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Background Myxomatous mitral valve degeneration (MMVD) is the most common degenerative heart disease in dogs and is associated with irreversible changes in the valve tissue. Although traditional cardiac biomarkers are efficient for diagnosing MMVD, there are limitations, therefore, it is important to find novel biomarkers. Cartilage intermediate layer protein 1 (CILP1), an extracellular matrix-derived protein, acts as a transforming growth factor-β antagonist and is involved in myocardial fibrosis. This study aimed to evaluate serum CILP1 levels in canines with MMVD. Dogs with MMVD were staged according to the American College of Veterinary Internal Medicine consensus guidelines. Data analysis was performed using the Mann–Whitney U test, Spearman’s correlation, and receiver operating characteristic (ROC) curves. Results CILP1 levels were elevated in dogs with MMVD (n = 27) compared to healthy controls (n = 8). Furthermore, results showed that CILP1 levels were significantly higher in stage C group dogs compared to healthy controls. The ROC curve of CILP1 and NT-proBNP were good predictors of MMVD, although no similarity was observed between the two. Left ventricular end-diastolic diameter normalized to the body weight (LVIDdn) and left atrial to aorta dimension (LA/Ao) showed a strong association with CILP1 levels; however, no correlation was observed between CILP1 levels and vertebral heart size (VHS) and vertebral left atrial score (VLAS). The optimal cut-off value was selected from the ROC curve and dogs were classified according to the cut-off value (1.068 ng/mL, sensitivity 51.9%, specificity 100%). Results showed a significant association of CILP1 with cardiac remodeling indicators, such as VHS, VLAS, LA/Ao, and LVIDdn. Conclusions CILP1 can be an indicator of cardiac remodeling in canines with MMVD and therefore, can be used as an MMVD biomarker.

IntroductionHouse dust mites (HDM) are regarded as essential environmental allergens not only in human, but also in canine atopic dermatitis (CAD), however, there are only a few studies on the influence of indoor HDM concentration on the disease.MethodsOur study analyzed the correlation between the indoor HDM concentration, the severity of CAD, and the residential environments in client-owned 35 AD and 13 healthy dogs. We measured the extent of CAD and severity index-04 (CADESI-04), pruritus visual analog scale (PVAS), and transepidermal water loss (TEWL), indoor relative humidity (RH) and analyzed the residential environment questionnaires to evaluate AD severity.ResultsThe Der f 1 concentration had an inverse association with TEWL, and no association with CADESI-04 and PVAS. The Der f 1 concentration was significantly high in the group living near the green area and 40% or higher RH.DiscussionOur results suggest two possibilities: (1) Living around green areas and maintaining an appropriate indoor climate may help to improve CAD clinical symptoms. (2) The HDM may contain endotoxin and when present in high concentrations in CAD, they play a preventive role by enhancing the skin barrier function. Further studies with a larger number of dogs may help further elucidate an association between CAD and Der f 1.

BackgroundAutophagy was reported to play a crucial role in maintaining general and skin health.MethodsThe study used a synthesized autophagy inducer (AI) (Aquatide™ cospharm Inc.; Daejeon, Korea), for evaluating the effects of autophagy on skin and hair in dogs. Twenty-two dogs with poor skin and hair which were diagnosed with canine atopic dermatitis (CAD) or pituitary-dependent hyperadrenocorticism (PDH) were included. Clinical scores using Canine Atopic Dermatitis Extent and Severity Index-04 (CADESI-04), Pruritus Visual Analog Scale (PVAS) and skin barrier function using measurement of transepidermal water loss (TEWL) were evaluated and canine keratinocytes were also used in vitro investigation of pro-inflammatory cytokines after AI treatment.ResultsIn the AI group, clinical scores and skin barrier function were improved at week 8 significantly compared to in the other groups. In particular, the AI significantly improved the hair surface damage at 8 weeks compared to the baseline. In vitro, the AI reduced pro-inflammatory cytokines by activating the 78-kDa glucose-regulated protein (GRP78).ConclusionAI improve skin barrier function and hair damage and reduce pro-inflammatory cytokines by inhibiting reactive oxygen species (ROS) production in dogs.

