[Outpatient laparoscopic hysterectomy in France: A monocentric randomized trial]. / Hystérectomie cœlioscopique ambulatoire en France : étude randomisée unicentrique.

OBJECTIVE: To demonstrate the feasibility of outpatient laparoscopic hysterectomy using the assessment of post-operative quality of life. METHODS: A prospective randomized single-center trial was performed in France between 2013 and 2016. A total of 42 patients needed laparoscopic hysterectomy was included. Postoperative quality of life was assessed using the standardized Euroquol questionnaire. Patients filled the score before the operation and then on the 3rd and 30th postoperative day. Secondary outcomes were assessment of postoperative pain, overall quality of life, analgesic use, and anxiety. The patients were randomized into two groups, group A with a conventional hospital stay of 2 to 3 days and group B with a short stay and a discharge the day after the intervention. RESULTS: Twenty-one patients were randomized to group A as well as group B. We did not find any significant differences between the two groups in our study either on our primary outcome or in the seconds ones. On day 3, the average of Euroquol score was 0.68 for group A against 0.50 for group B (P=0.05). Likewise, the scores for postoperative pain were similar with 70.6 in group A and 61.8 in group B (P=0.21). The trend was the same for quality of life score or anxiety. CONCLUSION: Our study shows the possibility and the safety of outpatient laparoscopic hysterectomy.

Highly anisotropic electric conductivity in PAN-based carbon nanofibers.

In addition to the chemical and physical properties of nanostructures their successful utilization for applications is strongly triggered by economic aspects. Electrospinning of nanowires from solution followed by subsequent annealing steps is a comparably cheap technique to fabricate conductive carbon nanofibers (CNF) made from polyacrylonitrile (PAN) molecules in large quantities. In this work, we investigated the microscopic properties of the CNFs with diameters of 100-300 nm by means of Raman and x-ray photoelectron spectroscopy and correlated these results with transport measurements done with a 4-tip STM. In particular, we investigated the effect of fiber alignment and knot densities, which can be controlled by applying constant creep due to stress during the stabilization process. The comparison of the conductivity obtained from single CNFs revealed further that the fiber crossings within the ensemble structure act as scattering centers and proofs that the transport is along the surfaces of the CNFs.

Transgenic silencing of neurons in the mammalian brain by expression of the allatostatin receptor (AlstR).

The mammalian brain is an enormously complex set of circuits composed of interconnected neuronal cell types. The analysis of central neural circuits will be greatly served by the ability to turn off specific neuronal cell types while recording from others in intact brains. Because drug delivery cannot be restricted to specific cell types, this can only be achieved by putting "silencer" transgenes under the control of neuron-specific promoters. Towards this end we have created a line of transgenic mice putting the Drosophila allatostatin (AL) neuropeptide receptor (AlstR) under the control of the tetO element, thus enabling its inducible expression when crossed to tet-transactivator lines. Mammals have no endogenous AL or AlstR, but activation of exogenously expressed AlstR in mammalian neurons leads to membrane hyperpolarization via endogenous G-protein-coupled inward rectifier K(+) channels, making the neurons much less likely to fire action potentials. Here we show that this tetO/AlstR line is capable of broadly expressing AlstR mRNA in principal neurons throughout the forebrain when crossed to a commercially-available transactivator line. We electrophysiologically characterize this cross in hippocampal slices, demonstrating that bath application of AL leads to hyperpolarization of CA1 pyramidal neurons, making them refractory to the induction of action potentials by injected current. Finally, we demonstrate the ability of AL application to silence the sound-evoked spiking responses of auditory cortical neurons in intact brains of AlstR/tetO transgenic mice. When crossed to other transactivator lines expressing in defined neuronal cell types, this AlstR/tetO line should prove a very useful tool for the analysis of intact central neural circuits.

Balanced tone-evoked synaptic excitation and inhibition in mouse auditory cortex.

The recent characterization of excitatory and inhibitory synaptic receptive fields in rat auditory cortex laid the basis for further investigation of the roles of synaptic excitation and inhibition in cortical computation and plasticity. The mouse is an increasingly important model system because of the wide range of genetic tools available for it. Here we present the first in vivo whole-cell voltage-clamp measurements of synaptic excitation and inhibition in the mouse cortex. We find that a substantial population of auditory cortical neurons receives balanced synaptic excitation and inhibition, whose amplitude ratios and relative time courses remain approximately constant across tone frequency. We conclude that the synaptic mechanisms underlying tone-evoked auditory cortical responses in mice closely resemble those in rats, supporting the mouse as a suitable model for synaptic processing in auditory cortex.

