Sexual dimorphism in aipysurine sea snakes (Elapidae, Hydrophiinae).

The transition from terrestrial to aquatic life by hydrophiine elapid snakes modified targets of natural selection and likely affected sexual selection also. Thus, the shift to marine life also might have affected sexual dimorphism. Our measurements of 419 preserved specimens of six species of aipysurine snakes (genera Emydocephalus and Aipysurus) revealed sexual dimorphism in mean adult snout-vent length (SVL), body width relative to SVL, lengths and widths of heads and tails relative to SVL, and eye diameter relative to head length. Females averaged larger than males in all taxa, and generally were wider-bodied with shorter and wider tails and smaller eyes. For other traits, sexual dimorphism varied among species: for example, relative head length ranged from male-biased to female-biased, and head shape (width relative to length) was highly dimorphic only in A. laevis. The transition to marine life may have eliminated male-male combat (reducing selection for large males) and favoured visual rather than pheromone-based mate-searching (favouring larger eyes in males). Variation in head-size dimorphism may reflect intersexual niche partitioning, with different taxa following different trajectories. Repeated evolutionary transitions from terrestrial to aquatic life in snakes provide a powerful opportunity to explore selective forces on sexually dimorphic traits.

Monitoring psychoactive substance use at six European festivals through wastewater and pooled urine analysis.

The consumption of psychoactive substances is considered a growing problem in many communities. Moreover, new psychoactive substances (NPS) designed as (legal) substitutes to traditional illicit drugs are relatively easily available to the public through e-commerce and retail shops, but there is little knowledge regarding the extent and actual use of these substances. This study aims to gain new and complementary information on NPS and traditional illicit drug use at six music festivals across Europe by investigating wastewater and pooled urine. Samples were collected, between 2015 and 2018, at six music festivals across Europe with approximately 465.000 attendees. Wastewater samples were also collected during a period not coinciding with festivals. A wide-scope screening for 197 NPS, six illicit drugs and known metabolites was applied using different chromatography-mass spectrometric strategies. Several illicit drugs and in total 21 different NPS, mainly synthetic cathinones, phenethylamines and tryptamines, were identified in the samples. Ketamine and the traditional illicit drugs, such as amphetamine-type stimulants, cannabis and cocaine were most abundant and/or frequently detected in the samples collected, suggesting a higher use compared to NPS. The analyses of urine and wastewater is quick and a high number of attendees may be monitored anonymously by analysing only a few samples which allows identifying the local profiles of use of different drugs within a wide panel of psychoactive substances. This approach contributes to the development of an efficient surveillance system which can provide timely insight in the trends of NPS and illicit drugs use.

Avoiding stay in the intensive care unit after liver transplantation: a score to assign location of care.

Select liver transplantation (LT) recipients in our program are transferred from operating room to postanesthesia care unit for recovery and extubation with transfer to the ward, completely eliminating an intensive care unit (ICU) stay. Developing a reliable method to determine patients suitable for fast-tracking would be of practical benefit to centers considering this practice. The aim of this study was to create a fast-tracking probability score that could be used to predict successful assignment of care location after LT. Recipient, donor and operative characteristics were assessed for independent association with successful fast-tracking to create a probability score. Of the 1296 LT recipients who met inclusion criteria, 704 (54.3%) were successfully fast-tracked and 592 (45.7%) were directly admitted to the ICU after LT. Based on nine readily available variables at the time of LT, we created a scoring system that classified patients according to the likelihood of being successfully fast-tracked to the surgical ward, with an area under the curve (AUC) of 0.790 (95% CI: 0.765-0.816). This score was validated in an independent group of 372 LT with similar AUC. We describe a score that can be used to predict successful fast-tracking immediately after LT using readily available clinical variables.

Myxoma of the left atrial appendage mimicking thrombus during aortic valve replacement.

Echocardiographic characterization of cardiac masses involving the left atrium are defined by morphologic shape and appearance, site of attachment, type of margins, and presence or absence in the left atrial appendage. Most reports use location in the LAA as strong supportive evidence of thrombus, especially if associated with other suggestive findings (i.e., atrial fibrillation, spontaneous echo contrast, or both). Other reported masses (non-thrombi) in the left atrial appendage are considered extremely rare. We report a case of a patient with coexisting aortic stenosis and atrial fibrillation diagnosed intraoperatively by transesophageal echocardiography with myxoma of the left atrial appendage.

Effects of perioperative analgesic technique on rate of recovery after colon surgery.

