A Rare Cause of Persistent Blood Loss after Continuous Ambulatory Peritoneal Dialysis Catheter Placement.

The laparoscopic placement of a continuous ambulatory peritoneal dialysis (CAPD) catheter is a widely used method in patients with end stage renal disease (ESRD). The potential complications of this procedure include perforation of intra-abdominal organs, surgical site infection, peritonitis, catheter migration, catheter blockage, port site herniation, and bleeding. In most cases, bleeding is considered to be an early-onset complication because it mostly occurs within the first seven days after surgery. We report a case of a 68-year-old female patient with a previous history of diabetes mellitus, myelodysplastic syndrome, extensive collateral varices, anaemia, and ESRD due to obstructive uropathy caused by retroperitoneal fibrosis, who presented with persistent blood loss after the laparoscopic placement of a CAPD catheter. Duplex ultrasonography showed that the CAPD catheter was transfixing a superficial epigastric varicose vein, a collateral vein, due to the occlusion of the left external iliac vein. Persistent blood loss after inserting a CAPD catheter without previous imaging of abdominal wall vessels is an indication for further diagnostics.

Multipartite Entanglement Generation and Contextuality Tests Using Nondestructive Three-Qubit Parity Measurements.

We report on the realization and application of nondestructive three-qubit parity measurements on nuclear spin qubits in diamond. We use high-fidelity quantum logic to map the parity of the joint state of three nuclear spin qubits onto an electronic spin qubit that acts as an ancilla, followed by a single-shot nondestructive readout of the ancilla combined with an electron spin echo to ensure outcome-independent evolution of the nuclear spins. Through the sequential application of three such parity measurements, we demonstrate the generation of genuine multipartite entangled states out of the maximally mixed state. Furthermore, we implement a single-shot version of the Greenberger-Horne-Zeilinger experiment that can generate a quantum versus classical contradiction in each run. Finally, we test a state-independent noncontextuality inequality in eight dimensions. The techniques and insights developed are relevant for fundamental tests as well as for quantum information protocols such as quantum error correction.

Inhibitory control in BALB/c mice sub-strains during extinction learning.

Dysregulation of executive function (EF) involves alterations in cognitive flexibility / control and is underscored by learning impairments in neurodevelopmental disorders. Here, we examine cognitive inflexibility in BALB/cJ mice (a mouse model showing diminished sociability, increased anxiety and inattentive behaviour) and closely related "reference" BALB/cByJ mice. We used an appetitive extinction paradigm to investigate if cognitive flexibility measures are different between learning acquisition and extinction. The two BALB/c sub-strains learned to respond to a stimulus in a touchscreen operant chamber, after which the reward was removed and responses should be inhibited. Both mice sub-strains showed a different rate of learning while acquiring the task, in which the BALB/cJ mice were faster learners compared to the BALB/cByJ mice. This was not observed during the extinction phase, in which the BALB/cJ mice were able to extinguish responding to unrewarded stimuli equally. Within the BALB/cJ sub-strain, variation in the ability to inhibit a learnt response was observed when comparing them to similar grouped BALB/cByJ mice: BALB/cJ animals that reached the criterion were more reward driven, while BALB/cJ mice failing to reach the set criterion during extinction processing make more mistakes. Additionally, the changes observed during acquisition, were driven by animals not reaching the extinction criterion. Our results suggest that the BALB/c mice sub-strains may use different strategies to learn during appetitive extinction. This may be useful in the phenotypic dissection of cognitive flexibility in BALB/c sub-strains and their mapping on genetic variance revealed by next-generation sequencing in future studies.

Outcome of acute intestinal failure.

BACKGROUND: Type 2 acute intestinal failure is characterized by the need for parenteral nutrition (PN) for several months, and is typically caused by complications of abdominal surgery with enteric fistulas or proximal stomas. This study aimed to evaluate clinical management according to quality indicators established by the Association of Surgeons of Great Britain and Ireland. METHODS: Consecutive patients with type 2 intestinal failure referred to a specialized centre were analysed. Outcomes included the rate of discontinuation of PN, morbidity and mortality. RESULTS: Eighty-nine patients were analysed, of whom 57 had an enteric fistula, 29 a proximal stoma (6 with distal fistulas), and three had intestinal failure owing to other causes. One patient was deemed inoperable, and nine patients died from underlying illness during initial management. Before reconstructive surgery, 94 per cent (65 of 66 operated and 3 patients scheduled for surgery) spent the period of rehabilitation at home. Discontinuation of PN owing to restoration of enteral autonomy was achieved in 65 (73 per cent) of 89 patients. Seven patients developed a recurrent fistula, which was successfully managed with a further operation in four, resulting in successful fistula takedown in 41 of 44 patients undergoing fistula resection. Three patients (5 per cent) died in hospital after reconstructive surgery. The overall mortality rate in this series, including preoperative deaths from underlying diseases, was 16 per cent (14 patients). CONCLUSION: Intestinal failure care and reconstructive surgery resulted in successful discontinuation of PN in the majority of patients, although disease-related mortality was considerable.

