Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial

Background: The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. Methods: Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups. Results: There were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01). Conclusion: The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.ope

Dyspnea after General Anesthesia in a Patient with Cerebral Palsy

When patients with cerebral palsy are put under general anesthesia, there may be problems like difficult endotracheal intubation caused by deviation of respiratory tract due to scoliosis, hypotension related to chronic malnutrition and anemia, and failure of ventilation due to deformation of the thoracic cavity. The main clinical problem of postanesthetic complication is hypoxemia. The patients with cerebral palsy need close monitoring during treatment under general anesthesia and postanesthetic management. The purpose of this report is to evaluate a patient with cerebral palsy and mental retardation appeared to have dyspnea after general anesthesia.ope

Staurosporine Induces ROS-Mediated Process Formation in Human Gingival Fibroblasts and Rat Cortical Astrocytes

In the present study, we investigated the effect of staurosporine on the formation of cellular processes in human gingival fibroblasts and rat astrocytes. Staurosporine caused a rapid induction of process formation in human gingival fibroblasts and rat astrocytes in a concentration dependent manner. The process formation of human gingival fibroblasts and rat astrocytes was prevented by the pretreatment with N-acetylcysteine, suggesting that staurosporine-induced ROS production was responsible for the process formation. Colchicine, a microtubule depolymerizing agent, inhibited the staurosporine-induced process formation, whereas cytochalasin D, an actin filament breakdown agent, failed to suppress the formation of cellular processes. This result indicated that polymerization of microtubule, and not actin filament, was responsible for the formation of cellular processes induced by staurosporine. In support of this hypothesis, Western blot analysis was conducted using anti-tubulin antibody, and the results showed that the amount of polymerized microtubule was increased by the treatment with staurosporine while that of depolymerized beta-tubulin in soluble fraction was decreased. These results indicate that staurosporine induces ROSmediated, microtubule-dependent formation of cellular processes in human gingival fibroblasts and rat astrocytes.ope

IMAGE FUSION ACCURACY FOR THE INTEGRATION OF DIGITAL DENTAL MODEL AND 3D CT IMAGES BY THE POINT-BASED SURFACE BEST FIT ALGORITHM

ope

The effects on postoperative oral surgery pain by varying NSAID administration times: Comparison on effect of preemptive analgesia

OBJECTIVE: Many studies on the efficacy of preemptive analgesia have been processed in different ways. But the value of preemptive analgesia is still controversial. The goal of this study was to compare analgesic effects of a nonsteroidal anti-inflammatory drug (NSAID) for oral surgical pain according to 3 different administration times. STUDY DESIGN: Using a randomized, parallel-group, single-center, and active-controlled test design, this study was conducted with 80 healthy patients undergoing a surgical removal of an impacted mandibular third molar requiring bone removal. The oral NSAID was first administered 1 hour preoperatively, or 1 hour postoperatively, or no scheduled administration pre- or postsurgery. Whenever patients felt at least moderate pain (score > or =5 on a 10-point scale) after surgery, they were instructed to take the same drug. Pain intensities and times to the first and second onsets of postoperative pain from the end of surgery were assessed for 24 hours. RESULTS: Of the 80 enrolled subjects in this study, 25 patients were assigned to the preemptive group, 26 to the posttreatment group, and 29 to the no-treatment group. The demographic distribution and duration of surgery in the 3 groups were statistically similar. The mean time to first onset of postoperative pain was significantly prolonged in the posttreatment group (277.2 minutes, P < .05) compared to the preemptive group (158.4 minutes) and the no-treatment group (196.5 minutes). The mean time to second onset of postoperative pain was not significantly different among the 3 groups. No significant statistical difference was found among the mean pain intensities at the first and second onsets of postoperative pain in the 3 groups. CONCLUSIONS: In this small selected group of subjects and limited study design, the analgesic effects of NSAID administered preoperatively were no longer effective for postoperative pain. The results in this population imply that scheduled postoperative analgesics before pain development are adequate for postoperative analgesia without preoperative administration.restrictio

Changes of the cell cycle regulatory molecules in the induction of F9 teratocarcinoma cell differentiation aft

