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Background: The objective of this study was to investigate the effect-site concentration (Ce) of remimazolam at loss of response (LOR) and recovery of response (ROR) in patients underwent general anesthesia using simulation. In addition, the relationships between patient’s factors and simulated Ce at LOR and ROR were examined.Methods: The medical records of 81 patients who underwent elective surgery under general anesthesia using remimazolam with simulation of Ce between August 4, 2021 and October 12, 2021, were retrospectively reviewed. Remimazolam was administered as an induction dose of 6 or 12 mg/kg/h until the patient became unresponsive, followed by 0.32 mg/kg/h to maintain BIS values below 60. Simultaneously, simulations of manual infusion mode were performed using Asan Pump software and the Ce of remimazolam was simulated using the Schüttler model. Whenever infusion rate of remimazolam was manually changed, the simulated Ce was confirmed almost simultaneously. LOR and ROR, defined as unresponsive and eye-opening to verbal commands, respectively, were recorded in the Asan Pump program.Results: The median (1Q, 3Q) simulated Ce at LOR and ROR were 0.7 (0.5, 0.9) and 0.3 (0.2, 0.4) g/ml, respectively. LOR was achieved in 1.9 min after remimazolam infusion with cumulative doses of 0.3 mg/kg. There was a significant relationship between age and simulated Ce at ROR (Ce at ROR = –0.0043 × age + 0.57, r = 0.30, P = 0.014). Conclusions: For optimal dosage adjustment, simulating Ce while administering remimazolam with a weight-based dose during anesthesia is helpful. Elderly patients may recover from anesthesia at lower Ce of remimazolam.

This study aims to analyze the effects of esthetic salon’s internal marketing factors on employees’ organizational commitment and customer-orientation. This study distributed 590 copies of questionnaire targeting Be-chae employees, and 570 effective copies of the questionnaire were used as final analysis data. For statistical processing, a SPSS v. 21.0 Statistical Package Program was used through the data coding and data cleaning process. The study results are as follows: the reward system by subfactor of the internal marketing factors at the esthetic salon, support from management, education/training, and welfare benefits were revealed as the factors enhancing employees’ organizational commitment in order. Education/training, communication, and the reward system were shown to elevate employees’ customer-orientation in order. As employees’ organizational commitment increased, customer-orientation was also higher. Therefore internal marketing has an important effect on employees’ organizational commitment and customer-orientation.

A novel ultra-short-acting benzodiazepine (BDZ), remimazolam (CNS 7056), has been designed by ‘soft drug’ development to achieve a better sedative profile than that of the current drugs. Notably, the esterase linkage in remimazolam permits rapid hydrolysis to inactivate metabolites by non-specific tissue esterase and induces a unique and favorable pharmacological profile, including rapid onset and offset of sedation and a predictable duration of action. Similar to other BDZs, its sedative effects can be reversed using flumazenil, a BDZ antagonist. The pharmacokinetics and pharmacodynamics of remimazolam are characterized by relatively high clearance, small steady-state volume of distribution, short elimination half-life, short context-sensitive half-life, and fast onset and recovery, indicating rapid elimination, minimal tissue accumulation, and good control. In addition, remimazolam possesses a superior safety profile, including low liability for cardiorespiratory depression and injection pain, making it a preferred hypnotic agent in various clinical settings. Early clinical investigations suggest that remimazolam is well tolerated and effective for procedural sedation and for induction and maintenance of general anesthesia. To date, however, the clinical use of remimazolam has been confined to a few volunteer studies and a limited number of clinical investigations. Therefore, further studies regarding its recovery issues or postoperative complications, characteristics of electroencephalogram changes, and cost-benefit analyses are required to facilitate its widespread use.

