Projections to the Red Nucleus from the Telencephalon and Diencephalon in the Rat, as Demonstrated by the HRP and Silver-impregnation Methods

Projections to the red nucleus from the telencephalon and diencephalon were examined in the rat using the horseradish peroxidase (HRP) and silver impregnation methods. After injections of HRP into the red nucleus, labeled cells were found mainly in the cerebral cortex and the zona incerta (ZI). In the cerebral cortex, labeled cells were present ipsilaterally in layer V of the motor area, and, to a lesser extent, in that of the somatic sensory area. Next, large lesions were placed in the frontal cortex. Terminal degeneration was found in the rostral half of the red nucleus. In the ZI, retrogradely labeled cells were found in the caudal part bilaterally. After injections of HRP into the ZI, anterogradely labeled fibers and terminals were traced. Labeled terminals were profuse in the rostral two-thirds of the red nucleus ipsilaterally and sparse contralaterally

Residual mitral regurgitation after repair for posterior leaflet prolapse- Importance of preoperative anterior leaflet tethering

Background Carpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long‐term results reported. However, residual mitral regurgitation ( MR ) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a posterior mitral leaflet repair. Methods and Results We retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3‐dimensional transesophageal echocardiography examination. Twelve had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual MR (odds ratio, 6.82; 95% confidence interval, 1.8–33.8; P =0.0049). Receiver operator characteristics curve analysis revealed a cut‐off value of 24.3° (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual MR . In multivariate regression analysis, smaller anteroposterior mitral annular diameter ( P &lt;0.001) and lower left ventricular ejection fraction ( P =0.002) were significantly associated with higher anterior mitral leaflet angle, whereas left ventricular and left atrial dimension had no significant correlation. Conclusions Anterior mitral leaflet tethering in cases of posterior mitral leaflet prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3‐dimensional transesophageal echocardiography are important for consideration of a careful surgical strategy. </jats:sec

157 Percutaneous femoral implantation of aortic valve prosthesis without surgical cutdown. A single center experience

PurposeFemoral transcatheter aortic valve implantation (TAVI) is usually done by surgical cut down under general anesthesia. Complete percutaneous approach has become widely accepted in endovascular management of aortic disease, and we have decided to apply this technique for TAVI. We aimed to evaluate the impact of the sheath size on safety and efficacy of this technique.MethodThe study cohort included 64 consecutive patients who underwent femoral approach using Prostar XL device at our institution between Mar 2008 and Feb 2010. The cohort was divided into two groups: group 1, 18 or 19 Fr sheath (1 Prostar XL device) and group 2, 22 or 24Fr (2 Prostar XL). The iliac and femoral angiogram was obtained before insertion and after removal of the sheath using contralateral approach. Device success was defined as immediate hemostasis without surgery or death related to access site during hospital stay.ResultsClinical characteristics were similar in both groups (83.6±5.7 years, male gender 50% and logistic Euroscore 25.3±11.0%) besides higher rate of hypertension (81.0% vs 56.1%; p=0.03) in group 1.In group 1, Corevalve was used in 14 cases and Edwards valve in 9 cases. In group 2, 22 Fr sheath was used in 22 cases and 24Fr in 19.The angiogram showed smaller femoral artery diameter in group 1 (7.7±1.2 vs 9.0±0.9mm; p=0.001 and common iliac artery 9.4±1.4 vs 11.5±1.8mm; p=0.001), a lower calcium score (0.6±0.8 vs 1.1±0.7; p=0.034) and tortuosity score (0.6±0.7 vs 1.2±0.7; p=0.001). Device success was achieved in 100% in group 1 and 95.1% in group 2 (p=ns).The rate of iliac artery perforation or rupture was lower in group 1 (0% vs 9.8%; p=0.044). Death due to access site complication was observed only in 1 case in group 2 (p=ns).ConclusionThanks to the development of lower profile devices, percutaneous approach for femoral arterial access is emerging as a promising method for TAVI and will decrease the need for general anesthesia in this high risk patients

Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City

Background: Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO. Methods: We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx. Results: A total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21-13.00], p = 0.023).Conclusions: From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO

Characterization and reactivity of soot from fast pyrolysis of lignocellulosic compounds and monolignols

peer-reviewedThis study presents the effect of lignocellulosic compounds and monolignols on the yield, nanostructure and reactivity of soot generated at 1250  ° C in a drop tube furnace. The structure of soot was characterized by electron microscopy techniques, Raman spectroscopy and electron spin resonance spectroscopy. The CO2 reactivity of soot was investigated by thermogravimetric analysis. Soot from cellulose was more reactive than soot produced from extractives, lignin and monolignols. Soot reactivity was correlated with the separation distances between adjacent graphene layers, as measured using transmission electron microscopy. Particle size, free radical concentration, differences in a degree of curvature and multi-core structures influenced the soot reactivity less than the interlayer separation distances. Soot yield was correlated with the lignin content of the feedstock. The selection of the extraction solvent had a strong influence on the soot reactivity. The Soxhlet extraction of softwood and wheat straw lignin soot using methanol decreased the soot reactivity, whereas acetone extraction had only a modest effect

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016)

Background and purposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 and published in the Journal of JSICM, [2017; Volume 24 (supplement 2)] https://doi.org/10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ) and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (> 66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation, and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty-seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for five CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals