Early Intervention Reduces the Spread of COVID-19 in Long-Term Care Facilities in the Republic of Korea

This study describes the epidemiological characteristics of coronavirus disease 2019 (COVID-19) based on reported cases from long-term care facilities. As of April 20th, 2020, 3 long-term care facilities in a metropolitan area of South Korea had reported cases of COVID-19. These facilities’ employees were presumed to be the sources of infection. There were 2 nursing hospitals that did not report any additional cases. One nursing home had a total of 25 cases, with an attack rate of 51.4% (95% CI 35.6–67.0), and a fatality rate of 38.9% (95% CI 20.3–61.4) among residents. The results from this study suggest that early detection and maintenance of infection control minimizes the risk of rapid transmission.

Metformin ameliorates experimental-obesity-associated autoimmune arthritis by inducing FGF21 expression and brown adipocyte differentiation

Rheumatoid arthritis (RA) is a systemic autoimmune disease involving excessive inflammation. Recently, RA associated with a metabolic disorder was revealed to be non-responsive to RA medications. Metformin has been reported to have a therapeutic effect on RA and obesity. The aim of this investigation was to study the therapeutic effect and the underlying mechanism of metformin's action in an experimental model of collagen-induced arthritis (CIA) associated with obesity. Metformin was administered daily for 13 weeks to mice with CIA that had been fed a high-fat diet. Metformin ameliorated the development of CIA in obese mice by reducing autoantibody expression and joint inflammation. Furthermore, metformin decreased the expression levels of pSTAT3 and pmTOR and had a small normalizing effect on the metabolic profile of obese CIA mice. In addition, metformin increased the production of pAMPK and FGF21. Metformin also induced the differentiation of brown adipose tissue (BAT), which led to a reciprocal balance between T helper (Th) 17 and regulatory T (Treg) cells in vitro and in vivo. These results suggest that metformin can dampen the development of CIA in obese mice and reduce metabolic dysfunction by inducing BAT differentiation. Thus, metformin could be a therapeutic candidate for non-responsive RA.

Interleukin-17 Enhances Germinal Center Formation and Immunoglobulin G1 Production in Mice

OBJECTIVE: Interleukin (IL)-17 is a pro-inflammatory cytokine that has pleiotropic effects on multiple target cells and thereby contributes to the development of immune-mediated inflammatory disorders. However, the role of IL-17 in the humoral immune response has not been clearly elucidated. METHODS: Mice deficient in IL-17A (IL-17A knockout [KO] mice) and wild type (WT) C57BL/6 mice were compared. Distinct B cell (mature/precursor and marginal zone/follicular) and plasma cell populations were compared using fluorescence-activated cell sorting (FACS) and confocal immunostaining. Immunoglobulin production was assessed by enzyme-linked immunosorbent assay. RESULTS: There was no difference in B cell and plasma cell populations between IL-17A KO and WT mice. However, after T cell-dependent antigen challenge, IL-17A KO mice produced lower levels of immunoglobulin (Ig)G1 than wild-type animals. IL-17A KO mice also showed reduced germinal center (GC) formation and lower expression of activation-induced cytidine deaminase, the essential enzyme for class switch recombination (CSR). IL-17 had no effect on the proliferation or survival of naïve B cells in in vitro functional studies. However, IL-17 treatment promoted naïve B cell differentiation into plasma cells in synergy with IL-4, although IL-17 alone had no effect. CONCLUSION: Our findings suggest that IL-17 contributes to the humoral immune response by enhancing GC formation, CSR to IgG1, and plasma cell differentiation in synergy with IL-4.

