Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 µg/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 µg/kg, 1-minute), and group 3 (high dose group, 0.2 µg/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO2 , respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times.In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

PURPOSE: To determine the change in lacrimal gland (LG) acinar cells induced by in vivo dry eye (DE). METHODS: Six to 8-week-old (C57BL/6) mice were placed in a controlled environment chamber at <20% humidity for 2 weeks, and a control group was bred in a normal environment. After these 2 weeks of dry eye (DE) induction, the mice were sacrificed and their LGs were collected. Lacrimal gland acinar cell organelle structures were observed with Transmission Electron Microscopy (TEM). TEM images were analyzed using the Image J program. RESULTS: The size of the LGs of DE-induced mice decreased compared to those of normal mice. Terminal deoxynucleotidyl transferase dUTP Nick End Labeling (TUNEL) staining was negative in DE-induced LGs. Under the TEM, the endoplasmic reticulum (ER) lumen was dilated and the lumen density increased in DE-induced mice. Additionally, cell organelles were surrounded by elongated ER lumens. The mitochondrial structure was destroyed and the number of vacuoles increased in the LGs of DE-induced mice. CONCLUSIONS: Structural changes of the LG developed due to DE induction. This suggests that the detailed mechanisms of these changes were ER stress and autophagy. However, there were no definite signs of apoptosis in the acinar cells of the DE-induced LGs. These findings are regarded as an important clue of the pathogenesis of non-Sjogren-type dry eye.
Acinar Cells* ; Animals ; Apoptosis ; Autophagy ; DNA Nucleotidylexotransferase ; Endoplasmic Reticulum ; Environment, Controlled ; Humidity ; Lacrimal Apparatus* ; Mice ; Microscopy, Electron, Transmission ; Organelles ; Vacuoles

Red ginseng (Panax ginseng), a Korean traditional medicinal plant, contains a variety of ginsenosides as major functional components. It is necessary to remove sugar moieties from the major ginsenosides, which have a lower absorption rate into the intestine, to obtain the aglycone form. To screen for microorganisms showing bioconversion activity for ginsenosides from red ginseng, 50 yeast strains were isolated from Korean traditional meju (a starter culture made with soybean and wheat flour for the fermentation of soybean paste). Twenty strains in which a black zone formed around the colony on esculin-yeast malt agar plates were screened first, and among them 5 strains having high beta-glucosidase activity on p-nitrophenyl-beta-D-glucopyranoside as a substrate were then selected. Strain JNO301 was finally chosen as a bioconverting strain in this study on the basis of its high bioconversion activity for red ginseng extract as determined by thin-layer chromatography (TLC) analysis. The selected bioconversion strain was identified as Candida allociferrii JNO301 based on the nucleotide sequence analysis of the 18S rRNA gene. The optimum temperature and pH for the cell growth were 20~30degrees C and pH 5~8, respectively. TLC analysis confirmed that C. allociferrii JNO301 converted ginsenoside Rb1 into Rd and then into F2, Rb2 into compound O, Rc into compound Mc1, and Rf into Rh1. Quantitative analysis using high-performance liquid chromatography showed that bioconversion of red ginseng extract resulted in an increase of 2.73, 3.32, 33.87, 16, and 5.48 fold in the concentration of Rd, F2, compound O, compound Mc1, and Rh1, respectively.
Absorption ; Agar ; Base Sequence ; beta-Glucosidase ; Candida* ; Chromatography, Liquid ; Chromatography, Thin Layer ; Fermentation ; Flour ; Genes, rRNA ; Ginsenosides* ; Hydrogen-Ion Concentration ; Intestines ; Panax* ; Plants, Medicinal ; Soybeans ; Triticum ; Yeasts

PURPOSE: To compare the corneal measurements of Sirius and Pentacam in normal cornea and post-corneal refractive surgery patients. METHODS: Subjects were tested by Pentacam (OCULUS, Wetzlar, Germany), and Sirius (CSO, Firenze, Italy). Measurements included central corneal thickness, thinnest corneal thickness, anterior chamber depth, anterior chamber volume, iridocorneal angle, corneal volume, pupil size, and curvature of cornea. RESULTS: A total of 88 eyes from 44 patients were included in the present study. When comparing Sirius and Pentacam in the normal cornea, corneal thickness (p = 0.693), thinnest corneal thickness (p = 0.386), anterior chamber depth (p = 0.155), anterior chamber volume (p = 0.650), and pupil diameter (p = 0.124) did not differ significantly. Corneal curvature (p < 0.001), corneal volume (p = 0.023), and iridocorneal angle (p < 0.001) were statistically different. When comparing Sirius and Pentacam in post-corneal refractive surgery patients, corneal thickness (p = 0.056) did not differ significantly. There was a statistical difference in corneal curvature (p < 0.001), thinnest corneal thickness (p = 0.019), anterior chamber depth (p < 0.001), anterior chamber volume (p < 0.001), iridocorneal angle (p < 0.001), corneal volume (p < 0.001), and pupil diameter (p < 0.001). CONCLUSIONS: Anterior segment measurements with Pentacam and Sirius showed differences in post-corneal refractive surgery patients.
Anterior Chamber ; Cornea ; Eye ; Humans ; Pupil ; Refractive Surgical Procedures

