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Abstract Background We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome. Methods Among patients who underwent TAVI between October 2015 and November 2019, those who had Sapien™ implanted with the transfemoral artery approach were included in the analysis. We used TAVI procedure time and surgery number to draw a learning curve. Then, we divided the patients into two groups before and after the number of cases where the sigmoid curve reaches a plateau. We compared the two groups regarding the surveyed factors and investigated the correlation between the TAVI procedure time and survey factors. Results Ninety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 23.2 cases and reached a plateau in 43.0 cases. Patients in the Late group had a shorter operating time, less contrast media, less radiation exposure, and less myocardial escape enzymes than the Early group. Surgical procedure time showed the strongest correlation with the surgical case number. Conclusion The number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.

Abstract Background Malignant hyperthermia (MH) is a rare, life-threatening disorder of calcium homeostasis in skeletal muscle cells that is triggered by volatile anesthetics and succinylcholine, leading to a hypermetabolic reaction. The pathogenic ryanodine receptor 1 (RYR1) gene variant is critical. Patients susceptible to MH should avoid triggering agents, and total intravenous anesthesia (TIVA) is preferred. Remimazolam is safe in patients with suspected MH. Case presentation We present the first case of remimazolam treatment in a genetically confirmed patient with MH without MH development. A 72-year-old man with a family history of MH underwent remimazolam-based TIVA. After informed consent was obtained, a muscle biopsy and genetic testing were performed. Intraoperatively and postoperatively, the patient exhibited no signs of MH. An enhanced function of the RYR1 channel into releasing calcium was indicated, and the genetic testing revealed a pathogenic variant of RYR1. Conclusions Remimazolam-based TIVA is safe in patients confirming the diagnosis of MH.

The Hunga Tonga–Hunga Ha′apai volcano erupted on 15 January 2022, launching Lamb waves and gravity waves into the atmosphere. In this study, we present results using 13 globally distributed meteor radars and identify the volcanogenic gravity waves in the mesospheric/lower thermospheric winds. Leveraging the High-Altitude Mechanistic general Circulation Model (HIAMCM), we compare the global propagation of these gravity waves. We observed an eastward-propagating gravity wave packet with an observed phase speed of 240 ± 5.7 m s−1 and a westward-propagating gravity wave with an observed phase speed of 166.5 ± 6.4 m s−1. We identified these waves in HIAMCM and obtained very good agreement of the observed phase speeds of 239.5 ± 4.3 and 162.2 ± 6.1 m s−1 for the eastward the westward waves, respectively. Considering that HIAMCM perturbations in the mesosphere/lower thermosphere were the result of the secondary waves generated by the dissipation of the primary gravity waves from the volcanic eruption, this affirms the importance of higher-order wave generation. Furthermore, based on meteor radar observations of the gravity wave propagation around the globe, we estimate the eruption time to be within 6 min of the nominal value of 15 January 2022 04:15 UTC, and we localized the volcanic eruption to be within 78 km relative to the World Geodetic System 84 coordinates of the volcano, confirming our estimates to be realistic.

Abstract Stratified turbulence (ST) has been proposed as a model for the dynamics of the mesosphere‐lower thermosphere (MLT) region. This theory postulates that for horizontal mesoscales (∼1–400 km), the kinetic energy of horizontal winds dissipates from large to small scales with an approximately mean constant rate. In this investigation, dissipation rates are quantified using meteor‐radar observations conducted in Northern Norway. The observed seasonal variability of dissipation rates exhibits maxima during the summer and winter, and minima near the equinoxes, between 80 and 95 km altitude. The results are compared with model predictions and earlier medium frequency radar, rocket, lidar, and satellite observations of MLT turbulence. The findings suggest that multi‐static meteor radar measurements of ST can provide a novel way to continuously monitor turbulent dissipation rates in the MLT region.

Continuous wind measurements using partial-reflection radars and specular meteor radars have been carried out for nearly 2 decades (2004–2022) at middle and high latitudes over Germany (∼ 54∘ N) and northern Norway (∼ 69∘ N), respectively. They provide crucial data for understanding the long-term behavior of winds in the mesosphere and lower thermosphere. Our investigation focuses on the summer season, characterized by the low energy contribution from tides and relatively stable stratospheric conditions. This work presents the long-term behavior, variability, and trends of the maximum velocity of the summer eastward, westward, and southward winds. In addition, the geomagnetic influence on the summer zonal and meridional wind is explored at middle and high latitudes. The results show a mesospheric westward summer maximum located around 75 km with velocities of 35–54 m s−1, while the lower-thermospheric eastward wind maximum is observed at ∼ 97 km with wind speeds of 25–40 m s−1. A weaker southward wind peak is found around 86 km, ranging from 9 to 16 m s−1. The findings indicate significant trends at middle latitudes in the westward summer maxima with increasing winds over the past decades, while the southward winds show a decreasing trend. On the other hand, only the eastward wind in July has a decreasing trend at high latitudes. Evidence of oscillations around 2–3, 4, and 6 years modulate the maximum velocity of the summer winds. In particular, a periodicity between 10.2 and 11.3 years found in the westward component is more significant at middle latitudes than at high latitudes, possibly due to solar radiation. Furthermore, stronger geomagnetic activity at high latitudes causes an increase in eastward wind velocity, whereas the opposite effect is observed in zonal jets at middle latitudes. The meridional component appears to be disturbed during high geomagnetic activity, with a notable decrease in the northward wind strength below approximately 80 km at both latitudes.

