Effects of neuromuscular blockade on the surgical conditions of laparoscopic totally extraperitoneal inguinal hernia repair: a randomized clinical trial.

PURPOSE: Unlike other laparoscopic techniques, the peritoneum is not incised in laparoscopic totally extraperitoneal inguinal hernia repair (TEP), and the preperitoneal space is developed as the surgical field by blunt dissection and CO2 insufflation. While many studies have investigated the effect of neuromuscular blockade (NMB) on the surgical conditions and postoperative pain of laparoscopic intraperitoneal surgery, few studies have investigated those of TEP. In the present study, we investigated the effect of NMB on the surgical conditions and postoperative pain of TEP. METHODS: Forty-two adult patients scheduled for unilateral TEP under general anesthesia with remifentanil and desflurane were randomly assigned to paralyzed or non-paralyzed groups. In the paralyzed group, rocuronium doses were administered to maintain post-tetanic count at ≤ 5 during surgery. Non-paralyzed subjects were not given any rocuronium. Postoperatively, surgeon-evaluated surgical conditions, assessed using a 100-mm visual analogue scale ranging from 0 mm (not acceptable) to 100 mm (excellent), were compared between the two groups. For evaluation of postoperative pain, the time from the end of anesthesia to the initial requirement of postoperative analgesia was compared by the log-rank test. RESULTS: Median [interquartile range] score of surgical condition in the paralyzed and non-paralyzed groups were 84 [75-90] and 84 [78-87], respectively (P = 0.46). Significant differences in postoperative analgesic requirements between the two groups were not confirmed (P = 0.74). CONCLUSION: NMB did not improve the surgical conditions nor reduce postoperative pain. NMB is not routinely needed for TEP just because it is a laparoscopic procedure. CLINICAL TRIAL REGISTRATION: The trial was registered in the UMIN clinical trials registry (UMIN000029683, October 24, 2017; Principal investigator: Masafumi Fujimoto, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033920 ) prior to patient enrolment.

Minimum stable structure of the receptor for advanced glycation end product possesses multi ligand binding ability.

The receptor for advanced glycation end products (RAGE) is a multi-ligand receptor involved in the development of diabetic complications. Although the soluble form of the extracellular domain maintains the ability to bind multi-ligands, it is unstable and degrades into several peptide species during storage. Proteolysis with thrombin or factor Xa revealed several protease sensitive sites. Most sensitive site is located between Arg228 and Val229, and peptide bond next to Arg216, Arg116, Arg114 and Trp271 are also cleaved. Seven truncated extracellular domains of RAGE were engineered in order to obtain a stable soluble fragment. RAGE 143 (Ala23-Thr143) is not only protease resistant but also shows the same ligand-binding ability as that of the full-length extracellular domain. The resultant minimum RAGE 143 works as a stable recognition devise to detect advanced glycation end products (AGEs).

Field trial of time-spreading and wavelength-hopping OCDM transmission using FBG en/decoders.

In this paper, field trial on optical code division multiplexing through the commercial-used fiber line is presented. We fabricated fiber Bragg grating en/decoders with time-spreading and wavelength-hopping scheme, considering environmental fluctuation of transmission fiber. 200 km-long transmission of 2-channel x 10 Gb/s signals was achieved on the field photonic network test bed of JGN II. Error free transmission was demonstrated in real field deployed single-mode transmission fiber.

Analysis of red cell and platelet morphology using an imaging-combined flow cytometer.

