'In vitro' binding of propofol to serum lipoproteins in thyroid dysfunction

OBJECTIVE: To determine a regression relationship between the unbound fraction (fu percent) of propofol, a highly lipophilic intravenous anaesthetic agent, and demographic and biochemical variables in a thyroid dysfunction population. METHODS: Serum samples from patients with hypo- (n=33) and hyperthyroidism (n=33) and also from healthy volunteers (control group; n=9) were spiked with propofol to a total (bound + unbound propofol) concentration of 10 microg/ml. The unbound concentration was determined using ultrafiltration followed by high-performance liquid chromatography with fluorimetric detection and the unbound fraction percent (fu) and the binding ratio [bound/free concentration (B/F)] were calculated. Albumin, alpha(1)-acid glycoprotein, cholesterol, triglycerides, HDL, LDL, VLDL lipoproteins, and T3 and T4 hormone concentrations were measured. B/F has a linear relationship with lipoprotein concentration--unlike that for fu which is curvilinear - so, we developed a linear regression model of B/F for propofol with the above biochemical variables and with gender. RESULTS: The fu in hypothyroidism was significantly lower than in the healthy control (mean +/- standard deviation 0.74 +/- 0.13% vs 0.87 +/- 0.12%, P < 0.01) but the fu was no different in hyperthyroid subjects than controls (0.94 +/- 0.16% vs 0.87 +/- 0.12%, P > 0.05). HDL, LDL and VLDL lipoproteins were significant predictors of B/F (P < 0.05) and were capable of explaining 54% of the variability in the 'in vitro' binding of propofol in thyroid disease. CONCLUSION: These results could help explain the interindividual variability in the protein binding of propofol in thyroid dysfunction patients and suggest the inclusion of lipoproteins in covariate model development for the pharmacokinetic/pharmacodynamic parameters of propofol.     

Ureteral implantation in peritoneum. Exceptional complication in renal transplantation

Because of the extraperitoneal location, generally used for renal grafting, intraperitoneal urine leaks are a rare complication after transplantation. We report a patient on peritoneal dialysis who developed ascites, abdominal pain, anuria and shock suddenly after renal transplantation. The patient was immediately taken back to the operating room. An abnormal implantation of ureter into the peritoneum overlying the bladder when carrying out an unstented parallel incision extravesical ureterone-ocystostomy was identified. After correcting ureter implantation the patient had immediate diuresis, renal function rapidly improved, with no further complications. Contributing causes were poor exposure, thickened peritoneum secondary to recurrent peritonitis, and the presence of residual peritoneal dialysis fluid.     

Comparing the acute response to cadmium toxicity of nauplii from different populations of Artemia

The lethal responses to cadmium of instar II nauplii from eight populations of Artemia belonging to the species Artemia franciscana, Artemia salina, Artemia persimilis, and Artemia parthenogenetica have been compared. Generalized linear models were used to fit mortality. The model indicates that there is a relationship between species, type of population, and mortality rate. The two populations of A. franciscana were the most sensitive to cadmium toxicity (median lethal concentration, LC50, of 93.3-142 mg/L), while the population of A. persimilis was the most resistant (LC50 of 284 mg/L). Differences in the phenotypic variability in each population were assessed through the slope of the mortality curve, with A. persimilis exhibiting the highest diversity. This study suggests that habitat peculiarities and historical origin of the populations may have a significant influence on their response to cadmium toxicity.     

Predictors of patient satisfaction with hospital health care

Background  

We used a validated inpatient satisfaction questionnaire to evaluate the health care received by patients admitted to several hospitals. This questionnaire was factored into distinct domains, creating a score for each to assist in the analysis.     

Evaluation of eustachian tube function with ventilation scintigraphy by using 133Xe gas

The aim of this study was to evaluate Eustachian tube function by ventilation scintigraphy. In 13 patients with normal tube function and 16 with one-sided tube dysfunction, 50 MBq 133Xe was applied into the nasopharyngeal space through a tube inserted into the nasal cavity. Immediately after the insufflation, the patients were asked to perform three Valsalva manoeuvres. The visualization of the middle ear was possible in 10 of the 13 patients (77 per cent) with normal tube function. Decreased uptake of the middle-ear region in the side of dysfunction was demonstrated in 11 of the 16 patients (68.7 per cent) with one-sided tube dysfunction. Quantitative evaluation by region of interest technique revealed that by using percentage retention of activity and uptake rates, there were significant differences between the sides of dysfunction and sides of normal tube function (p < 0.05) and also between sides of dysfunction and both sides of controls (p < 0.05). There was no significant differences between normal sides of patients and both sides of controls (p > 0.05). As a conclusion, this method is non-invasive, easy- to perform and has a low radiation burden in the evaluation of Eustachian tube function. Although the number of patients is limited, the test seems to be applicable with a success rate of about 74 per cent.     

LIM-homeodomain genes as territory markers in the brainstem of adult and developing Xenopus laevis

We investigated expression patterns of the LIM-homeodomain (LIM-hd) genes x-Lhx1, x-Lhx2, x-Lhx5, and x-Lhx9 in the brainstem of Xenopus laevis during larval development and in the adult. The two groups of paralogous genes, x-Lhx1/x-Lhx5 and x-Lhx2/x-Lhx9, showed fundamentally different expression patterns, being expressed in ventral versus dorsal territories of the midbrain and hindbrain, respectively. Indeed, prominent expression of x-Lhx1/5 was found in the mesencephalic tegmentum and the hindbrain reticular formation, whereas conspicuous x-Lhx2/9 expression was observed in the torus semicircularis and isthmic nucleus. A few shared expression domains for the two pairs of paralogs included the optic tectum and the anterodorsal and pedunculopontine nuclei. In each structure, expression of the two paralogs was almost identical, indicating that the regulation of their expression in this part of the brain has evolved slightly since gene duplication occurred. Notable exceptions included the expression of x-Lhx1 but not x-Lhx5 in the Purkinje cells and the expression of x-Lhx9 but not x-Lhx2 in the lateral line nucleus. The analysis of LIM-hd expression patterns throughout development allowed the origin of given structures in early embryos to be traced back. x-Lhx1 and x-Lhx5 were relevant to locate the cerebellar anlage and to follow morphogenesis of the cerebellar plate and cerebellar nuclei. They also highlighted the rhombomeric organization of the hindbrain. On the other hand, x-Lhx2 and x-Lhx9 showed a dynamic spatiotemporal pattern relative to tectal development and layering, and x-Lhx9 was useful to trace back the origin of the isthmus in early development.