Purpose: Sepsis-related deaths occur during both the early proinflammatory and the late immunosuppressive phases of the condition. The balance of pro- and anti-inflammatory responses is influenced by damaged cells that die via either proinflammatory necroptosis or anti-inflammatory apoptosis. Both forms of cell death may be mediated by reactive oxygen species (ROS) generated during the proinflammatory response. Recent evidence suggests that exercise training boosts antioxidative capacity and could offer protection against sepsis. Given these findings, we aimed to examine the impact of exercise training on neural cell death in the context of sepsis. Methods: We assessed the effectiveness of exercise in reducing ROS production and the inflammatory response using a cecal ligation and puncture (CLP)-induced sepsis model. Forty C57BL/6N male mice were randomly divided into 2 groups: control (CLP-Con; n=20) and experimental (CLP-Ex; n=20). Before the induction of sepsis by CLP, the CLP-Ex mice underwent interval training on a treadmill 3 days per week for 8 weeks. Each day involved 10 cycles of 2 minutes at 8 m/min and 2 minutes at 15 m/min. After the CLP procedure, we monitored the survival of 10 mice from each group over a 30-hour period. Results: The findings indicated that exercise training increased the survival rate among mice with CLP-induced sepsis by enhancing antioxidative capacity and delaying the transition from a hyperdynamic to an immunosuppressive state. Conclusions Exercise training may delay the progression from the hyperdynamic state to the hypodynamic phase of sepsis by increasing antioxidant capacity and reducing apoptotic cell death.

Purpose: This study aimed to evaluate the outcomes of isolated common femoral endarterectomy with patch angioplasty (IFEA) in the endovascular era. Materials and Methods: In 2012-2022, 189 limbs underwent femoral endarterectomy with patch angioplasty. Of them, 45 IFEAs were included. We evaluated safety based on early complications; efficacy with primary patency (PP) and reintervention, above-ankle amputation, or stenosis (RAS)-free survival. We also evaluated lesion characteristics and outcomes according to the inclusion criteria (IC) of vascular mimetic implant-common femoral artery (VMI-CFA) stenting trial. Results: Forty-one patients were male, and 30 IFEAs were required for claudication. No cases of early mortality occurred. Ten limbs (22%) developed localonvascular complications (hematoma, 3; lymphocele, 5; wound infection, 2), of which 8 resolved spontaneously. The overall PP and secondary patency rates were 100% at 1 year and 87% and 97% at 3 years, respectively. Twenty-one lesions (47%) did not meet the IC. The PP within the IC was 100% at 1 and 3 years, and the PP outside the IC was 100% at 1 year and 73% at 3 years (P=0.068). The overall RAS-free survival rates were 91% at 1 year and 81% at 3 years. All cases of RAS occurred in lesions outside the IC. The multivariate analysis showed that dialysis was associated with poor RAS-free survival (adjusted odds ratio, 8.56; 95% confidence interval, 1.9-35.5; P=0.005). Conclusion The recent VMI-CFA trial results should be interpreted with caution.IFEA is a low-risk and durable procedure; however, careful follow-up is warranted in patients undergoing dialysis.

Tidal volume by sevoflurane in small amounts is stable due to the increase in the breathing rate. But alveolus ventilation decreases due to sevoflurane as the degree of sedation increases; this ultimately causes PaCO2 to rise. The occurrence of suppression of breath increases the risk of severe hypoxia and hypercapnia in deeply sedated patients with disabilities. Sevoflurane inhalation anesthesia has a number of risks and may have unexpected problems with hemodynamic changes depending on the underlying state of the body. This study was conducted to examine the stability of internal acid-base system caused by respiratory depression occurring when patients with disabilities are induced by sevoflurane.Anesthetic induction was carried out by placing a mask on top of the patient's face and through voluntary breathing with 4 vol% of sevoflurane, 4 L/min of nitrous oxide, and 4 L/min of oxygen. After the patient's loss of consciousness and muscle relaxation, IV line was inserted by an expert and intravenous blood gas was analyzed by extracting blood from vein.In a deeply sedated state, the average amount of pH of the entire patients was measured as 7.36 ± 0.06. The average amount of PvCO₂ of the entire patients was measured as 48.8 ± 8.50 mmHg. The average amount of HCO₃₋ of the entire patients was measured as 27.2 ± 3.0 mmol/L.In conclusion, in dental treatment of patients with disabilities, the internal acid base response to inhalation sedation using sevoflurane is relatively stable.
Anesthesia, General ; Anesthesia, Inhalation ; Anoxia ; Blood Gas Analysis ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Hypercapnia ; Inhalation ; Masks ; Muscle Relaxation ; Nitrous Oxide ; Oxygen ; Respiration ; Respiratory Insufficiency ; Tidal Volume ; Unconsciousness ; Veins ; Ventilation

Tracheal injury in neonates is a rare but serious complication of endotracheal intubation. The morbidity and mortality are associated with early recognition and adequate management. Herein, we reported a case of perioperative management of neonatal tracheal injury following multiple attempts at endotracheal intubation caused by unanticipated difficulty.
Humans ; Infant, Newborn* ; Intubation, Intratracheal* ; Mortality

