Biomedical subjects

Takashi Nishino

Publications and source records attributed to Takashi Nishino.

At least 19 recordsLinked to original sources

PubMed2006

An additive interaction between different qualities of dyspnea produced in normal human subjects.

We evaluated the sensation of dyspnea induced by hypercapnia alone and a combination of hypercapnia and flow-resistive loading by the use of visual analogue scale (VAS) and the use of 13 listed descriptors in 23 healthy subjects. Hypercapnia alone caused a modest degree of dyspnea characterized by both air hunger and work/effort sensations. An addition of inspiratory flow-resistive loading (IRL) caused an increase in inspiratory difficulty and some attenuation of 'work/effort.' The addition of expiratory flow-resistive loading (ERL) caused an increase in expiratory difficulty and attenuation of 'air hunger.' The addition of both IRL and ERL caused a marked increase in dyspnea, the amount of which was close to the sum of the increases obtained individually by IRL and by ERL, while the quality of dyspnea was characterized predominantly by work/effort. These results suggest that despite the difference in quality of sensations, the intensity of dyspnea would sum linearly when the two kinds of loads are presented at the same time.

Adult↗

PubMed2006

[Airway management for patient safety: preface and comments].

Maintenance of patent airway has an essential role in respiratory management. The management of difficult airway is one of problems associated with the maintenance of airway patency. "Cannot intubate, cannot ventilate (CICV)" scenario is rare, but it usually leads to serious morbidity and mortality related to anesthesia. A wide variety of equipments and anesthetic techniques can be used to deal with this emergency situation. However, the recent practice of airway management seems to be very complex, depending on the introduction of new airway devices including laryngeal mask airway (LMA). In order to provide the reader with valuable information as to the new devices and airway-associated problems, five experts in this field contributed to this special issue of difficult airway problems.

Anesthesia↗

PubMed2006

[Diagnostic imaging in the field of anesthesiology: preface and comments].

In this special issue, the diagnostic imaging in the field of anesthesiology is featured. Four topics including preoperative upper airway radiograph, perioperative bronchofiberscopy, transesophageal echocardiography (TEE), and perioperative diagnosis of deep vein thrombosis are discussed. Diagnostic imaging can be a powerful tool to improve the quality of perioperative management of surgical patients.

Anesthesiology↗

PubMed2005

Effects of naloxone on respiratory sensation before and after a removal of severe respiratory stress.

Severe respiratory stress causes dyspnea, and a sudden release of this stress frequently accompanies a euphoric sensation. We hypothesized that acute severe respiratory stress may result in an elaboration of endogenous opioids within the central nervous system, and that these opioids may play significant roles in relieving dyspnea and generating euphoric sensation after a sudden removal of the stress. To test this hypothesis, we examined the effects of naloxone (0.04 mg/kg, I.V.) and the placebo (normal saline) on changes in respiratory sensation before and after the release of severe respiratory stress in a double-blind, randomized, crossover study in 14 healthy adults. Acute severe respiratory stress was induced by loaded breathing with a combination of resistive loading and hypercapnia. The subjects rated their changes in sensation by using a bidirectional visual analogue scale. Naloxone pretreatment affected neither the ventilation nor the development of dyspneic sensation during loaded breathing. Naloxone pretreatment only slightly attentuated the euphoric sensation developed after the release of severe respiratory stress. These findings suggest a small role of opioids in relieving dyspnea and in generating euphoria before and after a sudden removal of stress.

Adult↗

PubMed2005

Surface properties and structures of diblock copolymer and homopolymer with perfluoroalkyl side chains.

The surface free energy of diblock copolymer, composed of methyl methacrylate and 2-perfluorooctylethyl methacrylate (PMMA-b-PFEMA), was compared with that of PFEMA homopolymer (P-PFEMA) in correlation with their structures in the solid state and in the solution using dynamic contact angle, X-ray photoelectron spectroscopy, X-ray diffraction, and dynamic light scattering. The PMMA-b-PFEMA film cast from chloroform solution was found to possess very low surface free energy (7.8 mJ/m(2)) compared with the surface free energies of the P-PFEMA (8.5 mJ/m(2)) and the PMMA-b-PFEMA (9.8 mJ/m(2)) films cast from CF(3)CF(2)CHCl(2) solutions. These differences in the surface free energy were brought about by the variations in their surface structures. The very low surface free energy was considered to have originated from the surface segregation of the PFEMA segments highly self-assembled by the presence of chloroform.

