S. Y. Kim

Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery

BACKGROUNDnEmergence agitation is common after nasal surgery. We investigated the effects of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery in adult patients.nnnMETHODSnOne hundred patients undergoing nasal surgery were randomized into two groups. The dexmedetomidine group (Group D, n=50) received dexmedetomidine infusion at a rate of 0.4 μg kg(-1) h(-1) from induction of anaesthesia until extubation, while the control group (Group C, n=50) received volume-matched normal saline infusion as placebo. Propofol (1.5-2 mg kg(-1)) and fentanyl (1 μg kg(-1)) were used for induction of anaesthesia, and desflurane was used for maintenance of anaesthesia. The incidence of agitation, haemodynamic parameters, and recovery characteristics were evaluated during emergence. A 40-item quality-of-recovery questionnaire (QoR-40) was provided to patients 24 h after surgery.nnnRESULTSnThe incidence of agitation was lower in Group D than Group C (28 vs 52%, P=0.014). Mean arterial pressure and heart rate were more stable in Group D than in Group C during emergence (P<0.05). Time to extubation, bispectral index, and respiratory rate at extubation were similar between the groups. Global QoR-40 score at 24 h after surgery was higher in Group D (median [range], 183 [146 -198]) compared with Group C (178 [133-196]) (P=0.041).nnnCONCLUSIONSnIntraoperative infusion of dexmedetomidine provided smooth and haemodynamically stable emergence. It also improved quality of recovery after nasal surgery.

An interaction between the serotonin transporter promoter region and dopamine transporter polymorphisms contributes to harm avoidance and reward dependence traits in normal healthy subjects.

Summary.There is evidence for an association between polymorphisms of serotonin- and dopamine-related genes and temperamental personality traits. Recent findings have shown that interactions between allelic variants of the different genes may contribute to personality traits. We examined the effects of serotonin transporter-linked promoter region (5-HTTLPR) and dopamine transporter (DAT1) gene polymorphisms for associations with the Temperament and Character Inventory (TCI) temperament subscales in 209 Koreans. We found that the variants of 5-HTTLPR interacted with the DAT1 gene polymorphism to influence the HA and RD temperament subscales of TCI. Neither of these two genes affected any subscales of TCI alone.Controlling for the effects of gender and age, we found significant interactions between 5-HTTLPR and DAT1 genes on Harm Avoidance (HA) and Reward Dependence (RD) as measured by the TCI (Hotelling’s Trace = 3.0, P = 0.02). In the presence of the DAT1 10/10 genotype, subjects of group L of 5-HTTLPR had a significantly higher HA score and significantly lower RD score than those of group S (F = 5.04, df = 1, p = 0.03 and F = 8.35, df = 1, p = 0.004, respectively).These findings suggest that the variants of 5-HTTLPR interacted with the DAT1 gene polymorphism to influence the HA and RD temperament subscales of TCI.

Abdominal tuberculous lymphadenopathy: MR imaging findings

AbstractBackground: The purpose of this study was to evaluate the utility of magnetic resonance imaging (MRI) as a diagnostic tool in abdominal tuberculous lymphadenopathy.n Methods: MRI studies of 11 patients with histologically proven abdominal tuberculous lymphadenopathy were reviewed with regard to anatomic distribution, size, shape, degree, and pattern of enhancement and relation of the lesions to adjacent structures.n Results: The most common site of involvement was the periportal area (n= 6), followed by the peripancreatic (n= 5), mesenteric (n= 1), and paraaortic (n= 1) areas. Eight patients were readily diagnosed as having tuberculous lymphadenopathy on abdominal computed tomography. Three patients had a heterogeneously enhancing masslike lesion adjacent to the pancreas and were initially diagnosed as having cystic tumor of the pancreas. On MRI, 11 lesions showed T1 iso- or hypointensity and central T2 hyperintensity. Two lesions showed T1 iso- or hypointensity and central T2 hypointensity. The lesions with different T2 signal intensities showed different patterns of enhancement on contrast-enhanced dynamic studies. The relations between the enlarged lymph nodes and adjacent bile ducts or vascular structrues were well depicted on MRI.n Conclusion: MRI was useful in differentiating enlarged lymph nodes abutting the pancreas initially diagnosed as cystic neoplasms on abdominal computed tomography. RID= ID= Correspondence to: M.-J. Kim

Comparison of the Effects of Normal Saline Versus Plasmalyte on Acid-Base Balance During Living Donor Kidney Transplantation Using the Stewart and Base Excess Methods

