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Abstract Background Circulating tumor DNA (ctDNA) has emerged as a prognostic and predictive biomarker for detection of minimal residual disease (MRD), monitoring treatment response, and early detection of recurrence in cancer patients. In this study, we explored the utility of ctDNA‐based MRD detection to predict recurrence in a real‐world cohort of primarily early‐stage non‐small cell lung cancer (NSCLC) patients treated with curative intent. Methods Longitudinal plasma samples were collected post curative‐intent treatment from 36 patients with stage I–IV NSCLC. A personalized, tumor‐informed assay was used to detect and quantify ctDNA in plasma samples. Results Of the 24 patients with plasma samples available during the MRD window (within 6 months of curative surgery and before adjuvant therapy), ctDNA was detectable in two patients. Patients with ctDNA‐positivity during the MRD window were 15 times more likely to recur compared to ctDNA‐negative patients (HR: 15.0, 95% CI: 1.0–253.0, p = 0.010). At any time post‐curative intent treatment, ctDNA‐positivity was associated with significantly poorer recurrence‐free survival compared to persistently ctDNA‐negative patients (p

Background Mounier-Kuhn syndrome (MKS) is a rare disorder characterized by abnormal dilation of the trachea and main bronchi. MKS can be easily missed on chest X-rays, making diagnosis difficult. Under general anesthesia, challenges such as airway leakage or collapse during mechanical ventilation may complicate the achievement of adequate tidal volumes. Case A 94-year-old woman requiring emergency hemiarthroplasty of the hip under general anesthesia was admitted. Preoperative chest X-rays revealed dilation of the trachea and main bronchi, but the patient exhibited no respiratory symptoms. We diagnosed her with MKS and opted for an 8.0-mm-inner-diameter reinforced tracheal tube. We positioned the cuff in the subglottic area, inflating it while monitoring for air leakage. Throughout the surgery, adequate tidal volume was maintained. Conclusions Anesthesiologists must conduct a comprehensive evaluation of patients with MKS, including a review of chest radiographs, and establish a meticulous anesthesia plan prior to surgery.

Despite advances in emergency transfer systems and trauma medicine, the incidence of preventable deaths due to massive hemorrhage remains high. Recent immunological research has elucidated key mechanisms underlying trauma-induced coagulopathy in the early stages of trauma, including sympathoadrenal stimulation, shedding of the glycocalyx, and endotheliopathy. Consequently, the condition progresses to fibrinogen depletion, hyperfibrinolysis, and platelet dysfunction. Coexisting factors such as uncorrected acidosis, hypothermia, excessive crystalloid administration, and a history of anticoagulant use exacerbate coagulopathy. This study introduces damage-control anesthetic management based on recent insights into damage-control resuscitation, emphasizing the importance of rapid transport, timely bleeding control, early administration of antifibrinolytics and fibrinogen concentrates, and maintenance of calcium levels and body temperature. Additionally, this study discusses brain-protective strategies for trauma patients with brain injuries and the utilization of cartridge-based viscoelastic assays for goal-directed coagulation management in trauma settings. This comprehensive approach may provide potential insights for anesthetic management in the fast-paced field of trauma medicine.

ABSTRACTPreclinical evidence suggests that voltage gradients can act as a kind of top-down master regulator during embryogenesis and orchestrate downstream molecular-genetic pathways during organ regeneration or repair. Moreover, electrical stimulation shifts response to injury toward regeneration instead of healing or scarring. Cancer and embryogenesis not only share common phenotypical features but also commonly upregulated molecular pathways. Voltage-gated ion channel activity is directly or indirectly linked to the pathogenesis of cancer hallmarks, while experimental and clinical studies suggest that their modulation, e.g., by anesthetic agents, may exert antitumor effects. A large recent clinical trial served as a proof-of-principle for the benefit of preoperative use of topical sodium channel blockade as a potential anticancer strategy against early human breast cancers. Regardless of whether ion channel aberrations are primary or secondary cancer drivers, understanding the functional consequences of these events may guide us toward the development of novel therapeutic approaches.

