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Background Myringotomy with tympanostomy tube insertion (MTI) is a superficial surgical procedure used to prevent hearing loss in children with serous otitis media. Intravenous anesthesia, often ketamine, is preferred for this procedure because of its ability to induce sedation without compromising airway reflexes. However, ketamine alone may be insufficient and potentially lead to spontaneous movement during surgery. This study evaluated the effectiveness of midazolam and fentanyl as adjuvants to ketamine in reducing spontaneous movement during MTI and enhancing the quality of recovery. Methods This study involved two groups of 30 patients each: one group received intravenous ketamine (1.5 mg/kg) with an equal volume of normal saline (K group), while the other received a combination of midazolam, fentanyl, and ketamine (0.05 mg/kg, 1 μg/kg, and 1.5 mg/kg, respectively; MFK group). We assessed side effects, intraoperative patient movement, surgeon satisfaction, and emergence agitation scores. Results The MFK group exhibited significantly lower scores for patient movement (p

Background The pain-relief properties of tricyclic antidepressants can be attributed to several actions. Recent observations suggest that adenosine is involved in the antinociceptive effect of amitriptyline. The A3 adenosine receptor (A3AR) is the only adenosine subtype overexpressed in inflammatory and cancer cells. This study was performed to investigate the role of A3AR in the anti-nociceptive effect of amitriptyline. Methods Spinal nerve-ligated neuropathic pain was induced by ligating the L5 and L6 spinal nerves of male Sprague-Dawley rats. The neuropathic rats were randomly assigned to one of the following three groups (8 per group): a neuropathic pain with normal saline group, a neuropathic pain with amitriptyline group, and a neuropathic pain with amitriptyline and 3-ethyl-5-benzyl- 2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS) group. Amitriptyline or saline was administered intraperitoneally and 3-ethyl-5-benzyl-2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS-1191), an A3AR antagonist, was injected subcutaneously immediately before amitriptyline administration. The level of extracellular signal-regulated kinase P44/42 (ERK1/2), cyclic AMP response element-binding protein (CREB), and proinflammatory cytokines were assessed using immunoblotting or reverse-transciption polymerase chain reaction. Results Amitriptyline increased the mechanical withdrawal threshold of the neuropathic rats. The level of phospho-ERK1/2 and phospho-CREB proteins, and proinflammatory cytokines produced by spinal nerve ligation were significantly reduced by amitriptyline administration. However, the use of MRS-1191 before amitriptyline administration not only reduced the threshold of mechanical allodynia, but also increased the signaling protein and proinflammatory cytokine levels, which were reduced by amitriptyline. Conclusions The results of this study suggest that the anti-nociceptive effect of amitriptyline involves the suppression of ERK1/2 and CREB signaling proteins, and A3AR activation also affects the alleviation of the inflammatory response.

Objective To investigate the ability of kobusone to reduce high glucose levels and promote β-cell proliferation. Methods Four-week-old female db/db mice were assigned to the kobusone (25 mg/kg body weight, intraperitoneally twice a day) or control group (same volume of PBS). Glucose levels and body weight were measured twice a week. After 6 weeks, intraperitoneal glucose tolerance tests and immunohistochemical studies were performed, and insulin levels were determined. The expression of mRNAs involved in cell proliferation, such as PI3K, Akt, cyclin D3 and p57 Kip 2 , was measured by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Results Kobusone reduced blood glucose levels after 3 weeks and more strongly increased serum insulin levels than the vehicle. Immunohistochemistry illustrated that kobusone increased 5-bromo-2′-deoxyuridine incorporation into islet β-cells, suggesting that it can stimulate islet β-cell replication in vivo . RT-qPCR indicated that kobusone upregulated the mRNA expression of PI3K, Akt, and cyclin D3 and downregulated that of p57 Kip2 . Conclusion Our findings suggest that kobusone is a potent pancreatic islet β-cell inducer that has the potential to be developed as an anti-diabetic agent.

Background and Objectives: The effect of positive end-expiratory pressure (PEEP) on intraocular pressure (IOP) is debatable. There have been no studies investigating the effects of PEEP on IOP during one-lung ventilation (OLV). We aimed to investigate the effects of PEEP on IOP in patients undergoing OLV for video-assisted thoracoscopic surgery (VATs). Materials and Methods: Fifty-two patients undergoing VATs were divided into a zero-PEEP (ZEEP) and a 6 cmH2O of PEEP (PEEP) groups. IOP, ocular perfusion pressure (OPP), and respiratory and hemodynamic parameters were measured before induction (T1), immediately following endotracheal intubation (T2), 30 min (T3) and 60 min (T4) after a position change to the lateral decubitus position (LDP) and OLV, and 10 min following two-lung ventilation near the end of the surgery (T5). Results: There was no significant difference in IOP and OPP between the two groups. The IOP of the dependent eye was significantly higher than that of the non-dependent eye during LDP in both groups. Peak inspiratory pressure was significantly higher in the PEEP group than in the ZEEP group at T3–T5. Dynamic compliance was significantly higher in the PEEP group than in the ZEEP group at T2–T5. The ratio of arterial oxygen partial pressure to fractional inspired oxygen was significantly higher in the PEEP group than in the ZEEP group at T4. Conclusions: Applying 6 cmH2O of PEEP did not increase IOP but enhanced dynamic compliance and oxygenation during OLV. These results suggest that 6 cmH2O of PEEP can be safely applied during OLV in LDP.

Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for an epidural blood patch. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed. The patient underwent an acupuncture therapy for management of chronic low back pain due to postlaminectomy syndrome. After the procedure, the patient had a severe headache and the conservative treatment was not effective. The two interlaminar epidural blood patches at the L2–3 level and at the L3–4 level were failed. We performed transforaminal epidural blood patch at the L3–4 and L4–5 levels on the left side, the site of leakage in the MRI myelogram. His symptoms finally subsided without complication. This case demonstrates that targeted transforaminal epidural blood patch is a therapeutic option for the treatment of postdural puncture headache when epidural blood patch using an interlaminar approach is ineffective.

BackgroundMilrinone increases intracellular adenosine 3',5'-cyclic monophosphate concentration and enhances vascular relaxation. Nuclear factor-kappa B (NF-kB) plays a key role in inflammatory responses during ischemia-reperfusion (I/R) injury. We aimed to investigate the effect of milrinone on the inflammatory responses and NF-kB activation in renal I/R injury in mice.MethodsThirty C57BL/6 mice were allocated into 3 groups. In group S (n = 10), only right nephrectomy was done. In group C (n = 10), the left kidney was subjected to 30 min of ischemia after right nephrectomy. In group M (n = 10), milrinone (5 µg/kg) was administered before ischemia. After 24 hours of reperfusion, the serum creatinine was measured, kidney samples were obtained for histology, and expressions of NF-kB and proinflammatory cytokines were analyzed.ResultsIn group C, the serum creatinine concentration was markedly elevated, compared with group S. Creatinine concentration in group M was also elevated, but it was significantly lower than that in group C. Histologic evidence of renal damage was severe in group C, but it was improved in group M. In groups C and M, expression of NF-kB, tumor necrosis factor-α (TNF-α), intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-2 (MIP-2) mRNA increased significantly compared with group S (P < 0.05). But group M showed a lower expression of NF-kB, TNF-α, ICAM-1, MCP-1 and MIP-2 mRNA than group C (P < 0.05).ConclusionsMilrinone treatment attenuates the renal inflammatory response and activation of NF-kB, resulting in improvement of renal function and tissue injury.

BackgroundThe patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy.MethodsSeventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST), Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded.ResultsApply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P < 0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05).ConclusionsCompared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50's side effects.

We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.

We report a case of Rumpel-Leede (RL) phenomenon, - acute dermis capillary rupture, secondary to noninvasive blood pressure (NIBP) monitoring in a patient with type 2 diabetes mellitus (DM) and hypertension. The first most likely cause is vascular fragility in microangiopathy as a result of DM and chronic steroid use. The second is the increased venous pressure during cycling of the blood pressure cuff in a hypertensive state. Anesthesiologists need to be aware that acute dermal capillary rupture, although rare, can occur in patients with long-standing DM, hypertension and chronic steroid use.

This study investigated the sources and distribution characteristics of PM2.5 and its chemical components (ions, carbons, elements) at five locations within the Banwal and Sihwa National Industrial Complexes in Ansan and Siheung. These large-scale industrial clusters, comprising 7642 businesses across sectors such as petrochemicals, steel, machinery, and electronics, operate throughout the year. From 2020 to 2023, the average PM2.5 concentration in the study area was 28.66 ± 16.72 μg/m3, with notable seasonal differences observed across the five measurement points. Ionic components were the primary contributors to PM2.5, while carbon and trace element concentrations fluctuated with the seasons. The coefficient of divergence (COD) analysis indicated that emission source differences between sites were insignificant, with COD values consistently below the threshold of 0.3. Hierarchical cluster analysis (HCA) and principal component analysis (PCA) identified secondary aerosols and vehicle emissions as the main sources of PM2.5, alongside additional contributions from Asian dust, industrial emissions, road dust, coal combustion, metal processing, biomass burning, and soil dust. These results highlight the need for systematic and economical air pollution control strategies in complex industrial areas, using COD to identify source differences and quantify contributions at different sites. [ABSTRACT FROM AUTHOR]

