BACKGROUND: Simple manual method using a Nageotte hemocytometer counting residual leukocytes [White blood cells(WBC)] in blood components is subjective, labor-intensive, time consuming and variable within and between laboratories. The aim of this study was to evaluate usefulness for flow cytometric method to determinate very low numbers of leukocytes in leukocyte-free blood components. METHODS: Epics XL-MCL (Beckman Coulter Co.) was used for determination of fluorescence-labelled cells. The DNA in leukocytes was stained using propidium iodide (PI) and leukocytes were automatically analysed by flow cytometer. RESULTS: Linearity determined over a range of 0.5-50 WBC/muL was a value of r=0.994. The detection limit of this method was 4.4 WBC/muL and accuracy was 86.6% with linearity of r=0.991 over the 5-50 WBC/muL. Reproducibility was CV of 9.1% for 25.8 WBC/muL and 14.7% for 7.1 WBC/muL, respectively. CONCLUSION: Flow cytometric techniques provide a reproducible and objective tool for counting residual WBC in leukocyte free blood components compared with the Nageotte hemocytometer.
DNA ; Leukocytes* ; Limit of Detection ; Propidium

OBJECTIVE: This study evaluated the outcomes of ischemic stroke patients according to delirium motor subtype.METHODS: This study included patients who were admitted to the stroke unit between August 2017 and March 2019 and met the DSM-5 diagnostic criteria for delirium. Patients were assessed twice weekly throughout their delirium episodes using the Korean version of the Delirium Motor Subtype Scale (K-DMSS) and the Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98). The clinical characteristics and short-term outcomes of the patients were also assessed.RESULTS: A total of 943 stroke patients were included; the rate of incident delirium was 10.18%. Of the 95 delirium patients, 34 were classified as the hyperactive subtype, 30 as the mixed subtype, 25 as the hypoactive and six as no subtype. Among the subtype groups, the hypoactive subtype had the highest initial scores on the National Institutes of Health Stroke Scale (NIHSS; 6.72±4.75, p=0.02) and the modified Rankin Scale (mRS; 3.96±1.24, p<0.01). Additionally, the mixed and hypoactive subtypes had longer durations (p<0.01) and more severe symptoms of delirium (p=0.03) than the other motor subtypes, and the hypoactive subtype group had a significantly longer hospital stay (36.88±27.71 days, p<0.01) than the other subtype groups. After adjusting for baseline covariates in a multiple linear regression analysis, these differences remained significant.CONCLUSION: The present results suggest that the motor subtype of delirium is associated with different characteristics and outcomes in ischemic stroke patients.
Delirium ; Humans ; Length of Stay ; Linear Models ; National Institutes of Health (U.S.) ; Stroke

Group B subtype, A1B3, was observed in a 22-year-old blood donors by conventional serologic test. In our family study, his father demonstrated uncomplicated B phenotype and his mother typed as group A. We sequenced exon 6 and 7 of phenotypically A1B3 propositus and his family members by direct sequencing and PCR-based cloning. And we have identified a novel Bvar allele characterized by a 547G>A polymorphism present in propositus and his father. This suggests that the Bvar allele is expressed differently depending on the co-inherited ABO allele.
Alleles* ; Blood Donors ; Child* ; Clone Cells ; Cloning, Organism ; Exons ; Fathers* ; Humans ; Mothers* ; Phenotype ; Serologic Tests ; Young Adult

BACKGROUND: High risks of fire alway exist for buildings in urban areas, especially those in downtown. Crowds, as well as more complex and larger structures, may cause more victims in the event of fire; therefore, emergency medical service plans must be established for such disastrous events. METHODS: On the evening of October 30, 1999, a fire broke out in downtown, Dong-Incheon Live-Hof restaurant; 56 people were killed and 76 were injured. Most of them were teenagers. We retrospectively reviewed the medical records of the victims. RESULTS: 1) Among the 56 dead, 54 died from smoke inhalation, one from extensive burns, and one from sepsis during treatment. 2) Among the 76 injured, 70 patients suffered from smoke inhalation, 53 from burns, and 9 from several types of trauma (sprains, contusions, lacerations, abrasions, fractures, etc.). 3) Later complications were laryngeal edema, pulmonary edema, scar contracture, and hypoxic brain damage, and so forth. 4) Post traumatic stress syndrome was unexpectedly more prevalent in mildly to moderately injured survivors and witnesses than in seriously injured survivors. CONCLUSION: Many complications exist after a fire. Some may be resolved in time, but others may result in permanent sequelae. Early rescue, early triage, and early management during transport by emergency medical service (EMS) personnel can result in fewer complications and a lower mortality rate. Therefore, we propose the establishment of plans to be followed during various major disasters.
Adolescent ; Burns ; Cicatrix ; Contracture ; Contusions ; Disasters ; Emergency Medical Services ; Fires* ; Humans ; Hypoxia, Brain ; Inhalation ; Lacerations ; Laryngeal Edema ; Medical Records ; Mortality ; Pulmonary Edema ; Restaurants* ; Retrospective Studies ; Sepsis ; Smoke ; Survivors ; Triage

