Investigation and treatment of pulmonary embolism as a potential etiology may be important to improve post-resuscitation prognosis in non-shockable out-of-hospital cardiopulmonary arrest: report on an analysis of the SOS-KANTO 2012 study.

Background: The prognosis of non-shockable out-of-hospital cardiac arrest is worse than that of shockable out-of-hospital cardiac arrest. We investigated the associations between the etiology and prognosis of non-shockable out-of-hospital cardiac arrest patients who experienced the return of spontaneous circulation after arriving at hospital. Methods and Results: All subjects were extracted from the SOS-KANTO 2012 study population. The subjects were 3,031 adults: (i) who had suffered out-of-hospital cardiac arrest, (ii) for whom there were no pre-hospital data on ventricular fibrillation/pulseless ventricular tachycardia until arrival at hospital, (iii) who experienced the return of spontaneous circulation after arriving at hospital. We compared the patients' prognosis after 1 and 3 months between various etiological and presumed cardiac factors. The proportion of the favorable brain function patients that developed pulmonary embolism or incidental hypothermia was significantly higher than that of the patients with presumed cardiac factors (1 month, P < 0.0001 and P < 0.0001, respectively; 3 months, P = 0.0018 and P < 0.0001, respectively). In multiple logistic regression analysis, pulmonary embolism and incidental hypothermia were found to be significant independent prognostic factors for 1- and 3-month survival and the favorable brain function rate. Conclusions: In patients who suffer non-shockable out-of-hospital cardiac arrest, but who experience the return of spontaneous circulation after arriving at hospital, the investigation and treatment of pulmonary embolism as a potential etiology may be important for improving post-resuscitation prognosis.

Assessing injury severity in bicyclists involved in traffic accidents to more effectively prevent fatal bicycle injuries in Japan.

The objective of this study was to clarify the relationship between injury severity in bicyclists involved in traffic accidents and patient outcome or type of vehicle involved in order to propose effective measures to prevent fatal bicycle injuries. Hospital records were reviewed for all patients from 2007 to 2010 who had been involved in a traffic accident while riding a bicycle and were subsequently transferred to the Shock Trauma Center of Dokkyo Medical University Koshigaya Hospital. Patient outcomes and type of vehicle that caused the injury were examined. The mechanism of injury, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) of the patient were determined. A total of 115 patients' records were reviewed. The mean patient age was 47.1 ± 27.4 years. The average ISS was 23.9, with an average maximum AIS (MAIS) score of 3.7. The ISS, MAIS score, head AIS score, and chest AIS score were well correlated with patient outcome. The head AIS score was significantly higher in patients who had died (mean of 4.4); however, the ISS, MAIS score, and head AIS score did not differ significantly according to the type of vehicle involved in the accident. The mean head AIS scores were as high as 2.4 or more for accidents involving any type of vehicle. This study provides useful information for forensic pathologists who suspect head injuries in bicyclists involved in traffic accidents. To effectively reduce bicyclist fatalities from traffic accidents, helmet use should be required for all bicyclists.

Clinical efficacy and safety of arbekacin sulfate in patients with MRSA sepsis or pneumonia: a multi-institutional study.

Arbekacin (ABK) is an aminoglycoside and widely used in Japan for treatment of patients infected with methicillin-resistant Staphylococcus aureus (MRSA). Although, ABK has concentration-dependent antibacterial activity, the peak serum concentration (C (peak)) of ABK has not yet been fully investigated as an indicator of the efficacy of ABK. The present study was conducted in patients admitted to hospitals affiliated with the ABK Dose Finding Study Group, between October 2008 and June 2011, who had pneumonia or sepsis, the cause of which was identified or suspected to be MRSA. The initial target C (peak) was set at 15-20 µg/mL and therapeutic drug monitoring was conducted. Then the relationship between serum concentration and efficacy/safety of ABK was prospectively examined to obtain sufficient clinical efficacy. In total, 89 patients from 11 clinical sites in Japan were enrolled and 29 of these patients were subjected to efficacy analysis. The mean initial dose and C (peak) were 306.9 mg/day and 16.2 µg/mL, respectively. The efficacy rate was 95 % (19/20 patients) at 5-6 mg/kg or higher, 87.5 % (7/8) for sepsis and 90.5 % (19/21) for pneumonia, and the overall efficacy rate was 89.7 % (26/29). There was no increase in the incidence of adverse events. In conclusion, we recommend the initial dose of ABK at 5-6 mg/kg or higher and the dosage regimen should be adjusted to achieve C (peak) at 10-15 µg/mL or higher in the treatment of patients with pneumonia or sepsis caused by MRSA. This strategy would surely achieve low incidence of adverse events while obtaining high clinical efficacy.

