Sleep modulates cortical connectivity and excitability in humans: Direct evidence from neural activity induced by single‐pulse electrical stimulation

Sleep‐induced changes in human brain connectivity/excitability and their physiologic basis remain unclear, especially in the frontal lobe. We investigated sleep‐induced connectivity and excitability changes in 11 patients who underwent chronic implantation of subdural electrodes for epilepsy surgery. Single‐pulse electrical stimuli were directly injected to a part of the cortices, and cortico‐cortical evoked potentials (CCEPs) and CCEP‐related high‐gamma activities (HGA: 100–200 Hz) were recorded from adjacent and remote cortices as proxies of effective connectivity and induced neuronal activity, respectively. HGA power during the initial CCEP component (N1) correlated with the N1 size itself across all states investigated. The degree of cortical connectivity and excitability changed during sleep depending on sleep stage, approximately showing dichotomy of awake vs. non‐rapid eye movement (REM) [NREM] sleep. On the other hand, REM sleep partly had properties of both awake and NREM sleep, placing itself in the intermediate state between them. Compared with the awake state, single‐pulse stimulation especially during NREM sleep induced increased connectivity (N1 size) and neuronal excitability (HGA increase at N1), which was immediately followed by intense inhibition (HGA decrease). The HGA decrease was temporally followed by the N2 peak (the second CCEP component), and then by HGA re‐increase during sleep across all lobes. This HGA rebound or re‐increase of neuronal synchrony was largest in the frontal lobe compared with the other lobes. These properties of sleep‐induced changes of the cortex may be related to unconsciousness during sleep and frequent nocturnal seizures in frontal lobe epilepsy. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc .     

Evaluation of cholecystectomy in older individuals using real-world data: a multilevel analysis based on a nationwide administrative database in Japan

Journal of Gastroenterology - In the present study, we aimed to evaluate the clinical outcomes of cholecystectomy in older individuals. In this retrospective study, data from the Japanese Diagnosis...     

Assessment of cerebrovascular reserve with N-isopropyl-p-[123I]-iodoamphetamine time series analysis in patients with cerebrovascular disease

Using N-isopropyl-p-[¹²³I]-iodoamphetamine(¹²³I-IMP) and single-photon emission computed tomography (SPECT), the relationship between cerebrovascular reserve and the ¹²³I-IMP redistribution phenomenon was investigated.The 50 patients who matched the inclusion criteria were divided into control and ischemia groups, and the redistribution phenomenon was examined on resting images. The delayed images showed higher ¹²³I-IMP accumulation in lesions in the middle cerebral artery(MCA) area and anterior cerebral artery(ACA) area, these watershed areas in the ischemia group than in the control group, confirming that the redistribution phenomenon exists with statistical significance (Wilcoxon test; control group vs ischemic group in the ACA area[P = .002], ACA-MCA watershed area(P = .014), MCA area(P = .025), and MCA-posterior cerebral artery(PCA) watershed area(P = .002). The patients were then divided into 4 types according to the Kuroda grading system, and the difference in the redistribution phenomenon was investigated between type III and the other 3 types.Compared with type I and type II, type III had a significantly lower rate of decrease in the radioisotope (RI) count, verifying the redistribution phenomenon (Student t test: type I vs type III in the ACA area(P = .008), ACA-MCA watershed area(P = .009), MCA area(P < .001), and MCA-PCA watershed area(P = .002); type II vs type III in the ACA area(P = .004), ACA-MCA watershed area(P = .2575), MCA area(P < .001), and MCA-PCA watershed area(P < .001). No significant difference between type III and type IV was observed in any area [(Student t test: type III vs type IV in the ACA area(P = .07), ACA-MCA watershed area(P = .38), MCA area(P = .05), and MCA-PCA watershed area(P = .24)].The redistribution phenomenon is associated with resting cerebral blood flow (CBF), but not necessarily with cerebral vascular reactivity (CVR).     

A photochemical method for in vitro evaluation of fluid flow in human dentine

Objective

To evaluate the flow dynamics of dentine fluid using a chemiluminescence method in vitro.

