Publications by authors named "Sang Hun Kim"

124 Publications

Occurrence, Potential Sources, and Risk Assessment of Volatile Organic Compounds in the Han River Basin, South Korea.

Int J Environ Res Public Health 2021 Apr 2;18(7). Epub 2021 Apr 2.

Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwank-gu, Seoul 08826, Korea.

Increasing public awareness about the aesthetics and safety of water sources has shifted researchers' attention to the adverse effects of volatile organic compounds (VOCs) on humans and aquatic organisms. A total of 17 VOCs, including 10 volatile halogenated hydrocarbons and seven volatile non-halogenated hydrocarbons, were investigated at 36 sites of the Han River Basin, which is the largest and most important drinking water source for residents of the Seoul metropolitan area and Gyeonggi province in South Korea. The VOC concentrations ranged from below detection limits to 1.813 µg L. The most frequently detected VOC was 1,2-dichloropropane, with a detection frequency of 80.56%, as it is used as a soil fumigant, chemical intermediate, and industrial solvent. In terms of geographical trends, the sampling sites that were under the influence of sewage and industrial wastewater treatment plants were more polluted with VOCs than other areas. This observation was also supported by the results of the principal component analysis. In the present study, the detected concentrations of VOCs were much lower than that of the predicted no-effect concentrations, suggesting low ecological risk in the Han River. However, a lack of available ecotoxicity data and limited comparable studies warrants further studies on these compounds.
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http://dx.doi.org/10.3390/ijerph18073727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038302PMC
April 2021

Gold Standard? Method of Citric Acid Solution Swallowing Test as a Screening Test for Patients with Tracheostomy.

Dysphagia 2021 Apr 27. Epub 2021 Apr 27.

Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro Seo-Gu, Busan, 602-739, Republic of Korea.

This study aimed to apply various ranges of citric acid levels in the mouth and T-cannula to compare the validity with instrumental aspiration measures in patients with tracheostomy. Sixty-one patients underwent the citric acid cough reflex test (CRT) and videofluoroscopic swallowing study (VFSS). Citric acid was delivered via facemask and T-cannula at concentrations of 0.4 mol/L, 0.6 mol/L, and 0.8 mol/L. Further, we recorded the coughing count and presence of ≥ 2 (C2) and ≥ 5 (C5) coughs. CRT via facemask at 0.4 mol/L C2, 0.6 mol/L C5, and 0.8 mol/L C2 and C5 were significantly associated with the presence of tracheal aspiration during VFSS. The sensitivity and specificity were optimized at 0.8 mol/L C2 for mouth inhalation and at 0.8 mol/L C5 for T-cannula inhalation. There was a significant difference in the coughing count during CRT at 0.4 mol/L and 0.8 mol/L via mouth inhalation between patients with or without tracheal aspiration, but not via T-cannula. The AUC for 0.8 mol/L facemask inhalation was 0.701. The optimal cut-off value of coughing count was thrice with 84.62% sensitivity and 50.00% specificity on the ROC curve. Afferent sensory nerve desensitization around and below the tracheostomy site could affect coughing reflex initiation and decrease the sensitivity of detecting aspiration in tracheotomized patients. The citric acid CRT via facemask can reliably detect tracheal aspiration and presence of coughing reflex compared to that via T-cannula in patients with tracheostomy.
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http://dx.doi.org/10.1007/s00455-021-10300-9DOI Listing
April 2021

Dexmedetomidine decreased the post-thyroidectomy bleeding by reducing cough and emergence agitation - a randomized, double-blind, controlled study.

BMC Anesthesiol 2021 Apr 12;21(1):113. Epub 2021 Apr 12.

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-dearo, Donggu, 61453, Gwangju, Korea.

Background: Bleeding after thyroidectomy occurs due to violent coughing during emergence. Dexmedetomidine is helpful for the smooth emergence and suppression of cough. The purpose of the present study was to compare the effects of dexmedetomidine on postoperative bleeding after thyroidectomy.

Methods: Randomized, double-blind, controlled trials were conducted in female patients (ASA I-II, aged 20 to 60 years). The patients were randomly allocated into two groups. Approximately 15 min before the end of the surgery, dexmedetomidine was administered (0.6 µg/kg/h) without a loading dose in group D (n = 69), and normal saline was administered in group S (n = 70) at the same infusion rate. Hemodynamic data, coughing reflex, extubation time, Ramsay sedation scale (RSS), and recovery time were assessed during the administration of the study drugs and recovery from anesthesia. The amount of postoperative hemorrhage was measured for 3 days.

Results: Data from a total of 139 patients were analyzed. The incidence of severe cough was significantly lower in group D than in group S (4.3 % vs. 11.5 %, P = 0.022). The emergence agitation in the postanesthetic care unit was significantly lower in group D than in group S (P = 0.01). Postoperative bleeding was significantly lower in group D than in group S until the second postoperative day (P = 0.015).

Conclusions: Dexmedetomidine can be helpful in decreasing bleeding after thyroidectomy by reducing coughing and emergence agitation.

Trial Registration: This study was registered at http://clinicaltrials.gov (registration number NCT02412150, 09/04/2015).
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http://dx.doi.org/10.1186/s12871-021-01325-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040200PMC
April 2021

Effect of Nefopam-Based Patient-Controlled Analgesia with and without Fentanyl on Postoperative Pain Intensity in Patients Following Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Non-Inferiority Trial.

Medicina (Kaunas) 2021 Mar 27;57(4). Epub 2021 Mar 27.

Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-Daero, Dong-Gu, Gwangju 61452, Korea.

: We investigated the non-inferiority of patient-controlled analgesia (PCA), using either nefopam alone or combined nefopam-fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. : In this prospective, randomized, controlled study, 78 patients were allocated to receive nefopam 240 mg (Group N240) or nefopam 120 mg with fentanyl 600 μg (Group NF), equivalent to fentanyl 1200 μg, with a total PCA volume of 120 mL. Patients were given a loading dose (0.1 mL/kg) from the PCA device along with ramosetron (0.3 mg) and connected to a PCA device with a background infusion rate of 2 mL/h, bolus dose amount set at 2 mL, and lockout interval set at 15 min. Pain scores were obtained using the numeric rating scale (NRS) at 30 min after recovery room (RR) admission, as well as 8 and 24 h postoperatively. The primary outcome was analgesic efficacy evaluated using NRS-rated 8 h postoperatively. Other evaluated outcomes included the incidence rate of bolus demand, rescue analgesic and antiemetic requirements, and postoperative adverse effects. : NRS scores were not significantly different between the groups throughout the postoperative period ( = 0.539). NRS scores of group N240 were not inferior to those of group NF at 30 min after RR admission, or at 8 and 24 h postoperatively (mean difference [95% CI], -0.05 [-0.73 to 0.63], 0.10 [-0.29 to 0.50], and 0.28 [-0.06 to 0.62], respectively). Postoperative adverse effects were not significantly different between the two groups ( = 1.000) and other outcomes were also not significantly different between the two groups ( ≥ 0.225). : PCA using nefopam alone has a non-inferior and effective analgesic efficacy and produces a lower incidence of postoperative adverse effects compared to a combination of fentanyl and nefopam after laparoscopic cholecystectomy.
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http://dx.doi.org/10.3390/medicina57040316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067158PMC
March 2021

Identification of acquired tracheoesophageal fistula after tracheostomy decannulation by videofluoroscopic swallowing study: A case report.

Medicine (Baltimore) 2021 Apr;100(13):e25349

Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital.

Rationale: Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet.

Patient Concerns: A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since.

Diagnosis: VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia.

Intervention: VFSS was performed in this case.

Outcomes: In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery.

Lessons: This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.
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http://dx.doi.org/10.1097/MD.0000000000025349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021360PMC
April 2021

Requirement of future researches on burnout syndrome in interventional pain physicians in time of the COVID-19 pandemic.

Authors:
Sang Hun Kim

Korean J Pain 2021 Apr;34(2):137-138

Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea.

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http://dx.doi.org/10.3344/kjp.2021.34.2.137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019958PMC
April 2021

A novel assessment of abdominal pseudohernia after thoracolumbar vertebral compression fractures using surface electromyography and ultrasonography: A case report.

Medicine (Baltimore) 2021 Mar;100(9):e24973

Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital.

Rationale: An abdominal pseudohernia is a protrusion of the abdominal wall that there is no actual muscular disruption. This report presents a case in which abdominal muscle activities were accurately and quantitatively measured using ultrasonography (US) and surface electromyography in a patient with abdominal pseudohernia.

Patient Concerns: A 62-year-old man presented with a marked protrusion on the left abdomen with increasing abdominal pressure.

Diagnoses: First, the thickness of the abdominal muscle was measured with US while the patient constantly blew the positive expiratory pressure device. When the force was applied to the abdomen, the mean thickness of the muscle layer on the lesion site was found to be thinner. Second, the activities of the abdominal muscles were measured using surface electromyography by attaching electrodes to 8 channels at the same time. When the same pressure was applied on both sides of the abdomen, more recruitment occurred to compensate for muscle weakness at the lesion site. Through the previous 2 tests, the decrease in muscle activity in the lesion area could be quantitatively evaluated. Third, the denervation of the muscle was confirmed using US-guided needle electromyography.

Interventions: The patient in this case was wearing an abdominal binder. In addition, he had been training his abdominal muscles through McGill exercise and breathing exercises such as with a positive expiratory pressure device.

Outcomes: The patient was able to understand his symptoms. A follow-up test will be performed to see if there is any improvement.

Lessons: By using these outstanding assessment methods, proper diagnosis and rehabilitation treatment strategies can be developed.
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http://dx.doi.org/10.1097/MD.0000000000024973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939196PMC
March 2021

Review of machine learning methods in soft robotics.

PLoS One 2021 18;16(2):e0246102. Epub 2021 Feb 18.

Soft Robotics Research Center, Seoul National University, Seoul, Korea.

Soft robots have been extensively researched due to their flexible, deformable, and adaptive characteristics. However, compared to rigid robots, soft robots have issues in modeling, calibration, and control in that the innate characteristics of the soft materials can cause complex behaviors due to non-linearity and hysteresis. To overcome these limitations, recent studies have applied various approaches based on machine learning. This paper presents existing machine learning techniques in the soft robotic fields and categorizes the implementation of machine learning approaches in different soft robotic applications, which include soft sensors, soft actuators, and applications such as soft wearable robots. An analysis of the trends of different machine learning approaches with respect to different types of soft robot applications is presented; in addition to the current limitations in the research field, followed by a summary of the existing machine learning methods for soft robots.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246102PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891779PMC
February 2021

PINK1 Inhibits Multimeric Aggregation and Signaling of MAVS and MAVS-Dependent Lung Pathology.

