Search

We investigated the relationship between smoking and the risk of nonnormal (≤0.99) ankle-brachial index (ABI) at rest and after ankle plantar flexion exercise in healthy male community dwellers. A cross-sectional study was performed including 228 Japanese men aged 40 to 64 years without a history of cardiovascular diseases. Participants were classified as never, ex-, and current smokers. We estimated the multivariate-adjusted odds ratios (ORs) for nonnormal ABI of ex- and current smokers in relation to never smokers after adjusting for age and other confounding factors. At rest, the prevalence of nonnormal ABI was not significantly different by smoking status. After exercise, the prevalence of nonnormal ABI increased from 1.8% to 11.5% in ex-smokers and from 3.8% to 17.0% in current smokers, while the prevalence did not significantly change in never smokers. The multivariate-adjusted OR for nonnormal ABI after ankle plantar flexion exercise, in relation to never smokers, was 3.85 (95% confidence interval [CI]: 0.79-18.9) for ex-smokers and 6.97 (95% CI: 1.32-36.7) for current smokers. Our results suggest that ABI after ankle plantar flexion exercise is useful for early detection of subclinical peripheral artery ischemia in male smokers without typical symptoms.

Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n = 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). Placental transfer was assessed by the clearance of anesthetics by the placenta, defined by the ratio of anesthetic concentration in fetal vein and maternal artery, multiplied by fetal flow rate. Placental clearance was compared between different fetal perfusion states and anesthetics. Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P = 0.002, P < 0.001) and intermediate (P = 0.04, P = 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P = 0.93), intermediate perfusion (P = 1.00), and hypoperfusion (P = 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.

Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Pentax-AWS Airway Scope (AWS) with an infant-sized Intlock (AWS-I), Airtraq laryngoscope (ATQ) and Miller laryngoscope during chest compressions on an infant manikin. Twenty-three novice doctors performed tracheal intubation on an infant manikin using the AWS-I, ATQ and Miller laryngoscope, with or without chest compressions. In Miller laryngoscope trials, one participant failed to secure the airway without chest compressions, while nine failed with compressions (P < 0.05). In ATQ trials, none of the participants failed without compressions, while six failed with compressions (P < 0.05). In AWS-I trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the Miller laryngoscope and ATQ, but not with the AWS-I. The AWS-I is an effective device for endotracheal intubation during chest compressions in infant simulations managed by novice doctors.

Acute exposure to hepatotoxic doses of 2,3,7,8-tetrachloro- dibenzo-p-dioxin (TCDD) in mice is characterized by differential gene expression that can be phenotypically anchored to elevated levels of serum alanine aminotransferase, increased relative liver weights, hepatic steatosis, inflammation, and hepatocellular necrosis. Unlike most studies that focus on acute exposure effects, this study evaluated the long-term effects of a single oral gavage of 30 μg/kg TCDD at 1, 4, 12, 24, 36, and 72 weeks postdose in ovariectomized C57BL/6 mice. Hepatic TCDD levels were almost completely eliminated by 24 weeks with a calculated half-life of 12 days. Hepatic gene expression analysis identified 395 unique differentially expressed genes between 1 and 12 weeks that decreased to ≤ 8 by 72 weeks, consistent with the minimal hepatic TCDD levels. Hepatic vacuolization, characteristic of short-term exposure, subsided by 4 weeks. Similarly, TCDD-elicited hepatic necrosis and inflammation dissipated by 1 week. Collectively, these results suggest that TCDD-elicited histologic and gene expression responses can be correlated to elevated hepatic TCDD levels, which, once eliminated, elicit minimal hepatic gene expression and histologic alterations.

Purpose: American Heart Association (AHA) 2010 cardiopulmonary resuscitation guidelines recommend high-quality chest compressions (minimum interruption, a pace >100 compressions/min, and a depth more than 5 cm). They propose minor changes for pregnant women: manual left deviation of the uterus or a left-lateral incline of 27°-30° to alleviate pressure on the inferior vena cava. We examined the performance of the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (McL) for airway management during chest compressions on a 27° left-lateral tilt (27 LLT) operating table., Methods: The study included 18 novice doctors in our anesthesia department. They performed tracheal intubation on a manikin positioned on a 27 LLT operating table using the AWS or McL with or without chest compressions. We measured the intubation time and success rate for tracheal intubation., Results: Intubation success rate with the McL decreased with chest compressions compared to without chest compressions (12/18 vs. 18/18, P < 0.05). Intubation time with the McL was lengthened with chest compressions compared to without chest compressions (18.9 ± 4.0 s vs. 11.1 ± 1.0 s, P < 0.05). Intubation success rate was the same for the AWS with and without chest compressions (18/18 in both cases), and intubation time did not increase significantly without compressions compared to with compressions (11.6 ± 1.4 s vs. 12.6 ± 1.2 s, NS)., Conclusions: The AWS is an effective tool for airway management during chest compressions in 27 LLT in a manikin, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

A 46-year-old man was diagnosed with descending colon cancer and was planned to undergo left hemicolectomy under general anesthesia. His body mass index was 42.6 and due to his small mouth and jaw, we anticipated difficult mask ventilation and tracheal intubation. To avoid 'can't ventilate, can't intubate', we first inserted a size 3.5 air-Q laryngeal airway under moderate sedation, maintaining spontaneous ventilation. After confirming sufficient assisted ventilation, we used a bronchofiberscope to visualize placement of a gum elastic bougie in the trachea via the air-Q. Then, we replaced the air-Q with an outside diameter 8.5 mm tracheal tube. This case was a successful use of the air-Q under moderate sedation for airway management in the setting of anticipated difficult mask ventilation and tracheal intubation.

The Airway Scope™, a novel videolaryngoscope used for tracheal intubation, is minimally invasive and can be used in conscious patients. The parturient with a potentially difficult airway should sometimes be intubated while awake, without anaesthesia or neuromuscular block. Two pregnant women who experienced massive postpartum haemorrhage during caesarean section underwent unscheduled intraoperative tracheal intubation using the Airway Scope. They were conscious and were intubated with minimal local anaesthesia so as to prevent cardiovascular compromise. We believe the Airway Scope is useful for anaesthetic procedures in the parturient who has haemodynamic instability.

We report a case of awake intubation in a patient with a difficult airway combined with severe hemorrhagic shock using the Pentax-AWS Airwayscope (AWS). A 65-year-old man experienced severe hemorrhagic shock due to diaphragmatic hernia after extrapleural pneumonectomy and was scheduled for emergent exploratory thoracotomy under general anesthesia. Blood pressure was maintained with dopamine-noradrenaline support, and rapid transfusion. We anticipated difficult ventilation due to a swollen face and tongue. The patient underwent awake intubation with the AWS under dexmedetomidine sedation and lidocaine spray for laryngotracheal anesthesia. The patient did not buck during intubation and hemodynamic changes were minimal.

