bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra‐operative natural sound decreases salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia
Authors: ARAI Y.‐C. P. , SAKAKIBARA S. , ITO A. , OHSHIMA K. , SAKAKIBARA T. , NISHI T. , HIBINO S. , NIWA S. , KUNIYOSHI K.
Published: August 2010

Background: The perioperative period is psychologically as well as physically stressful for patients. Although music and sound are known to reduce patients' psychological stress, a few previous studies showed an objective outcome of music. The aim of the present study was to evaluate the relaxing effect of music during epidural anesthesia, using patients' salivary amylase activity.

Methods: Thirty‐two American Society of Anesthesiologists (ASA) I or II patients presenting for inguinal hernia repair under epidural anesthesia were randomly assigned to listen to sounds of a soft wind and a twitter (S group) or to have no sounds (N group). Patients' salivary amylase activity was evaluated on arrival to the operating room and at wound closure.

Results: Intra‐operative music significantly decreased salivary amylase activity at wound closure in the S group and the activity at wound closure of the S group was significantly smaller than that of the N group.

Conclusion: Intra‐operative natural sound significantly decreased salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.
Improved survival after an out‐of‐hospital cardiac arrest using new guidelines
Authors: STEINMETZ J. , BARNUNG S. , NIELSEN S. L. , RISOM M. , RASMUSSEN L. S.
Published: August 2010

Background: An out‐of‐hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30‐day survival after OHCA.

Methods: We prospectively recorded data on all patients with OHCA treated by the Mobile Emergency Care Unit of Copenhagen in two periods: 1 June 2004 until 31 August 2005 (before implementation) and 1 January 2006 until 31 March 2007 (after implementation), separated by a 4‐month period in which the above‐mentioned change took place.

Results: We found that 30‐day survival increased after the implementation from 31/372 (8.3%) to 67/419 (16%), P=0.001. ROSC at hospital admission, as well as survival to hospital discharge, were obtained in a significantly higher proportion from 23.4% to 39.1%, P<0.0001, and from 7.9% to 16.3%, P=0.0004, respectively. Treatment after implementation was confirmed as a significant predictor of better 30‐day survival in a logistic regression analysis.

Conclusion: The implementation of new resuscitation guidelines was associated with improved 30‐day survival after OHCA.
Effects of levosimendan on indocyanine green plasma disappearance rate and the gastric mucosal–arterial pCO2 gradient in abdominal aortic aneurysm surgery
Authors: LEPPIKANGAS H. , TENHUNEN J. J. , LINDGREN L. , SALENIUS J.‐P. , RUOKONEN E.
Published: August 2010

Background: Levosimendan has a dual mechanism of action: it improves myocardial contractility and causes vasodilatation without increasing myocardial oxygen demand. In a laboratory setting, it selectively increases gastric mucosal oxygenation in particular and splanchnic perfusion in general. The aim of our study was to describe the effects of levosimendan on systemic and splanchnic circulation during and after abdominal aortic surgery.

Methods: Twenty abdominal aortic aneurysm surgery patients were randomized to receive either levosimendan (n=10) or placebo (n=10) in a double‐blinded manner. Both the mode of anaesthesia and the surgical procedures were performed according to the local guidelines. Automatic gas tonometry was used to measure the gastric mucosal partial pressure of carbon dioxide. Systemic indocyanine green clearance plasma disappearance rate (ICG‐PDR) was used to estimate the total splanchnic blood flow.

Results: The immediate post‐operative recovery was uneventful in the two groups with a comparable, overnight length of stay in the intensive care unit. Cumulative doses of additional vasoactive drugs were comparable between the groups, with a tendency towards a higher cumulative dose of noradrenaline in the levosimendan group. After aortic clamping, the cardiac index was higher [4(3.8–4.7) l/min/m2 vs. 2.6(2.3–3.6) l/min/m2; P<0.05] and the gastric mucosal–arterial pCO2 gradient was lower in levosimendan‐treated patients [0.9(0.6–1.2) kPa vs. 1.7(1.2–2.1) kPa; (P<0.05)]. However, the total splanchnic blood flow, estimated by ICG‐PDR, was comparable [29(21–29)% vs. 20(19–25)%; NS]. Organ dysfunction scores (sequential organ dysfunction assessment) were similar between the groups on the fifth post‐operative day.

Conclusion: Levosimendan favours gastric perfusion but appears not to have a major effect on total splanchnic perfusion in patients undergoing an elective aortic aneurysm operation.
Pre‐operative oral carbohydrate treatment before coronary artery bypass surgery
Authors: JÄRVELÄ K. , MAARANEN P. , SISTO T.
Published: August 2010

Background: Cardiac surgery is a stress that causes insulin resistance, which leads to an increase in insulin requirement. The aim of the present study was to evaluate the effect of a pre‐operative oral carbohydrate drink vs. overnight fasting on perioperative insulin requirements in non‐diabetic patients undergoing elective coronary artery bypass grafting (CABG) surgery.

Methods: One hundred and one patients scheduled for CABG were enrolled in the study. After fasting overnight, the patients were randomised into two groups. In the control group (C), no drink was given in the morning. In the treatment group (T), the patients ingested 400 ml of carbohydrate fluid 2 h before induction of anaesthesia. Blood glucose and insulin requirement was recorded. Gastric drainage was measured. Post‐operative nausea and vomiting was recorded.

Results: Neither the number of patients requiring insulin nor the amount of insulin required to maintain normoglycaemia differed between the study groups. More patients in the treatment group experienced nausea post‐operatively (26 vs. 16, P=0.044), but vomiting was equally common in the study groups (10 vs. 7). Intra‐operative gastric drainage was 26.8±57.9 ml in the treatment group vs. 16±37.9 ml in the control group (NS).

