Anti-obesity effects of Camellia (Camellia oleifera Abel) oil treatment on high-fat diet-induced obesity in C57BL/6J mice.

PURPOSE: In the current study, we investigated the effects of camellia oil and camellia oil infused with herbs (Camellia oleifera Abel) on obesity in obese mice fed a high-fat diet (HFD). METHODS: The antioxidant activity of camellia oil in scavenging free radicals was investigated. Additionally, body and organ weight changes, serum and liver marker parameters, antioxidant enzyme activities, liver and epididymal fat histology, protein and gene expression associated with lipogenesis and hyperglycemia effect on adenosine monophosphate-activated protein kinase (AMPK) phosphorylation, were examined in HFD-induced obese mice. RESULTS: The hepatic steatosis and epididymal fat were significantly reduced by the oral administration of camellia oil and herb-infused camellia oil. Moreover, hepatic and serum marker parameters such as total cholesterol, insulin, triglycerides, tumor necrosis factor-α, adiponectin, thiobarbituric acid reactive substances, aspartate aminotransferase, and alanine transaminase were beneficially impacted. Additionally, the activity of antioxidant enzymes also increased. Camellia oil and herb-infused camellia oil treatments reduced the expression of genes linked to hyperglycemia and lipogenesis via activation of AMPK phosphorylation. CONCLUSION: For many people, exercise poses an obstacle in the daily routine due to lack of ease, difficulty in maintaining consistency, and hard work. Camellia oil combined with herbs has anti-obesity and antihyperglycemic effects. These findings indicate that treatment with herb-infused camellia oil is most beneficial for elderly individuals who do not prefer frequent exercise.

Survival differences between patients with de novo and relapsed/progressed advanced non-small cell lung cancer without epidermal growth factor receptor mutations or anaplastic lymphoma kinase rearrangements.

BACKGROUND: We aimed to examine whether patients with de novo and relapsed/progressed stage IIIB-IV non-small cell lung cancer (NSCLC) without epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations have different prognoses. METHODS: This retrospective study analyzed the Health Insurance Review and Assessment claims data in South Korea from 2013 to 2020. Patients with stage IIIB-IV NSCLC without EGFR or ALK mutations who received first-line palliative therapy between 2015 and 2019 were identified. Overall survival (OS), time to first subsequent therapy (TFST), and time to second subsequent therapy (TSST) were estimated using the Kaplan-Meier method. Multivariate Cox regression analysis was used to reveal the impact of de novo versus relapsed/progressed disease on OS. Treatment patterns, including treatment sequence, top five most frequent regimens, and time to treatment discontinuation, were described in both groups. RESULTS: Of 14,505 patients, 12,811 (88.3%) were de novo, and 1,694 (11.7%) were relapsed/progressed. The median OS in the de novo group was 11.0 versus 11.5 months in the relapsed/progressed group (P = 0.002). The ongoing treatment probability was higher in relapsed/progressed patients than in de novo patients from 6.4 months since the initiation of first-line treatment (P < 0.001). Median TSST was shorter in the de novo group than in the relapsed/progressed group (9.5 vs. 9.9 months, P < 0.001). In multivariate analysis, de novo disease was associated with shorter OS (hazard ratio 1.07; 95% confidence interval 1.01-1.14). The overall treatment patterns for de novo and relapsed/progressed patients were similar. CONCLUSIONS: De novo patients had poorer OS and TSST after the initiation of palliative therapy than relapsed/progressed patients. These findings suggest that the stage of the disease at the time of initial diagnosis should be considered in observational studies and clinical trials as a prognostic factor.

Effect of Probiotic Lactic Acid Bacteria (LAB) on the Quality and Safety of Greek Yogurt.

