[Soft tissue reconstruction strategy for sacral tumor resection].

Objective: To investigate the clinical strategy and effect of soft tissue reconstruction after sacral tumor resection in different planes. Methods: The data of 27 consecutive patients who underwent primary or secondary sacral tumor resection and soft tissue reconstruction from June 2012 to June 2021 at Dongnan Hospital of Xiamen University (the 909th Hospital) were retrospectively analyzed. There were 11 males and 16 females, aged (M(IQR)) (46.2±23.6) years (range: 16 to 72 years). Sacrospinous muscle, gluteus maximus and vertical rectus abdominis muscle flap were selected for soft tissue reconstruction according to the tumor site and the size of tissue defect. the postoperative follow-up was performed. The operative methods, intraoperative conditions, complications and disease outcomes were summarized. Results: Among the 27 patients with sacral tumor, the tumor plane was located in S1 in 8 cases, S2 in 5 cases and S3 or below in 14 cases. There were 12 patients with tumor volume≤400 cm3 and 15 patients with tumor volume>400 cm3. Operation time was 100(90) minutes (range: 70 to 610 minutes), intraoperative blood loss was 800(1 600) ml (range: 400 to 6 500 ml). Soft tissue reconstruction was performed by transabdominal rectus abdominis transfer repair in 2 cases, extraperitoneal rectus abdominis transfer repair in 1 case, gluteus maximus transfer repair in 5 cases, gluteus maximus advancement repair in 13 cases, and sacrospinous muscle transfer repair in 6 cases. Postoperative complications occurred in 6 cases, including 1 case of incision infection, 4 cases of skin border necrosis, and 1 case of delayed infection due to fracture of internal fixator 3 years after operation, all of them were cured. The follow-up time was (35±21) months. Among the patients, 6 patients had recurrence, 2 patients with Ewing sarcoma died of lung metastasis 1 year after operation, 4 patients with metastatic cancer died of primary disease, and the remaining patients survived without disease. Conclusion: Choosing different soft tissue reconstruction strategies according to sacral tumor location and tissue defect size can effectively fill the dead space after sacral tumor resection, reduce postoperative complications and improve the prognosis of patients.

Sidestream Dark Field (SDF) imaging of oral microcirculation in the assessment of systemic sclerosis.

INTRODUCTION: Systemic sclerosis (SSc) is a systemic disease characterised by abnormalities in small blood vessels, skin and organ fibrosis. It is assessed using generalised skin thickening scores, autoantibodies and nailfold capillaroscopy. Sidestream Dark Field imaging (SDF) is a non-invasive imaging tool that assesses microcirculation. This study aims to investigate the potential of using SDF as a diagnostic tool in SSc. METHOD: Oral microcirculation of 20 patients with SSc was compared to 20 age and gender matched controls using SDF imaging. Sublingual, buccal and incisor regions of the mouth were examined. All volunteers were female averaging 48.0 (24-64) years old. Vasculature was assessed by calculating the De Backer score and Functional Capillary Density (FCD) on an imaging software. RESULTS: At all regions of the mouth, SSc patients had a significantly lower De Backer score compared to controls (SSc 3.484 ±â€¯0.1361/mm vs Control 5.184 ±â€¯0.1896/mm, unpaired t-test p < 0.0001). The SSc patients showed significantly lower FCDs compared to controls at all areas as well (SSc 19.65 ±â€¯0.9445% vs Control 29.45 ±â€¯1.681%, unpaired t-test, p < 0.0001). The incisor regions had significantly higher De Backer and FCD scores than buccal and sublingual regions in both control and SSc patients (one way anova, p < 0.05). De Backer/FCD scores showed significant correlation against Rodnan Skin Scores in patients with SSc (Pearson correlation, p < 0.05). CONCLUSIONS: SSc patients showed decreased oral vasculature compared to controls. SDF imaging has shown the ability to be a useful diagnostic tool in the assessment of SSc.

Synergistic action of Bacillus subtilis, Escherichia coli and Shewanella putrefaciens along with Pseudomonas putida on inhibiting mild steel against oxygen corrosion.