Abstract Background The American Society of Anesthesiologists Physical Status Classification System is commonly used for preoperative assessment. Patient physical status before surgery can play an important role in postoperative nausea and vomiting. However, the relationship between the physical status classification and postoperative nausea and vomiting has not been well defined. Methods Adults aged ≥ 18 years who underwent procedures under anesthesia between 2015 and 2020 were included in the study. We analyzed the relationship of postoperative nausea and vomiting with physical status classification score using propensity score matching and Cox hazard regression. Differences in intraoperative use of vasopressor and inotropes and invasive monitoring were investigated according to the classification. Results A total of 163,500 patients were included in the study. After matching, classification 1 versus 2 included 43,400 patients; 1 versus ≤ 3, 13,287 patients; 2 versus ≤ 3, 23,530 patients (absolute standardized difference, 0–0.06). Patients with physical status classification ≤ 3 had a significantly lower postoperative nausea and vomiting risk than those with classification 1–2 (physical status classification 1 vs. ≤ 3, hazard ratio 0.76 [0.71–0.82], P < 0.001; 2 versus ≤ 3, hazard ratio 0.86 [0.82–0.91], P < 0.001). Intraoperative use of vasopressor or inotrope and invasive monitoring were noted more in the high physical status classification than the low physical status classification (absolute standardized difference [0.19–1.25]). Conclusion There were differences in intraoperative invasive monitoring and use of vasopressor or inotrope among the classifications, and a score of 3 or higher reduced the risk of postoperative nausea and vomiting more than a score of 1–2.

Key Clinical Message When performing noncardiac surgery in high‐risk patients with PCI, anesthesiologists should be prepared for in‐stent thrombosis, that do not respond to conventional treatments and cardiopulmonary resuscitation. VA‐ECMO is an advantageous treatment method in those patients.

Kuo-Chen Cheng,1,&ast; Chih-Cheng Lai,2,&ast; Cheng-Yi Wang,3 Ching-Min Wang,4 Chung-Han Ho,5– 7 Mei-I Sung,1 Shu-Chen Hsing,1 Kuang-Ming Liao,8 Shian-Chin Ko1 1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Internal Medicine, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan; 3Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan; 4Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan; 5Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 6Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, 11695, Taiwan; 7Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 8Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan&ast;These authors contributed equally to this workCorrespondence: Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan, Email abc8870@yahoo.com.tw Shian-Chin Ko, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, Email 737005@mail.chimei.org.twObjective: To investigate the impact of a multidisciplinary intervention on the clinical outcomes of patients with COPD.Methods: This study retrospectively extracted the data of patients enrolled in the national pay-for-performance (P4P) program for COPD in four hospitals. Only COPD patients who received regular follow-up for at least one year in the P4P program between September 2018 and December 2020 were included.Results: A total of 1081 patients were included in this study. Among them, 424 (39.2%), 287 (26.5%), 179 (16.6%), and 191 (17.7%) patients were classified as COPD Groups A, B, C, and D, respectively. Dual therapy with long-acting β 2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) was the most used inhaled bronchodilator at baseline (n = 477, 44.1%) patients, followed by LAMA monotherapy (n = 195, 18.0%), triple therapy with inhaled corticosteroid (ICS)/LABA/LAMA (n = 184, 17.0%), and ICS/LABA combination (n = 165, 15.3%). After one year of intervention, 374 (34.6%) and 323 (29.9%) patients had their pre- and post-bronchodilator-forced expiratory volume in one second (FEV1) increase of more than 100 mL. Both the COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) scores had a mean change of − 2.2 ± 5.5 and − 0.3 ± 0.9, respectively. The improvement in pulmonary function and symptom score were observed across four groups. The decreased number of exacerbations was only observed in Groups C and D, and not in Groups A and B.Conclusion: This real-world study demonstrated that the intervention in the P4P program could help improve the clinical outcome of COPD patients. It also showed us a different view on the use of dual therapy, which has a lower cost in Taiwan.Keywords: chronic obstructive pulmonary disease, COPD, dual therapy, Disease-Specific Care – Chronic Obstructive Pulmonary Disease, DSC-COPD, certification program, Joint Commission of Taiwan, pay-for-performance, quality-improvement

