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Background Serine synthetic pathway plays an essential role in the development and function of the nervous system. This study investigated whether the serine synthetic pathway was affected by repeated volatile anesthetic exposure using C. elegans and its relationship with anesthesia-induced neurotoxicity. Methods Synchronized worms were divided into two groups: the control and isoflurane groups. Worms in the isoflurane group were exposed to isoflurane for 1 h at each larval stage. The chemotaxis index was evaluated when they reached the young adult-stage in both groups. Also, RNA was extracted from the young adult-worms, and the expressions of C31C9.2, F26H9.5, and Y62E10 A.13 were evaluated using real-time polymerase chain reaction in both groups. At the same time, the l -serine level was measured. After phosphoserine phosphatase inhibitor – glycerophosphorylcholine (GPC) – and l -serine were treated, the change of chemotaxis index was determined. Results In young adult worms exposed to isoflurane, the genetic expressions of C31C9.2, F26H9.5, and Y62E10 A.13 were decreased, and a significant decrease was shown in Y62E10 A.13. The serine level in worms was also lower in the isoflurane group than in the control group (5.13 ± 1.44 vs. 7.65 ± 0.81 pM, n = 5 in each group, p = 0.009). Exposure to GPC reduced the chemotaxis index to a similar degree as repeated isoflurane exposure (52.9% in GPC group vs 58.7% in the isoflurane group). The chemotaxis index (61.1%) was not decreased by repeated isoflurane anesthesia in GPC-treated worms. In this condition, the l -serine level was low similarly in both groups (5.22 ± 1.19 vs. 4.90 ± 1.36 pM, n = 5 in each group, p = 0.702). When l -serine was supplied to C. elegans, the deteriorated chemotaxis index by isoflurane exposure recovered (78.1% in the control group vs. 75.5% in the isoflurane group, p = 0.465). Conclusion Serine synthetic pathway was negatively affected in C. elegans by repeated isoflurane exposure. Y62E10 A.13, which corresponds to phosphoserine phosphatase, was mostly influenced, followed by low l -serine level. Supplementation with l -serine could restore the chemotaxis index.

The effect of the Mega Acer kit@, a new heated and humidified breathing circuit (HHBC) containing a fluid-warming device, was investigated on intraoperative core temperature (T c). A total of 102 patients undergoing elective craniotomies were randomly divided into three groups based on the breathing circuit used: a conventional breathing circuit (group C, n = 34), a Fisher & Paykel HHBC (group F, n = 34), and the Mega (group M, n = 34). From baseline to the end of the surgery, T c and infusion fluid temperature (T f) were recorded at 15-min intervals. If T c became lower than 35.5 °C, a forced-air warmer was used. Baseline temperatures were 36.7 ± 0.3, 36.6 ± 0.2, and 36.6 ± 0.2 °C in groups C, M, and F, respectively. T c at the end of surgery dropped from baseline values by 1.0 ± 0.4, 0.5 ± 0.5, and 0.8 ± 0.5 °C in groups C, M, and F, respectively. From 60 min of post-induction to the end of surgery, T c was higher in group M than group C (p

The optimal timing of tracheostomy in neurosurgical patients is not well established. This retrospective study was conducted to determine the effect of the timing of tracheostomy on clinical outcome in mechanically ventilated neurosurgical patients admitted to the surgical intensive care unit (ICU).A total of 125 neurosurgical patients, who underwent tracheostomy and had total mechanical ventilation (MV) duration of ≥7 days from October 2007 to December 2011, were enrolled. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 10 days of MV in the early group (group E, n=39), whereas in the late group, it was performed after 10 days of MV (group L, n=86). The ICU and in-hospital mortality rates, total duration of MV, length of stay (LOS) in the ICU, hospital LOS, and incidence of ventilator-associated pneumonia (VAP) were compared between both the groups.The total MV duration and ICU LOS were significantly longer in group L than E (21.5±15.5 vs. 11.4±5.6 d, P0.001; 31.1±18.2 vs. 19.9±10.6 d, P0.001). The incidence of VAP before tracheostomy was higher in group L than group E (44 vs. 23%, P0.05). No significant difference was found in the ICU and in-hospital mortality rates and hospital LOS between the groups.Early tracheostomy reduced the MV duration, ICU LOS, and incidence of VAP in critically ill neurosurgical patients. However, early tracheostomy did not reduce either the ICU or hospital mortality.

