Investigation and treatment of pulmonary embolism as a potential etiology may be important to improve post-resuscitation prognosis in non-shockable out-of-hospital cardiopulmonary arrest: report on an analysis of the SOS-KANTO 2012 study.

Background: The prognosis of non-shockable out-of-hospital cardiac arrest is worse than that of shockable out-of-hospital cardiac arrest. We investigated the associations between the etiology and prognosis of non-shockable out-of-hospital cardiac arrest patients who experienced the return of spontaneous circulation after arriving at hospital. Methods and Results: All subjects were extracted from the SOS-KANTO 2012 study population. The subjects were 3,031 adults: (i) who had suffered out-of-hospital cardiac arrest, (ii) for whom there were no pre-hospital data on ventricular fibrillation/pulseless ventricular tachycardia until arrival at hospital, (iii) who experienced the return of spontaneous circulation after arriving at hospital. We compared the patients' prognosis after 1 and 3 months between various etiological and presumed cardiac factors. The proportion of the favorable brain function patients that developed pulmonary embolism or incidental hypothermia was significantly higher than that of the patients with presumed cardiac factors (1 month, P < 0.0001 and P < 0.0001, respectively; 3 months, P = 0.0018 and P < 0.0001, respectively). In multiple logistic regression analysis, pulmonary embolism and incidental hypothermia were found to be significant independent prognostic factors for 1- and 3-month survival and the favorable brain function rate. Conclusions: In patients who suffer non-shockable out-of-hospital cardiac arrest, but who experience the return of spontaneous circulation after arriving at hospital, the investigation and treatment of pulmonary embolism as a potential etiology may be important for improving post-resuscitation prognosis.

[How should we comprehend the guideline for the revised Organ Transplantation Law?].

In accordance with the revision of the "Organ Transplantation Law", the ordinances and the guideline for the law were also revised. The revision of the guideline, which finds legal basis on the circular notices, raises some issues about its position in the Japanese legislative system. It is quite ambiguous whether we should comprehend the guideline as the interpretation of the law, as the procedural guidance, or as the instruction within the administrative body. Thus, the legal obligation for the healthcare professionals to observe the guideline is also unclear. There are many issues about the transplantation law, the ordinances and the guideline. They include (1) Legal implication of the "brain death" (Is "brain death" absolutely synonymous with "death" ?), (2) Scientific relevance of the criteria for diagnosis of brain death, (3) Definition of the "adequate treatment" which is the prerequisite for diagnosis of brain death, (4) The time of death for the cases who were declared legally brain-dead but did not donate the organs, (5) By whom and when should the organ donation be proposed, and more. The ambiguity about the legal position of the guideline shall cause confusion in the scenes of clinical practice.

[Study on the distribution of collagen fibers in the bifurcating area of cerebral arterioles of Wistar rats].

It was previously reported that Mato cells (Mato's fluorescent granular perithelial cells) were frequently localized in the bifurcating areas of cerebral arterioles and occasionally, collagen fibers appeared close to Mato cells of aged rats. It has also been established that Mato cells were scavenger cells in the cerebral tissue and provided with MHC-class II antigen. The present paper deals with the relationship between the distribution of collagen fibers and Mato cells in the bifurcating area of cerebral arterioles. 6 Wistar rats (3 rats aged 4 months and 3 rats aged 16 months) were employed for this electron microscopical study. They were perfused with the mixture of paraform-glutaraldehyde solution, and cerebral cortices were excised and fixed with 1% osmic solution and embedded in Epon 812. In order to observe the bifurcating area of cerebral arterioles, serial semithin sections cutting with the diamond knife were stained with toluidine blue, and checked under the light microscope. After obtaining available regions, serial thin sections were stained with uranyl acetate and lead nitrate, and observed with Hitach H7600 electron microscope. In order to survey the distribution of collagen fibers, 2 groups of the specimens of 4 months old (2 rats) and 5 groups of specimens of 16 months old rats (2 rats) were prepared. Each group consisted of serial 10 thin sections. Other rats of young and aged were used for complementary use. From the observation, it is confirmed that in the cerebral arteriole, collagen fibers are localized only in the interstices around Mato cells, and the fibers appear in a small quantity in the rats aged 4 months, while a certain amounts of the fibers are arranged sporadically in the rats aged 16 months. However, no collagen fibers can be detected in the subendothelial space and in the interstices among smooth muscle cells of cerebral arteriole. If Mato cells lack in some regions of cerebral arterioles, collagen fibers cannot be recognized. The following is also to be stressed that no fibroblastoid cells do appear in any serial sections of cerebral arterioles. From these findings, it seems possible that Mato cells play a principal role in the formation of collagen fibers in the cerebral arterioles, and associate with the sclerosis of cerebral arterioles.

