Spectral analysis of spontaneous contractions of the isolated portal vein of rats

Summary The spontaneous contractions of segments of rat portal veins have been examined in vitro under isotonic and isometric conditions. The power density spectra of recorded time series lasting 10–60 min were calculated. The spectra usually consist of harmonic frequency components. Only during shorter periods of analysis (10 min time series) we sometimes found additional non-harmonic components. All frequency components are proportionally shifted by changes of the bath temperature according to an average Q₁₀ of 2.0. Increase of the load decreases the frequency of the contractions.The results of the spectral analysis, indicating a preponderance of a single source of periodicity, were supported by direct evidence of a pacemaker region. By recording contractions after systematic dissections of the portal vein segment, we found that spontaneous activity is generated at the central end of the segment.This work was supported by the Austrian Research Fund     

Frequency and Late Results of Local Recurrence and Metachronous Distant Metastases in Rectal Cancer

Over a 5-year period (1990 to 1995) 425 patients were operated on for rectal cancer. There were 48 local recurrences, 15 with additional distant metastases, 61 patients only had distant metastases. In our patients we found as a well known fact an increasing number of local recurrences and distant metastases with an increasing T- or N stage, no metastases in cases of low tumor grading (28/425 G1), but a high increase comparing patients with or without blood vessel invasion (V 12.3%, V1 42.9%). Lymphatic vessel invasion also shows a higher rate of local recurrences and distant metastases, even in nodal and blood vessel negative patients (L0, N0, V0, L1, N0, V0 60%).L- and V-positive patients should be included in a postoperative adjuvant therapy regime as well (together with all cases Stage II and III UICC), even in nodal negative cases.     

Impact of laughter on air trapping in severe chronic obstructive lung disease

Static and dynamic hyperinflation is an important factor of exertional dyspnea in patients with severe COPD. This proof-of-concept intervention trial sought to study whether laughter can reduce hyperinflation through repetitive expiratory efforts in patients with severe COPD. For small groups of patients with severe COPD (n = 19) and healthy controls (n = 10) Pello the clown performed a humor intervention triggering regular laughter. Plethysmography was done before and up to 24 hours after intervention. Laughing and smiling were quantified with video-analysis. Real-time breathing pattern was assessed with the LifeShirt™, and the psychological impact of the intervention was monitored with self-administered questionnaires. The intervention led to a reduction of TLC in COPD (p = 0.04), but not in controls (p = 0.9). TLC reduction was due to a decline of the residual volume. Four (22 [CI 95% 7 to 46] %) patients were ≥10% responders. The frequency of smiling and TLC at baseline were independent predictors of TLC response. The humor intervention improved cheerfulness, but not seriousness nor bad mood. In conclusion, smiling induced by a humor intervention was able to reduce hyperinflation in patients with severe COPD. A smiling-derived breathing technique might complement pursed-lips breathing in patients with symptomatic obstruction.     

May progesterone receptor membrane component 1 (PGRMC1) predict the risk of breast cancer?

Objective: Our and other studies have pointed on an important role of progesterone receptor membrane component 1 (PGRMC1) in development of breast cancer, especially in hormone therapy. To investigate if PGRMC1 could be used to predict the risk for getting breast cancer, we assessed in tissues of patients with primary invasive breast cancer, if the expression of PGRMC1 may be associated with the expression of estrogen receptor alpha (ERα), progesterone receptor (PR), and ki67.

Methods: Samples from 109 patients with breast cancer between the years 2008 and 2014 were obtained with the patients’ consent. Each sample was evaluated for the ERα, PR, Ki67, and PGRMC1 expression by immunohistochemistry using serial sections from the ame paraffin block comparing malignant tissue to benign tissue.

Results: Expression of PGRMC1 is increased in tumor area compared with non-cancerous tissue and positively correlates with ERα expression (OR?=?1.42 95%CI 1.06–1.91, p?=?0.02). No association was obtained between expression of PGRMC1 and PR or Ki67.

Conclusion: It can be suggested that women with breast epithelium highly expressing PGRMC1 and in interaction with ERα may have an increased risk to develop breast cancer, especially when treated with hormone therapy.     

Management of diabetes in pregnancy: comparison of guidelines with current practice at Austrian and Australian obstetric center

Aim

To compare Austrian and Australian national guidelines for gestational and pre-gestational diabetes and estimate the level to which physicians comply with their country’s guidelines.

