New Concept Air Conditioning System for the Operating Room to Minimize Patient Cooling and Surgeon Heating: A Historical Control Cohort Study.

BACKGROUND: Intraoperative hypothermia is a common adverse event. For avoiding the complication due to hypothermia, many warming devices and methods have been used in perioperative period. It has been reported that more patients undergoing laparoscopic surgery tend to have hypothermia than with open surgery. To avoid intraoperative hypothermia, many kinds of warming tools have been used. But, it was also reported that some warming methods increased perceptions of distraction and physical demand. METHODS: To achieve both patients' normothermia and surgeons' comfort, new air conditioning (AC) system was designed with considering the characteristics of laparoscopic surgery. The temperature of the airflows to the patient and to the surgeons can be adjusted independently in this new system. The new system has two parts. One controls the temperature of the central area over the operation table. The air from this part falls on the patients. The other part is the lateral area beside the operating table; the air from this part falls on the surgeons. The subjects of this study were 160 gastric cancer patients and 316 colorectal cancer patients undergoing laparoscopic surgery. The temperature of the central flow was set 23.5 °C, and the temperature of the lateral flow was set 22 °C just after the anesthesia. The number of timepoints the patient spent in hypothermic state, defined as a temperature cooler by 0.5 °C or more than that at the starting point of surgery, was determined in each patient. RESULTS: In the results, the rate of hypothermic state in old operation rooms was 23.8% and that in new operation rooms was 2.7% in male gastric cancer patients (p < 0.01). And those were 37.1% in old operation rooms and 0.9% in new operation rooms in female gastric cancer patients (p < 0.01). The rate of hypothermic state in old operation rooms was 30.0% and that in new operation rooms was 9.5% in male colorectal cancer patients (p < 0.01). And those were 41.6% in old operation rooms and 8.9% in new operation rooms in female colorectal cancer patients (p < 0.01). The similar results were showed in the study, which subjects were limited the patients undergoing surgery in 2015 and 2016; which were the last year the old operation rooms were used and the first year the new operation rooms were used. CONCLUSIONS: Thus, the usefulness of the new air conditioning system for achieving both patients' normothermia and comfort of surgeons could be verified in this study.

The α2A -adrenoceptor suppresses excitatory synaptic transmission to both excitatory and inhibitory neurons in layer 4 barrel cortex.

KEY POINTS: The effects of noradrenaline on excitatory synaptic transmission to regular spiking (excitatory) cells as well as regular spiking non-pyramidal and fast spiking (both inhibitory) cells in cortical layer 4 were studied in thalamocortical slice preparations, focusing on vertical input from thalamus and layer 2/3 in the mouse barrel cortex. Excitatory synaptic responses were suppressed by noradrenaline. However, currents induced by iontophoretically applied glutamate were not suppressed. Further, paired pulse ratio and coefficient of variation analysis indicated the site of action was presynaptic. Pharmacological studies indicated that the suppression was mediated by the α2- adrenoceptor. Consistent with this, involvement of α2A -adrenoceptor activation in the synaptic suppression in excitatory and inhibitory cells was confirmed by the use of α2A -adrenoceptor knockout mice. ABSTRACT: The mammalian neocortex is widely innervated by noradrenergic (NA) fibres from the locus coeruleus. To determine the effects of NA on vertical synaptic inputs to layer 4 (L4) cells from the ventrobasal thalamus and layer 2/3 (L2/3), thalamocortical slices were prepared and whole-cell recordings were made from L4 cells. Excitatory synaptic responses were evoked by electrical stimulation of the thalamus or L2/3 immediately above. Recorded cells were identified as regular spiking, regular spiking non-pyramidal or fast spiking cells through their firing patterns in response to current injections. NA suppressed (∼50% of control) excitatory vertical inputs to all cell types in a dose-dependent manner. The presynaptic site of action of NA was suggested by three independent studies. First, responses caused by iontophoretically applied glutamate were not suppressed by NA. Second, the paired pulse ratio was increased during NA suppression. Finally, a coefficient of variation (CV) analysis was performed and the resultant diagonal alignment of the ratio of CV-2 plotted against the ratio of the amplitude of postsynaptic responses suggests a presynaptic mechanism for the suppression. Experiments with phenylephrine (an α1 -agonist), prazosin (an α1 -antagonist), yohimbine (an α2 -antagonist) and propranolol (a ß-antagonist) indicated that suppression was mediated by the α2 -adrenoceptor. To determine whether the α2A -adrenoceptor subtype was involved, α2A -adrenoceptor knockout mice were used. NA failed to suppress EPSCs in all cell types, suggesting an involvement of the α2A -adrenoceptor. Altogether, we concluded that NA suppresses vertical excitatory synaptic connections in L4 excitatory and inhibitory cells through the presynaptic α2A -adrenoceptor.

Extraperitoneal colostomy in laparoscopic abdominoperineal resection using a laparoscopic retractor.

