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2.
J Hosp Infect ; 131: 228-233, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36460176

ABSTRACT

BACKGROUND: There have been limited data on the risk of onward transmission from individuals with Omicron variant infections who return to work after a 5-day isolation. AIM: To evaluate the risk of transmission from healthcare workers (HCWs) with Omicron variant who returned to work after a 5-day isolation and the viable-virus shedding kinetics. METHODS: This investigation was performed in a tertiary care hospital, Seoul, South Korea. In a secondary transmission study, we retrospectively reviewed the data of HCWs confirmed as COVID-19 from March 14th to April 3rd, 2022 in units with five or more COVID-19-infected HCWs per week. In the viral shedding kinetics study, HCWs with Omicron variant infection who agreed with daily saliva sampling were enrolled between February and March, 2022. FINDINGS: Of the 248 HCWs who were diagnosed with COVID-19 within 5 days of the return of an infected HCW, 18 (7%) had contact with the returned HCW within 1-5 days after their return. Of these, nine (4%) had an epidemiologic link other than with the returning HCW, and nine (4%) had contact with the returning HCW, without any other epidemiologic link. In the study of the kinetics of virus shedding (N = 32), the median time from symptom onset to negative conversion of viable virus was four days (95% confidence interval: 3-5). CONCLUSION: Our data suggest that the residual risk of virus transmission after 5 days of isolation following diagnosis or symptom onset is low.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Retrospective Studies , Kinetics , Health Personnel
4.
Int J Obstet Anesth ; 49: 103246, 2022 Feb.
Article in English | MEDLINE | ID: mdl-35012809

ABSTRACT

BACKGROUND: The optimal fluid strategy to prevent maternal hypotension during caesarean delivery remains unclear. This study aim was to compare the incidence of post-spinal anaesthesia hypotension in women receiving either colloid or crystalloid coload in the setting of prophylactic phenylephrine infusion during caesarean delivery. METHODS: Healthy mothers undergoing elective caesarean delivery under spinal anaesthesia were randomised to receive a rapid intravenous coload with 6% hydroxyethyl starch 130/0.4 10 mL/kg (colloid group) or balanced crystalloid solution (Plasma Solution A) 10 mL/kg (crystalloid group) during spinal anaesthesia. All women had a prophylactic phenylephrine infusion initiated at 25 µg/min immediately after the subarachnoid block and titrated to systolic blood pressure using a standardised protocol. The primary outcome was the incidence of hypotension (systolic blood pressure <80% of baseline) until delivery. RESULTS: The incidence of hypotension was 50% in the colloid group and 62% in the crystalloid group (absolute difference, -12% [95% CI -33% to 9%]; relative risk, 0.8 [95% CI 0.56 to 1.14]; P=0.314). No significant difference between groups was found in the number of hypotensive episodes (median 0.5 [IQR 0 to 1] vs 1 [0 to 2], P=0.132) or phenylephrine dose (675 [IQR 425 to 975] µg vs 750 [625 to 950] µg, P=0.109). The incidence of severe hypotension, symptomatic hypotension, bradycardia, nausea, and the neonatal outcomes were not significantly different. CONCLUSIONS: This study found no benefit of colloid coload compared with crystalloid coload for preventing maternal hypotension in the presence of prophylactic phenylephrine infusion during caesarean delivery.


Subject(s)
Anesthesia, Obstetrical , Anesthesia, Spinal , Hypotension , Anesthesia, Obstetrical/adverse effects , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/methods , Cesarean Section/methods , Colloids/therapeutic use , Crystalloid Solutions , Double-Blind Method , Female , Humans , Hypotension/etiology , Infant, Newborn , Phenylephrine/therapeutic use , Pregnancy , Vasoconstrictor Agents/therapeutic use
5.
J Hosp Infect ; 117: 28-36, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34453983

