Preeclampsia is a hypertensive disorder involving multiple organs during the late gestational period. It may cause maternal and fetal morbidity and mortality. Preeclampsia parturients have an increased risk of cesarean delivery for several reasons including growth retardation of the intrauterine fetus, fetal distress and termination of pregnancy for treatment of severe preeclampsia. The hemodynamic state of preeclampsia varies depending on the onset, the severity of preeclampsia and the involved organs. Spinal anesthesia is recommended for preeclampsia parturients because of its rapid onset, stable hemodynamics and fewer neurologic complications. Hypotension during spinal anesthesia occurs less in preeclampsia, as compared to healthy pregnant women. Hemodynamic monitoring and planned fluid administration are important to anesthetic management of preeclampsia parturients.
Anesthesia, Spinal ; Female ; Fetal Distress ; Fetus ; Hemodynamics* ; Humans ; Hypotension ; Mortality ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

PURPOSE: The objective of this study was to analyze the factors affecting the stages of exercise behaviors changes of low back pain patients. METHODS: The participants in this study were 220 low back pain patients who have been treated by therapeutic exercise or had the exercise treatment under the doctor's advice. The tools used for this study were the stages of exercise behavior change, intrinsic motivation questionnaires, and physical activity social support scale (PASS). RESULTS: The group that did exercise (preparation stage, maintenance stage, action stage) was 75.9% but the group that did not exercise (precontemplation stage, contemplation stage) was 24.1%. Social supports from family members and friends and motivation affected the exercise behaviors changes. And 34.6% of the exercise behavior change can be explained by the social support (family, friend) and motivation. CONCLUSION: There were two recommendations for maintaining the exercise behaviors of low back pain patients based on theoretical background. First, we recommended more exercise programs which reinforce social supports from family and friend for constant exercise behaviors of low back pain patients. Second, more exercise programs for the low back pain patients who have similar health goals or problems were needed for motivating them to join the exercise programs.
Friends ; Humans ; Low Back Pain* ; Motivation ; Motor Activity ; Surveys and Questionnaires

Trisomy 22 is closely associated with inv(16) or t(16;16) and could be a marker of cryptic rearrangement of CBFB/MYH11 in acute myeloid leukemia (AML). Trisomy 22 not associated with CBFB/MYH11 rearrangement is a rare event. Here, we report a case diagnosed as refractory anemia with excess blasts-2 (RAEB-2) with sole trisomy 22 in the absence of CBFB/MYH11 rearrangement. The cytogenetic study of bone marrow cells disclosed trisomy 22 in 10% of metaphase cells analyzed. The other chromosomal abnormalities were not found. Fluorescence in situ hybridization (FISH) using CBFB/MYH11 probe to detect cryptic inv(16)(p13q22) showed negative result. We also excluded rearrangements of chromosome 5, 7, 8, 20, and ETV6 by FISH. Sole trisomy 22 not associated with inv(16) is a true entity.
Anemia, Refractory ; Bone Marrow Cells ; Chromosome Aberrations ; Chromosomes, Human, Pair 22 ; Chromosomes, Human, Pair 5 ; Cytogenetics ; Fluorescence ; In Situ Hybridization ; Leukemia, Myeloid, Acute ; Metaphase ; Myelodysplastic Syndromes ; Trisomy

Contrast-induced encephalopathy (CIE) is a rare complication of angiography and endovascular intervention following administration of iodinated intravenous contrast agents. Neuroimaging findings of CIE usually show cerebral edema, leptomeningeal enhancement, and parenchymal signal abnormality on fluid-attenuated inverse recovery (FLAIR). Hyperintense acute reperfusion marker (HARM) generally implies an enhancement of the subarachnoid cerebrospinal fluid space on brain FLAIR imaging in cases of acute ischemic stroke or hyperperfusion syndrome. We report a case of possible CIE following cerebral angiography, accompanied by HARM sign.

The Republic of Korea has been using malaria antibody assays to screen blood donors and reduce the risk of transfusion-transmitted malaria (TTM). This study examined the effectiveness of the current malaria antibody test for screening blood donors and calculated the positive predictive value (PPV) with the real-time polymerase chain reaction (RT-PCR) as the reference. The reactive rate and PPV of the malaria antibody screening assay during particular period from 2020 to 2021 were 0.82% (248/30,309) and 0.40% (1/248), respectively. The low PPV of current malaria antibody screening in blood donors suggests that the effectiveness of this test is limited in terms of balancing blood safety and supply in low-prevalence situations.

