Assessment of circulatory and pulmonary endothelin-1 levels in a lavage-induced surfactant-depleted lung injury rabbit model with repeated open endotracheal suctioning and hyperinflation

AIMS

Endothelin-1 (ET-1) is a mediator of various physiological and pathological processes, including vascular inflammation, cell proliferation and vasoconstriction. Attenuation of ET action using ET-1 antagonists reduces pulmonary vascular leakage and inflammation in several models of lung injuries and experimental acute respiratory distress syndrome (ARDS). Based on these earlier reports, the current study investigates the patterns of ET-1 levels in circulation and pulmonary tissues in an experimental model of lavage-induced surfactant-depleted lung injury. Additionally, we also test the effects of open endotracheal suctioning (OES) and hyperinflation (HI) as recruitment maneuver following OES on ET-1 levels.

MAIN METHODS

Briefly, 24 Japanese white rabbits were anesthetized and intubated. Normal saline was instilled into the lung and washed mildly. After instillation, rabbits were ventilated at definite settings at a total duration of 3 hours. OES and HI were performed every 15 minutes from the beginning of the protocol.

KEY FINDINGS

Here, we show that both circulatory and pulmonary ET-1 levels increased in models with lung injury induced by saline lavage compared to healthy control group. No further aggravation in expression of pulmonary ET-1 was seen after OES and HI, although OES and HI worsened arterial hypoxygenation and severity of lung injury. In contrast, circulatory ET-1 levels significantly decreased after OES and HI but were not associated with blood pressure changes.

SIGNIFICANCE

We conclude that in a saline lavage-induced lung injury model, both circulatory and pulmonary ET-1 levels increased. Further, OES and HI exerted differential effects on ET-1 expression at both circulatory and pulmonary levels.

Significant reversal of cardiac upregulated endothelin-1 system in a rat model of sepsis by landiolol hydrochloride

AIMS

Landiolol hydrochloride, an ultra-short-acting highly cardio-selective β-1 blocker, has become useful for various medical problems. Recent studies have demonstrated that co-treatment with landiolol protects against acute lung injury and cardiac dysfunction in rats of lipopolysaccharide (LPS)-induced systemic inflammation, and was also associated with a significant reduction in serum levels of the inflammation mediator HMGB-1 and histological lung damage. Endothelin (ET)-1, a potent vasoconstrictor, has been implicated in pathogenesis of sepsis and sepsis-induced multiple organ dysfunction syndrome. Here, we investigated whether landiolol hydrochloride can play important roles in ameliorating LPS-induced alterations in cardiac ET system of septic rats.

MAIN METHODS

Eight-week-old male Wistar rats were administered LPS only for 3 h and the rest were treated with LPS as well as with landiolol non-stop for 3 h.

KEY FINDINGS

At 3 h after LPS (only) administration, circulatory tumor necrosis factor (TNF)-α level, blood lactate concentration and percentage of fractional shortening of heart were significantly increased. In addition, LPS induced a significant expression of various components of cardiac ET-1 system compared to control. Finally, treatment of LPS-administered rats with landiolol for 3 h normalized LPS-induced blood lactate levels and cardiac functional compensatory events, without altering levels of plasma TNF-α and ET-1. Most strikingly, landiolol treatment significantly normalized various components of cardiac ET-1 signaling system in septic rat.

SIGNIFICANCE

Taken together, these data led us to conclude that landiolol may be cardio-protective in septic rats by normalizing the expression of cardiac vasoactive peptide such as ET, without altering the circulatory levels of inflammatory cytokines.

Involvement of peptidyl-prolyl isomerase Pin1 in the inhibitory effect of fluvastatin on endothelin-1-induced cardiomyocyte hypertrophy

AIMS

Cardiac hypertrophy is elicited by endothelin (ET)-1 as well as other neurohumoral factors, hemodynamic overload, and oxidative stress; HMG-CoA reductase inhibitors (statins) were shown to inhibit cardiac hypertrophy partly via the anti-oxidative stress. One of their common intracellular pathways is the phosphorylation cascade of MEK signaling. Pin1 specifically isomerizes the phosphorylated protein with Ser/Thr-Pro bonds and regulates their activity through conformational changes. There is no report whether the Pin1 activation contributes to ET-1-induced cardiomyocyte hypertrophy and whether the Pin1 inactivation contributes to the inhibitory effect of statins. The aim of this study was to reveal these questions.

