Report on IL-10 gene polymorphism at position -819 for major depression and schizophrenia in Korean population

The present study was carried out to examine the relationship of interleukin (IL)-10 gene polymorphism at position -819 for major depression and schizophrenia in the Korean population. DNA was extracted from 92 Korean patients with major depression, 141 Korean patients with schizophrenia, and 146 ethnically matched controls. DNA was amplified by a polymerase chain reaction-based method and digested by MaeIII, and the restriction fragment length polymorphism of two alleles, IL-10*C and IL-10*T, were assessed. There were no significant differences in genotype frequencies of IL-10*T/T, IL-10*T/C, and IL-10*C/C as well as allelic frequencies of IL-10*T and IL-10*C between patients with major depression and controls in the Korean population. Comparison of genotype and allelic frequencies of IL-10 gene between patients with schizophrenia and controls were also not significant. The present study suggests that IL-10 gene polymorphism at position -819 does not confer susceptibility to major depression and schizophrenia, at least in the Korean population. Further systematic studies including various clinical variables would be required.     

Coiling of lumbar epidural catheters

BACKGROUND: The difficulties in threading an epidural catheter to vertebral levels remote to the puncture level have been well documented. This study was undertaken to determine the length that a single orifice epidural catheter can be threaded into the lumbar space without coiling (coiling length), and whether this is affected by the direction of the epidural needle bevel. METHODS: Forty-five young male patients scheduled for surgery under epidural analgesia were enrolled. The epidural space was identified using a midline approach at the L(2-3) or L(3-4) interspace with the loss of resistance to air technique. A 19-G single-orifice epidural catheter (Flextip Plus, Arrow International, Inc, Reading, PA, USA) was inserted through a Tuohy needle oriented either cephalad (n=20) or caudad (n=25). During insertion, the path and the position of the catheter tip was determined by fluoroscopy using iohexol dye. RESULTS: The median coiling length was 2.8 cm, ranging from 1.0 to 8.0 cm. Only 13% of epidural catheters could be threaded 4 cm beyond the tip of the needle without coiling. No significant difference was found in coiling length between the cephalad group (2.9 cm) and the caudad group (2.5 cm). CONCLUSION: This study demonstrates that coiling length is independent of whether the bevel of the Tuohy needle is directed cephalad or caudad. We recommend that an optimal insertion depth of an end-hole single orifice catheter is 3 cm.     

联合免疫阻断乙肝病毒母婴垂直传播及其母乳喂养安全的临床研究

0引言 乙肝病毒(HBV)可垂直传播感染新生儿,在实行免疫预防程序后,婴儿通过产程和产后感染HBV的途径得到了有效的控制,但HBV宫内感染难以阻断[1],是形成慢性乙肝的主要途径和原因. 阻断HBV母婴传播是控制乙肝流行及预防HBV相关肝病的关键[2]. 寻找有效阻断HBV母婴垂直传播的预防措施已成为世界上控制乃至消灭乙肝的关键课题. 我们用乙肝免疫球蛋白(HB immunoglobulin,HBIG)联合乙肝疫苗(Hbvac)治疗,有效地阻断HBV宫内传播,同时对应用联合免疫的产妇母婴喂养的有关问题进行分析.     

The influence of endotracheal tube tip design on nasal trauma during nasotracheal intubation: magill-tip versus murphy-tip

