観血および非観血的血圧測定値の差異について

To clarify the discrepancy between invasive (IBP) and noninvasive (NIBP) blood pressure, we studied the appropriateness of various methods and compared them. All data were collected in simulation studies and from routine clinical work. For IBP monitoring, pressure transducers (DTX or P50, Spectramed, USA) were used. NIBP was monitored in three ways; BP-308 (Colin, Japan) and Dynamap 8100 (Criticon, USA) for the oscillometric method, CBM-2000 (Colin, Japan) for the tonometric method and Finapres (Ohmeda, USA) for the zero transmural pressure method. IBP: In our estimation, small invisible air bubbles in the catheter make for a sharp, not dull pressure wave. This phenomenon is explained using frequency response curves. There was more than a 10mmHg difference in systolic pressures (aortic valve to bifurcation) and much greater difference in distal pressures. With a vasodilating condition, the situation is more complex and it is not so easy to get a true IBP. NIBP: Oscillometric pressure is little affected by peripheral vascular conditions and reflects the central pressure well, however, it is not a continuous pressure monitor. Continuous tonometry pressure was useful only when calibrated with oscillometric pressure. Zero transmural pressure is also an easy continuous method and reveals distal arterial conditions well, but is affected by finger cuff fitness. In conclusion, there is no reliable method, neither IBP nor NIBP for continuous blood pressure monitoring. However, we recommend the use of one of the continuous methods together with intermittent oscillometric pressure

解剖体において両側性の星状神経節ブロックは頻繁に硬膜外腔への薬液浸潤を起こす

It is well known that epidural infusion of injectate in association with a C6 paratracheal stellate ganglion block (SGB) leads to negative and/or positive side effects for the patient. However, this associated infusion has not been demonstrated experimentally using cadavers. We found that, in postmortem-fixed cadavers, epidural infusion occurred much more frequently in cases of bilateral SGB than in unilateral SGB. The frequency in the bilateral case (36.1%) was far beyond the two times of the unilateral one (7.7%). The injectate (latex resin, 10 ml for one side) was delivered from the prevertebral deposit into the epidural space by way of the spaces around the C8 and/or T1 spinal nerve roots. Thus, the latex spread around and/or in the brachial plexus usually combined with the epidural infusion. We speculate that the amount of injectate spreading into the prevertebral space in the bilateral injection (total 20 ml) was beyond the hypothetical tentative capacity and that the excess amount made the addional, perineural spread. The present results suggests that, in clinical cases, the frequency of epidural infusion depends on the amount of injectate even in the routine unilateral SGB. However, the cadaveric study did not indicate how much amount is the excess for the living patient

Reduced-intensity allogeneic stem cell transplantation for renal cell carcinoma: In vivo evidence of a graft-versus-tumor effect

金沢大学医薬保健研究域医学系We report the cases of 3 patients with advanced renal cell carcinoma who underwent reduced-intensity allogeneic stem cell transplantation. In 2 partial responders, histologic analyses of metastases revealed prominent accumulation of CD8+ T cells and degenerative changes of clear cell carcinoma, suggestive of induction of tumor-specific cytotoxic T lymphocytes

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

Changes in synaptic transmission of substantia gelatinosa neurons after spinal cord hemisection revealed by analysis using in vivo patch-clamp recording

Background After spinal cord injury, central neuropathic pain develops in the majority of spinal cord injury patients. Spinal hemisection in rats, which has been developed as an animal model of spinal cord injury in humans, results in hyperexcitation of spinal dorsal horn neurons soon after the hemisection and thereafter. The hyperexcitation is likely caused by permanent elimination of the descending pain systems. We examined the change in synaptic transmission of substantia gelatinosa neurons following acute spinal hemisection by using an in vivo whole-cell patch-clamp technique. Results An increased spontaneous action potential firings of substantia gelatinosa neurons was detected in hemisected rats compared with that in control animals. The frequencies and amplitudes of spontaneous excitatory postsynaptic currents and of evoked excitatory postsynaptic currentss in response to non-noxious and noxious stimuli were not different between hemisected and control animals. On the contrary, the amplitude and frequency of spontaneous inhibitory postsynaptic currents of substantia gelatinosa neurons in hemisected animals were significantly smaller and lower, respectively, than those in control animals (P?<?0.01). Large amplitude and high-frequency spontaneous inhibitory postsynaptic currents, which could not be elicited by mechanical stimuli, were seen in 44% of substantia gelatinosa neurons in control animals but only in 17% of substantia gelatinosa neurons in hemisected animals. In control animals, such large amplitude spontaneous inhibitory postsynaptic currents were suppressed by spinal application of tetrodotoxin (1??M). Cervical application of lidocaine (2%, 10??l) also inhibited such large amplitude of inhibitory postsynaptic currents. The proportion of multi-receptive substantia gelatinosa neurons, which exhibit action potential firing in response to non-noxious and noxious stimuli, was much larger in hemisected animals than in control animals. Conclusions These suggest that substantia gelatinosa neurons receive tonic inhibition by spinal inhibitory interneurons which generate persistent action potentials. Spinal hemisection results in hyperexcitation of substantia gelatinosa neurons at least in part by eliminating the tonic descending control of spinal inhibitory interneurons from supraspinal levelsArticleMOLECULAR PAIN.12:1744806916665820(2016)journal articl

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