BACKGROUND: The host response to natural fibers results in granuloma formation in an effort to limit tissue destruction. Matrix metalloproteinases (MMPs) are important molecules in the inflammatory granulomatous or reparative reaction. Here, we studied the foreign body reaction that occurs following natural fibers implantation by investigating MMPs and tissue Inhibitor of MMPs (TIMPs) in an in vivo model. METHODS: Female Sprague-Dawley rats were treated with crocidolite fiber or fibrous talc via subcutaneous and intraperitoneal injections and immunohistochemistry was conducted to confirm the expression of MMPs and TIMP-2 in tissue sections. RESULTS: We identified that mineral fibers elicited granulomas. Fibrous talc or intraperitoneal injection resulted in larger granulomas and severe tissue destruction compared with the lesions induced by crocidolite or subcutaneous injection. The expression of MMPs was elevated while granulomatous lesions were formed. The relative levels of MMPs were lower in the talc injected or intraperitoneal route models than those of crocidolite injected or subcutaneous injection models during the entire experiment. CONCLUSIONS: These findings demonstrate that specific expression of MMPs/TIMP is inversely related to the grade of tissue destruction and suggest that expression of MMPs is required for promoting granuloma formation and limiting tissue destruction.
Animals ; Asbestos ; Asbestos, Crocidolite ; Female ; Foreign Bodies ; Foreign-Body Reaction ; Granuloma ; Humans ; Immunohistochemistry ; Injections, Intraperitoneal ; Injections, Subcutaneous ; Matrix Metalloproteinases ; Mineral Fibers ; Rats ; Rats, Sprague-Dawley ; Talc ; Tissue Inhibitor of Metalloproteinase-2

Abdominal pain associated with chronic pancreatitis is often difficult to control with analgesics and can be severely debilitating with significant impairment of quality of life. In these patients, neurolytic celiac plexus block (NCPB) is an effective treatment option with a low complication rate. However, there is a risk of ejaculatory failure after NCPB, which may be a problem in patients with a long life expectancy. We report a case of ejaculatory failure after unilateral NCPB in a patient with chronic pancreatitis.
Abdominal Pain ; Analgesics ; Celiac Plexus ; Humans ; Life Expectancy ; Pancreatitis, Chronic ; Quality of Life

In order to study the treatment of aneurysms, the technique of making experimental aneurysms in laboratory animals must be established. In our study, to examine the feasibility of making experimental aneurysm and selective angiography on the common carotid artery in rabbits and to determine the size of experimental aneurysm after surgery, saccular aneurysms were fashioned on the right common carotid artery in 17 rabbits using a vein pouch technique. Selective angiography of the common carotid artery was performed immediately after surgery, and at 1 week, 4 weeks, and 8 weeks after surgery. Also, histological changes in the aneurysms were observed. In 16 rabbits with established successful experimental aneurysm, no differences were found in diet intake and behavior before and after surgery. The patency of the carotid artery was confirmed by selective angiography. The average size of the aneurysm immediately after surgery was similar to that of 1 week postoperatively in selective angiography, however it increased with time at 4weeks and 8 weeks. Histologically, infiltration of inflammatory cells and hemorrhage were found at the junction of the carotid artery and the vein pouch at 1 week, which disappeared at 4 weeks and 8 weeks. This study suggests experimental saccular aneurysm using the vein pouch technique might form aneurysms similar to that of the human in its properties such as increment of size, and selective angiography might be suitable for assessment of experimental aneurysm. Therefore, this animal model may be suitable for investigating new treatment methodologies for human aneurysms.
Aneurysm ; Angiography ; Animals, Laboratory ; Carotid Arteries ; Carotid Artery, Common ; Diet ; Hemorrhage ; Humans ; Models, Animal ; Rabbits ; Veins