Formation of ionic bonds between a fatty-acid Langmuir-Blodgett monolayer and a zinc oxide substrate.

A fatty-acid Langmuir-Blodgett (LB) monolayer ionically adsorbed to the substrate has been prepared by adopting ZnO-based conductor and pure water respectively as the substrate and subphase. Ionization of the fatty-acid molecules has been detected by infrared reflection-absorption spectroscopy (IR-RAS), which is enabled by the condensed free electrons in the doped ZnO substrate. On the contrary, IR-RAS measurements have indicated that fatty-acid molecules transferred onto Au and indium-tin-oxide substrates from a pure-water surface are not ionized. In addition, it has been demonstrated that these ionically bonded fatty-acid monolayers protect the ZnO transparent electrode from chemical attack by NH(3) gas. Since the LB technique is a simple method applicable to a wide variety of materials, the present results may lead to a new way of obtaining functional organic-inorganic nanosystems.

Adsorption of anionic nanosheets from their dilute colloidal suspensions onto gas-liquid interfaces with and without a Langmuir film of cationic surfactant.

The adsorption of [(Ca(2)Nb(3)O(10))(-)](n) (CNO) polyanionic nanosheets from their dilute colloidal suspensions onto gas-liquid interfaces with and without a cationic [N(CH(3))(2)(C(18)H(37))(2)](+) (DOA) surfactant film has been experimentally investigated. Our concern has been focused particularly on their dynamical aspects, which can be observed owing to the long specific time of the adsorption. The theoretical framework of the Langmuir adsorption model has enabled a quantitative analysis of the observed data, and that analysis has indicated that the presence of a positively charged Langmuir film enhances the ratio of the adsorption and desorption rate constants by approximately 30 times. Furthermore, the experimental results have shown that a "balanced" hybrid Langmuir film, in which both organic and inorganic constituents are densely packed, can be prepared.

Mass-casualty triage training for international healthcare workers in the Asia-Pacific region using manikin-based simulations.

INTRODUCTION: More than half of the world's disasters occur in the Asia-Pacific region. A simulation-based exercise to teach healthcare workers prehospital triage, tagging, and treatment methods was used to link disaster management theory to practice with a student-centered, hands-on educational activity. Various strategies for teaching disaster health education have been advocated, and best-practice disaster education models continue to be sought. METHODS: A manikin-based, primary triage and treatment course was adapted for international healthcare providers in the Asia-Pacific region using symbolic representations of triage categories and physical findings. The pedagogical construct that was used was an interactive, formative assessment in which faculty members mediated learner information gathering and interpretation during four simulation scenarios. After establishing a multi-casualty disaster context, a wireless, audience response system anonymously collected learner responses to four clinical situations: (1) leg wound (hemorrhagic shock/immediate); (2) chest wound (tension pneumothorax/immediate); (3) head wound (traumatic brain injury/expectant); and (4) limb trauma (leg fracture/delayed). RESULTS: There were 182 healthcare providers from eight Asia-Pacific countries (including the US) that participated in four simulation seminars. The simulation sessions were successfully tailored to groups of learners that varied in size and professional composition. Expectant and delayed triage categories posed the greatest challenge to learners. In one of two groups that were queried, learner self-confidence in applying principles of triage and treatment improved significantly. At the conclusion of the simulation sessions, learners strongly agreed that manikin-based simulation improved their understanding of triage, and should be used to teach principles of primary triage and treatment. CONCLUSIONS: Simulation training represents an opportunity to engage learners regardless of language and cultural barriers. Simulation-based training can be effective in introducing healthcare professionals to principles of primary triage and treatment in an effective and culturally sensitive manner. The characteristics of the course with respect to planned formative assessment and culturally competent scholarship were reviewed.