MAIN METHODS

We assessed neonatal rat cardiomyocyte hypertrophy using ET-1 and fluvastatin by the cell surface area, ANP mRNA expression, JNK and c-Jun phosphorylation, and [(3)H]-leucine incorporation.

KEY FINDINGS

Fluvastatin inhibited ET-1-induced increase in the cell surface area, ANP expression, and [(3)H]-leucine incorporation; and it suppressed the signaling cascade from JNK to c-Jun. The phosphorylated Pin1 level, an inactive form, was decreased by ET-1; however, it reached basal level by fluvastatin. Furthermore, Pin1 overexpression clearly elicited cardiomyocyte hypertrophy, which was inhibited by fluvastatin.

SIGNIFICANCE

This is the first report that ET-1-induced cardiomyocyte hypertrophy is mediated through the Pin1 activation and that the inhibitory effect of fluvastatin on cardiomyocyte hypertrophy would partly be attributed to the suppression of the Pin1 function. This study firstly suggests that Pin1 determines the size of hypertrophied cardiomyocyte by regulating the activity of phosphorylated molecules and that statins exert their pleiotropic effects partly via Pin1 inactivation.

Dual blockade of endothelin action exacerbates up-regulated VEGF angiogenic signaling in the heart of lipopolysaccharide-induced endotoxemic rat model

AIMS

Sepsis is a cluster of heterogeneous syndromes associated with progressive endotoxemic developments, ultimately leading to damage of multiple organs, including the heart. However, the pathogenesis of sepsis-induced myocardial dysfunction is still not fully understood. The present study is the first to examine alterations in expression of key angiogenic signaling system mediated by vascular endothelial growth factor (VEGF) in septic heart and the effects of endothelin dual blocker (ETDB) on it.

MAIN METHODS

Normal Wistar rats were either administered with: a) vehicle only (control group), b) lipopolysaccharide only (LPS: 15 mg/kg) and then sacrificed at different time points (1 h, 3 h, 6 h and 10 h), and c) the last group was co-administered with LPS and ETDB (SB-209670, 1 mg/kg body weight) for 6 h and then sacrificed.

KEY FINDINGS

Administration of LPS resulted in increases in levels of: a) serum tumor necrosis factor (TNF)-α, b) serum VEGF and c) serum endothelin (ET)-1 levels accompanied by up-regulation of cardiac VEGF and its downstream angiogenic signaling molecules. While cardiac TNF-α level was unchanged among experimental groups, cardiac ET-1 level was significantly higher in LPS-administered group.

SIGNIFICANCE

We conclude that elevation in VEGF angiogenic signaling may be triggered by diminished oxygenation in the myocardium following LPS administration as a consequence of sepsis-induced microvascular dysfunction. Because of this cardiac dysfunction, oxygen supply may be inadequate at microregional level to support the normal heart metabolism and function. ETDB at 6 h further increased the elevated levels of VEGF angiogenic signaling in endotoxemic heart.

Screening for gestational diabetes mellitus and its prevalence in Bangladesh

BACKGROUND

The prevalence of gestational diabetes mellitus (GDM) has important health complications for both mother and child and is increasing all over the world. Although prevalence estimates for GDM are not new in developed and many developing countries, data are lacking for many low-income countries like Bangladesh.

OBJECTIVE

To evaluate the prevalence of GDM in Bangladesh.

RESEARCH DESIGN AND METHODS

This cross-sectional study included 3447 women who consecutively visited the antenatal clinics with an average gestation age of 26 weeks. GDM was defined according to WHO criteria (fasting plasma glucose [FPG] ≥7.0 mmol/L or 2-h ≥7.8 mmol/L) and the new ADA criteria (FPG ≥5.3 mmol/L or 2-h ≥8.6 mmol/L OGTT). We also calculated overt diabetes as FPG ≥7.0 mmol/L.

RESULTS

Prevalence of GDM was 9.7% according to the WHO criteria and 12.9% according to the ADA criteria in this study population. Prevalence of overt diabetes was 1.8%. Women with GDM were older, higher educated, had higher household income, higher parity, parental history of diabetes, and more hypertensive, compared with non-GDM women.

CONCLUSION

This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help to formulate new policies to prevent and manage diabetes.