Effects of Head Nurses' Servant Leadership on Organizational Commitment among Clinical Nurses: Focused on the Mediating Effect of Empowerment / 간호행정학회지

PURPOSE: This study was performed to identify the mediating effect of empowerment in the relationship between head nurses' servant leadership and organizational commitment among clinical nurses. METHODS: A cross-sectional survey design was used. A convenience sample of 249 nurses was recruited from three hospitals located in J province, South Korea. Data were collected by self-report questionnaires, including general characteristics, servant leadership, empowerment, and organizational commitment. Data were analyzed with descriptive statistics, Pearson correlation coefficients, independent t-test, One-way ANOVA, and linear regression using the SPSS 22.0 program. RESULTS: Head nurses' servant leadership perceived by clinical nurses significantly influenced their organization commitment. Empowerment partly mediated the effect of servant leadership on organizational commitment. CONCLUSION: The findings suggest the importance of improving nurse managers' servant leadership and empowering nurses to increase their organizational commitment.

Prasugrel-Induced Hypersensitivity Skin Reaction

We report a case of hypersensitivity skin reaction to prasugrel. The patient exhibited a generalized skin rash after treatment with prasugrel, which was resolved after discontinuation of prasugrel and substitution to clopidogrel. Clopidogrel was successfully administered as an alternative to prasugrel without any signs of further hypersensitivity.

Factors Associated with Metabolic Syndrome and Related Medical Costs by the Scale of Enterprise in Korea

OBJECTIVES: The purpose of this study was to identify the risk factors of metabolic syndrome (MS) and to analyze the relationship between the risk factors of MS and medical cost of major diseases related to MS in Korean workers, according to the scale of the enterprise. METHODS: Data was obtained from annual physical examinations, health insurance qualification and premiums, and health insurance benefits of 4,094,217 male and female workers who underwent medical examinations provided by the National Health Insurance Corporation in 2009. Logistic regression analyses were used to the identify risk factors of MS and multiple regression was used to find factors associated with medical expenditures due to major diseases related to MS. RESULT: The study found that low-income workers were more likely to work in small-scale enterprises. The prevalence rate of MS in males and females, respectively, was 17.2% and 9.4% in small-scale enterprises, 15.9% and 8.9% in medium-scale enterprises, and 15.9% and 5.5% in large-scale enterprises. The risks of MS increased with age, lower income status, and smoking in small-scale enterprise workers. The medical costs increased in workers with old age and past smoking history. There was also a gender difference in the pattern of medical expenditures related to MS. CONCLUSIONS: Health promotion programs to manage metabolic syndrome should be developed to focus on workers who smoke, drink, and do little exercise in small scale enterprises.

Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis / 예방의학회지

OBJECTIVES: While there have been many quantitative studies on the public's attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the public's attitude. The purpose of this study was to identify factors that affect the public's beliefs and attitudes including contextual effects. METHODS: We analyzed survey on the public's beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the public's beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socio-economic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes. RESULTS: Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community. CONCLUSIONS: The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

Obesity aggravates the joint inflammation in a collagen-induced arthritis model through deviation to Th17 differentiation

White fat cells secrete adipokines that induce inflammation and obesity has been reported to be characterized by high serum levels of inflammatory cytokines such as IL-6 and TNF-alpha. Rheumatoid arthritis (RA) is a prototype of inflammatory arthritis, but the relationship between RA and obesity is controversial. We made an obese inflammatory arthritis model: obese collagen-induced arthritis (CIA). C57BL/6 mice were fed a 60-kcal high fat diet (HFD) from the age of 4 weeks and they were immunized twice with type II collagen (CII). After immunization, the obese CIA mice showed higher arthritis index scores and histology scores and a more increased incidence of developing arthritis than did the lean CIA mice. After treatment with CII, mixed lymphocyte reaction also showed CII-specific response more intensely in the obese CIA mice than lean CIA. The anti-CII IgG and anti-CII IgG2a levels in the sera of the obese CIA mice were higher than those of the lean CIA mice. The number of Th17 cells was higher and the IL-17 mRNA expression of the splenocytes in the obese CIA mice was higher than that of the lean CIA mice. Obese CIA mice also showed high IL-17 expression on synovium in immunohistochemistry. Although obesity may not play a pathogenic role in initiating arthritis, it could play an important role in amplifying the inflammation of arthritis through the Th1/Th17 response. The obese CIA murine model will be an important tool when we investigate the effect of several therapeutic target molecules to treat RA.

