A comparative study of Video laryngoscope vs Macintosh laryngoscope for prehospital tracheal intubation in Hiroshima, Japan.

Background: In Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope. Objective: The purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients. Method: This study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical transport data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the incidence of ROSC and CPC1-2. Results: A total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and 89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01-1.10, P = 0.01), the VL group shows significantly higher success rate than that of the ML group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03-1.09, P < 0.001). The ROSC rate and CPC1-2 rate are similar among the groups. Conclusion: Our data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is necessary for the future development of Emergency Medical Services (EMS) intubation devices.

Focusing and spin polarization of atomic hydrogen beam.

We have developed a spin-polarized-hydrogen beam with a hexapole magnet. By combining the beam chopper and pulsed laser ionization detection, the time-of-flight of the hydrogen beam was measured, and the dependence of the beam profile on the velocity was acquired, which was consistent with the beam trajectory simulations. The spin polarization of the beam was analyzed by using the Stern-Gerlach-type magnet in combination with the spatial scan of the detection laser. The spin polarization was about 95% at a focusing condition due to the hexapole magnet. The polarization was, on the other hand, reduced to about 70% for the beam at higher velocities, which is consistent with simulation results.

Effects of repeated epinephrine administration and administer timing on witnessed out-of-hospital cardiac arrest patients.

BACKGROUND: Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered. AIM: The aim of the study was to analyze the effects of repeated epinephrine administration after OHCA on favorable cerebral function coded by cerebral performance categories (CPC 1-2). METHODS: A nationwide, retrospective, population-based observational study was conducted by using Utstein-style data between 2010 and 2012 in Japan. The total of 11,876 cardiogenic and witnessed OHCA were stratified into 3 categories by the number of times epinephrine was administered (single, double, and three or more). In addition, the time elapsed between the emergency call and the initial epinephrine administration was divided into 3 time intervals (5 to 20min for the early administration group [EAG], 21 to 26min for the intermediate administration group [IAG], and 27 to 60min for the late administration group [LAG]). The primary endpoint was CPC 1-2 at 1month after cardiac arrest. A multivariable logistic regression was used for analysis. RESULTS: Achievement of CPC 1-2 at 1month was 4.8% for single, 2.4% for double, and 1.7% for three or more administered doses. For single and three or more administrations, CPC 1-2 was significantly higher in the IAG than in the LAG (adjusted odds ratio [AOR], 3.54, 3.02; 95% confidence interval [CI], 2.04-6.39, 1.16-9.43, for single and three or more administrations, respectively). The EAG showed significantly higher achievement of CPC 1-2 in all the epinephrine administration groups (AOR, 9.26, 7.57, 4.07; 95% CI, 5.44-16.59, 3.39-19.60, 1.59-12.69, for single, double, and three or more administrations, respectively). CONCLUSION: Repeated epinephrine administration improved CPC 1-2 outcome when epinephrine was administrated within 20min after an emergency call for witnessed cardiogenic OHCA.

Quick epinephrine administration induces favorable neurological outcomes in out-of-hospital cardiac arrest patients.

OBJECTIVE: This research is to study if quick administration of adrenaline on OHCA prior to hospitalization has an effect on improving CPC1-2 at one month. METHODOLOGY: A total 13,326 cases were extracted from 2011 to 2014 Utstein data for this retrospective cohort study, also, EMT reached the patients within 16min after 119 called and adrenaline was then administered within 22min of after contact. PATIENTS DIVIDED INTO TWO GROUPS: Patients were contacted within 8min of the 119 call (n=6956), and were contacted between 8 and 16min after the call (n=6370). Further divided into groups in which the adrenaline was administered within/without 10min after contact. Primary outcome was the rate of a good prognosis for cerebral performance (CPC1-2) at 1 month and secondary outcome was the return of spontaneous circulation (ROSC) rate. RESULTS: The odds ratio of the CPC1-2 at 1month by the EMS reached within 8min after 119 call and then adrenaline administered within 10min was 2.12 (1.54-2.92).Those reached between 8 and 16min was 2.66 (1.97-3.59). However, the ROSC rate was 2.00 (1.79-2.25) for those reached within 8min and also 2.00 (1.79-2.25) for those reached between 8min and 16min. CONSIDERATIONS: In cases of OHCA, it appears that the CPC1-2 rate after 1month can be improved even in cases where the victim is reached >8min after the 119 call, as long as the victim is reached within 16min and emergency responders administer the adrenaline as quickly as possible.

Graft-Versus-Host Disease Following Liver Transplantation: Development of a High-Incidence Rat Model and a Selective Prevention Method.

