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Hayato Ise,1,2 Ryohei Ushioda,1 Hirotsugu Kanda,3 Fumiaki Kimura,4 Yasuaki Saijo,5 Payam Akhyari,2 Artur Lichtenberg,2 Hiroyuki Kamiya1 1Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan; 2Department of Cardiovascular Surgery, Heinrich Heine University, Düsseldorf, Germany; 3Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan; 4Department of Cardiovascular Surgery, Kushiro Kojinkai Memorial Hospital, Kushiro, Japan; 5Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, JapanCorrespondence: Hirotsugu Kanda, Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan, Tel +81-166-68-2583, Fax +81-166-68-2589, Email hirotsugukanda0629@gmail.comPurpose: We aimed to identify the risk factors of critical bleeding and investigate the safety of recombinant activated factor VII (rFVIIa) in aortic surgery under hypothermic circulatory arrest (HCA).Patients and Methods: The present single-center retrospective study compared the baseline characteristics of 144 patients who underwent aortic surgery under HCA at our institute. Among the total cohort of 144 patients, 42 received rFVIIa (rFVIIa group), while the remaining 102 patients did not (non-rFVIIa group). Perioperative bleeding and transfusions, postoperative 30-day mortality, and adverse events (AEs) were analyzed in 29 propensity score-matched pairs.Results: Before surgery, the rFVIIa group demonstrated a greater number of shocks (p=0.019), higher JapanSCORE II mortality rate (p=0.033), low platelet count (p=0.015) and fibrinogen (p< 0.001) level, prolonged activated partial thromboplastin time (aPTT) (p=0.005) and prothrombin time international normalized ratio (PT-INR) (p=0.006), and longer aortic cross clamp time (p=0.049). Postoperative bleeding, transfusion, 30-day mortality, and AEs were comparable between the groups both in the entire-unmatched cohort and propensity score matching cohort.Conclusion: Preoperative shock, higher JapanSCORE II mortality rates, low platelet and fibrinogen levels, prolonged aPTT and PT-INR, and longer aortic clamping time might be risk factors for excessive bleeding and indicate the need for rFVIIa treatment. The present study suggests that rFVIIa can be safely used to address critical and continuous bleeding in spite of adequate transfusion and supplementation of other coagulation factors in aortic surgery under HCA, without an increase in 30-day mortality and AEs.Keywords: aortic surgery under hypothermic circulatory arrest, cardiac surgery, recombinant activated factor VII, retrospective study, uncontrollable bleeding

Ririko Nagabuchi,1 Hikari Minami,1 Makoto Sakikawa,2 Yoshiko Onodera,1 Megumi Kanao-Kanda,1 Hirotsugu Kanda1 1Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan; 2Department of Dentistry and Oral Surgery, Rinseikai Yoshida Hospital, Nayoro, JapanCorrespondence: Hirotsugu KandaDepartment of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan, Tel +81-166-68-2583, Fax +81-166-68-2589, Email h.kanda0629@nifty.comPurpose: Intubation and ventilation cannot be performed in cases of parapharyngeal space tumors as the enlargement of the upper airway leads to the obstruction and hindrance of the intubation procedure. However, there is limited literature on anesthetic management, including the airway, in this disease. Herein, we report a successful case of awake intubation in a patient with parapharyngeal space tumor.Case Presentation: A 64-year-old man with a history of giant parapharyngeal space tumor was scheduled for bilateral endoscopic sinus surgery and nasal septoplasty. We performed awake intubation using the McGrath® video laryngoscope, which resulted in excellent laryngeal deployment and a smooth procedure.Conclusion: We report the anesthetic management of a giant parapharyngeal space tumor with the potential for difficult airway management to maintain spontaneous breathing. Awake intubation was useful in maintaining ventilation and intubation in this case. The preparation of a cricothyroid puncture is needed in cases of intubation failure.Keywords: parapharyngeal space tumor, awake intubation, video laryngoscope

A new hyperon-proton scattering experiment, dubbed J-PARC E40, was performed to measure differential cross sections of the Σ+p, Σ−p elastic scatterings and the Σ−p → Λn scattering by identifying a lot of Σ particles in the momentum ranging from 0.4 to 0.8 GeV/c produced by the π±p → K+Σ± reactions. We successfully measured the differential cross sections of these three channels with a drastically improved accuracy with a fine angular step. These new data will become important experimental constraints to improve the theories of the two-body baryon-baryon interactions. Following this success, we proposed a new experiment to measure the differential cross sections and spin observables by using a highly polarized Λ beam for providing quantitative information on the ΛN interaction. The results of three Σp channels and future prospects of the Λp scattering experiment are described.

