Subarachnoid hemorrhage causing cardiopulmonary arrest: resuscitation profiles and outcomes

Aneurysmal subarachnoid hemorrhage (SAH) is a common cause of cardiopulmonary arrest (CPA). The outcomes of SAH patients presenting with CPA are extremely poor, and long-term survivors have occasionally been reported, but the circumstances under which SAH-CPA patients achieve long-term survival are unclear. Neurosurgeons will have to determine whether a SAH-CPA patient is brain-dead or not more often after enactment of the revised Organ Transplantation Act. Prediction of survival length may be important not only to neurosurgeons, but also to the transplantation team. A retrospective study was conducted to elucidate how often brainstem function was recovered in resuscitated SAH-CPA patients and whether the recovery was associated with longer survival. Among 315 patients with non-traumatic SAH admitted to our institution during 6 years, 35 (11%) presented with CPA. Ventricular fibrillation (VF) as initial cardiac rhythm was rare, observed only in 1 patient. The survival length ranged from 1 to 15 days (mean 3.5 ± 0.7 days), and none achieved long-term survival. Return of brainstem function, represented by spontaneous respiration and/or reactive pupils, was observed in 6 patients (17%), but was only partial and transient. Cardiac arrest to return of spontaneous circulation interval tended to be shorter in patients with transient recovery of the brainstem function than in those without recovery. However, the survival length was not significantly different between the two groups. In addition to the 35 SAH-CPA patients, another 44 SAH patients lost both brainstem reflexes and spontaneous respiration within 72 hours of admission. As a result, 79 (25%) of the 315 SAH patients were considered to have sustained fatal, irreversible brain damage. Review of previous experience suggests that SAH-CPA patients may survive only if the cause of cardiac arrest is VF and not brainstem damage/respiratory arrest. Approximately one-third of resuscitated SAH-CPA patients may die within 24 hours of arrival, for whom the declaration of brain death may be difficult.     

A Focal Mass-Forming Autoimmune Pancreatitis Mimicking Pancreatic Cancer with Obstruction of the Main Pancreatic Duct

Introduction and background  

Autoimmune pancreatitis (AIP) is a rare disease that closely mimics pancreatic cancer (PC) in its presentation. It is very important for clinicians to distinguish one from the other because their treatment and prognosis are vastly different. Typical radiological imaging findings, in particular observation of diffusely or segmentally narrowed main pancreatic duct (MPD) with an irregular wall by endoscopic retrograde cholangiopancreatography (ERCP), are essential for making the diagnosis of AIP. On the other hand, MPD obstruction is one of the most frequent features on ERCP.     

Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema

Measurement of the circumference is the most commonly used method for evaluating extremity lymphedema. However, comparison between different patients is difficult with this measurement. To resolve this problem, we have formulated a new index, lower extremity lymphedema (LEL) index, which can be easily obtained from measurements of the body. We evaluated correlation between lower LEL index and clinical stage in patients with LEL. The LEL indices were significantly correlated with clinical stages and could be used as a severity scale. The LEL index makes objective assessment of the severity of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the index useful for evaluation of lymphedema severities between different cases.     

Involvement of mouse μ-opioid receptor splice variants in the spinal antinociception induced by the dermorphin tetrapeptide analog amidino-TAPA

