Efficacy of modified thoracoabdominal nerves block through perichondrial approach in open gynecological surgery: a prospective observational pilot study and a cadaveric evaluation.

BACKGROUND: Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) was first described as a peripheral nerve block by Tulgar in 2019. This technique provides an analgesic effective range from Th7-11 with a single puncture per side. Although the efficacy and effective duration of M-TAPA have been reported, further examination is required. Therefore, this study aimed to evaluate the analgesic range and effective duration of M-TAPA in open gynecologic surgery. METHODS: Following approval, 10 adult female patients scheduled for open radical hysterectomy via a vertical incision or laparotomy using a midline incision from under the xiphoid process to the symphysis pubis were enrolled. The primary outcome was the number of anesthetized dermatomes at 2 and 24 h postoperatively. Secondary outcomes included numerical rating scale scores and the total amount of fentanyl used. Cadaveric evaluation was performed to assess the spread of the dye. RESULTS: The median numbers (interquartile range) of anesthetized dermatomes at 2 and 24 h postoperatively were 6 (5-7) and 6.5 (5-7) in the anterior cutaneous branch area and 5 (4-7) and 7 (5-7) in the lateral cutaneous branch area, respectively. There was an 85% chance of simultaneously acquiring analgesia in areas innervated by Th8-11, including complete block in areas innervated by the anterior cutaneous branches of Th9-10. Cadaveric evaluation showed the spread of the dye in Th8-11. CONCLUSIONS: M-TAPA may have analgesic effects in the areas supplied by the anterior cutaneous branches of Th8-11. TRAIL REGISTRATION: IRB approval (No.2700; registered on July 10, 2020) and registration (UMIN Clinical Trials Registry: UMIN000041137 ; registered on July 17, 2020).

Age-related changes of elements in human corpus callosum and relationships among these elements.

To elucidate compositional changes of the corpus callosum with aging, the authors investigated age-related changes of elements and relationships with their element contents in the corpus callosum. After ordinary dissection by medical students at Nara Medical University was finished, the genu, trunk, and splenium of the corpus callosum were resected from the subjects ranging in age from 58 to 94 years. The element contents of the corpus callosum were determined by inductively coupled plasma-atomic emission spectrometry. The contents of Ca, P, S, Mg, Zn, Fe, and Na did not change significantly in the genu, trunk, and splenium of the corpus callosum with aging. Regarding the relationships among the element contents, significant correlations were found among the contents of Ca, P, S, Mg, and Fe in all of the genu, trunk, and splenium of the corpus callosum with some exceptions.

Increases of calcium and phosphorus in the uterine arteries with aging.

To elucidate compositional changes of the uterine artery with aging, the authors investigated age-related changes of elements in the uterine arteries. After ordinary dissection by medical students at Nara Medical University was finished, the uterine arteries were resected from the subjects. The element content of the uterine arteries was analyzed by inductively coupled plasma-atomic emission spectrometry. The subjects ranged in age from 58 to 99 yr (average age = 82.7 +/- 10.1 yr). It was found that the Ca, P, and Na contents increased progressively in the uterine arteries with aging. A significant accumulation of Ca and P in the uterine arteries was found in the sixties and increased markedly in the eighties. It should be noted that as far as the arteries in those over 70 yr of age, the extent of accumulation of Ca and P was the highest in the uterine arteries within the limits of the arteries analyzed by us. Regarding the relationships among elements, significant direct correlations were found among the contents of Ca, P, Mg, Zn, and Na. As Ca increased in the uterine arteries, P, Mg, Zn, and Na increased simultaneously in the arteries.

Age-related changes of elements in thoracic and abdominal aortas and coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries and relationships in elements among their arteries.

To elucidate whether the accumulation of elements occurred simultaneously in the various arteries with aging, the authors investigated age-related changes of elements in the eight arteries, such as the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries, and the relationships in the element contents among their arteries. After ordinary dissection by medical students was finished, the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, common iliac, and uterine arteries were resected from the subjects, who ranged in age from 58 to 94 yr. The element contents were analyzed by inductively coupled plasma-atomic emission spectrometry. It was found that the accumulation of Ca was the highest in the common iliac artery and decreased in the order of the uterine artery, abdominal aorta, coronary artery, thoracic aorta, splenic artery, common carotid artery, and pulmonary artery. Regarding the relationships in the element contents among the eight arteries, it was found that there were significant direct correlations in the contents of Ca, P, Mg, Zn, Fe, and Na between the coronary and splenic arteries, and there were significant correlations in the contents of Ca, P, and Mg between the abdominal aorta and pulmonary artery.