The intubating laryngeal airway, air-Q ILA, was recently introduced in Japan. It has been used in adult patients for difficult airway management; however, there are few reports available on its use in pediatric patients. We report the use of the air-Q ILA in predicted difficult airway management in a 16-month-old patient with Apert syndrome characterized by acrocephalosyndactyly undergoing a syndactyly operation. It was somewhat difficult to keep his airway with a facemask, and an air-Q ILA was inserted. Following the ventilation via air-Q ILA, tracheal intubation guided by a tracheal fiberscope was attempted through the air-Q ILA. Five months after this operation, the patient again underwent the same operation. We managed his airway in the same way as previously, and the tracheal was intubated. This case shows that the air-Q ILA can be an alternative device in pediatric difficult airway management.

A 79-year-old man was diagnosed with maxillary cancer and underwent total maxillectomy under general anesthesia. The oropharyngeal airway was needed for efficient mask ventilation during anesthesia induction. The maxilla was totally resected and reconstructed with skin from a femoral flap. Tracheal extubation was considered to be difficult given that mask ventilation was contraindicated due to reconstruction of the maxilla. After inserting a tube exchanger (TE) into the trachea, the tracheal tube was exchanged with an air-Q laryngeal airway through the TE. After confirming effective ventilation with the air-Q mask, the patient was awakened from anesthesia. We confirmed sufficient spontaneous breathing and no active bleeding in the pharynx. After re-inserting the TE thorough air-Q, the air-Q was removed, followed by removal of the TE. These findings suggest that the air-Q and TE were effective in a case of difficult extubation after maxillectomy.

Unlabelled: We have investigated the involvement of glucocorticoid on methamphetamine (MA) induced hyperpyrexia using a bio-telemetric system. A significant level of hyperpyrexia was observed in MA administered rats. In contrast, increase of body temperature was suppressed by adrenalectomy or by the administration of RU-486, an antagonist of the glucocorticoid receptor. These data suggest that the glucocorticoid receptor may be involved in hyperpyrexia induced by MA., Keywords: methamphetamine - hyperpyrexia - glucocorticoid - corticosterone.

Background: Recent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasise that rescuers should minimise the interruption of chest compressions. To that end, supraglottic devices such as laryngeal mask airways (LMAs) are suggested as a backup for airway management during infant CPR. We therefore compared the utility of the air-Q(®) LMA (air-Q) with that of the Soft Seal(®) LMA (Soft Seal) for infant CPR in an infant manikin., Methods: Twenty-four novice doctors in the anaesthesia department performed insertion and ventilation with air-Q and Soft Seal on an infant manikin with or without chest compression., Results: Two doctors failed to insert the Soft Seal without chest compression, while nine failed during chest compression (P<0.05). However, only one doctor failed to insert the air-Q without chest compression, and two doctors failed during chest compression. Insertion time was not significantly increased with chest compression using either device. Insertion time during chest compression was significantly shorter for the air-Q than for the Soft Seal (P<0.05). The visual analogue scale (VAS) was used to evaluate difficulty of use (0mm (extremely easy) to 100mm (extremely difficult)). VAS scores did not change significantly by the addition of chest compression with either device; however, VAS scores during chest compression were significantly higher with Soft Seal than with the air-Q device., Conclusion: We conclude that novice doctors find the air-Q easier to use than Soft Seal for emergency airway management during chest compression in infants, in an infant manikin., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Interactions between environmental contaminants can lead to non-additive effects that may affect the toxicity and risk assessment of a mixture. Comprehensive time course and dose-response studies with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), non-dioxin-like 2,2',4,4',5,5'-hexachlorobiphenyl (PCB153) and their mixture were performed in immature, ovariectomized C57BL/6 mice. Mice were gavaged once with 30 μg/kg TCDD, 300 mg/kg PCB153, a mixture of 30 μg/kg TCDD with 300 mg/kg PCB153 (MIX) or sesame oil vehicle for 4,12, 24,72 or 168 h. In the 24h dose-response study, animals were gavaged with TCDD (0.3,1, 3, 6, 10, 15, 30, 45 μg/kg), PCB153 (3,10, 30, 60, 100, 150, 300, 450 mg/kg), MIX (0.3+3, 1+10, 3+30, 6+60, 10+100, 15+150, 30+300, 45 μg/kg TCDD+450 mg/kg PCB153, respectively) or vehicle. All three treatments significantly increased relative liver weights (RLW), with MIX eliciting significantly greater increases compared to TCDD and PCB153 alone. Histologically, MIX induced hepatocellular hypertrophy, vacuolization, inflammation, hyperplasia and necrosis, a combination of TCDD and PCB153 responses. Complementary lipid analyses identified significant increases in hepatic triglycerides in MIX and TCDD samples, while PCB153 had no effect on lipids. Hepatic PCB153 levels were also significantly increased with TCDD co-treatment. Microarray analysis identified 167 TCDD, 185 PCB153 and 388 MIX unique differentially expressed genes. Statistical modeling of quantitative real-time PCR analysis of Pla2g12a, Serpinb6a, Nqo1, Srxn1, and Dysf verified non-additive expression following MIX treatment compared to TCDD and PCB153 alone. In summary, TCDD and PCB153 co-treatment elicited specific non-additive gene expression effects that are consistent with RLW increases, histopathology, and hepatic lipid accumulation., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Excessive bleeding after cardiopulmonary bypass remains a major complication for cardiac surgery. The principal causes of hemostatic bleeding are related to inadequate surgical hemostasis or diluted coagulopathy. We investigated the efficacy of cryoprecipitate (Cryo) transfusion in thoracic aortic surgery with cardiopulmonary bypass., Methods: We divided 30 patients undergoing thoracic aortic surgery into two groups retrospectively. Fifteen patients transfused with cryoprecipitate and fresh frozen plasma (FFP) were defined as Group Cryo, and the other 15 patients transfused with FFP only were defined as Group FFP We compared the amount of blood products administered and the blood loss during the perioperative period between the two groups with P <0.05 to be significant., Results: There were no significant differences in the clinical background between the two groups. There were significant differences in the volume of blood loss (Group Cryo 544 +/- 233 ml, Group FFP 888 +/- 339 ml), requirements of FFP (Group Cryo 0.6 +/- 1.7 unit, Group FFP 4.3 +/- 6.0 unit) in ICU., Conclusions: Cryoprecipitate transfusion is an effective treatment for coagulopathy caused by dilution of coagulation factors after cardiopulmonary bypass.

