RESUMO
We previously developed two immune complex transfer enzyme immunoassays (ICT-EIA) to measure total adiponectin (T-AN) and high molecular weight adiponectin (H-AN) in urine and have verified their usefulness as biomarkers for diabetic kidney disease. In this study, we developed T-AN and H-AN assays using the sandwich EIA (Sand-EIA). The reactivities of Sand-EIAs were compared with ICT-EIAs by measuring size exclusion chromatography (SEC) fractions of urine and adiponectin standard. As a result, ICT-EIAs showed higher macromolecular specificity. We then analyzed the molecular profile of adiponectin in the urine of 5 patients with different eGFR stages by measuring SEC fractions of urine. The results showed that smaller adiponectin correlated relatively well with eGFR stage. Finally, because SEC is time-consuming, we investigated that the ratio of T-ANs by Sand-EIA and ICT-EIA could be a good indicator of the monomer adiponectin. The ratio was evaluated using 77 urine samples from patients with diabetes and showed a significant decrease at an earlier stage compared with other biomarkers. In conclusion, we demonstrated a new index to estimate monomer adiponectin in urine by using Sand-EIA and ICT-EIA, and urinary monomer adiponectin can be a good early indicator of deterioration of renal function in diabetic patients. J. Med. Invest. 70 : 464-470, August, 2023.
Assuntos
Diabetes Mellitus , Nefropatias Diabéticas , Humanos , Nefropatias Diabéticas/diagnóstico , Adiponectina/urina , Sensibilidade e Especificidade , Areia , Biomarcadores/urinaRESUMO
BACKGROUND AND AIMS: The abundance or decline of fern populations in response to environmental change has been found to be largely dependent on specific physiological properties that distinguish ferns from angiosperms. Many studies have focused on water use efficiency and stomatal behaviours, but the effects of nutrition acquirement and utilization strategies on niche competition between ferns and flowering plants are rarely reported. METHODS: We collected 34 ferns and 42 angiosperms from the Botanic Garden of Hokkaido University for nitrogen (N), sulphur (S), NO3- and SO42- analysis. We then used a hydroponic system to compare the different N and S utilization strategies between ferns and angiosperms under N deficiency conditions. KEY RESULTS: Ferns had a significantly higher NO3--N concentration and NO3--N/N ratio than angiosperms, although the total N concentration in ferns was remarkably lower than that in the angiosperms. Meanwhile, a positive correlation between N and S was found, indicating that nutrient concentration is involved in assimilation. Pteris cretica, a fern species subjected to further study, maintained a slow growth rate and lower N requirement in response to low N stress, while both the biomass and N concentration in wheat (Triticum aestivum) responded quickly to N deficiency conditions. CONCLUSIONS: The different nutritional strategies employed by ferns and angiosperms depended mainly on the effects of phylogenetic and evolutionary diversity. Ferns tend to adopt an opportunistic strategy of limiting growth rate to reduce N demand and store more pooled nitrate, whereas angiosperms probably utilize N nutrition to ensure as much development as possible under low N stress. Identifying the effects of mineral nutrition on the evolutionary results of ecological competition between plant species remains a challenge.
Assuntos
Gleiquênias , Magnoliopsida , Magnoliopsida/fisiologia , Filogenia , Gleiquênias/fisiologia , Evolução Biológica , TriticumRESUMO
To mitigate radioactive cesium from soil to plant, increasing and maintaining the exchangeable potassium (ExK) level during growth is widely accepted after Tokyo Electric Company's Fukushima Dai-ichi Nuclear Plant accident in Japan. This is because the antagonistic relationship between soil solution K and 134Cs + 137Cs (RCs) concentrations changes the transfer factor (TF: designated as the ratio of radioactivity of plant organ to soil) of RCs. As the relationship between ExK and TF depends on the soil types, crop species, and other environmental factors, the required amount of ExK should be set to a safe side. Eleven years after the accident, as the activity of 134Cs was almost negligible, 137Cs became the main RCs in most of the agricultural fields in Fukushima Prefecture. We propose a new indicator, the concentration ratio of plant 137Cs to soil exchangeable 137Cs (Ex137Cs), instead of TF, which showed a better correlation with ExK even among soils with different properties (or mineralogy).