Increases of calcium, phosphorus, and magnesium in both the right and left fibrous trigones of human heart with aging.

To elucidate compositional changes of the cardiac skeleton with aging, the authors investigated age-related changes of elements in both the right and left fibrous trigones of human heart by inductively coupled plasma atomic emission spectrometry (ICP-AES). After ordinary dissection by medical students was finished, hearts were resected from the subjects and both the right and left fibrous trigones were removed from the hearts. The subjects consisted of 10 men and 13 women, ranging in age from 62 to 99 years. The element content was determined by ICP-AES. The Ca, P, and Mg content began to increase in the seventies in both the right and left fibrous trigones, and increased markedly in the eighties. Regarding the relationships among element contents, extremely significant direct correlations were found among the contents of Ca, P, and Mg in both the right and left fibrous trigones.

Moderate accumulation of calcium and phosphorus in the splenic artery with aging and low accumulation of those in the pulmonary artery with aging.

To elucidate compositional changes of the arteries with aging, the authors investigated age-related changes of elements in the splenic and pulmonary arteries, which supplied blood to contractile organs. After ordinary dissection by medical students at Nara Medical University was finished, the splenic and pulmonary arteries were resected from the subjects, ranging in age from 58 to 94 years. The element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that a moderate accumulation of Ca and P occurred in the splenic artery with aging, but it hardly occurred in the pulmonary artery with aging. Regarding the relationship among elements, the finding that there were significant direct correlations among the contents of Ca, P, Mg, and Na was commonly obtained in both the splenic and pulmonary arteries. The accumulation of Ca and P in the splenic artery with aging occurred independently of that in the pulmonary artery. Histologic observation indicated that a major part of Ca deposits was seen in the middle tunica, but not in the internal tunica. Therefore, the calcification occurring in the splenic artery belonged to middle sclerosis.

High accumulation of calcium and phosphorus in the pineal bodies with aging.

To elucidate compositional changes of the pineal body with aging, the authors investigated age-related changes of elements in the pineal body. After the ordinary dissection by medical students was finished, the pineal bodies and seven arteries were resected from the subjects ranging in age from 58 to 94 years. The element contents were determined by inductively coupled plasma atomic emission spectrometry. It was found that a high accumulation of Ca and P occurred in the pineal bodies with aging. Regarding the relationships among the elements, it was found that there were significant direct correlations among the contents of Ca, P, and Mg. With regard to the relationships between the pineal body and the arteries, no significant correlations were found in the Ca content between the pineal body and the arteries, such as the thoracic and abdominal aortas and the coronary, common carotid, pulmonary, splenic, and common iliac arteries.

Differences in the element contents between gunshot entry wounds with full-jacketed bullet and lead bullet.

To elucidate characteristics of gunshot residues in gunshot entry wounds with full-jacketed and lead bullets, element contents in entry gunshot wounds and control skins were analyzed by inductively coupled plasma-atomic emission spectrometry (ICP-AES). It was found that a high content of Fe and Zn was deposited in the gunshot entry wounds with full-jacketed bullet, whereas a high content of Pb was deposited in the gunshot entry wounds with lead (unjacked) bullet. It should be noted that the content of Pb was significantly higher in the gunshot entry wounds with lead bullet than in those with full-jacketed bullet. Regarding the relationships among elements, it was found that there were significant direct correlations between Pb and either Sb or Ba contents in both gunshot entry wounds with full-jacketed and lead bullets. As Pb increased in both gunshot entry wounds, Sb and Ba also increased in the wounds.

Long-term effects of maternal separation coupled with social isolation on reward seeking and changes in dopamine D1 receptor expression in the nucleus accumbens via DNA methylation in mice.

