Cerebral air embolism caused by aspiration pneumonia: A case report.

Herein, we report a rare case of arterial cerebral air embolism (aCAE), that was probably caused by aspiration pneumonia. An 84-year-old-male presented with sudden loss of consciousness. Computed tomography (CT) of the head revealed air shadows along the sulcus of the right frontal and left posterior lobes. The abdominothoracic CT revealed aspiration pneumonia in the right upper lung with cavity formation. His clinical symptoms lessened after the administration of an antiepileptic. Because there was no prior history of any medical treatment, the patient was diagnosed with a noniatrogenic aCAE. Furthermore, in the absence of a right-to-left shunt, we determined that the air embolization was caused by the aspiration pneumonia. aCAE is a rare disease that can lead to miserable conditions. Most of causes aCAE are iatrogenic. However, a few cases of noniatrogenic aCAE have been reported. Some reports have suggested an associated between iatrogenic aCAE and raised intrathoracic pressure, which could lead to air entry into the pulmonary vein via the damaged alveolar wall. Even in noniatrogenic aCAEs, a sudden increase in intrathoracic pressure may cause airflow via the alveolar wall into the pulmonary veins, resulting in aCAE.

Structural effect of amine N-oxides on the facilitation of α-glucosidase-catalyzed hydrolysis reactions.

Activation and stabilization of enzymes is an important issue in their industrial application. We recently reported that synthetic betaines, derived from cellular metabolites, structure-dependently increased the activity and stability of various enzymes including hydrolases, oxidases, and synthetases simply by mixing them into the reaction buffer. In this report, we focus on amine N-oxides, which are similarly important metabolites in cells with a highly polarized N-oxide bond, and investigate their enzyme stabilization and activation behavior. It was revealed that synthetic amine N-oxides structure-dependently activate α-glucosidase-catalyzed hydrolysis reactions similarly to betaines. The subsequent comparison of the kinetic parameters, the optimal concentration range for activation, and the maximal activity, suggested that amine N-oxides facilitate hydrolysis reactions via the same mechanism as betaines, because no differences were confirmed. However, the enzyme stabilization effect of amine N-oxides was slightly superior to that of betaines and the temporal stability of the enzyme in aqueous solutions was higher in the low amine N-oxide concentration range. The rheological properties, CD spectra, and dynamic fluorescence quenching experiments suggested that the suppression of unfavorable conformational perturbation was related to the difference in the hydration environments provided by the surrounding water molecules. Thus, we clarified that amine N-oxides facilitate enzyme reactions as a result of their similarity to betaines and provide a superior stabilizing effect for enzymes. Amine N-oxides show potential for application in enzyme storage and long-term reactions.

Hydrogen-Release Reaction of a Complex Transition Metal Hydride with Covalently Bound Hydrogen and Hydride Ions.

The hydrogen-release reaction of a complex transition metal hydride, LaMg2 NiH7 , composed of La3+ , 2×Mg2+ , [NiH4 ]4- and 3×H- , was studied by thermal analyses, powder X-ray, and neutron diffraction and inelastic neutron scattering. Upon heating, LaMg2 NiH7 released hydrogen at approximately 567 K and decomposed into LaH2-3 and Mg2 Ni. Before the reaction, covalently bound hydrogen (Hc °v. ) in [NiH4 ]4- exhibited a larger atomic displacement than H- , although a weakening of the chemical bonds around [NiH4 ]4- and H- was observed. These results indicate the precursor phenomenon of a hydrogen-release reaction, wherein there is a large atomic displacement of Hc °v. that induces the hydrogen-release reaction rather than H- . As an isothermal reaction, LaMg2 NiH7 formed LaMg2 NiH2.4 at 503 K in vacuum for 48 h, and LaMg2 NiH2.4 reacted with hydrogen to reform LaMg2 NiH7 at 473 K under 1 MPa of H2 gas pressure for 10 h. These results revealed that LaMg2 NiH7 exhibited partially reversible hydrogen-release and uptake reactions.

