The effect of remimazolam on postoperative memory retention and delayed regeneration in breast surgery patients: Rationale and design of an exploratory,randomized, open,propofol-controlled,single-center clinical trial: A study protocol

Background:Remimazolam, a benzodiazepine ultra-short-acting sedative, has been used in general anesthesia since August 2020. It is used in awake surgeries that require awakening the patient in the middle of the surgery because of its rapid awakening effect as well as antagonistic interactions. If remimazolam has associated anterograde amnesia similar to benzodiazepines, it will have a positive effect on preventing psychological trauma. However, to our knowledge, the effect of remimazolam on anterograde amnesia has not been previously examined.Methods/design:The aim of this exploratory, open, propofol-controlled, single-center, randomized clinical trial is to examine the effect of remimazolam on postoperative memory retention and delayed regeneration. Seventy patients undergoing breast surgery will be included in the study. The patients will be randomly assigned to receive propofol or remimazolam as sedatives during surgery. The primary endpoint is the number of posters patients remember 24 hours after surgery (among 4 posters shown after awakening from anesthesia) as an assessment of anterograde amnesia. Secondary endpoints are retrograde amnesia, dose of analgesic given from the time the patient returns to the ward until 24 hours after surgery, immediate postoperative pain numerical rating scale scores, and pain numerical rating scale scores 24 hours after leaving the operating room. Recruitment will take place between October 2021 and March 2022 to achieve the target sample size.Discussion:To our knowledge, this is the first trial designed to examine the effects of remimazolam on postoperative memory retention and delayed regeneration in patients undergoing breast surgery.Trial registration:This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center on September 28, 2021 (UMIN-CTR: UMIN000045593).     

Formation of new corticorubral synapses as a mechanism for classical conditioning in the cat

An electron microscopic quantitative study of corticorubral synapses was performed in the cat which acquired classical conditioning. Conditioned stimulus was applied to the cerebral peduncle and the unconditioned stimulus was an electrical shock to the forelimb skin. The proportion of corticorubral synapses contacting with somata and proximal dendrite was increased after conditioning. It was suggested that collateral sprouting and the formation of new synapses underlie classical conditioning.     

Metastatic intradural extramedullary spinal cord tumor from ovarian cancer: A case report with a literature review

Context: Metastatic intradural extramedullary spinal cord tumors are extremely rare.Findings: A 76-year-old woman presented with intractable neck pain. Three years earlier, she had been treated for ovarian cancer with bilateral salpingo-oophorectomy. A year later, she underwent resection of a brain metastasis. Magnetic resonance imaging (MRI) showed an encapsulated intradural extramedullary mass at C4–C5. C4–C5 hemilaminectomy, tumor resection, and biopsy were performed. Histological examination of the resection revealed an adenocarcinoma. After surgery, her intolerable neck-shoulder pain was fully resolved, and she had no difficulties with daily living activities. However, two months later, she underwent gamma knife radiosurgery for the recurrent metastatic brain tumor, and four months later, she died from cachexia.Conclusion: Although cases of metastatic intradural extramedullary spinal tumors from ovarian cancer are extremely rare, their possibility should be considered in the differential diagnosis. A history of brain metastases and enhancement on T1-weighted MRI were helpful for making an accurate diagnosis.     

Bone trabecular pattern analysis in Down's syndrome with the use of computed panoramic tomography with a laser scan system. Quantitative analysis with the power spectrum method

A quantitative analysis of the mandibular bone trabeculae of 44 patients with Down's syndrome and 68 normal persons by means of panoramic tomography was performed with a laser scan system. The results showed that the normal persons exhibited a correlation between the trabecular pattern and aging, whereas the patients with Down's syndrome showed no such correlation. These findings were consistent with geromorphism, which is one of the systemic features of Down's syndrome.     

Loss of claudin-1 expression correlates with malignancy of hepatocellular carcinoma

BACKGROUND: The prognosis for the hepatocellular carcinoma (HCC) patient is affected by invasion and metastases. The attenuated expression of adherens junction protein epithelial-cadherin (E-cad) correlates with a more malignant potential in HCC. However, the potential of the claudin (CL) family of tight junctional proteins for HCC prognosis has remained unrecognized. MATERIALS AND METHODS: We immunohistochemically examined the expression of CL-1 and E-cad in resected specimens from 55 HCC cases. The percentage of CL-1- or E-cad-positive cells was counted in HCC cells and the surrounding hepatocytes and scored as 0 (0%), 1 (1-33%), 2 (34-66%), and 3 (67-100%). The expression of CL-1 or E-cad was considered "preserved" if the score in HCC was equal to or more than that in the surrounding hepatocytes, and "attenuated" if not so. RESULTS: In nontumorous tissue, CL-1 and E-cad were observed at the lateral surface of hepatocytes and biliary epithelial cells. In well-differentiated HCCs, the expression of CL-1 and E-cad was preserved in 12 of 14 cases. In poorly differentiated HCCs, E-cad expression was preserved in 9 of 18 cases, while CL-1 expression was preserved in only 4 cases (P<0.01 versus well-differentiated HCCs). HCCs with portal invasion showed significantly attenuated CL-1 expression than those without portal invasion (P<0.05). The survival rate after hepatectomy for HCC with attenuated CL-1 expression was significantly lower than that for HCC with preserved CL-1 expression. CONCLUSIONS: Attenuated expression of CL-1 closely correlates with the dedifferentiation and portal invasion of HCC. Down-regulated CL-1 expression may serve as a potential marker for a poor prognosis in HCC.     

Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis

OBJECTIVE: We placed temporary inferior vena cava filters to prevent pulmonary thromboembolism in patients with deep vein thrombosis (DVT) who were presumed to have an increased risk of pulmonary embolism in the perinatal period. These experiences of using temporary inferior vena cava filters in pregnant women are reported. METHODS: We reviewed 11 patients with DVT who underwent placement of a temporary inferior vena cava filter and delivered in our hospital between 1998 and 2004. All of the filters were placed at the suprarenal inferior vena cava before delivery. During filter placement, anticoagulant therapy was routinely performed, and we stopped the administration of anticoagulant agents intrapartum. RESULTS: No complications occurred at filter insertion or during placement. No symptomatic pulmonary thromboembolism occurred during or after delivery. All of the filters were successfully removed, one of which was exchanged for a permanent filter because the temporary filter captured a large thrombus. CONCLUSION: Intrapartum temporary inferior vena cava filters may reduce the incidence of pulmonary thromboembolism in pregnancy with DVT. Temporary inferior vena cava filters appear to be safe for pregnant women.