의학과/박사[한글] Retinoic acid(RA)/cyclic AMP (cAMP)에 의해 F9 세포의 분화가 유도된다는 사실은 RA/cAMP처리가 세포 주기 조절 물질들의 변화를 야기하여 F9 세포를 특정 세포 주기에서 성장을 멈추게 하고 정상 세포 주기로부터 이탈하게 할 수 있다는 가능성을 나타내므로 본 연구에서는 RA/cAMP처리가 F9세포의 분화를 유도할 때 세포 주기를 조절하는 물질들에 어떠한 변화를 일으킴으로써 F9 세포를 분화 경로로 이행하도록 하는지 그 기전을 밝혀보고자 하였다. F9 세포는 10% festal calf serum을 포함한 Dulbecco's modified Eagle's medium으로 배양하였으며, 분화 유도제로서 10**-7 M의 all-trans-RA와 0.5 mM의 dibutyryl cyclic AMP를 사용하여 각각의 분화제를 처리한 군과 두 분화제를 동시에 처리한 군으로 나누어 0, 24, 48, 72, 96시간동안 배양한 후 세포 주기 조절 단백질들의 양적 변화를 western blot 면역 염색을 이용하여 확인하였다. Tryphan blue dye exclusion 방법을 이용하여 세포의 수를 측정하여 성장 속도를 확인하였으며, 세포를 propidium iodide로 염색한 후 flow cytometry를 이용하여 세포 주기 분포의 변화를 알아보았다. Cyclin dependent kinase(cdk)의 활성 변화를 알아보기 위하여 histone Hl및 Rb kinase 분석을 시행하였고, (**32P)-orthorhosphate를 이용하여 F9 세포의 단백질을 대사적으로 표지시켜 cdk의 인산화 정도의 변화를 확인하여 다음과 같은 결과를 얻었다. F9 세포는 RA/cAMP처리에 의해서 분화가 유도되어 분화된 형태를 나타내었으며, 그 성장률은 대조군 세포에 비해 30% 이하로 감소하였고 F9 세포 고유의 세포 주기 분포 양상에서 벗어나 점차 Gl 기가 증가하였다. 세포 주기 조절 물질들의 양적 변화를 확인한 결과 cyclin D1은 RA 및 RA/cAMP를 처리하고 72시간 이후에 급격히 감소하였으며, cyclin D3도 같은 양상을 보였으나 그 감소의 정도는 미미하였으며, cyclin A 및 cyclin E는 양적인 변화를 관찰할 수 없었다. Cdk의 양적 변화를 확인한 결과 cdk2, cdk4 및 cdk6의 변화 는 관찰할 수 없었으며, cdk2 및 cdk4의 억제자 중 p21WAF1은 RA와 RA/cAMP를 처리한 세포의 경우에서는 시간이 경과함에 따라 그 양이 증가하는 것을 관찰할 수 있었고, p27kip1의 경우에서는 cAMP를 처리한 세포에서 그 발현양이 RA를 처리한 세포에서의 양에 비해 상대적으로 증가되어 있었으며, RA/cAMP를 처리한 세포에서도 양적으로 증가한 양상을 관찰할 수 있었다. Cdk2, cdk4 및 cdk6의 활성을 조사한 결과 cdk2의 활성은 모든 경우에서 24시간 이후 감소하는 경향을 보였으나, cdk4 및 cdk6의 활성은 관찰할 수 없었다. 분화 유도제를 처리하지 않은 활발히 성장하는 F9 세포에서도 cdk4 및 cdk6의 활성을 확인할 수 없었으므로 F9 세포에서는 cdk4 및 cdk6이 구조적으로 활성이 억제되어 있는 것으로 생각되었으며, 그 불활성의 원인은 cdk4 또는 cdk6의 14번째 threonine 또는 15번째 tyrosine이 구조적으로 인산화된 상태로 존재하며, 세포 주기의 진행 여부에 따라 인산화-탈인산화의 조절이 이루어지지 않기 때문인 것으로 생각되었다. 또한 Rb단백질의 양적 변화를 관찰할 수 없었으며, 인산화 상태의 변화도 관찰할 수 없었다. 이상의 결과를 종합하면 RA/cAMP처리에 의해 F9세포가 분화될 때 정상적인 세포 주기에서 벗어나 분화 과정으로 이행하는 이유는 cdk2의 억제자인 p21WAF1과 p27Kip1의 증가로 인하여 cdk2의 활성이 억제됨으로써 G1 기에서 S 기로의 이행이 억제 받기 때문으로 생각 되었다. 한편 구조적으로 cdk4 및 cdk6이 불활성화 상태를 유지하고 있는 F9 세포가 세포 성장을 지속할 수 있는 이유는 cyclin E의 지속적인 발현에 따라 pRb/E2F경로의 활성화를 거치지 않고서 다음 단계의 세포 주기를 진행할 수 있기 때문인 것으로 생각된다. [영문] F9 cells can be differentiated into variable cell types according to culture condition and drugs used in inducing differentiation. For example, RA only can differentiate F9 cells into visceral endoderm like cells and RA/cAMP treatment can induce differentiation of F9 cells into parietal endoderm-like cells. Progression from G1 to S phase of mammalian cell cycle is regulated by cyclin D dependent kinases cdk4 and cdk6 complexed to D type cyclins, and by cdk2 bound to cyclins E or A. Apart from reflecting cyclin accumulation and binding, cdk activity is regulated by negative and positive phosphorylation events and interactions with cdk inhibitors. Cdk inhibitors of the p16INK4 family specifically inhibit cdk4 and cdk6, whereas members of p21WAF1/p27Kip1 family inhibit a broader spectrum of cdks. When cells differentiate, they withdraw from the cell cycle to carry out their specialized functions and cell cycle regulatory proteins are often targeted for inactivation during cell