Objectives: To evaluate whether peripheral arterial catheter management is more effective than umbilical arterial management in very preterm neonates. Methods: Thirty-eight very preterm neonates born in Fukushima Medical University Hospital between October 2008 and March 2010 were evaluated. A peripheral arterial catheter was inserted in 19 neonates (peripheral group) and an umbilical arterial catheter in the remaining 19 neonates (umbilical group). Results: The median gestational ages of the peripheral and umbilical groups were 195 and 185 days, respectively (p=0.04). The systolic and diastolic blood pressure (BP) was significantly higher in the peripheral group than in the umbilical group (p=0.03 and p=0.001). There was a significant relationship between BP at cannulation and urinary output after cannulation for 24 h in the peripheral group (rs=0.49, p=0.03); however, no such significant relationship was found in the umbilical group. Conclusions: We considered that peripheral artery catheters provide a well-functioning route for continuous BP monitoring, even in very preterm neonates. Because umbilical catheter placement might affect urinary output, we speculated that peripheral arterial catheter placement would be a more effective management strategy than umbilical arterial catheter placement in very preterm neonates. Further studies of larger populations are necessary to evaluate the effectiveness of arterial management including long-term follow-up studies.
Objective: The purpose of this study was to observe endocrinological responses of veno-arterial and veno-venous extracorporeal membrane oxygenation (V-A and V-V ECMO) to support fetal oxygenation in utero. Methods: An ECMO system with a centrifugal pump was applied to six chronically instrumented fetal lambs, at 126-134 days of gestation. Blood was obtained through a double-lumen catheter inserted into the right atrium. After oxygenation, the blood was returned through a single-lumen catheter into either the carotid artery (veno-arterial; V-A ECMO) or the right atrium (V-V ECMO). After fetal hypoxia had been experimentally produced, V-A ECMO or V-V ECMO was instituted to maintain fetal oxygenation. We compared fetal blood gases and concentrations of atrial natriuretic peptide (ANP), epinephrine and norepinephrine with both routes of ECMO. Results: Fetal carotid artery pH did not change during hypoxemia, but decreased after instituting V-A ECMO and V-V ECMO. After instituting V-A ECMO or V-V ECMO for 30 min, oxygen partial pressure (pO2) in the fetal cranial carotid artery recovered from the hypoxic level. The ANP concentration in V-V ECMO was significantly lower than that in V-A ECMO. Fetal serum epinephrine and norepinephrine concentrations significantly increased in association with hypoxic stimulation. There was a further increase in fetal serum epinephrine concentration after instituting V-A ECMO. No significant difference in concentration was found after instituting V-V ECMO from that of after the institution of V-A ECMO. Conclusions: This study suggested that V-V ECMO may possibly be less invasive than V-A ECMO for fetal heart, because ANP, a cardiac distress index, was lower in V-V ECMO than in V-A ECMO.
The P2X3 receptor is a ligand-gated cation channel that is activated by extra cellular adenosine triphosphate (ATP) found in the dorsal root, trigeminal and nodose ganglia. It is one of the receptors transmitting nociceptive information of injuries and inflammation of the periphery by endogenous ATP released from damaged cells. The present study was performed in order to evaluate if there was an increased expression of P2X3-immunoreactivity in dorsal root ganglion (DRG) neurons after experimental disc herniation. There were four groups: exposure of the left L4 dorsal root ganglion and incision of the L4-L5 disc, exposure and slight displacement of the left L4 dorsal ganglion, sham exposure of the L4 dorsal root ganglion, and normal. Seven days after surgery, the DRG's were collected, sectioned and stained immunohistochemically for the P2X3 receptor. The expression of P2X3 increased significantly following incision of the L4-5 disc compared to the normal group. Sham surgery induced a minor, although statistically significant increase. Mechanical displacement did not induce any increased expression of the receptors. The study demonstrates that expression of the P2X3 receptors in the DRG may be induced by local application of nucleus pulposus. This may increase our understanding of the pathophysiologic mechanisms related to disc herniation and sciatica.