Abstract Necessary and sufficient opioids should be administered for safe and stable anesthesia. However, opioid sensitivity varies among individuals. We previously reported that sympathetic responses to nociceptive stimuli under propofol anesthesia could be predicted by measuring the minimum evoked current of the vascular stiffness value (MECK). However, this result has only been proven under propofol anesthesia. We propose that MECK could be used under anesthesia with a volatile anesthetic. Thirty patients undergoing laparotomy with sevoflurane anesthesia received 0.7 minimum alveolar concentration (MAC) sevoflurane and intravenous remifentanil at a constant concentration of 2 ng/mL, followed by tetanic stimulation, to measure MECK. After tetanic stimulation, the same anesthetic conditions were maintained, and the rate of change in systolic blood pressure (ROCBP) during the skin incision was measured. The correlation coefficient between the MECK and ROCBP during skin incision under sevoflurane anesthesia was R = − 0.735 (P

Abstract Respiratory monitoring is crucial during monitored anaesthesia care (MAC) to ensure patient safety. Patients undergoing procedures like gastrointestinal endoscopy and dental interventions under MAC have a heightened risk of aspiration. Despite the risks, no current system or device can evaluate aspiration risk. This study presents a novel acoustic monitoring system designed to detect fluid retention in the upper airway during MAC. We conducted a prospective observational study with 60 participants undergoing dental treatment under MAC. We utilized a prototype acoustic monitoring system to assess fluid retention in the upper airway by analysing inspiratory sounds. Water was introduced intraorally in participants to simulate fluid retention; artificial intelligence (AI) analysed respiratory sounds pre and post-injection. We also compared respiratory sounds pre-treatment and during coughing events. Coughing was observed in 14 patients during MAC, and 31 instances of apnoea were detected by capnography. However, 27 of these cases had breath sounds. Notably, with intraoral water injection, the Stridor Quantitative Value (STQV) significantly increased; furthermore, the STQV was substantially higher immediately post-coughing in patients who coughed during MAC. In summary, the innovative acoustic monitoring system using AI provides accurate evaluations of fluid retention in the upper airway, offering potential to mitigate aspiration risks during MAC. Clinical trial number: jRCTs 062220054.

Atmospheric gravity waves and traveling ionospheric disturbances can be observed in the neutral atmosphere and the ionosphere at a wide range of spatial and temporal scales. Especially at medium scales, these oscillations are often not resolved in general circulation models and are parameterized. We show that ionospheric disturbances forced by upward-propagating atmospheric gravity waves can be simultaneously observed with the EISCAT very high frequency incoherent scatter radar and the Nordic Meteor Radar Cluster. From combined multi-static measurements, both vertical and horizontal wave parameters can be determined by applying a specially developed Fourier filter analysis method. This method is demonstrated using the example of a strongly pronounced wave mode that occurred during the EISCAT experiment on 7 July 2020. Leveraging the developed technique, we show that the wave characteristics of traveling ionospheric disturbances are notably impacted by the fall transition of the mesosphere and lower thermosphere. We also demonstrate the application of using the determined wave parameters to infer the thermospheric neutral wind velocities. Applying the dissipative anelastic gravity wave dispersion relation, we obtain vertical wind profiles in the lower thermosphere.

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Background: Diabetic neuropathic pain is a known complication of diabetes mellitus (DM) and results from the complex interaction of various factors affecting the nervous system. Yokuansan (YKS) is a versatile traditional Japanese herbal medicine with a wide range of applications, especially in pain management and neurological manifestations. YKS has analgesic properties for nerve damage and is a potential treatment for DM-induced neuropathic pain, especially in patients with diabetic neuropathy. Thus, we examined the anti-allodynic effect of YKS on DM-induced neuropathic pain. Methods: All experiments were performed on 6-week-old male Sprague–Dawley rats. DM and diabetic neuropathy were induced in rats with streptozotocin. Mechanical allodynia was assessed using dynamic plantar esthesiometry. Additionally, we conducted an immunological assessment of microglia cell changes in the spinal cord and an experiment to clarify the involvement of serotonin. Results: Diabetes significantly reduced withdrawal thresholds in rats during the initial two weeks of the experiment, which stabilized thereafter. However, this effect was not investigated in the control group. We assessed, using the dynamic plantar test, the anti-allodynic effects of orally administered YKS (1 g/kg). Daily YKS administration significantly increased the withdrawal threshold in DM animals. Additionally, oral YKS reduced the expression of Ibal-1-positive microglia. To elucidate the mechanism of action of YKS, we explored the involvement of serotonin (5-hydroxytryptamine [5-HT]) receptors in mediating its effects. Intrathecal administration of 5-HT receptor antagonists (WAY-100635, ketanserin, and ondansetron) inhibited the protective effects of YKS. Conclusions: YKS exhibited an anti-allodynic effect, suggesting that YKS may activate 5-HT receptors in the spinal cord, thereby alleviating diabetic neuropathic pain.

