Association between intraoperative end-tidal carbon dioxide and postoperative nausea and vomiting in gynecologic laparoscopic surgery

Gynecologic laparoscopic surgery has a high incidence of postoperative nausea and vomiting (PONV). Studies suggest that low intraoperative end-tidal carbon dioxide (EtCO₂) is associated with an increased incidence of PONV, but the results have not been consistent among studies. This study investigated the association between intraoperative EtCO₂ and PONV in patients undergoing gynecologic laparoscopic surgeries under general anesthesia. This retrospective cohort study involved patients who underwent gynecologic laparoscopic surgeries under general anesthesia at Kyoto University Hospital. We defined low EtCO₂ as a mean EtCO₂ of < 35 mmHg. Multivariable modified Poisson regression analysis examined the association between low EtCO₂ and PONV during postoperative two days and the postoperative length of hospital stay (PLOS). Of the 739 patients, 120 (16%) had low EtCO₂, and 430 (58%) developed PONV during postoperative two days. There was no substantial association between low EtCO₂ and increased incidence of PONV (adjusted risk ratio: 0.96; 95% confidence interval [CI] 0.80–1.14; p = 0.658). Furthermore, there was no substantial association between low EtCO₂ and prolonged PLOS (adjusted difference in PLOS: 0.13; 95% CI − 1.00 to 1.28; p = 0.816). Intraoperative low EtCO₂, specifically a mean intraoperative EtCO₂ below 35 mmHg, was not substantially associated with either increased incidence of PONV or prolonged PLOS

nsPEFs induce the ISR via ROS-mediated HRI activation

The integrated stress response (ISR) is one of the most important cytoprotective mechanisms and is integrated by phosphorylation of the α subunit of eukaryotic translation initiation factor 2 (eIF2α). Four eIF2α kinases, heme-regulated inhibitor (HRI), double-stranded RNA-dependent protein kinase (PKR), PKR-like endoplasmic reticulum kinase (PERK), and general control nonderepressible 2 (GCN2), are activated in response to several stress conditions. We previously reported that nanosecond pulsed electric fields (nsPEFs) are a potential therapeutic tool for ISR activation. In this study, we examined which eIF2α kinase is activated by nsPEF treatment. To assess the responsible eIF2α kinase, we used previously established eIF2α kinase quadruple knockout (4KO) and single eIF2α kinase-rescued 4KO mouse embryonic fibroblast (MEF) cells. nsPEFs 70 ns in duration with 30 kV/cm electric fields caused eIF2α phosphorylation in wild-type (WT) MEF cells. On the other hand, nsPEF-induced eIF2α phosphorylation was completely abolished in 4KO MEF cells and was recovered by HRI overexpression. CM-H2DCFDA staining showed that nsPEFs generated reactive oxygen species (ROS), which activated HRI. nsPEF-induced eIF2α phosphorylation was blocked by treatment with the ROS scavenger N-acetyl-L-cysteine (NAC). Our results indicate that the eIF2α kinase HRI is responsible for nsPEF-induced ISR activation and is activated by nsPEF-generated ROS

Incidence, clinical characteristics and long-term prognosis of postoperative symptomatic venous thromboembolism: a retrospective cohort study

OBJECTIVES: The purpose of this study was to evaluate the incidence, clinical characteristics and prognosis of postoperative symptomatic venous thromboembolism (VTE) in Japan. DESIGN: Retrospective observational study. Two data sets, Contemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) Registry and Japanese Society of Anesthesiologists (JSA) annual report, were used for current analyses. SETTING: Eighteen of 29 centres participated in the COMMAND VTE Registry. PARTICIPANTS: Acute symptomatic patients with VTE who had undergone surgery 2 months prior to the diagnosis at 18 centres from January 2010 to December 2013 were identified in the COMMAND VTE Registry. From each centre's JSA annual report, the overall population that had received anaesthetic management during this period was retrieved. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the incidences and clinical characteristics of postoperative symptomatic VTE. The secondary outcomes were recurrent VTE, major bleeding and all-cause death. RESULTS: We identified 137 patients with postoperative symptomatic VTE, including 57 patients with pulmonary embolism. The incidences of postoperative symptomatic VTE and pulmonary embolism were 0.067% and 0.028%, respectively, based on data from 2 03 943 patients who underwent surgery, managed by anaesthesiologists, during the study period. The incidences of postoperative symptomatic VTE varied widely, depending on surgical and anaesthetic characteristics. Postoperative symptomatic VTE occurred at a median of 8 days after surgery, with 58 patients (42%) diagnosed within 7 days. The cumulative incidence, 30 days after VTE, of recurrent VTE, major bleeding, and all-cause death was 3.0%, 5.2%, and 3.7%, respectively. CONCLUSION: This study, combining the large real-world VTE and anaesthesiology databases in Japan revealed the incidence, clinical features and prognosis of postoperative symptomatic VTE, providing useful insights for all healthcare providers involved in various surgeries. TRIAL REGISTRATION: Not applicable

「自分でつかむ」という学習姿勢をはぐくむ講義展開 : 分娩における援助技術獲得の過程における試み(第1報)