Applying a pneumatic tourniquet provides surgeons with a bloodless surgical field. However, application of the tourniquet induces various physiological changes. We evaluated the effect of tourniquet deflation on the intracranial pressure by using ultrasonography to measure the optic nerve sheath diameter (ONSD) in patients undergoing lower limb surgery. The ONSD was measured in 20 patients at five time points: after anesthetic induction (T0) and immediately before (T1), immediately after (T2), 5 min after (T3), and 10 min after tourniquet deflation (T4). Hemodynamic and respiratory variables were recorded. The ONSD showed significant differences at each point (P Trial registration: ClinicalTrials.gov (NCT03782077).

The objective of this study was to evaluate the efficacy of an imidacloprid 10% and flumethrin 4.5% polymer matrix collar against the developmental stages of Haemaphysalis longicornis infesting dogs using the hair from treated dogs in a semi-in-vitro assay set. When incubated with 0.5 g of the hair collected from the dogs installed with the drug-embedded collar after 10 days, average death rate of the larval, nymphal, and adult H. longicornis was 21.5%, 77.9%, and 100% at 30 min, 1 hr, and 2 hr, respectively. This study showed the larval stages as well as the nymphal and adult stages of H. longicornis ticks are killed upon contact with the hair from dogs treated with the collar within 2 hr.

Background/Aim: N1S1 rat models are commonly used in human medicine to study hepatocellular carcinoma (HCC). However, their use in veterinary medicine has not been reported. Thus, the aim of this study was to investigate whether the N1S1 rat models could be used to study canine HCC. Materials and Methods: The animals were divided into four groups: normal rat, N1S1 rat, normal dog, and HCC dog. Liver tissues of all animals were evaluated for vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), platelet-derived growth factor receptor (PDGFR)-α, PDGFR-β, and c-kit by immunohistochemistry. Slides of each factor were scored according to the percentage of stained tumor cells and intensity of the staining. Results: Scores of VEGF and c-kit were high both in the tumor groups (the N1S1 rat and HCC dog groups) and the normal groups of dogs and rats. PDGFR-α was lower in the N1S1 rat group than that in the normal rat group (p=0.0042). It was also lower in the HCC dog group compared to the normal dog group (p=0.0008). PDGFR-β was higher in the HCC dog group than that in the normal dog group (p=0.0023) but was not detectable in the rat groups. EGFR was not detectable in any group. Conclusion: Based on immunochemistry results, PDGFR-α and PDGFR-β can be used as biomarkers of canine HCC. Because PDGFR-α showed consistency between rats and dogs, it can be used for studying canine HCC.

BACKGROUND AND OBJECTIVES Patients who undergo total knee arthroplasty (TKA) have a risk of postoperative anaemia. This observational study evaluated whether single-dose intravenous ferric carboxymaltose (FCM) administered immediately after TKA facilitates the correction of anaemia. MATERIALS AND METHODS We retrospectively analysed 722 patients who underwent primary TKA. The FCM group receiving 1000 mg intravenous FCM within one postoperative hour was compared with the non-FCM group that did not receive the medication. A propensity score matching with multiple logistic regression analysis was used to minimize intergroup differences in the baseline characteristics and postoperative blood loss. The rate and severity of postoperative anaemia were compared between the groups, along with haemoglobin (Hb) value, transfusion rate and complications. RESULTS After propensity score matching, 231 patients were included in each group. In the FCM group, the rate of anaemia at postoperative day (POD) 7 (p = 0.021) and postoperative week (POW) 5 (p