Masakazu Hirota,1 Hiroyuki Kanda,1 Takao Endo,2 Takeshi Morimoto,1 Tomomitsu Miyoshi,3 Takashi Fujikado1 1Department of Applied Visual Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; 2Department of Ophthalmology, Osaka University Graduate School of Medicine, Izumi, Osaka, Japan; 3Department of Integrative Physiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan Purpose: This study aimed to evaluate binocular coordination using video-oculography during smartphone reading in patients with intermittent exotropia compared to individuals with normal vision. Patients and methods: Eleven youth and adult patients with intermittent exotropia (21.9±9.3 years) and 15 control subjects (26.6±4.3 years) were examined. Eye movements were recorded during smartphone reading at 50, 30, and 20 cm using video-oculography. The loss of binocular coordination was tentatively defined as a horizontal disparity greater than 2°. The proportion of monocular viewing was the percentage of time for which binocularity was lost during smartphone reading. The proportion of monocular viewing, the reading speed, and the correlation between proportion of monocular viewing and reading speed were analyzed. Results: The proportion of monocular viewing during smartphone reading was significantly higher in the intermittent exotropia group than in the control group (P

Suguru Miyagawa,1,2 Hisashi Fukuyama,3 Masakazu Hirota,1 Tatsuo Yamaguchi,4 Kazuo Kitamura,4 Takao Endo,3 Hiroyuki Kanda,1 Takeshi Morimoto,1 Takashi Fujikado1 1Department of Applied Visual Science, Osaka University Graduate School of Medicine, Suita, Osaka, 2Technology Development Department Research and Development Section, Topcon Corporation, Itabashi, Tokyo, 3Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, 4Eye Care Technology Development Department, Product Technology Section, Topcon Corporation, Itabashi, Tokyo, Japan Purpose: The purpose of this study was to develop an algorithm based on region-based segmentation for automated calculations of human cone photoreceptor density of en face images obtained by an adaptive optics scanning laser ophthalmoscope (AOSLO). Subjects and methods: Cone mosaics of 15 eyes of 15 healthy subjects were photographed by a custom-built AOSLO. The cone density was calculated at 0.5, 1.0, and 1.5 mm temporal from the fovea using a region-based segmentation method (RSM) developed in our laboratory. The cone density was also determined by a manual identification method (MIM) and a conventional spatial filtering method (SFM). The cone densities of three eyes of three patients with retinal degeneration were calculated by the three methods and compared to the results from normal eyes. Results: The cone densities in healthy retinas determined by the RSM at 0.5, 1.0, and 1.5 mm temporal from the fovea were 28,436, 21,233, and 13,620 cells/mm2, respectively. These densities were in good agreement with a histological study and with in vivo AOSLO studies. The cone densities determined by RSM were different from those determined by MIM with a difference of 5% in healthy eyes. In eyes with retinal degeneration, with the appropriate threshold-level settings or spatial frequency bandwidth, the cone density measured by MIM was significantly closer to that measured by RSM than by SFM. Conclusion: These results suggest that our method is more stable than conventional methods in cases of non-periodical photoreceptor structures such as the affected retinal area. Our method can be used in the longitudinal follow-up of retinal degenerative diseases and to determine the effect of therapy. Keywords: AOSLO, adaptive optics, cone photoreceptor, photoreceptor density, retinal imaging, image processing