The manifestation of behavioral and psychological symptoms of dementia (BPSD) poses a considerable care burden and precipitates adverse health outcomes. Despite the increasing development of digital interventions, their application in the dementia population, specifically regarding their effectiveness in addressing BPSD, remains limited. Therefore, in this study, we aimed to describe a study protocol for evaluating the effectiveness of a mobile app-based individualized non-pharmacological intervention to improve BPSD in community-dwelling older adults. Methods: Employing a randomized control group pretest-posttest design, 36 dyads comprising people living with dementia (PLWD) and their family caregivers will be assigned to either an experimental or control group. The experimental group will engage in a 4-week regimen using a mobile app-based individualized non-pharmacological intervention, which includes recording and predicting BPSD. The control group will use the BPSD record system without accessing the individualized interventions. Both groups will continue with their usual care practices throughout the study period. Subsequently, an evaluation of the effectiveness of the mobile app-based individualized non-pharmacological intervention on BPSD will be conducted, which will serve as the primary outcome. Discussion: We hypothesize that the implementation of the mobile app-based individualized non-pharmacological intervention will alleviate BPSD. However, the research team may encounter several challenges owing to the novelty of digitalized interventions. Nevertheless, the results of this study will provide robust evidence regarding the efficacy of mobile app-based individualized non-pharmacological interventions for community-dwelling older PLWD.Trial registration: This trial has been registered with the Clinical Research Information Service in South Korea (CRIS No. KCT0008713; registered August 18, 2023).

BACKGROUND/OBJECTIVES: Atherosclerosis is associated with increased inflammation in the visceral adipose tissue (VAT). Vitamin D has been reported to modulate the inflammatory responses of stromal vascular cells (SVCs) and adipocytes in adipose tissue, but the role of vitamin D in atherosclerosis biology is unclear. This study examined the effects of in vitro 1,25-dihydroxyvitamin D 3 (1,25[OH] 2 D 3 ) treatment on the inflammatory responses of SVCs and adipocytes from atherosclerotic mice.MATERIALS/METHODS: C57BL/6J (B6) mice were divided randomly into 2 groups and fed a 10% kcal fat control diet (control group, CON) or 41% kcal fat, 0.21% cholesterol (high fat+ cholesterol, HFC) diet (obese group, OB), and B6.129S7-Ldlr tm1Her /J (Ldlr −/− ) mice were fed a HFC diet (obese with atherosclerosis group, OBA) for 16 weeks. SVCs and adipocytes isolated from VAT were pre-incubated with 1,25(OH) 2 D 3 for 24 h and stimulated with lipopolysaccarides for the next 24 h. Proinflammatory cytokine production by adipocytes and SVCs, the immune cell population in SVCs, and the expression of the genes involved in the inflammatory signaling pathway in SVCs were determined. RESULTS: The numbers of total macrophages and SVCs per mouse were higher in OB and OBA groups than the CON group. The in vitro 1,25(OH) 2 D 3 treatment significantly reduced macrophages/SVCs (%) in the OBA group. Consistent with this change, the production of interleukin-6 and monocyte chemoattractant protein 1 (MCP-1) by SVCs from the OBA group was decreased by 1,25(OH) 2 D 3 treatment. The 1,25(OH) 2 D 3 treatment significantly reduced the toll-like receptor 4 and dual-specificity protein phosphatase 1 (also known as mitogenactivated protein kinase phosphatase 1) mRNA levels in SVCs and MCP-1 production by adipocytes from all 3 groups. CONCLUSIONS These findings suggest that vitamin D can attribute to the inhibition of the inflammatory response in VAT from atherosclerotic mice by reducing proinflammatory cytokine production.