Am J Respir Cell Mol Biol 2021 May;64(5):592-603

Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and.

Mitochondria have emerged as important signaling organelles where intracellular perturbations are integrated and, consequently, intracellular signaling pathways are modulated to execute appropriate cellular functions. MAVS (mitochondrial antiviral signaling protein) represents such an example that functions as a platform molecule to mediate mitochondrial innate immune signaling. Recently, multimeric aggregation of MAVS has been identified as a key molecular process for its signaling. The underlying mechanisms to regulate this, however, are still incompletely understood. We hypothesized that PINK1 (PTEN-induced kinase 1) plays an important role in the regulation of multimeric MAVS aggregation and its consequent pathobiology. To test whether PINK1 interacts with MAVS, bimolecular fluorescence complementation analysis and IP were performed. RLH (RIG-I-like helicase) and NLRP3 inflammasome signaling were evaluated by assay. functional significance of PINK1 in the regulation of MAVS signaling was evaluated from both murine modeling of influenza viral infection and bleomycin-induced experimental pulmonary fibrosis, wherein MAVS plays important roles. Multimeric MAVS aggregation was induced by mitochondria dysfunction, and, during this event, the stabilized PINK1 interacted physically with MAVS and antagonized multimeric MAVS aggregation. Accordingly, the MAVS-mediated antiviral innate immune and NLRP3 inflammasome signaling were enhanced in PINK1 deficiency. In addition, studies revealed that MAVS-mediated pulmonary antiviral innate immune responses and fibrotic responses after bleomycin injury were enhanced in PINK1 deficiency. In conclusion, these results establish a new role of PINK1 in the regulation of MAVS signaling and the consequent pulmonary pathobiology.
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http://dx.doi.org/10.1165/rcmb.2020-0490OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086043PMC
May 2021

Capillary leak syndrome and disseminated intravascular coagulation after kidney transplantation in a patient with hereditary angioedema - A case report.

Anesth Pain Med (Seoul) 2021 Jan 27;16(1):75-80. Epub 2021 Jan 27.

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.

Background: Hereditary angioedema (HAE) is a rare disease caused by the deficiency of C1 esterase inhibitor. HAE has a risk of life-threatening complications such as capillary leak syndrome (CLS) and disseminated intravascular coagulation (DIC).

Case: A 42-year-old male patient with HAE presented for deceased-donor kidney transplantation. Prophylactic fresh frozen plasma (FFP) was given before surgery because of the risk of edema development. With careful management during anesthesia, there were no problems during surgery. However, generalized edema, hypotension, hypoalbuminemia, massive drainage of serosanguineous fluids from the intraabdominal space, and DIC occurred on the day after surgery. CLS was suspected and sustained hypotension with generalized edema became worse despite treatment with albumin, danazol, FFP, and vasoactive drugs. The patient's condition worsened despite intensive care and he died due to shock.

Conclusions: The anesthesiologist should prepare for the critical complications of HAE and prepare the appropriate treatment options.
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http://dx.doi.org/10.17085/apm.20098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861902PMC
January 2021

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study.

Medicina (Kaunas) 2021 Jan 6;57(1). Epub 2021 Jan 6.

Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea.

The fixed-rate continuous background infusion mode with bolus dosing is a common modality for intravenous patient-controlled analgesia (PCA). However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM) where the background injection rate varies depending on the patient's bolus demand. We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated to either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data on bolus demand count, total infused volume, and background infusion rate were downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. The NRS score was not significantly different between groups throughout the postoperative period ( = 0.621), decreasing with time in both groups ( < 0.001). The bolus demand count was not significantly different between groups throughout ( = 0.756). The mean total cumulative infused PCA volume was lower in group OBIM (84.0 (95% confidence interval: 78.9-89.1) mL) than in group TBIM (102 (97.8-106.0) mL; < 0.001). The total cumulative opioid dose in fentanyl equivalents, after converting sufentanil to fentanyl using an equipotential dose ratio, was lower in group OBIM (714.1 (647.4-780.9) μg) than in group TBIM (963.7 (870.5-1056.9) μg); < 0.001). The background infusion rate was significantly different between groups throughout the study period ( < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour and lower from the 18th to the 48th postoperative hour. The OBIM combined with bolus dosing reduces the cumulative PCA volume and opioid consumption compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy.
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http://dx.doi.org/10.3390/medicina57010042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825461PMC
January 2021

Anti-Cancer Effects of RAW 264.7 Cells on Prostate Cancer PC-3 Cells.

Ann Clin Lab Sci 2020 Nov;50(6):739-746

Department of Microbiology and Immunology, Pusan National University School of Medicine, Yangsan, Korea

Macrophages have the potential to re-programing tumor cells in the tumor microenvironments. Thus we investigated anti-cancer effects of M1-polarized macrophages by lipopolysaccharide (LPS) on the physiological properties of human prostate cancer PC-3 cells. To identify communications with immune cells and tumor cells, we performed in-direct way by using conditioned-media (CM) and analyzed tumor properties via quantitative polymerase chain reaction, enzyme-linked immunosorbent assay and western blot and flow cytometry. CM of M1-polarized macrophages induced apoptotic cell death in PC-3 cells, and it surprisingly suppressed tumor parameters including epithelial to mesenchymal transition (EMT), invasion, migration and angiogenesis. EMT specific markers, N-cadherin, snail-1, and TGF β2 were diminished; however, E-cadherin was increased. In addition, migration markers, vimentin and CCL2 were down-regulated, and finally wound healing was also inhibited. Decreased expression of matrix metalloprotein (MMP)-9 and VEGFA might reduce the invasive and angiogenic abilities of PC-3 cells. These results suggested that co-culture with CM of M1-polarized macrophages showed higher anti-cancer effects on PC-3 cells. Thus, therapeutic targeting of macrophages toward PC-3 cells may represent a useful strategy to complement with the secreted molecules of RAW 264.7 cells as inhibitors of metastasis and anti-cancer agents.
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November 2020

Clinically relevant concentrations of dexmedetomidine may reduce oxytocin-induced myometrium contractions in pregnant rats.