Conclusion: In this study patient population, a pre‐operative oral carbohydrate drink did not reduce post‐operative insulin resistance or post‐operative nausea and vomiting. According to our findings, it is safe to allow cardiac surgery patients to drink clear fluids up to 2 h before induction of anaesthesia, because gastric emptying of the drink was almost total and no aspiration occurred.
Peripheral intravenous catheter use in Europe: towards the use of safety devices
Authors: STRAUSS K. W. , ONIA R. , VAN ZUNDERT A. A. J.
Published: August 2010

Background: Peripheral intravenous catheters are among the most widely used medical devices in the world. European patients are increasingly aware of the risk of health care associated infections and the role catheters play in their facilitation.

Aims: We intend to show that European health care providers are increasingly aware of the occupational risks of bloodborne infections such as HIV and hepatitis which can be transmitted by the needles from catheters and that the political will is building to take action to ensure safer devices are provided.

Methods: We review the wide variety of peripheral intravenous catheters which are specially engineered to reduce these risks.

Results: Available safety devices include spring‐loaded retractable needles, guards that shield the dangerous tips and closed, needle‐free access valves for intravenous sets.

Conlusions: It is no longer necessary for patients and professionals to take risks to health and life when solutions which minimize these risks are at hand.
Lung injury following thoracic aortic occlusion: comparison of sevoflurane and propofol anaesthesia
Authors: ANNECKE T. , KUBITZ J. C. , LANGER K. , HILBERATH J. M. , KAHR S. , KROMBACH F. , BITTMANN I. , REHM M. , KEMMING G. I. , CONZEN P. F.
Published: August 2010

Background: Halogenated anaesthetics have been shown to reduce ischaemia–reperfusion injuries in various organs due to pre‐ and post‐conditioning mechanisms. We compared volatile and total intravenous anaesthesia with regard to their effect on remote pulmonary injury after thoracic aortic occlusion and reperfusion.

Methods: Eighteen pigs were randomized after sternotomy and laparotomy (fentanyl–midazolam anaesthesia) to receive either sevoflurane or propofol in an investigator‐blinded fashion. Ninety minutes of thoracic aortic occlusion was induced by a balloon catheter. During reperfusion, a goal‐directed resuscitation protocol was performed. After 120 min of reperfusion, the anaesthetic regimen was changed to fentanyl–midazolam again for another 180 min. The oxygenation index and intra‐pulmonary shunt fractions were calculated. After 5 h of reperfusion, a bronchoalveolar lavage was performed. The total protein content and lactate dehydrogenase activity were measured in epithelial lining fluid (ELF). Alveolar macrophage oxidative burst was analysed. The wet to dry ratio was calculated and tissue injury was graded using a semi‐quantitative score. Ten animals (n=5 for each anaesthetic) without aortic occlusion served as time controls.

Results: The oxygenation index decreased and the intra‐pulmonary shunt fraction increased significantly in both occlusion groups. There were no significant differences between sevoflurane and propofol with respect to the oxygenation index, ELF composition, morphologic lung damage, wet to dry ratio and alveolar macrophage burst activity. Differences were, however, seen in terms of systemic haemodynamic stability, where catecholamine requirements were less pronounced with sevoflurane.

Conclusion: We conclude that the severity of remote lung injury was not different between sevoflurane and propofol anaesthesia in this porcine model of severe lower‐body ischaemia and reperfusion injury.
Correlation between plasma milrinone concentration and renal function in patients with cardiac disease
Authors: HASEI M. , UCHIYAMA A. , NISHIMURA M. , MASHIMO T. , FUJINO Y.
Published: August 2010

Background: The dose of milrinone should be reduced in patients with renal failure. However, there is little data examining the relationship between plasma concentration of milrinone (pCmil) and renal function in intravenous infusion.

Methods: We evaluated the pCmil relative to renal function during intravenous infusion. We enrolled 10 heart failure patients. Milrinone was continuously infused at a rate of 0.2 μg/kg/min. Blood samples were collected at 6, 12, 24, and 48 h after the beginning of infusion. Urine was sampled during the first 24 h to calculate creatinine clearance (CLcr) and renal clearance of milrinone (rCLmil).

Results: The pCmil exhibited stability over 6 h after the beginning of infusion. During the first 24 h, CLcr and rCLmil were 62.2±30.6 ml/min and 1.67±0.77 ml/kg/min (106.2±60.3 ml/min), respectively. The rCLmil was highly correlated with CLcr. Y=1.77X−3.89 (X, CLcr; Y, rCLmil; R2=0.809, P<0.0001). Significant correlations were observed between CLcr and the plasma concentration during the continuous infusion. This correlation was expressed as the equation Y=51.1 × (BW/X)+28.2 (X; CLcr, Y; plasma concentration; BW, body weight; R2=0.695, P<0.01).

Conclusion: The pCmil exhibited stability 6 h or later after the continuous infusion of milrinone 0.2 μg/kg/min. The pCmil can be estimated by the value of CLcr and BW.
Paediatric Rapid Response Systems: a literature review
Authors: WINBERG H. , NILSSON K. , ÅNEMAN A.
Published: August 2010

Background: Paediatric cardiorespiratory arrest carries a poor prognosis. The most common cause is respiratory insufficiency or hypotension/shock, which can be reversible. The use of RRSs in adult hospitals that proactively intervene when signs of physiological instability occur is widespread and increasing although the level of evidence for their efficiency is a matter of debate.

Methods: A systematic literature review was undertaken to evaluate and summarise the current knowledge about paediatric RRSs.

