Search

Abstract Background We report a pediatric case where bilateral regional oxygen saturation (rSO2) measurements were useful in determining the selective cerebral perfusion (SCP) flow rate. Case presentation A 9-year-old Japanese boy, 128 cm tall and weighing 25.6 kg, was scheduled for aortic arch reconstruction due to a 90–100 mmHg pressure gradient. Pediatric-sized oximetry sensors were attached to the bilateral forehead area. The rSO2 levels were 70–80% on the right and 80–90% on the left during cardiopulmonary bypass. Immediately following deep hypothermic circulatory arrest with the body temperature cooled to 25 °C, SCP was initiated from the right brachiocephalic artery at 10 mL/kg/min. As the rSO2 decreased steeply to 43–45% on the right and to 32–38% on the left, the SCP flow was increased to 15 mL/kg/min. The right rSO2 increased promptly to 50–60%, but the left rSO2 remained at 30–40%. After the SCP flow was increased to 20 mL/kg/min, bilateral rSO2 levels of 50–60% were obtained, and the SCP flow rate was maintained. The patient was transferred to the ICU postoperatively and extubated on the second postoperative day with no neurological abnormalities. Conclusions Bilateral rSO2 measurements are essential even for a pediatric patient undergoing SCP, despite the limited forehead area.

IntroductionAberrant fixation and scan paths in visual searches have been repeatedly reported in schizophrenia. The frontal eye fields (FEF) and thalamus may be responsible for fixation and scan paths. These two regions are connected by superior thalamic radiation (STR) in humans. Studies have reported reduced fixation numbers and shortened scan path lengths in individuals with attenuated psychosis syndrome (APS) and schizophrenia. In this study, we hypothesized that STRs in the white matter fiber bundles of impairments underlie abnormalities in fixation and scan path length in individuals with APS.MethodsTwenty-one individuals with APS and 30 healthy controls participated in this study. All participants underwent diffusion tensor imaging, and fractional anisotropy (FA) values of the left and right STR were analyzed using the novel method TractSeg. The number of eye fixations (NEF), total eye scanning length (TESL), and mean eye scanning length (MESL), derived using the exploratory eye movement (EEM) test, were adopted to evaluate the fixation and scan path length. We compared the FA values of the bilateral STR and EEM parameters between the APS and healthy control groups. We investigated the correlation between bilateral STR and EEM parameters in the APS and healthy control groups.ResultsNEF, TESL, MESL, and the FA values of the left STR were significantly reduced in individuals with APS compared to healthy controls. The left STR FA value in the APS group was significantly positively correlated with the MESL (r = 0.567, p = 0.007). In addition, the right STR FA value of the APS group was significantly correlated with the TESL (r = 0.587, p = 0.005) and MESL (r = 0.756, p = 0.7×10-4).DiscussionThese results demonstrate that biological changes in the STR, which connects the thalamus and FEF, underlie abnormalities in fixation and scanning. Recently, aberrations in the thalamus–frontal connection have been shown to underlie the emergence of psychotic symptoms. STR impairment may be a part of the biological basis of APS in individuals with subthreshold psychotic symptoms.

Abstract A 69-year-old male patient with mitral valve prolapse was scheduled for mitral valve plasty. Sixteen years earlier, he had undergone right open thoracotomy for esophageal cancer with subtotal esophagectomy, cervicothoraco-abdominal three-region dissection, posterior mediastinal tube reconstruction, and cervical anastomosis. Postoperatively, the patient had a treatment- and recurrence-free course, and an upper gastrointestinal endoscopy performed 2 years prior revealed no abnormality. We scheduled a transesophageal echocardiography for mitral valve surgery. We attempted to insert the probe but felt resistance at the height of the mid-thoracic region, and the image quality was poor, so we abandoned the intraoperative diagnosis. The surgery was performed as planned, and when the probe was manipulated again at the time of cardiopulmonary withdrawal, the mitral valve could be observed. The mitral valve was judged to be sufficiently repaired, and the surgery was terminated. There were no complications associated with transesophageal echocardiography.

Summary: Smooth muscle cell (SMC) accumulation is central to the pathogenesis of elastin-defective arterial diseases, including supravalvular aortic stenosis (SVAS). We previously demonstrated that elastin insufficiency activates Notch signaling in aortic SMCs. Activation of Notch is catalyzed by the enzyme gamma-secretase, but the role of catalytic subunits presenilin (PSEN)-1 or PSEN-2 in elastin aortopathy is not defined. Genetic approaches reveal that endothelial cell-specific Psen1 deletion does not improve elastin aortopathy whereas the deletion of either Psen1 in SMCs or Psen2 globally attenuates Notch pathway and SMC proliferation, mitigating aortic disease. With SMC-specific Psen1 deletion in elastin nulls, these rescue effects are more robust and in fact, survival is increased. SMC deletion of Psen1 also attenuates hypermuscularization in newborns heterozygous for the elastin null gene, which genetically mimics SVAS. Similarly, the pharmacological inhibition of PSEN-1 mitigates SMC accumulation in elastin aortopathy. These findings put forth SMC PSEN-1 as a potential therapeutic target in SVAS.