ABSTRACT

BACKGROUND: There is growing evidence that super-spreading events (SSEs) and multiple-spreading events (MSEs) are a characteristic feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, data regarding the possibility of SSEs or MSEs in healthcare settings are limited. METHODS: This study was performed at a tertiary-care hospital in Korea. We analysed the nosocomial COVID-19 cases that occurred in healthcare workers and inpatients and their caregivers between January and 20th December 2020. Cases with two to four secondary cases were defined as MSEs and those with five or more secondary cases as SSEs. FINDINGS: We identified 21 nosocomial events (single-case events, N = 12 (57%); MSE + SSE, N = 9 (43%)) involving 65 individuals with COVID-19. Of these 65 individuals, 21 (32%) were infectors. The infectors tended to have a longer duration between symptom onset and diagnostic confirmation than did the non-infectors (median two days vs zero days, P=0.08). Importantly, 12 (18%) individuals were responsible for MSEs and one (2%) for an SSE, which collectively generated 35 (54%) secondary cases. CONCLUSION: In a hospital with thorough infection-control measures, approximately 70% of the nosocomial cases of COVID-19 did not generate secondary cases, and one-fifth of the infectors were responsible for SSEs and MSEs, which accounted for approximately half of the total cases. Early case identification, isolation, and extensive contact tracing are important for the prevention of transmission and SSEs.


Subject(s)
COVID-19 , Cross Infection , Cluster Analysis , Contact Tracing , Cross Infection/epidemiology , Humans , SARS-CoV-2
6.
J Nutr Health Aging ; 24(6): 582-590, 2020.
Article in English | MEDLINE | ID: mdl-32510110

ABSTRACT

OBJECTIVES: Compare the diagnostic performance of FRAIL against Fried Phenotype and Frailty Index (FI), and identify clinical factors associated with pre-frailty/frailty. DESIGN: Cross-sectional analysis. SETTING: Community-based screenings in Senior Activity Centres, Residents' Corners and Community Centres in northeast Singapore. PARTICIPANTS: 517 community dwelling participants aged >55 years and ambulant independently (with/ without walking aids) were included in this study. Residents of sheltered or nursing homes, and seniors unable to ambulate at least four meters independently were excluded. MEASUREMENTS: The multidomain geriatric screen included assessments for social vulnerability, mood, cognition, sarcopenia and nutrition. Participants completed a battery of physical fitness tests for grip strength, gait speed, lower limb strength and power, flexibility, balance and endurance, with overall physical performance represented by Short Physical Performance Battery (SPPB). Frailty status was assigned on FRAIL, Fried and 35-item FI. RESULTS: Prevalence of frailty was 1.3% (FRAIL) to 3.1% (FI). Pre-frailty prevalence ranged from 17.0% (FRAIL) to 51.2% (FI). FRAIL demonstrated poor agreement with FI (kappa=0.171, p<0.0001), and Fried (kappa=0.194, p<0.0001). A lower FRAIL cut-off ≥1 yielded significantly improved AUC of 0.70 (95%CI 0.55 to 0.86, p=0.009) against Fried, and 0.71 (95%CI 0.55 to 0.86, p=0.008) against FI. All 3 frailty measures were diagnostic of impaired physical performance on SPPB, with AUCs ranging from 0.69 on FRAIL to 0.77 on Fried (all p values <0.01). Prevalence of low socio-economic status, depression, malnutrition and sarcopenia increased significantly, while fitness measures of gait speed, balance, and endurance declined progressively across robust, pre-frail and frail on all 3 frailty instruments (p <0.05). CONCLUSIONS: Our results suggest that different frailty instruments may capture over-lapping albeit distinct constructs, and thus may not be used interchangeably. FRAIL has utility for quick screening, and any positive response should trigger further assessment, including evaluation for depression, social vulnerability and malnutrition.


Subject(s)
Diagnostic Equipment/standards , Frail Elderly/psychology , Frailty/psychology , Geriatric Assessment/methods , Independent Living/standards , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged
8.
Clin Microbiol Infect ; 24(10): 1104.e5-1104.e8, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29870856