Fluorocarbons↗

PubMed2005

Effects of film-forming conditions on surface properties and structures of diblock copolymer with perfluoroalkyl side chains.

Film-forming conditions (cast solvents and film-forming technique: casting or spin-coating) are found to regulate the surface free energy of a diblock copolymer composed of methyl methacrylate and 2-perfluorooctylethyl methacrylate (PMMA-b-PFEMA). The surface properties and structures both in the solid state and in the solution of this polymer were investigated using dynamic contact angle, X-ray photoelectron spectroscopy, X-ray diffraction, reflection-adsorption Fourier transform infrared spectroscopy, dynamic light scattering, and surface pressure measurements. The surface free energy of the PMMA-b-PFEMA film drastically changed from 7.8 to 28.4 mJ/m(2), depending on the film-forming conditions. For the film cast from the micellar solution, the surface free energy is governed by the unimers, localized at the air-solution interface. On the other hand, higher amounts of micelles with the laid perfluoroalkyl side chains were exposed on the surface of the spin-coated film, which yielded a relatively high surface free energy. These findings demonstrated a significant effect of the in-solution molecular association on the surface structures and properties of the solid. In particular, the in-solution unimers played the most important role in lowering the surface free energy of the PMMA-b-PFEMA films.

Journal Article↗

PubMed2005

Laryngeal reflex before and after placement of airway interventions: endotracheal tube and laryngeal mask airway.

BACKGROUND: Previous reports indicate that detrimental laryngeal function persists over several hours after tracheal extubation even in patients who have regained full consciousness from anesthesia. The authors hypothesize that even after minor surgery, the presence of an endotracheal tube (ETT) impairs the receptors at the vocal cord and diminishes the defensive laryngeal function. The hypothesis was tested by comparing types of experimentally induced laryngeal airway reflexes before and after surgery in anesthetized patients with use of either an ETT or a Laryngeal Mask Airway. METHODS: Twenty adult patients undergoing elective minor surgeries were randomly allocated into two groups, the ETT and Laryngeal Mask Airway groups, depending on the airway management method used during surgery. While maintaining sevoflurane at 1 minimum alveolar concentration, laryngeal and respiratory responses were elicited by instillation of distilled water on the vocal cords immediately before and after surgery. Furthermore, the vocal cord angles were endoscopically measured under complete paralysis. RESULTS: Some laryngeal reflex responses of both groups, particularly the cough reflex, were significantly attenuated after minor surgery. Significant narrowing of the glottic aperture was evident in patients with ETT placement but not in patients with Laryngeal Mask Airway placement. CONCLUSIONS: With either airway intervention, laryngeal defensive reflexes are depressed immediately after surgery even without visible laryngeal swelling. The sensory impairment attributable to the presence of an ETT cannot be the solo factor responsible for the modification of the defensive airway reflexes elicited from the larynx.

Adult↗

PubMed2005

Sniffing position improves pharyngeal airway patency in anesthetized patients with obstructive sleep apnea.

BACKGROUND: Appropriate bag-and-mask ventilation with patent airway is mandatory during induction of general anesthesia. Although the sniffing neck position is a traditionally recommended head and neck position during this critical period, knowledge of the influences of this position on the pharyngeal airway patency is still inadequate. METHODS: Total muscle paralysis was induced with general anesthesia in 12 patients with obstructive sleep apnea, eliminating neuromuscular factors contributing to pharyngeal patency. The cross-sectional area of the pharynx was measured endoscopically at different static airway pressures. Comparison of static pressure-area plot between the neutral and sniffing neck positions allowed assessment of the influence of the neck position change on the mechanical properties of the pharynx. RESULTS: The static pressure-area curves of the sniffing position were above those of neutral neck position, with increasing maximum cross-sectional area and decreasing the closing pressure at both retropalatal and retroglossal airways. The beneficial effects of the sniffing position were greater in obstructive sleep apnea patients with higher closing pressure and smaller body mass index. CONCLUSIONS: Sniffing position structurally improves maintenance of the passive pharyngeal airway in patients with obstructive sleep apnea and may be beneficial for both mask ventilation and tracheal intubation during anesthesia induction.

Adult↗

PubMed2005

Airway protective reflexes evoked by laryngeal instillation of distilled water under sevoflurane general anesthesia in children.

