Aim. The study assessed the usefulness of a recently developed method for respiratory rate (RR) monitoring in patients undergoing endoscopic submucosal dissection (ESD) under deep sedation. Methods. ...Study subjects comprised 182 consecutive patients with esophageal cancer or gastric cancer undergoing ESD. The usefulness of acoustic RR monitoring was assessed by retrospectively reviewing the patients’ records for age, gender, height, weight, past history, serum creatinine, RR before ESD, and total dose of sedative. Results. Respiratory suppression was present in 37.9% of (69/182) patients. Continuous monitoring of RR led to detection of respiratory suppression in all these patients. RR alone was decreased in 24 patients, whereas both RR and blood oxygen saturation were decreased in 45 patients. Univariate analysis showed female gender, height, weight, and RR before treatment to be significantly associated with respiratory suppression. Multivariate analysis showed RR before treatment to be the only significant independent predictor odds ratio (OR) 0.83, 95% confidence interval (CI) 0.73–0.95, and P=0.006 of respiratory suppression. Conclusion. In this study, the difference in RR before treatment between patients with and without respiratory suppression was subtle. Therefore, we suggest that acoustic RR monitoring should be considered in patients undergoing ESD under sedation to prevent serious respiratory complications.
Purpose
Previous in vitro studies have shown that degradation of opioid peptides during incubation with cerebral membrane preparations is almost completely prevented by a mixture of three peptidase ...inhibitors (PIs), namely, amastatin, captopril, and phosphoramidon. In the present in vivo study, we evaluate the effects of intrathecal administration of these PIs on antinociception by Met
5
enkephalin (ME) or PIs themselves.
Methods
Drugs were administered into the thoracolumbar level of the spinal cord in the intrathecal space in rat. Induction of antinociception was measured by the tail immersion assay, with 55 °C as the nociceptive stimulus. Effects of PIs on antinociception were evaluated by dose–response study (ME, 1–20 nmol; PIs, 1–20 nmol each), by comparison of differences among two combinations of PIs (amastatin and captopril; captopril and phosphoramidon; amastatin and phosphoramidon) and three PIs (amastatin, captopril, and phosphoramidon), and by using opioid receptor selective antagonists.
Results
Intrathecal administration of ME with these three PIs or PIs alone significantly and dose dependently increased antinociception in a μ- and δ-opioid receptor antagonist-reversible manner; moreover, the degree of antinociception with a combination of any two of these was less than that with all three, indicating that any residual single peptidase could inactivate significant amounts of ME.
Conclusion
The present data, together with those of earlier studies, clearly demonstrate that amastatin-, captopril-, and phosphoramidon-sensitive enzymes play an important role in inactivation of opioid peptides at the spinal level.
Colorectal cancer is the third most common cancer worldwide with nearly 2 million cases per year. Immune cells and inflammation are a critical component of colorectal cancer progression, and they are ...used as reliable prognostic indicators of patient outcome. With the growing appreciation for immunology in colorectal cancer, interest is growing on the role γδ T cells have to play, as they represent one of the most prominent immune cell populations in gut tissue. This group of cells consists of both resident populations—γδ intraepithelial lymphocytes (γδ IELs)—and transient populations that each has unique functions. The homeostatic role of these γδ T cell subsets is to maintain barrier integrity and prevent microorganisms from breaching the mucosal layer, which is accomplished through crosstalk with enterocytes and other immune cells. Recent years have seen a surge in discoveries regarding the regulation of γδ IELs in the intestine and the colon with particular new insights into the butyrophilin family. In this review, we discuss the development, specialities, and functions of γδ T cell subsets during cancer progression. We discuss how these cells may be used to predict patient outcome, as well as how to exploit their behavior for cancer immunotherapy.
An aortic-to-radial arterial pressure gradient may develop during and after cardiopulmonary bypass (CPB). The mechanisms of this pressure gradient remain controversial. To clarify the cause of the ...pressure gradient after CPB, the authors investigated the relationship between the pressure gradient and changes in the pulse wave velocity (PWV) before and after CPB.