Yoshiko Onodera, Megumi Kanao-Kanda, Hirotsugu Kanda, Tomoki Sasakawa, Hiroshi Iwasaki, Takayuki Kunisawa Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Hokkaido, Japan Purpose: Pregnancy-induced analgesia develops during late pregnancy, but it is unclear whether this analgesia is effective against neuropathic pain. The detailed molecular mechanisms underlying pregnancy-induced analgesia have not been investigated. We examined the antinociceptive effect of pregnancy-induced analgesia in a neuropathic pain model and the expression of tumor necrosis factor (TNF)-α, glial fibrillary acidic protein (GFAP), Iba-1, and c-Fos in the spinal dorsal horn just before parturition. Materials and methods: Female Sprague Dawley rats (200–250 g) were randomly assigned to one of four groups (pregnant + chronic constriction injury [CCI]; pregnant + sham injury; not pregnant + CCI; and not pregnant + sham injury). Separate groups were used for the behavioral and tissue analyses. CCI of the left sciatic nerve was surgically induced 3 days after confirming pregnancy in the pregnancy group or on day 3 in the not pregnant group. The spinal cord was extracted 18 days after CCI. TNF-α, GFAP, Iba-1, and c-Fos expression levels in the spinal dorsal horn were measured by Western blot analysis. Mechanical threshold was tested using von Frey filaments. Results: The lowered mechanical threshold induced by CCI was significantly attenuated within 1 day before parturition and decreased after delivery. TNF-α expression in CCI rats was decreased within 1 day before parturition. Further, GFAP, Iba-1, and c-Fos expression in the spinal dorsal horn was reduced in the pregnant rats. Serum TNF-α in all groups was below measurable limits. Conclusion: Our findings indicate that pregnancy-induced analgesia suppresses neuropathic pain through reducing spinal levels of TNF-α, GFAP, Iba-1, and c-Fos in a rat model of CCI. Keywords: pregnancy-induced analgesia, TNF-α, neuropathic pain, glial cell

Izumi Sato, Hirotsugu Kanda, Megumi Kanao-Kanda, Atsushi Kurosawa, Takayuki Kunisawa Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan Abstract: We report a case of iatrogenic pneumothorax in which chest tube placement was avoided by continuous intraoperative evaluation with transthoracic ultrasonography. A 53-year-old man had undergone a subsegmentectomy. While attempting to place a central venous catheter in the right internal jugular vein after the induction of anesthesia, we identified gas absorption during the puncture and suspected a pneumothorax. Chest X-ray revealed an ~5-mm collapse of the right lung apex. Tension pneumothorax was a concern during surgery because of the long-term positive pressure ventilation, but we decided to start the operation without preventative chest tube placement. During the operation, we regularly observed the midclavicular line of the second intercostal space using ultrasound. The operation was completed uneventfully. In this case, we effectively utilized ultrasound and avoided preventive chest tube placement and the associated complications. Transthoracic ultrasonography could be performed easily and continuously during surgery and was effective for evaluating the progression of an intraoperative pneumothorax. Keywords: transthoracic ultrasonography, iatrogenic pneumothorax, central venous catheterization

Hirotsugu Kanda,1 Yuji Hirasaki,2 Takafumi Iida,1 Megumi Kanao-Kanda,1 Yuki Toyama,1 Takayuki Kunisawa,1 Hiroshi Iwasaki11Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan; 2Department of Anatomy, The Jikei University Graduate School of Medicine, Minato-ku, Tokyo, JapanPurpose: The aim of this study was to investigate fluid loading-induced changes in left ventricular end-diastolic volume (LVEDV) and stroke volume variability (SVV) in patients with end-stage renal disease (ESRD) using real-time three-dimensional transesophageal echocardiography and the Vigileo-FloTrac system.Patients and methods: After obtaining ethics committee approval and informed consent, 28 patients undergoing peripheral vascular procedures were studied. Fourteen patients with ESRD on hemodialysis (HD) were assigned to the HD group and 14 patients without ESRD were assigned to the control group. Institutional standardized general anesthesia was provided in both groups. SVV was measured using the Vigileo-FloTrac system. Simultaneously, a full-volume three-dimensional transesophageal echocardiography dataset was acquired to measure LVEDV, left ventricular end-systolic volume, and left ventricular ejection fraction. Measurements were obtained before and after loading 500 mL hydroxyethyl starch over 30 minutes in both groups.Results: In the control group, intravenous colloid infusion was associated with a significant decrease in SVV (13.8%±2.6% to 6.5%±2.6%, P