Anesth Pain Med (Seoul) 2020 Oct;15(4):451-458

Department of Anesthesiology and Pain Medicine, College of Medicine, Chosun University, Gwangju, Korea.

Background: Recently, there have been some trials to use dexmedetomidine in the obstetric field but concerns regarding the drug include changes in uterine contractions after labor. We aimed to evaluate the effects of dexmedetomidine on the myometrial contractions of pregnant rats.

Methods: In a pilot study, the contraction of the myometrial strips of pregnant Sprague-Dawley rats in an organ bath with oxytocin at 1 mU/ml was assessed by adding dexmedetomidine from 10 to 10 M accumulatively every 20 min, and active tension and the number of contractions were evaluated. Then, changes in myometrial contractions were evaluated from high doses of dexmedetomidine (1.0 × 10 to 1.2 × 10 M). The effective concentrations (EC) for changes in uterine contractions were calculated using a probit model.

Results: Active tension and the number of contractions were significantly decreased at 10 M and 10 M dexmedetomidine, respectively (P < 0.05). A complete loss of contractions was seen at 10 M. Dexmedetomidine (1.0 × 10 to 1.2 × 10 M) decreased active tension and the number of contractions in a concentration-dependent manner. The EC of dexmedetomidine for inhibiting active tension and the number of contractions was 5.16 × 10 M and 2.55 × 10 M, respectively.

Conclusions: Active tension of the myometrium showed a significant decrease at concentrations of dexmedetomidine higher than 10 M. Thus, clinical concentrations of dexmedetomidine may inhibit uterine contractions. Further research is needed for the safe use of dexmedetomidine in the obstetrics field.
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http://dx.doi.org/10.17085/apm.20036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724122PMC
October 2020

IN REPLY.

Anesth Pain Med (Seoul) 2020 Jan;15(1):130

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.

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http://dx.doi.org/10.17085/apm.2020.15.1.130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713859PMC
January 2020

Effect of gastric decompression on postoperative vomiting in pediatric patients undergoing strabismus surgery: a randomized controlled study.

Anesth Pain Med (Seoul) 2020 Jan;15(1):66-72

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.

Background: Postoperative vomiting (POV) is one of the most serious complications in pediatric patients undergoing strabismus surgery. This study was conducted to test the hypothesis that gastric decompression (GD) could prevent POV caused by gastric distension after mask ventilation.

Methods: A total of 60 pediatric patients (ASA PS I-II, aged one to 10 years) were randomly allocated to two groups; Group D (n = 30) and Group C (n = 30). Induction of anesthesia was performed with careful face mask ventilation with 100% O (3 L/min) and sevoflurane 3 vol% to limit airway pressure below 20 cmHO. Endotracheal intubation was done after confirming adequate neuromuscular blockade. Then, the patients in Group D received GD, while patients in Group C did not. After the surgery, POV was assessed during the emergence from anesthesia in the operating room and postanesthetic care unit (30 min and 60 min).

Results: During the emergence, POV was significantly decreased in Group D compared to Group C (Group D 3.3% vs. Group C 30.0%, P = 0.006). The odds ratio analysis showed a lower incidence of POV in Group D (odds ratio = 0.080; 95% confidence limit: 0.009-0.685) during the emergence period. There was no significant difference in the incidence of POV in the postanesthetic care unit (Group D 6.7% vs. Group C 4.3% at 30 min, P = 1.000; 0% in both groups at 60 min).

Conclusions: GD reduced the incidence of POV in pediatric patients undergoing strabismus surgery during emergence.
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http://dx.doi.org/10.17085/apm.2020.15.1.66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713869PMC
January 2020

Mitochondrial antiviral signaling protein is crucial for the development of pulmonary fibrosis.

Eur Respir J 2021 Apr 15;57(4). Epub 2021 Apr 15.

Section of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

Danger signals, or damage-associated molecular patterns (DAMPs), instigate mitochondrial innate immune responses wherein mitochondrial antiviral signaling protein (MAVS) functions as a key platform molecule to mediate them. The role of MAVS in the pathogenesis of idiopathic pulmonary fibrosis (IPF), however, has not yet been identified. Whether MAVS signalling can be modulated by currently existing drugs has also not been explored.We used an established model of pulmonary fibrosis to demonstrate that MAVS is a critical mediator of multiple DAMP signalling pathways and the consequent lung fibrosis after bleomycin-induced injury After bleomycin injury, MAVS expression was mainly observed in macrophages. Multimeric MAVS aggregation, a key event of MAVS signalling activation, was significantly increased and persisted in bleomycin-injured lungs. A proapoptotic BH3 mimetic, ABT-263, attenuated the expression of MAVS and its signalling and, consequently, the development of experimental pulmonary fibrosis. In contrast, the therapeutic effects of nintedanib and pirfenidone, two drugs approved for IPF treatment, were not related to the modulation of MAVS or its signalling. Multimeric MAVS aggregation was significantly increased in lungs from IPF patients as well.MAVS may play an important role in the development of pulmonary fibrosis, and targeting MAVS with BH3 mimetics may provide a novel and much needed therapeutic strategy for IPF.
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http://dx.doi.org/10.1183/13993003.00652-2020DOI Listing
April 2021

Highly Conductive and Flexible Dopamine-Graphene Hybrid Electronic Textile Yarn for Sensitive and Selective NO Detection.

