[Anesthetic Management of Three Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy].

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronically progressing or relapsing disease caused by immune-mediated peripheral neuropathy. We report the anesthetic management of three CIDP patients who underwent elective orthopedic surgeries. Owing to the risk of neuraxial anesthetics triggering demyelination, general anesthesia was selected to avoid epidural or spinal anesthesia or other neuraxial blockade. It was also judged prudent to avoid prolonged perioperative immobilization, which might compress vulnerable peripheral nerves. For Patient 1, general anesthesia was induced with propofol, remifentanil, and sevoflurane, and was maintained with sevoflurane and remifentanil. For Patients 2 and 3, general anesthesia was induced and maintained with propofol and remifentanil. For tracheal intubation, under careful monitoring with peripheral nerve stimulators, minimal doses of rocuronium (0.6-0.7 mg x kg(-1)) were administered. When sugammadex was administered to reverse the effect of rocuronium, all patients rapidly regained muscular strength. Postoperative courses were satisfactory without sequelae.

10 micrometer-scale SPM local oxidation lithography.

10 micrometer-scale scanning probe microscopy (SPM) local oxidation lithography was performed on Si. In order to realize large-scale oxidation, an SPM tip with a contact length of 15 microm was prepared by focused-ion-beam (FIB) etching. The oxidation was carried out in contact mode operation with the contact force ranging from 0.1 to 2.1 microN. The applied bias voltage was 50 V, and scanning speed was varied from 10 to 200 microm/s. The scan length was 15 microm for one cycle. The influence of contact force on the large-scale oxidation was investigated. At high contact force, the Si oxide with good size uniformity was obtained even with high scanning speed. The SPM tip with larger contact length may increase the spatial dimensions of the water meniscus between the SPM tip and sample surface, resulting in the larger dimensions of the fabricated oxide. Furthermore, the throughput of large-scale oxidation reached about 10(3) microm2/s by controlling the scanning speed and contact force of the SPM tip. It is suggested that SPM local oxidation can be upscaled by using a SPM tip with large contact length.

Nanomachining of permalloy for fabricating nanoscale ferromagnetic structures using atomic force microscopy.

It is well-known that the tip of an Atomic Force Microscope (AFM) can act as a cutting tool for machining various types of materials. In this article, AFM machining experiments have been conducted to investigate the machining characteristics of a nickel-iron thin film material. The influences of the machining parameters on the resulting machined geometries and surfaces are specifically investigated. The machining parameters considered include the normal applied force, number of machining cycles, machining speed, and machining direction. To demonstrate its versatility, the machining technique developed has been applied for fabricating a NiFe based nanostructure required by many ferromagnetic devices. All results indicate that the machined groove size can be well correlated with and precisely controlled by the applied force and the machining cyclic number. The AFM machining technique is indeed simple and predictable for machining nanostructures with specified dimension and controllable precision.

[Case of a schizophrenic patient refusing emergent operation for ovarian torsion].

We report a case of a schizophrenic patient who rejected an emergent operation for ovarian torsion. A 48-year-old woman with ovarian torsion strictly turned down emergent surgery against the recommendation of her gynecologist, who could not communicate with her. In response to his request, a psychiatrist examined and diagnosed her as schizophrenia. Therefore, she was transferred to our hospital for management in closed wards. She was so paranoiac and self-defensive that we, the psychiatrist, the gynecologist, and the anesthesiologist, could not obtain informed consent for the operation from her. Because this was an emergent and life-threatening case, we attempted anesthesia and surgery with the consent of her mother and uncle. First, we took her not directly to the operating room but to ICU to relieve her anxiety and fear. Then, we intubated her under sedation and analgesia. Finally, we took her to the operating room and started the operation. Anesthesia was maintained with 1.5-2.0% sevoflurane and fentanyl (total 9 microg x kg(-1)). The operation was uneventful and she was retransferred to ICU with the tracheal tube in place. Next day she was extubated and left ICU. She was informed by her psychiatrist of the fact that the operation had been performed. Fortunately, her mental status and postoperative course was generally stable.

[Cesarean section in a morbidly obese parturient with borderline personality disorder under combined spinal and epidural anesthesia].