BackgroundPsychological inflexibility is a core concept of acceptance and commitment therapy (ACT), which is a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and maintain a penile erection sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men younger than 40 years, whereas biological factors are more likely to be the underlying cause in older men. ObjectiveThis web-based cross-sectional study examined differences in depression, anxiety, and psychological inflexibility among men with ED younger and older than 40 years in a Japanese population. MethodsWe used a web-based survey to gather data from various community samples. ED was assessed by the International Index of Erectile Function‐5 (IIEF-5) questionnaire, while depression, anxiety, and psychological inflexibility were evaluated by the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Valuing Questionnaire–Obstacle Subscale (VQ-OB) questionnaires. The chi‐square test estimated the scores of PHQ-9 and GAD-7 among men with ED, comparing those younger than 40 years and those older than 40 years. Additionally, a two-way ANOVA was conducted with ED severity and age group as independent variables, assessing psychological inflexibility. ResultsValid responses from 643 individuals (mean age 36.19, SD 7.54 years) were obtained. Of these, 422 were younger than 40 years (mean age 31.76, SD 5.00 years), and 221 were older than 40 years (mean age 44.67, SD 2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≥10 between men with ED younger and older than 40 years (P

Abstract Background Although there are reports of recovery of cardiac function after renal transplantation, the feasibility of renal transplantation in patients with low cardiac function remains controversial. Case presentation A 59-year-old Japanese male was scheduled to undergo living-donor renal transplantation (LDRT) under general anesthesia. Preoperative transthoracic echocardiography revealed severe mitral regurgitation (MR) and a left ventricular ejection fraction (LVEF) at 30%. LDRT was conducted prior to cardiac surgery with restrictive fluid management and close monitoring of cardiac function. The patient’s renal function improved promptly after the LDRT, and his hemodynamics were stable throughout the perioperative period. Along with improvements in the patient’s renal function and anemia, the patient’s cardiac function improved to LVEF 50% and achieved drastically improved MR as well as cardiac function, without intervention. Conclusion This case indicates that LDRT has the potential to improve cardiac function in patients who have been on hemodialysis for more than 20 years.

Abstract Background JCOG1015A1 is an ancillary research study to determine the organ-specific dose constraints in head and neck carcinoma treated with intensity-modulated radiation therapy (IMRT) using data from JCOG1015. Methods Individual patient data and dose-volume histograms of organs at risk (OAR) were collected from 74 patients with nasopharyngeal carcinoma treated with IMRT who enrolled in JCOG1015. The incidence of late toxicities was evaluated using the cumulative incidence method or prevalence proportion. ROC analysis was used to estimate the optimal DVH cut-off value that predicted toxicities. Results The 5-year cumulative incidences of Grade (G) 1 myelitis, ≥ G1 central nervous system (CNS) necrosis, G2 optic nerve disorder, ≥ G2 dysphagia, ≥ G2 laryngeal edema, ≥ G2 hearing impaired, ≥ G2 middle ear inflammation, and ≥ G1 hypothyroidism were 10%, 5%, 2%, 11%, 5%, 26%, 34%, and 34%, respectively. Significant associations between DVH parameters and incidences of toxicities were observed in the brainstem for myelitis (D1cc ≥ 55.8 Gy), in the brain for CNS necrosis (D1cc ≥ 72.1 Gy), in the eyeball for optic nerve disorder (Dmax ≥ 36.6 Gy), and in the ipsilateral inner ear for hearing impaired (Dmean ≥ 44 Gy). The optic nerve, pharyngeal constrictor muscle (PCM), and thyroid showed tendencies between DVH parameters and toxicity incidence. The prevalence proportion of G2 xerostomia at 2 years was 17 versus 6% (contralateral parotid gland Dmean ≥ 25.8 Gy vs less). Conclusions The dose constraint criteria were appropriate for most OAR in this study, although more strict dose constraints might be necessary for the inner ear, PCM, and brainstem.

Background: It is generally assumed that erectile dysfunction (ED) under the age of 40 is primarily driven by psychosocial factors. Aims This cross-sectional study evaluated ED, depression, anxiety, and quality of life among young Japanese men. Materials and Methods: We used an online survey to gather data from a wide range of community samples. ED was assessed by the IIEF-5 questionnaire, while depression, anxiety, and quality of life were assessed by the PHQ-9, GAD-7, and LISAT-8 questionnaires, respectively. Categorical data were evaluated by chi-square test and numerical data were estimated by one-way ANOVA. Post-hoc tests were conducted using the Holm method, which was used to control for type I errors. Cohen’s d index was calculated as effect sizes. Results: Valid responses from 329 individuals (age 33.93 ± 6.41 years) were obtained. According to IIEF-5 scores, the distribution of various severities of ED was as follows: non-ED, 37.39%; mild ED, 18.24%; mild to moderate ED, 27.36%; and moderate and severe ED, 17.02%. There were no significant differences in depression and anxiety between non-ED and ED men. In contrast, there were significant differences in quality of life between non-ED and ED men ( P < .01). Conclusions: We conclude that psychosocial factors may also be the cause of ED in young Japanese men besides depression and anxiety, and ED may reduce quality of life in various aspects. It is necessary to develop a Japanese version scale to measure ED-related psychosocial factors.