Background Postoperative pain occurring after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is difficult to control because of extensive surgical injuries and long incisions. We assessed whether the addition of a four-quadrant transabdominal plane (4Q-TAP) block could help in analgesic control. Methods Seventy-two patients scheduled to undergo elective CRS with HIPEC and intravenous patient-controlled analgesia (IV PCA) were enrolled. The patients received 4Q-TAP blocks in a 10 ml mixture of 2% lidocaine and 0.75% ropivacaine per site (4Q-TAP group, n = 36) or normal saline (control group, n = 33). Oxycodone in the post-anesthesia care unit (PACU) and pethidine or tramadol in the ward were used as rescue analgesics. The primary outcome was less than 3 times of rescue analgesic administration (%) in the ward for 5 postoperative days. Secondary endpoints included oxycodone requirement in PACU, fentanyl doses of IV PCA, morphine milligram equivalent (MME) of total opioid use, hospital stay, and postoperative complications. Results During 5 postoperative days, there was no difference in pain scores and total rescue analgesic administration between two groups. However, the use of oxycodone in PACU (P = 0.011), fentanyl requirement in IV PCA (P = 0.029), and MME/kg of total opioid use (median, 2.35 vs. 3.21 mg/kg, P = 0.009) were significantly smaller in the 4Q-TAP group. Hospital stay and incidence of postoperative morbidity were similar in both groups. Conclusions The 4Q-TAP block enhanced multimodal analgesia and decreased opioid requirements in patients with CRS with HIPEC, but did not change postoperative recovery outcomes.

We aimed to identify the causes of inconsistent results between non-invasive prenatal testing (NIPT) and invasive testing methods for trisomy 21. In the first case, NIPT was performed at 11 weeks of pregnancy, and the result showed a high risk of trisomy 21 [fetal fraction (FF) = 6.98%, 21 chromosome Z-score = 3.6]. The patient underwent quantitative fluorescent (QF)-PCR and karyotyping at 14 + 0 weeks of pregnancy through CVS showing mosaicism of 47, XX, + 21[11] and 46, XX [39] in karyotyping. The patient underwent amniocentesis at 15 + 6 weeks, showing a normal pattern in QF-PCR and 46, XX karyotyping in long term culture. The second case underwent NIPT at 16 + 5 weeks of pregnancy (FF = 7.52%, 21 chromosome Z-score = 2.503). She underwent an invasive test at 19 weeks through amniotic fluid sampling. As a result, trisomy 21 was detected by QF-PCR, and mosaicism of XX, +21[22]/46, XX [4] was identified by karyotyping. Despite significant advances in fetal chromosome analysis using NIPT, invasive testing is still needed as placenta-derived DNA does not reflect 100% fetal genetic information. Placental mosaicism can be detected by NIPT, but more research is needed to increase its sensitivity. Therefore, if the NIPT result is positive, an invasive test can confirm the result, and continuous monitoring is required even if the NIPT result is negative.

Abstract Background Predicting difficult airway is challengeable in patients with limited airway evaluation. The aim of this study is to develop and validate a model that predicts difficult laryngoscopy by machine learning of neck circumference and thyromental height as predictors that can be used even for patients with limited airway evaluation. Methods Variables for prediction of difficulty laryngoscopy included age, sex, height, weight, body mass index, neck circumference, and thyromental distance. Difficult laryngoscopy was defined as Grade 3 and 4 by the Cormack-Lehane classification. The preanesthesia and anesthesia data of 1677 patients who had undergone general anesthesia at a single center were collected. The data set was randomly stratified into a training set (80%) and a test set (20%), with equal distribution of difficulty laryngoscopy. The training data sets were trained with five algorithms (logistic regression, multilayer perceptron, random forest, extreme gradient boosting, and light gradient boosting machine). The prediction models were validated through a test set. Results The model’s performance using random forest was best (area under receiver operating characteristic curve = 0.79 [95% confidence interval: 0.72–0.86], area under precision-recall curve = 0.32 [95% confidence interval: 0.27–0.37]). Conclusions Machine learning can predict difficult laryngoscopy through a combination of several predictors including neck circumference and thyromental height. The performance of the model can be improved with more data, a new variable and combination of models.