Sedation is often necessary to optimize care for critically ill children requiring mechanical ventilation. If too light or too deep, however, sedation can cause significant adverse reactions, making it important to assess the degree of sedation and maintain its optimal level. We evaluated the efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. We compared 12 month data in 21 patients (intervention group), for whom we used the pediatric intensive care unit (PICU) sedation protocol of Asan Medical Center (Seoul, Korea) and the COMFORT scale to maintain optimal sedation, with the data in 20 patients (control group) assessed before using the sedation protocol and the COMPORT scale. Compared with the control group, the intervention group showed significant decreases in the total usage of sedatives and analgesics, the duration of mechanical ventilation (11.0 days vs. 12.5 days) and PICU stay (15.0 days vs. 19.5 days), and the development of withdrawal symptoms (1 case vs. 7 cases). The total duration of sedation (8.0 days vs. 11.5 days) also tended to decrease. These findings suggest that application of protocol-based sedation with the COMPORT scale may benefit children requiring mechanical ventilation.
Anesthetics, Intravenous/administration & dosage/therapeutic use ; Child, Preschool ; Conscious Sedation/methods/standards ; Critical Care/*methods/standards ; *Critical Illness ; Female ; Fentanyl/administration & dosage/therapeutic use ; Humans ; Hypnotics and Sedatives/administration & dosage/*therapeutic use ; Infant ; Infusions, Intravenous ; Intensive Care Units/statistics & numerical data ; Length of Stay ; Male ; Midazolam/administration & dosage/therapeutic use ; *Respiration, Artificial ; Treatment Outcome

Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but no method could monitor or predict it real-time during surgery. We measured bioelectrical impedance (BEI) and cell viability to assess the usefulness of BEI during I/R in rat liver. A 70% partial liver ischemia model was used. BEI was measured at various frequencies. Adenosine triphosphate (ATP) content, and palmitic acid oxidation rate were measured, and histological changes were observed in order to quantify liver cell viability. BEI changed significantly during ischemia at low frequency. In the ischemia group, BEI increased gradually during 60 min of ischemia and had a tendency to plateau thereafter. The ATP content decreased below 20% of the baseline level. In the I/R group, BEI recovered to near baseline level. After 24 hr of reperfusion, the ATP contents decreased to below 50% in 30, 60 and 120 min of ischemia and the palmitic acid metabolic rates decreased to 91%, 78%, and 74%, respectively, compared with normal liver. BEI may be a good tool for monitoring I/R during liver surgery. The liver is relatively tolerant to ischemia, however after reperfusion, liver cells may be damaged depending upon the duration of ischemia.
Adenosine Triphosphate/metabolism ; Animals ; *Cell Survival ; Electric Impedance ; Energy Metabolism ; Ischemia/*metabolism ; Liver/*metabolism/pathology ; Male ; Palmitates/metabolism ; Rats ; Rats, Sprague-Dawley ; *Reperfusion ; Reperfusion Injury/metabolism/pathology

The effect of lidocaine on the neuromuscular junction and the interaction between lidocaine and the muscle relaxant, succinylcholine(SCC) or vecuronium(VEC), were investigated in 12 cats of either sex using the sciatic nerve-anterior tibialis muscle preparation. The degree of twitch depression with lidocaine itself was 16.43+/-14.94%, and the ED from dose-response curves of SCC and VEC(8.35+/-4.62 and 6.36+/-8.03 ug/kg, respectively) in group II (under lidocaine infusion) were smaller than those(20.57+/-15.80 and 8.98+/-7.31 ug/kg) in group I (without lidocaine). There was no difference in the duration of action of SCC and VEC between the two groups, but the onset of VEC in group II was longer than in group I(p<0.05), The mean arterial pressure(MAP) after lidocaine infusion was reduced 149.17 to 130.83mmHg and MAPs at the same dose of each agent were also lower in group II than in group L The authors conclude that lidocaine itself produces the twitch depression and potentiates the SCC-or VEC-induced neuromuscular block. However, there is no influence on the duration of SCC or VEC.
Animals ; Cats* ; Depression ; Drug Interactions ; Lidocaine* ; Neuromuscular Blockade* ; Neuromuscular Junction ; Succinylcholine* ; Vecuronium Bromide*