cycle withdrawal. Thus, to investigate the changes of the cell cycle regulatory molecules in the course of differentiation, F9 cells are used as a model system and RA/cAMP are used to induce differentiation. F9 cells were grown in DMEM containing 10% fetal calf seam at 37℃ in a humidified atmosphere of 5% CO^^2 in air. All-trans-RA (10**-7M) or dbcAMP (0.5 mM) was added to the culture to induce differentiation and then, cultures were maintained for 24, 48, 72, and 96 hours. Proteins were isolated at each time point and western blot immunostaining was dane to examine the changes in the level of expression of cell cycle regulatory proteins. To monitor the cell growth rate, viable cells were counted by using tryphan blue dye exclusion method and to monitor the change of cell cycle distribution, cells were stained with propidium iodide and then, analyzed with flow cytometry. The activity of cdk was checked by histone H1 or Rb kinase assay, and phosphorylation status of cdk was checked by metabolic labelling of proteins with [**32p]-orthophosphate followed by immunoprecipitation with anti-cdk2 or anti-cdk4 antibody. Through these experiments, we obtained following results. First, F9 cells showed morphologically differentiated phenotype after 96 hours treatment of RA/cAMP and the growth was inhibited up to 30% that of control cells. Moreover, cell cycle phase distribution was changed in a way that the S phase was reduced and Gl phase was gradually prolonged. Second, we examined the expression level of cell cycle regulatory proteins. In case of cyclin A or E, the important cyclins for transition from G1 to S phase, no change was observed in the expession level regardless of the treatment or time. Cyclin D1 and D3, however, decreased after 72 hours of treatment of RA or Rf/cAMP treatment. Third, although the expression level of cdk2, cdk4 or cdk6 were maintained without any changes, the activity of cdk2 was down regulated after 24 hours of each treatment but unexpectedly, we could not detect any activity of cdk4 or cdk6. Moreover, cdk2 was rarely phosphorylated and showed no change but cdk4 was phosphorylated regardless of treatment and time, even in the control cells. Fourth, the cdk inhibitors were examined. In case of p21WAF1, the expression was up regulated in RA or RA/cAMP treated cells but there was no change in cAMP treated cells. In case of p27Kip1, the expression was more elevated in the cAMP and RA/cAMP treated cells than in RA treated cells. Fifth, the expression level and the phosphorylation status of pRb showed no change. Taken together these results, we concluded that cdk2 inactivation by up-regulation of cdk inhibitor, p21WAFl and p27Kip1, is the main event for RA/cAMP treatment to induce differentiation of F9 cells. In addition cdk4 and cdk6 were constitutively inactivated in F9 cells possibly by inhibitory phosphorylation of cdk and thus, to maintain the cell cycle of F9, cells should adopt another mechanism bypassing pRb/E2F activation pathway, arid it could be achieved by sustained expression of cyclin E and associated kinases.restrictio

