[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.

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.

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.

Clinical efficacy and electrophysiologic effects of intravenous and oral encainide in patients with accessory atrioventricular pathways and supraventricular arrhythmias.

The electrophysiologic effects and clinical efficacy of intravenous (i.v.) and oral encainide were studied in 13 patients with accessory atrioventricular (AV) pathways (7 overt, 1 intermittent and 5 concealed) and drug-resistant supraventricular arrhythmias (5 paroxysmal atrial fibrillation, 1 atrial tachycardia and 7 with orthodromic circus movement tachycardia). Previously, therapy had failed with a mean of 3 conventional antiarrhythmic agents. In 5 patients, amiodarone administration had also been unsuccessful. All patients underwent programmed electrical stimulation of the heart before and after 1.5 mg/kg of i.v. encainide. Seven patients were restudied during oral encainide therapy (mean 155.8 +/- 54.2 mg/day) 3 days to 6 weeks (average 21 days) later. Anterograde conduction over the accessory AV pathway blocked in 4 of 7 patients after i.v. encainide. Oral encainide blocked anterograde conduction over the accessory pathway or prolonged the refractory period of the accessory pathway in 3 of 4 patients. This change in anterograde conduction was independent of the predrug value for the anterograde refractory period of the accessory AV pathway. Intravenous and oral encainide had minimal effects on retrograde conduction over the accessory AV pathway. The clinical effect of oral encainide was studied in 12 patients. Four patients responded to oral encainide and have been free of arrhythmia or side effects for 2 to 20 months (average 10.5). Encainide failed to prevent the clinical arrhythmia in 2 patients. In 4 patients with atrial arrhythmias, circus movement tachycardia developed during oral encainide therapy. In 1 patient the frequency of circus movement tachycardia increased with oral encainide treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Ventilatory and hyperkalemic responses to incremental exercise after propranolol treatment.

The purpose of the present study was to examine the relationship of plasma potassium (K+) and minute ventilation (VE) during incremental cycling (20 W/2 min) under conditions of beta-adrenergic blockade (80 mg of propranolol) and placebo in six untrained male subjects. No significant differences existed between treatments in O2 uptake, CO2 production, blood lactate, pH, or VE during the submaximal work stages of incremental exercise common to both treatments (20-220 W). During exercise with beta-blockade, plasma K+ concentrations were found to be significantly elevated compared with control levels at every work stage except 20 W. Significant positive correlations between VE and plasma K+ were found during both beta-blockade (r = 0.99) and control conditions (r = 1.00). Although the high correlation between VE and K+ was not altered with beta-blockade, propranolol treatment resulted in a significant reduction in the slope of this relationship during incremental exercise (P < 0.01). These findings suggest that 1) beta-blockade decreases the VE-K+ relationship observed during exercise and 2) K+ stimulation of muscle afferents is not an important signal in the control of exercise ventilation.

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.

Skin testing for chymopapain allergy in chemonucleolysis.

Chemonucleolysis with chymopapain (Chymodiactin, Discase) bears the risk of unpredictable anaphylactic reactions. The rate of anaphylaxis is reported to be between 0.35% and 1.5%. Serological in vitro tests such as RAST (radio-allergo-sorbent test) or ChymoFAST (fluorescent allergo-sorbent test) are used to determine increased specific immunoglobulin E antibody titers against chymopapain in patients submitted to chemonucleolysis. Alternatively, skin prick tests have also been applied in clinical trials. A skin prick test including Discase, Chymodiactin, and Solutrast 250 M, which is a radiopaque dye, has been performed in a total of 257 patients; 222 patients were tested before, and 35 patients were tested after chemonucleolysis with chymopapain. From the group tested before chemonucleolysis, 2.3%-3.3% had positive skin tests. After chemonucleolysis, the overall allergy rate to chymopapain increased to 42.9%. Positive skin reactions seem to be time-dependent--between the 3rd and 12th weeks after chemonucleolysis, more than 70% of the patients had positive skin tests. There was no correlation between a history of previous allergy and the skin test result. Patients with positive skin tests should be excluded from chemonucleolysis. This procedure increases the safety for patients submitted to chemonucleolysis. No anaphylactic reaction has been observed hitherto in more than 350 patients who were treated with the intradiskal injection of chymopapain after a negative skin prick test.

[The influence of drug liberation from drug forms on local therapy of infected bone cavities]. / Untersuchungen zur Beeinflussung der Wirkstoffliberation aus Arzneiformen zur lokalen Therapie infizierter Knochenhöhlen.