Abstract Infectious complications remain a major clinical problem in colorectal surgery. Presepsin has been reported to be a useful marker to diagnose sepsis, similar or superior to procalcitonin (PCT) and C-reactive protein (CRP). The aim of this study was to assess the diagnostic value of presepsin in the early detection of infectious complications after elective colorectal surgery, compared with CRP and PCT. This study was a prospective observational study. Patients of age > 18 who underwent elective colon resections were enrolled. Blood samples were collected just before surgery and on postoperative day (POD) 1, 2, 3, 4, and 6 to measure plasma levels of biomarkers. We evaluated the association between circulating biomarkers and infections. A total of 114 patients were examined, and 27 patients (23.7%) developed infectious complications. CRP and PCT markedly increased from POD 1 to POD 3 and then gradually decreased toward POD 6 in both groups, but the trends of the decrease in the infected group were blunt, compared with those in the non-infected group. On the other hand, presepsin did not show major changes just after surgery, but it increased on POD 4 and POD 6, when the complications occurred. Monitoring the presepsin trends after colorectal surgeries could be helpful to detect postoperative infectious complications. Trial registration: UMIN000025313. Registered on 17 December 2016.

Abstract Background The Acceptance and Commitment Therapy (ACT) model of human functioning uses the behavioral processes of acceptance, mindfulness, and values, which together compose psychological flexibility, the ability to contact the present moment more fully as a conscious human being and to either change or persist when doing so serves valued ends. To increase the effectiveness of interventions in the medical treatment of diabetes, it is important to examine the effects on patients with type 2 diabetes of promoting the active component patterns of ACT. This study explores these points. Methods Questionnaires were administered to type 2 diabetes patients who were registered in the database of a research service provider, and data was collected and analyzed from a total of 211 patients (mean age ± SD was 58.84 years old ±10.25, 14.69% were females). Results Cluster analysis yielded four clusters: “Average” (average levels of acceptance, mindfulness, and values), “Flexibility” (high levels of acceptance, mindfulness, and values), “Values/low” (average levels of acceptance and mindfulness, and a low level of values), “Values/high” (average levels of acceptance and mindfulness and a high level of values). Patients in the “Flexibility” and “Values/high” clusters had significantly fewer depressive symptoms than the other clusters. However, members of the “Values/high” cluster demonstrated significantly higher glycated hemoglobin levels than those in the other clusters. Conclusions The results above indicate that each part of the ACT model is necessary for managing diabetes treatment while improving quality of life. The importance of values is emphasized in ACT for diabetes patients, but we argue, given our results, that acceptance and mindfulness are very important for Japanese patients with type 2 diabetes. This study is limited to Japanese patients with type 2 diabetes. In further research, the subject population must be expanded to people from other areas and of different racial backgrounds.

ABSTRACT: Background: Erectile dysfunction (ED) is a multifactorial disorder with both psychogenic and organic components, but psychosocial factors are usually neglected. Objective: The purpose of this study was to develop a smartphone application targeting psychosocial factors of ED and to examine its feasibility, acceptability, and treatment response to determine the parameters for a larger clinical trial. Methods: In this single-arm feasibility study, 8 participants with situational ED were enrolled. Dr. App, a newly developed smartphone treatment application for patients with psychogenic ED consisting of 8 weekly modules based on Acceptance and Commitment Therapy, was delivered. The primary outcome was comparison of the International Index of Erectile Function-15 domain scores measured pre- and post-intervention. Results: Six out of 8 participants completed the Dr. App and the post-intervention measures. The Wilcoxon signed-rank test showed a significant change in erectile function (P < 0.05; r = –0.65) and a significant trend in intercourse satisfaction (P < 0.10; r = –0.47) and overall satisfaction (P < .10; r = –0.47). Additionally, the reliable change index values were used to calculate the number of participants for whom a clinically meaningful difference occurred. The results showed that 33.30% of the participants had clinically meaningful differences in erectile function and 66.70% in intercourse satisfaction and overall satisfaction. On the other hand, no significant differences were shown in orgasmic function and sexual desire. Conclusions: Findings from this study support the feasibility, acceptability, and potential usefulness of the smartphone application targeting psychosocial factors of ED and warrant a larger randomized clinical trial to confirm the results.

