Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery.

BACKGROUND: Despite significant improvements in outcomes following non-obstetric surgery with implementation of enhanced recovery after surgery (ERAS) protocols, development of these protocols for cesarean delivery is lacking. We evaluated implementation of an ERAS protocol for patients undergoing elective cesarean delivery, specifically the effect on opioid consumption, pain scores and length of stay as well as complications and re-admissions. METHODS: An ERAS protocol was developed and implemented for women undergoing elective cesarean delivery. The protocol construction included specific evidence-based items applicable to peripartum management and these were grouped into the three major phases of patient care: antepartum, intrapartum and postpartum. A before-and-after study design was used to compare maternal outcomes. To account for confounders between groups, a propensity matched scoring analysis was used. The primary outcome was postpartum opioid use in mg-morphine equivalents (MMEQ). RESULTS: We included 357 (n=196 before; n=161 after) women who underwent elective cesarean delivery. A significant difference in opioid consumption (28.4 ±â€¯24.1 vs 46.1 ±â€¯37.0 MMEQ, P <0.001) and in per-day postoperative opioid consumption (10.9 ±â€¯8.7 vs 15.1 ±â€¯10.3 MMEQ, P <0.001), lower peak pain scores (7 [5-9] vs 8 [7-9], P=0.007) and a shorter hospital length of stay (2.5 ±â€¯0.5 vs 2.9 ±â€¯1.2 days, P <0.001) were found after the introduction of the ERAS protocol. CONCLUSIONS: Implementation of ERAS protocols for elective cesarean delivery is associated with significant improvements in analgesic and recovery outcomes. These improvements in quality of care suggest ERAS protocols should be considered for elective cesarean delivery.

X-ray reflectivity analysis of titanium dioxide thin films grown by cathodic arc deposition.

TiO2 thin films deposited by a vacuum arc on a glass substrate were characterized by X-ray reflectivity (XRR), X-ray diffraction (XRD), scanning electron microscopy (SEM) and atomic force microscopy (AFM). Several thin films with different amounts of deposited TiO2 mass and different deposition and annealing temperatures were studied. A qualitative analysis of the XRD patterns indicated the presence of the anatase and/or rutile crystalline phases in most of the studied samples. From the analysis of the experimental XRR curves--which exhibited a wide angular range of oscillatory behavior--the thickness, mass density and interface roughness were determined. All XRR patterns were well fitted by modeled curves that assume the presence of a single and homogeneous TiO2 layer over which a very thin H2O layer is adsorbed. The thickest H2O adsorption layers were developed in films with the highest anatase content. Our overall results of the XRR analyses are consistent with those derived from the imaging techniques (SEM and AFM).

[Anxiety disorders]. / Angststörungen.

With a lifetime prevalence of approximately 17% anxiety disorders are among the most common mental disorders worldwide. The disease progression can take a chronic course leading to a considerable impairment of the affected person. The current medical classification list (ICD-10) by the World Health Organization differentiates between agoraphobia, social phobia, specific phobia, panic disorder and generalized anxiety disorder. The etiology is multicausal comprising an interaction of genetic and psychosocial factors. For treatment, psychotherapy, psychopharmacological treatment and a combination of both methods are eligible. Anxiety disorders are often associated with physical illness either as the causative factor or the consequence. In particular, anxiety has been identified as an independent risk factor for cardiovascular disease. Anxiety disorders associated with somatic diseases are often unrecognized, therefore an optimization of diagnostic and treatment strategies is necessary.

[HERV-K-associated carcinogenesis: co-expression of viral and cellular proteins in the development of human germ-cell tumors].

