Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia

The beneficial effects of dexmedetomidine (DEX) have not been extensively investigated in elderly patients receiving spinal anesthesia. This study evaluated the effects of intravenous DEX infusion on stress and hemodynamic response, as well as on postoperative analgesia in elderly patients undergoing total knee arthroplasty (TKA). We randomly allocated 45 adult patients to 3 patient groups (n=15 each): uni-saline group patients underwent unilateral TKA with saline administration, uni-DEX group patients underwent unilateral TKA with DEX administration, and bilateral-DEX group patients underwent bilateral TKA with DEX administration. Serum interleukin-6 (IL-6) levels were significantly lower in the bilateral-DEX group than in the uni-saline group 6 and 24h postoperatively, and were negatively correlated with total DEX dosage 24h postoperatively. Bradycardia occurred more frequently in the uni-DEX and bilateral-DEX groups than in the uni-saline group. The total dose of required supplementary analgesics was significantly higher in the uni-saline group than in the uni-DEX and bilateral-DEX groups 6h postoperatively. The results indicate that perioperative intravenous DEX administration decreases postoperative serum IL-6 levels in patients undergoing bilateral TKA, and has a postoperative analgesic effect in patients undergoing unilateral or bilateral TKA

Hepatocellular Carcinoma Arising in a Huge Hepatocellular Adenoma with Bone Marrow Metaplasia

Hepatocellular adenoma (HCA) is the most common type of benign liver tumor, and its major complication is malignant transformation to hepatocellular carcinoma (HCC). Here, we report a case of HCC arising in HCA with bone marrow metaplasia in a 24-year-old Korean woman who presented with abdominal discomfort. A huge liver mass was found on abdominal ultrasonography. She underwent surgical hepatic resection, and the resected specimen was entirely involved by a 20-cm-sized tumor. Histological review revealed a well differentiated HCC arising from inflammatory HCA with β-catenin nuclear positivity and bone marrow metaplasia that contained hematopoietic cells. This case was unique because malignant transformation, inflammatory type HCA, β-catenin nuclear staining, and bone marrow metaplasia were simultaneously observed. Additionally, it should be noted that a large HCA with β-catenin activation can undergo malignant transformation and should be surgically resected in a timely manner

Influence of Long-term Climate on Fatigue Life of Bridge Pier Concrete and a Reinforcement Method

This paper quantitatively evaluated the fatigue life of concrete around the air-water boundary layer of bridge piers located in inland rivers, considering the long-term climate. The paper suggests a method to predict the low-cycle fatigue life by demonstrating a thermal-fluid-structural analysis of bridge pier concrete according to long-term climate such as temperature, velocity and pressure of air and water in the process of freezing and thawing in winter. In addition, it proposes a reinforcing method to increase the life of damaged piers and proves the feasibility of the proposed method with numerical comparison experiment

Tailored growth of graphene oxide liquid crystals with controlled polymer crystallization in GO-polymer composites

Graphene Oxides (GOs) have been frequently employed as fillers in polymer-based applications. While GO is known to nucleate polymer crystallization in GO-polymer composites reinforcing the mechanical properties of semicrystalline polymers, its counter effect on how polymer crystallization can alter the microstructure of GO has rarely been systematically studied yet. In this work, we study the GO nematic liquid crystal (LC) phase during polymer crystallization focusing on their hierarchical structures by employing in situ small/wide-angle X-ray scattering/diffraction (SAXS/WAXD) techniques. We found that GO LC and polymer crystals co-exist in the GO/polymer complex, where the overall liquid crystallinity is influenced by polymer crystallization. While polymer crystallizes in bulk or at the interface depending on the cooling rate, the interfacial crystallization of poly(ethylene glycol) (PEG) on GO improves both GO alignment and orientation of PEG crystal. This work provides an opportunity to develop a hierarchical structure of GO-based crystalline polymer nanocomposites, whose directionality can be controlled by polymer crystallization under proper cooling rates

Inactivated vaccine with glycyrrhizic acid adjuvant elicits potent innate and adaptive immune responses against foot-and-mouth disease

