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Background Patients who undergo urinary catheterization may experience postoperative catheter-related bladder discomfort (CRBD). Previous studies have indicated that drugs with antimuscarinic effects could reduce the incidence and severity of CRBD. Accordingly, this study was carried out to investigate whether nefopam, a centrally acting analgesic with concomitant antimuscarinic effect, reduces the incidence and severity of CRBD. Methods Sixty patients with American Society of Anesthesiologists physical status I and II and aged 18–70 years who were scheduled to undergo elective ureteroscopic litholapaxy participated in this double-blinded study. Patients were divided into control and nefopam groups, comprising 30 patients each. In the nefopam group, 40 mg nefopam in 100 ml of 0.9% saline was administered intravenously. In the control group, only 100 ml of 0.9% saline was administered. All patients had a urethral catheter and ureter stent inserted during surgery. The incidence and severity of CRBD, numerical rating scale (NRS) score of postoperative pain, rescue pethidine dose, and side effects were recorded in the post-anesthesia care unit after surgery. Results The incidence (P = 0.020) and severity (P < 0.001) of CRBD were significantly different between the control group and the nefopam group. The NRS score of postoperative pain (P = 0.006) and rescue dose of pethidine (P < 0.001) were significantly higher in the control group than in the nefopam group. Conclusions Intravenous administration of nefopam in patients scheduled to undergo ureteroscopic litholapaxy reduced the incidence and severity of CRBD, NRS score of postoperative pain and analgesic requirements.

Background: Nefopam is a non-opioid, non-steroidal analgesic drug with fewer adverse effects than narcotic analgesics and nonsteroidal anti-inflammatory drugs, and is widely used for postoperative pain control. Because nefopam sometimes causes side effects such as nausea, vomiting, somnolence, hyperhidrosis and injection-related pain, manufacturers are advised to infuse it slowly, over a duration of 15 minutes. Nevertheless, pain at the injection site is very common. Therefore, we investigated the effect of warmed carrier fluid on nefopam injection-induced pain. Methods: A total of 48 patients were randomly selected and allocated to either a control or a warming group. Warming was performed by diluting 40 mg of nefopam in 100 ml of normal saline heated to 31-32°C using two fluid warmers. The control group was administered 40 mg of nefopam dissolved in 100 ml of normal saline stored at room temperature (21-22°C) through the fluid warmers, but the fluid warmers were not activated. Results: The pain intensity was lower in the warming group than in the control group (P ＜ 0.001). The pain severity and tolerance measurements also showed statistically significant differences between groups (P ＜ 0.001). In the analysis of vital signs before and after the injection, the mean blood pressure after the injection differed significantly between the groups (P = 0.005), but the heart rate did not. The incidence of hypertension also showed a significant difference between groups (P = 0.017). Conclusions: Use of warmed carrier fluid for nefopam injection decreased injection-induced pain compared to mildly cool carrier fluid. (Korean J Pain 2018; 31: 102-8)

Background The stroke volume variation (SVV), based on lung-heart interaction during mechanical ventilation, is a useful dynamic parameter for fluid responsiveness. However, it is affected by many factors. The aim of this study was to evaluate the effects of SVV on Trendelenburg (T) and reverse Trendelenburg (RT) position and to further elaborate on the patterns of the SVV with position. Methods Forty-two patients undergoing elective surgery were enrolled in this study. Fifteen minutes after standardized induction of anesthesia with propofol, fentanyl, and rocuronium with volume controlled ventilation (tidal volume of 8 ml/kg of ideal body weight, inspiration : expiration ratio of 1 : 2, and respiratory rate of 10-13 breaths/min), the patients underwent posture changes as follows: supine, T position at slopes of operating table of -5°, -10°, and -15°, and RT position at slopes of operating table of 5°, 10°, and 15°. At each point, SVV, cardiac output (CO), peak airway pressure (PAP), mean blood pressure, and heart rate (HR) were recorded. Results The SVV was significant decreased with decreased slopes of operating table in T position, and increased with increased slopes of operating table in RT position (P = 0.000). Schematically, it was increased by 1% when the slope of operating table was increased by 5°. But, the CO and PAP were significant increased with decreased slopes of operating table in T position, and decreased with increased slopes of operating table in RT position (P = 0.045, 0.027). Conclusions SVV is subjected to the posture, and we should take these findings into account on reading SVV for fluid therapy.

Background: Although a brachial plexus block can be used to provide anesthesia and analgesia for upper extremity surgery, its effects using MgSO4 on postoperative pain management have not been reported. The aim of this study was to evaluate brachial plexus block using MgSO4 on postoperative analgesia. Methods: Thirty-eight patients who were scheduled to undergo upper extremity surgery were randomly allocated into two groups: patients receiving axillary brachial plexus block with 0.2% ropivacaine 20 ml and normal saline 2 ml (group S) or 0.2% ropivacaine 20 ml and MgSO4 200 mg (group M). Before extubation, the blocks were done and patient controlled analgesia was started, and then, the patients were transported to a postanesthetic care unit. The postoperative visual analogue scale (VAS), opioid consumption, and side effects were recorded. Results: The two groups were similar regarding the demographic variables and the duration of the surgery. No differences in VAS scores were observed between the two groups. There was no statistically significant difference in opioid consumption between the two groups. Nausea was observed in three patients for each group. Conclusions: Axillary brachial plexus block using MgSO4 did not reduce the level of postoperative pain and opioid consumption. (Korean J Pain 2011; 24: 158-163)

Background During coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB. Methods Forty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used. Results There was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group. Conclusions Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.

