Shoseiryuto Ameliorated TDI-Induced Allergic Rhinitis by Suppressing IL-33 Release from Nasal Epithelial Cells.

Toluene diisocyanate (TDI) is a major cause of occupational asthma and rhinitis. Shoseiryuto (SST) is one of the traditional herbal medicines (Kampo medicine) and has long been used as a natural medicine for allergic diseases such as allergic rhinitis (AR) and asthma. Recent studies have shown that the expression and release of IL-33, which regulates the TH2 cytokine response in epithelial cells, is an important step in developing the inflammatory response of the nasal mucosa. In this study, we investigated whether SST may ameliorate the TDI-induced AR-related symptoms in rats and inhibit IL-33 release from nasal epithelial cells. An AR rat model was generated by sensitization and induction with TDI. SST was administered during the sensitization period. AR-related symptoms in rats were evaluated, and IL-33 release was measured both in vivo and in vitro. SST suppressed symptoms appearing in TDI-induced AR model rats, such as elevated serum histamine and IL-33 levels in nasal lavage fluid (NLF)/serum, which were suppressed by SST administration. TDI-induced IL-33 release from the nasal epithelial cell nuclei was also observed and suppressed in SST-treated rats and cultured nasal epithelial cells. These results suggest that SST ameliorates the symptoms of TDI-induced AR at least partially by inhibiting IL-33 release from nasal epithelial cells.

Yokukansan Alleviates Cancer Pain by Suppressing Matrix Metalloproteinase-9 in a Mouse Bone Metastasis Model.

Bone cancer pain control is difficult because it includes various characteristics of pain such as nociceptic and neuropathic pain. In this study, we investigated the effect of yokukansan (YKS), one of the traditional Japanese herbal medicines, on cancer pain in mouse bone metastasis model. Oral administration of YKS significantly alleviated pain behavior measured by quantitative body weight bearing. Furthermore, the pain behavior was also significantly alleviated by intrathecal and intraperitoneal administration of matrix metalloproteinase- (MMP-) 9 inhibitor, but not of MMP-2 inhibitor. MMP-9 expression was significantly elevated in the bone tissue on day 3 after carcinoma cell injection and in the ipsilateral spinal cord on day 7, which was suppressed by YKS administration. Taken together, these results suggest that YKS alleviates cancer pain via suppressing MMP-9 expression in bone metastasis model in mice.

Corrigendum to "Yokukansan Alleviates Cancer Pain by Suppressing Matrix Metalloproteinase-9 in a Mouse Bone Metastasis Model".

[This corrects the article DOI: 10.1155/2019/2956920.].

A postoperative left ventricular-right atrial shunt due to infectious endocarditis after aortic repair with aortic valve replacement detected by transesophageal echocardiography.

Infectious endocarditis (IE) with acute heart failure is a medical emergency. In particular, postoperative IE after aortic repair with an artificial vascular graft is a life-threatening matter. We present a case in which a mobile abscess appeared on the aortic valve annulus with an intra-cardiac shunt in the left ventricle (LV) to the right atrium (RA) after ascending aortic repair with aortic valve replacement (AVR) for acute type A aortic dissection. It was diagnosed with transesophageal echocardiography (TEE), which prompted further exploration.

Comparison of mechanisms of allodynia induced by acromelic acid A between early and late phases.

We previously showed that intrathecal administration of acromelic acid A (ACRO-A) provoked tactile allodynia in mice. As well, recent studies have demonstrated that the activation of NMDA glutamate receptor-neuronal nitric oxide synthase (nNOS) pathway and glia play crucial roles in the development and maintenance of neuropathic pain. In order to clarify their involvement in ACRO-A-induced allodynia, we investigated the effects of various agents on two mouse models at early and late-phase allodynia. The agents employed were Ca(2+) channel α2δ ligands, NMDA and AMPA receptor antagonists, nNOS, and Ca(2+)/calmodulin kinase II inhibitors. When injected simultaneously with ACRO-A, all of these agents blocked allodynia in the early-phase group; however, they did not block allodynia when injected 7 days after the administration of ACRO-A in the late-phase group. In order to block glial activation, astrocytic inhibitor L-α-aminoadipate (LAA) or microglial inhibitor minocycline was administrated, and allodynia was examined on day 7. Activations of nNOS and glia in the spinal cord were histochemically examined at 1 h or 1 week after injection of ACRO-A. We found that nNOS activity increased 1 h after ACRO-A injection; however, it did not increase 1 week after ACRO-A injection. Conversely, microglial activation was observed 1 week after ACRO-A injection and was significantly inhibited with minocycline treatment. Moreover, only LAA was found to inhibit late-phase allodynia. In this study, we demonstrate that NMDA receptor activation is involved only in ACRO-A-induced tactile allodynia in the early phase, and that spinal astrocytic activation contributes to allodynia in the late phase.

Comparison of positional shift of supraglottic devices resulting from chest compressions: simulation using a manikin and automated chest compression system.

