BACKGROUND: Sugammadex reverses rocuronium-induced neuromuscular blockade quickly and effectively. Herein, we compared the efficacy of sugammadex and pyridostigmine in the reversal of rocuronium-induced light block or minimal block in pediatric patients scheduled for elective entropion surgery. METHODS: A prospective randomized study was conducted in 60 pediatric patients aged 2–11 years who were scheduled for entropion surgery under sevoflurane anesthesia. Neuromuscular blockade was achieved by administration of 0.6 mg/kg rocuronium and assessed using the train-of-four (TOF) technique. Patients were randomly assigned to 2 groups receiving either sugammadex 2 mg/kg or pyridostigmine 0.2 mg/kg and glycopyrrolate 0.01 mg/kg at the end of surgery. Primary outcomes were time from administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0. Time from the administration of reversal agents to extubation and postoperative adverse events were also recorded. RESULTS: There were no significant differences in the demographic variables. Time from the administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0 were significantly shorter in the sugammadex group than in the pyridostigmine plus glycopyrrolate group: 1.30 ± 0.84 vs. 3.53 ± 2.73 min (P < 0.001) and 2.75 ± 1.00 vs. 5.73 ± 2.83 min (P < 0.001), respectively. Extubation time was shorter in the sugammadex group. Adverse events, such as skin rash, nausea, vomiting, and postoperative residual neuromuscular blockade (airway obstruction), were not statistically different between the two groups. CONCLUSIONS: Sugammadex provided more rapid reversal of rocuronium-induced neuromuscular blockade in pediatric patients undergoing surgery than did pyridostigmine plus glycopyrrolate.
Anesthesia ; Delayed Emergence from Anesthesia ; Entropion ; Exanthema ; Glycopyrrolate ; Humans ; Nausea ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Pediatrics ; Prospective Studies ; Pyridostigmine Bromide ; Vomiting

BACKGROUND: Maternal hypotension is a common complication during obstetric spinal anesthesia. This study was conducted to investigate the role of autonomic function testing in predicting maternal hypotension during spinal anesthesia induced to conduct Cesarean sections (C-section). METHODS: This study was conducted on 32 parturients undergoing C-section under spinal anesthesia. Sympathetic function tests included measuring diastolic blood pressure changes in response to hand gripping and systolic blood pressure changes response to moving from a supine to a standing position. Sympathetic dysfunction is said to exist when there are abnormal responses to both sympathetic function tests. Parasympathetic function tests included measuring heart rate responses to deep breathing and heart rate responses to moving from a supine to a standing position. Parasympathetic dysfunction is said to exist when there are abnormal responses to both parasympathetic function tests. After the onset of spinal anesthesia, blood pressure was measured every minute until childbirth. RESULTS: Hypotension occurred in 22 of the 32 parturients. There was no correlation between sympathetic dysfunction and hypotension incidence, but 12 of the 12 (100%) of the positive group and 10 of the 20 (50%) of the negative group experiencing parasympathetic dysfunction, respectively, experienced hypotension with a significant difference of P = 0.004. The group experiencing parasympathetic dysfunction had statistically significantly higher phenylephrine requirements were also greater in the parasympathetic dysfunction positive group (P < 0.003). CONCLUSIONS: This study's findings suggested that the parasympathetic function tests may be useful methods for predicting the incidence of maternal hypotension during spinal anesthesia induced for C-section.
Anesthesia, Spinal ; Autonomic Nervous System ; Blood Pressure ; Cesarean Section ; Female ; Hand ; Hand Strength ; Heart Rate ; Humans ; Hypotension ; Incidence ; Parasympathetic Nervous System ; Parturition ; Phenylephrine ; Pilot Projects ; Posture ; Pregnancy ; Respiration ; Sympathetic Nervous System

