Efficacy of repeated administration of intravenous acetaminophen for pain management after total knee arthroplasty.

Intravenous acetaminophen is an integral component of multimodal postoperative pain management. This prospective study aims to assess the efficacy of the repeated administration of intravenous acetaminophen and the impact on postoperative patient satisfaction with postoperative pain management after total knee arthroplasty (TKA). We enrolled 98 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals (AAP group) or not to receive intravenous acetaminophen (control group). All patients underwent single-shot femoral nerve block after general anesthesia, as well as intraoperative periarticular infiltration of analgesia prior to implantation. The primary outcome was the postoperative numerical rating scale (NRS) pain score at rest. The NRS score was measured just before the administration of study drugs, immediately after arrival in the ward (time 0), and at 6, 12, 18, 24, and 48 h (time 1 to time 5, respectively) postoperatively. We also evaluated the mean doses of rescue opioid use for 24 h postoperatively. At time 5, the AAP group had significantly improved mean NRS score than controls (3.0 vs. 4.0; P < 0.01). Rescue opioid use was significantly lower in the AAP group for 24 hours compared to controls (0.3 µg vs. 0.9 µg; P < 0.01). Repeated intravenous acetaminophen administration after TKA may provide better analgesia and reduce opioid use.

Histamine-2 receptor antagonists (H2RA) may negatively impact ADL assessment in patients on a convalescent rehabilitation ward.

Background/aim: In the convalescent rehabilitation ward, many elderly patients undergo rehabilitation. Histamine-2 receptor antagonists (H2RA), which is a one of the acid secretion inhibitors, is frequently prescribed for the patients as a peptic ulcer prevention measure. At present, H2RA are reported as being associated with factors that reduce cognitive function. However, little is known about the relationship H2RA and rehabilitation outcome. Therefore, this study examined the relationship between H2RA use and Functional Independence Measure (FIM) gain, which determines rehabilitation outcomes for patients admitted to the convalescent rehabilitation ward. Patients and methods: We retrospectively investigated FIM gain on discharge by both the administration group (H2RA (+)) (n = 118) and non-administration group (H2RA (-)) (n = 118). Results: The FIM gain scores of Motor FIM total, Cognition FIM total, and Total FIM were significantly lower in H2RA (+) than in H2RA (-) (Motor FIM total: 8.0 [4.0-16.0] [Inter-Quartile Range] vs. 12.0 [5.0-19.2], p =0.0217, Cognition FIM total: 3.0 [1.0-6.0] vs. 5.0 [2.0-7.0], p =0.0120, Total FIM: 11.5 [4.8-20.2] vs. 17.0 [8.0-27.0], p =0.0089). Conclusion: The administration of H2RA to elderly patients undergoing rehabilitation may prevent cognitive function maintenance or recovery by rehabilitation.

Polarization control with an X-ray phase retarder for high-time-resolution pump-probe experiments at SACLA.

Control of the polarization of an X-ray free-electron laser (XFEL) has been performed using an X-ray phase retarder (XPR) in combination with an arrival timing diagnostic on BL3 of the SPring-8 Angstrom Compact free-electron LAser (SACLA). To combine with the timing diagnostic, a pink beam was incident on the XPR crystal and then monochromated in the vicinity of samples. A high degree of circular polarization of ∼97% was obtained experimentally at 11.567 keV, which agreed with calculations based on the dynamical theory of X-ray diffraction. This system enables pump-probe experiments to be operated using circular polarization with a time resolution of 40 fs to investigate ultrafast magnetic phenomena.

Anticholinergic load negatively correlates with recovery of cognitive activities of daily living for geriatric patients after stroke in the convalescent stage.

WHAT IS KNOWN AND OBJECTIVE: Anticholinergic drugs are associated with risks of falls, confusion and cognitive dysfunction. However, the effect of anticholinergic drug use on rehabilitation outcomes after a stroke is poorly documented. We therefore aimed to establish whether the anticholinergic load was associated with functional recovery among geriatric patients convalescing after stroke. METHOD: Consecutive geriatric stroke patients admitted and discharged from a convalescence rehabilitation ward between 2010 and 2016 were included in this retrospective cohort study. Anticholinergic load was assessed by the Anticholinergic Risk Scale (ARS), and functional recovery was assessed by the Functional Independence Measure (FIM). The primary outcome was cognitive FIM (FIM-C) gain, but we also assessed the interaction of other putative factors identified from univariate analysis. Multivariate analyses were performed, adjusting for confounding factors. RESULTS AND DISCUSSION: We included 418 participants (171 males, 247 females) with a median age of 78 years (interquartile range, 72-84 years). Multiple regression analysis revealed that ARS change, length of stay, and epilepsy were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with anticholinergic load. WHAT IS NEW AND CONCLUSION: A causal relationship cannot be established, but increased ARS scores during hospitalization may predict limited cognitive functional improvement in geriatric patients after stroke. Alternatively, cognitive impairment may lead to increased use of anticholinergic drugs.

