Performance testing of the neutron flux monitors from 10keV to 1MeV developed for BNCT: A preliminary study.

The neutron flux monitors from 10keV to 1MeV designed for boron neutron capture therapy (BNCT) were experimentally tested with prototype monitors in an appropriate neutron field produced at the intense deuterium-tritium neutron source facility OKTAVIAN of Osaka University, Japan. The experimental test results and related analysis indicated that the performance of the monitors was good and the neutron fluxes from 10keV to 1MeV of practical BNCT neutron sources can be measured within 10% by the monitors.

Experimental study on the performance of an epithermal neutron flux monitor for BNCT.

The performance of an epithermal neutron (0.5eV

Study on measuring device arrangement of array-type CdTe detector for BNCT-SPECT.

AIM: To design the measuring device arrangement of array-type CdTe detector for BNCT-SPECT. BACKGROUND: In a boron neutron capture therapy, a very serious unsolved problem exists, namely that the treatment effect for BNCT cannot be known during irradiation in real time. Therefore, we have been developing a so-called BNCT-SPECT with a CdTe detector, which can obtain a three-dimensional image for the BNCT treatment effect by measuring 478 keV gamma-rays emitted from the excited state of (7)Li nucleus created by the (10)B(n,α) reaction. However, no practical uses were realized at present, because BNCT-SPECT requires very severe conditions for spatial resolution, measuring time, statistical accuracy and energy resolution. MATERIALS AND METHODS: The design study was performed with numerical simulations carried out by a 3-dimenaional transport code, MCNP5 considering the detector assembly, irradiation room and even arrangement of arrayed CdTe crystals. RESULTS: The estimated count rate of 478 keV gamma-rays was sufficiently large being more than the target value of over 1000 counts/h. However, the S/N ratio did not meet the target of S/N > 1. We confirmed that deterioration of the S/N ratio was caused by the influence of Compton scattering especially due to capture gamma-rays of hydrogen. Theoretical calculations were thereafter carried out to find out whether anti-Compton measurement in an array-type CdTe detector could decrease the noise due to Compton scatterings. CONCLUSIONS: The calculation result showed that the anti-coincidence would possibly increase the S/N ratio. In the next phase, an arrayed detector with two CdTe crystals will be produced to test removal possibility of the anti-coincident event.

Basic detection property of an array-type CdTe detector for BNCT-SPECT - Measurement and analysis of anti-coincidence events.

Our research group is now investigating a BNCT-SPECT system with cadmium tellurite (CdTe) detectors, which can obtain a three-dimensional image of the BNCT treatment effect by measuring the 478keV gamma-rays emitted from an excited state of the 7Li nucleus generated by the 10B(n,α) reaction. The BNCT-SPECT system is composed of a collimator and an array-type CdTe detector. In this study, we produced an array detector with two CdTe elements to test the basic detection property for anti-coincidence events. Our investigation confirmed that the detector offers an improved S/N ratio by the anti-coincidence detection. We also proposed an estimation method using the MCNP5 to analyze coincidence events in the detector.

Characterization measurement of a thick CdTe detector for BNCT-SPECT - detection efficiency and energy resolution.

Author׳s group is carrying out development of BNCT-SPECT with CdTe device, which monitors the therapy effect of BNCT in real-time. From the design calculations, the dimensions were fixed to 1.5×2×30mm(3). For the collimator it was confirmed that it would have a good spatial resolution and simultaneously the number of counts would be acceptably large. After producing the CdTe crystal, the characterization measurement was carried out. For the detection efficiency an excellent agreement between calculation and measurement was obtained. Also, the detector has a very good energy resolution so that gamma-rays of 478keV and 511keV could be distinguished in the spectrum.

Effect of seven tricyclic diterpenoids from needles of Taxus media var. Hicksii on stimulus-induced superoxide generation, tyrosyl or serine/threonine phosphorylation and translocation of cytosolic compounds to the cell membrane in human neutrophils.