Assuntos
Acidente Nuclear de Fukushima , Monitoramento de Radiação , Poluentes Radioativos do Solo , Poluentes Radioativos do Solo/análise , Solo , Radioisótopos de Césio/análise , Plantas , JapãoRESUMO
The Mekong Delta River in Vietnam is facing salinity intrusion caused by climate change and sea-level rise that is severely affecting rice cultivation. Here, we evaluated salinity responses of 97 rice accessions (79 landraces and 18 improved accessions) from the Mekong Delta population by adding 100 mM NaCl to the nutrient solution for up to 20 days. We observed a wide distribution in salinity tolerance/sensitivity, with two major peaks across the 97 accessions when using the standard evaluation system (SES) developed by the International Rice Research Institute. SES scores revealed strong negative correlations (ranging from - 0.68 to - 0.83) with other phenotypic indices, such as shoot elongation length, root elongation length, shoot dry weight, and root dry weight. Mineral concentrations of Na+ in roots, stems, and leaves and Ca2+ in roots and stems were positively correlated with SES scores, suggesting that tolerant accessions lower their cation exchange capacity in the root cell wall. The salinity tolerance of Mekong Delta accessions was independent from the previously described salinity tolerance-related locus Saltol, which encodes an HKT1-type transporter in the salinity-tolerant cultivars Nona Bokra and Pokkali. Indeed, genome-wide association studies using SES scores and shoot dry weight ratios of the 79 accessions as traits identified a single common peak located on chromosome 1. This SNP did not form a linkage group with other nearby SNPs and mapped to the 3' untranslated region of gene LOC_Os01g32830, over 6.5 Mb away from the Saltol locus. LOC_Os01g32830 encodes chloroplast glycolate/glycerate translocator 1 (OsPLGG1), which is responsible for photorespiration and growth. SES and shoot dry weight ratios differed significantly between the two possible haplotypes at the causal SNP. Through these analyses, we characterize Doc Phung, one of the most salinity-tolerant varieties in the Mekong Delta population and a promising new genetic resource.
RESUMO
Light quality affects plant growth and the functional component accumulation of fruits. However, there is little knowledge of the effects of light quality based on multiomics profiles. This study combined transcriptomic, ionomic, and metabolomic analyses to elucidate the effects of light quality on metabolism and gene expression in tomato fruit. Micro-Tom plants were grown under blue or red light-emitting diode light for 16 h daily after anthesis. White fluorescent light was used as a reference. The metabolite and element concentrations and the expression of genes markedly changed in response to blue and red light. Based on the metabolomic analysis, amino acid metabolism and secondary metabolite biosynthesis were active in blue light treatment. According to transcriptomic analysis, differentially expressed genes in blue and red light treatments were enriched in the pathways of secondary metabolite biosynthesis, carbon fixation, and glycine, serine, and threonine metabolism, supporting the results of the metabolomic analysis. Ionomic analysis indicated that the element levels in fruits were more susceptible to changes in light quality than in leaves. The concentration of some ions containing Fe in fruits increased under red light compared to under blue light. The altered expression level of genes encoding metal ion-binding proteins, metal tolerance proteins, and metal transporters in response to blue and red light in the transcriptomic analysis contributes to changes in the ionomic profiles of tomato fruit.
