Prediction of urine volume soon after birth using serum cystatin C

Background

Urine volume is an important clinical finding particularly during the early neonatal period. Oliguria is not a sign of impaired renal function but also a predictive factor for various complications and prognoses. It has been postulated that serum cystatin C (S-CysC) is a more sensitive biomarker for renal function than serum creatinine (S-Cr) in both adults and children. The objective of the current study was to investigate whether urine volume during 24 h after birth can be predicted using S-CysC.

Methods

The subjects were 87 infants. The average gestational age was 34.7 ± 2.9 weeks and the average birth weight was 2135 ± 614 g. Blood samples were obtained from either the umbilical cord or the peripheral veins or artery of the newborn at birth. Data regarding the amount of urine volume and fluid intake during the first 24 h of life, maternal S-Cr and S-CysC levels within 48 h before delivery, and neonatal S-Cr and S-CysC levels at birth were collected from the medical records.

Results

A significantly positive correlation was observed between maternal and neonatal S-Cr levels (r = 0.84, p < 0.0001) but not between maternal S-Cr levels and neonatal S-CysC levels (r = ?0.069, p = 0.52). A significant negative correlation was seen between neonatal S-CysC levels and urine volume (r = ?0.47, p < 0.0001).

Conclusion

The present study findings indicate that it may be possible to use S-CysC levels at birth to predict urine volume during the first 24 h of life.

     

Hippocampal acetylcholine efflux increases during negative patterning and elemental discrimination in rats

The purpose of this paper is to examine whether hippocampal acetylcholine (ACh) efflux increases during negative patterning (NP) discrimination tasks. For these tasks, a rat's response was rewarded when either a single stimulus A (tone) or stimulus B (light) was presented, but was not rewarded when the compound stimulus AB (tone+light) was presented to the NP group of rats. An elemental discrimination (E) task was given to another group (E group). In the E group, the rat's response was rewarded when one of two stimuli (e.g., tone) was presented, but not rewarded when the other stimulus (e.g., light) was presented. After reaching a learning criterion, a guide cannula was implanted into dorsal hippocampus under anesthesia. In test sessions, rats were given the same task as before the guide cannula implantation, and ACh efflux was measured. Hippocampal ACh efflux increased during both NP and E tasks. In addition, the magnitude of increase was higher in the NP group than in the E group. Thus, over all our results demonstrate that task difficulty is a critical factor that relates to the difference in ACh efflux in the hippocampus.     

Successful thoracoscopic lobectomy for lung cancer in a patient with anatomic variation of the left inferior pulmonary vein

We present a case of primary lung cancer with a rare distribution pattern of left inferior pulmonary vein (PV), encountered in the thoracoscopic left lower lobectomy. Thoracoscopic observation revealed 2 trunks of inferior PV (ventral and dorsal branch) at the stem level. The ventral trunk consisted of a branch of vein (V(5)) from the lingular segment and venous ramifications (V(8)a, V(9) and V(10)a) from the basal segment. On the other hand, a branch of vein (V(6)) from the superior segment in the lower lobe and other veins (V(8)b and V(10)b + c) from the basal segment emptied together into the dorsal trunk. We successfully carried out a thoracoscopic left lower lobectomy without excision of the aberrant vein (V(5)). Retrospective review of the preoperative chest CT demonstrates the double trunk inferior PV and the aberrant lingular branch emptying with V(8)a into the ventral trunk. Knowledge of the branching variations of PV from preoperative evaluations leads to appropriate thoracoscopic procedures for lung cancer.     

A device guidance method for organ motion compensation in MRI-guided therapy

Organ motion compensation in image-guided therapy is an active area of research. However, there has been little research on motion tracking and compensation in magnetic resonance imaging (MRI)-guided therapy. In this paper, we present a method to track a moving organ in MRI and control an active mechanical device for motion compensation. The method proposed is based on MRI navigator echo tracking enhanced by Kalman filtering for noise robustness. We also developed an extrapolation scheme to resolve any discrepancies between tracking and device control sampling rates. The algorithm was tested in a simulation study using a phantom and an active mechanical tool holder. We found that the method is feasible to use in a clinical MRI scanner with sufficient accuracy (0.36 mm to 1.51 mm depending on the range of phantom motion) and is robust to noise. The method proposed may be useful in MRI-guided targeted therapy, such as focused ultrasound therapy for a moving organ.     

Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous-flow left ventricular-assist device support

Severe aortic insufficiency (AI) after implantation of continuous-flow left ventricular-assist device (LVAD) affects device performance and outcomes. However, the mechanism for the occurrence and progression of AI has not been elucidated. We investigated the impact of nonphysiological retrograde blood flow in the aortic root on AI after LVAD implantation. Blood flow pattern was analyzed in patients with and without AI (n = 3 each) who underwent LVAD implantation, by computational fluid dynamics with patient-specific geometries, which were reproduced using electrocardiogram-gated 320-slice computed tomographic images. The total volume of retrograde blood flow during one cardiac cycle (716 ± 88 mL) was higher and the volume of slow blood flow (<0.1 cm/s) (0.16 ± 0.04 cm³) was lower in patients with AI than in those without AI (360 ± 111 mL, P = .0495, and 0.49 ± 0.08 cm³, P = .0495, respectively). No significant difference in wall shear stress on the aortic valve was observed between the groups. Patients with AI had a perpendicular anastomosis at the distal ascending aorta and the simulation in the modified anastomosis model of patients with AI showed that the retrograde blood flow pattern depended on the angle and position of anastomosis. Computational fluid dynamics revealed strong retrograde blood flow in the ascending aorta and aortic root in patients with AI after LVAD implantation. The angle and position of LVAD outflow anastomosis might impact retrograde blood flow and de novo AI after LVAD implantation.     

The superior approach with the stomach roll-up technique improves intraoperative outcomes and facilitates learning laparoscopic distal pancreatectomy: a comparative study between the superior and inferior approach

Surgery Today - We introduced a superior approach and a unique technique to retract the stomach, called the “stomach roll-up technique”, to standardize laparoscopic distal...     

Screening and management for ischemic heart disease in patients undergoing emergency surgery for a type A acute aortic dissection

Purpose

We assessed the incidence of coronary artery disease (CAD) during hospitalization after emergency surgery for a type A acute aortic dissection.

Methods

A total of 123 patients underwent multi-slice computed tomography (MSCT) scans during an early stage after surgery. The patients were divided into two groups: group I consisted of 14 patients (11.4 %) who had coronary artery stenosis of more than 75 % on MSCT, and group II consisted of 109 patients (88.6 %) who had no coronary lesions.

Results

The prevalence of diabetes, dyslipidemia and a smoking history was significantly higher in group I. Although the serum low-density lipoprotein cholesterol levels were similar, the high-density lipoprotein cholesterol (HDL) level was significantly lower in group I (36.4 ± 7.9 mg/dl) than in group II (49.6 ± 13.5 mg/dl, P = 0.0005). The maximum carotid intima-media thickness (IMT) was significantly thicker in group I (1.17 ± 0.37 mm) compared to group II (0.96 ± 0.33 mm, P = 0.0297). The logistic regression analysis detected that a carotid IMT over 1.1 mm (odds ratio 4.35, P = 0.0371) and HDL less than 40 mg/dl (odds ratio 3.90, P = 0.0482) were predictors for CAD.

Conclusions

CAD screening should be recommended for patients with aortic dissection who have several atherosclerosis risk factors, even after emergency surgery.     

Needle tract implantation of hepatoblastoma after percutaneous needle biopsy: report of a case

A 13-year-old boy was referred to us for investigation of a giant liver mass, approximately 16 cm in diameter. Sonographically guided percutaneous needle biopsy was performed and histological examination revealed a fetal-type hepatoblastoma. After four courses of chemotherapy, we performed a left hepatic trisegmentectomy. Follow-up computed tomography, 55 months after the surgery, showed a 1-cm tumor on the route of the preoperative needle biopsy. A second laparotomy revealed a peritonealised tumor, which was excised. The histology of this tumor was identical to that of the primary hepatoblastoma. To our knowledge, this is only the second report of needle tract implantation of hepatoblastoma after percutaneous needle biopsy.