Abstract Background Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%). Results In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p

Background Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. Conclusions REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.

Abstract Background and objectives Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. Case report We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. Conclusion Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.

Purpose This study compared the pain-relieving effects of human milk, sucrose, and distilled water during examinations for retinopathy of prematurity. Methods Forty-five preterm infants were randomly assigned to receive a pacifier dipped in one of three solutions: human milk (n=14), 24% sucrose (n=15), or distilled water (n=16), 2 minutes before an eye examination. Their pain score, pulse rate, and oxygen saturation were measured at three time points: 5 minutes before the examination, 30 seconds after speculum introduction, and 2 minutes after the examination. Results The infants’ mean gestational age and weight at birth were 33.1±2.1 weeks and 1,842±470 g, respectively. There were no between-group differences in pain relief during the eye examination. The pain score significantly increased both during (p

If the presence of a goiter causes airway deformities in the supraglottic and infraglottic areas, difficult airway should be considered and airway evaluation including physical examination, radiologic studies, and indirect laryngoscopy should be preoperatively performed to determine the airway management plan. Various methods such as direct laryngoscopy, videolaryngoscopy, awake fiberoptic intubation, tracheostomy, and extracorporeal membrane oxygenation support have been reported to secure the airway. In most previously reported goiter cases, the upper airway patency was well maintained and the endotracheal tube was easily passed even when there was severe tracheal narrowing and deviation. We describe a case of successful combined use of videolaryngoscopy and fiberoptic bronchoscopy for advancement of an endotracheal tube through a narrow trachea due to the presence of a huge goiter.

This Article contains errors in Fig. 3, Fig. 4 and Fig. 7, for which we apologize. In Fig. 3, panel ‘b’, the 0.5 hour time point after Ku55933 treatment images were inadvertently replaced with duplicates of the 3 hour time point after Ku55933 treatment images in Fig. 3b. Additionally, in panel ‘b’, the 0.5 hour time point after Nu7026 treatment images were inadvertently replaced with duplicates of the 180 min time point after siMDC1 treatment images in Fig. 3d. In Fig. 4, panel ‘g’, RNF168 foci in U2OS cell images were inadvertently replaced with duplicates of RNF168 foci in HeLa cell images in Fig. 4f. In Fig. 7, panel ‘b’, the DAPI images 0.5 hours after IR under siID3 treatment were inadvertently replaced with DAPI images of a different field of view from the same experiment. Additionally, in panel ‘i’, the shID3 mock-treated GFP-ID3 cells image was inadvertently replace with duplications of the shID3 mock-treated GFP-ID3 cells image in Fig. 7g.

We report the first mitochondrial genome of the Antarctic microalga Micractinium simplicissimum KSF0127. The circular mitochondrial genome was 67,923 bp in length and contained 45 protein-coding genes, one ribosomal RNA gene, and 60 transfer RNA genes. The phylogenetic tree was constructed with eight previously reported mitogenome sequences and showed the phylogenetic position of M. simplicissimum KSF0127 within the Chlorellaceae family.

MDC1 is a key component of the DNA damage response and interacts with several factors such as γ-H2AX. Here the authors show that MDC1 interacts with ID3, facilitating MDC1 recruitment to sites of damage and repair of breaks.

