Inguinal Hernia Repair in the New Millennium: Plug and Patch Repair with Local Anesthesia

Plug and patch repair is a safe, economic method for repairing inguinal hernias, with patient comfort comparable to that with laparoscopic hernia repair. The technique is simple to perform under local anesthesia and easily learned without a learning curve. Complications are rare, and recovery and return to work are rapid. After performing plug and patch repair on 400 patients with a follow-up examination rate of 93% and a median postoperative observation time of 42 months, we have recorded a recurrence rate of only 0.25%.     

Psycho-neurogene Faktoren bei der Genese lebensbedrohlicher Arrhythmien

Tachyarrhythmien treten h?ufig w?hrend erh?hter psychischer Erregung auf. Bei Patienten, bei denen ein Kardioverter Defibrillator (ICD) implantiert wurde, lassen sich arrhythmische Episoden und deren Onset-Zeitpunkt exakt aufzeichnen und erlauben so einerseits die Differenzierung der aufgetretenen Rhythmusst?rung und andererseits eine detailliertere Analyse der situativen Umst?nde und m?glicher an der Ausl?sung beteiligter psychischer Komponenten. In der vorliegenden einzelfallbezogenen Studie wurden bei 3 m?nnlichen Patienten im Alter zwischen 60 und 68 Jahren, bei denen der ICD erfolgreich eine ventrikul?re Tachykardie terminiert hatte, die ICD-Protokolle und die damit korrespondierenden Patientenaussagen analysiert. Die Analyse der akuten Onset-Bedingungen konnte ausgepr?gte Zusammenh?nge zwischen lebensbedrohlichen Herzrhythmusst?rungen in natürlicher Umgebung und emotionalen Stressoren aufdecken. Als Stressoren wurden unterschieden eine vulnerable Situation, die eine psychogene Triggerung maligner Arrhythmien bewirkte (Fall 1); eine Panikepisoden-?hnliche Erwartungsspannung (Fall 2) sowie eine aversive ?rgerreaktion, die auf dem Boden eines andauernden Zustandes von Hilf- und Ausweglosigkeit (Fall 3) einen besonders potenten sympathiko-exzitatorischen Stimulus darstellt. Dieses Ergebnis deckt sich mit einer Reihe von laborexperimentellen und epidemiologischen Studien, die einen Zusammenhang zwischen psychischer Erregung und der Entstehung von Tachyarrhythmien belegen. Die Berücksichtigung emotional-kognitiver Faktoren bei der Arrhythmogenese k?nnte ein Beitrag bei der Therapie zur Pr?vention des pl?tzlichen Herztodes werden.     

Individual differences in moral judgment competence influence neural correlates of socio-normative judgments

To investigate how individual differences in moral judgmentcompetence are reflected in the human brain, we used event-relatedfunctional magnetic resonance imaging, while 23 participantsmade either socio-normative or grammatical judgments. Participantswith lower moral judgment competence recruited the left ventromedialprefrontal cortex and the left posterior superior temporal sulcusmore than participants with greater competence in this domainwhen identifying social norm violations. Moreover, moral judgmentcompetence scores were inversely correlated with activity inthe right dorsolateral prefrontal cortex (DLPFC) during socio-normativerelative to grammatical judgments. Greater activity in rightDLPFC in participants with lower moral judgment competence indicatesincreased recruitment of rule-based knowledge and its controlledapplication during socio-normative judgments. These data supportcurrent models of the neurocognition of morality according towhich both emotional and cognitive components play an importantrole.     

Three-center feasibility of lung clearance index in infants and preschool children with cystic fibrosis and other lung diseases

Background

Lung clearance index (LCI) detects early ventilation inhomogeneity and has been suggested as sensitive endpoint in multicenter intervention trials in infants and preschoolers with cystic fibrosis (CF). However, the feasibility of multicenter LCI in this age group has not been determined. We, therefore, investigated the feasibility of LCI in infants and preschoolers with and without CF in a three-center setting.

High trait emotional intelligence in men: Beneficial for perceived stress levels but disadvantageous for the physiological response to acute stressors?