Background: The increased distribution of crystalloid solution into the interstitial space may decrease the effectiveness of intravascular volume loading in patients. We investigated whether preoperative hydration status after overnight fasting affects interstitial fluid redistribution and thus the magnitude of hypotension during general anesthesia., Methods: Sixty ASA physical status I/II patients undergoing tympanoplasty fasted from midnight. Anesthesia was induced by fentanyl and propofol and maintained with sevoflurane and remifentanil. Coinciding with the induction of anesthesia, 15 mL/kg acetated Ringer solution was infused IV over 60 minutes followed by 1 mL/kg acetated Ringer solution over the next 30 minutes. Urine osmolalities after induction of anesthesia and during the study period (pre-U(osm), post-U(osm)) and percent decreases of whole-body bioelectrical resistance for extracellular fluid relative to baseline at the end of the study period (ΔR(e)) were measured. Patients with a pre-U(osm) < the 25th percentile or with a pre-U(osm) > the 75th percentile of pre-U(osm) were categorized in the hydrated or the dehydrated group, respectively. A range of variables, including mean arterial blood pressure during the 30- to 90-minute period relative to baseline, and ΔR(e), were compared between the groups., Results: The dehydrated group (pre-U(osm) >759.5 mOsm/kg, n = 15) had a lower age (44 vs 52 years, P = 0.049) and had a higher post-U(osm) (181 vs 55 mOsm/kg, P = 0.001) compared with the hydrated group (pre-U(osm) <378.5 mOsm/kg, n = 15). Mean arterial blood pressure during the 30- to 90-minute period relative to baseline (0.67 vs 0.67, P = 0.85) with 95% confidence interval for the difference of means (-0.070 to 0.084) and ΔR(e) (5.6% vs 6.0%, P = 0.58) with 95% confidence interval for the difference of means (-1.85% to 1.06%) were similar for the hydrated and dehydrated groups., Conclusions: Preoperative dehydration after overnight fasting as measured by urine osmolality did not alter the magnitude of hypotension during general anesthesia. This finding suggests that intravascular volume loading with crystalloid solution to prevent hypotension during general anesthesia is an unfounded practice for low risk patients after overnight fasting.

Background: Recent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Miller laryngoscope (Mil) with Airtraq (ATQ) during chest compression in an infant manikin., Methods: Twenty staff doctors in intensive care and emergency medicine performed tracheal intubation on an infant manikin with Mil and ATQ with or without chest compression., Results: In Mil trials, no participants failed without chest compression, but 6 of them failed during chest compression (P < 0.05). In ATQ trials, all participants successfully secured the airway regardless of chest compression. Intubation time was significantly lengthened due to chest compression in Mil trials, but not in ATQ trials. The visual analog scale (VAS) for laryngoscope image did not significantly change due to chest compression for ATQ or Mil trials. In contrast, chest compression worsened VAS scores for tube passage through the glottis in Mil trials, but not in ATQ trials., Conclusion: We conclude that ATQ performed better than Mil for endotracheal intubation during chest compression in infant simulations managed by expert doctors., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

A 37-year-old woman with bronchial tumor was scheduled for the removal of the mass with fiberoptic bronchoscope. Intubating laryngeal mask airway (ILMA) was used for fiberoptic surgery. Through a size 3 ILMA, a 5.9 mm outer diameter fiberoptic bronchoscope reached the trachea easily. The operation was successfully performed with assisted ventilation. Intraoperative laryngospasm was treated with intravenous suxamethonium. The ILMA allowed removal of the bronchial tumor with fiberoptic bronchoscope.

We report a case of awake intubation utilizing Pentax-AWS Airwayscope in semi-sitting position. A 74-year-old man with myasthenia gravis and cervical disc hernia was scheduled for distal gastrectomy under general anesthesia. He could not move his head due to severe cervical disc hernia and also could not sufficiently breathe due to the fatigue of respiratory muscles by myasthenia gravis in supine position. With fentanyl bolus administration and lidocaine spray for laryngotracheal anesthesia, we performed awake intubation in semi-sitting position with AWS from cranial side. The patient did not buck during intubation and no hemodynamic change was observed.

Cardiac amyloidosis may cause restrictive cardiomyopathy associated with heart failure, conduction disorder and ischemic heart disease. Therefore, patients with amyloidosis require careful hemodynamic monitoring in perioperative period. A 63-year-old man with cardiac amyloidosis was scheduled for pneumonectomy. His transthoracic echocardiography assessment showed a hypertrophic interventricular septum and slight decreased ejection fraction of 55%, but left ventricular (LV) diastolic function was decreased. Pulse Doppler for mitral valve inflow showed that the early peak velocity/atrial peak velocity (E/A) ratio was 0.9, the deceleration time (DT) was 163 msec and the early diastolic mitral annular tissue velocity (E') was 4 cm x sec(-1). These data suggested a pseudonormalization state. We performed careful monitoring using arterial pressure-based cardiac output (APCO), central venous oxygen saturation (ScvO2) and transesophageal echocardiography. There were no severe complications such as circulatory collapse and arrhythmia in the perioperative period.

The toxic equivalency factor (TEF) approach recommended by the World Health Organization is used to quantify dioxin-like exposure concentrations for mixtures of polychlorinated dibenzo-dioxins, -furans, and polychlorinated biphenyls (PCBs), including 2,3,7,8-tetrachlorodibenzofuran (TCDF) and 3,3',4,4',5-pentachlorobiphenyl (PCB126) relative to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Whole-genome microarrays were used to evaluate the hepatic gene expression potency of TCDF and PCB126 relative to TCDD with complementary histopathology, tissue level analysis, and ethoxyresorufin-O-deethylase (EROD) assay results. Immature ovariectomized C57BL/6 mice were gavaged with 0.001, 0.01, 0.03, 0.1, 0.3, 1, 3, 10, 30, 100, and 300 μg/kg TCDD and TEF-adjusted doses (TEF for TCDF and PCB126 is 0.1) of TCDF or PCB126 (1, 3, 10, 30, 100, 300, 1000, and 3000 μg/kg of TCDF or PCB126) or sesame oil vehicle and sacrificed 24 h post dose. In general, TCDD, TCDF, and PCB126 tissue levels, as well as histopathological effects, were comparable when comparing TEF-adjusted doses. Automated dose-response modeling (ToxResponse Modeler) of the microarray data identified 210 TCDF and 40 PCB126 genes that exhibited sigmoidal dose-response curves with comparable slopes when compared with TCDD. These similar responses were used to calculate a median TCDF gene expression relative potency (REP) of 0.06 and a median PCB126 gene expression REP of 0.02. REPs of 0.02 were also calculated for EROD induction for both compounds. Collectively, these data suggest that differences in the ability of the liganded aryl hydrocarbon receptor:AhR nuclear translocator complex to elicit differential hepatic gene expression, in addition to pharmacokinetic differences between ligands, influence their potency in immature ovariectomized C57BL/6 mice.