To elucidate the role of some viral and cellular proteins in the occurrence and development of HERV-K-associated germ-cell tumors (GCT), reverse-transcription polymerase chain reaction using specific primers has been employed to study the transcription of the protein Rec HERV-K and the possible interaction of the protein Rec(cORF), that has transforming properties, and the cellular protein PLZF, that is a negative regulator of cell division, in human GCT tissues, in the testicular parenchyma adjacent to a tumor, and in the normal testicular tissues. It was shown that there was expression of Rec(cORF) of mRNA, rather than cellular PLZF in all malignant GCT tissues, this led to the conclusion that no interaction occured between the Rec HERV-K and PLZF proteins in the GCT cells. At the same time co-expression of Rec and PLZF protein was first revealed at the level of transcription in the testicular parenchyma adjacent to a tumor that exhibited carcinoma in situ cells. By taking into account that the protein Rec HERV-K has transforming activity and it is presumed to be Implicated in the development of GCT, the authors discuss a possible role in the Rec HERV-K/HTDV and cellular PLZF interaction in the pathogenesis of GST at the early stages of its genesis.

[Antibodies to stuctural proteins of endogenous retrovirus of the HERV-K/HTDV family as markers of human germ cell tumors].

Human germ cell tumors (GCT) have been found to be closely associated with the expression of HERV-K/HTDV proviruses and most patients with GCT produce antibodies to the major HERV-K/HTDV Gag and Env proteins. The findings have shown a strong association of the level of HERV-K/HTDV antibodies with the clinical course of the disease and therapy success, which makes it possible to confirm the fact that viral protein antibodies may be used as an additional marker of GCT.

Solitary human endogenous retroviruses-K LTRs retain transcriptional activity in vivo, the mode of which is different in different cell types.

Solitary long terminal repeats (LTRs) of human endogenous retroviruses (HERVs), tens of thousands of which are spread all over the genome, contain a variety of potential transcription regulatory elements. Information on transcriptional behavior of individual solitary LTRs, however, is limited. We studied the transcriptional activity of several individual HERV-K LTRs in a variety of tissues and cell lines. The RT-PCR technique targeted at specific amplification of the U3 or U5 regions of individual LTRs together with their unique genomic flanks was used to estimate the content of each region in the transcripts. An unequal abundance of the U3 and U5 regions of the transcripts of the same LTR in different cells and tumors was observed. Each LTR is transcribed differently in different cells or tissues, and transcriptional behavior of different LTRs was different in the same cell line or tissue. The transcriptional status of LTRs varies in response to mitogenic and stress factors and in tumor tissues compared to normal counterparts. The LTRs thus seem to be the subjects of specific transcription regulation. The data obtained indicate that an appreciable fraction of the LTRs retained regulatory potential throughout millions of years of evolution and thus may contribute to the overall transcription regulatory network.

[Expression of endogenous retroviruses of the HERV-K/HTDV family in patient with germinogenic tongue tumors]. / Ekspressiia éndogennykh retrovirusov semeistva HERV-K/HTDV u bol'nykh germinogennym opukholiami iaichka.

Transcription of HERV-K/HTDV proviruses in various morphological forms of GCTs and in normal testicular parenchyma and placenta was studied by RT-PCR with specific primers discriminating type 1 proviruses from type 2 ones. The results indicate that transcription of type 2 HERV-K/HTDV proviruses takes place and mRNA of protein cORF, coded for only by type 2 proviruses, is synthesized in all malignant germinogenic tumors. In normal testicular tissue and placenta type 1 HERV-K/HTDV proviruses are expressed. No expression of HERV-K/HTDV proviruses was detected in nongerminogenic testicular tumors. Since cORF protein possesses transforming activity, its possible role in the pathogenesis of GCTs is discussed. Generation of humoral immune response to structural HERV-K/HTDV proteins in various morphological forms of GCTs confirmed the possibility of using antibodies to structural HERV-K/HTDV proteins as additional markers of GCTs.

Spontaneous spinal epidural hematoma. Another neurologic complication of cocaine?

OBJECTIVES: To describe a patient with a spontaneous spinal epidural hematoma associated with cocaine use and to present issues related to pathogenesis and management of this potential complication. DESIGN: Case report. SETTING: Municipal hospital. CASE: A spontaneous spinal epidural hematoma developed at the thoracic level in a 62-year-old man in association with cocaine use. Clinical, laboratory, and radiologic data are presented. MAIN OUTCOME AND RESULTS: The patient was treated medically with intravenous and oral dexamethasone sodium phosphate. His neurologic status gradually improved during a 12-day hospitalization. CONCLUSION: Cocaine use should be considered in the evaluation of spontaneous spinal epidural hemorrhage.