A red fluorophore comprising a borinate-containing xanthene analogue as a polyol sensor.

A xanthene derivative containing a borinate moiety emitted red fluorescence with a high quantum yield. The interaction between the borinate and a sugar molecule induced a fluorescence change based on the change in the HOMO-LUMO gap. The response was pH-resistant in a wide range. In addition, catechol quenched through photoinduced electron transfer. The red fluorescence and polyol binding ability of dyes will pave the way for new biological applications of chemical sensors.

Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?

OBJECTIVES: The purpose of this study was to clarify the prognostic factors for cervical spondylotic amyotrophy (CSA). METHODS: The authors retrospectively reviewed the medical records of 47 consecutive patients with CSA in whom the presence/absence of the pyramidal tract sign was noted. We analyzed whether the age, sex, presence of diabetes mellitus, medication (vitamin B12), type of the most atrophic and impaired muscle, the muscle strength at the presentation, the presence of the pyramidal tract sign, magnetic resonance imaging (MRI) findings, including the presence and number of T2 high signal intensity areas (T2 HIA) in the spinal cord and the conversion to surgery were associated with the recovery of muscle strength in the patients. In addition, we also investigated whether the duration of symptoms before surgery and the type of surgery were associated with the recovery of muscle strength in patients who required conversion to surgical treatment. RESULTS: The presence of T2 HIA on MRI (P=0.002), the number of T2 HIA on MRI (P=0.002) and conversion to surgery (P=0.015) were found to be significantly associated with a poorer recovery at the observational final follow-up. Further, the presence of the pyramidal tract sign (P=0.043) was significantly associated with a poor recovery at the final follow-up after surgery. CONCLUSION: The presence of a high signal intensity change on T2-weighted MRI and the pyramidal tract sign can be used as prognostic factors for patients with CSA.

Uterine endometrial carcinoma with trophoblastic differentiation: a case report with literature review.

Choriocarcinoma is categorized as either gestational or nongestational depending on its origin. Nongestational choriocarcinoma originated in the trophoblastic differentiation is a rare but an aggressive tumor. This article reports a nongestational case of a uterine endometrial carcinoma with trophoblastic differentiation. A 54-year-old woman with a history of atypical genital bleeding that underwent semi-radical hysterectomy, bilateral salpingo-oophrectomy, and pelvic lymph nodes dissection. Pathological investigation showed that the tumor had endometrioid adenocarcinoma and choriocarcinomatous components. Although a series of multimodality treatments including craniotomy were performed, she died of aggressive lung and brain metastases one year after the primary surgery.

Spin caloritronics in metallic superlattices.

Spin caloritronics, a research field studying on the interconversion between a charge current (Jc) and a heat current (Jq) mediated by a spin current (Js) and/or magnetization (M), has attracted much attention not only for academic interest but also for practical applications. Newly discovered spin-caloritronic phenomena such as the spin Seebeck effect (SSE) have stimulated the renewed interest in the thermoelectric phenomena of a magnet, which have been known for a long time, e.g. the anomalous Nernst effect (ANE). These spin-caloritronic phenomena involving the SSE and the ANE have provided with a new direction for thermoelectric conversion exploitingJsand/orM. Importantly, the symmetry of ANE allows the thermoelectric conversion in the transverse configuration betweenJqandJc. Although the transverse configuration is totally different from the conventional longitudinal configuration based on the Seebeck effect and has many advantages, we are still facing several issues that need to be solved before developing practical applications. The primal issue is the improvement of conversion efficiency. In the case of ANE-based applications, a material with a large anomalous Nernst coefficient (SANE) is the key for solving the issue. This review article introduces the increase ofSANEcan be achieved by forming superlattice structures, which has been demonstrated for several kinds of materials combinations. The overall picture of studies on spin caloritronics is first surveyed. Then, we mention the pioneering work on the transverse thermoelectric conversion in superlattice structures, which was performed using Fe-based metallic superlattices, and show the recent studies for the Ni-based metallic superlattices and the ordered alloy-based metallic superlattices.