A radical hysterectomy was performed in a patient complicated with bronchiectasis, under combined spinal-epidural anesthesia. The patient was asymptomatic and preoperatively diagnosed with bronchiectasis on an anesthetic consultation with an anesthesiologist. An epidural catheter was inserted between T12 and L1, and spinal anesthesia was subsequently performed with 0.5% bupivacaine 2.8 ml and fentanyl 10 microg. It was necessary to administer a supplemental epidural dose of 0.375% ropivacaine fifty minutes after the start of the operation. Postoperative epidural analgesia was effective and no perioperative complications were observed.

We report a case of tension pneumothorax associated with asthma attack during general anesthesia. An 86-year-old woman with dementia underwent cataract surgery under general anesthesia. At 70 min after the start of operation, airway pressure suddenly increased from 19 to 28 cm HO2O. In spite of bag ventilation with 100% oxygen, Sp(O2) decreased to 81%. Chest-Xp showed typical image of tension pneumothorax. Chest drainage was immediately performed, after which Pa(O2) recovered soon. She was extubated on postoperative day 1 without any neurological disorder. Hyperinflation of fragile alveoli by mechanical ventilation was likely a cause of tension pneumothorax.

Polychlorinated biphenyls (PCBs) are ubiquitous contaminants found as complex mixtures of coplanar and non-coplanar congeners. The hepatic temporal and dose-dependent effects of the most abundant non-dioxin-like congener, 2,2',4,4',5,5'-hexachlorobiphenyl (PCB153), were examined in immature, ovariectomized C57BL/6 mice, and compared to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the prototypical aryl hydrocarbon receptor (AhR) ligand. Animals were gavaged once with 300 mg/kg PCB153 or sesame oil vehicle and sacrificed 4, 12, 24, 72 or 168 h post dose. In the dose-response study, mice were gavaged with 1, 3, 10, 30, 100 or 300 mg/kg PCB153 or sesame oil for 24 h. Significant increases in relative liver weights were induced with 300 mg/kg PCB153 between 24 and 168 h, accompanied by slight vacuolization and hepatocellular hypertrophy. The hepatic differential expression of 186 and 177 genes was detected using Agilent 4 x 44 K microarrays in the time course (|fold change|> or =1.5, P1(t)> or =0.999) and dose-response (|fold change|> or =1.5, P1(t)> or =0.985) studies, respectively. Comparative analysis with TCDD suggests that the differential gene expression elicited by PCB153 was not mediated by the AhR. Furthermore, constitutive androstane and pregnane X receptor (CAR/PXR) regulated genes including Cyp2b10, Cyp3a11, Ces2, Insig2 and Abcc3 were dose-dependently induced by PCB153. Collectively, these results suggest that the hepatocellular effects elicited by PCB153 are qualitatively and quantitatively different from TCDD and suggestive of CAR/PXR regulation., (2009 Elsevier Inc. All rights reserved.)

Spinal anesthesia is a safe and effective anesthetic technique for cesarean section, considering its simplicity, rapidity, accompanied maternal awareness and distribution of anesthetic agents. The problems of spinal anesthesia, hypotension, postdural puncture headache, failed spinal anesthesia, and its duration, have been investigated. Intravenous fluid therapy may reduce the incidence and severity of the hypotension. Colloid administration is one of the interventions for prevention of hypotension. Low dose phenylephrine is effective without fetal acidosis in healthy mother. The fluid and vasoconstrictor therapies for hypotension induced by spinal anesthesia were briefly reviewed. Postdural puncture headache is one of the troublesome problems. Epidural blood patch is one of the definitive treatments; however further randomized trials are required. Spinal opioid has improved the quality of spinal anesthesia. The recommended dose of spinal opioid in the recent obstetric anesthesia textbooks has been reviewed. The recent issue about safety and effectiveness in obstetric anesthesia has been briefly discussed.

Background: There is controversy regarding which fluid management regimen provides the best postoperative outcome. Interstitial fluid accumulation may adversely affect postoperative outcome, but the effect of surgical duration on fluid balance is unknown. In this study, we used a mathematical model to describe fluid distribution., Methods: Previously published data from bioimpedance analysis in patients undergoing abdominal surgery were used to calculate changes to interstitial volume (DeltaV(IT), percent change relative to baseline) in uninjured and injured tissues. Ratios of DeltaV(IT) in uninjured and injured tissues at the end of surgery to total fluid volume infused during surgery (V(INF), mL/kg) were compared between surgeries of duration <3 h (n = 5) and > or = 3 h (n = 25). Critical values for change in plasma volume (DeltaV(PL), percent change relative to baseline) and DeltaV(IT), which give rise to adverse outcome, were calculated from previously published data on the physiological effects of IV fluid administration in healthy volunteers. Finally, simulated abdominal surgery in a 70 kg man for 1-8 h was used to determine the effect of crystalloid infusion rate between 2 and 30 mL x kg(-1) x h(-1) on DeltaV(PL) and DeltaV(IT). Fluid infusion rates that maintained DeltaV(PL) and DeltaV(IT) in uninjured tissue within critical values were then computationally determined as a function of duration of surgery., Results: Bioimpedance data showed that the differences in DeltaV(IT)/V(INF) ratios between uninjured and injured tissues were significant only for surgical duration > or = 3 h (0.30 +/- 0.17% x kg/mL vs 1.55 +/- 0.73% x kg/mL, P < 0.0001). Differences of DeltaV(IT)/V(INF) ratios between surgical durations <3 and > or = 3 h were found only for injured tissue (0.45 +/- 0.35% x kg/mL vs 1.55 +/- 0.73% x kg/mL, P = 0.003). The range of fluid infusion rates required to maintain DeltaV(PL) and DeltaV(IT) within the critical values (>-15% and <20%, respectively) was wide for short-duration surgery (2-18.5 mL x kg(-1) x h(-1) for a 2 h-surgery), whereas it was narrow for long-duration surgery (5-8 mL x kg(-1) x h(-1) for a 6 h-surgery)., Conclusions: Based on our model, it should be possible to increase the fluid infusion rate without significant interstitial edema for abdominal surgery of <3 h duration. However, our model predicts that restrictive fluid management should be used in abdominal surgery of >6 h duration to avoid excessive interstitial edema.