Assuntos
Solanum lycopersicum , Solanum lycopersicum/genética , Solanum lycopersicum/metabolismo , Frutas/metabolismo , Transcriptoma , Regulação da Expressão Gênica de Plantas , Perfilação da Expressão GênicaRESUMO
BACKGROUND: Little is known of whether Internet use is associated with physical activity among socially isolated older adults during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated the association between Internet use and physical activity, and whether this association differs depending on social isolation among community-dwelling Japanese older adults. METHODS: A cross-sectional study was conducted with 1048 community-dwelling residents aged 65-90 years. Data were obtained using a self-reported questionnaire in August 2020. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form. Multivariable logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between Internet use and moderate-to-vigorous physical activity (MVPA). RESULTS: Internet use showed a significant association with MVPA (OR = 1.42, 95% CI: 1.06-1.90) after adjusting for age, sex, self-reported socioeconomic status, and other health-related characteristics. When the results were stratified by social participation and living status, Internet use was associated with a significantly higher likelihood of MVPA among participants with no social participation (OR = 1.81, 95% CI: 1.03-3.17) and living with family (OR = 1.40, 95% CI: 1.02-1.93). CONCLUSION: Internet use was associated with sufficient physical activity, and this association may differ depending on the social isolation among community-dwelling older adults in Japan.
Assuntos
COVID-19 , Pandemias , Idoso , COVID-19/epidemiologia , Estudos Transversais , Exercício Físico , Humanos , Vida Independente , Uso da Internet , Japão/epidemiologiaRESUMO
Here we compare mineral accumulation and global gene expression patterns between two metal hyperaccumulator plants - Noccaea japonica, originating from Ni-rich serpentine soils, and Noccaea caerulescens (ecotype Ganges), originating from Zn/Pb-mine soils - under excess Ni conditions. Significant differences in the accumulation of K, P, Mg, B, and Mo were explained by the expression levels of specific transporters for each mineral. We previously showed that total Ni accumulation in the whole plant is higher in N. caerulescens than in N. japonica. Here we found a similar tendency for Fe under excess Ni; however, the expression of iron-regulated transporter 1 (IRT1), which encodes the primary Fe uptake transporter and causes excess Ni uptake in Arabidopsis thaliana, was higher in N. japonica. NjIRT1 has a point mutation at Asp100, which is essential for Fe transport, and so might lack its Fe and possibly Ni transport function. Noccaea japonica might have lost its IRT1 function, which would prevent excess Ni uptake via IRT1 in Ni-rich soils, and come to rely on other transporters.
Assuntos
Brassicaceae/genética , Brassicaceae/metabolismo , Minerais/metabolismo , Níquel/metabolismo , Arabidopsis/metabolismo , TranscriptomaRESUMO
Leaf ionome indicates plant phylogenetic evolution and responses to environmental stress, which is a critical influential factor to the structure of species populations in local edaphic sites. However, little is known about leaf ionomic responses of local plant species to natural edaphic mineral variations. In the present study, all plant species and soil samples from a total of 80 soil sites in Shiozuka Highland were collected for multi-elemental analysis. Ioniomic data of species were used for statistical analysis, representing 24 species and 10 families. Specific preferences to ionomic accumulation in plants were obviously affected by the phylogeny, whereas edaphic impacts were also strong but limited within the phylogenetic preset. Correlations among elements resulted from not only elemental synergy and competition but also the adaptive evolution to withstand environmental stresses. Furthermore, ionomic differences of plant families were mainly derived from non-essential elements. The majority of variations in leaf ionome is undoubtedly regulated by evolutionary factors, but externalities, especially environmental stresses also have an important regulating function for landscape formation, determining that the contributions of each factor to ionomic variations of plant species for adaptation to environmental stress provides a new insight for further research on ionomic responses of ecological speciation to environmental perturbations and their corresponding adaptive evolutions.