BACKGROUND: Choice of perioperative analgesia may affect the rate of recovery of gastrointestinal function and thus duration and cost of hospitalization after colonic surgery. METHODS: Fifty-four patients undergoing partial colectomy surgery were randomized into four groups. All groups received a standardized general anesthetic. Group MB received a preoperative bolus of epidural bupivacaine and morphine followed by an infusion of morphine and bupivacaine. Group M received a preoperative bolus of epidural morphine followed by an infusion of morphine. Group B received a preoperative bolus of bupivacaine followed by an infusion of bupivacaine. Group P received a preoperative bolus of intravenous morphine followed by intravenous patient-controlled morphine postoperatively. All patients participated in a standardized recovery program to minimize the influence of nonanalgesic factors on recovery of gastrointestinal function. All epidural groups were double-blinded. All patients were deemed ready for discharge according to prospectively defined criteria. RESULTS: Groups B and MB reported superior analgesia with activity (P < 0.01). Group M had a greater incidence of pruritus (P < 0.05). Group B had a greater incidence of orthostatic hypotension (P = 0.04). Groups B and MB recovered gastrointestinal function and fulfilled discharge criteria approximately 1.5 days earlier than groups M and P (P < 0.005). CONCLUSIONS: Epidural analgesia with bupivacaine and morphine provided the best balance of analgesia and side effects while accelerating postoperative recovery of gastrointestinal function and time to fulfillment of discharge criteria after colon surgery in relatively healthy patients within the context of a multimodal recovery program.

Improved detection of silent cardiac ischemia with a 12-lead portable microprocessor-driven real-time electrocardiographic monitor.

OBJECTIVE: To compare a microprocessor-driven real-time 12-lead electrocardiographic monitoring device with Holter monitoring for detection of ischemia. DESIGN: Electrocardiographic monitoring was conducted in 110 patients at bed rest or undergoing surgical procedures. MATERIAL AND METHODS: In three groups of patients, simultaneous monitoring with a 12-lead real-time device and a 2-channel Holter system was performed to detect ischemic episodes. The differences in the number of ischemic events and the total time of ischemia revealed by the two devices were analyzed statistically. RESULTS: In patients with coronary artery disease, more ischemic ST-segment shifts were detected by the 12-lead device than by Holter monitoring (44 versus 16 events; P < 0.05). Total time of ischemia was also greater with the 12-lead device (879 versus 273 minutes; P < 0.05). Ischemia was detected by both techniques in 6 patients, only by the 12-lead device in 12, and only by Holter monitoring in 1. Neither device detected ischemia in control subjects. The 12-lead device had an advantage in detecting inferior ischemia, and it identified an additional 13 patients with unstable angina who had changes in T-wave polarity but did not exhibit ST-segment shifts. CONCLUSION: The 12-lead real-time electrocardiographic monitoring device is superior to Holter monitoring in detecting and facilitating real-time identification of myocardial ischemia in patients at bed rest.

Laparoscopic placement of ventriculoperitoneal shunts: preliminary report.

We used a laparoscopic technique for the percutaneous placement of the peritoneal end of cerebrospinal fluid shunts in adult patients with obstructive or normal-pressure hydrocephalus. Concurrent with the initial cranial part of the procedure, pneumoperitoneum is established in a routine fashion, and a video-laparoscope and grasping forceps are inserted into the peritoneal cavity. With use of a pacemaker introducer kit, the peritoneal catheter is placed percutaneously under direct laparoscopic vision through a small upper abdominal incision into the peritoneal cavity. At the completion of the procedure, the patency of the assembled shunt system can be verified by observing free flow of cerebrospinal fluid from the catheter tip as the valve is being pumped. We found that this technique is particularly useful in technically challenging cases--for example, those involving obese patients and those who have undergone multiple abdominal operations. No complications associated with the technique were encountered.

Sodium nitroprusside decreases spinal cord perfusion pressure during descending thoracic aortic cross-clamping in the dog.