Results: Paediatric RRSs are in use in several places around the world. One study shows a statistically significant decrease in mortality rate after implementation. Two studies show a non‐significant association with decreased mortality rate. Cardiac and/or respiratory arrest rates decreased in all four before‐after studies with statistical significance in two.

Conclusions: Cardiac arrest and death are rare in paediatric hospitals, which can in part explain the difficulties to demonstrate statistically significant benefits. There are also specific problems regarding calling criteria due to age related physiological diversity as well as chronic disease.
Caffeine poisoning and lactate rise: an overlooked toxic effect?
Authors: SCHMIDT A. , KARLSON‐STIBER C.
Published: August 2010

Severe caffeine poisoning is rare but associated with a high mortality. The symptoms are mainly attributable to hyperadrenergic stimulation, are relatively well known and described in the literature. Transient rises in plasma lactate levels may occur but are, however, less well described. We present a case of serious caffeine poisoning with a concomitant rise in lactate treated with a non‐selective β‐blocker and discuss briefly the symptomatology, the management of caffeine poisoning and the association between lactate and metabolic acidosis.
Effects of remifentanil on gastric tone
Authors: WALLDÉN JAKOB , THÖRN SVEN‐EGRON , LINDBERG GREGER , WATTWIL MAGNUS
Published: August 2010

Objectives: Opioids are well known for impairing gastric motility. The mechanism is far from clear and there is wide interindividual variability. The purpose of this study was to evaluate the effect of remifentanil on proximal gastric tone.

Materials and methods: Healthy volunteers were studied on two occasions and proximal gastric tone was measured by a gastric barostat. On the first occasion (n=8), glucagon 1 mg IV was given as a reference for a maximal relaxation of the stomach. On the second occasion (n=9), remifentanil was given in incremental doses (0.1, 0.2 and 0.3 μg/kg/min) for 15 min each, followed by a washout period of 30 min. Thereafter, remifentanil was readministered, and 10 min later glucagon 1 mg was given. Mean intragastric bag volumes were calculated for each 5‐min interval.

Results: Glucagon decreased gastric tone in all subjects. Remifentanil had a marked effect on gastric tone; we found two distinct patterns of reactions with both increases and decreases in gastric tone and, during the remifentanil infusion, glucagon did not affect gastric tone.

Conclusions: Remifentanil induced changes in gastric tone with both increases and decreases. The effect of remifentanil on gastric tone is probably dependent on the current state of the systems involved.
Preferences for colloid use in Scandinavian intensive care units
Authors:   The FLUIDS study investigators for the Scandinavian Critical Care Trials Group
Published: August 2010

Background: Fluid resuscitation is a frequent intervention in intensive care. Colloids are widely used, but recent data suggest harm by some of these solutions. This calls for more clinical studies on this matter, but the current preferences for colloid use in Scandinavian intensive care units (ICUs) are unknown.

Methods: In March–May 2007, 120 Scandinavian ICUs were invited to answer a web‐based survey consisting of 18 questions on types of colloids, indications, contraindications and rationale of use.

Results: Seventy‐three ICUs, of which 31 were university hospital units, answered the questionnaire. Most ICUs used both synthetic and natural colloids, and hydroxyethyl starch (HES) 130/0.4 was the preferred colloid in 59 units. Eleven ICUs had protocols for colloid use. The most frequent indication was second‐line fluid for hypovolaemia, but one in three ICUs used colloids as first‐line fluid. Thirty‐five ICUs had contraindications, which were mainly for the use of synthetic colloids (acute renal failure 25 units, bleeding 15 units). Most units based the use of colloids on theoretical knowledge and tradition. Sixty‐five and 54 ICUs were ready to change colloid use based on data from randomised trials of ICU patients showing changes in mortality or renal function, respectively.

Conclusion: Most Scandinavian ICUs use both synthetic and natural colloids, but HES 130/0.4 is by far the preferred colloid. Few units have protocols for colloid use, but most use them for hypovolaemia, and the majority have no contraindications. Most ICUs are ready to change colloid use if randomised trials in ICU patients show changes in mortality or renal function.
Xenon alters right ventricular function
Authors: HEIN M. , BAUMERT J. H. , ROEHL A. B. , PASCH L. , SCHNOOR J. , COBURN M. , ROSSAINT R.
Published: August 2010

Background: In contrast to other volatile anesthetics, xenon produces less cardiovascular depression with fewer fluctuations of various hemodynamic parameters, but reduces cardiac output (CO) in vivo. Besides an increase in left ventricular afterload and reduction of heart rate, an impairment of the right ventricular function might be an additional pathophysiological mechanism for the reduction of CO. Therefore, we used an animal model to study the effects of xenon as a supplemental anesthetic on right ventricular function, especially right ventricular afterload.

Methods: Right ventricular function was monitored with a volumetric pulmonary artery catheter in 11 pigs during general anesthesia with thiopental. Six animals received additional 70% (volume) xenon (equivalent to 0.55 MAC minimum alveolar concentration). Parameters for systolic function, afterload, and preload were calculated at baseline and during 50 min of xenon application, and in a corresponding control group. Significant differences were detected by multivariate analyses of variance for repeated measures.

Results: Xenon reduced CO on average by 30% and increased pulmonary arterial elastance by 60%, which led to a reduction of the right ventricular ejection fraction by 25%. Whereas right ventricular preload remained stable, maximal slope of pulmonary artery pressure and the right ventricular elastance increased. No effect on the ratio of stroke work and end‐diastolic volume was found.