The Hunga Tonga–Hunga Ha′apai volcano eruption was a unique event that caused many atmospheric phenomena around the globe. In this study, we investigate the atmospheric gravity waves in the mesosphere/lower-thermosphere (MLT) launched by the volcanic explosion in the Pacific, leveraging multistatic meteor radar observations from the Chilean Observation Network De Meteor Radars (CONDOR) and the Nordic Meteor Radar Cluster in Fennoscandia. MLT winds are computed using a recently developed 3DVAR+DIV algorithm. We found eastward- and westward-traveling gravity waves in the CONDOR zonal and meridional wind measurements, which arrived 12 and 48 h after the eruption, and we found one in the Nordic Meteor Radar Cluster that arrived 27.5 h after the volcanic detonation. We obtained observed phase speeds for the eastward great circle path at both locations of about 250 m s−1, and they were 170–150 m s−1 for the opposite propagation direction. The intrinsic phase speed was estimated to be 200–212 m s−1. Furthermore, we identified a potential lamb wave signature in the MLT winds using 5 min resolved 3DVAR+DIV retrievals.

Background and purpose: In this study, we aimed to elucidate the action mechanisms of propofol, particularly those underlying propofol-induced protein kinase C (PKC) translocation.Experimental approach: Various PKCs fused with green fluorescent protein (PKC-GFP) or other GFP-fused proteins were expressed in HeLa cells, and their propofol-induced dynamics were observed using confocal laser scanning microscopy. Propofol-induced PKC activation in cells was estimated using the C kinase activity receptor (CKAR), an indicator of intracellular PKC activation. We also examined PKC translocation using isomers and derivatives of propofol to identify the crucial structural motifs involved in this process.Key results: Propofol persistently translocated PKCα conventional PKCs and PKCδ from novel PKCs (nPKCs) to the plasma membrane (PM). Propofol translocated PKCδ and PKCη of nPKCs to the Golgi apparatus and endoplasmic reticulum, respectively. Propofol also induced the nuclear translocation of PKCζ of atypical PKCs or proteins other than PKCs, such that the protein concentration inside and outside the nucleus became uniform. CKAR analysis revealed that propofol activated PKC in the PM and Golgi apparatus. Moreover, tests using isomers and derivatives of propofol predicted that the structural motifs important for the induction of PKC and nuclear translocation are different.Conclusion and implications: Propofol induced the subtype-specific intracellular translocation of PKCs and activated PKCs. Additionally, propofol induced the nuclear translocation of PKCs and other proteins, probably by altering the permeability of the nuclear envelope. Interestingly, propofol-induced PKC and nuclear translocation may occur via different mechanisms. Our findings provide insights into the action mechanisms of propofol.

Patients undergoing gastrectomy for gastric cancer may experience alterations in olfaction, yet the association between olfactory changes and postoperative weight loss remains uncertain. This study aimed to elucidate the relationship between olfactory changes and postoperative weight loss in patients with gastric cancer. Patients who underwent radical gastrectomy for gastric cancer between February 2022 and August 2022 were included in the study. Those experiencing a higher Visual Analog Scale (VAS) score postoperatively compared to preoperatively were deemed to have undergone olfactory changes. Postoperative weight loss was determined using the 75th percentile as a cutoff value, designating patients surpassing this threshold as experiencing significant weight loss. Multivariate logistic regression analysis was employed to identify risk factors for postoperative weight loss, with statistical significance set at p < 0.05. Out of 58 patients, 10 (17.2%) exhibited olfactory changes. The rate of postoperative weight loss at one month was markedly higher in the group with olfactory changes compared to those without (9.6% versus 6.2%, respectively; p = 0.002). In addition, the group experiencing olfactory changes demonstrated significantly lower energy intake compared to the group without such changes (1050 kcal versus 1250 kcal, respectively; p = 0.029). Logistic regression analysis revealed olfactory changes as an independent risk factor for significant weight loss at one month postoperatively (odds ratio: 7.64, 95% confidence interval: 1.09–71.85, p = 0.048). In conclusion, olfactory changes emerged as an independent risk factor for postoperative weight loss at one month in patients with gastric cancer following gastrectomy.

Refractory peripheral neuropathy can occur as a side effect in 60–70% of patients receiving Paclitaxel (PTX). Yokukansan (YKS) is a Japanese herbal medicine reported to have analgesic properties for entrapment nerve injuries. Therefore, we investigated the anti-allodynic effect of Yokukansan on Paclitaxel-induced neuropathic pain. All experiments used 6-week-old male Sprague Dawley rats. Mechanical allodynia was evaluated using a dynamic plantar aesthesiometer. A mobile touch-stimulator unit applied progressively increasing force to the mid-plantar region of the hind paw in a vertical direction until the animal withdrew its paw. This was carried out before the Paclitaxel administration and during the first, second, third, and fourth weeks. Using a rat model of PTX-induced neuropathic pain (PTX rat), we injected PTX (intraperitoneally, 2 mg/kg) five times every 2 days. Using the dynamic plantar test, we evaluated the anti-allodynic effect of YKS (orally administered, 1 g/kg). YKS administration on a daily basis significantly enhanced the withdrawal threshold in PTX rats and reduced the expression level of activated microglia immunostaining with Iba1, a specific marker for microglia. The intrathecal administration of WAY-100635 (5-hydroxytryptamine [5-HT]1A receptor antagonist) and Ketanserin (5-HT2A/2C receptor antagonist) inhibited the protective effects of YKS. YKS exhibited an anti-allodynic effect in a rodent model of PTX-induced neuropathic pain by reducing the sensitivity to pain stimuli. These results suggest that Yokukansan may activate 5-HT receptors in the spinal cord, mediating Paclitaxel-induced neuropathic pain.

We thank the authors for their insightful and thoughtful commentary on our recent publication [...]

