Evaluation of the Arrow Flex Tip Plus epidural catheter tip position and migration during continuous thoracic analgesia.
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Adult↗
Biomedical subjects
Shinji Takahashi
Publications and source records attributed to Shinji Takahashi.
Multilocus sequence typing system for group B streptococcus.
A multilocus sequence typing (MLST) system was developed for group B streptococcus (GBS). The system was used to characterize a collection (n = 152) of globally and ecologically diverse human strains of GBS that included representatives of capsular serotypes Ia, Ib, II, III, V, VI, and VIII. Fragments (459 to 519 bp) of seven housekeeping genes were amplified by PCR for each strain and sequenced. The combination of alleles at the seven loci provided an allelic profile or sequence type (ST) for each strain. A subset of the strains were characterized by restriction digest patterning, and these results were highly congruent with those obtained with MLST. There were 29 STs, but 66% of isolates were assigned to four major STs. ST-1 and ST-19 were significantly associated with asymptomatic carriage, whereas ST-23 included both carried and invasive strains. All 44 isolates of ST-17 were serotype III clones, and this ST appeared to define a homogeneous clone that was strongly associated with neonatal invasive infections. The finding that isolates with different capsular serotypes had the same ST suggests that recombination occurs at the capsular locus. A web site for GBS MLST was set up and can be accessed at http://sagalactiae.mlst.net. The GBS MLST system offers investigators a valuable typing tool that will promote further investigation of the population biology of this organism.
Adult↗
Curved-end guidewire for central venous cannulation in neonate.
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Catheterization, Central Venous↗
[Rhabdomyolysis after nephrectomy in the lateral flexed decubitus position].
We report two cases of the rhabdomyolysis of the erector spine muscles occurring after nephrectomy in lateral flexed decubitus position. Case 1. A 39-year-old man (170-cm, 85-kg) underwent right nephrectomy for a right renal tumor. The patient was placed in a left flexed lateral decubitus position with a roll placed under the dependent iliac crest and upper half of the body was rotated backward for 6 h. The patient complained of severe left low back pain after the operation. On postoperative day 2, serum creatinine increased to 28,480 U.l-1 (MM 99%). Computed tomography scanning performed on postoperative day 4 showed hypodensity of the left erector spine muscles. Although the patient complained of severe pain, no other critical complications including renal failure occurred during the postoperative period. Case 2. A 59-year-old man (169-cm, 87-kg) was scheduled for right nephroureterectomy and partial resection of bladder for a right renal tumor. The patient was placed in a right flexed lateral decubitus position with a roll of towel and sponge placed under the dependent iliac crest for 8 hr. On postoperative day 1, CPK increased to 35,315 U.l-1 (MM 99%) and peaked at 55,760 U.l-1 (MM 99%) on postoperative day 2. Haptoglobin was administered and lactated Ringer and loop diuretics were administered. Fortunately the patient did not develop renal failure. Direct, prolonged pressure on the paravertebral muscle was the etiology of rhabdomyolysis in our cases. Although our cases were not severe and the complications were not induced, it must be kept in mind that excessive pressure in a limited area can damage the muscle during prolonged surgery.
Adult↗
Correlation of phylogenetic lineages of group B Streptococci, identified by analysis of restriction-digestion patterns of genomic DNA, with infB alleles and mobile genetic elements.
Phylogenetic lineages of pathogenic Streptococcus agalactiae (group B streptococci [GBS]) can be identified by analysis of restriction-digestion patterns (RDPs) of chromosomal DNA. The purpose of the present study was to correlate GBS RDP types and (1) alleles of the highly conserved gene encoding translation-initiation factor IF2, infB, and/or (2) the inserted elements IS1548 and GBSi1. Only 1 combination of serotype and infB allele was found within each RDP type. Strains within a particular RDP type also tend to have the same inserted elements in each of 3 loci examined. A novel insertion sequence, designated "IS1563," was found within all RDP type II-2 strains. Most RDP types could be identified by a combination of serotype, infB allele, and inserted elements at each of the loci. These molecular markers can be used to identify GBS populations and to correlate RDP types and phylogenetic lineages identified by different methods.
Alleles↗
Identification of genes regulating colorectal carcinogenesis by using the algorithm for diagnosing malignant state method.
We studied the expression profiles of various stages of colorectal tumors (adenoma (AD), seven samples; carcinoma (CA), 16 samples) by using cDNA microarrays and developed ADMS (algorithm for diagnosing malignant state) method, selecting 335 clones characteristic of CA state. We, then, applied ADMS to 12 additional samples (five from primary lesions with metastasis and seven metastases); all 16 CAs and 12 metastatic tumors were diagnosed correctly as cancerous states. Although three of the seven ADs were diagnosed as "cancerous," the large size of two of these tumors suggested their potential malignancy. Our strategy for selecting clones characteristic of the malignant state is widely applicable to diagnosis and for predicting the stage of progression during multistep carcinogenesis. Of the 335 clones we selected, 135 were known genes. Included in the 135 genes were tumor suppressor and growth factor-related genes and were consistent with the literature. ADMS is a reliable means for identifying genes useful for the diagnosis of cancer.