Taxol has been widely used as an anticancer drug for ovarian, breast, lung and prostate cancer. Some kinds of Taxus plants are widely distributed in the Northeast Asia region. We have isolated seven tricyclic diterpenoids, taxinine, taxagifine, 5-O-cinnamoyltaxacin I triacetate, 5-decinnamoyltaxinine J, 5-cinnamoyl-9-acetyltaxicin I, taxacin and taxol from the needles of Taxus media var. Hicksii, and investigated their effects on stimulus-induced superoxide generation and translocation of cytosolic compounds to the cell membrane in human neutrophils. Six tricyclic diterpenoids used in this experiment suppressed the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) and arachidonic acid (AA) in a concentration-dependent manner. Taxinine significantly suppressed the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA). The compounds also suppressed fMLP- and AA-induced tyrosyl or PMA-induced serine/threonine phosphorylation, and translocation of cytosolic compounds, p47 (phox), p67 (phox) and Rac to the cell membrane in parallel with the suppression of the stimulus-induced superoxide generation.

[Management of anesthesia with artificial pancreas STG-22 for pheochromocytoma resection].

A 74-year-old woman underwent radical nephrectomy for an adrenaline predominant pheochromocytoma in the left adrenal gland. She was pretreated with doxazosin for 3 weeks before surgery. Anesthesia was induced with intravenous fentanyl, midazolam and vecuronium, and inhaled sevoflurane in oxygen. A central venous catheter was inserted into the right internal jugular vein and a PiCCO catheter was inserted into the femoral artery for the monitoring of cardiac function and hemodynamics. In addition, continuous monitoring and automatic control of blood glucose were started using STG-22. Target concentration of blood glucose was set at 120-140 mg x dl(-1). Anesthesia was maintained with sevoflurane and remifentanil. Prostaglandin E1, nitroglycerin and dexmedetomidine were infused continuously from the start of surgery, and the systolic blood pressure was kept within 120-160 mmHg. During surgical manipulation around the tumor, there were sudden increases in blood pressure, heart rate and blood glucose concentration. Thus, phentolamine and landiolol were also administered to control blood pressure and heart rate. On the contrary, after the tumor removal, noradrenaline, dobutamine and milrinone were required to maintain blood pressure. The STG-22 worked well to maintain blood glucose concentrations during surgery without any hyper- and hypoglycemic events.

Antiperoxidation activity of triterpenoids from rhizome of Anemone raddeana.

Four triterpenoid compounds hederacolchiside E (1), hederasaponin B (2), raddeanoside 20 (3) and raddeanoside 21 (4) were isolated from ethanol extracts of rhizome of Anemone raddeana Regel. The effects of these triterpenoids on superoxide generation, tyrosyl phosphorylation of proteins and translocation of cytosolic compounds, such as p47(phox), p67(phox) and Rac to the cell membrane in human neutrophils was investigated. The superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was slightly suppressed by hederasaponin B, raddeanoside 20 and raddeanoside 21 in a concentration dependent manner. The superoxide generation induced by arachidonic acid (AA) was suppressed by hederasaponin B and raddeanoside 21 significantly. fMLP- and AA-induced tyrosyl phosphorylation and translocation of the cytosolic proteins: p47(phox), p67(phox), and Rac to the cell membrane were suppressed in parallel with the suppression of stimulus-induced superoxide generation.

[Pulmonary aspiration during anesthetic induction in a patient with a history of distal gastrectomy].

We experienced a case of pulmonary aspiration during anesthetic induction. Posterior laminoplasty was scheduled for a 59-year-old man with ossification of posterior longitudinal ligament, who had undergone distal gastrectomy 30 years ago. Anesthesia was induced with intravenous administration of midazolam and fentanyl, and inhalation of sevoflurane was gradually increased to 7% in oxygen under spontaneous breathing, since difficult intubation had been predicted due to poor neck mobility However, the patient vomited during laryngoscopy. Orotracheal intubation was performed with a fiberscope and the excreta was suctioned through the endotracheal tube. The patient was admitted to the ICU after taking chest X-ray and the operation was postponed for one month. At the second attempt, awake intubation was planned for the patient under sedation with dexmedetomidine. Food intake and drinking were restricted for the patient from the previous night. After administration of fentanyl, continuous administration of intravenous dexmedetomidine was started, and 2% lidocaine viscous solution was gargled. Endotracheal intubation was successfully performed using AirWay Scope without pulmonary aspiration, and midazolam was administered intravenously. Surgery was completed without any troubles, and the patient was extubated fully awake.

