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Supplemental Digital Content is available in the text., Objectives: We conducted a pilot study using an experimental study protocol to evaluate the measurement error of arterial pulse contour analysis-derived stroke volume due to improper transducer leveling during the passive leg raising test and the impact of such error on the determination of fluid responsiveness. Design: Prospective observational study. Setting: A medical-surgical ICU at a tertiary referral center in Kobe, Japan. Patients: Consecutive critically ill adult patients using the FloTrac system Version 4.0 (Edwards Lifesciences, Irvine, CA) for hemodynamic monitoring between September 1, 2018, and November 31, 2018. Interventions: None. Measurements and Main Results: Using 20 patients, we estimated the change in the zero-reference level of an arterial transducer during head-down tilting as the vertical distance between the zero-reference levels of the transducer in the 45° semi-recumbent and supine positions. Using the FloTrac system Version 4.0, we recorded the hemodynamic variables every 20 seconds for 180 seconds at each of the following three points: 1) baseline, 2) after the transducer was elevated by the predetermined distance, and 3) after the transducer had returned to baseline. With respect to the predetermined change in the transducer level, a mean value of 18 ± 3 cm resulted in an increase in stroke volume measurement (mean value, 11 mL/beat; 95% CI, 10–13). This value corresponded to 20% (95% CI, 18–23%) of the baseline value 20 seconds after changing the transducer level. A significant correlation was observed between the predetermined change in the transducer level and the increase in the measured stroke volume (r2 = 0.58; p < 0.001). CONCLUSIONS: When using the FloTrac system Version 4.0, a rapid increase in stroke volume was observed after elevating the arterial transducer. Clinicians and researchers are advised that proper leveling of the arterial transducer is necessary in order to accurately assess the change in arterial pulse contour analysis-derived stroke volume during the passive leg raising test.

Purpose We evaluated whether longer term hemodialysis (HD) is associated with a higher incidence of vasoplegic syndrome (VS) after cardiac surgery. Methods This retrospective, single-center cohort study included 562 consecutive patients who underwent cardiac surgery in a tertiary hospital from January 2015 to December 2016. We assessed VS occurrence and its relationship with HD duration and other risk factors. To assess the effect of the HD duration on VS occurrence, we constructed ordinal variables: HD = 0 (non-HD), 0 180 min were significantly more common in the VS group (P 180 min) were subjected to multivariate regression analysis. Long-term HD was identified as an independent predictor of VS (odds ratio, 2.29, 95% confidence interval, 1.66–3.18). Conclusions Longer term HD may be associated with a higher VS incidence after cardiac surgery. VS should be given attention after cardiac surgery in chronic HD-dependent patients.

We herein report the successful management of a condition mimicking acquired laryngomalacia using conservative methods in an elderly man with a progressive neurological disorder. The patient developed stridor and was transferred to the intensive-care unit. Flexible laryngoscopy revealed a collapsed epiglottis during inspiration, as seen in acquired laryngomalacia, with mucinous material firmly adhered to the epiglottis. The stridor resolved after the removal of this material. Pathology revealed keratinized material, suggesting a collection of sputum or epithelial tissue. Thus, flexible laryngoscopy can differentiate the cause of airway obstruction and avoid unnecessary endotracheal intubation in patients with neurological disorders.

Bezafibrate is a commonly used medicine for hyperlipidemia and is known to have an effect of lowering biliary enzymes, alkaline phosphatase (ALP) and γ-glutamyltransferase. Recent studies showed that it upregulated mdr2/MDR3 P-glycoprotein expression which increased biliary phospholipid secretion into bile and had a cyto-protective effect against cholestasis. To evaluate the efficacy of bezafibrate in primary biliary cirrhosis(PBC), 11 pre-cirrhotic PBC patients were treated with oral administration of 400 mg/day of bezafibrate for 12–21 months. One of them was stage III and the rest was stage I–II. Two patients had pruritus and chronic fatigue, and two chronic fatigue. Bezafibrate was co-administered in seven patients who had been treated with ursodeoxycholic acid but shown incomplete responses. In 11 patients, values of ALP decreased by 50–70% and were normalized in five. After 2 months from the start, all symptoms lessened and eventually disappeared as biliary enzymes levels decreased. As for the immunological parameters, IgM decreased significantly in five patients but antimitochondrial antibody titers were not affected. The present data suggest that bezafibrate has additional effects and is safe for pre-cirrhotic primary biliary cirrhosis. The evaluations of long-term efficacy and toxicity including histological changes are needed.

Controversy persists concerning the two concepts of the histogenesis and progression of colorectal cancer: the adenoma-carcinoma sequence and de novo cancer. The depressed type of colorectal tumor has attracted attention because it is thought to be a de novo cancer that has a higher rate of submucosal compared with the protruding type tumor.1-4 However, reports of small advanced colorectal cancer are rare. This is a case of a depressed type colon cancer invading the subserosa, which appears to be a case of minute advanced colorectal cancer.

The present study was undertaken to determine whether administration of adriamycin causes the depletion of riboflavin content. Rats received intraperitoneal injections of adriamycin (4 mg per kg body weight) for 6 consecutive days. Urinary riboflavin excretion began to increase after 2 days of treatment with adriamycin. Erythrocyte FAD levels decreased gradually and plasma lipid peroxide contents increased markedly at the 6th day. The activity coefficient of erythrocyte glutathione reductase showed a significant increase before the decrease of flavin content and the elevation of lipid peroxide level. Therefore, the value of this coefficient obtained from erythrocyte appears to be a reliable index of riboflavin deficiency, particularly during the early stage.

In dog heart mitochondria, the total flavin content was found to be higher in intermyofibrillar mitochondria (0.88 nmol per mg protein for FAD, 0.10 for FMN) than in subsarcolemmal mitochondria (0.27 for FAD, 0.07 far FMN). Sixty-minute occlusion of the coronary artery led to a decrease in FAD content in the ischemic region by approximately one-third. Glutathione reductase activity in subsarcolemmal mitochondria was depressed significantly by Ischemia. The activity coefficient increased to 1.36 from the control (1.07). Our results indicate that depletion of riboflavin content in mitochondria may be related to various metabolic alterations under ischemia and that riboflavin in subsarcolemmal mitochondria is influenced more by ischemia than that in intermyofibrillar ones.

Introduction: Monitoring continuous cardiac index (CCI) with pulmonary artery catheter (PAC) is valuable for postoperative management after cardiac surgery. However, some reports have shown that intermittent pneumatic compression (IPC) devices, which are used to prevent deep venous thrombosis and pu

Washed platelets were prepared from healthy children and adults, and patients with renal glomerular diseases, and incubated with [1-14C] arachidonate to measure the generation capacities of thromboxane (Tx) A2 and 12-hydroxyeicosatetraenoate (12-HETE). Tx generation capacity of platelets was significantly higher in patients with chronic glomerulonephritis, purpura nephritis and lupus nephritis than in healthy control subjects. There was no significant increase in minimal change nephrotic syndrome. 12-HETE showed a decreasing tendency in the glomerular diseases, which was restored to normal level by in vitro addition of indomethacin. Such increased Tx generation capacity of platelets may cause abnormal enhancement of platelet functions and conceivably constitute an aggravating factor of glomerular and microvascular damage in the affected kidney.