Elevation and suppression of paraoxon-induced epileptic activity in the rat hippocampus

Background: Organophosphorus cholinesterase inhibitors and an elevated extracellular potassium concentration ([K+]e) elicit clinical epilepsy. We investigated (1) the epilepsy-inducing actions of paraoxon (POX) with elevated [K+]e and (2) the effects of atropine,pralidoxime, and selective muscarinic acetylcholine receptor (mAChR) antagonists on the actions of POX.Materials and Methods: Orthodromically elicited population spikes and fi eld excitatory postsynaptic potentials were simultaneously recorded from the CA1 region in rat hippocampal slices using a multi-electrode array system. Statistics were performed using ANOVA with Bonferroni testing (n = 6).Results: Epileptic activity was elicited in high (7.5, 9.0 mM) [K+]e with or without POX, but not in normal (4.5 mM) [K+]e. The incidence of epileptic activity with POX (83.3%) was signifi cantly higher (p < 0.05) than that without POX in 7.5 mM [K+]e (16.7%). The number of additional population spikes with POX (1.33 ± 1.03) was signifi cantly higher than that prior to and during treatment with atropine (0.16 ± 0.40 and 0.16 ± 0.40, respectively, p < 0.05) or prior to treatment with M1 and M3 mAChR antagonists (0 and 0.16 ± 0.40, respectively, p < 0.05), but not with pralidoxime, M2, or M4 mAChR antagonists in 7.5 mM [K+]e.Conclusion: POX-induced cholinesterase inhibition elicited epileptic activity in elevated [K+]e but not normal [K+]e. Treatment for hyperkalemia likely prevents development of epilepsy following organophosphate intoxication. Atropine, rather than pralidoxime, may be effective at inhibiting organophosphate-induced epileptic activity.departmental bulletin pape

Sepsis-induced modulation of long-term potentiation induced by theta burst stimulation in the rat hippocampus

We investigated the influences of sepsis on central synaptic plasticity in vitro. Cecal ligation and puncture (CLP) was performed by creating rat sepsis models, which were divided into early and late sepsis groups (8 and 16 h after CLP, respectively). In the CA1 of the rat hippocampal slices, orthodromically elicited population spikes (PSs) and field excitatory postsynaptic potentials (fEPSPs) were simultaneously recorded, and their long-term potentiation (LTP) was induced by theta burst stimulation (TBS). TBS induced LTPs of PSs and fEPSPs in all groups. In the sham and early sepsis groups, there was no significant difference in LTPs between PSs and fEPSPs. However, in the late sepsis group, the LTP of PSs was greater than that of fEPSPs (p &lt; 0.05) and was greater than the LTPs of PSs in the sham and early sepsis groups (p &lt; 0.05). Superoxide dismutase, administered immediately before CLP, inhibited the enhancement of LTP in PS, as observed in the late sepsis group. The initial rapid potentiation component of LTP in fEPSPs was suppressed or reduced in all groups that underwent CLP. The results indicate that CLP-induced sepsis modulates hippocampal synaptic plasticity, depressing excitatory synaptic transmissions and facilitating somatic excitability, which is induced by septic oxygen superoxide

Severe accidental colchicine poisoning by the autumn crocus: A case of successful treatment