RESUMO
Physical activity (PA) is a key determinant of health in older adults. However, little is known about the effect of social factors on PA among older adults during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we aimed to clarify the association between socioeconomic status, social participation, and PA during the pandemic. A cross-sectional study was conducted on 999 community-dwelling residents aged 65-90 years. A self-administered questionnaire was used to collect socioeconomic status, social participation, and PA data in August 2020. Multivariable logistic regression analyses were used to calculate the odds ratios (ORs) for the associations between socioeconomic status, social participation, and maintaining PA. For both sexes, PA was reduced by approximately 5%-10% after the onset of COVID-19-related distancing restrictions. Men with a low socioeconomic status were less physically active (OR = 0.49, 95% CI: 0.30-0.82). Women who reported social participation had higher odds of maintaining PA (OR = 1.67, 95% CI: 1.13-2.45) during the restrictions. Higher socioeconomic status and social participation levels before the COVID-19 pandemic may have helped older adults to maintain PA during the COVID-19 pandemic. Further research is needed to clarify the potential effects of these factors on the health of older adults.
Assuntos
COVID-19 , Exercício Físico , Pandemias , Classe Social , Participação Social , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Inquéritos e QuestionáriosRESUMO
Ionomics is the measurement of total metal, metalloid, and nonmetal accumulation in living organisms. Plant ionomics has been applied to various types of research in the last decade. It has been reported that the ionome of a plant is strongly affected by its evolution and by environmental factors. In this study, we analyzed the concentration of 23 elements in leaves of 819 plant species (175 families) growing in the Botanic Garden of Hokkaido University, Japan. Relative variation estimated by the coefficient of variation in foliar concentrations of essential elements among various plant species tended to be low, whereas nickel concentration showed exceptionally large relative variation. By contrast, the relative variation in nonessential elements was high, particularly in sodium, aluminum, and arsenic. The higher relative variations in these element concentrations can be explained by the occurrence of plants that are hyperaccumulators for these elements. Differences in life forms such as herbaceous/woody species, deciduous/evergreen woody species and annual/perennial herbaceous species affected the concentration of several elements in the leaves. These differences were considered to be due to the combined factors including differences in lifespan, growth rate, and cell wall thickness of the leaves. Results of principal component analyses (based on concentration data of essential and nonessential elements in leaf samples) indicated phylogenetic influences on plant ionomes at the family level in Polypodiales, Pinales, Poales, and Ericales. Furthermore, when analyzing correlations among concentrations of all elements in each order and comparing among different orders, the results also suggested that Polypodiales, Pinales, and Poales each had a specific ion homeostasis network.
Assuntos
Folhas de Planta , Universidades , Japão , Filogenia , PlantasRESUMO
To elucidate the unknown regulatory mechanisms involved in aluminum (Al)-induced expression of POLYGALACTURONASE-INHIBITING PROTEIN 1 (PGIP1), which is one of the downstream genes of SENSITIVE TO PROTON RHIZOTOXICITY 1 (STOP1) regulating Al-tolerance genes, we conducted a genome-wide association analysis of gene expression levels (eGWAS) of PGIP1 in the shoots under Al stress using 83 Arabidopsis thaliana accessions. The eGWAS, conducted through a mixed linear model, revealed 17 suggestive SNPs across the genome having the association with the expression level variation in PGIP1. The GWAS-detected SNPs were directly located inside transcription factors and other genes involved in stress signaling, which were expressed in response to Al. These candidate genes carried different expression level and amino acid polymorphisms. Among them, three genes encoding NAC domain-containing protein 27 (NAC027), TRX superfamily protein, and R-R-type MYB protein were associated with the suppression of PGIP1 expression in their mutants, and accordingly, the system affected Al tolerance. We also found the involvement of Al-induced endogenous nitric oxide (NO) signaling, which induces NAC027 and R-R-type MYB genes to regulate PGIP1 expression. In this study, we provide genetic evidence that STOP1-independent NO signaling pathway and STOP1-dependent regulation in phosphoinositide (PI) signaling pathway are involved in the regulation of PGIP1 expression under Al stress.