To investigate how sevoflurane modifies airway protective reflexes in anesthetized children, we recruited patients younger than 12-yr-old for our study. Anesthesia was induced with inhaled sevoflurane in oxygen. The airway was managed with a laryngeal mask airway and the patient breathing spontaneously. Depending on the depth of anesthesia, the subjects were divided into two groups: Group 1 and Group 2 (1% and 2% of end-tidal sevoflurane concentration, respectively). Behaviors of the larynx were assessed mainly by the fiberscopic images of the larynx as well as respiratory flow and esophageal pressure. A small dose, 0.02 mL/kg of distilled water (minimum 0.2 mL) was instilled to the larynx through a channel of the scope to evoke an airway protective reflex from the larynx. The responses were categorized into passive (laryngeal closure, laryngospasm, and apnea) and active (cough, expiration reflex, and swallowing reflex) responses. Ten subjects were included in each group. In both groups, the primary responses were passive; however, in Group 1, active reflexes were also observed in 8 of 10 subjects; no subjects in Group 2 had active reflexes (P < 0.01). We concluded that, in children, the depth of general anesthesia with sevoflurane modified airway protective reflexes.

Anesthesia, General↗

PubMed2005

[Intra-operative ketamine administration reduced the level of post-thoracotomy pain].

BACKGROUND: Two different types of post-operative pain (such as acute pain and chronic pain) occur in patients undergoing thoracotomy. It has been suggested that the acute post-thoracotomy pain consists of inflammatory pain and chronic post-thoracotomy pain caused by intercostal neuralgia. In the present study, we examined the effect of intra-operative administration of ketamine, an NMDA receptor antagonist, on the acute and chronic post-thoracotomy pain. METHODS: Sixteen patients were assigned to one of two groups (ketamine or control). The ketamine group received a ketamine bolus (1 mg x kg(-1)) just before the skin incision, followed by continuous infusion of ketamine (1 mg x kg(-1) x hr(-1)) during surgery. RESULTS: Verbal rating scores (VRSs) at rest and on cough were significantly lower in the ketamine group on day 1 and VRS of chronic pain was also significantly lower in the ketamine group 4 weeks after the surgery. CONCLUSIONS: These data suggest that post-thoracotomy pain might be mediated by NMDA receptor dependent central sensitization and that the intra-operative administration of ketamine might block the development of the NMDA receptor dependent central sensitization.

Aged↗

PubMed2005

[Effects of simultaneous epidural administration of ropivacaine and morphine on the post-operative pain in the gynecologic patients].

BACKGROUND: We examined the effects of simultaneous epidural administration of ropivacaine with morphine on the level of the post-operative METHODS: Forty-one patients were assigned to one of three groups [ropivacaine (R), ropivacaine + morphine (RM) or morphine (M)]. In the R group, 5 ml of 1% ropivacaine bolus was administered just before the skin incision followed by infusion of 0.2% ropivacaine (5 ml x hr(-1)) during the first 48 hours after the operation. In the RM and M groups, 5 ml of 1% ropivacaine + 2 mg of morphine bolus was administered just before the skin incision followed by infusion of 0.2% ropivacaine (RM group, 5 ml x hr(-1)) or saline (M group, 5 ml x hr(-1)) + 4 mg x day(-1) of morphine during the first 48 hours after the operation. RESULTS: The score of post-operative pain in the R group is higher than that of the MR group or that of M group. There is no difference between the score of post-operative pain of the MR group and that of the M group. CONCLUSIONS: These data suggested that simultaneous epidural administration of ropivacaine with morphine produces no beneficial effect as compared with morphine alone.

Adolescent↗

PubMed2004

Surface properties and structures of diblock and random copolymers with perfluoroalkyl side chains.

Polymers with perfluoroalkyl side chains have recently attracted a great deal of interest as additives to surface hydrophobicity to values higher than these corresponding to polytetrafluoroethylene. The structure and surface free energy of random and diblock copolymers of methyl methacrylate and 2-perfluorooctylethyl methacrylate (PMMA-r-PFEMA and PMMA-b-PFEMA, respectively) were compared using dynamic contact angle, X-ray photoelectron spectroscopy, X-ray diffraction, and reflection-adsorption FT-IR spectroscopy. The PMMA-b-PFEMA solution cast film showed a surface free energy of 7.8 mJ/m2. This value was lower than that of PMMA-r-PFEMA solution cast film (13.4 mJ/m2) but is comparable to the lowest value (6.7 mJ/m2) reported in literature. The surface of PMMA-b-PFEMA was almost covered with the CF3 groups of self-assembled perfluoroalkyl side chains. On the other hand, more CF2 groups and methacrylate main chain were exposed on the PMMA-r-PFEMA film surface due to parallel orientation of the perfluoroalkyl side chains, which determined the relatively higher surface free energy of the PMMA-r-PFEMA film.