Abstract Background We measured catecholamine levels during periodic blood pressure fluctuations in patients with pheochromocytoma. Case presentation A 43-year-old man presented with periodic blood pressure fluctuations during surgery for a renal pelvic tumor. His blood levels of catecholamines (ng/mL) changed dramatically over a short time during blood pressure fluctuations: adrenaline 0.36 to 3.22, noradrenaline 0.47 to 1.98, and dopamine 0.02. After the diagnosis of pheochromocytoma, oral treatment with doxazosin 2 mg/day was administered, and left adrenalectomy was performed 4 months after the initial surgery. Periodic circulation fluctuations occurred after tracheal intubation at the time of anesthesia induction, but the degree of fluctuation was smaller than that of the first surgery. Conclusions The data suggest that the periodic blood pressure fluctuations in pheochromocytoma patients are caused by changes in blood catecholamine levels. Our data suggests that alpha blockers may also be effective against the cyclic fluctuations that occur in patients with pheochromocytoma.

Meteor radars have become widely used instruments to study atmospheric dynamics, particularly in the 70 to 110 km altitude region. These systems have been proven to provide reliable and continuous measurements of horizontal winds in the mesosphere and lower thermosphere. Recently, there have been many attempts to utilize specular and/or transverse scatter meteor measurements to estimate vertical winds and vertical wind variability. In this study we investigate potential biases in vertical wind estimation that are intrinsic to the meteor radar observation geometry and scattering mechanism, and we introduce a mathematical debiasing process to mitigate them. This process makes use of a spatiotemporal Laplace filter, which is based on a generalized Tikhonov regularization. Vertical winds obtained from this retrieval algorithm are compared to UA-ICON model data. This comparison reveals good agreement in the statistical moments of the vertical velocity distributions. Furthermore, we present the first observational indications of a forward scatter wind bias. It appears to be caused by the scattering center's apparent motion along the meteor trajectory when the meteoric plasma column is drifted by the wind. The hypothesis is tested by a radiant mapping of two meteor showers. Finally, we introduce a new retrieval algorithm providing a physically and mathematically sound solution to derive vertical winds and wind variability from multistatic meteor radar networks such as the Nordic Meteor Radar Cluster (NORDIC) and the Chilean Observation Network De meteOr Radars (CONDOR). The new retrieval is called 3DVAR+DIV and includes additional diagnostics such as the horizontal divergence and relative vorticity to ensure a physically consistent solution for all 3D winds in spatially resolved domains. Based on this new algorithm we obtained vertical velocities in the range of w = ± 1–2 m s−1 for most of the analyzed data during 2 years of collection, which is consistent with the values reported from general circulation models (GCMs) for this timescale and spatial resolution.

Abstract Background Myofascial pain syndrome is one of the causes of prolonged postoperative pain after abdominal surgery. However, diagnosis and treatment of myofascial pain syndrome, especially its myofascial trigger point (MTrP), have not been well established. Case presentation A 55-year-old man experienced severe subacute abdominal pain after laparoscopic hepatectomy despite aggressive postoperative pain management. He had a positive Carnett’s sign, indicating abdominal wall pain, 2 weeks after the surgery. Ultrasonography showed a hyperechoic spot surrounded by a hypoechoic area in the inner abdominal oblique muscle under the palpable spot that fulfills the criteria of MTrP. The echogenic MTrP disappeared after repetitive ultrasound-guided trigger point injections (USG TPIs) with pain relief. Conclusions Our present case indicates that diagnosing myofascial pain by visualizing the echogenic MTrPs in the abdominal muscles, and subsequent USG TPIs, might provide an accurate maneuver for diagnosis and treatment of subacute myofascial pain after abdominal surgery.

Remimazolam is a novel general anesthetic and its safety in patients with malignant hyperthermia (MH) is unknown. We used myotubes derived from the skeletal muscle of patients with MH to examine the response to ryanodine receptor 1 (RYR1) agonist and remimazolam in MH-susceptible patients. Patients underwent muscle biopsy for the Ca2+-induced Ca2+ release (CICR) rate test, a diagnostic tool for MH in Japan. Ten patients had myotubes obtained from skeletal muscle cultures, and the genes associated with malignant hyperthermia in these patients were analyzed. The EC50 of caffeine, cresol, and remimazolam to induce intracellular calcium concentration change were compared between myotubes from CICR-negative genetic test patients and myotubes from other patients. Eight of the ten were CICR-positive, five of whom had RYR1 causative gene mutations or variants. Two patients had CICR-negative genetic tests, and as expected had the highest EC50 (the concentration of a drug that gives a half-maximal response) in response to caffeine, 4CmC and remimazolam. Three patients had a positive CICR but no known variants in RYR1 or CACNA1S (voltage-gated calcium channel subunit alpha1S). Myotubes in these patients had significantly lower EC50s for all agents than myotubes in CICR-negative patients. When myotubes from a patient who was CICR-negative and had no gene variant were used as a control, myotubes from CICR-positive patients were more hyper-responsive than controls to all stimulants used. The EC50 for remimazolam was lowest for myotubes from CICR-positive, RYR1-mutant patients, at 206 µM (corresponding to 123 µg/mL). The concentration was more than 80-times higher than the clinical concentration. RYR1 gene variants in R4645Q and W5020G were shown to be causative gene mutations for MH. Intracellular calcium in myotubes from MH patients are elevated at high concentrations of remimazolam but not at clinically used concentrations of remimazolam. Remimazolam appears to be safe to use in patients with MH.