Greek yogurt is a strained yogurt with a high protein content that brings nutritional benefits. To enhance the functional benefits of Greek yogurt, Greek yogurt was prepared with various combinations of probiotic lactic acid bacteria (LAB) (Streptococcus thermophilus, Lactobacillus bulgaricus, Lactobacillus gasseri BNR17, and Lactobacillus plantarum HY7714). Effects of probiotic LAB on quality, sensory, and microbiological characteristics of Greek yogurt were then compared. Among samples, Greek yogurt fermented by S. thermophilus and L. bulgaricus showed the highest changes of pH and titratable acidity during 21 d of storage at 4 °C. Greek yogurt fermented with L. plantarum HY7714 had a higher viscosity than other samples. Greek yogurt fermented with S. thermophilus, L. bulgaricus, L. gasseri BNR17, and L. plantarum HY7714 showed superior physicochemical properties and received the highest preference score from sensory evaluation among samples. Overall, the population of enterohaemorrhagic Escherichia coli (EHEC) was more effectively reduced in Greek yogurt fermented with probiotic LAB than in commercial Greek yogurt during storage at 4, 10, and 25 °C. Thus, the addition of L. gasseri BNR17 and L. plantarum HY7714 as starter cultures could enhance the microbial safety of Greek yogurt and sensory acceptance by consumers.

Adherence is an optimal factor for maximizing the effective and safe use of oral anticoagulants in patients with atrial fibrillation.

Few studies assessed the association between major adverse cardiovascular events and adherence to warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate the effects of adherence to oral anticoagulants (OACs) in patients with AF using claims data (July 2014-April 2019). Using the initial 3-month medication possession rate (MPR), patients were categorized into adherent (MPR ≥ 0.8) or non-adherent (MPR < 0.8) groups. Propensity score matching of non-adherent group to adherent group was conducted for warfarin (1:1) and DOAC (1:3), respectively. Incidence of ischemic stroke, myocardial infarction (MI), intracranial hemorrhage, and all-cause death was assessed in the matched cohort (67,147 patients). The hazard ratio (HR) for adherence to OAC was estimated using the Cox proportional hazard model with adjusting covariate including age and sex. The risk for ischemic stroke, MI, and all-cause death was lower in the DOAC adherent group than in the DOAC non-adherent group (HR: 0.78; 95% confidence intervals: 0.73-0.84; 0.75, 0.60-0.94; 0.54, 0.51-0.57, respectively). Adherence to OAC was not associated with the risk of intracranial hemorrhage (1.01, 0.85-1.20). Commitment programs to improve adherence in patients with AF could maximize drug effectiveness and safety.

Haematological cancer versus solid tumour end-of-life care: a longitudinal data analysis.

OBJECTIVE: To explore differences in end-of-life healthcare utilisation and medication costs between patients with haematological malignancies and patients with solid tumours. METHODS: Data on deceased patients with cancer were selected from the sample cohort data of health insurance claims from 2008 to 2015 in South Korea. They were categorised into two groups: patients with haematological malignancies and patients with solid tumours. Longitudinal data comprised the patient-month unit and aggregated healthcare utilisation and medication cost for 1 year before death. Healthcare utilisation included emergency room visits, hospitalisation and blood transfusions. Medication costs were subdivided into anticancer drugs, antibiotics, opioids, sedatives and blood preparation. Generalised linear mixed models were used to evaluate differences between the two groups and time trends. RESULTS: Of the 8719 deceased patients with cancer, 349 died from haematological malignancies. Compared with solid tumours, patients with haematological malignancies were more likely to visit the emergency room (OR=1.36, 95% CI 1.10 to 1.69) and receive blood transfusions (OR=5.44, 95% CI 4.29 to 6.90). The length of hospitalisation of patients was significantly different (difference=2.49 days, 95% CI 1.75 to 3.22). Medication costs, except for anticancer treatment, increased as death approached. The costs of antibiotics and blood preparations were higher in patients with haematological malignancies than in those with solid tumours: 3.24 (95% CI 2.14 to 4.90) and 4.10 (95% CI 2.77 to 6.09) times higher, respectively. CONCLUSIONS: Patients with haematological malignancies are at a higher risk for aggressive care and economic burden at the end of life compared with those with solid tumours. Detailed attention is required when developing care plans for end-of-life care of haematological patients.

The economic impact of disease progression and death in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer patients: using Korean nationwide health insurance claims data.

