bluuebunny/crossref_metadata_2025_split huggingface dataset:
Slow oscillation of membrane currents mediated by glutamatergic inputs of rat somatosensory cortical neurons: in vivo patch‐clamp analysis
Authors: Doi Atsushi , Mizuno Masaharu , Katafuchi Toshihiko , Furue Hidemasa , Koga Kohei , Yoshimura Megumu 
Published: October 2007

AbstractUsing in vivo patch‐clamp technique, the slow oscillation of membrane currents was characterized by its synaptic nature, correlation with electroencephalogram (EEG) and responses to different anesthetic agents, in primary somatosensory cortex (SI) neurons in urethane‐anesthetized rats. In more than 90% of the SI neurons, the slow oscillation of the inward currents (0.1–2.5 Hz) with the duration of several hundreds of a millisecond was observed at the holding membrane potential of −70 mV. The reversal potential of the inward currents was approximately 0 mV and was suppressed by application of an α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazole propionate (AMPA) receptor antagonist. In most cases (> 90%) the inward current was synchronized with positive wave of the surface EEG recorded from ipsilateral and even contralateral cortical regions. The frequency as well as duration of the slow oscillation decreased by a volatile anesthetic agent, isoflurane (1.5–5.0%), and excitatory postsynaptic currents (EPSCs) were almost abolished at the highest concentration. Intraperitoneal injection of pentobarbital (25 mg/kg) also decreased the frequency of the slow oscillation without affecting short EPSCs. When γ‐aminobutyric acid A (GABAA) receptors were activated by local microinjection of muscimol (3 × 10−3 m, 1–10 µL) into the thalamus, the frequency of the slow oscillation markedly decreased, but was not abolished completely. These findings suggest that the slow oscillation of the inward currents is generated by the summation of glutamatergic EPSCs, and affected by isoflurane and pentobarbital differently. In addition, GABAergic system in the thalamus can affect the frequency, but is not essentially implicated in the genesis of the slow oscillation.
A simple method to reduce the inspiratory oxygen fraction for high pulmonary blood flow patients in an operating room
Authors: ASAKURA AYAKO , MIYASHITA TETSUYA , FUJIMOTO JUNICHI , MORIMURA NAOTO , KURAHASHI KIYOYASU , YAMADA YOSHITSUGU 
Published: October 2007

SummaryBackground:  Low inspired oxygen acutely increases pulmonary vascular resistance and decreases pulmonary‐systemic blood flow ratio. We present a simple method to lower inspired oxygen fraction (FIO2 < 0.21) without supplemental nitrogen, during mechanical ventilation by an anesthesia machine.Methods:  After institutional approval, seven healthy adult volunteers and three infants (0–12 month old) scheduled for congenital heart surgery were enrolled in this study. All the infants were diagnosed with congestive heart failure because of high pulmonary blood flow and were thought to benefit from low FIO2. The volunteers performed spontaneous ventilation (fresh air flow rate = 10 l·min−1, tidal volume = 600 ml, frequency = 10 br·min−1). The infants were mechanically ventilated with air (fresh air flow rate = 6 l·min−1, tidal volume = 10 ml·kg−1, 15 < frequency < 30 br·min−1 to adjust PaCO2 between 5.8 kPa and 6.5 kPa (45–50 mmHg), after induction of general anesthesia and tracheal intubation. The fresh gas flow rates were determined by the following formula. Fresh gas flow rate = (FIO2 − FEO2) EVE/(0.21 + FIO2 − FEO2 − target FIO2). We recorded FIO2 every 5 min for 30 min. When arterial oxygen saturation decreased >15%, fresh gas flow rates were increased to adjust FIO2 to 0.21.Results:  In all of the seven volunteers and three infants target FIO2 was achieved in <10 min. FIO2 was kept at 0.18 ± 0.01 (SD) by calculated fresh air flow rates. In one infant, SpO2 decreased >15% 20 min after lowering FIO2, we had to discontinue this study, and increase fresh gas flow to ventilate the infant with FIO2 0.21. In the other two infants, FIO2 was maintained throughout the study.Conclusions:  This simple and convenient method to decrease FIO2, has a utility in clinical situations, in which pulmonary vascular resistance is to be increased to improve systemic oxygen delivery in patients with high pulmonary blood flow during cardiac surgery.
Multidrug intravenous anesthesia for children undergoing MRI: a comparison with general anesthesia
Authors: SHORRAB AHMED A. , DEMIAN ATEF D. , ATALLAH MOHAMED M. 
Published: October 2007

