Comparison of pre-emptive butorphanol or metamizole with ketamine +medetomidine and s-ketamine + medetomidine anaesthesia in improving intraoperative analgesia in mice.

In accordance with the 'refinement' component of the 3Rs, the primary aim of this study was to investigate and compare ketamine + medetomidine (KM) and s-ketamine + medetomidine (SKM) anaesthetic protocols in C57BL/6J mice (both sexes). We sought to determine whether s-ketamine could provide adequate surgical tolerance at a 50% dose relative to that of ketamine racemate and whether antagonism of medetomidine could be initiated 15 min earlier. The second aim was to investigate the potential improvement in analgesia for both anaesthetic protocols by adding butorphanol or metamizole. Analgesia was tested via the pedal withdrawal reaction (PWR) to a painful stimulus. During anaesthesia, respiratory frequency, pulse oximetry, body temperature and PWR were monitored. Among the 16 mice in each group, the PWR was lost in all the KM + metamizole (35:56 ± 6:07 min), KM + butorphanol (43:45 ± 2:14 min) and SKM + butorphanol (24:03 ± 5:50 min) mice, 15 of the non-premedicated KM (37:00 ± 8:11 min) mice, and 9 of the pure SKM (20:00 ± 4:19 min) mice; the latter group increased to 11 mice (17:16 ± 5:10 min) with premedication of metamizole. In contrast to the racemic combination, s-ketamine at the dose used here did not lead to sufficient loss of the PWR. However, earlier partial antagonism of SKM resulted in a slightly shorter and qualitatively better recovery than later partial antagonism of SKM. The addition of metamizole or butorphanol to KM or SKM anaesthesia positively influences the analgesic quality. However, when butorphanol is added, controlled ventilation may be necessary, especially for male mice.

The gold-standard genome of Aspergillus niger NRRL 3 enables a detailed view of the diversity of sugar catabolism in fungi.

The fungal kingdom is too large to be discovered exclusively by classical genetics. The access to omics data opens a new opportunity to study the diversity within the fungal kingdom and how adaptation to new environments shapes fungal metabolism. Genomes are the foundation of modern science but their quality is crucial when analysing omics data. In this study, we demonstrate how one gold-standard genome can improve functional prediction across closely related species to be able to identify key enzymes, reactions and pathways with the focus on primary carbon metabolism. Based on this approach we identified alternative genes encoding various steps of the different sugar catabolic pathways, and as such provided leads for functional studies into this topic. We also revealed significant diversity with respect to genome content, although this did not always correlate to the ability of the species to use the corresponding sugar as a carbon source.

[Three-dimensional vectorcardiography to predict CRT-responder]. / Dreidimensionale Vektorkardiographie zur CRT-Responderbestimmung.

Cardiac resynchronization therapy (CRT) is an accepted treatment for congestive heart failure (NYHA III-IV), but a substantial number of patients show no response to therapy. LBB, QRS width and echocardiographic measurements are parameters for indication, but they are not valid to predict hemodynamic response. A new method based on vector ECG analysis can deliver additional information, such as: parts or areas with late excitation, and with slow or fast depolarization speed. Electrical excitation is a prerequisite for contraction; this leads to the hypothesis that areas with late electrical activation will contract later. Algorithms for analysis of the vector ECG (determination of the vector -- time, area and speed) may help to identify responders and non-responders.

[A simple method for AV-delay determination in dual chamber pacemakers]. / Eine einfache Methode zur Bestimmung des AV-Intervalls bei Zweikammerschrittmachern.