Roles of juvenile hormone, a brain factor and adipokinetic hormone in regulation of vitellogenin biosynthesis in locusta migratoria.

In maturing adult female migratory locusts, the rises in JH and Vg in the hemolymph are greatly accelerated by enriched feeding; hereafter the JH titer fluctuates with vitellogenic cycles, falling to a low level at the oviposition stage. In fat bodies incubated in vitro, the JH analog, methoprene, and brain extract from well-fed locusts (but not starved locusts) stimulated Vg synthesis synergistically. Repeated washing of fat bodies from oviposition stage locusts led to a rise in Vg synthesis after 4 h, which was prevented by addition of locust adipokinetic hormone (AKH). We conclude that at least three hormonal factors interact in the control of Vg synthesis in locus fat body: JH and a brain factor stimulate, reflecting development and nutrition, while AKH inhibits at the oviposition stage.

Early single-photon emission computed tomography in mild head trauma. A controlled study.

Although computed tomography (CT) and magnetic resonance imaging scans often appear normal after mild head trauma, many patients experience attentional or other cognitive disturbances that are difficult to quantify by neuropsychological testing in the absence of a premorbid profile. Within 2 days of mild head trauma, 14 patients with normal-appearing brain CTs were studied with single-photon emission computed tomography (SPECT). They were compared to 15 normal control subjects and to 12 patients with mild human immunodeficiency virus (HIV) encephalopathy. Ten of 14 head trauma patients were separated from the normal control subjects by both independent readers, blinded to the clinical diagnosis. None of the SPECT results from normal control subjects were "read" as trauma. Trauma could not be differentiated from HIV encephalopathy. The observed percentage agreement between raters was 0.83 (kappa = 0.72). SPECT is more sensitive than CT in detecting brain injury after mild head trauma.

Failure of the tourniquet-twitch test as a diagnostic or screening test for malignant hyperthermia.

We have performed the tourniquet-twitch test of Roberts and Ryan in normal and in malignant hyperthermia (MH) patients and relatives. This test measures the ratio of electrically induced thumb twitches noted after 10 min of ischemia with those noted immediately prior to the ischemia. We found no significant differences in this ratio between normal subjects and those who have had MH reactions, or relatives of such individuals. Furthermore, we have observed no significant differences in tourniquet-twitch ratios between those with normal caffeine-halothane contractures and persons with caffeine-halothane contractures tests positive for MH. These findings do not agree with those of Roberts and Ryan, who reported that tourniquet-twitch ratios were higher in MH patients than in normal patients. We have, however, determined that subjects with tourniquet-twitch ratios greater than or equal to 1.8 are substantially younger than those with tourniquet-twitch ratios less than or equal to 1.0. Therefore we do not believe that the tourniquet-twitch test is useful as a diagnostic, or even as a screening test for MH.

Effect of bromocriptine on plasma catecholamines in normal subjects and prolactin-secreting tumor patients.

The effect of short term bromocriptine (5 mg/day, 5 days) on plasma epinephrine (E), norepinephrine (NE), dopamine (DA) and prolactin (PRL) was studied in 4 normal women and 6 bearing PRL-secreting tumors. When studied on placebo no significant differences were found between controls and patients in E, NE and DA plasma levels. Bromocriptine induced: a 70% decrease in PRL levels in both groups, a significant (p less than 0.05) decrease in plasma NE levels in the control group, no significant change in plasma NE levels in the hyperprolactinemic patients when considered as a group. These results do not indicate that bromocriptine is a useful tool in the diagnosis of defective central dopaminergic regulation since individual responses of the PRL-secreting tumor patients were variable. Nevertheless, the impaired response of the group as a whole may be suggesting an underlying alteration of DA2 receptor activity in these tumor patients.