BACKGROUND: Hypotension is a very common side effect of spinal anesthesia for cesarean delivery. If we can predict the degree of blood pressure decrease after spinal anesthesia, hypotension will be treated better. Tachycardia may reflect the effective circulatory volume deficit. We studied if preoperative heart rate can predict the degree of hypotension after spinal anesthesia. METHODS: Fifty-two parturients for elective cesarean delivery were enrolled and the gestation periods of all parturient were over 37 weeks. In the supine position, noninvasive blood pressure (BP) and heart rate (HR) were measured as baseline values. After change to the right decubitus position, spinal anesthesia was done. Hyperbaric bupivacaine 8 mg and fentanyl 15 microg were injected intrathecally through 26G spinal needle. After return to the wedged supine position, BP and HR were measured every minute until anesthetic level was fixed. If mean BP decreased below 70% value of baseline, ephedrine 5 mg was injected intravenously. The lowest mean BP, hypotension (<80% of baseline) and total ephedrine requirement were recorded. Retrospective analysis was done after grouping by baseline heart rate (below 80 vs. over 80 beats/min). RESULTS: The patients who had more rapid heart rate before anesthesia, tended to have more decrease of mean BP during spinal anesthesia (P < 0.001, R = 0.45). In retrospective group analysis, the incidence of hypotension was lower in low HR group (46% vs. 83%, P = 0.014). CONCLUSIONS: If preoperative heart rate is over 80 beats/min, careful management is required to prevent hypotension during spinal anesthesia for cesarean delivery.
Anesthesia ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Ephedrine ; Fentanyl ; Heart ; Heart Rate ; Humans ; Hypotension ; Incidence ; Needles ; Pregnancy ; Retrospective Studies ; Supine Position ; Tachycardia

BACKGROUND: This clinical study was designed to evaluate the effect of midazolam as a premedication on the onset of propofol and rocuronium during propofol target-controlled infusion (TCI). METHODS: Seventy four patients (ASA class I or II) were randomly allocated to receive either no premedication (control group) or premedication with 0.04 mg/kg intravenous midazolam (midazolam group). Anesthesia was induced and maintained with propofol TCI. Time from propofol injection to loss of consciousness (LOC) and estimated effect concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was injected. We monitored the degree of neuromuscular blockade by acceleromyography. The following parameters were measured and compared between groups: Time from rocuronium injection to depression of twitch height below 25%, time to maximal depression of twitch height (defined as rocuronium onset time). RESULTS: Systolic blood pressure before induction was lower in midazolam group (125 +/- 15 vs 135 +/- 20 mmHg), however, there was no difference in blood pressure at LOC between groups (111 +/- 16 vs 106 +/- 21 mmHg). In midazolam group, time to LOC in propofol TCI was shorter (63 +/- 22 vs. 203 +/- 118 sec) and estimated effect site concentration of propofol was significantly lower than control group (0.9 +/- 0.3 vs. 2.2 +/- 0.4 microl/ml). The onset time of rocuronium was not different between groups (120 +/- 39 vs. 137 +/- 42 sec). CONCLUSIONS: Midazolam pretreatment fastens the onset time of propofol and decreases the propofol requirement for LOC. However, it does not influence the onset of rocuronium.
Androstanols ; Anesthesia ; Blood Pressure ; Depression ; Humans ; Midazolam ; Neuromuscular Blockade ; Premedication ; Propofol ; Unconsciousness

BACKGROUND:Rocuronium is a commonly used muscle relaxant, however, it has severe injection pain.We supposed that injection pain of rocuronium was due to acidity of solution.We studied whether pH elevation of rocuronium with bicarbonate relieves injection pain. METHODS:We included 140 adult patients with 18 G intravenous catheter in arm for general anesthesia and they were randomly allocated to two groups.All patients received 0.6 mg/kg of rocuronium, one group (Group C) received rocuronium only (pH = 4.04) and the other group (Group B) received bicarbonate mixed rocuronium (rocuronium:bicarbonate = 5 ml :1 ml, pH of mixture = 7.14).The severity (none, mild, severe) of injection pain was assessed.Just after assessment, 5 mg/kg of thiopental was injected for loss of conciousness. Twitch of supramaximal stimuli was monitored and intubation time was considered the interval from injection to 75% depression and onset time the interval from injection to maximal depression. RESULTS:The incidence of injection pain of group C was 96.9% and 18.8% in group B (P< 0.01). Intubation time and onset time were 79.5 +/- 24.4 sec and 114.3 +/- 43.6 sec in group C and 80.6 +/- 27.0 sec and 115.2 +/- 46.2 sec in group B.There was no significant difference between groups. CONCLUSIONS:Our result shows that adding bicarbonate to rocuronium is effective to relieve injection pain of rocuronium without change of onset of rocuronium.
Adult ; Androstanols ; Anesthesia, General ; Arm ; Catheters ; Depression ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intubation ; Muscles ; Sodium Bicarbonate ; Thiopental