl=4.6) and a Cl(-)-permeable channel of 64 pS (PK/PCl=0.058). Open state probability of both channels showed little voltage dependence. The results indicate that distinct single channels of 60 to approximately 251 pS are present in relative abundance and, in addition, that the planar lipid bilayer technique can be a useful tool for the study of single ion channels in F. hepatica.

The effect of bloodless pump prime on cerebral oxygenation in paediatric patients

BACKGROUND

In paediatric patients, crystalloid prime for cardiopulmonary bypass (CPB) causes further haemodilution in comparison with blood-containing prime. Thus it may affect the cerebral oxygen supply/demand balance. The purpose of the study was to compare the effect of bloodless pump prime with that of blood-containing prime on cerebral oxygenation in children.

METHODS

Thirty-six paediatric patients scheduled for elective repair of atrial or ventricular septal defect were enrolled. In Group C (n = 18), the CPB circuit was primed only with crystalloid. In Group B (n = 18), red blood cells were added to achieve a haematocrit (Hct) of 20% during CPB. The regional cerebral oxygen saturation (rSO(2)) value measured by near-infrared spectroscopy was compared between the two groups.

RESULTS

In both groups, rSO(2) decreased below baseline at the start of CPB and during rewarming (P < 0.001, for both groups during each period). At the start of CPB, haemodilution was greater in Group C than in Group B (Hct 16.1 +/- 0.7% vs. 20.7 +/- 0.5%; P < 0.01), and there was a greater reduction in rSO(2) in Group C (49.0 +/- 5.4% vs. 59.2 +/- 7.0%; P < 0.01). During rewarming, rSO(2) was significantly lower in Group C than in Group B (57.8 +/- 5.3% vs. 62.8 +/- 6.2%; P < 0.01).

CONCLUSIONS

In paediatric patients, the haemodilution associated with crystalloid priming causes a greater reduction in rSO(2) than with blood-containing prime at the starting period of CPB and the rewarming period.

Polymorphism of angiotensin-converting enzyme gene and BMI in obese Korean women

BACKGROUND

The renin-angiotensin system (RAS) plays a role in the pathogenesis of metabolic diseases. This system was recently found to be completely expressed in human adipose tissue. Especially angiotensin II, the active component of RAS, may affect adipogenesis and adipocyte metabolism. We examined whether obese and non-obese subjects differ from angiotensin-converting enzyme (ACE) genotype distribution, and whether the ACE genotypes affect the anthropometric parameters or the degrees of body mass index (BMI).

METHODS

The study included 155 obese healthy women (BMI > or = 25 kg/m(2), range 25-54.7, age range 15-40 years), 82 non-obese women (BMI < 25 kg/m(2), range 15-40 years), and 613 random controls. Total fat mass and percent body fat (PBF) were determined by dual-energy X-ray absorptiometry (DEXA). Genomic DNA was extracted and used for polymerase chain reaction (PCR)-based genotyping of ACE.

RESULTS

Age, percent body fat, waist-to-hip ratio (WHR), body mass index, and cholesterol concentrations did not differ from ACE genotype. No differences were observed for allelic and genotype frequencies between obese women (BMI > or = 25) and 82 non-obese women or 613 random controls. In addition, no association of ACE polymorphism was observed with BMI for genotype in obese women.

CONCLUSIONS

ACE polymorphism is not a significant factor for BMI and does not contribute to the odds of obesity in obese healthy women from Korea.