Partially hydrolyzed guar gum (PHGG) is a soluble dietary fiber that is effective for defecation control. It influences the gut microbiota, by which it is metabolized to yield short-chain fatty acids (SCFAs), and it was also recently shown to protect against influenza infection in humans. We here investigated the effects of PHGG in a mouse model of influenza H1N1 virus infection. Eight-week-old C57BL/6 mice were fed normal chow with or without PHGG (500 mg/kg per day) for 4 weeks, infected with H1N1 at 10 weeks of age, and analyzed at 12 weeks of age. Administration of PHGG attenuated the decline in body weight induced by H1N1 infection without affecting food intake. It also ameliorated intestinal atrophy and increased the production of SCFAs including acetic acid, propionic acid, and butyric acid in the cecum, thereby preventing the inhibitory effect of H1N1 infection on SCFA production. The H1N1-induced increases in the serum concentrations of inflammatory cytokines including interferon-γ and interleukin-6 and anti-inflammatory cytokine such as interleukin-10 were all inhibited by PHGG intake. In addition, PHGG administration attenuated inflammatory gene expression in the lung and promoted both natural killer cell activity and regulatory T-cell differentiation in the spleen. Our findings suggest that the consumption of PHGG may improve the gut environment and thereby limit the inflammatory response to H1N1 infection. They may thus provide the basis for novel dietary intervention strategies to suppress the excessive inflammation associated with virus infection.

Abstract Background Occlusion or malposition of the venous cannula during cardiopulmonary bypass (CPB) increases central venous pressure (CVP). When high CVP is measured, we need to determine if it is actually high or if it is measured due to catheter occlusion or technical problems with the measurement. Case presentation We experienced a case of excessively high CVP due to malposition of the venous cannula during CPB. A 78-year-old woman underwent an aortic arch replacement for acute aortic dissection. During CPB, CVP increased up to 78 mmHg, and the time above 50 mmHg was 48 min. In this case, ultrasonography of the internal jugular vein (IJV) was useful to confirm high CVP. Conclusions Ultrasonography is now a familiar diagnostic tool and can be used at any time. We should consider ultrasonography as the first choice for diagnosing the cause of high CVP during CPB.

Abstract The mesosphere/lower thermosphere (MLT, 80–100 km) region is an important boundary between Earth's atmosphere below and space above and may act as a sensitive indicator for anthropogenic climate change. Existing observational and modeling studies have shown the middle atmosphere and the MLT is cooling and contracting because of increasing greenhouse gas emissions. However, trend analyses are highly sensitive to the time periods covered, their length, and the measurement type and methodology used. We present for the first time the linear and 11‐year solar cycle responses in the meteor ablation altitude distributions observed by 12 meteor radars at different locations. Decreasing altitudes were seen at all latitudes (linear trends varying from −10.97 to −817.95 m dec−1), and a positive correlation with solar activity was seen for most locations. The divergence of responses at high latitudes indicates an important and complex interplay between atmospheric changes and dynamics at varying time scales.

Specular meteor radars (SMRs) and partial reflection radars (PRRs) have been observing mesospheric winds for more than a solar cycle over Germany (∼ 54∘ N) and northern Norway (∼ 69∘ N). This work investigates the mesospheric mean zonal wind and the zonal mean geostrophic zonal wind from the Microwave Limb Sounder (MLS) over these two regions between 2004 and 2020. Our study focuses on the summer when strong planetary waves are absent and the stratospheric and tropospheric conditions are relatively stable. We establish two definitions of the summer length according to the zonal wind reversals: (1) the mesosphere and lower-thermosphere summer length (MLT-SL) using SMR and PRR winds and (2) the mesosphere summer length (M-SL) using the PRR and MLS. Under both definitions, the summer begins around April and ends around middle September. The largest year-to-year variability is found in the summer beginning in both definitions, particularly at high latitudes, possibly due to the influence of the polar vortex. At high latitudes, the year 2004 has a longer summer length compared to the mean value for MLT-SL as well as 2012 for both definitions. The M-SL exhibits an increasing trend over the years, while MLT-SL does not have a well-defined trend. We explore a possible influence of solar activity as well as large-scale atmospheric influences (e.g., quasi-biennial oscillation (QBO), El Niño–Southern Oscillation (ENSO), major sudden stratospheric warming events). We complement our work with an extended time series of 31 years at middle latitudes using only PRR winds. In this case, the summer length shows a breakpoint, suggesting a non-uniform trend, and periods similar to those known for ENSO and QBO.