The Effectiveness of an Intervention Program for Subway Operators for Symptoms of Post-traumatic Stress Disorder After the Persons Had Fallen Under a Train / 대한산업의학회지

OBJECTIVE: The aims of this study were to evaluate the level of job stress in subway workers and to determine the main factors that aggravated their PTSD(Post-Traumatic Stress Disorder) symptom, which were due to having fallen under a train, and to verify the effectiveness of the intervention program. METHODS: The questionnaires utilized in the survey were composed of the Korean Occupational Stress Scale (the short form, 24 items), the depression scale, the coping scale II, the PTSD scale and the life style, health status and occupational properties. The intervention program for PTSD symptoms was executed for 18 subway operators who had experienced deadly accidents in their service from June 2004 to May 2006. The intervention programs included exercise, meditation and deep breathing for 8 weeks and a written message was sent twice per week. RESULTS: Compared with pre-intervention, the post-intervention group showed significantly lower scores for the KOSS, depressive symptom and the PTSD. CONCLUSION: This study showed the intervention program was effective to lower the job stress, the PTSD symptoms and depressive symptoms, and to improve the coping skills. It was suggested that the mental health promotion program should be implemented for subway workers to prevent occupational mental diseases.

Effect of Tracheostomy Tube on Swallowing in Patients with Stroke

OBJECTIVE: To investigate the characteristics and severity of swallowing difficulties among stroke patients with a tracheostomy tube, compared to those without. METHOD: A retrospective study was performed on two groups of 17 stroke patients with a tracheostomy tube (58.8 years) and without a tracheostomy tube (69.8 years) fed by Levine tube or a gastrostomy tube. There were no differences in the FIM (functional independence measure) score and brain lesions between the two groups. We evaluated the functional dysphagia scale (FDS) and aspiration; classified before, during, and after swallowing aspiration and silent aspiration. The swallowing task consisted of 2 ml of fluid and a videofluoroscopic swallowing study. RESULTS: There were no significant differences between the oral preparatory, oral and pharyngeal phase for the two groups in FDS. However, frequency of silent aspiration (p=0.007) and the total frequency of aspiration (p=0.038) were significantly higher in patients with tracheostomy. CONCLUSION: Patients with stroke who underwent tracheostomy showed no meaningful difference in FDS. However, there were significant differences in terms of silent aspiration and the total frequency of aspiration; caused by laryngopharyngeal desensitization and the anterior tethering effect on the tracheostomy tube. We have to pay more attention to the treatment and care of patients with tracheostomy tubes.

The Relationship Between Job Stress and Quality of Life for Hospital Workers by Type of Employment / 대한산업의학회지

OBJECTIVE: This study was conducted to evaluate the relationship between job stress and quality of life for hospital workers by type of employment. METHODS: Data were obtained for 361 workers in a large hospital 172 of whom were categorized as typical workers defined by permanent employee and 189 of whom were categorized as atypical workers defined by fixed-term contraction. Job stress was assessed using the Korean Occupational Stress Scale-Short Form and the World Health Organization Quality of Life-BREF Questionnaire RESULTS: Atypical workers had significantly higher scores for job-related stress in the domains of insufficient control, over work, job insecurity, and lack of reward in the workplace compared with typical workers, who had higher scores for stress in the domains of job demands and occupational climate. Test scores also indicated that typical workers had a significantly better quality of life than atypical workers, especially in terms of mental health, social relationships and environment. CONCLUSION: These findings suggested that factors contributing to job-related stress were different between typical and atypical hospital and typical workers are likely to have a better quality of life.