OBJECTIVES: Recognizing the value of anticancer treatments based on progression-free survival and overall survival may help decision making in healthcare policy. We aimed to measure and compare the impact of disease progression and terminal state prior to death on healthcare costs in HR+, HER2- ABC patients. METHODS: We conducted a retrospective study using Korean nationwide health insurance claims database between 1 September 2012 and 31 August 2017. The impact of disease progression was estimated by measuring the average incremental monthly cost per patient during 1 year after progression compared to 1 year before progression. Death-related costs per patient per month (PPPM) were measured for those who died within 1 year after progression. Generalized estimating equation (GEE) was used to estimate the variations in PPPM costs by progression and death with adjustment for clinical factors. RESULTS: After progression, 1,636 patients expensed $2,892 per month more on average than before progression ($3762 vs. $870). The GEE analysis with adjustment for baseline characteristics showed that PPPM costs increased by 3.46 folds (95% CI = 3.06-3.93) after progression. Also, PPPM costs were 1.74 (95%CI = 1.43-2.12) times higher in patients who died within 1 year after progression relative to survived patients. When considering the interaction between progression and death, deceased patients showed higher increased ratio of PPPM costs after progression (4.91; p=value<.0001) than survived patients (2.95; 95% CI = 2.61-3.34). CONCLUSIONS: From the payer's perspective, more healthcare costs incurred during the progression state than terminal state in HR+, HER2- ABC patients. The impact of disease progression emphasizes the importance of effectively treating HR+, HER2- ABC patients.

Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea.

OBJECTIVES: Asthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation. DESIGN: Nationwide population-based observational study. SETTING: Korean National Sample Cohort database. PARTICIPANTS: We included 22 130 adults with asthma diagnoses more than twice (ICD-10 (International Classification of Diseases, Tenth revision) codes J45 and J46) and one prescription for asthma medication from 2010 to 2011. OUTCOME MEASURES: Asthma exacerbation was defined as having a corticosteroid (CS) burst characterised by a prescription of high-dose oral CS for ≥3 days or one systemic CS injection, hospitalisation or emergency department visit. RESULTS: Among severities, history of CS bursts was significantly associated with exacerbation. In mild and moderate asthma, exacerbation was significantly associated with age ≥45 years, being female, gastro-oesophageal reflux disease and chronic rhinitis. High medication possession ratio (MPR≥50%), compared with low MPR (<20%) showed adjusted ORs of 0.828 (95% CI 0.707 to 0.971) and 0.362 (0.185 to 0.708) in moderate and severe asthma, respectively. In severe asthma, compared with mild asthma, only allergic rhinitis and history of hospitalisation were strongly associated with exacerbation. When comparing frequent exacerbators to patients with single exacerbation, age ≥45 years, atopic dermatitis, anxiety and history of CS burst were significant risk factors in mild and moderate asthma, whereas no risk factors were significant in severe asthma. CONCLUSIONS: Different associations between risk factors and asthma exacerbations based on asthma severity suggest that patients with mild asthma require greater attention to their age and comorbidities, whereas those with severe asthma require greater attention to hospitalisation history and drug adherence.

Development of Burdock Root Inulin/Chitosan Blend Films Containing Oregano and Thyme Essential Oils.

In this study, inulin (INU) extracted from burdock root was utilized as a new film base material and combined with chitosan (CHI) to prepare composite films. Oregano and thyme essential oils (OT) were incorporated into the INU-CHI film to confer the films with bioactivities. The physical and optical properties as well as antioxidant and antimicrobial activities of the films were evaluated. INU film alone showed poor physical properties. In contrast, the compatibility of INU and CHI demonstrated by the changes in attenuated total reflectance-Fourier transformation infrared spectrum of the INU-CHI film increased tensile strength and elongation at break of the INU film by 8.2- and 3.9-fold, respectively. In addition, water vapor permeability, water solubility, and moisture content of the films decreased proportionally with increasing OT concentration in the INU-CHI film. Incorporation of OT also increased the opacity of a and b values and decreased the L value of the INU-CHI films. All INU-CHI films containing OT exhibited antioxidant and antimicrobial properties. Particularly, the INU-CHI film with 2.0% OT exhibited the highest 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid), 2,2-diphenyl-1-picrylhydrazyl radical scavenging, and antimicrobial activities against four pathogens. Thus, the INU-CHI film containing OT developed in this study might be utilized as an active packaging material in the food industry.

