Association between Sarcopenia and Survival in Patients Undergoing Gamma Knife Surgery for Brain Metastasis from Breast Cancer: A Retrospective Single-centre Cohort Study.

AIMS: Many recent studies related to cancer surgery have reported that sarcopenia influences mortality in surgical patients. However, few comprehensive studies have examined the associations between sarcopenia and short- and long-term surgical outcomes of metastatic cancer, especially breast cancer with brain metastasis. In the present study, we investigated the association between sarcopenia and mortality in patients who underwent gamma knife radiosurgery (GKRS) for brain metastasis with breast cancer. MATERIALS AND METHODS: This retrospective study analysed 157 patients who underwent GKRS for brain metastasis with breast cancer between January 2014 and December 2018. A Cox regression analysis was carried out to evaluate the association between sarcopenia and mortality at 90 days, 180 days, 1 year, 3 years and the overall period. RESULTS: In the Cox regression analysis, sarcopenia was significantly associated with high 90-day mortality (adjusted hazard ratio 3.46, 95% confidence interval 1.24-9.67, P = 0.018), 180-day mortality (adjusted hazard ratio 2.67, 95% confidence interval 1.37-5.22, P = 0.004), 1-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.42-4.02, P = 0.001), 3-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.53-3.74, P < 0.001) and overall mortality (adjusted hazard ratio 2.11, 95% confidence interval 1.37-3.26, P < 0.001). CONCLUSION: Sarcopenia could be a risk factor for short- and long-term mortality in patients undergoing GKRS for brain metastasis from breast cancer.

Pretransplant Left Ventricular Dysfunction Adversely Affects Perioperative Outcomes in Pediatric Liver Transplantation: A Retrospective Observational Study.

BACKGROUND: Although left ventricular diastolic dysfunction (LVDD) is a pronounced feature of adult cirrhotic cardiomyopathy and a major predictor of poor outcomes following liver transplantation (LT), little is known about if pretransplant cardiac dysfunction affects perioperative outcomes in pediatric LT. METHODS: We retrospectively evaluated pretransplant clinical and Doppler echocardiographic data for 45 consecutive pediatric LT recipients who were treated between 2007 and 2013 (median age = 15 months; interquartile range = 9 to 78 months). LVDD was defined according to the cirrhotic cardiomyopathy criteria, and the myocardial performance index (MPI) was measured using tissue Doppler imaging. Intraoperative data and hospitalization days following LT were compared. RESULTS: LVDD and MPI ≥0.5 (defined as a z score ≥2) were observed in 13% and 27% of patients, respectively. Patients with an MPI ≥0.5 demonstrated the increased accumulation of lactate at the end of their LT operation (mean = 2.48 vs 0.82; P = .026) compared with patients with an MPI <0.5. The hospital stay was longer in patients with LVDD (median = 46 days vs 30 days; P = .041) and patients with an MPI ≥0.5 (median = 38 days vs 29 days; P = .014) compared with patients without LVDD and MPI <0.5, respectively. CONCLUSIONS: LVDD might be less prevalent (13%) in pediatric patients compared with adults. However, pretransplant cardiac dysfunction in patients with LVDD and an MPI ≥0.5 adversely affects perioperative outcomes, necessitating that such pediatric LT recipients be cautiously observed perioperatively.

The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section.

BACKGROUND: Continuously infused phenylephrine is frequently used to reduce the incidence of hypotension in women undergoing cesarean section under spinal anesthesia, but less is known about the prophylactic bolus method. We evaluated three prophylactic bolus doses of phenylephrine during low-dose spinal anesthesia for cesarean section. METHODS: One-hundred-and-eighty-four patients were randomized to receive 0.9% saline 2mL (Control Group) or phenylephrine 1.0µg/kg (PHE1 Group), 1.5µg/kg (PHE1.5 Group), or 2.0µg/kg (PHE2 Group) immediately after induction of combined spinal-epidural anesthesia. Maternal blood pressure and heart rate were recorded at 1-min intervals until delivery. Hypotension, defined as systolic blood pressure <80% of baseline, was treated with rescue doses of phenylephrine 100µg at 1-min intervals until hypotension resolved. The incidence of nausea, vomiting, bradycardia, and hypertension, as well as Apgar scores and umbilical blood gases, were recorded. RESULTS: The incidence of hypotension was 71.7% (33/46) in the Control Group, 68.9% (31/45) in the PHE1 Group, 37.0% (17/46) in the PHE1.5 Group and 45.7% (21/46) in the PHE2 Group (P=0.001). The total rescue dose of phenylephrine was greater in the Control Group than those in the PHE1.5 Group (P<0.05) and PHE2 Group (P<0.05). The incidence of hypertension increased as the dose of prophylactic phenylephrine increased (P<0.001) and was highest in the PHE2 group (37%). Other variables did not differ among the four groups. CONCLUSIONS: Under the conditions of this study, prophylactic bolus injection of phenylephrine 1.5µg/kg was a suitable alternative method for reducing the incidence of hypotension during low-dose spinal anesthesia for cesarean section.

Quantification of Both Platelet Count and Fibrinogen Concentration Using Maximal Clot Firmness of Thromboelastometry During Liver Transplantation.

