Anesthesia in a severe anorexic with cirrhosis

Recent advancements in intensive care have increased the number of severe anorexia nervosa patients presenting for surgery. We provided anesthesia to a patient who had a 22-year history of anorexia with life-threatening cirrhosis. Although surgery should be avoided in patients with end-stage cirrhosis, she was in the best preoperative optimized condition compared to her condition over the past few years. Potential complications are heart failure easily caused by deterioration of cirrhosis, lethal arrhythmias related to electrolyte disturbances and increased myocardial sensitivity to drugs, and refeeding syndrome in the postoperative period. The several rare events that we experienced are worth reporting

Oral Local Anesthesia Successfully Ameliorated Neuropathic Pain in an Upper Limb Suggesting Pain Alleviation through Neural Plasticity within the Central Nervous System: A Case Report

Neural blockades are considered an alternative to pharmacotherapy for neuropathic pain although these blockades elicit limited effects. We encountered a patient with postbrachial plexus avulsion injury pain, which was refractory to conventional treatments but disappeared temporarily with the administration of the local anesthetic lidocaine around the left mandibular molar tooth during dental treatments. This analgesic effect on neuropathic pain by oral local anesthesia was reproducible. Under conditions of neuropathic pain, cerebral somatotopic reorganization in the sensorimotor cortices of the brain has been observed. Either expansion or shrinkage of the somatotopic representation of a deafferentated body part correlates with the degree of neuropathic pain. In our case, administration of an oral local anesthetic shrank the somatotopic representation of the mouth, which is next to the upper limb representation and thereby expanded the upper limb representation in a normal manner. Consequently, oral local anesthesia improved the pain in the upper limb. This case suggests that pain alleviation through neural plasticity within the brain is related to neural blockade

Efficiency of a New Fiberoptic Stylet Scope in Tracheal Intubation

Background: Failed or difficult tracheal intubation is an important cause of morbidity and mortality during anesthesia. Although a number of fiberoptic devices are available to circumvent this problem, many do not allow manual control of the flexion of the tip and necessitate time-consuming preparation, special training, or the use of an external light source. To improve these limitations, the authors designed a new fiberoptic stylet scope (FSS) that has a simple form of a standard stylet with the fiberoptic view and maneuverability of its tip. This study was undertaken to prospectively evaluate the effectiveness of the FSS in tracheal intubation. Methods: Thirty-two patients undergoing general surgery participated in this study. The authors used a standard laryngoscope only to elevate the tongue, then tracheal intubation was attempted with the glottic opening being viewed only through the FSS. The success rate, time necessary for intubation, hemodynamics, and adverse effects were recorded. Results: The success rate of tracheal intubation on the first attempt using the FSS was 94% (30 of 32 patients), and the remaining two patients were intubated successfully on the second attempt. The mean time necessary for the intubation procedure was 29 ؎ 14 s in all patients (mean ؎ SD). Changes in hemodynamics during intubation were well within acceptable ranges. There were no major adverse effects, but minor sore throat (28%) and minor hoarseness (25%) on the first postoperative day. Conclusions: Tracheal intubation using the FSS proved to be a simple and effective technique for airway management

Impact of patient characteristics on the efficacy and safety of landiolol in patients with sepsis-related tachyarrhythmia: Subanalysis of the J-Land 3S randomised controlled study

Background The J-Land 3S trial demonstrated that landiolol is effective and tolerated for treating sepsis-related tachyarrhythmias. Patient characteristics (e.g. baseline heart rate [HR], type of tachyarrhythmia, and concomitant disorders) may impact the outcomes of landiolol therapy. We performed subanalyses of J-Land 3S to evaluate the impact of patient characteristics on the efficacy and safety of landiolol for treating sepsis-related tachyarrhythmia. Methods Patients (≥20 years old; N = 151) hospitalised with sepsis at 54 participating hospitals in Japan with HR ≥100 beats/min for ≥10 min accompanied by diagnosis of tachyarrhythmia were randomised 1:1 to conventional sepsis therapy alone (control group) or conventional sepsis therapy plus landiolol (landiolol group). The efficacy and safety of landiolol were assessed in prespecified analyses of patients divided into subgroups by baseline characteristics and in post hoc, multivariate analyses with adjustment for age and HR at baseline. Findings The percentage of patients with HR of 60–94 beats/min at 24 h after randomisation (primary endpoint) was greater in the landiolol group in most subgroups in univariate unadjusted analyses and in multivariate logistic regression. The incidence of new-onset arrhythmia by 168 h and mortality by 28 days were also lower in the landiolol group in most subgroups in univariate and multivariate Cox proportional hazards models. No subgroups showed a markedly higher incidence of adverse events in univariate or multivariate logistic regression analyses