Graft-versus-host disease (GvHD) following liver transplantation (LT) is a rare but serious complication with no presently available animal model and no preventive measures. To develop a rat model of GvHD after LT (LT-GvHD), we preconditioned hosts with sublethal irradiation plus reduction of natural killer (NK) cells with anti-CD8α mAb treatment, which invariably resulted in acute LT-GvHD. Compared with those in the peripheral counterpart, graft CD4+ CD25- passenger T cells showed lower alloreactivities in mixed leukocyte culture. Immunohistology revealed that donor CD4+ T cells migrated and formed clusters with host dendritic cells in secondary lymphoid organs, with early expansion and subsequent accumulation in target organs. For selectively preventing GvHD, donor livers were perfused ex vivo with organ preservation media containing anti-TCRαß mAb. T cell-depleted livers almost completely suppressed clinical GvHD such that host rats survived for >100 days. Our results showed that passenger T cells could develop typical LT-GvHD if resistant cells such as host radiosensitive cells and host radioresistant NK cells were suppressed. Selective ex vivo T cell depletion prevented LT-GvHD without affecting host immunity or graft function. This method might be applicable to clinical LT in prediagnosed high-risk donor-recipient combinations and for analyzing immunoregulatory mechanisms of the liver.

Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients.

OBJECTIVE: To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest. MATERIALS AND METHODS: A total of 119 639 witnessed cardiac arrest patients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups. RESULTS: The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference. CONCLUSION: Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.

Supersonic molecular beam studies of dissociative adsorption of H2 on Ru(0001).

We examined reactivity of H(2) on Ru(0001) using molecular beam techniques and we compared our results to experimental results for similar systems. The dissociative adsorption of H(2) on Ru(0001) is similar to that on Pt(111) and Ni(111), although on ruthenium nonactivated adsorption is strongly suggested. However, we find no clear signature of a steering- or precursor-based mechanism that favors nonactivated reaction paths at low kinetic energy. In comparison to Pd(111) and Rh(111) our results indicate that a universal mechanism enhancing reactivity at low energy does not have a mass dependence. In addition, we have compared our results to predictions of reactivity for H(2) on Ru(0001) from six-dimensional dynamical calculations using two different generalized gradient approximation functionals. It leads us to conclude that the PW91 functional yields a more accurate value for the minimum energy path but does not impose enough corrugation in the potential. The revised-Perdew-Burke-Ernzerhof (RPBE) functional appears to behave slightly better at higher energies, but we find significant quantitative disagreement. We show that the difference is not due to different energy resolutions between experiment and theory. However, it may be due to a dependence of the reactivity on rotational state or on omission of relevant dimensions in the theoretical description.

Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors.

BACKGROUND AND STUDY AIMS: We undertook this retrospective study to evaluate the frequency and prognosis of endoscopic treatment of laterally spreading tumors (LSTs) in the rectum. The recurrence rate for lesions of the lower rectum was compared with that of the upper rectum. PATIENTS AND METHODS: During the period from July 1989 to June 2002, a total of 1237 rectal tumors were detected. LSTs accounted for 6.9 % (85/1237) of all rectal tumors. A total of 224 tumors of the lower rectum were detected among the 1237 rectal tumors. LSTs accounted for 16.1 % (36/224) of all the lower rectal tumors. From 85 LST lesions, 67 were evaluated for their prognosis after endoscopic mucosal resection (EMR). Patients whose LSTs had been resected were followed up by endoscopy at the following frequencies: once 15 (22.4 %); twice (more than 1 year), 20 (29.9 %); three times (more than 3 years), 21(31.3 %); and four times or more (more than 5 years), 11 (16.4 %). RESULTS: A total of 67 patients with endoscopically treated LSTs were followed up by endoscopy. We observed recurrences in two lesions of the upper rectum (2/38, 5.3 %) and five lesions of the lower rectum (5/29, 17.2 %) (P = 0.2364); all seven lesions were resected piecemeal. LSTs whose horizontal margin reached the pectinate line frequently recurred in the lower rectum, at a rate of 80 % (4/5). However, all patients were completely cured by additional endoscopic resections, the greatest number of treatments being four. CONCLUSION: For early detection of recurrence and successful endoscopic cure, further colonoscopic examination within a few months after the first treatment is necessary.

Features of distamycin preferential binding sites on natural DNA predicted using differential scanning calorimetry.

The interaction of distamycin with ColE1 DNA was examined by using differential scanning calorimetry (DSC) taking the helix-coil transition theory of DNA into consideration. Our results here strongly indicate that the affinity of distamycin to DNA, at a low distamycin concentration, depends highly on the DNA sequence, and preferential binding occurs to the sites of four to six successive A-T pairs having two or more successive G-C pairs on both their ends.

Concentrations of apolipoprotein C-III in healthy cows during the peripartum period and cows with milk fever.