The effects of vasodilation on cardiac output measured by PiCCO.

OBJECTIVES: The purpose of this study was to investigate the effects of vasodilation on cardiac output (CO) measured by pulse contour method using PiCCO (Pulsion Medical Systems AG, Munich, Germany) in comparison with CO by the thermodilution method. DESIGN: A prospective observational study. SETTINGS: An operating room in a university hospital. PARTICIPANTS: Twenty patients scheduled for off-pump coronary artery bypass grafting. INTERVENTIONS: After anesthesia induction with midazolam, fentanyl, and vecuronium, the PiCCO catheter and pulmonary artery catheter were inserted. Before the initiation of surgery, progressively higher infusions of prostaglandin E1 (PGE1) were administered for vasodilation. MEASUREMENTS AND MAIN RESULTS: CO was measured before PGE1 (control); at PGE1 0.01, 0.02, and 0.04 microg/kg/min; and 15 minutes after stopping PGE1 infusion. Systemic vascular resistances (SVRs) at PGE1 0.02 and 0.04 microg/kg/min were significantly lower than the control value. The correlation coefficient (R(2)) at each point, percentage error, and limits of agreement (bias +/- 2 standard deviation of bias) were 0.89, 17, -0.21 +/- 0.53 before PGE1; 0.72, 27, -0.31 +/- 0.93 at 0.01 microg/kg/min; 0.53, 40, -0.62 +/- 1.41 at 0.02 microg/kg/min; 0.57, 34, -0.61 +/- 1.26 at 0.04 microg/kg/min; and 0.97, 21, -0.14 +/- 0.69 L/min 15 minutes after the end of infusion, respectively. CONCLUSIONS: PiCCO may not be an alternative to thermodilution measurement without recalibration when SVR decreases by infusion of PGE1 > or = 0.02 microg/kg/min.

Inhibitory effects of ginsenosides from the root of Panax ginseng on stimulus-induced superoxide generation, tyrosyl or serine/threonine phosphorylation, and translocation of cytosolic compounds to plasma membrane in human neutrophils.

The effects of five ginsenosides (G-Rh2, -Rd, -Rb1, -Rb2, -Rh1) isolated from the root of Panax gingseng on stimulus-induced superoxide generation in human neutrophils were evaluated by measuring the reduction of ferricytochrome c. The tyrosyl or serine/threonine phosphorylation of neutrophil proteins and translocation of p47phox, p67phox, and Rac to the plasma membrane were detected using specific monoclonal antibodies. G-Rh2 significantly suppressed superoxide generation induced by N-formylmethionyl-leucylphenylalanine (fMLP), phorbol 12-myristate 13-acetate (PMA), and arachidonic acid (AA) in a concentration-dependent manner. G-Rh1 showed a comparably lower suppression on fMLP-induced superoxide generation. G-Rd, -Rb1, and -Rb2 also suppressed AA-induced superoxide generation in high concentrations. G-Rd and G-Rb1 showed no effect on fMLP- and PMA-induced superoxide generation. FMLP-, PMA-, and AA-induced tyrosyl or serine/threonine phosphorylation and translocation of p47phox, p67phox, and Rac to the plasma membrane were in parallel with the suppression of the stimulus-induced superoxide generation.

The accuracy of a continuous blood glucose monitor during surgery.