This study focus on the characteristics and of the Fragment of Stone Buddha of Hoeamsa Temple(檜巖寺). As is well known, this temple had been developed rebuilding by supporting of the royal family from the late of Korea Dynasty to the early of Joseon Dynasty(朝鮮). The Hoeamsa Temple Site in Yangju(陽州) is believed to have been destroyed in a fire in the late 16th century, and various artifacts have been excavated after several excavations since 1999. This Temple has been excavated a variety of Fragment of Stone Buddha statues. The Buddha statue of Hoeamsa Temple in Yangju has a hole on top of high usnisa(肉髻), and special folds in the left arm and a thick clothing style. It was reflects the sculptural Joseon style modified by the Tibet-Chinese style. This style is very similar to that of Buddha statues produced in the 15th century, supported by the royal family of Joseon. In particular, these statues were believed to have been produced around the first half of the 15th century when the temple was heavily fortified with the support of Prince Hyo-ryeong(孝寧大君). It is also interesting to note that these statues show the sculptural features of the early Joseon Dynasty, reflecting the Tibetan-Chinese sculptures style, compared to those of the Buddhist sculptures in the first half of the 15th century during the year of Yeongrak (1403~1424) and Seondeok (1426~1435), the kings of the Ming Dynasty. This reflects the development of Buddhist sculptures in the early Joseon Dynasty in line with the trend of Buddhist art in East Asia.

The Eleveld propofol pharmacokinetic (PK) model, which was developed based on a broad range of populations, showed greater bias (- 27%) in elderly subjects in a previous validation study conducted by Vellinga and colleagues. We aimed to develop and externally validate a new PK-pharmacodynamic (PK-PD) model of propofol for elderly subjects. A population PK-PD model was constructed using propofol plasma concentrations and bispectral index (BIS) values that were obtained from 31 subjects aged 65 years older in previously published phase I studies. The predictive performance of the newly-developed PK-PD model (Choi model) was assessed in a separate Korean elderly population and compared with that of the Eleveld model. A three-compartment mammillary model using an allometric expression and a sigmoid E

Inserting a double-lumen endotracheal tube (DLT) poses more challenge than inserting a single-lumen tube. The C-MAC D-blade videolaryngoscope is a useful alternative to the direct laryngoscope. However, no study has compared its performance with that of the McCoy laryngoscope, which has a hyperangulated blade tip similar to that of the C-MAC D-blade. We aimed to compare the performance of the C-MAC D-blade videolaryngoscope with that of the McCoy laryngoscope in DLT intubation.In this prospective randomized controlled study, 90 patients requiring DLT intubation were randomly allocated to either the C-MAC D-blade videolaryngoscope group (group C, n = 47) or McCoy laryngoscope group (group M, n = 43). During intubation, the percentage of glottic opening, modified Cormack-Lehane grade, time taken for intubation, malposition of the bronchial lumen, and hemodynamic parameters were recorded. After intubation, we assessed the intubation difficulty scale score and, a postoperative sore throat in the recovery room.The time taken for intubation was 35.85 ± 10.77 seconds and 33.18 ± 11.97 seconds in groups C and M, respectively (P = .269). The modified Cormack-Lehane grade was significantly lower in group C than in group M (P = .000). Percentage of glottic opening was significantly higher in group C (79.36 ± 13.42%) than in group M (53.49 ± 29.83%) (P = .000). The intubation difficulty scale score was significantly lower in group C than in group M (P = .030). There were no significant differences between the 2 groups in terms of malposition status, hemodynamic parameters, or visual analog scale score for a postoperative sore throat.Although the time taken for intubation was comparable between the 2 intubation devices, the C-MAC D-blade videolaryngoscope facilitated glottis visualization and reduced the intubation difficulty scale better than the McCoy laryngoscope in patients undergoing DLT intubation.