Case 1, a 6-year-old, spayed female Pug, presented with severe systemic urticaria, edema, and erythema. The dog had received a famotidine injection as a treatment for repeated vomiting in another hospital. On physical examination, hyperthermia was observed. Moderate pancytopenia, hypoalbuminemia, and increased CRP and D-dimer were also observed in blood tests. Hyposthenuric proteinuria, pulmonary interstitial infiltration, and hepatomegaly were found in other tests. In the histology of the skin, dermal edema and infiltration of inflammatory cells were observed. Therefore, she was diagnosed with acute systemic hypersensitivity. Case 2, a 13-month-old, neutered male Pembroke welsh corgi, presented with severe and patchy systemic ulcerative skin lesions. The dog had a history of soft feces and pain around the anus 2 days before. Thrombocytopenia, and increased CRP and D-dimer were observed in blood tests. In histology, epidermal necrolysis, separation of the epidermis and dermis, and infiltration of inflammatory cells were observed. Therefore, he was diagnosed with an immune-mediated disease with necrolysis dermatitis. Case 3, a 12-year-old, spayed female Pomeranian, presented with severe systemic alopecia, pustule, and crust on the skin. The dog had received an infection treatment from a local hospital. Severe regenerative anemia (hematocrit 15.3%, negative saline agglutination test, negative slide agglutination test, negative Coomb's test, prominent spherocytes) elevated liver enzymes, and increased CRP and D-dimer were observed in blood tests. On histopathology of the skin, pustules, acantholytic cells, and inflammatory cells were observed in the keratin layer of the epithelium. Therefore, she was diagnosed with Pemphigus foliaceus concurrent with immune-mediated hemolytic anemia. The 3 cases were diagnosed with fatal immune-mediated skin disease concurrently with hematological and systemic abnormalities. All the cases were treated with immune-suppressive drugs, prednisolone, and cyclosporine. In cases 2 and 3, the dogs also received human intravenous immunoglobulin as an immune modulator. The treatment was successful with significant improvements in all the 3 cases.

An 8-year-old, spayed female Maltese dog was presented with a one-month history of erythema, swelling and alopecia of periocular region with pruritus. The skin lesions were first detected at the age of three years, but this was the first time that symptoms had appeared in the eyes. Physical examination revealed markedly swollen and erythematous eyelids and conjunctiva including Meibomian glands. In addition, periocular alopecia and tears were identified. Slit lamp microscopy revealed erythema of conjunctiva and swelling of Meibomian glands. The Schirmer’s tear test was normal. Impression smear cytology of eyes revealed sterile neutrophils and corneal epithelial cells. There were no virus or bacterial infections in the eyes. On skin examination, generalized erythema was detected but there were no other skin lesions. A case of allergic blepharoconjunctivitis associated with canine atopic dermatitis was diagnosed based on history taking and skin examination. Treatment included cetirizine, cyclosporine, prednisolone and Forus eye drops®. The owner was instructed to wear an Elizabethan collar around his dog's neck at all times and restrict walking. And the diet was changed to hypoallergenic dog food. Medications and environmental restrictions significantly reduced erythema, edema and swelling of meibomian glands. Pruritus was also decreased. Six weeks later, the edema lesions of eyes disappeared.

Background Cutaneous cysts are common in dogs, and surgical resection is the recommended treatment. However, additional therapy may be required for ruptured follicular cysts with severe cutaneous complications. Case presentation A 3‐year‐old neutered male Samoyed was presented with multifocal masses on the forelimbs. A 5‐year‐old neutered female Maltese was also presented with multiple masses and ruptured lesions, which were ulcerative and painful, around the parotid and submandibular glands. The lesions were examined cytologically. In addition, bacterial and fungal cultures and histopathologic examination were performed. Cutaneous multifocal nodules in the Samoyed could not be diagnosed via cytological examination or bacterial/fungal culture. Histopathology revealed numerous follicular cysts with multiple pyogranulomas of various sizes, some of which contained central keratin debris. In the Maltese, cytologic examination revealed central keratins or enucleated ghost cells in the intact cysts and few keratinized squamous cells mixed with neutrophils, mucus and metachromatic cells in the ruptured cysts. Histopathologic examination revealed severely dilated follicular cysts. Oral steroid and cyclosporine therapy resulted in marked improvement in the aseptic pyogranulomas after 2 weeks in formal case and combined with a surgery for residual cysts in latter case. Conclusions We have reported two canine cases of ruptured follicular cysts causing foreign body‐like aseptic pyogranulomas around cutaneous tissues and their successful management with pharmacological therapy and surgery., We have reported two canine cases of ruptured follicular cysts causing foreign body‐like aseptic pyogranulomas around cutaneous tissues and their successful management with pharmacological therapy and surgery.