Activation of abscisic acid biosynthesis in the leaves of Arabidopsis thaliana in response to water deficit.

It is well known that endogenous abscisic acid (ABA) levels increase rapidly in response to drought stress and that this induces stomatal closure. In Arabidopsis thaliana, ABA levels increased rapidly in the leaves and roots when intact wild-type whole plants were exposed to drought stress. However, if the leaves and roots were separated and exposed to drought independently, the ABA level increased only in the leaves. These results suggest that, under our experimental conditions, ABA is synthesized mainly in the leaves in response to drought stress and that some of the ABA accumulated in the leaves is transported to the roots. Tracer experiments using isotope-labeled ABA indicate that the movement of ABA from leaves to roots is activated by water deficit in the roots. We also demonstrate that the endogenous ABA level in the leaves increased only when the leaves themselves were exposed to drought stress, suggesting that leaves play a major role in the production of ABA in response to acute water shortage.

Drought induction of Arabidopsis 9-cis-epoxycarotenoid dioxygenase occurs in vascular parenchyma cells.

The regulation of abscisic acid (ABA) biosynthesis is essential for plant responses to drought stress. In this study, we examined the tissue-specific localization of ABA biosynthetic enzymes in turgid and dehydrated Arabidopsis (Arabidopsis thaliana) plants using specific antibodies against 9-cis-epoxycarotenoid dioxygenase 3 (AtNCED3), AtABA2, and Arabidopsis aldehyde oxidase 3 (AAO3). Immunohistochemical analysis revealed that in turgid plants, AtABA2 and AAO3 proteins were localized in vascular parenchyma cells most abundantly at the boundary between xylem and phloem bundles, but the AtNCED3 protein was undetectable in these tissues. In water-stressed plants, AtNCED3 was detected exclusively in the vascular parenchyma cells together with AtABA2 and AAO3. In situ hybridization using the antisense probe for AtNCED3 showed that the drought-induced expression of AtNCED3 was also restricted to the vascular tissues. Expression analysis of laser-microdissected cells revealed that, among nine drought-inducible genes examined, the early induction of most genes was spatially restricted to vascular cells at 1 h and then some spread to mesophyll cells at 3 h. The spatial constraint of AtNCED3 expression in vascular tissues provides a novel insight into plant systemic response to drought stresses.

Transient expression of AtNCED3 and AAO3 genes in guard cells causes stomatal closure in Vicia faba.

Abscisic acid (ABA) regulates stomatal closure in response to water loss. Here, we examined the competence of guard cells to synthesize ABA, using two Arabidopsis ABA biosynthetic enzymes. 35S pro::AtNCED3-GFP and AAO3-GFP were introduced into guard cells of broad bean leaves. AtNCED3-GFP expression was detected at the chloroplasts, whereas green fluorescent protein (GFP) and AAO3-GFP were in the cytosol. The stomatal aperture was decreased in AtNCED3-GFP- and AAO3-GFP-transformed guard cells. This indicated that ABA biosynthesis is stimulated by heterologous expression of AtNCED3 and Arabidopsis aldehyde oxidase 3 (AAO3) proteins, which both seem to be regulatory enzymes for ABA biosynthesis in these cells. Furthermore, stomatal closure by the expression of AtNCED3 and AAO3 suggested that the substrates of the enzymes are present and native ABA-biosynthesis enzymes are active in guard cells.

Effect of ABA upon anthocyanin synthesis in regenerated torenia shoots.

To elucidate the mechanism of anthocyanin synthesis induction concomitant with chlorophyll degradation, we established a system in which anthocyanin synthesis and degradation of chlorophyll in regenerated torenia (Torenia fournieri) shoots was induced on medium containing 7% sucrose. Here, we studied the effect of several plant-growth regulators on anthocyanin synthesis and the degradation of chlorophyll in the torenia shoot regenerating system. Exogenous abscisic acid (ABA) could induce anthocyanin synthesis and chlorophyll senescence in regenerating torenia shoots on the medium containing a low concentration of sucrose (1.5%). We determined the changes in the amount of endogenous ABA in the regenerated shoots during the process of anthocyanin synthesis on the medium containing 7% sucrose. It was revealed that the 7% sucrose treatment elevated endogenous ABA levels before the induction of anthocyanin synthesis and chlorophyll degradation. However, while retransfer to the 1.5% sucrose medium resulted in a gradual decrease in the ABA level and a failure of induction of anthocyanin synthesis, normal shoot regeneration. These results suggest that changes in the amount of endogenous ABA may play an important role in the induction of anthocyanin synthesis and chlorophyll degradation in regenerated torenia shoots.