ABSTRACT

OBJECTIVES: The aim of this study was to compare clearance rates and related characteristics of patients carrying KPC-producing carbapenemase-producing Enterobacteriaceae (CPE) with those of patients carrying NDM-1-producing CPE. METHODS: From November 2010 to October 2016, consecutive patients whose clinical or surveillance cultures yielded CPE were prospectively identified and followed in a 2700-bed tertiary referral hospital. CPE control protocols included strict single-room isolation, contact precautions and weekly surveillance cultures. CPE clearance was defined as three or more consecutive CPE-negative cultures without relapse. We compared patients carrying NDM-1 CPE and KPC and those with and without clearance. The time to CPE clearance or discharge was assessed using the Kaplan-Meier method and NDM-1 CPE and KPC CPE groups were compared. RESULTS: A total of 147 patients carrying CPE, 106 with NDM-1 and 41 with KPC, were included in the study. At the time of hospital discharge, 12 of the 106 patients carrying NDM-1 CPE were clear of CPE, whereas none of the KPC CPE patients were (NDM-1, 11.3% (12/106) versus KPC, 0% (0/41), p 0.02). There was no significant association between CPE clearance and factors such as an immunocompromised condition, antibiotic usage, or species of colonizing organism. Among 40 patients who were readmitted, CPE non-clearance was significantly higher in patients carrying KPC CPE (NDM-1, 36.7% (11/30) versus KPC, 80.0% (8/10), p 0.03). CONCLUSIONS: Compared with NDM-1 CPE patients, patients carrying KPC CPE had a significantly lower probability of clearance during hospitalization. Furthermore, KPC CPE carriage persisted for a substantial period of time following patient discharge.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Carbapenem-Resistant Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/drug therapy , beta-Lactamases/metabolism , Aged , Bacterial Proteins/metabolism , Carbapenem-Resistant Enterobacteriaceae/metabolism , Enterobacteriaceae Infections/metabolism , Female , Humans , Infection Control/methods , Male , Microbial Sensitivity Tests/methods , Middle Aged , Prospective Studies , Tertiary Care Centers
9.
Benef Microbes ; 7(5): 731-737, 2016 Nov 30.
Article in English | MEDLINE | ID: mdl-27824272

ABSTRACT

Treatment and prevention methods for non-steroidal anti-inflammatory drug-induced enteropathy have not yet been established. We tested the preventive effects of s-pantoprazole sodium trihydrate (PAN), polaprezinc (PZ), and probiotics on an indomethacin (Indo)-induced small intestinal injury in a rat model. Rats were randomised into 6 groups to receive: normal saline (control), Indo (6 mg/kg), PZ plus Indo, PAN plus Indo, or probiotics plus Indo (at 108 and 109 cfu/head) for 2 weeks. We measured body weight, food intake, severity of small intestinal damage, haemoglobin (Hb) levels in the small intestinal fluid, intestinal inflammatory cytokines, and a few groups of faecal bacteria. The experimental groups were found to have the following survival rates: 0% for the Indo, PZ, and PAN groups; 50% for both probiotic groups; and 100% for control. Treatment with probiotics of different concentrations reduced small intestinal lesion scores and intestinal fluid Hb as compared with the Indo group, while these parameters did not reduce in the PZ and PAN groups. The anti-inflammatory marker interleukin 10 increased in both probiotic groups. Analysis of a few groups of faecal bacteria revealed that Indo-induced a significant increase in Gram-negative bacteria and decreases in Bifidobacterium and Lactobacillus. Similar changes were also observed in the PZ and PAN groups. However, opposite effects were found in both probiotic groups. The use of probiotics appeared to be beneficial in preventing Indo-induced chronic small intestinal injury.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Ulcer Agents/pharmacology , Indomethacin/adverse effects , Probiotics/pharmacology , 2-Pyridinylmethylsulfinylbenzimidazoles/pharmacology , Animals , Bifidobacterium/drug effects , Bifidobacterium/growth & development , Body Weight , Carnosine/analogs & derivatives , Carnosine/pharmacology , Chronic Disease , Cytokines/metabolism , Disease Models, Animal , Eating , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/growth & development , Intestine, Small/injuries , Lactobacillus/drug effects , Lactobacillus/growth & development , Male , Organometallic Compounds/pharmacology , Pantoprazole , Random Allocation , Rats , Rats, Sprague-Dawley , Zinc Compounds/pharmacology
10.
Anaesthesia ; 71(9): 1030-6, 2016 09.
Article in English | MEDLINE | ID: mdl-27396474

ABSTRACT

In clinical practice, both a thin-walled introducer needle and catheter-over-needle technique can be used to allow insertion of a guidewire during central venous catheterisation using the Seldinger technique. We compared the incidence of catheterisation-related complications (arterial puncture, haemothorax, pneumothorax, haematoma and catheter tip malposition) and insertion success rate for these two techniques in patients requiring right-sided subclavian central venous catheterisation. A total of 414 patients requiring infraclavicular subclavian venous catheterisation were randomly allocated to either a thin-walled introducer needle (needle group, n = 208) or catheter-over-needle technique (catheter group, n = 206). The catheterisation-related complication rate was lower in the needle group compared with the catheter group (5.8% vs. 15.5%; p = 0.001). Overall insertion success rates were similar (97.1% and 92.7% in the needle and catheter groups respectively; p = 0.046), although the first-pass success rate was higher in the needle group (62.0% vs. 35.4%; p < 0.001). We recommend the use of a thin-walled introducer needle technique for right-sided infraclavicular subclavian venous catheterisation.


