Serotonin2B receptor (5-HT2BR) antagonists inhibit cocaine-induced hyperlocomotion independently of changes of accumbal dopamine (DA) release. Given the tight relationship between accumbal DA activity and locomotion, and the inhibitory role of medial prefrontal cortex (mPFC) DA on subcortical DA neurotransmission and DA-dependent behaviors, it has been suggested that the suppressive effect of 5-HT2BR antagonists on cocaine-induced hyperlocomotion may result from an activation of mPFC DA outflow which would subsequently inhibit accumbal DA neurotransmission. Here, we tested this hypothesis by means of the two selective 5-HT2BR antagonists, RS 127445 and LY 266097, using a combination of neurochemical, behavioral and cellular approaches in male rats. The intraperitoneal (i.p.) administration of RS 127445 (0.16 mg/kg) or LY 266097 (0.63 mg/kg) potentiated cocaine (10 mg/kg, i.p.)-induced mPFC DA outflow. The suppressant effect of RS 127445 on cocaine-induced hyperlocomotion was no longer observed in rats with local 6-OHDA lesions in the mPFC. Also, RS 127445 blocked cocaine-induced changes of accumbal glycogen synthase kinase (GSK) 3β phosphorylation, a postsynaptic cellular marker of DA neurotransmission. Finally, in keeping with the location of 5-HT2BRs on GABAergic interneurons in the dorsal raphe nucleus (DRN), the intra-DRN perfusion of the GABAAR antagonist bicuculline (100 μM) prevented the effect of the systemic or local (1 μM, intra-DRN) administration of RS 127445 on cocaine-induced mPFC DA outflow. Likewise, intra-DRN bicuculline injection (0.1 μg/0.2 μl) prevented the effect of the systemic RS 127445 administration on cocaine-induced hyperlocomotion and GSK3β phosphorylation. These results show that DRN 5-HT2BR blockade suppresses cocaine-induced hyperlocomotion by potentiation of cocaine-induced DA outflow in the mPFC and the subsequent inhibition of accumbal DA neurotransmission.Though the numbers remain small, the use of continuous-flow left ventricular assist devices as a bridge to recovery in pediatric patients has been increasing. Select patients may have sufficient myocardial recovery to allow for device removal. Here, we describe a 13-year old requiring left ventricular assist device implantation for myocarditis who was referred for explant of the device after recovery. This was performed via thoracotomy, without cardiopulmonary bypass, using a newly developed titanium recovery plug that is custom designed to fit the HeartMate 3.We report a case of resection of a reconstructed diaphragm with fascia lata after 13 years. A 66-year-old man was diagnosed with a solitary fibrous tumor (SFT) of the pleura. Thirteen years ago, resection for left postoperative pleural dissemination of solitary fibrous tumor with diaphragmatic resection was performed, and left fascia lata was used for diaphragmatic reconstruction. He relapsed and the diaphragm was re-resected and re-reconstructed with right fascia lata. The resected, reconstructed fascia lata had micro-vessels in the fibrous stroma and it was observed that the autologous tissue had become more resistant to infection by obtaining a blood supply. Considerable mediastinal bleeding is a recognized complication after cardiac surgery and may require reexploration and blood product transfusion, both of which are associated with inferior clinical outcomes with greater morbidity and mortality. The aim of this study was to develop a hemostasis checklist, with the intention of reducing mediastinal bleeding after cardiac surgery. A hemostasis checklist was developed with multidisciplinary collaboration. It contains 2 components a series of surgical sites and factors affecting coagulation status. Selleck Dolutegravir The checklist is performed at a time-out before sternal wire insertion. Analysis compared outcomes for patients undergoing cardiac surgery in the 1 year before and 2 years after implementation. A total of 5542 patients underwent surgery during the study. After we implemented the checklist, there was a significant reduction in the reexploration rate (3.5% versus 1.9%; P < .001) and the proportion of patients bleeding greater than 1 L in 12 hours (6.1% versus 2.8ation, which has resulted in a major reduction in blood product consumption. Together, these have resulted in an associated reduction in intensive care unit and hospital length of stay, and a considerable financial savings. This highlights that perioperative bleeding is a preventable complication. Although the Kidney Disease Improving Global Outcomes (KDIGO) criteria are used to define acute kidney injury, the criteria have limitations for including 2 different serum creatinine criteria in stage 1. We hypothesized that there would be differences in clinical outcomes between the 2 subgroups of stage 1 acute kidney injury in patients undergoing cardiac or thoracic aortic surgery. We reviewed 2510 cases. Patients with KDIGO stage 1 were divided into 2 subgroups (stage 1a 0.3 mg/dL or greater of absolute increase in serum creatinine, n= 376; and stage 1b 50% or greater relative increase, n= 365). Propensity score analysis was performed between stage 1a and 1b groups, yielding 240 pairs. We compared the length of hospital stay, the incidence of cardiovascular complications, 5-year all-cause mortality between these subgroups. Overall survival was compared between the subgroups after propensity score matching. We performed sensitivity analysis for Acute Kidney Injury Network (AKIN) criteria. Length of hospital stay and 5-year all-cause mortality were worse in patients with KDIGO stage 1b compared with stage 1a. Five-year patient survival was significantly worse in patients with stage 1b compared with stage 1a after matching (log rank test, P= .002). We found similar results regarding AKIN criteria. Subgroup analysis showed that the significant difference in survival existed only when baseline serum creatinine was 0.8 mg/dL or greater. The KDIGO or AKIN criteria for stage 1 acute kidney injury could be further divided into 2 substages with different severity of clinical outcomes. These modified criteria could give additional prognostic information in patients undergoing cardiac or thoracic aortic surgery.The KDIGO or AKIN criteria for stage 1 acute kidney injury could be further divided into 2 substages with different severity of clinical outcomes. These modified criteria could give additional prognostic information in patients undergoing cardiac or thoracic aortic surgery.