Neutrophil-to-lymphocyte Ratio as A Predictor of Aspiration Pneumonia in Drug Intoxication Patients

PURPOSE: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission. METHODS: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (ρ) were performed. RESULTS: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p 3.47).

Seasonal acclimation in sudomotor function evaluated by QSART in healthy humans

The quantitative sudomotor axon reflex testing (QSART) is a classic test of routine postganglionic sudomotor function. We investigated sudomotor function by QSART after summer (July 2012) and winter (January 2013) seasonal acclimation (SA) in the Republic of Korea. QSART with acetylcholine (ACh) iontophoresis were performed to determine directly activated (DIR) and axon reflex-mediated (AXR1, 2) sweating rate. Onset time of axon reflex, activated sweat gland density (ASGD), activated sweat gland output (ASGO), tympanic and skin temperatures (T(ty), T(sk)), basal metabolic rate (BMR), and evaporative loss volume changes were measured. Tympanic and mean body temperature (T(b); calculated from T(ty), T(sk)) were significantly lower after summer-SA than that of winter-SA. Sweat onset time was delayed during winter-SA compared to that after summer-SA. BMR, AXR(1), AXR(2), and DIR sweat rates, ASGD and ASGO, and evaporative loss volume were significantly diminished after winter-SA relative to after summer-SA. In conclusion, changes in sweating activity measured by QSART confirmed the involvement of the peripheral nervous system in variation of sudomotor activity in seasonal acclimation.

Seasonal Acclimatization in Summer versus Winter to Changes in the Sweating Response during Passive Heating in Korean Young Adult Men

We investigated the sweating response during passive heating (partial submersion up to the umbilical line in 42+/-0.5degrees C water, 30 min) after summer and winter seasonal acclimatization (SA). Testing was performed in July during the summer, 2011 [summer-SA; temp, 25.6+/-1.8degrees C; relative humidity (RH), 82.1+/-8.2%] and in January during the winter, 2012 (winter-SA; temp, -2.7+/-2.9degrees C; RH, 65.0+/-13.1%) in Cheonan (126degrees52'N, 33.38'E), Republic of Korea. All experiments were carried out in an automated climatic chamber (temp, 25.0+/-0.5degrees C: RH, 60.0+/-3.0%). Fifteen healthy men (age, 23.4+/-2.5 years; height, 175.0+/-5.9 cm; weight, 65.3+/-6.1 kg) participated in the study. Local sweat onset time was delayed during winter-SA compared to that after summer-SA (p< 0.001). Local sweat volume, whole body sweat volume, and evaporative loss volume decreased significantly after winter-SA compared to those after summer-SA (p<0.001). Changes in basal metabolic rate increased significantly after winter-SA (p< 0.001), and tympanic temperature and mean body temperature were significantly lower after summer-SA (p<0.05). In conclusion, central sudomotor acitivity becomes sensitive to summer-SA and blunt to winter-SA in Rebubic of Korea. These results suggest that the body adjusts its temperature by economically controlling the sweating rate but does not lower the thermal dissipation rate through a more effective evaporation scheme after summer-SA than that after winter-SA.

Effect of Posture on Muscle Activity and Oxygen Uptake in Cycle Ergometer / 대한스포츠의학회지

This study evaluated the effects of saddle height on the muscle activity and oxygen uptake during bicycling. The subjects were 20 young adult volunteers. Muscle activity and oxygen uptake were measured with the two saddle heights (maximum knee extension of 180degrees and 120degrees) and at two power outputs (70 and 100 watts, respectively.) The pedaling rate was 40 rpm. The exercise time was 1 minute and the resting time between each condition was 3 minutes. The raw electromyogram activity was measured for 1 minute and was converted to a root mean square value. Oxygen uptake was measured during exercise using the mixing chamber mode. The activities of two flexors (the medial hamstring and medial head of gastrocnemius) increased at the high saddle height and the activities of four extensors (rectus femoris, vastus medialis, vastus lateralis, and tibialis anterior) increased at the low saddle height. The oxygen uptake at the low saddle height was significantly higher than that at the high saddle height. The oxygen uptake positively correlated with the muscle activities of the knee extensors. The muscle activity and oxygen uptake were significantly affected by the postures (saddle heights) in cycle ergometer. The postures should be considered in the exercise test and prescription.