BACKGROUND: Mitral stenosis (MS) and mitral regurgitation (MR) have different pathophysiologies and left ventricular function after miral valve replacement (MVR) in both diseases has been well known. However, there has been no report comparing the change of right ventricular (RV) function immediately after MVR. We evaluated the change of RV function following MVR in MS and MR using a RV ejection fraction (RVEF) thermodilution catheter. METHODS: With IRB approval, 27 patients with MS and 22 patients with MR undergoing MVR were included. Patients with tricuspid regurgitation were excluded. A RVEF catheter was inserted before the induction of anesthesia. Hemodynamic parameters were measured after anesthesia (T1, control), immediately after the termination of cardiopulmonay bypass (T2) and after the sternum was closed (T3). RESULTS: Pulmonary capillary wedge pressure (PCWP) and end systolic and end diastolic RV volume index (RVESVI and RVEDVI) were higher in MS than in MR and there was no difference in RVEF at T1. Heart rate increased and mean pulmonary artery pressure (mPAP), PCWP, and pulmonary vascular resistance significantly decreased at T2 in both groups. RVEF increased and RVESV and RVEDV decreased significantly only in MS after MVR versus that at T2. There was no difference in hemodynamic parameters between both groups at T2 and T3. CONCLUSIONS: RV function was significantly improved in MS but not in MR after MVR. However, there was no significant hemodynamic difference between MS and MR after MVR, though they are known to have different preoperative pathophysilogies and postoperative left heart functions.
Anesthesia ; Catheters ; Ethics Committees, Research ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sternum ; Thermodilution ; Tricuspid Valve Insufficiency ; Vascular Resistance ; Ventricular Function, Left ; Ventricular Function, Right*

OBJECTIVE: It is still unclear whether angiogenic potential, which is believed to be a prerequisite for tumor development, is an important prognostic factor in ovarian carcinoma. The current study was designed to examine the relationship among Vascular endothelial growth factor (VEGF) expression, angiogenesis in ovarian neoplasms and clinicopathological prognostic variables. METHODS: A according to the WHO classification and FIGO staging epithelial ovarian carcinoma was classified. Microvessel density and VEGF status were evaluated by immunohistochemistry in 77 epithelial ovarian carcinomas. RESULTS: Positive immunostaining for VEGF was observed in 92.6% (50 out of 54) of ovarian carcinomas, which was significantly higher than that of low malignant potential (LMP) tumors (12 out of 23; 52.2%) (p<0.001). In ovarian carcinomas, positive VEGF immunostaining was also observed more frequently, even though not significantly, in tumor of elder age group (more than 60 years) (p=0.05) and less differentiated (p=0.05). CD34 immunostaining revealed increased microvessel density in ovarian carcinomas larger than 10 cm in size (p=0.029) and in mucinous type tumors (p=0.025). Microvessel counts of epithelial ovarian carcinomas examined were not correlated with VEGF expression. Histologic type (p=0.0428), differentiation (p=0.0083) and FIGO stage (p=0.0004) also influenced overall survival of ovarian carcinomas in univariate analysis. But multivariate analysis revealed that disease stage was the only significant and independent prognostic factor of ovarian carcinomas (p=0.001). In advanced ovarian tumors (stage III/IV), microvessel density was the only significant prognostic factor (p=0.002). CONCLUSION: Therefore, the expression of VEGF could be used as an adjuvant indicator of differing borderline tumor from ovarian carcinoma. And microvessel density of advanced ovarian carcinoma may enhance the predictability of patient at high risk for tumor progression who are potential candidate for further aggressive therapy.
Classification ; Humans ; Immunohistochemistry ; Microvessels* ; Mucins ; Multivariate Analysis ; Ovarian Neoplasms ; Prognosis* ; Vascular Endothelial Growth Factor A*

BACKGROUND: It has been known that radial artery pressure (RAP) some times underestimate the central pressure. In many studies, femoral artery pressure (FAP) and RAP have been considered as central and peripheral artery pressures, respectively and there might be a possibility that age and the change of blood pressure exert different effect on FAP and RAP. This study evaluated the effect of esmolol (E) on RAP and FAP and the changes in their pulse pressure (PP) in different age groups. METHODS: Fifty-one adult patients without cardiovascular disease were enrolled in this study. Twenty six patients were younger than 25 years (group 1) and 25 patients were older than 50 years (group 2). Radial and femoral arteries were cannulated and recorded before anesthesia. After induction of anesthesia, FAP, RAP and heart rate were recorded (T1) and then E was infused to decrease the FAP to 15% lower than its value of T1(T2). Variables were recorded 30 sec after the cessation of E infusion. RESULTS: Systolic pressure and PP of RAP were greater than of FAP in group 1, but those of FAP were greater than of RAP in group 2 before anesthesia. FAP was higher than RAP in both groups after anesthesia, regardless of the infusion of E. E infusion didn't change the pressure gradients between FAP and RAP in either group, except systolic pressure gradient in group 2. The PP of FAP was identical with of RAP in group 1 at both T1 and T2 but greater than of RAP in group 2 at both periods. E decreased the PP of both RAP and FAP in both groups. CONCLUSIONS: RAP is lower than FAP, and the PP of both pressures are affected by age and esmolol after anesthesia. However, the differences between both pressures are maintained after E infusion.
Adult ; Anesthesia ; Arteries ; Blood Pressure* ; Cardiovascular Diseases* ; Femoral Artery ; Heart Rate ; Humans ; Phenylephrine ; Radial Artery*