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BACKGROUND: The precise underlying mechanism of antioxidant effects of dexmedetomidine-induced neuroprotection against cerebral ischemia has not yet been fully elucidated. Activation of Nuclear factor erythroid 2-related factor (Nrf2) and Heme Oxygenase-1 (HO-1) represents a major antioxidant-defense mechanism. Therefore, we determined whether dexmedetomidine increases Nrf2/HO-1 expression after global transient cerebral ischemia and assessed the involvement of Protein Kinase C (PKC) in the dexmedetomidine-related antioxidant mechanism. METHODS: Thirty-eight rats were randomly assigned to five groups: sham (n...=...6), ischemic (n...=...8), chelerythrine (a PKC inhibitor; 5...mg.kg(-1) IV administered 30...min before cerebral ischemia) (n...=...8), dexmedetomidine (100.....g.kg(-1) IP administered 30...min before cerebral ischemia (n...=...8), and dexmedetomidine...+...chelerythrine (n...=...8). Global transient cerebral ischemia (10...min) was applied in all groups, except the sham group; histopathologic changes and levels of nuclear Nrf2 and cytoplasmic HO-1 were examined 24...hours after ischemia insult. RESULTS: We found fewer necrotic and apoptotic cells in the dexmedetomidine group relative to the ischemic group (p...

Transversus abdominis plane block (TAPB) is commonly used for postoperative pain control after laparoscopic cholecystectomy. However, few studies have analyzed its effect on pulmonary function. The goal of this study was to elucidate the effect of ultrasound-guided bilateral TAPB on pulmonary function preservation and analgesia after laparoscopic cholecystectomy.We enrolled 58 patients who underwent laparoscopic cholecystectomy. Among them, 53 were randomized to group T (n = 27) and group C (n = 26). Group T and group C received ultrasound-guided bilateral TAPB with 40 ml of 0.375% ropivacaine and 40 ml of 0.9% normal saline, respectively. Visual analog scale (VAS) scores, patient-controlled analgesia (PCA) consumption, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and modified Borg scale scores were measured until 24 h post-surgery.The VAS scores were significantly lower in group T than in group C at 1 and 8 h after the surgery. PCA consumption was significantly lower in group T than in group C at all postoperative time points. FEV1, PEF, and FEV1/FVC were more preserved in group T than in group C at 1 h. Group T had significantly lower modified Borg scale scores than did group C at 1 and 8 h.Ultrasound-guided TAPB is effective in pulmonary function preservation and pain control after laparoscopic cholecystectomy. Therefore, it could be a great option for multimodal analgesia, preservation of pulmonary function, prevention of pulmonary complications including atelectasis, and promotion of postoperative recovery after laparoscopic cholecystectomy.This study was enrolled in the Clinical Research Information Service (Clinical Research Information Service, KCT0004435, Hwa Yong Shin, 2019-08-19).

Background This study was performed to evaluate the effectiveness of ramosetron orally disintegrating tablets (ODTs) in preventing post-discharge nausea and/or vomiting (PDNV) in female patients following outpatient surgery under general anesthesia. Methods This multicenter randomized study included three South Korean tertiary hospitals. Before surgery, 138 patients were randomly allocated into two groups. In the ramosetron group, ramosetron ODT 0.1 mg was administered after discharge in the morning of postoperative days 1 and 2. Metoclopramide 10 mg was administered as a rescue antiemetic (capped at 30 mg per day). In the control group, patients were administered only metoclopramide 10 mg when nausea and/or vomiting occurred. The primary outcome was the incidence of nausea during 24 h after discharge. Results We found significant differences in the incidence (13% vs. 33%, P = 0.008) and severity (P = 0.011) of nausea between the ramosetron and the control groups during 24 h after discharge. In addition, the rate of rescue antiemetic (metoclopramide) administration during 24 h after discharge was lower in the ramosetron group (6%) than in the control group (18%) (P = 0.033). Patient satisfaction score was higher in the ramosetron group than in the control group (P < 0.001). Conclusion Ramosetron ODT reduces the incidence and severity of postoperative nausea after discharge during the first 24 h and may be a valuable option for the prevention of PDNV in female patients after day surgery under general anesthesia. Trial registration ClinicalTrials.gov, NCT04297293. Registered on 05 March 2020