Early-life stress has long-lasting effects on the stress response, emotions, and behavior throughout an individual's life. Clinical reports have demonstrated that child abuse victims exhibit impairments in reward-associated behavior; yet, the mechanism for this effect remains unclear. Maternal separation (MS) or MS coupled with social isolation (SI) (MS+SI) is widely used as a model for early-life stress in rodent studies. We employed mice subjected to MS+SI to clarify the long-term effect of early-life stress on reward-seeking involving palatable foods by a conditioned place-preference (CPP) paradigm. Prior MS+SI experience decreased exploration time in a chocolate-paired compartment in adult female mice, but not in male mice. We then focused on the mesolimbic dopamine pathway associated with reward-seeking behavior and measured both mRNA and protein levels of tyrosine hydroxylase (TH) in the ventral tegmental area (VTA) and dopamine D1 and D2 receptors in the nucleus accumbens (NAc). MS+SI female mice had significantly lower D1 receptor mRNA and protein levels than controls, whereas the expression of TH and the D2 receptor was similar in the 2 groups. All mRNA and protein levels were unchanged in MS+SI male mice. When attempting to elucidate the mechanism underlying downregulation of the D1 receptor in the NAc of MS+SI females, we found hypermethylation of the Drd1a promoter region. These results suggest that early-life stress affects reward-seeking behavior in female mice, which may be associated with the downregulation of D1 receptor in the NAc via epigenetic modification of its promoter region.

Age-dependent increase of magnesium in the cerebral arteries of Thai.

To elucidate compositional changes of the cerebral arteries with aging, the authors investigated age-related changes of elements in the cerebral arteries by inductively coupled plasma-atomic emission spectrometry (ICP-AES). After an ordinary dissection by medical students at Chiang Mai University was finished, the anterior, middle, and posterior cerebral arteries and the anterior and posterior communicating arteries were resected from the subjects. The subjects consisted of six men and seven women, ranging in age from 34 to 86 yr. The element content was determined by ICP-AES. It was found that the Mg content increased progressively with aging in all of the anterior, middle, and posterior cerebral arteries, but the Ca and P content did not increase significantly with aging in the anterior, middle, and posterior cerebral arteries, with the one exception being that the P content increased significantly in the posterior cerebral arteries with aging. The average content of Ca was higher in the order of the anterior communicating, anterior cerebral, posterior communicating, posterior cerebral, and middle cerebral arteries.

Decreases of calcium and phosphorus in monkey cardiac walls with development and aging.

To elucidate compositional changes of the cardiac walls with development and aging, the authors investigated changes of elements in the atrial and ventricular walls of monkeys. The left and right atrial walls, left and right ventricular walls, and interatrial and interventricular septa were resected from the subjects. The subjects consisted of 17 rhesus and 13 Japanese monkeys, ranging in age from 10 d to 33 yr. The element content of the cardiac walls was analyzed by inductively coupled plasma-atomic emission spectrometry. The Ca and P contents decreased in all of the left and right atrial and ventricular walls, interatrial septa, and interventricular septa with development, whereas the S and Mg contents decreased in the left and right ventricular walls with development. Regarding the relationships among elements, significant direct correlations were found among Ca, P, Mg, and Zn in all of the left and right atrial walls, left and right ventricular walls, and interatrial and interventricular septa, with some exceptions. As Ca decreased in the cardic walls, P, Mg, and Zn decreased simultaneously in the cardiac walls. The mass ratio of Ca/P decreased gradually with Ca decrease in both the atrial and ventricular walls, but it was not constant.

Earlier accumulation of calcium, phosphorus, and magnesium in the coronary artery in comparison with the ascending aorta, aortic valve, and mitral valve.

To explore reasons for a high accumulation of Ca and P occurring in the coronary artery of Thai with aging, the authors investigated age-related changes of elements in the coronary artery, ascending aorta near the heart, and cardiac valves in single individuals, and the relationships in the elements between the coronary artery and either the ascending aorta or cardiac valves. After an ordinary dissection by medical students at Chiang Mai University was finished, the anterior descending arteries of the left coronary artery, ascending aortas, mitral valves, and aortic valves were resected from the subjects. The subjects consisted of 17 men and 9 women, ranging in age from 46 to 76 yr. The element content was analyzed by inductively coupled plasma-atomic emission spectrometry. The average content of Ca and P was the highest in the coronary artery and decreased in the order aortic valve, ascending aorta, and mitral valve. The Ca, P, and Mg content increased in the coronary artery in the fifties and in the ascending aorta, aortic valve, and mitral valve in the sixties. It should be noted that the accumulation of Ca, P, and Mg occurred earlier in the coronary artery than in the ascending aorta, aortic valve, and mitral valve. It was found that with respect to the Ca, P, Mg, and Na contents, the coronary artery correlated well with both the aortic valve and ascending aorta, especially with the aortic valve, but it did not correlate with the mitral valves. This finding suggests that the accumulation of Ca, P, Mg, and Na occurs in the coronary artery together with the aortic valve and ascending aorta, but not together with the mitral valve. Because regarding the accumulation of Ca, P, and Mg, the ascending aorta and aortic valve are preceded by the coronary artery, it is unlikely that the accumulation of Ca, P, and Mg spreads from the ascending aorta or aortic valve to the coronary artery.