[Acute coronary syndrome in the elderly. Optimal revascularisation strategies]. / Das akute Koronarsyndrom im höheren Lebensalter. Optimale Revaskularisationsstrategien.

Although there are accepted guidelines for treatment of acute coronary syndromes and ST-segment elevation myocardial infarction, elderly patients may have a variety of conditions that can complicate the decision making process about the best therapy. For fear of adverse effects many elderly patients do not receive potentially lifesaving treatments, such as percutaneous coronary intervention or thrombolytic therapy. Appropriate revascularisation therapy also often will be received too late in the course of the infarct, when irreversible myocardial damage has occurred. Many studies, however, show that older patients will benefit substantially from these therapies and early treatment improves outcome in this population, despite a higher risk of complications. In this review, the evidence regarding medical and revascularisation therapies in acute coronary syndromes in the elderly is critically examined.

Antibody levels against Chlamydia pneumoniae and outcome of roxithromycin therapy in patients with acute myocardial infarction. Results from a sub-study of the randomised Antibiotic Therapy in Acute Myocardial Infarction (ANTIBIO) trial.

BACKGROUND: Results of studies concerning prevention of cardiovascular disease by treatment with macrolide antibiotics targeting C. pneumoniae infection are still controversial. This study describes the results of different tests for infection with C. pneumoniae as well as the effect of treatment with roxithromycin in patients with acute myocardial infarction (AMI) in relation to their serostatus against C. pneumoniae. METHODS: We analysed blood of 160 patients who came from the ANTIBIOtic therapy after an AMI ( ANTIBIO-) study, a prospective, randomised, placebo-controlled, double-blind study to investigate the effect of roxithromycin 300 mg/OD for 6 weeks in patients with an AMI. Anti- Chlamydia IgG-, IgA-, and IgM-antibodies of these patients were analysed by means of different test systems. RESULTS: There was a good correlation between the two IgG and IgA methods (r = 0.900, p < 0.001 and r = 0.878, p < 0.001, respectively), but marked differences in the prevalence of positive tests. This resulted in only moderate concordance values, as expressed by the Kappa coefficients, for IgG kappa = 0.611 (95% CI = 0.498-0.724, p < 0.001) and for IgA kappa = 0.431 (95% CI: 0.322-0.540, p < 0.001). No significant association between positive C. pneumonia titers and the combined clinical endpoint during the 12 month follow-up could be found. In all test systems used, patients with positive anti- C. pneumoniae titers did not benefit from roxithromycin therapy (p = ns). CONCLUSION: Depending on the test system used, there are large differences in the prevalence of anti- C. pneumoniae seropositive patients. Clinical events during the 12 month follow-up after AMI did not depend on serostatus against C. pneumoniae and treatment with roxithromycin did not influence these events, independently of the serostatus against C. pneumoniae. However, the power of this subgroup analysis was low to detect small but significant differences.

Changes of QT dispersion in patients with coronary artery disease dependent on different methods of stress induction.

BACKGROUND: Episodes of stress-induced myocardial ischemia in patients with coronary artery disease (CAD) may cause increases of QT dispersion (QTd). HYPOTHESIS: Aim of this study was to analyze the effect of increasing heart rates on QTd and to compare the effect of different methods of stress induction in patients with varying degrees of CAD when estimating QTd. METHODS: We studied 58 patients, 22 with prior myocardial infarction (MI), 25 without MI or wall motion disturbances at rest, and 11 patients without evidence of CAD. Prior to coronary angiography, standard 12-lead ECGs were obtained at rest as well as during dynamic exercise and pharmacologic stress using arbutamine simultaneously with echocardiography. QTd was determined at each stress level by subtracting minimal from maximal QT interval duration. RESULTS: QTd values at rest were not consistently higher in the patients with CAD. At maximal heart rate, QTd was statistically significantly higher in patients with CAD with a better discrimination between groups for pharmacologic stress (p < 0.005 for exercise, p < 0.0001 for arbutamine). Patients after MI had higher QTd values under all conditions than did the groups without MI. As in patients with CAD, the values of this group changed more radically as a result of pharmacologic stress. CONCLUSION: Patients with CAD can be identified on the basis of QTd under stress. These changes were not as marked in patients with MI as their rest values were already increased. Overall, drug-induced stress produced greater differences than dynamic exercise, suggesting that the ischemic threshold might be lower in the former.