Effects of Right Atrioventricular Expanded Polytetrafluoroethylene Path Graft Reconstruction on Arrhythmogenicity and Ventricular Function in Dogs.

Right atrioventricular pericardial autografts, including the coronary groove, may cause myocardial ischemia. Our aim was to explore the effects of this procedure using an expanded polytetrafluoroethylene (ePTFE) patch on arrhythmogenicity and right ventricular function. Four healthy beagles and one client-owned golden retriever with recurrent cardiac tamponade as a result of hemangiosarcoma were included. The four healthy dogs underwent right atrioventricular ePTFE patch graft reconstruction after complete resection of the right auricle. Right ventricular function and arrhythmia were evaluated using tricuspid annular plane systolic excursion and tissue Doppler imaging on echocardiography and Holter electrocardiography, respectively, before and after surgery. The golden retriever underwent right atrioventricular ePTFE patch graft reconstruction followed by resection of the cardiac mass. None of the echocardiographic values, not involving systolic function, changed after surgery in the four healthy dogs. Transient arrhythmias tended to increase 1 day after surgery. The dog with recurrent cardiac tamponade exhibited more severe arrhythmia and required transient antiarrhythmic treatment for 3 days and survived the cardiac tamponade for 434 days after surgery. We showed that an ePTFE patch can serve as a suitable alternative material for right atrioventricular patch graft reconstruction, although transient arrhythmias may occur following surgery.

Direct posttranslational modification of astrocytic connexin 43 proteins by the general anesthetic propofol in the cerebral cortex.

Propofol is widely used as a general anesthetic and is generally considered to exert its action by regulating neuronal firing via facilitation of GABAA receptors. However, accumulating evidence suggests that propofol also acts on astrocytes, including inhibitory effects on gap junctional coupling, but the underlying molecular mechanisms remain largely unknown. Here, using acute cortical brain slices prepared from mice, we characterize propofol-induced molecular changes in astrocytic gap junction protein connexin 43 (Cx43). Propofol does not change the protein expression level of Cx43 or its incorporation into gap junctional plaques, according to biochemical and immunohistochemical analyses. However, propofol alters migration pattern of Cx43 on western blot, suggesting changes in its posttranslational modifications. Indeed, this change is accompanied by an increase in the phosphorylation of Cx43 at serine 368, which is known to reduce permeability of Cx43 gap junctions. Finally, we show that this change occurs in the absence of neuronal firing or glutamatergic transmissions. Overall, these results show that propofol induces posttranslational modification of Cx43 directly on astrocytes at the site of gap junctional plaques, exerting direct pharmacological action on astrocytes in parallel with its action on neurons.

Organocatalytic Arylation of α-Ketoesters Based on Umpolung Strategy: Phosphazene-Catalyzed SN Ar Reaction Utilizing [1,2]-Phospha-Brook Rearrangement.

An organocatalytic arylation of α-ketoesters was developed on the basis of umpolung strategy. Phosphazene P2-tBu efficiently catalyzes the three-component coupling reaction of α-ketoesters, a silylated secondary phosphite, and electron-deficient fluoroarenes to provide α-hydroxyester derivatives possessing an electron-deficient aryl group at the α-position. The reaction involves the catalytic generation of α-oxygenated ester enolates from α-ketoesters through the [1,2]-phospha-Brook rearrangement followed by the SN Ar reaction.

Efficient Synthesis of Polysubstituted Pyrroles Based on [3+2] Cycloaddition Strategy Utilizing [1,2]-Phospha-Brook Rearrangement under Brønsted Base Catalysis.

An efficient method for the synthesis of polysubstituted pyrroles was established based on the [3+2] cycloaddition strategy utilizing the [1,2]-phospha-Brook rearrangement under Brønsted base catalysis. The less-explored approach of the [3+2] cycloaddition, that is, the reaction of a C3 subunit with imines, was successfully achieved by making use of newly designed C3 subunits containing the requisite umpolung. The two-step formal [3+2] cycloaddition involves the catalytic generation of an α-oxygenated propargyl anion through the [1,2]-phospha-Brook rearrangement followed by γ-addition to the imine under Brønsted base catalysis and the subsequent intramolecular cyclization mediated by Au catalyst or a halogenation reagent to afford polysubstituted pyrroles having a variety of substituents in a positional selective manner. The pyrroles thus synthesized were amenable to further transformations, such as palladium-catalyzed cross-coupling reactions. The operationally very simple method with readily available substrates provides new access to a diverse array of well-organized polysubstituted pyrroles.

