Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s40981-026-00849-5

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Long QT syndrome (LQTS) refractory to standard treatments, including β-blockers and implantable cardioverter-defibrillators (ICDs), has been indicated for left cardiac sympathetic denervation (LCSD) in Europe and the United States. However, the clinical implementation of LCSD remains rarely performed in Japan as it is not covered by national health insurance. CASE PRESENTATION: A 49-year-old woman with LQTS experienced frequent ICD activations, and β-blocker up-titration was limited due to severe heart failure. As a stellate ganglion block transiently shortened QT interval, LCSD was considered to prevent life-threatening arrhythmic events. Total intravenous anesthesia combined with a left thoracic paravertebral block was used to attenuate sympathetic nervous activation. Thoracoscopic LCSD was performed without arrhythmia or hemodynamic instability. The patient remained stable postoperatively, with no further ICD activations. CONCLUSION: This case demonstrates the safe perioperative management of LCSD for drug-refractory LQTS by incorporating strategies to minimize QT prolongation and suppress malignant arrhythmias.

DOI： 10.1186/s40981-025-00815-7

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Neural circuits are refined by strengthening frequently used or advantaged synapses while eliminating redundant connections. In neonatal mice, cerebellar Purkinje cells (PCs) are initially innervated by multiple climbing fibers (CFs) of similar strength. By postnatal day 7 (P7), one CF, the "winner," is selectively strengthened and begins dendritic translocation by P9, while both "winner" and "loser" CFs temporarily maintain somatic synapses. Although the functional differentiation of CF inputs is well understood, their structural differentiation is less clear. In this study, we examined "winner" CF synapses in dendrites and both "winner" and "loser" synapses in the soma using serial electron microscopy and immunohistochemistry in C57BL/6 mice. We found that "winner" CF synapses, both in the soma and dendrites, developed more complex pre- and postsynaptic structures than "loser" CFs, with an expanded area of postsynaptic density. Additionally, "winner" CF synapses expressed significantly higher levels of AMPA-type glutamate receptors. Notably, only dendritic "winner" synapses showed increased levels of Rab3-interacting molecule RIM, a key presynaptic regulator of neurotransmitter release. These findings reveal the molecular and structural features that enable "winner" CFs to reinforce their synaptic strength and innervation, allowing them to outcompete other inputs during early development.

DOI： 10.1523/JNEUROSCI.2156-24.2025

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

STUDY OBJECTIVE: We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees. DESIGN: A cadaveric observational study and a clinical randomized controlled trial. SETTING: Sapporo Medical University Hospital. PATIENTS: A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers. INTERVENTIONS: Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group). MEASUREMENTS: The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases. MAIN RESULTS: Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87-158] vs 46 s [34-54] s, p < 0.001 and 197 [156-328] vs 341 [303-488] s, p = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263-467] s vs 391 [354-533] s, p = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], p = 0.019). CONCLUSIONS: Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.

DOI： 10.1016/j.jclinane.2024.111740

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND OBJECTIVES: There is still no consensus on the analgesic range and mechanisms of action of modified thoracoabdominal nerve block through perichondrial approach (M-TAPA). This cadaveric study aimed to determine the spread of an injectate following simulated M-TAPA. METHODS: Simulated M-TAPA injections (n=8) were administered on both sides of soft embalmed Thiel cadavers with 25 mL of a saline-soluble dye. Anatomic dissection was performed to document staining (deeply, faintly, or not stained) of the anterior cutaneous branches of the thoracoabdominal nerves and determine the extent of the injectate spread of the dye to the intercostal space in the thoracic cage following a simulated M-TAPA. RESULTS: The median (IQR) dermatome of the stained segmental nerve was T10 (T8-T11) and the median (IQR) number of stained segmental nerves was 3 (4-2). The T9, T10 and T11 segmental nerves were stained in 75%, 100% and 62.5% of simulated M-TAPA, respectively. Conversely, the T8 segmental nerve was stained in only 25% of simulated M-TAPA. No injectate spread of dye to the intercostal space in the thoracic cage was observed in eight simulated injections of M-TAPA. CONCLUSION: Our findings suggest that M-TAPA most likely involves the T9, T10 and T11 segmental nerves and that the local anesthetic may not spread to the intercostal space in the thoracic cage in M-TAPA. Further studies are required to confirm the precise mechanism of action and efficacy of M-TAPA in a large sample of human participants.

DOI： 10.1136/rapm-2022-104275

PubMed

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Total pages：178   Language：Japanese  

CiNii Books

ASIN

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Other Link： https://mol.medicalonline.jp/library/ebooks/detail?id=12191

Total pages：140   Language：Japanese  

CiNii Books

ASIN

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Other Link： https://webview.isho.jp/book/detail/abs/10.18886/9784498056169

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

We describe two cases of chest wall reconstruction using pedicled latissimus dorsi musculocutaneous flap. It is often difficult to place the thoracic epidural catheter because the latissimus dorsi muscle attaches directly to the spinous processes of vertebrae Th5-L5. We therefore administered single-shot epidural analgesics at the level of the Th8/9 epidural space before induction of general anesthesia containing 2 mg of morphine and 4 mL of 0.375% levobupivacaine. In case 1, the patient had minimal post-operative pain throughout hospitalization. Although right atelectasis was noted immediately after surgery, it resolved spontaneously the next day. In case 2, the patient complained of moderate postoperative pain at postoperative day 0 to 1, which gradually resolved. Neither of the patients manifested with critical adverse events secondary to the administration of opioids or epidural procedure. Both the quality of analgesia and patient satisfaction were better than with conventional postoperative analgesic management mainly using continuous intravenous opioids and non-regional anesthesia.

Other Link:： https://search.jamas.or.jp/link/ui/2023178979

DOI： 10.2199/jjsca.43.25

CiNii Research

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J-GLOBAL

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Event date： 2025.9

Language：English   Presentation type：Poster presentation  

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Event date： 2025.3

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2014.10

Language：English   Presentation type：Poster presentation  

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