Subject(s)
Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Hemorrhage/epidemiology , Medical Errors/statistics & numerical data , Pneumothorax/epidemiology , Subclavian Vein , Catheterization, Central Venous/instrumentation , Catheters , Female , Hematoma/epidemiology , Hemothorax/epidemiology , Humans , Incidence , Middle Aged , Needles , Prospective Studies , Single-Blind Method
11.
J Fish Dis ; 39(1): 31-9, 2016 Jan.
Article in English | MEDLINE | ID: mdl-25345976

ABSTRACT

Streptococcus parauberis is an increasing threat to aquaculture of olive flounder, Paralichthys olivaceus Temminck & Schlegel, in South Korea. We developed a real-time polymerase chain reaction (PCR) method using the TaqMan probe assay to detect and quantify S. parauberis by targeting the gyrB gene sequences, which are effective for molecular analysis of the genus Streptococcus. Our real-time PCR assay is capable of detecting 10 fg of genomic DNA per reaction. The intra- and interassay coefficient of variation (CV) values ranged from 0.42-1.95%, demonstrating that the assay has good reproducibility. There was not any cross-reactivity to Streptococcus iniae or to other streptococcal/lactococcal fish pathogens, such as S. agalactiae and Lactococcus garvieae, indicating that the assay is highly specific to S. parauberis. The results of the real-time PCR assay corresponded well to those of conventional culture assays for S. parauberis from inoculated tissue homogenates (r = 0.957; P < 0.05). Hence, this sensitive and specific real-time PCR is a valuable tool for diagnostic quantitation of S. parauberis in clinical samples.


Subject(s)
Fish Diseases/microbiology , Flounder , Real-Time Polymerase Chain Reaction/veterinary , Streptococcal Infections/veterinary , Streptococcus/isolation & purification , Animals , DNA Gyrase/genetics , DNA Primers/standards , DNA, Bacterial/analysis , Fisheries , Fluorescent Dyes/standards , Gene Dosage , Intestinal Mucosa/microbiology , Kidney/microbiology , Real-Time Polymerase Chain Reaction/standards , Reproducibility of Results , Sensitivity and Specificity , Spleen/microbiology , Streptococcal Infections/microbiology , Streptococcus/genetics , Streptococcus/growth & development
12.
Br J Anaesth ; 114(2): 307-18, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25163467

ABSTRACT

BACKGROUND: The antioxidant mechanism of sevoflurane post-conditioning-induced neuroprotection remains unclear. We determined whether sevoflurane post-conditioning induces nuclear factor erythroid 2-related factor (Nrf2, a master transcription factor regulating antioxidant defence genes) and haemoxygenase-1 (HO-1, an antioxidant enzyme) expression, and whether protein kinase C (PKC) is involved in Nrf2 activation, in a rat model of transient global cerebral ischaemia/reperfusion (I/R) injury. METHODS: Eighty-six rats were assigned to five groups: sham (n=6), control (n=20), sevoflurane post-conditioning (two cycles with 2 vol% sevoflurane inhalation for 10 min, n=20), chelerythrine (a PKC inhibitor; 5 mg kg(-1) i.v. administration, n=20), and sevoflurane post-conditioning plus chelerythrine (n=20). The levels of nuclear Nrf2 and cytoplasmic HO-1 were assessed 1 or 7 days after ischaemia (n=10 each, apart from the sham group, n=3). RESULTS: On day 1 but not day 7 post-ischaemia, Nrf2 and HO-1 expression were significantly higher in the sevoflurane post-conditioning group than in the control group. Chelerythrine administration reduced the elevated Nrf2 and HO-1 expression induced by sevoflurane post-conditioning. CONCLUSIONS: Sevoflurane post-conditioning increased Nrf2/HO-1 expression via PKC signalling in the early phase after transient global cerebral I/R injury, suggesting that activation of antioxidant enzymes may be responsible for sevoflurane post-conditioning-induced neuroprotection in the early phase after cerebral I/R injury.