BACKGROUNDnIschemia-reperfusion injury is an inevitable consequence of kidney transplantation, leading to metabolic acidosis. This study compared the effects of normal saline (NS) and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation using the Stewart and base excess (BE) methods.nnnMETHODSnPatients were randomized to an NS group (nxa0= 30) or a Plasmalyte group (nxa0=xa030). Arterial blood samples were collected for acid-base analysis after induction of anesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2), and at the end of surgery (T3). In addition serum creatinine and 24-hour urine output were recorded on postoperative days 1,2, and 7. Over the first postoperative 7 days we recorded episodes of graft failure requiring dialysis.nnnRESULTSnCompared with the Plasmalyte group, the NS group showed significantly lower values of pH, BE, and effective strong ion differences during the postreperfusion period (T2 and T3). Chloride-related values (chloride [Cl(-)], free-water corrected Cl(-), BEcl) were significantly higher at T1, T2, and T3, indicating hyperchloremic rather than dilutional metabolic acidosis. Early postoperative graft functions in terms of serum creatinine, urine output, and graft failure requiring dialysis were not significantly different between the groups.nnnCONCLUSIONSnBoth NS and Plamalyte can be used safely during uncomplicated living donor kidney transplantation. However, Plasmalyte more stably maintains acid-base and electrolyte balance compared with NS especially during the postreperfusion period.

Comparison of the tuberculin skin test and interferon-γ release assay for the diagnosis of latent tuberculosis infection before kidney transplantation

PurposeThe evaluation of latent tuberculosis infection (LTBI) is recommended before kidney transplantation. The interferon-γ release assay has been reported to be more specific than the tuberculin skin test (TST) for detecting LTBI. We compared the TST and QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening for LTBI and determined the agreement between the two tests in renal transplant recipients before transplantation.MethodsAdult patients who were evaluated for renal transplantation between May 2010 and February 2012 at Severance Hospital in South Korea were prospectively enrolled. We performed TST and QFT-GIT.ResultsOf the 126 patients, 23 (19.3xa0%) had positive TST results and 53 (42.1xa0%) had positive QFT-GIT results. Agreement between the TST and QFT-GIT was fair (κxa0=xa00.26, Pxa0<xa00.001). The induration size of TST was significantly correlated with a positive rate of QFT-GIT (Pxa0=xa00.015). Age (odds ratio [OR] 1.08, 95xa0% confidence interval [CI] 1.03–1.13, Pxa0=xa00.003), male sex (OR 2.73, 95xa0% CI 1.17–6.38, Pxa0=xa00.021), and risk for LTBI (OR 4.62, 95xa0% CI 1.15–18.64, Pxa0=xa00.031) were significantly associated with positive QFT-GIT results. For positive TST results, only male sex was associated (OR 4.29, 95xa0% CI 1.40–13.20, Pxa0=xa00.011).ConclusionThe positivity for QFT-GIT was higher than the positivity for TST, and QFT-GIT more accurately reflected the risk for LTBI. However, a further longitudinal study is needed in order to confirm that the QFT-GIT test can truly predict the development of TB after renal transplantation.

Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia

Park IH, Ku J, Lee H, Kim SY, Kim SI, Yoon KJ, Kim J‐J. Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia.

The Responses of Multiple Cytokines Following Incubation of Whole Blood from TB Patients, Latently Infected Individuals and Controls with the TB Antigens ESAT‐6, CFP‐10 and TB7.7

The development of clinically relevant biomarkers is important for diagnosing latent tuberculosis infection (LTBI) and active tuberculosis (TB) and predicting their prognoses. This study examined whether the responses of multiple cytokines can be used as a biomarker to distinguish the TB infection status and mycobacterial load. We analysed the responses of multiple cytokines (IFN‐γ, IL‐2, IL‐10, IL‐13, IL‐17 and TNF‐α) in the supernatant from the QuantiFERON‐TB Gold In‐Tube assay following stimulation of whole blood from the TB group (n = 32), LTBI group (n = 19) and healthy controls (n = 30) with TB antigens (ESAT‐6, CFP‐10 and TB7.7). The median responses of IFN‐γ, IL‐2, IL‐10 and IL‐13 were higher in the LTBI and active TB groups than in the non‐TB control group (IFN‐γ, P < 0.001; IL‐2, P < 0.001; IL‐10, P = 0.012; IL‐13, P < 0.001). The median IL‐2/IFN‐γ ratio of the LTBI group was higher than that of the active TB group (P = 0.014) and differed significantly between patients with LTBI, patients with smear‐negative TB and patients with smear‐positive TB (P = 0.027). This difference was especially evident between the patients with LTBI and patients with smear‐positive TB (P = 0.047). In conclusion, IFN‐γ, IL‐2, IL‐10 and IL‐13 can serve as biomarkers for distinguishing TB infection. In addition, the IL‐2/IFN‐γ ratio appears to be a biomarker for diagnosing LTBI and may be useful as a prognostic factor and for evaluating treatment responses.