Repeated open endotracheal suctioning causes gradual desaturation but does not exacerbate lung injury compared to closed endotracheal suctioning in a rabbit model of ARDS

Background

Although endotracheal suctioning induces alveolar derecruitment during mechanical ventilation, it is not clear whether repeated endotracheal suctioning exacerbates lung injuries. The present study aimed to determine whether repeated open endotracheal suctioning (OS) exacerbates lung injury compared to closed endotracheal suctioning (CS) during mechanical ventilation in an animal model of acute respiratory distress syndrome (ARDS).

Methods

Briefly, thirty six Japanese white rabbits were initially ventilated in pressure-controlled mode with a constant tidal volume (6 mL/kg). Then, lung injury was induced by repeated saline lavage. The rabbits were divided into four groups, namely: a) OS; b) CS; c) control with ARDS only; d) and healthy control (HC) without ARDS. Animals in all the groups were then ventilated with positive end expiratory pressure (PEEP) at 10 cm H₂O. CS was performed using 6 French-closed suctioning catheters connected to endotracheal tube under the following conditions: a) a suctioning time and pressure of 10 sec and 140 mm Hg, respectively; and b) a suction depth of 2 cm (length of adapter) plus tracheal tube. OS was performed using the same conditions described for CS, except the ventilator was disconnected from the animals. Each endotracheal suctioning was performed at an interval of 30 min.

Results

PaO2/FIO2 (P/F) ratio for CS, control and HC groups remained at >400 for 6 hours, whereas that of the OS group progressively declined to 300 (p < 0.05), with each suctioning. However, no difference was observed either in lung injury score (histology) or in the expression pattern of inflammatory cytokines (tumor necrosis factor-α and interleukin-6) after 6 hours between the OS and CS groups in the circulatory as well as the pulmonary tissues.

Conclusions

Progressive arterial desaturation under conditions of repeated endotracheal suctioning is greater in OS than in CS time-dependently. However, OS does not exacerbate lung injury during mechanical ventilation when observed over a longer time span (6 hours) of repeated endotracheal suctioning, based on morphological and molecular analysis.

Do dispatcher instructions facilitate bystander-initiated cardiopulmonary resuscitation and improve outcomes in patients with out-of-hospital cardiac arrest? A comparison of family and non-family bystanders

OBJECTIVES

Bystander-initiated cardiopulmonary resuscitation (CPR) has been reported to increase the possibility of survival in patients with out-of-hospital cardiopulmonary arrest (OHCA). We evaluated the effects of CPR instructions by emergency medical dispatchers on the frequency of bystander CPR and outcomes, and whether these effects differed between family and non-family bystanders.

METHODS

We conducted a retrospective cohort study, using Utstein-style records of OHCA taken in a rural area of Japan between January 2004 and December 2009.

RESULTS

Of the 559 patients with non-traumatic OHCA witnessed by laypeople, 231 (41.3%) were given bystander CPR. More OHCA patients received resuscitation when the OHCA was witnessed by non-family bystanders than when it was witnessed by family members (61.4% vs. 34.2%). The patients with non-family-witnessed OHCA were more likely to be given conventional CPR (chest compression plus rescue breathing) or defibrillation with an AED than were those with family-witnessed OHCA. Dispatcher instructions significantly increased the provision of bystander CPR regardless of who the witnesses were. Neurologically favorable survival was increased by CPR in non-family-witnessed, but not in family-witnessed, OHCA patients. No difference in survival rate was observed between the cases provided with dispatcher instructions and those not provided with the instructions.

CONCLUSIONS

Dispatcher instructions increased the frequency of bystander CPR, but did not improve the rate of neurologically favorable survival in patients with witnessed OHCA. Efforts to enhance the frequency and quality of resuscitation, especially by family members, are required for dispatcher-assisted CPR.

Higher gravidity and parity are associated with increased prevalence of metabolic syndrome among rural Bangladeshi women

Background

Parity increases the risk for coronary heart disease; however, its association with metabolic syndrome among women in low-income countries is still unknown.

Objective

This study investigates the association between parity or gravidity and metabolic syndrome in rural Bangladeshi women.

Methods

A cross-sectional study was conducted in 1,219 women aged 15–75 years from rural Bangladesh. Metabolic syndrome was defined according to the standard NCEP-ATP III criteria. Logistic regression was used to estimate the association between parity and gravidity and metabolic syndrome, with adjustment of potential confounding variables.