BACKGROUND: Protocols for tight control of blood glucose can be difficult to achieve in the surgical setting, especially when relying upon intermittent blood glucose testing. A continuous blood glucose monitoring system can facilitate blood glucose management. In the present study, we compared blood glucose measured continuously (STG-22, Nikkiso, Tokyo, Japan), during surgery with coincident measurements obtained intermittently using a conventional laboratory glucometer (ABL 800FLEX (Radiometer Medical Aps, [symbol: see text], Denmark). The goal of the study was to determine the reliability and accuracy of the continuous method during surgery. MATERIAL AND METHODS: Twenty-nine patients scheduled for routine surgery with general anesthesia were enrolled in this study. After anesthetic induction, a 20G IV catheter was inserted in a peripheral forearm vein and connected to the continuous blood glucose monitor. A radial arterial catheter was also inserted from which samples for blood glucose estimation were obtained by an anesthesiologist, following an established protocol of discarding 3 mL of blood before the actual blood sampling. Blood glucose was measured by ABL 800FLEX immediately after sampling. One hundred points of paired blood glucose values were obtained, which were compared using Bland and Altman analysis. RESULTS: Bias and upper and lower limits of agreement were -2.6, 23, and -28, respectively. The percentage error of the lower/upper limits of agreement was 21% and 18%, respectively. DISCUSSION AND CONCLUSIONS: The blood glucose measurements obtained continuously agreed with the coincident intermittent measurements within 21%. The STG-22 may still be useful for following changes continuously and reducing the frequency of intermittent measurement, but the need for testing samples with a reliable device is not eliminated.

[A case of subarachnoid hemorrhage with different BIS values observed between the right and left forehead].

We experienced a case of subarachnoid hemorrhage with different BIS values observed between the right and left forehead. A 71-year-old woman was scheduled for endovascular coiling. She had been already intubated and showed little response to painful stimulation without sedation (Japan coma scale; III-200). Anesthesia was induced and maintained with propofol. BIS monitoring was started from the right forehead before anesthetic induction (r-BIS), and additional monitoring from the left side was started after induction (1-BIS). When the operation was started, 1-BIS was 40 and r-BIS was 30. During the operation, 1-BIS was always higher than r-BIS; 1-BIS was 49 +/- 10 and r-BIS was 37 +/- 7 (mean +/- SD). The difference between r-BIS and 1-BIS was more than 10 for 68% of operation time. Since abnormal EEG pattern was observed, we concluded that abnormal EEG influenced BIS value, and 1-BIS after anesthesia was higher than that of her actual conscious level. EEG of a patient with acute stroke sometimes shows an abnormal pattern. Anesthesiologists should keep in mind the possibility that an abnormal EEG might influence BIS value.

Effects of vasodilation on cardiac output measured by PulseCO.

BACKGROUND: The instability of cardiac output (CO) measured by PulseCO (LiDCO Ltd.) during cardiac surgery has been reported. In the present study, we investigated the effects of vasodilation by prostaglandin E1 (PGE1) on the relation between cardiac output measured by PulseCO and that by thermodilution. METHODS: Twenty patients who underwent off-pump coronary artery bypass grafting (OPCAB) were enrolled in this study. After premedication with oral diazepam 10 mg, anesthesia was induced with midazolam, fentanyl and vecuronium. CO was measured after anesthesia induction, at PGE1 0.01, 0.02 and 0.04 microg/(kg min) and at 15 min after the stop of the infusion. RESULTS: Systemic vascular resistances (SVRs) by PGE1 at 0.02 and 0.04 microg/(kg min) were significantly lower than the control value. The correlation coefficient (R2) between the two techniques at each point, percentage error and limits of agreement (bias +/-2SD of bias) were 0.78, 3, 0.05 +/- 0.17 at 0.01 microg/(kg min), 0.20, 10, -0.18 +/- 0.12 at 0.02 microg/(kg min), 0.46, 28, -0.50 +/- 0.24 at 0.04 microg/(kg min) and 0.97, 1, 0.02 +/- 0.27 L/min at 15 min after stop of infusion, respectively. CONCLUSION: PulseCO might underestimate CO compared to that by bolus thermodilution method when simply decreasing the SVR by infusion of PGE1. Therefore, PulseCO might be unsuitable in cardiac surgery.