We aimed to evaluate the predictive performance of previously constructed free (Cfree) and total (Ctotal) cefoxitin pharmacokinetic models and the possibility of administering cefoxitin via the target-controlled infusion (TCI) method in clinical practice. Two external validation studies (N = 31 for Cfree model, N = 30 for Ctotal model) were conducted sequentially. Cefoxitin (2 g) was dissolved in 50 mL of normal saline to give a concentration of 40 mg mL-1. Before skin incision, cefoxitin was infused with a TCI syringe pump. Target concentrations of free concentration and total concentration were set to 25 and 80 μg mL-1, respectively, which were administered throughout the surgery. Three arterial blood samples were collected to measure the total and free plasma concentrations of cefoxitin at 30, 60 and 120 min, after the start of cefoxitin administration. The predictive performance was evaluated using four parameters: inaccuracy, divergence, bias and wobble. The pooled median (95% confidence interval) biases and inaccuracies were -45.9 (-47.3 to -44.5) and 45.9 (44.5 to 47.3) for Cfree model (Choi_F model), and -16.6 (-18.4 to -14.8) and 18.5 (16.7 to 20.2) for Ctotal model (Choi_Told model), respectively. The predictive performance of the newly constructed model (Choi_Tnew model), developed by adding the total concentration data measured in the external validation, was better than that of the Choi_Told model. Models constructed with total concentration data were suitable for clinical use. Administering cefoxitin using the TCI method in patients maintained the free concentration above the minimal inhibitory concentration (MIC) breakpoints of the major pathogens causing surgical site infection throughout the operation period.

Background The head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway. Methods Sixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation. Results The mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P P Conclusion In the head-elevated position, aligning the AM-S in the horizontal plane consistently improved laryngeal visualization without worsening the view when the McGrath MAC videolaryngoscope was used in patients with simulated difficult airways. It also improved the ease of intubation, which reduced the need for optimization maneuvers. Trial registration This trial was registered with www.clinicaltrials.gov, NCT04716218, on 20/01/2021.

Stochastic particle impact electrochemistry (SPIE) is considered one of the most important electro-analytical methods to understand the physicochemical properties of single entities. SPIE of individual insulating particles (IPs) has been particularly crucial for analyses of bioparticles. In this article, we introduce stochastic particle approach electrochemistry (SPAE) for electrochemical analyses of IPs, which is the advanced version of SPIE; SPAE is analogous to SPIE but focuses on deciphering a sudden current drop (SCD) by an IP-approach toward the edge of an ultramicroelectrode (UME). Polystyrene particles (PSPs) with and without different surface functionalities (-COOH and - NH

The aim of this study was to explore the utility of target-concentration controlled infusion (TCI) as a prophylactic antibiotic administration method based on the results of a population pharmacokinetic model of cefazolin. In patients undergoing elective gastric surgery, 2 g of cefazolin was dissolved in 50 mL of saline and administered for 10 min prior to skin incision. Arterial blood samples were obtained at preset intervals to measure the total and free plasma concentrations of cefazolin. Population pharmacokinetic analysis was performed using non-linear mixed-effects modelling. To evaluate the effectiveness of the TCI method, stochastic simulation was performed based on the model construction results. In total, 360 total and 360 free plasma concentration measurements from 40 patients were used to characterise the pharmacokinetics of cefazolin. The changes in the total concentration of cefazolin over time were well-explained by the three-compartment mammillary model. Fat-free mass and estimated glomerular filtration rate were significant covariates. The probability of target attainment (PTA) to reach the target 100% fraction of time that the free plasma concentration of cefazolin was maintained above its minimal inhibitory concentration (fT MIC) at MIC of 4 mg/L was also notably higher in the TCI method (90.7%) than in the standard method (17.0%). When cefazolin is administered by the TCI method, patient-tailored antibiotic dosing may be possible. The potential benefits of administering prophylactic antibiotics by the TCI method were observed. Further research is warranted to confirm the effectiveness of the TCI method.

