[Ventilatory management in shared airway surgery: current status, challenges, and future directions]

A shared airway during anesthesia refers to maintaining the airway and ventilation of the patient by the anesthesiologist as the surgeon performs the procedures in the same anatomic space. Due to the narrow airway space in shared airway surgery, the difficulty lies both in the exposure of surgery field and implementation of the optimized airway management strategy and maintaining the airway safety in clinical practice. In recent years, many new visualized airway management tools and supraglottic ventilation devices have been invented and verified in clinical settings. Especially, the development of tubeless supraglottic oxygenation and ventilation technique provides new insights into the airway management. This review intends to provide a reference for future innovations in airway management tools and ventilation techniques by summarizing previous airway management strategies of shared airway surgery to benefit more patients.

Identify the patients perceived learning needs after myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular disease is the major trait to public health and the leading cause of death worldwide.  There are over 1 million new and recurrent myocardial infarctions (MI) occur each year and 12,000 of these individuals are still living. Patients surviving from MI have to adapt to live with the heart disease and restore their quality of life. Hence health education for patients to combat the disease as secondary prevention has become very important. Health care professionals must understand the information needs of patients so that effective health education could be taken place consistently with patients’ needs, to optimize outcome of risk factor modification and lifestyle changes.

Purpose

This study aims to identify post MI patients" perceived learning needs and the demographic factors that influence the needs.

Methods

Cross-sectional design and convenience sampling method were used for this study. A questionnaire adapted from Cardiac Patient Learning Needs Inventory (CPLNI) was completed by 56 patients who were recruited from a tertiary hospital during inpatient hospitalization in Malaysia. Data from the questionnaires were analyzed using SPSS version 24.

Results

It was shown that patients’ perceived learning needs were highly important in all eight domains. All domains range from mean 3.52-3.66. Information in the domains of other pertinent information (sign and symptom of MI), medication as well as anatomy and physiology were highly needed by post MI patients, with mean 3.66, 3.65 and 3.64 respectively. Age was significantly related to the patients’ learning need in the domain of anatomy and physiology.

Conclusion

MI patients need abundant cardiac related information prior discharge, to regain and improve their life. This need should be met by delivering appropriate health education before discharge or during follow-up by health care professionals. There is a necessity to integrate this study finding into the cardiac rehabilitation content to benefit post MI patients.

Tuberculosis of the breast: 10 years' experience in one institution

SETTING

Breast tuberculosis (TB) is rare even in endemic areas. Its presentation is variable and non-specific, and its diagnosis is therefore usually delayed.

DESIGN

We recruited breast TB cases between 1998 and June 2009 at Kaohsiung Medical Center in southern Taiwan. We retrospectively reviewed the clinical features, diagnosis and management of breast TB.

RESULTS

A total of 26 patients with breast TB (25 females) were included in this study. The most common presentation was breast tumour, followed by breast abscess and painful sensation. Patients received partial mastectomy or incision and drainage. The pathological examination revealed granulomatous inflammation, acute and chronic inflammation or both. Polymerase chain reaction has very low sensitivity in diagnosing breast TB. The interval between initial presentation and definite treatment was an average of 54.5 days. All patients received anti-tuberculosis chemotherapy, with excellent response.

CONCLUSION

The presentation of breast TB is variable and diagnosis is usually delayed. The disease can be diagnosed through pathological tests and a high suspicion by experienced physicians. The definite treatment is adequate anti-tuberculosis chemotherapy after surgical excision or drainage.

Ohtsuki Kenji and the beginnings of lay analysis in Japan

The authors outline the major role played by Ohtsuki Kenji in the formation of the Japanese Psychoanalytic Society. Unlike the other pioneers of psychoanalysis in Japan, Ohtsuki never went abroad or met Freud. He was a literature graduate who taught himself the fundamentals of psychoanalysis. He organised the translation of Freud's complete works, formed a psychoanalytic training institute and started a journal that carried English-language editorials. These became the major means whereby foreign analysts came to know and understand the Japanese psychoanalytic scene. A number of rival groups amalgamated to form the Japanese Psychoanalytical Association in the mid-fifties, excluding Ohtsuki's group despite its pre-war prominence. The authors reconsider Ohtsuki's role in the light of his many articles, his autobiography, new information uncovered in interviews conducted with current analysts and with Ohtsuki's widow and son. They describe his championing of lay analysis, and his criticisms of medicalisation of the discipline and of the view from abroad that questioned the suitability of Japanese culture for psychoanalytic therapy, as well as his efforts to modify some of the basic tenets of psychoanalysis to accord with his own views in his later work.