Purpose: We aimed to investigate the placental transfer of local anesthetics in perfusates with different pH values, using a dual-perfused human cotyledon model., Methods: The dual-perfused human cotyledon model was prepared from placentas obtained following cesarean delivery (n = 5). Protein-free solution was perfused through both maternal and fetal arteries. Four amide-type local anesthetics (mepivacaine [Mep]; lidocaine [Lid]; bupivacaine [Bup]; and ropivacaine [Rop]) were added to the maternal perfusate at 1 microg ml(-1). Three conditions were tested (stage 1, maternal pH 7.4, fetal pH 7.4; stage 2, maternal pH 7.4, fetal pH 6.9; and stage 3, maternal pH 6.9, fetal pH 6.9). Venous blood samples were collected from the fetal circuit after stabilization. The fetal vein/maternal artery concentration ratio (F/M ratio) of the local anesthetics was used as an index of placental transfer. The concentration of human chorionic gonadotropin (hCG) in the maternal vein was measured at the end of each stage., Results: The F/M ratios in all stages were in the order of: Mep > Lid > Bup [symbol: see text] Rop. The F/M ratios of Mep were significantly higher than those of the other local anesthetics in all stages. The F/M ratios of Lid were higher than those of Rop in stages 2 and 3. The F/M ratios of Lid and Rop were higher in stage 2 than in stage 3. However, the differences between the F/M ratios in the three stages were not as large as expected from the basic uncharged ([B]) condition and pH gap. The concentration of hCG showed a time-dependent decrease with increasing stage (stage 1, 81.0 +/- 58.9 mIU ml(-1); stage 2, 57.4 +/- 31.8 mIU ml(-1); stage 3, 32.1 +/- 19.7 mIU ml(-1))., Conclusion: Our data clearly show that it is the basic uncharged concentration that mainly determines the placental transfer of amide-type local anesthetics with protein-free perfusate. This finding suggests that Rop and Bup can be used more safely than Mep in terms of placental transfer.

Background: Difficult airway management (DAM) is one of the most important issues for anesthesiologists. The DAM practical seminar was held for the purpose of improving skill and ability for decision-making to the anesthesiologist's DAM., Methods: In clinical setting, perioperative medical team, which consists of anesthesiologists and nurses, has to struggle against difficult airway cases. To improve the ability of team practice for DAM, we started a training program corresponding to difficult airway management which a nurse and the anesthesiologist jointly perform in the Hyogo College of Medicine Hospital Central Operation Center., Results: From September 2005 to September 2006, we held 6 seminars and 18 anesthesiologists and 17 nurses took part in them. The comment after attendance shows that it was very useful. In scenario session, we trained case management according to the routine emergency call system of Hyogo College of Medicine Hospital Central Operation Center. During session, we discovered the defect of the manual corresponding to emergency, and its improvement., Conclusions: The DAM practical seminar in the hospital is useful not only for perioperative team practice training, but also for improving the emergency call system.

Background: Dichlorodiphenyltrichloroethane (DDT) is a persistent estrogenic organochlorine pesticide that is a rodent hepatic tumor promoter, with inconclusive carcinogenicity in humans. We have previously reported that o, p'-DDT elicits primarily PXR/CAR-mediated activity, rather than ER-mediated hepatic responses, and suggested that CAR-mediated effects, as opposed to ER-mediated effects, may be more important in tumor promotion in the rat liver. To further characterize species-specific hepatic responses, gene expression analysis, with complementary histopathology and tissue level analyses were investigated in immature, ovariectomized C57BL/6 mice treated with 300 mg/kg o, p'-DDT, and compared to Sprague-Dawley rat data., Results: Rats and mice exhibited negligible histopathology with rapid o, p'-DDT metabolism. Gene expression profiles were also similar, exhibiting PXR/CAR regulation with the characteristic induction of Cyp2b10 and Cyp3a11. However, PXR-specific target genes such as Apoa4 or Insig2 exhibited more pronounced induction compared to CAR-specific genes in the mouse. In addition, mouse Car mRNA levels decreased, possibly contributing to the preferential activation of mouse PXR. ER-regulated genes Cyp17a1 and Cyp7b1 were also induced, suggesting o, p'-DDT also elicits ER-mediated gene expression in the mouse, while ER-mediated effects were negligible in the rat, possibly due to the inhibitory effects of CAR on ER activities. In addition, o, p'-DDT induced Gadd45a, Gadd45b and Cdkn1, suggesting DNA damage may be an additional risk factor. Furthermore, elevated blood DHEA-S levels at 12 h after treatment in the mouse may also contribute to the endocrine-related effects of o, p'-DDT., Conclusion: Although DDT is known to cause rodent hepatic tumors, the marked species differences in PXR/CAR structure, expression patterns and ligand preference as well as significant species-specific differences in steroidogenesis, especially CYP17A1 expression and activity, confound the extrapolation of these results to humans. Nevertheless, the identification of potential modes of action as well as species-specific responses may assist in the selection and further development of more appropriate models for assessing the toxicity of DDT to humans and wildlife.

The production of technical penta-BDE products such as Great Lakes DE-71 is not a clean process but, instead, gives complex mixtures of various BDE congeners. This study reports the verification of the structures of many of the BDE congeners in Great Lakes DE-71 using (1)H NMR and/or GC/MS. In total, 24 BDE congeners, including nine (tetra-BDEs 42, 48, 51, and 91; penta-BDEs 102, 104, and 119; hexa-BDEs 149 and 155) which had not been reported previously, were identified in this technical mix by (1)H NMR. The quantification of these congeners was realized by two independent methods: (1)H NMR spectroscopy in combination with HRGC/LRMS and isotopic dilution and HRGC/HRMS analysis. The values obtained compare well between methods, and with data produced in earlier studies.

Electrochemical debromination of the commercial decabromodiphenyl ether flame retardant DE-83 in partly aqueous tetrahydrofuran (THF) solution gave lower brominated congeners by sequential loss of bromine atoms. Hydrodebromination was most facile for the most heavily brominated congeners. It involves initial electron transfer and proton transfer from water, rather than hydrogen atom abstraction from THF, as shown by experiments with deuterated water. The product distribution from electrolysis involves preferential loss of bromine meta- and para- to the ether linkage, comparable with the products of metabolism of BDE-209 in various organisms. Significantly, the environmentally relevant congeners BDE-47, BDE-99, and BDE-154 were not major products of debromination of BDE-209 by the electron transfer mechanism.