Influence of the strain effect on magnetocrystalline anisotropy in Co2Fe0.4Mn0.6Si Heusler alloys.

The perpendicular magnetocrystalline anisotropy, magnetoelastic properties as well as the Gilbert damping factor in Co2Fe0.4Mn0.6Si thin films were found to depend on a magnetic layer thickness, and they can be also tuned by the application of additional Ag buffer layer. The tetragonal distortion of a magnetic layer was found to increase with decreasing thickness, and after the application of an additional Ag buffer layer, the character of this distortion was changed from tensile to compressive in the plane of a film. A correlation between the tetragonal distortion and perpendicular magnetocrystalline anisotropy was found. However, the magnitude of the observed tetragonal distortion for most samples seems to be too small to explain alone the experimentally found large magnitude of the perpendicular magnetocrystalline anisotropy. For these samples, other mechanisms including both surface and volume effects must be taken into account.

Comparison of aldosterone production among human adrenocortical cell lines.

Several human adrenocortical cell lines have been used as model systems for aldosterone production. However, these cell lines have not been directly compared with each other. Human adrenal cell lines SW13, CAR47, the NCI-H295 and its sub-strains and sub-clones were compared with regard to aldosterone production and aldosterone synthase (CYP11B2) expression. Culture media was collected 48 h after incubation, aldosterone secretion was measured and the data were normalized to the amount of cell protein. RNA was isolated for microarray analysis and quantitative RT-PCR (qPCR). The cell lines with the highest aldosterone production were further tested with regard to angiotensin II (Ang II) stimulation. Neither aldosterone nor CYP11B2 transcript were detected in SW13 or CAR47 cells. The aldosterone production by the NCI-H295, H295A, H295R-S1, H295R-S2, H295R-S3, HAC13, HAC15 and HAC50 were 119, 1, 6, 826, 18, 139, 412, and 1 334 (pmol/mg protein/48 h), respectively. H295A and H295R-S1 expressed less CYP11B2 than the commonly used H295R-S3 cells; while NCI-H295, H295R-S2, HAC13, HAC15 and HAC50 expressed 24-, 14-, 3-, 10-, and 35-fold higher CYP11B2 compared with the H295R-S3 cells. When treated with Ang II, NCI-H295, H295R-S2, HAC13, HAC15 and HAC50 showed significantly higher aldosterone production than the basal level (p<0.05). A comparison of the available human adrenal cell lines indicates that the H295R-S2 and the clonal cell lines, HAC13, HAC15 and HAC50 produced the highest levels of aldosterone and responded well to Ang II.

Development of visible light tomographic imaging system for field-reversed configuration collisional merging experiment.

A visible light tomographic imaging system has been developed for the collisional merging experiment of field-reversed configurations (FRCs) on the FRC Amplification via Translation-Collisional Merging device at Nihon University. Two FRCs formed by field-reversed theta-pinch translate at super-Alfvénic velocity and collide with each other. The translation and collision processes are completed in 20-30 µs, and a single FRC is reformed in ∼70 µs. To study these translation and collisional merging processes, the tomographic system, including fast response tomographic cameras and a reconstruction method assuming a Rigid-Rotor (RR) model, is developed. The developed tomographic cameras simply consist of 16 channels of multi-anode photomultipliers, a band-pass filter, a slit, and a cylindrical lens, which expands the viewing angle. Because the viewing angle is limited by the size of the viewports of the metal chamber, the iterative method assuming the RR model has been applied to reconstruct tomographic images from a small number of projections. The developed tomographic imaging system can estimate the behavior of FRCs. Four cameras are installed in the two cross sections near the collision point. The radial shift of each translated FRC can be calculated by this system. Details of the developed tomographic camera system and RR reconstruction method are reported.

Development of multichord ion Doppler spectroscopy system for toroidal flow measurement of field-reversed configuration.

A double-chord ion Doppler spectroscopy (IDS) system was developed to measure the ion temperature and flow velocity of field-reversed configuration (FRC) plasmas in the FRC amplification via a translation-collisional merging (FAT-CM) device. Adopting a Czerny-Turner mount monochromator and 16-channel photomultiplier tube array, the developed IDS system achieves high wavelength resolution and fast time response. In addition, two vertically aligned optical paths share the optical system up to the monochromator and then branch just before the detector, successfully reducing crosstalk to <1%. The Doppler broadening was measured at two measurement points in the FAT-CM device, simultaneously, and ion temperatures of ∼50 eV were measured. Toroidal spin-up from 7 to 15 km/s and a steady flow velocity of ∼10 km/s were estimated from the Doppler shift obtained by the developed system. The observation of the toroidal flow velocity and the spatial profile of the ion temperature of the FRC plasma in the FAT-CM device were realized. These spectroscopic diagnostic's double chord capabilities will aid in understanding and improving the FRC plasmas.