Histone modifications are key epigenetic regulatory features that have important roles in many cellular events. Lysine methylations mark various sites on the tail and globular domains of histones and their levels are precisely balanced by the action of methyltransferases (‘writers’) and demethylases (‘erasers’). In addition, distinct effector proteins (‘readers’) recognize specific methyl-lysines in a manner that depends on the neighboring amino-acid sequence and methylation state. Misregulation of histone lysine methylation has been implicated in several cancers and developmental defects. Therefore, histone lysine methylation has been considered a potential therapeutic target, and clinical trials of several inhibitors of this process have shown promising results. A more detailed understanding of histone lysine methylation is necessary for elucidating complex biological processes and, ultimately, for developing and improving disease treatments. This review summarizes enzymes responsible for histone lysine methylation and demethylation and how histone lysine methylation contributes to various biological processes.
Biological Processes ; Epigenomics ; Histone Code ; Histones* ; Lysine* ; Methylation* ; Methyltransferases ; Tail ; Writing*

Purpose: Overactive bladder (OAB) symptoms might be affected by weather, but only a few clinical studies have investigated this issue. We investigated seasonal variations in OAB-drug prescription rate (DPR) in men using nationwide claims data in Korea. Methods: A total of 2,824,140 men aged over 18 years were included from the Health Insurance Review and Assessment service – National Patient Sample data between 2012 and 2016. Depending on the monthly average temperature, the seasons were divided into 3 groups, namely, hot (June, July, August, and September), intermediate (April, May, October, and November), and cold (January, February, March, and December) seasons. OAB-DPR was estimated using the claims data, and differences in its rate were examined among the 3 seasonal groups. Results: The overall OAB-DPR was 1.97% (55,574 of 2,824,140). The OAB-DPR were 0.38%, 0.63%, 0.92%, 1.74%, 4.18%, 7.55%, and 9.69% in the age groups of under 30, 30s, 40s, 50s, 60s, 70s, and over 80 years, respectively; thus, the prescription rate increased with age (P<0.001), with a steeper increase after 60 years of age. OAB-DPR was 1.02% in the hot season, 1.19% in the intermediate season, and 1.27% in the cold season, with significant differences among the 3 seasonal groups (P<0.001). These seasonal variations persisted in the subgroup analysis in each age decade (P<0.001). Conclusions OAB-DPR varied with seasons and was significantly higher in the cold season than in the hot season, suggesting that cold weather may affect development and aggravation of OAB symptoms in men.

BACKGROUND/AIMS: Chicken skin mucosa (CSM), surrounding colorectal adenoma, is an endoscopic finding with pale yellow-speckled mucosa; however, its clinical significance is unknown. This study aimed to evaluate the prevalence and clinical characteristics of CSM, and the association between colorectal carcinogenesis and CSM. METHODS: This cross-sectional study was performed in 733 consecutive patients who underwent endoscopic polypectomy for colorectal adenoma after the screening of colonoscopy at the Asan Health Promotion Center between June 2009 and December 2011. The colonoscopic and pathological findings of colorectal adenoma including number, size, location, dysplasia, morphology, and clinical parameters were reviewed. RESULTS: The prevalence of CSM was 30.7% (225 of 733 patients), and most CSM-related adenomas were located in the distal colon (93.3%). Histological analysis revealed lipid-laden macrophages in the lamina propria of the mucosa. Multivariate analyses showed that CSM was significantly associated with advanced pathology, including villous adenoma and high-grade dysplasia (odds ratio [OR], 2.078; 95% confidence interval [CI], 1.191-3.627; P=0.010), multiple adenomas (i.e., > or =2 adenomas; OR, 1.692; 95% CI, 1.143-2.507; P=0.009), and a protruding morphology (OR, 1.493; 95% CI, 1.027-2.170; P=0.036). There were no significant differences in polyp size or clinical parameters between patients with and without CSM. CONCLUSIONS: CSM-related adenoma was mainly found in the distal colon, and was associated with advanced pathology and multiple adenomas. CSM could be a potential predictive marker of the carcinogenetic progression of distally located colorectal adenomas.
Adenoma* ; Adenoma, Villous ; Carcinogenesis ; Chickens* ; Chungcheongnam-do ; Colon* ; Colonoscopy ; Cross-Sectional Studies ; Health Promotion ; Humans ; Macrophages ; Mass Screening ; Mucous Membrane* ; Multivariate Analysis ; Pathology ; Polyps ; Prevalence ; Skin*