Erratum: Effect of Posture on Muscle Activity and Oxygen Uptake in Cycle Ergometer / 대한스포츠의학회지

No abstract available.

The Effect of Supplementary Selenium on Leukocytes and HSP70 Expression after Half-Body Immersion

This study examined the effect of supplementary selenium on leukocytes and heat shock protein (HSP) 70 expression in serum during half-body immersion. The subjects were male college tennis athletes. All subjects participated in two repeated experiments with a 1 week interval. During the 30 min intermittent half-body immersion, subjects were given 500 mL of water with or without selenium (100 microg). Blood samples were taken from the antecubital vein, and differential counts were made. Serum HSP70 protein was analyzed using a commercial ELISA kit. After half-body immersion, leukocytes and lymphocytes increased significantly but neutrophils decreased significantly in both trials (with or without selenium). Selenium supplementation, compared with placebo, decreased levels of leukocytes, neutrophils, and monocytes, but not lymphocytes, to the resting level or below 60 min after immersion. Only lymphocytes continued to increase in both trials during the recovery period. Serum HSP70 protein level did not change after immersion, but it decreased 60 min after immersion with the administration of selenium. In conclusion, supplementary selenium reduced the systemic immune response and serum HSP70 protein accumulation after half-body immersion.

Effect of Perioperative Perineural Injection of Dexamethasone and Bupivacaine on a Rat Spared Nerve Injury Model

BACKGROUND: Neuropathic pain resulting from diverse causes is a chronic condition for which effective treatment is lacking. The goal of this study was to test whether dexamethasone exerts a preemptive analgesic effect with bupivacaine when injected perineurally in the spared nerve injury model. METHODS: Fifty rats were randomly divided into five groups. Group 1 (control) was ligated but received no drugs. Group 2 was perineurally infiltrated (tibial and common peroneal nerves) with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 3 was infiltrated with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) after surgery. Group 4 was infiltrated with normal saline (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 5 was infiltrated with only 0.4% bupivacaine (0.2 ml) before surgery. Rat paw withdrawal thresholds were measured using the von Frey hair test before surgery as a baseline measurement and on postoperative days 3, 6, 9, 12, 15, 18 and 21. RESULTS: In the group injected preoperatively with dexamethasone and bupivacaine, mechanical allodynia did not develop and mechanical threshold forces were significantly different compared with other groups, especially between postoperative days 3 and 9 (P < 0.05). CONCLUSIONS: In conclusion, preoperative infiltration of both dexamethasone and bupivacaine showed a significantly better analgesic effect than did infiltration of bupivacaine or dexamethasone alone in the spared nerve injury model, especially early on after surgery.

The effect of Oligonol intake on cortisol and related cytokines in healthy young men

This study investigated the effects of Oligonol intake on cortisol, interleukin (IL)-1beta, and IL-6 concentrations in the serum at rest and after physical exercise loading. Nineteen healthy sedentary male volunteers participated in this study. The physical characteristics of the subjects were: a mean height of 174.2 +/- 2.7 cm, a mean weight of 74.8 +/- 3.6 kg and a mean age of 22.8 +/- 1.3 years. Each subject received 0.5 L water with Oligonol (100 mg/day) (n = 10) or a placebo (n = 9) daily for four weeks. The body composition, the white blood cell (WBC) and differential counts as well as the serum cortisol, IL-1beta, and IL-6 concentrations were measured before and after Oligonol intake. The cortisol concentration and serum levels of IL-1beta and IL-6 after Oligonol intake were significantly decreased compared to before treatment (P < 0.01, respectively). In addition, the rate of increase of these factors after exercise was decreased compared to the placebo group. There was no change in the WBC and differential cell counts. These results suggest that oral Oligonol intake for four weeks had a significant effect on inhibition of inflammatory markers in healthy young men.