Magnolol, honokiol, and obovatol are well-known bioactive constituents of the bark of Magnolia officinalis and have been used as traditional Chinese medicines for the treatment of neurosis, anxiety, and stroke. We recently isolated novel active compound (named 4-O-methylhonokiol) from the ethanol extract of Magnolia officinalis. The present study aimed to test two different doses of ethanol extracts of Magnolia officinalis (5 and 10 mg/kg/mouse, p.o., 1 week) and 4-O-methylhonokiol (0.75 and 1.5 mg/kg/mouse, p.o., 1 week) administered for 7 days on memory impairment induced by scopolamine (1 mg/kg body weight i.p.) in mice. Memory and learning were evaluated using the Morris water maze and the step-down avoidance test. Both the ethanol extract of Magnolia officinalis and 4-O-methylhonokiol prevented memory impairment induced by scopolamine in a dose-dependent manner. The ethanol extract of Magnolia officinalis and 4-O-methylhonokiol also dose-dependently attenuated the scopolamine-induced increase of acetylcholinesterase (AChE) activity in the cortex and hippocampus of mice, and inhibited AChE activity in vitro with IC(50) (12 nM). This study, therefore, suggests that the ethanol extract of Magnolia officinalis and its major ingredient, 4-O-methylhonokiol, may be useful for the prevention of the development or progression of AD.

Alzheimer's disease (AD) is characterized by progressive cognitive impairment. The effect of presenilin 1 (PS1) and PS2 mutation on cognition has been well characterized in a variety of transgenic mice. However, noncognitive behaviors have not been considered in these mice. In the present study, we found that transgenic mice expressing mutant PS2 (N141I) displayed decreased anxiety behavior determined by the elevated plus maze test and the light dark box test. However, these mice showed biphasic ambulatory activity (hyperactivity followed by hypoactivity) in an open field test. Correlated well with the reduced anxiety, expression of GABAAα1 receptor was higher whereas c-Fos was lower in the cortex, hippocampus, and amygdala of the mice expressing PS2 mutation than those of the wild-type PS2 or nontransgenic control mice. These data indicate that PS2 mutation causes reduction of anxiety, and this effect may be related to the change of the expression of GABAAα1 receptor and c-Fos. These findings could be useful in the understanding and the treatment of AD patients. © 2008 Wiley-Liss, Inc.

We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of the anterior papillary muscle and chordae to the anterior leaflet after successful cardiopulmonary resuscitation. Emergency repair of the papillary muscle was performed under cardiopulmonary bypass.

高分子系ナノコンポジットは高分子中に分子 (ナノ) レベルで複合剤を分散させたものであり, 通常の複合材料よりも飛躍的な性能の向上, 新たな機能発現が期待されている. 本研究では, 難燃性ABS樹脂の合成を目的とし, 有機化粘土を用いてABS系ナノコンポジットを合成した. 具体的には, モンモリロナイト型粘土鉱物と塩化ベンザルコニウムおよび4-ビニルピリジンを用いて有機化粘土を合成し, この有機化粘土存在下でアクリロニトリル (A) とスチレン (S) を共重合させることによって層はく離型ナノコンポジット (AS-clay) を合成した. XRD測定の結果より合成した有機化粘土の層間 (d=13.07～15.86Å) は, もとのモンモリロナイト型粘土鉱物の層間 (d=12.47Å) より広がっていることが確認された. 有機化粘土のIR測定においても塩化ベンザルコニウムおよび4-ビニルピリジンに起因する吸収がみられた. AS-clayにおいては, XRD測定の結果, 結晶領域に起因するピークの消失がみられ, 粘土の層はく離が起こっていることが確認された. AS-clay, AS樹脂およびABS樹脂を所定の条件下で混練することにより得られるAS-clay/ABS樹脂複合材料は, ABS樹脂に比べ燃焼速度は遅くなり, 難燃性の向上がみられた.

This article describes the syntheses and polymerizations of new chiral cinchoninyl(2-methacryloyloxyethyl) carbamate (CIMOC) from 2-methacryloyloxyethyl isocyanate (MOI) and cinchonine. Radical homopolymerizations were performed with AIBN as initiator in suitable solvent in a sealed tube at 60 °C. Number average molecular weights (Mn) of poly(CIMOC) were 2.6–11.8×103. Specific optical rotations ([α]435) of poly(CIMOC) were +84.0° to 0.72° in THF. The polymers obtained were tested for their efficiency in catalyzing the Michael addition of ethyl 1-oxo-2-indan carboxylate to methylvinyl ketones. The Michael adducts using poly(CIMOC-co-styrene) showed higher enantio excess (20%ee) compared to those obtained by using non-polymeric catalyst CIMOC (14%ee) and poly(CIMOC) (13%ee).