SummaryBackground:  We used a multidrug intravenous anesthesia regimen with midazolam, ketamine, and propofol to provide anesthesia for children during magnetic resonance imaging (MRI). This regimen was compared with general anesthesia in a randomized comparative study. Outcome measures were safety, side effects and recovery variables in addition to adverse events in relation to age strata.Methods:  The children received either general anesthesia with propofol, vecuronium and isoflurane [general endotracheal anesthesia (GET) group; n = 313] or intravenous anesthesia with midazolam, ketamine, and propofol [intravenous anesthesia (MKP) group; n = 342]. Treatment assignment was randomized based on the date of the MRI. Physiological parameters were monitored during anesthesia and recovery. Desaturation (SpO2 < 93%), airway problems, and the need to repeat the scan were recorded. The discharge criteria were stable vital signs, return to baseline consciousness, absence of any side effects, and ability to ambulate.Results:  With the exception of two children (0.6%) in the MKP group, all enrolled children completed the scan. A significantly greater number (2.3%) required a repeat scan in the MKP group (P < 0.05) and were sedated with a bolus dose of propofol. The total incidence of side effects was comparable between the MKP (7.7%) and GET groups (7.0%). Infants below the age of 1 year showed a significantly higher incidence of adverse events compared with the other age strata within each group. Within the MKP group, risk ratio was 0.40 and 0.26 when comparing infants aged below 1 year with the two older age strata, respectively. Recovery characteristics were comparable between both groups.Conclusions:  Intravenous midazolam, ketamine and propofol provides safe and adequate anesthesia, comparable with that obtained from general endotracheal anesthesia, for most children during MRI.
Use of the ProSeal™ laryngeal mask airway in an infant with a repaired H‐type tracheoesophageal fistula and tracheomalacia
Authors: OLOMU PATRICK N. , KIDD JOSEPH N. , KOSTER KIM R. 
Published: October 2007

SummaryThe ProSeal™ laryngeal mask airway (PLMA) is a relatively new airway device with design features that improve the quality of positive pressure ventilation (PPV) and may decrease the risk of gastric aspiration. We describe the use of this device for the anesthesia management of an infant with an esophagocutaneous fistula following repair of an H‐type tracheoesophageal fistula and tracheomalacia, in which avoidance of tracheal intubation was desired. This case report demonstrates that the PLMA may be a useful and practical alternative to tracheal intubation in an infant with a tenuous airway.
Awake tracheal intubation through the laryngeal mask in neonates with upper airway obstruction
Authors: ASAI TAKASHI , NAGATA ATSUSHI , SHINGU KOH 
Published: October 2007

SummaryNeonates with Pierre Robin or Treacher‐Collins syndrome are at risk of upper airway obstruction and may require surgical fixation of the tongue to the mandible. Such neonates are at high risk of hypoxia during induction of anesthesia and thus awake fiberoptic intubation would be required. We experienced neonates in whom awake fiberoptic intubation could not be carried out, because of severe hypoxia. Awake insertion of the laryngeal mask solved this problem. A 1‐month‐old neonate with Pierre Robin syndrome and another with Treacher‐Collins syndrome were scheduled for surgical fixation of the tongue to the mandible, for constant upper airway obstruction. In both patients, awake fiberoptic intubation was attempted but abandoned, because SpO2 rapidly decreased during the attempts. Awake insertion of the laryngeal mask relieved upper airway obstruction and facilitated oxygenation. Fiberoptic intubation through the laryngeal mask was easily achieved. Anesthesia was then induced. No hypoxia occurred after insertion of the laryngeal mask. In a further two neonates with Treacher‐Collins syndrome and in one neonate with Pierre Robin syndrome, awake fiberoptic intubation through the laryngeal mask was also successful. We believe that in neonates with predicted difficult intubation, who are at risk of upper airway obstruction and awake fiberoptic intubation could aggregate hypoxia, awake insertion of the laryngeal mask can be useful in facilitating oxygenation (by relieving upper airway obstruction) and in facilitating fiberoptic intubation.
The electroencephalograph during anesthesia and emergence in infants and children
Authors: DAVIDSON ANDREW J. , SALE STEVEN M. , WONG CONNIE , MCKEEVER STEPHEN , SHEPPARD SUZETTE , CHAN ZEKE , WILLIAMS CHRIS 
Published: October 2007