A 9‐year‐old intact female toy poodle was presented with oedema around the neck, including pus and cutaneous necrosis, 2 days after starting firocoxib treatment and placement of a cervical collar for intervertebral disc disease. Cytology of the pus revealed predominantly mature neutrophils with fewer macrophages and lymphocytes, indicating sterile inflammation. Although a skin biopsy could have provided more diagnostic information, it was not performed at presentation. Firocoxib treatment was discontinued, and immunosuppressive therapy including cyclosporine was initiated, which significantly alleviated the skin lesions. The dog recovered fully in 7 weeks. The final diagnosis was a possible cutaneous adverse drug reaction to firocoxib based on history, clinical signs and response to therapy., Firocoxib, a selective cyclooxygenase (COX)‐2 enzyme inhibitor, is commonly prescribed for various conditions in dogs. It can cause a cutaneous adverse drug reaction and this case report describes a successful medical management of that.

Background and Objectives: Recent studies revealed that the extremely low activity of serum alanine aminotransferase (ALT) is associated with frailty and contributes to increased mortality after acute physical stress. We aimed to investigate whether the extremely low activity of serum ALT (

Postoperative delirium is a common complication in elderly patients who have undergone hip fracture surgery. Since postoperative delirium is associated with poor outcomes and the treatment is very complicated, identifying the patients at high risk for delirium and providing more attentive care to prevent postoperative delirium is essential. In this study, we aimed to assess the association of an elevated C-reactive protein (CRP)/albumin ratio with the increased incidence of postoperative delirium in elderly people who had undergone hip fracture surgery.A total of 629 patients who underwent hip fracture surgery between January 2014 and December 2018 were retrospectively analyzed. Patients were classified into two groups according to preoperative CRP/albumin cut-off levels (1.5 and ≥1.5). We performed a propensity score matching analysis to compare the incidence of postoperative delirium and overall mortality between the two groups. Multivariate logistic regression and Cox regression analyses were performed to examine the association of the preoperative CRP/albumin ratio with postoperative delirium and overall mortality.There were significant differences in the incidence of postoperative delirium (18.0 % vs. 35.8 %, P 0.001) and overall mortality (26.7 % vs. 46.9 %, P 0.001) between the groups before matching. We also observed significant differences in the incidence of postoperative delirium (20.7 % vs. 32.7 %, P = 0.019) and overall mortality (34.7 % vs. 46.0 %, P = 0.046) between the groups after matching. A high CRP/albumin ratio (≥1.5) was significantly associated with a higher incidence of postoperative delirium (adjusted odds ratio [OR]: 2.11, 95 % confidence interval [CI]: 1.40-3.18, P 0.001) and a higher rate of overall mortality (adjusted hazard ratio [HR]: 1.44, 95 % CI: 1.07-1.93, P = 0.015).Preoperative CRP/albumin ratio might be an independent risk factor of postoperative delirium and surgical prognosis in elderly patients undergoing hip fracture surgery.

While the use of fluoroscopy-guided transforaminal epidural steroid injection (TFESI) to help spread the injectate toward the ventral side has increased, this procedure has a radiation risk. Recently, ultrasound has been widely used in the medical field; among ultrasound methods, color Doppler is useful for predicting the direction of the injectate.This study describes a novel technique employing color Doppler to help predict epidural space spread in interlaminar epidural steroid injection (ILESI).Prospective observational study.The study took place at a single pain clinic within a medical center in Jeonju, Republic of Korea.We enrolled 35 patients scheduled for lumbar epidural steroid injection (ESI). Ultrasound-guided epidural lateral parasagittal interlaminar injection was performed and real-time images using color Doppler were recorded during injections of 5 mL of 0.1% ropivacaine containing contrast dye with dexamethasone 5 mg (1 mL). Fluoroscopy-guided TFESI was performed if it was difficult to perform the procedure based on ultrasound images.The analysis included 30 images from 30 patients. The observed sensitivity, specificity, positive predictive value, and negative predictive values of the ultrasound color Doppler were 100%, 89.5%, 84.6%, and 100%, respectively. The agreement with ultrasound color Doppler was 93.3%.The sample size was relatively small.The main advantage of ultrasound-guided ILESI is the lack of radiation exposure and contrast medium requirement. Color Doppler may be a reliable imaging modality to predict epidural space spread during ultrasound-guided ILESI. It is worth predicting the spread in the anterior epidural space (AES) by first attempting ultrasound-guided ESI. If the injectate has not spread to the AES, fluoroscopy-guided TFESI may be a good option after confirming improvement of the patient's symptoms.