In vivo regulation of hepatitis B virus replication by peroxisome proliferators

The role of the peroxisome proliferator-activated receptor alpha (PPARalpha) in regulating hepatitis B virus (HBV) transcription and replication in vivo was investigated in an HBV transgenic mouse model. Treatment of HBV transgenic mice with the peroxisome proliferators Wy-14,643 and clofibric acid resulted in a less than twofold increase in HBV transcription rates and steady-state levels of HBV RNAs in the livers of these mice. In male mice, this increase in transcription was associated with a 2- to 3-fold increase in replication intermediates, whereas in female mice it was associated with a 7- to 14-fold increase in replication intermediates. The observed increases in transcription and replication were dependent on PPARalpha. HBV transgenic mice lacking this nuclear hormone receptor showed similar levels of HBV transcripts and replication intermediates as untreated HBV transgenic mice expressing PPARalpha but failed to demonstrate alterations in either RNA or DNA synthesis in response to peroxisome proliferators. Therefore, it appears that very modest alterations in transcription can, under certain circumstances, result in relatively large increases in HBV replication in HBV transgenic mice.

Freud's deshi: the coming of psychoanalysis to Japan

This paper presents an account of four Japanese men, three of whom had an audience with Freud and who, with differing experiences and ambitions, returned to Japan to practice and develop psychoanalysis. Only two received any formal training, and two were strongly influenced by Buddhist thought. Freud gave no clear sign as to whom to appoint as leader, leaving the situation unsettled. This may have contributed to the continuing split and rivalry between groups, a split which was not resolved until the formation of the Japanese Psychoanalytic Society for trained analysts and the Association for interested laymen in the 1950s. From the beginning the development of psychoanalysis in Japan was informed by a paradox: the need to get Freud's approval and hence appear orthodox, while assimilating some of the concepts to the dictates of the culture.

Characterization of adhesive interactions between human endothelial cells and megakaryocytes

Cell-cell adhesion is essential for many immunological functions and is believed to be important in the regulation of hematopoiesis. Adhesive interactions between human endothelial cells and megakaryocytes were characterized in vitro using the CMK megakaryocytic cell line as well as marrow megakaryocytes. Although there was no adhesion between unactivated human umbilical vein endothelial cells (HUVEC) and megakaryocytes, treatment of HUVEC with inflammatory cytokines such as IL-1 beta, tumor necrosis factor alpha, INF-gamma, or the phorbol ester phorbol myristate acetate (PMA) resulted in a time- and dose-dependent increase in adhesion. Stimulation of marrow megakaryocytes or CMK cells with the cytokines IL-1 beta, GM-CSF, IL-6, IL-3, or PMA augmented their adhesion to endothelium. Monoclonal antibodies against the LFA-1 subunit of the leukocyte adherence complex CD18 inhibited the binding of marrow megakaryocytes or CMK cells to HUVEC. Adhesion blocking experiments also demonstrated that the VLA-4/VCAM-1 pathway was important for megakaryocyte attachment to HUVEC. Adhesion promoted maturation of megakaryocytic cells as measured by increased expression of glycoproteins GpIb and GpIIb/IIIa and by increased DNA content. These observations suggest that alterations in megakaryocyte adhesion may occur during inflammatory conditions, mediated by certain cytokines, resulting in augmented megakaryocyte maturation.