Effect of the Heat-exposure on Peripheral Sudomotor Activity Including the Density of Active Sweat Glands and Single Sweat Gland Output

Tropical inhabitants are able to tolerate heat through permanent residence in hot and often humid tropical climates. The goal of this study was to clarify the peripheral mechanisms involved in thermal sweating pre and post exposure (heat-acclimatization over 10 days) by studying the sweating responses to acetylcholine (ACh), a primary neurotransmitter of sudomotor activity, in healthy subjects (n=12). Ten percent ACh was administered on the inner forearm skin for iontophoresis. Quantitative sudomotor axon reflex testing, after iontophoresis (2 mA for 5 min) with ACH, was performed to determine directly activated (DIR) and axon reflex-mediated (AXR) sweating during ACh iontophoresis. The sweat rate, activated sweat gland density, sweat gland output per single gland activated, as well as oral and skin temperature changes were measured. The post exposure activity had a short onset time (p<0.01), higher active sweat rate [(AXR (p<0.001) and DIR (p<0.001)], higher sweat output per gland (p<0.001) and higher transepidermal water loss (p<0.001) compared to the pre-exposure measurements. The activated sweat rate in the sudomotor activity increased the output for post-exposure compared to the pre-exposure measurements. The results suggested that post-exposure activity showed a higher active sweat gland output due to the combination of a higher AXR (DIR) sweat rate and a shorter onset time. Therefore, higher sudomotor responses to ACh receptors indicate accelerated sympathetic nerve responsiveness to ACh sensitivity by exposure to environmental conditions.

Heat Acclimatization in Hot Summer for Ten Weeks Suppress the Sensitivity of Sweating in Response to Iontophoretically-administered Acetylcholine

To determine the peripheral mechanisms involved in thermal sweating during the hot summers in July before acclimatization and after acclimatization in September, we evaluated the sweating response of healthy subjects (n=10) to acetylcholine (ACh), a primary neurotransmitter involved in peripheral sudomotor sensitivity. The quantitative sudomotor axon reflex test (QSART) measures sympathetic C fiber function after iontophoresed ACh evokes a measurable reliable sweat response. The QSART, at 2 mA for 5 min with 10% ACh, was applied to determine the directly activated (DIR) and axon reflex-mediated (AXR) sweating responses during ACh iontophoresis. The AXR sweat onset-time by the axon reflex was 1.50+/-0.32 min and 1.84+/-0.46 min before acclimatization in July and after acclimatization in September, respectively (p<0.01). The sweat volume of the AXR(1) [during 5 min 10% iontophoresis] by the axon reflex was 1.45+/-0.53 mg/cm2 and 0.98+/-0.24 mg/cm2 before acclimatization in July and after acclimatization in September, respectively (p<0.001). The sweat volume of the AXR(2) [during 5 min post-iontophoresis] by the axon reflex was 2.06+/-0.24 mg/cm2 and 1.39+/-0.32 mg/cm2 before and after acclimatization in July and September, respectively (p<0.001). The sweat volume of the DIR was 5.88+/-1.33 mg/cm2 and 4.98+/-0.94 mg/cm2 before and after acclimatization in July and September, respectively (p<0.01). These findings suggest that lower peripheral sudomotor responses of the ACh receptors are indicative of a blunted sympathetic nerve response to ACh during exposure to hot summer weather conditions.

The Influence of Alpha-fetoprotein on Natural Suppressor Cell Activity and Ehrlich Carcinoma Growth

The influence of alpha-fetoprotein (AFP) on the bone marrow (BM) natural suppressor (NS) cells of intact Ehrlich carcinoma -bearing CBA mice was studied. Bone marrow NS cells were fractionated into three fractions by isopycnic centrifugation on percoll gradients: NS1 (rho=1.080 g/ml), NS2 (rho=1.090 g/ml) and NS3 (1.100>rho>1.090 g/ml). These fractions were highly different in their sensitivity to known NS cell inductors (interleukin (IL)-2, IL-3 or histamine). None of the NS fractions isolated from the intact mice spontaneously produced antiproliferative activity, however, they showed a high level of NS (antiproliferative and natural killer cell inhibitory) activity under the influence of AFP. A single injection of AFP to intact mice led to an increase of spontaneous NS activity and the inhibition of natural killer cell activity. NS activity, especially NS2, was increased in when tumor cells were subcutaneously inoculated three days after AFP injection. In the AFP-treated mice, the tumor mass at 14 days was 60% larger than that in the untreated mice. Our data confirmed that AFP is a tumor marker that can inhibit cancer immunity and plays a role in cancer pathogenesis.