Increasing numbers of sense-antisense transcripts (SATs), which are transcribed from the same chromosomal location but in opposite directions, have been identified in various eukaryotic species, but the biological meanings of most SATs remain unclear. To improve understanding of natural sense-antisense transcription, we performed comparative expression profiling of SATs conserved among humans and mice. Using custom oligo-arrays loaded with probes that represented SATs with both protein-coding and non-protein-coding transcripts, we showed that 33% of the 291 conserved SATs displayed identical expression patterns in the two species. Among these SATs, expressional balance inversion of sense-antisense genes was mostly observed in testis at a tissue-specific manner. Northern analyses of the individual conserved SAT loci revealed that: (i) a smeary hybridization pattern was present in mice, but not in humans, and (2) small RNAs (about 60 to 80 nt) were detected from the exon-overlapping regions of SAT loci. In addition, further analyses showed marked alteration of sense-antisense expression balance throughout spermatogenesis in testis. These results suggest that conserved SAT loci are rich in potential regulatory roles that will help us understand this new class of transcripts underlying the mammalian genome.

The present study investigated proliferation of MKN28 and MKN45 human gastric cancer cells regulated by the N-methyl-d-aspartate (NMDA) receptor subunit. The NMDA receptor antagonist dl-2-amino-5-phosphonovaleric acid (AP5) inhibited proliferation of MKN45 cells, but not MKN28 cells. Of the NMDA subunits such as NR1, NR2 (2A, 2B, 2C, and 2D), and NR3 (3A and 3B), all the NMDA subunit mRNAs except for the NR2B subunit mRNA were expressed in both MKN28 and MKN45 cells. MKN45 cells were characterized by higher expression of the NR2A subunit mRNA and lower expression of the NR1 subunit mRNA, but MKN28 otherwise by higher expression of the NR1 subunit mRNA and lower expression of the NR2A subunit mRNA. MKN45 cell proliferation was also inhibited by silencing the NR2A subunit-targeted gene. For MKN45 cells, AP5 or knocking-down the NR2A subunit increased the proportion of cells in the G(1) phase of cell cycling and decreased the proportion in the S/G(2) phase. The results of the present study, thus, suggest that blockage of NMDA receptors including the NR2A subunit suppresses MKN45 cell proliferation due to cell cycle arrest at the G(1) phase; in other words, the NR2A subunit promotes MKN45 cell proliferation by accelerating cell cycling.

Polychlorinated biphenyls are persistent environmental pollutants that elicit a wide range of effects in humans and wildlife, mediated by the aryl hydrocarbon receptor. 3,3',4,4',5-pentachlorobiphenyl (PCB126) is the most potent congener with relative effect potencies ranging from 0.0026 to 0.857, and a toxic equivalency factor (TEF) of 0.1 set by an expert panel of the World Health Organization. In this study, the hepatic effects elicited by 300 microg/kg PCB126 were compared with 30 microg/kg 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in immature, ovariectomized female C57BL/6 mice. Comprehensive hepatic gene expression analyses with complementary histopathology, high-resolution gas chromatograph/high-resolution mass spectrometer tissue analysis, and clinical chemistry were examined. For temporal analysis, mice were orally gavaged with PCB126 or sesame oil vehicle and sacrificed after 2, 4, 8, 12, 18, 24, 72, 120, or 168 h. In the dose-response study, mice were gavaged with 0.3, 1, 3, 10, 30, 100, 300, 1000 microg/kg PCB126, 30 or 100 microg/kg TCDD and sacrificed after 72 h. 251 and 367 genes were differentially expressed by PCB126 at one or more time points or doses, respectively, significantly less than elicited by TCDD. In addition, there was less vacuolization and necrosis, and no immune cell infiltration, despite comparable or higher TEF-adjusted hepatic PCB126 levels. The functional annotation of differentially expressed genes was consistent with the observed histopathology. Collectively, the data indicate that 300 microg/kg PCB126 elicited a subset of weaker effects compared with 30 microg/kg TCDD in immature, ovariectomized C57BL/6 mice.

Technical-grade dichlorodiphenyltrichloroethane (DDT) is an agricultural pesticide and malarial vector control agent that has been designated a potential human hepatocarcinogen. The o,p'-enantiomer exhibits estrogenic activity that has been associated with the carcinogenicity of DDT. The temporal and dose-dependent hepatic estrogenicity of o,p'-DDT was investigated using complementary DNA microarrays in immature ovariectomized Sprague-Dawley rats with complementary histopathology and tissue-level analysis. Animals were gavaged with 300 mg/kg o,p'-DDT either once or once daily for 3 consecutive days. Liver samples were examined 2, 4, 8, 12, 18, or 24 h after a single dose or following three daily doses. For dose-response studies, a single dose of 3, 10, 30, 100, or 300 mg/kg body weight o,p'-DTT was administered for 3 consecutive days. Genes associated with drug metabolism (Cyp2b2 and Cyp3a2), the nuclear receptors constitutive androstane receptor (CAR) and pregnane X receptor (PXR), cell proliferation (Ccnd1, Ccnb1, Ccnb2, and Stmn1), and oxidative stress (Gclm and Hmox1) were significantly induced. Cyp2b2 exhibited dose-dependent regulation and was significantly induced across all time points, while cell proliferation- and oxidative stress-related genes exhibited transient induction. The induction of Cyp2b2 and Cyp3a2 mRNA levels suggest PXR/CAR activation, consistent with expression of genes associated with oxidative stress. Few genes known to be estrogen receptor (ER) regulated were differentially expressed when compared to the hepatic gene expression profile elicited by ethynyl estradiol in immature ovariectomized C57BL/6 mice using the same study design and analysis methods. These data indicate that o,p'-DDT elicits PXR/CAR-, not ER-, mediated gene expression in the rat liver. Based on the species-specific differences in CAR regulation, the extrapolation of rodent DDT hepatocarcinogenicity to humans warrants further investigation.

Background: The Japanese Society of Anesthesiologists (JSA) started the annual survey of the critical incidents related to anesthesia in 1992. The certified anesthesia-training hospitals, which are more than 700 in Japan, send the questionnaire results to JSA every year. This is a nationwide large-scale survey, in which more than 150 million cases are analyzed per year. The accuracy of each data is essential for such a large data base. In this report, we examined the accuracy of data in our institute., Methods: We have examined 2238 cases of anesthesia that we had managed between January 1 and June 30, 2005 in the Hyogo Medical College Hospital. We analyzed the data accuracy regarding the classification of surgical procedures, and anesthesia methods, especially total intravenous anesthesia (TIVA)., Results: The error rate in the classification of surgical procedures was 15.1%. There were three types of errors; incorrect selection (8.1%), suspension by choosing "others" (4.9%), and no selection (2.1%). Inhalation anesthetics were used in 44.6% of cases which had been enrolled as TIVA., Conclusions: The high error rate in the classification of surgical procedures and anesthesia methods impair the reliability of data analysis. We expect to discuss further at the JSA meeting regarding the method of the survey.

