Background
We examined the hypothesis that the minimum alveolar concentration of desflurane for maintaining bispectral index (BIS) below 50 (MACBIS50) decreases with advance of age.
Methods
Sixty ...young (20–30 year), middle‐aged (31–65 year) and elderly (66–80 year) patients were included (n = 20, each group). Five minutes following the start of continuous intravenous administration of remifentanil at 0.25 μg/kg/min, general anaesthesia was induced with propofol 2 mg/kg and rocuronium 0.8 mg/kg to facilitate tracheal intubation. Infusion of remifentanil was stopped immediately after tracheal intubation. When BIS began to increase > 60, maintenance of anaesthesia was started with an end‐tidal desflurane concentration of 4.0% and maintained for 10 min followed by 1‐min assessment of BIS taken at 10‐s intervals. MACBIS50 of each age group was estimated by up–down methodology.
Results
MACBIS50 of desflurane in young, middle‐aged and elderly patients was 4.25% end‐tidal (95% confidence intervals 4.04–4.46), 3.58% (3.38–3.79) and 2.75% (2.50–3.00) respectively. MACBIS50 was higher (P = 0.011) in young patients and lower (P = 0.012) in elderly patients than those in middle‐aged patients.
Conclusions
Advance in age significantly decreased the concentrations of desflurane required to maintain BIS below 50. BIS reflected age‐associated decrease in end‐tidal concentrations of desflurane required for maintaining adequate depth of anaesthesia during resting state.
Introduction: In our former study, we had validated the previously developed predictive model for in-hospital falls (Saga fall risk model) using eight simple factors (age, sex, emergency admission, ...department of admission, use of hypnotic medications, history of falls, independence of eating, and Bedriddenness ranks BRs), proving its high reliability. We found that only admission to the neurosurgery department, history of falls, and BRs had significant relationships with falls. In the present study, we aimed to clarify whether each of these three items had a significant relationship with falls in a different group of patients. Methods: This was a single-center based, retrospective study in an acute care hospital in a rural city of Japan. We enrolled all inpatients aged 20 years or older admitted from April 2015 to March 2018. We randomly selected patients to fulfill the required sample size. We performed multivariable logistic regression analysis using forced entry on the association between falls and each of the eight items in the Saga fall risk model 2. Results: A total of 2932 patients were randomly selected, of whom 95 (3.2%) fell. The median age was 79 years, and 49.9% were men. Multivariable analysis showed that female sex (odds ratio OR 0.6, 95% confidence interval CI 0.39-0.93, p = 0.022), having a history of falls (OR 1.9, 95% CI 1.16-2.99, p = 0.010), requiring help with eating (OR 1.9, 95% CI 1.12-3.35, p = 0.019), BR of A (OR 6.6, 95% CI 2.82-15.30, p < 0.001), BR of B (OR 7.5, 95% CI 2.95-19.06, p < 0.001), and BR of C (OR 4.1, 95% CI 1.53-11.04, p = 0.005 (were significantly associated with falls. Conclusion: History of falls and BRs were independently associated with in-hospital falls. Keywords: bedridden, Bedriddenness ranks, fall, predictive model, validation, Saga fall risk model 2
Summary
Both internal and external oxidative stresses act on DNA and can induce carcinogenesis. 8‐hydroxydeoxyguanosine (8‐OHdG) is an indicator of oxidative stress and it leads to transversion ...mutations and carcinogenesis. 8‐OHdG is excision‐repaired by 8‐OHdG DNA glycosylase (OGG1). The purpose of this study is to clarify the effect of oxidative DNA damage and repair enzymes on esophageal carcinogenesis. The levels of 8‐OHdG and OGG1 were immunohistochemically evaluated in resected specimens, including squamous cell carcinoma (SCC) in 97 patients with esophageal cancer. Higher levels of 8‐OHdG in normal esophageal epithelium were associated with a higher smoking index (P = 0.0464). The 8‐OHdG level was higher in cancerous areas than in normal epithelia (P = 0.0061), whereas OGG1 expression was weaker in cancerous areas than in normal epithelia (P < 0.0001). An increase of OGG1 expression in normal epithelium was observed as 8‐OHdG levels increased (P = 0.0011). However, this correlation was not observed in cancerous areas. High OGG1 expression in the cytoplasm was related to deeper tumors (P = 0.0023), node metastasis (P = 0.0065) and stage (P = 0.0019). Oxidative DNA damage, which is attributable to smoking as well as disturbances in DNA repair systems, appears to be closely related to esophageal carcinogenesis and its progression.