ACS Appl Mater Interfaces 2020 Oct 24;12(41):46629-46638. Epub 2020 Sep 24.

School of Biomedical Engineering, Korea University, Seoul 02841, South Korea.

Graphene-based electronic textile (e-textile) gas sensors have been developed for detecting hazardous NO gas. For the e-textile gas sensor, electrical conductivity is a critical factor because it directly affects its sensitivity. To obtain a highly conductive e-textile, biomolecules have been used for gluing the graphene to the textile surface, though there remain areas to improve, such as poor conductivity and flexibility. Herein, we have developed a dopamine-graphene hybrid electronic textile yarn (DGY) where the dopamine is used as a bio-inspired adhesive to attach graphene to the surface of yarns. The DGY shows improved electrical conductivity (∼40 times) compared to conventional graphene-based e-textile yarns with no glue. Moreover, it exhibited improved sensing performance in terms of short response time (∼2 min), high sensitivity (0.02 μA/ppm), and selectivity toward NO. The mechanical flexibility and durability of the DGY were examined through a 1000-cycle bending test. For a practical application, the DGY was attempted to detect the NO emitted from vehicles, including gasoline, diesel, and fuel cell electric vehicles. Our results demonstrated that the DGYs-as a graphene-based e-textile gas sensor for detecting NO-are simple to fabricate, cheap, disposable, and mechanically stable.
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http://dx.doi.org/10.1021/acsami.0c11435DOI Listing
October 2020

Temporal-spatial variation and environmental risk assessment of pharmaceuticals in tributaries of the Han River watershed, South Korea.

Sci Total Environ 2020 Nov 25;741:140486. Epub 2020 Jun 25.

National Institute of Environmental Research, Han River Environment Research Center, 42, Dumulmeori-gil 68beon-gil, Yangseo-myeon, Yangpyeong-gun, Gyeonggi-do 12585, Republic of Korea.

Eight compounds from three categories of pharmaceuticals [5 antibiotics, 2 non-steroidal anti-inflammatory drugs, and 1 anti-epileptics] were monitored at 24 sites in the tributaries of the Han River watershed in South Korea, 2016. The seasonal occurrence, temporal-spatial variation, potential compound source(s), and a risk assessment of this watershed, which is the largest drinking water source in the country, were investigated. Clarithromycin was detected most frequently (72.2%) with the greatest median concentration (0.151 ± 0.072 μg L), followed by carbamazepine and sulfamethoxazole. The seasonality of the pharmaceuticals was observed, with higher concentrations and detection frequencies in spring than in summer and autumn; this was possibly caused by lower levels of microbial activities associated with lower water temperatures than other seasons. In terms of geographical variation, urban areas had higher pharmaceutical concentrations than rural areas, which was attributed to the former's high population density and largest wastewater treatment plants (WWTPs) regardless of season. The total concentration and detection frequency of WWTPs were 12.4 and 2.5 times higher in downstream sites than upstream sites, thereby conveying that WWTPs were the main source for the presence of pharmaceuticals in tributaries. According to the results produced from calculations of the risk quotient (RQ) of aquatic organisms, clarithromycin and sulfamethazine were identified as posing relatively high ecological risk (RQ > 1) during the spring that was identified for this study. This study can provide policymakers with scientific support for prioritizing pollutant management and collections of global data on emerging pollutants.
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http://dx.doi.org/10.1016/j.scitotenv.2020.140486DOI Listing
November 2020

Effective dose of intravenous oxycodone depending on sex and age for attenuation of intubation-related hemodynamic responses

Turk J Med Sci 2021 02 26;51(1):102-110. Epub 2021 Feb 26.

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea

Background/aim: Preoperative intravenous oxycodone may help to prevent or attenuate intubation-related hemodynamic responses (IRHRs), but its pharmacokinetics differs according to age and sex. Therefore, we investigated the 95% effective dose (ED95) of intravenous oxycodone for attenuating all IRHRs, depending on the age and sex of the study population.

Materials And Methods: All patients were allocated to one of 6 groups: 1) 20–40 year old males, 2) 41–65yearold males, 3) 66–80 year old males, 4) 20–40 year old females, 5) 41–65yearold females, and 6) 66–80 year old females (groups YM, OM, EM, YF, OF, and EF, respectively). Using Dixon’s up-and-down method, the first patient in each group was slowly injected with intravenous oxycodone (0.1 mg kg–1) 20 min before intubation. The subsequent patient received the next oxycodone dose, which was decreased or increased by 0.01 mg kg–1, depending on the “success” or “failure” of attenuation of all IRHRs to within 20% of the baseline values at 1 min after intubation in the previous patient. After obtaining 8 crossover points, predictive ED95 was estimated with probit regression analysis.

Results: ED95 varied greatly according to age and sex. ED95was 0.133 mg kg–1, 0.181 mg kg–1, 0.332 mg kg–1, 0.183 mg kg–1, 0.108 mg kg–1, and 0.147 mg kg–1in groups YM, OM, EM, YF, OF, and EF, respectively.

