The effect of palonosetron on rocuronium-induced withdrawal movement

AbstractBackgroundRocuronium causes pain and withdrawal movement during induction of anesthesia. In this study, palonosetron was investigated to have analgesic effect on the reduction of rocuronium-induced withdrawal movement.Methods120 patients were randomly assigned to one of three groups to receive either saline, lidocaine 20mg, or palonosetron 0.075mg with a tourniquet applied two minutes before thiopental sodium (5mg·kg−1) was given intravenously. After loss of consciousness, rocuronium (0.6mg·kg−1) was injected and the withdrawal movement was estimated by 4-point scale in a double-blind manner.ResultsThe overall incidence of rocuronium withdrawal movement was 50% with lidocaine (p=0.038), 38% with palonosetron (p=0.006) compared with 75% for saline. The incidence of no pain to mild pain was significantly lower in the lidocaine and palonosetron groups (85% and 92% respectively) than in the saline group (58%). However, there was no significant difference in withdrawal movement between the lidocaine and palonosetron groups. There was no severe movement with palonosetron.ConclusionPretreatment of palonosetron with venous occlusion may attenuate rocuronium-induced withdrawal movement as effective as the use of lidocaine. It suggested that peripheral action of palonosetron was effective to reduce rocuronium-induced withdrawal movement

Mesenteric extraskeletal osteosarcoma with telangiectatic features: a case report

<p>Abstract</p> <p>Background</p> <p>Extraskeletal osteosarcoma is a rare malignant mesenchymal tumor, with a predominant occurrence in the extremities. Only two cases of mesenteric extraskeletal osteosarcoma have been documented. We describe an unusual case of extraskeletal osteosarcoma with telangiectatic features occurring in the mesentery.</p> <p>Case presentation</p> <p>A 67-year-old male presented with blood-tinged stool of 1-month's duration. On colonoscopy, a solid mass was detected protruding from the colon wall. Computed tomography showed a 15 × 9.7 cm heterogeneously enhancing mass, with mottled calcification and a cystic portion, occupying the left upper quadrant of the abdominal cavity. Curative resection of the tumor was performed, and the excised tumor was composed of large multilocular cysts containing old hematomas and necrotic debris. The histology revealed an osteosarcoma showing osteoid formation and blood-filled spaces lined with atypical cells. Despite postoperative chemotherapy, he developed a recurrent peritoneal mass and multiple lung metastases 3 months postoperatively.</p> <p>Conclusion</p> <p>Given the rarity of cases of mesenteric extraskeletal osteosarcoma, its biologic behavior at this location remains to be determined. However, extraskeletal osteosarcoma with telangiectatic features is an uncommon entity to be recognized because of the possible fatal outcome related to the tumors.</p

DIRECT CAROTID WALL SHEAR STRESS IN ACUTE CORONARY SYNDROME PATIENTS DECREASED AFTER ONE MONTH MEDICAL MANAGEMENT

Fuente Fuente, Carlos;Montes Gil, Antonio;Periel Piquer, Montserra

Tongue bite in a patient with tracheostomy after prone position -A case report-

A 22-year-old man underwent an operation for posterolateral fusion of the lumbar spine at L3-5. He was ventilated via a tracheostomy site in a prone position for 210 minutes. Ventilator function and eyeballs were checked periodically. After changing his position to supine for the wake-up test, it was noticed that his tongue was self-inflicted and looked to be cut unless immediate decompression was applied. After several manual attempts to open the mouth failed, anesthesia depth was deepened with thiopental sodium and neuromuscular blocker to decompress and reposition the tongue into the intraoral cavity. Minimal teeth marks and scarring remained after seven months without any complications

First Fatal Oseltamivir-Resistant 2009 Pandemic Influenza A (H1N1) Case in an Adult in Korea

It has been suggested that oseltamivir-resistant influenza viruses harboring the H274/275Y mutation are less virulent than are those that are oseltamivir-sensitive, and fatality attributed to infection with an oseltamivir-resistant virus is very rare. Here we report the first fatal adult case of oseltamivir-resistant 2009 pandemic influenza A (H1N1) in Korea. A 60-year-old Korean male who had hypertension, diabetes mellitus, chronic kidney disease, and dilated cardiomyopathy visited Chonnam National University Hospital because of a 7-day history of chest pain and dyspnea. The patient was at another clinic and had been medicated with oseltamivir (75 mg twice daily) beginning 7 days before admission. Empirical antibiotics were started on the first day of hospitalization. Reverse-transcriptase polymerase chain reaction for 2009 pandemic influenza A (H1N1) was reported to be positive, and a double dose of oseltamivir (150 mg twice per day) was started on day four of hospitalization. However, the pneumonia worsened and the patient died, despite 3 days of high-dose antiviral therapy and 6 days of antibacterial therapy. An H275Y mutation was detected in the neuraminidase gene sequence. This case shows that oseltamivir resistance after short-term drug exposure is possible and can be fatal, emphasizing that early use of zanamivir should be considered in suspicious cases

Functional Recapitulation of Smooth Muscle Cells Via Induced Pluripotent Stem Cells From Human Aortic Smooth Muscle Cells