Traumatic neuroma results from regeneration attempts of the proximal end of an injured or severed nerve, resulting in a non-neoplastic nodular lesion. The lower extremity after amputation is the most common site, followed by the head and neck. Traumatic neuromas occurring in the abdomen, however, are rare. In the abdominal region, traumatic neuromas occur in the cystic duct stump and the common bile ducts as well as around the celiac trunk. This study reports a case of a 59-year-old man who presented with a traumatic neuroma arising at the stump of the inferior mesenteric artery after rectal cancer surgery. Traumatic neuromas at the stump of the inferior mesenteric artery have not been previously reported. The lesion exhibited atypical imaging features, including a well-enhanced nodule, a significant interval growth in size and a mild increase in 18F-fluorodeoxyglucose uptake, resembling lymph node metastasis. This case report will help physicians understand the sites of occurrence and imaging features of traumatic neuromas in the abdomen. (Korean J Gastroenterol 2016;68:279-283)

Antarctic lichens have been used as indicators of climate change for decades, but only a few species have been studied. We assessed the photosynthetic performance of the fruticose lichen Cladonia borealis under natural and laboratory conditions using the PAM fluorescence system. Compared to that of sun-adapted Usnea sp., the photosynthetic performance of C. borealis exhibits shade-adapted lichen features, and its chlorophyll fluorescence does not occur during dry days without rain. To understand its desiccation-rehydration responses, we measured changes in the PSII photochemistry in C. borealis under the average light intensity of dawn light and daylight and the desiccating conditions of its natural microclimate. Interestingly, samples under daylight and rapid-desiccation conditions showed a delayed reduction in Fv’/Fm’ and rETRmax, and an increase in Y(II) and Y(NPQ) levels. These results suggest that the photoprotective mechanism of C. borealis depends on sunlight and becomes more efficient with improved desiccation tolerance. Amplicon sequencing revealed that the major photobiont of C. borealis was Asterochloris irregularis, which has not been reported in Antarctica before. Collectively, these results from both field and laboratory could provide a better understanding of specific ecophysiological responses of shade-adapted lichens in the Antarctic region.

Chalcone isomerase (CHI) is an important enzyme for flavonoid biosynthesis that catalyzes the intramolecular cyclization of chalcones into (S)-flavanones. CHIs have been classified into two types based on their substrate specificity. Type I CHIs use naringenin chalcone as a substrate and are found in most of plants besides legumes, whereas type II CHIs in leguminous plants can also utilize isoliquiritigenin. In this study, we found that the CHI from the Antarctic plant Deschampsia antarctica (DaCHI1) is of type I based on sequence homology but can use type II CHI substrates. To clarify the enzymatic mechanism of DaCHI1 at the molecular level, the crystal structures of unliganded DaCHI1 and isoliquiritigenin-bound DaCHI1 were determined at 2.7 and 2.1 Å resolutions, respectively. The structures revealed that isoliquiritigenin binds to the active site of DaCHI1 and induces conformational changes. Additionally, the activity assay showed that while DaCHI1 exhibits substrate preference for naringenin chalcone, it can also utilize isoliquiritigenin although the catalytic activity was relatively low. Based on these results, we propose that DaCHI1 uses various substrates to produce antioxidant flavonoids as an adaptation to oxidative stresses associated with harsh environmental conditions.

The Arctic moss Aulacomnium turgidum (Wahlenb.) Schwaegr. is distributed widely above the Arctic Circle and can regenerate successfully after 400 years of ice entombment. Here, we report the complete mitogenome sequence of A. turgidum (103,937 bp). The genome contains 3 ribosomal RNAs, 24 transfer RNAs, and 40 protein-encoding genes. In a phylogenetic tree generated using the combined amino acid sequences of 32 mitochondrial genes from A. turgidum, 25 Bryophyta, and three Marchantiophyta, the phylogenetic position of A. turgidum (Rhizogoniales) is close to that of the Hypnales and Ptychomniales, forming a monophyletic clade with perfect supporting values.

The complete mitogenome (106,827 bp) of the Antarctic moss Bartramia patens Brid. (Bartramiaceae) was analyzed. It consists of 40 protein-coding genes, 3 ribosomal RNAs, and 24 transfer RNAs. The phylogenetic tree based on the combined amino acids sequences of 32 mitochondrial genes showed B. patens to have a sister relationship with B. pomiformis. The size of the mitochondrial genome of B. patens was 629 bp larger than that of B. pomiformis due to the expansion of the intronic region. This phenomenon is very characteristic and requires more comparative studies with the mitogenomes of other bryophytes.

