Usefulness of the perfusion index for monitoring the response to intravenous ketamine infusion therapy in patients with complex regional pain syndrome.

BACKGROUND: This study was performed to compare the perfusion index (PI) between affected and unaffected limbs in patients with complex regional pain syndrome (CRPS); it also evaluated the usefulness of the PI for monitoring the response to intravenous ketamine infusion therapy in such patients. METHODS: In total, 46 patients with CRPS in one arm or leg were enrolled in this study. The PIs of the unaffected (PIControl ) and affected (PICRPS ) limbs were simultaneously evaluated before and after treatment. RESULTS: PICRPS was significantly lower than PIControl at all time points. The change in PI from immediately before to 30 min after intravenous ketamine infusion therapy (TBefore and T30 min , respectively) in the affected limb was significantly correlated with the change in visual analog pain scale (VAS) between the two time points (r = 0.646, p < 0.001). The area under the curve for the changes in VAS and PICRPS between TBefore and T30 min was 0.928. The optimal threshold value for the change in PICRPS between TBefore and T30 min , to distinguish responders with a ≥ 50-point reduction in VAS score from nonresponders, was 22.60% with a sensitivity of 0.811 (95% CI: 0.774-0.848) and a specificity of 0.889 (95% CI: 0.848-0.930). Thirty-one patients showed a ≥ 50-point reduction in VAS score [67% (95% CI: 54%-80%)] and 15 patients showed a < 50-point reduction in VAS score [33% (95% CI: 20%-46%)]. Thirty patients showed an increased PI ≥ 22.60% [65% (95% CI: 50%-78%)] and 16 patients showed an increased PI < 22.60% [35% (95% CI: 22%-50%)]. Twenty-seven patients had a ≥ 50-point reduction in VAS score and an increased PI ≥ 22.60% [59% (95% CI: 44%-74%)]. Eleven patients had shown a < 50-point pain reduction in VAS score and increased PI < 22.60% [24% (95% CI: 13%-37%)]. CONCLUSION: The PI significantly differed between affected and unaffected limbs in patients with CRPS. The PI may be useful for monitoring the response to intravenous ketamine therapy in patients with CRPS.

General anesthesia, using remimazolam, for the patient with myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD): A case report.

RATIONALE: Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is one of auto-immune demyelinating diseases of nervous system. Although both regional anesthesia and general anesthesia has been successfully performed in the patient with demyelinating diseases of nervous system, it has been controversial which one is better. PATIENT CONCERNS: Forty-four male patient was admitted for arthroscopic elbow surgery due to limitation of range of motion. The patient was diagnosed as MOGAD with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, and steroid was used to prevent and treat symptoms and signs. DIAGNOSIS: He was diagnosed as MOGAD with anti-NMDA receptor encephalitis, 1 year ago. The patient complaint of dizziness, diplopia, nausea, vomiting, seizure, general weakness and so on when he was confirmed as MOGAD with anti-NMDA receptor encephalitis. The diagnosis of MOGAD was confirmed with positive anti-myelin oligodendrocyte glycoprotein (MOG) Immunoglobulin (Ig)G and negative anti-aquaporin 4 (AQP4) IgG in the blood. INTERVENTIONS AND OUTCOMES: After steroid cover, total intravenous anesthesia (TIVA) with remimazolam and remifentanil was established for the patients. Rocuronium was administered under monitoring of neuromuscular blockade, using train of 4 (TOF). The operation was performed without any event under right lateral decubitus position. The patient was uneventfully recovered from anesthesia. LESSONS: The case report showed total intravenous anesthesia with remimazolam and remifentanil under proper monitoring was successfully performed in the patient with MOGAD.

Facile in Situ Synthesis of Multiple-Heteroatom-Doped Carbons Derived from Polyimide Precursors for Flexible All-Solid-State Supercapacitors.

Efficient strategies to prepare carbon materials with improved electrochemical performance for supercapacitors have been in great demand. Herein, we develop multiple-heteroatom-doped carbons (from single- to triple-doped) by pyrolysis of polyimide precursors using a facile in situ approach. This approach can be used to tune heteroatom compositions by controlling the desired polyimide monomer functional groups as well as introducing external doping sources into the polyimide precursor solutions. Various types of multiple-heteroatom-doped carbons such as N; N,S-; N,F-; N,S,B-; and N,F,B-doped carbons are synthesized. Among these synthesized multiple-heteroatom-doped carbons, the specific capacitance of N,F,B triple-doped carbon exhibits 350.3 F g-1 at 1 A g-1 in a three-electrode system. Furthermore, a flexible all-solid-state supercapacitor device using the N,F,B-doped carbon with poly(vinyl alcohol)-1 M H2SO4 gel electrolyte demonstrates a volumetric energy density of 0.58 mW h cm-3. It is expected that this synthesis strategy for multiple-heteroatom-doped carbons can be used for practical supercapacitor applications.

Nondestructive determination of the ambroxol content in tablets by Raman spectroscopy.

We describe a method for determining the ambroxol content in tablets nondestructively. To obtain a reliable quantitative calibration, we prepared 20 pellet samples (ambroxol content: 8.30-16.25 wt.%) and acquired their Raman spectra while rotating the pellets. The spectra of the rotated samples reflected the compositional variations better than those that were recorded without rotation. To reduce both the baseline variations and the spectral noise simultaneously, the spectra were pre-processed using wavelet transformation (WT). Then, we used the normalization method before partial least-squares (PLS) regression to correct Raman intensity variation from laser power fluctuation. The achieved standard error of cross validation (SECV) was 0.30%. Two different datasets where Raman intensity was artificially changed were prepared and the corresponding spectra were quantitatively analyzed. The result was reproducible even if laser intensity was fairly changed. Additionally, two different commercial tablets were analyzed and the accuracy of measurement was better for a tablet that had the similar spectral features of the standard pellet samples. The proposed method can be utilized for the analysis of commercial tablets if standard tablets of various ambroxol concentrations that have the same chemical components including additives and the same physical shape of tablets are available.