Apolipoprotein (apo) C-III is a low-molecular-mass protein mainly distributed in the high-density lipoprotein fraction in cattle serum. We have recently shown that the apoC-III concentration is decreased in cows with fatty liver, ketosis, left displacement of the abomasum, retained placenta and milk fever. The decrease was most distinct in milk fever, thereby suggesting that apoC-III is particularly relevant to the development of milk fever and also that apoC-III is a candidate diagnostic marker for this disease. The purpose of the present study was to examine whether the apoC-III concentration in healthy cows is altered during the peripartum period, to assess the usefulness of apoC-III as a marker for milk fever. ApoC-III concentrations in 17 cows were monitored during the peripartum period (-48 to +12 days from parturition). Of the 17 cows, 14 were apparently healthy during the period. The apoC-III concentrations in the 14 healthy cows were unaltered during the period from -48 to -21 days, but thereafter showed individual variations. Compared with values during the period from -48 to -21 days, the apoC-III concentration was increased (137%) in 5 cows during the period from +1 to +12 days, whereas it decreased (60.7%) in 9 cows. Three cows suffered from milk fever at -3 to +10 days. Decreased apoC-III concentrations in diseased cows (15 to 37% of controls) were more distinct than in the 9 healthy cows. The apoC-III concentration was correlated with lecithin:cholesterol acyltransferase activity in cows with milk fever, but not in healthy cows. Correlation analysis also indicated that apoC-III and apoB-100 concentrations were negatively correlated in 5 healthy cows with increased apoC-III concentrations, but positively in 9 healthy cows with decreased concentrations and cows with milk fever. Determination of the apoC-III concentration during the peripartum period is suggested to be helpful in diagnosing milk fever. The possible relevance of apoC-III and apoB-100 in the development of milk fever is also implied.

Decreased concentration of serum apolipoprotein C-III in cows with fatty liver, ketosis, left displacement of the abomasum, milk fever and retained placenta.

Apolipoprotein (apo) C-III is a low molecular mass protein mainly distributed in the high-density lipoprotein (HDL) fraction. In cows with postparturient diseases such as ketosis, concentrations of cholesterol, phospholipids and apoA-I and the activity of lecithin:cholesterol acyltransferase, which are mainly distributed in or functionally associated with HDL, are reduced. The purpose of the present study was to examine whether the serum concentration of apoC-III was similarly decreased in the postparturient diseases. Compared with healthy controls, the apoC-III concentration was significantly (P<0.01) decreased in cows with fatty liver, ketosis, left displacement of the abomasum, milk fever and retained placenta. Concentrations of apoC-III in the HDL fractions from diseased cows were also lower than in controls. Of the diseased cows, the decreased apoC-III concentration was particularly distinct in cows with milk fever. Increased nonesterified fatty acid and reduced free cholesterol, cholesteryl ester and phospholipid concentrations were observed in cows with milk fever, as in the other diseased cows. The decrease in the apoC-III concentration is suggested to be closely associated with the postparturient disorders, in particular with milk fever.

Reduction in serum lecithin:cholesterol acyltransferase activity prior to the occurrence of ketosis and milk fever in cows.

Lecithin:cholesterol acyltransferase (LCAT) is the enzyme responsible for production of cholesteryl esters in plasma. The LCAT activity is reduced in cows with fatty liver developed during the nonlactating stage and those with the fatty liver-related postparturient diseases such as ketosis. The purpose of the present study was to examine whether reduced LCAT activity during the nonlactating stage could be detected before the occurrence of postparturient diseases. Sera from 24 cows were collected at approximately 10-day intervals from -48 to +14 days from parturition. Of the 24 cows, 14 were apparently healthy, whereas 7 had ketosis and 3 had milk fever at around parturition. Of the 14 healthy cows, 7 had unaltered LCAT activity during the observation period, whereas 7 showed reduced activity from -20 to +14 days. Ketosis and milk fever occurred at from -3 to +10 days, but reductions of LCAT activity in diseased cows had already been observed from days -20 to 0. These results suggest that LCAT activity is virtually unaffected during the peripartum period at least in some healthy cows and also that the reduction in LCAT activity can be detected before the occurrence of ketosis and milk fever.

[The usefulness of dynamic computed tomography scanning in predicting the outcome of acute stroke patients].