Abstract Background Acute normovolemic hemodilution (ANH) is used to reduce the risk of peri-operative allogeneic blood transfusion. Although crystalloid and/or colloid solutions have been used for volume replacement during ANH, no studies have examined the differences among solutions on the volume status, electrolytes, acid-base balance, and hemodynamic status during surgery with ANH. Methods We retrospectively compared the effect of Ringer’s lactate with 3% dextran-40 (Saviosol®, DEX group) and 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®, HES group) on blood hemoglobin serum electrolytes and estimated blood volume before induction of anesthesia (baseline), after ANH and after blood transfusion following surgery in patients undergoing open gynecological surgery (n = 111 and 67, respectively). The primary outcomes were the changes in hemoglobin and electrolytes after ANH. Results There were no differences in hemoglobin or electrolytes between the two groups at baseline. Postoperative hemoglobin was significantly higher (11.0 ± 1.5 g/dL vs 9.9 ± 1.3 g/dL) (mean ± SD) in the DEX group than in the HES group (p = 0.03). Postoperative potassium was significantly decreased from the baseline both in the DEX group (137.9 ± 2.5 mmol/L vs 136.3 ± 2.7 mmol/L) and in the HES group (138.3 ± 2.0 mmol/L vs 137.8 ± 2.5 mmol/L) (p < 0.001 for both); however, it was significantly higher than in the DEX group after surgery (p < 0.001). Estimated blood volume after surgery was significantly increased after ANH in both groups; however, it was larger in the HES group than in the DEX group. Conclusions Postoperative hemoglobin and potassium were significantly higher, and estimated blood volume was significantly smaller in the DEX than in the HES group.

BackgroundA brief measure of dispositional mindfulness is important for applied research on mindfulness. Although short forms of the Five Facet Mindfulness Questionnaire (FFMQ), which measures the five aspects of mindfulness (i.e., observing, describing, acting with awareness, non-judging, and non-reactivity), have been developed worldwide, the validity and reliability of the Japanese version has not been examined. This study aims to examine the validity and reliability of the 24-item and 15-item versions of the FFMQ in Japan, which are the most widely used versions worldwide.MethodsOnline surveys were conducted for 889 adults in Japan through an online survey company using self-reported questionnaires including the FFMQ to confirm the factor structure and validity. To examine construct validity, we examined the relationship between the short form of FFMQ and mind wandering, interoceptive awareness, experiential avoidance, cognitive fusion, openness, neuroticism, self-compassion, depression, and anxiety, which have been theoretically or empirically shown to be related to mindfulness. In addition, 137 adults responded to the FFMQ again, after four weeks, for the test-retest reliability.ResultsThe correlated five-factor and four-factor (excluding observing) models and the higher-order factor hierarchical model did not show sufficient goodness of fit, while the 24-item version showed acceptable fit when uncorrelated method factors loaded on by the positive and negative (reverse-scored) items were added. However, the 15-item version did not show acceptable fits for any of the models. Regarding reliability, the 24-item version showed acceptable values. In terms of the relationship between the original and the shortened version of the FFMQ, the 24-item version shared approximately 80% of the variance with the original one. In addition, although the wording effects of positive and negative items seemed to affect the correlations between the FFMQ and the other scales, the associations with related concepts were as predicted generally, supporting the construct validity of the short form of the FFMQ.ConclusionIn Japan, the 24-item version of FFMQ showed acceptable validity and reliability similar to the original version, and we recommend that the 24-item version be used.

Obstructive arterial diseases, including supravalvular aortic stenosis (SVAS), atherosclerosis, and restenosis, share 2 important features: an abnormal or disrupted elastic lamellae structure and excessive smooth muscle cells (SMCs). However, the relationship between these pathological features is poorly delineated. SVAS is caused by heterozygous loss-of-function, hypomorphic, or deletion mutations in the elastin gene (ELN), and SVAS patients and elastin-mutant mice display increased arterial wall cellularity and luminal obstructions. Pharmacological treatments for SVAS are lacking, as the underlying pathobiology is inadequately defined. Herein, using human aortic vascular cells, mouse models, and aortic samples and SMCs derived from induced pluripotent stem cells of ELN-deficient patients, we demonstrated that elastin insufficiency induced epigenetic changes, upregulating the NOTCH pathway in SMCs. Specifically, reduced elastin increased levels of γ-secretase, activated NOTCH3 intracellular domain, and downstream genes. Notch3 deletion or pharmacological inhibition of γ-secretase attenuated aortic hypermuscularization and stenosis in Eln–/– mutants. Eln–/– mice expressed higher levels of NOTCH ligand JAGGED1 (JAG1) in aortic SMCs and endothelial cells (ECs). Finally, Jag1 deletion in SMCs, but not ECs, mitigated the hypermuscular and stenotic phenotype in the aorta of Eln–/– mice. Our findings reveal that NOTCH3 pathway upregulation induced pathological aortic SMC accumulation during elastin insufficiency and provide potential therapeutic targets for SVAS.