不飽和イソシアナート化合物である2-メタクリロイルオキシエチルイソシアナート (MOI) を種々の光学活性なアルコールまたはアミンと反応させることにより, ウレタンまたはウレア結合を有するキラルメタクリレート (RMOC, RMOU) を合成した. アゾビスイソブチロニトリル (AIBN) を開始剤として用いRMOCおよびRMOUのラジカル重合を行い, 得られたポリマーの旋光性, 不斉認識能について検討した. ポリ (RMOC) およびポリ (RMOU) は, ウレタンまたはウレア部位に起因する水素結合を有していた. ポリ (RMOC) およびポリ (RMOU) の旋光性は温度により影響を受けた. これは水素結合および側鎖置換基間の相互作用に基づくポリマーの高次構造の変化によるものと考えられた. RMOCまたはRMOUとスチレン (ST) またはメチルメタクリレート (MMA), ブチルメタクリレート (BMA) との共重合により得られたコポリマーの旋光性は, コモノマーユニットにより強く影響を受けた. ポリ (RMOC) およびポリ (RMOU) は種々のラセミ体に対して不斉認識能を示し, 高速液体クロマトグラフィー (HPLC) 用キラル固定相として有用と思われた. また, MOIを用いキラルなポリアクリルアミドマクロモノマー (PMB-1, PMB-2, PPAE-1, PPAE-2) を合成した. これらのマクロモノマーの重合体はマンデル酸やメントールに対し光学分割能を示し, この不斉認識能はグラフトポリマー鎖による高次構造に起因するものと考えられた.

With the growing popularity of the Internet, Korea has been successful in providing broadband Internet services to the level of universal service. More than 70 percent of households have high-speed Internet connection, and their lives have been changed dramatically. The cutting edge technology of broadband Internet has a profound impact on many aspects of the economy, education, entertainment, and social culture. This article addresses the experiences and future perspectives of KT (formerly Korea Telecom) in providing the broadband network and services in Korea. We present our experiences in the deployment of the world's largest ADSL network, and our ongoing deployment of VDSL and WLAN. Based on the accomplishment in broadband access, we also provide a forecast on the next generation of broadband services and the corresponding technologies required to support these services.

A new chiral methacrylate, (S)-(+)-1-cyclohexylethyl-(2-methacryloyloxyethyl)urea (CEMOU), was synthesized from 2-methacryloyloxyethyl isocyanate (MOI) and (S)-(+)-cyclohexylethylamine. Radical homopolymerization of CEMOU was performed in several solvents to obtain the corresponding chiral polymers having hydrogen bonds based on urea moieties. Specific optical rotations of poly(CEMOU) were slightly changed by the measurement temperature, which may be attributed in part to a change of conformation caused by hydrophobic interaction between the cyclohexyl groups. From the results of radical copolymerization of CEMOU (M1) with styrene (ST, M2) or methyl methacrylate (MMA, M2), monomer reactivity ratios (r1, r2) and Alfrey–Price Q–e values were determined: r1 = 0.89, r2 = 0.12, Q1 = 2.45, e1 = 0.68 for the CEMOU–ST system; r1 = 0.48, r2 = 0.18, Q1 = 8.39, e1 = 1.97 for the CEMOU–MMA system. The chiroptical property of the poly(CEMOU-co-ST) was slightly influenced by the co-units. Poly(CEMOU)-bonded silica gel as the chiral stationary phase (CSP) was prepared for high-performance liquid chromatography (HPLC). The CSP resolved trans-2-dibenzyl-4,5-di(o-hydroxyphenyl)-1,3-dioxolane in normal phase such as n-hexane/2-propanol by HPLC. © 2003 Wiley Periodicals, Inc. J Appl Polym Sci 90: 1018–1025, 2003

(R)-(−)-1-(1-Naphthyl)ethyl(2-methacryloyloxyethyl)urea (NEMOU) was synthesized from 2-methacryloyloxyethyl isocyanate (MOI) and (R)-(+)-1-(1-naphthyl)ethylamine. Radical homopolymerizations of NEM...