The aim of this study was to investigate whether brain dynamic computed tomography (CT) is useful in predicting clinical outcome. Thirty patients suffering from cerebral ischemia in the territory of the middle cerebral artery (MCA) underwent dynamic CT scanning within 6 hours of stroke onset. Regions of interest (ROIs) were placed in the bilateral MCA territories and three parameters, peak value (PV), time to peak (TP), and PV divided by TP, were calculated from time-density curves (TDCs) on ROIs. After conventional treatment using pharmacological agents, the 30-day clinical outcome was evaluated on the Glasgow outcome scale. To investigate the relationship between the disease-to-contralateral side ratio of each parameter's value and 30-day clinical outcome, TDCs were classified into the following four types; type 1, with TP ratio less than 1.1; type 2, with TP ratio ranging from 1.1 to 1.5 and PV/TP ratio more than 0.75; type 3, with TP ratio ranging from 1.1 to 1.5 and PV/TP ratio less than 0.75; and type 4, with TP ratio more than 1.5 and PV/TP ratio less than 0.3. Clinical outcome in patients with type 1 or 2 TDC was better than in patients with type 3 or 4 TDC (p < 0.01, Fisher's exact test). We can conclude that dynamic CT is a useful means for estimating the clinical prognosis of acute stroke patients after conventional treatment. Poor clinical outcome following conventional therapy is expected in patients with type 3 or 4 TDC in contrast to patients with type 1 or 2 TDC.

Immunological functions of mouse liver resident high density lymphocytes.

Liver-derived high density lymphocytes (Matsunaga cells) have been detected as members of resident T cells in the mouse liver. In this study, we assessed the immunological functions of liver-derived high density lymphocytes of BALB/c mice in comparison with those derived from spleen and peripheral blood. Liver-derived high density lymphocytes proliferated in response to the syngeneic and allogeneic mixed lymphocyte reaction, as well as those derived from spleen and peripheral blood. The allo-activated cytotoxic T lymphocyte activity of liver-derived high density lymphocytes against PHA-blasts of C57BL/6 mice was lower than that of spleen- and peripheral blood-derived lymphocytes. The suppressor activity of syngeneic- or allo-activated high density lymphocytes of the liver, spleen, and the peripheral blood was assessed by measuring their suppressive effect on the proliferation or on the generation of allo-specific cytotoxic activity in allogeneic mixed lymphocyte reaction. The suppression was concentration-dependent and strongest in liver-derived lymphocytes.

Riboflavin deficiency caused by treatment with adriamycin.

The present study was undertaken to determine whether administration of adriamycin causes the depletion of riboflavin content. Rats received intraperitoneal injections of adriamycin (4 mg per kg body weight) for 6 consecutive days. Urinary riboflavin excretion began to increase after 2 days of treatment with adriamycin. Erythrocyte FAD levels decreased gradually and plasma lipid peroxide contents increased markedly at the 6th day. The activity coefficient of erythrocyte glutathione reductase showed a significant increase before the decrease of flavin content and the elevation of lipid peroxide level. Therefore, the value of this coefficient obtained from erythrocyte appears to be a reliable index of riboflavin deficiency, particularly during the early stage.

[A case of arteriovenous malformation in a neonate].

Although arteriovenous malformation (AVM) is considered a congenital disease, few cases of AVM are manifested clinically in the neonatal period. In this paper a neonatal case of AVM manifested as intracranial hemorrhage is reported. A newborn female infant 12 days after birth, was admitted to a hospital with the chief complaint of sudden onset of vomiting and fever. Neurological examination revealed left hemiparesis with bulging of the anterior fontanel. CT examination demonstrated a large mass lesion with hemorrhage in the right parietal lobe. The lesion was enhanced with contrast medium. Consent for surgery was not able to be obtained from her family, so she was treated conservatively. A gradually enlarging cyst surrounding the mass appeared in follow-up CT examination. Her left hemiparesis and bulging of the anterior fontanel remained unchanged, and a rather good general health condition was maintained. Consent for surgery was finally obtained from her parents and the patient was transferred to our hospital three months after the onset of the symptoms. Cerebral angiogram showed AVM with a big aneurysmal sac. The feeder arteries of the AVM arose from the right middle cerebral artery and the anterior cerebral artery. The drainers poured into the superior sagittal sinus. AVM was removed totally by right parietal craniotomy on the 24th January, 1989. Postoperatively, her left hemiparesis started to improve gradually. Her general condition was also good, and she showed no neurological deficits at the age of 8 months.(ABSTRACT TRUNCATED AT 250 WORDS)

O2-. spin trapping on cardiac submitochondrial particles isolated from ischemic and non-ischemic myocardium.

An electron spin resonance (ESR) spin trapping technique was applied to determine the generation of superoxide anions in submitochondrial particles prepared from the ischemic heart. Ischemia was produced in the dog heart by occlusion of the circumflex coronary artery for 60 min. Mitochondria were prepared from ischemic and non-ischemic regions of myocardial tissue. To avoid the influence of superoxide dismutase located in the mitochondrial matrix, submitochondrial particles were utilized instead of whole mitochondria. Using the spin trap 5,5'-dimethyl-1-pyrroline-N-oxide (DMPO), the kind of active oxygen species generated from the mitochondrial electron transport system was determined from ESR spectrum. The relative signal intensity of the DMPO-superoxide anion adduct was found to be high in submitochondrial particles prepared from subsarcolemmal mitochondria obtained from the ischemic region, as compared with those from the non-ischemic region.