[Study on the distribution of collagen fibers in the bifurcating area of cerebral arterioles of Wistar rats].

It was previously reported that Mato cells (Mato's fluorescent granular perithelial cells) were frequently localized in the bifurcating areas of cerebral arterioles and occasionally, collagen fibers appeared close to Mato cells of aged rats. It has also been established that Mato cells were scavenger cells in the cerebral tissue and provided with MHC-class II antigen. The present paper deals with the relationship between the distribution of collagen fibers and Mato cells in the bifurcating area of cerebral arterioles. 6 Wistar rats (3 rats aged 4 months and 3 rats aged 16 months) were employed for this electron microscopical study. They were perfused with the mixture of paraform-glutaraldehyde solution, and cerebral cortices were excised and fixed with 1% osmic solution and embedded in Epon 812. In order to observe the bifurcating area of cerebral arterioles, serial semithin sections cutting with the diamond knife were stained with toluidine blue, and checked under the light microscope. After obtaining available regions, serial thin sections were stained with uranyl acetate and lead nitrate, and observed with Hitach H7600 electron microscope. In order to survey the distribution of collagen fibers, 2 groups of the specimens of 4 months old (2 rats) and 5 groups of specimens of 16 months old rats (2 rats) were prepared. Each group consisted of serial 10 thin sections. Other rats of young and aged were used for complementary use. From the observation, it is confirmed that in the cerebral arteriole, collagen fibers are localized only in the interstices around Mato cells, and the fibers appear in a small quantity in the rats aged 4 months, while a certain amounts of the fibers are arranged sporadically in the rats aged 16 months. However, no collagen fibers can be detected in the subendothelial space and in the interstices among smooth muscle cells of cerebral arteriole. If Mato cells lack in some regions of cerebral arterioles, collagen fibers cannot be recognized. The following is also to be stressed that no fibroblastoid cells do appear in any serial sections of cerebral arterioles. From these findings, it seems possible that Mato cells play a principal role in the formation of collagen fibers in the cerebral arterioles, and associate with the sclerosis of cerebral arterioles.

Gene expression of MC3T3-E1 cells on fibronectin-immobilized titanium using tresyl chloride activation technique.

Fibronectin (FN) can be immobilized directly on titanium surfaces using tresyl chloride activation technique. The key advantage of tresyl chloride activation technique lies in its simplicity. In this study, we examined the cell attachment and gene expression of MC3T3-E1 cells on FN-immobilized titanium using GeneChip. Cells attached on FN-immobilized titanium at a higher rate than untreated titanium. FN altered the gene expression profile, whereby 62 genes were found to be up-regulated, while 56 genes were found to down-regulate to over twice the level on day 14. FN not only enhanced the expression levels of IBSP and OMD, but also decreased SULF1 mRNA level. Taken together, the immobilization of FN on tresylated titanium promoted early matrix mineralization and bone formation.

[Case in which magnesium sulfate effectively treated ventricular tachycardia due to overdose of pilsicainide hydrochloride].

A 34-year-old man ingested an excessive amount of pilsicainide hydrochloride (Sunrythm, total dose, 2,500 mg) with suicide attempt. On admission, consciousness was impaired and circulatory failure was evident. Systolic blood pressure was 74 mmHg. As electrocardiography (ECG) revealed ventricular tachycardia (VT), cardioversion was administered but was unsuccessful. We therefore administered magnesium sulfate. This resulted in immediate reversion to normal rhythm; however, PQ and QRS intervals remained prolonged, consistent with the effects of a Vaughan Williams class I c Na-channel blocker. Blood pressure rose to over 100 mmHg, and circulatory and respiratory function improved immediately. Plasma concentration of pilsicainide hydrochloride was markedly increased to 7.22 microg/mL (therapeutic range: 0.2 approximately 1.0 microg/ mL) on admission. We performed direct hemoperfusion (DHP) to reduce pilsicainide concentration. DHP was performed twice, and drug concentration was measured each time. DHP was insufficiently effective for reducing plasma pilsicainide concentration. In conclusion, administration of magnesium sulfate is an effective therapy for Pilsicainide-induced ventricular tachycardia.