Antimicrobial activity of gelatin films based on duck feet containing cinnamon leaf oil and their applications in packaging of cherry tomatoes.

Duck feet gelatin (DFG) films were prepared and applied to the packaging of cherry tomatoes. Cinnamon leaf oil (CLO) was incorporated into the DFG films at concentrations of 0.5, 1.0, and 1.5% to provide antimicrobial activity. The DFG films with 1.0% CLO incorporation exhibited the most desirable tensile strength (41.6 MPa) and elongation at break (18.5%). Regarding the antimicrobial activity, the DFG films containing CLO significantly inhibited the growth of foodborne pathogens. In addition, the DFG film with 1.0% CLO was employed in the coating and wrapping of cherry tomatoes inoculated with Salmonella typhimurium. The DFG film with 1.0% CLO incorporation reduced the population of the bacteria to below the detection limit. Moreover, the DFG film with CLO delayed the color change on cherry tomatoes. Overall, the DFG film with CLO enhanced the shelf life of cherry tomatoes and can be used as an antimicrobial packaging.

Hydrothermal treatment of Ti surface to enhance the formation of low crystalline hydroxyl carbonate apatite.

BACKGROUND: Ti and its alloys have been widely used as orthopedic and dental implants due to their outstanding mechanical properties and biocompatibility. However, long time is required to form bond between Ti implant and surrounding tissues. Therefore, these implants necessitate surface treatment such as mechanical/chemical treatment and coating of bioactive materials for improving the osseointegration. RESULTS: This study was focused on the calcium-phosphate (Ca-P) coating on machined Ti, blasted-Ti (B-Ti), and blasted-NaOH-etched-Ti (BNH) surfaces by hydrothermal method to evaluate the ability of HA formation. Nanostructured morphology was created by NaOH etching on blasted-Ti surface. XRD analysis confirmed the existence of sodium titanate phase on such samples. Rutile and anatase phases along with hydroxyapatite were observed after hydrothermal treatment in Ca-P solution. Substantial hydroxyapatite together with TiO2 was observed during hydrothermal treatment at 200°C for 12 hrs. Blasted-NaOH-etched samples (BNH-Ti) revealed appreciable bone-like apatite formation as compared to machined-Ti and blasted-Ti (B-Ti) surfaces. However, maximum HA formation was confirmed on Ca-P coated-BNH samples (BNHA-Ti-200-12) by XRD and ICP analysis. CONCLUSION: Multistep surface treatment adopted in current study would be effective to enhance HA formation on Ti surface.

Differential Gene Expression in GPR40-Overexpressing Pancreatic ß-cells Treated with Linoleic Acid.

"G protein-coupled receptor 40" (GPR40), a receptor for long-chain fatty acids, mediates the stimulation of glucose-induced insulin secretion. We examined the profiles of differential gene expression in GPR40-activated cells treated with linoleic acid, and finally predicted the integral pathways of the cellular mechanism of GPR40-mediated insulinotropic effects. After constructing a GPR40-overexpressing stable cell line (RIN-40) from the rat pancreatic ß-cell line RIN-5f, we determined the gene expression profiles of RIN-5f and RIN-40. In total, 1004 genes, the expression of which was altered at least twofold, were selected in RIN-5f versus RIN-40. Moreover, the differential genetic profiles were investigated in RIN-40 cells treated with 30 µM linoleic acid, which resulted in selection of 93 genes in RIN-40 versus RIN-40 treated with linoleic acid. Based on the Kyoto Encyclopedia of Genes and Genomes Pathway (KEGG, http://www.genome.jp/kegg/), sets of genes induced differentially by treatment with linoleic acid in RIN-40 cells were found to be related to mitogen-activated protein (MAP) kinase- and neuroactive ligand-receptor interaction pathways. A gene ontology (GO) study revealed that more than 30% of the genes were associated with signal transduction and cell proliferation. Thus, this study elucidated a gene expression pattern relevant to the signal pathways that are regulated by GPR40 activation during the acute period. Together, these findings increase our mechanistic understanding of endogenous molecules associated with GPR40 function, and provide information useful for identification of a target for the management of type 2 diabetes mellitus.