Increases of calcium and magnesium and decrease of iron in human posterior longitudinal ligaments of the cervical spine with aging.

To elucidate compositional changes of ligaments with aging, the authors investigated age-related changes of elements in the posterior longitudinal ligaments (PLLs) by inductively coupled plasma-atomic emission spectrometry. After the ordinary dissection, PLLs were resected from the subjects ranging in age from 65 to 95 yr. The PLLs of the cervical spine were resected between the fourth and fifth cervical vertebrae, the PLLs of the thoracic spine between the fifth and seventh thoracic vertebrae, and the PLLs of the lumbar spine between the second and third lumbar vertebrae. Calcium and magnesium increased progressively with aging in the PLLs of the cervical spine, but they did not increase with aging in the PLLs of the thoracic and lumbar spine. In contrast, iron decreased gradually with aging in the PLLs of the cervical spine. Regarding the relationships among elements, significant correlations were found among the contents of calcium, phosphorus, magnesium, and sodium in the PLLs of the cervical spine.

Age-related attenuation in the elements in monkey sino-atrial node.

Changes in trace elements of the sino-atrial (SA) node with aging was investigated using 24 hearts of the Japanese and rhesus monkeys of ages ranging from 27 d to 30 yr. With aging, sympathetic activity decreases and SA nodal function deteriorates. The SA nodal tissue was removed from the anatomical position and was confirmed by means of histological observation. The elements, such as Ca, P, S, Mg, Na, Fe, and Zn, were analyzed using inductively coupled plasma-atomic emission spectrometry (ICP-AES). Advancing age never increased the contents of the trace elements, but decreased them. The correlation coefficients for the age-dependent attenuations were -0.561 (n = 24, p < 0.01) in Ca and -0.482 (n = 24, p < 0.05) in P. The correlations for the attenuations induced by other trace elements were not significant. Furthermore, close relationships of the elements between Ca and P, S, Zn, or Na contents, between P and Zn or Na contents, and between Zn and Na contents were observed. These results indicate that the elements in the monkey SA node are attenuated with an increase in age, presumably suggesting the age-related suppression of cardiac functions as a result of the histological alterations of the SA nodal cells.

Age-related changes of elements in renal arteries of Thai and Japanese and the relationships among elements.

To examine whether there were differences between races in regard to age-related changes of elements and the relationships among elements in the arteries, the authors investigated both the renal arteries of Thai and Japanese. The Thai subjects consisted of 27 men and 11 women, ranging in age from 27 to 88 yr, whereas the Japanese subjects consisted of 19 men and 26 women, ranging in age from 61 to 99 yr. After the ordinary dissections at Chiang Mai University and Nara Medical University were completed, the bilateral renal arteries were resected and the element contents were determined by inductively coupled plasma-atomic emission spectrometry. In the Thai, a slight accumulation of calcium and phosphorus occurred in the fifties, but thereafter hardly increased. In contrast, in the Japanese, an accumulation of calcium and phosphorus began to occur in the seventies and increased markedly in the eighties. The result revealed that a higher accumulation of calcium and phosphorus occurred in the renal arteries of the Japanese in old age compared with those of the Thai. Regarding the relationships among elements, extremely or very significant direct correlations were found among the contents of calcium, phosphorus, magnesium, and sodium in both the renal arteries of the Thai and Japanese, except for magnesium and sodium contents in the renal arteries of the Thai.

Comparison of calcium accumulation between the arteries of human and monkey.

To examine whether an accumulation of elements in the arteries was affected by the way of walking, the authors investigated age-related changes of elements in the arteries of the Japanese, Thai, and Japanese monkeys. After the ordinary dissections by medical students were finished, the subclavian, axillary, brachial, radial, common iliac, external iliac, femoral, and posterior tibial arteries were resected from the subjects of the Japanese and Thai over 60 yr of age and they were also resected from the Japanese monkeys over 20 yr of age. The element content was determined by inductively coupled plasma-atomic emission spectrometry. It was found that in an comparison between the arteries of anatomically corresponding regions, the average content of Ca was eight times or four times higher in the arteries of the lower limb than in the arteries of the upper limb in the Japanese or Thai over 60 yr of age, respectively. In the Japanese monkeys over 20 yr of age, the average content of Ca was 1.2 times higher in the arteries of the lower limb than in the arteries of the upper limb. The result suggests that an accumulation of Ca in the arteries of the lower limb with aging is affected by the way of walking.