Microbial biofilm can effectively alter the electrochemical characteristics at metal/solution interface that can either accelerate or decelerate corrosion. The present paper reports about microbiologically induced corrosion inhibition (MICI) using Pseudomonas putida as a dominant bacterium under aerobic condition. Effective corrosion inhibition is achieved by the synergistic metabolic action of P. putida along with Escherichia coli, Bacillus subtilis or Shewanella putrefaciens. The synergistic metabolic actions of these bacteria in biopassivation are analysed with various aspects such as electrochemical impedance spectroscopy (EIS), Fourier transform infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FESEM) and confocal laser scanning microscopy (CLSM). Surface topography is quantitatively analysed using optical scanning profilometry (OSP). The binary culture system containing P. putida + E. coli and P. putida + S. putrefaciens achieves an inhibition efficiency of 90% and 85% respectively, despite S. putrefaciens being a corrosion causing bacteria. The P. putida + E. coli system could form a stable biofilm on mild steel surface, with a high corrosion potential (- 329 mV vs. Ag/AgCl/KCl sat'd) and a low corrosion rate (1.65 × 10-1 mmpy). The presence of B. subtilis in the culture promotes corrosion against normal predictions. In the present case, the metabolic activities of the bacterial system on the mild steel surface cause depletion of oxygen in the medium that leads to suppression of corrosion. In addition, the biofilm could form an effective protective barrier on the metal surface that can suppress diffusion of corrosion products resulting in enhanced corrosion inhibition efficiency.

Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy.

This study validated the effectiveness and safety of the treatment for residual stones using flexible ureteroscopy (fURS) and holmium laser (0.6-1.2 J, 20-30 Hz) lithotripsy via a fiber with a 200-µm core diameter and 0.22 numerical aperture (NA) after the management of complex calculi with single-tract percutaneous nephrolithotomy (PCNL). Between January 2014 and June 2016, 27 consecutive patients with complex calculi underwent fURS and holmium laser lithotripsy after a planned single-tract PCNL. Among the 27 patients with complex calculi, 9 had full staghorn calculi, 7 had partial staghorn calculi, and 11 had multiple calculi. After the first single-tract PCNL session, the mean stone size and mean stone surface area were 18.0 ± 10.7 mm and 181.9 ± 172.2 mm2, respectively. Treatment for residual stones with fURS and holmium laser lithotripsy was successfully completed and was performed without intraoperative complications. The mean operative time of the fURS procedure was 69.1 ± 23.6 min, and the mean hospital stay was 5.3 ± 2.4 days. The mean decrease in the hemoglobin level was 7.3 ± 6.5 g/l. After the fURS procedure, the overall stone-free rate was 88.9%. The overall postoperative complication rate was 14.8% (Clavien grade I 11.1%; Clavien grade II 3.7%). The current approach tested here combines the advantages of both PCNL and fURS and effectively manages complex calculi with a high stone-free rate (SFR) (88.9%). This approach also reduced the number of treatment sessions, the number of percutaneous access tracts, and the blood loss and potential morbidity associated with multiple tracts.

[Expression of miR-212 and miR-132 in serum of patients with primary liver cancer and their targeted regulation of GP73].