Stem cells are used for the investigation of developmental processes at both cellular and organism levels and offer tremendous potentials for clinical applications as an unlimited source for transplantation. Gangliosides, sialic acid-conjugated glycosphingolipids, play important regulatory roles in cell proliferation and differentiation. However, their expression patterns in stem cells and during neuronal differentiation are not known. Here, we investigated expression of gangliosides during the growth of mouse embryonic stem cells (mESCs), mesenchymal stem cells (MSCs) and differentiated neuronal cells by using high-performance thin-layer chromatography (HPTLC). Monosialoganglioside 1 (GM1) was expressed in mESCs and MSCs, while GM3 and GD3 were expressed in embryonic bodies. In the 9-day old differentiated neuronal cells from mESCs cells and MSCs, GM1 and GT1b were expressed. Results from immunostaining were consistent with those observed by HPTLC assay. These suggest that gangliosides are specifically expressed according to differentiation of mESCs and MSCs into neuronal cells and expressional difference of gangliosides may be a useful marker to identify differentiation of mESCs and MSCs into neuronal cells.
Neurons/*cytology/*metabolism ; Mice ; Mesenchymal Stem Cells/*cytology/*metabolism ; Gangliosides/*metabolism ; Embryonic Stem Cells/*cytology/*metabolism ; Cells, Cultured ; Cell Differentiation ; Animals

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been widely used for treatment of gastric mucosal tumors because of its relative safety and minimal invasiveness. However, the bleeding after EMR has been regarded as a major complication. Herein, we assessed the bleeding rates and risk factors related to bleeding after EMR. METHODS: We retrospectively analyzed the medical records of two hundred and fortynine patients with 283 lesions who underwent EMR for flat adenoma (78.8%), hyperplastic polyp (4.9%), and early gastric cancer (16.3%) from January 1999 to August 2003. Bleeding during EMR was defined as an immediate bleeding while bleeding on follow-up day endoscopy after EMR was considered as an delayed bleeding We evaluated risk factors related to bleeding using univariate and multivariate analysis. RESULTS: Bleeding after EMR occurred in 99 patients (35%). Immediate bleeding occurred in 31.8% and was more frequent in the case of beginners, upper part of the stomach or EMR prcedures using needle knife. Delayed bleeding occurred in 7.1% and was more frequent in the case of flat or depressed lesions, or occurrence after the incidence of immediate bleeding. Risk factors related to EMR bleeding were experience of operator (beginner vs. expert, p= 0.001), anatomical location (upper vs. lower, p=0.018), and methods of procedure (needle-knife vs. snare or band, p=0.001). CONCLUSIONS: We concluded that experience of operator, anatomical location, and method of procedure were the risk factors related to bleeding after EMR.
Adenoma ; Endoscopy ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Medical Records ; Multivariate Analysis ; Needles ; Polyps ; Retrospective Studies ; Risk Factors* ; SNARE Proteins ; Stomach ; Stomach Neoplasms

BACKGROUND/AIMS: Paradoxical reaction after midazolam administration is relatively uncommon and can obstruct the performance of ERCP. But it can not be predicted before drug administration. We investigate the difference in occurrence of paradoxical reaction according to personal characteristics and clinical status of patients. METHODS: During 155 ERCP procedures, we injected midazolam and meperidine intravenously for conscious sedation until deep sleep occurred. Among 155 patients, 108 patients did not showed paradoxical reaction (group I) and 47 patients (30.3%) showed gross behavioral disturbance and/or agitation (group II). Paradoxical agitation was seen in 9 (7.1%) procedures. RESULTS: Type A-like personality (p=0.002), sleep-talking habit (p=0.026) and presence of pain at the beginning of ERCP (p=0.036) and during ERCP (p=0.021) were seen more frequently in group II. Duration of ERCP was longer (p=0.034) and dosage of midazolam was larger (p=0.009) in group II. In multivariate analysis, having sleep-talking (OR, 5.5), type A-like personality (OR 3.9) and dosage of midazolam (OR 1.3) were risk factors of paradoxical reaction. CONCLUSIONS: Paradoxical agitation after midazolam administration was uncommon and can be managed with flumazenil. Paradoxical reaction can be predicted more often in patients with type A-like personality, sleep-talking habit, complaining pain before ERCP, and in patients injected large dosage of midazolam.
Cholangiopancreatography, Endoscopic Retrograde* ; Conscious Sedation* ; Dihydroergotamine ; Flumazenil ; Humans ; Meperidine ; Midazolam* ; Multivariate Analysis ; Risk Factors