The cold-adapted species Chorisodontium aciphyllum is widespread in the maritime Antarctic. Here, we sequenced complete mitochondrial genome of C. aciphyllum (GenBank accession number: MK651511), and this is the first report on the mitogenome of the order Dicranales. Its length is 105,766 bp and it contains three ribosomal RNA (rRNA), 24 transfer RNA, and 40 protein-coding genes. The mitochondrial structure and gene order was similar to other bryophytes. Phylogenetic tree based on combined analysis with amino acids sequences of 36 mitochondrial genes in C. aciphyllum, 24 Bryophyta, and three Marchantiophyta showed conserved relationship of the bryophyte in accordance with evolutionary structure.

BackgroundThe aim of this study was to evaluate the sedative effect of dexmedetomidine (DEX) added to ropivacaine for supraclavicular brachial plexus block (BPB) using the bispectral index (BIS).MethodsSixty patients (American Society of Anesthesiologists physical status 1 or 2, aged 20-65 years) undergoing wrist and hand surgery under supraclavicular BPB were randomly allocated to two groups. Ultrasound-guided supraclavicular BPB was performed with 40 ml of ropivacaine 0.5% and 1 µg/kg of DEX (Group RD) or 0.01 ml/kg of normal saline (Group R). The primary endpoint was the BIS change during 60 min after block. The secondary endpoint was the change in the mean arterial blood pressure (MAP), heart rate (HR), and SpO2 and the onset time and duration of the sensory and motor block.ResultsIn Group RD, the BIS decreased significantly until 30 min after the block (69.2 ± 13.7), but remained relatively constant to 60 min (63.8 ± 15.3). The MAP, HR and BIS were significantly decreased compared with Group R. The onset time of the sensory and motor block were significantly faster in Group RD than in Group R. The duration of the sensory and motor block were significantly increased in Group RD.ConclusionsDEX added to ropivacaine for brachial plexus block induced sedation that corresponds to a BIS value of 60 from which patients are easily awakened in a lucid state. In addition, perineural DEX shortened the onset time and prolonged the duration of the sensory and motor blocks.

Adhesion molecules such as ICAM-1 are important in theinfiltration of leukocytes into the site of inflammation. In thisstudy, we investigated the inhibitory effects of curcumin onICAM-1 expression and monocyte adhesiveness as well as itsunderlying action mechanism in the TNF-α-stimulated keratinocytes.Curcumin induced expression of heme oxygenase-1(HO-1) in the human keratinocyte cell line HaCaT. In addition,curcumin induced Nrf2 activation in dose- and time-dependentmanners in the HaCaT cells. Curcumin suppressed TNF-α-induced ICAM-1 expression and subsequent monocyte adhesion,which were reversed by the addition of tin protoporphyrinIX (SnPP), a specific inhibitor of HO-1, or HO-1knockdown using siRNA. Furthermore, Nrf2 knockdown usingsiRNA reversed the inhibitory effect of curcumin on theTNF-α-induced ICAM-1 expression and adhesion of monocytesto keratinocytes. These results suggest that curcumin may exertits anti-inflammatory activity by suppressing the TNF-α-inducedICAM-1 expression and subsequent monocyte adhesion viaexpression of HO-1 in the keratinocytes. [BMB Reports 2013;46(8): 410-415]

PurposeThere was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B).MethodsA prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients.ResultsThere was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1.ConclusionEstablishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required.

Mucoceles are common benign cystic lesions of the oral cavity that develop following extravasation or retention of mucous material from the major or minor salivary glands. Mucoceles are usually located in the lower lip (60 to 70% of cases), and the floor of the mouth is only involved in 6 to 15% of cases. Submandibular gland mucocele is extremely rare but should be considered in the differential diagnosis of swelling at the submandibular triangle in young children. We present the rare case of a 16-month-old child who was diagnosed with bilateral submandibular gland mucocele, presenting as serial swellings in both submandibular regions. We removed the cystic mass with the submandibular and sublingual glands to prevent recurrence.