High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture.

BACKGROUND: After transcatheter angiographic embolization (TAE), massive gluteal muscle necrosis was found in patients during open reduction and internal fixation for pelvic fracture. METHODS: In our six patients, magnetic resonance imaging (MRI) scans obtained 1 and 4 weeks after TAE demonstrated ischemic damage of the gluteal muscle. RESULTS: Total reopening of the embolized artery was confirmed in only one case on the second angiogram obtained 1 month after TAE. In five patients, massive muscle necrosis, previously confirmed on MRI, was macroscopically found during open reduction and internal fixation or debridement surgery. In two patients, severe complications developed, such as soft tissue infection caused by necrosis, skin necrosis accompanied by subcutaneous infection, and sepsis. CONCLUSION: MRI revealed that TAE more frequently causes profound ischemic damage or necrosis than has been thought. This will be a warning to those who use TAE. Before definitive stabilization, external fixation may be recommended as a first-choice procedure for resuscitation and, then, unilateral selective TAE.

Cold acclimation in bryophytes: low-temperature-induced freezing tolerance in Physcomitrella patens is associated with increases in expression levels of stress-related genes but not with increase in level of endogenous abscisic acid.

Bryophyte species growing in areas in which temperatures fall below zero in winter are likely to have tolerance to freezing stress. It is well established in higher plants that freezing tolerance is acquired by exposure to non-freezing low temperatures, accompanied by expression of various genes and increases in levels of the stress hormone abscisic acid (ABA). However, little is known about the physiological changes induced by cold acclimation in non-vascular plants such as bryophytes. We examined the effects of low temperatures on protonema cells of the moss Physcomitrella patens (Hedw.) Bruch and Schimp. The freezing tolerance of protonema cells was clearly increased by incubation at low temperatures ranging from 10 degrees C to 0 degrees C, with maximum tolerance achieved by incubation at 0 degrees C for several days. The enhancement of freezing tolerance by low temperatures occurred in both light and dark conditions and was accompanied by accumulation of several transcripts for late-embryogenesis-abundant (LEA) proteins and boiling-soluble proteins. By de-acclimation, low-temperature-induced expression of these transcripts and proteins, as well as the freezing tolerance, was reduced. Interestingly, endogenous levels of ABA in tissues or that secreted into the culture medium were not specifically increased by low-temperature treatment. Furthermore, removal of ABA from the medium by addition of activated charcoal did not affect low-temperature-induced freezing tolerance of the protonema cells. Our results provide evidence that bryophytes have an ABA-independent cold-signaling pathway leading to expression of stress-related genes and resultant acquisition of freezing tolerance.

Spectroscopic study of J aggregates of amphiphilic merocyanine dyes formed in their pure Langmuir films.

It is known that an amphiphilic merocyanine dye, 3-carboxymethyl-5-[2-(3-octadecyl-2(3H)- benzothiazolylidene)ethylidene]-2-thioxo-4-thiazolidinone (DS) and its derivatives DSe and 6MeDS form J aggregates under the presence of metallic cations, although the dyes' static dipole moments must be favorable for H aggregates. A metal-free J aggregate of 6MeDS has been generated in its pure Langmuir films and transferred onto CaF2 substrates to investigate the molecular environment around the carboxylic group born by the dye. Combining visible and infrared spectroscopy, geometrical consideration based on ab initio calculations, and simulation of the excitation energy, a structural model of this J aggregate has been proposed. With this model, formation of intermolecular carboxyl-keto hydrogen bonds, which can compensate the electrostatic disadvantage of the J aggregate under the presence of water, has been suggested. As for another derivative of DS, DO, similar discussion has been made for its Mg2+ -containing J aggregate, which is found in this work. In addition, the proposed structural model can tell the cause of the difference in the tendency to J aggregate among 6MeDS, DSe, DS, and DO.

