Gastric intramucosal perfusion during descending aortic repair under femoro-femoral bypass

The changes in gastric mucosal perfusion during distal aortic perfusion with femoro-femoral bypass (F-F bypass) were assessed by air-automated gastric tonometry. A prospective study was performed in six patients who underwent descending aortic surgery for aortic aneurysm under F-F bypass with mild hypothermia (34 degrees C). Gastric intramucosal pH (pHi) and PaCO2-PgCO2 gap (PCO2 gap) were measured. Data are presented as means and standard deviations and analyzed by using one-way analysis of variance followed by Scheffe test. Perioperative variables of hepatorenal functions are also evaluated. The PCO2 gap significantly increased during F-F bypass (3.0 +/- 2.1 mm Hg at control, 14.2 +/- 5.5 mm Hg during F-F bypass; p = 0.004), indicating abnormal gastric mucosal perfusion during F-F bypass. Significantly low pHi was found at weaning from F-F bypass (7.35 +/- 0.05 at control, 7.21 +/- 0.10 at weaning; p = 0.009), which might be related to progressing systemic metabolic acidosis. No impairment of hepatorenal functions was observed after the surgery. Distal perfusion with F-F bypass during descending aortic surgery could impair the gastric mucosal perfusion, but may have little effect on postoperative visceral dysfunction.     

Endovascular Treatment of Spontaneous Isolated Dissecting Aneurysm of the Superior Mesenteric Artery Using Stent-Assisted Coil Embolization

Spontaneous isolated dissecting aneurysm of the main trunk of the superior mesenteric artery is a rare condition. We treated a patient with this condition successfully by stent-assisted coil embolization. Intravascular stent placement may widen the indications for endovascular coiling of the aneurysmal false lumen to avoid perforation.     

Semiology of hyperkinetic seizures of frontal versus temporal lobe origin

Aims. Hyperkinetic seizures are usually associated with frontal lobe epilepsy. However, some patients have hyperkinetic seizures of temporal lobe origin. The semiological differences in hyperkinetic seizures between frontal and temporal lobe epilepsy have not been well studied. Here, we retrospectively assessed ictal semiology in order to distinguish between hyperkinetic seizures of frontal lobe origin and those of temporal lobe origin. Methods. We retrospectively reviewed data on patients who had undergone surgery for hyperkinetic seizures of temporal or frontal lobe origin and achieved favourable seizure outcomes (Engel Class I) with a minimum postoperative follow‐up of 24 months. We reviewed seizure histories, imaging reports, video‐EEG monitoring data, operative records, and pathological findings. We analysed and compared the hyperkinetic semiology of video‐recorded seizures of temporal lobe origin and those of frontal lobe origin. Results. Forty hyperkinetic seizures in eight patients (seven adult patients and one 12‐year‐old patient) with temporal lobe epilepsy and 45 hyperkinetic seizures in nine patients (eight adult patients and one 16‐year‐old patient) with frontal lobe epilepsy were analysed. Emotional facial expressions (such as fear, laughing, or anger), bilateral forceful elbow flexion, bilateral forceful grasping, facial flushing, and bilateral facial contraction were observed significantly more frequently in seizures of frontal lobe origin. Oroalimentary automatisms, seizures during wakefulness, salivation, and bilateral drop of the corners of the mouth were observed significantly more frequently in seizures of temporal lobe origin. Conclusions. Observation of a number of signs during hyperkinetic manifestations may help to predict whether a seizure originates from the frontal lobe or the temporal lobe.     

Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10–20 mm in diameter

International Urology and Nephrology - We investigated the clinical efficacy of the Triple D score (TrD-S) on stone-free rate (SFR) prediction following shockwave lithotripsy (SWL) for renal stones...     

Involvement of p38MAPK in Impaired Neutrophil Bactericidal Activity of Hemodialysis Patients

Mortality from infections has been reported to be higher in hemodialysis (HD) patients. Although dysfunction of neutrophils against bacterial infection was reported in HD patients, the precise mechanism remains to be clarified. We therefore examined the impacts of neutrophil inflammatory signaling on bactericidal activity in HD patients. Comprehensive analyses of intracellular signalings were performed in whole blood of HD patients and control using a microarray system. To confirm the contribution of the signaling to bactericidal activity in neutrophils, we examined the phosphorylation, bacterial killing function, reactive oxygen species (ROS) production, and myeloperoxidase (MPO) release in neutrophils against Staphylococcus aureus. RNA microarray analysis showed the suppression of p38 mitogen activated protein kinase (MAPK) signaling in HD patients. Neutrophils in HD patients showed the impairment of bactericidal activity against S. aureus compared to healthy subjects. Phosphorylation rate of p38MAPK of neutrophils in response to S. aureus was lower in HD patients than healthy subjects. The levels of ROS produced by neutrophils after co‐culture with S. aureus were lower in HD patients, on the other hand, there was no difference of MPO release between HD patients and healthy subjects. A selective pharmacological inhibitor of p38MAPK suppressed bacterial killing function as well as ROS production in neutrophils of healthy subjects. Impairment of p38MAPK signaling pathway might contribute to the suppression of neutrophil bactericidal activity in HD patients through less production of ROS.     

