BACKGROUND: Total intravenous anesthesia (TIVA) is by definition a technique involving the induction and maintenance of the anesthetic state with intravenous drugs alone. In particular, propofol and opioid and muscle relaxants allow enhanced control of the state of anesthesia for the entire duration of the surgical procedure. We evaluated the clinical usefulness of TIVA with fixed fentanyl concentration 3 ng/ml using isoconcentration nomogram and titrated propofol for coronary artery bypass graft. METHODS: Anesthesia was induced using 1% propofol mixed with lidocaine 0.5 mg/kg and ephedrine 10 mg (150 ml/hr) until loss of consciousness in 19 patients undergoing coronary artery bypass graft. Infusion rate of propofol was adjusted in response to blood pressure and pulse rate. To achieve constant fentanyl concentration, infusion rate of fentanyl was changed timely according to isoconcentration nomogram. Infusion of propofol and fentanyl was discontinued 15 and 30 min before predictable end of surgery, respectively. Intraoperative hemodynamics, recovery profile and postoperative analgesic requirements were checked. RESULTS: Overall intraoperative hemodynamics including cardiac index and PCWP showed no significant changes compared with preinduction control value except during CPB period. Average flow rate of propofol and fentanyl was 3.4 0.2 mg/kg/hr and 2.8 0.4 g/kg/hr, respectively. Spontaneous eye opening time was 96.4 min after discontinuation of fentanyl. More than 80% (16/19) of patients did not require any analgesic during first postoperative 24hrs for pain relief. CONCLUSIONS: TIVA with propofol and fentanyl (3 ng/ml) could be a suitable and safe anesthetic technique for coronary artery bypass graft.
Anesthesia ; Anesthesia, Intravenous* ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Ephedrine ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine ; Nomograms ; Propofol ; Transplants ; Unconsciousness

PURPOSE: The aim of this study was to determine the impact of nursing organizational culture types on innovative behavior and job embeddedness among clinical nurse. METHODS: For this study a descriptive correlational study design was used. Participants were 293 nurses who had more than one year work experience. They were recruited from two university hospitals, one in Seoul and one in Gyeonggi province in 2016. Collected data were analyzed using SPSS/WIN 21.0 statistics program. RESULTS: Hierarchy-oriented culture was the highest type of organizational culture perception and innovation-oriented culture, the lowest. Multiple linear regression analyses showed that, when age and total clinical experience were adjusted for, innovation-oriented culture perception was the most significant factor influencing innovative behavior, followed by task-oriented culture and relation-oriented culture in that order (R²=.33, F=24.50, p<.001). Relation-oriented culture perception was the factor most influencing job embeddedness, followed by task-oriented culture and innovation-oriented culture in that order (R²=.48, F=55.98, p<.001). CONCLUSION: More systematic and sustained organizational efforts are required to improve the hierarchy-oriented culture highly perceived by nurses and to emphasize innovation-oriented, relation-oriented and task-oriented organizational culture to increase innovative behavior and job embeddedness among clinical nurses.
Gyeonggi-do ; Hospitals, University ; Job Satisfaction ; Linear Models ; Nursing* ; Organizational Culture* ; Seoul

PURPOSE: In this study, behavioral styles of Dominance, Influence, Steadiness, and Conscientiousness (DISC) were examined and differences in job satisfaction and clinical competence among newly hired nurses were explored. METHODS: For this explanatory correlational research, 176 newly hired clinical nurses were recruited from three university hospitals and one general hospital located in Seoul and Gyeonggi province. Data were collected in August, 2013 though self-report questionnaires. RESULTS: The distribution of behavioral styles was 11.4%, 42%, 29% and 17.6% for Dominance, Influence, Steadiness, and Conscientiousness respectively. DISC behavioral styles were associated with sub-areas of job satisfaction such as professional position and doctor-nurse relationship. DISC behavioral styles were significantly associated with the total score for clinical competence and sub-areas of data collection, basic nursing skills, critical thinking, education and leadership, and attitudes toward professional development and practical skills. Multiple linear regression analysis showed that DISC behavioral styles predicted clinical competence (Adj. R2=.14, F=9.42, p<.001). CONCLUSION: A focus on cultivating influential and steady behavioral styles among newly hired nurses can be helpful in improving job satisfaction and clinical competence. There is a need to improve interpersonal relationships through a deeper understanding of each person's behavioral style based on the analysis of DISC behavioral styles.
Clinical Competence ; Data Collection ; Education ; Gyeonggi-do ; Hospitals, General ; Hospitals, University ; Job Satisfaction* ; Leadership ; Linear Models ; Nursing ; Surveys and Questionnaires ; Seoul ; Thinking