Simultaneous analysis of plural samples in a CE-CL detector possessing micro-space area for reaction/detection.

Plural samples were simultaneously analyzed in a capillary electrophoresis (CE)-chemiluminescence (CL) detector system, taking advantage of a micro-space area for reaction/detection at the tip of the capillary. The CL reaction of 1,10-phenanthroline and hydrogen peroxide was adopted and a Cu(II) sample was used as a model. Three different length capillaries were inserted into a flow-type CL detection cell made of a Teflon tube. Three samples migrated in the corresponding capillaries at the same time and mixed with the CL reagent at the tip of capillary to produce CL. The simultaneous analysis of plural samples in the present system supported the possibility that a real sample could be determined more easily, rapidly, and precisely with the calibration curve.

Effects of ethylene and abscisic acid upon heterophylly in Ludwigia arcuata (Onagraceae).

In this study, we examined the effects of ethylene and abscisic acid (ABA) upon heterophyllous leaf formation of Ludwigia arcuata Walt. Treatment with ethylene gas resulted in the formation of submerged-type leaves on terrestrial shoots of L. arcuata, while treatments with ABA induced the formation of terrestrial-type leaves on submerged shoots. Measurement of the endogenous ethylene concentration of submerged shoots showed that it was higher than that of terrestrial ones. In contrast, the endogenous ABA concentration of terrestrial shoots was higher than that of submerged ones. To clarify interactions of ethylene and ABA, simultaneous additions of these two plant hormones were examined. When L. arcuata plants were treated with these two plant hormones, the effects of ABA dominated that of ethylene, resulting in the formation of terrestrial-type leaves. This suggests that ABA may be located downstream of ethylene in signal transduction chains for forming heterophyllous changes. Further, ethylene treatment induced the reduction of endogenous levels of ABA in tissues of L. arcuata, resulting in the formation of submerged-type leaves. Thus the effects of ethylene and ABA upon heterophyllous leaf formation are discussed in relationship to the cross-talk between signaling pathways of ethylene and ABA.

[Assessment of peripheral blood perfusion during open heart surgery with sublingual PCO2 measured by ISFET-PCO2 sensor].

Sublingual tissue PCO2 (PSLCO2) was continuously monitored with an ISFET-based PCO2 sensor during and after the open-heart surgery under cardiopulmonary bypass (CPB) in order to study the effect of CPB on the peripheral blood perfusion. In addition, PSLCO2 monitoring was carried out in several cases of off-pump CABG. In the cases of open-heart surgery with CPB, PSLCO2 increased from 35.0 +/- 5.6 mmHg at the induction of anesthesia to the maximum value of 55.7 +/- 6.0 mmHg during CPB. After declamping of the aorta, PSLCO2 decreased gradually to 49.0 +/- 4.0 mm Hg 6 hr after the admission to ICU. The value of arterial lactate as another index of peripheral blood perfusion also increased gradually after the start of CPB, reaching to the maximum value of 8.8 +/- 1.1 mmol.l-1 just after being admitted into ICU. In the case of off-pump CABG, PSLCO2 and arterial lactate showed a slight increase during the later part of the surgery, but the change was not so significant as in the case of open-heart surgery under CPB. Through this study, typical changing pattern of PSLCO2 during the open-heart surgery was recognized. The change of PSLCO2 always preceded that of arterial lactate. We also experienced one case in which early stage of hypoperfusion was detected through the monitoring of PSLCO2. These results suggest clinical advantages of PSLCO2 monitoring.

[Pathophysiologic changes in trauma patients and indications of damage control surgery].

Damage control surgery has become an inevitable strategy in the treatment of severely traumatized patients. Rationale for the DCS is the fact that the mortality in surgical patients who developed hypothermia, acidosis, and coagulopathy (lethal triad) is extremely high unless patients' physiologic stability was reestablished. DCS is usually indicated when patient shows signs of lethal triad during surgical operation. As most of patients who subsequently needed DCS could be judged as having most severe injuries during resuscitative phase, it may be more wise to select candidates for DCS during this phase than to indicate DCS during operation.