Abstract Background Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy. We describe perioperative management for innominate artery transection in a case with TIF. Case presentation A 4-year-old Japanese female with Marshal-Smith syndrome presented for management of TIF. She underwent tracheostomy at the age of 3 months and an uncuffed tracheostomy tube was inserted. One month before admission to our hospital, intermittent tracheal bleeding, suggesting TIF, occurred. Although we considered to change to a cuffed endotracheal tube, craniofacial abnormality suggested difficult oral intubation, and there was a possibility of rebleeding. Finally, innominate artery transection was performed under total intravenous anesthesia without changing the tracheostomy tube. Surgery completed uneventfully and she received mechanical ventilation under sedation for a day, followed by weaning without complications. Conclusions A cuffed tracheostomy tube should have been inserted before surgery for effective hemostasis against sudden bleeding from TIF even though conversion to oral intubation was difficult.

Abstract Background Splenic cord capillary hemangioma is a rare benign vascular lesion classified as a splenic hamartoma. On the other hand, non-islet cell tumor hypoglycemia (NICTH) is one of the rare causes of spontaneous hypoglycemia and is considered to be one of the paraneoplastic syndromes. To the best of our knowledge, this is the first reported case of a splenic cord capillary hemangioma with NICTH. Case presentation A 25-year-old male was referred to our hospital with hypoglycemia. Except for his low blood sugar, there were no abnormal findings from laboratory tests, which included an endocrinological examination. Enhanced computed tomography confirmed the presence of a solid mass measuring about 6 cm in the retroperitoneum, and a tumorectomy was performed. During this operation, it became clear that the tumor turned out to be a splenic parenchyma, and as a result, a total splenectomy was performed. Microscopically, we diagnosed this as a cord capillary hemangioma, and through immunohistochemistry, we found that some tumor cells were positive for insulin-like growth factor -II. Fortunately, the hypoglycemia-related symptoms disappeared after surgical resection was performed. The patient is still alive and well without evidence of local tumor recurrence 15 years after the operation. Conclusions Splenic cord capillary hemangioma, one of the types of splenic hamartomas, is a very rare benign vascular lesion and might be associated with hypoglycemia thought to be NICTH.

There is urgent demand for biologically compatible vascular grafts for both adult and pediatric patients. The utility of conventional nonbiodegradable materials is limited because of their thrombogenicity and inability to grow, while autologous vascular grafts involve considerable disadvantages, including the invasive procedures required to obtain these healthy vessels from patients and insufficient availability in patients with systemic atherosclerosis. All of these issues could be overcome by tissue-engineered vascular grafts (TEVGs). A large body of evidence has recently emerged in support of TEVG technologies, introducing diverse cell sources (e.g., somatic cells and stem cells) and novel fabrication methods (e.g., scaffold-guided and self-assembled approaches). Before TEVG can be applied in a clinical setting, however, several aspects of the technology must be improved, such as the feasibility of obtaining cells, their biocompatibility and mechanical properties, and the time needed for fabrication, while the safety of supplemented materials, the patency and nonthrombogenicity of TEVGs, their growth potential, and the long-term influence of implanted TEVGs in the body must be assessed. Although recent advances in TEVG fabrication have yielded promising results, more research is needed to achieve the most feasible methods for generating optimal TEVGs. This article reviews multiple aspects of TEVG fabrication, including mechanical requirements, extracellular matrix components, cell sources, and tissue engineering approaches. The potential of periodic hydrostatic pressurization in the production of scaffold-free TEVGs with optimal elasticity and stiffness is also discussed. In the future, the integration of multiple technologies is expected to enable improved TEVG performance.

Postoperative delirium (POD) is a well-recognized postoperative complication and is associated with increased morbidity and mortality. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) could be an effective predictor of POD after head and neck free-flap reconstruction. This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective head and neck free-flap reconstruction surgery. POD was assessed with the Intensive Care Delirium Screening Checklist (ICDSC) during admission to our intensive care unit (ICU). POD was defined as an ICDSC score ≥4. Risk factors for POD were evaluated by univariate and multivariate logistic regression analysis. We included 97 patients. The incidence of POD was 20.6% (20/97). Significantly longer ICU stays were observed in the patients with POD compared to those without POD (median [interquartile range]: 5 [4-6] vs. 4 [4-5], p = 0.031). Higher preoperative NLR values (3 3.0 (adjusted Odds Ratio: 23.6, 95% Confidence Interval: 6.6-85.1; p

Abstract Background The purpose of this study was to determing which psychological traits of Japanese type 2 diabetes patients would provide reliability and validity to the Japanese version of the Acceptance and Action Diabetes Questionnaire (AADQ-J). Methods Various questionnaires were administered to type 2 diabetes patients who were registered on the database of the research service provider; data from a total of 600 patients (mean ± SD age was 57.50 ± 9.87 years, female 21.83%) were analyzed. Results Three items were excluded because of psychometric concerns related to the original 11-item AADQ. Confirmation factor analyses revealed that the eight-item version demonstrated the best indicators of a goodness of fit. The questionnaire showed adequate internal consistency. The questionnaire demonstrated high measurement accuracy in broad trait values by the test information function of Item Response Theory. The questionnaire showed stronger positive correlations with self-care activities and HbA1c than with diabetes distress and depressive mood. Conclusions The eight-item Japanese version of AADQ has reliability and validity for type 2 diabetes patients.