SummaryBackground:  The characteristics of the electroencephalogram (EEG) during anesthesia in children are poorly described. An understanding of the EEG during anesthesia may help explain and predict the performance of EEG‐derived depth of anesthesia monitors in children. This study aims to describe the association between age and some basic characteristics of the EEG during nonstandardized anesthesia in children and infants.Methods:  Sixty‐four children aged 9 days to 12 years were enrolled in this observational physiological study. Anesthesia was given at the discretion of the anesthetist. EEG was recorded from after induction to emergence using a BRM2 brain monitor ’’BrainZ Instruments, Auckland, New Zealand‘‘ in parietal and frontal montages. For comparison, 90% spectral edge frequency (SEF‐90) and power were determined at three points (equilibrium during anesthesia, when the volatile agent was discontinued and at emergence), and children were divided into three age groups (0–6 months, 6–24 months and 2–12 years).Results:  Fifty‐seven children had artifact‐free EEG data. From equilibrium to emergence the mean forehead power decreased substantially in children aged 2–12 years (3171–153 μV2, P < 0.001) and 6–24 months (756–140 μV2, P < 0.001) but no difference was found in infants aged 0–6 months (93–63 μV2, P = 0.4). From equilibrium to emergence mean forehead spectral edge frequency increased in children aged 2–12 years (10.8–13.7 Hz, P = 0.01) but no change was found in children aged 6–24 months (12.7–12.7 Hz, P = 0.9) or 0–6 months (9.45–7.26 Hz, P = 0.08). Throughout emergence, infants demonstrated a discontinuous EEG pattern with intermittent bursts separated with low amplitude.Conclusions:  During anesthesia, the EEG in infants is fundamentally different from the EEG in older children. This study supports the need for specific infant‐derived algorithms if EEG‐derived anesthesia depth monitors are to be used in infants.
Does the Italian pediatric anesthesia training program adequately prepare residents for future clinical practice? What should be done?
Authors: ASTUTO MARINELLA , LAURETTA DANIELA , MINARDI CARMELO , DISMA NICOLA , SALVO IDA , GULLO ANTONINO 
Published: October 2007

SummaryBackground:  Pediatric anesthesia should be considered a subspecialty addressing the complete pediatric population (from preterm to teenager) and requiring particular anatomical, pathophysiological, pharmacological and anesthesiological knowledge. A survey was conducted to evaluate the training in pediatric anesthesia performed by Medical Schools of Anesthesia in Italy and to assess if the European Federation of Associations of Pediatric Anesthesia (FEAPA) guidelines for training in pediatric anesthesia had been adopted.Methods:  The survey was addressed to the Directors of the Departments of Anesthesia and Intensive Care of the Medical Schools throughout Italy using a questionnaire.Results:  We contacted all 37 Schools of Anesthesia, but only 26 of these (70 %) answered all the questions. A specific training program exists in 24 (92%). The duration of the training is variable: in 40% of the schools it lasts 2 months, in 27% 3 months and in 33% more than 3 months (3–6 months). Only 29% of the Schools required a minimum number of procedures to be performed during the training period. A final test is performed in 46% of the Schools. A dedicated staff for pediatric anesthesia exists in 70% of the Italian Schools.Conclusions:  In Italy, the FEAPA guidelines have not yet been completely adopted. The experience of a dedicated unit for pediatric anesthesia will be invaluable to define operative guidelines, courses and to establish the minimum equipment necessary for pediatric management in nonspecialist hospitals.
Comparison of different near‐infrared spectroscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in children
Authors: NAGDYMAN NICOLE , EWERT PETER , PETERS BJÖRN , MIERA OLIVER , FLECK THILO , BERGER FELIX 
Published: October 2007