A 21-year-old morbidly obese parturient with a body mass index of 45.5 kg x m(-2) underwent an emergent cesarean section for obstructed labor under combined spinal and epidural anesthesia. At age 15, she was diagnosed as borderline personality disorder. In spite of the drug therapy, her mental status was unstable. During anesthesia and surgery, her psychiatrist attended beside her to ease her anxiety and mental stress. An experienced anesthesiologist encouraged her and maintained her in the sitting position during epidural catheterization and spinal puncture. The distance between the skin and the epidural space was about 6.5 cm at the L3-4 interspace via midline approach. An epidural catheter was inserted 5 cm cephalad. Subsequently, the L4-5 subarachnoid space was accessed at a depth of about 7.0 cm. A 3 ml bolus of 0.5% hyperbaric bupivacaine was given. The anesthetic level was T4 at the start of the operation. Throughout the surgery, sufficient analgesia was obtained and any complication such as severe hypotension or respiratory depression did not develop and her postoperative course was uneventful.

Altered expression profiles of clock genes hPer1 and hPer2 in peripheral blood mononuclear cells of cancer patients undergoing surgery.

Patients undergoing surgery often develop symptoms of circadian rhythm disorders such as insomnia or delirium. However, the effect of surgery on the biological clock remains unknown. The present study examines the expression of clock genes in peripheral blood mononuclear cells (PBMCs) and measures plasma hormone concentrations in patients with esophageal cancer and early gastric cancer who underwent surgery. Six blood samples per day were collected from 9 patients with esophageal cancer before and after esophagectomy and from 9 patients with early gastric cancer before and after laparoscopy-assisted distal gastrectomy (LADG). The expression profiles of hPer1 and hPer2 mRNAs in PBMCs were determined by real-time RT-PCR. Plasma melatonin and cortisol concentrations were measured by radioimmunoassay. Plasma melatonin levels decreased in both groups throughout the day and plasma cortisol levels changed after surgery. The acrophase of clock gene expression was altered after surgery as follows: hPer1, from 6:19+/-1:50 to 13:59+/-0:59 (p=0.0003) and from 7:47+/-1:27 to 12:33+/-1:30 (p=0.0043) and hPer2, from 5:01+/-2:59 to 19:30+/-2:15 (p<0.0001) and from 6:49+/-1:59 to 13:39+/-3:06 (p=0.0171) in patients with esophageal and early gastric cancer, respectively. The post-operative phase change of hPer2 was more prominent after esophagectomy than after LADG. Our results suggest that surgical stress affects the peripheral clock as well as endogenous hormones in humans.

Experimental neuropathy in mice is associated with delayed behavioral changes related to anxiety and depression.

BACKGROUND: Patients with chronic pain frequently suffer affective disorders, particularly anxiety and depression. Although clinical research on the relationship between pain and depressive symptoms has been done, it is not clear whether pain causes depression or depression exaggerates pain. To investigate the relation between pain and affect, we measured anxiety and depression-related behaviors in mice after spinal nerve ligation using classical behavioral tests. METHODS: After unilateral ligation of the left fifth lumbar nerve, we measured pain behaviors using von Frey and radiant heat tests. Activity level, anxiety-related behaviors, and depression-related behaviors were tested with open field, light-dark exploration, elevated plus-maze, and forced swim tests. RESULTS: Sensory hypersensitivity was observed within a few days after ligation. Anxiety and depression-related behaviors were not seen 2 and 7 days after ligation. However, 15 and 30 days after ligation we found clear evidence of anxiety and depression-related behaviors, without loss of mobility. CONCLUSIONS: Nerve injury can trigger affective disturbances in mice that appear much later than sensory hypersensitivity.

Swelling behavior of the cellulose Ibeta crystal models by molecular dynamics.

The various crystal models of cellulose Ibeta, each differing in crystal size, have been studied by computer simulation using the amber molecular-dynamics package and the GLYCAM parameters. The four types of crystal model were constructed by a combination of two base-plane sizes, consisting of either 24 or 48 chains and two chain lengths having either 10 or 20 residues. The base planes of the crystal models were composed by the edges of the [1,1,0], [1,-1,0], and [1,0,0] crystal planes, where the [1,1,0] plane was assigned to the longest edge. The crystal models were soaked in water boxes to investigate their swelling behavior. Unexpectedly, the crystal models twisted quickly to form a slightly right-handed shape during the initial approximately 50 ps and that, in a steady, swollen state, the twisted forms remained for the rest of the simulation time. In spite of such overall deformation, the inner part of the swollen model fairly reproduced the important structural features of the original crystal structure, such as the rotational positions of the substituent groups and the hydrogen-bonding scheme. On heating the crystal model up to 550 K, the twisted shape was conserved in most of the temperature range, while the initial conformations of the substituent groups deviated above approximately 430 K, followed by appreciable disordering in chain sheets at higher temperatures. It is suggested that some internal tensions are involved within a chain sheet of the initial structure. In the course of swelling, some of these tensions were released to introduce a twisted shape in the crystal models.