Background: The American Heart Association 2010 Guidelines for Resuscitation suggest the use of supraglottic devices as an alternative to tracheal intubation during cardiopulmonary resuscitation. This study aimed to evaluate supraglottic device displacement and the effect of tape fixation by simulation with a manikin and automated chest compression system. Methods: We placed eight supraglottic devices (ProSeal, i-gel, Classic, Soft Seal, Fastrack, Supreme, Ambu-aura-i, air-Q) into an advanced life support simulator, and compared no fixation and Durapore tape fixation conditions. After 5 min of automated chest compressions, positional shift of the supraglottic devices was measured. A total of five trials were carried out in each setting. Statistical analysis was carried out with two-way repeated measures anova. P < 0.05 was considered significant. Results: Positional shift after 5 min of chest compressions were as follows: ProSeal, 0.68 ± 0.26 cm; i-gel, 0.50 ± 0.16 cm; Classic, 0.36 ± 0.15 cm; Soft Seal, 0.32 ± 0.08 cm; Fastrack, 0.20 ± 0.07 cm; Supreme, 0.20 ± 0.07 cm; Ambu-aura-i, 0.18 ± 0.08 cm; and air-Q, 0.12 ± 0.04 cm. Positional shift was larger with the ProSeal and i-gel compared with any of the other six supraglottic devices (P < 0.05). Conversely, positional shift was significantly smaller with the air-Q than the other supraglottic devices (P < 0.05). Tape fixation reduced positional shift for all supraglottic devices, with a significant reduction observed with ProSeal, i-gel, Classic, and Soft Seal. Conclusion: Simulation analysis revealed that positional shift of air-Q by chest compressions is smaller than those of seven other supraglottic devices.

[Successful anesthetic management of a patient with giant pheochromocytoma using high-dose landiolol hydrochloride].

We report successful anesthetic management of a patient with pheochromocytoma using high-dose landiolol hydrochloride. A 55-year-old man was scheduled to undergo resection of giant pheochromocytoma. Epidural anesthesia was not performed due to anticoagulant therapy for lower limb thrombus. Tracheal intubation was performed with the Pentax-AWS Airwayscope. Preoperative screening revealed urine adrenaline 2.567.0 microg x day(-1) urine noradrenaline 1,734.0 microg x day(-1), and a tumor diameter of 96 x 60 mm. Catecholamine surge was controlled with 50 microg x kg(-1) x min(-1) continuous infusion of landiolol hydrochloride and IV bolus phentolamine. On tumor resection, although systemic blood pressure increased to 294 mmHg and was unresponsive to repeated phentolamine administration, the heart rate remained at 70-105 beats x min(-1) and there were no significant ST changes.

[Awake intubation with landiolol and dexmedetomidine in a patient with anxiety neurosis].

We report a successful case of awake intubation in a patient with anxiety neurosis via continuous administration of landiolol and dexmedetomidine. A 52-year-old woman weighing 46.8 kg with anxiety neurosis experienced postoperative bleeding after left-side thyroidectomy and was scheduled for emergent hemostasis under general anesthesia Due to swelling of the neck, we anticipated a difficult airway and decided to perform awake intubation. She showed extreme insecurity and shivering, and initially did not agree to the procedure. To calm her anxiety and panic, we continuously administered 10 microg x kg(-1). min(-1) landiolol and 1.0 microg x kg(-1) hr(-1) dexmedetomidine. After 10 minutes, her shivering disappeared, and she agreed to undergo awake intubation, which was performed with the Pentax-AWS Airwayscope and thin Intlock blade. The patient bucked slightly during intubation but hemodynamic changes were minimal.

[Successful one-lobe ventilation in a patient combined with multiple bulla and interstitial pneumonia].

Respiratory management of interstitial pneumonia during general anesthesia is challenging, especially for one-lung ventilation. We report the successful left-side one-lung ventilation after left lower lobectomy. A 79-year-old man with interstitial pneumonia was scheduled for right side bulla resection. After epidural anesthesia at T8-9, under dexmedetomidine and propofol sedation and regional anesthesia with lidocaine, a double-lumen tube was inserted with a Macintosh laryngoscope preserving spontaneous breathing. Next, we continuously administered propofol at 1.5-2.0 microg x ml(-1) in target-controlled infusion manner, 0.8 microg x kg(-1) x hr(-1) dexmedetomidine and 50 mg x hr(-1) aminophylline for minimizing hypoxic vasocontriction. The bispectral index was maintained within 40-60 by titrating the dose of propofol. Analgesia was performed with epidural 100 microg fentalyl and 6 ml of 0.375% ropivacaine administration. The lowest Spo2 during one-lobe ventilation was 88% which recovered to 97% by oxygen administration to right lung with no pressure. We could keep about 3-4 l of minute volume and accumulation of Paco2 was acceptable. The patient was under one-lobe (left upper lobe) ventilation with spontaneous breathing during the operation. Open bulla resection was performed uneventfully. There were no complications from one-lobe ventilation and the patient was extubated in the operating room. One-lung ventilation, which preserves spontaneous breathing is considered effective for preventing barotrauma in patients with interstitial pneumonia. Dexmedetomidine as well as propofol or aminophylline may be effective avoiding hypoxic vasoconstriction. Furthermore, we could perform one-lobe ventilation with left-upper lobe with maintaining sufficient oxygenation and ventilation.

[Successful nasotracheal intubation with the Pentax-AWS Airwayscope and gum-elastic bougie in a patient with recurrent tongue cancer].

We report our experience of successful nasotracheal intubation with a spiral tube, by using the Pentax-AWS Airwayscope (AWS) with a gum-elastic bougie (GEB) in a patient with invasive recurrent tongue cancer. The patient was a 55-year-old man who had undergone partial resection of the tongue and cervical lymphadenectomy, and was scheduled for extended resection of the tongue and larynx under general anesthesia. Sufficient mask ventilation with the head-tilt and chin-lift maneuver was achieved. We first inserted AWS gently and visualized the glottis. Next, we inserted the 15 Fr GEB through his nasal aperture and placed it in the trachea under the guidance of the AWS monitor. This allowed us to place the spiral tube uneventfully through the GEB. No evidence of bleeding or damage of the tumor was found. Nasotracheal intubation with the GEB under the guidance of the AWS monitor may be useful in cases such as those involving tongue cancer in which oral space is either narrowed or restricted.