Complications of Artificial Airways

의학과/석사[영문] [한글] 인공기도는 기도확보나 호흡관리를 위해 널리 이용되나 인공기도 자채에 의한 합병증이 야기되기도 하며 환자에게 치명적이거나 영구적인 손상을 가져오기도 한다. 인공기도에 따른 합병증은 언제든지 발생하며 경한 것부터 환자의 생명을 위협하는 심 한 합병증까지 매우 다양하게 나타난다. 인공기도에 의한 합병증의 발생에는 여러가지 요인들이 복합적으로 작용하고 있어 인공 기도의 기낭내압(cuff pressure), 거치기간 등 몇가지 요인을 제외하고는 명확히 밝혀진 바가 적다. 본 연구는 1990년 3월에서 8월까지 6개월간 신촌세브란스 병뭔 중환자실에 입원한 기관 내삽관이나 기관절개술을 시행한 332명을 대상으로 환자의 연령 및 성별, 이용된 인공기 도의 거치경로, 삽관횟수 및 거치기간, 수술여부, 환기기(ventilator) 사용 여부, 삽관을 시행한 의사와 사용한 약물, 질환 장기, 집중 치료의 결과 등을 조사하고, 인공기도의 사용에 따른 합병증을 관찰하여 다음과 같은 결과를 얻었다. 1. 332명의 환자 중 인공기도에 따른 합병증은 58명의 환자에서 발생되어 17.5%의 발생 율을 보였으며 총 발생례수는 63례였다. 2. 환자의 연령별 합병증의 발생율은 소아층(82명)얘서 17.1%, 성인층(250명)에서 17.6 %였으며, 성별로 본 합병중의 발생율은 여자환자(132명)애서 18,2%, 남자 환자(200명)에 서 17.0%로 환자의 연령 및 성별과 합병증의 발생과는 유의할 만한 관계가 없었다. 3. 인공기도애 따른 합병증 발생율은 기관내삽관을 한 환자(303명)에서 15.5%가 발생한 데 비하여 기관절개술을 받은 환자(29명)에서는 37.9%로 현저히 증가하고, 인공기도의 거 치기간이 길수록 증가하는 경향을 보인다(p<0.05). 4. 기관내삽관을 시행할 때 마취과 의사가 시행하는 경우(215명)가 합병증 발생율이 13 .0%로 타과 의사가 시행한 경우(106명)의 25.5%에 비해 낮게 나타났으며, 삽관전에 진정 재와 근이완제를 투여한 환자(204명)와 진정제를 투여한 환자(28명)에서 합병증 발생율이 각각 12,8%와 17.9%로 약물을 사용하지 않은 환자(66명)에서의 30.3%와 큰 차이를 보였 다(p<0.05). 5. 질병이 유발된 장기별로 본 합병증의 발생 빈도는 전신 감염이 있는 경우(6명)가 50 .0%로 가장 높게 나타났고, 심혈관계 이상이 있는 환자(169명)에서 9.5%로 가장 낮게 나 타나 환자의 질환장기에 따라 합병증의 발생빈도가 다르게 나타났다(p<0.05). 6. 환자에 대한 집중 치료의 효과는 인공기도에 따른 합병증의 발생율과 유의성이 없었 다. Complications of Artificial Airways Jeong Wan Kang Department of Medical Science, The Graduate School, Yonsei University (Directed by Prof. Kwang Won Park, M.D.) Artificial airways have been widely used to keep patency of airway and apply respiratory care, however those airways may cause frequent and severe complications. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. The purpose of this study was to assess the incidence, evolution and long-term effects of complications following antificial airways and to evaluate the effect of factors in the genesis of those complications. 332 consecutive patients admitted to Intensive Care Unit in Shinchon Severance Hospital over a 6-month period from March, 1990 to August, 1990 were studied who had been intubated or tracheostomied. 1. Complication following artificial airways occurred in 58 patients among 332 patients and the rate of complication was 17.5% and the total numbers of complication were 63 cases. 2. The rate of complications related to age was 17.1% in children(82 cases), 17.6% in adults(250 cases) and related to sex 18.2% in female(132 cases), 17.O% in male(200 cases). There was no significant relationship between the rate of complications and patient's demographic factors, such as age and sex. 3. The rate of complications was higher in the tracheostomied patients(37.9%) than the intubated patients(15.5%), and increased in the patients intubated during longer period of duration(p<0,05). 4. Those who had been intubated by anesthesiologists(215 cases) had less complications(13.0%) than those(106 cases) intubated by others(25.5%). The rate of complications was 12.8% in those(204 cases) who had been administered sedative and muscle relaxant just before intubation and 17.9% in those(28 cases)administered sedative. These show a great difference from that in those(66 caes) administered no drug(30.3%)(p<0.05). 5. The rate of complications was highest(50.0%) in septic patients(6 cases) and lowest(9.5%) in the cardiovascular system patients(169 cases). This was statistically significant(p<0.05). 6. There was no significant relationship between the rate of complications following artificial airways and the outcome of the patients.restrictio