Access to surgical care and essential anesthesia is an integral part of universal health coverage. Also, increasing access to surgical care depends on a parallel increase in access to safe anesthesia. Today, five billion people (more than two-thirds of the world’s population) still do not have adequate, quality surgery and anesthesia care at the right time. Therefore, the World Federation of Societies of Anesthesiologists and the World Health Organization developed the International Standards for Safe Practice of Anesthesia. The standards include the following components, which are essential for the safety of patients undergoing surgical procedures: professional expertise, facilities and equipment, medications and intravenous fluids, monitoring, and anesthesia. In this article, it is emphasized that wherever and whenever possible, anesthesia should be provided, led, or overseen by an anesthesiologist. It is also strongly recommended that essential equipment is in place and adequate training to handle it safely has been provided. Unfortunately, some operating rooms of small hospitals and clinics does not meet the above standards. It may be difficult for each hospital to manage autonomously due to the lack of a unified checklist for essential standardized requirements. By introducing appropriate anesthesia safety standards in the operating rooms of small hospitals and surgery clinics, it will be possible to increase patient safety during surgery performed under general anesthesia, deep sedation, moderate sedation, or regional anesthesia. Through this process, it is expected that the mortality and morbidity rate of unexpected surgery patients can be minimized.

With the aggressive scaling of MOSFET devices below 3nm, the role of TCAD in selecting a feasible device architecture for next node has become extremely important. There is an enormous opportunity cost for each choice, so the pros and cons of each option must be identified through seamless pre-validation using TCAD. Therefore, it is important to understand which TCAD solutions are necessary to validate the architecture candidate in rigorous way. This paper describes which TCAD solutions are important in atomic/device/standard cell/block-chip level for next generation logic pathfinding from the perspective view of a semiconductor manufacturing industry.

A novel algorithm is introduced to extract the electrical roughness at the first principle level. The autocorrelation and root-mean-squared height of roughness spectrum are extracted for 3×3 nm2 Si/SiO 2 samples. As an application, the impact of Ge-O bond on electrical roughness is demonstrated. The result concludes that electrical roughness of a given interface can be substantially larger than geometrical values.

Background:Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV).Objectives:This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery.Methods:We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group.Results:Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%]vs.45[10.4%],P= 0.002) and POD1 (60[19.0%]vs.59[13.6%],P= 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49vs.3.13 ± 1.53,P= 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75vs. 0.21 ± 0.62,P= 0.027) and rescue anti-emetics (27 [17.2%]vs. 15 [9.6%],P= 0.047) on POD 0 were both lower in the group P.Conclusion:In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

Fault detection of Photovoltaic (PV) is one of the important issues in PV Farm. There is a way to monitor power for PV failure detection, but it is necessary to connect a device for measuring power at all PV. Therefore, PV Farm owners have to more spend cost for monitoring as number of PV. In this paper, we propose a monitoring system that does not require connection of power sensors, communication modules and processors to each PV. For this purpose, generated power is modulated depending on specified frequency band.

Objective: To evaluate the pathological changes of the placenta to determine the mechanism underlying placenta-derived fetal growth restriction (FGR) and investigate its influence on neonatal outco...

Peak shaving is an important technology in power grid. Many studies on peak shaving are being conducted, using ESS, shiftable load, and V2G. However, they do not consider of the ESS SoC and supply power reduction because they are only for peak shaving. ESS SoC is related to battery life which is directly linked to costs. Reduction supplying power causes problems that uncertainty and inconvenience to customers. Therefore, it is necessary to consider the problems of peak shaving. This paper presents ESS SoC optimization by controlling that charging and discharging of EV. It can reduce supplying power and peak shaving.

Introduction: Spinal anesthesia during elective cesarean section often induces maternal hypotension, and vasopressors are the most reliable agents to counteract this. We conducted a systematic review and network meta-analysis to compare and specifically evaluate the efficacy of vasopressors in preventing maternal hypotension (effectiveness) and decreasing fetal acidosis (safety) in parturients undergoing spinal anesthesia for cesarean section. Methods: We performed a systematic and comprehensive search to identify all randomized controlled studies on vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia, which had been published until June 30, 2019 and updated until September 20, 2020. A network meta-analysis was conducted to combine direct and indirect comparisons of vasopressors. The primary outcomes included minimum systolic blood pressure, the incidence of hypotension, and fetal acidosis. Stata SE 15.0 was used for the meta-analysis. Results: Forty-five studies (n = 3,369) with six different vasopressors injected using various methods were included. Based on the surface under the cumulative ranking curve (SUCRA) value, intravenous (IV) continuous infusion of mephentermine (SUCRA value 83.4%) was the most efficacious vasopressor with the lowest incidence of hypotension, followed by continuous infusion of ephedrine with norepinephrine bolus (81.6%) and norepinephrine (76.4%). Compared with an IV bolus injection, all analyzed vasopressors were more effective when they were infused continuously for managing maternal hypotension. In terms of safety, only angiotensin II as an IV continuous infusion (94.7%) was efficacious in preventing fetal acidosis, resulting in a pH closer to 7.4, and there were no significant differences in umbilical arterial pH between the test and control groups. Conclusion: Clinicians should continuously infuse vasopressors to manage maternal hypotension during cesarean section under spinal anesthesia. According to SUCRA, norepinephrine administered as an IV continuous infusion was the third most efficacious vasopressor with the lowest incidence of maternal hypotension, and it could be a potential alternative to phenylephrine. Meanwhile, only angiotensin II administered as an IV continuous infusion caused less umbilical arterial acidosis than the control group.