Anaphylactic reactions to blood transfusion can lead to life-threatening cardiovascular disruptions. We describe a case in which anaphylaxis due to blood transfusion during general anesthesia was the probable cause of coronary artery spasm. Thirty minutes after the transfusion of concentrated red blood cells, the patient's blood pressure had dropped to 70/40 mmHg and peak airway pressure had increased to 35 cmH2O. The ST segment of the ECG was simultaneously elevated, and the left upper arm became extensively flushed. The tryptase concentration in the patient's plasma collected 3 h postoperatively was 13.9 microg x l(-1) (normal range, 2.1-9.0 microg x l(-1)). This case report emphasizes that anaphylactic reactions to blood transfusion can potentially lead to coronary artery spasm.

Background: N-methyl-D-aspartate (NMDA) receptor is the major excitatory neurotransmitter receptor in the central nervous system. Recent evidence has pointed to expression of NMDA receptor in peripheral non-neuronal tissues and organs; however, little is known about the expression of the receptor in the stomach. The present study identified what types of NMDA receptor subunits are expressed in the rat stomach and examined whether vagotomy affects their expression., Methods: To see the expression and distribution of the mRNAs and proteins for the NMDA receptor subunits, real-time reverse transcription-polymerase chain reaction, Western blotting, in situ hybridization, and immunohistochemistry were carried out on rat stomach with and without vagotomy., Results: Of the NMDA receptor subunits, NR1, NR2 (2A, 2B, 2C, 2D), and NR3 (3A, 3B), all NR subunit mRNAs except for the NR2B subunit mRNA were expressed in the intact rat stomach, with huge expression of NR2D mRNA. Expression of NR2D subunit mRNA and protein significantly increased after vagotomy. Increased expression was found in mucosal cells, the myenteric plexus, and the outer membrane of the stomach with vagotomy., Conclusions: Vagotomy upregulates expression of the NR2D subunit in the stomach and therefore, the NR2D subunit may be implicated in gastric motility.

Background: Information is lacking concerning optimal infusion rates of crystalloid during resuscitation from acute haemorrhage. In this study, a mathematical model was used to predict infusion volume of crystalloid needed to restore and maintain blood volume after acute haemorrhage., Methods: The scenario was a haemorrhage of 15 ml kg(-1) over 30 min in a 70 kg man. A bolus of crystalloid was administered at a rate of 40, 60, 80, 100, or 120 ml kg(-1) h(-1) until blood volume was restored. Fluid infusion rate needed to maintain blood volume for a further 1 h was computed., Results: Blood volume was restored earlier at high bolus infusion rates compared with low bolus infusion rates (6 min at 120 ml kg(-1) h(-1) vs 63 min at 40 ml kg(-1) h(-1)). Fluid infusion rates for blood volume maintenance approached 33 ml kg(-1) h(-1) irrespective of bolus infusion rates. The restoration fluid volume at 40 ml kg(-1) h(-1) was 2.9 litre, three times that at 80-120 ml kg(-1) h(-1). The maintenance fluid volume at 80-120 ml kg(-1) h(-1) was 2.9 litre, 0.6 litre more than that at 40 ml kg(-1) h(-1). During the blood volume maintenance, the interstitial volume increased to 3.8 litre above normal at 40 ml kg(-1) h(-1) and to 2.5 litre at 80-120 ml kg(-1) h(-1)., Conclusions: Bolus crystalloid infusion exceeding 80 ml kg(-1) h(-1) may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.

A 56-year-old man with Marfan's syndrome was scheduled for a valve-sparing aortic root replacement operation because of annuloaortic ectasia and aortic regurgitation. He had severe dyspnea. When the operation started, SpO2 decreased at the time of the median sternotomy, and increased by manual inflation. After sternal closure, PIP increased from 20 cmH2O to 28 cmH2O, SpO2 decreased from 98% to 66%, and the expiratory pattern indicated airway obstruction. Because hypoxemia persisted, we reopened the sternum, resulting in increased SpO2 and decreased PIP, but hypercapnea remained. Fiberoptic bronchoscopy revealed a narrowing of the tracheal and bronchial lumen. We suspected tracheobronchomalacia, and the tracheal tube was advanced to just above the carina. We succeeded in extubating 7 days after the operation. Since he had severe persisting dyspnea, we suggested reopening the partial sternum to decompress the intrathoracic pressure, and closing the skin. The sternum was reopened, and he had no dyspnea after the second operation. The mechanism of tracheobronchomalacia is considered to be related to the connective tissue defect of Marfan's syndrome. Suddenly SpO2 is decreased and PIP and Et(CO2) are increased after closure of the sternum. Bronchoscopy was useful in making the diagnosis.

Background: Surgical injury causes acute sequestration of interstitial fluid in injured tissue. Fluid sequestration treated with IV fluid administration can lead to postoperative complications related to excessive intravascular volume. Quantitative prediction of interstitial fluid sequestration may foster a better understanding of the relationship between fluid administered and the resulting balance between intra- and extravascular fluid., Methods: We developed a mathematical model describing the dynamic distribution and transport of fluid and proteins with the goal of quantifying the balance of fluid between intra- and extravascular compartments. Fluid volume changes in the plasma, interstitial and urine compartments were calculated for a simulated 4 h abdominal surgery in a 70 kg male. To validate the model, we compared the results obtained with those measured by segmental bioelectrical impedance on 30 patients undergoing elective abdominal surgery., Results: The model predicted that, compared to the normal state, surgical injury would result in the sequestration of 705 mL of interstitial fluid in injured tissue, whereas plasma volume would undergo a 356 mL decrease. During surgery, it was not possible to obtain a normal plasma volume, even with fluid replacement at a rate of almost 20 mL x kg(-1) x h(-1). Bias and limit of agreement on interstitial fluid volume changes in body segments between bioelectrical impedance and model prediction were -131 and 325 mL, respectively for limbs, and -157 and 834 mL for the trunk., Conclusions: The model shows that increasing the fluid replacement rate above 10 mL x kg(-1) x h(-1) does not have the desired effect on plasma volume but instead increases the interstitial volume.

