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Background Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N‐methyl‐d‐aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat. Methods We searched MEDLINE, EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non‐analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random‐effects model. Results We included 41 randomized controlled trials involving 3784 participants. Topical ketamine was associated with reduced incidence of sore throat at 24 hours postoperatively compared to non‐analgesic methods (risk ratio, 0.45; 95% CI, 0.37‐0.54; P < .001). We found significant publication bias, but the results remained unchanged with a trim‐and‐fill analysis. Trial sequential analysis (TSA) suggested that the efficacy of topical ketamine was adequate (TSA‐adjusted 95% CI, 0.33‐0.56). The GRADE quality for this evidence was moderate. Topical ketamine was inferior to a combination of nebulized ketamine and clonidine in preventing postoperative sore throat. Conclusions Preoperative, topical ketamine application may be more effective than non‐analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.

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Background: Cardiovascular dysfunction is the main manifestation of b-blocker intoxication; however, respiratory manifestations have rarely been reported. Case Presentation: A 41-year-old man, who had ingested 300 mg carvedilol in a suicide attempt, was transferred to our emergency department. The patient had wheezing on arrival; however, he had no known history of bronchial asthma. In the absence of signs of heart failure, we gave the patient inhaled procaterol, a short-acting b2 agonist. The wheezing disappeared approximately 60 h after carvedilol ingestion and did not recur thereafter. Conclusion: We report a case of wheezing caused by carvedilol intoxication. Although rare, clinicians should recognize that wheezing or bronchospasm can develop following b-blocker intoxication, for which a short-acting b2 agonist could be indicated.

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CD8 + T cells, dendritic cells and macrophages were increased in 4 of 6 patients post LMB-100 treatments. The enhanced anti-tumor effects with LMB-100/aPD1 combination were also observed in the PBMC humanized mouse model transplanted with the tumor cells derived the patient with complete response. In the 531LN2-hMSLN mouse syngeneic model, tumor growth was significantly inhibited by LMB-100/ aPD-1 treatments than either monotherapy and overall survival was improved in the combination treated mice. The median tumor volume was 865mm 3 , 420mm 3 , 277mm 3 , and 65mm 3 in untreated, LMB-100treated, aPD-1-treated, and combination treated groups respectively on day 34 post tumor inoculation (p<0.001). We observed increased expression of genes related to CD8 + T cells and antigen presentation in tumors treated with LMB-100/aPD-1 compared to either agent alone. Flow cytometry confirmed the CD8 + T cells increase in LMB-100 /aPD-1 treated 531LN2-hMSLN tumor. Depletion of CD8 + T cells significantly negated the anti-tumor benefits in LMB-100/aPD-1-treated mice. Conclusion: Pembrolizumab following LMB-100 is associated with durable tumor response in mesothelioma patients as well as pre-clinical models of mesothelioma and lung cancer. This combination is currently being evaluated in a prospective clinical trial in patients with mesothelioma (clinicaltrials.gov # NCT03644550).

要約： 【目的】 本研究の目的は，外傷後の QOL の経時的変化を調査し，それに影響を与える因 子を明らかにすることである。 【方法】 2013 年 9 月から 2015 年 9 月までに当院に入院した外傷 患者を対象とし，SF-36 スコアの推移を 1 年間フォローアップした。プライマリアウトカムを 退院後 1 年間の SF-36 の身体機能スコアと心の健康スコアとし，それに影響を与える因子を linear mixed-effects model を用いて検討した。 【結果】 対象患者は 129 人であった。下肢外傷， 譫妄，同居家族ありが身体機能スコアを，既婚が心の健康スコアを低下させていた。Injury severity score (ISS) ，手術の有無は影響を及ぼさなかった。 【結論】 受傷 12ヵ月経過しても健 康関連 QOL は国民標準値に至らなかった。社会背景や受傷部位が長期的な QOL に強く影響を 及ぼしていた。