BACKGROUND: Rotation thromboelastometry (ROTEM®) is increasingly used in liver transplantation (LT). Of the ROTEM® parameters, maximum clot firmness (MCF) of EXTEM (MCFEXT) and INTEM (MCFINT) are influenced by both platelet count (PLT) and fibrinogen concentration (FIB), whereas MCF of FIBTEM (MCFFIB) is solely influenced by FIB. We aimed to determine whether using MCFs of thromboelastometry could reliably predict both PLT and FIB and to evaluate their relations in patients with thrombocytopenia and hypofibrinogenemia during LT. METHODS: A total of 4100 retrospective ROTEM® assays with simultaneous standard laboratory tests performed during LT were analyzed in 295 patients. The optimal cut-off values of PLT and FIB according to the ROTEM® transfusion guideline were determined by area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis. RESULTS: MCFEXT and MCFINT showed good correlation with platelet count (r = 0.79 and 0.80, respectively, P < .001) and with fibrinogen concentration (r = 0.67 and 0.66, respectively, P < .001). MCFFIB and fibrinogen concentration were highly correlated (r = 0.84, P < .001). Additionally, PLT and FIB were calculated mathematically: PLT (/µL) = 14827 + 3.93 (MCFEXT)(2.5); FIB (mg/dL) = 63 + 0.00082 (MCFEXT)(3.0); FIB (mg/dL) = 29 + 13.3 MCFFIB. MCFEXT <35 mm predicted PLT of 43 × 10(3)/µL (AUC = 0.89) and FIB of 91 mg/dL (AUC = 0.78), whereas MCFEXT <45 mm predicted PLT of 52 × 10(3)/µL (AUC = 0.89) and FIB of 121 mg/dL (AUC = 0.86), MCFFIB <8 mm predicted FIB of 128 mg/dL (AUC = 0.94). MCFINT showed almost the same cut-off values as MCFEXT. CONCLUSIONS: Both PLT and FIB can be reliably quantified by MCFs of thromboelastometry, reducing the needs for additional laboratory tests to know values of thrombocytopenia and hypofibrinogenemia in patients undergoing LT.

Stimulation of plasminogen activator activity by free radicals in boar spermatozoa.

Plasminogen activators (PAs), commonly found on the membrane of spermatozoa, convert plasminogen into plasmin and may participate in mammalian fertilization. Correlations have been reported between reactive oxygen species (ROS) and spermatozoa function, although the relationship between PA activity and ROS is unknown. We investigated the effects of ROS on PA activity. We used an in vitro model of free radical generation whereby boar spermatozoa were preincubated in xanthine and xanthine oxidase (X-XO) and PA activity was then measured. The acrosome reaction of boar spermatozoa was significantly promoted by 100 mU/mL plasmin (P<0.01), similar to levels achieved when stimulated with the positive calcium (2 mM) control. The addition of plasminogen to the fertilization medium significantly promoted both spermatozoa binding (157.5+/-14.0 spermatozoa/oocyte) and the percentage of oocytes with a male pronucleus (74.5+/-6.4%) compared with control (98.4+/-21.8 spermatozoa/oocyte and 51.4+/-5.3%, respectively; P<0.05). The acrosome reactions of spermatozoa were significantly higher when incubated with calcium (2 mM; 60.2+/-2.7%), calcium (2 mM)+EDTA (6 mM; 29.4+/-4.2%), sodium nitroprusside (0.1 microM; 38.0+/-4.2%), H(2)O(2) (100 microM; 56.0+/-3.0%), and X-XO (0.5 mM and 0.05 U/mL, respectively; 31.8+/-3.7%) compared with non-capacitation medium as control (19.0+/-2.7%; P<0.05). However, when spermatozoa were incubated with only X-XO, PA activity was significantly higher than with other treatments (P<0.05). Moreover, the addition of the antioxidant superoxide dismutase to the X-XO system significantly blocked the PA activity of spermatozoa (P<0.05). The PA activity of spermatozoa treated with X-XO was significantly reduced by the addition of MEK inhibitor (55.2+/-5.6 ng/mL) and p38 inhibitor (57.4+/-2.7 ng/mL), but not PI3K inhibitor, compared to the control (X-XO; 68.0+/-5.8 ng/mL; P<0.05). The induction of PA activity in boar spermatozoa by free radical generation suggests the PA/plasmin system plays a role in mammalian fertilization.

[Two components in bereitschaftspotential].

In this work the BP onsettimes of voluntary movement and instructed movement were compared. Our results show that there is no significant difference (P > 0.05) between BP onsettimes of the two kinds of movement and that BP occurs before the instruction of movement. The early component of BP, i.e. the negative wave before the presentation of instruction, had no relationship with movement preparation. For the analysis of the source of the BP early component, the BP onsettimes of unconscious eyeblink and instructed eyeblink or self-initiated voluntary eyeblink were compared. It was found that the BP onsettime of unconscious eyeblink was much shorter than that of the two kinds of conscious (P < 0.05) eyeblink. These results suggest that the BP early component is elicited by psychological factors, rather than the result of the preparatory processes of movements in the brain.