Circadian rhythm of acute phase proteins under the influence of bright/dim light during the daytime.

We investigated the influence of two different light intensities, dim (100 lx) and bright (5000 lx), during the daytime on the circadian rhythms of selected acute phase proteins of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), alpha1-antichymotrypsin (ACT), transfferin (TF), alpha2-macroglobulin (alpha2-m), haptoglobin (HP), and ceruloplasmin (CP). Serum samples were collected from 7 healthy volunteers at 4 h intervals during two separate single 24 h spans during which they were exposed to the respective light intensity conditions. A circadian rhythm was detected only in ACT concentration in the bright light condition. The concentration of ACT, a positive acute phase protein (APP), increased (significantly significant differences in the ACT concentration were detected at 14:00 and 22:00 h) and AGP showed a tendency to be higher under the daytime bright compared to dim light conditions. There were no significant differences between the time point means under daytime dim and bright light conditions for alpha2-M, AGP, Tf, Cp, or Hp. The findings suggest that some, but not all, APP may be influenced by the environmental light intensity.

[Actigraphic assessment of the effects of hypnotics on the night before surgery in relation with the severity of surgery].

BACKGROUND: Hypnotics have been used to provide adequate sleep on the night before surgery, but these effects have rarely been investigated. We investigated whether the preoperative hypnotic effects are related with the severity of surgery with quantitative evaluation using actigraph. METHODS: Sleep time on the night before surgery was evaluated after the administration of brotizolam 0.25 mg in 40 patients awaiting surgery; 20 patients for cardiovascular surgeries (Group I) and 20 patients for general surgeries (Group II). Sleep and awake state were identified by wrist activity measured with a motion-logger actigraph. Sleep time was assessed in total period from 22:00 to 6:00 and its 4 subdivided 2-hour periods (22:00-24:00, 24:00-2:00, 2:00-4:00, 4:00-6:00). RESULTS: The total sleep time in Group II (448 +/- 22 min) was significantly longer than that in Group I (409 +/- 44 min). Group I showed a significant reduction in sleep time in the period of 4:00-6:00 compared with other periods, whereas Group II did not show any difference among 4 periods. Group I showed significant shorter sleep time in the period of 4:00-6:00 compared with Group II. CONCLUSIONS: An actigraphic assessment of sleep time has demonstrated the possible influence of the severity of surgery on the sleep time on the night before surgery.

Effects of dim or bright-light exposure during the daytime on human gastrointestinal activity.

On the basis of our previous findings that bright-light exposure during the daytime has profound influence on physiological parameters such as melatonin secretion and tympanic temperature in humans, we proposed the hypothesis that bright vs. dim light-exposure during the daytime has a different influence on the activity of the digestive system via the endocrine and/or autonomic nervous system. To examine this hypothesis, we conducted a series of counterbalanced experiments in which subjects stayed the daytime (7:00 to 15:00h) under either a dim (80 lux) or bright (5,000 lux) light condition. We measured gastrointestinal activity using a breath hydrogen (indicative of carbohydrate malabsorption) and an electrogastrography (EGG, indicative of gastric myoelectric activity) test. The results showed the postprandial breath hydrogen excretion during the following nighttime period after daytime exposure to the dim-light condition was significantly higher than under the bright-light condition (p < 0.05). In addition, the spectrum total power of the EGG recorded after taking the evening meal was significantly lower for the dim than bright-light condition (p < 0.05). These results support our hypothesis and indicate that dim-light exposure during the daytime suppresses the digestion of the evening meal, resulting in malabsorption of dietary carbohydrates in it.

[Postoperative management in single-lung transplantation for lymphangioleiomyomatosis].