Activation of Rac1-dependent redox signaling is critically involved in staurosporine-induced neurite outgrowth in PC12 cells

Staurosporine, a non-specific protein kinase inhibitor, has been shown to induce neurite outgrowth in PC12 cells, but the mechanism by which staurosporine induces neurite outgrowth is still obscure. In the present study, we investigated whether the activation of Rac1 was responsible for the neurite outgrowth triggered by staurosporine. Staurosporine caused rapid neurite outgrowth independent of the ERK signaling pathways. In contrast, neurite outgrowth in response to staurosporine was accompanied by activation of Rac1, and the Rac1 inhibitor NSC23766 attenuated the staurosporine-induced neurite outgrowth in a concentration-dependent manner. In addition, suppression of Rac1 activity by expression of the dominant negative mutant Rac1N17 also blocked the staurosporine-induced morphological differentiation of PC12 cells. Staurosporine caused an activation of NADPH oxidase and increased the production of reactive oxygen species (ROS), which was prevented by NSC23766 and diphenyleneiodonium (DPI), an NADPH oxidase inhibitor. Staurosporine-induced neurite outgrowth was attenuated by pretreatment with DPI and exogenous addition of sublethal concentration of H2O2 accelerated neurite outgrowth triggered by staurosporine. These results indicate that activation of Rac1, which leads to ROS generation, is required for neurite outgrowth induced by staurosporine in PC12 cells.ope

A SURVEY OF DENTAL TREATMENT UNDER OUTPATIENT GENERAL ANESTHESIA IN DEPARTMENT OF PEDIATRIC DENTISTRY AND CLINIC FOR DISABLED AT YONSEI UNIVERSITY DENTAL HOSPITAL

General anesthesia has been researched and developed in dentistry as on type of management technique to sedate patients who may be uncontrollable or require medical consideration. There has been continuous research into this area, but analysis of large set of patients over a sustained period of time is lacking. Thus, this study analyzes the records of patients who received general anesthesia at the Yonsei University Dental Hospital Department of Pediatric and Clinic for the Disabled. 1. Patient's age ranged from 1 to 66, with under 5 being the largest group with 410 members(38.5%). The study included more men than women, with 695 male members(65.3%). 2. Type of dental procedure performed were as follows(per person) : 5.6 Dental restoration; 2.3 Endodontic treatment of deciduous and primary teeth; 2.5 preformed crowning; and 1.6 extractions. Procedures took an average of 100 minutes. 3. 1022 patients(95.9%) received dental care under general anesthesia once and 43 patients(4.1%) received dental care under general anesthesia two or more times. Dentistry under general anesthesia has the many benefit. However, without appropriate post-treatment care, it is difficult to maintain good oral health. Therefore, it is important to improve the efficiency and safety of general anesthesia through future researchope