BACKGROUND: Several recent studies have suggested the context-sensitive half-time (CSHT) as a clinically more relevant measure of decreasing drug concentrations after a constant infusion of a given duration. The purpose of this study was to simulate the CSHT using a PK-SIM computer simulation program and compare this with duration of propofol infusion and real awakening time from anesthesia for the evaluation of CSHT as a useful tool of prediction of recovery from anesthesia. METHODS: Ninety-five ASA class I or II adult patients (18-55 yrs) scheduled for orthopedic elective surgery were randomly allocated into 5 groups according to duration of propofol infusion. Five groups were Group 1: less than 60 min, Group 2: 61-120 min, Group 3: 121-180 min, Group 4: 181-240 min, and Group 5: 241-300 min. Anesthesia was induced and maintained with propofol-nitrous oxide (67%)-oxygen (33%) according to Prys-Roberts' method. Propofol was discontinued immediately after skin closure and duration of infusion was checked. Duration of infusion, CSHT, and awakening time from anesthesia were compared and evaluated correlationship among them using a correlation coefficient. RESULTS: Plasma and effect site concentration after 5 hrs infusion of propofol derived from computer simulation was 3.3 microgram/ml. Awakening time for each group was 8.5-11.8 min and plasma CSHT for that was 6.4-9.5 min. The correlation coefficient (r) between duration of propofol infusion and awakening time was 0.98 (p<0.01) and that between CSHT and awakening time was 0.95 (p<0.01). CONCLUSIONS: There were strong relationship among duration of infusion of propofol, awakening time and CSHT. It seems that CSHT could be a good predictor of awakening from propofol-N20-02 general anesthesia.
Adult ; Anesthesia* ; Anesthesia, General ; Computer Simulation* ; Humans ; Orthopedics ; Plasma ; Propofol* ; Skin

OBJETIVE: To investigate the efficacy of high infusion frequency of liquid nitrogen on pregnancy in human embryo after freezing and thawing. MATERIALS AND METHODS:: 150 infertile patients underwent 162 consecutive thawing-ET cycles. In the high infusion frequency group (Group A), 47 patients (50 cycles) underwent cryopreservation with high infusion frequency of liquid nitrogen. In the low infusion frequency group (Group B), 103 patients (112 cycles) underwent cryopreservation with low infusion frequency of liquid nitrogen. We analyzed the clinical characteristics, fertilization rates, development of embryo, good quality embryo ratio, implantation rates, and pregnancy rates between these two groups. RESULTS: There was no difference between the groups with regard to clinical characteristics (mean age, infertility duration, infertility factors, hormone profile), mean number of oocyte retrieval, fertilization rates, and mean embryo number of transfers. The survival rates in group A was 64.9% (228 of 350 embryos), and among the 228 embryos 190 embryos (83.3%) which progressed to the two- to eight-cell stage. After thawing, the embryo numbers were 65 (34.2%), 29 (15.3%), 35 (18.4%), and 37 (19.5%) of grades 1, 2, 3, and above 4, respectively. The survival rates in group B was 63.8% (482 of 755 embryos), and among the 482 embryos 465 embryos (96.5%) which progressed to the two- to eight-cell stage. After thawing, the embryo numbers were 106 (22.8%), 94 (20.2%), 89 (19.1%), and 112 (24.1%) of grades 1, 2, 3, and above 4, respectively. There was no difference in embryo quality change after the freezing-thawing procedure between the groups. Implantation rates (31.1% vs. 34.3%) were not significant. However hCG positive rates in group A (40%) were higher than group B, but not statistically significant. Clinical pregnancy rate (26% vs. 25.9%), on going pregnancy rates (>20 weeks) were not significant (26% vs. 25%). CONCLUSION: We compared embryo quality change, survival rates, and pregnancy rates between high infusion frequency group and low infusion frequency group and the results were similar between the two groups. Therefore, high infusion frequency of liquid nitrogen for cryopreservation is a worthy method to preserve in human embryos.
Cryopreservation ; Embryonic Development* ; Embryonic Structures* ; Female ; Fertilization ; Freezing* ; Humans* ; Infertility ; Nitrogen* ; Oocyte Retrieval ; Pregnancy ; Pregnancy Rate* ; Pregnancy* ; Survival Rate

