Integrated Distress Activity Score (IDAS): A Possible Tool for Determining Continuous Deep Sedation

Integrated Distress Activity Score (IDAS) was developed in order to evaluate both positive and negative aspects of patient’s conditions throughout hospitalization. IDAS were evaluated by nurses everyday and when patients continued to have IDAS less than or equal to zero, we used this tool for determining continuous deep sedation. From 2013-2017, 1306 patients were enrolled in the study. The average rate of continuous deep sedation in the PCU was 1.2%(16 patients). Dyspnea was the most common condition (62.5%, 10 patients), followed by delirium (37.5%, 6 patients).The average days that took to decide for sedation (from the day when IDAS was less than or equal to zero), was 3.7 days. This study suggested that IDAS could be a useful tool for determining continuous deep sedation.

Study on the efficacy of and adverse reactions to high-dose dexamethasone therapy for neurological symptoms of spinal cord compression due to malignant tumors

<b>Objective</b>: Spinal cord compression symptoms are complications that greatly reduce the quality of life of cancer patients. We report a retrospective study on the efficacy of and adverse reactions to high-dose dexamethasone therapy for patients with concomitant spinal cord compression symptoms. <b>Subjects</b>: This study included 8 patients with concomitant spinal cord compression symptoms who received high-dose dexamethasone therapy at our hospital between May 2009 and September 2011. <b>Results</b>: Only high-dose dexamethasone therapy was performed in 8 patients who could not undergo radiotherapy or surgery in combination. Among them, the results of manual muscle testing were improved in 4 patients (50.0%), and grades according to the modified Frankel Classification showed improvement in 5 patients (62.5%). Out of 7 non-ambulatory patients, one (14.3%) regained independent ambulation with highdose dexamethasone therapy alone and was discharged home. No serious adverse reactions were observed in any of the 8 patients. <b>Discussion</b>: This study suggested high-dose dexamethasone therapy to possibly be a useful option for relieving neurological symptoms in patients with spinal cord compression who cannot undergo radiotherapy or surgery in combination.

Alternative routes of administration in palliative medicine: availability of sublingual administration

<b>Purpose</b>: Evaluation of the efficacy and safety of sublingual drug administration in palliative care patients lacking the ability to swallow as well as other drug administration routes. <b>Methods</b>: Buprenorphine, 0.1∼0.2mg/dose (n=15) and fentanyl, 0.05∼0.2mg/dose (n=26) were administered sublingually for cancer pain, and midazolam, 0.1mg/kg (n=16) for insomnia respectively. <b>Results</b>: The three drugs were all rapidly absorbed by the oral cavity and showed efficacy in about 90% of patients. No adverse events were observed other than drowsiness, nausea and over production of sputum in patients suffering from dysphagia. <b>Conclusion</b>: Sublingual administration is a viable alternative for maintaining the quality of life of patients not accessible through conventional administration routes in the palliative setting. Palliat Care Res 2010; 5(1): 201-205

Cystic fibrosis transmembrane conductance regulator and SLC26 transporters in HCO₃⁻ secretion by pancreatic duct cells / 生理学报

Pancreatic duct cells secrete HCO3(-) ions into a HCO3(-)-rich luminal fluid (~140 mmol/L in human) against at least a 6-fold concentration gradient. Candidate mechanisms for HCO3(-) transport across the apical membrane include Cl(-)-HCO3(-)exchange by an SLC26 anion transporter and diffusion via the HCO3(-) conductance of cystic fibrosis transmembrane conductance regulator (CFTR). Members of the SLC26 family are known to mediate Cl(-)-HCO3(-) exchange across the apical membrane of other epithelia and both SLC26A6 and SLC26A3 have been detected in pancreatic ducts. Co-expression studies have also revealed that murine slc26a6 and slc26a3 physically interact with CFTR through the STAS domain of slc26 and the R domain of CFTR, resulting in mutually enhanced activity. Other studies have indicated that these exchangers are electrogenic: slc26a6 mediating 1Cl(-)-2HCO3(-) exchange and slc26a3 mediating 2Cl(-)-1HCO3(-) exchange. Recent experiments using isolated pancreatic ducts from slc26a6(-)/(-) mice suggest that slc26a6 mediates most of the Cl(-)-dependent secretion of HCO3(-) across the apical membrane in the mouse and the data are consistent with the reported electrogenicity of slc26a6. However, the role of SLC26A6 in human pancreatic HCO3(-) secretion is less clear because human ducts are capable of secreting much higher concentrations of HCO3(-). The role of SLC26A6 must now be evaluated in a species such as the guinea pig which, like the human, is capable of secreting HCO3(-) at a concentration of ~140 mmol/L. From existing guinea pig data we calculate that a 1Cl(-)-2HCO3(-) exchanger such as slc26a6 would be unable to secrete HCO3(-) against such a steep gradient. On the other hand, the HCO3(-) conductance of CFTR could theoretically support secretion of HCO3(-) to a much higher concentrations. CFTR may therefore play a more important role than SLC26A6 in HCO3(-) secretion by the guinea pig and human pancreas.

Serotonin and pancreatic duct function

1. 5-HT inhibits spontaneous fluid secretion as well as stimulated secretion with secretin (cAMP mediated) or ACh (Ca2+ mediated) in the isolated guinea pig pancreatic ducts. 2. The inhibitory effect of 5-HT is reversible and is dependent on the concentration in the range 0.01-0.1 microM, which is much lower than those that affect intestinal motility and secretion. 3. The 5-HT3 receptor in duct cells appears to mediate the inhibitory effect of 5-HT. 4. [Ca2+]i is unlikely to mediate the inhibitory effect of 5-HT.

Bicarbonate transport in microperfused pancreatic ducts

No abstract available.