Two types of new chiral methacrylates, cinchoninyl(2-methacryloyloxyethyl)carbamate (CIMOC) and cinchonidinyl(2-methacryloyloxy-ethyl)carbamate (CDMOC) were synthesized from 2-methacryloyloxyethyl isocyanate (MOI) and cinchona alkaloid such as cinchonine and cinchonidine, respectively. Radical polymerizations of CIMOC and CDMOC were performed under several conditions to obtain the corresponding polymers whose specific optical rotations ([ α ] 435 25 ) were 84.0–89.0° and 0.39–0.72°, respectively. From the results of radical copolymerizations of RMOC (CIMOC and CDMOC, M 1 ) with styrene (ST, M 2 ) or methyl methacrylate (MMA, M 2 ), monomer reactivity ratios ( r 1 , r 2 ) and Alfrey–Price Q – e were determined: r 1 =0.18, r 2 =0.48, Q 1 =0.53, e 1 =0.92 for the CIMOC–ST system; r 1 =0.53, r 2 =0.26, Q 1 =4.91, e 1 =1.80 for the CIMOC–MMA system r 1 =0.59, r 2 =0.47, Q 1 =0.86, e 1 =0.33 for the CDMOC–ST system; r 1 =0.28, r 2 =0.59, Q 1 =2.15, e 1 =1.74 for the CDMOC–MMA system. The chiroptical properties of the copolymers were strongly influenced by co -units. Poly(RMOC)-bonded-silica gel as chiral stationary phase (CSP) was prepared for high performance liquid chromatography (HPLC). The CSPs resolved some racemates such as mandelic acid and trans -2-dibenzyl-4,5-di( o -hydroxyphenyl)-1,3-dioxolane by HPLC. The chiral recognition ability of poly(RMOC) may be due to the interaction between some cinchona alkaloid units and the racemates and/or to secondary and higher-ordered structures of the polymer.

Chiral poly(acrylamide) macromonomers (PMB-1, PMB-2, PPAE-1, and PPAE-2) were synthesized from 2-methacryloyloxyethyl isocyanate and prepolymers, that is, poly[(S)-methylbenzyl acrylamide] or poly(L-phenylalanine ethylester acrylamide with a terminal carboxylic acid or hydroxy group. Radical homopolymerizations of poly(acrylamide) macromonomers were carried out under several conditions to obtain the corresponding optically active polymers. A strong temperature dependence on the specific optical rotation was observed for poly(PPAE-2) in comparison with that for the corresponding prepolymer. This might have resulted from a change in the conformation caused by hydrogen bonds between polymer-graft branches in the polymacromonomer. Radical copolymerizations of poly(acrylamide) macromonomers with styrene and methyl methacrylate were performed with azobisisobutyronitrile in tetrahydrofuran at 60 °C. Chiroptical properties of the copolymers were slightly influenced by comonomer units. Chiral stationary phases were prepared by the radical polymerization of poly(acrylamide) macromonomers in the presence of silica gel containing vinyl groups on the surface. Some racemic compounds such as menthol and mandelic acid were resolved on the chiral stationary phases for high-performance liquid chromatography. The conformation based on hydrogen bonds between polymer-graft branches in the polymacromonomers may play an important role in chiral discrimination.

Synthesis of Novel Chiral Poly(methacrylate)s Having Urea Moieties and ( S )-Methylbenzyl or l-Phenylalanine Methyl Ester Groups and Their Chiral Recognition Abilities

Synthesis of Novel Chiral Polymethacrylate Bearing Urethane and 1,1′-Binaphthalene Moieties and Its Chiral Recognition Ability

Four new types of poly(N-substituted maleimide) macromonomers (RMI, R = N-substituent, phenyl and cyclohexyl) were synthesized from methacryloyloxyethyl isocyanate (MOI) and oligomaleimides. The obtained macromonomers were polymerized in tetrahydrofuran (THF) to afford the corresponding polymacromonomers with degradation temperature of 266-272°C in high yields. The radical polymerizations of the macromonomers with styrene (ST) or methyl methacrylate (MMA) were performed in THF at 60°C to give the corresponding copolymers. The obtained copolymers exhibited higher glass transition temperatures than those of poly(ST) and poly(MMA).

Four new chiral methacrylates bearing urethane bonds and N,N-dibenzylamino groups (RMOC) were synthesized from 2-methacryloyloxyethyl isocyanate (MOI) and four chiral alcohol derivatives of α-amino acids, L-valine, L-leucine, D-phenylglycine, and L-phenylalanine. Radical polymerizations of RMOC were performed under various conditions to obtain the corresponding poly(RMOC) with number average molecular weights (Mn) of 2.4×104—6.4×104. Poly(RMOC) has hydrogen bonds based on urethane segments in solvent and exhibited negative (levo) rotation. Specific optical rotations of poly(RMOC) were slightly influenced by solvent and temperature. Radical copolymerizations of RMOC with styrene (ST) and methyl methacrylate (MMA) were performed with AIBN in toluene at 60°C. Monomer reactivity ratios (r1, r2) and Alfrey-Price Q-e were determined. Chiroptical properties of the copolymers were scarcely affected by co-units of ST and MMA. Chiral stationary phases (CSPs) for high performance liquid chromatography (HPLC) were prepared from poly(RMOC) and silica gel and optical resolution ability was investigated. CSPs resolved some racemic compounds (1—5) using methanol/water as mobile phase.

