Anesthetic management for emergent Cesarean section in a patient with toxic epidermal necrolysis -A case report-

Toxic epidermal necrolysis (TEN) is rare but serious cutaneous reaction with significant mortality and long-term morbidity. Various etiologies, particularly numerous medications and infectious agents have been implicated. It is characterized as inflammatory bullous lesions of the skin and mucous membrane and can develop serious complications such as pneumonia, pneumothorax, sepsis and renal failure. In general, patients with TEN are managed as severe second-degree burn patients with preventing excessive fluid deficit and infections. In this case, we aimed to present anesthetic management of a 26-year-old pregnant woman with TEN who received general anesthesia during emergent cesarean section

Amniotic fluid embolism that took place during an emergent Cesarean section -A case report-

Amniotic fluid embolism (AFE) is a rare but fatal obstetric emergency, characterized by sudden cardiovascular collapse, dyspnea or respiratory arrest and altered mentality, disseminated intravascular coagulation (DIC). It can lead to severe maternal morbidity and mortality, but the prediction of its occurrence and treatment are very difficult. We experienced a case of AFE during emergent Cesarean section in a 40+6 weeks healthy pregnant woman, age 33. Sudden dyspnea, hypotension, signs of pulmonary edema and DIC were developed during Cesarean section, and cardiac arrest followed after these events. The course of these events was so rapid and catastrophic, which was consistent with AFE. Thus, we report this case precisely and review pathophysiology, diagnosis, treatment of AFE by referring to up-to-date literatures

Chatter Detection and Diagnosis in Hot Strip Mill Process With a Frequency-Based Chatter Index and Modified Independent Component Analysis

In this article, we propose a framework to monitor the chatter phenomenon and to diagnose the cause variables of chatter occurred in the hot strip mill process (HSMP). For monitoring chatter, we develop a chatter index (CI) that quantifies chatter to confirm its occurrence. Based on the data classified as normal by the CI, a multivariate statistical process monitoring model for detecting chatter is constructed using the modified independent component analysis (MICA) method. The monitoring results show that the model based on the MICA outperforms other models based on the principal component analysis and independent component analysis. For the diagnosis of the cause variables of detected chatter, various contribution plots can be used. In this article, we develop a relative contribution plot for a more obvious diagnosis than the existing contribution plot. Using this, we diagnose and analyze the cause variables of the detected chatter in the HSMP.11Nsciescopu

ACCORD: an assessment tool to determine the orientation of homodimeric coiled-coils

The coiled-coil (CC) domain is a very important structural unit of proteins that plays critical roles in various biological functions. The major oligomeric state of CCs is a dimer, which can be either parallel or antiparallel. The orientation of each α-helix in a CC domain is critical for the molecular function of CC-containing proteins, but cannot be determined easily by sequence-based prediction. We developed a biochemical method for assessing differences between parallel and antiparallel CC homodimers and named it ACCORD (Assessment tool for homodimeric Coiled-Coil ORientation Decision). To validate this technique, we applied it to 15 different CC proteins with known structures, and the ACCORD results identified these proteins well, especially with long CCs. Furthermore, ACCORD was able to accurately determine the orientation of a CC domain of unknown directionality that was subsequently confirmed by X-ray crystallography and small angle X-ray scattering. Thus, ACCORD can be used as a tool to determine CC directionality to supplement the results of in silico prediction. © The Author(s) 20171101sciescopu

Treat-to-target versus high-intensity statin treatment in patients with or without diabetes mellitus: a pre-specified analysis from the LODESTAR trialResearch in context

Summary: Background: The impact of titrated versus fixed intensity statin therapy in patients with coronary artery disease (CAD) and diabetes mellitus (DM) remains to be elucidated. Methods: This was a pre-specified analysis of patients with and without DM from the LODESTAR trial. Patients with CAD were randomly assigned to receive either a treat-to-target strategy with a target LDL-C level of 50–70 mg/dL or a high-intensity statin treatment. Primary outcome was the 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. Secondary outcomes were safety endpoints. This trial is registered with ClinicalTrials.gov, NCT02579499. Findings: Between September 9, 2016 and November 27, 2019, 4400 patients with CAD were enrolled in the LODESTAR trial. The median age was 65 years (interquartile range, 59–73 years), 3172 (72%) were male, and 1468 (33%) had DM at baseline. There was no significant difference in the occurrence of the primary outcome between the treat-to-target group and high-intensity statin group among patients with DM (10.5% versus 11.1%, hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.69–1.29, p = 0.70) and those without DM (6.9% versus 7.5%, HR 0.93, 95% CI 0.71–1.21, p = 0.58). Among patients without DM, there was a trend towards a lower risk of new-onset DM in the treat-to-target group (8.4% versus 10.4% in the high-intensity statin group, HR 0.79, 95% CI 0.62–1.01; p = 0.06). Interpretation: In patients with CAD, a treat-to-target LDL-C strategy of 50–70 mg/dL as the goal was comparable to high-intensity statin therapy in terms of 3-year clinical efficacy and safety outcomes regardless of the presence of DM. Funding: Sam Jin Pharmaceutical, Seoul, Korea and Chong Kun Dang Pharmaceutical, Seoul, Korea