Abstract Background We report the case of a child with Krabbe disease who underwent three repeated surgeries and anesthetic management, and we discuss the major concerns about Krabbe disease and the usefulness of a perioperative administration of dexmedetomidine to prevent emergence agitation and hypertension. The patient was scheduled to undergo bilateral orchiopexy, adenotonsillectomy, and knee flexor tendon lengthening under general anesthesia during a 2-year period. Case presentation Adenotonsillectomy was scheduled as the second operation when the patient was 4 years old. His height and body weight were 93 cm and 10.3 kg, respectively. Anesthesia was induced with 8% sevoflurane mixed with 6 L/min of O2 and maintained with N2O (3.5 L/min), O2 (1.5 L/min), and sevoflurane (1.5–2.0%). Upon completion of the right tonsillectomy, 1 h before the end of the surgery, a continuous infusion of dexmedetomidine (0.2 μg/kg/h) was started to prevent emergence agitation, irritability, resultant hypertension, and postoperative bleeding. Fentanyl (25 μg) was administered intravenously to reduce postoperative pain. The surgery was uneventful, and the patient’s emergence from general anesthesia was prompt. He exhibited no symptoms of emergence agitation or irritability. During his stay in the intensive care unit, 0.2–0.7 μg/kg/h of dexmedetomidine and 6.25 μg/h of fentanyl were continuously administered. The patient was discharged to the ward the following morning without complications. Conclusions The perioperative administration of dexmedetomidine was useful to prevent emergence agitation, hypertension, and resultant postoperative bleeding in a pediatric patient with Krabbe disease. Three repeated anesthetic management using inhalation anesthesia were completed uneventfully without muscle relaxants.

Abstract Background We have reviewed four cases of Kawasaki disease treated with plasma exchange with 5% albumin in electrolyte-balanced solution, according to the recommended guidelines for Kawasaki disease in the intensive care unit, as their responses to intravenous immunoglobulin therapy were poor. Case presentation The four cases were aged between 5 months and 3 years and weighted between 6.4 and 15.6 kg. The plasma levels of C-reactive protein were significantly decreased after plasma exchange (p

Abstract Chronic inflammatory demyelinating polyneuropathy (CIPD) is a rare acquired immune-mediated progressive and relapsing disorder that causes peripheral neuropathy lasting more than 2 months. We report the successful anesthetic management of a 66-year-old man with CIPD undergoing the laparoscopic Hartmann procedure. We induced and maintained total intravenous anesthesia (TIVA) using propofol, remifentanil, and ketamine without muscle relaxants. We performed ultrasound-guided transversus abdominis plane and rectus sheath blocks with 60 ml of 0.25% levobupivacaine for achieving good surgical conditions. For postoperative analgesia, we intravenously administered fentanyl (200 μg) and acetaminophen (1000 mg). The patient was uneventfully extubated in the operating room after confirming adequate spontaneous breathing. The postoperative course was uneventful without any respiratory complications such as respiratory depression, aspiration pneumonia, or progression of CIPD symptoms.

Abstract Shortage of autologous blood vessel sources and disadvantages of synthetic grafts have increased interest in the development of tissue-engineered vascular grafts. However, tunica media, which comprises layered elastic laminae, largely determines arterial elasticity, and is difficult to synthesize. Here, we describe a method for fabrication of arterial grafts with elastic layer structure from cultured human vascular SMCs by periodic exposure to extremely high hydrostatic pressure (HP) during repeated cell seeding. Repeated slow cycles (0.002 Hz) between 110 and 180 kPa increased stress-fiber polymerization and fibronectin fibrillogenesis on SMCs, which is required for elastic fiber formation. To fabricate arterial grafts, seeding of rat vascular SMCs and exposure to the periodic HP were repeated alternatively ten times. The obtained medial grafts were highly elastic and tensile rupture strength was 1451 ± 159 mmHg, in which elastic fibers were abundantly formed. The patch medial grafts were sutured at the rat aorta and found to be completely patent and endothelialized after 2.5 months, although tubular medial constructs implanted in rats as interpositional aortic grafts withstood arterial blood pressure only in early acute phase. This novel organized self-assembly method would enable mass production of scaffold-free arterial grafts in vitro and have potential therapeutic applications for cardiovascular diseases.

Neuropeptide S (NPS) is an endogenous peptide that regulates various physiological functions, such as immune functions, anxiety-like behaviors, learning and memory, the sleep–wake rhythm, ingestion, energy balance, and drug addiction. These processes include the NPS receptor (NPSR1). The NPS–NPSR1 system is also significantly associated with the onset of disease, as well as these physiologic functions. For example, NPS is involved in bronchial asthma, anxiety and awakening disorders, and rheumatoid arthritis. In this review, among the various functions, we focus on the role of NPS in anesthesia-induced loss of consciousness; analgesia, mainly by anesthesia; and sleep–wakefulness. Progress in the field regarding the functions of endogenous peptides in the brain, including NPS, suggests that these three domains share common mechanisms. Further NPS research will help to elucidate in detail how these three domains interact with each other in their functions, and may contribute to improving the quality of medical care.