Anesthetic management and associated complications of peroral endoscopic myotomy:A case series

AIM To investigate the anesthetic management of peroral endoscopic myotomy(POEM) and its associated complications.METHODS This study was a single-center,retrospective,observational study comprising a case series of all patients who underwent POEM in our hospital from April 2015 to November 2016.We collected data regarding patient characteristics,anesthetic methods,surgical factors,and complications using an electronic chart.RESULTS There were 86 patients who underwent POEM in our hospital during the study period.Preoperatively,patients were maintained on a low residue diet for 48 h prior to the procedure.They were fasted of solids for 24 h before surgery.There was one case of aspiration(1.2%).During POEM,patients were positioned supine with the upper abdomen covered by a clear drape so that pneumoperitoneum could be timeously identified.In three cases,the peak airway pressure exceeded 35 cm H2 O during volume controlled ventilation with tidal volumes of 6-8 m L/kg and subsequent impairment of ventilation.These cases had been diagnosed with spastic esophageal disorders(SEDs) and the length of the muscular incision on the esophageal side was longer than normal.CONCLUSION In the anesthetic management of POEM,it is important to prevent aspiration during induction of anesthesia and to identify and treat complications associated with CO_2 insufflation.     

Association between tear film break up time and blink interval in visual display terminal users

AIM: To investigate the association between tear film break up time (TBUT) and blinking interval in visual display terminal (VDT) users. METHODS: Nine hundred and thirty VDT users underwent dry eye testing, and functional visual acuity (FVA) test. The blinking interval during FVA was compared with TBUT. Subjects with longer blinking interval than TBUT were considered as unstable tear film. Logistic regression analysis revealed the risk factors for unstable tear group. RESULTS: Among 930 workers, 858 subjects (92.3%) participated in this study. Almost 80% of the subjects were categorized into the unstable tear group. Unstable tear group has significantly lower Schirmer values and TBUT (17.5±11.6 vs 21.1±11.5 mm, 3.7±2.6 vs 5.7±2.7s, both P<0.001). There were no significant differences in epithelial staining or severity of symptoms. Logistic regression showed that over 40y was a risk for being unstable tear group [odds ratio (OR)=1.53; 95% confidence interval (CI)=1.06-2.20]. Contact lens use was protective factor for being in the unstable tear group (OR=0.37; 95%CI= 0.26-0.53). CONCLUSION: Subjects with shorter TBUT than blinking interval are prevalent among VDT users. Subjects over the age of 40 shows an increased risk for unstable tear film.     

Establishment and characterization of a novel neuroendocrine carcinoma cell line derived from a human ascending colon tumor

The incidence of rare neuroendocrine tumors (NET) is rapidly increasing. Neuroendocrine carcinoma (NEC) is a NET with poorly differentiated histological features, high proliferative properties and associated poor prognoses. As these carcinomas are so rare and, thus, affect only a small number of patients allowing for few cell lines to be derived from patient biopsies, the histological, immunohistochemical, and clinical characteristics associated with colorectal NEC and NEC in other organs have yet to be clearly defined. Herein, we describe the establishment of a novel NEC cell line (SS‐2) derived from a tumor resection of the ascending colon from a 59‐year‐old Japanese woman. The histological, electron microscopic and immunohistochemical features of chromogranin A (CgA) as well as confirmation of synaptophysin positivity in this tumor were typical of those commonly observed in surgically resected colorectal NEC. Further, the Ki‐67 labeling index of the resected tumor was >20% and, thus, the tumor was diagnosed as an NEC of the ascending colon. The SS‐2 cell line maintained characteristic features to those of the resected tumor, which were further retained following implantation into subcutaneous tissues of nude mice. Additionally, when SS‐2 cells were seeded into ultra‐low attachment plates, they formed spheres that expressed higher levels of the cancer stem cell (CSC) marker CD133 compared to SS‐2 cells cultured under adherent conditions. SS‐2 cells may, therefore, contribute to the current knowledge on midgut NEC biological function while providing a novel platform for examining the effects of colorectal NEC drugs, including CSC.