Driving performance of outpatients achieving discharge criteria after deep sedation is worse than these of their escort-driver: a prospective observational study on simulator.

Background: Achieving post-anesthesia discharge criteria after surgery or outpatient procedures does not mean that the patient has regained all his or her faculties, such as driving. Although mandated by many clinical guidelines, there is no evidence that escort-drivers reduce the risk of traffic accidents after deep sedation. The purpose of this study was to evaluate that hypothesis that driving performance as measured using a driving simulation would not differ between patients who had undergone deep sedation for gastrointestinal endoscopy meeting discharge criteria and their escorts. Methods: This prospective study included patients scheduled for ambulatory gastrointestinal endoscopy under deep propofol sedation (patient group) and their escorts (escort group). Driving performance of escorts and patients (when discharge criteria were met) was assessed using a driving simulator. Results: 30 patients and their escorts were included. Patients crossed the midline significantly more frequently than escorts (3 [2-4] (median [IQR]) and 2 [1-3] crossings, respectively, p=0.015]. Patients were speeding for a higher proportion of the distance traveled compared with escorts (37 (20)% (mean (SD)) and 24 (17)% in patients and escorts, respectively, p = 0.029). There were no significant differences between groups in other simulation parameters. Conclusions: The ability to stay within the traffic lanes, as measured by the number of midline crossing during a simulated driving performance, is impaired in patients who meet discharge criteria after gastrointestinal endoscopy under deep sedation compared with their escorts. This finding does not support a practice of allowing patients to drive themselves home after these procedures.

Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele.

Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14-8.23; P<0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19-3.77; P=0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08-3.47; P=0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10-5.50; P=0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30-0.72; P=0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01-1.04; P<0.001) and age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54-0.69) and a specificity of 0.63 (95% CI, 0.59-0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.

Biomaterial-dependent MMP-2 expression in fibroblasts from patients with recurrent incisional hernias.

With regard to the pathogenesis of recurrent incisional hernia, an impaired connective tissue quality leading to an aberrant scarring process has been proposed. For the matrix metalloproteinase (MMP-2) a pathogenetic involvement in direct inguinal hernia development is reported. With mesh implantation as the gold standard treatment for incisional hernias, the aim of the present study was to investigate the MMP-2 expression in patients with recurrent incisional hernias with and without mesh-materials. In primary fibroblast cultures obtained from skin scars in patients with and without recurrent incisional hernias, MMP-2 synthesis and gene expression were investigated. Furthermore, MMP-2 synthesis and gene expression of fibroblasts were compared after incubation with two different mesh materials: polypropylene and absorbable polyglactin filaments. MMP-2 enzyme activity was determined by semiquantitative zymography and mRNA synthesis by quantitative RT-PCR. Both MMP-2 enzyme activity and mRNA expression were similar in hernia and control fibroblasts in vitro. In control fibroblasts mesh incubation did not significantly affect MMP-2 expression, whereas polypropylene mesh contact of fibroblasts from patients with recurrent incisional hernias led to a major decrease of MMP-2 activity and of mRNA expression. In the absence of biomaterials fibroblasts from recurrent incisional hernia, patients have no alterations of their MMP-2 synthesis compared to control fibroblasts, whereas a specific response was found after biomaterial contact hereby indicating differences in fibroblast phenotype.

Analysis of collagen-interacting proteins in patients with incisional hernias.

BACKGROUND: In recent years a disorder of the collagen metabolism has been suggested for the pathogenesis of abdominal wall hernias. Previous investigations of skin specimens revealed a reduction in the collagen I/III ratio and alterations in matrix metalloproteinases in patients with incisional hernias. We investigated known collagen-interacting proteins to further characterize connective tissue in these patients. PATIENTS AND METHODS: Skin scars from patients with either primary or recurrent incisional and recurrent inguinal hernias, as a subgroup of incisional hernias, were analyzed for overall collagen content and for the distribution of collagen types I and III by crosspolarization microscopy. The expression of collagen type V, collagen receptor discoidin domain receptor 2, matrix metalloproteinase 1, connective tissue-like growth factor, and tenascin was determined by immunohistochemistry. Mature abdominal skin scars from patients without evident hernia served as controls. RESULTS: Patients with recurrent incisional hernia showed lowest ratios of collagen types I to III. Contents of overall collagen and of collagen type V did not differ between the groups. In patients with either primary or recurrent incisional hernias the proportion of collagen receptor discoidin domain receptor 2 positive cells was increased. Matrix metalloproteinase 1 expression was more pronounced in patients with recurrent incisional or inguinal hernias than in controls. Connective tissue-like growth factor was significantly increased in recurrent inguinal hernia patients. The expression of tenascin was notably decreased in all hernia groups. CONCLUSIONS: The observed alterations in the expression of collagen-interacting proteins again indicate the possibility of a fundamental connective tissue disease as the causal factor in the pathogenesis of (recurrent) incisional hernias.

Single-lead VDD-pacing system incorporating high impedance stimulation: a multicentre study.