The ductus arteriosus (DA) immediately starts closing after birth. This dynamic process involves DA-specific properties, including highly differentiated smooth muscle, sparse elastic fibers, and intimal thickening (IT). Although several studies have demonstrated DA-specific gene expressions using animal tissues and human fetuses, the transcriptional profiles of the closing DA and the patent DA remain largely unknown. We performed transcriptome analysis using four human DA samples. The three closing DA samples exhibited typical DA morphology, but the patent DA exhibited aorta-like elastic lamellae and poorly formed IT. A cluster analysis revealed that samples were clearly divided into two major clusters, the closing DA and patent DA clusters, and showed distinct gene expression profiles in IT and the tunica media of the closing DA samples. Cardiac neural crest-related genes such as JAG1 were highly expressed in the tunica media and IT of the closing DA samples compared to the patent DA sample. Abundant protein expressions of jagged 1 and the differentiated smooth muscle marker calponin were observed in the closing DA samples but not in the patent DA sample. Second heart field-related genes such as ISL1 were enriched in the patent DA sample. These data indicate that the patent DA may have different cell lineages compared to the closing DA.

Inhalational anesthetics was previously reported to suppress glioma cell malignancy but underlying mechanisms remain unclear. The present study aims to investigate the effects of sevoflurane and desflurane on glioma cell malignancy changes via microRNA (miRNA) modulation. The cultured H4 cells were exposed to 3.6% sevoflurane or 10.3% desflurane for 2 h. The miR-138, -210 and -335 expression were determined with qRT-PCR. Cell proliferation and migration were assessed with wound healing assay, Ki67 staining and cell count kit 8 (CCK8) assay with/without miR-138/-210/-335 inhibitor transfections. The miRNA downstream proteins, hypoxia inducible factor-1α (HIF-1α) and matrix metalloproteinase 9 (MMP9), were also determined with immunofluorescent staining. Sevoflurane and desflurane exposure to glioma cells inhibited their proliferation and migration. Sevoflurane exposure increased miR-210 expression whereas desflurane exposure upregulated both miR-138 and miR-335 expressions. The administration of inhibitor of miR-138, -210 or -335 inhibited the suppressing effects of sevoflurane or desflurane on cell proliferation and migration, in line with the HIF-1α and MMP9 expression changes. These data indicated that inhalational anesthetics, sevoflurane and desflurane, inhibited glioma cell malignancy via miRNAs upregulation and their downstream effectors, HIF-1α and MMP9, downregulation. The implication of the current study warrants further study.

Inhalational anaesthetics were previously reported to promote ovarian cancer malignancy, but underlying mechanisms remain unclear. The present study aims to investigate the role of sevoflurane- or desflurane-induced microRNA (miRNA) changes on ovarian cancer cell behaviour. The cultured SKOV3 cells were exposed to 3.6% sevoflurane or 10.3% desflurane for 2 h. Expression of miR-138, -210 and -335 was determined with qRT-PCR. Cell proliferation and migration were assessed with wound healing assay, Ki67 staining and Cell Counting Kit-8 (CCK8) assay with or without mimic miR-138/-210 transfections. The miRNA downstream effector, hypoxia inducible factor-1α (HIF-1α), was also analysed with immunofluorescent staining. Sevoflurane or desflurane exposure to cancer cells enhanced their proliferation and migration. miR-138 expression was suppressed by both sevoflurane and desflurane, while miR-210 expression was suppressed only by sevoflurane. miR-335 expression was not changed by either sevoflurane or desflurane exposure. The administration of mimic miR-138 or -210 reduced the promoting effects of sevoflurane and desflurane on cancer cell proliferation and migration, in line with the HIF-1α expression changes. These data indicated that inhalational agents sevoflurane and desflurane enhanced ovarian cancer cell malignancy via miRNA deactivation and HIF-1α. The translational value of this work needs further study.

Abstract Background It has been reported that prolonged intensive care unit (ICU) stay after cardiac surgery is associated with poor patient outcome. In addition, prolonged stay can block the efficient use of ICU beds with an increase in expenditure of health-care costs. The aim of the present study was to retrospectively determine which pre- and intra-operative factors could significantly affect ICU-free survival days (IFSD) which has been suggested to reflect postoperative patients’ outcome, as well as variables significantly associated with the main predictors of IFSD. Findings We reviewed anesthesia charts and medical records of 145 patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) in our hospital from January 2014 to October 2015, and 72 patients’ records were finally used for the analysis. IFSD was a median of 25 days (95% CI 24–26). The multiple regression analysis indicated that preoperative estimated glomerular filtration rate, differences between preoperative mean arterial pressure and mean CPB pressure, and blood lactate level at 2 h after CPB (CPB-2 h) were independently associated with IFSD (β regression coefficients 0.086, −0.083, and −3.601, respectively). Conclusion In addition to preoperative renal function and differences between preoperative MAP and CPB pressure, the lactate level at CPB-2 h could be a major predictor of postoperative outcome in patients undergoing cardiac surgery.