This work examines the mass spectra of several environmentally relevant amides, perfluorooctanesulfonamide (FOSA), NMeFOSA, NEtFOSA, and NMe(2)FOSA, under electron ionization conditions. A previous mass spectral study of FOSA and NEtFOSA led the authors to propose possible structures for some of the fragment ions and fragmentation pathways that might explain their formation. In the present communication, further fragment ions are identified for these two compounds and alternative fragmentation pathways proposed. Mass spectral analyses of NMeFOSA and NMe(2)FOSA and of mass-labeled NMeFOSA and NEtFOSA reinforce our conclusions about potential fragmentation pathways for these amides and the fragment ions expected. The mass spectral data presented here will help chemists to identify signals found in a gas chromatographic/mass spectrometric (GC/MS) analysis that stem from these perfluoroalkylsulfonamides.

Purpose: Flurbiprofen axetil emulsion (FA), a prodrug of nonsteroidal anti-inflammatory drugs (NSAIDs) that is widely used for perioperative pain relief in Japan, has been effective for reducing propofol injection pain, but the mechanism is unclear. The purpose of this study was to test the hypothesis that the reduction of propofol injection pain by FA may be attributed to a decrease in free propofol concentration., Methods: Diprivan (propofol emulsion; Dipri; AstraZeneca, Cheshire, UK) and Propofol-Lipuro (Lipuro; B. Braun, Melsungen, Germany) were used. A randomized double-blind study was performed to compare pain on injection with six kinds of propofol solution: plain Dipri, a 3 : 1 (v/v) mixture of Dipri and saline (Dipri-S), a 3 : 1 mixture of Dipri and FA (Dipri-FA), plain Lipuro, a 3 : 1 mixture of Lipuro and saline (Lipuro-S), and a 3 : 1 mixture of Lipuro and FA (Lipuro-FA). Three hundred patients (American Society of Anesthesiologists [ASA] physical status [PS] I-II) scheduled for elective surgery received one of these six propofol emulsions (n = 50, each group). Injection pain was evaluated every 10 s after the start of a 1-min infusion of up to 2 mg x kg(-1) propofol. We also measured the in vitro free propofol concentrations of the propofol preparations that we tested (n = 5, each)., Results: The mixture of FA with propofol decreased the incidence of injection pain, compared with plain propofol, for Lipuro (P < 0.01) but not for Dipri. The free propofol concentration in each emulsion in vitro was also decreased by mixing the propofol with saline or FA. The incidence of pain was reduced in a free-propofol concentration-dependent manner (R(2) = 0.926)., Conclusion: The findings suggest that the reduction of propofol injection pain by FA may be explained, at least in part, by a reduction in the free propofol concentration.

In an effort to further characterize conserved and species-specific mechanisms of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-mediated toxicity, comparative temporal and dose-response microarray analyses were performed on hepatic tissue from immature, ovariectomized Sprague Dawley rats and C57BL/6 mice. For temporal studies, rats and mice were gavaged with 10 or 30 microg/kg of TCDD, respectively, and sacrificed after 2, 4, 8, 12, 18, 24, 72, or 168 h while dose-response studies were performed at 24 h. Hepatic gene expression profiles were monitored using custom cDNA microarrays containing 8567 (rat) or 13,361 (mouse) cDNA clones. Affymetrix data from male rats treated with 40 microg/kg TCDD were also included to expand the species comparison. In total, 3087 orthologous genes were represented in the cross-species comparison. Comparative analysis identified 33 orthologous genes that were commonly regulated by TCDD as well as 185 rat-specific and 225 mouse-specific responses. Functional annotation using Gene Ontology identified conserved gene responses associated with xenobiotic/chemical stress and amino acid and lipid metabolism. Rat-specific gene expression responses were associated with cellular growth and lipid metabolism while mouse-specific responses were associated with lipid uptake/metabolism and immune responses. The common and species-specific gene expression responses were also consistent with complementary histopathology, clinical chemistry, hepatic lipid analyses, and reports in the literature. These data expand our understanding of TCDD-mediated gene expression responses and indicate that species-specific toxicity may be mediated by differences in gene expression which may help explain the wide range of species sensitivities and will have important implications in risk assessment strategies.

The cryoprotective effect of intracellular free high-mannose oligosaccharides (HMOS) on mammalian cells and proteins was examined by monitoring PC-12 cell viability and assaying protein kinase C (PKC)-epsilon activity. 1-Deoxymannojirimycin, an inhibitor of alpha-mannosidase, to cause an increase in intracellular free HMOS, significantly rescued PC-12 cells with 2-h freezing insult at -15 degrees C in a concentration (1-50mM)- and pretreatment time (48-72h)-dependent manner, as compared with unpretreated cells; full rescue from freezing injury was obtained with 1-deoxymannojirimycin at more than 25mM for 48-h pretreatment and more than 3mM for 72- and 96-h pretreatment. For PC-12 cells pretreated with 1-deoxymannojirimycin at 1mM for 72h, thawed cell viability after more than 8-w cryopreservation at -80 degrees C in 10% (v/v) dimethyl sulfoxide was much higher than that for cells without pretreatment. PKC-epsilon activity was well preserved after 16-h cryopreservation at -20 degrees C in the presence of mannose 9-N-acetylglucosamine 2 (Man9-GlcNAc2) (1 mM), an HMOS, while the activity was reduced to 15% without Man9-GlcNAc2. Collectively, the results of the present study suggest that intracellular free HMOS is a key molecule to protect mammalian cells and proteins from freezing injury; in other words, HMOS could be a new target for cryopreservation of mammalian cells and proteins.

Very little data is available about the presence of the brominated flame retardant, DBDPE, in the environment. This study reports the characterization of [(13)C(14)]-decabromodiphenylethane and the use of this surrogate standard to positively identify and quantify the presence of DBDPE in sewage sludge samples. The large difference in response factors between BDE-209 and DBDPE predicates the use of [(13)C(14)]-decabromodiphenylethane as a surrogate standard to improve the accuracy when determining the levels of DBDPE in environmental samples.

Background: There is no information on the acquisition status of the written informed consent to clinical anesthesia practice of medical students., Methods: The contents of the clinical practice were divided into three categories: No.1 (the minor procedures such as mask-and-bag ventilation, blood drawing, drug administration), No.2 (only the visit), No.3 (non-cooperation). We asked the patient to chose one of them. From the written informed consents given by 1531 patients scheduled for operation, we analyzed the degree of the cooperation and the relation between the cooperation and the patient background., Results: Although 78% of patients agreed to cooperate in some way (No.1 or No.2), there were only 15% of patients who allowed students to perform minor procedures., Conclusions: The results showed that clinical practice in anesthesiology can not be performed properly by only the visit. For a meaningful clinical practice in anesthesiology to be performed, it will be useful to use high-fidelity human patient simulator (HF-PS) actively and campaign for the cooperation and the understanding of the general pablic about medical education.