BackgroundFoot-and-mouth disease (FMD) is an extremely contagious viral disease that is fatal to young animals and is a major threat to the agricultural economy by reducing production and limiting the movement of livestock. The currently commercially-available FMD vaccine is prepared using an inactivated viral antigen in an oil emulsion, with aluminum hydroxide [Al(OH)3] as an adjuvant. However, oil emulsion-based options possess limitations including slow increases in antibody titers (up to levels adequate for defense against viral infection) and risks of local reactions at the vaccination site. Further, Al(OH)3 only induces a T helper 2 (Th2) cell response. Therefore, novel adjuvants that can address these limitations are urgently needed. Glycyrrhizic acid (extracted from licorice roots) is a triterpenoid saponin and has great advantages in terms of price and availability.MethodsTo address the limitations of the currently used commercial FMD vaccine, we added glycyrrhizic acid as an adjuvant (immunostimulant) to the FMD bivalent (O PA2 + A YC) vaccine. We then evaluated its efficacy in promoting both innate and adaptive (cellular and humoral) immune reactions in vitro [using murine peritoneal exudate cells (PECs) and porcine peripheral blood mononuclear cells (PBMCs)] and in vivo (using mice and pigs).ResultsGlycyrrhizic acid has been revealed to induce an innate immune response and enhance early, mid-, and long-term immunity. The studied bivalent vaccine with glycyrrhizic acid increased the expression of immunoregulatory genes such as pattern-recognition receptors (PRRs), cytokines, transcription factors, and co-stimulatory molecules.ConclusionCollectively, glycyrrhizic acid could have utility as a novel vaccine adjuvant that can address the limitations of commercialized FMD vaccines by inducing potent innate and adaptive immune responses

Sclerosing encapsulating peritonitis in a long-term propranolol user

Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction that is characterized by the encasement of the small bowel by a thick, whitish, and fibrous membrane. The pathophysiology of SEP is poorly understood and preoperative diagnosis is difficult. Previous reports suggest that SEP may be linked to the chronic use of β-adrenergic blockers. A 46-year-old man with liver cirrhosis and end-stage renal disease on hemodialysis presented with recurrent abdominal pain and borborygmi. He had been taking propranolol to prevent bleeding from gastroesophageal varices for the past 15 years. Abdominal computed tomography showed ileal loops encapsulated by soft tissue with dilatation of the proximal small bowel on the right side of the abdomen. Barium follow-through showed conglomerated distal ileal loops with a cauliflower-like appearance. Explorative laparotomy revealed a thick, fibrous, whitish capsule encapsulating the ileal loops. The covering membrane was dissected and excised, resulting in an improvement in symptoms after surgery. Accordingly, a final diagnosis of SEP was made. Due to the lack of other apparent causes for SEP, we conclude that in this case, the long-term use of propranolol may be associated with the development of SEP

A case of back pain caused by Salmonella spondylitis -A case report-

Salmonella spondylitis is a rare illness, and it generally occurs in patients who have already had sickle cell anemia, and it is even rarer in patients who are without sickle cell anemia. A 61-year-old male patient was hospitalized for the evaluation of his renal function and then treatment was started for his back pain. His back pain had developed about 2 months previously without any specific trauma. Only a bulging disc was detected on the initial lumbar MRI. Regarding his fever, it was diagnosed as possible atypical pneumonia, scrub typhus, etc., and multiple antibiotic therapy was administered. At the time of transfer, the leucocytes and hs-CRP were normal and the ESR was elevated. A diagnostic epidural block was performed for his back pain, but his symptoms were not improved. Lumbar MRI was performed again and it showed findings of infective spondylitis. Salmonella D was identified on the abscess culture and so he was diagnosed as suffering from Salmonella spondylitis. After antibiotic treatment, his back pain was improved and the patient was able to walk

Dietary pattern and health-related quality of life among breast cancer survivors

Background There is limited evidence for the association between dietary pattern and quality of life among breast cancer survivors. We examined the association between dietary patterns and health-related quality of life (HRQoL) among Korean breast cancer survivors. Methods Our study included a total of 232 women, aged 21 to 79 years, who had been diagnosed with stage I to III breast cancer and who underwent breast cancer surgery at least 6 months prior to our baseline evaluation. We assessed HRQoL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire Breast Cancer Module 23 (QLQ-BR23). We conducted a factor analysis to identify the major dietary patterns and used a generalized linear model to obtain the least squares mean (LS mean) and 95% confidence interval (CI) for HRQoL according to the dietary pattern scores. Results We identified 2 major dietary patterns: the Healthy dietary pattern and the Western dietary pattern. We found that breast cancer survivors who had higher Healthy dietary pattern scores tended to have lower dyspnea scores but higher insomnia scores, compared to breast cancer survivors with lower Healthy dietary pattern scores. For dyspnea, the LS mean (95% CI) was 8.86 (5.05-15.52) in the bottom quartile and 2.87 (1.62-5.08) in the top quartile (p for trend = 0.005). This association was limited to survivors with stage I for dyspnea or survivors with stage II or III for insomnia. Conclusions Healthy dietary patterns were associated with better scores for dyspnea but worse scores for insomnia among breast cancer survivors. Other components of EORTC QLQ did not vary by dietary patterns overall, but they warrant further investigation for subgroups of breast cancer survivors.This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014R1A2A2A01007794). The funding body had no role in the design of the study, collection, analysis and interpretation of data, and manuscript writing