Sepsis-associated neuroinflammation in the spinal cord

Septic patients commonly present with central nervous system (CNS) disorders including impaired consciousness and delirium. Today, the main mechanism regulating sepsis-induced cerebral disorders is believed to be neuroinflammation. However, it is unknown how another component of the CNS, the spinal cord, is influenced during sepsis. In the present study, we intraperitoneally injected mice with lipopolysaccharide (LPS) to investigate molecular and immunohistochemical changes in the spinal cord of a sepsis model. After LPS administration in the spinal cord, pro-inflammatory cytokines including interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha mRNA were rapidly and drastically induced. Twenty-four-hour after the LPS injection, severe neuronal ischemic damage spread into gray matter, especially around the anterior horns, and the anterior column had global edematous changes. Immunostaining analyses showed that spinal microglia were significantly activated and increased, but astrocytes did not show significant change. The current results indicate that sepsis induces acute neuroinflammation, including microglial activation and pro-inflammatory cytokine upregulation in the spinal cord, causing drastic neuronal ischemia and white matter edema in the spinal cord

A case of left ventricular free wall rupture after insertion of an IMPELLA® left ventricular assist device diagnosed by transesophageal echocardiography

[Background]The IMPELLA® is a minimally invasive left ventricular assist device. We report a case in which transesophageal echocardiography (TEE) was useful in diagnosis of left ventricular rupture after IMPELLA® insertion. [Case presentation]A 75-year-old man presented to the emergency room with chest pain and underwent percutaneous coronary intervention for 100% stenosis of the left anterior descending branch #7. An IMPELLA® was inserted to stabilize the circulation, but hypotension persisted. Transthoracic echocardiography revealed increased pericardial effusion and suspicion of free wall left ventricular rupture, leading to emergency surgery. TEE revealed the IMPELLA® straying into the left ventricle apical wall and cardiac tamponade. Hemorrhage was observed from the thinning free wall and the tip of the IMPELLA® was palpable. The IMPELLA® was removed and the left ventricular wall was repaired. [Conclusions]The IMPELLA® requires implantation of the tip in the left ventricle, but it should be noted that a fragile ventricular wall can be easily perforated

The inhibitory effects of Orengedokuto on inducible PGE2 production in BV-2 microglial cells

[Background and aim] Reactive microglia has been associated with neuroinflammation caused by the production of proinflammatory molecules such as cytokines, nitric oxide, and prostaglandins. The overexpression of these molecules may provoke neuronal damage that can cause neurodegenerative diseases. A traditional herbal medicine, Orengedokuto (OGT), has been widely used for treating inflammation-related diseases. However, how it influences neuroinflammation remains poorly understood. [Experimental procedure] This study investigated the effects of OGT on inflammatory molecule induction in BV-2 microglial cells using real-time RT-PCR and ELISA. An in vivo confirmation of these effects was then performed in mice. [Results and conclusion] OGT showed dose-dependent inhibition of prostaglandin E2 (PGE2) production in BV-2 cells stimulated with lipopolysaccharide (LPS). To elucidate the mechanism of PGE2 inhibition, we examined cyclooxygenases (COXs) and found that OGT did not suppress COX-1 expression or inhibit LPS-induced COX-2 upregulation at either the transcriptional or translational levels. In addition, OGT did not inhibit COX enzyme activities within the concentration that inhibited PGE2 production, suggesting that the effect of OGT is COX-independent. The inhibitory effects of OGT on PGE2 production in BV-2 cells were experimentally replicated in primary cultured astrocytes and mice brains. OGT can be useful in the treatment of neuroinflammatory diseases by modulating PGE2 expression

前立腺癌細胞におけるアンドロゲン受容体の転写活性に対するプロポフォールの影響

京都大学0048新制・課程博士博士(医学)甲第20970号医博第4316号新制||医||1026(附属図書館)京都大学大学院医学研究科医学専攻(主査)教授 小川 修, 教授 戸井 雅和, 教授 万代 昌紀学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDFA

分布型TOPMODELを用いた大規模流域に対する降雨流出解析

本研究は修正分布型TOPMODELを3つの大流域 (アマゾン川、ブラマプトラ川、揚子江)に適用し、その降雨 追跡(流出)モデルとしての特性を評価するものである。修正分布型TOPMODELにおいては、従来のTOPMODELで 一定値を利用していた流域内の流下流速を小流域の特性を反映して変化させ、セル毎の降水量と蒸発散量の 変化を考慮し、最終的にモンテカルロ法で最適化し決定する。修正分布型TOPMODELではGRDCの日観測流量に 対してナッシュ係数でそれぞれアマゾン川 0.48、ブラマプトラ川 0.82、揚子江 0.78 を得ており、本手法が信 頼に足る方法であることを裏付けている。The objective of this study is to apply a modified distributed TOPMODEL approach to three large-scale basins as a Rainfall Routing Model (RRM): the Amazon, the Brahmaputra and the Yangtze basins. This modified approach uses a multi-velocities parameterization to routing the flow. The modified model also uses spatially distributed rainfall and evapotranspiration data through a cell-to-cell routing method. Monte Carlo method was used to find the best set of parameters. The modified model obtained Nash-Sutcliffe coefficient values of 0.48, 0.82 and 0.78 for the Amazon, the Brahmaputra and the Yangtze basins, respectively. The simulations showed that the modified TOPMODEL approach seems to be a reasonable hydrological model to estimate stream flow discharges in large-scale river basins.本研究は修正分布型TOPMODELを3つの大流域 (アマゾン川、ブラマプトラ川、揚子江)に適用し、その降雨 追跡(流出)モデルとしての特性を評価するものである。修正分布型TOPMODELにおいては、従来のTOPMODELで 一定値を利用していた流域内の流下流速を小流域の特性を反映して変化させ、セル毎の降水量と蒸発散量の 変化を考慮し、最終的にモンテカルロ法で最適化し決定する。修正分布型TOPMODELではGRDCの日観測流量に 対してナッシュ係数でそれぞれアマゾン川 0.48、ブラマプトラ川 0.82、揚子江 0.78 を得ており、本手法が信 頼に足る方法であることを裏付けている。The objective of this study is to apply a modified distributed TOPMODEL approach to three large-scale basins as a Rainfall Routing Model (RRM): the Amazon, the Brahmaputra and the Yangtze basins. This modified approach uses a multi-velocities parameterization to routing the flow. The modified model also uses spatially distributed rainfall and evapotranspiration data through a cell-to-cell routing method. Monte Carlo method was used to find the best set of parameters. The modified model obtained Nash-Sutcliffe coefficient values of 0.48, 0.82 and 0.78 for the Amazon, the Brahmaputra and the Yangtze basins, respectively. The simulations showed that the modified TOPMODEL approach seems to be a reasonable hydrological model to estimate stream flow discharges in large-scale river basins

Uterine rupture successfully treated with a damage‐control strategy of hysterectomy and resuscitative endovascular balloon occlusion of the aorta‐assisted cardiopulmonary resuscitation

Abstract Background Uterine rupture is a major cause of postpartum hemorrhage (PPH) that requires surgery. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is also helpful for PPH. However, the effectiveness of REBOA in PPH with cardiac arrest is unknown. Case Presentation A 40‐year‐old woman developed hemorrhagic shock due to uterine rupture after an induced delivery. She developed cardiac arrest, but was rescued by cardiopulmonary resuscitation (CPR), REBOA, a hysterectomy, and pelvic gauze packing. The hemodynamics were too unstable to move to the operating room. Then we initiated the CPR assisted with REBOA and decided to activate massive transfusion and perform laparotomy in the emergency room. She was finally discharged home without neurological sequelae. Conclusion Our damage control strategy, including REBOA‐assisted CPR, contributed to saving the life of a patient with a life‐threatening PPH