With regard to an optimum local pharmaco-therapy in infected bone cavities, in vitro examinations by means of a flow model based on the half-change method had been performed to liberate Gentamycin from globular embeddings in polymethylmethacrylate. The Gentamycin had been determined in a micro-biological manner. The release behaviour of the polymere carrier could be controlled by adding Polyethylenglycol 400 as softener or butane dioldimethacrylate as wettener. Adding 20 vol.-% of Polyethylenglycol 400, the Gentamycin release could be increased to the 8-fold, whereas the addition of 5 vol.-% of butane dioldimethacrylate resulted in a decrease amounting to 7/8 exit value.

[Cardiac findings in alcoholic liver disease]. / Kardiale Befunde bei alkoholischer Lebererkrankung.

In a prospective study 53 patients with alcohol-induced liver disease (fatty liver in 27, cirrhosis in 26) were studied clinically and with non-invasive techniques (electrocardiogram, systolic time intervals, M-mode echocardiography, upright bicycle stress test) to detect a possible cardiac involvement. Mean daily alcohol consumption was comparable in both groups (136 g/day over 16 years vs 124 g/day over 14 years). 15 to 41% of patients (more patients with fatty liver) complaint of angina pectoris and dyspnea at exercise or had palpitations. Echocardiography and systolic time intervals demonstrated in both groups (in patients with cirrhosis despite of a more intensive therapy with digitalis and diuretics) a marked enlargement of left ventricular dimensions with a significant (p less than 0.05) degree of dysfunction (PEP/LVET). Electrocardiography showed abnormalities in 26 to 44% of patients: signs of right ventricular enlargement in 26% of patients with fatty liver, and a prolongation of myocardial repolarisation (QTc) in 44% of patients with cirrhosis. Patients with alcohol-induced liver disease deserve more attention of their cardiac complaints, clinical and functional findings.

[Clinical experience with combined automatic implantable cardioverter-defibrillator and pacemaker systems]. / Klinische Erfahrungen einer kombinierten antitachykarden und antibradykarden Herzschrittmachertherapie.

Patients who need an implantable Cardioverter/Defibrillator (ICD) often require a cardiac pacemaker (PM) to treat underlying symptomatic bradycardia. In some cases the simultaneous therapy has caused interactions between the systems with defaults on both sides.Four patients with an ICD of the newer generation received a single or dual chamber pacemaker system. In all cases bipolar pacemaker electrodes were used. They were positioned together with the ICD-electrode in the right ventricular apex without regard to the distance between them. In order to exclude possible interference between systems special tests were performed during the operative procedure with respect to the system implanted first. In a follow-up period of 4-14 months all patients had episodes of ventricular tachycardia or ventricular fibrillation that were terminated successfully. Two patients with a bradycardia related arrhythmia after shock delivery showed a correct pacemaker stimulation. Subsequent to the start of pacemaker therapy improvement in stress capacity could be documented, partly on the basis of echocardiography.Combined ICD and PM therapy can thus be generally regarded as compatible. For AV-sequential pacing at least three electrodes and two aggregates are necessary. The development of an ICD with the option for a dual-chamber stimulation would simplify the therapy, along with a greater acceptance on part of the patients.

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.

[QT time and the ventricular refractory period in programmed electrical stimulation of the heart in patients with ventricular and supraventricular tachycardias--effect of sotalol]. / QT-Zeit und ventrikuläre Refraktärzeit während programmierter elektrischer Stimulation des Herzens bei Patienten mit ventrikulären und supraventrikulären Tachykardien--Einfluss von Sotalol.

The QT-interval in the surface electrocardiogram (usually lead II) and the effective refractory period of the right ventricle (ERP-V) were investigated in 16 patients with documented supraventricular tachycardia (SVT) and in 18 patients with documented ventricular tachycardia (VT) during basic pacing (QT1) and programmed stimulation of the right ventricular apex (QT2) (single-test stimulation at 3 different rates, BCL: 600 ms, 500 ms, 430 ms). The effects of intravenous and oral Sotalol were analysed in the SVT-group. An increase in heart rate was followed by a significant decrease of the QT-intervals and ERP-V in both groups. The QT-intervals and the ERP-V were statistically significantly prolonged by intravenous Sotalol. The VT-group showed a statistically significant longer shortest QT2-interval during programmed stimulation, which can be explained by a greater dispersion of action potentials leading to an inhomogenous ventricular recovery process, which may represent the electrical substrate for the arrhythmia.