A comparative study among normal saline, water soluble gel and 2% lidocaine gel as a SLIPA lubricant.

BACKGROUND: This study was designed to find appropriate lubricant for streamed lined liner of pharyngeal airway™ (SLIPA™). We evaluated the incidence of sore throat, nausea, vomiting, hoarseness, paresthesia and blood stain after using saline, water soluble gel and 2% lidocaine gel as a SLIPA™ lublicant. METHODS: One hundred twenty three patients scheduled for minor surgery to whom the SLIPA™ was considered suitable were randomly allocated to one of three groups which receive normal saline, water soluble gel or 2% lidocaine gel as a SLIPA™ lublicant. Patients were interviewed at recovery room, post operation 6-12 hour, post operation 18-24 hour about sore throat and other complications. RESULTS: There were no statistical difference in sore throat and blood stain among three groups. Also there were no statistical differences in hoarseness, nausea, vomiting. The incidence of paresthesia in 2% lidocaine gel group was significantly higher than those of the other two groups immediately after operation, but it was resolved after leaving the recovery room. CONCLUSIONS: Our results suggest that normal saline, water soluble gel and 2% lidocaine gel are all available as a SLIPA™ lubricant. Size of SLIPA™, insertion technique and difficulty of insertion should be further investigated as the main causes of a sore throat and other complications which can occur after the insertion of SLIPA™.

Anesthetics influence the incidence of acute kidney injury following valvular heart surgery.

Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is lacking. Here we studied the effect of propofol anesthesia on the occurrence of acute kidney injury following heart surgery with cardiopulmonary bypass. One hundred and twelve patients who underwent valvular heart surgery were randomized to receive either propofol or sevoflurane anesthesia, both with sufentanil. Using Acute Kidney Injury Network criteria, significantly fewer patients developed acute kidney injury postoperatively in the propofol group compared with the sevoflurane group (6 compared with 21 patients). The incidence of severe renal dysfunction was significantly higher in the sevoflurane group compared with the propofol group (5 compared with none). The postoperative cystatin C was significantly lower in the propofol group at 24 and 48 h. Serum interleukin-6 at 6 h after aorta cross-clamp removal, C-reactive protein at postoperative day 1, and segmented neutrophil counts at postoperative day 3 were also significantly lower in the propofol group. Thus, propofol anesthesia significantly reduced the incidence and severity of acute kidney injury in patients undergoing valvular heart surgery with cardiopulmonary bypass compared with sevoflurane. This beneficial effect of propofol may be related to its ability to attenuate the perioperative increase in proinflammatory mediators.

Efficacy of perioperative oral triiodothyronine replacement therapy in patients undergoing off-pump coronary artery bypass grafting.

OBJECTIVE: The aim of this study was to assess the effects of oral triiodothyronine (T3) therapy on postoperative thyroid hormone concentrations, hemodynamic variables, and outcomes. DESIGN: A prospective, randomized, controlled, double-blind study. SETTING: Cardiac operating room at a single institution. PARTICIPANTS: One hundred patients undergoing elective off-pump coronary artery bypass graft surgery. INTERVENTIONS: Patients received either 20 µg of oral T3 or placebo every 12 hours starting 20 minutes before anesthetic induction, for a total of 4 doses. MEASUREMENTS AND MAIN RESULTS: Plasma concentrations of thyroid hormones were measured serially before surgery, upon arrival in the intensive care unit, and 12, 24, and 36 hours after surgery. Hemodynamic variables also were recorded serially. Postoperative inotrope requirement and major morbidity endpoints were assessed. Serum T3 concentrations were significantly higher with fewer patients having T3 concentrations below the normal range in the T3 group than the placebo group throughout the postoperative period. Hemodynamic variables, postoperative inotrope requirement, and outcome variables showed no differences between the groups. CONCLUSIONS: Oral T3 therapy significantly attenuated the postoperative decline in T3 concentrations in patients undergoing off-pump coronary artery bypass graft surgery. The lack of apparent clinical benefit merits further investigations in patients with reduced cardiac performance.