We performed this study to assess the influence of endotracheal tube (ETT) tip design (Murphy-tip versus Magill-tip) on nasal trauma during nasotracheal intubation with a conventional polyvinyl chloride ETT. Patients were randomly allocated to one of four groups (n = 25 each): Magill-tipped ETT and Murphy-tipped ETT with or without thermosoftening. After preparation with a vasoconstrictor, the selected, well-lubricated ETT was advanced blindly into the nasopharynx, and intubation was completed under direct laryngoscopy. The severity of epistaxis was estimated based on the distance that blood had traveled up the suction catheter and tubing. Without thermosoftening, the Murphy-tipped ETT produced more severe epistaxis than the Magill-tipped ETT (P < 0.05). Thermosoftening effectively reduced the severity of epistaxis for both conventional types of ETT (P < 0.05). However, there was no difference in the severity of epistaxis and the incidence of nasal injury and pain between the Magill-tipped, non-thermosoftened ETT and Murphy-tipped, thermosoftened ETT. Thermosoftening is recommended because it decreases the trauma during nasotracheal intubation. However, if one chooses to use a normal ETT, the Magill-tipped ETT will cause fewer traumas than the Murphy-tipped ETT. IMPLICATIONS: During nasotracheal intubation with conventional endotracheal tubes, Magill-tipped, non-thermosoftened tubes seem to be comparable to Murphy-tipped, thermosoftened tubes with regard to trauma on the nasal mucosa.     

A new technique to determine the size of double-lumen endobronchial tubes by the two perpendicularly measured bronchial diameters

The cross-section of the mainstem bronchi is not completely round. For preoperative selection of a double-lumen endobronchial tube size, it may be necessary to measure the mediolateral and the anteroposterior bronchial diameters, which can be measured respectively on chest radiograph and computed tomography. With Internal Review Board approval and patients' informed consent, 105 elective thoracic surgical patients who needed left-sided double-lumen tubes were enrolled. Double-lumen tube size was selected depending on the arithmetic mean of the mediolateral and anteroposterior bronchial diameters. Moreover, the outer diameters of the bronchial tube should be smaller than both mediolateral and anteroposterior diameters. The recommended bronchial diameter for each double-lumen tube size was chosen so that the mean of the two bronchial diameters was 0 to 2.0 mm larger than the upper limit of 95% confidence interval of the averaged outer diameter of the bronchial tube of the selected double-lumen tube. In no case was the predicted double-lumen tube size inappropriate. Generally, anteroposterior bronchial diameters appeared to be different from mediolateral diameters (P=0.001). The double-lumen tube size to be selected based on only one bronchial diameter was different from the one selected based on two perpendicularly measured bronchial diameters in 54.3% of patients (57/105). Preoperative selection of the double-lumen tube size based on the anteroposterior, mediolateral and mean bronchial diameters seems to be useful in that this may obviate the need to change an inappropriately sized double-lumen tube and may be helpful in reducing the related complications.     

Intra- and extra-pericardial lengths of the superior vena cava in vivo: implication for the positioning of central venous catheters

To reduce the possibility of cardiac tamponade, a rare but lethal complication of central venous catheters, the tip of the central venous catheter should be located above the cephalic limit of the pericardial reflection, not only above the superior vena cava-right atrium junction. This study was performed to measure the superior vena cava lengths above and below the pericardial reflection in cardiac surgical patients. Cardiac surgical patients (n = 61; 27 male), whose age [mean +/- SD (range)] was 47 +/- 15 (15-75) years, were studied. The intrapericardial and extrapericardial lengths, and the length of the medial duplicated part were measured separately. The whole vertical lengths of the superior vena cava on either side were calculated respectively by adding the intra-and extrapericardial and medial duplication lengths. The lateral extrapericardial was 29.1 +/- 6.5 (Mean +/- SD) (9-49) mm (range), and lateral extrapericardial length was 32.6 +/- 6.9 (20-53) mm. The medial extrapericardial length was 23.3 +/- 5.0 (11-39) mm, medical duplicated length was 7.2 +/- 3.3 (4-20) mm, and medial intrapericardial was 28.3 +/- 7.0 (20-52) mm. The averaged superior vena cava length of both sides was 60.3 +/- 9.0 (44.5-90) mm. Almost half of the superior vena cava was found to be within the pericardium and half out. This information may be helpful in deciding how far a central venous catheter should be withdrawn beyond the superior vena cava-right atrial junction during right atrial electrocardiographic guided insertion, and in the prediction of optimal central venous catheter insertion depth.