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Pulmonary hypertension is characterized by higher-than-normal pulmonary arterial pressures. This case report describes the perioperative management of a male patient with idiopathic pulmonary hypertension and a history of vasovagal syncope during previous dental extractions with local anesthesia. He underwent successful extraction of a single tooth with intravenous moderate sedation using dexmedetomidine and midazolam as well as prilocaine with felypressin for local anesthesia. There are many considerations surrounding the anesthetic management of patients with pulmonary hypertension, including the need to maintain systemic blood pressure, avoid hypoxemia and hypercapnia, and ensure adequate analgesia.

Objectives: The benefit of using a noncontact eye-tracking system is its low a burden on individuals for measuring biological signals. The goal of this study was to develop a visually induced motion sickness (VIMS) evaluation index using data collected with a noncontact eye-tracking system for driving simulator (DS) experiments., Methods: The participants included nine elderly people with visual and balance functions that did not interfere with their daily life. The gaze data of the participants were measured at rest-both before and after DS trials. The participants answered followed up the simulator sickness questionnaire (SSQ) before and after each trial. The participants were divided into two groups on the basis of their SSQ results. One group experienced VIMS during the DS trial (four people; average age, 79.0 years), whereas the other group did not experience it (five people; average age, 71.2 years)., Results: The results of VIMS symptoms were confirmed: data concerning the locus of eye-tracking were lengthened, the eye-tracking data were diffused. This experiment demonstrated the usefulness of sparse density as a quantification index based on eye-tracking data in the evaluation of VIMS., Conclusions: Regarding the application of the findings of this study, it is believed that it will be easier to detect VIMS symptoms induced by DS operations if the index can be used for an eye-tracking data-based evaluation of VIMS.

In this study, we discuss the psychological acceptability of an utterance strategy used by the D riving S upport A gent (DSA). Previous literature regarding DSA suggests that the adoption of a small robot as a form will increase acceptability. However, the agent's utterance has been reported as a problem faced by the user. Therefore, in this study, we designed the agent's utterance using politeness strategy as described by Brown and Levinson's famous sociolinguistics and pragmatics theory and analyzed its acceptability through a participant-based experiment. In this experiment, we used positive and negative politeness strategies (PPS and NPS, respectively). In general, PPS is utilized to reflect the desire to be liked/recognized by others, whereas NPS is utilized to reflect the need for not wanting to be disturbed by others. Based on our results, PPS was rated high compared to NPS ( n = 197). Therefore, many participants highly evaluated PPS. However, there was a group of participants who appreciated NPS. There were also participants who evaluated the two strategies equally. The number of participants in these three groups was observed at 4:1:1. This result contributes as an index on the utterance design of the DSA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Miyamoto, Katagami, Shigemitsu, Usami, Tanaka, Kanamori, Yoshihara and Fujikake.)

The mesothelium, covered by a continuous monolayer of mesothelial cells, is the first protective barrier against metastatic ovarian cancer. However, mesothelial cells release tumor-promoting factors that accelerate the process of peritoneal metastasis. We identified cancer-associated mesothelial cells (CAMs) that had tumor-promoting potential. Here, we found that plasminogen activator inhibitor-1 (PAI-1) induced the formation of CAMs, after which CAMs increasingly secreted the oncogenic factors interleukin-8 (IL-8) and C-X-C motif chemokine ligand 5 (CXCL5), further promoting the metastasis of ovarian cancer cells in a feedback loop. After the formation of CAMs, PAI-1 activated the nuclear factor kappa B (NFκB) pathway in the CAMs, thus transcriptionally upregulating the expression of the downstream NFκB targets IL-8 and CXCL5. Moreover, PAI-1 correlated with peritoneal metastasis in ovarian cancer patients and indicated a poor prognosis. In both ex vivo and in vivo models, after PAI-1 expression was knocked down, the metastasis of ovarian cancer cells decreased significantly. Therefore, targeting PAI-1 may provide a potential target for future therapeutics to prevent the formation of CAMs and alleviate peritoneal metastasis in ovarian cancer patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