Prolidase isoenzymes in the rat: their organ distribution, developmental change and specific inhibitors.

Lack of prolidase I (PD I) leads to prolidase deficiency, a disease characterized by intractable skin lesions, recurrent respiratory infections, and mental retardation. The present study was undertaken to characterize and determine the physiologic roles of different prolidase isoenzymes. Two isoforms of prolidase were isolated from rat kidney. PD I showed higher activity against seryl-proline and alanyl-proline, whereas PD II was active especially against methionyl-proline. PD I was highly concentrated in the small intestine and kidney, whereas PD II was shown not to vary in the organs examined. Expression of PD I and PD II in the small intestine were maximal within 1 wk of birth, and then rapidly declined. The changes of prolidase in the kidney and heart were found to differ slightly. N-benzyloxycarbonyl-l-proline and captopril inhibited PD I dose-dependently, but showed no inhibition of PD II at low concentrations. NiCl2 inhibited PD II much more effectively than PD I. Our findings suggest that PD I functions by way of an intestinal peptide carrier, which may also be regulated by the uptake of various iminodipeptides. Similarly, age-related alterations of prolidase isoenzymes suggest that intestinal PD II also participates in absorption of proline and other amino acids early in life.

Tethered cord syndrome discovered in preoperative examination.

We present an instructive case of a 47-year-old female patient with tethered cord syndrome, discovered before arthroscopy was to be performed under routine spinal anesthesia for right knee arthritis. The patient had no symptoms except for right knee-joint pain, but weakness in the left dorsiflexors and decreased range of motion in the left ankle and toe joints were found on preoperative physical examination. In addition, clawfoot deformity was discovered in the left foot. A small stigma was observed on the skin in the sacral region. A magnetic resonance imaging scan showed the spinal cord tethered to an intrathecal mass in the sacral region. Therefore, we avoided spinal anesthesia. The arthroscopy proceeded uneventfully with the patient under general anesthesia.

Effects of quazepam as a preoperative night hypnotic: comparison with brotizolam.

PURPOSE: The purpose of this study was to evaluate the effects of quazepam, a long-acting hypnotic, as a preoperative night medication in comparison with brotizolam, a shortacting hypnotic. METHODS: Two hundred patients (aged 30 to 70 years) admitted for elective general anesthesia at various hospitals were enrolled. Quazepam 15 mg, 30 mg, or 45 mg, or brotizolam 0.25 mg (40 patients each), was administered orally at 9 p.m. in the evening of the day before surgery. The control group (40 patients) did not receive any drugs. The quality of night sleep between the night during hospitalization and the night before surgery was compared by using a questionnaire. In the first 8 patients who received quazepam 15 mg, 30 mg, and 45 mg, the plasma concentrations of quazepam and its metabolites were measured 12 h after the drug administration, when the patients were brought into the operating room. RESULTS: In all the drug-administered groups, the speed of falling asleep, sleeping state, and feeling of freshness in the morning improved compared to the previous night and compared to the control group; the frequency of nocturnal awakening and dreaming decreased, and the total duration of sleep the night before surgery increased. Total duration of sleep was significantly longer in the groups with quazepam 30 mg and 45 mg than in the control and brotizolam 0.25 mg groups. No patients were drowsy with plasma concentrations of quazepam of 30 to 65 ngxml(-1). CONCLUSION: The preoperative night hypnotics, quazepam and brotizolam improved sleep before surgery. As a preoperative night hypnotic, quazepam 30 mg and 45 mg increased the total duration of sleep compared to brotizolam 0.25 mg.

Efficacy of a heat and moisture exchanger in inhalation anesthesia at two different flow rates.