Three new monomers, 2-hydroxyethoxycarbonylethyl methoxycarbonylethyl sulfide (HEMS), 2-hydroxyethoxycarbonyl (2´-methyl) ethyl methoxycarbonylethyl sulfide (HMMS), and 3, 3´-dithiodiethylcarboxy allyl (DTCA) were synthesized from 3-mercaptopropionic acid (3-MPA) or methyl 3-mercaptopropionate (M3-MP). Polycondensations of HEMS and HMMS were performed with several metal acetates as catalysts to obtain the corresponding polythioethers with number average molecular weights (Mn) of up to 6.4×103. Radical polymerizations of DTCA were carried out in bulk at 110°C to obtain polymers having allyl groups in the side chain. Polymerizations of DTCA with ethylene diamine (EDA) or hexamethylene diamine (HDA) were performed under various conditions to obtain the corresponding polymers. Decomposition temperatures (Td) and glass transition temperatures (Tg) of the polymers were 146—252°C and -54—-1°C, respectively. Crystallinity of the polymers obtained by polymerizations of DTCA with EDA and HDA was 25—49%

Chiral methacrylates, that is, cholesteryl (ChMOC) and l-menthyl (MnMOC) N-(2-methacryloyloxyethyl)carbamates, were synthesized from 2-methacryloyloxyethyl isocyanate and cholesterol and l-menthol, respectively. Radical polymerizations of ChMOC and MnMOC gave number-average molecular weights for poly(ChMOC) and poly(MnMOC) of up to 3.74 × 104 and 9.39 × 104, respectively, and the specific rotations ([α]) were −43.1° to −47.7° and −87.6° to −89.0°, respectively. Temperature dependence of the specific optical rotation was observed for poly(ChMOC) but not for poly(MnMOC). The hydrogen bonds based on urethane segments for poly(ChMOC) were stronger than those for poly(MnMOC) according to IR spectra. In addition, the chiroptical properties of poly(ChMOC) were slightly affected by temperature in the presence of trifluoroacetic acid acting as an inhibitor for the formation of hydrogen bonds. Therefore, poly(ChMOC) may have a regular conformation due to hydrogen bonds and interaction between cholesteryl groups. Radical copolymerizations of ChMOC with styrene, methyl methacrylate, N-cyclohexylmaleimide, and N-phenylmaleimide were performed with 2,2′-azobisisobutyronitrile in tetrahydrofuran at 60 °C. Monomer reactivity ratios and Alfrey–Price Q–e were determined. Chiroptical properties of the copolymers were influenced by co-units. Thermal and X-ray diffraction analyses were performed for the homopolymers and copolymers. © 2000 John Wiley & Sons, Inc. J Polym Sci A: Polym Chem 38: 4315–4325, 2000

There have been many reports on the synthesis of macromonomers using thiols such as 3-mercaptopropionic acid (3-MPA). Star-shaped polymers containing sulfur were prepared by the radical polymerizations of macromonomers, and properties for paints were studied. Mercapto-modified polymers were highly adsorptive against heavy metal ions and useful for chain transfer agents of the radical polymerization to synthesize graft copolymers. The substituted allylic sulfides obtained from thiols as chain transfer agents in the radical polymerization gave end-functional polymers of controlled molecular weight. From this point of view, thiols such as 3-MPA are very often utilized for polymerization retarders and regulators in the field of macromolecules. The objective of our studies was to search for effective and wide applications of thiols such as 3-MPA, except for the application for polymerization retarder and regulator. We previously reported on the synthesis and characterization of the polymers containing sulfur in the main chain using 3-MPA. It is difficult to synthesize vinyl compounds from thiols because addition reactions of thiols to olefins occur easily. Otsu et al. reported on the polymerization reactivities of alkyl thioacrylate. In this study we synthesized and polymerized the novel vinyl monomers methoxycarbonylethyl thioacrylate (MTA), methoxycarbonylethyl thiomethacrylate (MTM), and menthoxycarbonylethyl thiomethacrylate (MnTM), which had a thioester group in the side chain, from 3-MPA and methyl 3-mercaptopropionate (M3-MP). The monomers were homopolymerized and copolymerizationed with styrene (St), methyl methacrylate (MMA), or N-cyclohexyl maleimide (CHMI). The characterizations of the polymers are examined.

Background: Emergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. Methods: Forty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU. Results: Nine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale. Conclusions: Propofol may decrease incidence of emergence agitation compared to sevoflurane in adults under going closed reduction of nasal bone fracture. (Korean J Anesthesiol 2012; 63: 48-53)

