Melittin-induced pain model has been known to be very useful for the study of pain mechanism. Melittin-induced nociceptive responses are reported to be modulated by the changes in the activity of excitatory amino acid receptor, calcium channel, spinal serotonin receptor and extracellular signaling-regulated kinase. The present study was undertaken to investigate the role of cyclooxygenase (COX) in the melittin-induced nociception. Changes in mechanical threshold, flinchings and paw thickness were measured before and after intraplantar injection of melittin in the rat hind paw. Also studied were the effects of intraperitonealy administered diclofenac (25 mg & 50 mg/kg), piroxicam (10 mg & 20 mg/kg) and meloxicam (10 mg & 20 mg/kg) on the melittin-induced nociceptions. Intraplantar injection of melittin caused marked reduction of mechanical threshold that was dose-dependently attenuated by non-selective COX inhibitor (diclofenac) and selective COX-1 inhibitor (piroxicam), but not by COX-2 inhibitor (meloxicam). Melittin-induced flinchings were strongly suppressed by non-selective COX and COX-1 inhibitor, but not by COX-2 inhibitor. None of the COX inhibitors had inhibitory effects on melittin-induced increase of paw thickness (edema). These experimental findings suggest that COX-1 plays an important role in the melittin-induced nociceptive responses.
Animals ; Calcium Channels ; Cyclooxygenase 1* ; Cyclooxygenase Inhibitors ; Diclofenac ; Melitten ; Nociception ; Phosphotransferases ; Piroxicam ; Prostaglandin-Endoperoxide Synthases ; Rats ; Receptors, Glutamate ; Serotonin

Epidemiological studies have suggested an association between pesticide exposure and Parkinson's disease. In this study, we examined the neurotoxicity of an organochlorine pesticide, heptachlor, in vitro and in vivo. In cultured SH-SY5Y cells, heptachlor induced mitochondria-mediated apoptosis. When injected into mice intraperitoneally on a subchronic schedule, heptachlor induced selective loss of dopaminergic neurons in the substantia nigra pars compacta. In addition, the heptachlor injection induced gliosis of microglia and astrocytes selectively in the ventral midbrain area. When the general locomotor activities were monitored by open field test, the heptachlor injection did not induce any gross motor dysfunction. However, the compound induced Parkinsonism-like movement deficits when assessed by a gait and a pole test. These results suggest that heptachlor can induce Parkinson's disease-related neurotoxicities in vivo.
Animals ; *Apoptosis ; Astrocytes/drug effects/pathology ; Cell Line, Tumor ; Cells, Cultured ; Dopaminergic Neurons/*drug effects/pathology ; Gait ; Heptachlor/*toxicity ; Humans ; *Locomotion ; Mice ; Neurotoxicity Syndromes/etiology/physiopathology ; Parkinsonian Disorders/chemically induced ; Pesticides/*toxicity ; Substantia Nigra/*drug effects/pathology/physiopathology

Purpose: The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists.
Methods: Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly).
Results: In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%).
Conclusion The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.

Purpose: The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists.
Methods: Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly).
Results: In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%).
Conclusion The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.

Purpose: This study was conducted to update the existing evidence-based nursing clinical practice guideline for indwelling urinary catheterization (IUC). Methods: The guideline have been revised in 22 steps based on international standards. The quality of the practice guidelines to be used for revision was evaluated using the Appraisal of Guidelines for Research and Evaluation II. The evaluation of the content appropriateness and applicability of the draft recommendations of the revised practice guidelines was performed using the RAND/UCLA Appropriateness Method, a decision-making method developed by the RAND Corporation. Four guidelines were used for the revision. Results: The updated nursing practice guideline for IUC consisted of 9 domains and 134 recommendations. The numbers of recommendations in each domain were: 4 Assessment, 20 Equipment, 11 Catheter insertion, 52 Catheter maintenance, 4 Catheter and drainage bag change, 9 Catheter removal, 22 Complications management, 5 Education and consult, and 7 Hospital support. The recommended grade was 8.2% for A, 38.1% for B, and 53.7% for C. Among these, the major revision was done in 11 recommendations (8.2%). A total of 29 recommendations (21.6%) were newly added. 30 (22.4%) recommendations had minor revisions such as changes or addition for some words or sentences, and 13 (9.7%) recommendations were deleted. Conclusion Revised nursing practice guideline is expected to serve as an evidence-based practice guideline for IUC in Korea. This guideline will provide health care providers, patients, and caregivers with information to help manage IUC, leading to improved patient outcomes.