Association of Current and Past Smoking with Metabolic Syndrome in Men / 예방의학회지

OBJECTIVES: The objective of this study was to determine the relationship between past smoking and the risk factors for metabolic syndrome. METHODS: From January 2007 to December 2007, a total of 3,916 over thirty years old male health screen examinees were divided into the nonsmoking, smoking, ex-smoking groups. The diagnosis of metabolic syndrome was based on the criteria of the NCEP ATP (Executive Summary of The Third Report of The National Cholesterol Education Program). Metabolic syndrome was defined as the presence of three or more of the following: a blood pressure > or = 130/85 mmHg, a fasting glucose level > or = 110 mg/dL, a HDL-C (High Density Lipoprotein Cholesterol) level or = 150 mg/dL and, a waist circumference men > or = 102 cm, but a waist to hip ratio > 0.90 was used as a surrogate for the waist circumference. RESULTS: After adjustment for age, alcohol consumption and, exercise in the smokers, for the ex-smokers compared with the nonsmokers, the odds ratio (OR) of a lower HDL cholesterol level (< 40 mg/dL) was 1.29 (95% CI=1.03-1.61) in the smokers, the ORs of a higher triglyceride level were 1.35 (95% CI=1.09-1.66) in the ex-smokers and, 2.12 (95% CI=1.75-2.57) in the smokers, and the OR of a waist to hip ratio was 1.25 (95% CI=1.03-1.52) in the ex-smokers. When there were over three components of metabolic syndrome in the ex-smokers and smokers as compared with the nonsmokers, the odds ratio against the risk of metabolic syndrome were 2.39 (95% CI=1.00-6.63) and 2.37 (95% CI=1.02-6.46), respectively. CONCLUSIONS: The present study suggested that there is an association of smoking with metabolic syndrome in men.

Awareness and Attitude Toward Suicide in Community Mental Health Professionals and Hospital Workers / 예방의학회지

OBJECTIVES: The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. METHODS: This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. RESULTS: There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. CONCLUSIONS: This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.

Comparison of Real-time PCR Methods and pp65 Antigenemia Assay to Detect Cytomegalovirus Reactivation in Hematopoietic Stem Cell Transplantation / 감염과화학요법

Human cytomegalovirus (HCMV) is a common human pathogen that causes morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. Early diagnosis of HCMV infection or reactivation, and setting threshold values for effective pre-emptive therapies, are required for appropriate HCMV disease prevention in HSCT recipients. We compared the HCMV infections detected by the two methods, LightCycler-based PCR (LC PCR) and in-house immediate early protein PCR (in-house IE PCR) with the results of a pp65 antigenemia assay as the reference. The sensitivity and specificity for the in-house IE PCR were 79.3% and 72.7%, respectively, and 82.9% and 40.7%, respectively, for the LC PCR. The correlation between the HCMV viral load and pp65 antigenemia in HSCT recipients was r=0.603 with in-house IE PCR and r=0.525 with LC PCR. The discordant results between methods and relatively low (r) values suggest that we need more study to set threshold values according to the using methods with clinical outcome.

Comparison of Real-time PCR Methods and pp65 Antigenemia Assay to Detect Cytomegalovirus Reactivation in Hematopoietic Stem Cell Transplantation / 감염과화학요법

Human cytomegalovirus (HCMV) is a common human pathogen that causes morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. Early diagnosis of HCMV infection or reactivation, and setting threshold values for effective pre-emptive therapies, are required for appropriate HCMV disease prevention in HSCT recipients. We compared the HCMV infections detected by the two methods, LightCycler-based PCR (LC PCR) and in-house immediate early protein PCR (in-house IE PCR) with the results of a pp65 antigenemia assay as the reference. The sensitivity and specificity for the in-house IE PCR were 79.3% and 72.7%, respectively, and 82.9% and 40.7%, respectively, for the LC PCR. The correlation between the HCMV viral load and pp65 antigenemia in HSCT recipients was r=0.603 with in-house IE PCR and r=0.525 with LC PCR. The discordant results between methods and relatively low (r) values suggest that we need more study to set threshold values according to the using methods with clinical outcome.