Subject(s)
Anesthetics, Inhalation/pharmacology , Heme Oxygenase-1/biosynthesis , Ischemic Attack, Transient/metabolism , Methyl Ethers/pharmacology , NF-E2-Related Factor 2/biosynthesis , Protein Kinase C/physiology , Animals , Brain/pathology , Caspase 3/biosynthesis , Conditioning, Psychological/drug effects , Cytoplasm/enzymology , Gene Expression/drug effects , Ischemic Attack, Transient/pathology , Rats , Rats, Sprague-Dawley , Sevoflurane , Signal Transduction/drug effects
13.
Bone Marrow Transplant ; 49(9): 1212-6, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25000455

ABSTRACT

The objective of this study was to evaluate the efficacy and safety of micafungin for the prevention of invasive fungal infection (IFI) during the neutropenic phase of allogeneic hematopoietic SCT (allo-HSCT) in children and adolescents. This was a prospective, multicenter, open-label, single-arm study. Micafungin was administered i.v. at a dose of 1 mg/kg/day (max 50 mg) from the beginning of conditioning until neutrophil engraftment. Treatment success was defined as the absence of proven, probable, possible or suspected IFI through to 4 weeks after therapy. From April 2010 to December 2011, 155 patients were enrolled from 11 institutions in Korea, and 147 patients were analyzed. Of the 147 patients, 121 (82.3%) completed the protocol without premature interruption. Of the 132 patients in whom micafungin efficacy could be evaluated, treatment success was achieved in 119 patients (90.2%). There was no proven fungal infection in any patient. The number of patients with probable, possible and suspected IFI was two, two and nine, respectively. Thirty-five patients (23.8%) experienced 109 adverse events (AEs) possibly related to micafungin. No patients experienced grade IV AEs. Two patients (1.4%) discontinued micafungin administration due to adverse effects. None of the deaths were related to the study drug.


Subject(s)
Antifungal Agents/therapeutic use , Echinocandins/therapeutic use , Hematopoietic Stem Cell Transplantation/methods , Lipopeptides/therapeutic use , Neutropenia/microbiology , Adolescent , Adult , Antifungal Agents/adverse effects , Child , Child, Preschool , Echinocandins/adverse effects , Female , Humans , Infant , Infant, Newborn , Lipopeptides/adverse effects , Male , Micafungin , Prospective Studies , Transplantation Conditioning/methods , Treatment Outcome , Young Adult
14.
Eur J Pain ; 18(2): 192-203, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24038618

ABSTRACT

BACKGROUND: Recently, the pulsed radiofrequency (PRF, pulsed fashion) procedure was introduced for neuropathic pain management. Since PRF-induced lesions do not need high temperature compared with conventional continuous RF (CRF)-induced lesions, there is no significant loss of sensory fibres after application. METHODS: The progressive changes in the expression of eight representative inflammatory cytokines - glial fibrillary acidic protein, tumour necrosis factor alpha, interleukin-6, cyclooxygenase-II, inducible nitric oxide synthase, nuclear factor-κB, monocyte chemoattractant protein-1 and macrophage inflammatory protein-1α - as well as the morphological changes in extracellular matrices by Masson's trichrome and Verhoeff-van Gieson staining and atomic force microscopy were assessed for normal (control), sham (no RF current), PRF and CRF (positive control) rats. The RF procedure used in this study was similar to the methods used in human clinical trials. RESULTS: All proposed inflammatory proteins showed up-regulation after RF thermal treatments. Specifically, PRF-treated rats showed recovery of up-regulated inflammatory cytokines on day 30 after application, while CRF rats showed significant up-regulation that persisted until day 30. The control and sham groups showed normal unmyelinated axon and collagen structures. PRF-induced lesions showed less fibre destruction than CRF-induced lesions. PRF-induced lesions also showed mild axonal damage and little swelling of the mitochondria. CRF-induced lesions showed ultrastructural changes of sciatic nerve fibres that were irreversible. CONCLUSIONS: PRF-induced pain relief may be due to temporary blockage of nerve signals through the nerve pathway responsible for reversible neuronal depression. However, CRF-induced pain relief may be due to permanent blockage of nerve signals through other nerve pathways. Therefore, CRF could be applied to chronic inflammatory models used to study the mechanism of neuropathic pain.