Cytokine gene expression and synthesis by human megakaryocytic cells

Cytokine expression and production by human megakaryocytic cells were studied using the CMK cell line as a model for cytokine gene expression by cell line as a model for cytokine gene expression by polymerase chain reaction (PCR) and for cytokine protein synthesis by specific radioimmunoassays. CMK cells at all stages of maturation were found to constitutively express moderate mRNA levels for tumor necrosis factor (TNF-alpha), transforming growth factor beta (TGF-beta), interleukin (IL) 1 beta, and endothelial cell growth factor (ECGF) transcripts. After 6-h treatment with the phorbol ester PMA, gene expression for IL-1 alpha, granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-3, and the IL-6 receptor were increased. After 24 h of exposure to PMA, levels for most cytokines declined to baseline, except for IL-6 which appeared as a new transcript. PMA-stimulated CMK lines synthesized low levels of TNF-alpha and IL-6, and higher levels of GM-CSF, IL-1 beta, and IL-1 alpha protein. These observations suggest that cells of megakaryocytic lineage are capable of producing a repertoire of cytokines which could mediate an autocrine role as well as modulate the replication and function of other hematopoietic cells.

Electron microscopy of Hodgkin's disease tissue cultures

Cells from 9 monolayer tissue cultures prepared from Hodgkin's disease tumors in the spleen were examined in the electron microscope. Three established culture lines (carried in vitro for greater than 3 years and passaged greater than 200 times) that contained aneuploid karyotypes were composed of oval cells with numerous interdigitating surface microvilli. The nuclei were complex and convoluted with multiple large nucleoli and dispersed chromatin. The cytoplasm contained lysosomes, microfilaments, a complex Golgi apparatus, nondilated rough endoplasmic reticulum, polyribosomes, fat, and glycogen. One Hodgkin's disease monolayer with aneuploid chromosomes examined from the 4th to 48th passage in culture was composed of larger cells with fewer microvilli and numerous multinuclear giant cells. Two monolayers derived from transplanted tumors in nude mice inoculated with Hodgkin's disease cultured cells were similar to the original cell lines. The ultrastructural features of these 6 cultures with aneuploid karyotypes differed from those of 3 monolayers which, although prepared from Hodgkin's disease splenic tumors, were composed of fibroblastic cells with diploid chromosomes. The aneuploid Hodgkin's disease cultures did not resemble 6 normal spleen, thymus, or lung monolayers, Raji lymphoblastoid suspension cultures, or Hela cells. Our electron microscopic studies indicate that adherent cells which replicate in some monolayer tissue cultures derived from Hodgkin's disease tumors are related to and possibly derived from neoplastic macrophages.

Reaction of immune complexes with Hodgkin's disease tissue cultures: radioimmune assay and immunoferritin electron microscopy

We examined the binding of soluble immune complexes in sera from patients with Hodgkin's disease to established tissue cultures derived from the tumor. Circulating immune complex levels were determined by the Raji cell assay, and the reaction of serum with cultured cells was examined with a radioimmune assay and by immunoferritin electron microscopy. Serum with elevated immune complexes was found to react with cells of Hodgkin's disease monolayers when tested with radioiodine-labeled antisera against human IgG heavy and light chains and the complement 3 (C3) component. When examined with the electron microscope, monolayers incubated with Hodgkin's disease serum containing immune complex and labeled with ferritin-conjugated antiserum to C3 contained surface-bound ferritin particles with a uniform but discontinuous pattern. Absorption of Hodgkin's disease serum with monolayer cells reduced immune complexes and decreased reactivity of the sample with cultured cells by radioimmune assay. Sera of patients with other disorders and aggregated gamma-globulin with complement, despite markedly elevated immune complex levels, did not react positively with monolayers derived from Hodgkin's disease tumors, and none of the sera reacted with normal cultured spleen. The approximate size of serum components reacting with Hodgkin's disease monolayers was estimated by sucrose density gradient centrifugation. Sedimentation fractions in the 19S region reacted with monolayer cells when tested with 125I-labeled antisera to both IgG and C3 and contained immunoglobulin-complement complexes by gel diffusion and immunoabsorption. A component sedimenting at 7-9S contained immunoglobulin not complexed with complement; this component reacted with monolayer cells when tested with anti-IgG antiserum but did not react when tested with antibody to C3. The reaction of Hodgkin's disease monolayers with serum containing immune complexes differed from that of two suspension culture lines composed of cells with surface complement and IgG Fc receptors. Inasmuch as cells of our long-term Hodgkin's disease monolayers do not contain these surface receptors, possibly the antibody component of the immune complex reacts with antigens on the surface of cultured cells.