Results

Subjects with the highest gravidity (> = 4) had 1.66 times higher odds of having metabolic syndrome compared to those in the lowest gravidity (0-1) (P_trend = 0.02). A similar association was found between parity and metabolic syndrome (P_trend = 0.04), i.e., subjects in the highest parity (> = 4) had 1.65 times higher odds of having metabolic syndrome compared to those in the lowest parity (0-1). This positive association of parity and gravidity with metabolic syndrome was confined to pre-menopausal women (P_trend <0.01). Among the components of metabolic syndrome only high blood pressure showed positive association with parity and gravidity (P_trend = 0.01 and <0.001). Neither Parity nor gravidity was appreciably associated with other components of metabolic syndrome.

Conclusions

Multi parity or gravidity may be a risk factor for metabolic syndrome.

Metabolic syndrome among pre- and post-menopausal rural women in Bangladesh: result from a population-based study

BACKGROUND

Prevalence of non-communicable diseases are a challenging problems among menopausal women specially in a least developed country like Bangladesh, where majority of women suffering from at least one chronic diseases after menopausal age. So, the main objective of this study was to determine the prevalence of metabolic syndrome and related risk factors in Bangladeshi pre- and post-menopausal women living in the rural setting.

METHODS

This study is based on a community based cross-sectional survey among 1802 rural women aged ≥15 years. Metabolic syndrome was defined according to the criteria of NCEP-ATP III. Logistic regression was used to estimate the association between menopausal status and metabolic syndrome and its components.

RESULTS

Metabolic syndrome was presented in 25.6% respondents and it was more prevalent among post-menopausal (39.3%) as compared to pre-menopausal (16.8%) women. Logistic regression analysis reveals that prevalence of metabolic syndrome was 1.78 times higher in post-menopausal women than pre-menopausal women (P = 0.001). Prevalence of high blood pressure, elevated fasting blood glucose, and high triglyceride were significantly higher in post-menopausal women than pre-menopausal women (P < 0.05). However, prevalence of low high-density lipoprotein cholesterol was significantly lower in post-menopausal women than pre-menopausal women (P < 0.001).

CONCLUSIONS

Metabolic syndrome seems to be a major health problem among post-menopausal women in many developing countries like Bangladesh and proper policy emphasis should be given on its prevention and control.

Disruption of components of vascular endothelial growth factor angiogenic signalling system in metabolic syndrome. Findings from a study conducted in rural Bangladeshi women

Metabolic syndrome (MetS) is associated with impaired angiogenesis, a process that is chiefly regulated by vascular endothelial growth factor (VEGF) upon binding to its specific receptors, VEGF-R1 and VEGF-R2. The purpose of the present study was to assess trends or patterns in plasma levels of VEGF and its soluble receptors in subjects with (MetS) or without (non-MetS) MetS; and further examine their association with clinical or metabolic parameters using a subpopulation of South Asian country. A total of 1,802 rural Bangladeshi women aged ≥15 years were studied using a population-based cross-sectional survey. Plasma levels of VEGF were found to be significantly increased (MetS vs. non-MetS: 483.9 vs. 386.9, p<0.001), whereas, the soluble forms of VEGF receptors, sVEGF-R1 and sVEGF-R2, were significantly decreased in subjects with Mets (sVEGF-R1, MetS vs. non-MetS: 512.5 vs. 631.3, p<0.001; sVEGF-R2, MetS vs. non-MetS: 9,302.8 vs. 9,787.4, p=0.004). After adjustment for age and all potential variables, multiple regression analysis revealed that plasma levels of VEGF had significant positive association with blood glucose (p = 0.019) and body mass index (p = 0.007). We also found that mean plasma levels of VEGF increased in direct proportion to levels of MetS components. The present study is the first ever to demonstrate a positive association between trends in levels of plasma VEGF and MetS using a large sample size from South Asia. The association between plasma VEGF and MetS needs further investigations in order to clearly decipher the clinical predictive value and accuracy of plasma VEGF in MetS.

Suitability of polymers as screw post materials in primary teeth: an in vitro study

AIM

Primary teeth undergo physiological root resorption during the transition to permanent dentition. The aim of this study was to assess the potential use of screw posts in core build-up for primary teeth while adequately retaining the crown restoration and allowing smooth physiological root resorption.