The Association of Cardiovascular Risk Factors with Nonalcoholic Fatty Liver Disease in Health Checkup Examinees / 예방의학회지

OBJECTIVES: The purpose of this study was to evaluate the relationship of nonalcoholic fatty liver and cardiovascular risk factors. METHODS: This study was conducted to investigate the association of nonalcoholic fatty liver and cardiovascular risk factors for adult men (n=2976) and women (n=2442) who were over 19 years old, after excluding the HBsAg(+) or anti-HCV(+) patients and the men and women with increased alcohol intake (men: 40 g/week, women: 20 g/week). RESULTS: Compared with the normal liver subjects, the nonalcoholic fatty liver subjects showed a significantly increased frequency of abnormal systolic blood pressure (> or =120 mmHg), fasting blood sugar (> or =100 mg/dL), total cholesterol (> or =200 mg/dL), triglyceride (> or =150 mg/dL), high density lipoprotein cholesterol ( or =130g m/dL) and abdominal obesity in men, and all these measures were significantly increased in the women except for abnormal HDL cholesterol. After adjusting for the body mass index, age, smoking, exercise and a nonalcoholic liver, the odds ratios of an abnormal waist hip ratio were 1.35(95% Confidence Interval=1.05-4.72) in the mild fatty liver, 1.61(1.19-2.18) in the moderate fatty liver, 2.77(1.57-4.92) in the severe fatty liver compared with a normal liver. The adjusted odds ratios for abnormal fasting blood sugar were 1.26(1.03-1.53) in the mild fatty liver, 1.62(1.27-2.06) in the moderate fatty lliver and 1.77(1.12-2.78) in the severe fatty liver. The adjusted odds ratios for abnormal triglyceride were 1.38(1.11-1.72) in the mild fatty liver, 1.73(0.33-2.24) in the moderate fatty liver and 1.91(1.17-3.10) in the severe fatty liver of men. Adjusted odds ratios for abnormal triglyceride were 1.50(1.04-2.15) in mild, 1.71(1.07-2.68) in moderate, 1.81(0.69-4.38) in severe fatty liver of women. CONCLUSIONS: The nonalcoholic fatty liver subjects had more cardiovascular risk factors compared with the normal liver subjects. Thus, prevention and treatment of the nonalcoholic fatty liver is necessary by lifestyle modifications such as restriction of alcohol intake, no smoking, exercise and adequate eating habits.

The Change of Non-smoking Knowledge and Attitude of Intensive Course of Anti-smoking Leadership Training / 대한산업의학회지

OBJECTIVES: To evaluate the effectiveness of an anti-smoking readership training program on the knowledge, attitude and practice in health managers and supervisors in the workplace. METHODS: We surveyed 482 health managers and supervisors in the workplace from April 2005 to September 2005. The questionnaire included whether or not a smoking cessation program was conducted in their workplace. We assessed before and after educations program about knowledge, attitude and practice for smoking cessation. The 10-hour education program included the benefit of quit smoking, the law for smoking restriction, cognitive therapy, stress management, nicotine addiction, replacement therapy, case study about workplace for anti-smoking policy and program. RESULTS: For the change in the mean scores of all items in knowledge, attitude and practice were significantly increased after the intervention. CONCLUSION: Even a short, 10-hour intervention course of anti-smoking leadership training program was effective for improving the knowledge, attitude, practice to quit smoking activity in workplace. Nevertheless, the program effectiveness would be increased by including a re-training course and website support.