The objective of the present study was to evaluate anti-inflammatory effects of betulinic acid on lipopolysaccharide (LPS)-stimulated BV2 microglial cells. Pretreatment of betulinic acid significantly attenuated LPSinduced NO production and protein expression of iNOS. Betulinic acid also significantly suppressed LPS-induced release and expression of cytokines such as TNF-α and IL-1β. Furthermore, betulinic acid significantly suppressed LPSinduced MMP-9 expression, which has been suggested to play an important role in the migration of activated microglia. In order to understand the possible mechanism by which betulinic acid suppresses LPS-induced cytokine production and migration of microglia, the role of NF-kB, a major proinflammatory transcription factor, was examined. Betulinic acid significantly suppressed LPS-induced degradation of IkB, which retains NF-kB in the cytoplasm. Therefore, nuclear translocation of NF-kB upon LPS stimulation was significantly suppressed bybetulinic acid. Taken together, the present study for the first time demonstrates thatbetulinic acid possesses anti-inflammatory activity and inhibition of microglial migration through the suppression of nuclear translocation of NF-kB in BV2 microglial cells.

Minimizing hemodynamic changes during the peri-intubation period is a concern for anesthesiologists. We investigated the effect of lidocaine sprayed on the laryngoscope blade and trachea on hemodynamics during direct laryngoscopic intubation. Seventy-two patients were randomly allocated to one of four groups: 10 % lidocaine was sprayed either on the laryngoscope blade (group L), on the trachea (group V), or on the laryngoscope blade and the trachea (group LV). No lidocaine was used in group C. Anesthesia was induced in all patients with remifentanil (effect site concentration: 4.0 ng/ml) and propofol (effect site concentration 4.0 μg/ml) continuous infusion using a target control infusion (TCI) device. Mean arterial pressure (MAP) and heart rate (HR) were recorded during the peri-intubation period. Changes in MAP and HR over time were markedly different among the four groups (P

Neurofibrillary tangle (NFT) is a characteristic hallmark of Alzheimer's disease. GSK3β has been reported to play a major role in the NFT formation of tau. Dysfunction of autophagy might facilitate the aggregate formation of tau. The present study examined the role of GSK3β-mediated phosphorylation of tau species on their autophagic degradation. We transfected wild type tau (T4), caspase-3-cleaved tau at Asp421 (T4C3), or pseudophosphorylated tau at Ser396/Ser404 (T4-2EC) in the presence of active or enzyme-inactive GSK3β. Trehalose and 3-methyladenine (3-MA) were used to enhance or inhibit autophagic activity, respectively. All tau species showed increased accumulation with 3-MA treatment whereas reduced with trehalose, indicating that tau undergoes autophagic degradation. However, T4C3 and T4-2EC showed abundant formation of oligomers than T4. Active GSK3β in the presence of 3-MA resulted in significantly increased formation of insoluble tau aggregates. These results indicate that GSK3β-mediated phosphorylation and compromised autophagic activity significantly contribute to tau aggregation.