METHODS

To determine whether biodegradable polymers such as polyglycolic acid (PGA) and poly-L-lactic acid (PLLA) were appropriate as post materials, bending strength test and bending elastic modulus test were performed according to ISO standards. The prepared screw posts were immersed in 0.01 mol/L phosphate-buffered saline at 37 degrees Celsius, and changes due to hydrolysis were observed. Results In the bending strength test and bending elastic modulus test, PGA and PLLA showed similar values to composite resins used for core build-up. Although both showed adequate hydrolysis, the hydrolysis rate of PGA was higher than that of PLLA.

CONCLUSION

PGA and PLLA may be suitable as biodegradable screw posts for primary teeth because they have appropriate strength and hydrolysis ability.

Minimum alveolar concentrations of sevoflurane for maintaining bispectral index below 50 in children

OBJECTIVE

To determine minimum alveolar concentration (MAC) of sevoflurane for maintaining bispectral index (BIS) below 50 (MAC(BIS50) ) in children.

BACKGROUND

MAC(BIS50) of sevoflurane in adults was reported to be 0.97%, which has not been elucidated in children.

METHODS/MATERIALS

Twenty children, American Society of Anesthesiologists physical status I or II, aged 1-8, were induced and anesthetized with sevoflurane in oxygen. After tracheal intubation, we started maintenance of anesthesia with endtidal sevoflurane concentrations of 2.6%. The endtidal sevoflurane concentration at which BIS was measured was predetermined by the up-down method (with 0.2% as a step size). After 10 min at predetermined endtidal sevoflurane concentrations, BIS was measured for 1 min. MAC(BIS50) was determined using Dixon's up-down method and probit test.

RESULT

MAC(BIS50) of sevoflurane was 2.83% (95% confidence intervals: 2.70-3.14) in children.

CONCLUSIONS

MAC(BIS50) of sevoflurane in children was calculated to be three times as high as in adults. This indicates that high endtidal sevoflurane concentration is required to suppress electroencephalogram activity in children.

First Report of Tomato leaf curl New Delhi virus Infecting Cucumber in Central Java, Indonesia

Cucumber (Cucumis sativus L.) is an important vegetable in Indonesia. Cucumber plants showing yellowy green mosaic symptoms on leaves were observed in Klaten, Central Java, Indonesia in August 2008. Total DNAs were extracted from symptomatic leaves, and the putative viral genomes were amplified by PCR with the Deng A and B primers (2). The PCR-amplified viral genomic DNA was sequenced. The remaining part of DNA-A was amplified with two primers sets (ToLCNDV-A1F 5'-ACCAACAGGCCGATGAACA-3' and ToLCNDV-A1R 5'-TTCCCACTATCTTCCTGTGCA-3'; ToLCNDV-A2F 5'-TCGAGTGTGATRAAGAYTGCA-3' and ToLCNDV-A2R 5'-ACTAACTAAGCATTGCAGCGTC-3' [R = A and G, Y = C and T]) and sequenced. The remaining part of DNA-B was amplified with two primers sets (ToLCNDV-B1F 5'-ARGAGTTYMCRYYTGTGGA-3' and ToLCNDV-B1R 5'-TKCWGTYGGTCATGTCGT-3'; ToLCNDV-B2F 5'-TCYGTCAATCKCATGTCGYGT-3' and ToLCNDV-B2R 5'-CCTTACGCGTATAYTGTYTRGA-3' [K = G and T, M = A and C, W = A and T]) and sequenced. Full-length DNA-A (2,739 nt; GenBank Accession No. AB613825) and DNA-B (2,690 nt; GenBank Accession No. AB613826) sequences of a bipartite Tomato leaf curl New Delhi virus (ToLCNDV) from Central Java were obtained and they were most similar to the corresponding sequences of both DNA-A and DNA-B of ToLCNDV-[cucumber:Thailand] (DNA-A, GenBank Accession No. AB330079; DNA-B, GenBank Accession No. AB330080) at 95.5 and 91.0% nucleotide identities, respectively. On the basis of high nucleotide sequence identity with ToLCNDV-[cucumber:Thailand] and the demarcation criteria in species identification (3), the virus isolate from the diseased cucumber in Central Java is considered as a variant of ToLCNDV and was accordingly named ToLCNDV-Indonesia[Indonesia:Java:Cucumber:2008] (ToLCNDV-ID[ID:Jav:Cuc:08]). Although the importance of begomovirus diseases on chili pepper (Solanaceae) is currently highly noticed in Indonesia (1), ToLCNDV was newly isolated from cucumber (Cucurbitaceae) in this study. Therefore, farmers in Indonesia should pay more attention to controlling begomovirus vectors, white flies, on Cucurbitaceae. To our knowledge, this is the first report of the natural occurrence of ToLCNDV in Indonesia. References: (1) P. J. D. Barro et al. Biol. Invas.10:411, 2008. (2) D. Deng et al. Ann. Appl. Biol. 125:327, 1994. (3) C. M. Fauquet et al. Arch. Virol. 153:783, 2008.