Spectroscopic observation of super-Alfvénic field-reversed configuration merging process by mixing of tracer ions.

Visualization of the collisional merging formation process of field-reversed configuration (FRC) has been attempted. In the collisional merging formation process, two initial FRC-like plasmoids are accelerated toward each other by a magnetic pressure gradient. The relative speed of the collision reaches several times the typical ion sonic speed and Alfvénic speed. The magnetic structure of the initial-FRCs is disrupted in the collision process, but the FRC-like magnetic structure is reformed in ∼30 µs after the collision. Magnetic reconnection should occur in this process; however, general theoretical models in magnetohydrodynamics approximation cannot be applied to this process because of the high-beta nature of FRC and super-Alfvénic/sonic relative speed. In this work, the spectroscopic observation of the collisional merging FRC formation was conducted to evaluate the timescale and geometry of merging. A slight amount of tracer element (e.g., helium) was mixed into one of two initial-FRCs. Mixing of the tracer did not cause serious adverse effects on the performance of the initial-FRC in the collision and merging processes. The collision and merging processes were visualized successfully and observed using a fast-framing camera with a bandpass filter. The timescale of merging and the outflow speed in the collisional merging process of FRCs were optically evaluated for the first time.

Magnetoelastic interactions and magnetic damping in Co2Fe0.4Mn0.6Si and Co2FeGa0.5Ge0.5 Heusler alloys thin films for spintronic applications.

Co2Fe0.4Mn0.6Si (CFMS) and Co2FeGa0.5Ge0.5 (CFGG) Heusler alloys are among the most promising thin film materials for spintronic devices due to a high spin polarization, low magnetic damping and giant/tunneling magnetoresistance ratios. Despite numerous investigations of Heusler alloys magnetic properties performed up to now, magnetoelastic effects in these materials remain not fully understood; due to quite rare studies of correlations between magnetoelastic and other magnetic properties, such as magnetic dissipation or magnetic anisotropy. In this research we have investigated epitaxial CFMS and CFGG Heusler alloys thin films of thickness in the range of 15-50 nm. We have determined the magnetoelastic tensor components and magnetic damping parameters as a function of the magnetic layer thickness. Magnetic damping measurements revealed the existence of non-Gilbert dissipation related contributions, including two-magnon scattering and spin pumping phenomena. Magnetoelastic constant B11 values and the effective magnetic damping parameter αeff values were found to be in the range of - 6 to 30 × 106 erg/cm3 and between 1 and 12 × 10-3, respectively. The values of saturation magnetostriction λS for CFMS Heusler alloy thin films were also obtained using the strain modulated ferromagnetic resonance technique. The correlation between αeff and B11, depending on magnetic layer thickness was determined based on the performed investigations of the above mentioned magnetic properties.

Factors limiting quantitative phase retrieval in atomic-resolution differential phase contrast scanning transmission electron microscopy using a segmented detector.

Quantitative differential phase contrast imaging of materials in atomic-resolution scanning transmission electron microscopy using segmented detectors is limited by various factors, including coherent and incoherent aberrations, detector positioning and uniformity, and scan-distortion. By comparing experimental case studies of monolayer and few-layer graphene with image simulations, we explore which parameters require the most precise characterisation for reliable and quantitative interpretation of the reconstructed phases. Coherent and incoherent lens aberrations are found to have the most significant impact. For images over a large field of view, the impact of noise and non-periodic boundary conditions are appreciable, but in this case study have less of an impact than artefacts introduced by beam deflections coupling to beam scanning (imperfect tilt-shift purity).

Surface-assisted spin Hall effect in Au films with Pt impurities.

We show, both experimentally and theoretically, a novel route to obtain giant room temperature spin-Hall effect due to surface-assisted skew scattering. In the experiment, we report the spin-Hall effect in Pt-doped Au films with different thicknesses t(N). The giant spin-Hall angle γ(S)=0.12±0.04 is obtained for t(N)=10 nm at room temperature, while it is much smaller for the t(N)=20 nm sample. Combined ab initio and quantum Monte Carlo calculations for the skew scattering due to a Pt impurity show γ(S)≅0.1 on the Au (111) surface, while it is small in bulk Au. The quantum Monte Carlo results show that the spin-orbit interaction of the Pt impurity on the Au (111) surface is enhanced, because the Pt 5d levels are lifted to the Fermi level due to the valence fluctuation. In addition, there are two spin-orbit interaction channels on the Au (111) surface, while only one in bulk Au.