목 적 : 최근 요배양이 음성이거나 기준이하의 세균 집락이 있었던 경우에서도 신피질 손상이나 요역류가 있음이 보고되고 있으며, 실제 소변 배양검사에서 낮은 세균 집락을 보인 경우에도 요로 감염이 확인된 연구 보고들이 있다. 이에 저자들은 발열과 농뇨가 있는 영아에서 전형적인 요로 감염의 특성을 분석하고, 요로 감염이 의심되나 소변 배양 검사가 음성인 경우에도 영상 및 기능 검사상 이상 여부를 파악하여 관련 인자를 확인하고자 하였다. 방 법 : 2001년 1월부터 2003년 2월까지 가톨릭대학교 의과대학 성모자애병원 소아과에 발열을 주소로 내원하여 일반 요 검사상 농뇨 소견을 보여 입원한 12개월 이하의 환아 136명을 대상으로 소변 배양 검사를 실시하고, 배양 검사 결과와 상관없이 요로 감염 의심 시 신장의 급성 감염 상태를 방영하는 DMSA scan과 요 역류 검사를 시행하여 이상 여부와 관련 인자를 분석하였고, 동시에 임상특성과 원인균도 분석하였다. 결 과 : 136명 중 53명의 환아에서 소변 배양 검사에서 세균이 배양되었으며 57균주가 동정되었다. 단일 균주에 의한 감염 빈도가 92.5%(49/53)이었고, E. coli가 49주(86%)로 가장 많았으며 E. faecalis, M. morganii, Proteus, P. aeruginosa, S. aureus, E. fergusonii 순으로 분리되었다. 이들 균주는 대체적으로 cephalosporins 및 aminoglycosides에 감수성이 높았으나, aminopenicillins에는 감수성이 낮았다. DMSA scan과 요 역류 검사는 배양검사 양성인 경우와 음성인 경우에서 유사한 비율로 이상 소견을 보였다. 소변 배양 검사 양성 유무와 상관없이 농뇨를 보인 영아에서 발열 기간이 48시간 이상인 경우, 연령이 증가할수록, CRP가 높을수록 급성기에 시행한 DMSA scan 검사 이상 유무에 유의성이 있음을 확인하였다. 결 론 : 요로 감염 균주에 대해 1세대, 3세대 cephalosporins와 amikacin에 감수성이 높아 요로 감염 영아에서 이들 항생제의 병합요법이 고려될 수 있다. 또한 발열과 농뇨가 있는 영아에서, 소변 배양 검사가 음성이더라도 나이가 3개월 이상이고 48시간 이상의 발열을 보인 경우, C-반응 단백 수치가 높은 경우에는 급성기의 DMSA scan 검사와 요역류 검사를 시행하여 신장 이상 유무를 확인하고 조기 치료 방침을 결정하는 것이 이후에 신장실질 질환으로의 이환을 막는데 도움을 줄 수 있을 것이다. 【Objective : Urinary tract infection(UTI) is a frequent serious bacterial infection in young infants. The clinical presentation may be non-specific and variable, depends on factors such as the age and the level of infection. Children with renal involvement may be at risk of permanent renal damage. Experimental studies have shown that renal lesions caused by acute febrile UTI may be prevented or diminished by early diagnosis and treatment. Therefore, it is important to find a method that can permit early diagnosis and identification of patients who are at risk for progressive renal damage. We designed this study to identify related factors in culture positive UTI infants, and also to identify related factors in culture negative UTI infants, who are febrile with pyuria, by using renal imaging and functional studies including renal sonography, DMSA scan and VCUG. Methods : Retrospectively analyzed the medical records of 136 febrile infants with pyuria over 2 years(from January 2001 to February 2003). Urine culture was done in all cases, and regardless of urine culture findings, renal imaging study was done if symptomatic UTI suspected. Results : Total 57 organisms were isolated in 53 patients. E. coli was the most common organism(86%), followed by E. faecalis, M. morganii, Proteus species, P. aeruginosa, S. aureus and E. fergusonii. Most of the isolates had high sensitivity on cephalosporins or amikacin and had low sensitivities on aminopenicillins. Abnormal acute phase DMSA scan or VCUG findings were seen in both urine culture positive and negative group without statistical differences(P>0.05). In febrile infants with pyuria, fever over 48 hours, older age and high CRP related to abnormal acute phase DMSA scan findings regardless urine culture results. Conclusion : 1st or 3rd generation cephalosporins with amikacin could be the first choice of treatment for UTI. Febrile infants with positive urine culture dose mean urinary tract infection but not acute pyelonephritis which directly relates to cortical damage which could be confirmed by acute phase DMSA scan. Even cases with negative urine culture findings, acute pyelonephritis should be concerned in febrile infants with pyuria who are older than 3 months of age, has fever over 48 hours or high CRP level. And in such cases, acute phase DMSA scan and VCUG should be evaluated for early treatment and long term prognosis.】