Objective. To investigate the association between exposure to general anesthesia and the development of Alzheimer’s disease (AD) and dementia by reviewing and integrating the evidence from epidemiological studies published to date. Methods. We searched MEDLINE, EMBASE, and Google Scholar to identify all relevant articles up to April 2018 reporting the risk of AD/dementia following exposure to general anesthesia and finally updated in February 2020. We included patients older than 60 or 65 years who had not been diagnosed with dementia or AD before the study period. The overall pooled effect size (ES) was evaluated with a random-effect model. Subgroup analyses were conducted and possibility of publication bias was assessed. Results. A total of 23 studies with 412253 patients were included in our analysis. A statistically significant positive association between exposure to general anesthesia and the occurrence of AD was detected in the overall analysis (pooled ES=1.11, 95%confidence interval=1.07–1.15), but with substantial heterogeneity (pχ2<0.001, I2=79.4). Although the overall analysis revealed a significant association, the results of the subgroup analyses were inconsistent, and the possibility of publication bias was detected. Conclusions. This meta-analysis demonstrated a significant positive association between general anesthesia and AD. However, considering other results, our meta-analysis must be interpreted with caution. Particularly, it should be considered that it was nearly impossible to discriminate the influence of general anesthesia from the effect of surgery itself on the development of AD. Further, large-scale studies devised to reduce the risk of bias are needed to elucidate the evidence of association between general anesthesia and AD. Trial registration. PROSPERO International prospective register of systematic reviews CRD42017073790.

Summary: Objective: This study aims to evaluate retrospectively the electronic medical records of surgical patients who received intravenous patient-controlled analgesia, to identify potential relationships between the incidence and risk factors of postoperative nausea and vomiting (PONV). Methods: Records of 6773 adult patients who received fentanyl-based intravenous patient-controlled analgesia after surgery at Chung-Ang University Hospital between January 1, 2010 and December 31, 2015 were reviewed. Multiple logistic regressions were used to identify risk factors for PONV. Results: Of 6773 patients, 1216 (18.0%) were recorded to have PONV. In multiple logistic regression analysis, female gender, nonsmoking status, history of motion sickness or PONV, use of desflurane and nitrous oxide, and preintubation use of opioid analgesia were independent risk factors for PONV. Conclusions: Despite the use of antiemetic prophylaxis, 18.0% of patients with intravenous patient-controlled analgesia had PONV. Use of desflurane and nitrous oxide, in addition to risk factors included in the Apfel score (female gender, nonsmoking status, history of PONV or motion sickness, and use of postoperative opioids) were identified as independent risk factors. As the incidence of PONV was 2.8%, 6.0%, 11.7%, 15.2%, 21.1%, 50.0%, and 100% for patients who had 0, 1, 2, 3, 4, 5, and all these risk factors, respectively, risk-adapted, multimodal, or combination therapy should be applied for patients receiving general anesthesia. Keywords: analgesia, antiemetics, patient-controlled analgesia, postoperative nausea and vomiting

The Udu-dong archeological site in Chuncheon, South Korea, dates back to the Proto–Three Kingdoms Period (approximately 100 BC to AD 350). Many artifacts, including some earthenware, have been excavated in these ancient dwelling sites. We applied three geochronological dating methods (radiocarbon, optically stimulated luminescence (OSL), and archeomagnetic dating) to the archeological remains of this large-scale human settlement and reconstructed the history of depositional processes prior to human settlement. The timing of the ancient community’s settlement was investigated by radiocarbon dating of the charcoal fragments collected from old furnaces. Archeomagnetic dating allowed us to constrain the time period of the settlement’s abandonment by dating the last use of fire. The timing and development of fluvial deposits underlying the settlement site were reconstructed by OSL dating combined with sedimentary facies analysis. Our results show that, following the deposition of coarse sediments starting 10,000 years ago, the region formed a stable floodplain environment starting around 3000 years ago; people began to form clustered settlements approximately 50 years later. For the subsequent 150 years or so, the area was heavily used as a settlement site, with people evenly distributed across it, before eventual abandonment of the site around AD 200–250. Because the sedimentary deposits do not show any significant facies change during this period, we conclude that any catastrophic events were not the main reason for settlement abandonment. This study suggests that combining scientific and archeological analyses have significant benefits for studies of such archeological sites. Therefore, continuous collection of such data can provide important information for the excavation and protection of prehistoric or historic sites.