Conclusion: The reduction in CO during xenon anesthesia was partly due to an impairment of the right ventricular function, mainly caused by an increased afterload, without an impairment of systolic ventricular function.
Are women more sensitive to a pre‐curarization dose of rocuronium than men?
Authors: Mencke T. , Soltesz S. , Sauer M. , Menzebach A. , Silomon M. , Nöldge‐Schomburg G.
Published: August 2010

Background: There is increasing evidence that there are gender‐related differences in the pharmacodynamics of neuromuscular blocking drugs. However, it is not known whether gender influences the pharmacodynamics of a pre‐curarizing dose.

Methods: In the first part, we measured the neuromuscular blockade after administration of rocuronium 0.03 mg/kg (10% of ED95) after induction of anaesthesia in 20 patients (10 female and 10 male patients) by electromyography. In the second part, 40 female and 40 male patients were observed for signs and symptoms of muscle weakness 2.5 min after injection of rocuronium 0.03 mg/kg before loss of consciousness. Succinylcholine‐associated post‐operative myalgia (POM) was also assessed.

Results: Median twitch heights were comparable between the two groups: 95.5 (range: 85–97; female) vs. 96.0 (range: 85–99; male), (NS). Train‐of‐four ratios were 97.5 (range: 64–100; female) vs. 99.0 (range: 52–100; male) (NS). Signs and symptoms of muscle weakness were observed in 64 (80%) patients, but there were no gender‐related differences. The incidence and severity of POM did not differ significantly between the study groups.

Conclusions: Pre‐curarization with rocuronium 0.03 mg/kg affected men and women equally. Nor was the incidence and the severity of muscle weakness affected by gender.
Performance of electrical impedance tomography in detecting regional tidal volumes during one‐lung ventilation
Authors: PULLETZ S. , ELKE G. , ZICK G. , SCHÄDLER D. , SCHOLZ J. , WEILER N. , FRERICHS I.
Published: August 2010

Background: Electrical impedance tomography (EIT) is becoming a new medical imaging modality for continuous monitoring of regional lung function in the intensive care unit or operating room. The aim of our study was to evaluate the performance of EIT in detecting regional tidal volumes in patients during volume‐controlled mechanical ventilation of one or both lungs.

Methods: Ten adult patients undergoing elective thoracic surgery were included. EIT measurements were performed with the Goe‐MF II EIT system. Data were collected before surgery during ventilation of both, the right and left lungs. Tidal volumes of 800 and 400 ml were applied during bilateral and unilateral ventilation, respectively.

Results: Ventilation‐related impedance changes determined in the whole chest cross‐section during the right and left lung ventilation did not significantly differ from each other and were equal to 47.6±5.6% and 48.5±7.8% (mean±SD) of the value determined during bilateral ventilation. During unilateral ventilation, EIT clearly separated the ventilated and non‐ventilated lung regions; nevertheless, ventilation‐related impedance changes were also detected at the non‐ventilated sides in areas corresponding to 3.4±4.1% and 12.4±6.9% of the scan halves during ventilation of the left and right lung, respectively. Changes in global tidal volumes were adequately detected by EIT during both bilateral and unilateral lung ventilation.

Conclusion: Although good separation of the ventilated and non‐ventilated sides of the chest was possible, the data indicate that reliable quantification of regional tidal volumes during asymmetric or inhomogeneous distribution patterns requires regions‐of‐interest analysis.
Adenosine and adenosine uptake inhibitors potentiate the neuromuscular blocking action of rocuronium mediated by adenosine A1 receptors in isolated rat diaphragms
Authors: NARIMATSU E. , NIIYA T. , KAWAMATA M. , NAMIKI A.
Published: August 2010

Background: Adenosine, which pre‐junctionally modulates neuromuscular transmission, and adenosine uptake inhibitors, which increase extracellular adenosine, have been used clinically. We investigated the effects of adenosine, dipyridamole and midazolam on the neuromuscular blocking action of rocuronium.

Methods: Isometric twitch tensions of rat nerve‐hemidiaphragm preparations elicited by indirect (phrenic nerve) supra‐maximal stimulation at 0.1 Hz were evaluated (n=6 in all data).

Results: Pre‐treatments with adenosine (0.1 and 1 μM) and CCPA (1 μM, adenosine A1 receptor agonist), but not that with CGS21680 (0.5 μM, A2 receptor agonist), shifted the rocuronium concentration–twitch tension curves to the left and decreased the rocuronium concentration for 50% twitch depression (IC50) compared with the control (P<0.01). The leftward shift induced by 1 μM adenosine was inhibited by pre‐treatments with theophylline (50 μM, non‐selective adenosine receptor antagonist) and DPCPX (0.2 μM, A1 receptor antagonist) but not by that with DPMA (5 μM, A2 receptor antagonist). Pre‐treatments with dipyridamole and midazolam, adenosine uptake inhibitors, shifted the curve to the left and decreased IC50 at supra‐therapeutic concentrations (10 and 2.5 μM, respectively) but not at clinical concentrations (2 and 0.5 μM, respectively), and the leftward shifts were inhibited by pre‐treatment with DPCPX (0.2 μM).

Conclusion: The results indicate that adenosine potentiates the neuromuscular blocking action of rocuronium mediated by adenosine A1 receptors and that supra‐therapeutic concentrations of dipyridamole and midazolam also potentiate the action of rocuronium by increasing endogenous adenosine concentration.
Effect of continuous morphine infusion on hypoxic–ischaemic brain damage of neonatal rats
Authors: Kawaraguchi Y. , Sasaoka N. , Kawaguchi M. , Inoue S. , Hayashi H. , Konishi N. , Furuya H.
Published: August 2010

Background: Opioids are commonly administered to critically ill neonates and infants for general anaesthesia and sedation. However, the clinical safety of these drugs, especially the effects on hypoxic–ischaemic damage of the developing brain, has not been well investigated. The present study was therefore conducted to investigate the effects of continuous morphine infusion on brain damage after hypoxic–ischaemic insults in neonatal rats.