Genome-wide association studies (GWASs) facilitated the discovery of countless disease-associated variants. However, GWASs have mostly been conducted in European ancestry samples. Recent studies have reported that these European-based association results may reduce disease prediction accuracy when applied in non-Europeans. Therefore, previously reported variants should be validated in non-European populations to establish reliable scientific evidence for precision medicine. In this study, we validated known associations with type 2 diabetes (T2D) and related metabolic traits in 125,850 samples from a Korean population genotyped by the Korea Biobank Array (KBA). At the end of December 2020, there were 8,823 variants associated with glycemic traits, lipids, liver enzymes, and T2D in the GWAS catalog. Considering the availability of imputed datasets in the KBA genome data, publicly available East-Asian T2D summary statistics, and the linkage disequilibrium among the variants (r2 < 0.2), 2,900 independent variants were selected for further analysis. Among these, 1,837 variants (63.3%) were statistically significant (p < 0.05). Most of the non-replicated variants (n = 1,063) showed insufficient statistical power and decreased minor allele frequencies compared with the replicated variants. Moreover, known variants showed <10% genetic heritability. These results could provide valuable scientific evidence for future study designs, the current power of GWASs, and future applications in precision medicine in the Korean population.

Understanding depth of anesthesia is essential for the anesthesiologist. Although electroencephalogram (EEG) has been proposed and studied as a method of determining anesthetic depth, major limitations restrict its usefulness. For example, spectral edge frequency (SEF) dose not correlate well with the level of sedation. However, recently introduced bispectral index (BIS) which is derived from frequency, amplitude and coherence of the EEG is strongly correlated with clinical measurements of sedation and hypnosis. BIS monitoring may be used to guide the titration of anesthetic agents to achieve effective dosing without increasing the risk of awareness and to allow a better balance of hypnotic and analgesic administration. We report two cases of successful BIS monitoring for the measurement of intraoperative hypnotic state of patient during propofol target controlled infusion (TCI).
Anesthesia ; Anesthesia, General* ; Anesthetics ; Electroencephalography ; Humans ; Hypnosis ; Propofol*

BACKGROUND: Intracranial pressure monitoring gives useful information in many neurosurgical conditions. And, measurement of the extradural pressure has always seemed an attractive alternative for intracranial pressure (ICP) monitoring. Also, choice of anesthetic agent may affect the management of intracranial pressure. The aim of this study was to evaluate the effect of propofol, isoflurane and enflurane on ICP by measuring lumbar epidural pressure. METHODS: Forty seven adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to anesthetic agent for maintenance: group I (isoflurane, n = 15), group P (propofol, n = 17), and group E (enflurane, n = 15). Premedication was performed by intramuscular injection of 0.2 mg of glycopyrrolate. ECG, noninvasive blood pressure monitoring device, and pulse oximeter was used for patient monitoring. A twenty gauge epidural catheter was placed 3-4 cm above the insertion site (L3-4). The pressure monitoring kit was connected to a catheter and was zeroed at the middle ear level. Epidural pressure was cheked every 10 min and compared to the control and among groups during maintenance of anesthesia. RESULTS: Demographic data showed no difference among groups. Preinduction epidural pressures were 7.4 +/- 1.4, 7.1 +/- 1.1, 7.2 +/- 1.0 mmHg in group P, I and E, respectively. During maintenance, group I did not show any statistically significant changes in epidural pressure, but pressure was reduced in group P and elevated in group E significantly 100 min after administering the maintenance anesthetics. CONCLUSIONS: Among the three anesthetic agents, propofol may be a more suitable maintenanace anesthetic agent for patients with increased ICP.
Adult ; Anesthesia ; Anesthetics ; Blood Pressure Monitors ; Catheters ; Ear, Middle ; Electrocardiography ; Enflurane* ; Glycopyrrolate ; Humans ; Injections, Intramuscular ; Intracranial Pressure ; Isoflurane* ; Monitoring, Physiologic ; Orthopedics ; Premedication ; Propofol*