Luminescence and Location of Gd3+ or Tb3+ Ions in Perovskite-Type LaScO3.

The luminescence properties of Gd3+ or Tb3+ ions at La and Sc sites were investigated in LaScO3 with a distorted perovskite-type structure (ABO3). Although the luminescence of lanthanide ions located at B sites is not common and has not been examined in detail, Gd3+ or Tb3+ luminescence from B sites and A sites is clearly observed in Gd3+- or Tb3+-doped LaScO3. The differences in the luminescence characteristics concern peak positions, peak shapes, and decay time, which are all influenced by the crystal field and the site symmetry. The UV luminescence of Gd3+ at B sites shows a red shift compared to Gd3+ at A sites, and the green luminescence of Tb3+ at B sites contrasts with the blue-violet and green luminescence of Tb3+ at A sites. The decay time of the luminescence from B sites is systematically longer than that from A sites in both the Gd3+ and Tb3+ cases.

Entropic effects make a more tightly folded conformer of a ß-amino acid less stable: UV-UV hole burning and IR dip spectroscopy of l-ß3-homotryptophan using a laser desorption supersonic jet technique.

UV-UV hole burning and IR dip spectra of l-ß3-homotryptophan were measured by a laser desorption supersonic jet technique as a bottom-up approach to understand the secondary structures of ß-peptides. 14 conformers were found by UV-UV hole burning spectroscopy. The conformers were classified into three groups depending on their hydrogen bonding patterns observed in their conformer-specific IR spectra, and tentatively assigned by comparing with quantum chemical calculations. Group 1 had free OH stretch but no NH2 anti-symmetric stretch vibrational transition and was assigned to NH-π hydrogen bonded structures. Group 2, including the most abundant conformer, showed both free OH and NH2 anti-symmetric stretch vibrations, and belonged to NH-O hydrogen bonded conformations. Group 3 of conformers had hydrogen-bonded OH stretch IR transition and had OH-N hydrogen bonds. The internal hydrogen bond of group 3 is a C6 hydrogen bond due to the additional carbon atom at the ß position and shows a shorter bond length than that of a C5 hydrogen bond. While the OH-N C6 hydrogen bond is stronger than NH-O, the entropic effect prefers the more flexible NH-O hydrogen bonded structure. It is expected that the unnatural C6 hydrogen bond influences the conformations of ß-peptides and builds totally different secondary structures than those of α-peptides.

Generation and Application of Homoenolate Equivalents Utilizing [1,2]-Phospha-Brook Rearrangement under Brønsted Base Catalysis.

A new method for catalytic generation of a homoenolate equivalent and its application to carbon-carbon bond formation was developed by utilizing the [1,2]-phospha-Brook rearrangement under Brønsted base catalysis. The α-oxygenated allyl anions, which can serve as homoenolate equivalents, were catalytically generated in situ by treating readily available chalcones with diethyl phosphite or the pre-formed 1,2-adducts of diethyl phosphite with chalcones in the presence of a catalytic amount of a phosphazene base, P2-tBu. The resulting allyl anions were subsequently trapped by various electrophiles, including Michael acceptors, imines, and aldehydes, providing the corresponding adducts in good yields with moderate to good diastereoselectivities.

Intramolecular addition of benzyl anion to alkyne utilizing [1,2]-phospha-Brook rearrangement under Brønsted base catalysis.

A novel reaction system for intramolecular addition of benzyl anions to alkynes was developed by utilizing the [1,2]-phospha-Brook rearrangement under Brønsted base catalysis. The present reaction is a rare example of a catalytic addition reaction of an unstabilized benzyl anion under Brønsted base catalysis.