Conclusion: ED95 is higher in males with increasing age but is ambiguous for females. ED95 is higher in males than in females over 40 years of age but is higher in females than in males under 41 years of age. However, after considering the age and sex of the study population, these results can be used as reference doses for further studies to verify the clinical effects of oxycodone for attenuating all IRHRs.
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http://dx.doi.org/10.3906/sag-2004-63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991858PMC
February 2021

Conus Medullaris Syndrome Due to Missed Thoracolumbar Spinal Fracture in a Patient with Ankylosing Spondylitis who Underwent Hip Surgery.

Turk J Anaesthesiol Reanim 2020 Apr 25;48(2):160-164. Epub 2019 Nov 25.

Department of Anaesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea.

Ankylosing spondylitis (AS) is vulnerable to fracture, and the missed diagnosis can lead to neurological deterioration. Herein, we present the conus medullaris syndrome due to aggravation of the missed spinal fracture in an 85-year-old woman with AS who underwent hip surgery. She underwent osteosynthesis in a supine position with supports under her shoulders and head due to spine deformity with AS, but was fully supine without supports after surgery. She showed complete paraplegia at postoperative 12 h. The re-reading radiological imaging showed the missed spinal fracture, of which the deteriorated dislocation was revealed on the re-examined radiological evaluation. This deterioration was not recovered ultimately despite an emergent surgery. A thorough preoperative assessment is essential to prevent the missed diagnosis of spinal fracture and minimise deterioration due to its dislocation, with specific spine precaution during transport, transfer and positioning.
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http://dx.doi.org/10.5152/TJAR.2019.72368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101197PMC
April 2020

Current status of pain medicine training in anesthesiology and pain medicine residency programs in university hospitals of Korea: a survey of residents' opinions.

Reg Anesth Pain Med 2020 04 26;45(4):283-286. Epub 2020 Jan 26.

Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Background: In Korea, anesthesiologists are expected to be mainstream pain medicine (PM) practitioners. However, anesthesiology and pain medicine (APM) residency programs mostly emphasize anesthesia learning, leading to insufficient PM learning. Therefore, this study evaluated the current status of PM training in APM residency programs in 10 Korean university hospitals.

Methods: Overall, 156 residents undergoing APM training participated anonymously in our survey, focusing on PM training. We assessed the aim, satisfaction status, duration, opinion on duration, desired duration, weaknesses of the training programs and plans of residents after graduating. We divided the residents into junior (first and second year) and senior (third and fourth year). Survey data were compared between groups.

Results: Senior showed significantly different level of satisfaction grade than did junior (p=0.026). Fifty-seven (81.4%) residents in junior and forty (46.5%) residents in senior underwent PM training for ≤2 months. Most (108; 69.2%) residents felt that the training period was too short for PM learning and 95 (60.9%) residents desired a training period of ≥6 months. The most commonly expressed weakness of the training was low interventional opportunity (29.7%), followed by short duration (26.6%). After residency, 80 (49.1%) residents planned to pursue a fellowship.

Conclusions: Dissatisfaction with PM training was probably due to a structural tendency of the current program towards anesthesia training and insufficient clinical experience, which needs to be rectified, with a change in PM curriculum.
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http://dx.doi.org/10.1136/rapm-2019-100995DOI Listing
April 2020

Gabexate mesilate ameliorates the neuropathic pain in a rat model by inhibition of proinflammatory cytokines and nitric oxide pathway suppression of nuclear factor-κB.

Korean J Pain 2020 Jan;33(1):30-39

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.

Background: This study examined the effects of gabexate mesilate on spinal nerve ligation (SNL)-induced neuropathic pain. To confirm the involvement of gabexate mesilate on neuroinflammation, we focused on the activation of nuclear factor-κB (NF-κB) and consequent the expression of proinflammatory cytokines and inducible nitric oxide synthase (iNOS).

Methods: Male Sprague-Dawley rats were used for the study. After randomization into three groups: the sham-operation group, vehicle-treated group (administered normal saline as a control), and the gabexate group (administered gabexate mesilate 20 mg/kg), SNL was performed. At the 3rd day, mechanical allodynia was confirmed using von Frey filaments, and drugs were administered intraperitoneally daily according to the group. The paw withdrawal threshold (PWT) was examined on the 3rd, 7th, and 14th day. The expressions of p65 subunit of NF-κB, interleukin (IL)-1, IL-6, tumor necrosis factor-α, and iNOS were evaluated on the 7th and 14th day following SNL.

Results: The PWT was significantly higher in the gabexate group compared with the vehicle-treated group ( < 0.05). The expressions of p65, proinflammatory cytokines, and iNOS significantly decreased in the gabexate group compared with the vehicle-treated group ( < 0.05) on the 7th day. On the 14th day, the expressions of p65 and iNOS showed lower levels, but those of the proinflammatory cytokines showed no significant differences.

Conclusions: Gabexate mesilate increased PWT after SNL and attenuate the progress of mechanical allodynia. These results seem to be involved with the anti-inflammatory effect of gabexate mesilate via inhibition of NF-κB, proinflammatory cytokines, and nitric oxide.
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http://dx.doi.org/10.3344/kjp.2020.33.1.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944363PMC
January 2020

Correlations between Aspiration and Pharyngeal Residue Scale Scores for Fiberoptic Endoscopic Evaluation and Videofluoroscopy.