The pressure gradient from the aorta to the radial artery and a change in PWV were measured with a wire (0.37 mm in diameter) tipped with a miniature pressure transducer in 12 patients undergoing cardiac surgery. The pressure distributions and waveforms were measured and recorded with electrocardiograph. The PWV was calculated by measuring the propagation time between the R wave of the electrocardiograph and the rising point of the arterial pressure waveform at 10-cm intervals.
After CPB, 7 of 12 patients demonstrated a marked pressure gradient. In these patients, the pressure distribution showed a gradual decrease toward the periphery without a precipitous step-down in pressure at any one specific anatomic location. The PWV decreased as the intraarterial pressure decreased from the aorta to the radial artery, and the relative arterial elasticity decreased linearly toward the periphery.
The results showed that the decrease in PWV implies a decrease in arterial elasticity, and the decrease in the arterial elasticity correlated with the decrease in intraarterial pressure. These findings demonstrated that a radial artery pressure lower than the aortic pressure after CPB may be due to the decrease in arterial elasticity.
Purpose
The N- and C-terminal regions of dynorphin (Dyn) A (1–17) activate opioid and N-methyl-D-aspartate receptors, respectively. Earlier studies demonstrated that Dyn-converting enzyme cleaved Dyn ...A (1–17) mainly at the Arg
6
–Arg
7
bond, resulting in the production of N- and C-terminal region peptide fragments, and that this enzyme was not inhibited by a mixture of the three peptidase inhibitors (PIs) amastatin (A), captopril (C), and phosphoramidon (P). The purpose of the present study was to evaluate antinociceptive potential and toxicity with intracerebroventricular administration of Dyn A (1–17) or (1–13) under pretreatment with a mixture of A, C, and P and/or Dyn-converting enzyme inhibitor (
p
-hydroxymercuribenzoate).
Methods
Peptide fragments from Dyn A (1–17) following incubation with membrane preparation under pretreatment with a mixture of the three PIs was identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometer (MALDI–TOF–MS). Infusion of drugs and peptides into the third ventricle in rats was performed via indwelling cannulae. Induction of antinociception and toxicity by Dyn A (1–17), Dyn A (1–13), Dyn A (1–6), or Dyn A (7–17) were determined by the tail-flick test and induction of barrel rotation, respectively. The effects of the PIs on antinociception and toxicity were evaluated by a dose−response study and a comparison of differences among various combinations of Dyn A (1–17) or Dyn A (1–13) and the three PIs and
p
-hydroxymercuribenzoate.
Results
MALDI–TOF–MS analysis identified Dyn A (1–6) and Dyn A (1–10) fragments as products following incubation of Dyn A (1–17) with membrane preparation of rat midbrain under pretreatment with a mixture of the three PIs. Pretreatment with a mixture of the three PIs produced an approximately 30-fold augmentation in antinociception induced by low-dose intracerebroventricular administration of Dyn A (1–17) or (1–13) in a μ-, δ- and κ-opioid receptor antagonist-reversible manner, but without signs of toxicity such as barrel rotation in the rat. Dyn A (1–17)-induced antinociception and toxicity was greater than that of Dyn A (1–6), Dyn A (1–13), or Dyn A (7–17) at the same dose. Dyn A (1–17)-induced antinociception and toxicity under pretreatment with various combinations of the three PIs and
p
-hydroxymercuribenzoate was greater than that with a mixture of the three PIs alone.
Conclusion
These findings suggest that administration of a mixture of the three PIs increases Dyn A (1–17)- or (1–13)-induced antinociception under physiological conditions without toxicity.
