Brain-Derived Major Glycoproteins Are Possible Biomarkers for Altered Metabolism of Cerebrospinal Fluid in Neurological Diseases.

Cerebrospinal fluid (CSF) plays an important role in the homeostasis of the brain. We previously reported that CSF major glycoproteins are biosynthesized in the brain, i.e., lipocalin-type prostaglandin D2 synthase (L-PGDS) and transferrin isoforms carrying unique glycans. Although these glycoproteins are secreted from distinct cell types, their CSF levels have been found to be highly correlated with each other in cases of neurodegenerative disorders. The aim of this study was to examine these marker levels and their correlations in other neurological diseases, such as depression and schizophrenia, and disorders featuring abnormal CSF metabolism, including spontaneous intracranial hypotension (SIH) and idiopathic normal pressure hydrocephalus (iNPH). Brain-derived marker levels were found to be highly correlated with each other in the CSF of depression and schizophrenia patients. SIH is caused by CSF leakage, which is suspected to induce hypovolemia and a compensatory increase in CSF production. In SIH, the brain-derived markers were 2-3-fold higher than in other diseases, and, regardless of their diverse levels, they were found to be correlated with each other. Another abnormality of the CSF metabolism, iNPH, is possibly caused by the reduced absorption of CSF, which secondarily induces CSF accumulation in the ventricle; the excess CSF compresses the brain's parenchyma to induce dementia. One potential treatment is a "shunt operation" to bypass excess CSF from the ventricles to the peritoneal cavity, leading to the attenuation of dementia. After the shunt operation, marker levels began to increase within a week and then further increased by 2-2.5-fold at three, six, and twelve months post-operation, at which point symptoms had gradually attenuated. Notably, the marker levels were found to be correlated with each other in the post-operative period. In conclusion, the brain-derived major glycoprotein markers were highly correlated in the CSF of patients with different neurological diseases, and their correlations were maintained even after surgical intervention. These results suggest that brain-derived proteins could be biomarkers of CSF production.

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy.

Proton therapy for paediatric cancer patients is an effective treatment; however, young children have may have difficulties staying still during irradiation. This study investigated the indication of general anaesthesia in paediatric proton therapy. Background information and anaesthesia/treatment protocols were retrospectively extracted from the medical records of cancer patients under 15 years who underwent proton therapy at Southern TOHOKU General Hospital, Fukushima, Japan between April 2016 and December 2018. The anaesthesia and non-anaesthesia groups were compared to evaluate factors determining the need for general anaesthesia. Thirty-two patients who received 285 irradiations were analysed. The median age was 5 years old (range: 1-15), and 13 patients (40.6%) were female. Twelve (37.5%) patients received general anaesthesia. In the general anaesthesia group, airway management using a laryngeal mask was performed in 11 patients (91.6%). Patient age was significantly lower in the general anaesthesia group than in the non-anaesthetised group (p < 0.001). Considering all background factors, only age was strongly associated with anaesthesia in the univariate logistic regression model (odds ratio 0.55 [95% confidence interval 0.35-0.86]; P < 0.01). Thus, age is one of the most important factors determining the need for general anaesthesia during proton therapy in children.

[A Case of Anaphylaxis during Anesthesia Caused Twice by Rocuronium Bromide.]

A 49-year-old woman was scheduled for endoscopic cholecystectomy under general anesthesia in another hospital. The anesthesia was performed by a surgeon, but the operation was cancelled because of anaphylac- tic shock, and the surgeon performed emergency treatment Afterward, the surgeon declined operation, and she could not receive medical treatment. She visited our hospital for complete examination and 'operation. Drug-induced lymphocyte stimulation test (DLST) and standard perioperative test results were almost normal, and we could not find the cause of anaphylaxis preoperatively. After induction of anesthesia, the erythema ap- peared with hypotension and tachycardia. She was responsive to symptomatic treatment such as transfu- sion, antihistamine agent and streroid administration. After the recovery from the shock state, the operation proceeded without complications and she recovered from anesthesia uneventfully. She had no major post- operative complication.

A comparison of intravenous sedation with two doses of dexmedetomidine: 0.2 µg/kg/hr Versus 0.4 µg/kg/hr.

The present study investigated the physiologic and sedative effects between two different continuous infusion doses of dexmedetomidine (DEX). Thirteen subjects were separately sedated with DEX at a continuous infusion dose of 0.2 µg/kg/hr for 25 minutes after a loading dose of 6 µg/kg/hr for 5 minutes (0.2 group) and a continuous infusion dose of 0.4 µg/kg/hr for 25 minutes after a loading dose of 6 µg/kg/hr for 5 minutes (0.4 group). The recovery process was then observed for 60 minutes post infusion. The tidal volume, mean arterial pressure, and heart rate in both groups decreased significantly during infusion, but they were within a clinically acceptable level. A Trieger dot test plot error ratio in the 0.4 group was significantly higher than that in the 0.2 group until 15 minutes post infusion. Sedation appears to be safe at the infusion doses of DEX studied. However, increasing maintenance infusion doses of DEX from 0.2 µg/kg/hr to 0.4 µg/kg/hr delays some recovery parameters.

[Anesthetic practices and use of brain protective therapies for cerebral aneurysm surgery in Japan].

We surveyed anesthetic practices and the use of cerebral monitoring and brain protective therapies during cerebral aneurysm surgery by sending a questionnaire to 822 hospitals in Japan. Three hundred and fifty four hospitals responded. For induction, 51% used thiopental, 41% used propofol, and 94% supplemented induction with fentanyl. For maintenance 45% used isoflurane, 29% used sevoflurane, and 26% used propofol. Only 6% used EEG and/or evoked potentials in most of their patients. Specific brain protective measures were used in most of the hospitals. If used, 97% used mannitol, 43% used steroids and 23% used a certain level of induced hypothermia. When mild hypothermia was used, 39% used 33-34 degrees C, 59% used>34 degrees C, 2% used <33 degrees C, and only 4% used mild hypothermia in every patient. During temporary clipping, 18% kept the blood pressure equal to the level when awake, while 56% used induced hypotension. To control blood pressure during extubation, 72% used nicardipine or nitroglycerine. The use of intraoperative brain protective therapies were common but brain monitoring was not the standard.