The individual adjustment of the AV intervals is a prerequisite for the hemodynamic advantages of dual-chamber pacing. The methods for the optimization of the AV-Delay (AVD) applied so far are time intensive. A simple and fast method is the approximate adjustment of the AVD with the surface-ECG. The aim of this work is the conception and validation of this new method. The optimal AVD is given if at the end of the atrial contraction the mitral valve is closed by the ventricular increase of pressure. In order to achieve this with pacemaker patients, the individually different atrial and ventricular conduction times must be considered. The different conduction times can be determined from the surface-ECG. Intra- and interatrial conduction times can be defined by the beginning of the atrial spike up to the end of the p-wave. The beginning of ventricular pressure increase corresponds to the peak of the stimulated QRS complex (beginning of the Iso-Volumetric Contraction time, ISVC) and depends on the interventricular conduction time.¶ In the case of 100 patients, who did not receive a cardiac pacemaker, the interval at the end of the p-wave (left atrial excitation, EP) up to the peak of the r-wave (ISVC) during rest and exercise was measured and an age referred average value of 100ms determined; this serves as standard value if no AV-conduction is available. The approximated optimized AVD is given if the interval of the end at the p-wave to the peak of the QRS-Complex amounts to 100ms. By means of a simple algorithm, the optimized AVD can, thus, be calculated:¶ After programming a long AVD, the interval at the end of the native or paced p-wave up to the peak of the stimulated QRS-Complex (EP/ISVC) is determined. This value EP/ISVC is then taken from the long AVD, the 100ms standard value is added and one receives the approximately optimized AVD.¶ In order to validate the described method, 13 consecutive patients (2 female, 11 male, average age 67±7.8 years) were included, and received for different indication (7 sick sinus syndrome, 4 AV block III, 2 binode disease) a DDD pacemaker (Affinity, St. Jude Medical).¶ About 8 weeks after implantation all patients underwent a PA catheter investigation, in order to optimize the AV-/PV-Delay of the pacemaker regarding the maximum cardiac output (CO). For CO measurement the thermo dilution method was applied. Altogether 17 complete hemodynamic measurements (9 times with different PVDs, 8 times with different AVDs) were executed. The patients 10-13 could be examined both in the VDD and in the DDD mode.¶ The minimum determined CO amounted to 3.5 l/min, the maximal CO 7.1 l/min and the average value was 5.62±0.98 l/min. In all patients not only one optimal AVD was found but, moreover, a varied interval of AVDs with which optimal CO results could be obtained. The comparison of surface ECG optimized AVD with the PA catheter optimized AVD showed a statistically significant correlation (0.825PV, 0.982 AV, P<0.01). Sixteen out of seventeen measurements were at an interval which enables hemodynamic optimal CO or stroke volume. Only one AVD determined from the surface ECG was situated slightly (10 ms) outside of a hemodynamic optimal determined AVD. Despite the encouraging test results represented here, further studies should examine the value of the new algorithm in comparison with the other techniques for AVD optimization.

[Experiences with PTCA at the Klagenfurt Regional Hospital]. / Erfahrung mit der PTCA am Landeskrankenhaus Klagenfurt.

From October 1986 to July 31th 1990 343 patients had coronary dilatations (PTCA) at the Landeskrankenhaus Klagenfurt. In total 380 stenoses in the coronary vessels were dilated. In 83% of stenoses "complete revascularization" was obtained. Success rate was 90%.

A chromosome supplement to the London Dysmorphology Database.

A supplement to the computerised database for the diagnosis of rare dysmorphic syndromes described by Winter et al is presented, which includes a list of syndromes occurring in patients with unbalanced chromosome aberrations. The extension of the original programme is based on Schinzel's Catalogue of unbalanced chromosome aberrations in man.

[Preoperative risk assessment in pediatric surgery]. / Präoperative Risikobeurteilung in der Kinderchirurgie.

The further development of the risk score presented by us in 1976 combined with Peter's score now permits a satisfactory preoperative risk estimation in pediatric surgery for all age groups. The score includes 18 lines for all significant preoperative parameters and the procedure planned. Each parameter is judged by a number of points according to its significance (1-4 points). An increasing number of points indicates an increasing operation risk. The evaluation of 533 cases using this core proved it to be a reliable preoperative risk estimation.

[Preoperative risk evaluation in juvenile ileus]. / Präoperative Risikoabwägung beim kindlichen Ileus.

Preoperative risk calculation in children with bowel obstruction allows early therapeutic measures to improve prognosis. In a retrospective study the preoperative status was evaluated in 310 newborns and 127 children beyond the newborn period who had to be operated for bowel obstruction. Preoperative parameters were: age, birth weight (newborns), weight, body temperature, red and white blood count, electrolytes, urea-nitrogen, total serum protein, pH, PO2, PCO2 and base excess. These parameters were compared in surviving children and children who died postoperatively. In newborns a statistically significant difference between both groups was found for birth weight, rectal temperature, pH and total serum protein, whereas in children beyond the newborn age the same was true for age, weight and total serum protein. Besides well balanced electrolytes and good management of artificial respiration, total serum protein and in newborns additionally blood-pH and rectal temperature must be normalized preoperatively to reduce the risk in children with bowel obstruction.