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Masaki Todani,
Motoki Fujita,
Ryosuke Tsuruta, Takashi Nakahara,
Takeshi Yagi,
Chiyomi Oshima,
Masatsugu Igarashi,
Koshiro Takahashi,
Shunji Kasaoka,
Makoto Yuasa,
Tsuyoshi Maekawa
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ABSTRACT: Abstract The study was performed to demonstrate superoxide radical (O(2).-) generation, systemic inflammation and liver injury caused by heatstroke and to reveal suppressive effects of moderate hypothermia. Heatstroke was defined as achieving pharyngeal temperature of 40 degrees C with arterial pressure reduction. Heatstroke rats were divided to four groups by the temperature after the onset; 40 degrees C, 37 degrees C, 32 degrees C and sham-treated with 37 degrees C. O(2).- current was measured continuously in the right atrium using an electrochemical O(2).- sensor. The O(2).- current increased in all groups except for the sham-treated group during the induction. After the onset of heatstroke, the O(2).- current was suppressed with temperature-dependency. Plasma and liver high-mobility group box 1, intercellular adhesion molecule-1, plasma aspartate aminotransferase and alanine aminotransferase were also suppressed with the suppression of O(2).- generation. Therefore, excessive O(2).- generation might be a key factor in heatstroke and the suppression with moderate hypothermia would be a therapeutic modality.
Free radical research 04/2010; 44(4):462-72. · 2.22 Impact Factor
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Yasutaka Koga,
Motoki Fujita,
Ryosuke Tsuruta,
Yoichi Koda, Takashi Nakahara,
Takeshi Yagi,
Tetsuya Aoki,
Chihiro Kobayashi,
Tomonori Izumi,
Shunji Kasaoka,
Makoto Yuasa,
Tsuyoshi Maekawa
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ABSTRACT: To investigate the effects of ulinastatin, a urinary trypsin inhibitor (UTI), on jugular venous superoxide radical (O₂⁻·) generation, oxidative stress, early inflammation, and endothelial activation in forebrain ischemia/reperfusion (FBI/R) rats.
Fourteen Wistar rats were allocated to a control group (n = 7) and a UTI group (n = 7). Throughout the experiments, O₂⁻· in the jugular vein was measured by the produced current using a novel electrochemical O₂⁻· sensor. Forebrain ischemia was induced by occlusion of the bilateral common caroti darteries with hemorrhagic hypotension for 20 min, followed by reperfusion. In the UTI group, UTI (5 U/g) was administered intravenously immediately after reperfusion. At 60 min after reperfusion, plasma and brain were harvested, and malondialdehyde, high-mobility group box 1 (HMGB1) protein, and intercellular adhesion molecule-1 (ICAM-1) were measured.
O₂⁻· current increased gradually during forebrain ischemia in both groups. The current increased markedly in the control group immediately after reperfusion but was significantly attenuated in the UTI group after reperfusion. Brain and plasma malondialdehyde, HMGB1, and ICAM-1 were significantly attenuated in the UTI group compared with those in the control group, except for brain HMGB1, which was associated with the amount of O₂⁻· generated during FBI/R.
UTI suppressed jugular venous O₂⁻· generation, oxidative stress, early inflammation, and endothelial activation in FBI/R rats. Therefore, UTI might be a useful agent for the therapy of the cerebral ischemia/reperfusion pathophysiology.
Neurological Research 03/2010; 32(9):925-32. · 1.52 Impact Factor
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ABSTRACT: High-mobility group box 1 protein (HMGB1) is a nuclear factor that is a potent proinflammatory mediator, and may trigger increases in other inflammatory cytokines. The inflammatory cytokines in the cerebrospinal fluid (CSF) of patients with subarachnoid hemorrhage (SAH) have been reported previously, but HMGB1 has not. In this study, we measured HMGB1 and the inflammatory cytokines in the CSF of patients with SAH.
CSF samples were collected on days 3, 7, and 14 from the drainage tubes of the postaneurysm clips of 39 patients with SAH. HMGB1, interleukin-6 (IL-6), IL-8, and tumor necrosis factor alpha (TNF-alpha) were measured in the CSF, and compared between the patients with favorable (good recovery and moderate disability) and unfavorable outcomes (severe disability, vegetative state, and death) at 3 months.
In the unfavorable outcome group, HMGB1 (P = 0.017), IL-6 (P = 0.003), IL-8 (P = 0.041), and TNF-alpha (P = 0.002) were significantly increased. HMGB1 correlated significantly with IL-6, IL-8, and TNF-alpha (R = 0.672, 0.421, and 0.697, respectively).