[Anesthetic management of a patient with multiple system atrophy undergoing adrenal gland tumor surgery]

We report anesthetic management of a 61-year-old man with multiple system atrophy undergoing adrenal grand tumor surgery. Before surgery, he was sufficiently hydrated and an elastic bandage had been applied to the legs. After epidural catheterization for the postoperative analgesia, general anesthesia was induced with midazolam 7 mg and remifentanil 0.25 microg x kg(-1) x min(-1) and his trachea was intubated. During surgery, general anesthesia was maintained with sevoflurane and remifentanil 0.12-0.25 microg x kg(-1) x min(-1). Hemodynamics was almost stable although transient hypotension occurred during surgery because of bleeding and partial clamping of the inferior vena cava. After surgery, he emerged from anesthesia and tracheal tube was removed uneventfully. However, on the first postoperative day, hypotension and respiratory failure occurred. Noradrenaline infusion was needed to treat hypotension due to vasodilation and reintubation was performed. After several days, hypotension and respiratory failure improved and he was discharged from ICU.

[Comparative study of oral tracheal tube extubation force in a baby manikin model: taping methods and tube diameters]

BACKGROUND

Adhesive tape is the standard method for securing tracheal tubes. There have been several studies about extubation forces in adult models. However, there have been few in pediatric models. Therefore, we examined the force required to extubate tracheal tube from a manikin using three methods.

METHODS

A baby simulation manikin was orally intubated. The tracheal tube (3.0 to 4.5 mm internal diameter) was fixed at the right oral corner. The tracheal tube was secured with adhesive tape with three different methods as follows: 1) 0.63 cm-wide tape coiled around the tube twice, 2) 1.25 cm-wide tape coiled around the tube twice, 3) 1.25 cm-wide tape coiled up three times around the tube ("puttee style"). Adhesive tape was attached 10 cm on both sides of the tube along the lips. The tracheal tube was connected to a force-measuring device and pulled vertically until the tube was displaced 1 cm distally from the initial position. The required force was defined as the "extubation force". Each method was repeated 5 times.

RESULTS

The extubation force was larger when the tape used was wider, and the contact area between the tracheal tube and tape was larger. The force was also larger as the tube diameter became larger.

CONCLUSIONS

To fix a tracheal tube securely, adhesive tape should be wider and the contact area between the tube and the tape should be larger. In this regard, "puttee style" fixation seems to be effective.

Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder

BACKGROUND

Adhesive tape is commonly used to secure the endotracheal tube (ETT) in anesthesia and intensive-care settings.

OBJECTIVE

To determine the force required to extubate when the ETT is secured with adhesive tape or commercially available ETT holders.

METHODS

We orally intubated a simulation manikin with a standard 8.0-mm inner-diameter ETT, inflated the cuff to 20 cm H(2)O, and measured the force required to extubate with the ETT secured in several ways. We tested 3 brands of tape (Durapore, Multipore Dry, and Wardel) with 6 methods, and 2 commercially available ETT holders (LockTite and Thomas) with one method. We also tested a bite block (Universal Bite Block) with 2 methods. We used a releasable cable tie with the bite block and/or ETT holder. We connected the ETT to a digital force gauge and pulled perpendicular to the oral cavity, until the entire cuff was removed from the trachea. In each trial we considered the largest force recorded the extubation force.

RESULTS

One of the conventional tape methods (with wider tape and longer tape strips) required the largest force to extubate.

CONCLUSIONS

With tape strips of sufficient length and width, a conventional tape method was superior to the 2 tested commercial ETT holders in holding the ETT in place in the manikin.