Adenoma↗
Mechanism of postoperative liver failure after excessive hepatectomy investigated using a cDNA microarray.
BACKGROUND/PURPOSE: Excessive hepatectomy often causes fatal liver failure. We have reported that this is mainly mediated by apoptosis, characterized pathologically by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling (TUNEL) assay-positive hepatocytes and a ladder pattern in DNA fragmentation assays. METHODS: To investigate the mechanism, we used cDNA microarray analysis to compare clearly differentiated rat partial hepatectomy (PHx) models (90% PHx, and 95% PHx). All 90% PHx rats survived, but the 95% PHx animals died of hepatic failure within 96 h. Remnant liver was obtained at four time points (1, 3, 12, and 24 h after PHx). After RNA extraction, two samples were labeled with different fluorescent dyes and hybridized to the Institute of Physical and Chemical Research (RIKEN) set of 18 816 full-length enriched mouse cDNA arrays. Scanning for fluorescent dye signals was performed, and the mRNA expression ratio of the two models was examined. RESULTS: Genes of the p21 cyclin-dependent kinase (CDK) inhibitor, Fas, interleukin (IL)-18, and many caspases were upregulated at 1 h after PHx in the 95% PHx group. On the other hand, genes of Bcl-2, heat shock proteins, and glutathione-S-transferase were downregulated. CONCLUSIONS: We concluded that fatal hepatic failure after excessive hepatectomy was characterized by increased apoptosis and diminished liver regeneration.
Animals↗
Effects of sigma(1) receptor ligand MS-377 on D(2) antagonists-induced behaviors.
(R)-(+)-1-(4-Chlorophenyl)-3-[4-(2-methoxyethyl)piperazin-1-yl]methyl-2-pyrrolidinone L-tartrate (MS-377) is a novel antipsychotic agent with selective and high affinity for sigma(1) receptor. The present study was carried out to clarify the interaction of MS-377 with dopamine D(2) receptor antagonists (D(2) antagonists) in concurrent administration, and then the involvement of sigma receptors in the interaction. The effects of MS-377 on haloperidol- or sultopride-induced inhibition of apomorphine-induced climbing behavior and catalepsy were investigated in mice and rats, respectively. In addition, the effects of (+)-SKF-10,047 and SA4503, both of which are sigma receptor agonists, and WAY-100,635, which is a 5-HT(1A) receptor antagonist, on the interaction due to the concurrent use were also investigated. MS-377 potentiated the inhibitory effects of haloperidol or sultopride on apomorphine-induced climbing behavior in a dose-dependent manner. In contrast, MS-377 did not affect the catalepsy induction by these drugs. The potentiation of the inhibitory effects of haloperidol or sultopride on apomorphine-induced climbing behavior by MS-377 was not inhibited by WAY-100,635, but was inhibited by (+)-SKF-10,047 and SA4503. These findings showed that MS-377 potentiates the efficacy of D(2) antagonists, but it does not deteriorate the adverse effect. Moreover, sigma(1) receptors are involved in this potentiation of the efficacy of D(2) antagonists by MS-377.
Amisulpride↗
The efficacy of hemodynamic and T-wave criteria for detecting intravascular injection of epinephrine test dose in propofol-anesthetized adults.
UNLABELLED: A recent study demonstrated 100% effectiveness of hemodynamic criteria during propofol anesthesia, when a full dose of an epinephrine (15 microg)-containing test dose was injected intravascularly. We designed this dose-response study to determine minimal effective epinephrine doses and efficacies of hemodynamic and T-wave criteria for detecting intravascular injection of the epinephrine test dose in propofol-anesthetized adults. Eighty healthy adult patients were randomly assigned to one of four groups according to a simulated IV test dose using propofol (133 microg center dot kg(-1) center dot min(-1)) and nitrous oxide (FIO(2) = 0.33) anesthesia after endotracheal intubation (n = 20 each). The Saline group received 3 mL of normal saline IV; the Epinephrine-15 group received 3 mL of 1.5% lidocaine containing 15 microg epinephrine; and the Epinephrine-10 and -5 groups received 2 and 1 mL of the test dose of the identical components, respectively. Heart rate (HR), systolic blood pressure (SBP), and lead II of the electrocardiogram were recorded continuously for 5 min after the IV injection of the study drug via a peripheral vein. Sensitivities and specificities of 100% were obtained based on the modified HR (positive if greater-than-or-equal to 10 bpm increase) and the T-wave (positive if greater-than-or-equal 25% in amplitude) criteria if greater-than-or-equal 5 microg of epinephrine was injected IV. Based on the SBP criterion (positive if greater-than-or-equal 15 mm Hg increase), however, 100% sensitivity and specificity were associated only with greater-than-or-equal 10 microg of epinephrine doses. These results suggest that the minimal effective epinephrine doses for detecting unintentional intravascular injection are 5 microg based on the HR and T-wave criteria, and 10 microg based on the SBP criterion in adult patients anesthetized with propofol and nitrous oxide. IMPLICATIONS: Accidental migration of an epidural catheter into a blood vessel is often detected by hemodynamic changes after injecting an epidural test dose containing epinephrine. Our results suggest that 5 microg of epinephrine is not adequate to reliably produce hemodynamic and T-wave alterations in adult patients during propofol anesthesia.
