BACKGROUND: Midazolam has been reported to have a spinally mediated antinociceptive effect. In this randomized, double-blind study, we evaluated whether a small dose of midazolam added to fentanyl-ropivacaine mixture for PCEA (patient controlled epidural analgesia) improves epidural analgesia in patients underwent elective subtotal gastrectomy. METHODS: Forty five patients, ASA physical status I and II, undergoing subtotal gastrectomy were randomly allocated to receive 0.2% ropivacaine mixed with fentanyl 4microg/ml or 0.2% ropivacaine mixed with fentanyl 4microg/ml and midazolam 0.2 mg/ml. The infusion rate was set to deliver 4 ml/hr of the study solution, with a bolus of 2 ml per demand and a 20 minutes lockout time. RESULTS: Infused volume (P < 0.05) and VAS scores (P < 0.05) was significantly lower in the patients receiving midazolam. However, there were no differences in requiring rescue analgesics, PONV (postoperative nausea and vomiting), sedation scores, urinary retention, and pruritus between groups. CONCLUSIONS: Small dose of midazolam could augment analgesia without adverse effects when added to thoracic epidural infusion of fentanyl and ropivacaine.
Amides ; Analgesia ; Analgesia, Epidural ; Analgesics ; Double-Blind Method ; Fentanyl ; Gastrectomy ; Humans ; Midazolam ; Nausea ; Postoperative Nausea and Vomiting ; Pruritus ; Urinary Retention

Portable wireless ultrasound has been emerging as a new ultrasound device due to its unique advantages including small size, lightweight, wireless connectivity and affordability. Modern portable ultrasound devices can offer high quality sonogram images and even multiple ultrasound modes such as color Doppler, echocardiography, and endovaginal examination. However, none of them can provide elastography function yet due to the limitations in computational performance and data transfer speed of wireless communication. Also phase-based strain estimator (PSE) that is commonly used for conventional elastography cannot be adopted for portable ultrasound, because ultrasound parameters such as data dumping interval are varied significantly in the practice of portable ultrasound. Therefore, this research aims to propose a new elastography method suitable for portable ultrasound, called the robust phase-based strain estimator (RPSE), which is not only robust to the variation of ultrasound parameters but also computationally effective. Performance and suitability of RPSE were compared with other strain estimators including time-delay, displacement-gradient and phase-based strain estimators (TSE, DSE and PSE, respectively). Three types of raw RF data sets were used for validation tests: two numerical phantom data sets modeled by an open ultrasonic simulation code (Field II) and a commercial FEA (Abaqus), and the one experimentally acquired with a portable ultrasound device from a gelatin phantom. To assess image quality of elastograms, signal-to-noise (SNRe) and contrast-to-noise (CNRe) ratios were measured on the elastograms produced by each strain estimator. The computational efficiency was also estimated and compared. Results from the numerical phantom experiment showed that RPSE could achieve highest values of SNRe and CNRe (around 5.22 and 47.62 dB) among all strain estimators tested, and almost 10 times higher computational efficiency than TSE and DSE (around 0.06 vs. 5.76 s per frame for RPSE and TSE, respectively).
Dataset ; Echocardiography ; Elasticity Imaging Techniques ; Gelatin ; Methods ; Ultrasonics ; Ultrasonography