Synthesis of phenanthrene derivatives by intramolecular cyclization utilizing the [1,2]-phospha-Brook rearrangement catalyzed by a Brønsted base.

The synthesis of functionalized phenanthrene derivatives was achieved by intramolecular cyclization utilizing the [1,2]-phospha-Brook rearrangement under Brønsted base catalysis. Treatment of biaryl compounds having an α-ketoester moiety and an alkyne moiety at the 2 and 2' positions, respectively, with diisopropyl phosphite in the presence of a catalytic amount of phosphazene base P2-tBu provides 9,10-disubstituted phenanthrene derivatives in high yields. This reaction involves the generation of an ester enolate through an umpolung process, that is, addition of diisopropyl phosphite to a keto moiety followed by the [1,2]-phospha-Brook rearrangement, the intramolecular addition to an alkyne, and the [3,3] rearrangement of the allylic phosphate moiety in a consecutive fashion.

Diode laser coagulation for the treatment of epistaxis in a Scottish fold cat.

We report the case of a 4-year-old, castrated 4.2-kg Scottish fold cat with recurrent epistaxis that was unresponsive to medical therapy. Diathermocoagulation of the nasal mucosa with a diode laser controlled the epistaxis and there was no significant recurrence of epistaxis during 1 year of follow-up.

Coagulation à la diode laser pour le traitement de l'épistaxis chez un chat Scottish Fold. Nous signalons le cas d'un chat Scottish Fold castré âgé de 4 ans d'un poids de 4,2 kg atteint d'épistaxis récurrente qui n'a pas répondu au traitement médical. La diathermocoagulation de la muqueuse nasale à l'aide d'une diode laser a contrôlé l'épistaxis et il n'y pas eu de récurrence de l'épistaxis durant le suivi d'un an.(Traduit par Isabelle Vallières).

Successful endonasal transsphenoidal surgery to treat acute internal carotid artery occlusion caused by pituitary apoplexy: Usefulness of arterial spin labeling imaging for emergency decision.

Background: Pituitary apoplexy (PA) is a rare clinical condition presenting with acute headache, visual disturbance, and disorientation. PA can cause strokes due to acute internal cervical artery occlusion (ICO), which is an extremely rare condition. Arterial spin labeling (ASL) on magnetic resonance imaging (MRI) is a popular technique, which is a quantitative perfusion imaging useful for the diagnosis of ischemia. We report a treatment with acute pseudo-ICO in which ASL on MRI was useful for the decision of surgery timing. Case Description: A 50-year-old male presented with a sudden headache and nausea. MRI and magnetic resonance angiography revealed a large pituitary tumor and left ICO. However, the left middle cerebral and anterior cerebral arteries were depicted due to a cross-flow through the anterior communicating artery. ASL on MRI showed decreased perfusion of the left hemisphere, suggesting acute ICO. As he had no neurological deficit, we treated him conservatively, following the guidelines. Two days after admission, he presented with sensory aphasia and incomplete right paralysis. Emergency head computed tomography revealed a low-density area in his left temporal lobe. We decided on emergency tumor decompression surgery to prevent ischemic progression. We performed endonasal transsphenoidal surgery. Postoperative MRI showed recanalization of the left internal carotid artery (ICA). His incomplete right paralysis improved immediately after surgery but remains mild sensory aphasia. Conclusion: ICO-related PA is a very rare occasion but there are few similar reports. Some cases of successful ICO treatment due to PA have been reported, but the question of whether emergency or elective surgery is better remains unanswered. Our case may have been no neurological deficit if we had decided to have surgery on admission. Hypoperfusion of the ICA area due to PA may be an adaptation of emergency surgery. Perfusion images like ASL could be a useful technique to decide on surgery or conservative treatment.

Combined thoracoscopic and laparoscopic surgery for epiphrenic diverticulum with associated gastroesophageal reflux disease: a case report.