[Airway management using i-gel in two patients for awake craniotomy]

The i-gel (Intersurgical Ltd., Wokingham, Berkshire, UK) is a new single-use noninflatable supraglottic airway device. It is composed of a soft, gel-like, transparent, thermoplastic elastomer, which provides a perilaryngeal seal without cuff inflation. In this case report, we describe the airway management using i-gel in two patients scheduled for awake craniotomy. One patient underwent the implantation of brain stimulator electrodes and the other patient underwent the removal of a glioma near Broca's area. After anesthesia was induced with propofol and remifentanil, airway was secured using i-gel. Anesthesia was maintained using oxygen, air and propofol, supplemented with an infusion of remifentanil. Anesthesia was discontinued after completion of craniotomy. The i-gel was removed when patients opened their eyes upon calling their names out. The i-gel was reinserted before the closure of the dura without difficulties despite the fact that necks were rotated about 30 degrees rightward, and remained in place until the end of surgery. All procedures finished uneventfully and without adverse events. We conclude that i-gel is effective in asleep-awake-asleep technique because of its easiness in reinsertion under condition of rotated neck.

Radiologic and neuropathologic findings in patients in a family with dentatorubral-pallidoluysian atrophy

We describe the cases of 2 patients, a father and his son, with DRPLA who underwent MR examinations prior to death and in whom postmortem examinations of the brain were obtained. MR imaging findings had the following features: 1) atrophy of the cerebellum and brain stem were the common findings, 2) high-signal-intensity lesions in the cerebral white matter and brain stem were observed on T2-weighted images in the patient with adult-onset DRPLA, 3) signal-intensity changes in the cerebral white matter were restricted to the periventricular white matter in the patient with juvenile-onset DRPLA, but these changes appear in the advanced stage, and 4) progressive cerebral atrophy was more marked in the patient with juvenile-onset DRPLA. In the patients with DRPLA, the abnormal high signal intensity of the cerebral white matter or brain stem on MR images reflect the loss of myelinated fibers. Cerebral atrophy mainly reflects atrophy of the neuropile.

Novel strategy for prevention of esophageal stricture after endoscopic surgery

BACKGROUND/AIMS

Recently, novel endoscopic surgery, including endoscopic submucosal dissection (ESD), was developed to resect a large superficial gastrointestinal cancer. However, circumferential endoscopic surgery in the esophagus can lead to esophageal stricture that affects the patient's quality of life. This major complication is caused by scar formation, and develops during the two weeks after endoscopic surgery. We hypothesized that local administration of a controlled release anti-scarring agent can prevent esophageal stricture after endoscopic surgery. The aims of this study were to develop an endoscopically injectable anti-scarring drug delivery system, and to verify the efficacy of our strategy to prevent esophageal stricture.

METHODOLOGY

We focused on 5-Fluorouracil (5-FU) as an anti-scarring agent, which has already been shown to be effective not only for treatment of cancers, but also for treatment of hypertrophic skin scars. 5-FU was encapsulated by liposome, and then mixed with injectable 2% atelocollagen (5FLC: 5FU-liposome-collagen) to achieve sustained release. An in vitro 5-FU releasing test from 5FLC was performed using high-performance liquid chromatography (HPLC). Inhibition of cell proliferation was investigated using normal human dermal fibroblast cells (NHDF) with 5FLC. In addition, a canine esophageal mucosal resection was carried out, and 5FLC was endoscopically injected into the ulcer immediately after the operation, and compared with a similar specimen injected with saline as a control.

RESULTS

5-FU was gradually released from 5FLC for more than 2 weeks in vitro. The solution of 5-FU released from 5FLC inhibited NHDF proliferation more effectively than 5-FU alone. In the canine model, no findings of stricture were observed in the 5FLC-treated dog at 4 weeks after the operation and no vomiting occurred. In contrast, marked esophageal strictures were observed with repeated vomiting in the control group. Submucosal fibrosis was markedly reduced histologically in the 5FLC-treated dog compared with the control.

CONCLUSIONS

5FLC showed sustained release of 5-FU and decreased cell proliferation in vitro. The clinically relevant canine model demonstrated that local endoscopic injection of 5FLC can prevent post-operative esophageal stricture. These results suggest that our strategy may be useful for preventing post-operative esophageal stricture.