Neuroinflammation and accumulation of β-amyloid are critical pathogenic mechanisms of Alzheimer's disease (AD). In the previous study, we have shown that systemic lipopolysaccharide (LPS) caused neuroinflammation with concomitant increase in β-amyloid and memory impairments in mice. In an attempt to investigate anti-neuroinflammatory properties of obovatol isolated from Magnolia obovata, we administered obovatol (0.2, 0.5 and 1.0 mg/kg/day, p.o.) to animals for 21 days before injection of LPS (0.25 mg/kg, i.p.). We found that obovatol dose-dependently attenuates LPS-induced memory deficit in the Morris water maze and passive avoidance tasks. Consistent with the results of memory tasks, the compound prevented LPS-induced increases in Aβ₁₋₄₂ formation, β- and γ-secretases activities and levels of amyloid precursor protein, neuronal β-secretase 1 (BACE1), and C99 (a product of BACE1) in the cortex and hippocampus. The LPS-mediated neuroinflammation as determined by Western blots and immunostainings was significantly ameliorated by the compound. Furthermore, LPS-induced nuclear factor (NF)-κB DNA binding activity was drastically abolished by obovatol as shown by the electrophoretic mobility shift assay. The anti-neuroinflammation and anti-amyloidogenesis by obovatol were replicated in in vitro studies. These results show that obovatol mitigates LPS-induced amyloidogenesis and memory impairment via inhibiting NF-κB signal pathway, suggesting that the compound might be plausible therapeutic intervention for neuroinflammation-related diseases such as AD.

Accumulations of amyloid-β (Aβ) and oxidative damage are critical pathological mechanisms in the development of Alzheimer's disease (AD). We previously found that 4-O-methylhonokiol, a compound extracted from Magnolia officinalis, improved memory dysfunction in Aβ-injected and presenilin 2 mutant mice through the reduction of accumulated Aβ. To investigate mechanisms of the reduced Aβ accumulation, we examined generation, degradation, efflux and aggregation of Aβ in Swedish AβPP AD model (AβPPsw) mice pre-treated with 4-O-methylhonokiol (1.0 mg/kg) for 3 months. 4-O-methylhonokiol treatment recovered memory impairment and prevented neuronal cell death. This memory improving activity was associated with 4-O-methylhonokiol-induced reduction of Aβ1-42 accumulation in the brains of AβPPsw mice. According to the reduction of Aβ1-42 accumulation, 4-O-methylhonkiol modulated oxidative damage sensitive enzymes. 4-O-methylhonkiol decreased expression and activity of brain beta-site AβPP cleaving enzyme (BACE1), but increased clearance of Aβ in the brain through an increase of expressions and activities of Aβ degradation enzymes; insulin degrading enzyme and neprilysin. 4-O-methylhonkiol also increased expression of Aβ transport molecule, low density lipoprotein receptor-related protein-1 in the brain and liver. 4-O-methylhonkiol decreased carbonyl protein and lipid peroxidation, but increased glutathione levels in the brains of AβPPsw mice suggesting that oxidative damage of protein and lipid is critical in the impairment of those enzyme activities. 4-O-methylhonokiol treatment also prevented neuronal cell death in the AβPPsw mousee brain through inactivation of caspase-3 and BAX. These results suggest that 4-O-methylhonokiol might prevent the development and progression of AD by reducing Aβ accumulation through an increase of clearance and decrease of Aβ generation via antioxidant mechanisms.

We have studied the mechanism of Bragg diffraction in electrooptic thin-film lightguides and examined in effectiveness of interaction between the electric field and optical field. Expressions for the full detail the deflection voltage and the power per bandwidth are obtained and applied to various modulator structures using out-diffused, metal-diffused, epitaxial, and sputtered-film (electrooptic substrate) waveguides. An expression for minimum interaction length to ensure better than 30-dB extinction ratio is derived. The theoretical results are checked with experimental observations from an electrooptic substrate modulator we fabricated, and good agreement is obtained.

Oxidative stress induced neuronal cell death by accumulation of β-amyloid (Aβ) is a critical pathological mechanism of Alzheimer's disease (AD). Intracerebroventrical infusion of Aβ(1-42) (300 pmol/day per mouse) for 14 days induced neuronal cell death and memory impairment, but pre-treatment of 4-O-methylhonokiol (4-O-MH), a novel compound extracted from Magnolia officinalis for 3 weeks (0.2, 0.5 and 1.0 mg/kg) prior to the infusion of Aβ(1-42) and during the infusion dose dependently improved Aβ(1-42)-induced memory impairment and prevented neuronal cell death. Additionally, 4-O-MH reduced Aβ(1-42) infusion-induced oxidative damages of protein and lipid but reduced glutathione levels in the cortex and hippocampus. Aβ(1-42) infusion-induced activation of astrocytes and p38 mitogenic activated protein (MAP) kinase was also prevented by 4-O-MH in mice brains. In further study using culture cortical neurons, p38 MAP kinase inhibitor abolished the inhibitory effect of 4-O-MH (10 μM) on the Aβ(1-42) (5 μM)-induced reactive oxidative species generation and neuronal cell death. These results suggest that 4-O-MH might prevent the development and progression of AD through the reduction of oxidative stress and neuronal cell death via inactivation of p38 MAP kinase pathway.