PURPOSE: The changes in the levels of eicosanoids and isoprostane (8-iso-PGF2alpha) were investigated in brain tissue of 7 day-old rats after hypoxic-ischemic (HI) injury. METHODS: The 7 day-old newborn rats underwent right unilateral common carotid artery ligation followed by exposure to hypoxia with 8% oxygen for 150 minutes. There after, the pups were decapitated during reoxygenation 21% period of 0, 1, 6, 24, and 72 hours and their cerebral hemisheres were dissected through sagittal plane. Ipsilateral and contralateral cerebral hemesheres to common carotid artery ligation were used to determine the water content for estimation of severity of brain edema (n=5) and to measure the levels of eicosanoid and isoprostane (n=7). The levels of 6-keto-PGF1alpha, TXB2, and PGE2 were measured by RP-HPLC (reversed-phase high-performance liquid chromatography) and the levels of isoprostane (8-iso-PGF2alpha) were measured by enzyme immunoassay. The changes of eicosanoid and isoprostane levels during reoxygenation period were observed and comparisons between ipsilateral and contralateral hemispheres were done. RESULTS: The edema of ipsilateral cerebral hemesheres to common carotid artery ligation was more severe than that of contralateral cerebral hemisheres (P<0.05). The levels of 6-keto-PGF1alpha, TXB2, and PGE2 were found to increase during the early period of reoxygenation after HI insult, peak at 1 hour, and then decrease to the control levels at 72 hour (P<0.05). But, the levels of 8-iso-PGF2alpha did not significantly increase during the period of reoxygenation. The levels of 6-keto-PGF1alpha, TXB2, and PGE2 of ipsilateral hemispheres had a tendency to be higher than those of contralateral hemispheres during the initial 6 hour reoxygenation period, but the levels of 8-iso-PGF2alpha of ipsilateral hemispheres were significantly higher than those of contralateral hemispheres during the relatively later reoxygenation period (P<0.05). CONCLUSION: Reoxygenation after hypoxic-ischemic injury increased the levels of 6-keto-PGF1alpha, TXB2, and PGE2 in 7 day-old rat brain during the early period of reoxygenation, but the levels of isoprostane (8-iso-PGF2alpha) were not significantly increased during the reoxygenation period after HI injury.
Animals ; Anoxia ; Brain Edema ; Brain* ; Carotid Artery, Common ; Dinoprostone ; Edema ; Eicosanoids* ; Humans ; Immunoenzyme Techniques ; Infant, Newborn* ; Ischemia ; Isoprostanes* ; Ligation ; Oxygen ; Rats*

Osteoporotic fractures (OFs) are critical hard outcomes of osteoporosis and are characterized by decreased bone strength induced by low bone density and microarchitectural deterioration in bone tissue. Most OFs cause acute pain, hospitalization, immobilization, and slow recovery in patients and are associated with increased mortality. A variety of genetic studies have suggested associations of genetic variants with the risk of OF. Genome-wide association studies have reported various single-nucleotide polymorphisms and copy number variations (CNVs) in European and Asian populations. To identify CNV regions associated with OF risk, we conducted a genome-wide CNV study in a Korean population. We performed logistic regression analyses in 1,537 Korean subjects (299 OF cases and 1,238 healthy controls) and identified a total of 8 CNV regions significantly associated with OF (p < 0.05). Then, one CNV region located on chromosome 20q13.12 was selected for experimental validation. The selected CNV region was experimentally validated by quantitative polymerase chain reaction. The CNV region of chromosome 20q13.12 is positioned upstream of a family of long non-coding RNAs, LINC01260. Our findings could provide new information on the genetic factors associated with the risk of OF.
Acute Pain ; Asian Continental Ancestry Group ; Bone and Bones ; Bone Density ; DNA Copy Number Variations ; Genome-Wide Association Study ; Hospitalization ; Humans ; Immobilization ; Logistic Models ; Mortality ; Osteoporosis ; Osteoporotic Fractures* ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; RNA, Long Noncoding