援助技術とは,ただ手順の総合体ではなく,対象への理解に基づいた働きかけでなければならない。また,技術とは実施者の成長に応じて熟達,変化しなければ技術とは言えないという側面を持っている。しかし,近年若者の学習や自己の役割の自覚に関する変化の中で,学生の主体性や積極性の不足が問題とされる事が多い。本学において助産学を受講する学生の姿勢にも,同様の問題を感じ,学習効果を得るだけでなく,援助者としての成長を促すきっかけとなることを期待して,「助産技術学I」において平成16年度より新たな講義展開を試みた。「助産技術学I」は分娩における援助技術を学習する科目であり,これまで教員の講義・演習を中心とした科目であったが,新たな講義計画では,ビデオや資料を手がかりに,グループによる自己学習を中心に,教員はその理解の確認と修正を行ないながら,学生の気づきを促し,学生各々の変化やグループの形成過程を見守る方法をとった。結果として,誤った理解や学習不足の学生は見られず,技術修得の状況も良好であった。また,何よりも大きな変化は,学生の学習姿勢に積極性が見られるようになった点であった。その変化が,我々が意図した人間的な成長に繋がるのかは,まだ評価の段階では無いと思うが,学生は「自分でつかむ」という姿勢の一端は体験できたように思う。ここに,新たな講義展開の状況と,学生の変化を報告し,今後の課題を明らかにしたい。The assisting technique should not be a simple combination of procedures but should be an activity based on understanding of objects. In addition, the technique has an aspect that it cannot be called a technique unless a performer of a technique reaches proficiency and the technique changes with his or her growth. Consciousness of young people about learning in schools and their own role in the society is recently changing, and as a result, lack of independence and active inquiring of students frequently becomes a subject of discussion. We found the identical problem in students learning midwifery in our university as well. Since April 2004, we consequently attempted to develop a new teaching plan in the lesson "conduct of labor I " expecting not only to obtain a high teaching effect but also to give an impetus to the students so that they would become persons eager to assist human. In our new education plan, students learned the lesson by themselves mainly through group studies using videotapes or available data as introductory tools. Teachers remained to help students by pointing out information and points of view that were unnoticed by them, and watched changes in individual students and in the process of group formation, while ascertaining and correcting what understood by the students

豆類の脱湿・吸湿時における挙動について

The changes in water contents of adzuki beans, cowpeas, toramames (a variety of kidney bean) and soybeans during removal and absorption of moisture were investigated to clarify the effect of humidity on behavior of beans. It was found that dehumidified adzuki beans hardly absorbed moisture even if they were put in the overhumid circumstance for a long time and the dehumidification of adzuki beans occurred through hilum. Beans other than adzuki beans absorbed more moisture than the original water content by addition of moisture after dehumidification. Adzuki beans were used as the stuff for packing into pillow in Japan till recent years. This suggests that the characteristics on dehumidification and humidification of adzuki beans were utilized for the material

マツタケ TRICHOLOMA MATSUTAKE SING. ノ ジンコウ バイヨウ ダイ1ホウ マツタケ シジッタイ カラノ キンシ ノ ブンリ ト バイヨウ

Tricholoma matsutake is one of the parasitic fungi which weakly grow not only on the artificial culture media, but on the field. The isolation of Tricholoma matsutake hyphae and the culture of the hyphae were investigated in a test tube. We have been able to isolate hyphae using explants from gills of unspread cap of Tricholoma matsutake fruiting bodys. For the isolation of hyphae, it was concluded that the best medium was Hamada medium, the next one was 1/10 conc. Hamada medium and the third one was Waxman medium. Hamada medium has been mainly used for the culture medium because the better growthes of hyphae (60 mm/90 day) were achieved. The growth (elongation) rates of the hyphae were scarcely regarded as significant by the various additions. While, the forme of the mycelia were regarded as significant by the additions of inorganic salts and metal ions

Discovery of the Fastest Early Optical Emission from Overluminous SN Ia 2020hvf: A Thermonuclear Explosion within a Dense Circumstellar Environment

Ia型超新星の爆発直後の閃光を捉えることに成功 --特異な爆発に至る恒星進化の謎に迫る--. 京都大学プレスリリース. 2021-12-10.In this Letter we report a discovery of a prominent flash of a peculiar overluminous Type Ia supernova, SN 2020hvf, in about 5 hr of the supernova explosion by the first wide-field mosaic CMOS sensor imager, the Tomo-e Gozen Camera. The fast evolution of the early flash was captured by intensive intranight observations via the Tomo-e Gozen high-cadence survey. Numerical simulations show that such a prominent and fast early emission is most likely generated from an interaction between 0.01 M⊙ circumstellar material (CSM) extending to a distance of ∼10¹³ cm and supernova ejecta soon after the explosion, indicating a confined dense CSM formation at the final evolution stage of the progenitor of SN 2020hvf. Based on the CSM–ejecta interaction-induced early flash, the overluminous light curve, and the high ejecta velocity of SN 2020hvf, we suggest that the SN 2020hvf may originate from a thermonuclear explosion of a super-Chandrasekhar-mass white dwarf (“super-MCh WD”). Systematical investigations on explosion mechanisms and hydrodynamic simulations of the super-MCh WD explosion are required to further test the suggested scenario and understand the progenitor of this peculiar supernova