SummaryBackground:  We compared two different near‐infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO2) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO2) and central SvO2 from the superior caval vein (SVC) during elective cardiac catheterization in children.Methods:  A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO2 in the left jugular bulb and with SvO2. rSO2 was compared with SjO2 from the right jugular bulb and SvO2. Linear regression analysis and Pearson’s correlation coefficient were calculated and Bland–Altman analyses were performed.Results:  Cerebral TOI and SjO2 were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO2 with r = 0.74 (P < 0.0001). Bland–Altman plots showed a mean bias of −4.3% with limits of agreement of 15.7% and −24.3% for TOI and SjO2 and a mean bias of −4.9% with limits of agreement of 10.3% and −20.1% for TOI and SvO2. Cerebral rSO2 and SjO2 showed a significant correlation (r = 0.83, P < 0.0001) and rSO2 and SvO2 showed excellent correlation with r = 0.93 (P < 0.0001). Bland–Altman plots showed a mean bias of −5.2% with limits of agreement of between 8.4% and −18.8% for rSO2 and SjO2 and a mean bias of 5.6% with limits of agreement of 13.4% and −2.2% for rSO2 and SvO2.Conclusions:  Both near‐infrared spectroscopy devices demonstrate a significant correlation with SjO2 and SvO2 values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO2 and SvO2.
Anorectal amelanotic melanoma
Authors: Hillenbrand A. , Barth T. F. E. , Henne‐Bruns D. , Formentini A. 
Published: October 2007

AbstractObjective  Anorectal melanoma is a rare, highly malignant tumour with a poor 5 year survival of 10%. Most anorectal melanomas have gross and/or histologic pigmentation, however about 30% of anorectal melanomas are amelanotic.Method  We report three cases of amelanotic anorectal melanomas and integrate our data with six case reports of amelanotic malignant melanoma from the literature. Further we compare clinicopathological data and clinical outcome with large series of anorectal melanomas (both, amelanotic and pigmentated).Results  There were seven females and two males, of median age 62 years (range: 45–75 years). Rectal bleeding was the leading symptom in all cases with a mean duration of 4 months before diagnosis. Eight of nine patients developed distant metastases. Median survival was 14 months (range: 3–60 months). A tumour thickness of < 4 mm was correlated with long‐term disease‐free survival, whereas tumour thickness of 4 mm or more was correlated with systemic recurrence.Conclusion  Early diagnosis is key for efficient treatment and improved survival rate for patients with this unusual variant of melanoma. There is no difference in terms of age, time of diagnosis, stage and survival between pigmented and amelanotic anorectal melanoma.
Adenocarcinoma of the anal transitional zone after double stapled ileal pouch‐anal anastomosis for ulcerative colitis
Authors: Chia C. S. , Chew M. H. , Chau Y. P. , Eu K. W. , Ho K. S. 
Published: October 2007

AbstractThe development of adenocarcinoma in the anal transitional zone, after restorative proctocolectomy for ulcerative colitis, is rare. We report the first Asian and sixth known case. A 41‐year‐old Indian lady had a long standing history of ulcerative colitis. Restorative proctocolectomy and stapled ileal pouch‐anal anastomosis without mucosectomy was performed. She remained asymptomatic until 3 years later when she complained of discomfort on defecation. A poorly differentiated adenocarcinoma in the anal transition zone was diagnosed and she subsequently underwent an abdomino‐perineal resection. The previously reported cases in the literature are reviewed. We also discuss the suggested surveillance for high‐risk patients who have undergone an ileal‐anal pouch anastomosis.
Associates of change in liver fat content in the morbidly obese after laparoscopic gastric banding surgery
Authors: Phillips M. L. , Boase S. , Wahlroos S. , Dugar M. , Kow L. , Stahl J. , Slavotinek J. P. , Valentine R. , Toouli J. , Thompson C. H. 
Published: October 2007