Adult↗
Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway.
UNLABELLED: Lightwand devices are effective and safe as an aid to tracheal intubation. Theoretically, avoiding direct-vision laryngoscopy could allow for less stimulation by intubation than the conventional laryngoscopic procedure. We designed this prospective randomized study to assess the cardiovascular changes after either lightwand or direct laryngoscopic tracheal intubation in adult patients anesthetized with sevoflurane. Sixty healthy adult patients with normal airways were randomly assigned to one of three groups according to intubating procedure under sevoflurane/nitrous oxide anesthesia (fraction of inspired oxygen = 0.33) (n = 20 each). The lightwand group received tracheal intubation with Trachlight, the laryngoscope-intubation group received tracheal intubation with a direct-vision laryngoscope (Macintosh blade), and the laryngoscopy-alone group received the laryngoscope alone. Heart rate and systolic blood pressure were recorded continuously for 5 min after tracheal intubation or laryngoscopy with enough time to intubate. All procedures were successful on the first attempt. The maximum heart rate and systolic blood pressure values obtained after intubation with Trachlight (114 +/- 20 bpm and 143 +/- 30 mm Hg, respectively) did not differ from those with the Macintosh laryngoscope (114 +/- 20 bpm and 138 +/- 23 mm Hg), but they were significantly larger than those in the laryngoscopy-alone group (94 +/- 19 bpm and 112 +/- 21 mm Hg) (P < 0.05). Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation. IMPLICATIONS: The magnitude of hemodynamic changes associated with tracheal intubation with the Trachlight is almost the same as that which occurs with the direct laryngoscope. Hemodynamic changes are likely to occur because of direct tracheal irritation rather than direct stimulation of the larynx.
Adult↗
Long-range mapping of the Streptococcus agalactiae phylogenetic lineage restriction digest pattern type III-3 reveals clustering of virulence genes.
Human isolates of serotype III Streptococcus agalactiae (group B streptococcus [GBS]) can be divided into three separate phylogenetic lineages based on analysis of the restriction digest patterns (RDPs) of chromosomal DNA. Nine DNA sequences that are present in all isolates of the RDP III-3 phylogenetic lineage, but not in the other lineages, were identified by genomic subtractive hybridization. A complete physical map of a III-3 chromosome was constructed. Six of the nine III-3-specific sequences mapped to a 340-kb Sse8387I fragment which contains or is located close to known GBS virulence genes. One of the III-3-specific probes, AW-10, encodes part of GBSi1, a group II intron that is inserted at two sites within the GBS genome. The second chromosomal site for GBSi1 was isolated, sequenced, and mapped to a location near the locus responsible for hemolysin production. These findings suggest that the genetic variation that distinguishes the RDP type III-3 strains from other serotype III strains occurs largely within localized areas of the genome containing known or putative virulence genes.
Base Sequence↗
Limited genetic diversity of recent invasive isolates of non-serotype b encapsulated Haemophilus influenzae.
Invasive infections caused by non-type b encapsulated Haemophilus influenzae have increased in frequency in the last decade. This change prompted us to characterize the genetic relationships of 48 recently isolated invasive H. influenzae type a (Hia), e (Hie), and f (Hif) strains by comparison of restriction digest patterns (RDPs). Recent Hia isolates exhibited moderate genetic diversity, with the majority segregating into two major clonotypes. Recent Hie and, especially, Hif strains displayed considerably restricted genetic diversity. In particular, all but one Hif strain segregated into a single clonotype, and half of these isolates had identical RDPs. These results are consistent with the hypothesis that the increased incidence of disease due to non-type b encapsulated H. influenzae reflects the emergence of hypervirulent clones, especially in the case of Hif. Alternatively, it is possible that non-type b encapsulated H. influenzae strains have limited overall genetic diversity.
Bacterial Capsules↗