Although extraperitoneal colostomy is often performed to prevent postoperative parastomal hernia formation following an open abdominoperineal resection of lower rectal cancer, it has not been widely employed laparoscopically because of the difficulty associated with the extraperitoneal route. This paper describes a laparoscopic extraperitoneal sigmoid colostomy using the Endo Retract™ Maxi instrument. This surgical technique is easy, and helps to prevent the development of parastomal hernias.

Fast activation of feedforward inhibitory neurons from thalamic input and its relevance to the regulation of spike sequences in the barrel cortex.

Thalamocortical afferents innervate both excitatory and inhibitory cells, the latter in turn producing disynaptic feedforward inhibition, thus creating fast excitation-inhibition sequences in the cortical cells. Since this inhibition is disynaptic, the time lag of the excitation-inhibition sequence could be approximately 2-3 ms, while it is often as short as only slightly above 1 ms; the mechanism and function of such fast IPSPs are not fully understood. Here we show that thalamic activation of inhibitory neurons precedes that of excitatory neurons, due to increased conduction velocity of thalamic axons innervating inhibitory cells. Developmentally, such latency differences were seen only after the end of the second postnatal week, prior to the completion of myelination of the thalamocortical afferent. Furthermore, destroying myelination failed to extinguish the latency difference. Instead, axons innervating inhibitory cells had consistently lower threshold, indicating they had larger diameter, which is likely to underlie the differential conduction velocity. Since faster activation of GABAergic neurons from the thalamus can not only curtail monosynaptic EPSPs but also make disynaptic ISPSs precede disynaptic EPSPs, such suppression theoretically enables a temporal separation of thalamically driven mono- and disynaptic EPSPs, resulting in spike sequences of 'L4 leading L2/3'. By recording L4 and L2/3 cells simultaneously, we found that suppression of IPSPs could lead to deterioration of spike sequences. Thus, from the end of the second postnatal week, by activating GABAergic neurons prior to excitatory neurons from the thalamus, fast feedforward disynaptic suppression on postsynaptic cells may play a role in establishing the spike sequences of 'L4 leading L2/3 cells'.

TRPV2-immunoreactive intrinsic neurons in the rat intestine.

Transient receptor potential channel vanilloid subfamily 2 (TRPV2) was shown to receive noxious thermal stimuli (>52 degrees C), and to be expressed in fine myelinated afferent neurons. The mRNA and the immunoreactivity have also been detected in several peripheral tissues. We examined the expression of TRPV2 in the rat intestine. An analysis by transcriptase-polymerase chain reaction (RT-PCR) demonstrated TRPV2 gene expression in the intestine. Many TRPV2-positive neurons were observed in the myenteric plexus by immunohistochemistry. Some of these neurons were positive for calbindin D-28K (CaBP), which is present in intrinsic afferent neurons. TRPV2 immunoreactivity was also observed in nodose ganglion neurons (vagal afferents). These findings suggest that TRPV2 is expressed not only in sensory ganglion neurons, but also in enteric neurons, including primary afferent neurons.

Electroacupuncture induces the expression of Fos in rat dorsal horn via capsaicin-insensitive afferents.

Fos is expressed in rat dorsal horn neurons after electroacupuncture (E-acupuncture), but it is unclear which types of afferent fibers are involved in the expression. It is thought that the Fos expression is induced via Adelta afferents rather than C afferents, since the threshold of Adelta afferents to electrical stimulation is much lower than that of unmyelinated ones. Therefore, neonatally capsaicin treated rats lacking many C afferents were examined to clarify this. Fos expression in the dorsal horn after injection of formalin into the hindpaw was severely attenuated by neonatal capsaicin treatment. However, Fos expression after E-acupuncture to the pads of the hindpaw was unaffected by the same treatment. These results suggest that E-acupuncture induces the expression of Fos in the dorsal horn neurons via capsaicin-insensitive afferents, presumably Adelta afferents.

Chronic electrical stimulation of afferents from one eye changes ocular dominance of visual cortical neurons in kittens.

Binocular visual responsiveness of neurons in visual cortex of the cat can be changed by monocular visual deprivation in the critical period of postnatal development. It is hypothesized that afferents from each eye compete with one another for synaptic connections with cortical neurons so that less active afferents from the deprived eye fail to maintain the connections. This hypothesis predicts that an increase in inputs from one eye instead of decrease due to deprivation should also change binocular responsiveness of cortical neurons. However, the hypothesis has not successfully been tested with experimental activation of afferents from one eye. In the present study, we activated one of the optic nerves by chronic electrical stimulation of theta-burst type in behaving kittens for 2 days. After such a monocular activation, visual cortical neurons showed a significant ocular dominance shift in favor of the electrically activated eye, although neurons in the activated and nonactivated layers of the dorsal lateral geniculate nucleus had no biased visual responses. Also, we found no detectable difference between activated and nonactivated eye responses of cortical neurons in other response properties such as orientation selectivity. These results support the hypothesis that the balance between activities of both afferents is critical for formation or consolidation of each eye-specific pathway.