Aim:  Hepatic steatosis affects up to 30% of the population. After weight loss, monitoring of the change in hepatic steatosis is not routinely performed. This study aimed to define the closest associates of change in liver fat content in a population of obese females following laparoscopic gastric banding surgery.Methods:  Before and 3 months after surgery, proton magnetic resonance spectroscopy and magnetic resonance imaging were used to estimate the amount of lipid contained within the liver and abdominal subcutaneous and visceral compartments of 29 obese [mean body mass index (BMI) 39 ± 5 kg/m2], non‐diabetic women aged between 20 and 62 years. Liver enzymes, fasting plasma glucose and insulin were also measured as well as body weight, BMI and waist circumference. Insulin sensitivity was estimated using homeostasis model assessment insulin resistance index.Results:  Significant reductions occurred in body weight (p < 0.001), abdominal fat volumes (p < 0.001) and liver fat (p = 0.037) 3 months after surgery. Change in liver fat content more closely associated with change in serum gamma‐glutamyl transferase (GGT; r = 0.71, p < 0.001) than with changes in weight (r = 0.10, p = 0.612) and waist circumference (r = 0.15, p = 0.468).Conclusions:  Our findings suggest that obese non‐diabetic female patients who have undergone significant weight loss over 3 months can be better assessed for the regression of excess liver fat content by monitoring changes in serum GGT levels rather than changes in simple anthropometry.
Effects of metformin on peripheral insulin sensitivity and intracellular lipid contents in muscle and liver of overweight Japanese subjects
Authors: Tamura Y. , Watada H. , Sato F. , Kumashiro N. , Sakurai Y. , Hirose T. , Tanaka Y. , Kawamori R. 
Published: October 2007

Aim:  Recent studies suggest that insulin resistance is associated with increased intrahepatic lipid (IHL) and intramyocellular lipid (IMCL) contents. While metformin improves insulin resistance mainly in liver, its effects on IHL and IMCL have not been clarified yet. The aim of this study was to investigate the effects of low‐dose metformin (750 mg/day) on peripheral insulin sensitivity, IHL and IMCL.Methods:  Before and 3 months after low‐dose metformin therapy, eight overweight/obese Japanese subjects [body mass index (BMI) >25 kg/m2] were studied with blood sampling, measurement of IHL and IMCL by 1H magnetic resonance spectroscopy and glucose infusion rate (GIR) during euglycaemic–hyperinsulinaemic clamp as an index of peripheral insulin sensitivity.Results:  A 3‐month low‐dose metformin therapy did not alter body weight, total body fat, fat distribution or physical activity level but increased GIR by 31% (from 6.24 ± 0.86 to 7.82 ± 0.82 mg/kg/min, p < 0.01). Although metformin treatment did not alter IMCL (from 4.1 ± 1.0 to 4.2 ± 0.9, not significant), it decreased IHL by 21% (from 15.9 ± 2.8 to 11.8 ± 2.2%, p < 0.05).Conclusions:  A 3‐month low‐dose metformin treatment improved peripheral insulin sensitivity and reduced IHL, without significantly changing BMI, adiposity or IMCL.
Detection of impaired glucose tolerance and undiagnosed type 2 diabetes in UK South Asians: an effective screening strategy
Authors: Hanif M. W. , Valsamakis G. , Dixon A. , Boutsiadis A. , Jones A. F. , Barnett A. H. , Kumar S. 
Published: October 2007

Aim:  We tested a stepwise, community‐based screening strategy for glucose intolerance in South Asians using a health questionnaire in conjunction with body mass index (BMI). Anthropometric measurements (waist and hip circumference, sagittal diameter and percentage body fat) were then conducted in a hospital setting followed by an oral glucose tolerance test (OGTT) to identify subjects at the highest risk and analyse the factors predicting that risk.Methods:  A health questionnaire was administered to 435 subjects in a community setting and BMI was measured. Subjects were graded by a risk score based on the health questionnaire as high, medium and low. Subjects with high and medium risk scores and a representative sample of those with low scores had anthropometric measurements in hospital followed by an OGTT. In total, 205 (47%) of the subjects had an OGTT performed.Results:  In total, 48.7% of the subjects tested with an OGTT had evidence of glucose dysregulation: 20% had diabetes and 28.7% had impaired glucose tolerance (IGT). Logistic regression model explained 49.1% of the total variability. The significant predictors of diabetes and IGT were Blood Glucose Monitoring Strips (BMI), random blood glucose (BM), sibling with diabetes and presence of diagnosed hypertension or ischaemic disease. Most of these predictors along with other heredity diabetes factors create a composite score, with high predictability, as the receiver operating curve analysis shows.Conclusion:  We describe a simple, stepwise strategy in a community setting, based on a health questionnaire and anthropometric measurements, to explain about 50% of cases with IGT and diabetes and diagnose about 50% of cases from the population screened. We have also identified factors that predict the risk.