Methods: Seven‐day‐old Sprague–Dawley rats were subjected to left common carotid artery ligation followed by a 90‐min exposure of 8% oxygen. The rats were administered morphine (0.1, 0.3 or 1 mg/kg/h) or saline continuously for 72 h using osmotic minipumps. Seven days later, the rats were weighed and their brains were morphologically categorized into groups based on the following grades: 0=normal, 1=mild atrophy, 2=moderate atrophy, 3=atrophy with cystic cavitation <3 mm and 4=cystic cavitation >3 mm. For histological assessment, the ratio of the surviving neurons (ipsilateral/contralateral) was calculated in the cornu ammonis fields, CA1 and CA3, and the dentate gyrus (DG).

Results: One week after recovery (P14), the rats in the 1 mg/kg/h group showed significantly poorer weight gain compared with the other groups. However, the morphological score of the brains and the ratio of the surviving neurons in the CA1, CA3 and DG were similar among the groups.

Conclusion: Our results indicate that continuous administration of morphine does not worsen brain damage 7 days after hypoxic–ischaemic insults in neonatal rats.
Prognostic merit of N‐terminal‐proBNP and N‐terminal‐proANP in mechanically ventilated critically ill patients
Authors: BERDAL J.‐E. , STAVEM K. , OMLAND T. , HALL C. , SMITH‐ERICHSSEN N.
Published: August 2010

Background: Amino‐terminal fragments of type‐A and type‐B natriuretic peptide prohormones (NT‐proBNP, NT‐proANP) are powerful prognostic markers in patients with cardiac disease, and NT‐proBNP has been demonstrated to predict outcome in severe sepsis and septic shock. We assessed the prognostic value of NT‐proBNP and NT‐proANP in a consecutive series of mechanically ventilated intensive care patients and compared their prognostic merit.

Methods: Seventy unselected patients admitted to the intensive care unit (ICU) were included in the study 48 h after start of controlled mechanical ventilation. Venous blood was obtained on inclusion and assayed for NT‐proBNP and NT‐pro ANP. Univariate and multivariate logistic regression analysis was used to assess the association of NT‐proBNP and NT‐proANP levels with 30‐day mortality. Established risk factors and possible confounders were used as covariates. Discrimination of different prognostic models was assessed calculating the area under the receiver‐operating characteristics curve (ROC‐AUC).

Results: NT‐proBNP and NT‐proANP levels were higher in non‐survivors (n=25) than in 30‐day survivors (n=45). Log NT‐proBNP [odds ratio (OR) 2.34, 95% CI 1.17–4.66], and log NT‐proANP (OR 2.44, 95% CI 1.12–5.30) were independently predictive of increased mortality. A prior diagnosis of chronic obstructive lung disease was predictive of decreased mortality (OR 0.29, 95% CI 0.08–1.00). The relative prognostic values, evaluated by the ROC‐AUCs of NT‐proBNP (AUC 0.74, 95% CI 0.61–0.86) and NT‐proANP (AUC 0.73, 95% CI 0.61–0.86), were nearly identical.

Conclusions: High NT‐proANP and NT‐proBNP levels associated with decreased short‐term survival in unselected, mechanically ventilated ICU patients. NT‐proANP performed equally well as a prognostic indicator as NT‐proBNP, and may represent a clinically useful alternative to NT‐proBNP.
Post‐operative pressure lability and cardiac baroreflex in normotensive patients as a function of age
Authors: CIVIDJIAN A. , MEYRIEUX V. , GRATADOUR P. , SAGNARD P. , ANNAT G. , BOULEZ J. , VIALE J. P. , QUINTIN L.
Published: August 2010

Background: Pressure lability may be linked to the loss of the cardiac baroreflex. The reduction of the sensitivity of the cardiac baroreflex has not been delineated in the post‐operative period according to age in normotensive patients. This study addresses pressure lability and slope of the cardiac baroreflex as a function of age.

Methods: Patients were allocated to the following three groups: young (20–39 years, n=7), middle aged (40–59 years, n=7) and elderly (60–79 years, n=6), and studied before minor intra‐abdominal surgery under CO2 peritoneal insufflation and nitrous oxide–isoflurane–sufentanil anesthesia, up to 24 h after extubation. An electrocardiogram and non‐invasive beat‐by‐beat pressure monitoring (Finapres®) allowed offline calculation of the sensitivity of the cardiac baroreflex (‘sequence’ technique) and standard deviation (SD) of heart rate (HR; HR variability) and systolic blood pressure (SBP; pressure lability).

Results: Before anesthesia, (a) an inverse relationship was observed between the slope of the cardiac baroreflex and age and (b) a trend (P<0.09) existed between the slope of the cardiac baroreflex and pressure lability, irrespective of age. During the early post‐operative period, young patients returned to their baseline slope of the cardiac baroreflex; no inverse relationship between increased SD of SBP and decreased SD of RR interval was observed. Middle‐aged and elderly patients displayed a depressed slope of the cardiac baroreflex both before and after anesthesia.

Conclusion: At variance with the pre‐operative period, no simple inverse relationship was observed between increased pressure lability and depressed HR variability in young patients during the early post‐operative period.
Post‐conditioning reduces infarct size in an open‐chest porcine acute ischemia–reperfusion model
Authors: LIE R. H. , HASENKAM J. M. , NIELSEN T. T. , POULSEN R. , SLOTH E.
Published: August 2010

Background: Timely reperfusion is a prerequisite for myocardial salvage; however, re‐oxygenation of the ischemic myocardium initiates reperfusion injury. Post‐conditioning diminishes the detrimental aftermath of an acute myocardial infarction through alleviation of reperfusion injury. Ischemic post‐conditioning consists of a series of brief interruptions in the coronary blood supply that has to be applied within the first minutes after re‐establishing the coronary flow.