AbstractBackgroundThe common garden plant autumn crocus contains colchicine and its derivatives. Colchicine poisoning causes abdominal cramps and diarrhea within hours. Several days later, multiorgan failure, pancytopenia, and cardiovascular collapse occur.1,2 Severe colchicine poisoning is associated with high mortality.Case reportA 63-year-old woman who accidentally ingested an autumn crocus, which contained ∼0.38 mg colchicine, had severe vomiting and was taken to an emergency center. She presented with symptoms of gastroenterocolitis within 1 hour of ingestion, and bone marrow hypoplasia with pancytopenia developed on the 3rd day after ingestion. We continued administration of granulocyte colony-stimulating factor (300 μg) for 5 days until we confirmed that the patient's white blood cell count was increasing. Also, there was focal and segmental intestinal ischemia and some cakes of charcoal remained in the intestinal tract. Therefore, we presumed that nonocclusive mesenteric ischemia was caused by hypotension with severe dehydration, although pseudo-obstruction due to the activated charcoal may have been a contributing factor. We were able to promptly intervene to treat paralytic ileus and gastrointestinal edema before anticipated worsening of abdominal compartment syndrome, by conducting open peritoneal drainage. Despite severe poisoning, our patient survived with intensive care. Conclusion: Colchicine intoxication may lead to a sudden and extreme critical course. Therefore, as there is no means to predict prognosis from initial severity of symptoms at onset, we suggest that all patients suspected of colchicine intoxication should be managed in hospital with continuous vital sign monitoring and frequent laboratory testing for at least a few days after ingestion

Prehospital emergency care patient satisfaction scale [PECPSS] for care provided by emergency medical teams: Scale development and validation

The purpose of this study was to develop and validate an emergency medical technician (EMT) care patient satisfaction scale to measure patient satisfaction with prehospital emergency care. To date, patient satisfaction surveys of EMTs have been performed subjectively, e using each facility's questionnaire, without the use of a validated patient satisfaction scale. However, no specific scale has been devised to assess patient satisfaction with EMTs. The study population comprised patients who used an ambulance between November 2020 and May 2021 (N = 202). A survey instrument was administered to participants who provided informed consent. In the process of validating the patient satisfaction scale, an exploratory factor analysis (EFA) of construct validity was performed. The results of the EFA showed a factor structure consisting of five factors: “teamwork”, “explanation and communication”, “physical treatment and psychological support”, “quickness of transport”, and “environment in the ambulance”. In addition, domain and summary scores showed good internal reliability (Cronbach's range = 0.82–0.94). The patient satisfaction scale developed in this study was designed and validated considering the role of EMTs and patients' needs for prehospital care. This scale may be useful in the development of assessments and interventions to improve patient satisfaction with EMTs

The lesion site of organophosphorus-induced central apnea and the effects of antidotes

Abstract Organophosphorus poisoning kills individuals by causing central apnea; however, the underlying cause of death remains unclear. Following findings that the pre-Bötzinger complex impairment alone does not account for central apnea, we analyzed the effect of paraoxon on the brainstem-spinal cord preparation, spanning the lower medulla oblongata to phrenic nucleus. Respiratory bursts were recorded by connecting electrodes to the ventral 4th cervical nerve root of excised brainstem-spinal cord preparations obtained from 6-day-old Sprague–Dawley rats. We observed changes in respiratory bursts when paraoxon, neostigmine, atropine, and 2-pyridine aldoxime methiodide were administered via bath application. The percentage of burst extinction in the paraoxon-poisoning group was 50% compared with 0% and 18.2% in the atropine and 2-pyridine aldoxime methiodide treatment groups, respectively. Both treatments notably mitigated the paraoxon-induced reduction in respiratory bursts. In the neostigmine group, similar to paraoxon, bursts stopped in 66.7% of cases but were fully reversed by atropine. This indicates that the primary cause of central apnea is muscarinic receptor-mediated in response to acetylcholine excess. Paraoxon-induced central apnea is hypothesized to result from neural abnormalities within the inferior medulla oblongata to the phrenic nucleus, excluding pre-Bötzinger complex. These antidotes antagonize central apnea, suggesting that they may be beneficial therapeutic agents

Ipsilateral Acetabular and Femoral Neck and Shaft Fractures

Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures

Malignant Hemispheric Cerebral Infarction Associated with Idiopathic Systemic Capillary Leak Syndrome