Objective: To investigate the expression of miR-212 and miR-132 in the serum of patients with primary liver cancer and their targeted regulation of GP73. Methods: The patients with liver cancer, chronic hepatitis B, or liver cirrhosis who were hospitalized in Taizhou People's Hospital from January 2015 to December 2016 were enrolled, and healthy volunteers were also enrolled as controls. Quantitative real-time PCR was used to measure the serum levels of miR-212 and miR-132, and the association between the expression of serum miR-212 and miR-132 and the clinicopathological features of patients with liver cancer was analyzed. A Spearman's rank correlation analysis was used to analyze the correlation between serum miR-212/miR-132 and GP73. Western blot was used to measure the protein expression of GP73, and MTT assay was used to measure the survival rate of cells. The Levene's homogeneity of variance test was used for data analysis. The independent samples t-test was used for comparison of means between two samples, and ANOVA was used for comparison of means between multiple samples. Results: A total of 90 patients with liver cancer, 60 with chronic hepatitis B, 68 with liver cirrhosis, and 100 healthy volunteers were enrolled. The relative expression levels of miR-212 and miR-132 in serum were 0.046 6 ± 0.024 7 and 0.005 9 ± 0.003 0 in the patients with liver cancer, 0.979 7 ± 0.259 5 and 1.001 8 ± 0.249 9 in the healthy volunteers, 0.588 2 ± 0.216 5 and 0.345 7 ± 0.233 8 in the patients with hepatitis, and 0.313 8 ± 0.153 3 and 0.080 1 ± 0.042 66 in the patients with liver cirrhosis. Compared with the normal controls, all patients had significant reductions in the expression of serum miR-212 (t = 10.26, 20.86, and 35.80, all P < 0.01) and miR-132 (t = 16.55, 36.09, and 39.85, all P < 0.01). In the patients with liver cancer, the relative expression of miR-212 and miR-132 was negatively correlated with alpha-fetoprotein (miR-212: t = -4.46, P < 0.01; miR-132: t = -4.83, P < 0.01), TNM stage (miR-212: t = 6.569, P < 0.01; miR-132: t = 7.31, P < 0.01), degree of tumor differentiation (miR-212: t = 5.268, P < 0.01; miR-132: t = 5.914, P < 0.01), and presence of portal vein tumor thrombus (miR-212: t = 5.16, P < 0.01; miR-132: t = 3.681, P < 0.01), while it was not correlated with tumor size (miR-212: t = 0.687, P > 0.05; miR-132: t = 0.887, P > 0.05). In addition, serum miR-212 and miR-132 were negatively correlated with GP73 in the patients with liver cancer (miR-212: r(s) = -0.709, P < 0.01; miR-132: r(s) = -0.877, P < 0.01). Overexpression of miR-212 or miR-132 in HepG2 cells significantly inhibited the activity and expression of 3'-UTR, and interference of miR-212 or miR-132 significantly increased the activity and expression of 3'-UTR in GP73. Overexpression of GP73 reversed the reduction in survival rate of hepatoma cells induced by the overexpression of miR-212 or miR-132. Conclusion: Patients with liver cancer have a significant reduction in the expression of miR-212 and miR-132 in serum, which is closely associated with the development, progression, and metastasis of liver cancer, and miR-212 and miR-132 in hepatoma cells inhibit the growth of liver cancer by targeted regulation of GP73 expression.

Motivators and deterrents to blood donation among Black South Africans: a qualitative analysis of focus group data.

BACKGROUND AND OBJECTIVES: South Africa has a markedly skewed representation where the majority of blood (62%) is presently collected from an ethnically White minority. This study seeks to identify culturally specific factors affecting motivation of donors in South Africa. MATERIALS AND METHODS: We performed a qualitative study to evaluate motivators and deterrents to blood donation among Black South Africans. A total of 13 focus groups, comprising a total of 97 Black South Africans, stratified by age and geographic location were conducted. Transcripts of the interviews were analysed using a coding framework by Bednall & Bove. RESULTS: Participants made 463 unique comments about motivators focusing primarily on promotional communications (28%), incentives (20%) and prosocial motivation (16%). Participants made 376 comments about deterrents which focused primarily on fear (41%), negative attitudes (14%) and lack of knowledge (10%). CONCLUSION: Although prosocial motivation (altruism) was the most frequently mentioned individual motivator, promotional communication elicited more overall comments by participants. As reported by many authors, fear and lack of awareness were strong deterrents, but scepticism engendered by perceived racial discrimination in blood collection were unique to the South African environment.

Metal-based non-enzymatic systems for cholesterol detection: mechanisms, features, and performance.

Metal based catalysts and electrodes are versatile tools known for their redox properties, catalytic efficiency, and stability under various conditions. Despite the absence of significant scientific hurdles, the utilization of these methods in cholesterol detection, particularly in non-enzymatic approaches, has been relatively underexplored. To this end, there is a pressing need to delve deeper into existing metal-based systems used in non-enzymatic cholesterol sensing, with the goal of fostering the development of innovative practical solutions. Various electrode systems, such as those employing Ni, Ti, Cu, Zn, W, Mn, and Fe, have already been reported for non-enzymatic cholesterol detection, some of them elucidated sensing mechanisms and potential in physiological detection. A detailed mechanistic understanding of oxide-based cholesterol sensors, along with the methodologies for constructing such systems, holds promise of advancing the exploration of practical applications. This review aims to provide a broad perspective on metal oxide systems and their characteristics that are conducive to non-enzymatic cholesterol sensing. It is intended to serve as a springboard with offering a guide to the design and development of efficient and sensitive electrochemical cholesterol sensors.