Abstract Background Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by joint inflammation, abnormal body composition, and an increased risk for sarcopenia. Muscle wasting in turn increases the risk of infection, morbidity, and premature mortality, but little is known of the relation between nutrient intake and sarcopenia in RA. Methods A prospective cohort study with follow‐up for 1 year examined body composition and diet in female outpatients with RA. We performed logistic regression analysis to assess which factors might have contributed to this loss of muscle mass. Multivariate logistic regression analysis with a forward–backward stepwise selection was also analysed. SKG/Jcl mice, which develop RA spontaneously, were fed normal chow or a high‐fat diet (HFD) and evaluated for inflammation and muscle mass. Results A total 53 female patients were included. The median age was 57.0 years, with an interquartile range (IQR) of 49.5 to 62.0 years, and the median disease duration was 4.0 years, with an IQR of 2.0 to 9.0 years. Fourteen patients (26.4%) had skeletal muscle mass index below the cut‐off for sarcopenia (≤5.7 kg/m2) as defined by the Asia Working Group for Sarcopenia. Multiple logistic regression analysis revealed that the intake of saturated fatty acids was associated with a >5% decrease in skeletal muscle index of RA patients over 1 year [odds ratio 95% confidence interval 1.431 (1.082–1.894), P = 0.012]. In 9 weeks old SKG/Jcl mice, HFD feeding precipitated the onset of RA and exacerbated rheumatoid synovitis in association with the induction of T helper 17 cell differentiation. The serum concentrations of inflammatory cytokines including IL‐6 and TNF‐α were significantly higher in HFD‐fed RA mice than in normal chow (NC)‐fed RA mice or in HFD‐fed control mice (IL‐6; 3.8 vs. 32.2 pg/mL, P

(1) Background: Remimazolam is a novel benzodiazepine that prevents postoperative nausea and vomiting (PONV), is more effective than volatile anesthetics, and was recently approved for use in Japan. (2) Methods: This prospective, double-blind, randomized controlled trial study aimed to compare the efficacy of remimazolam and propofol as general anesthetics in terms of the incidence of PONV after laparoscopic gynecological surgery (UMIN000046237). High-risk female patients who underwent general anesthesia with either remimazolam or propofol for the maintenance of anesthesia were enrolled. The primary outcome was the incidence of PONV in the two groups (i.e., REM versus PROP) 2 h and 24 h after surgery. The incidence of vomiting without nausea, rescue antiemetic use, and the severity of nausea were also evaluated. (3) Results: No significant differences in PONV were identified between the REM and PROP groups at 2 h or 24 h. Furthermore, no differences were observed in any of the measured parameters, and no adverse events were reported. (4) Conclusions: The results of the present study suggest that remimazolam may be as effective as propofol in preventing PONV; however, further investigation is necessary to identify possible differences between these two agents.

Abstract Background Coronary artery disease is a leading cause of morbidity and mortality among patients with diabetes. Previously, we demonstrated that branched-chain amino acids (BCAAs) showed cardioprotective effects against cardiac ischemia/reperfusion (I/R) injury. A recent study suggested that leucine (Leu), a BCAA, is a key amino acid involved in mammalian target of rapamycin (mTOR) activity and mitochondrial function. However, whether Leu has cardioprotective effects on diabetic hearts is unclear. In this study, we examined the preconditioning effect of Leu treatment on high-fat diet (HFD)-induced obese mouse which simulate prediabetic heart. Methods In vivo mice models of I/R injury were divided into the following groups: control, mTOR+/−, and high-fat diet (HFD)-induced obese groups. Mice were randomly administered with Leu, the mTOR inhibitor rapamycin (Rap), or Leu with Rap. Isolated rat cardiomyocytes were subjected to simulated I/R injury. Biochemical and mitochondrial functional assays were performed to evaluate the changes in mTOR activity and mitochondrial dynamics caused by Leu treatment. Results Leu-treated mice showed a significant reduction in infarct size when compared with the control group (34.8% ± 3.8% vs. 43.1% ± 2.4%, n = 7, p

Ground-based remote sensing of atmospheric parameters is often limited to single station observations by vertical profiles at a certain geographic location. This is a limiting factor for investigating gravity wave dynamics as the spatial information is often missing, e.g., horizontal wavelength, propagation direction or intrinsic frequency. In this study, we present a new retrieval algorithm for multistatic meteor radar networks to obtain tomographic 3-D wind fields within a pre-defined domain area. The algorithm is part of the Agile Software for Gravity wAve Regional Dynamics (ASGARD) and called 3D-Var, and based on the optimal estimation technique and Bayesian statistics. The performance of the 3D-Var retrieval is demonstrated using two meteor radar networks: the Nordic Meteor Radar Cluster and the Chilean Observation Network De Meteor Radars (CONDOR). The optimal estimation implementation provide statistically sound solutions and diagnostics from the averaging kernels and measurement response. We present initial scientific results such as body forces of breaking gravity waves leading to two counter-rotating vortices and horizontal wavelength spectra indicating a transition between the rotational k−3 and divergent k-5/3 mode at scales of 80–120 km. In addition, we performed a keogram analysis over extended periods to reflect the latitudinal and temporal impact of a minor sudden stratospheric warming in December 2019. Finally, we demonstrate the applicability of the 3D-Var algorithm to perform large-scale retrievals to derive meteorological wind maps covering a latitude region from Svalbard, north of the European Arctic mainland, to central Norway.

A 31 MHz meteor radar located in Svalbard was used to observe polar mesospheric echoes (PMSEs) during summer 2020. Data from 19 July were selected for detailed analysis, with a focus on extracting additional information to characterize the atmosphere in the PMSE region. The use of an all-sky meteor radar adds an additional use to data collected for meteor observations and enables the detection of PMSE layers across a wide field of view. Comparison with data from a 53.5 MHz narrow-beam mesosphere–stratosphere–troposphere (MST) radar shows good agreement in the morphology of the layer as detected between the two systems. Doppler spectra of PMSE layers reveal fine structure, including regions of enhanced return that move across the radar's field of view. Examination of the relationship between range and Doppler shift of off-zenith portions of the layer enables the estimation of wind speeds with high temporal resolution during PMSE conditions. Trials demonstrate good agreement between wind speeds obtained from PMSE Doppler spectra and those calculated from specular meteor trail radial velocities. Combined with the antenna polar diagram of the radar, this same relationship was used to infer the aspect sensitivity of observed PMSE backscatter, yielding a mean backscatter angular width of 6.8±3.3∘. A comparison of underdense meteor radar echo decay times during and outside of PMSE conditions did not demonstrate a strong correlation between the presence of PMSEs and shortened underdense meteor radar echo durations.