Subject(s)
Cytokines/metabolism , Neuralgia/pathology , Neuralgia/therapy , Sciatic Nerve/pathology , Animals , Axons/pathology , Disease Models, Animal , Male , Neuralgia/metabolism , Radio Waves , Rats , Rats, Sprague-Dawley , Sciatic Nerve/metabolism , Up-Regulation
15.
Cell Death Dis ; 4: e957, 2013 Dec 12.
Article in English | MEDLINE | ID: mdl-24336077

ABSTRACT

Mycobacterial heparin-binding haemagglutinin antigen (HBHA) is a virulence factor that induces apoptosis of macrophages. Endoplasmic reticulum (ER) stress-mediated apoptosis is an important regulatory response that can be utilised to study the pathogenesis of tuberculosis. In the present study, HBHA stimulation induced ER stress sensor molecules in a caspase-dependent manner. Pre-treatment of RAW 264.7 cells with an IκB kinase 2 inhibitor reduced not only C/EBP homology protein expression but also IL-6 and monocyte chemotactic protein-1 (MCP-1) production. BAPTA-AM reduced both ER stress responses and caspase activation and strongly suppressed HBHA-induced IL-6 and MCP-1 production in RAW 264.7 cells. Enhanced reactive oxygen species (ROS) production and elevated cytosolic [Ca(2+)]i levels were essential for HBHA-induced ER stress responses. Collectively, our data suggest that HBHA induces cytosolic [Ca(2+)]i, which influences the generation of ROS associated with the production of proinflammatory cytokines. These concerted and complex cellular responses induce ER stress-associated apoptosis during HBHA stimulation in macrophages. These results indicate that the ER stress pathway has an important role in the HBHA-induced apoptosis during mycobacterial infection.


Subject(s)
Calcium/metabolism , Cytosol/metabolism , Endoplasmic Reticulum Stress/drug effects , Lectins/pharmacology , Macrophages/drug effects , Macrophages/metabolism , Reactive Oxygen Species/metabolism , Animals , Apoptosis/drug effects , Cell Line , Mice
16.
Anaesthesia ; 68(12): 1259-65, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24219252

ABSTRACT

We investigated changes in concentrations of interleukin-1ß, interleukin-6, tumour necrosis factor-α and bradykinin in blood during passage through a cell salvage device and a leucocyte depletion filter, with or without application of subatmospheric pressure across the filter. Blood samples from 19 healthy women undergoing scheduled caesarean section showed concentrations of cytokines and bradykinin in blood filtered under gravity flow that were equal to or significantly lower than those of pre-operative venous blood samples. They were also significantly lower than that in postoperative orthopaedic shed blood, which is commonly reinfused after orthopaedic surgery. A minority of samples taken from blood that had been filtered using subatmospheric pressure showed raised interleukin-6 concentrations. We suggest that use of a leucocyte depletion filter for cell-salvaged blood with gravity flow is likely to be safe with regard to concentrations of cytokines and bradykinin. However, this may not hold true for the filter used with subatmospheric pressure. If transfusion of salvaged blood using a leucocyte depletion filter seems to induce hypotension, elevation of interleukin-6 should be suspected.


Subject(s)
Blood Transfusion, Autologous/methods , Bradykinin/blood , Cytokines/blood , Filtration/instrumentation , Leukocyte Reduction Procedures/instrumentation , Operative Blood Salvage/instrumentation , Adult , Atmospheric Pressure , Blood Transfusion, Autologous/instrumentation , Cesarean Section , Female , Filtration/methods , Humans , Interleukin-1beta/blood , Interleukin-6/blood , Leukocyte Reduction Procedures/methods , Leukocytes , Operative Blood Salvage/methods , Tumor Necrosis Factor-alpha/blood
17.
Drug Res (Stuttg) ; 63(12): 633-8, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23884659