Aberrant activation of liver X receptors impairs pancreatic beta cell function through upregulation of sterol regulatory element-binding protein 1c in mouse islets and rodent cell lines.

AIMS/HYPOTHESIS: Liver X receptors (LXR) are important transcriptional regulators of lipid and glucose metabolism. Our previous report demonstrated that LXR activation inhibited pancreatic beta cell proliferation through cell cycle arrest. Here we explore the role of LXR activation in beta cell insulin secretion and the underlying mechanism that might be involved. METHODS: Mouse pancreatic islets or insulin-secreting MIN6 cells were exposed to the LXR agonist, T0901317, and insulin secretion, glucose and fatty acid oxidation, and lipogenic gene expression were assessed. The unsaturated fatty acid eicosapentaenoic acid and the dominant negative sterol regulatory element binding protein 1c (SREBP1c) were used to inhibit endogenous SREBP1c and evaluate the involvement of SREBP1c in beta cell dysfunction induced by LXR activation. RESULTS: Treatment with the LXR agonist decreased beta cell glucose sensitivity and impaired glucose-stimulated insulin secretion in vivo and in vitro. This was accompanied by derangements of beta cell glucose oxygen consumption, glucose oxidation, ATP production and intracellular voltage-gated calcium channel flux. LXR activation also regulated the expression of lipid metabolism-related genes such as Fas, Acc (also known as Acaca) and Cpt1a, and led to intracellular lipid accumulation. Further studies revealed that inhibition of SREBP1c abolished LXR activation-induced lipid accumulation and improved beta cell glucose metabolism, ATP production and insulin secretion. CONCLUSIONS/INTERPRETATION: Our data reveal that aberrant activation of LXR reproduced the phenomenon of beta cell dysfunction in the development of type 2 diabetes in vitro and in vivo. Upregulation of SREBP1c production and the lipotoxicity mediated by it played a central role in this process.

MiR-548b-3p inhibits proliferation and migration of breast cancer cells by targeting MDM2.

OBJECTIVE: The aim of this study was to explore the expression and biological functions of micro ribonucleic acid (miR)-548b-3p in breast cancer (BC), and to investigate its potential molecular mechanism. PATIENTS AND METHODS: The expression level of miR-548b-3p in BC tissues and cells was detected by quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR). Subsequently, the impacts of miR-548b-3p on the proliferation, apoptosis, and cycle, as well as migration and invasion of BC cells, were explored using colony formation assay and 5-ethynyl-2'-deoxyuridine (EdU) staining, flow cytometry, and transwell assay, respectively. The possible downstream target genes of miR-548b-3p were predicted via bioinformatics and verified through qRT-PCR and Western blotting. Furthermore, Dual-Luciferase reporter gene assay was employed to confirm whether miR-548b-3p could directly bind to murine double minute 2 (MDM2). RESULTS: QRT-PCR results showed that miR-548b-3p expression was significantly downregulated in 37 out of 43 BC tissues. Subsequent in-vitro experiments indicated that the overexpression of miR-548b-3p significantly inhibited the proliferation and metastasis, whereas promoted the apoptosis of BC cells. Bioinformatics predicted that MDM2 was the downstream target gene of miR-548b-3p. After overexpression of miR-548b-3p, qRT-PCR, and Western blotting results revealed that the expression of MDM2 was remarkably downregulated. Dual-Luciferase reporter gene assay further confirmed that miR-548b-3p could directly bind to MDM2. CONCLUSIONS: MiR-548b-3p expression was significantly downregulated in BC. In addition, lowly expressed miR-548b-3p repressed the proliferation and metastasis of BC cells through targeted regulation of MDM2.

Effects of Vitamin B12 on postoperative cognitive dysfunction induced by isoflurane anesthesia in rats.

OBJECTIVE: Postoperative cognitive dysfunction is a clinical syndrome associated with cognitive decline in patients after anesthesia. This study aimed to investigate the effect of VB12 (Vitamin B12), a kind of necessary micronutrients promoting the growth and development of the nervous system, on cognitive dysfunction induced by isoflurane anesthesia. MATERIALS AND METHODS: Eighteen-month-old rats were exposed to or were not exposed to 1.4% isoflurane for 2 h. Two hours before isoflurane exposure, rats in groups with VB12 were injected intramuscularly with VB12 at 10 or 20 µg. Two weeks later, rats were subjected to Barnes maze and Morris water maze. RESULTS: Rats exposed to isoflurane had significant impairments in long-term spatial memory assessed by Barnes maze. There was no statistical significance in the percentage of swimming time and path length in the Morris water maze tests among five groups, suggesting that isoflurane may not impair the recall of learned information in rats. Isoflurane increased the expression of interleukin 1ß (IL-1ß) and activated caspase 3 in the hippocampus, but not cortex of the rats. The increase of IL-1ß and activated caspase 3 was attenuated by VB12. However, isoflurane did not change the amount of tumor necrosis factor-α (TNF-α) and ß-amyloid peptide in the hippocampus and cerebral cortex. CONCLUSIONS: VB12 can attenuate cognitive dysfunction induced by isoflurane anesthesia. At the same time, IL-1ß may play an important role in this isoflurane effect.

Aberrant expression of the myeloid zinc finger gene, MZF-1, is oncogenic.

The zinc finger gene MZF-1 is preferentially expressed in primitive hematopoietic cells and plays an important role in regulating myelopoiesis. Regulators of development are potential targets for neoplastic transformation. This study investigated whether unregulated expression of MZF-1 could function as an oncogene. Retroviral transduction and subsequent overexpression of MZF-1 resulted in loss of contact inhibition, loss of substrate dependence, and more rapid cell cycling in NIH 3T3 cells. The MZF-1-transformed 3T3 cells formed aggressive tumors in athymic mice. Disruption of the tight lineage- and stage-specific regulation of MZF-1 can result in neoplastic transformation of embryonic fibroblasts. Therefore, MZF-1 represents a novel oncogene.

Efficacy evaluation of D-dimer and modified criteria in overt and nonovert disseminated intravascular coagulation diagnosis.

INTRODUCTION: D-dimer (D-D) was shown to be an important indicator for the diagnosis of overt disseminated intravascular coagulation (DIC) and nonovert DIC. However, its diagnostic cutoff value in the clinic is not clearly defined. METHODS: D-D, fibrinogen degradation products (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), antithrombin (AT), and blood platelet count (PLT) of 360 cases were used to assess the diagnostic efficacy of D-D (InnovanceR reagent) for the diagnosis of DIC and nonovert DIC, compared to, or combined with, other DIC coagulation indicators. RESULTS: When D-D > 3.0 µg/mL was used as the cutoff, the sum of diagnostic sensitivity and specificity reached maximum values for DIC and nonovert DIC, whereas the sum of misdiagnoses and missed diagnosis rate was minimal. Excluding D-D, AT, or Fg, but not TT, from the test combination reduced the diagnostic sensitivity of DIC or nonovert DIC by various degrees. The area under the receiver-operating characteristic curve of D-D for diagnosing DIC and nonovert DIC was 0.97 and 0.98, respectively. Combining two factors, D-D > 3.0 µg/mL and FDP > 10 mg/L, increased the sensitivity and specificity for the diagnosis of DIC and nonovert DIC. CONCLUSION: The cutoff value of D-D is >3.0 µg/mL; combined testing of D-D and FDP could be used as primary screening for diagnosing DIC and nonovert DIC in clinical practice.

pH-dependent and ligand induced conformational changes of eucaryotic protein synthesis initiation factor eIF-(iso)4F: a circular dichroism study.