Paraplegia is a devastating complication of surgery on the descending thoracic aorta. During surgical repair, the aorta is cross-clamped, and nitroprusside is often used to treat arterial hypertension that can occur above the cross-clamp. Twenty-one dogs were studied to determine the effects of nitroprusside on intraspinal pressures, mean aortic pressures below the cross-clamp, and spinal cord perfusion pressure. Perfusion pressure in spinal radicular arteries originating below the aortic cross-clamp was estimated as the distal aortic pressure minus intraspinal pressure. Nitroprusside was used to return the mean arterial pressure above the cross-clamp to values similar to the pre-cross-clamp levels in 7 dogs. Fourteen animals did not receive sodium nitroprusside. Aortic cross-clamping resulted in small but significant increases in intraspinal pressure (4.3 +/- 0.8 to 7.5 +/- 0.9 mm Hg in non-nitroprusside-treated dogs, and 3.4 +/- 1.0 to 5.6 +/- 1.5 mm Hg in the nitroprusside group before nitroprusside). Nitroprusside caused a further increase in intraspinal pressure (5.6 +/- 1.5 to 8.3 +/- 2.2 mm Hg) and a decrease in aortic pressure below the cross-clamp (26 +/- 5 to 18 +/- 4 mm Hg). The increase in intraspinal pressure and the decrease in aortic pressure below the cross-clamp after nitroprusside resulted in a decrease in spinal cord perfusion pressure from 19 +/- 5 mm Hg to 11 +/- 4 mm Hg. Because nitroprusside decreases spinal cord perfusion pressure and may increase the risk of spinal cord ischemia, the avoidance of large doses of nitroprusside to arbitrarily return mean arterial pressure above the cross-clamp to pre-cross-clamp levels is recommended.

Changes in red cell volume distribution frequency after acute blood loss in goats (Capra hircus).

Red blood cell volume distribution frequency, red cell counts, packed cell volumes and reticulocyte counts were monitored during recovery from severe haemorrhagic anaemia in goats. During the first three weeks after haemorrhage there was a small transient reticulocyte response and the cells produced were significantly larger than normal. These large cells persisted in the circulation as a distinct subpopulation of macrocytes, so that the rate of red cell production during this phase could be measured. The findings suggest that red cell volume distribution measurement is a useful method for retrospective diagnosis of severe haemorrhage and for monitoring recovery. The technique also provided a means of assessing erythropoietic activity in a species in which the reticulocyte response to red cell loss is minimal.

Inflammatory oncotaxis after testing the skin of the cancer patient.

A case is presented in which a patient with Dukes C adenocarcinoma of the sigmoid colon subsequently developed a soft tissue metastasis at the site of a marked delayed type hypersensitivity response to the commonly used skin test antigen Dinitrochlorobenzene (DNCB). A possible cause and the implications of this rare occurrence are discussed. It is concluded that the inflammatory response to DNCB and the subsequent metastasis in this patient were causally related. Physicians who utilize skin testing in cancer patients should be aware of the possibility of "inflammatory oncotaxis" with the development of metastatic lesions in unusual places.

Effect of exogenous lipids and lipoproteins on the primary immune response in vitro.

Cholesterol and certain lipoproteins have regulatory effects on the primary immune responses of murine spleen cells in vitro. The plaque-forming cell (PFC) responses to sheep red blood cells of trinitrophenylated Brucella abortus were studied in complete, lipid-depleted or lipoprotein-reconstituted media. The requirement for exogenous low density lipoprotein (LDL) and its cholesterol moiety was established by comparison of the yield of PFC in cell cultures deprived of lipoproteins with that in cultures to which specific classes of lipoproteins were added. The spleen cells in complete medium yielded about 10-fold greater PFC responses than cells in lipoprotein-deficient medium. In lipoprotein-deficient media, human LDL completely reversed the decreased immune response, LDL lipids and free cholesterol partially reversed the deficit, the human high density lipoproteins and an apo B phospholipid complex were ineffective. In complete media, cholesterol at higher concentrations (100--200 microgram/ml) and LDL lipids partially inhibited the primary immune response. Exogenous cholesterol was required for the in vitro response to both thymus-dependent and thymus-independent antigens.

Failure of amygdalin to arrest B16 melanoma and BW5147 AKR leukemia.

Parenteral amygdalin was found to be ineffective in C57BL/6 mice with B16 melanoma and in AKR mice with BW5147 lymphatic leukemia, in doses ranging from 50 to 5000 mg/kg.

The in vitro reconstitution of a functional rough membrane active in protein synthesis.

Rough endoplasmic reticulum was reconstituted from free polyribosomes and rough membrane stripped from its ribosomes by KCl and puromycin. The reconstituted rough membrane resembled the native rough membrane in the following aspects: RNA/protein ratio, buoyant density in a continuous sucrose gradient, amino acid incorporation capacity and sensitivity towards protein synthesis inhibitors. When the reconstitution was done with double labelled polyribosomes ([32-P] polyribosomes, [3-H] leucine labelling of nascent peptide chain before or after the attachment of the polyribosomes to the membrane) both labels banded together with the reconstituted rough membrane band. Hybrid rough membrane could be formed from rat liver stripped rough membrane and wheat germ ribosomes. This hybrid membrane could translate globin mRNA.