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

Abstract Opioid inhibition of nociceptive stimuli varies in individuals and is difficult to titrate. We have reported the vascular stiffness value (K) as a standard monitor to quantify sympathetic response with high accuracy. On the contrary, among individuals, a considerable variation in the rate of change in K for constant pain has been observed. In this study, we proposed a new index, the minimum stimulus intensity value that evoked the response on K (MECK: Minimum Evoked Current of K), and evaluated its accuracy in predicting sympathetic response to nociceptive stimuli under constant opioid administration. Thirty patients undergoing open surgery under general anesthesia were included. After anesthetic induction, remifentanil was administered at a constant concentration of 2 ng/ml at the effect site followed by tetanus stimulation. MECK was defined as the minimal current needed to produce a change in K. MECK significantly (P

Abstract The objective of this study was to examine the impact of around-the-clock (ATC) administration of intravenous (IV) acetaminophen following robot-assisted radical prostatectomy (RARP). Intravenous infusion of acetaminophen was started on the day of the operation at 1000 mg/dose every 6 h, and the infusion was continued on a fixed schedule until postoperative day 2 a.m. In a retrospective observational study, we compared 127 patients who were administered IV acetaminophen on a fixed schedule (ATC group) with 485 patients who were administered analgesic drugs only as needed (PRN group). We investigated postoperative pain intensity and additional analgesic consumption on postoperative day 0, 1, 2, 3, and 5 between the two groups. Postoperative pain scores were significantly lower in the ATC group than in the PRN group at 1 and 2 days, and this period matched the duration of ATC administration of IV acetaminophen. Postoperative frequency of rescue analgesia was significantly lower in the ATC group than in the PRN group at postoperative 0, 1, and 2 days. ATC administration of IV acetaminophen has the potential to be a very versatile and valuable additional dose to achieve appropriate postoperative analgesia in patients with RARP.

Abstract Background Remimazolam is a novel short-acting benzodiazepine characterized by metabolism independent from organ function. We report intraoperative MEP responses of two patients who underwent spine surgery under general anesthesia using remimazolam. Case presentation In case 1, MEP monitoring was successfully performed with the use of a fixed dose of remimazolam at 0.5 mg/kg/h and remifentanil at 0.2 μg/kg/min. In case 2, an increasing dose of remimazolam from 0.5 to 1.5 mg/kg/h during the operation did not affect MEP signals. In both cases, remimazolam was titrated to maintain the values of entropy electroencephalogram (EEG) monitoring at 40–60. Conclusions General anesthesia using remimazolam and remifentanil can be a valuable alternative for spine surgery with MEP monitoring by EEG to assess the optimal dose.

Many anesthetics, including Propofol, have been reported to induce elevation of intracellular calcium, and we were interested to investigate the possible contribution of calcium elevation to the mechanism of the newly approved remimazolam actions. Remimazolam is an intravenous anesthetic first approved in Japan in July 2020, and is thought to exert its anesthetic actions via γ-aminobutyric acid A (GABAA) receptors; however, the precise mechanisms of how remimazolam elevates intracellular calcium levels remains unclear. We examined the remimazolam-induced elevation of intracellular calcium using SHSY-5Y neuroblastoma cells, COS-7 cells, HEK293 cells, HeLa cells, and human umbilical vein endothelial cells (HUVECs) loaded with fluorescent dyes for live imaging. We confirmed that high concentrations of remimazolam (greater than 300 μM) elevated intracellular calcium in a dose-dependent manner in these cells tested. This phenomenon was not influenced by elimination of extracellular calcium. The calcium elevation was abolished when intracellular or intraendoplasmic reticulum (ER) calcium was depleted by BAPTA-AM or thapsigargin, respectively, suggesting that calcium was mobilized from the ER. Inhibitors of G-protein coupled receptors (GPCRs)-mediated signals, including U-73122, a phospholipase C (PLC) inhibitor and xestospongin C, an inositol 1,4,5-triphosphate receptors (IP3R) antagonist, significantly suppressed remimazolam-induced calcium elevation, whereas dantrolene, a ryanodine receptor antagonist, did not influence remimazolam-induced calcium elevation. Meanwhile, live imaging of ER during remimazolam stimulation using ER-tracker showed no morphological changes. These results suggest that high doses of remimazolam increased intracellular calcium concentration in a dose-dependent manner in each cell tested, which was predicted to be caused by calcium mobilization from the ER. In addition, our studies using various inhibitors revealed that this calcium elevation might be mediated by the GPCRs-IP3 pathway. However, further studies are required to identify which type of GPCRs is involved.

Abstract Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA.