The components of the herb Magnolia officinalis have exhibited antioxidant and neuroprotective activities. In this study, we investigated effects of ethanol extract of M.officinalis and its major component 4-O-methylhonokiol on memory dysfunction and neuronal cell damages caused by A beta. Oral pretreatment of ethanol extract of M. officinalis (2.5, 5 and 10mg/kg) and 4-O-methylhonokiol (1mg/kg) into drinking water for 5 weeks suppressed the intraventricular treatment of A beta(1-42) (0.5 microg/mouse, i.c.v.)-induced memory impairments. In addition, 4-O-methylhonokiol prevented the A beta(1-42)-induced apoptotic cell death as well as beta-secretase expression. 4-O-methylhonokiol also inhibited H(2)O(2) and A beta(1-42)-induced neurotoxicity in cultured neurons as well as PC12 cells by prevention of the reactive oxygen species generation. 4-O-methylhonokiol also directly inhibited beta-secretase activity and A beta fibrilization in vitro. Thus, ethanol extract of M. officinalis may be useful for prevention of the development or progression of AD, and 4-O-methylhonokiol may be a major active component.

Amyloid beta (Abeta)-induced neurotoxicity is a major pathological mechanism of Alzheimer disease (AD). In this study, we investigated the inhibitory effect of l-theanine, a component of green tea (Camellia sinensis), on Abeta(1-42)-induced neuronal cell death and memory impairment. Oral treatment of l-theanine (2 and 4 mg/kg) for 5 weeks in the drinking water of mice, followed by injection of Abeta(1-42) (2 microg/mouse, icv), significantly attenuated Abeta(1-42)-induced memory impairment. Furthermore, l-theanine reduced Abeta(1-42) levels and the accompanying Abeta(1-42)-induced neuronal cell death in the cortex and hippocampus of the brain. Moreover, l-theanine inhibited Abeta(1-42)-induced extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase as well as the activity of nuclear factor kappaB (NF-kappaB). l-Theanine also significantly reduced oxidative protein and lipid damage and the elevation of glutathione levels in the brain. These data suggest that the positive effects of l-theanine on memory may be mediated by suppression of ERK/p38 and NF-kappaB as well as the reduction of macromolecular oxidative damage. Thus, l-theanine may be useful in the prevention and treatment of AD.

Astrocytes are one of major glial cell types in the central nervous system (CNS), and can support many functions of neuronal cells. In the present study, we demonstrated that the differentiation of rat embryonic neuronal cells was promoted by treatment with astrocyte and microglia-conditioned medium. Cytokine assays identified that the IL-4, MIP-1, KC, and RANTES as were released from astrocyte, and these chemokines promote differentiation of rat embryonic neuronal cells. However, chemokine-promoted neuronal cell differentiation was suppressed by antibodies of these chemokines and their receptor (CCR5). CCR5 and neuronal cell differentiation marker proteins were found to be colocalized, and their expressions were enhanced by chemokines. Furthermore, the differentiation of neuronal cells from CCR5 knock-out mice and of neuronal cells from mice knocked down with the CCR5 siRNA were significantly reduced and delayed. Bradykinin elevated calcium influx in the embryonic neuronal cells. These data suggest that specific chemokines derived from astrocytes may significantly have influence on the CCR5-mediated differentiation of embryonic neuronal cells.

Background Alzheimer's disease (AD) is characterized by extensive loss of neurons in the brain of AD patients. Intracellular accumulation of beta-amyloid peptide (Aβ) has also shown to occur in AD. Neuro-inflammation has been known to play a role in the pathogenesis of AD. Methods In this study, we investigated neuro-inflammation and amyloidogenesis and memory impairment following the systemic inflammation generated by lipopolysaccharide (LPS) using immunohistochemistry, ELISA, behavioral tests and Western blotting. Results Intraperitoneal injection of LPS, (250 μg/kg) induced memory impairment determined by passive avoidance and water maze tests in mice. Repeated injection of LPS (250 μg/kg, 3 or 7 times) resulted in an accumulation of Aβ1–42 in the hippocampus and cerebralcortex of mice brains through increased β- and γ-secretase activities accompanied with the increased expression of amyloid precursor protein (APP), 99-residue carboxy-terminal fragment of APP (C99) and generation of Aβ1–42 as well as activation of astrocytes in vivo. 3 weeks of pretreatment of sulindac sulfide (3.75 and 7.5 mg/kg, orally), an anti-inflammatory agent, suppressed the LPS-induced amyloidogenesis, memory dysfunction as well as neuronal cell death in vivo. Sulindac sulfide (12.5–50 μM) also suppressed LPS (1 μg/ml)-induced amyloidogenesis in cultured neurons and astrocytes in vitro. Conclusion This study suggests that neuro-inflammatory reaction could contribute to AD pathology, and anti-inflammatory agent could be useful for the prevention of AD.

