Facilitating Community Risk Communication for Wide-Area Evacuation during Large-Scale Floods.

Large-scale floods have been occurring more frequently in Japan as a result of current global weather anomalies, yet evacuation procedures face several issues. These include low evacuation rates of citizens, wide-area evacuation by car, and residents who cannot evacuate on their own. For example, in the Kofu Basin, Yamanashi Prefecture, due to the size of the potential inundation area and a population that exceeds 300,000 people spread across 10 municipalities, a large number of residents would have to evacuate across municipal boundaries by car. The author proposed and applied a risk communication method to the Riverside District, Chuo City (with about 1400 households and a population of about 4000), assisting in developing a community disaster management plan for wide-area evacuation without a single victim in case of floods, which has been in place for three years. The next step was risk communication to key stakeholders, such as national, prefectural, and municipal governments. Finally, a public symposium on large-scale evacuation in the Kofu Basin was held. During the panel discussion with representatives of the Kofu River and National Road Office, prefectural government of Yamanashi, the municipality, community residents, and the author as panelists, the role of each stakeholder in area-wide evacuation was clarified and confirmed.

Acute stress increases the synthesis of 7α-hydroxypregnenolone, a new key neurosteroid stimulating locomotor activity, through corticosterone action in newts.

7α-Hydroxypregnenolone (7α-OH PREG) is a newly identified bioactive neurosteroid stimulating locomotor activity in the brain of newt, a wild animal, which serves as an excellent model to investigate the biosynthesis and biological action of neurosteroids. Here, we show that acute stress increases 7α-OH PREG synthesis in the dorsomedial hypothalamus (DMH) through corticosterone (CORT) action in newts. A 30-min restraint stress increased 7α-OH PREG synthesis in the brain tissue concomitant with the increase in plasma CORT concentrations. A 30-min restraint stress also increased the expression of cytochrome P450(7α) (CYP7B), the steroidogenic enzyme of 7α-OH PREG formation, in the DMH. Decreasing plasma CORT concentrations by hypophysectomy or trilostane administration decreased 7α-OH PREG synthesis in the diencephalon, whereas administration of CORT to these animals increased 7α-OH PREG synthesis. Glucocorticoid receptor was present in DMH neurons expressing CYP7B. Thus, CORT appears to act directly on DMH neurons to increase 7α-OH PREG synthesis. We further investigated the biological action of 7α-OH PREG in the brain under stress. A 30-min restraint stress or central administration of 7α-OH PREG increased serotonin concentrations in the diencephalon. Double immunolabeling further showed colocalization of CYP7B and serotonin in the DMH. These results indicate that acute stress increases the synthesis of 7α-OH PREG via CORT action in the DMH, and 7α-OH PREG activates serotonergic neurons in the DMH that may coordinate behavioral responses to stress. This is the first demonstration of neurosteroid biosynthesis regulated by peripheral steroid hormone and of neurosteroid action in the brain under stress in any vertebrate class.

Biosynthesis, mode of action, and functional significance of neurosteroids in the purkinje cell.

The brain has traditionally been considered to be a target site of peripheral steroid hormones. In addition to this classical concept, we now know that the brain has the capacity to synthesize steroids de novo from cholesterol, the so-called "neurosteroids." In the middle 1990s, the Purkinje cell, an important cerebellar neuron, was identified as a major site for neurosteroid formation in the brain of mammals and other vertebrates. This discovery has provided the opportunity to understand neuronal neurosteroidogenesis in the brain. In addition, biological actions of neurosteroids are becoming clear by the studies using the Purkinje cell, an excellent cellular model, which is known to play an important role in memory and learning processes. Based on the studies on mammals over the past decade, it is considered that the Purkinje cell actively synthesizes progesterone and estradiol from cholesterol during neonatal life, when cerebellar neuronal circuit formation occurs. Both progesterone and estradiol promote dendritic growth, spinogenesis, and synaptogenesis via each cognate nuclear receptor in the developing Purkinje cell. Such neurosteroid actions mediated by neurotrophic factors may contribute to the formation of cerebellar neuronal circuit during neonatal life. 3α,5α-Tetrahydroprogesterone (allopregnanolone), a progesterone metabolite, is also synthesized in the cerebellum and considered to act as a survival factor of Purkinje cells in the neonate. This review summarizes the current knowledge regarding the biosynthesis, mode of action, and functional significance of neurosteroids in the Purkinje cell during development in terms of synaptic formation of cerebellar neuronal networks.

Evaluation of low-dose propofol preadministration to attenuate vascular pain during induction of anesthesia.

STUDY OBJECTIVE: To determine whether a small dose of propofol before induction decreases pain with injection using two different formulas of propofol-10% long-chain triglycerides (LCT) and medium-chain triglycerides (MCT) and LCT. DESIGN: Prospective, randomized, comparative study. SETTING: University-affiliated hospital. PATIENTS: 200 ASA physical status I and II patients. INTERVENTIONS: Group A (LCT control) and group B (MCT/LCT control) were first preadministered normal saline plus Intralipid (Otsuka Pharmaceutical Co, Ltd, Tokyo, Japan) as a placebo, whereas group C (LCT study) and group D (MCT/LCT study) received each formulation of propofol 0.1 mg/kg before induction. After three minutes, groups A and C received LCT propofol two mg/kg for induction. Groups B and D received LCT/MCT propofol in the same manner. MEASUREMENT: Pain was evaluated blindly at the time of both preadministration and induction, using a 4-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. MAIN RESULTS: 36 (72%) LCT and 31 (62%) LCT/MCT control group patients (groups A and B) had pain. Pretreatment with propofol (groups C and D) attenuated the frequency of pain significantly in 21 (42%) and 24 (48%) patients at induction, respectively. CONCLUSION: Long-chain triglyceride and LCT/MCT propofol, 0.1 mg/kg administration before induction, resulted in attenuated pain at an induction dose of propofol.

[Blood lactate levels during fast-track cardiac anesthesia].

BACKGROUND: Lactate is a very sensitive marker of outcomes in critically ill patients. The aim of this study was to investigate the significance of blood lactate measurement during fast-track cardiac anesthesia. METHODS: We examined arterial blood lactate levels of 12 patients following coronary artery bypass graft surgery under intermittent aortic cross clamping with fast-track cardiac anesthesia. Anesthesia was induced with propofol and fentanyl, and maintained with propofol, fentanyl (total 400-1000 micrograms) and isoflurane. Blood samples were collected from a radical artery catheter. RESULTS: At the termination of the extracorporeal circulation, the blood lactate was 10.3 +/- 2.0 (7.4-12.5) mmol.l-1. This value decreased slowly to 1.5 +/- 0.4 mmol.l-1 on the second postoperative day. All patients were extubated within 4 hours after surgery. Vital signs were stable, and no cardiac events occurred perioperatively. CONCLUSIONS: A continuous decline in blood lactate levels was related to a favorable postoperative course. Further research might be required to prevent transient hyperlactecemia at the end of cardiopulmonary bypass.