BACKGROUND: Surgery is indicated for symptomatic epiphrenic esophageal diverticula. Based on the features of a case, thoracoscopic or laparoscopic approaches may be used. Epiphrenic diverticula are often associated with esophageal motility disorders, but cases of reflux esophagitis have rarely been reported. In this report, we describe a case of an epiphrenic esophageal diverticulum with reflux esophagitis, which was successfully treated by thoracoscopic diverticulectomy and laparoscopic fundoplication. CASE PRESENTATION: A 69-year-old man visited the hospital with a chief complaint of eructation and hiccup. Upper gastrointestinal endoscopy revealed a diverticulum in the left wall of the esophagus, which was 37-45 cm distal to the incisors. High-resolution manometry (HRM) showed no esophageal motility disorders. Due to the large size of the diverticulum, a thoracoscopic resection of the esophageal diverticulum was performed. Additionally, the patient had reflux esophagitis due to a hiatal hernia. The anti-reflux mechanism would be more impaired during the diverticulectomy; therefore, we decided that anti-reflux surgery should be performed simultaneously. Thoracoscopic esophageal diverticulectomy and laparoscopic Dor fundoplication were performed. The patient had an uncomplicated postoperative course and was discharged on the tenth operative day. He has been symptom-free without acid secretion inhibitors for 21 months after the surgery. CONCLUSIONS: We described a rare case of a large epiphrenic diverticulum with reflux esophagitis. A good surgical outcome was achieved by thoracoscopic resection of the diverticulum and laparoscopic Dor fundoplication.

Surgical Correction of Infundibular Muscular Ventricular Septal Defect in a Cat: A Case Report.

Ventricular septal defects (VSDs) can lead to congestive heart failure and pulmonary hypertension, particularly in patients with large shunts. However, no surgical treatment for feline VSD has been reported. Here, we elucidated the first surgical correction of an infundibular muscular VSD in a one-year-old Ragdoll cat, atypically located and classified under the Soto classification rather than the standard Kirklin classification, through cardiac arrest using cardiopulmonary bypass-a method rarely used in feline cardiac surgery. Detailed echocardiography revealed that the defect required intervention owing to left heart and main pulmonary artery enlargement. Despite the VSD being located on the contralateral side, as anticipated in the preoperative examinations, the choice of median sternotomy allowed for the successful closure of the defect. Conversely, the insertion of two cannulas into the ascending aorta resulted in damage to the adjacent thoracic duct, causing transient chylothorax, which was resolved with conservative treatment. Cardiac arrest induced by a cardioplegic solution facilitated the surgical procedure, although it leads to anemia in cats. However, on postoperative day 490, the patient exhibited only minor residual shunting, with normalized heart size, and remained healthy. This technique appears to be a viable treatment option for congenital heart disease in cats.

Two cases of new-born puppies with transient pulmonary edema.

Acute pulmonary edema in puppies generally occurs due to congenital left-right shunts such as patent ductus arteriosus or large ventricular septal defects. Herein, we presented two cases of puppies with no apparent congenital cardiovascular disease. Case 1: A 12-day-old male Labrador Retriever, weighing 1.15 kg, was unable to suckle sufficiently from its dam and exhibited laboured breathing. Pulmonary edema was identified in all lung lobes by radiography, furthermore, echocardiography revealed significant enlargement of the left side of the heart. Pulmonary edema secondary to volume overload was suspected and furosemide was administered. The respiratory status was improved on the following day. Pimobendan was administered orally in addition to furosemide and both were withdrawn 6 weeks later when the heart size was normalized. Case 2: A 15-day-old female Standard Poodle, weighing 0.68 kg, was less active than other littermates and exhibited laboured breathing. Radiography revealed pulmonary edema in the right posterior lobe, dilatation of the caudal vena cava and ascites. Echocardiography revealed significant enlargement of the left atrium and ventricle perhaps owing to decreased left ventricular contractility. Furosemide and pimobendan were administered. One week later, appetite was improved and supraventricular tachycardia of 375 bpm was observed. Therefore, tachycardia-induced dilated cardiomyopathy was suspected which returned to sinus rhythm with diltiazem treatment, however, it was recurred. Upon sotalol monotherapy, a normal heart size was observed seven months later. In conclusion, we encountered two new-born puppies with transient pulmonary edema that were temporarily treated with pimobendan and furosemide.