Idiopathic systemic capillary leak syndrome (ISCLS) is a rare condition that is characterized by unexplained episodic capillary hyperpermeability due to a shift of fluid and protein from the intravascular to the interstitial space. This results in diffuse general swelling, fetal hypovolemic shock, hypoalbuminemia, and hemoconcentration. Although ISCLS rarely induces cerebral infarction, we experienced a patient who deteriorated and was comatose as a result of massive cerebral infarction associated with ISCLS. In this case, severe hypotensive shock, general edema, hemiparesis, and aphasia appeared after serious antecedent gastrointestinal symptoms. Progressive life-threatening ischemic cerebral edema required decompressive hemicraniectomy. The patient experienced another episode of severe hypotension and limb edema that resulted in multiple extremity compartment syndrome. Treatment entailed forearm and calf fasciotomies. Cerebral edema in the ischemic brain progresses rapidly in patients suffering from ISCLS. Strict control of fluid volume resuscitation and aggressive diuretic therapy may be needed during the post-leak phase of fluid remobilization

Effect of prehospital advanced airway management on out‐of‐hospital cardiac arrest due to asphyxia: A JAAM‐OHCA registry‐based observational study in Japan

Abstract Aim To investigate the relationship between prehospital advanced airway management (AAM) and neurological outcomes in patients with asphyxia‐related out‐of‐hospital cardiac arrest (OHCA). Methods We retrospectively analyzed data from the Japanese Association for Acute Medicine OHCA registry between June 2014 and December 2017. Patients with asphyxia‐related cardiac arrest aged ≥18 years were included. The primary outcome was a 1‐month favorable neurological outcome (cerebral performance category [CPC] 1–2). Results Of the 34,754 patients in the 2014–2017 JAAM‐OHCA Registry, 1956 were included in our analysis. Cerebral performance category 1–2 was observed in 31 patients (1.6%), while CPC 3–5 was observed in 1925 patients (98.4%). Although prehospital AAM was associated with unfavorable neurological outcomes (odds ratio [OR], 0.269; 95% confidence interval [CI], 0.114–0.633; p = 0.003) in the univariate analysis, the association was not significant in the multivariate analysis. Compared with the AAM group, the non‐AAM group showed increased rates of cardiac arrest after emergency medical service contact (4.3 vs. 7.2%, p = 0.009) and Glasgow Coma Scale ≥4 at hospital admission (1.9% vs. 4.7%, p = 0.004). Among the 903 patients for whom the time to return of spontaneous circulation (ROSC) could be calculated, the time from witnessed cardiac arrest to ROSC was significantly shorter (median, 8.5 vs. 37.0 min; p < 0.001) for those with favorable neurological outcomes than for those without. Conclusion Prehospital AAM is not associated with improved neurological outcomes among those with asphyxia‐related OHCA. However, the time from cardiac arrest to the first ROSC was significantly shorter among those with favorable outcomes

Prediction of the future number of fall-related emergency medical services calls in older individuals

Abstract Background Falls among older individuals contribute significantly to the rise in ambulance transport use. To recognize the importance of future countermeasures, we estimated the projected number and percentage of fall-related emergency medical service (EMS) calls. Methods We examined the sex, age group, and location of falls among patients aged ≥ 65 years who contacted emergency services in Sapporo City from 2013 to 2021. Annual fall-related calls per population subgroup were calculated, and trends were analyzed. Four models were used to estimate the future number of fall-related calls from the 2025–2060 projected population: (1) based on the 2022 data, estimates from the 2013–2022 data using (2) Poisson progression, (3) neural network, (4) estimates from the 2013–2019 data using neural network. The number of all EMS calls was also determined using the same method to obtain the ratio of all EMS calls. Results During 2013–2022, 70,262 fall-related calls were made for those aged ≥ 65 years. The rate was higher indoors among females and outdoor among males in most age groups and generally increased with age. After adjusting for age, the rate increased by year. Future estimates of the number of fall calls are approximately double the number in 2022 in 2040 and three times in 2060, with falls accounting for approximately 11% and 13% of all EMS calls in 2040 and 2060, respectively. Conclusion The number of fall-related EMS calls among older people is expected to increase in the future, and the percentage of EMS calls will also increase; therefore, countermeasures are urgently needed