RESUMO
To identify unknown regulatory mechanisms leading to aluminium (Al)-induction of the Al tolerance gene ALS3, we conducted an expression genome-wide association study (eGWAS) for ALS3 in the shoots of 95 Arabidopsis thaliana accessions in the presence of Al. The eGWAS was conducted using a mixed linear model with 145,940 genome-wide single nucleotide polymorphisms (SNPs) and the association results were validated using reverse genetics. We found that many SNPs from the eGWAS were associated with genes related to phosphatidylinositol metabolism as well as stress signal transduction, including Ca2+signals, inter-connected in a co-expression network. Of these, PLC9, CDPK32, ANAC071, DIR1, and a hypothetical protein (AT4G10470) possessed amino acid sequence/ gene expression level polymorphisms that were significantly associated with ALS3 expression level variation. Furthermore, T-DNA insertion mutants of PLC9, CDPK32, and ANAC071 suppressed shoot ALS3 expression in the presence of Al. This study clarified the regulatory mechanisms of ALS3 expression in the shoot and provided genetic evidence of the involvement of phosphatidylinositol-derived signal transduction under Al stress.
Assuntos
Transportadores de Cassetes de Ligação de ATP/fisiologia , Alumínio/toxicidade , Proteínas de Arabidopsis/fisiologia , Arabidopsis/genética , Fosfatidilinositóis/metabolismo , Brotos de Planta/metabolismo , Transdução de Sinais , Transportadores de Cassetes de Ligação de ATP/genética , Transportadores de Cassetes de Ligação de ATP/metabolismo , Arabidopsis/metabolismo , Arabidopsis/fisiologia , Proteínas de Arabidopsis/genética , Proteínas de Arabidopsis/metabolismo , Estudo de Associação Genômica Ampla , Malatos/metabolismo , Brotos de Planta/fisiologia , Polimorfismo de Nucleotídeo Único/genética , Estresse Fisiológico , TranscriptomaRESUMO
Japanese larch (Larix kaempferi = L. leptolepis) is often characterized by its high growth rate with heterophyllous shoots, but the functional differences of heterophyllous shoots still remain unclear. Recently, abrupt high temperature and drought during spring induced high photosynthetic rate via change in leaf morphology of the deciduous habit. In order to reveal the photosynthetic characteristics of both short and long-shoot needles of sunny canopy of the larch trees using a canopy tower, we calculated the seasonal change of gas exchange characters and leaf mass per area (LMA) and foliar nitrogen content (N) of heterophyllous needles: short and long-shoot needles over 3 years. No marked difference in light-saturated photosynthetic rates (Psat) was observed between short and long shoots after leaf maturation to yellowing, although the difference was obvious in a specific year, which only shows that seasonal change in temperature and soil moisture determines the in situ photosynthetic capacity of needles. The large annual and seasonal variations in Psat in both shoots were found to be mainly determined by climatic variations, while shoot types determined the strategy of their photosynthetic N utilization as well as the stomatal regulation.
RESUMO
Glomerular filtration rate (GFR) and urinary albumin excretion rate (UAER) are used to diagnose and classify the severity of chronic kidney disease. Total adiponectin (T-AN) and high molecular weight adiponectin (H-AN) assays were developed using the fully automated immunoassay system, HI-1000 and their significance over conventional biomarkers were investigated. The T-AN and H-AN assays had high reproducibility, good linearity, and sufficient sensitivity to detect trace amounts of adiponectin in the urine. Urine samples after gel filtration were analyzed for the presence of different molecular isoforms. Low molecular weight (LMW) forms and monomers were the major components (93%) of adiponectin in the urine from a diabetic patient with normoalbuminuria. Urine from a microalbuminuria patient contained both high molecular weight (HMW) (11%) and middle molecular weight (MMW) (28%) adiponectin, although the LMW level was still high (52%). The amount of HMW (32%) and MMW (42%) were more abundant than that of LMW (24%) in a diabetic patient with macroalbuminuria. T-AN (r = - 0.43) and H-AN (r = - 0.38) levels showed higher correlation with estimated GFR (eGFR) than UAER (r = - 0.23). Urinary levels of both T-AN and H-AN negatively correlated with renal function in diabetic patients and they may serve as new biomarkers for diabetic kidney disease.
Assuntos
Adiponectina/urina , Nefropatias Diabéticas/urina , Limite de Detecção , Urinálise/métodos , Adiponectina/química , Adulto , Idoso , Automação , Biomarcadores/química , Biomarcadores/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peso Molecular , Multimerização Proteica , Estrutura Quaternária de ProteínaRESUMO
OBJECTIVE: Hypoventilation and carbon dioxide (CO2) retention are common during sedation. The current study investigated the ventilation responses to nasal high flow (NHF) during sedation with propofol. METHODS: NHF of 30 L/min and 60 L/min with room air was applied during wakefulness and sedation in 10 male volunteers. Ventilation was monitored by respiratory inductance plethysmography, transcutaneous partial pressure of CO2 (TcCO2), and SpO2. RESULTS: During sedation, NHF of 30 L/min and 60 L/min reduced the TcCO2 by 2.9 ± 2.7 mmHg (p = 0.025) and by 3.6 ± 3.4 mmHg (p = 0.024) without affecting SpO2 and reduced the mean respiratory rate by 3 ± 3 breaths/min (p = 0.011) and by 4 ± 3 breaths/min (p = 0.003), respectively. CONCLUSION: During sedation with propofol, NHF without supplemental oxygen attenuated CO2 retention and reduced the respiratory rate. The findings show that NHF can improve ventilation during sedation, which may reduce the risk of complications related to hypoventilation.
Assuntos
Hipnóticos e Sedativos/administração & dosagem , Oxigenoterapia/métodos , Propofol/administração & dosagem , Ventilação Pulmonar/fisiologia , Taxa Respiratória/fisiologia , Vigília/fisiologia , Administração Intranasal , Adulto , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Estudos Cross-Over , Voluntários Saudáveis , Humanos , Masculino , Ventilação Pulmonar/efeitos dos fármacos , Taxa Respiratória/efeitos dos fármacos , Vigília/efeitos dos fármacosRESUMO
This data article provides atomic force microscopy (AFM) amplitude images of botulinum toxin complex (TC) molecules produced by Clostridium botulinum serotype D strain. C. botulinum produces different-sized TC molecules, such as a complex of botulinum neurotoxin and nontoxic nonhemagglutinin proteins (M-TC) and complex of M-TC and hemagglutinin subcomplex (L-TC). In this data article, the M and L-TC produced by serotype D strain 4947 were imaged by AFM. The M-TC molecule had a globular structure with a 30.5-nm diameter and a 2.1-nm height, while the L-TC molecule had a distinct structure in which several spheres were connected to a globular structure that was 40.7 nm in diameter and 3.5 nm in height.
RESUMO
To elucidate the mechanism of adaptation of leguminous plants to iron (Fe)-deficient environment, comprehensive analyses of soybean (Glycine max) plants (sampled at anthesis) were conducted under Fe-sufficient control and Fe-deficient treatment using metabolomic and physiological approach. Our results show that soybeans grown under Fe-deficient conditions showed lower nitrogen (N) fixation efficiency; however, ureides increased in different tissues, indicating potential N-feedback inhibition. N assimilation was inhibited as observed in the repressed amino acids biosynthesis and reduced proteins in roots and nodules. In Fe-deficient leaves, many amino acids increased, accompanied by the reduction of malate, fumarate, succinate, and α-ketoglutarate, which implies the N reprogramming was stimulated by the anaplerotic pathway. Accordingly, many organic acids increased in roots and nodules; however, enzymes involved in the related metabolic pathway (e.g., Krebs cycle) showed opposite activity between roots and nodules, indicative of different mechanisms. Sugars increased or maintained at constant level in different tissues under Fe deficiency, which probably relates to oxidative stress, cell wall damage, and feedback regulation. Increased ascorbate, nicotinate, raffinose, galactinol, and proline in different tissues possibly helped resist the oxidative stress induced by Fe deficiency. Overall, Fe deficiency induced the coordinated metabolic reprogramming in different tissues of symbiotic soybean plants.