Essential updates 2020/2021: Recent topics in surgery and perioperative therapy for esophageal cancer.

In this review, we focused on four topics, namely, minimally invasive esophagectomy (MIE), robot-assisted minimally invasive esophagectomy (RAMIE), conversion and salvage surgery, and neoadjuvant and adjuvant therapy, based on notable reports published in the years 2020 and 2021. It seems that while the short-term outcomes of minimally invasive Ivor Lewis esophagectomy (MIE-IL) were better than those of open Ivor Lewis esophagectomy (OE-IL), there were no significant differences in the long-term outcomes between MIE-IL and OE-IL. Similarly, the short-term outcomes of minimally invasive McKeown esophagectomy (MIE-MK) were better than those of open McKeown esophagectomy (OE-MK), while there were no significant differences in the long-term outcomes between MIE-MK and OE-MK. Furthermore, the short-term outcomes of robot-assisted minimally invasive Ivor Lewis esophagectomy (RAMIE-IL) were superior to those of completely minimally invasive Ivor Lewis esophagectomy (CMIE-IL). On the other hand, there were advantages and disadvantages in relation to the short-term outcomes of robot-assisted minimally invasive McKeown esophagectomy (RAMIE-MK) as compared with completely minimally invasive McKeown esophagectomy (CMIE-MK). However, there were no significant differences in the long-term outcomes between RAMIE-MK and CMIE-MK. Further research is needed to evaluate of short-term and long-term outcomes of transmediastinal esophagectomy with and without robotic assistance. Both induction chemotherapy and induction chemoradiotherapy appear to be promising to secure a higher rate of conversion surgery. Neoadjuvant chemoimmunotherapy and chemoimmunoradiotherapy have shown promising results and are expected as new powerful therapies.

Cor triatriatum sinister with dextrocardia in association with ostium secundum atrial septal defect, subpulmonary ventricular septal defect and bicuspid pulmonary valve in a pig.

Necropsy of a 52-day-old Camborough pig revealed numerous cardiac malformations. The positional relationship of the atria, ventricles and great vessels was a mirror image type (I, L and L): inverted arrangement of the atria, with a left-sided right atrium and right-sided left atrium (situs inversus); inverted arrangement of the ventricles, with a left-sided morphological right ventricle and right-sided morphological left ventricle (L-loop); and aortic valve to the front left relative to the pulmonary valve (L-malposed). The major malformations included an ostium secundum atrial septal defect, cor triatriatum sinister (CTS), a subpulmonary ventricular septal defect and a bicuspid pulmonary valve. Histological examination revealed myocyte hypertrophy, focal myocardial necrosis and calcification in the left morphological right ventricle of the heart. To the best of our knowledge, this is the first report of CTS in pigs. Although the individual malformations found in the present case are not unique, an unusual combination of these cardiac malformations has not been described in animals.

Laparoscopic Heller myotomy and Dor fundoplication following an unsuccessful peroral endoscopic myotomy.

BACKGROUND: Achalasia is an esophageal motility disorder that presents as dysphagia and severely affects quality of life. An esophageal myotomy has been the golden standard for treatment. Peroral endoscopic myotomy (POEM) as a first-line therapy has an acceptable outcome. However, after the clinical failure of POEM, appropriate second-line therapy is rather controversial. Here, we present the first published case in English of a patient who was successfully treated using laparoscopic Heller myotomy (LHM) with Dor fundoplication following an unsuccessful POEM. CASE PRESENTATION: A 64-year-old man with type 1 achalasia who had been previously treated with POEM visited our hospital for further treatment. After undergoing LHM with Dor fundoplication, his Eckardt score improved from 3 to 0 points. On a timed barium esophagogram (TBE), the barium height improved from 119 mm/119 mm (1 min/5 min) to 50 mm/45 mm. No significant complications have occurred postoperatively for 1 year. CONCLUSION: Treating refractory achalasia is challenging, and treatment options are controversial. LHM with Dor fundoplication after POEM could be a safe and efficient option for the treatment of refractory achalasia.