Yonsei Med J 2019 Dec;60(12):1181-1186

Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Purpose: To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients.

Materials And Methods: We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed.

Results: A total of 178 participants were enrolled in our study. In correlation analysis, PAS (=0.74), vallecula retention (=0.76), and pyriform sinus retention (=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (<0.05).

Conclusion: Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.
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http://dx.doi.org/10.3349/ymj.2019.60.12.1181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881705PMC
December 2019

Dexmedetomidine as a non-triggering anesthetic agent in a patient with MELAS syndrome and systemic sepsis - A case report.

Anesth Pain Med (Seoul) 2019 Oct;14(4):416-422

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.

Background: The selection of anesthetic agents is important in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome patient because serious and unexpected complications can occur after anesthetic exposure.

Case: A 30-year-old man with MELAS syndrome and sepsis underwent colectomy. Propofol was administered by step-wise until target effect-site concentration (Ce) 1.0 μg/ml and stopped for the loss of consciousness and to avoid hemodynamic instability. After the loss of consciousness, total intravenous anesthesia (TIVA) using dexmedetomidine (1.0 μg/ml/h) and remifentanil (1-4 ng/ml of Ce) was performed for the maintenance of anesthesia to avoid malignant hyperthermia and mitochondrial dysfunction. During the surgery, the bispectral index score stayed between 26 and 44, and increased to 97 after the end of anesthesia.

Conclusions: TIVA with dexmedetomidine and remifentanil as non-triggering anesthetic agents in patients with MELAS syndrome and systemic sepsis may have advantages to decrease damages associated with mitochondrial stress and metabolic burden.
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http://dx.doi.org/10.17085/apm.2019.14.4.416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713802PMC
October 2019

Approach for naso-orbito-ethmoidal fracture.

Arch Craniofac Surg 2019 Aug 20;20(4):219-222. Epub 2019 Aug 20.

Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.
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http://dx.doi.org/10.7181/acfs.2019.00255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715548PMC
August 2019

Sarcopenia Associated with Chronic Obstructive Pulmonary Disease.

J Bone Metab 2019 May 31;26(2):65-74. Epub 2019 May 31.

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

Sarcopenia is frequently associated with chronic diseases such as chronic obstructive pulmonary disease (COPD) and cancer. COPD, which is characterized by an irreversible airflow limitation, exacerbates respiratory distress as the disease progresses. The prevalence of sarcopenia in stable COPD was reported to be 15% to 25% in previous foreign studies and 25% in a Korean study. As the amount of activity decreases, muscle mass decreases and eventually oxygen cannot be used effectively, resulting in a vicious cycle of deterioration of exercise capacity. Deconditioning due to decreased activity is a major cause of limb muscle dysfunction in patients with COPD. In these patients, the factors that decrease muscle strength and endurance include chronic inflammation, oxidative stress, inactivity, hypoxemia, hormone abnormality, deficits of nutrients such as protein and vitamin D, and the use of systemic corticosteroid. Therefore, treatment and management should either inhibit this process or should be directed toward supplementing the deficiency, such as with exercise, nutritional support, and medications and supplements. The relationship between sarcopenia and COPD is increasingly being reported, with some overlap in clinical features and treatments. We are fascinated to be able to diagnose 2 diseases through similar physical performance tests and to improve both diseases using the same treatment such as exercise. Therefore, this review summarizes the clinical relevance and integrative management of the 2 diseases.
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http://dx.doi.org/10.11005/jbm.2019.26.2.65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561852PMC
May 2019

Effect of sec-O-glucosylhamaudol on mechanical allodynia in a rat model of postoperative pain.

Korean J Pain 2019 Apr;32(2):87-96

Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.

Background: This study was performed in order to examine the effect of intrathecal sec-O-glucosylhamaudol (SOG), an extract from the root of the Peucedanum japonicum Thunb., on incisional pain in a rat model.

Methods: The intrathecal catheter was inserted in male Sprague-Dawley rats (n = 55). The postoperative pain model was made and paw withdrawal thresholds (PWTs) were evaluated. Rats were randomly treated with a vehicle (70% dimethyl sulfoxide) and SOG (10 μg, 30 μg, 100 μg, and 300 μg) intrathecally, and PWT was observed for four hours. Dose-responsiveness and ED50 values were calculated. Naloxone was administered 10 min prior to treatment of SOG 300 μg in order to assess the involvement of SOG with an opioid receptor. The protein levels of the δ-opioid receptor, κ-opioid receptor, and μ-opioid receptor (MOR) were analyzed by Western blotting of the spinal cord.

Results: Intrathecal SOG significantly increased PWT in a dose-dependent manner. Maximum effects were achieved at a dose of 300 μg at 60 min after SOG administration, and the maximal possible effect was 85.35% at that time. The medial effective dose of intrathecal SOG was 191.3 μg (95% confidence interval, 102.3-357.8). The antinociceptive effects of SOG (300 μg) were significantly reverted until 60 min by naloxone. The protein levels of MOR were decreased by administration of SOG.

Conclusions: Intrathecal SOG showed a significant antinociceptive effect on the postoperative pain model and reverted by naloxone. The expression of MOR were changed by SOG. The effects of SOG seem to involve the MOR.
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http://dx.doi.org/10.3344/kjp.2019.32.2.87DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549587PMC
April 2019

Effect of different doses of intravenous oxycodone and fentanyl on intubation-related hemodynamic responses: A prospective double-blind randomized controlled trial (CONSORT).