Background Hyperthermia is relatively rare during general anesthesia; however, a few studies have been conducted on hyperthermia and the neuromuscular blockade (NMB) induced by rocuronium, and the reversal of NMB by sugammadex. We investigated the effect of hyperthermia status on the NMB induced by rocuronium, and its reversal by sugammadex, in isolated phrenic nerve hemidiaphragm (PNHD) preparations of the rat. Methods Thirty-three male Sprague-Dawley rat PNHD preparations were randomly assigned to three groups at different temperatures (36 °C, 38 °C, and 40 °C; each group, n = 11, in Krebs solution). The train-of-four (TOF) and twitch height responses were checked mechanomyographically. The PNHD were treated with progressively increasing doses of rocuronium and three effective concentrations (ECs), EC50, EC90, and EC95, of rocuronium were analyzed in each group via nonlinear regression analysis. Then, sugammadex was administered in doses equimolar to rocuronium. Thereafter, the T1 height (%), TOFR (%) and the duration index were measured. Results The EC of rocuronium (EC50, EC90, and EC95) decreased significantly in accordance with increasing temperature. The groups at 36 °C and 40 °C showed clear differences in all areas (all P Conclusion A rise of temperature from 38 °C to 40 °C in rat PNHD preparations proportionally enhanced the NMB induced by rocuronium. In addition, equimolar doses of sugammadex to the administered rocuronium showed a slower recovery time as the temperature rises.

The aim of this study was to determine whether serum symmetric dimethylarginine (SDMA) and cystatin C (CysC) levels can be utilized as more accurate markers of early kidney dysfunction in dogs. Forty-one client-owned dogs with chronic kidney disease (CKD), which were clinically stable, and ten beagles as healthy controls were included. All dogs underwent physical examination, systemic blood pressure measurement, complete blood cell count, and plasma biochemistry analyses. Frozen serum was used for SDMA and CysC analyses. Data analysis was performed using Kruskal Wallis, Pearson's correlation, Bland-Altman plots, and receiver operating characteristic curve. SDMA and CysC levels were significantly higher in patients with CKD at various International Renal Interest Society (IRIS) stages than in the healthy controls. In particular, CysC level was the only biomarker that could indicate the earliest stage of CKD (IRIS stage I). Similar to these results, CysC level showed better sensitivity and specificity compared to the other biomarkers in early CKD dogs.

Purpose Alterations in the intestinal microbiota in early life affects the development of atopic dermatitis (AD) in humans. This study aimed to further investigate the effects of gut dysbiosis in early life in an ovalbumin (OVA)-induced mouse model of AD. Methods The AD mouse model was developed by serial OVA sensitization and mice were treated with an antibiotic cocktail in their drinking water for 2 weeks before primary sensitization. Probiotics (Lactobacillus rhamnosus, 1 × 10⁹ CFU) or 100 μL of fresh fecal supernatant were orally administered daily from 1 week before the first sensitization until the end of the study. Results The AD mice which received antibiotics had significantly aggravated phenotypes, including clinical score, transepidermal water loss, and histopathology, compared to those treated with healthy feces or probiotics. Total systemic immunoglobulin E production and skin interleukin (IL) 4 levels were significantly increased in the antibiotic-treated mice compared to the other groups. Antibiotic treatment also increased the levels of IL17 and group 3 innate lymphoid cells (ILC3) in the gut and significantly suppressed the production of short-chain fatty acids (SCFAs) and decreased the number FOXP3⁺ cells. Conclusions Our results suggest that the status of the gut microbiota in early life in the mouse may play a crucial role in AD development through intestinal SCFA production through regulate the numbers of CD4⁺IL17⁺/CD4⁺FOXP3⁺ regulatory T cells and ILC3s.