The structural features of wheat germ protein synthesis initiation factor eIF-(iso)4F, which has a cap binding protein as one of its two subunits, are unknown. In this study, circular dichroism (CD) spectra and secondary structure prediction were obtained for eIF-(iso)4F and its two subunits, p28 and p86. The alpha-helix content of eIF-(iso)4F changed from 42% at pH 6.3 to 15% at pH 7.6, the optimum pH for cap binding. The beta-sheet content increased from 14% (pH 6.3) to 38% at pH 7.6. The CD spectra of the two subunits, p28 and p86 were also measured and analyzed. The separated subunits both had a higher alpha-helix content at pH 7.6 than the native protein, giving values of 60% and 34% alpha-helix for p28 and p86, respectively. Binding of the dinucleotide cap analog to p28 reduced the alpha-helix content to approximately 8% with an increase in the beta sheet content from 10% to 37%. The conformational changes in eIF-(iso)4F upon binding with mRNA are dependent on cap or oligonucleotide structure. A conformation consisting of approximately the same alpha-helix and beta-sheet content can be induced by ligands even at non-optimal pH values. This large conformational transition suggests eIF-(iso)4F binds nucleic acids by interaction of a beta-sheet motif and that this conformational transition may have a regulatory role.

Detection of guinea pig cytomegalovirus nucleic acids in cultured cells with biotin-labelled hybridization probes.

Biotin labelled hybridization probes prepared from recombinant plasmids containing segments of the guinea pig cytomegalovirus (GPCMV) genome were used to detect GPCMV nucleic acids in guinea pig cells by in situ hybridization. The time course of GPCMV infection was assessed in two cultured cell types, guinea pig embryo (GPE) cells and 104C1 cells, a transformed and cloned guinea pig cell line. Detection of GPCMV nucleic acids was accomplished in both cell types with individual GPCMV DNA fragments and with mixtures of GPCMV DNA fragments. When compared to other established methods of GPCMV detection, the method of in situ hybridization enabled the detection of a higher percentage of positive cells early during the course of the infection. In addition, differences in the replication cycle of GPCMV in the two cultured cell lines could be demonstrated. These findings will facilitate future studies of GPCMV tissue tropism in vivo.

Causes of airway obstruction during cuffed oropharyngeal airway use.

This study investigated the cause for needing airway maneuvers to maintain a patent airway during the use of cuffed oropharyngeal airway (COPA). Twenty adult patients (29.4+/-6.8 years-old, ASA 1-2) scheduled for minor gynecological surgery who required brief manipulations of the airway despite COPA use following the manufacture's guidelines, were enrolled in this study. To obtain airway patency, 15 patients required only the head-tilt maneuver. In eight of the 15 patients, the laryngeal inlet was opened partially (n=4) or completely (n=4). Despite lifting the epiglottis, the laryngeal inlet was incomplete at the level of pharyngeal view. The patency of the laryngeal inlet was decided by the extent of the distance between the posterior pharyngeal wall and the lateral glossoepiglottic fold, which was made by hyoid bone. In the other seven patients, the head-tilt maneuver elevated the epiglottis and completely opened the laryngeal inlet. Five patients required both the jaw-thrust and head-tilt maneuver. Of these patients lifting the epiglottis was incomplete in three and the laryngeal inlet was partially collapsed in one even after the airway manipulations. The airways in these three patients, however, became patent after manipulations despite the persisting partial obstruction.

[Perioperative pulmonary embolism: a nationwide survey in Japan].

Pulmonary embolism is a leading cause of death and morbidity in the perioperative period. To obtain a contemporary overview of the epidemiology of acute pulmonary embolism, a questionnaire was mailed to anesthesia department chair-persons at 179 hospitals in Japan. The 158 cases were reported from the 88 hospitals. The cause of embolism was thromboembolism 127, gas 13, fat 9, amniotic fluid 4 and tumor 3. The mortality rate for patients with thromboembolism was high (29%). Dyspnea was the most frequent symptom (60%) and hypotension was the most frequent clinical sign (54%). The signs which suggested massive pulmonary embolism, such as hypotension, cyanosis (53%), syncope (39%) and cardiac arrest (29%) were frequently seen. Most of the pulmonary embolisms occurred during the operation and within 7 days after the operation. The high risk factors associated with thromboembolism were age, malignancy, obesity and the type of surgery performed. Treatment performed included anticoagulation 81%, catecholamine infusion 66%, thrombolysis 14%, surgical embolectomy 8% and extra-corporeal circulation 4%. This study indicates that the perioperative pulmonary embolism is still associated with high mortality and requires an immediate diagnosis and intensive therapy.