In general anesthesia with endotracheal intubation, a circle system with a heat and moisture exchanger (HME) and a low total flow is often used to prevent hypothermia and to maintain inspired gas humidity. The purpose of the present study was to compare the inspired gas humidity and body temperature, in general anesthesia with or without an HME at two different total flow rates. Eighty patients (American Society of Anesthesiologists [ASA] I or II) scheduled to undergo either orthopedic or head and neck surgery were studied. They were divided into four groups, of 20 patients each: total flow of 2 lxmin(-1) with (group HME2L) or without (group 2L) HME, and a total flow of 4 lxmin(-1) with (group HME4L) or without (group 4L) HME. The relative and absolute humidity and pharyngeal and inspired gas temperatures were measured for 2 h after endotracheal intubation. The relative humidity was not significantly different among groups 2L, HME2L, and HME4L. Group 4L had significantly lower absolute humidity than group 2L. The pharyngeal temperature did not decrease significantly for 2 h in any of the groups. During general anesthesia with a total flow of 2 lxmin(-1) in 2 h, HME might not be necessary, while with a total flow of 4 lxmin(-1), HME could be useful to maintain inspired gas humidity.

Different effects of sulfur amino acids on prolidase and prolinase activity in normal and prolidase-deficient human erythrocytes.

BACKGROUND: Prolidase and prolinase activity is known to be enhanced significantly in some diseases. Recently, the effect of amino acids on prolidase and prolinase activity in normal and prolidase-deficient human erythrocytes was investigated. It was reported that both enzymes were enhanced by glycine and alanine in the presence of MnCl(2). METHODS: Erythrocytes were isolated from heparinized blood from normal human and a patient with prolidase deficiency. Effects of various sulfur amino acids on prolidase and prolinase activities against iminodipeptides in the presence of 1 or 0.1 mmol/l MnCl(2) were investigated. RESULTS: Prolinase activity against prolylglycine in normal and prolidase-deficient erythrocyte lysates was inhibited by L-methionine, NAc-L-methionine and D,L-methionine in a concentration-dependent manner, but D-methionine enhanced the activity in low concentrations (0-20 mmol/l). D,L-Homocysteine inhibited the activity more strongly than other sulfur amino acids tested in a concentration-dependent manner. On the other hand, prolidase activity against glycylproline was enhanced by L-methionine, D-methionine, D,L-methionine, D,L-homocysteine thiolactone and D,L-ethionine. The rates of enhancement by these sulfur amino acids were in the following order: D,L-ethionine>D,L-methionine, D-methionine, D,L-homocysteine thiolactone>L-methionine (10 mmol/l). CONCLUSION: The prolinase activity in normal and prolidase-deficient erythrocyte lysates was inhibited by L-methionine, D,L-ethionine and D,L-homocysteine. On the other hand, prolidase activity in their erythrocyte lysates was enhanced by D,L-ethionine, D-methionine and L-methionine. These results indicate the effects of these sulfur amino acids on prolidase and prolinase activities were different.

Effect of five triterpenoid compounds from the buds of Aralia elata on stimulus-induced superoxide generation, tyrosyl phosphorylation and translocation of cytosolic compounds to the cell membrane in human neutrophils.

The buds of Aralia elata (Miq.) Seem (Japanese angelica tree) have long been used as a tonic, antiarthritic and antidiabetic agent in China and Japan. We have isolated five triterpenoids, congmuyanosides A, C, D, echinocystic acid and 3-O-[beta-D-glucopyranosyl(1-->2)-beta-D-glucopyranosyl]-hederagenin from the buds of Aralia elata , and investigated their effects on stimulus-induced superoxide generation in human neutrophils. Congmuyanoside A, echinocystic acid and 3-O-[beta-D-glucopyranosyl(1-->2)-beta-D-glucopyranosyl]-hederagenin suppressed the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) in a concentration-dependent manner. Congmuyanosides C, D and echinocystic acid significantly suppressed the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA) and arachidonic acid (AA). The compounds also suppressed fMLP- and AA-induced tyrosyl or PMA-induced serine/threonine phosphorylation and translocation of cytosolic compounds, p47 (phox), p67 (phox) and Rac to the cell membrane.