Medicine (Baltimore) 2019 May;98(18):e15509

Department of Anesthesiology and Pain Medicine, Chosun University Hospital.

Background: Intubation using direct laryngoscopy is a risky and painful procedure that is associated with undesirable hemodynamic changes such as tachycardia, hypertension, and arrhythmia. Recently, intravenous oxycodone was introduced and used for the control of acute postoperative pain and to attenuate intubation-related hemodynamic responses (IRHRs), but there is insufficient information regarding its proper dosage. We investigated the attenuating effects of different doses of oxycodone and fentanyl on IRHRs.

Methods: For calculating oxycodone effective dose (ED95), which attenuated all IRHR changes to less than 20% over baseline values in 95% of male patients at 1 minute after intubation, oxycodone 0.1 mg/kg was injected for the first patient 1 hour before intubation, and the next dose for each subsequent patient was determined by the response of the previous patient using Dixon up-and-down method with an interval of 0.01 mg/kg. After obtaining the predictive oxycodone ED95, 148 patients were randomly allocated to groups receiving normal saline (group C), oxycodone ED95 (group O1), oxycodone 2 × ED95 (group O2), or fentanyl 2 μg/kg (group F). We recorded the incidence of "success" as a less than 20% change from baseline values in all IRHRs 1 minute after intubation.

Results: The predictive oxycodone ED95 was 0.091 (0.081-0.149) mg/kg. The incidence of "success" was highest in group O2 (75.7%), followed by group O1 (62.2%) and group F (45.9%) with significant differences between the groups (P < .001). The systolic, diastolic, mean arterial pressure, and heart rate were not significantly different among groups after administration of either oxycodone or fentanyl. The percentage hemodynamic changes of the group O2 were significantly lower than those of groups F and O1, but the absolute percentage hemodynamic changes were not significantly different among groups F, O1, and O2. The recalculated oxycodone ED95 with probit analysis (0.269 mg/kg) was needed to prevent any arterial pressure and heart rate changes.

Conclusions: Oxycodone 0.182 mg/kg is more effective in attenuating all IRHRs than fentanyl 2 μg/kg with safe hemodynamic changes. Further research is required to determine if the recalculated oxycodone ED95 (0.269 mg/kg) is also effective and hemodynamically safe for preventing all IRHRs.
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http://dx.doi.org/10.1097/MD.0000000000015509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504337PMC
May 2019

The Effects of Mono-(2-Ethylhexyl) Phthalate (MEHP) on Human Estrogen Receptor (hER) and Androgen Receptor (hAR) by YES/YAS In Vitro Assay.

Molecules 2019 Apr 19;24(8). Epub 2019 Apr 19.

Environmental Safety Group, Korea Institute of Science and Technology (KIST⁻Europe), 66123 Saarbrucken, Germany.

Endocrine active compounds with structural similarities to natural hormones such as 17β-estradiol (E2) and androgen are suspected to affect the human endocrine system by inducing hormone-dependent effects. This study aimed to detect the (anti-)estrogenic and (anti-)androgenic activities of mono-(2-ethylhexyl) phthalate (MEHP) by yeast estrogen/androgen bioassay (YES/YAS). In addition, the mechanism and uptake of MEHP to receptors during agonistic and antagonistic activities were investigated through the activation signal recovery test and chromatographic analysis using liquid chromatography and tandem mass spectrometry (LC-MS/MS). Estrogenic and androgenic activities of MEHP were not observed. However, MEHP exhibited anti-estrogenic (IC = 125 μM) and anti-androgenic effects (IC = 736 μM). It was confirmed that these inhibitory effects of MEHP were caused by receptor-mediated activity of the estrogen receptor and non-receptor-mediated activity of the androgen receptor in an activation signal recovery test. When IC concentrations of anti-estrogenic and androgenic activity of MEHP were exposed to yeast cells, the uptake concentration observed was 0.0562 ± 0.0252 μM and 0.143 ± 0.0486 μM by LC-MS/MS analysis.
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http://dx.doi.org/10.3390/molecules24081558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515293PMC
April 2019

Revisiting respiratory muscle strength and pulmonary function in spinal cord injury: The effect of body positions.

Neuro Endocrinol Lett 2018 Sep;39(3):189-195

Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.

Objectives: In the subjects with high cervical spinal cord injury (SCI), The difference of respiratory muscle strength and pulmonary function according to supine and sitting position were investigated whether there are changes in the tendency.

Methods: Twenty-three subjects with high cervical SCI and 23 subjects with low cervical and thoracic SCI were evaluated. The reference neurological level of injury for dividing the groups was fifth cervical vertebrae (C5). SCI severity was classified as motor-complete SCI. The supine and sitting forced vital capacity (FVC), percent of the predicted FVC (FVC%), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), MEP / MIP ratio, and peak cough flow (PCF) were compared.

Results: The significantly higher FVC, FVC% in the low cervical and thoracic SCI group was identified in the supine position than the sitting position. The same tendency was observed in the high cervical SCI group. In the comparison of respiratory muscle strength, higher values of supine MEP and MIP were found only in the high cervical SCI group. PCF is more positively correlated with MIP than with MEP in all groups.

Conclusion: We found that the supine position is more advantageous for the strong breathing and larger lung capacity in patients with high cervical SCI. The positive correlation between PCF and MIP in the patients with high cervical SCI was also confirmed. These results may be used to establish a pulmonary rehabilitation strategy for patients with high cervical SCI.
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September 2018