In the rodent olfactory system, neuroblasts produced in the ventricular-subventricular zone of the postnatal brain migrate tangentially in chain-like cell aggregates toward the olfactory bulb (OB) through the rostral migratory stream (RMS). After reaching the OB, the chains are dissociated and the neuroblasts migrate individually and radially toward their final destination. The cellular and molecular mechanisms controlling cell-cell adhesion during this detachment remain unclear. Here we report that Fyn, a nonreceptor tyrosine kinase, regulates the detachment of neuroblasts from chains in the male and female mouse OB. By performing chemical screening and in vivo loss-of-function and gain-of-function experiments, we found that Fyn promotes somal disengagement from the chains and is involved in neuronal migration from the RMS into the granule cell layer of the OB. Fyn knockdown or Dab1 (disabled-1) deficiency caused p120-catenin to accumulate and adherens junction-like structures to be sustained at the contact sites between neuroblasts. Moreover, a Fyn and N-cadherin double-knockdown experiment indicated that Fyn regulates the N-cadherin-mediated cell adhesion between neuroblasts. These results suggest that the Fyn-mediated control of cell-cell adhesion is critical for the detachment of chain-forming neuroblasts in the postnatal OB. SIGNIFICANCE STATEMENT In the postnatal brain, newly born neurons (neuroblasts) migrate in chain-like cell aggregates toward their destination, where they are dissociated into individual cells and mature. The cellular and molecular mechanisms controlling the detachment of neuroblasts from chains are not understood. Here we show that Fyn, a nonreceptor tyrosine kinase, promotes the somal detachment of neuroblasts from chains, and that this regulation is critical for the efficient migration of neuroblasts to their destination. We further show that Fyn and Dab1 (disabled-1) decrease the cell-cell adhesion between chain-forming neuroblasts, which involves adherens junction-like structures. Our results suggest that Fyn-mediated regulation of the cell-cell adhesion of neuroblasts is critical for their detachment from chains in the postnatal brain., (Copyright © 2018 the authors 0270-6474/18/384599-12$15.00/0.)

Epithelial ovarian cancer (EOC) is believed to cause peritoneum dissemination through microenvironmental cell‑to-cell communication between the tumor and mesothelium, leading to the further acquisition of progressive and metastatic potentials. In the present study, we aimed to determine the role of cancer-associated mesothelial cells (CAMCs) in the promotion of tumor neovascularization and vascular permeability via enhanced vascular endothelial growth factor (VEGF) production. We examined whether a characteristic morphological change in human peritoneal mesothelial cells (HPMCs) was observed in the presence of malignant ascites and tumor-derived TGF-β. We focused on the enhanced production of VEGF in CAMCs and its crucial role in endothelial migration and tube formation. Normal HPMCs showed an epithelial morphology with a cobblestone appearance. When HPMCs were co-cultured with malignant ascites from patients with advanced EOC, a dramatic morphologic change was noted from an epithelioid pattern to an α-SMA-positive fibroblastic, mesenchymal pattern. Additionally, we found that EOC-derived TGF-β induced typical EMT-like morphological alteration in HPMCs, which was associated with CAMCs. We further discovered that CAMCs play a crucial role in the enhanced migration and tube formation of endothelial cells by the promotion of VEGF production. In conclusion, our findings indicate the possible involvement of CAMCs in the neovascularization of EOC and enhancement of vascular permeability, resulting in the formation of malignant ascites. The novel mechanism of CAMCs as a facilitator of EOC progression is displayed by microenvironmental cell-to-cell communication between EOC and the mesothelium.