Effectiveness of Tailored Health Promotion Program for Reducing Cardiovascular Risk Factors in Subway Workers / 대한산업의학회지

OBJECTIVES: This study explores the effects of a tailored health promotion program, in order to reduce cardiovascular risk, in areas which include hypertension, dyslipidemia, abnormal blood glucose and body mass index. METHODS: In this paper, health risk appraisal relating to lifestyle was surveyed and physical fitness, blood pressure and blood lipid profile and glucose were checked. Then, a 12 week tailored health promotion program with 40 subway workers of Seoul was conducted. The Tailored health promotion program included a smoking cessation program, drinking restriction, diet, exercise prescription and a stress management program. RESULTS: The number of subjects engaging in regular exercise increased from 42.5% to 100%, and the number of smokers reduced from 72.5% to 60%, and 12.5% of contemplate stage was shift to action stage. The mean level of drinking per day, significantly decreased from 34.9 g to 24.2. The body mass index, systolic blood pressure, total cholesterol, triglyceride, and Fasting blood glucose significantly decreased after the intervention program. In addition the tailored health promotion program resulted in a significant reduction in two factors for the cardiovascular high risk group, hypertension above 140 mmHg in systolic blood pressure and dyslipidemia above 200 mg/dl in triglyceride. CONCLUSION: In this paper, it is demonstrated that the tailored health promotion program,, including the smoking cessation program, drinking restriction, diet, exercise prescription and stress management program, resulted in effective reduction in cardiovascular risk factor. Therefore associated workplace tailored health promotion programs relating to specific individual risk factor, should be developed and implemented.

Correlations between Numerical Rating Scale and Visual Analog Scale Pain Scores in the Assessment of Postoperative Pain / 대한마취과학회지

BACKGROUND: We wondered what type of pain scores is more available and reliable during the immediate postoperative period. In this study, we compared a numerical rating scale (NRS) with a visual analog scale (VAS) pain scores to assess postoperative pain. METHODS: Fifty patients were educated as to how to describe pain intensity using the NRS (11-point) and VAS (10 cm) scores during the evening before elective laparoscopic cholecystectomy. Following their operation, patients checked their pain intensity using NRS and VAS at postoperative 1 hour in the recovery room with the assistance of an anesthesiologist, and 3, 6, 12, 18 and 24 h by themselves. The absolute values of the NRS and VAS scores were analyzed for inter-individual variability and for correlations between the two. RESULTS: Forty-eight patients finished this study. The absolute value of the mean NRS score was slightly higher than that of the mean VAS score at each time point. However, the mean difference was only 0.4. Overall, the two parameters correlated well at each of the six measurement times. The correlation coefficients between the absolute values of the NRS and VAS pain scores for all measurement times were over 0.95. CONCLUSIONS: This data suggests that NRS and VAS pain scores are well correlated, and that they are equally useful at assessing immediate postoperative pain.

The Effects of Intraperitoneal Instillation of Lidocaine before Pneumoperitoneum on Postoperative Pain Score and Intraoperative Changes of Blood Pressure in Patients with a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of pre-emptive subdiaphragmatic instillation of lidocaine before pneumoperitoneum on postoperative pain following a laparoscopic cholecystectomy (LC) and also to evaluate it's effect on the changes of blood pressure during an operation. METHODS: Thirty-three relatively healthy patients for an LC were allocated into the two groups. after the induction of general anesthesia with sodium thiopental, vecuronium, nitrous oxide and enflurane (1-2 vol%), 0.2% lidocaine 200 ml was subdiaphragmatically instilled 10 min before pneumoperitoneum in the lidocaine group (n = 15), and normal saline in the control group (n = 18). The changes of the systolic and mean arterial pressure (SAP and MAP), postoperative pain score, and the number of analgesics used during the postoperative 24 h were compared between two groups. RESULTS: The pain scores at postoperative 1, 3, 6, 12, 18 and 24 h and the number of analgesics used were significantly low in the lidocaine group compared to the control group (P<0.01). The elevations of SAP and MAP during pneumoperitoneum were significantly attenuated in the lidocaine group (P<0.01). CONCLUSIONS: This data suggests that subdiaphragmatic instillation of lidocaine before pneumoperitoneum is effective in the control of postoperative pain following an LC and also effective to attenuate the elevation of blood pressure during pneumoperitoneum. However, further study is needed to evaluate the safety of these methods before recommendation of routine use.