Background Neuromuscular blocking agents (NMBAs) and neuromuscular monitoring in anesthetic management are integral for endotracheal intubation, better visualization of the surgical field, and prevention of residual neuromuscular blockade and pulmonary complications. Sugammadex is a drug that reduces risk of residual neuromuscular blockade, with more rapid recovery compared to anticholinesterase. The purpose of this study was to investigate current usage status of NMBAs and antagonist with neuromuscular monitoring, among anesthesiologists in Korea. Methods Anesthesiologists working in Korea were invited to participate in an online survey via email January 2-February 28, 2018. The questionnaire consisted of 45 items, including preferred NMBAs, antagonists, neuromuscular monitoring, and complications related to the use sugammadex. A total of 174 responses were analyzed. Results Rocuronium was a commonly used NMBA for endotracheal intubation (98%) of hospitals, and maintenance of anesthesia (83.3%) in of hospitals. Sugammadex, pyridostigmine, and neostigmine were used in 89.1%, 87.9%, and 45.4% of hospitals. Neuromuscular monitoring was employed in 79.3% of hospitals; however only 39.7% of hospitals used neuromuscular monitoring before antagonist administration. Usual dosage range of sugammadex was 2.1-4 mg/kg in 35.1% of hospitals, within 2 mg/kg in 34.5% of hospitals, and 1 vial regardless of body weight in 22.4% of hospitals. Sugammadexrelated complications were encountered by 14.9% of respondents. Conclusions This survey indicates several minor problems associated with the use of antagonists and neuromuscular monitoring. However, most anesthesiologists appear to have appropriate information regarding the usage of NMBAs and sugammadex.

Background/Aim: No study has investigated skin barrier dysfunction with systemic diseases in veterinary medicine. We investigated the mechanism of disturbed skin barrier function in dogs with internal diseases. Materials and Methods: Healthy controls and dogs with systemic diseases were enrolled in three different disease groups: malignant tumor, hyperadrenocorticism and kidney disease. Transepidermal water loss (TEWL), serum levels of five selective pro-inflammatory cytokines and claudin-1, and complete blood count were measured. Results: TEWL was significantly increased in the malignant tumor group while serum claudin-1 concentrations were significantly lower compared to controls. Tumor necrosis factor-α was also significantly increased in the cancer group. In addition, the malignant tumor group showed significantly higher monocyte chemotactic protein-1 after chemotherapy, but lower interleukin-6 levels, compared to dogs with no chemotherapy. Conclusion: Skin barrier function was decreased in dogs with malignant tumors compared to dogs with other systemic diseases by oxidative stress and a reduction in tight junction proteins.

Staggered bilateral total knee arthroplasty, two procedures performed 4-7 days apart during a single hospitalization, has an increased risk of blood transfusion. This observational study aimed to evaluate whether immediate post-operative single, high-dose intravenous iron supplementation could reduce transfusion requirements and facilitate anaemia recovery in patients.We retrospectively analysed 131 patients who underwent staggered bilateral total knee arthroplasty. The ferric carboxymaltose (FCM) group received 1000 mg of FCM after the first operation. The non-FCM group did not receive intravenous iron. The transfusion rate and post-operative complications were compared between the groups. The anaemia rate was evaluated pre-operatively, during hospitalization, and 5 weeks after the second total knee arthroplasty.The FCM group comprised 78 patients (59.5%). The rate (21.8% vs. 47.2%, p = 0.004) and amount of transfusion (0 [0-2] vs. 0 [0-0], p = 0.001) was significantly lower in the FCM group than in the non-FCM group. Although both groups' pre-operative haemoglobin concentrations were not significantly different, the FCM group demonstrated higher haemoglobin values 5 weeks post surgery (12.25 ± 0.83 mg/dl vs. 11.48 ± 1.36 mg/dl, p 0.001). More non-FCM patients developed moderate to severe anaemia at 5 weeks post surgery (p 0.001). The mortality and complication rates were not significantly different.Immediate post-operative, high-dose, intravenous iron treatment may contribute to reduced transfusion rates, facilitate haemoglobin recovery after staggered bilateral total knee arthroplasty, and minimize the development of moderate to severe anaemia.

Background and Objectives: Some of the postoperative complications following orthopaedic surgeries are associated with a systemic inflammatory response (SIR), which varies depending on the anaesthetic technique. We aimed to compare the effects of general and spinal anaesthesia on the SIR after total knee arthroplasty (TKA), based on C-reactive protein (CRP) levels, the platelet-lymphocyte ratio (PLR), and the neutrophil-lymphocyte ratio (NLR). Materials and Methods: Patients who underwent TKA between January 2014 and December 2018 were included. Electronic medical records of the patients were retrospectively reviewed and analysed. To reduce the impact of potential confounding factors, we performed propensity score matching according to the anaesthetic technique. Results: A total of 1311 TKA cases were analysed. After propensity score matching, the maximal CRP value and changes in CRP levels in the general anaesthesia group were higher than those in the spinal anaesthesia group. However, the maximal NLR and PLR and the changes in NLR and PLR were not different between the two groups. There were no differences in postoperative clinical outcomes. Conclusion: Spinal anaesthesia tended to induce a lower inflammatory response than general anaesthesia when considering CRP levels in patients undergoing TKA. However, the effects of anaesthetic techniques on the overall outcomes were not significant.