BackgroundCoughing during emergence from general anesthesia may be detrimental in children. We compared the effect of a small dose of propofol or ketamine administered at the end of sevoflurane anesthesia on the incidence or severity of coughing in children undergoing a minimal invasive operation.MethodsOne hundred and eighteen children aged between 3 and 15 years, American Society of Anesthesiologists (ASA) status I, were enrolled in this randomized double blind study. Anesthesia was induced with propofol or ketamine and maintained with sevoflurane in N2O/O2. Each group received propofol 0.25 mg/kg or ketamine 0.25 mg/kg and the control group received saline 0.1 ml/kg. The decision to perform tracheal extubation was based on specified criteria, including the resumption of spontaneous respiration. During emergence from anesthesia and extubation, coughing was observed and graded at predefined times.ResultsThe incidence of emergence without coughing was higher in the propofol group than in the ketamine and control group (19%, 11% and 6%, respectively), whereas the incidence of severe coughing was higher in the control group than in propofol and ketamine group (17.14%, 10.0% and 6.98%, respectively).ConclusionsThe addition of propofol 0.25 mg/kg decreased the incidence of coughing after sevoflurane general anesthesia in children undergoing non-painful procedures.

Tracheobronchial injury is uncommon in children, but may result in life-threatening conditions. We present a case of transection of the right intermediate bronchus, right middle lobe bronchus and right lower lobe bronchus in a 28-month-old child with blunt chest injury. The gold standard for diagnosis is tracheobronchoscopy, however, the bronchoscopy may not always be available for little children. For diagnosis in similar cases, a high index of suspicion should be needed based on symptoms, chest X-ray and computed tomography findings. In addition, anesthesiologists should be aware of this dangerous condition and must be fully prepared for rapid and appropriate management during operation.

BackgroundWe evaluated the effect and safety of the immediate postoperative continuous infusion of remifentanil at two doses in patients undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) with alfentanil-based patient-controlled analgesia (PCA).MethodsThe study enrolled 50 ASA physical status 1 or 2 patients scheduled to undergo LAVH. Anesthesia was maintained with sevoflurane-remifentanil-air. At the last skin suture, the sevoflurane was discontinued, and patients were randomized to receive remifentanil 0.05 µg/kg/min (group I) or 0.1 µg/kg/min (group II). PCA was started at the time of eye opening and response to a verbal command. In the recovery room, we monitored the mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), SpO2, and bispectral index (BIS) at 5-minute intervals. Thirty minutes after starting PCA, the remifentanil was discontinued. Pain was assessed using a visual analog scale (0 = no pain; 100 = the worst possible pain) at 0, 5, 10, and 30 minutes after stopping the remifentanil infusion.ResultsThe eye opening time, BIS, MAP, and HR did not differ significantly between the two groups, and pain scores were similar between the two groups. Respiratory depression (SpO2 < 90% or RR < 8/min) did not occur in group I but did occur in three patients in group II.ConclusionsContinuous remifentanil infusion (0.05 µg/kg/min) immediately postoperatively with alfentanil-based PCA had a similar effect as a 0.1 µg/kg/min infusion with respect to pain control without side effects. However, special attention must be given to respiratory depression.

The unique biological features of supramolecular DNA have led to an increasing interest in biomedical applications such as biosensors. We have developed an i-motif and G-rich DNA conjugated single-walled carbon nanotube hybrid materials, which shows reversible conformational switching upon external stimuli such as pH (5 and 8) and presence of ions (Li+ and K+). We observed reversible electrochemical redox activity upon external stimuli in a quick and robust manner. Given the ease and the robustness of this method, we believe that pH- and ion-driven reversible DNA structure transformations will be utilized for future applications for developing novel biosensors.