Methods: Sixteen female mixed Danish Landrace and Yorkshire pigs weighing 20 kg were included. The heart was exposed through a midline sternotomy. A snare was positioned around the left anterior descending coronary artery downstream of the second diagonal branch. After randomization to either no treatment (control group) or treatment by ischemic post‐conditioning (post‐conditioning group), the pigs underwent 45 min of ischemia and 180 min of reperfusion. The post‐conditioning group had a post‐conditioning algorithm applied consisting of 15 s of reperfusion alternating with 15 s of re‐occlusion repeated 10 times.

Results: The groups were comparable with regard to body weight, hemodynamics and the size of the area at risk. The post‐conditioning group had an absolute reduction in infarct size of 18.1% [confidence interval (CI): 6.2: 30.0%] compared with the control group (P=0.0056). In the post‐conditioning group, infarction developed in 39.6±12.0% (1 SD) of the area at risk compared with 57.8±10.2% (1 SD) in the control group.

Conclusion: When ischemic post‐conditioning was applied at reperfusion, we found an absolute reduction in infarct size of 18.1% presumably attributable to a diminished reperfusion injury. The model we have developed is suitable for further studies of this promising intervention.
Significance of retrograde diastolic uterine artery blood flow during regional anesthesia in instrumented pregnant sheep
Authors: KAVASMAA T. , MÄKIKALLIO K. , ERKINARO T. , ACHARYA G. , HAAPSAMO M. , ALAHUHTA S. , RÄSÄNEN J.
Published: August 2010

Background: We studied the interactions between uterine and placental hemodynamics during maternal hypotension in chronically instrumented fetal sheep. In addition, we investigated maternal hemodynamic characteristics, fetoplacental hemodynamics and fetal acid–base status when a retrograde diastolic uterine artery blood flow pattern is present during maternal hypotension.

Methods: Invasive maternal and fetal hemodynamic parameters, uterine (QUtA) and placental (QUA) volume blood flows and acid–base values were examined in 24 chronically instrumented sheep at baseline and during epidural‐induced maternal hypotension at 117–132 (term 145) days of gestation. Uterine artery blood flow velocity waveforms were obtained by Doppler ultrasonography.

Results: Maternal hypotension decreased QUtA without affecting QUA. During hypotension, eight out of 24 sheep demonstrated a retrograde diastolic blood flow velocity waveform pattern in the uterine artery. Maternal systolic, diastolic and mean arterial blood pressures were significantly lower in the retrograde group than in the antegrade group. No statistically significant differences in QUtA, QUA and fetal blood gas values were detected between the two groups during hypotension.

Conclusions: An acute decrease in uterine artery volume blood flow during maternal hypotension is not compensated by increased placental volume blood flow. A retrograde diastolic blood flow pattern in the uterine artery is related to lower maternal arterial pressures, especially during diastole. A uterine artery retrograde diastolic blood flow pattern does not have any additional detrimental short‐term effects on fetal acid–base status.
Bleeding time prolonged by daily low‐dose aspirin is shortened by one medium dose aspirin
Authors: YOKOYAMA T. , YAMASAKI F. , YAMASHITA K. , MANABE M. , SUWA K.
Published: August 2010

Background: In planning surgery, a low‐dose aspirin regimen for prevention of thrombotic events is often discontinued in order to avoid the risk of excessive bleeding during surgery. However, this procedure increases the risk from adverse thrombotic events. We propose a different method, which may normalize the prolonged bleeding time caused by low‐dose aspirin. We verified the effectiveness of this method in healthy volunteers.

Methods: Volunteers with bleeding time prolonged by taking 81 mg of aspirin a day for a period of 1 week were randomly divided into two groups. The test group of 18 volunteers received a dose of 660 mg of aspirin, while the control group of 16 received placebo. Bleeding time and maximum platelet activity were then evaluated.

Results: Before 660 mg of aspirin or placebo, bleeding time was prolonged: in the aspirin group from 3.1 ± 0.7 to 6.1 ± 1.4 min (n=18), and in the placebo group from 2.9 ± 0.9 to 6.1 ± 1.5 min (n=16). This prolongation was significant in both groups at the P<0.01 level. In the test group, bleeding time was shortened to 4.5 ± 1.3 min (P<0.01), which is in the normal range, while it remained prolonged in the control group (6.0 ± 1.2 min). Platelet activity, on the other hand, was suppressed in both groups.

Conclusion: We conclude that 660 mg of aspirin effectively shortens the bleeding time prolonged by daily low‐dose (81 mg) aspirin.
The endothelin receptor antagonist tezosentan improves renal microcirculation in a porcine model of endotoxemic shock
Authors: FENHAMMAR J. , ANDERSSON A. , FRITHIOF R. , FORESTIER J. , WEITZBERG E. , SOLLEVI A. , HJELMQVIST H.
Published: August 2010

Background:Impaired renal microcirculation has been suggested as a factor contributing to the development of renal dysfunction in sepsis. This study was conducted to elucidate the role of endothelin‐1 (ET‐1)in mediating reductions in renal microcirculatory blood flow during endotoxemic shock.

