Both statins and magnesium are associated with NMDA receptors and anti-inflammatory effect. Peripheral NMDA receptors are known to be involved in inflammationinduced pain. This study aimed to investigate the impact of perioperative use of a statin– magnesium combination on opioid consumption in patients who underwent cardiac surgery. This was a retrospective study of 542 patients who underwent cardiac surgery. The patients were divided into two groups according to statin use: the statin–magnesium group (n=375) and the magnesium-only group (n=167). Patients in the magnesium- only group received only perioperative magnesium, but no statins, to prevent atrial fibrillation following cardiac surgery. After propensity-score matching, 228 patients (n=114 in each group) were analyzed to investigate opioid consumption, visual analogue scale (VAS) pain scores over a 72-h period, and pain outcomes according to the duration of statin treatment (<1 or ≥1 yr). The consumed opioid volume was significantly smaller in statin–magnesium group than the magnesium-only group, both before (p=0.010) and after matching (p=0.017). The statin–magnesium combination did not significantly reduce the VAS pain scores compared with magnesium alone. Although the statin–magnesium combination did not significantly reduce the pain intensity compared with magnesium alone, the combination therapy was effective in reducing opioid consumption after surgery.

No abstract available.
Sarcoma*

Thrombotic thrombocytopenic purpura (TTP) can cause serious morbidity and mortality, and differentiating between this disease and systemic lupus erythematosus (SLE) can prove challenging. Although rare, TTP accompanied by SLE is linked to several complications and a higher mortality rate. Herein, we report a case of a 16-year-old boy who presented with systemic symptoms, such as petechiae, and was diagnosed with acquired TTP following a laboratory test. Steroid treatment was initiated and a diagnosis of SLE was reached after the symptoms had improved. Treatment with low-dose prednisone in addition to hydroxychloroquine was continued. The patient did not develop renal failure or neurologic deficit. No specific symptoms were observed after treatment and during the follow-up period. Early treatment of SLE is crucial, but it is difficult to reach an early diagnosis because the symptoms are similar to those of TTP. In the current study, an early diagnosis of TTP led to prompt treatment, thereby avoiding the fatal symptoms that could be caused by SLE.

Background: Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants. Methods: We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed. Results: In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701–0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360–0.550) and that for ANC was 0.453 (95% CI, 0.359–0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis. Conclusion CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.

No abstract available.
Animals ; Heart* ; Rats*

PURPOSE: Congenital hypothyroidism (CH) is the most common cause of preventable mental retardation. Recently, the detection of CH cases with eutopic thyroid gland has increased due to neonatal screening programs. In this study, we aimed to identify and evaluate predictive factors that could distinguish between permanent and transient CH in patients with eutopic thyroid gland. METHODS: We retrospectively reviewed 100 children diagnosed with CH and with eutopic thyroid gland. All subjects were treated with levothyroxine and underwent re-evaluation after 3 years of age. RESULTS: Of the 100 CH patients, 35 (35.0%) were diagnosed with permanent CH (PCH) and 65 (65.0%) were diagnosed with transient CH (TCH). The initial thyroid stimulating hormone levels were significantly lower in the TCH subjects than in PCH subjects. In addition, the mean doses of levothyroxine (µg/kg/day) at the 1st, 2nd, and 3rd year of treatment were significantly lower in subjects with TCH than in PCH subjects with eutopic thyroid gland. Based on the receiver operating characteristic (ROC) curve, the optimal cutoff dose of levothyroxine at 3 years of 2.76 µg/kg/day could predict TCH, and was associated with 87.3% sensitivity and 67.6% specificity, with an area under the ROC curve of 0.769. CONCLUSION: The levothyroxine dose requirement during treatment period has a predictive role in differentiating TCH from PCH in CH patients with eutopic thyroid gland.
Child* ; Congenital Hypothyroidism* ; Humans ; Infant, Newborn ; Intellectual Disability ; Neonatal Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thyroid Gland* ; Thyrotropin ; Thyroxine

BACKGROUND: The objective of this study was to explore whether individual variations in the concentration of growth factors (GFs) influence the biologic effects of platelet-rich plasma (PRP) on human mesenchymal stem cells (HMSCs). METHODS: The concentrations of 7 representative GFs in activated PRP (aPRP) were measured using ELISA. The effects of PRP on the proliferation and alkaline phosphatase (ALP) activity of HMSCs were examined using several concentrations of aPRP from 3 donors; the relationships between the GF levels and these biologic effects were then evaluated using 10% aPRP from 5 subgroups derived from 39 total donors. HMSCs were cultured in DMEM with the addition of aPRP for 4 or 12 days; then, DNA content and ALP activity were measured. RESULTS: The quantity of DNA increased significantly at a 10% concentration of aPRP, but the ALP activity was suppressed at this concentration of aPRP. The GF concentrations varied among donors, and 5 subgroups of characteristic GF release patterns were identified via cluster analysis. DNA levels differed significantly between groups and tended to be higher in groups with higher concentrations of transforming growth factor-beta1 (TGF-beta1) and platelet-derived growth factors (PDGFs). DNA quantity was positively correlated with TGF-beta1 concentration, and was negatively correlated with donor age. ALP activity was negatively correlated with PDGF-BB concentration. CONCLUSIONS: The varying GF concentrations may result in different biologic effects; thus, individual differences in GF levels should be considered for reliable interpretation of the biologic functions and standardized application of PRP.
Alkaline Phosphatase/metabolism ; Blood Donors ; Cell Differentiation ; Cells, Cultured ; Culture Media/chemistry ; DNA/analysis ; Humans ; Intercellular Signaling Peptides and Proteins/*pharmacology ; Mesenchymal Stem Cells/*cytology/drug effects ; Platelet-Derived Growth Factor/pharmacology ; Platelet-Rich Plasma/*metabolism ; Transforming Growth Factor beta1/pharmacology