Ovarian cancer, one of the poor-prognosis gynecological malignancies, is often associated with extensive peritoneal carcinomatosis when initially treated. The mechanism of the formation of peritoneal carcinomatosis from ovarian cancer is still unknown. It has been reported that overexpression of cancer-related growth factors and/or receptors may worsen the prognosis of diseases. In the previous paper, we had established the human ovarian serous adenocarcinoma cell lines from those with no potentiality of peritoneal dissemination (FOC-3) to high potentiality (MFOC-3), however, the mechanism of its phenotypical change remains unknown. In this paper, we compared these two cell lines for growth potential and the expression of growth factor heregulin (HRG)-1α and HER-2, HER-3, and HER-4 receptors. In addition, the effect of anti-receptor antibodies on cell growth was investigated. RT-PCR and Western blot analysis found the promotion of the expression of HRG precursor and HRG-1α in MFOC-3. Examination of the number of growing cells over time revealed a statistically significant increase in the number of cells in MFOC-3 compared with FOC-3. In a study using the addition of exogenous HRG-1α, no changes were observed in FOC-3 while statistically significant cell growth was noted in MFOC-3. In a growth inhibition study, statistically significant cell growth inhibition was achieved with the addition of anti-HER2 receptor antibody. Taken together, the results of this study suggested that HRG may play an important role in the increased growth potential of peritoneal dissemination of ovarian cancer. In particular, HER-2 receptors that can act as a starting point to trigger intracellular signaling pathways are strongly involved in the progression of cancer. Therefore, molecular target drug therapies blocking the HER-2 receptor are promising candidates for ovarian cancer treatment in the future.
Some patients with rotator cuff tear have shoulder stiffness preoperatively. Concomitant preoperative shoulder stiffness may affect postoperative outcomes of arthroscopic subacromial decompression (ASD) for rotator cuff tear. The purpose of this study was to compare postoperative outcomes for ASD between rotator cuff tear patients with and without preoperative shoulder stiffness and to analyze the serial change in functional scores, range of motion (ROM), and pain intensity of the 2 groups after operation. 60 shoulders of 58 patients who underwent ASD for rotator cuff tear were studied. Arthroscopic release was performed for the stiffness group. The results were assessed before surgery and 1, 3, 6, 12 and 24 months after surgery, and the results in the stiffness group and non-stiffness group were compared. No differences in serial changes for postoperative outcomes of ASD were seen in terms of the Japanese Orthopaedic Association shoulder scoring system (JOA scores) and the visual analog scale (VAS scores) for pain at night and pain during motion between the stiffness group and non-stiffness group. However, compared to the non-stiffness group, forward flexion and abduction angles were significantly smaller for the stiffness group at 1 and 3 months after surgery. External rotation and internal rotation angles were significantly smaller at 1 month after surgery for the stiffness group than for the non-stiffness group. Preoperative shoulder stiffness does not affect improvement of postoperative JOA scores and VAS scores of ASD. When measured 6 months after surgery, ROM in the stiffness group and the non-stiffness group was similar.
Dendritic cells (DCs) are powerful antigen-presenting cells (APCs) that have attracted attention in recent years from the viewpoint of DC vaccine therapy against cancer. However, the existence of a strongly immunosuppressed state in cancer-bearing individuals inhibits DC maturation, which is one of the problems facing anti-cancer DC vaccine therapy. Isolated DCs loaded with tumor antigen ex vivo and administered as a cellular vaccine have been found to induce protective and therapeutic anti-tumor immunity in experimental animals. In clinical trials of DC vaccination for cancer patients, induction of anti-tumor immune responses and tumor regression has been observed. In this study, eighty-one advanced cancer patients unsuccessfully treated by established treatment in individual cases were selected between January 2002 and May 2007 at Fukushima Medical University. The usefulness of DC therapy was investigated by intradermal injection of peptide pulsed DCs for an overall objective response rate of 28.0%. Furthermore, direct injection of immature DCs into tumor extracted an overall objective response rate of 35.7%, and especially 40.0% for advanced pancreatic cancer by using endoscopic ultrasound-guided fine-needle injection technique as a novel approach. These results indicate that DC-based vaccination could be a promising treatment modality for various cancers, however multiple hurdles must be cleared before the development of an affordable DC-based vaccination can be used worldwide.