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

Background and Objectives: Although epidural steroid injections are used as an effective treatment, this technique is associated with rare but serious ischemic complications, especially when particulate steroids are used. However, recent studies have reported that even if non-particulate steroids are used, particulates are formed by the interaction with some local anesthetics (LA), causing ischemic complications. This observational study evaluated commonly used combinations of non-particulate steroids and LA with contrast media via microscopic analysis and analyzed the chemical properties of each mixture to identify the correlation of particulate formation. Materials and Methods: Commonly used clinical non-particulate and particulate steroids, contrast media, and LA agent combinations were evaluated macroscopically and microscopically. The pH values were also measured at both room temperature (26 °C) and body temperature (36 °C). Where particulates were observed, the particulate size was measured. Results: Macroscopically, the mixture of non-particulate steroid and ropivacaine had a slightly cloudy appearance at all concentrations, but there was no visible particulate. However, when observed under a microscope, the pH-dependent particulate formation was observed at all concentration combinations tested. (0.1% ropivacaine: from 19 μm to 70 μm, and 0.2% ropivacaine: from 37 μm to 108 μm at room temperature (26 °C)). When contrast media was mixed or the temperature was raised to body temperature (36 °C), the number and size of the particulates decreased or dissolved. Conclusions: The combination of ropivacaine and dexamethasone, a non-particulate steroid, mainly used in epidural injections, forms particulates. However, when mixed with contrast media, particulates are dissolved because of changes in pH and factors affecting particulate formation. In fluoroscopy-guided injections, the use of contrast media could resolve particulate formation.

Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%, the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period.

The psoas-to-lumbar index (PLVI) has been reported as a simple and easy way to measure central sarcopenia. However, only few studies have evaluated the association between PLVI and survival in surgical patients. This study evaluated the association between preoperative PLVI and mortality in elderly patients who underwent hip fracture surgery. We retrospectively analyzed 615 patients who underwent hip fracture surgery between January 2014 and December 2018. The median value of each PLVI was calculated according to sex, and the patients were categorized into two groups on the basis of the median value (low PLVI group vs. high PLVI group). Cox regression analysis was performed to evaluate the risk factors for 1 year and overall mortalities. The median values of PLVI were 0.62 and 0.50 in men and women, respectively. In the Cox regression analysis, low PLVI was significantly associated with higher 1 year (hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.18–2.96, p = 0.008) and overall mortalities (HR: 1.51, 95% CI: 1.12–2.03, p = 0.006). Low PLVI was significantly associated with a higher mortality. Therefore, PLVI might be an independent predictor of mortality in elderly patients undergoing hip fracture surgery.

Purpose Protease-activated receptor 2 (PAR2) reportedly triggers the immune response in allergic asthma. We aimed to investigate the mechanism on allergic inflammation mediated by PAR2. Methods Human lung epithelial cells (A549 cells) were used for in vitro, and the German cockroach extract (GCE)-induced mouse model was developed for in vivo studies. Results In A549 cells, the levels of reactive oxygen species (ROS) and thymic stromal lymphopoietin (TSLP) were significantly increased by GCE treatment, but were suppressed by PAR2-antagonist (PAR2-ant) or N-acetylcysteine (NAC) treatment. Claudin-1 was degraded by GCE, and was restored by PAR2-ant or NAC in the cells. In the mouse model, the clinical appearance including bronchial hyperresponsiveness, bronchoalveolar lavage fluid analysis and total immunoglobulin E were significantly suppressed by PAR2-ant or NAC. Moreover, TSLP levels in the lung were suppressed by the same treatments in the lung. Claudin-1 was also degraded by GCE, and was restored by PAR2-ant or NAC. Conclusions ROS generation and epidermal tight junction degradation are triggered by protease, followed by the induction of TSLP in allergic asthma. Our findings could suggest that PAR2-ant or anti-oxidants could be considered for allergic diseases as preventive alternatives.