Beeinflussung der Atemsteigerung bei Muskelarbeit durch partiellen neuromuskulären Block (Tubocurarin)

Zusammenfassung In 17 Versuchen erhielten 7 Versuchspersonen 0,09–0,16 (Mittel 0,13) mg Tubocurarin/kg i.v. Vor und nach der Injektion wurde die gleiche Muskelarbeit geleistet (Beinarbeit; O₂-Aufnahme etwa das dreifache des Ruheumsatzes). Gemessen wurden Atemzeitvolumen, alveolarer O₂- und CO₂-Druck, Blutdruck und Pulsfrequenz. Die Curaredosen führten zu einer Erschwerung der Arbeit, beeinträchtigten jedoch nicht die Atmung.Bei gleicher Muskelarbeit ventilierte die Mehrzahl der Versuchspersonen, vor allem im Beginn der Arbeit, unter Curare mehr als bei der Kontrollarbeit ohne Curare. Am deutlichsten war dies bei denjenigen Versuchspersonen ausgeprägt, die schon ohne Curare im Beginn der Arbeit eine plötzliche Steigerung der Ventilation zeigten.Es wird angenommen, daß unter Curare die gleiche Muskelarbeit mit einer verstärkten motorischen Innervation geleistet wird. Die dabei beobachtete Ventilationssteigerung wird als weiteres Argument für einen Einfluß der motorischen Innervation auf die Atemzentren angesehen.Mit 3 TextabbildungenHerrn Professor Dr. Hans Winterstein zum 80. Geburtstag gewidmet.     

1141610241Altered expression of HuR, an mRNA stabilizing protein, mediates aberrant Placenta Growth Factor (PlGF) expression in preeclampsia

Background:  Control of mRNA stability is an essential regulatory process in eukaryotic gene expression. HuR, a 3'UTR mRNA binding protein, can protect AU-rich mRNA from degradation in response to stresses. PlGF, an angiogenic growth factor, contains two consensus AU-rich sites suggesting that under normal conditions HuR may protect PlGF mRNA from degradation. Trophoblast expression of PlGF is significantly decreased in preeclampsia and by hypoxia in vitro . We hypothesize that decreased levels of cytoplasmic HuR may contribute to decreased PlGF expression in hypoxic and preeclamptic trophoblast.
Methods:  Western blots were used to determine relative effects of in vitro hypoxia on HuR protein expression and subcellular localization in trophoblast. Immunohistochemistry was used to compare HuR expression patterns in trophoblast of preeclamptic and normal placentae.
Results:  Cytoplasmic expression of HuR was decreased 1.4 fold in the cytoplasm and 1.2 fold in the nucleus of JEG3 cells. A shift in HuR was more apparent in primary trophoblast with a greater than 2-fold decrease in the cytoplasm and a 1.4 fold decrease in the nucleus following 24 hr of hypoxia. Immunohistochemical analyses detected HuR expression in near term trophoblast in situ . However, this technical approach did not detect a significant change in HuR expression between normal and preeclamptic trophoblast.
Conclusions:  HuR expression is decreased in hypoxic trophoblast, at least in vitro , which may provide a causal link to decreased PlGF mRNA expression. Down regulation of trophoblast PlGF expression is thought to contribute to the pathophysiology associated with preeclampsia including the relative lack of perfusion of the placenta and systemic renal effects.     

Quantitation of cytomegalovirus (hCMV) DNA and β-actin DNA by duplex real-time fluorescence PCR in solid organ (liver) transplant recipients