A 35-yr-old woman presented with dyspnea has been diagnosed as having lymphangioleiomyomatosis (LAM). Despite treatment with estrogen, her pulmonary function deteriorated progressively. In January 2001, a left single-lung transplantation was performed on her from a cadaveric donor. On admission to the ICU after the transplantation, arterial blood gas analysis showed a severe respiratory acidosis. A double-lumen endotracheal tube (ETT) was replaced by a single-lumen ETT for a better suctioning of secretion. Gas exchange improved after the replacement of ETT and suctioning of secretion by bronchoscopy. Five hours after the admission to the ICU, the breath sound decreased over the right thorax. The chest X-ray showed right pneumothorax, and a chest tube was inserted. The patient was weaned from mechanical ventilation gradually and extubated on the 6th ICU day. The patient was discharged from ICU to the general ward on the 9th ICU day without pneumonia and other complications. The development of pneumothorax in the recipient lung should be kept in mind during the perioperative period of lung transplantation for LAM.

Influences of diurnal bright or dim light exposure on urine volume in humans.

We investigated with eight healthy females if 8 hr diurnal (0700 to 1500 h) bright rather than dim light (5,000 vs. 80 lx) influenced urine volume. Environmental illuminance was made identical at all other times besides 07:00 to 15:00 h. The participants spent time at strictly regulated schedules in a bioclimatic chamber (26 degrees C, relative humidity 60%) for 57 h. Blood was drawn (2 ml) just before lunch in order to calculate Creatinine clearance (Ccr). Urine volume was significantly higher during wakefulness and the 8-h sleep period with bright rather than dim light. Ccr was significantly higher after bright light. The results were discussed in terms of suppression of the sympathetic nerve system under the influence of diurnal bright light exposure. We also discussed these in terms of physiological polymorphisms.

Gene flow and spatio-temporal genetic variation among sympatric populations of Tetranychus kanzawai (Acari: Tetranychidae) occurring on different host plants, as estimated by microsatellite gene diversity.

We investigated spatio-temporal genetic variation in allele frequency and estimated gene flow among sympatric populations of Tetranychus kanzawai on different host plants by the use of microsatellite markers. In the analysis of spatial genetic variation, no isolation by distance was detected among the populations. Gene flow between populations on Hydrangea macrophylla and those on other host plants was relatively restricted, whereas the populations on Akebia quinata and Clerodendrum trichotomum were almost panmictic. Our study on temporal genetic variation showed (1) that population differentiation was slightly reduced during the period from April to May owing to frequent gene flow among populations; and (2) that population differentiation was greatly enhanced from May to October because of bottleneck effects. Genetic differentiation among T. kanzawai populations was caused by the effect of host plants rather than by the effect of geographic distance among populations, suggesting possibility of sympatric host race formation in this species.

Isolation, characterization, inheritance and linkage of microsatellite markers in Tetranychus kanzawai (Acari: Tetranychidae).

We isolated and characterized seven microsatellite markers in Tetranychus kanzawai (Acari: Tetranychidae). We also examined the conformity of the isolated markers to Mendelian laws and analyzed linkage among the microsatellite loci. All microsatellite markers fit expected 1:1 disomic segregation ratio and hence were inherited in a Mendelian manner. Significant pairwise linkage was detected in three pairs of microsatellite loci. These isolated microsatellite markers may become a powerful tool for the study of behavioral ecology, population genetics, and genome mapping of T. kanzawai.

Validity of gastric intramucosal pH (pHi) for circulatory evaluation in pediatric patients.

OBJECTIVE: To determine if the measurement of gastric intramucosal pH (pHi) is useful for evaluation of circulatory status of critically ill pediatric patients. DESIGN: Prospective clinical study. SETTING: General intensive care unit in a university hospital. PATIENTS: Seven pediatric patients (mean age: 2 y.o.); six post-cardiac surgery, one receiving barbiturate therapy. INTERVENTIONS: Tonometric catheters were placed via nasogastric approach. pHi was measured after confirmation of the catheter position by X-ray. MEASUREMENTS AND MAIN RESULTS: Saturation of venous blood oxygen (SvO2), arterial keton body ratio (AKBR), serum lactate level and pHi were evaluated simultaneously. No patients survived with pHi below 7.22; pHi above 7.11 significantly correlated with SvO2 values (r = 0.814, p < 0.001); pHi below 7.11 did not show any significant correlation with SvO2. Whereas SvO2 values of under 40% were distributed in the pHi range from 7.11 to 7.19, pHi below 7.11 occurred when SvO2 values were more than 40%. AKBR and serum lactate level did not correlate with pHi. CONCLUSION: pHi can be a useful parameter for evaluating the circulatory status of critically ill pediatric patients; it allows reliable evaluation of splanchnic and peripheral perfusion.