BACKGROUND: More remifentanil and less propofol may speed up the early recovery from anesthesia. This study evaluated the hemodynamic response and recovery profile of high-dose remifentanil/lowdose propofol anesthesia, compared with low-dose remifentanil/highdose propofol anesthesia for lower abdominal surgery. METHODS: Sixty women undergoing lower abdominal surgery were randomly assigned to either groups H or L. Anesthesia was maintained with remifentanil 0.5 micro/kg/min and propofol 4 mg/kg/h in group H, or with remifentanil 0.25 micro/kg/min and propofol 8 mg/kg/h in group L. The heart rate, blood pressure, and EEG bispectral index (BIS) score were recorded. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. RESULTS: In both groups, the heart rate and systolic blood pressure were decreased over time compared with the preanesthetic baseline values (P < 0.05) but there were no differences between the two groups. The frequency of hemodynamic events (hypertension, hypotension, and bradycardia) and their rescue drugs were similar in the two groups. The BIS scores were lower during anesthesia in group L than in group H (P < 0.05). The time to spontaneous ventilation, eye opening on verbal command, extubation, orientation, and full recovery were faster in group H than in group L (P < 0.05). The incidences of side effects were similar in both groups. CONCLUSIONS: In lower abdominal surgery, high-dose remifentanil/ low-dose propofol anesthesia offers faster recovery than low-dose remifentanil/high-dose propofol anesthesia. However, there were no differences in the hemodynamic changes and side effects between the groups.
Anesthesia ; Anesthesia, Intravenous* ; Anesthetics ; Blood Pressure ; Electroencephalography ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Propofol* ; Ventilation

BACKGROUND: The Cobra Perilaryngeal Airway(TM) (Cobra PLA) and the Proseal Laryngeal Mask Airway(TM) (Proseal LMA) provide higher sealing pressures than the classic LMA. The authors compared the clinical effectiveness of these two airway types for controlled ventilation during laparoscopic cholecystectomy. METHODS: One hundred and twenty patients (ASA physical status I-II, aged 18-65 yrs) scheduled for laparoscopic cholecystectomy were randomly allocated for airway management with the Cobra PLA or the Proseal LMA. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion system. Insertion characteristics, anatomical positions, airway adequacies, ventilation efficacies, degrees of gastric distension, and postoperative adverse events (sore throat, dysphagia, and dysphonia) were noted. RESULTS: The number of insertion attempts, insertion times, airway sealing pressure, and airway positions were similar in the two groups. In one Cobra PLA patient, tracheal intubation was needed due to inadequate ventilation before pneumoperitoneum. During pneumoperitoneum, oxygenation and ventilation were optimal in all patients in both groups, and degrees of gastric distension were similar. Furthermore, no differences were found in terms of the incidences of adverse effects. CONCLUSIONS: Cobra PLA and Proseal LMA were found to have similar insertion characteristics and both provided adequate airways and effective ventilation during laparoscopic cholecystectomy.
Aged ; Airway Management ; Anesthesia ; Cholecystectomy, Laparoscopic ; Deglutition Disorders ; Elapidae ; Humans ; Incidence ; Intubation ; Laryngeal Masks ; Oxygen ; Pharynx ; Piperidines ; Pneumoperitoneum ; Propofol ; Ventilation

BACKGROUND:Rocuronium is widely used because of rapid onset and intermediate duration of action.The volatile anesthetics potentiate the effect of nondepolarizing muscle relaxants. This study was designed to compare effects of inhalational agents with that of propofol on the muscle relaxation of rocuronium. METHODS:One hundred and thirty-six patients were divided four groups, which were given sevoflurane, isoflurane, desflurane and propofol.Anesthesia was induced with propofol 2 mg/kg and fentanyl 100microg.A ulnar nerve was stimulated with supramaximal stimuli.Anesthesia was maintained with 1.25 MAC inhalational agents or propofol of 7 mg/kg/hr for twenty minutes.Rocuronium 0.1, 0.15 or 0.2 mg/kg was administered.The degree and onset time of maximal depression was recorded.A supplementary dose of rocuronium was given so that all patients received a cumulative dose of rocuronium 0.6 mg/kg. We measured 10% recovery time. RESULTS:The ED50 of rocuronium were 0.157 in the sevoflurane, 0.167 in the isoflurane, 0.169 in the desflurane, and 0.187 mg/kg in the propofol. The ED95 were 0.296 in the sevoflurane, 0.313 in the isoflurane, 0.325 in the desflurane, and 0.407 mg/kg in the propofol.The onset time to maximal depression was prolonged in inhalational agent groups which were administered rocuronium 0.2 mg/kg. The 10% recovery time was delayed in inhalational agent groups than in propofol group. CONCLUSIONS:The inhalational anesthetics had more potent muscle relaxation effect than propofol.We suggest that the dose of rocuronium for adequate muscle relaxation be adjusted according to anesthetics used.
Androstanols ; Anesthetics ; Depression ; Fentanyl ; Humans ; Isoflurane ; Methyl Ethers ; Muscle Relaxation ; Muscles ; Neuromuscular Blockade ; Propofol ; Ulnar Nerve