Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

BACKGROUND AND OBJECTIVES: Viral and vascular disorders are considered to be a major cause of idiopathic sudden sensorineural hearing loss (ISSNHL). Lipoprostaglandin E₁ (lipo-PGE₁) has vasodilating activity and has been used to treat ISSNHL. The purpose of this study was to determine the specific therapeutic effects of lipo-PGE₁ and compare them to other treatment modalities for ISSNHL. SUBJECTS AND METHODS: The study group had 1,052 patients diagnosed with ISSNHL. All were treated with steroid, carbogen inhalation, stellate ganglion block (SGB), or PGE₁. The CP group (steroid, carbogen inhalation, and PGE1 injection; 288 patients) was treated with lipo-PGE₁ and carbogen inhalation, the CS group (steroid, carbogen inhalation, and stellate ganglion block; 232 patients) with steroid, carbogen inhalation, and SGB, the C group (steroid and carbogen inhalation; 284 patients) with steroid and carbogen, and the control group (steroid only; 248 patients) with steroid only. Patients in the groups receiving lipo-PGE₁ received a continuous infusion of 10 µL lipo-PGE₁. RESULTS: The overall recovery rate after treatment was 52.2%, and recovery rates by group were 67.7% in the CP group, 54.3% in the CS group, 52.1% in the C group, and 32.2% in the control group. Therefore, the therapeutic results in groups treated with lipo-PGE₁ were better than results in other groups. The difference was statistically significant. CONCLUSIONS: The study results suggested that the CP group received effective treatment modalities for ISSNHL. The combined therapy of lipo-PGE₁ with carbogen inhalation in patients with ISSNHL was more beneficial than other treatment modalities.
Alprostadil ; Hearing Loss, Sensorineural* ; Humans ; Inhalation ; Stellate Ganglion ; Therapeutic Uses*

INTRODUCTIONThe integration of reactive oxygen species is strongly associated with important pathophysiological mechanisms that mediate myocardial ischaemia/reperfusion (I/R) damage. Pyruvate is an efficacious scavenger of reactive oxygen species and a previous study has shown that ethyl pyruvate (EP) has a myocardial protective effect against regional I/R damage in an in vivo rat model. The purpose of this study was to determine whether the myocardial protective effect of EP is associated with anti-apoptosis.

METHODSRats were allocated to receive EP dissolved in lactated Ringer's solution or lactated Ringer's solution alone, via intraperitoneal infusion one hour before ischaemia. They were exposed to 30 minutes of ischaemia followed by reperfusion of the left coronary artery territory over two hours. Anti-apoptotic effects were checked using several biochemical parameters after two hours of reperfusion. Apoptosis was analysed using measured caspase-3 activity, Western blotting of B-cell lymphoma 2 (Bcl-2) family protein cleaved by caspase-3, and assessment of DNA laddering patterns and the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining test.

RESULTSIn ischaemic myocardium, EP increased Bcl-2 expression, but reduced Bcl-2-associated X protein and cleaved caspase-3 expressions. EP reduced the expression of DNA laddering and the number of myocardial I/R-damaged TUNEL-positive cells.

CONCLUSIONThis study demonstrated that EP has an anti-apoptotic effect after regional I/R damage in an in vivo rat heart model. The myocardial protective effect of EP may be related to its anti-apoptotic effect.

BACKGROUND: The aim of this study was to evaluate the effect of aging on the hemodynamic response to endotracheal intubation during the induction of anesthesia. METHODS: Fifty patients with American Society of Anesthesiologists physical status classification 1 or 2 were enrolled and allocated according to age to either group N (35-44 years, not elderly, n=25) or group E (65-74 years, elderly, n=25). The patients were administered 3 minimum alveolar concentrations of sevoflurane for 5 minutes for the induction of anesthesia. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before (baseline), immediately after (T0), and at 1-minute intervals during the first 4 minutes after endotracheal intubation (T1-T4). RESULTS: SAP increased by 15.4% and 10.8%(p<0.05) from the baseline at T0 and T1, respectively, in group N, and by 21.6%, 17.8%, and 11.8%(p<0.05) from the baseline at T0, T1 and T2 respectively, in group E. The SAP increases at T0, T1 and T2 were significantly greater in group E than in group N (p<0.05). The HR increases at T0 and T1 were significantly greater for group N than for group E (p<0.05). CONCLUSION: We recommend that anesthesiologists vigilantly monitor and attenuate adverse hemodynamic responses for at least 5 minutes after endotracheal intubation especially in elderly patients, particularly because significant systolic hypertension can occur in this age group.
Aged ; Aging* ; Anesthesia* ; Arterial Pressure ; Classification ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal*

BACKGROUND AND OBJECTIVES: Esophageal perforation is relatively uncommon and requires careful diagnostic evaluation and expert management. It has a high mortality due to significant mediastinal and pleural contamination leading to sepsis and multiple organ failure. We reviewed our experience of esophageal perforation to determine how to better recognize such a lesion and facilitate its correct management. SUBJECTS AND METHOD: A retrospective chart review was performed on all patients treated for esophageal perforation from January 2000 to March 2016. These patients have been studied with respect to gender and age distribution, causes, sites, clinical manifestation, complications, management and postoperative complications. RESULTS: Patients ranged in age from 21 to 87 years, with an average age of 57.6±12.4 years. Fifty of the patients were men and 21 were women. The causes of the perforations were as follows: foreign body retention (18 patients), trauma (17 patients), Boerhaave's syndrome (22 patients), and iatrogenic (14 patients). The sites of esophageal perforation were: the cervical esophagus (25 patients), thoracic esophagus (44 patients) and abdominal esophagus (2 patients). Primary repair only was performed in seven (9.9%) patients, whereas 32 (45%) patients were treated with primary repair & patch, seven (9.9%) patients with T-tube drainage. Exclusion & division were performed in three (4.2%) patients and esophagectomy was performed in two (2.8%) patients. Twenty (28.2%) patients were treated conservatively. CONCLUSION: Early recognition and appropriate management of esophageal perforation are essential for reduction of morbidity and mortality.
Age Distribution ; Drainage ; Esophageal Perforation* ; Esophagectomy ; Esophagus ; Female ; Foreign Bodies ; Humans ; Male ; Methods ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Retrospective Studies ; Sepsis