Purpose:The surgical techniques widely used in Japan for idiopathic carpal tunnel syndrome (CTS) are the Okutsu method of endoscopic carpal tunnel release (ECTR) and palmar incision for open carpal tunnel release (OCTR). However, no prospective randomized controlled trials (RCTs) have compared treatment outcomes between these two procedures. This RCT compared short-term outcomes between ECTR and OCTR for CTS. Materials and Methods:Subjects were 101 hands (79 patients) treated in the department. ECTR was performed on 51 hands (40 patients), and OCTR was performed on 50 hands (39 patients). For assessment items, the following patient-based outcomes were evaluated: 1) changes in subjective symptoms; and 2) impairment in activities of daily living. The following items were also evaluated by physicians: 3) abductor pollicis brevis-distal latency (APB-DL); 4) sensation; and 5) muscle strength. All these assessments were made in postoperative weeks 4 and 12. Results: Recovery of muscle strength at postoperative week 4 was significantly better with ECTR (p< 0.05), but no significant differences were identified between groups in any of the other items. The ECTR group showed transient postoperative exacerbation of subjective symptoms in two hands (4%) and of APB-DL in three hands (6%). Comparison of hands with improved and exacerbated postoperative APB-DL in the ECTR group revealed significantly greater preoperative electrophysiological severity in exacerbated hands (p< 0.05). The cause of postoperative exacerbation with ECTR was considered to be transient nerve dysfunction resulting from the unique aspects of the ECTR procedure. Conclusions: Compared with OCTR, ECTR offers superior recovery of muscle strength in the early postoperative period. At the same time, ECTR may carry a risk of transient nerve dysfunction in the early postoperative period. Caution must therefore be exercised when using ECTR for patients with severe electrophysiological findings.
There are few studies of the therapeutic effects of long-term corset wearing in patients with chronic low back pain. The aim of this study was to evaluate the effects of long-term corset wearing on chronic low back pain and to examine the myoelectrical activities of the paravertebral muscles. Forty subjects with chronic low back pain were enrolled and randomly divided into two groups: a group wearing corsets for 6 months (CW) group and a group not wearing corsets (NW). The treatment effects were measured using the Japanese Orthopaedic Association (JOA) score. Muscle endurance was evaluated during the Biering-Sorensen test (S-test), and the degree of muscle fatigue was evaluated by the change in percent mean power frequency (%MPF) of the paravertebral muscles. Corset treatment for chronic low back pain improved low back pain and increased muscle endurance for a short period of time. Paravertebral muscle fatigue was not increased by long-term corset wearing for chronic low back pain, and weakening of the paravertebral muscles was not observed up to 6 months after the start of corset wearing.
