Wireless Interrogation During Cardiac Surgery For a Patient With Aveir Leadless Pacemaker: A Case Report.

Intraoperative wireless interrogation is a useful monitoring method for the leadless pacemaker (LP); however, there are few reports on this technique. A 60-year-old woman underwent cardiac surgery 24 days after Aveir LP implantation. Considering the risk of intraoperative device dislodgment and pacemaker malfunction due to electromagnetic interference, the LP was monitored by wireless interrogation via body-surface electrodes, and no device dislodgement or pacemaker malfunction was observed during surgery. Our findings suggest that wireless interrogation using body-surface electrodes on the chest is a practical and valuable monitoring technique in open-heart surgery, which lends additional safety to anesthetic management.

Acute Exacerbation of Rheumatoid Arthritis-Associated Interstitial Lung Disease After Thoracic Surgery in the Absence of Usual Interstitial Pneumonia Pattern on CT.

The usual interstitial pneumonia (UIP) pattern observed on chest computed tomography (CT) is considered a risk factor for the development of postoperative acute exacerbation in interstitial lung disease (ILD). However, the risk factors for acute exacerbation in patients with rheumatoid arthritis (RA)-associated ILD have not been adequately investigated. We present a case of postoperative acute exacerbation after thoracic surgery in a 73-year-old man with RA-ILD and non-UIP pattern on chest CT. This case report emphasizes that postoperative acute exacerbation can develop even in the absence of a radiological UIP pattern.

Incidence of perioperative hypotension in patients undergoing transurethral resection of bladder tumor after oral 5-aminolevulinic acid administration: a retrospective multicenter cohort study.

PURPOSE: Tumors can be visualized using 5-Aminolevulinic acid hydrochloride (5-ALA) during transurethral resection of bladder tumors (TURBT). Hypotension is an adverse effect of 5-ALA; however, its incidence and morbidity rates are unknown. This study aimed to describe the incidence of perioperative hypotension and identify risk factors for hypotension among patients after 5-ALA administration in TURBT. METHODS: This retrospective multicenter cohort study was conducted at three general hospitals in Japan. Adult patients who underwent elective TURBT after 5-ALA administration between April 2018 and August 2020 were included. The primary outcome was the incidence of perioperative hypotension (mean blood pressure < 65 mmHg). The secondary outcomes were the use of vasoactive agents and adverse events, including urgent intensive care unit (ICU) admission. Multivariate logistic regression analysis was performed to investigate risk factors of the incidence of intraoperative hypotension. RESULTS: The median age of 261 patients was 73 years. General anesthesia was induced in 252 patients. The intraoperative hypotension was observed in 246 (94.3%) patients. Three patients (1.1%) were urgently admitted to the ICU for continued vasoactive agent use after surgery. All three patients had renal dysfunction. Multivariate logistic regression analysis revealed that general anesthesia was significantly associated with intraoperative hypotension (adjusted odds ratio, 17.94; 95% confidence interval, 3.21-100.81). CONCLUSION: The incidence of hypotension in patients undergoing TURBT after 5-ALA administration was 94.3%. The incidence of urgent ICU admission with prolonged hypotension was 1.1% in all patients with renal dysfunction. General anesthesia was significantly associated with intraoperative hypotension.

Mechanical Positive Pressure Ventilation and Voice Training via the Blom® Tracheostomy Tube: A Case Study.

Patients with a Blom® tracheostomy tube (containing a cuff) can vocalize while on mechanical ventilation, which can significantly improve the patient's quality of life. This is brought by the purpose-built structure of the tracheostomy tube that allows the expiration to be expelled through the glottis. However, this characteristic may complicate the measurement of the patient's tidal volume, as most of the expiration does not return to the ventilator. Owing to the necessity of insertion of the speech cannula, which acts as an inner cannula, to enable patient vocalization, the air passage likely becomes constricted, thus increasing airway resistance. Difficulty in applying appropriate positive end-expiratory pressure (PEEP) and ventilator auto-triggering may also be problematic. Therefore, alveolar ventilation is predicted to decrease without adjusting the ventilation settings. Our experience using the Blom® tracheostomy tube revealed some problems, and we provide suggestions for patient management. We herein report on the experience of a patient having inserted the Blom® tracheostomy tube receiving mechanical positive pressure ventilation during vocal training.