Rationale: Generation of induced pluripotent stem (iPS) cells has been intensively studied by a variety of reprogramming methods, but the molecular and functional properties of the cells differentiated from iPS cells have not been well characterized. Objective: To address this issue, we generated iPS cells from human aortic vascular smooth muscle cells (HASMCs) using lentiviral transduction of defined transcription factors and differentiated these iPS cells back into smooth muscle cells (SMCs). Methods and Results: Established iPS cells were shown to possess properties equivalent to human embryonic stem cells, in terms of the cell surface markers, global mRNA and microRNA expression patterns, epigenetic status of OCT4, REX1, and NANOG promoters, and in vitro/in vivo pluripotency. The cells were differentiated into SMCs to enable a direct, comparative analysis with HASMCs, from which the iPS cells originated. We observed that iPS cell-derived SMCs were very similar to parental HASMCs in gene expression patterns, epigenetic modifications of pluripotency-related genes, and in vitro functional properties. However, the iPS cells still expressed a significant amount of lentiviral transgenes (OCT4 and LIN28) because of partial gene silencing. Conclusions: Our study reports, for the first time, the generation of iPS cells from HASMCs and their differentiation into SMCs. Moreover, a parallel comparative analysis of human iPS cell-derived SMCs and parental HASMCs revealed that iPS-derived cells possessed representative molecular and in vitro functional characteristics of parental HASMCs, suggesting that iPS cells hold great promise as an autologous cell source for patient-specific cell therapy. (Circ Res. 2010;106:120-128.)Yu JY, 2007, SCIENCE, V318, P1917, DOI 10.1126/science.1151526Hanna J, 2007, SCIENCE, V318, P1920, DOI 10.1126/science.1152092Takahashi K, 2007, CELL, V131, P861, DOI 10.1016/j.cell.2007.11.019Byrne JA, 2007, NATURE, V450, P497, DOI 10.1038/nature06357Lee TH, 2007, PLOS MED, V4, P1101, DOI 10.1371/journal.pmed.0040186Matsumura H, 2007, NAT METHODS, V4, P23, DOI 10.1038/NMETH973Aoi T, 2008, SCIENCE, V321, P699, DOI 10.1126/science.1154884Dimos JT, 2008, SCIENCE, V321, P1218, DOI 10.1126/science.1158799Barroso-delJesus A, 2008, MOL CELL BIOL, V28, P6609, DOI 10.1128/MCB.00398-08Aasen T, 2008, NAT BIOTECHNOL, V26, P1276, DOI 10.1038/nbt.1503Stadtfeld M, 2008, SCIENCE, V322, P945, DOI 10.1126/science.1162494Okita K, 2008, SCIENCE, V322, P949, DOI 10.1126/science.1164270Tateishi K, 2008, J BIOL CHEM, V283, P31601, DOI 10.1074/jbc.M806597200Zhang JH, 2009, CIRC RES, V104, pE30, DOI 10.1161/CIRCRESAHA.108.192237Soldner F, 2009, CELL, V136, P964, DOI 10.1016/j.cell.2009.02.013Chang SA, 2008, STEM CELLS, V26, P1901, DOI 10.1634/stemcells.2007-0708Park IH, 2008, NATURE, V451, P141, DOI 10.1038/nature06534Lowry WE, 2008, P NATL ACAD SCI USA, V105, P2883, DOI 10.1073/pnas.0711983105Laurent LC, 2008, STEM CELLS, V26, P1506, DOI 10.1634/stemcells.2007-1081Kim JB, 2008, NATURE, V454, P646, DOI 10.1038/nature07061Ross JJ, 2006, J CLIN INVEST, V116, P3139, DOI 10.1172/JCI28184Takahashi K, 2006, CELL, V126, P663Yu JY, 2006, STEM CELLS, V24, P168, DOI 10.1634/stemcells.2005-0292Cowan CA, 2005, SCIENCE, V309, P1369, DOI 10.1126/science.1116447Adhikary S, 2005, NAT REV MOL CELL BIO, V6, P635, DOI 10.1038/nrm1703DALLAFAVERA R, 1982, P NATL ACAD SCI-BIOL, V79, P78241

Hypocomplementemia (C3) as an Independent Predictor for Children with Acute Post-streptococcal Glomerulonephritis: A Long-Term Observation

OBJECTIVE: The aim of this study was to examine the altering patterns in clinical characteristics and severity of acute post-streptococcal glomerulonephritis (APSGN) in children. PATIENTS AND METHODS: We analyzed the medical records of 119 children who were diagnosed with APSGN from 1987 to 2018, retrospectively. The patients were divided into two groups: Group I (n=72, before 1998) and Group II (n=47, after 1998). Clinical, radiologic, and laboratory findings were compared between the two groups. RESULTS: The clinical manifestations, including vomiting (20.8% vs. 4.3%, p=0.014), oliguria (40.3% vs. 19.1%, p=0.016), and generalized edema (86.1% vs. 63.8%, p=0.005), were statistically less frequent since 1998. Pulmonary edema on chest X-ray (22.7% vs. 4.4%, p=0.014) was less frequent in Group II than in Group I. The level of BUN (23.3±19.3 vs. 18.8±11.2, p=0.009) was lower in Group II than in Group I, while that of creatinine was not significantly different between the two groups. C3 level was an independent factor for predicting the development of edema (odds ratio [OR]: 1.034, 95% CI: 1.010-1.060, p=0.006) and acute nephritic symptoms (≥2) (OR: 0.974, 95% CI: 0.952-0996, p=0.020). It was also negatively correlated with an increasing number of acute nephritic symptoms, including oliguria and edema, in patients with APSGN (R=−0.182, p=0.048). CONCLUSIONS: This study demonstrated that APSGN had favorable clinical manifestations and severity over the past 30 years. The monitoring of C3 levels can be used to assess the disease severity and risk of complications, including edema and oliguria, which are decreasing in South Korean children