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Purpose Remimazolam is a new ultra-short-acting benzodiazepine with unknown effects on cerebral circulation. We measured total cerebral hemoglobin concentrations, which reflect cerebral blood volume (CBV), and cerebral oxygen saturation, using time-domain near-infrared spectroscopy, which can measure the absolute values of cerebral hemoglobin concentrations. We also measured cerebral blood flow velocity (CBFV) in the middle cerebral artery using transcranial Doppler as an indicator of cerebral blood flow (CBF). We did so to examine the effect of remimazolam on cerebral circulation in humans, as assessed CBV, CBF, and cerebral oxygen saturation. Methods This was a prospective, observational study. Fifteen patients without serious complications scheduled for general anesthesia were recruited. We measured total cerebral hemoglobin concentrations, CBFV, and cerebral oxygen saturation throughout the anesthetic induction course with remimazolam. Results Total cerebral hemoglobin concentrations did not change during the process (p = 0.51). In contrast, the mean CBFV was reduced by 11% (significant, p = 0.04). The drop in mean blood pressure following the induction of anesthesia was 17%; however, it was within the range of cerebrovascular autoregulation. Moreover, cerebral oxygen saturation increased by 4% (statistically significant, p < 0.01). Conclusions We found that anesthetic induction with remimazolam did not alter CBV and reduced CBF in uncomplicated patients., Author(s): Takashi Soejima [sup.1], Kentaro Ueda [sup.1], Sakae Hasegawa [sup.1], Hiromitsu Motoe [sup.1], Kazufumi Okada [sup.2], Yoichi M. Ito [sup.2], Koji Hoshino [sup.1], Yuji Morimoto [sup.1] Author Affiliations: (1) grid.412167.7, [...]

Background: Most rugby injuries occur during tackles, therefore investigating safe tackling techniques is essential. Objectives: To determine the effects of different tackle heights and shoulder preference on head and trunk acceleration. Methods: Thirty-nine rugby players belonging to university leagues, adult leagues, and adult leagues, tackled a stationary tackle bag under three height conditions (high, middle, and low) with a dominant shoulder and a non-dominant shoulder. We calculated the peak head and trunk accelerations (PhA and PtA, respectively) during the tackles and evaluated the difference in accelerations by the tackle height and side. Results: The PhA (26.1 g (17.1) g) during the tackles was significantly higher than the PtA (11.7(7.2) g, p < 0.01). The PhA was significantly larger in the high (27.4 (19.4) g) and middle (27.7 (17.0) g) tackles compared to the low (23.4 (14.6) g) tackle (high vs low: p < 0.01; middle vs low: p < 0.01). The PhA was significantly lower during the dominant shoulder side (23.0 (13.7) g) tackles than during the non-dominant shoulder side (30.4 (21.3) g) tackles (p < 0.01). Conclusion: The results suggest that coaching strategies and policies aimed at reducing tackler height and improving tackle technique on the non-dominant shoulder would help reduce head acceleration forces. [ABSTRACT FROM AUTHOR]

Purpose Inflammation after stent graft surgery is known as postimplantation syndrome (PIS) and it causes leukocytosis. However, we have experienced leukopenia in the very early postoperative phase of endovascular surgery at our institution. We investigated leukopenia, an under-recognized phenomenon that occurred after transcatheter aortic valve implantation (TAVI), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR). Methods Records of patients who underwent TAVI, EVAR, and TEVAR between March 2018 and February 2019 were retrospectively reviewed. Primary outcomes were the decline rate of white blood cell count (DR-WBC) in the immediate postoperative period and its differences among surgical procedures. The secondary endpoint was the relationship between DR-WBC and infectious complications. Furthermore, the incidence of PIS and its differences among the procedures and associations with DR-WBC were evaluated. Results A total of 108 patients (TAVI 41, EVAR 37, TEVAR 30) were included. DR-WBC immediately after surgery was higher in the TAVI group when compared with other groups (TAVI, 43.1 ± 22.6%; EVAR, 27.6 ± 17.3%; TEVAR, 25.4 ± 27.4%; P < 0.01). DR-WBC was not significantly different regardless of postoperative infection (P = 0.45) or PIS (P = 0.62). The incidence rate of PIS was higher in the EVAR group compared with the TAVI group, and was not associated with DR-WBC. Conclusions Leukopenia was a common phenomenon immediately after endovascular surgery, especially TAVI. It resolved a day after surgery and was not associated with PIS or infectious complications. Therefore, it seems to be a transient abnormal hematological finding and a self-limiting condition., Author(s): Takashi Soejima [sup.1], Kazuyuki Mizunoya [sup.1], Yuki Izumi [sup.2], Takeshi Yokoyama [sup.2], Ryo Takagi [sup.3], Yuji Morimoto [sup.1] Author Affiliations: (1) grid.412167.7, 0000 0004 0378 6088, Department of Anesthesiology, [...]

Abstract Purpose To investigate the usefulness of the “inducer grafting” technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. Methods Twenty knees of 20 patients (mean age at the time of surgery, 23.1 years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients). “Inducer grafting” technique After harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15 months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. Results One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. Conclusion These results suggest that the “inducer grafting” technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes anserinus. However, this technique couldn’t improve the deficits in knee flexion torque after ACL reconstruction.

PCR cannot distinguish live microorganisms from dead ones. To circumvent this disadvantage, ethidium/propidiummonoazide (EMA/PMA) and psoralen to discriminate live from dead bacteria have been used for 2 decades. These methods require the use of numerous laborious procedures. We introduce an innovative method that uses platinum compounds, which are primarily used as catalysts in organic chemistry and partly used as anti-cancer drugs. Microorganisms are briefly exposed to platinum compounds in vivo, and these compounds penetrate dead (compromised) microorganisms but not live ones and are chelated by chromosomal DNA. The use of platinum compounds permits clear discrimination between live and dead microorganisms in water and milk (including Cronobacter sakazakii and Escherichia coli) via PCR compared with typically used PMA. This platinum- PCR method could enable the specific detection of viable coliforms in milk at a concentration of 5-10 CFU mL-1 specified by EU/USA regulations after a 4-h process. For sample components, environmental water contains lower levels of PCR inhibitors than milk does, and milk is similar to infant formula, skim milk and blood; thus, the use of the platinum-PCR method could also prevent food poisoning due to the presence of C. sakazakii in dairy products. This method could provide outstanding rapidity for use in environmental/food/ clinical tests. Platinum-PCR could also be a substitute for the typical culture-based methods currently used. [ABSTRACT FROM AUTHOR]