Methods:A prospective, randomized, and experimental study was performed with 16 anesthetized and mechanically ventilated pigs. After 2 h of lipopolysaccaride‐induced endotoxemia, eight animals received a bolus dose of the dual endothelin receptor antagonist tezosentan (1 mg/kg), followed by a continuous infusion of 1 mg/kg/h throughout the experiment. Eight animals served as the control group. Renal microcirculation, total renal blood flow, plasma creatinine levels, cardiac index, and mean arterial pressure were measured. Plasma samples were collected for the measurement of tumor necrosis factor α (TNF‐α), interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), ET‐1, angiotensin II, and aldosterone.

Results:Endotoxin infusion resulted in a state of circulatory shock with impairment of renal microcirculation. An increase in the plasma levels of TNF‐α, IL‐6, IL‐10, ET‐1, angiotensin II, and aldosterone was also observed.

Tezosentan attenuated the decrease in renal microcirculation and renal blood flow, and attenuated the increase in plasma creatinine. Treatment with tezosentan did not significantly affect the plasma cytokine, angiotensin II, or aldosterone response to endotoxemia.

Conclusion:These results indicate that treatment with the dual endothelin receptor tezosentan in endotoxemic shock attenuates the reduction of renal microcirculation and total renal blood flow independently of plasma changes in the renin–angiotensin–aldosterone system or early plasma cytokine response.
Activity of the descending noradrenergic pathway after surgery in rats
Authors: WANG Y. , FENG C. , WU Z. , WU A. , YUE Y.
Published: August 2010

Background:Previous studies have shown that activation of the descending noradrenergic inhibition pathway results in analgesia after surgery. However, the time course of activity of the descending noradrenergic pathway after surgery has not been examined previously. Here, we investigated the spinal release of noradrenaline (NA) in the post‐operative period in a freely moving rat model of incisional pain.

Methods:Loop microdialysis catheters were implanted subarachnoidally via the atlanto‐occipital membrane in Sprague–Dawley rats. Twelve healthy rats without neural deficits were divided into two groups, Group A and Group B, following 5 days of recovery. A plantar incision in the right hind paws of rats in Group A was performed under 1.2% isoflurane. All rats in Group B were only anesthetized by 1.2% isoflurane for the same duration. The microdialysate samples for NA determination were collected before anesthesia, 3 h and 1, 2 and 3 days after incision (or isoflurane anesthesia in Group B) in both groups. The cumulative pain scores were assessed at the above time points.

Results:The spinal release of NA increased gradually, peaked at 2 days after the incision and remained at the peak level up to the third day after the incision. The cumulative pain scores peaked 3 h after the incision, and gradually decreased afterwards and returned to the baseline values 3 days after the incision.

Conclusions:The descending NA tone might be apparently more active in the post‐operative period. The descending noradrenergic inhibitory pathway plays an important role in post‐operative neuroplasticity.
Effect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery
Authors: FERASATKISH R. , DABBAGH A. , ALAVI M. , MOLLASADEGHI G. , HYDARPUR E. , MOGHADAM A. A. , FARITUS Z. S. , TOTONCHI M. Z.
Published: August 2010

Background: Post‐operative pain control is one of the greatest concerns for both physicians and patients. In this study, the effect of magnesium sulfate (MgSO4) solution infusion on post‐operative pain scores and extubation time in patients undergoing elective coronary artery bypass graft (CABG) surgeries was assessed.

Methods: In a double‐blind, randomized, placebo‐controlled clinical trial, 218 patients scheduled for elective CABG were selected and randomly assigned to two groups. After matching inclusion and exclusion criteria for the patients, intravenous MgSO4 was administered intraoperatively for one group and placebo to the second group. Except for this, all the cases were similar regarding anesthesia and surgery.

Results: The MgSO4 patients were extubated sooner compared with the placebo group. Pain scores reported by the group who received MgSO4 were less at the 6th, 12th, 18th and 24th hours after the operation; also, they needed less morphine sulfate during this period.

Conclusion: The results demonstrated a significantly shortened post‐operative time for extubation and reduced acute post‐operative pain scores by intravenous MgSO4 infusion during elective CABG surgery.
Animal model for study of human hepatitis viruses
Authors: Chayama Kazuaki , Hayes C Nelson , Hiraga Nobuhiko , Abe Hiromi , Tsuge Masataka , Imamura Michio
Published: August 2010

Human hepatitis B virus (HBV) and hepatitis C virus (HCV) infect only chimpanzees and humans. Analysis of both viruses has long been hampered by the absence of a small animal model. The recent development of human hepatocyte chimeric mice has enabled us to carry out studies on viral replication and cellular changes induced by replication of human hepatitis viruses. Various therapeutic agents have also been tested using this model. In the present review, we summarize published studies using chimeric mice and discuss the merits and shortcomings of this model.
The severity of endoscopic gastric atrophy could help to predict Operative Link on Gastritis Assessment gastritis stage
Authors: Quach Duc Trong , Le Huy Minh , Nguyen Oanh Thuy , Nguyen Trung Sao , Uemura Naomi
Published: August 2010

Background And Aims:  The aims of the present study were to evaluate the role of moderate‐to‐severe endoscopic gastric atrophy (EGA) on predicting Operative Link on Gastritis Assessment (OLGA) gastritis stage, and to assess the association of high‐stage OLGA gastritis with gastric neoplasia in patients with non‐ulcer dyspepsia.

Methods:  A cross‐sectional study was carried out on 280 dyspeptic outpatients. EGA was assessed according to the Kimura–Takemoto classification. Gastritis stage was established according to the OLGA staging system and gastric neoplasia was assessed according to the Vienna classification. The pathologists who read the specimens were kept blind to the endoscopic results.