Laser-based flow cytometry and aperture-impedance methods are still the dominant technologies used for cell analysis in haematology, but both are limited to areas such as morphological analysis of red cell shape and high-sensitivity detection of platelet agglutinates and aggregates. Flow cytometry alone does not provide precise measurement of red cell volume without chemical pretreatment before detection and aperture-impedance is still considered the gold standard in the field of particle volume analysis. In the present study, an experimental prototype instrument called the imaging-combined flow cytometer (IFC) was evaluated. The IFC is equipped with an imaging device consisting of a pulse laser, lens units and a charge-coupled device (CCD) camera in addition to the flow-cytometric optical set-up. A personal computer was attached to the instrument to handle images derived from the imaging device. Laser illumination was triggered so that the image of an object was captured for each exposure of the CCD camera. Objects in the images were used to calculate size and shape information and to compute fractal texture features by image processing after each measurement. The advantage of the IFC is that it can capture images of selected cells of interest at the same time as flow-cytometric detection. Estimation of red cell volume, discrimination of red cells and platelets, and detection of platelet agglutinates and aggregates were attempted using the IFC in combination with image processing, It was found that image analysis on the IFC could provide a substitutional function for mean corpuscular volume (MCV) estimation and detection of platelet agglutinates and aggregates. The additional information generated by the IFC may be useful in diagnostic haematology.

Effect of triacylglycerols containing medium- and long-chain fatty acids on body fat accumulation in rats.

Effect of triacylglycerols containing medium- and long-chain fatty acids (TML) on body fat accumulation was studied in rats. Male Wistar rats were fed an experimental diet containing 25% soybean oil or TML for 6 weeks. The food intake for 6 weeks did not significantly differ between the two diet groups. However, the perirenal and mesenteric adipose tissue weight and carcass fat content were significantly lower in the TML diet group than in the soybean oil diet group. The epididymal adipose tissue weight and liver triacylglycerol content did not significantly differ between the two diet groups. The digestibility of dietary fat did not significantly differ between the two diet groups. These results suggest that an intake of TML decreases body fat accumulation compared to an intake of soybean oil in rats.

A study of the relationship between metabolism using 1H-MRS and function using several neuropsychological tests in temporal lobe epilepsy.

Several investigators have reported on the relationship between metabolism, using magnetic resonance spectroscopy (MRS), and function, using neuropsychological tests in temporal lobe epilepsy (TLE) patients, but the opinions regarding the results remain in contention. The aim of this study is to examine the relationship between metabolism, using proton MRS ((1)H-MRS), and function using several neuropsychological tests in the temporal lobes of TLE patients. We studied 29 TLE patients at our hospital using(1)H-MRS and neuropsychological tests. We used a clinical 1.5 T MR unit. We conducted five neuropsychological tests to examine the function of the left or right temporal lobe. There were significant correlations between the N-acetylaspartate/creatine + phosphocreatine (NAA/Cr) ratios and the scores of almost all of the neuropsychological tests for the temporal lobe function ipsilateral to the spike focus. However, in two Wechsler Memory Scale-Revised (WMS-R) subtests we found no significant correlation in the ipsilateral side. These findings suggest that the NAA/Cr ratios, which reflect neural metabolism, are closely related to function in the temporal lobes of TLE patients. The disparity between the results in two subtests of WMS-R show that several tests may be necessary in order to assess temporal lobe function.

Automated detection of morphological alterations during apoptosis.

A convenient means of measuring apoptosis is described using an automated analyzer (MF-1; Sysmex), which normally provides rapid measurement of malarial parasites. By means of this MF-1 procedure, apoptotic cells exhibited characteristic changes of light scatter (size) and fluorescence (DNA content) relating to cell shrinkage and nuclear fragmentation of apoptosis.

A study of the relationship between the seizure focus and 1H-MRS in temporal lobe epilepsy and frontal lobe epilepsy.

Several studies of temporal lobe epilepsy (TLE) patients have investigated the relationship between the seizure focus and 1H magnetic resonance spectroscopy (1H-MRS). There have also been a few reports in other types of partial epilepsy. We examined the relationship between the seizure focus and the reduction in N-acetylaspartate: creatine (NAA : Cr) ratio using 1H-MRS in both TLE and frontal lobe epilepsy (FLE) patients. We studied 21 patients with unilateral TLE and seven patients with unilateral FLE. We used a 1.5 Tesla magnetic resonance unit (Signa Horizon; General Electric). Approximately 15 x 15 x 20 mm3 voxel of interest (VOI) was placed over the anterior portion of the bilateral hippocampus in the TLE patients, and the anterodorsal position of bilateral frontal lobe in the FLE patients. The seizure focus was identified by interictal scalp electro-encephalogram (EEG). In the TLE patients the NAA : Cr ratios were reduced in the seizure focus, while in the FLE patients they were not always reduced in the seizure focus. In the TLE patients the coincidence rate between the seizure focus and the reduction in the NAA:Cr ratio was 90% (19 of 21 patients), while in the FLE patients the coincidence rate was only 57% (four of seven patients).