Normal glucose enhances neuronal regeneration after lidocaine-induced injury.

BACKGROUND: Local anaesthetics exhibit direct neurotoxic effects on neurones. Numerous studies have investigated the factors that may reverse this neuropathology, but the effects of glucose conditions on neuronal regeneration after lidocaine-induced injury have not been examined by observing living neurones. The present study investigated the effects of different glucose conditions on neurite length, growth cone regeneration, and cell death in dorsal root ganglia (DRG) neurones after lidocaine-induced injury in vitro. METHODS: DRG explants were isolated from chick embryos at embryonic day 8 and cultured in media containing low, normal, or high glucose concentrations (10, 25, or 40 mM) for 24 h. Tissues were exposed to lidocaine 8 mM for 1 h, then rinsed and incubated for a further 24 h. Neurite length and growth cone collapse assays were performed to assess neuronal growth and regeneration. Lactate dehydrogenase (LDH) and caspase assays were also performed to detect neuronal cell death. RESULTS: Addition of lidocaine for 1 h resulted in >97% growth cone collapse and neurite destruction under all three glucose conditions. Two hours after rinsing out the lidocaine, significant reversal of growth cone collapse and neurite elongation was observed under all glucose conditions. Growth cone collapse was higher under low-glucose condition (P<0.05). High glucose negatively affected neurite length more than growth cone collapse. At 24 h, LDH release with both low- and high-glucose conditions was higher than with normal glucose (P<0.05). Low- and high-glucose conditions increased caspase 3/7 activation. CONCLUSIONS: Normal glucose is optimal for neuronal recovery after lidocaine-induced injury in vitro.

Anticholinergic Load and Nutritional Status in Older Individuals.

OBJECTIVES: The association between anticholinergic load-based Anticholinergic Risk Scale scores and nutritional status is unclear in Japanese patients. The aim of this study was to establish whether anticholinergic load affects the nutritional status of geriatric patients in convalescent stages. DESIGN: Retrospective longitudinal cohort study. SETTING: Convalescent rehabilitation wards. PARTICIPANTS: Of the 1490 patients aged ≥65 years who were discharged from convalescent rehabilitation wards between July 2010 and October 2018, 908 patients met the eligibility criteria. They were categorized according to the presence or absence of increased anticholinergic load from admission to discharge. MEASUREMENTS: Demographic data, laboratory data, the Functional Independence Measure were analyzed between the groups. The primary outcome was Geriatric Nutritional Risk Index (GNRI) at discharge. Multiple linear regression analysis was performed to analyze the relationship between anticholinergic load and GNRI at discharge. RESULTS: Multiple linear regression analysis after adjusting for confounding factors revealed that anticholinergic load was independently and negatively correlated with GNRI at discharge. Particularly, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc. increased significantly from admission to discharge. CONCLUSION: Increased anticholinergic load during hospitalization may be a predictor of nutritional status in geriatric patients.

Shortened ALK1 regulatory fragment maintains a specific activity in arteries feeding ischemic tissues.

Specific transgene induction in angiogenic blood vessels has been in demand in gene therapies for several cardiovascular and malignant proliferative diseases in which the vasculature is an essential part of the disease process. In addition to improvements of delivery vehicles, promoters specific to angiogenic blood vessels have been sought for driving expression of the therapeutic gene. Earlier, we isolated a mouse activin receptor-like kinase 1 (Alk1; Acvrl1) transcriptional regulatory fragment that specifically induces transgene expression in newly forming and remodeling arteries in tumor and wound-healing lesions. For the purpose of gene therapy, however, this 9.2 kb regulatory fragment is too large to be incorporated into most viral transfer vectors. To bypass this limitation, highly conserved regions within the Alk1 gene were used to generate a shortened regulatory fragment. In transgenic mice, the shortened 4.8 kb Alk1PIB fragment showed comparable specificities in angiogenic and remodeling feeding arteries. In addition, the Alk1PIB fragment in a recombinant adenovirus vector showed transcriptional activity in cultured human iliac arterial endothelial cells (HIAECs). The Alk1PIB fragment may be used to target therapeutic protein expression in the feeding arteries to assist in the regeneration of ischemic tissues or to induce damages to the lesions, such as malignant tumors.