Relationship between afferent and central temporal patterns in the locust olfactory system.

Odors evoke synchronized oscillations and slow temporal patterns in antennal lobe neurons and fast oscillations in the mushroom body local field potential (LFP) of the locust. What is the contribution of primary afferents in the generation of these dynamics? We addressed this question in two ways. First, we recorded odor-evoked afferent activity in both isolated antennae and intact preparations. Odor-evoked population activity in the antenna and the antennal nerve consisted of a slow potential deflection, similar for many odors. This deflection contained neither oscillatory nor odor-specific slow temporal patterns, whereas simultaneously recorded mushroom body LFPs exhibited clear 20-30 Hz oscillations. This suggests that the temporal patterning of antennal lobe and mushroom body neurons is generated downstream of the olfactory receptor axons. Second, we electrically stimulated arrays of primary afferents in vivo. A brief shock to the antennal nerve produced compound PSPs in antennal lobe projection neurons, with two peaks at an approximately 50 msec interval. Prolonged afferent stimulation with step, ramp, or slow sine-shaped voltage waveforms evoked sustained 20-30 Hz oscillations in projection neuron membrane potential and in the mushroom body LFP. Projection neuron and mushroom body oscillations were phase-locked and reliable across trials. Synchronization of projection neurons was seen directly in paired intracellular recordings. Pressure injection of picrotoxin into the antennal lobe eliminated the oscillations evoked by electrical stimulation. Different projection neurons could express different temporal patterns in response to the same electrical stimulus, as seen for odor-evoked responses. Conversely, individual projection neurons could express different temporal patterns of activity in response to step stimulation of different spatial arrays of olfactory afferents. These patterns were reliable and remained distinct across different stimulus intensities. We conclude that oscillatory synchronization of olfactory neurons originates in the antennal lobe and that slow temporal patterns in projection neurons can arise in the absence of temporal patterning of the afferent input.

Odour encoding by temporal sequences of firing in oscillating neural assemblies.

Stimulus-evoked oscillatory synchronization of activity has been observed in many neural systems, including the cerebral cortex of mammals and the brain of insects. The possible functions of such rhythmic synchronization in neural coding, however, remain largely speculative. In the locust, odours evoke activity in dynamic (evolving) ensembles of transiently synchronized neurons. We report here that the active neurons composing these ensembles change in a stimulus-specific manner and with a high degree of reliability on a cycle-by-cycle basis during an odour response. Hence, information about an odour is contained not only in the neural assembly active at each oscillation cycle, but also in the precise temporal sequence in which these assemblies are updated during an odour response. Neural coding with oscillations thus allows combinatorial representations in time as well as in space.

[The so-called paling of the heart muscle and its value as an expression of ischemic myocardial damage]. / Die sog. Abblassung des Herzmuskels und ihre Wertigkeit als Ausdruck einer ischämischen Myokardschädigung.

Postmortem examination of human hearts demonstrated that fluorescent microscopic evidence of damage to the myocardium is present in most cases with so-called "paling". "Paling" is insufficient, however, to verify irreversible damage of the myocardium since nearly 1/3 of such cases have negative fluorescence microscopic reactions. In cases of acute coronary death with and without grossly visible signs of an ischemic myocardial damage necroses are demonstrable by fluorescence microscopy. This finding is not influenced by advanced autolysis. A fluorochromation with acridinorange at pH 7.0 is recommended in all cases of acute coronary death with and without paling or other macroscopic signs of acute ischemic damage to the heart muscle.

Distinct rhythmic locomotor patterns can be generated by a simple adaptive neural circuit: biology, simulation, and VLSI implementation.

Rhythmic motor patterns can be induced in leg motor neurons of isolated locust thoracic ganglia by bath application of pilocarpine. We observed that the relative phases of levators and depressors differed in the three thoracic ganglia. Assuming that the central pattern generating circuits underlying these three segmental rhythms are probably very similar, we developed a simple model circuit that can produce any one of the three activity patterns and characteristic phase relationships by modifying a single synaptic weight. We show results of a computer simulation of this circuit using the neuronal simulator NeuraLOG/Spike. We built and tested an analog VLSI circuit implementation of this model circuit that exhibits the same range of "behaviors" as the computer simulation. This multidisciplinary strategy will be useful to explore the dynamics of central pattern generating networks coupled to physical actuators, and ultimately should allow the design of biologically realistic walking robots.