Valproic acid-induced hyperammonemic encephalopathy with triphasic waves.

PURPOSE: To examine a patient with valproic acid (VPA)-induced hyperammonemic encephalopathy accompanied by triphasic waves. METHODS: A 61-year-old male patient with epilepsy experienced disturbance of consciousness after VPA dose was increased because of poor seizure control. The electroencephalogram (EEG) taken on admission revealed triphasic waves and high-amplitude delta-activity with frontal predominance. Although serum hepatic enzymes, such as AST and ALT, were normal, serum ammonium level was high at 96 microg/dl (normal range, 3-47 microg/dl). Serum amino acid analysis showed multiple minor abnormalities. Administration of VPA was discontinued immediately after admission, while other anticonvulsants were continued. RESULTS: The patient's condition was improved on the fourth day of admission. An EEG, serum ammonium level, and amino acid profile were normal on the eighth day. Based on VPA administration, serum ammonium levels, and results of amino acid analysis, this patient had VPA-induced hyperammonemic encephalopathy. CONCLUSIONS: Our case indicates that caution is required if triphasic waves appear in VPA-induced hyperammonemic encephalopathy.

Ictal brain hemodynamics in the epileptic focus caused by a brain tumor using functional magnetic resonance imaging (fMRI).

Using functional magnetic resonance imaging (fMRI) we were able to observe, in detail, ictal brain hemodynamics during epileptic seizure caused by a brain tumor. A 53-year-old man was experencing partial motor seizures of the left side of his face and neck. In a brain MR image a mass lesion was found in the subcortical area of the right frontal lobe. We found focal spikes in his right hemisphere, though dominantly in C4 and T4 regions. fMRI investigations were carried out at 1.5 T (GE Signa Horizon) using gradient-echo echo-planar neuroimaging. We were able to perform the ictal examination twice. The activated regions were focalized and clearly found only on the lateral side of the tumor base. The region was in agreement with the epileptic focus examined using an electrocorticogram (ECOG). The signal intensity in the seizure focus rapidly increased 30 seconds before the convulsion was observed. After the end of the convulsion it also took 30 seconds to restore the signal intensity to the baseline value. fMRI is a very useful tool for various studies such as the identification of the epileptic focus, the mechanism of epileptic seizure, and so on.

Bone mineral density of epileptic patients on long-term antiepileptic drug therapy: a quantitative digital radiography study.

In order to assess the bone atrophy lesions of epileptic patients, the bone mineral densities (BMDs) of their lumbar spines and femoral necks were measured using quantitative digital radiography (QDR). The study groups were 44 patients on long-term medication for epilepsy and 62 healthy control subjects. We selected patients who had been taking phenytoin, barbiturates, and/or acetazolamide for at least 5 years. BMDs at both sites were significantly lower in the patient group than in the control group. No sex differences were found in BMDs. There were no significant correlations with the onset or the duration of illness and BMD. We compared BMD according to the type of epileptic drug being taken and theorized that phenytoin, barbiturates, and acetazolamide reduced BMD. BMDs of the 15 patients were measured again 7 years later, and were found to be significantly lower at both sites than in the previous examination. These results confirm the presence of bone atrophy lesions in epileptic patients on long-term antiepileptic drugs. Patients on antiepileptic therapy for long periods should have their BMDs checked, because they are prone to developing bone atrophy.

A study of motor dysfunction associated with schizophrenia based on analyses of movement-related cerebral potentials and motor conduction time.