Choriocarcinoma is a malignant gestational trophoblastic neoplasia (GTN) and one of the curable types of gynecological cancer. However, 10% of choriocarcinoma patients have a poor prognosis, particularly when they have metastasis, apart from pulmonary metastasis, or do not go into remission by the second chemotherapeutic regimen. We herein present the case of a 36-year-old patient who had choriocarcinoma with metastases to the lungs, liver and kidneys. The 5th and 6th regimens with cisplatin for choriocarcinoma failed and the patient developed brain metastases. She was then treated with four cycles of high-dose ifosfamide, carboplatin and etoposide (ICE) with blood progenitor cell support after confirming the effectiveness of ICE at normal doses. The serum human chorionic gonadotropin (hCG) level was 140,009 mIU/ml at the start of high-dose ICE and the patient tolerated this regimen well. However, the beneficial effect was decreasing with each successive course of treatment, with the lowest level of hCG at 103 mIU/ml after the fourth course. The patient did not achieve complete remission and succumbed to the disease 4 months after the last chemotherapy. The findings of the present case and a review of the related literature suggest that high-dose ICE with stem cell rescue may be considered as a viable treatment option for a multi-drug resistant choriocarcinoma or GTN.

Visually induced motion sickness (VIMS) is caused by sensory conflict, the disagreement between vergence and visual accommodation while observing stereoscopic images. VIMS can be measured by psychological and physiological methods. We propose a mathematical methodology to measure the effect of three-dimensional (3D) images on the equilibrium function. In this study, body sway in the resting state is compared with that during exposure to 3D video clips on a liquid crystal display (LCD) and on a head mounted display (HMD). In addition, the Simulator Sickness Questionnaire (SSQ) was completed immediately afterward. Based on the statistical analysis of the SSQ subscores and each index for stabilograms, we succeeded in determining the quantity of the VIMS during exposure to the stereoscopic images. Moreover, we discuss the metamorphism in the potential functions to control the standing posture during the exposure to stereoscopic video clips.

Background: As for cervical spine injury, special consideration for airway management is required but the optimal strategy remains controversial. Direct laryngoscopy (DL) creates some degree of cervical extension leading to secondary neurologic deterioration. Fiberoptic bronchoscopy (FOB) may facilitate tracheal intubation with little cervical motion, but has several inherent limitations. A few objective data prompted us to compare the neurologic outcome relating to the orotracheal intubation using the different types of technique, the DL with a Macintosh blade or the FOB., Methods: To identify the effect of different methods on the intubation time, neurologic disability, and adverse effects, 68 cervical spine-injured patients with the use of DL (group L; 36 patients) or FOB (group F; 32 patients) were retrospectively reviewed using hospital records. Following the induction of general anesthesia, the trachea was intubated with no immobilizing forces in group L, while awake intubation was accomplished in group F after judicious application of local anesthesia to the larynx and trachea., Results: No significant differences were observed between the groups in age, BMI, intubation time, postoperative neurologic outcome or incidence of aspiration pneumonia. Moreover, no neurologic deterioration was shown after DL and orotracheal intubation., Conclusions: We found no evidence to support the routine practice of the bronchoscope-assisted awake intubation in patients with cervical spine injury. The clinical value of this technique in offering some neurologic advantage remains limited.

Background: Little information is available about anesthetic management in spine surgery for infectious spondylitis, in which major bleeding can be expected. The amount of blood loss may vary somewhat with pyogenic or tuberculous spondylitis. Limited data prompted us to get a clue to determine how best to care for these patients., Methods: To examine the amount of intraoperative bleeding, 71 patients with either pyogenic (group A; 44 patients) or tuberculous spondylitis (group B; 27 patients) were retrospectively reviewed using hospital records. They underwent posterior fusion with instrumentation and anterior radical resection of the lesion., Results: No significant differences were observed between the groups in age, gender, comorbidity or length of hospital stay. Operative time was longer in patients with group B (A: 126 +/- 41 vs B: 197 +/- 76 min, P<0.01). There was a trend toward greater blood loss in group B, especially massive bleeding (>1.5 l) occurred at a higher rate (13.6 vs 33.3%, P=0.05). The number of involved vertebrae was more in group B (1.8 +/- 0.9 vs 2.9 +/- 1.3, P<0.01). Both operative time and blood loss volume showed a good correlation with the number of vertebrae infected, suggesting that extensive eradication over several spinal segments may be indicated for tuberculous spondylitis., Conclusions: Spine surgery for tuberculous spondylitis is more likely to carry risks of longer operative time and higher rate of blood loss.

