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Hitoshi Takahashi,1 Hisashi Higuchi,2 Kazuhiro Sato,3 Mitsuhiro Kamata,3 Keizo Yoshida,4 Katsuji Nishimura1 1Department of Neuropsychiatry, Tokyo Women’s Medical University School of Medicine, Shinjuku-ku, 2Suzuki Jikoh Hospital, Ome-shi, Tokyo, 3Akita Kaiseikai Hospital, Akita-shi, 4Health Care Promotion Division, DENSO Corporation, Kariya-shi, Aichi, Japan Objective: We investigated the association between serotonin- or 5-hydroxytryptamine (5-HT)-related gene polymorphisms and response to antidepressant treatment in a specific symptom cluster of major depression by using the three-factor model of the Montgomery–Åsberg Depression Rating Scale (MADRS), ie, dysphoria (items of sadness, pessimistic thoughts, and suicidal thoughts), retardation (items of lassitude, inability to feel, apparent sadness, and concentration difficulties), and vegetative symptoms (items of reduced sleep, reduced appetite, and inner tension). Methods: This study was an open-label and nonrandomized trial. A total of 160 patients with baseline MADRS scores of ≥21, who were treated with fluvoxamine or milnacipran for 6 weeks, were included in the statistical analysis. Polymorphisms within a 5-HT transporter (5-HTT) gene-linked polymorphic region (5-HTTLPR), a variable number of tandem repeats in the second intron of the 5-HTT gene (5-HTTVNTR), and 5HT2A receptor (1438G/A) were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The 5-HTTLPR polymorphisms affected the MADRS score change in dysphoria, but not in retardation, vegetative, or total symptoms. Dysphoria scores significantly decreased in patients with the S/S genotype compared to those in patients with the short (S)/long (L) + L/L genotype. However, 5-HTTVNTR and 1438G/A polymorphisms were not significantly associated with the treatment response to any cluster of depressive symptoms. When a Bonferroni correction was made, however, our results did not reach the criteria for statistical significance. Conclusion: The use of a single total depression rating scale may not be sufficient to accurately estimate the clinical response to antidepressants. Analyzing a subset of symptoms in psychological scales could be important when performing pharmacogenetic studies. Keywords: serotonin transporter polymorphism, dysphoria score, antidepressants, MADRS

Mineto Kamata,1 Roby Sebastian,1,2 Patrick I McConnell,3 Daniel Gomez,4 Aymen Naguib,1,2 Joseph D Tobias1,2,5 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, 3Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, 4Cardiovascular Perfusion Services and Heart Center, Nationwide Children’s Hospital and The Ohio State University, 5Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Abstract: Heparin-induced thrombocytopenia (HIT) can cause life-threatening complications following the administration of heparin. Discontinuation of all sources of heparin exposure and the use of alternative agents for anticoagulation are necessary when HIT is suspected or diagnosed. We present the successful use of bivalirudin anticoagulation in an adolescent patient during cardiopulmonary bypass who underwent both placement of a left ventricular assist device and subsequent heart transplantation within a 36-hour period. The pathophysiology and diagnosis of HIT are reviewed, previous reports of the use of direct thrombin inhibitors for cardiac surgery are presented, and potential dosing regimens for bivalirudin are discussed. Keywords: bivalirudin, anticoagulation, cardiopulmonary bypass, heart transplant

Mineto Kamata,1 Marco Corridore,1,2 Joseph D Tobias1–3 1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; 2Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; 3Department of Pediatrics, The Ohio State University, Columbus, OH, USA Abstract: In critically ill neonates and infants, major interventions, including thoracotomy, may result in significant postoperative respiratory insufficiency and pain leading to the need for postoperative mechanical ventilation. Although there are many potential options for providing postoperative analgesia, there continues to be expanding use of regional anesthesia in this population. One of the many reported advantages is the provision of postoperative analgesia while avoiding the deleterious effects on respiratory function that may be seen with systemic opioids. We report the use of thoracic epidural anesthesia using a continuous infusion of chloroprocaine to provide analgesia following thoracotomy and epicardial pacemaker placement in an infant. The perioperative plan was complicated by comorbid conditions including congenital complete heart block, recent rhinovirus infection with residual respiratory involvement, and prematurity. Keywords: chloroprocaine, epidural anesthesia, thoracotomy, pacemaker

Radioactive decay is not only important in the field of radiochemistry but also useful as a teaching material for chemical kinetics. Although differential equations are often used to explain how decay rate changes over time, there are many students even in college or university who are not very good at mathematics and have difficulty in solving differential equations. Those students are expected to appreciate institutive and schematic illustrations using Excel sheets. In this paper, a water and tank model to demonstrate how radionuclides decay and decrease over time is presented as an example of the model that the students can develop or rearrange by themselves. Therefore, only four arithmetical operations were used in the sheet, so that the students can easily grasp the basic concept of a decay curve or radioactive equilibrium even if they do not have great knowledge of differential equations. In addition, only “Record Macro” and built in “Charts” were used on the sheet, and therefore, no knowledge or skill in graphic programming, such as Visual Basic, is needed to make and use the sheet. A brief online survey indicated the model was interesting to high school students. Since Excel is widely used all over the world, the sheets we have developed can be used in many countries without additional expense.