PURPOSE: The rapid recognition of cardiac arrest is an important factor for survival in cardiac arrest patients, and gasping is a primary barrier to the recognition of a cardiac arrest. This study examined differences in capability of recognizing a cardiac arrest and gasping among lay people, hospital nurses, and medical dispatchers. METHODS: From January to July 2016, 193 participants (65 lay people 62 hospital nurses, and 66 medical dispatchers) watched video clips of a collapsed virtual patient with unresponsiveness, gasping or seizure and answered a questionnaire asking whether the patient was in cardiac arrest or not. The results of the questionnaire were analyzed and compared among the groups. RESULTS: The total score of the questionnaire on the determination of cardiac arrest among lay people, nurses, and medical dispatchers were significant (3.09±1.43 vs. 4.15±1.22 vs. 4.45±1.29 points, p < 0.01). In the questions regarding cardiac arrest with gasping, the correct answer rate was highest in the dispatchers, followed in order by nurses and lay people (82.5% vs. 54.8% vs. 29.7%, p < 0.001). CONCLUSION: In this study, lay people had the lowest recognition capability of a cardiac arrest and gasping among the groups. In addition, gasping is a meaningful barrier to cardiac arrest recognition for both lay people and healthcare providers.
Cardiopulmonary Resuscitation ; Health Personnel ; Heart Arrest* ; Humans ; Respiration ; Seizures

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor, with a low-grade malignant potential, occurring predominantly in children and young adults. Association between AFH and other malignancies has been rarely reported. A 27-year-old man who presented with a palpable abdominal mass was diagnosed as having testicular cancer with multiple liver and lung metastases. At 16 months after chemotherapy, a follow-up computed tomographic scan revealed a supraclavicular mass measuring 3 cm in size, which was suspected to be a recurrence. The patient underwent surgical excision, and the mass was pathologically diagnosed as a AFH. The patient has had no local recurrence and no distant metastasis for 12 months after resection. To the best of our knowledge, this is the first case report of AFH as a second tumor in a patient with testicular cancer.
Adult ; Child ; Follow-Up Studies ; Histiocytoma ; Histiocytoma, Benign Fibrous ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Recurrence ; Testicular Neoplasms ; Young Adult

No abstract available.
Humans ; Recurrent Laryngeal Nerve* ; Thyroid Gland* ; Vocal Cord Paralysis*

Myxoma of the aortic valve is an exceedingly uncommon condition. In this article, we report the case of a 72-year-old man with myxoma arising from the aortic valve. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.
Aged ; Aortic Valve ; Cardiopulmonary Bypass ; Humans ; Myxoma

BACKGROUND: During laparoscopic surgery, high airway pressures are generally followed by a diaphragmatic shift and hyperventilation. We hypothesize that normocapnea can be maintained with the same amount of CO2 output (VCO2) during pneumoperitoneum (PP). METHODS: Six anesthetized rabbits were mechanically ventilated at a respiratory rate of 20/min with FIO2 0.5. At the end of the expiratory limb of the ventilator, the mean partial pressure of CO2 was measured. The internal carotid artery was catheterized. Baseline values for blood pressure, heart rate, arterial blood gas analysis, and ventilatory variables were obtained. CO2 gas was introduced into the peritoneum with an intra-abdominal pressure of 12 mmHg. The measurements at baseline and at PP1 were compared. The respiratory rate was changed from (20/min PP1, to 40/min PP2, 80/min PP3 or 120/min PP4) while calculating VCO2 and comparing ventilatory variables under PP at the same time. RESULTS: The peak inspiratory pressure (PIP) and tidal volume (VT) at PP1 increased, compared with baseline. With the same PaCO2, the VT decreased significantly from (45 +/- 8 ml PP1 to 29 +/- 5 ml PP2, 19 +/- 4 ml PP3 and 15 +/- 2 ml PP4), respectively. The PIP was reduced. However, the dead space to tidal volume ratio (VD/VT) was greater at higher RR during PP. CONCLUSIONS: PP increased the PIP and VT for the removal of overloaded CO2. Less VT at a higher respiratory rate could be used with the same amount of VCO2 during PP. However, the VD/VT was elevated by the induction of PP and by the increase in respiratory rate.
Blood Gas Analysis ; Blood Pressure ; Carbon ; Carotid Artery, Internal ; Catheters ; Extremities ; Heart Rate ; Hyperventilation ; Laparoscopy ; Partial Pressure ; Peritoneum ; Pneumoperitoneum ; Rabbits ; Respiratory Rate ; Tidal Volume ; Ventilators, Mechanical

Renal and perirenal abscesses are disease entities caused by infections in or around the kidneys. As imaging modalities have improved in quality and convenience, diagnosing these diseases has become easier. Some cases are refractory to conventional treatment and require surgical correction, although most patients can be cured by antibiotic treatment and percutaneous drainage. We here report the case of a patient with a perirenal abscess that recurred twice after appropriate antibiotic treatment and percutaneous drainage. Although Gram-negative bacilli are the most common pathogenic cause of these diseases, we isolated methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis in our patient. Thus, poor responses to appropriate treatment in patients with a perirenal abscess can result not only from antimicrobial resistance or a co-infection but also from the 2 conditions existing concomitantly.
Abscess ; Coinfection ; Drainage ; Escherichia ; Escherichia coli ; Humans ; Kidney ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mycobacterium ; Mycobacterium tuberculosis ; Perinephritis ; Tuberculosis