Abstract Background Hyperventilation syndrome (HVS) sometimes occurs in patients under stressful conditions and may provoke severe complications such as myocardial infarction and death. The authors report a case of HVS following general anesthesia, where a continuous intravenous infusion of dexmedetomidine was effective for HVS. Case presentation A 23-year-old male patient with recurrent tongue cancer was scheduled to undergo partial glossectomy and neck dissection. Emergence from general anesthesia was prompt. Twenty-two minutes after extubation, the patient complained of unbearable distress caused by the urinary catheter. He began to cry, with an increased respiratory rate of over 40 breaths per minute. Intravenous infusion of flurbiprofen, droperidol, and morphine was not effective. Electrocardiography and laryngofiberscopy indicated the absence of acute coronary syndrome and airway obstruction, respectively. An arterial blood gas determination showed pH 7.63, PaCO2 18.2 mmHg, PaO2 143 mmHg on O2 mask 4 L/min, Ca2+ 4.29 mmol/L, and lactate 3.4 mmol/L. The patient was diagnosed with HVS. Dexmedetomidine infusion 2.0 μg/kg/h for 10 min followed by 0.7 μg/kg/h reduced respiratory rate, suppressed arousal, and disappeared the complaint of bladder distension. One hour after extubation, an arterial blood gas determination showed pH 7.33, PaCO2 51.3 mmHg, PaO2 196 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.5 mmol/L. After admission to the intensive care unit, dexmedetomidine infusion was maintained at the rate of 0.2 to 0.7 μg/kg/h until the following morning, and he did not complain of distress caused by the urinary catheter. Conclusions HVS can occur after emergence from general anesthesia, and dexmedetomidine infusion was effective for HVS.

Abstract Background A pulse oximeter is one of the most important monitors to save patients undergoing anesthesia and monitored sedation. The authors report a case of orthopedic surgery, in which interference of pulse oximetry occurred when using a Stealth Station™ navigation system (Medtronic Sofamor Danek, Memphis, TN). Applying a black plastic shield (Masimo Ambient Shield: Masimo Corporation, Irvine, CA) completely eliminated the interference. Case presentation A 37-year-old male patient with a giant cell tumor of the left femur was scheduled to undergo curettage of the femur using an intraoperative CT three-dimensional imaging system (O-arm™) and Stealth Station™ navigation system. During the surgery, the SpO2 value, which was maintained between 97 and 99% until the time, disappeared suddenly with abnormal pulse wave. Because a distortion in the SpO2 value was reproduced by repeated movement of cameras on the head of the Stealth Station™ navigation system, we recognized that the interference signal was coming from the navigation system. To eliminate the infrared light, the pulse oximetry probe was covered with a black plastic shield and the interference was completely eliminated. Conclusions The Stealth Station™ navigation system was found to interfere with the SpO2 value, and a black plastic shield was useful for eliminating the interfering signal. Anesthesiologists should understand the risk of interference by the neuro-navigation system and know how to solve the problem.

The ductus arteriosus (DA) closes after birth to adapt to the robust changes in hemodynamics, which require intimal thickening (IT) to occur. The smooth muscle cells of the DA have been reported to play important roles in IT formation. However, the roles of the endothelial cells (ECs) have not been fully investigated. We herein focused on tissue-type plasminogen activator (t-PA), which is a DA EC dominant gene, and investigated its contribution to IT formation in the DA.ECs from the DA and aorta were isolated from fetal rats using fluorescence-activated cell sorting. RT-PCR showed that the t-PA mRNA expression level was 2.7-fold higher in DA ECs than in aortic ECs from full-term rat fetuses (gestational day 21). A strong immunoreaction for t-PA was detected in pre-term and full-term rat DA ECs. t-PA-mediated plasminogen-plasmin conversion activates gelatinase matrix metalloproteinases (MMPs). Gelatin zymography revealed that plasminogen supplementation significantly promoted activation of the elastolytic enzyme MMP-2 in rat DA ECs. In situ zymography demonstrated that marked gelatinase activity was observed at the site of disruption in the internal elastic laminae (IEL) in full-term rat DA. In a three-dimensional vascular model, EC-mediated plasminogen-plasmin conversion augmented the IEL disruption. In vivo administration of plasminogen to pre-term rat fetuses (gestational day 19), in which IT is poorly formed, promoted IEL disruption accompanied by gelatinase activation and enhanced IT formation in the DA. Additionally, experiments using five human DA tissues demonstrated that the t-PA expression level was 3.7-fold higher in the IT area than in the tunica media. t-PA protein expression and gelatinase activity were also detected in the IT area of the human DAs.t-PA expressed in ECs may help to form IT of the DA via activation of MMP-2 and disruption of IEL.