An archeomagnetic study has been performed for six archeological relics of the Proto-Three Kingdoms period excavated in Jungdo Island, South Korea. Among a total of 90 samples from hearths remains of six dwelling sites, the characteristic remanent magnetization components were isolated from 70 samples using the progressive alternating field demagnetizations and considered to record faithfully a thermoremanent magnetization at the timing of the last cooling of the hearths. Two different approaches were made to determine the archeomagnetic ages: One is the conventional method using the relocated paleosecular variation (PSV) curve obtained from southwestern Japan. The other method adopts a Matlab archaeo_dating tool using a Bayesian statistics with global geomagnetic field prediction model (ARCH3K.1). Both archeomagnetic ages using two individual dating methods generally overlapped with the radiocarbon age ranges for each sites. However, no systematic relationship between archeomagnetic ages and radiocarbon ages was observed, implying that neither the relocated Japanese PSV data nor the global model accurately represent the Korean secular variation during the archeological period of this study. At present, archeomagnetic dating in Korea should be carefully applied in conjunction with other dating methods on the consideration of archeological context.

A paleomagnetic investigation has been carried out for the Lower Triassic Donggo Formation exposed in the Danyang area on the Yeongnam Massif to constrain local and regional tectonic history of the Taebaeksan Zone, Korean Peninsula. Among a total of 201 samples from 18 sites of the Donggo Formation, the characteristic remanent magnetization (ChRM) components were obtained from 166 samples. Field tests such as tilt test and reversal test reveal that the ChRM of the Donggo Formation is of primary in origin. The Early Triassic paleomagnetic pole position calculated from the site-mean directions of the primary magnetization is at 40.7°N, 17.8°E (A95 = 5.3°). Comparison of the reliable paleomagnetic poles from the Danyang (this study), Taebaek, and Yemi areas in the Taebaeksan Zone reveals a regional division of the pole position, indicating the clockwise vertical-axis rotation of the Taebaek area by 47.2 ± 11.1° with respect to the Danyang and Yemi areas after the formation of the Pyeongan Supergroup. In addition, there is a significant relation between strike deviations and declination deviations with some flattening of the regression line in the southern Taebaeksan Zone. Thus, it is interpreted that the Pyeongan Supergroup in this region had a primary curvature at the timing of sedimentation and subsequently experienced post-Early Triassic oroclinal bending of approximately 47°.

Dexmedetomidine (DXM) has anti-inflammatory effects, which is considered an important mechanism of DXM-induced neuroprotection from cerebral ischemia/reperfusion injury. We determined whether the anti-inflammatory effects of DXM are associated with inhibition of the toll-like receptor (TLR)-4/nuclear factor kappa B (NF-κB) pathway in a rat model of transient global cerebral ischemia/reperfusion injury. Fifty rats were randomly assigned to one of five groups (10 rats/group): Group S received no treatment; Group C underwent transient global ischemia (10min); Group D received DXM 30min before ischemia; Group R received resatorvid, a selective TLR-4 antagonist, 30min before ischemia; and Group RD received resatorvid and DXM 30min before ischemia. The numbers of necrotic and apoptotic cells and the levels of TLR-4, NF-κB, and caspase-3 were assessed 1day after ischemia, and pro-inflammatory cytokines including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) were measured before ischemia and 2, 6, and 24h thereafter. The necrotic and apoptotic cell counts and levels of TLR-4, NF-κB, and caspase-3 were higher in Group C than in other groups. TNF-α were higher in Group C than in other groups 2h after ischemia, whereas IL-6 were higher in Group C 6h after ischemia. IL-1β was higher in Group C than in Group D 6 and 24h after ischemia. Our findings suggest that the anti-inflammatory action of DXM via inactivation of the TLR-4/NF-κB pathway, in part, may explain DXM-induced neuroprotection after cerebral ischemia.