Materials and methods

Horizontally sliced coronal dentine specimens with thicknesses of 1.4, 1.6, 1.8, and 2.0 mm (n = 10 each) were prepared from extracted human third molars. After cleaning with EDTA, a mounted specimen was clamped between 2 acrylic chambers attached to both the occlusal and pulpal sides. The occlusal chamber, which was closed with a glass coverslip, was filled with a chemiluminescent solution (0.02% luminol and 1% sodium hydroxide in water). A trigger solution of 1% hydrogen peroxide and 1% potassium ferricyanide was injected into the pulpal chamber at a constant pressure of 2.5 kPa, and allowed to immediately flow into the patent dentinal tubules. Four consecutive measurements (T1–T4) were performed on each sample by recording the emission of chemiluminescence with a photodetector. The relationship between the crossing time of the liquid through the slice and dentine thickness was examined.

Results

An apparent time delay was detected between the starting points of the trigger solution run and photochemical emission at T1. Dt (Dt, s) values of each thickness group were 13.6 ± 4.25 for 1.4 mm, 18.1 ± 2.38 for 1.6 mm, 28.0 ± 2.46 for 1.8 mm, and 39.2 ± 8.61 for 2.0 mm, respectively. Dt significantly decreased as dentine became thinner towards the pulp chamber (P < 0.001).

Conclusions

The velocity of fluid flow increased both with increasing dentine depth or reduction of remaining dentine thickness.     

Myocardial alpha 1-adrenoceptors mediate positive inotropic effect and changes in phosphatidylinositol metabolism. Species differences in receptor distribution and the intracellular coupling process in mammalian ventricular myocardium.

Species-dependent variations of myocardial alpha 1-adrenoceptor-mediated positive inotropic effects of epinephrine were assessed in relation to characteristics of alpha 1-receptor bindings and acceleration of phosphatidylinositol metabolism in the isolated rat, rabbit, and dog ventricular myocardium. Epinephrine in the presence of the beta-adrenoceptor antagonist bupranolol (10(-6) M) elicited a positive inotropic effect through activation of alpha 1-adrenoceptors in rat and rabbit, whereas in dog ventricular myocardium, bupranolol abolished the positive inotropic effect of epinephrine. [3H]Prazosin bound to membrane fractions derived from rat, rabbit, and dog ventricular muscle with high affinities in a saturable and reversible manner. In dog, Bmax and Kd values of alpha 1-adrenoceptor binding sites were identical to those in rabbit ventricular muscle. The Bmax value of alpha 1-adrenoceptors in rat ventricle was the highest, amounting to two to four times those in rabbit and dog. Epinephrine displacement curves for the specific binding of [3H]prazosin in the membrane fraction of these species showed high and low affinity sites with slope factors significantly less than unity, which were shifted to single low affinity sites with slope factors close to unity by addition of 5'-guanylylimidodiphosphate. Accumulation of [3H]inositol 1-phosphate [( 3H]IP1) in ventricular slices prelabeled with [3H]myo-inositol was increased by epinephrine in a time- and concentration-dependent manner in rat ventricular slices. [3H]IP1 accumulation likewise was facilitated by alpha 1-adrenoceptor stimulation in rabbit ventricular slices, whereas the extent of [3H]IP1 accumulation was much less than that in rat. In dog ventricular slices, [3H]IP1 was not accumulated by epinephrine. In rabbit papillary muscle, the time course of increase in contractile force induced by alpha-adrenoceptors coincided with the prolongation of the action potential duration with a similar time course, which is in strong contrast to previous findings in rat that the contractile response was dissociated from the electrophysiological response to alpha-adrenoceptor stimulation. The present results indicate that a wide range of variation of alpha 1-adrenoceptor-mediated regulation of myocardial contractility may be ascribed to different contributions of facilitatory as well as inhibitory regulatory processes that lead to intracellular Ca2+ mobilization subsequent to myocardial alpha 1-adrenoceptor activation among mammalian species.     

Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study

Purpose

Despite extensive research on enteral nutrition (EN) for patients in shock, it remains unclear whether this should be postponed in patients with cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). In this study, we aimed to compare outcomes of early and delayed EN for patients with cardiogenic or obstructive shock requiring VA-ECMO.