Background: Inhalation induction with desflurane can cause airway irritability and sympathetic stimulation. The aim of this study was to investigate whether lidocaine and fentanyl could reduce these unwanted reactions. Methods: Seventy-five patients who had premedication with midazolam were randomly allocated to one of three groups to receive intravenous saline (S group), lidocaine 1.5 mg/kg (L group), fentanyl 1 μg/kg (F group), respectively, before tidal volume induction with desflurane in oxygen and nitrous oxide. We recorded airway irritability such as cough, apnea, laryngospasm and excitatory movement and hemodynamic changes. Results: Airway irritability was not significantly different between the groups. In F group, mean blood pressure at LOC ver and LOC BIS and heart rate at LOC ver, LOC BIS and just before intubation were lower than those of S group (P ＜ 0.05). Other results were not significantly different. Conclusions: The results of the study showed that intravenous fentanyl and lidocaine had no beneficial effects to reduce airway irritability, but intravenous fentanyl could significantly reduce hemodynamic stimulation during inhalation induction with desflurane in the patients who were premedicated with midazolam. (Korean J Anesthesiol 2009; 57: 693∼7)

Background: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. Methods: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. Results: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. Conclusions: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best

Spontaneous intracranial hypotension due to spinal cerebrospinal fluid leakage is uncommon, relatively benign and usually self-limiting. However it is being increasingly recognized as a cause of postural headaches. The treatment options range from conservative supportive measures to an pidural blood patch. We report a 40-year-old woman who developed intracranial hypotention without any preceding events such as lumbar puncture, back trauma, surgical procedures or medical illnesses. The site of the cerebrospinal fluid leakage was identified at between the C1 to C2 level using computerized tomographic myelography. Consequently, the patient underwent a CT-guided autologous epidural blood patch at the C3-C4 level. Her symptoms were relieved immediately without recurrence.

Background: Angiotensin-converting enzyme inhibitors (ACE-I) have been widely used for cardiac patients. This study investigated the effect of omitting ACE-I medication on hemodynamics during induction of anaesthesia and operation in patients chronically treated with ACE-I undergoing off pump coronary artery bypass graft surgery (OPCAB). Methods: Sixty patients scheduled for OPCAB were included in this study. Patients not treated with ACE-I were included in control group (Group 1, n = 20). And then, patients treated with ACE-I more than 4 weeks were randomly divided into two groups: continuing group including patients who continued ACE-I medication until the morning of surgery (Group 2, n = 20) and discontinuing group including patients who discontinued ACE-I one day before the surgery (Group 3, n = 20). Norepinephrine (8μg/ml) was infused when systolic blood pressure decreased below 90 mmHg during induction and operation. Amount of norepinephrine infused and hemodynamic data were recorded. Results: Significantly larger amount of norepinephrine was infused in Group 2 than in other two groups during obtuse marginal artery anastomosis. Total amount of norepinephrine infused during the all coronary anatsomosis was significantly larger in Group 2 than those values in other two groups. Conclusions: Continuing ACE-I treatment until the morning of surgery significantly increased the use of norepinephrine during the anastomosis. In contrast, there was no significant difference in the use of norepinephrine between Group 1 and Group 3. Discontinuing ACE-I before the surgery may helpful to maintain hemodynamics stable during coronary anastomosis in OPCAB. (Korean J Anesthesiol 2007; 52: 34～41)

Bisphenol A (BPA), a ubiquitous environmental contaminant, has been shown to cause developmental toxicity and carcinogenic effects. BPA may have physiological activity through estrogen receptor (ER) -alpha and -beta, which are expressed in the central nervous system. We previously found that exposure of BPA to immature mice resulted in behavioral alternation, suggesting that overexposure of BPA could be neurotoxic. In this study, we further investigated the molecular neurotoxic mechanisms of BPA. BPA increased vulnerability (decrease of cell viability and differentiation, and increase of apoptotic cell death) of undifferentiated PC12 cells and cortical neuronal cells isolated from gestation 18 day rat embryos in a concentration-dependent manner (more than 50 microM). The ER antagonists, ICI 182,780, and tamoxifen, did not block these effects. The cell vulnerability against BPA was not significantly different in the PC12 cells overexpressing ER-alpha and ER-beta compared with PC12 cells expressing vector alone. In addition, there was no difference observed between BPA and 17-beta estradiol, a well-known agonist of ER receptor in the induction of neurotoxic responses. Further study of the mechanism showed that BPA significantly activated extracellular signal-regulated kinase (ERK) but inhibited anti-apoptotic nuclear factor kappa B (NF-kappaB) activation. In addition, ERK-specific inhibitor, PD 98,059, reversed BPA-induced cell death and restored NF-kappaB activity. This study demonstrated that exposure to BPA can cause neuronal cell death which may eventually be related with behavioral alternation in vivo. However, this neurotoxic effect may not be directly mediated through an ER receptor, as an ERK/NF-kappaB pathway may be more closely involved in BPA-induced neuronal toxicity.

In this case, a successful mitral valve repair was confirmed by transesophageal echocardiography (TEE) at the end of a cardiopulmonary bypass. The left ventricular vent was placed through the mitral valve to remove the air after the TEE examination, and on its way out, the left ventricular vent damaged the anterior mitral leaflet (AML). Re-examination of the valve with TEE detected the new mitral valve insufficiency. The CPB was reinstituted, and tearing of the lateral third part of the anterior mitral leaflet was found. This case emphasizes the importance of TEE in the operating room as a continuous monitor, not only to evaluate the result of the cardiac surgery, but also to detect any unpredictable events during the surgery.