ABSTRACT

Leflunomide is a disease-modifying antirheumatic drug. The purpose of this study was to evaluate the bioequivalence of a test drug (CJ leflunomide) and a commercially available reference drug (Arava®) at 2 doses (10 and 20 mg) in healthy Korean volunteers. This was a single-dose (28 individuals enrolled at each dose group), randomized, open-label, 2-way crossover study. The 2 treatment periods were separated by a 56-day wash-out interval. Blood sampling was conducted until 672 h after drug administration. Plasma teriflunomide (active metabolite of leflunomide) concentrations were determined, and pharmacokinetic parameters were calculated. Bioequivalence was evaluated using an ANOVA model, based on the AUCt and the Cmax after administration of leflunomide tablets. Bioequivalence was defined as the 90% confidence intervals (CIs) of the geometric mean ratios (GMRs) of AUCt and Cmax for the test and reference drugs being within the range of 0.80-1.25. The GMRs (90% CI) for AUCt and Cmax were 0.9506 (0.9091-0.9941) and 0.9861 (0.9360-1.0389), respectively, in the 10 mg study, and 0.9524 (0.9101-0.9968) and 0.9740 (0.9314-1.0186), respectively, in the 20 mg study. The 90% CIs of AUCt and Cmax at each dose were within the accepted range for bioequivalence. Based on the results, the test drug (CJ leflunomide) was bioequivalent to the commercially available reference drug (Arava®) at both doses.


Subject(s)
Antirheumatic Agents/pharmacokinetics , Crotonates/blood , Isoxazoles/pharmacokinetics , Toluidines/blood , Adult , Analysis of Variance , Antirheumatic Agents/administration & dosage , Area Under Curve , Cross-Over Studies , Dose-Response Relationship, Drug , Humans , Hydroxybutyrates , Isoxazoles/administration & dosage , Leflunomide , Middle Aged , Nitriles , Republic of Korea , Therapeutic Equivalency , Young Adult
18.
Acta Anaesthesiol Scand ; 57(6): 784-92, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23550795

ABSTRACT

BACKGROUND: Post-arrest variables associated with long-term survival after cardiopulmonary resuscitation (CPR) in intensive care unit (ICU) patients remain unclear. This study was designed to identify pre- and intra-arrest factors associated with survival 3 months after CPR in ICU patients and to identify post-arrest factors associated with long-term survival in those who survived 24 h after CPR. METHODS: A total of 131 ICU patients undergoing CPR from January 2009 to June 2010 were included. Data were retrospectively analysed and categorized based on the Utstein template. RESULTS: The overall survival rate 3 months after CPR was 20.6%. Logistic regression analysis revealed that acute physiology and chronic health evaluation (APACHE) II score (odds ratio, 95% confidence interval, 0.87 [0.83-0.93]; P < 0.001), ventricular tachycardia/ventricular fibrillation (VT/VF, 5.55 [1.55-19.83]; P = 0.032), and normoxia during CPR (4.45 [1.34-14.71]; P = 0.045) were significant independent pre- and intra-arrest predictors of 3-month survival after CPR in ICU patients. Fifty-seven patients survived 24 h after CPR, and their 3-month survival rate was 47.4%. Early enteral nutrition (9.94 [1.96-50.43]; P = 0.030) and normoxia after return of spontaneous circulation (10.75 [2.03-55.56]; P = 0.030) were predictive of 3-month survival in patients who survived 24 h after CPR. CONCLUSIONS: Normoxia during CPR and VT/VF were predictors of long-term survival after CPR in ICU patients. In patients surviving 24 h after CPR, initiation of enteral nutrition within 48 h and maintenance of normoxia were associated with a positive outcome.


Subject(s)
Cardiopulmonary Resuscitation , Heart Arrest/therapy , Intensive Care Units , APACHE , Aged , Blood Glucose/analysis , Body Temperature , Brain Damage, Chronic/etiology , Brain Death , Cardiotonic Agents/therapeutic use , Comorbidity , Critical Illness , Enteral Nutrition , Epinephrine/therapeutic use , Female , Glasgow Coma Scale , Heart Arrest/etiology , Heart Arrest/mortality , Humans , Male , Middle Aged , Oxygen/blood , Recovery of Function , Retrospective Studies , Survival Analysis , Survival Rate , Tachycardia, Ventricular/complications , Treatment Outcome , Ventricular Fibrillation/complications
19.
Br J Anaesth ; 110(6): 988-95, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23404987