Fluorocarbons↗

PubMed2004

Quantitative assessment of tracheal collapsibility in infants with tracheomalacia.

Infantile tracheomalacia is a potentially life-threatening disease requiring prolonged artificial respiratory support. Diagnosis and management of this disease may be further improved by establishing a suitable objective and quantitative assessment protocol for tracheal collapsibility. It is our hypothesis that tracheal collapsibility can be represented by the relationship between intraluminal pressure and the cross-sectional area of the trachea. To test this hypothesis, static pressure/area relationships of the trachea were obtained from anesthetized and paralyzed infants, who were diagnosed as having tracheomalacia by endoscopic observation. These relationships were fitted on a linear regression model, followed by calculation of the estimated closing pressure. The tracheal closing pressure ranged from -8 to -27 cm H(2)O, suggesting easy collapsibility of the trachea during crying or coughing and noncollapsibility during the spontaneous respiratory cycle, which coincided with the infants' symptoms. It is our conclusion that tracheal collapsibility of infants with tracheomalacia can be quantitatively assessed by the static pressure/area relationship of the trachea obtained under general anesthesia and paralysis.

Airway Resistance↗

PubMed2004

Influences of head positions and bite opening on collapsibility of the passive pharynx.

A collapsible tube surrounded by soft material within a rigid box was proposed as a two-dimensional mechanical model for the pharyngeal airway. This model predicts that changes in the box size (pharyngeal bony enclosure size anatomically defined as cross-sectional area bounded by the inside edge of bony structures such as the mandible, maxilla, and spine, and being perpendicular to the airway) influence patency of the tube. We examined whether changes in the bony enclosure size either with head positioning or bite opening influence collapsibility of the pharyngeal airway. Static mechanical properties of the passive pharynx were evaluated in anesthetized, paralyzed patients with sleep-disordered breathing before and during neck extension with bite closure (n = 11), neck flexion with bite closure (n = 9), and neutral neck position with bite opening (n = 11). Neck extension significantly increased maximum oropharyngeal airway size and decreased closing pressures of the velopharynx and oropharynx. Notably, neck extension significantly decreased compliance of the oropharyngeal airway wall. Neck flexion and bite opening decreased maximum oropharyngeal airway size and increased closing pressure of the velopharynx and oropharynx. Our results indicate the importance of neck and mandibular position for determining patency and collapsibility of the passive pharynx.

Adult↗

PubMed2004

Effects of withdrawal of phasic lung inflation during normocapnia and hypercapnia on the swallowing reflex in humans.

PURPOSE: This study was done to test the hypothesis that hypercapnia has a direct, inhibitory effect on swallowing. METHODS: We investigated changes in the frequency and timing of repeated swallows induced by continuous infusion of water into the pharynx before, during, and after transient airway occlusion at normocapnia and hypercapnia in 12 healthy volunteers. Hypercapnia was induced by adding a dead space. Ventilation was monitored using a pneumotachograph, and swallowing was identified by submental electromyogram. RESULTS: We found that hypercapnia decreased the frequency of swallows (8.2 +/- 3.7 vs 11.4 +/- 5.3 swallows.min-1 [mean +/- SD]: hypercapnia vs normocapnia; P < 0.05), together with a loss of the preponderant coupling of swallows with expiratory phase observed at normocapnia. We also found that the withdrawal of phasic lung inflation produced by airway occlusion at end-expiration suddenly increased the swallowing frequency, both at normocapnia (from 11.4 +/- 5.3 to 16.7 +/- 3.7 swallows.min-1; P < 0.01) and at hypercapnia (from 8.2 +/- 3.7 to 22.0 +/- 6.7 swallows.min-1; P < 0.01). Although the degree of increased swallowing frequency during airway occlusion was more prominent at hypercapnia than at normocapnia ( P < 0.05), the distribution of the timing of swallows in relation to the phase of the respiratory cycle during airway occlusion at hypercapnia was similar to that during airway occlusion at normocapnia. CONCLUSION: The results of our study strongly suggest that the attenuation of the swallowing reflex during hypercapnia is not due to the direct, inhibitory effect of CO2 on the swallowing center, but, rather, is due to the increased inhibitory influence of a lung-volume-related reflex.

Adult↗

PubMed2004

Mandibular advancement improves the laryngeal view during direct laryngoscopy performed by inexperienced physicians.