HMGB1 was increased in the CSF of SAH patients with an unfavorable outcome, as were the other cytokines. These results suggest that HMGB1 and cytokines are related to the brain damage observed after SAH. HMGB1 might play a key role in the inflammatory response in the CNS of SAH patients.
Neurocritical Care 09/2009; 11(3):362-8. · 2.47 Impact Factor
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ABSTRACT: Heart rate variability (HRV) is widely used to evaluate autonomic nervous function; however, real-time monitoring of HRV has rarely been attempted in the intensive care unit (ICU). We report our experience in performing real-time monitoring of HRV in our ICU.
We investigated 10 critically ill patients on total ventilatory support. Heart rate variability analysis was performed using the MemCalc system, which is a noninvasive, real-time analysis system. The low-frequency (LF) component of HRV reflects sympathetic and parasympathetic modulation, whereas the high-frequency (HF) component mainly reflects parasympathetic modulation. The LF/HF ratio represents a measure of sympathetic/parasympathetic balance.
The HRV parameters for patients breathing spontaneously after extubation were significantly higher than those for patients on total ventilatory support. These findings suggest that mechanical ventilation under sedation may reduce autonomic nervous function in critically ill patients. In a representative case with septic shock, systolic blood pressure and LF/HF ratio showed a significant increase after intravenous infusion of epinephrine and then the HF component showed a significant increase due to vagal reflex.
The MemCalc system is practicable for real-time monitoring of HRV in the ICU. Heart rate variability parameters may offer useful information in the management of critically ill patients.
Journal of critical care 09/2009; 25(2):313-6. · 2.13 Impact Factor
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ABSTRACT: A 37-year-old man was transferred to our emergency center because of heat stroke with circulatory shock. Despite aggressive body cooling, massive intravenous transfusion, and supply of inotropic agents, shock was persistent. To evaluate adrenal function, an adrenocorticotropic hormone stimulation test was conducted and the results indicated that he had critical illness-related corticosteroid insufficiency (CIRCI) as a result of adrenal insufficiency. Continuous hydorocortisone administration was started and he recovered from shock within a few hours. He was discharged on the thirty-seventh hospital day. Serum cortisol and cytokine concentrations were initially high and the cytokines decreased subsequent to hydrocortisone administration. It is speculated that CIRCI is an exacerbating factor in heat stroke, and hydrocortisone may be a potential therapeutic approach in such patients.
Journal of Anesthesia 02/2009; 23(2):266-9. · 0.83 Impact Factor
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ABSTRACT: Candida dubliniensis is rare and very similar to C. albicans. To date, detailed clinical reports on C. dubuliniensis recovered from an immunocompromised patient have not been described in Japan. A 71-year-old man with end-stage liver cirrhosis had been treated for suppurative omarthritis due to methicillin-resistant Staphylococcus aureus (MRSA). Anti-MRSA agents and broad-spectrum antimicrobials but no antifungal agents had been administrated. C. dubliniensis, isolated from the sputum, was eliminated by selective digestive decontamination and supportive therapy. This case emphasizes the need to recognize this emerging Candida sp., C. dubliniensis in cases of opportunistic infection.
Internal Medicine 02/2007; 46(9):597-600. · 0.94 Impact Factor
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ABSTRACT: To investigate the prevalence and associated factors of delirium in critically ill patients during an intensive care unit (ICU) stay.
We investigated 103 of 172 patients admitted consecutively to a university-based 20-bed ICU in a 3-month period. Six ICU physicians, who were familiar with the Confusion Assessment Method for the ICU (CAM-ICU), assessed patient delirium daily. Patient demographics, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation and maximum serum C-reactive protein (max-CRP) level during the ICU stay (max-CRP) were compared between patients who developed delirium and those who did not.
Twenty-one (20%) of 103 patients and 13 (76%) of 17 mechanically ventilated patients developed delirium. APACHE II scores and max-CRP were significantly higher in patients who experienced delirium than in those who did not (P<.001). Use of a mechanical ventilator (P=.002), max-CRP (P=.032) and length of ICU stay (P=.043) were identified as independent associations for delirium development.
The prevalence of delirium was 20% in ICU patients and 80% in ventilated patients in a Japanese ICU.
General hospital psychiatry 32(6):607-11. · 2.67 Impact Factor
