Effect of atropine and propofol on the minimum anaesthetic concentration of isoflurane in the freshwater turtle Trachemys scripta (yellow-bellied slider).

OBJECTIVE: To determine if the administration of atropine would reduce the measured minimum anaesthetic concentration of isoflurane (MACisoflurane) in freshwater turtles - the yellow-bellied slider (Trachemys scripta scripta). STUDY DESIGN: Paired, blinded, randomized, prospective studies of 1) the effect of atropine in isoflurane anaesthetized freshwater turtles (T. scripta scripta) and 2) the effect of atropine in yellow-bellied sliders in which anaesthesia was induced with propofol and maintained with isoflurane. ANIMALS: T. scripta scripta (n = 8), female, adult. METHODS: Atropine (2 mg kg-1) or an isovolumetric control injection of saline was administered intraperitoneally 15 minutes prior to induction of anaesthesia with isoflurane. Individual MACisoflurane was then determined by end-tidal gas analysis in a bracketing design by an experimenter blinded to the administered drug, with a 2 week washout period. The experiment was repeated, with atropine (2 mg kg-1) or saline administered intravascularly in combination with propofol for anaesthetic induction. Linear mixed modelling was used to determine the effects of atropine and propofol on the individual MACisoflurane. Data are presented as mean ± standard deviation. RESULTS: Premedication with atropine significantly reduced MACisoflurane (p = 0.0039). In isoflurane-induced T. scripta scripta, MACisoflurane decreased from 4.2 ± 0.4% to 3.3 ± 0.8% when atropine had been administered. Propofol as an induction agent had a MAC-sparing effect (p < 0.001) such that MACisoflurane following propofol and a control injection of saline was 2.3 ± 1.0%, which decreased further to 1.5 ± 0.8% when propofol was combined with atropine. CONCLUSIONS AND CLINICAL RELEVANCE: Atropine, presumably by inhibiting parasympathetically mediated pulmonary artery constriction, decreases right-to-left cardiac shunting and the MACisoflurane in yellow-bellied sliders, and thereby may facilitate control of inhalant anaesthesia. Propofol can be used for induction of anaesthesia and reduces the required concentration of inhaled anaesthesia assessed 1.5 hours following induction.

Work ability in rheumatoid arthritis patients: a register study on the prospective risk of exclusion and probability of returning to work.

Objectives: The aim was to study work ability in patients with RA compared with the general population by investigating the rates and risks of long-term sickness absence, unemployment and disability pension, and the chance of returning to work and the changes in these risks over time (1994-2011). Methods: This was a cohort study with up to 17 years of follow-up (mean 6.95 years/person) including 6677 RA patients of working age (identified in the nationwide DANBIO registry) and 56 955 matched controls from the general population. A multi-state model was used to analyse all shifts between the work-related states (long-term sickness absence, unemployment and disability pension, as well as the chance of returning to work) and calculate hazard rates (HRs). Analyses were stratified by disease duration and controlled for socio-demographic factors, physical job exposure and somatic and psychiatric co-morbidities. Results: RA patients had increased risk of long-term sickness absence (e.g. early RA: HR = 4.00, 95% CI: 3.64, 4.30) and disability pension (e.g. established RA: HR = 2.75, 95% CI: 2.54, 2.98) relative to controls. From 1994-99 to 2006-11, a decrease in the effect of established RA was observed [long-term sickness absence: from HR = 2.25 (95% CI: 1.99, 2.54) to 1.63 (95% CI: 1.51, 1.75); and disability pension: from HR = 3.49 (95% CI: 2.83, 4.32) to 2.40 (95% CI: 2.15, 2.69)]. RA patients had a lower chance of returning to work from long-term sickness absence or unemployment (HR = 0.60, HR=0.80), and this did not change over time. Conclusion: RA patients remain at high risk for long-term sickness absence and disability pension, despite a positive development between 1996-99 and 2006-11. Returning to work after sick leave or unemployment remains a challenge for RA patients.

Physiological and molecular mechanisms of inorganic phosphate handling in the toad Bufo bufo.

The aim of this study was to elucidate mechanisms of P(i) handling in toads (Bufo bufo). We introduced toads to experimental solutions of various [P(i)] and high P(i) diets and measured urine and lymph [P(i)]. Both lymph and urine [P(i)] increased with increasing P(i) loads, indicating P(i) absorption across skin and intestine. An initial fragment of a NaPi-II type transporter was amplified from kidney, and the full-length sequence was obtained. The protein showed the molecular hallmarks of NaPi-IIb transporters. When expressed in Xenopus oocytes the clone showed unusual pH dependence, but apparent affinity constants for P(i) and Na(+) were in the range of other NaPi-II transporters. Expression profiling showed that the transporter was present in skin, intestine and kidney. Reverse transcription-polymerase chain reaction assays on dissected renal tubules indicated expression in the collecting duct system. Collecting tubules and ducts were isolated, perfused and microelectrode recordings showed electrogenic P(i) transport in apical and basolateral membranes. Taken together, our results show that P(i) is handled by intestine, kidney and skin. The presently cloned NaPi-IIb is a likely candidate involved in P(i) absorption across these epithelia. In addition, electrophysiological experiments suggest that the collecting duct system plays an important role in P(i) homeostasis.