Hirotsugu Kanda,1 Yuji Hirasaki,2 Takafumi Iida,1 Megumi Kanao,1 Yuki Toyama,1 Takayuki Kunisawa,1 Hiroshi Iwasaki,11Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, 2Department of Anatomy, The Jikei University Graduate School of Medicine, Tokyo, JapanPurpose: The aim of this clinical trial was to investigate changes in stroke volume variability (SVV) and left ventricular end-diastolic volume (LVEDV) after a fluid bolus of crystalloid or colloid using real-time three-dimensional transesophageal echocardiography (3D-TEE) and the Vigileo-FloTrac™ system.Materials and methods: After obtaining Institutional Review Board approval, and informed consent from the research participants, 22 patients undergoing scheduled peripheral vascular bypass surgery were enrolled in the study. The patients were randomly assigned to receive 500 mL of hydroxyethyl starch (HES; HES group, n=11) or normal saline (Saline group, n=11) for fluid replacement therapy. SVV was measured using the Vigileo-FloTrac system. LVEDV, stroke volume, and cardiac output were measured by 3D-TEE. The measurements were performed over 30 minutes before and after the fluid bolus in both groups.Results: SVV significantly decreased after fluid bolus in both groups (HES group, 14.7%±2.6% to 6.9%±2.7%, P0.05). Stroke volume significantly increased after infusion in the HES group (50.6±12.5 mL to 61.6±19.1 mL, P0.05). Cardiac output measured by 3D-TEE significantly increased in the HES group (3.5±1.1 L/min to 3.9±1.3 L/min, P0.05).Conclusion: Administration of colloid and crystalloid induced similar responses in SVV. A higher plasma-expanding effect of HES compared to normal saline was demonstrated by the significant increase in LVEDV.Keywords: colloid–crystalloid controversy, fluid responsiveness, three-dimensional transesophageal echocardiography (3D-TEE)

Megumi Kanao-Kanda, Hirotsugu Kanda, Osamu Takahata, Takayuki Kunisawa Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan Abstract: Gabapentin, an anticonvulsant agent, is now often used for the treatment of neuropathic pain all over the world. It is unclear whether the combined use of gabapentin, sodium valproate, and flunitrazepam results in enhancement of the side effect, a gait disturbance. A 60-year-old man was taking oral sodium valproate for symptomatic epilepsy after a brain contusion and flunitrazepam to relieve insomnia. Oral gabapentin therapy was started for suspected neuropathic pain. Although the initial dose of oral gabapentin (200 mg) relieved the pain, the lower extremities became weak, resulting in a gait disturbance. The therapy was restarted with a halved dose, and this resolved the gait disturbance and relieved the pain. Keywords: gabapentin, gait disturbance, side effect, neuropathic pain

Megumi Kanao-Kanda, Takayuki Kunisawa, Kunihiko Yamamoto, Hirotsugu Kanda, Hiroshi Iwasaki Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, JapanInsufficient pulmonary blood flow through a right ventricle-to-pulmonary artery conduit following the Norwood procedure is remediable by adding a modified Blalock–Taussig shunt (MBTS).1 First, however, perioperative hypoxemia must be managed. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is likely to be a useful method for respiratory support in such cases.2,3 We present the case of a 2-month-old patient with graft dysfunction after the Norwood procedure who underwent MBTS with VV-ECMO support.

Negatively charged pions from two-body decays of stopped Λ4H hypernuclei were studied in 2012 at the Mainz Microtron MAMI, Germany. The momenta of the decay-pions were measured with unprecedented precision by using high-resolution magnetic spectrometers. A challenge of the experiment was the tagging of kaons from associated K+∧ production off a Be target at very forward angles. In the year 2014, this experiment was continued with a better control of the systematic uncertainties, with better suppression of coincident and random background, improved particle identification, and with higher luminosities. Another key point of the progress was the improvement in the absolute momentum calibration of the magnetic spectrometers.