[Pulmonary complications following laparoscopic cholecystectomy in patients with abnormal spirometry].

The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPC) and the value of preoperative spirometry to predict PPC after laparoscopic cholecystectomy. Sixty-four of 1372 patients (8%) showed abnormal spirometry data. One out of 1372 patients developed aspiration pneumonia. The patient had high risk factors for serious PPC such as ASA physical status 4.84 y/o, longer anesthesia duration (230 min), multiple brain infarction and low albuminemia. Thirty to 39% of patients with abnormal spirometry showed less severe PPC such as atelectasis, lung collapse and pleural effusion, and incidence was the similar with normal lung function patients. Postoperative blood gas analysis showed a slight increase in arterial carbon dioxide tension during oxygen therapy. However, none of the patients with abnormal spirometry and less severe PPC developed manifest PPC (pneumonia, respiratory failure). Less severe PPC disappeared within second to third postoperative days. We conclude that laparoscopic intervention significantly reduced the incidence of severe PPC and the preoperative spirometry was not recommended in patients with no pulmonary symptoms.

[Power spectrum of experimental gas embolism in dogs and a new device for its detection].

We studied the power spectrum of precordial Doppler sounds during experimental CO2 and air embolism and developed a new device for detection (intravascular gas detector) and examined its usefulness in experimental CO2 and air embolism in dogs and in a patient during laparoscopic surgery. We did digital tape recordings during CO2 and air embolism in seven anesthetized mongrel dogs (7-16 kg body) to generate power spectrum of the heart sound on a dynamic signal analyzer. The power spectrum of "mill-wheel murmur" was found to be 10-30 dB higher than the baseline heart sound in the range of 200 and 2500 Hz. The intravascular gas detector was designed to set off alarm sounds whenever the difference of energy between the Doppler sounds low-pass filtered at 250 Hz and the Doppler sounds high-pass filtered at 250 Hz was increased. The alarm was activated immediately during experimental CO2 and air embolism and also during laparoscopic appendectomy. The alarm sounds during the appendectomy coincided with gas bubbles detected by a transesophageal echocardiography. By use of this detector, CO2 and air embolism can be easily detected and the anesthesiologist does not need to pay continuous attention to Doppler sounds by diverting his or her concentration on the patient.

[A case of sudden death during postoperative Holter ECG examination in a patient who experienced intraoperative cardiac arrest].

We report a case of postoperative sudden death during Holter-ECG examination in a 62-yr-old male, who experienced intraoperative cardiac arrest possibly due to myocardial ischemia. Although the patient recovered from intraoperative event without any neurological sequelae, he suffered from spontaneous ventricular tachycardia following mild ST segment depression that led to cardiac arrest on the 58th postoperative day. Precise mechanism of sudden death was not clear because coronary angiography or autopsy was not performed. However, the postoperative Holter-ECG revealed frequent episodes of silent 0.5-1.0 mm ST segment depression during tachycardia which had not been observed in the preoperative 12-lead ECG. Thus a likely explanation would be that the patient had the undetected coronary artery disease with frequent episodes of silent ischemia and finally was led to the fatal arrhythmia. In this case, so called "stunned myocardium" following repeated silent ischemia may have also contributed to the life-threatening arrhythmias. This case suggests that even mild ST depression might lead to life-threatening arrhythmias in the patients with silent ischemia. Adequate preoperative evaluation and careful perioperative observation are necessary for these patients.

[A case of inspiratory unidirectional value malfunction detected by an abnormal capnogram pattern].

We report a case of substantial rebreathing which occurred during the thoracoscopic bulla resection despite a normal FICO2 reading on capnogram. Early detection of inspiratory unidirectional valve malfunction as the cause of the rebreathing was only possible by careful observation of the capnogram pattern. During the course of one lung anesthesia, a rising end-tidal CO2 concentration (FETCO2) and a change in the pattern of the capnogram were observed. However, the lowest FICO2 value in the late phase of inspiration stayed below the alarm limit setting of rebreathing. For this reason, the capnograph failed to identify the beginning of inspiration and perceived the high FICO2 value in early inspiration as part of expiratory plateau. In case of the inspiratory valve malfunction, it is possible that analysis of the capnogram reveals underestimated FICO2.