BACKGROUND: Several reports have shown that schizophrenics have motor dysfunction. The aim of this study was to identify the site of the nerve damage responsible for the motor dysfunction in schizophrenics by measuring both movement-related cerebral potentials (MRCPs) and motor conduction times. METHODS: The subjects were 27 patients and 31 controls. There was no significant difference in age, nor in the length of the subjects' arms between the two groups. MRCPs were recorded during voluntary self-paced index movements of the thumb. The motor nerve conduction time was determined by magnetically stimulating the motor cortex and the spinal root. RESULTS: Six of 27 schizophrenics had normal MRCPs, but the remaining 21 showed abnormal MRCPs. Of the 31 controls, 27 were normal, whereas 4 showed abnormal MRCPs. The difference between the two groups was significant; however, no significant differences were found in the motor conduction times, the motor root conduction times, or the central motor conduction times between the two groups. CONCLUSIONS: Our results suggest that the responsible focus of motor nerve disorder in schizophrenia lies in the motor-integrating system in frontal lobe, and not in the nervous conduction system from the brain to the muscles.

Mapping epileptic foci by the dipole tracing method in a brain tumor patient with olfactory seizures: comparison with intraoperative electrocorticograms.

We estimated the position of the epileptic foci in a case of brain tumor with olfactory seizures using the Dipole Tracing Method (DTM) and compared the results with electrocorticograms (ECoGs) recorded during surgical resection. The case was a 24-year-old male. Electroencephalograms (EEG) showed frequent focal spikes in the right temporal area. Magnetic resonance imaging revealed a tumor in the right hippocampus region. We analyzed the spikes using DTM with a CDT-1000 EEG analyzer. The locations of two independent foci were analyzed; one was thought to be in the right hippocampus and the other in the right superior temporal gyrus. When the ECoG was taken, the results were in very close correlation with those of DTM, demonstrating the accuracy of DTM in the estimation of the location of epileptic foci in epileptic seizures with brain lesions.

Frontal lobe epilepsy with secondarily generalized 3 Hz spike-waves: a case report.

We report a case of frontal lobe epilepsy with bursts of 3 Hz spike-wave, often dominant in the left frontal lobe, that sometimes developed into a secondary bilateral generalization. This patient was a 69-year-old male with a history of epileptic seizures that began 3 months following a head injury at the age of 17. His seizures occurred two or three times a day, but after medication the frequency was halved. The seizures began with a feeling of heaviness of the head, accompanied by myoclonus at both angles of the mouth. Consciousness was clear for most of the seizures, which ranged from several seconds to many minutes. When seizures lasted for longer than 10 minutes, a temporary generalization accompanied by a loss of consciousness was sometimes observed. Neurological tests and cranial MRI yielded no abnormal local findings. The secondary generalized seizure seen in this case is the so called "secondary bilateral synchrony (SBS)." We succeeded in making an EEG recording of the bilateral generalization of a seizure discharge originating in the left frontal lobe, which until now has not been done. This case is direct proof that a primary frontal focus can give rise to SBS.

Study on FIRDA and 3 Hz rhythmic slow wave bursts occurring in the frontal area of epileptic patients.

We classified epileptic patients with frontal-dominant rhythmic slow-wave bursts into a FIRDA group with frequencies of 1.5 to 2.5 Hz and a 3 Hz group with a frequency of 3 Hz. We compared the two groups in clinical background and EEG findings. The patients in the FIRDA group were older, and partial epilepsy was more common. In the 3 Hz group, idiopathic generalized epilepsy was more common. All of the partial epilepsy in the patients in the FIRDA group was symptomatic, and organic brain damage such as sequelae of brain tumor surgery, or cerebrovascular disorders, etc., were the most common primary diseases. There was no difference between the two groups in frequency of seizures, and VPA was the drug most often used to treat the patients in the 3 Hz group. No morphological differences between the two group, except the difference in frequency, were observed among the EEG findings. Accompaniment by localized spike waves or sharp waves was more common in the FIRDA group. When epilepsy was accompanied by rhythmic slow-wave bursts in the frontal area, its clinical significance depended on whether its frequency was 2.5 Hz or less or 3 Hz. When it was 2.5 Hz or less, symptomatic partial epilepsy was more common, suggesting the presence of large, prominent organic brain damage, such as sequelae of brain tumor surgery or cerebrovascular disorders. Idiopathic generalized epilepsy, on the other hand, was shown to be more common when the frequency was 3 Hz.