Long-Term Tropical Residency Diminishes Central Sudomotor Sensitivities in Male Subjects

Tropical natives (TROP) are capable of tolerating tropical heat because of their long-term adaptation to tropical environments. When exposed to heat stress, these natives tend to respond with lower sweat output, which is generally thought to be the result of heat acclimatization. The main objective of this study was to clarify central mechanisms inherent to suppressed thermal sweating in tropical natives (Malaysians) by comparing their sweating responses to those of temperate native (TEMP) (Koreans). This experiment was conducted in a thermoneutral climatic chamber (24+/-0.5 degrees C, 40+/-3% relative humidity). Heat loads were applied to each subject by the immersion of their lower legs in a hot water bath (43 degrees C for 30 min). Sweat onset-time and sweat volume were compared between TROP and TEMP. The sweat onset-times on four selected points on the body ranged from 10.25 to 13.47 min in TEMP subjects, and from 16.24 to 17.83 min in TROP subjects (p<0.001). The local sweat volumes at the same sites ranged from 4.30 to 9.74 mg/cm2 in TEMP subjects, and from between 1.80 to 4.40 mg/cm2 in TROP subjects (p<0.001). These results demonstrated a significant difference between TROP and TEMP subjects with regard to the manner in which they regulate their body temperatures when exposed to heat loads, and verified that long-term thermal adaptation blunts sweating sensitivities.

Comparison of Interleukin-8 Levels in Long-Distance Runners and Healthy Sedentary Non-Athletic Control Subjects

We have previously demonstrated that the level of leukocytes and neutrophils significantly increased immediately and 30 min after exercise. Interleukin-8 (IL-8) is an inflammatory cytokine that acts as a chemokine on neutrophils. In the present study, we evaluated the correlation between the number of neutrophils and leukocytes, and between the number of neutrophils and plasma IL-8 level. Long-distance trained runners (TRs, n = 10) and untrained sedentary control subjects (SEDs, n = 10) ran for one hour at 70% of heart rate reserve. In the TR, the number of neutrophils correlated significantly with the number of leukocytes in the blood. However, there was no correlation between the number of neutrophils and the plasma IL-8 concentration in both groups. Expressions of IL-8 protein and mRNA were markedly higher in the TRs as compared to the SEDs at three time intervals (pre-exercise, immediately after exercise, and post exercise). In conclusion, our results show that 1) the neutrophil level was dependent on the level of leukocytes 2) there was no correlation between the neutrophils count and plasma IL-8 concentration and 3) a higher plasma IL-8 level in athletes may be a unique characteristic of intensive training.

Sweating by Exercise Controls Body Temperature through Increase of Interleukin-1beta

This study was designed to investigate the expression and production of interleukin-1beta (IL-1beta) in human peripheral blood of trained runners and untrained controls after temporary moderate intensity exercise. Male long-distance trained runners (TR) and untrained sedentary control subjects (SED) ran for 1 h at 70% of heart rate reserve (HRR). IL-1beta gene and protein expressions were significantly higher in TR than those with SED at all 3 intervals examined independently. Significant increases in total sweat volume and oral temperature were observed after exercise in both groups, however, there were some differences between the groups. We conclude, therefore, that sweating due to exercise is associated with increase of IL-1beta and it is correlated with decrease of oral temperature.