N-Methylamide-structured SB366791 derivatives with high TRPV1 antagonistic activity: toward PET radiotracers to visualize TRPV1.

Transient receptor potential cation channel subfamily V member 1 (TRPV1)-targeted compounds were synthesized by modifying the structure of SB366791, a pharmaceutically representative TRPV1 antagonist. To avoid amide-iminol tautomerization, structurally supported N-methylated amides (i.e., 3-alkoxy-substitued N-meythylamide derivatives of SB366791) were evaluated using a Ca2+ influx assay, in which cells expressed recombinant TRPV1 in the presence of 1.0 µM capsaicin. The antagonistic activities of N-(3-methoxyphenyl)-N-methyl-4-chlorocinnamamide (2) (RLC-TV1004) and N-{3-(3-fluoropropoxy)phenyl}-N-methyl-4-chlorocinnamamide (4) (RLC-TV1006) were found to be approximately three-fold higher (IC50: 1.3 µM and 1.1 µM, respectively) than that of SB366791 (IC50: 3.7 µM). These results will help reinvigorate the potential of SB366791 in medicinal chemistry applications. The 3-methoxy and 3-fluoroalkoxy substituents were used to obtain radioactive [11C]methoxy- or [18F]fluoroalkoxy-incorporated tracers for in vivo positron emission tomography (PET). Using the 11C- or 18F-labeled derivatives, explorative PET imaging trials were performed in rats.

Monitored Anesthesia Care of Two Patients with Highly Elevated Subpulmonic Ventricular Pressure due to Adult Congenital Heart Disease.

Procedural sedation and analgesia for patients with adult congenital heart disease (ACHD) and highly elevated subpulmonic ventricular pressure require proper anesthesia care to prevent a pulmonary hypertensive crisis. We describe the monitored anesthesia care (MAC) of two patients with ACHD (a complete atrioventricular septal defect and congenitally corrected transposition of the great arteries) and highly elevated subpulmonic ventricular pressure. In both patients, preprocedural transthoracic echocardiography was useful for detecting severely elevated subpulmonic ventricular pressure. The MAC involved the infusion of propofol, dexmedetomidine, and fentanyl. Norepinephrine was continuously administered from the preanesthetic period. No hemodynamic instability or respiratory depression was observed during the MAC. Continuous administration of norepinephrine from the preinduction period was helpful for preventing hypotension. We added dexmedetomidine to our MAC regimen of propofol and fentanyl because it exerts both sedative and analgesic effects. Dexmedetomidine does not cause respiratory depression; thus, our MAC regimen is believed to be theoretically safe for patients with ACHD and elevated subpulmonic ventricular pressure. Our findings suggest that safe MAC for patients with ACHD and highly elevated subpulmonic ventricular pressure may require careful consideration of the anesthetic regimen and close observation by adequately trained personnel, which is best provided at regional ACHD centers.

Severe and Prolonged Hypotension After Oral 5-Aminolevulinic Acid Administration in a Patient With End-Stage Renal Disease Undergoing Transurethral Resection of a Bladder Tumor: A Case Report.

A 72-year-old man with end-stage renal disease (ESRD) undergoing transurethral resection of a bladder tumor experienced severe and prolonged hypotension after receiving oral 5-aminolevulinic acid (5-ALA). Continuous infusions of norepinephrine and vasopressin ultimately resolved the hypotension over the course of 26 hours. It is uncertain whether 5-ALA is causative or is a contributing factor that influences other factors, such as hypovolemia after hemodialysis and autonomic nerve dysfunction associated with ESRD. Our findings suggest that anesthesiologists should be aware of the possible occurrence of hypotension after administration of 5-ALA, and urologists should consider intravesical 5-ALA administration in patients with ESRD.

Solubility-Improved 10-O-Substituted SN-38 Derivatives with Antitumor Activity.