Even now rare human cytomegalovirus (hCMV) reactivation is still a life-threatening complication after solid organ transplantation. Although PCR techniques are regarded as the most sensitive detection methods for hCMV, their accuracy and reproducibility are limited. This is a major disadvantage with quantitative PCR assays, which are thought to provide valuable information about hCMV latency or active viral replication in transplant patients. To enhance the diagnostic safety of quantitative hCMV PCR, we developed a duplex real-time fluorescence PCR that is capable of quantifying hCMV DNA and beta-actin DNA as internal control simultaneously within one reaction. By the use of 6-carboxyfluorescein and hexa-chloro-6-carboxyfluorescein as reporter fluorophores and 4-(4'-dimethylamino-phenylazo) benzoic acid as dark quencher dye, hCMV DNA and beta-actin DNA could be quantified in parallel in a wide linear range from 10(1) to 10(7) copies, each. To test the clinical applicability of this approach, we investigated hCMV DNA kinetics in peripheral leukocytes of three hCMV antigen-positive and four antigen-negative patients after liver transplantation, as assessed by intracellular hCMV pp65 alkaline phosphate-anti-alkaline phosphate (APAAP) complex. While all APAAP-negative individuals remained PCR negative, kinetics of HCMV DNA in leukocyte DNA samples of APAAP-positive patients correlated closely with hCMV antigen tests. Here, comparison of separate and simultaneous target quantitation revealed identical results. It is of interest that, while single hCMV antigen positivity is commonly not regarded as a reliable parameter of viral reactivation, in our study a viral load greater than 10(4) copies/2x10(5) beta-actin DNA copies clearly indicated a subsequent increase in APAAP-positive leukocytes. We conclude that with the presented method the reliability of hCMV quantitation via real-time PCR can be substantially increased and may be used to monitor hCMV kinetics in vivo.     

Dynamik der echten venösen Beimischung in der Lunge

Ohne Zusammenfassung     

Practicability and clinical relevance of routine psychological screening of patients in general internal medicine units

In medical patients, anxiety and depression are frequent but often undiagnosed problems. The aim of the present study was to test and evaluate a psychological screening in medical in-patients. Using the Hospital Anxiety and Depression Scale (HADS), we screened 454 out of 743 consecutive medical in-patients. Physical symptoms and diagnoses were also recorded. Elevated scores for anxiety and depression were found in 20.8% and 23.9%, respectively. They were relatively independent of physical findings but correlated with subjective symptoms. In a subgroup who completed the questionnaire twice, HADS scores remained constant until discharge. Cardiological patients with abnormal baseline anxiety stayed significantly longer in hospital than those who were not anxious. Over a one-year follow-up, initially depressed patients had a risk of in-hospital death that was 2.5 times higher. This effect remained stable after controlling for baseline diagnoses and indices of severity of the disease.     

Complications after laryngeal surgery: videofluoroscopic evaluation of 120 patients

AIM: Videofluoroscopic assessment of the spectrum and incidence of swallowing complications after state-of-the-art laryngeal cancer surgery. MATERIALS AND METHODS: We retrospectively studied videofluoroscopic examinations of 120 patients (94 men, 26 women; mean age, 58 years) with suspected complications after laryngeal resection (partial laryngectomy, 65; total laryngectomy, 55). Swallowing function (i.e., oral bolus control, laryngeal elevation and closure, presence of pharyngeal residue, aspiration) and structural abnormalities such as strictures, fistulas and tumour recurrence were assessed by videofluoroscopy. RESULTS: Abnormalities were found in 110 patients, including strictures in nine, fistulas in six and mass lesions in 13 patients. Aspiration was found in 63 patients overall (partial laryngectomy, 61/65; total laryngectomy, 2/55), occurring before swallowing in five, during swallowing in 34, after swallowing in nine and at more than one phase in 15 patients. Pharyngeal paresis was detected in three and pharyngeal weakness in 19 patients. Pharyngo-oesophageal sphincter dysfunction was observed in 10 cases. CONCLUSION: Aspiration is a very common complication after partial laryngeal resection. It is mainly caused by incomplete laryngeal closure, sphincter dysfunction or pharyngeal pooling. Videofluoroscopy is the only radiological technique able to identify both disordered swallowing function and structural changes after laryngeal resection. Detection of these complications is crucial for appropriate further therapy.Kreuzer, S. H. (2000). Clinical Radiology55, 775-781.     

Knowledge and attitudes about otitis media risk: implications for prevention

OBJECTIVES: To investigate maternal knowledge and attitudes about otitis media (OM) risk, to estimate the prevalence of risk factors in the first year of life, and to identify barriers to the reduction of risk factors (eg, formula feeding, day care attendance, and exposure to passive smoke). METHODS: Questionnaires mailed to a systematic sample of 504 Minnesota women >/=18 years old identified through 1994 birth certificates. RESULTS: Eighty percent returned a completed survey. According to maternal report, 29% of infants (age 8 to 13 months) had recurrent OM (>/=3 episodes) and 2% had tympanostomy tubes. Forty-six percent attended day care, 29% had >/=1 smoking parent, and 49% breastfed for 相似文献