Methods

Austrian (ÖDG, Austrian Diabetes Society) and Australian guidelines (ADIPS, Australasian Diabetes in Pregnancy Society) for the treatment of gestational diabetes and pre-gestational diabetes were systematically reviewed. Current practices in two obstetric centers in Austria and Australia were assessed by interviewing key stakeholders through questionnaires assessing different components of diabetes care. For gestational diabetes, these components were screening, abnormal oral glucose tolerance test values (mmol/L), abnormal values for diagnosis, further management when abnormal values are detected, monitoring/glucose targets (mmol/L), further management and indications for insulin therapy, route and timing of delivery, and postpartum management and counseling. For pre-gestational diabetes, the components were management during the preconceptional period, glucose target values, medical surveillance, obstetric surveillance, medication used, route and timing of delivery, and postpartum management and counseling.

Results

More variation was found in the management of gestational than pre-gestational diabetes. There were differences in oral glucose tolerance test and cut-off levels for diagnosing gestational diabetes in both centers and guidelines. Australian guidelines recommended two-stage screening for gestational diabetes, while Austrian guidelines recommended one-stage screening. At the Austrian obstetric center, amniocentesis was recommended for determining the start of insulin treatment in pregnant women with gestational diabetes. This approach was neither used at the Australian obstetric center nor recommended by any of the two guidelines.

Conclusion

Our study showed that it was difficult to standardize screening criteria and diagnostic methods for gestational and pre-gestational diabetes. National and international consensus has yet to be achieved in the management of diabetes in pregnancy.The number of cases of diabetes worldwide has significantly increased in the last decade and it is expected to double by 2030 (1). This “diabetic epidemic” also considerably affects pregnant women (2). However, the management of pre-gestational and gestational diabetes, the latter being defined as glucose intolerance first detected in pregnancy, remains controversial (3). Gestational and pre-gestational diabetes are associated with increased feto-maternal morbidity, including stillbirth, macrosomia, and fetal malformations, as well as long-term complications in the mother and offspring (4-6). However, treatment and/or monitoring reduce perinatal mortality to the rate in the healthy population. There is no internationally agreed approach and there are neither up-to-date World Health Organization (WHO) recommendations nor fact sheets designed especially for diabetes in pregnancy. The complexity of gestational and pre-gestational diabetes, its underlying pathogenetic mechanism, and recent insights into potential and far-ranging complications have justified the establishment of a considerable number of recent national guidelines (7). Variation in treatment strategies has originated from different views, approaches, and traditional management in obstetric clinics around the globe.As a novelty, this study does not only compare national guidelines of Austria and Australia, two developed high-income countries situated on different continents, but also estimates the level to which physicians comply with their country’s guidelines. Since currently no international standardized approach to screening criteria and diagnostic methods for gestational diabetes and pre-gestational diabetes exists and opinions differ even on the national level, we hypothesized that there were major differences in screening, diagnosing, and treating diabetes in pregnancy. An additional aim of this study was to produce a table of requirements that should be incorporated into future guidelines.     

Platelet activation and myocardial necrosis in patients undergoing radiofrequency and cryoablation of isthmus-dependent atrial flutter.

AIMS: Lower platelet activation by cryoenergy compared with radiofrequency (RF) energy was recently demonstrated immediately following ablation procedures of cardiac arrhythmias. Due to the delayed occurrence of cryolesions it is currently unknown, if cryoenergy and RF energy are associated with similar platelet activation and myocardial necrosis in the days after the procedure. METHODS AND RESULTS: We enrolled 38 patients with common atrial flutter undergoing cavotricuspid isthmus ablation with either RF energy (n = 23) or cryoenergy (n = 13). Ten patients undergoing RF ablation and receiving aspirin served as antiplatelet control group. Troponin T and platelet surface protein expression of P-selectin were determined before and immediately after ablation as well as on day 1 and 2 thereafter. Rise in troponin T was amplified after RF ablation (0.50 +/- 0.37 microg/L) when compared with cryoablation (0.24 +/- 0.20 microg/L; P = 0.024). In patients without aspirin, a significant increase in P-selectin expression was observed on day 1 after intervention in RF ablation compared with cryoablation (80 +/- 26 vs. 63 +/- 16 arbitrary units; P = 0.048). Platelet activation was attenuated in patients receiving aspirin. CONCLUSION: Successful ablation of atrial flutter with cryoenergy is associated with less myocardial necrosis and platelet activation compared with ablation with RF energy. Increased platelet activation following RF ablation can be attenuated by concomitant treatment with aspirin.