Association between vitamin D deficiency and tuberculosis in a Korean population.

BACKGROUNDnSeveral in vitro studies have been conducted regarding the immunomodulatory and mycobactericidal roles of vitamin D in tuberculous infection. However, discrepancies exist among epidemiological studies. We compared vitamin D deficiency between patients with tuberculosis (TB) and healthy control subjects and identified risk factors for vitamin D deficiency.nnnMETHODnThis was an age- and sex-matched case-control analysis of 94 TB cohort and 282 Korean national survey participants.nnnRESULTSnThe median baseline 25-hydroxyvitamin D (25[OH]D) level in the TB group (9.86 ng/ml, IQR 7.19-14.15) was lower than in controls (16.03 ng/ml, IQR 12.38-20.30, P < 0.001). The prevalence of severe vitamin D deficiency was higher in patients with TB (51.1%) than in controls (8.2%, P = 0.001). The median 25(OH)D level increased from 11.40 ng/ml (IQR 7.85-15.73) to 13.18 ng/ml (IQR 10.60-19.71) after treatment completion (P = 0.037). On multivariate analysis, presence of TB and history of TB were independently associated with severe vitamin D deficiency.nnnCONCLUSIONnPatients with TB had a higher prevalence of vitamin D deficiency than control subjects in a Korean population. The median 25(OH)D level increased after TB treatment. Further studies are needed to establish a causal relationship.

Association between genetic variants in the IRGM gene and tuberculosis in a Korean population

PurposeTo investigate immunity-related guanosine triphosphatase family M (IRGM) genetic variants associated with susceptibility to tuberculosis (TB) in a Korean population.MethodsWe conducted a prospective case–control study including 193 patients with active TB in Severance Hospital and 230 age- and sex-matched unrelated controls registered in Yonsei Cardiovascular Genome Center. Based on associations with other chronic inflammatory conditions, we analyzed the allele and genotype frequencies of rs72553867, rs10065172, and rs12654043 among patients with TB and healthy controls.ResultsThe T allele of rs10065172 was significantly associated with protection against developing TB based on allele frequency [Pxa0=xa00.042; odds ratio (OR) 0.75] and genotype distribution in the codominant model (Pxa0=xa00.036; OR 0.73).ConclusionsThis is the first study to identify a significant association between the IRGM single-nucleotide polymorphism (SNP) rs10065172 and susceptibility to active TB disease in an Asian population. The results suggest that IRGM genetic variants could be associated with susceptibility to active TB disease in the Korean population.

Conversion rates of an interferon-γ release assay and the tuberculin skin test in the serial monitoring of healthcare workers

PurposeRegular monitoring of latent tuberculosis (TB) infection in healthcare workers (HCWs) is recommended, but the view about the effective method and performance of serial monitoring is controversial. The aim of this study was to determine differences in conversion rates according to TB exposure risk using the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT), and to evaluate the reproducibility and within-subject variability of the QFT-GIT in South Korea.MethodsFifty-three HCWs were grouped according to their risk for TB exposure: group 1, high risk (nxa0=xa021); group 2, low risk (nxa0=xa032). Baseline and follow-up TSTs and QFT-GITs were performed from June 2009 to July 2011. Enzyme-linked immunosorbent assays (ELISAs) were repeated for the second QFT-GIT and a third QFT-GIT was performed after 8xa0weeks when discordant results of the second TST and QFT-GIT or a conversion or reversion were observed.ResultsNo difference in the QFT-GIT conversion rate was evident between the two groups (15.4 vs. 6.5xa0%, pxa0=xa00.57), and no TST conversion was observed. The rate of QFT-GIT positivity was higher in the high-risk group (first QFT-GIT: 38.1 vs. 3.1xa0%, pxa0=xa00.002; second QFT-GIT: 33.3 vs. 9.4xa0%, pxa0=xa00.039). The re-test reproducibility of QFT-GIT results was high (100xa0%), and the within-subject results of repetitive QFT-GITs were variable.ConclusionsStricter prevention strategies remain necessary in HCWs at high risk of TB exposure, and serial interferon-γ release assays (IGRAs) should be interpreted with caution in HCWs.