Copper thiocyanato complexes and cocaine – a case of ‘black cocaine’

The chemical composition of a black powder confiscated by German customs was elucidated. Black powders are occasionally used as a ‘transporter’ for cocaine and are obviously especially designed to cloak the presence of the drug. The material consisting of cocaine, copper, iron, thiocyanate, and graphite was approached by analytical tools and chemical modelling. Graphite is added to the material probably with the intention of masking the typical infrared (IR) fingerprints of cocaine and can be clearly detected by powder X‐ray diffraction (XRD) and Raman spectroscopy. Cu²⁺ and NCS^? ions, when carefully reacted with cocaine hydrochloride, form the novel compound (CocH)₂[Cu(NCS)₄] (CocH⁺ = protonated cocaine), which has been characterised by single crystal XRD, IR, NMR, UV/Vis absorption and EPR spectroscopy. Based on some further experiments the assumed composition of the original black powder is discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

Erythromycin antagonizes the deceleration of gastric emptying by glucagon-like peptide 1 and unmasks its insulinotropic effect in healthy subjects

Glucagon-like peptide 1 (GLP-1) has been proposed to act as an incretin hormone due to its ability to enhance glucose-stimulated insulin secretion. Because GLP-1 also decelerates gastric emptying, it physiologically reduces rather than augments postprandial insulin secretory responses. Therefore, we aimed to antagonize the deceleration of gastric emptying by GLP-1 to study its effects on insulin secretion after a meal. Nine healthy male volunteers (age 25 +/- 4 years, BMI 25.0 +/- 4.9 kg/m2) were studied with an infusion of GLP-1 (0.8 pmol.kg(-1).min(-1) from -30 to 240 min) or placebo. On separate occasions, the prokinetic drugs metoclopramide (10 mg), domperidone (10 mg), cisapride (10 mg, all at -30 min per oral), or erythromycin (200 mg intravenously from -30 to -15 min) were administered in addition to GLP-1. A liquid test meal (50 g sucrose and 8% mixed amino acids in 400 ml) was administered at 0 min. Capillary and venous blood samples were drawn for the determination of glucose (glucose oxidase), insulin, C-peptide, GLP-1, glucagon, gastric inhibitory polypeptide (GIP), and pancreatic polypeptide (specific immunoassays). Gastric emptying was assessed by the phenol red dilution technique. Statistical analyses were performed using repeated-measures ANOVA and Duncan's post hoc test. GLP-1 significantly decelerated the velocity of gastric emptying (P < 0.001). This was completely counterbalanced by erythromycin, whereas the other prokinetic drugs used had no effect. Postprandial glucose concentrations were lowered by GLP-1 (P < 0.001 vs. placebo), but this effect was partially reversed by erythromycin (P < 0.05). Insulin secretory responses to the meal were lower during GLP-1 administration (P < 0.05 vs. placebo). However, when erythromycin was added to GLP-1, insulin concentrations were similar to those in placebo experiments. The suppression of meal-related increments in glucagon secretion by GLP-1 was reversed by erythromycin (P < 0.001). The time course of GIP secretion was delayed during GLP-1 administration (P < 0.05), but when erythromycin was added, the pattern was similar to placebo experiments. GLP-1 administration led to a reduction in pancreatic polypeptide plasma concentrations (P < 0.05). In contrast, pancreatic polypeptide levels were markedly increased by erythromycin (P < 0.001). Intravenous erythromycin counteracts the deceleration of gastric emptying caused by GLP-1, probably by interacting with the parasympathetic nervous system (pancreatic polypeptide responses). Despite augmented rises in insulin secretion, the glucose-lowering effect of GLP-1 is markedly reduced when the deceleration of gastric emptying is antagonized, illustrating the importance of this facet of the multiple antidiabetic actions of GLP-1.     

Da Vinci© Skills Simulator™: is an early selection of talented console surgeons possible?

To investigate whether the learning curve of robotic surgery simulator training depends on the probands’ characteristics, such as age and prior experience, we conducted a study of six distinct proband groups, using the da Vinci Skills Simulator: experienced urological robotic surgeons, surgeons with experience as da Vinci tableside assistants, urological surgeons with laparoscopic experience, urological surgeons without laparoscopic experience, and complete novices aged 25 and younger and 40 and older. The results showed that all experienced robotic surgeons reached expert level (>90 %, as defined previously in the literature) within the first three repetitions and remained on a high level of performance. All other groups performed worse. Tableside assistants, laparoscopically experienced surgeons, and younger novices showed a better performance in all exercises than surgeons without laparoscopic experience and older novices. A linear mixed-effects model analysis demonstrated no significant difference in learning curves between proband groups in all exercises except the RW1 exercise for the younger proband group. In summary, we found that performance in robotic surgery, measured by performance scores in three virtual simulator modules using the EndoWrist techniques, was dependent on age and prior experience with robotic and laparoscopic surgery. However, and most importantly, the learning curve was not significantly affected by these factors. This suggests that the da Vinci Skills Simulator? is a useful practice tool for everyone learning or performing robotic surgery, and that early selection of talented surgeons is neither possible nor necessary.     

A Review of Sexual Health Among Lesbian,Gay, and Bisexual Veterans

Research on the sexual health of lesbian, gay, and bisexual (LGB) military veterans is limited. Nevertheless, studies have identified significant health concerns such as depression, anxiety, problem drinking, smoking, and cardiovascular disease that contribute to poor sexual health and sexual problems. Research on health disparities among LGB individuals and veterans generally suggests that sexual minority status and military service place LGB veterans at even greater risk of poor sexual health. It is possible that concealment of sexual orientation during military service contributed to health risks. The VHA has begun raising awareness of veterans’ sexual health needs, particularly LGB and transgender veterans. Additional research in this area and a positive sexual health approach by providers can begin to address the needs of LGB veterans. A positive sexual health approach would also benefit heterosexuals and non-veterans.     

Die Olekranonosteotomie

In recent years the increase of interest for surgery of the elbow has fostered the development of new and modified triceps sparing approaches. Olecranon osteotomy is a widely accepted method especially for open reduction and internal fixation of displaced intra-articular fractures because it provides excellent exposure of the joint surfaces. Due to several reports describing numerous complications, the enthusiasm for this procedure is currently limited. Several intra-articular and extra-articular techniques for refixation of the olecranon have been developed to limit these complications and good results have been obtained. This paper describes various techniques, analyzes advantages and disadvantages and shows alternative ways and solutions for different indications.