Methods

In this retrospective database study drawing on the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016, we identified patients with cardiogenic or obstructive shock who had received VA-ECMO for more than 2 days. We allocated the patients to two groups: those who received EN within 2 days (early) or 3 days or more (delayed) after starting VA-ECMO. We then used a marginal structural model to analyze associations between early EN and various outcomes, including in-hospital mortality and 28-day mortality.

Results

We identified 1769 eligible patients during the 69-month study period, 220 of whom (12%) received early EN. After using a marginal structural model to adjust for baseline and time-dependent confounders, we found that the early EN group showed significantly lower in-hospital mortality [hazard ratio 0.78, 95% confidence interval (95% CI) 0.62–0.98, P?=?0.032] and lower 28-day mortality (hazard ratio 0.74, 95% CI 0.56–0.97, P?=?0.031) than the delayed EN group.

Conclusions

According to this retrospective database study, early EN is not associated with harm but rather with lower mortality in patients with cardiogenic or obstructive shock requiring at least 2 days of VA-ECMO.

     

Variations in the preoperative resources use and the practice pattern in Japanese cholecystectomy patients

Purpose  

There are several preoperative treatment options, such as the staged bile duct intervention (BDI), for the successful completion of a cholecystectomy, regardless of the use of an open cholecystectomy (OC) or a laparoscopic cholecystectomy (LC). However, few studies have investigated how the characteristics of the patient or the hospital affect the preoperative resource use. This study determined the factors, including the hospital characteristics, associated with the preoperative resource utilization or with the treatment process.     

A case of small cell carcinoma of the kidney

A 47-year-old man had a retroperitoneal tumor measuring 18 cm in maximum diameter of the left kidney that was diagnosed with computed tomography (CT)-guided needle biopsy as small cell carcinoma. Microscopically, the tumor cells showed immunohistochemical reaction for neural cell adhesion molecule antibodies. This patient with advanced renal small cell carcinoma and multiple metastatic lesions was treated with the first-line combination chemotherapy of cisplatin, etoposide and ifosphamide, which showed a partial response of primary renal tumor and a complete response of liver metastasis, and with the second-line chemotherapy of cisplatin and irinotecan, which showed a complete response of Virchow's nodal metastasis. Thereafter, in spite of salvage chemotherapy of amurubicin hydrochloride for persistent and refractory renal small cell carcinoma, he died 32 months after the first presentation due to local progression. However, combination chemotherapy of these anticancer agents made his prognosis more favorable than we expected before treatment. The extrapulmonary small cell carcinomas are generally known to be more aggressive and malignant than the lung small cell carcinomas, and small cell carcinoma arising from the kidney is an extremely rare malignant neoplasm, with only 34 cases reported in the English or Japanese literature. The prognosis of renal small cell carcinomas is currently limited as compared with the lung small cell carcinomas, and therefore a cumulative investigation of a larger number of cases treated with multidisciplinary modalities including combination chemotherapy is necessary.     

Development of clinical pharmacy services to improve drug adherence in psychiatric hospital patients

In the present study, we investigated whether the pharmacy services in our psychiatric hospital helped to improve the attitude of psychiatric patients to drugs. The subjects were 168 patients who received advice on medication at the hospital between August 2008 and December 2009. We found that anxiety about medication in 76% of these patients was relieved by the provision of clinical pharmacy services. This can be attributed to patients gaining an understanding of the importance of taking medication at a particular time, drug types, drug efficacy and drug-induced adverse events. Patient drug adherence scores using the 10-item version of the Drug Attitude Inventory (DAI-10) were significantly improved after pharmacy services were provided, indicating an improvement in drug adherence. There was a significant positive correlation between the DAI-10 score and understanding of the necessity for medication, but no correlation between the DAI-10 score and the amount of drug administered or number of doses taken per day. These results suggest that the clinical pharmacy services improve understanding of the importance of medication timing, drug type, drug efficacy and drug-induced adverse events, and also relieve medication anxiety, enhance understanding of the necessity of taking medication and improve patient attitude to a drug. We intend to further take comprehensive measures including educational, behavioral and emotional intervention.