Background: Both Macintosh-geometry and hyper-angulated videolaryngoscopes provide a better laryngeal view than conventional direct laryngoscope. However, the Macintosh-geometry videolaryngoscopes may not provide as dramatic an improvement in the laryngeal view as the hyper-angulated videolaryngoscopes because they lack the capacity to view structures around corners, so glottic exposure using the Macintosh-geometry videolaryngoscopes may be incomplete in some difficult airway. Patient positioning has an important effect on laryngeal visualization and successful tracheal intubation. However, the ideal head and neck position for videolaryngoscope has not yet been evaluated. We evaluated the effects of the back-up position on laryngeal visualization and ease of intubation using a Macintosh-geometry videolaryngoscope in patients with a simulated difficult airway.Methods: Sixty-four patients were included in this prospective, crossover, randomized controlled trial. Limited neck movement and mouth opening were simulated using a cervical collar. The laryngeal view was assessed in both neutral and back-up positions, in a randomized order, using a Macintosh-geometry videolaryngoscope, based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. When scoring laryngeal visualization, external laryngeal manipulation was not permitted. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, Intubation Difficulty Scale (IDS) scores, and time to intubation.Results: The mean POGO score improved significantly in the back-up position (59.4 ± 23.8%) compared with the neutral position (37.5 ± 24%) (P P P Conclusion: The back-up position significantly improved the laryngeal view during Macintosh-geometry videolaryngoscope-guided intubation. It also improved ease of intubation, reflected in a reduced need for optimization maneuvers.Trial registration: This trial was registered with www.clinicaltrials.gov, NCT04716218, on 20/01/2021.

The Zn-polyiodide redox flow battery is considered to be a promising aqueous energy storage system. However, in its charging process, the electrode kinetics of I

Background Self-monitoring smartphone apps and health coaching have both individually been shown to improve weight-related outcomes, but their combined effects remain unclear. Objective This study aims to examine the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in people with overweight and obesity. Methods Relevant articles published from inception till June 9, 2022, were searched through 8 databases (Embase, CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, and Web of Science). Effect sizes were pooled using random-effects models. Behavioral strategies used were coded using the behavior change techniques taxonomy V1. Results A total of 14 articles were included, representing 2478 participants with a mean age of 39.1 years and a BMI of 31.8 kg/m2. Using combined intervention significantly improved weight loss by 2.15 kg (95% CI −3.17 kg to −1.12 kg; P Conclusions Combined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app. Trial Registration PROSPERO CRD42022345133; https://tinyurl.com/2zxfdpay

ImportanceCommunication about patients’ goals and planned and potential treatment is central to advance care planning. Undertaking or confirming advance care plans is also essential to preoperative preparation, particularly among patients who are frail or will undergo high-risk surgery.ObjectiveTo evaluate the association between patient risk of hospitalization or death and goals-of-care conversations documented with a completed Life-Sustaining Treatment (LST) Decisions Initiative note among veterans undergoing surgery.Design, Setting, and ParticipantsThis retrospective cross-sectional study included 190 040 veterans who underwent operations between January 1, 2017, and February 28, 2020. Statistical analysis took place from November 1, 2021, to November 17, 2022.ExposurePatient risk of hospitalization or death, evaluated with a Care Assessment Need (CAN) score (range, 0-99, with a higher score representing a greater risk of hospitalization or death), dichotomized as less than 80 or 80 or more.Main Outcomes and MeasuresPreoperative LST note completion (30 days before or on the day of surgery) or no LST note completion within the 30-day preoperative period prior to or on the day of the index operation.ResultsOf 190 040 veterans (90.8% men; mean [SD] age, 65.2 [11.9] years), 3.8% completed an LST note before surgery, and 96.2% did not complete an LST note. In the groups with and without LST note completion before surgery, most were aged between 65 and 84 years (62.1% vs 56.7%), male (94.3% vs 90.7%), and White (82.2% vs 78.3%). Compared with patients who completed an LST note before surgery, patients who did not complete an LST note before surgery tended to be female (9.3% vs 5.7%), Black (19.2% vs 15.7%), married (50.2% vs 46.5%), and in better health (Charlson Comorbidity Index score of 0, 25.9% vs 15.2%); to have a lower risk of hospitalization or death (CAN score Conclusions and RelevanceDespite increasing LST note implementation, a minority of veterans completed an LST note preoperatively. Although doing so was more common among veterans with an elevated risk compared with those at lower risk, improving proactive communication and documentation of goals, particularly among higher-risk veterans, is needed. Doing so may promote goal-concordant surgical care and outcomes.