We examined the efficacy of a unique experimental approach to brain protection with mild hypothermic circulatory arrest, using rapid cooling and re-warming in a swine model. Methods: In 30 male pigs, total cardiopulmonary bypass was established. The animals were divided into three groups. Group A underwent slow cooling and 20 minutes of deep hypothermic arrest (20°C) followed by slow re-warming up to 36°C. Group B underwent mild hypothermica rrest (20°C) and slow re-warming. Group C underwent mild hypothermic arrest using rapid cooling and re-warming. Laboratory data, cerebral blood flow and oxygen intakes were assessed at 4 points throughout the examination. After examination, specimens from cerebral cortex and hippocampus were investigated microscopically. Results: Platelet counts were signi- ficantly better in group C than in group A at the end of re-warming. By contrast, cerebral blood flow and platelet counts were worst in group A compared with the other groups. There were no significant deferences in the pathological findings in brain tissues using Kluver-Barrera stain between the 3 groups. Conclusion: Moderate hypothermic circulatory arrest and rapid re-warming was considered quite effective for preventing blood coagulation disorder.
We report our clinical experience of hypodermoclysis (HDC) in elderly patients at the end of life in a long-term care unit. The subjects were 92 patients who died during hospitalization in the long-term care unit between the 2007 and 2010. The underlying conditions included cerebrovascular disease in 48 cases (52.2%), dementia in 11 cases (12%), and malignant tumor in 5 cases (5.4%). The patients were divided into the HDC group (24 cases) and the intravenous infusion (IV) group (68 cases), and the duration of infusion, infusion dose, and clinical progress were compared retrospectively. The median age was 85 years in the HDC group and 84 years in the IV group. Dementia was common in the HDC group, and the two groups did not differ significantly with respect to the cause of death. The duration of infusion was 36.5 (5-107) days in the HDC group and 34.5 (3-158) days in the IV group, with no significant difference between the groups. The infusion dose was 500 (250-700) ml/day in the HDC group and 750 (500-1200) ml/day in the IV group, with the dose being significantly lower in the HDC group. Peripheral edema was evident in 9 cases (37.5%) in the HDC group and 39 cases (57.4%) in the IV group, with no significant difference between the groups. There were no adverse events in either group. Intravenous catheterization was difficult in 10 cases, and consequently, these patients were shifted to HDC. HDC exhibited the same life-prolonging effects and safety as IV in elderly patients at the end of life in the long-term care unit.
The author previously established a molecular tree based on the cDNA-derived primary structures of globins in two giant tortoises, Geochelone nigra and G. gigantea. The divergence time was estimated to be 15-21 million years ago. In the present study, the author reexamined the divergence time of these two species using another source of genetic information--globin-introns--including those from the Chaco tortoise (G. chilensis), a close relative of G. nigra. The previously determined divergence time was supported by the findings of this intron study. However, the inter-relationships based on the intron nucleotide sequences of the globins from the three Geochelone species remain controversial, because it is difficult to determine which of the three is the ancestral species. In addition, the nucleotide sequences reveal the following interesting characteristics: (1) an abnormal GC dinucleotide sequence located at the 5'-splicing site of the second intron of αD globins instead of a consensus GT--this finding is common to all studied Geochelone species; (2) a repeated sequence 5'-GCCCCGCGCCCCGC-3' found only in the first intron of the G. nigra a A globin gene, is a unique feature distinguishing the Galapagos giant tor-toise from the other Geochelone tortoises that have non-repeated GCCCCGC sequences.