Age-dependent decreases of calcium, phosphorus, sulfur, and zinc in the cardiac valves of monkeys.

To elucidate compositional changes of the cardiac valves in monkey with aging, the authors investigated age-related changes of elements in the four cardiac valves of rhesus and Japanese monkeys and the relationships among elements by inductively coupled plasma-atomic emission spectrometry (ICP-AES). The four cardiac valves of the aortic, pulmonary, mitral, and tricuspid valves were resected from 19 rhesus and 11 Japanese monkeys, ranging in age from 10 d to 33 yr. The element contents were determined by ICP-AES. It was found that the Ca, P, S, and Zn contents were high in the four cardiac valves of the monkeys below 1 yr and thereafter decreased significantly with aging, except for Ca in the mitral valve, for which no significant correlation was found between age and Ca content. The Ca and P contents did not increase in the four cardiac valves at old age. This result revealed that calcification scarcely occurred in the four cardiac valves at old age. With regard to the relationships among elements, it was found that there were significant direct correlations among the Ca, P, S, and Zn contents in all of the four cardiac valves of the monkeys, with two exceptions between P and Zn contents in both the aortic and pulmonary valves. Therefore, as Ca decreased in the four cardiac valves, P, S, and Zn decreased simultaneously in the same cardiac valves.

Age-dependent increases of calcium and phosphorus in human epiglottal cartilage.

To elucidate compositional changes of the elastic cartilage with aging, the authors investigated age-related changes of elements in the epiglottal cartilages by inductively coupled plasma-atomic emission spectrometry. After the ordinary dissection by medical students at Chiang Mai University was finished, the epiglottises were resected from the subjects. The epiglottal cartilages were isolated and the element contents were determined. The subjects consisted of 11 men and 14 women, ranging in age from 39 to 92 yr old. It was found that although the extent of accumulation of calcium and phosphorus was slight, calcium and phosphorus increased progressively in the epiglottal cartilages with aging. In contrast, sulfur, magnesium, zinc, iron, and sodium did not change significantly in them. Regarding the relationships among elements, it was found that there were significant correlations among calcium, phosphorus, magnesium, and sodium in the epiglottal cartilages, with one exception between calcium and sodium contents. In comparison between men and women, no significant differences were found in the predominant elements such as calcium, sulfur, and phosphorus in the epiglottal cartilages.

Persistent left hepatic venous connection with the right atrium and the ductus venosus.

An anomalous left hepatic vein opening independently of the coronary sinus into the right atrium was found in the cadaver of an 88-year-old Japanese man. This vein originated from the left lobe of the liver, perforated the diaphragm at the left side of the vena caval foramen and opened into the right atrium. The left hepatic vein anastomosed mutually with the middle hepatic vein at the level of venule. The ligamentum venosum originated from the left branch of the portal vein and was connected directly to the left hepatic vein. The development of the central systemic venous system and a possible explanation for the morphogenesis of this anomaly were reviewed. As a result, the occurrence of this anomalous vein was explained as being due to the persistence of the left vitelline connection with the left sinus horn and the ductus venosus.

Compositional changes of the muscular layers of the stomach with aging.

To elucidate compositional changes of the stomach with aging, the authors investigated age-related changes of the elements and relationships among the elements in the muscular layers of the pylorus, cardia, lesser curvature, and greater curvature by inductively coupled plasma-atomic emission spectrometry. After ordinary dissection by medical students, the pylori, cardias, lesser curvatures, and greater curvatures were removed from the subjects, consisting of 19 men and 1 woman, ranging in age from 65 to 95 yr. The muscular layers were isolated and the element contents were determined. The calcium content increased progressively with aging in the muscular layers of the pylorus, cardia, and lesser curvature, whereas it tended to increase in the muscular layer of the greater curvature with aging. Regarding sulfur, the content increased significantly in the muscular layer of the pylorus with aging, but not significantly in the muscular layers of the cardia, lesser curvature, and greater curvature with aging. Regarding the relationships among the elements, significant direct correlations were found among calcium, phosphorus, sulfur, and magnesium in both the muscular layers of the pylori and cardias, with some exceptions.