A decrease in core temperature during general anesthesia is attenuated by infusion of an intravenous amino acid mixture. The purpose of the present study was to investigate the influence of physical ...and endocrine changes caused by ovariectomy on the inhibitory effect of amino acid infusion on anesthesia-induced hypothermia. Sprague-Dawley female rats were divided into a sham-operated (Sham) group and an ovariectomized (OVX) group. Saline solution or an amino acid mixture solution was infused for 180 min during sevoflurane anesthesia, and the rectal temperature was measured (4 groups). Intraperitoneal white adipose tissue mass, bilateral gastrocnemius weight and plasma insulin levels were measured. In the Sham rats, no inhibitory effect of the amino acid mixture on anesthesia-induced hypothermia was found, while in the OVX rats, hypothermia was significantly decreased. The intraperitoneal fat weight/body weight ratio was significantly higher in the OVX rats than in the Sham rats, but the gastrocnemius weight/body weight ratio was not significantly different. After amino acid infusion, the plasma insulin level was significantly higher in the OVX rats than in the Sham rats. In conclusion, our findings suggest that, in rats, ovarian function or female hormone affects protein turnover mediated by increase in insulin secretion and, thus, decreases the inhibitory effect of an infusion of amino acid mixture on anesthesia-induced hypothermia.
A 90-year-old man underwent emergency thrombectomy for acute occlusion of the right femoral and popliteal arteries. After an epidural catheter (used for intraoperative/postoperative management) was ...removed, a spinal epidural hematoma involving the Th12 to L3 areas developed. Emergency removal of the hematoma and decompression of the spinal cord were performed. Possibly, the hematoma had developed due to therapy with an antiplatelet agent, cilostazol, which had been started on the first postoperative day, and due to the removal of the catheter, on the third postoperative day, in addition to the patient’s advanced age. This case may be the first report of spinal epidural hematoma associated with both cilostazol and epidural anesthesia. From the time course in this patient, important knowledge of drug actions and follow-up may be gained for determining the timing of catheter removal in a patient receiving antiplatelet therapy with cilostazol.
Retrospective investigations were conducted at Nagoya City University Hospital and two other institutions in order to determine whether treatment in a postanesthesia care unit (PACU) reduces severe ...adverse events (SAEs) in general wards among postoperative patients. The number of cases involving a "code blue (CB)" status within 12 hours after leaving the operating room or PACU was one or two at each institution. The proportion of patients with CB in the early postoperative period tended to be lower in the hospitals with a PACU than in the hospitals without a PACU, at 0.006% and 0.02 - 0.03% of operative cases, respectively. Although treatment in a PACU may help to reduce SAEs in general wards among postoperative patients, further investigation is required.
Purpose
In a previous study using the tail-flick test, we found that intracerebroventricular administration of
d
-serine, an endogenous co-agonist at the glycine sites of
N
-methyl-
d
-aspartate ...(NMDA) receptors, elicited an antinociceptive effect on thermal nociception. The purpose of the present study was to evaluate the effect of intracerebroventricular administration of
d
-serine on nociception induced by tissue damage or inflammation using the formalin test.
Methods
Infusion of drugs into the third ventricle in rat was performed via indwelling cannulae. Drugs were infused at a volume of 10 μl over 2 min, and the infusion cannula was left in place for 2 min before removal. The formalin test was performed 10 min after drug administration.
Results
Intracerebroventricular administration of
d
-serine significantly and dose-dependently decreased the number of flinches in both the early and late phases in the formalin test. This antinociceptive effect was antagonized by intracerebroventricular administration of L-701,324, a selective antagonist at the glycine sites of NMDA receptors.
Conclusion
The present data suggest that activation of NMDA receptors via glycine sites at the supraspinal level induces an antinociceptive effect on both acute and tonic pain.
56 years old female who had the past history of malignant hyperthermia（MH）, was planned a laminectomy. Muscle biopsy was also performed during the operation because she hoped full examination about ...the MH. As a result, it was cleared that she had the high incidence for MH. And the fact was shared among her family. So, her son could tell his family history of MH to the doctors when he would be performed the emergency operation caused his head injury. Therefore, he was managed in a safe without having MH during his anesthesia. It can say that MH may be more likely to develop at the time of his operation if there is no recognition for his family history of MH. The enlightenment action that the patient and its families recognized enough about MH was very important. And more, it is important duty for us.
PDF
![Potentiation of [Met5]enkep...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/0913-8668/small "Potentiation of [Met5]enkephalin-induced antinociception by mixture of three peptidase inhibitors in rat")