Nicotine poisoning due to intravenous injection of cigarette soakage

A 27-year-old female nurse intravenously injected 5 mL of cigarette soakage solution that contained approximately 5.7 mg nicotine, in a suicidal attempt. Clinical manifestations consisted of nausea, palpitation, abdominal pain, repeated vomiting, and diarrhea. She remained fully conscious during this episode. About 7 hours later, she visited emergency department on foot and received fluid infusion for dehydration. She fully recovered at night of the day. This is the first documented report of acute nicotine poisoning due to intravenous injection of cigarette soakage in humans. Signs and symptoms appeared immediately after the injection, but this case seemed to be relatively mild in terms of clinical manifestation. The elimination half-life of nicotine seems to be short, that is, less than 1 hour. Therefore, if initial treatment is appropriate and the patient can survive acute phase of nicotine poisoning, prognosis is good.

Change in carrier type in high-k gate carbon nanotube field-effect transistors by interface fixed charges

We study the phenomenon of change in carrier type in carbon nanotube field-effect transistors (CNFETs) caused by the atomic layer deposition (ALD) of a HfO(2) gate insulator. When a HfO(2) layer is deposited on a CNFET, the type of carrier changes from p-type to n-type. The so-obtained n-type device has good performance and stability in air. The conductivity of such a device with a channel length of 0.7 microm is 11% of the quantum conductance 4e(2)/h. The contact resistance for electron current is estimated to be 14 kOmega. The n-type conduction of this CNFET is maintained for more than 100 days. The change in carrier type is attributed to positive fixed charges introduced at the interface between the HfO(2) and SiO(2) layers. We also propose a novel technique to control the type of conduction by utilizing interface fixed charges; this technique is compatible with Si CMOS process technology.

Plasma hormone levels and semen quality in male cats during non-breeding and breeding seasons

Female cats are known to be seasonal breeders and male cats annual breeders. Despite this, there are limited data on the influence of breeding season (BS) on hormone concentration and semen quality in the male cat. This study compared plasma concentrations of LH and testosterone (T), and semen quality during the non-breeding season (NBS) and BS in five male cats subject to natural hours of daylight but a constant environmental temperature. Plasma LH and T concentrations were higher during the BS in 2/35 and 3/5 cats, respectively, although when comparing both hormones combined, values were higher during the BS than the NBS in all cats (p < 0.01). There were no significant differences in the percentage of abnormal sperm between the cats. Overall, semen quality was superior during the BS with larger semen volume in 2/5, sperm motility in 2/5 and sperm viability in 3/5 cats. Although there was a clear seasonal effect on hormone secretion and semen quality, during the NBS all cats were likely to have been fertile.

Persistent gut motor dysfunction in a murine model of T-cell-induced enteropathy

BACKGROUND

Inflammatory bowel disease (IBD) patients in remission often experience irritable bowel syndrome (IBS)-like symptoms. We investigated the mechanism for intestinal muscle hypercontractility seen in T-cell-induced enteropathy in recovery phase.

METHODS

BALB/c mice were treated with an anti-CD3 antibody (100 microg per mouse) and euthanized at varying days post-treatment to investigate the histological changes, longitudinal smooth muscle cell contraction, cytokines (Th1, Th2 cytokines, TNF-alpha) and serotonin (5-HT)-expressing enterochromaffin cell numbers in the small intestine. The role of 5-HT in anti-CD3 antibody-induced intestinal muscle function in recovery phase was assessed by inhibiting 5-HT synthesis using 4-chloro-DL-phenylalanine (PCPA).

KEY RESULTS

Small intestinal tissue damage was observed from 24 h after the anti-CD3 antibody injection, but had resolved by day 5. Carbachol-induced smooth muscle cell contractility was significantly increased from 4 h after injection, and this muscle hypercontractility was evident in recovery phase (at day 7). Th2 cytokines (IL-4, IL-13) were significantly increased from 4 h to day 7. 5-HT-expressing cells in the intestine were increased from day 1 to day 7. The 5-HT synthesis inhibitor PCPA decreased the anti-CD3 antibody-induced muscle hypercontractility in recovery phase.

CONCLUSIONS & INFERENCES

Intestinal muscle hypercontractility in remission is maintained at the smooth muscle cell level. Th2 cytokines and 5-HT in the small intestine contribute to the maintenance of the altered muscle function in recovery phase.