Aneuploidy has been suggested as a marker for stratification of many neoplasms but its potential usefulness in adenocarcinoma (ADC) with bronchioloalveolar (BAC) pattern has not been well defined. We examined paraffin-embedded tissue sections from 28 cases of ADC with BAC pattern as well as 7 benign lung lesions and 9 normal lung tissue samples for chromosomal aneuploidy by in situ hybridization using digoxigenin-labelled probes for chromosomes 1 and X. Of the 28 ADC with BAC pattern, 17 (61%) were diploid and 11 (39%) were aneuploid. Of the 17 diploid cases, 7 (41%) were male and 10 (59%) were female and of the 11 aneuploid cases, 2 (18%) were male, 9 (82%) were female. Regarding the cell type, 24 (86%) were adenocarcinomas in situ (AIS) so called BAC and minimally invasive ADC (MIA), and 4 cases (14%) were invasive ADC. Of the 12 cases each of AIS and MIA, 9 (75%) and 8 (67%) had diploid pattern respectively. Of the 4 invasive ADC cases, all had aneuploid pattern. Seventeen cases (71%) with T1 tumor size (> 0 mm∼≤30 mm), had diploid and 4 cases (100%) with T2 tumor size (> 30 mm ≤70 mm) had aneuploid pattern. Statistical analyses showed that nuclear diploidy was significantly correlated with AIS and MIA tumor types while aneuploidy correlated with invasive ADC type (P=0.025). Also a significant correlation was found between ploidy and tumor size (P=0.033). In conclusion, these findings suggest that DNA ploidy analysis provides useful information for the assessment of cellular kinetics and reflect histopathological subtypes in ADC with BAC pattern that are destined to behave aggressively.
A 40-year-old female patient underwent surgery at our hospital for recurrent pneumothorax. A defect on the right diaphragm was diagnosed as ectopic endometriosis. However, air leakage continued 2 days after surgery. Chest computed tomography identified a 5-mm ground glass opacity in the right S3 field, suggestive of lung cancer. Ten days after the initial surgery, she underwent curative surgery for both pneumothorax and the lung tumor. The tumor was diagnosed as bronchioloalveolar carcinoma, but no other endometriosis was identified. The patient has remained well with no recurrence of lung cancer or pneumothorax since the second surgery.
Purpose of the study The measurement of stroke volume variation (SVV) using the FloTracTM system (Edwards Lifescience, USA) is useful to estimate cardiac preload. We evaluated the benefits of SVV monitoring for adjusting fluid supplementation during laparoscopic adrenalectomy under anesthesia in patients with pheochromocytoma. Subjects and Methods Among 10 patients who underwent laparoscopic adrenalectomy for pheochromocytoma in our institution from June 2004 to December 2009, SVV was not monitored in 5 patients (group I) and in the other 5 patients (group II), SVV monitoring was performed. Subject age, height and body weight, total volume of fluid supplemented, blood loss, urine output and net fluid in-out balance during the procedure were retrospectively assessed. In those with SVV monitoring, infusion volume was adjusted for SVV less than 13%. Results There were significant differences in the patient age and body weight between the two groups (group I: 64.2 years old and 55.1 kg; group II: 43.6 years old and 71.7 kg). Both total infusion volume and urine output were significantly higher in group I compared with group II (5,610 vs. 2,400 ml and 1,125 vs. 750 ml, respectively). Total blood loss was similar between the two groups. Values of the net fluid balance divided by the body weight and total anesthesia period (hr) were significantly lower in group II compared with group I (I; +13.2 in group I and +6.2 in group II, ml/kg/hr). Conclusions These data suggest that SVV monitoring is helpful to estimate the optimal volume for fluid supplementation and could prevent excessive fluid infusion during surgical procedures.
It is essential to examine brain materials for the understanding the cause and pathology of mental disorders. Recent methodological progress urges us to set up well qualified brain banks. Human tissue and Bio-banking is a complex field and the daily practice of brain banks needs to abide by several golden standards in order to avoid pitfalls in basic research: 1) A donor system in which informed consent is granted for the use of the samples for scientific research, including genetic analysis and access to medical records, 2) Rapid autopsy system, 3) Compatibility of protocols for procurement, management, handling and storage, 4) A generally accepted consensus on diagnostic criteria, 5) Quality control, 6) Abiding by local/international legal and ethical guidelines for work with human material, 7) Proper safety procedures. In the present review, the authors introduced the activities of European brain banks, and discussed on their current issues, and on the problems remain to be resolved.