Sialic acid is a diverse group of monosaccharides often found on the termini of N- and O-linked glycans as well as being components of glycoconjugates. Hypersialylation has been associated with the progression of chronic inflammation-mediated diseases such as cardiovascular disease and cancer. Given its role in infection and disease-related processes, sialic acid is a promising target for therapeutic approaches that utilize carbohydrate-binding molecules. In this study, we screened for sialic acid-recognizing variable lymphocyte receptors (VLRBs) or ccombodies from inshore hagfish (Eptatretus burgeri) using a synthetic Neu5Ac-glycoconjugate as an antigen in immunoassay. Resulting ccombodies, 2D8, 5G11, 4A1, and 5F8 were further characterized in terms of their binding activity and specificity. A competitive ELISA using free haptens showed strong inhibition using either N-acetylneuraminic acid (Neu5Ac) and N-glycolylneuraminic acid (Neu5Gc). The half-maximal inhibitory concentrations (IC50) for Neu5Ac ranged from 7.02 to 17.06 mM, with candidates 4A1 and 5G11 requiring the least and highest amounts, respectively. IC50 values for Neu5Gc ranged from 8.12 to 13.91 mM, for 4A1 and 5G11, respectively. Candidate ccombodies also detected naturally occurring sialic acid from known sialoglycoproteins using a dot blot assay. Neu5Gc-5G11 and Neu5Ac-2D8 yielded the strongest and weakest docking interactions with affinity values of −5.9 kcal/mol and −4.9 kcal/mol, respectively. Hydrogen bonding and hydrophobic interactions were predicted to be the predominant noncovalent forces observed between the ccombodies and sialic acid. This study demonstrates that glycan-binding VLRBs from hagfish hold promise in augmenting the glycobiologists' toolkit in investigating the roles of glycans in human and animal health and disease. [ABSTRACT FROM AUTHOR]

Junction barrier Schottky design Ga2O3 rectifiers allow for a combination of low turn-on voltage and high breakdown voltage. Ni/Au/Ga2O3 Schottky rectifiers and NiO/Ga2O3 heterojunction rectifiers were fabricated on the same wafer and the percentage of the relative areas and diameters of each were varied from pure Schottky devices to pure heterojunction devices. The on-voltage increased from 0.6 V for Schottky rectifiers to 2.4 V for heterojunction rectifiers, with a monotonic decrease in forward current at fixed bias of 5 V from 375 nA cm−2 to 175 nA cm−2. Conversely, the breakdown voltage increased monotonically as the proportion of heterojunction area increased, from 1.2 kV for Schottky rectifiers to 6.2 kV for pure heterojunction devices. Breakdown mostly was initiated at the edge of the anode contact but could also occur at the transition region from the Schottky contact to NiO edge termination. The Baliga figure of merit increased with both the relative percentage of area and diameter of the heterojunction contact from 0.2 GW cm−2 to 3 GW cm−2, while the energy loss during switching also increased from 2 to 3.9 W cm−2. These trends illustrate the trade-offs of Schottky versus pn junctions for the operation of Ga2O3 rectifiers. [ABSTRACT FROM AUTHOR]

Vertical geometry NiO/Ga2O3 heterojunction (HJ) rectifiers and Ni/Au Schottky rectifiers fabricated on the same wafer and each with the same diameter (100 μm) were operated at 77–473 K to compare their capabilities in space-like environments. The HJ rectifiers suffer a 4-order reduction in forward current at 77 K due to the freeze-out of acceptors in the NiO, leading to MIS-type operation. By sharp contrast, the Schottky rectifiers have higher forward current and lower on-resistance at 77 K compared to 298 K due to improved carrier mobility. The on/off ratio of Schottky rectifiers at 77 K becomes similar to HJ rectifiers at 298–473 K. The reverse recovery time of Schottky rectifiers is reduced from 20 ns at 273 K to 16 ns at 77 K, while HJ rectifiers cannot be switched at this temperature. While the latter are superior for high-temperature applications, the former are better suited to cryogenic operation. [ABSTRACT FROM AUTHOR]

Abstract Stretchable lithium batteries have attracted considerable attention as components in future electronic devices, such as wearable devices, sensors, and body‐attachment healthcare devices. However, several challenges still exist in the bid to obtain excellent electrochemical properties for stretchable batteries. Here, a unique stretchable lithium full‐cell battery is designed using 1D nanofiber active materials, stretchable gel polymer electrolyte, and wrinkle structure electrodes. A SnO2/C nanofiber anode and a LiFePO4/C nanofiber cathode introduce meso‐ and micropores for lithium‐ion diffusion and electrolyte penetration. The stretchable full‐cell consists of an elastic poly(dimethylsiloxane) (PDMS) wrapping film, SnO2/C and LiFePO4/C nanofiber electrodes with a wrinkle structure fixed on the PDMS wrapping film by an adhesive polymer, and a gel polymer electrolyte. The specific capacity of the stretchable full‐battery is maintained at 128.3 mAh g−1 (capacity retention of 92%) even after a 30% strain, as compared with 136.8 mAh g−1 before strain. The energy densities are 458.8 Wh kg−1 in the released state and 423.4 Wh kg−1 in the stretched state (based on the electrode), respectively. The high capacity and stability in the stretched state demonstrate the potential of the stretchable battery to overcome its limitations.