The effect of celiac plexus block on heart rate variability

Background

Celiac plexus block (CPB) can be used for treating intra-abdominal visceral pain syndromes. The celiac plexus is the largest plexus of the sympathetic nervous system. Several nerve blocks have a marked effect on autonomic nervous activity. Furthermore, stellate ganglion block changes cardiac autonomic nervous activity. Thus, CPB could influence the sympathetic activity of the cardiac plexus. The aim of the present study was to see whether CPB modulated heart rate variability (HRV) in patients with pancreatic cancer.

Methods

Twelve patients received neurolytic CPB using 14 ml absolute alcohol. Data recorded in a palm-sized electrocardiographic unit were analyzed for HRV.

Results

CPB using a neurolytic solution did not induce any significant changes in the low-frequency (LF)/high-frequency (HF) ratio of HRV (LF/HF, P = 0.4642). Furthermore, the procedure did not induce any significant changes in blood pressure (systolic, P = 0.5051; diastolic, P = 0.5180).

Conclusion

CPB did not induce any significant changes in HRV or hemodynamics.     

Aortic arch thrombosis in the neonate

Aortic arch thrombosis (AAT) of the neonate is rare but life-threatening by fatal compromise associated with thrombotic obstruction of the ascending aorta. We report a neonate with AAT who demonstrated a severe coarctation of the aorta and cerebral hypo-perfusion immediately after birth. Echocardiography confirmed the diagnosis of AAT on the findings of a large thrombus located on the transverse arch and blocking the cervical arterial branches. Low-molecular-weight heparin reduced the size of the thrombus and improved the hemodynamics of coarctation and cerebral perfusion. Echocardiography is a powerful tool to make a diagnosis and to monitor the size and regression of AAT.     

A tie-over with “untied” parallel stitches: A useful technique for fixation of a bolster after treatment of cryptotia

We describe a new technique for the treatment of cryptotia by which stitches for bolster fixation are inserted parallel to the auriculartemporal sulcus and temporarily left untied. After the bolster has been inserted into the temporal sulcus, the corresponding ends of the threads are tied to each other. Our technique is easy to use and secures a firm bolster fixation, and we recommend it for the treatment of cryptotia.     

Capillary filling analysis by digital subtraction angiography for vertebro-basilar insufficiency

Abstract

Vertebro-basilar insufficiency (VBI) is a vague clinical entity including several symptoms such as faintnessdizziness, vertigo. Millikan and Siekert reported a ‘syndrome of intermittent insufficiency of basilar arterial system'1. But vascular abnormalities responsible for such symptoms are often hardly diagnosed by conventional angiography, because vertebro-basilar artery systems have many kinds of anomalous congenital origins2. Conventional angiography gives us arterial informations such as stenosis, occlusion and malformationsbut it often fails to reveal capillary perfusions because of its relatively poor density resolution. Digital subtraction angiography (DSA) is considered to have improved density resolutioni, and it may enable us to detect vascular perfusions more sensitively in the capillary phase. In this study, we evaluated the usefulness of the capillary filling analysis in digital subtraction angiography for diagnosis of VBI.     

Brain perfusion asymmetry in patients with oral somatic delusions

Oral cenesthopathy is a somatic delusion or hallucination involving the oral area and is categorized as a delusional disorder, somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.     

Influence of oxygen inhibition on the surface free energy and enamel bond strength of self-etch adhesives

We compared the surface free energies and enamel bond strengths of single-step self-etch adhesives with and without an oxygen-inhibited layer. The adhesives were applied to the enamel surfaces of bovine incisors, light irradiated, and the oxygen-inhibited layer was either retained or removed with ethanol. The surface free energies and their components (γ(S)(LW), γ(S)(+), and γ(S)(-)) were determined by measuring the contact angles of three test liquids placed on the cured adhesives. The enamel bond strengths of specimens with and without the oxygen-inhibited layer were measured. For all surfaces, the value of the estimated surface tension component γ(S)(LW) was relatively constant. The value of the γ(S)(+) component increased slightly when the oxygen-inhibited layer was removed, whereas that of the γ(S)(-) component decreased significantly. The enamel bond strengths of the self-etch adhesives were significantly lower in the specimens without an oxygen-inhibited layer. The oxygen-inhibited layer therefore appeared to promote higher enamel bond strength.     

Amphipathic helical peptide-based fluorogenic probes for a marker-free analysis of exosomes based on membrane-curvature sensing

With increasing knowledge about the diverse roles of exosomes in the biological process, much attention has been paid to develop analytical methods for detection and quantification of exosomes. Immunoassays based on the recognition of exosomal protein markers by antibodies were widely used. However, considering that exosomal protein composition varies with the cell type, the protein markers should be carefully selected for a sensitive and selective analysis of target exosomes. Herein, we developed a new class of exosome-binding fluorogenic probes based on membrane curvature (MC) sensing of amphipathic helical (AH) peptides for exosome analysis without the need to use protein markers on the exosomal membranes. The C-terminal region of apolipoprotein A-I labeled with Nile red (ApoC-NR) exhibited a significant fluorescence enhancement upon selective binding to the highly curved membranes of synthetic vesicles. Circular dichroism (CD) measurements involving 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC)/1-2-dioleoyl-sn-glycerol (DOG) vesicles suggested that ApoC-NR recognizes the lipid packing defects in the surface of highly curved membranes via the hydrophobic insertion of the α-helix structure of the ApoC unit. ApoC-NR exhibited a stronger binding affinity for exosome-sized vesicles and a higher MC selectivity compared to all other previously reported peptide probes. ApoC-NR can be used in a simple and rapid “mix and read” analysis of various kinds of exosomes derived from different cell types (limit of detection: –10⁵ particles/μL) without being influenced by the variation in the expression of the surface proteins of the exosomes, which stands in sharp contrast to immunoassays.

Fluorogenic probes based on membrane curvature sensing-amphipathic helical peptides have been developed for a marker-free exosome analysis.