With the objective of improving the poor water solubility of the potent antitumor compound SN-38, 10-O-substituted SN-38 derivatives were developed by the introduction of fluoroalkyl, fluorobenzoyl, or bromobenzoyl groups. The 10-O-fluoropropyl-substituted compound 2 {(S)-4,11-diethyl-9-(3-fluoropropoxy)-4-hydroxy-1H-pyrano[3',4':6,7]indolizino[1,2-b]quinoline-3,14(4H,12H)-dione} was found to be 17-fold more soluble than SN-38 in phosphate-buffered saline, and it exhibited a level of biological activity ≈50 % that of SN-38 in a cytotoxicity assay using the prostate cancer cell line PC-3. Five other derivatives did not show solubility improvements to the same extent, but their activities in cytotoxicity assays were nearly the same as that of SN-38. In vivo studies of 2 with PC-3 tumor-bearing mice revealed that it has higher antitumor activity than SN-38, even at lower dosage. These results will promote the medicinal chemistry application of 10-O-modifications of SN-38 and help reestablish the potential this drug. Furthermore, the inclusion of fluoro and bromo substituents means that the synthetic strategy developed here may be used to obtain 18 F- or 76 Br-labeled SN-38 derivatives for in vivo positron emission tomography studies.

[Benefit of Intraoperative Mannitol Use during Endoscopic Surgery for Intracerebral Hemorrhage].

BACKGROUND: Endoscopic hematoma evacuation is an established treatment option for patients with intra- cerebral hemorrhage (ICH). The purpose of this study is to investigate the benefit of mannitol use during en- doscopic hematoma evacuation. METHODS: One hundred patients with ICH treated by endoscopic surgery from June 2009 to November 2014 were retrospectively reviewed. We divided them into mannitol administered group (n=19) and non- administered group (n=81). RESULTS: As for the patient background, surgical time, amount of intraoperative bleeding, residual hema- toma, re-operation and postoperative 30-day mortality, no significant differences were found between the two groups. CONCLUSIONS: There was no clear clinical benefit of intraoperative mannitol use during endoscopic surgery for ICH.

Novel plant immune-priming compounds identified via high-throughput chemical screening target salicylic acid glucosyltransferases in Arabidopsis.

Plant activators are compounds, such as analogs of the defense hormone salicylic acid (SA), that protect plants from pathogens by activating the plant immune system. Although some plant activators have been widely used in agriculture, the molecular mechanisms of immune induction are largely unknown. Using a newly established high-throughput screening procedure that screens for compounds that specifically potentiate pathogen-activated cell death in Arabidopsis thaliana cultured suspension cells, we identified five compounds that prime the immune response. These compounds enhanced disease resistance against pathogenic Pseudomonas bacteria in Arabidopsis plants. Pretreatments increased the accumulation of endogenous SA, but reduced its metabolite, SA-O-ß-d-glucoside. Inducing compounds inhibited two SA glucosyltransferases (SAGTs) in vitro. Double knockout plants that lack both SAGTs consistently exhibited enhanced disease resistance. Our results demonstrate that manipulation of the active free SA pool via SA-inactivating enzymes can be a useful strategy for fortifying plant disease resistance and may identify useful crop protectants.

Quadruple click: a facile pathway leading to tetrakis(4-(1,2,3-triazolyl)methyl)-ethylenediamine derivatives as a new class of extracting agents for soft metal ions.

Tetrakis(triazolylmethyl)ethylenediamine, which is a class of tetrakis(2-pyridylmethyl)ethylenediamine (TPEN) analogue, is synthesized by a quadruple click reaction of tetrapropargylated ethylenediamine and four equivalents of alkyl azide. The obtained compound efficiently extracted the soft metal cadmium(II) ions by solvent extraction. It is also found that an N-isopropylacryl amide (NIPA) gel using the triazole ethylenediamine as a cross-linker exhibits a temperature-dependent extraction performance.

Facile Sc(OTf)3-catalyzed generation and successive aromatization of isobenzofuran from o-dicarbonylbenzenes.

Isobenzofuran can be prepared from o-phthalaldehyde using hydrosilane. The formed isobenzofuran is trapped by an alkene via a Diels-Alder reaction. Further dehydration proceeds to furnish the conjugated aromatic compound. This multistep reaction was promoted by catalytic amounts of Sc(OTf)(3).