Candidiasis is one of the most common causes of late-onset infection among very-low-birth-weight infants (VLBW) in most neonatal intensive care units and is associated with significant morbidity and mortality. Standard therapy consists of the administration of amphotericin B, amphotericin B complex, and fluconazole. In many cases, candidiasis is not easily eradicated, despite the administration of these drugs. We report our experience of the addition of high-dose caspofungin to the conventional antifungal drugs in a VLBW infant with refractory candidemia.

An airway-exchange catheter (AEC) can increase the safety of exchanges of endotracheal tubes (ETTs); however, the procedure is associated with potential risks. We describe a case of esophageal misplacement of a single-lumen ETT after switching from a double-lumen tube, despite the use of an AEC as a guidewire. To avoid this, physicians should consider the insertion depth and maintenance depth of the AEC and should verify its position before changing ETTs and should perform, if possible, with simultaneous visualization of the glottis with direct or video laryngoscopy during the exchange. Additionally, the new ETT position should be confirmed by auscultation, end-tidal carbon dioxide, and portable chest X-ray.

We report a difficult case of tracheostomy in a 34-year-old obese woman with a short neck. The tracheostomy tube placement repeatedly failed because of anatomical changes due to obesity and a short neck, tracheal mucosal swelling due to prolonged intubation, and unexpected false passage; however, it was successfully performed using an endotracheal tube exchanger as a guidewire.

Approximately 70% of KRAS-positive colorectal cancers (CRCs) have a CpG island methylator phenotype (CIMP) characterized by aberrant DNA hypermethylation and transcriptional silencing of many genes. The factors involved in, and the mechanistic basis of, CIMP is not understood. Among the CIMP genes are the tumor suppressors p14ARF, p15INK4B, and p16INK4A, encoded by the INK4-ARF locus. In this study, we perform an RNA interference screen and identify ZNF304, a zinc-finger DNA-binding protein, as the pivotal factor required for INK4-ARF silencing and CIMP in CRCs containing activated KRAS. In KRAS-positive human CRC cell lines and tumors, ZNF304 is bound at the promoters of INK4-ARF and other CIMP genes. Promoter-bound ZNF304 recruits a corepressor complex that includes the DNA methyltransferase DNMT1, resulting in DNA hypermethylation and transcriptional silencing. KRAS promotes silencing through upregulation of ZNF304, which drives DNA binding. Finally, we show that ZNF304 also directs transcriptional silencing of INK4-ARF in human embryonic stem cells.

We recently showed that streptozotocin (STZ) injections in rats lead to the development of painful peripheral diabetic neuropathy (PDN) accompanied by enhancement of CaV3.2 T-type calcium currents (T-currents) and hyperexcitability in dorsal root ganglion (DRG) neurons. Here we used the classical peripherally acting T-channel blocker mibefradil to examine the role of CaV3.2 T-channels as pharmacological targets for treatment of painful PDN. When administered intraperitoneally (i.p.), at clinically relevant doses, mibefradil effectively alleviated heat, cold and mechanical hypersensitivities in STZ-treated diabetic rats in a dose-dependent manner. We also found that CaV3.2 antisense (AS)-treated diabetic rats exhibit a significant decrease in painful PDN compared with mismatch antisense (MIS)-treated diabetic rats. Co-treatment with mibefradil (9 mg/kg i.p.) resulted in reversal of heat, cold and mechanical hypersensitivity in MIS-treated but not in AS-treated diabetic rats, suggesting that mibefradil and CaV3.2 AS share the same cellular target. Using patch-clamp recordings from acutely dissociated DRG neurons, we demonstrated that mibefradil similarly blocked T-currents in diabetic and healthy rats in a voltage-dependent manner by stabilizing inactive states of T-channels. We conclude that antihyperalgesic and antiallodynic effects of mibefradil in PDN are at least partly mediated by inhibition of CaV3.2 channels in peripheral nociceptors. Hence, peripherally acting voltage-dependent T-channel blockers could be very useful in the treatment of painful symptoms of PDN.