Assuntos
Glycine max/metabolismo , Ferro/metabolismo , Nitrogênio/metabolismo , Folhas de Planta/metabolismo , Nódulos Radiculares de Plantas/metabolismo , Aminoácidos/biossíntese , Compostos de Amônio/metabolismo , Cromatografia Gasosa , Peroxidação de Lipídeos , Malondialdeído/metabolismo , Espectrometria de Massas , Metaboloma/genética , Metaboloma/fisiologia , Fixação de Nitrogênio/genética , Fixação de Nitrogênio/fisiologia , Nitrogenase/metabolismo , Folhas de Planta/química , Folhas de Planta/enzimologia , Raízes de Plantas/química , Raízes de Plantas/enzimologia , Raízes de Plantas/metabolismo , Nódulos Radiculares de Plantas/química , Nódulos Radiculares de Plantas/enzimologia , Glycine max/química , Açúcares/metabolismo , SimbioseRESUMO
INTRODUCTION: Acute pancreatitis is a known complication of pancreaticoduodenectomy (PD). However, no reports in the literature describe a late delayed severe acute pancreatitis. We report a case of acute pancreatitis 5 years after PD in a patient who needed intensive care for his complication. PRESENTATION OF CASE: A 64-years-old man presented with upper abdominal pain and reported a history of PD 5 years prior to presentation. Contrast-enhanced computed tomography revealed an edematous pancreatic remnant with inflammation of the surrounding tissue, and he was diagnosed with acute pancreatitis. His condition worsened, and he was transferred to our hospital the following day. He was admitted to the intensive care unit to manage respiratory and circulatory insufficiency. Although his condition improved, an abdominal abscess was identified, and necrosectomy was performed on day 43 of hospitalizaiton. We carefully removed as much necrotic tissue as was possible without injury to the pancreaticojejunal anastomosis and the ascending colon. Inflammation gradually subsided, and he was discharged on day 111 of hospitalization. The last drain was removed in day 133 of admission to our hospital. Pancreatitis and abdominal abscess have not recurred until the time of writing this paper. DISCUSSION: Delayed severe acute pancreatitis is rare. Necrosectomy can treat an abdominal abscess; however it is important to avoid injury to other organs. CONCLUSION: Clinicians should be aware that severe acute pancreatitis can occur after PD.
RESUMO
Background: Sevoflurane is generally the preferred anesthetic agent for general anesthesia in pediatric patients, due to its rapid induction and recovery characteristics. However, it has been recognized that a major complication is emergence agitation when awakening from general anesthesia. The aim of this study was to evaluate the occurrence rate of emergence agitation in the operating room and postoperative recovery area following intraoperative administration of midazolam to pediatric patients under general anesthesia. Patients and methods: One hundred and twenty pediatric patients undergoing dental treatment under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=40 each in the 0.1 mg/kg midazolam, 0.05 mg/kg midazolam, and control with saline groups). Midazolam or saline was injected intravenously approximately 30 minutes before the end of the dental treatment. We used the Richmond Agitation and Sedation Scale (RASS) to assess the level of sedation and drowsiness at emergence phase in the operating room. We also used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level of agitation and delirium at the full recovery phase from anesthesia in the recovery area. Results: At the emergence phase, the incidence of emergence agitation in the 0.1 mg/kg midazolam group was significantly lower than in the other groups (p=0.0010). At the recovery phase, there was no significant difference among the three groups. The odds ratio between PAED score and RASS score was 4.0 using logistic regression analysis. The odds ratio between PAED score and Disability was 2.5. Conclusion: Administration of a single dose of 0.1 mg/kg midazolam dose significantly decreases the incidence of severe emergence agitation at the emergence after sevoflurane anesthesia, but not at the recovery phase. Furthermore, the evaluation of sedative and agitation condition using RASS score at emergence from anesthesia is useful to predict occurrence of agitation in the recovery phase.