BACKGROUND: Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist that is widely used for sedation and analgesia during the perioperative period. Intravenous administration of dexmedetomidine induces transient hypertension due to vasoconstriction via the activation of the alpha2-adrenoceptor on vascular smooth muscle. The goal of this in vitro study is to investigate the calcium-dependent mechanism underlying dexmedetomidine-induced contraction of isolated endothelium-denuded rat aorta. METHODS: Isolated endothelium-denuded rat thoracic aortic rings were suspended for isometric tension recording. Cumulative dexmedetomidine concentration-response curves were generated in the presence or absence of the following inhibitors: alpha2-adrenoceptor inhibitor rauwolscine; voltage-operated calcium channel blocker verapamil (5 x 10(-7), 10(-6) and 5 x 10(-5) M); purported inositol 1,4,5-trisphosphate receptor blocker 2-aminoethoxydiphenylborate (5 x 10(-6), 10(-5) and 5 x 10(-5) M); phospholipase C inhibitor U-73122 (10(-6) and 3 x 10(-6) M); and store-operated calcium channel inhibitor gadolinium chloride hexahydrate (Gd3+; 5 x 10(-6) M). Dexmedetomidine concentration-response curves were also generated in low calcium concentrations (1 mM) and calcium-free Krebs solution. RESULTS: Rauwolscine, verapamil, and 2-aminoethoxydiphenylborate attenuated dexmedetomidine-induced contraction in a concentration-dependent manner. Low calcium concentrations attenuated dexmedetomidine-induced contraction, and calcium-free Krebs solution nearly abolished dexmedetomidine-induced contraction. However, U-73122 and Gd3+ had no effect on dexmedetomidine-induced contraction. CONCLUSIONS: Taken together, these results suggest that dexmedetomidine-induced contraction is primarily dependent on extracellular calcium concentrations that contribute to calcium influx via voltage-operated calcium channels of isolated rat aortic smooth muscle. Dexmedetomidine-induced contraction is mediated by alpha2-adrenoceptor stimulation. Dexmedetomidine-induced contraction appears to be partially mediated by calcium release from the sarcoplasmic reticulum.
Administration, Intravenous ; Analgesia ; Animals ; Aorta ; Calcium ; Calcium Channels ; Contracts ; Dexmedetomidine ; Estrenes ; Gadolinium ; Hypertension ; Inositol 1,4,5-Trisphosphate ; Isotonic Solutions ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Perioperative Period ; Pyrrolidinones ; Rats ; Sarcoplasmic Reticulum ; Type C Phospholipases ; Vasoconstriction ; Verapamil ; Yohimbine

BACKGROUND: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. METHODS: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. RESULTS: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 +/- 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 +/- 0.5 vol%; P < 0.001) compared to patients in group D (7.9 +/- 0.5 vol%). CONCLUSIONS: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.
Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Extremities ; Heart Rate ; Humans ; Isoflurane ; Orthopedics ; Piperidines

Myotonic dystrophy is an autosomal-dominant inherited neuromuscular disorder that's characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, the heart, lung and intestine. Its most common complication is postoperative respiratory failure. We encountered a patient who developed sudden unexpected peripartum cardiomyopathy (PPCM) and respiratory failure due to presumed myotonic dystrophy after cesarean section. We report here on our clinical experience with this malady and we include a brief review of the medical literature on myotonic dystrophy.
Cardiomyopathies ; Cataract ; Cesarean Section ; Female ; Heart ; Humans ; Intestines ; Lung ; Muscle Weakness ; Muscles ; Muscular Dystrophies ; Myotonia ; Myotonic Dystrophy ; Peripartum Period ; Pregnancy ; Respiratory Insufficiency

BACKGROUND: The authors evaluated the hemodynamic effects of body position measured by esophageal Doppler monitor (EDM) during laparoscopic cholecystectomy or gynecologic laparoscopic surgery. METHODS: Fifty patients scheduled to undergo laparoscopic cholecystectomy (Group C) or gynecologic laparoscopic surgery (Group G), were divided into two groups. Pneumoperitoneum was instituted by CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured by the use of EDM: before skin incision (T1), 5, 10 and 15 min after changing position (T2, T3 and T4), and 5 min after CO2 exsufflation (T5). RESULTS: MAP (mean arterial pressure) was significantly higher in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). CO (cardiac output) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). And there were not significant differences in HR (heart rate) between two groups. PV (peak velocity) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). And there were not significant differences in FTc (corrected flow time) between two groups. But FTc in Group C was restored after CO2 exsufflation, FTc in Group G was not restored after CO2 exsufflation. CONCLUSIONS: Changing position in the gynecologic laparoscopic surgery group can elevate MAP and decrease CO. Therefore, careful caution is required in patients with cardiovascular disease who are undergoing gynecologic laparoscopic surgery.
Cardiovascular Diseases ; Cholecystectomy, Laparoscopic ; Hemodynamics ; Humans ; Laparoscopy ; Organothiophosphorus Compounds ; Pneumoperitoneum ; Skin