In order to test theoretical frameworks of the baryon-baryon interactions and to confirm the ”Pauli effect between quarks” for the first time, we propose an experiment to measure low-energy hyperon proton scattering cross sections in the following channels with high statistics, 1. Σ− p elastic scattering, 2. Σ− p → Λn inelastic scattering, 3. Σ+ p elastic scattering. According to theoretical models based on quark-gluon picture for the short range part of the baryon-baryon interactions, the Σ+ p channel is expected to have an extremely repulsive core due to the Pauli effect between quarks, which leads a Σ+ p cross section twice as large as that predicted by conventional meson exchange models with a phenomenologically treated short range repulsive core. In addition, measurement of the Σ− p channel where the quark Pauli effect is not effective is also necessary to test the present theoretical models based on meson exchange picture with the flavor SU(3) symmetry. Thus this experiment will provide essential data to test the frameworks of the theoretical models of the baryon-baryon interactions and to investigate the nature of the repulsive core which has not been understood yet. In order to overcome the experimental difficulties in measuring low-energy hyperon proton scattering, we will use a new experimental technique in which a liquid H2 target is used as hyperon production and hyperon scattering targets with a detector system surrounding the LH2 target for detection of a scattered proton and a decay product from a hyperon. The hyperon scattering event is kinematically identified. Because imaging detectors used in past experiments are not employed, high intensity π beam can be used, allowing us to take high statistics data of 100 times more than the previous experiments. We have proposed an experiment of Σp scattering at the K1.8 beam line by utilizing the K1.8 beam line spectrometer and the SKS spectrometer. A high intensity π beams of 2×107/spill at 1.32 GeV/c and 1.42 GeV/c for the Σ− and Σ+ productions, respectively, are used to produce as many hyperon beam as possible.With 16×106 Σ− beam and 55×106 Σ+ beam around 500 MeV/c which are tagged by the spectrometers, we will detect ~10,000 Σ− p and Σ+ p scattering events and ~6,000 Σ− p → Λn inelastic reaction events in 60 days beam time in total. In this proceedings, we will present the experimental plan of the scattering experiment and results of the detailed simulation studies.

The photoproduction of K0 and Λ on the deuteron was measured in order to investigate the γn → K0Λ reaction process near the threshold (Eγ = 0.8-1.1 GeV). K0 and Λ events were clearly seen in the π+π− and the pπ− invariant mass spectra, respectively. The momentum spectra of the γd → K0X and the γd → ΛX reactions were derived. Additionally, the energy dependence of the integral cross section for the Λ production was also obtained. The K0 momentum spectra were in agreement with the previous results within statistical errors. The angular distribution of the γn → K0Λ reaction in the center of mass system was extracted and it had the backward distribution. The total cross section of the γn → K0Λ reaction, which was estimated by subtracting the contribution of K+Λ process from the Λ production on the deuteron, was almost the same as that of the γp → K+Λ.

We present the measured spin correlation coefficient C y , y for p- 3 He elastic scattering at 100 MeV at the angles θ c. m. = 46. 9 ∘ – 149. 2 ∘ in the center of mass system. The experiment was performed using a 100 MeV polarized proton beam in conjunction with the polarized 3 He target. Proton beams were injected to the target, and scattered protons were detected by using E- Δ E detectors which consisted of plastic and NaI(Tl) scintillators. The data are compared with rigorous numerical calculations based on realistic NN potentials as well as with the Δ -isobar excitation. The obtained results indicate that the C y , y expands the knowledge of the nuclear interactions with Δ -isobar or those including 3NFs that are masked in nucleon-deuteron elastic scattering. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV)-related neuropathic pain is a debilitating chronic condition that is severe and unrelenting. Despite the extensive research, the exact neuropathological mechanisms remain unknown, which hinders our ability to develop effective treatments. Loss of GABAergic tone may have an important role in the neuropathic pain state. Glutamic acid decarboxylase 67 (GAD67) is one of the isoforms that catalyze GABA synthesis. Here, we used recombinant herpes simplex virus (HSV-1) vectors that encode gad1 gene to evaluate the therapeutic potential of GAD67 in peripheral HIV gp120-induced neuropathic pain in rats. We found that (1) subcutaneous inoculation of the HSV vectors expressing GAD67 attenuated mechanical allodynia in the model of HIV gp120-induced neuropathic pain, (2) the anti-allodynic effect of GAD67 was reduced by GABA-A and-B receptors antagonists, (3) HSV vectors expressing GAD67 reversed the lowered GABA-IR expression and (4) the HSV vectors expressing GAD67 suppressed the upregulated mitochondrial superoxide and Wnt5a in the spinal dorsal horn. Taken together, our studies support the concept that recovering GABAergic tone by the HSV vectors may reverse HIV-associated neuropathic pain through suppressing mitochondrial superoxide and Wnt5a. Our studies provide validation of HSV-mediated GAD67 gene therapy in the treatment of HIV-related neuropathic pain.