Adverse surgical outcomes appear to be more frequent in patients with known obstructive sleep apnea (OSA). However, OSA patients may present for surgery without a prior diagnosis. A 37-year-old man underwent craniotomy for surgical direct neck clipping of the right ruptured internal carotid aneurysm. His intraoperative and early postoperative courses were uneventful. At night, about 48 hr after surgery, he developed sudden generalized tonic-clonic convulsion and temporary depressed consciousness resulting in marked hypercapnea (Pa(CO2)>100 mmHg). His respiration was transiently supported by PSV mode via LMA. He soon got well without neurologic deficits. At night, about 74 hr postoperatively, a generalized convulsion was again observed with hypercapnea. Aside from the respiratory support, percutaneous cricothyroidotomy was performed using Minitrach II system for his airway control, leading to no further recurrence of seizure. He was suspected to have unrecognized OSA due to such characteristic findings of sleep apnea as obesity (BMI>30) and witnessed apneas by his family. Postoperative rapid eye movement (REM) sleep rebound has been suggested to contribute to two consecutive night appearance of seizure. Clinical suspicion for OSA should be required preoperatively and perioperative heightened awareness is recommended.

A 64-year-old woman with hypertension, diabetes mellitus and asymptomatic first degree AV block underwent low anterior resection of the rectum. Anesthesia was induced with propofol, vecuronium bromide and remifentanil and maintained with nitrous oxide in oxygen, propofol and remifentanil. We did not use epidural anesthesia. After the operation, the patient was admitted to the intensive care unit under general anesthesia with propofol and remifentanil. In addition, dexmedetomidine was given without loading dose. The EKG changed from first degree AV block to second degree AV block followed by complete AV block and finally cardiac arrest. As soon as we performed heart massage, sinus rhythm appeared. We should be careful in giving dexmedetomidine to a patient with AV block.

We propose a new index, sparse density (SPD), of stationary stabilograms for detecting the metamorphism in the (temporally averaged) potential function of stochastic differential equations, which occurs when a human attempts to maintain an upright posture. It is known that a mathematical model of the body sway can be developed by a stochastic process. The authors have succeeded in finding the nonlinearity in the potential function. In this study, subjects in a standing position were stimulated by three-dimensional (3-D) movies on an head-mounted display (HMD). We also measured the degree of determinism in the dynamics of the sway of the center of gravity of the subjects. The Double-Wayland algorithm was used as a novel method. As a result, the dynamics of the body sway in the presence of the stimulus as well as in its absence were considered to be stochastic. The metamorphism in the potential function during exposure to the conventional 3-D images could be detected by using the SPD.

Subject performance in reading characters on mobile phone liquid crystal displays was researched by using (a) English sentences with 3 or 4 different sizes of characters on 2 types of displays with different resolutions (n=23; age=31.6+/-6.0 years), (b) Japanese characters in 3 different sizes and 2 types of font (n=98; age=44.5+/-18.5 years), and (c) Japanese characters vertically enlarged 1-4 times (n=120; age=46.9+/-18.6 years). Subjective evaluation, reading speed, number of reading errors, and viewing distance were recorded. Readability was higher with higher resolution displays, and with Gothic than with Mincho font in Japanese. Young subjects shortened the viewing distance as characters became smaller, whereas elderly subjects increased the viewing distance irrespective of the size of characters. Characters of 3-5 mm are appropriate for the young but inadequate for the elderly. Readability of Japanese characters improved when they were vertically enlarged to approximately twice the width.

In order to evaluate display devices, a geostationary image and the character were generally used in previous studies. We have proposed a new method for comparing the standing posture when a subject views a liquid crystal display (LCD) displaying a movie scrolling from the left to the right. In this study, we mathematically measured the degree of determinism in the dynamics of the sway of center-of-gravity. The Double-Wayland algorithm was used as a novel method. As a result, the dynamics of the sway when subjects viewed the movie as well that of the sway in the resting state was considered to be stochastic. The moving map task would not change it into a deterministic one.