Antimicrobial Ointments and Methicillin-Resistant Staphylococcus aureus USA300

We tested 259 methicillin-resistant Staphylococcus aureus isolates and 2 USA300 ATCC type strains for susceptibility to bacitracin and neomycin contained in over-the-counter antibacterial ointments. Resistance to both bacitracin and neomycin was found only in USA300. The use of over-the counter antimicrobial drugs may select for the USA300 clone

Brain Dp140 alters glutamatergic transmission and social behaviour in the mdx52 mouse model of Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a muscle disorder caused by DMD mutations and is characterized by neurobehavioural comorbidities due to dystrophin deficiency in the brain. The lack of Dp140, a dystrophin short isoform, is clinically associated with intellectual disability and autism spectrum disorders (ASDs), but its postnatal functional role is not well understood. To investigate synaptic function in the presence or absence of brain Dp140, we utilized two DMD mouse models, mdx23 and mdx52 mice, in which Dp140 is preserved or lacking, respectively. ASD-like behaviours were observed in pups and 8-week-old mdx52 mice lacking Dp140. Paired-pulse ratio of excitatory postsynaptic currents, glutamatergic vesicle number in basolateral amygdala neurons, and glutamatergic transmission in medial prefrontal cortex-basolateral amygdala projections were significantly reduced in mdx52 mice compared to those in wild-type and mdx23 mice. ASD-like behaviour and electrophysiological findings in mdx52 mice were ameliorated by restoration of Dp140 following intra-cerebroventricular injection of antisense oligonucleotide drug-induced exon 53 skipping or intra-basolateral amygdala administration of Dp140 mRNA-based drug. Our results implicate Dp140 in ASD-like behaviour via altered glutamatergic transmission in the basolateral amygdala of mdx52 mice

Widespread occurrence of distinct alkenones from Group I haptophytes in freshwater lakes: Implications for paleotemperature and paleoenvironmental reconstructions

Alkenones are C35-C42 polyunsaturated ketone lipids that are commonly employed to reconstruct changes in sea surface temperature. However, their use in coastal seas and saline lakes can be hindered by species-mixing effects. We recently hypothesized that freshwater lakes are immune to species-mixing effects because they appear to exclusively host Group I haptophyte algae, which produce a distinct distribution of alkenones with a relatively consistent response of alkenone unsaturation to temperature. To evaluate this hypothesis and explore the geographic extent of Group I haptophytes, we analyzed alkenones in sediment and suspended particulate matter samples from lakes distributed throughout the mid- and high latitudes of the Northern Hemisphere (n = 30). Our results indicate that Group I-type alkenone distributions are widespread in freshwater lakes from a range of different climates (mean annual air temperature range: -17.3-10.9 degrees C; mean annual precipitation range: 125-1657 mm yr(-1); latitude range: 40-81 degrees N), and are commonly found in neutral to basic lakes (pH > 7.0), including volcanic lakes and lakes with mafic bedrock. We show that these freshwater lakes do not feature alkenone distributions characteristic of Group II lacustrine haptophytes, providing support for the hypothesis that freshwater lakes are immune to species-mixing effects. In lakes that underwent temporal shifts in salinity, we observed mixed Group I/II alkenone distributions and the alkenone contributions from each group could be quantified with the RIK37 index. Additionally, we observed significant correlations of alkenone unsaturation (U-37(K)) with seasonal and mean annual air temperature with this expanded freshwater lakes dataset, with the strongest correlation occurring during the spring transitional season (U-37(K) = 0.029 * T - 0.49; r(2) = 0.60; p < 0.0001). We present new sediment trap data from two lakes in northern Alaska (Toolik Lake, 68.632 degrees N, 149.602 degrees W; lake E5, 68.643 degrees N, 149.458 degrees W) that demonstrate the highest sedimentary fluxes of alkenones in the spring transitional season, concurrent with the period of lake ice melt and isothermal mixing. Together, these data provide a framework for evaluating lacustrine alkenone distributions and utilizing alkenone unsaturation as a lake temperature proxy. (C) 2018 Elsevier B.V. All rights reserved