The causes of difficult tracheal intubation and preoperative assessments in different age groups.

BACKGROUND: We studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups. METHODS: Patients were divided into young (< 40 yr, n = 75 ), middle (40-59 yr, n = 83), and old (≥ 60 yr, n = 89) group. Airway assessment factors such as head and neck movement, thyromental distance, interincisor gap, dentition, Mallampati score, and Arné score were assessed. After muscle relaxation, cervical joint rigidity and Cormack-Lehane (C-L) grade were assessed. The differences in airway assessment factors between difficult (C-L grade 3, 4) and easy (C-L grade 1, 2) intubation were then examined. Logistic regression analysis was also carried out to identify the extent to which airway assessment factors reflected difficult intubation. RESULTS: As aging, head and neck movement, thyromental distance, and interincisor gap decreased, the grade of dentition, Mallampati score, cervical joint rigidity and the ratio of Arné score > 11 increased. In the old and middle group, the incidence of difficult intubation was increased compared with the young group. Dentition in the young group, Mallampati score and interinsisor gap in the middle group and Mallampati score, cervical joint rigidity in the old group respectively predicted difficult intubation. CONCLUSIONS: Compared to young individuals, middle-aged or elderly adults are likely to experience more difficulty in endotracheal intubation and its predictive factors could vary by age group.

Synaptic vesicle protein 2b is expressed temporospatially in (pre)odontoblasts in developing molars.

The formation of dentin and enamel is initiated by the differentiation of odontogenic precursor cells into odontoblasts and ameloblasts, respectively. This study was performed to identify new molecules involved in the differentiation of odontogenic cells. The genes expressed differentially between the root stage (after the differentiation of odontogenic cells and dental hard-tissue formation) and the cap stage (before the differentiation of odontogenic cells and dental hard-tissue formation) were searched using differential display PCR. For the first time, synaptic vesicle protein (SV) 2b, an important transmembrane transporter of Ca(2+) -stimulated vesicle exocytosis, was identified as a differentially expressed molecule. Real-time PCR and western blotting revealed an increase in the transcriptional and translational levels of SV2b during or after the differentiation of odontogenic cells. Immunofluorescence revealed this molecule to be localized in not only fully differentiated odontoblasts but also in pre-odontoblasts before dentin matrix secretion. The expression pattern of the SV2a isoform was similar to that of the SV2b isoform, whereas the SV2c isoform showed a contrasting pattern of expression. After treatment with alendronate, an inhibitor of protein isoprenylation for the transport of secretory vesicles, the expression of SV2a and SV2b decreased, whereas that of SV2c increased. These results suggest that the SV2 isoforms are functional molecules of (pre)odontoblasts which may be involved in vesicle transport.

A comparison of hemodynamic changes after endotracheal intubation by the Optiscope™ and the conventional laryngoscope.

BACKGROUND: Optiscope™ is a newly developed video stylet device. This study evaluated and compared the hemodynamic changes observed after endotracheal intubation with video stylet and after conventional laryngoscopic endotracheal intubation. METHODS: Fifty-eight adult patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2, undergoing general anesthesia, were randomized into two groups: one group of patients were intubated using video stylet (n = 29) and the other group were intubated using direct laryngoscope (n = 29). Systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), heart rate (HR), POGO (percentage of glottic opening) score, time for intubation and degree of sore throat were recorded. RESULTS: There were no significant differences in the SBP, MAP, DBP, HR, and the sore throat incidence between the two groups. Optiscope™ produced better POGO scores, but time for intubation was longer than with conventional laryngoscope. CONCLUSIONS: Optiscope™, when compared with conventional laryngoscope for intubation, does not modify the hemodynamic response, but it provides a better view of the vocal cords.

Efficacy of dexamethasone added to ramosetron for preventing postoperative nausea and vomiting in highly susceptible patients following spine surgery.