AIM: The purpose of this study was to evaluate the performance of a new VDD pacing system incorporating a high impedance, single-pass VDD lead. The new lead is a bipolar, steroid-eluting, high impedance lead with a full-ring atrial dipole. METHODS AND RESULTS: The system was implanted in 46 patients with high degree atrioventricular (AV) block. Patients were followed at pre-discharge, 6 weeks, and 3 months. The mean measured P-wave amplitude was stable, with values between 1.18 and 1.43 mV. Atrial sensing was reliable during short-term evaluation at rest and in the sitting position, with AV-synchronous stimulation between 98.79 +/- 6.90% and 99.73 +/- 1.47%. Holter recordings after 6 weeks demonstrated AV-synchronous stimulation in 99.57 1.03% of all P-waves. Lead impedance was stable during follow-up, with mean values between 1000 and 1167 Q. Mean ventricular pacing thresholds (at 0.5 ms) were 0.47 V at implant, 0.49 V at pre-discharge, 0.74 V at 6 weeks, and 0.72 V at 3 months. R-wave amplitude remained stable between 14.9 and 16.7 mV during follow-up. CONCLUSION: This new single-pass VDD lead system provided reliable atrial sensing and stable high impedance stimulation during a 3-month follow-up period.

Alterations of physiological energetics, growth and reproduction of Daphnia magna under toxicant stress.

The study investigates the relationship between changes in physiological energetics of organisms and alterations of growth, development and reproduction of Daphnia magna. Groups of primiparous daphnids were subjected to 8-day exposures to the heavy metals cadmium and copper or to the cationic surfactant, cetyltrimethylammonium bromide (CTAB). Energetic alterations were estimated from the measurement of oxygen consumption and feeding activity which was performed during the last 3 days of the exposure period and from the calculation of simplified carbon balances. The physiological effects were compared to effects on organismal growth and reproduction as obtained from 17-day exposure experiments. Toxicant exposure reduced weight and body length of daphnids indicating an impaired growth rate, but effects on total metabolic costs measured as weight-specific oxygen consumption could not be detected. Net carbon gain of individuals decreased in a concentration-dependent way for the tested chemicals reflecting effects on biomass of daphnids. In the case of cadmium and copper, reproduction ( summation operatormx: number of offspring per female of age x born during the time interval x-1 to x, summarised over the entire exposure period) and the estimate for the intrinsic rate of natural increase, derived from the 17-day exposure-experiment, were affected at concentrations comparable to the effect levels as observed for growth. In the case of copper, the concentrations affecting growth and reproduction were close to the 17-day LC(50) value. CTAB caused a reduction in body length of primiparous daphnids whereas a decrease in the reproductive performance was not apparent. In conclusion, the chemicals did not change metabolic costs of exposed daphnids as it would be expected as a consequence of resistance or repair mechanisms, however, they induced alterations of SFG, growth, reproduction and intrinsic rate of natural increase. These alterations were chemical-specific. The fact that toxicant-related effects on growth and reproduction could not be linked to an elevated metabolic rate of daphnids may indicate that demand side effects occurred early during exposure - before the start of respirometric measurements - or that effects on growth were caused by an altered energy uptake. The results illustrate the importance of trade-off processes in regulating the distribution of energy among growth and reproduction of daphnids.

Discrimination of related transcribed and non-transcribed repetitive DNA sequences from the Y chromosomes of Drosophila hydei and Drosophila eohydei.

The short arm of the Y chromosome of Drosophila hydei carries a single male fertility gene, gene Q, which forms the lampbrush loop pair Nooses. Conflicting observations have been reported concerning the identity of the repetitive DNA sequences that are transcribed in this loop pair. It has been claimed by other investigators that the loop transcripts contain repeats of two distinct, but related families of Y-specific repetitive DNA sequences, ay1 and YsI. We reinvestigated this issue, using as probes single ay1 and YsI repeats which, under stringent conditions, hybridize only to members of their own family. Under non-stringent conditions, both repeats hybridize in situ to Nooses transcripts. However, if hybridization conditions are stringent, only the ay1 probe hybridizes to loop transcripts. Hybridizations to Northern blots of testis RNA confirm these results. Further, YsI repeats are not found the closely related species D. eohydei. We conclude that the YsI repeats are not relevant for the function of fertility gene Q.

Partial reconstruction of the lampbrush loop pair Nooses on the Y chromosome of Drosophila hydei.

We present the analysis of genomic DNA fragments that were isolated as potential segments of the lampbrush loop pair Nooses on the short arm of the Y chromosome of Drosophila hydei. More than 300 kb of DNA were recovered in BamHI lambda and cosmid clone groups. This DNA is composed of the Y-specific ay1 family of repetitive DNA sequences, and of other repetitive DNA sequences, which at least in part are also located elsewhere in the genome (Y-associated sequences). Two additional classes of DNA fragments were obtained from an EcoRI library. One of them consists of ay1 repeats without apparent interspersion, including a total of more than 300 kb of DNA. The other is composed of tandemly repeated YsI sequences, a Y-specific sequence derived from ay1. This class includes more than 400 kb of DNA, which is also not interspersed by other sequences. Our results show that only the ay1 repeats interspersed by Y-associated DNA sequences can represent parts of the 260 kb transcription unit forming the lampbrush loop, whereas the ay1 and YsI repeats without interspersion form separate and nontranscribed clusters of repetitive DNA.