We investigated age-related differences in the minimum alveolar concentration (MAC) of isoflurane and sevoflurane for maintaining bispectral index (BIS) below 50 (MACBIS50).
One hundred and twenty ...young (≤40 yr), middle-aged (41–69 yr), and elderly (≥70 yr) patients were randomly allocated to one of the six groups. Anaesthesia was induced with isoflurane or sevoflurane in oxygen. After tracheal intubation, we arbitrarily started maintenance of anaesthesia in each group with end-tidal isoflurane and sevoflurane concentrations of 0.8 and 1.2 vol%, respectively. After 10 min at predetermined end-tidal isoflurane or sevoflurane concentrations, BIS was measured for 1 min. MACBIS50 of isoflurane or sevoflurane for each group was determined by up–down methodology.
MACBIS50 of isoflurane in young, middle-aged, and elderly patients was 0.82% end-tidal (95% confidence intervals 0.76–0.88), 0.67% (0.61–0.73), and 0.56% (0.51–0.61), respectively, and that of sevoflurane in young, middle-aged, and elderly patients was 1.28% (1.24–1.32), 0.97% (0.89–1.05), and 0.87% (0.84–0.90), respectively. For both isoflurane and sevoflurane, the MACBIS50 was significantly higher (P=0.002 and 0.001, respectively) in young patients and significantly lower (P=0.02 for both) in elderly patients than those in middle-aged patients.
Advance in age significantly decreased the concentrations of isoflurane and sevoflurane required to maintain BIS below 50. BIS correctly reflected age-associated decrease of end-tidal concentrations of isoflurane and sevoflurane required for maintaining adequate depth of anaesthesia during resting state.
In this study, we investigated the magnetic properties of Si-gradient steel sheet produced by CVD (chemical vapor deposition) siliconizing process, comparing with 6.5% Si steel sheet. The Si-gradient ...steel sheet having silicon concentration gradient in the thickness direction, has larger hysteresis loss and smaller eddy current loss than the 6.5% Si steel sheet. In such a loss configuration, the iron loss of the Si-gradient steel sheet becomes lower than that of the 6.5% Si steel sheet at high frequencies. The experiment suggests that tensile stress is formed at the surface layer and compressive stress is formed at the inner layer in the Si gradient steel sheet. The magnetic anisotropy is induced by the internal stress and it is considered to affect the magnetization behavior of the Si-gradient steel sheet. The small eddy current loss of Si-gradient steel sheet can be explained as an effect of magnetic flux concentration on the surface layer.
Both calcium and 1,25(OH)
2D promote the differentiation of keratinocytes in vitro. The autocrine or paracrine production of 1,25(OH)
2D by keratinocytes combined with the critical role of the ...epidermal calcium gradient in regulating keratinocyte differentiation in vivo suggest the physiologic importance of this interaction. The interactions occur at a number of levels. Calcium and 1,25(OH)
2D synergistically induce involucrin, a protein critical for cornified envelope formation. The involucrin promoter contains an AP-1 site essential for calcium and 1,25(OH)
2D induction and an adjacent VDRE essential for 1,25(OH)
2D but not calcium induction. Calcium regulates coactivator complexes that bind to the Vitamin D receptor (VDR). Nuclear extracts from cells grown in low calcium contain an abundance of DRIP
205, whereas calcium induced differentiation leads to reduced DRIP
205 and increased SRC 3 which replaces DRIP in its binding to the VDR. In vivo models support the importance of 1,25(OH)
2D–calcium interactions in epidermal differentiation. The epidermis of
1αOHase null mice fails to form a normal calcium gradient, has reduced expression of proteins critical for barrier function, and shows little recovery of the permeability barrier when disrupted. Thus in vivo and in vitro, calcium and 1,25(OH)
2D interact at multiple levels to regulate epidermal differentiation.
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