This study examined the relationship between trait emotional intelligence (EI) and stress in 110 male employees. Particularly, the association between trait EI and perceived chronic stress, occupational stress, and the physiological stress response was examined. Trait EI, perceived chronic stress, and occupational stress levels were assessed via questionnaires. The physiological stress response was measured by means of salivary free cortisol and heart rate variability (HRV) in response to the Trier Social Stress Test for Groups. Consistent with previous findings, men with high trait EI showed significantly lower perceived chronic and occupational stress levels than men with low trait EI. However, men with high trait EI also showed significantly higher cortisol reactivity than their low trait EI counterparts. Similarly, HRV in men with high trait EI appeared to be lower than in men with low trait EI but HRV differences between groups were not significant. Our findings suggest that trait EI might play a critical role in the stress regulation process but due to the cross‐sectional design of the study no causal conclusions can be drawn. Experimental studies need to explore further whether and how trait EI affects psychological and physiological stress responses.     

End-of-life care in intensive care units: family routines and environmental factors

The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end‐of‐life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified good‐bye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow‐up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow‐up visit, although in most cases the bereaved family had to initiate the follow‐up by contacting the ICU. Guidelines in the area of end‐of‐life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families.     

CORMs protect endothelial cells during cold preservation,resulting in inhibition of intimal hyperplasia after aorta transplantation in rats

Allograft vasculopathy is the leading cause for chronic transplant loss. We investigated if the addition of carbon monoxide releasing molecules (CORMs) to the preservation solution would protect the endothelium from cold preservation injury in an aortic transplantation model. In particular, we tested if CORM preserve vascular functioning and limit neo‐intima formation following cold preservation (Cp). Abdominal aortas from Lewis or Fisher rats were subjected to Cp in University of Wisconsin (UW) solution to which 50 μm of CORM‐3 was added or not. Hereafter, whole mount staining, acetylcholine mediated vasorelaxation (AMV) and aortic transplantation was performed. In vitro CORM‐3 protected human umbilical vein endothelial cells from Cp injury and prevented denudation and intercellular gap formation in aortic grafts. Cp resulted in loss of AMV of aorta segments. By contrast, AMV was preserved after the addition of CORM‐3 during Cp. Two months after transplantation Cp of aorta grafts resulted in an increased adventitial remodelling and neo‐intima formation. This was significantly blunted by CORM‐3 in syngeneic recipients. Our study demonstrates that addition of CORM‐3 to UW solution prevents endothelial damage, thereby maintaining vascular function directly after cold preservation. Hence, our findings might offer a novel strategy to prevent vascular damage during CP.     

Comparison of microarray-based RNA expression with ELISA-based protein determination of HER2, uPA and PAI-1 in tumour tissue of patients with breast cancer and relation to outcome

Purpose  

Prognostic and predictive markers in breast cancer are currently determined by single analysis of protein amounts. If RNA-based multi-gene analyses enter clinical practice, simultaneous determination of currently established markers like human epidermal growth factor receptor 2 (HER2), urokinase plasminogen activator (uPA) and its inhibitor (PAI-1) would represent an elegant simplification. To investigate the correlation between RNA and protein levels, we assessed HER2, uPA and PAI-1 in patients with breast cancer. In addition, we evaluated the influence of these factors on patient outcome.     

Analyses of phenotypic and functional characteristics of CX3CR1-expressing natural killer cells

We previously demonstrated a correlation between the frequency of CX3CR1-expressing human natural killer (NK) cells and disease activity in multiple sclerosis and showed that CX3CR1(high) NK cells were more cytotoxic than their CX3CR1(neg/low) counterparts. Here we aimed to determine whether human NK cell fractions defined by CX3CR1 represent distinct subtypes. Phenotypic and functional NK cell analyses revealed that, distinct from CX3CR1(high), CX3CR1(neg/low) NK cells expressed high amounts of type 2 cytokines, proliferated robustly in response to interleukin-2 and promoted a strong up-regulation of the key co-stimulatory molecule CD40 on monocytes. Co-expression analyses of CX3CR1 and CD56 demonstrated the existence of different NK cell fractions based on the surface expression of these two surface markers, the CX3CR1(neg) CD56(bright), CX3CR1(neg) CD56(dim) and CX3CR1(high) CD56(dim) fractions. Additional investigations on the expression of NK cell receptors (KIR, NKG2A, NKp30 and NKp46) and the maturation markers CD27, CD62L and CD57 indicated that CX3CR1 expression of CD56(dim) discriminated between an intermediary CX3CR1(neg) CD56(dim) and fully mature CX3CR1(high) CD56(dim) NK cell fractions. Hence, CX3CR1 emerges as an additional differentiation marker that may link NK cell maturation with the ability to migrate to different organs including the central nervous system.