Atlantoaxial Joint Syndrome Misconceived as an Idiopathic Neuralgia: A case report / 대한통증학회지

Although the atlantoaxial joint is the most common site of rheumatoid arthritis, our patient had no symptoms or signs suggestive of rheumatoid arthritis. The atlantoaxial joint is frequently involved in degenerative osteoarthritis, especially in elderly patients. An 81-year old man presented with severe intermittent electric shock like, lancinating pain from the occipital to the temporal and parietofrontal areas. He also had neck pain and a limited range of motion. After many examinations and laboratory tests, at the department of neurology and neurosurgery, he was diagnosed with idiopathic neuralgia. The diagnosis of atlantoaxial joint syndrome was confirmed, and treated successfully with atlantoaxial joint block.

The Clinical Effectiveness and Selectivity of Radiofrequency Trigeminal Rhizotomy Using a 2 mm Active Tip Electrode for the Treatment of Trigeminal Neuralgia / 대한마취과학회지

BACKGROUND: To minimize the side effects of radiofrequency trigeminal rhizotomy by making a more selective minimal lesion for the target division of a trigeminal rootlet, we performed this study to evaluate the effectiveness and the selectivity of radiofrequency trigeminal rhizotomy using a 2 mm active tip electrode as compared to a 5 mm active tip electrode. METHODS: The authors evaluated 36 cases, in which radiofrequency thermocoagulation of a trigeminal rootlet was performed using a 2 mm active tip electrode or a 5 mm active tip electrode at 75oC for 60 seconds in patients suffering from trigeminal neuralgia. One month after each operation, we assessed the clinical effects, selectivity, and the side effects of these operations. RESULTS: Of the 36 patients, 34 patients experienced loss of tic pain. In terms of effectiveness, no difference was found between the two groups. In terms of selectivity, some superiority was shown by the 2 mm active tip electrode, but this was not statistically significant. Masseter weakness or dysesthesia occurred in six patients who suffered from tic pain in the V3 region, and who were operated upon with a 5 mm active tip electrode. Major complications like anesthesia dolorosa, and corneal anesthesia were absent in any patients. CONCLUSIONS: For target specific lesion generation of trigeminal rootlets, single lesion generation using a 2 mm active tip electrode may be as clinically effective as a 5 mm tip and is more selective in use.

Stereotactic S5 Dorsal Root Ganglionotomy Using Radiofrequency Lesion Generation: A case report / 대한마취과학회지

Dorsal root ganglionotomy of the S5 nerve is useful for pain around the coccyx. The S5 dorsal root ganglion lies behind the sacrum at a level 1 cm caudal to the S2 foraminal opening and approximately 2 mm lateral to the midline of the sacrum. A small burr-hole was made through the plates of the posterior sacrum to approach the dorsal root ganglion of S5 nerve. Sensory stimulation was performed at 0.3 V, 50 Hz. No motor fasciculations was noted at 0.6 V, 2 Hz. A thermal lesion was created at 75oC for 60 sec. The patient whom we report now was a 67-year-old male who suffered from the pain around the coccyx due to rectal cancer metastasis. He failed to respond to other oral and invasive conventional therapy. We experienced a successful result in the treatment of his intractable pain after the S5 dorsal root ganglionotomy.

Economical Sweating Function in Africans: Quantitative Sudomotor Axon Reflex Test

People in tropics have the ability to tolerate heat by residential permanence in the tropics. Previously, we have shown that African and Thai subjects who lived for whole their lives in only their respective countries sweat less under hot conditions than South Koreans who also lived whole their lives in Korea. The difference in sweating responses was attributed to the dissimilar central and peripheral sweating mechanisms operating in people from both groups. In the present study, acetylcholine (ACh), the primary transmitter for the sudomotor functions, was iontophoretically administered to South Koreans and Africans to determine the characteristic sudorific responses of their acclimatized biologic make-up to their respective environments. Using quantitative sudomotor axon reflex test (QSART), direct (DIR) and axon reflex (AXR) responses were evaluated. The findings revealed that the sweat onset-time among South Koreans was 0.91 min earlier than among Africans (P< 0.01). The axon reflex sweat volume of nicotine receptor activity AXR (1) and sweat volume of muscarinic receptor activity DIR (2) among South Koreans were 79% and 53% greater (P< 0.01), respectively. These results indicate that the reduced thermal sweating among Africans is at least in part attributed to the diminished sensitivity of sweat glands to ACh.