Effects of an aqueous extract of cocoa on nitric oxide production of macrophages activated by lipopolysaccharide and interferon-gamma.

OBJECTIVE: Macrophages are the primary targets of bacterial lipopolysaccharide (LPS). The effects of cocoa extract on production of nitric oxide (NO) by murine J774.1 macrophages activated by LPS and interferon-gamma (IFN-gamma) were examined. METHODS: Cocoa was suspended in heated water and centrifuged, and the supernatant was then filtered. Nitrite was measured as a quantitative indicator of NO by spectrophotometry. LPS (1.0 mg/mL) and IFN-gamma (100 U/mL) were added to cultured macrophages with 0.05% cocoa extract, 0.25% cocoa extract, or pure water. NO synthesis by macrophages was significantly inhibited by cocoa extract (P < 0.01). RESULTS: The inhibitory effect increased with concentration of the extract (P < 0.01). IFN-gamma (100 U/mL) and, later, LPS (100 microgram/mL) were added, together with 2.0% cocoa or pure water, to cultured macrophages. An inhibitory effect on NO production was observed on addition of only IFN-gamma, but more significant effects were obtained with addition of LPS (P < 0.01) and addition of both was most effective (P < 0.01). CONCLUSIONS: These data suggested that cocoa extract contains a suppressor of NO production in murine macrophages activated by LPS and IFN-gamma. This effect does not appear to be caused merely by neutralization of LPS.

Severe low back pain due to retroperitoneal abscess formation in diabetic patients

We report two cases of diabetic patients with severe low back pain associated with retroperitoneal abscesses. In the first case, multiple retroperitoneal and spinal epidural abscesses were detected. Paraplegia due to the spinal epidural abscess was not relieved by drainage of the abscess and subsequent antibiotic therapy. In the second case, drainage of the retroperitoneal abscess and antibiotics were immediately started, resulting in successful recovery. Thus, we suggest that if a diabetic patient complains of low back pain, potential abscess formations should be considered and given appropriate treatment before administering epidural anesthetic injections for pain relief.

Anatomically correct reduction and fixation of a Tile C-1 type unilateral sacroiliac disruption using a rod and pedicle screw system between the S1 vertebra and the ilium: experimental and clinical case report.

We have developed a new surgical technique for the treatment of Tile C-1 type sacroiliac disruption. We tried this procedure first in a cadaveric specimen and then applied it to a clinical case. We used the Texas Scottish Rite Hospital (TSRH) rod and pedicle screw system to insert one screw into the S1 vertebra without using an image intensifier and the other screw into the bone marrow of the ilium from the posterosuperior iliac spine. A straight rod was connected between the two screws by using a manipulator to attempt to reduce and fix the sacroiliac disruption. The combined pubic symphysis diastasis could be simultaneously reduced and fixed by using a plate through another incision, resulting in anatomically correct reconstruction of the pelvic ring. In this procedure, the alignment of the sacroiliac joint can be reversibly and directly changed during reduction and fixation. The sacroiliac joint can be strongly fixed because the screws can be freely inserted into the intact portion of the pelvis and the adjacent lumbar spine, if necessary. Good reduction is obtained because direct compression force is applied to the fracture site. The posterior and anterior procedures can be simultaneously performed under the same lateral position.

Severe low back pain due to retroperitoneal abscess formation in diabetic patients.

We report two cases of diabetic patients with severe low back pain associated with retroperitoneal abscesses. In the first case, multiple retroperitoneal and spinal epidural abscesses were detected. Paraplegia due to the spinal epidural abscess was not relieved by drainage of the abscess and subsequent antibiotic therapy. In the second case, drainage of the retroperitoneal abscess and antibiotics were immediately started, resulting in successful recovery. Thus, we suggest that if a diabetic patient complains of low back pain, potential abscess formations should be considered and given appropriate treatment before administering epidural anesthetic injections for pain relief.