This paper investigates the impact of BEOL design on device and backend reliability – HCI, BTI, EM – due to dependence of self-heating on BEOL in highly-scaled FinFETs. Our analysis indicates that due to poor thermal coupling to substrate – in the thin fin body devices – a large part of heat flows out of BEOL. This makes self-heating, and thus device (FEOL) temperature, very sensitive to BEOL design. The heat flow through BEOL also significantly increases the metal and via temperatures. The increased temperature negatively affects the overall reliability, and one of the ways to mitigate device degradation is optimization of BEOL design.

This study aimed to compare obstetrical complications and neonatal outcomes between monochorionic and dichorionic discordant twin pregnancies.We enrolled 296 patients with twin pregnancy who delivered at Busan Paik Hospital between January 2014 and December 2017. The prevalence of obstetrical complications, neonatal mortality between monochorionic and dichorionic twins was compared. We also investigated whether there is a difference in neonatal outcome and neonatal morbidity between monochorionic discordant twins without monochorionic-specific complications and dichorionic discordant twins.The risk of fetal deathRisk of birth weight discordance is higher in monochorionic twin but no significant difference was observed in maternal outcomes, neonatal mortality and morbidity between noncomplicated monochorionic and dichorionic discordant twins.

Study Objective To compare the effectiveness of streamlined liner of pharyngeal airway (SLIPA) in paralyzed and nonparalyzed, anesthetized patients undergoing gynecological surgery. Design Prospective randomized double-blind clinical trial. Setting Intraoperative. Patients A total of 80 female patients with American Society of Anesthesiologists class I or II and who were undergoing gynecological surgery. Interventions The patients were randomly allocated to either the nonparalyzed group (group NR, n=40) or the paralyzed group (group R, n=40). Measurements Oropharyngeal leakage pressure was the primary outcome. Insertion time; number of insertion attempts; success rate at first insertion; involuntary movement; peak inspiratory pressure (PIP); leakage fraction; hemodynamic changes; complications, such as blood tinging, regurgitation, and sore throat; and recovery time were also evaluated for secondary outcomes. Main Results Oropharyngeal leakage pressure, which is primary outcome, was no difference among the groups. Insertion time, number of insertion attempts, success rate at first insertion, involuntary movement, leakage fraction, hemodynamic changes, and complications were not statistically different among the groups. The PIP in group NR was significantly increased compared to that of group R ( P =.002). Recovery time was significantly longer in group R than in group NR ( P Conclusions SLIPA had good performance in both paralyzed and nonparalyzed patients. There was no difference in SLIPA performance or complications irrespective of muscle relaxant use, except decrease in PIP and prolong recovery time in paralyzed patients.

BACKGROUND Sugammadex is a new agent that reverses neuromuscular blockade by aminosteroid neuromuscular blocker. This retrospective study compared the effects of sugammadex on post-operative nausea and vomiting (PONV) with those of a pyridostigmine-glycopyrrolate mixture. METHODS We reviewed the electronic medical records of 7179 patients who had received fentanyl-based, intravenous, patient-controlled analgesia (IV-PCA) at Chung-Ang University Hospital between January 1, 2010 and December 31, 2015. We categorized the patients into two groups on the basis of the type of reversal agent to neuromuscular blockade that was used: a traditional reversal agent (pyridostigmine-glycopyrrolate mixture; Group R; n = 7059) and sugammadex (Group S; n = 120). The propensity score matching method was then used to select 408 subjects in Group R and 115 subjects in Group S; on the basis of their covariates, these subjects were then matched with a counterpart in the other group. RESULTS After propensity score matching, the two groups were well balanced with respect to all baseline covariates. In Group S, the numeric rating scale of nausea on day 0, as well as the number of patients who vomited on day 0, was lower than that in group R. Furthermore, Group S used fewer rescue antiemetics on day 0 and had a higher complete response on day 0. CONCLUSION Sugammadex might be more beneficial for PONV compared to pyridostigmine-glycopyrrolate mixture for patients who have received opioid-based IV-PCA.

This paper proposes a new NLC (Nearest Level Control) scheme for MMCs (Modular Multilevel Converters), which offers voltage ripple reductions in the DC capacitor of the SM (Sub-Module), the output voltage harmonics, and the switching losses. The feasibility of the proposed NLC was verified through computer simulations. Based on these simulation results, a hardware prototype of a 10kVA, DC-1000V MMC was manufactured in the lab. Experiments were conducted to verify the feasibility of the proposed NLC in an actual hardware environment. The experimental results were consistent with the results obtained from the computer simulations.