Summary: Background & aims: Many studies have reported the effects of preoperative clear fluid carbohydrate supplements; however, few studies have reported the effects of preoperative jelly-type carbohydrate supplements. This study aimed to assess the effect of a jelly-type oral nutritional supplement (ONS) on metabolism, redox balance by using various surrogate markers and to evaluate its excretion from the stomach. Methods: This study was conducted according to a crossover design. Participants underwent a control experiment whereby they fasted after dinner and only ingested water until the experiment. The remaining participants underwent an ONS experiment whereby they ingested 400 g of ONS before bed and another 400 g at 7:00 am. Blood samples were collected at 9:00 am. After a break of at least 24 h, participants underwent the alternate experiment. Results: Thirty minutes after intake of jelly, the gastric antrum appeared flat (the same result as that at baseline) on ultrasonography. The ONS group showed significantly lower serum free fatty acid levels (100 μEq/L, p = 0.027, vs. 327 μEq/L, n = 6), total ketone bodies levels, 3-MH/creatinine levels, and oxidative stress surrogate markers. Serum insulin levels were significantly higher and participant's satisfaction was improved in the ONS group. Conclusions: We have the limitations of our methodologies as surrogate markers, compared with direct measurement of lipolysis, proteolysis and redox balance regulation. But Jelly-type ONS suppresses the catabolism of adipose tissue and muscle protein, decreases oxidative stress and improves patient satisfaction in healthy participants, without any increased risk of aspiration. Keywords: Crossover design, Jelly-type oral nutritional supplement, Metabolism, Antioxidation, ERAS

Abstract Background Methylmalonic acidemia (MMA) is a metabolic disorder of organic acids and is characterized by the accumulation of methylmalonic acids. Case presentation The patient was a 19-year-old female diagnosed with severe MMA at 3 days of age, who was scheduled for renal replacement therapy. Preoperatively, there was no evidence of metabolic acidosis or electrolyte abnormalities. Glucose was administered preoperatively following a 6-h fast. Anesthesia was administered using thiamylal, remifentanil, rocuronium, and sevoflurane. After tracheal intubation, the patient underwent an ultrasound-guided bilateral rectus sheath block with ropivacaine. A drop in blood sugar level was treated with 5% glucose. Extubation was performed after intravenous administration of sugammadex. Conclusions We report the anesthetic management of a patient with MMA using a combination of general anesthesia and rectus sheath block.

Abstract Background Barber-Say syndrome (BSS) is a very rare congenital disorder characterized by macrostomia, cutis laxa, and other features. We report our experience of performing general anesthesia on a Japanese child with BSS. Case presentation A bilateral repair of the corners of the mouth under general anesthesia was planned for an 18-month-old male with macrostomia; the child was 75 cm in height and weighed 9.9 kg. As insertion of the peripheral intravenous catheter was difficult, it was inserted before the surgery by a pediatrician. The patient wore a mask and was ventilated manually after loss of consciousness with intravenous anesthesia. A mask for adults provided a superior fit and was effective in preventing air leakage from the corners of the mouth. After rocuronium was administered, the larynx was spread with a Macintosh laryngoscope. There was no laryngeal anatomical abnormality, and tracheal intubation was readily possible. The operation was completed without incident. Stiffening of both arms occurred for several seconds one hour after the operation ended, but the patient did not develop other complications. Conclusions Mask ventilation and the insertion of an intravenous catheter may be difficult in the general anesthesia of patients with BSS, and anesthetic management requires caution.

Abstract Background This study investigated plasma concentrations of substance P (SP) in patients undergoing general anesthesia (GA) and postoperative nausea and vomiting (PONV). This prospective, observational, cohort study included 23 patients who underwent scheduled surgery under general anesthesia. Blood was collected from the radial artery at predetermined time points (15–30 mins prior anesthesia, 15–30 mins after surgery/GA, and 24 h after surgery). PONV, SP concentrations, risk factors, and analgesics used were measured. Findings Nine of 23 patients experienced PONV. In patients without PONV, SP concentrations significantly decreased (P

We have quantitatively evaluated generation mechanisms of a sporadic sodium layer (SSL) based on observational data obtained by multiple instruments at a high-latitude station: Ramfjordmoen, Tromsø, Norway (69.6° N, 19.2° E). The sodium lidar observed an SSL at 21:18 UT on 22 January 2012. The SSL was observed for 18 min, with a maximum sodium density of about 1.9 × 1010 m−3 at 93 km with a 1.1 km thickness. The European Incoherent Scatter (EISCAT) UHF radar observed a sporadic E layer (Es layer) above 90 km from 20:00 to 23:00 UT. After 20:00 UT, the Es layer gradually descended and reached 94 km at 21:18 UT when the SSL appeared at the same altitude. In this event, considering the abundance of sodium ions (10 % or less), the Es layer could provide only about 37 % or less of the sodium atoms to the SSL. We have investigated a temporal development of the normal sodium ion layer with a consideration of chemical reactions and the effect of the (southwestward) electric field using observational values of the neutral temperature, electron density, horizontal neutral wind, and electric field. This calculation has shown that those processes, including contributions of the Es layer, would provide about 88 % of sodium atoms of the SSL. The effects of meteor absorption and auroral particle sputtering appear to be less important. Therefore, we have concluded that the major source of the SSL was sodium ions in a normal sodium ion layer. Two processes – namely the downward transportation of sodium ions from a normal sodium ion layer due to the electric field and the additional supply of sodium ions from the Es layer under relatively high electron density conditions (i.e., in the Es layer) – played a major role in generating the SSL in this event. Furthermore, we have found that the SSL was located in a lower-temperature region and that the temperature inside the SSL did not show any remarkable temperature enhancements.