BACKGROUND: Opioid-based patient controlled analgesia (PCA) provides adequate pain control following spinal surgeries at the expense of increased risk of postoperative nausea and vomiting (PONV). We evaluated the efficacy of dexamethasone added to ramosetron, which is a newly developed five-hydroxytryptamine receptor 3 antagonist with a higher receptor affinity and longer action duration compared to its congeners, on preventing PONV in highly susceptible patients receiving opioid-based IV PCA after spinal surgery. METHODS: One hundred nonsmoking female patients undergoing spinal surgery were randomly allocated to either a ramosetron group (group R) or a ramosetron plus dexamethasone group (group RD)., Normal saline (1 ml) or 5 mg of dexamethasone was injected before anesthetic induction, while at the end of the surgery, ramosetron (0.3 mg) was administered to all patients and fentanyl-based IV PCA was continued for 48 hrs. The incidence and severity of PONV, pain score and the amount of rescue antiemetics were assessed for 48 hours after surgery. RESULTS: The number of patients with moderate to severe nausea (20 vs. 10, P = 0.029), and overall incidence of vomiting (13 vs. 5, P = 0.037) were significantly lower in the group RD than in the group R, respectively. Rescue antiemetic was used less in the RD group without significance. CONCLUSIONS: Combination of ramosetron and dexamethasone significantly reduced the incidence of moderate to severe nausea and vomiting compared to ramosetron alone in highly susceptible patients receiving opioid-based IV PCA after surgery.

Effect of combined remote ischemic preconditioning and postconditioning on pulmonary function in valvular heart surgery.

BACKGROUND: The aim of this study was to evaluate the lung-protective effect of combined remote ischemic preconditioning (RIPCpre) and postconditioning (RIPCpost) in patients undergoing complex valvular heart surgery. METHODS: In this randomized, placebo-controlled, double-blind trial, 54 patients were assigned to an RIPCpre plus RIPCpost group or a control group (1:1). Patients in the RIPCpre plus RIPCpost group received three 10-min cycles of right-side lower-limb ischemia of 250 mm Hg at both 10 min after anesthetic induction and weaning from cardiopulmonary bypass. The primary end point was to compare postoperative Pao(2)/Fio(2). Secondary end points were to compare pulmonary variables, incidence of acute lung injury, and inflammatory cytokines. RESULTS: In both groups, Pao(2)/Fio(2) at 24 h postoperation was significantly decreased compared with each corresponding baseline value. However, intergroup comparisons of pulmonary variables, including Pao(2)/Fio(2) and incidence of acute lung injury, revealed no significant differences. Serum levels of IL-6, IL-8, IL-10, and tumor necrosis factor-α were all significantly increased in both groups compared with each corresponding baseline value, without any significant intergroup differences. There were also no significant differences in transpulmonary gradient of IL-6, IL-10, and tumor necrosis factor-α between the groups. CONCLUSIONS: RIPCpre plus RIPCpost as tested in this randomized controlled trial did not provide significant pulmonary benefit following complex valvular cardiac surgery.

Differential expression of cyclophilin A and EMMPRIN in developing molars of rats.

A complex and intricate cascade of gene expression is essential for late stage tooth development. This study was performed to detect molecules involved in dental hard tissue formation and tooth eruption by comparing gene expression in cap stage molar germs (before eruptive movement and dental hard tissue formation) with that in root formation stage molar germs (after eruptive movement and dental hard tissue formation). DD-PCR revealed that cyclophilin A (Cyp-A), a potent chemoattractant for monocytes as well as a ligand for extracellular matrix metalloproteinase inducer (EMMPRIN) was expressed differentially in the two stages molar germs. The levels of Cyp-A and EMMPRIN mRNA were significantly higher at the root formation stage than at the cap and crown stages of the molar germs. Immunofluorescence showed that Cyp-A and EMMPRIN were expressed strongly in the follicular cells overlaying the occlusal region of the molar germs at the root formation stage. In contrast, their immunoreactivity was weak in the follicular tissues and was not region-specific in molar germs at the cap stage. In addition, the MCP-1 and CSF-1 mRNA levels increased in parallel to that of Cyp-A mRNA and the increased number of osteoclasts at the occlusal region. Immunoreactivity against Cyp-A and EMMPRIN was also observed in the fully differentiated ameloblasts and odontoblasts. This study suggests that Cyp-A and EMMPRIN play roles in the maturation of dental hard tissue and the formation of an eruption pathway.