OBJECTIVES: This study was aimed to examine the efficacy and safety of modafinil in psychostimulant-inapplicable children with attention deficit hyperactivity disorder (ADHD) due to insufficient treatment response or intolerable adverse effects. METHODS: Fifteen children (8.8+/-1.8 years, 14 boys, total IQ 107.22+/-13.4) were recruited for this study. ADHD was confirmed by K-SADS-PL. The efficacy was assessed by ADHD rating scale (ADHDRS), Conner's parental rating scale-revised (CPRS-R), ADHDRS school version, clinical global impression (CGI) and computerized neurocognitive function test. Mean dose of modafnil was 250. 0+/-103.3 mg. RESULTS: Total score (p=0.012) and hyperactive/impulsive score (p=0.021) of ADHDRS for investigator, as well as CPRS-R score (p<0.01) and CGI-severity score (p<0.01) were significantly reduced after 39.2+/-8.7 days of modafinil administration. Response time of word color test was also significantly decreased after medication. Decreased appetite (2 subjects), insomnia (2 subjects), irritability (1 subject) and alopecia (1 subject) were observed during this study period. CONCLUSION: Modafinil was effective and well-tolerated for the psychostimulant-inapplicable children with ADHD.
Alopecia ; Appetite ; Attention Deficit Disorder with Hyperactivity* ; Child* ; Humans ; Parents ; Reaction Time ; Research Personnel ; Sleep Initiation and Maintenance Disorders

PURPOSE: Reactive oxygen species have been recognized as a common signaling mediator in diverse stimuli-induced apoptosis and hydrogen peroxide is a natural one of those reactive oxygen species. This study was performed to investigate the role of caspases in hydrogen peroxide-induced apoptosis of HL 60 cells. METHODS: Apoptosis was induced in HL 60 cells by treating 50microM hydrogen peroxide for 2, 4, and 6 hrs and induction of apoptosis was confirmed by flow cytometry and DNA fragmentation analysis. Caspase substrate assay was used to show the activity of caspases and then protein levels of caspase and its substrate were analyzed using immunoblotting. RESULTS: During the apoptosis, caspase substrates assay showed the increased activity of caspase-3, -7, -10, but not that of caspase-8 nor caspase-9, and immunoblotting analysis showed decreasing procaspase-3 protein with the progression of apoptosis. Furthermore, with progression of apoptosis, analysis of caspase substrates showed retinoblastoma protein decreased while cleaved 89kD fragment of poly (ADP-ribosyl) polymerase protein increased. CONCLUSION: These results suggest that hydrogen peroxide-induced apoptosis in HL 60 cells is not associated with the activation of caspase-8 nor caspase-9. Rather, caspase-3 is directly activated and responsible for hydrogen peroxide-induced apoptosis of HL 60 cells.
Apoptosis* ; Caspase 3* ; Caspase 8 ; Caspase 9 ; Caspases ; DNA Fragmentation ; Flow Cytometry ; HL-60 Cells* ; Humans* ; Hydrogen Peroxide ; Hydrogen* ; Immunoblotting ; Leukemia* ; Reactive Oxygen Species ; Retinoblastoma Protein

OBJECTIVES: While parents who foster children with epilepsy would have considerable parenting difficulties, the parenting stress and sense of competence have not been investigated. We investigated maternal parenting stress, parenting satisfaction and sense of parenting competence in children with seizure disorders, and the associations with seizure-related variables. METHODS: Mothers of 79 children with seizure disorders (41 boys, 38 girls; mean age, 9.9+/-2.3 years) and 79 healthy comparison subjects matched for age and sex were recruited for this study. The Korean version of the Parenting Stress Index (K-PSI-SF) and the Parenting Sense of Competence (K-PSOC) were used to assess parenting stress, parenting satisfaction and parenting efficacy. RESULTS: Mothers of children with seizure disorders showed higher scores on stress related to difficult child and child learning and parenting anxiety compared to mothers of healthy children. In addition, scores on stress related to parental-child interaction and child learning were significantly associated with parental economic status. Scores on stress from parental-child interaction was also correlated with seizure severity, and stress from child learning was correlated with seizure type. Sense of parenting competence and anxiety scores were correlated with paternal educational status, respectively. CONCLUSION: These findings suggest that mothers of children with epilepsy have greater parenting stress and anxiety and social and seizure-associated factors may affect the parenting stress and anxiety.
Anxiety ; Child* ; Educational Status ; Epilepsy* ; Female ; Humans ; Learning ; Mental Competency* ; Mothers ; Parenting* ; Parents* ; Seizures*