The present study was conducted to investigate day-night variations of plasma thyroid hormone and energy substrate levels in rats after acclimation to heat loaded for several hours at a fixed time per day. The heat-acclimated rats were exposed to an ambient temperature of 33 degrees C for 5 h in the last half of the dark phase for 16 consecutive days, while the control rats were kept at 24 degrees C for the same period. After completing the schedule, plasma levels of triiodothyronine (T3), free T3 (FT3), thyroxine (T4), free T4 (FT4), cortisol, triglyceride, nonesterified fatty acid, total protein, and glucose were measured at 3-h intervals between 00:00 and 18:00 (dark phase, 03:00-15:00). The plasma levels of T3 and FT3 of the heat-acclimated rats were higher than those of the controls in the last half of the dark phase. Similar differences were observed for T4 and FT4 levels. The plasma cortisol level was consistently higher in the heat-acclimated rats than in the control rats. There were no particular differences in energy-substrate levels between the two groups at any time of the day. These results indicate that heat exposure at a fixed time per day alters the pattern of day-night variations of plasma thyroid hormone levels in rats. It is noteworthy that the plasma levels of thyroid hormones, especially T3 and FT3, increased during the period when the rats had been previously exposed to heat.

The effects of cold exposure for several hours at a fixed time once a day on nyctohemeral variations of hypothalamic temperature (Thy), heat balance, and feeding and locomotor activities were examined in rats. The cold-exposed group was subjected to an ambient temperature of 3 degrees C for about 5 h in the last half of the dark phase daily for 10 or more than 21 consecutive days, while the control rats were kept constant at 24 degrees C. The 10-d cold exposure had little effect on nyctohemeral changes in Thy and locomotor activity. However, after completing a 3- to 4-week cold exposure schedule, the levels of Thy, heat loss, heat production, and feeding and locomotor activities of the cold-exposed rats significantly decreased for 1-2 h during the period of the previous cold exposure time. These decreases lasted for at least 2 d after the end of the cold exposure schedule. These results suggest that the patterns of nyctohemeral changes in body core temperature and feeding and locomotor activities were altered after repeated cold exposure at a fixed time once a day in rats.

The relationships between body core temperature and environmental temperature (T(a)) at the onset of tail skin vasodilation, thermally-induced salivary secretion and cold-induced thermogenesis were examined in rats. Hypothalamic temperature (Thy) was measured as an index of body core temperature. Internal body heating and cooling were made using an intravenous thermode chronically implanted in the inferior vena cava at various T(a)s. External heating and cooling were made by changing T(a) at a constant rate, while Thy was controlled at constant levels with the thermode. Internal heating induced tail skin vasodilation but not thermally-induced salivary secretion, and internal cooling induced cold-induced thermogenesis. External warming caused tail skin vasodilation and thermally-induced salivary secretion, but external cooling failed to induce cold-induced thermogenesis. There were significant correlations between Thy and T(a) at the onset of tail skin vasodilation, thermally-induced salivary secretion and cold-induced thermogenesis. When T(a) was taken as an indicator of thermal input from the skin, the ratios of the potency of inputs from the body core and skin were estimated to be between 8:1 and 6:1 at the onset of tail skin vasodilation, 8:1 at the onset of thermally-induced salivary secretion, and 5:1 for the control of cold-induced thermogenesis. These results suggest that, in rats, the contribution of thermal input from the skin to the onset of thermoregulatory responses is relatively small.

To examine the influence of atrial fibrillation (Af) on stroke onset, we measured the plasma D-dimer level, thrombin antithrombin III complex and plasmin alpha 2 antiplasmin complex (PAP) in 46 stroke patients with Af and 87 stroke patients without Af. These marker levels were significantly higher in Af patients with stroke than in those without stroke (n = 16), and thus do not seem to be affected by Af alone. Abnormal values were also more frequent in acute Af stroke patients with visible occlusion of the major cerebral artery than in those without Af. The D-dimer and PAP levels in all Af stroke patients in the younger-aged patients (< or = 64 years) were significantly higher than those without Af, but not noted in the older-aged group (> or = 75 years). These results suggest that the D-dimer and PAP levels in younger-aged patients with Af indicate the existence of cerebral emboli due to Af.