BACKGROUND: When oral or nasal fiberoptic laryngoscopy is attempted, mandibular advancement has been reported to improve the laryngeal view. The authors hypothesized that mandibular advancement may also improve the laryngeal view during direct laryngoscopy. METHODS: Forty patients undergoing elective surgery under general anesthesia were included in this study. After establishment of an adequate level of anesthesia and muscle relaxation, direct laryngoscopy was performed by inexperienced physicians. Four different maneuvers--simple direct laryngoscopy without any assistance (C), simple direct laryngoscopy with mandibular advancement (M), simple direct laryngoscopy with the BURP maneuver (backward, upward, rightward pressure maneuver of the larynx; B), and simple direct laryngoscopy with both mandibular advancement and the BURP maneuver (BM)--were attempted in each subject, and the laryngeal aperture was videotaped with each procedure. An instructor in anesthesiology who was blinded to the procedure evaluated the visualization by reviewing videotape off-line, using the Cormack-Lehane classification system (grades I-IV) and a rating score within each subject (1 = best view; 4 = poorest view). The Friedman test followed by the Student-Newman-Keuls test was performed for statistical comparison. P < 0.05 was considered significant. RESULTS: The laryngeal view was improved with M and B when compared with C (P < 0.05 by both rating and Cormack-Lehane evaluation). BM was the most effective method to visualize the laryngeal aperture (P < 0.05, vs. B and M by rating evaluation), whereas B and M were the second and the third most effective methods, respectively. No statistical difference was observed between B and M with the Cormack-Lehane classification. CONCLUSION: Mandibular advancement improves the laryngeal view during direct laryngoscopy performed by inexperienced physicians.

Aged↗

PubMed2004

Dilated cardiomyopathy caused by aberrant endoplasmic reticulum quality control in mutant KDEL receptor transgenic mice.

Aberrant protein folding beyond the capacity of endoplasmic reticulum (ER) quality control leads to stress response in the ER. The Lys-Asp-Glu-Leu (KDEL) receptor, a retrieval receptor for ER chaperones in the early secretory pathway, contributes to ER quality control. To elucidate the function of the KDEL receptor in vivo, we established transgenic mice expressing a mutant KDEL receptor. We found that the mutant KDEL receptor sensitized cells to ER stress and that the mutant mice developed dilated cardiomyopathy. Ultrastructural analyses revealed expanded sarcoplasmic reticulums and protein aggregates that obstructed the adjacent transverse tubules of the mutant cardiomyocytes. Cardiomyocytes from the mutant mice were sensitive to ER stress when treated with tunicamycin and showed a functional defect in the L-type Ca(2+) current. We observed ubiquitinated protein aggregates, enhanced expression of CHOP (a death-related transcriptional factor expressed upon ER stress), and apoptosis in the mutant hearts. These findings suggest that impairment of the KDEL receptor disturbs ER quality control, resulting in accumulation of misfolded proteins in the ER in an in vivo system, and that the dilated cardiomyopathy found in the mutant KDEL receptor transgenic mice is associated with ER stress.

Animals↗

PubMed2004

Synthesis and characterization of stimuli-sensitive hydrogels having a different length of ethylene glycol chains carrying phosphate groups: loading and release of lysozyme.

In order to prepare a polymer matrix capable of loading protein at high density, anionic hydrogels were synthesized by copolymerizing a monomer carrying a pendant phosphate group, methacryloyl-polyoxyethyl phosphate, with N-isopropylacrylamide and N,N'-methylene-bis-acrylamide, and the stumuli-sensitivity of hydrogels was characterized. The number of repeating ethylene glycol units in the phosphate carrying monomer was 1, 2, 5 or 8. Lysozyme bearing a positive net charge was immobilized in the hydrogel through formation of polyelectrolyte complex. It was shown that the amount of complexed lysozyme reached to 1.7 g/g dry gel, when high content of a phosphate-carrying monomer with 5 ethylene glycol units was incorporated into a hydrogel. It was further found that lysozyme complexed with phosphate-carrying network could be released by immersion of the lysozyme/hydrogel composite in a phosphate buffer solution of pH 7.4 owing to the pH-sensitivity of the hydorgel but no lysozyme was released at pH 1.4. The initial rate of lysozyme release was varied depending on the length of the ethylene glycol chains possessed by a network polymer and the content of the phosphate-carrying monomer unit. Lysozyme released from the phosphate-carrying hydrogel was proved to retain enzymatic activity at a level similar to the activity of lysozyme, which had been kept in buffer solution.

Ethylene Glycol↗