The involvement of the mouse μ-opioid receptor (mMOR-1) splice variants in the antinociceptive effect of intrathecally (i.t.) administered N(α)-amidino-Tyr-D-Arg-Phe-β-Ala (amidino-TAPA) and [D-Ala(2),N-MePhe(4),Gly-ol(5)]enkephalin (DAMGO) was investigated in mice by monitoring the recovery from acute antinociceptive tolerance to amidino-TAPA and DAMGO. A single i.t. pretreatment with DAMGO produced an acute antinociceptive tolerance, which peaked at 2h and disappeared within 5h after the pretreatment. In contrast, a single i.t. pretreatment with amidino-TAPA produced an acute antinociceptive tolerance, which disappeared within 3h after the pretreatment. The concomitant i.t. pretreatment with an antisense oligodeoxynucleotide (ODN) for exon-1, exon-12, exon-13 or exon-14 of mMOR-1 maintained the acute antinociceptive tolerance to amidino-TAPA for 24h after the pretreatment. On the other hand, the concomitant i.t. pretreatment with an antisense ODN for exon-1 of mMOR-1, but not an antisense ODN for exon-12, exon-13 or exon-14 of mMOR-1, maintained the acute antinociceptive tolerance to DAMGO for 24h after the pretreatment. The present results suggest that the spinal antinociception of amidino-TAPA is partially mediated through the activation of the amidino-TAPA-sensitive and DAMGO-insensitive mMOR-1 splice variants MOR-1J, MOR-1K and MOR-1L, which contain the sequence encoded by exon-12, exon-13 and exon-14, respectively.     

Phosphorylation and activation of cell division cycle associated 8 by aurora kinase B plays a significant role in human lung carcinogenesis

Through genome-wide gene expression analysis of lung carcinomas, we detected in the great majority of lung cancer samples cotransactivation of cell division cycle associated 8 (CDCA8) and aurora kinase B (AURKB), which were considered to be components of the vertebrate chromosomal passenger complex. Immunohistochemical analysis of lung cancer tissue microarrays showed that overexpression of CDCA8 and AURKB was significantly associated with poor prognosis of lung cancer patients. AURKB directly phosphorylated CDCA8 at Ser(154), Ser(219), Ser(275), and Thr(278) and seemed to stabilize CDCA8 protein in cancer cells. Suppression of CDCA8 expression with small interfering RNA against CDCA8 significantly suppressed the growth of lung cancer cells. In addition, functional inhibition of interaction between CDCA8 and AURKB by a cell-permeable peptide corresponding to 20-amino acid sequence of a part of CDCA8 (11R-CDCA8(261-280)), which included two phosphorylation sites by AURKB, significantly reduced phosphorylation of CDCA8 and resulted in growth suppression of lung cancer cells. Our data imply that selective suppression of the CDCA8-AURKB pathway could be a promising therapeutic strategy for treatment of lung cancer patients.     

Redox regulation of neuronal survival mediated by electrophilic compounds

The importance of phosphorylation of key threonine, serine and tyrosine residues is a well known essential feature of many signal transduction pathways. A similar, highly conserved redox reaction involving cysteine thiols is now emerging as an important regulator of protein function. An example of this redox regulation is S-nitrosylation (the transfer of a nitric oxide group to a key protein thiol). Here, we review the chemical biology of an additional class of drugs, electrophiles (electron-deficient carbon centers), that react with key protein thiols, and provide insights into a broader class of reactions implicated in redox signaling. Interestingly, certain electrophilic compounds, including endogenous metabolites and natural products, seem to have neuroprotective effects, and this has resulted in the development of neuroprotective electrophilic drugs, including prostaglandin derivatives and hydroquinones, that exert their action through activating antioxidant-signaling cascades.     

A case report of the effect of acetate-free biofiltration on arrhythmia in a hemodialysis patient

This case report concerns a hemodialysis patient with arrhythmia. A 71-year-old man had undergone hemodiafiltration (HDF) for 17 years for the treatment of chronic glomerulonephritis. Because of repeated heart failure and chronic atrial fibrillation, he could not continue receiving standard hemodialysis, which is hemodialysis using bicarbonate dialysate including a small amount of acetate. Neither elevating the sodium concentration of the dialysate nor changing the HDF modality was effective. Acetate-free biofiltration (AFB) was initiated and this treatment dramatically ameliorated the patient's intradialytic acute hypotension and arrhythmia. The patient's quality of life subsequently improved and his scores on the Short-form 36 questionnaire (a measure of quality of life) increased. AFB is an HDF technique based on the continuous postdilution infusion of a sterile isotonic bicarbonate solution. Previous studies have reported that acetate induces chemical cytokines and vasodilator substances. AFB may be effective for preventing acute hypotension and arrhythmia during dialysis and may improve quality of life, including mental status.