Results:  The mean age of patients was 46.1 years (range 20–78 years) with a male‐to‐female ratio of 1:1. High‐stage gastritis (e.g. stage III or IV) was confirmed in 13 (4.6%) patients. All of these patients were more than 40 years‐of‐age (P = 0.01), had Helicobacter pylori infection (P = 0.0006) and moderate‐to‐severe EGA (P < 0.001). Low‐grade dysplasia was found in seven patients: 4/13 (30.7%) with high‐stage gastritis versus 3/267 (1.1%) with low‐stage gastritis (P < 0.001). Six of these patients had moderate‐to‐severe EGA (P = 0.048). The sensitivity, specificity, positive predictive value and negative predictive value of this endoscopic finding in high‐stage gastritis diagnosis were 100%, 57.7%, 10.3% and 100%, respectively.

Conclusions:  OLGA high‐stage gastritis was associated with gastric dysplasia and was mostly diagnosed in patients with moderate‐to‐severe EGA. The absence of this endoscopic finding could effectively rule out the possibility of having high‐stage gastritis.
AN IMMUNOFLUORESCENT STUDY OF CIRCULATING ANTI‐LIVER ANTIBODIES IN CHRONIC LIVER DISEASES
Authors: Tsuji Takao , Ogawa Katsuo , Kosaka Kiyowo
Published: August 2010

A modified indirect Coons' immunofluorescent technic was used to determine whether or not there exist circulating anti‐liver tissue antibodies in the sera of 20 patients with various chronic liver diseases and 25 patients other than liver diseases. The normal liver tissue obtained from victims of traffic accident within 3 hours of death was used as antigen.

For the control gamma‐globulin in the normal liver was stained by direct Goons' technic. Even in the normal liver, intracytoplasmic gamma‐globulin was observed in a certain cytoplasm of the hepatic cells in three out of five cases, and also in the cytoplasm of Kupffer's cells in one of them. The incidence of circulating antibody to the cytoplasm of hepatic cell was 13 out of 20 cases (65%), anti‐nucleus antibody was one in 20 (5%), and anti‐cytoplasm of bile ductular cell antibody was two in 20 patients (10%) with chronic liver diseases, whereas the sera of normal persons as well as of patients other than liver diseases were all proved to be negative. The anti‐nucleus antibody was non‐specific in species and organs.

No close correlation was found among the appearance of anti‐liver tissue antibodies, gamma‐globulin quantities in sera, and tissue reactions such as single cell necrosis, piecemeal necrosis, and cell infiltration in the Glisson's capsule. Nonetheless, the appearance of circulating antibody to the cytoplasm of hepatic cell was detected in seven of 8 patients (87.5%) with active chronic hepatitis. The results imply an etiological role of anti‐liver tissue antibody on the progression and prolongation of liver diseases.
EXPERIMENTAL APPROACH IN STUDIES ON PATHOGENESIS OF BACILLARY DYSENTERY: WITH SPECIAL REFERENCES TO THE INVASION OF BACILLI INTO INTESTINAL MUCOSA*
Authors: OGAWA Hidemasa
Published: August 2010

Pathogenic behaviors of Shigella and Shigella‐like group of enteropa‐thogenic Escherichia coli, which are equally causative organisms in bacil‐lary dysentery, were demonstrated in experimental infection in monkeys and other experimental systems.

From these observations it is concluded that virulent strain of Shigella and enteropathogenic E. coli show specific affinity to epithelial cells and their invasion into those cells of colonic mucosa in the initial stage is an indispensable factor by which the later process of the infection can be established.

The importance of hypersensitivity as a factor to determine the development of bacillary dysenteric colitis was emphasized. ACTA PATH. JAP. 20: 261 ‐ 277, 1970.
LIGHT AND ELECTRON MICROSCOPICAL ASPECTS OF INTERSTITIAL CELL HYPERPLASIA OF TESTIS: – Report of Two Cases –
Authors: SATODATE Ryoichi , KATO Jutaro , MURAMOTO Toshikazu
Published: August 2010

Light and electron microscopic observations of interstitial cell hyperplasia of testis were made. Some of the hyperplastic interstitial cells in the first case were so atypical that tumorous growth was considered to occur in part.

Electron microscopically, the cytoplasm of hyperplastic interstitial cells were filled with vesicles. A large amount of lipochrome pigment granules were found in hyperplastic interstitial cells of the first case, but only scarcely in those of the second case. The pigment granules were assumed to have been induced from mitochondria. Lamellar structures, originating from endoplasmic reticulum, were occasionally found in cytoplasm. Bundles of fibrils were seen scattered in the cytoplasm of some interstitial cells. The bundles were rarely encountered within the lysosomal or pigmental granules, though they were very scarce. They showed occasionally a large aggregation, which might be a precursor of Reinke crystalloid. ACTA PATH. JAP. 20: 387–398, 1970.
AN ULTRASTRUCTURAL STUDY ON GERMINOMA CELLS
Authors: Koide Osamu , Iwai Shigetoshi
Published: August 2010

Germinoma cells were ultrastructurally studied in 17 cases composed of 8 cases with testicular seminoma, 3 cases with ovarian dysgerminoma, 5 cases with intracranial germinoma and one case with mediastinal germinoma. The tumor cells were generally polyhedral in shape, and has frequently a cytoplasmic process, occasionally a long process like a pseudopod. Regarding several components of the cytoplasm, most of the tumor cells in all but few cases had varying numbers of glycogen granules and fatty droplets, some of tumor cells in all but few cases had annulate lamellae, junctional apparatuses and microvilli, while stacks of rER or large autolysomes were observed in some of the tumor cells in several cases. In some of the seminoma cells and dysgerminoma cells observed were one or more of 4 types of intranuclear pseudoinclusions. Definite differences among germinoma cells associated with their originating sites were not recognized except for a few features of the nucleus.