Non-convulsive status epilepticus induced by antidepressants.

We report on a 27-year-old woman of non-convulsive status epilepticus (NSE) very probably induced by antidepressants. She has no history of febrile convulsions, or epileptic seizures. There are no genetic factors for epilepsy in her family. As she developed depressive illness, she consulted a doctor. Clomipramine 25 mg i.v. drip/day and maprotiline 75 mg/os/day were started. Recently she began to doze, so an EEG was performed. Continuous generalized 2-3 Hz spike and wave complexes were observed. Clomipramine and maprotiline were stopped the same day, and the patient's drowsiness gradually improved. There are some case reports of NSE induced by antidepressants. However, the patients in these reports had received frequent electroconvulsive therapy (ECT) and were middle aged and may have been affected by an organic brain disorder. The present patient was young, and had not received ECT. It is therefore very likely that antidepressants may have been responsible for the occurrence of NSE in this patient. It is concluded that NSE should be considered an adverse effect of any antidepressant.

Function of silica bodies in the epidermal system of rice (Oryza sativa L.): testing the window hypothesis.

Silicon has been considered to be important for normal growth and development of the rice plant (Oryza sativa L.). To investigate the physiological function of deposited silica in rice leaves, the hypothesis that silica bodies in the leaf epidermal system might act as a 'window' to facilitate the transmission of light to photosynthetic mesophyll tissue was tested. The silica content of leaves increased with supplied silicon and was closely correlated with the number of silica bodies per unit leaf area in the epidermal system. There was a significant difference in silica deposition and formation of silica bodies between Si-treated and non-treated leaves; silicon was polymerized inside the silica cells and bulliform cells of the epidermis, in Si-treated leaves. Although the 'windows' were only formed in leaves with applied silicon, optical properties of leaf transmittance, reflectance and absorptance spectra in Si-treated and non-treated leaves were almost equal. Furthermore, light energy use efficiency and quantum yield of Si-treated leaves were less than in leaves not containing silica bodies. Thus, silica bodies, at least based on the data, do not function as windows in rice leaves.

Flow cytometer and imaging device used in combination.

This report presents a flow cytometer devised by the authors and equipped with a CCD camera to obtain images of selected particles. Each image is linked to a point in the scattergram from which it can be retrieved from memory. The system uses an argon ion laser for flow-cytometric analysis and a diode-pumped pulse laser (532nm) to generate CCD images. Aggregated platelets in a blood sample and casts in a urine sample can be detected by this system. A fast flow rate is suitable for efficient flow-cytometric detection, and image resolution is sufficiently adequate for recognizing aggregated platelets and casts. Flow-cytometric and morphological data are used together to distinguish different types of cells in the same region on the scattergram and identify cells present in extremely small numbers among the majority.

Effects of zonisamide on BAEP, SSEP and P300.

The effects of zonisamide on BAEP, SSEP and P300 were studied. The subjects were 12 patients (4 men and 8 women) with untreated epilepsy. Their ages ranged from 16 to 59 years, with a mean of 26.3 +/- 12.0 years. The daily dose of zonisamide was between 200 mg. to 600 mg. (2 to 6 tablets, 2.9 +/- 1.1 tablets on average). The serum concentrations of zonisamide ranged from 11.4 to 32.5 micrograms/ml, with a mean of 18.7 +/- 8.5 micrograms/ml 1 year after administration. Central conduction time and latency in BAEP and SSEP and amplitude, response time and latency in P300 were investigated. There were no significant differences in any of the tests. Zonisamide did not affect any of these evoked responses and may be less toxic to the central nervous system than other antiepileptic drugs.