PURPOSE: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. We report our initial experience. METHODS: This case series consisted of all consecutive patients (n = 34) who underwent NSM through a periareolar incision in our institution between August 2017 and December 2018. All patients underwent NSM through periareolar incision followed by immediate reconstruction with an implant or deep inferior epigastric perforator flap. Patient demographics, tumor and treatment characteristics, and short-term postoperative outcomes were reviewed. RESULTS: The mean patient age was 46.74 ± 6.69 years (range, 38–62 years), and the mean operation time was 96.68 ± 28.00 minutes. Indications included in situ cancer in 12 cases and invasive cancer in 22 cases. There was 1 major complication (postoperative hematoma) requiring operative reintervention. No other complications including fistula, implant exposure, or reconstruction failure was observed. At the time of writing, no case of local recurrence has been observed. CONCLUSION Our initial report shows that NSM with immediate reconstruction may successfully be performed through periareolar incision. This method maximizes esthetic effects and may be an appropriate surgical option for NSM.

Classical Hodgkin lymphoma (cHL) is a highly curable disease, but the prognosis for relapsed/refractory cHL is grave. Pembrolizumab has recently shown impressive effects in patients with relapsed/refractory cHL in a phase Ib study (KEYNOTE-013). This report presents a case of a 17-year-old male with refractory cHL who received multiple chemotherapy regimens and radiotherapies, including brentuximab vedotin. Following both the second and fourth cycles of intravenous pembrolizumab 100 mg (2 mg/kg), positron emission tomography/computed tomography (PET/CT) scan showed progression. However, because performance status and fever improved, treatment was continued, and complete remission was confirmed by PET/CT after eight cycles of pembrolizumab. This case suggests that clinicians need to be aware of the potential for pseudoprogression in patients treated with pembrolizumab.
Adolescent ; Drug Therapy ; Electrons ; Fever ; Hodgkin Disease* ; Humans ; Male ; Positron-Emission Tomography and Computed Tomography ; Prognosis ; Radiotherapy

Micro-emboli have been reported to occur commonly during arthroscopic surgery, which is frequently performed as an orthopedic surgical procedure. We here report a patient who experienced unilateral postoperative visual loss after a hip arthroscopy using irrigation fluid in the supine position without any evidence of external compression to either eye throughout the surgical procedure. Retinal fundoscopy suggested that the patient had central retinal artery occlusion, one of the causes of the postoperative visual loss. This case suggests that arthroscopic surgery may pose a substantial risk for paradoxical air embolism, such as central retinal artery occlusion, and suggests the need to prevent the entry of micro-air bubbles during such a type of surgery.
Arthroscopy* ; Embolism, Air ; Hip* ; Humans ; Orthopedic Procedures ; Postoperative Period ; Retinal Artery Occlusion ; Retinaldehyde ; Supine Position*

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

Leptomeningeal metastasis (LM) is a rare but fatal clinical condition with a short survival time. The incidence of LM from epidermal growth factor receptor mutant (EGFRm) non–small cell lung cancer (NSCLC) has increased due to the limited efficacy of first- or second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the central nervous system (CNS). Osimertinib is a third-generation, irreversible, CNS penetrant, oral EGFR TKI that demonstrates promising efficacy in CNS metastases regardless of T790M. Herein, we report four cases of T790M-negative EGFRm NSCLC patients treated with osimertinib combined with systemic chemotherapy, who progressed on prior EGFR TKI and developed LM with extracranial lesions. The combination treatment was well tolerated, and the mean overall survival from LM diagnosis was 14.7 months (95% confidence interval, 10.4 to 19.0). These results suggest that osimertinib combined with systemic chemotherapy would be a reasonable treatment option for T790M-negative EGFRm NSCLC patients who develop LM with extracranial progression to prior EGFR TKI. A further prospective study is warranted.