ABSTRACT

BACKGROUND: The purpose of this study was to investigate whether combined administration of celecoxib and sevoflurane after ischaemia produces additive neuroprotection against transient global cerebral ischaemia in rats. METHODS: Cerebral ischaemia was induced by bilateral common carotid artery occlusion with haemorrhagic hypotension for 8 min. After ischaemia, no drugs were administered in the sham (n=4) and control (n=10) groups. In the celecoxib group (n=10), celecoxib 2 mg kg(-1) was administered after reperfusion. In the sevoflurane group (n=10), after reperfusion, sevoflurane 2.4% was inhaled two times for 5 min each at an interval of 10 min to achieve postconditioning. In the celecoxib+sevoflurane group (n=10), administration of celecoxib 2 mg kg(-1) and the sevoflurane postconditioning were performed simultaneously. Necrotic or apoptotic cells were examined in the hippocampus 7 days after ischaemia. Serum levels of proinflammatory cytokines including tumour necrosis factor-α and interleukin-1ß were measured 2 h, and 3 and 7 days after ischaemia. RESULTS: Necrotic or apoptotic cells were observed more frequently in the control group than in the celecoxib or sevoflurane groups 7 days after ischaemia (P<0.05). Cytokine levels were higher in the control group when compared with the celecoxib or sevoflurane groups 2 h after ischaemia (P<0.05). However, the histological outcomes and cytokine levels were similar in all three groups treated with celecoxib or sevoflurane. CONCLUSIONS: Combined treatment with celecoxib and sevoflurane after global cerebral ischaemia has no additive neuroprotective effects in rats.


Subject(s)
Anesthetics, Inhalation/administration & dosage , Brain Ischemia/drug therapy , Cyclooxygenase 2 Inhibitors/administration & dosage , Methyl Ethers/administration & dosage , Neuroprotective Agents/pharmacology , Pyrazoles/administration & dosage , Sulfonamides/administration & dosage , Animals , Celecoxib , Drug Synergism , Interleukin-1beta/blood , Male , Methyl Ethers/pharmacology , Pyrazoles/pharmacology , Rats , Rats, Sprague-Dawley , Sevoflurane , Sulfonamides/pharmacology , Tumor Necrosis Factor-alpha/blood
20.
Br J Anaesth ; 110(5): 773-9, 2013 May.
Article in English | MEDLINE | ID: mdl-23274781

ABSTRACT

BACKGROUND: Symptomatic cerebral hyperperfusion (SCH) is a potential complication after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with moyamoya disease. This retrospective study was designed to determine factors associated with SCH after STA-MCA anastomosis in adult moyamoya patients. METHODS: Eighty-two adult moyamoya patients undergoing STA-MCA anastomosis between July 2005 and December 2010 were enrolled. Laboratory data such as haemoglobin and white blood cell (WBC) count, preoperative (patient characteristic data, initial clinical manifestation, the angiographic staging), intraoperative (surgical time, the operative side, anaesthetic technique, fluid balance, arterial pressure, arterial partial pressure of carbon dioxide, the lowest haematocrit, and intraoperative transfusion), and postoperative (arterial pressure, Acute Physiology and Chronic Health Evaluation II score) data were collected and used as predictable factors for postoperative SCH, in which a focal intense increase in cerebral blood flow at the anastomosis site was shown in postoperative single-photon emission computed tomography. RESULTS: Among 82 patients with 99 surgeries, 39 patients (47 sides, 47%) suffered from transient neurological deterioration due to SCH from 1 to 9 days after operation (median: 2 days), which was sustained for 1-14 days (median: 7 days). The operation on the dominant hemisphere [odds ratio (OR), 5.09; 95% confidence interval (CI), 2.07-12.54, P<0.001] was an independent risk factor for SCH. Also, WBC count on postoperative day 1 was significantly correlated with SCH (OR 1.19; 95%CI, 1.02-1.38, P=0.029). CONCLUSIONS: The operation on the dominant hemisphere and increased postoperative WBC count may be associated with SCH after STA-MCA anastomosis in adult-onset moyamoya patients.


Subject(s)
Cerebral Revascularization/adverse effects , Cerebrovascular Circulation/physiology , Hyperemia/etiology , Middle Cerebral Artery/surgery , Moyamoya Disease/surgery , Temporal Arteries/surgery , Adult , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Brain/diagnostic imaging , Cerebral Revascularization/methods , Female , Humans , Hyperemia/diagnostic imaging , Leukocyte Count , Male , Middle Aged , Moyamoya Disease/diagnostic imaging , Retrospective Studies , Risk Factors , Tomography, Emission-Computed, Single-Photon , Young Adult
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