The role of 5-HT2C receptors in touchscreen visual reversal learning in the rat: a cross-site study.

RATIONALE: Reversal learning requires associative learning and executive functioning to suppress non-adaptive responding. Reversal-learning deficits are observed in e.g. schizophrenia and obsessive-compulsive disorder and implicate neural circuitry including the orbitofrontal cortex (OFC). Serotonergic function has been strongly linked to visual reversal learning in humans and experimental animals but less is known about which receptor subtypes are involved. OBJECTIVES: The objectives of the study were to test the effects of systemic and intra-OFC 5-HT2C-receptor antagonism on visual reversal learning in rats and assess the psychological mechanisms underlying these effects within novel touchscreen paradigms. METHODS: In experiments 1-2, we used a novel 3-stimulus task to investigate the effects of 5-HT2C-receptor antagonism through SB 242084 (0.1, 0.5 and 1.0 mg/kg i.p.) cross-site. Experiment 3 assessed the effects of SB 242084 in 2-choice reversal learning. In experiment 4, we validated a novel touchscreen serial visual reversal task suitable for neuropharmacological microinfusions by baclofen-/muscimol-induced OFC inactivation. In experiment 5, we tested the effect of intra-OFC SB 242084 (1.0 or 3.0 µg/side) on performance in this task. RESULTS: In experiments 1-3, SB 242084 reduced early errors but increased late errors to criterion. In experiment 5, intra-OFC SB 242084 reduced early errors without increasing late errors in a reversal paradigm validated as OFC dependent (experiment 4). CONCLUSION: Intra-OFC 5-HT2C-receptor antagonism decreases perseveration in novel touchscreen reversal-learning paradigms for the rat. Systemic 5-HT2C-receptor antagonism additionally impairs late learning-a robust effect observed cross-site and potentially linked to impulsivity. These conclusions are discussed in terms of neural mechanisms underlying reversal learning and their relevance to psychiatric disorders.

Quantum information. Unconditional quantum teleportation between distant solid-state quantum bits.

Realizing robust quantum information transfer between long-lived qubit registers is a key challenge for quantum information science and technology. Here we demonstrate unconditional teleportation of arbitrary quantum states between diamond spin qubits separated by 3 meters. We prepare the teleporter through photon-mediated heralded entanglement between two distant electron spins and subsequently encode the source qubit in a single nuclear spin. By realizing a fully deterministic Bell-state measurement combined with real-time feed-forward, quantum teleportation is achieved upon each attempt with an average state fidelity exceeding the classical limit. These results establish diamond spin qubits as a prime candidate for the realization of quantum networks for quantum communication and network-based quantum computing.

"Here's my dilemma". Moral case deliberation as a platform for discussing everyday ethics in elderly care.

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: 'resident's behavior', 'divergent perspectives on good care' and 'organizational context'. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical 'blind spots'.

Organizing moral case deliberation experiences in two Dutch nursing homes.

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and were organized apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other.

Requirement-driven dental education and the patient's right to informed consent.

In dental education, students spend much of their time treating patients' oral health care needs. Many dental schools still require students to complete a specified number of treatments of various kinds before they can graduate. It often happens that students need to do a particular treatment in order to complete school requirements, when this treatment is not what the patient truly needs, or is not the only treatment indicated for the patient's condition. Consequently, students will be tempted to talk the patient into accepting the procedure. Likewise, educational requirements may tempt the student to postpone certain treatments or forgo non-credit-bearing interventions altogether. We argue that this conflict of interest is inevitable (even though the educational system adopted by the school may mitigate the problem) and analogous to that found in therapeutical experimentation. Hence, we advocate the same ethical solution as has long been adopted for conflicts arising in biomedical experimentation: informed consent.

Brainstem auditory evoked response changes following electro-acupuncture therapy in chronic pain patients.

Brainstem auditory evoked responses were recorded in 17 patients with chronic pain who had been given electro-acupuncture therapy. The absolute peak latencies of waves I to V, and interpeak latencies and amplitudes of waves I and V were analysed before electro-acupuncture and compared with values obtained during electro-acupuncture and 5 min after its termination after one, five and 10 sittings. At these sittings the intensity of pain was recorded with the help of a 100 mm visual analogue scale. Each patient had 10 sittings given on alternate days. The absolute peak latencies of waves I, II, and III were delayed significantly (p < 0.05) after 5 and 10 sittings and amplitudes of wave V decreased significantly (p < 0.05) after 5 and 10 sittings. Visual analogue scores also decreased significantly (p < 0.01) during these sittings. It was established that before and after 10 sittings of electro-acupuncture, there was a significant positive correlation between visual analogue scores and the amplitude of wave V (p < 0.01). There was a negative correlation between visual analogue scores and absolute peak latencies of wave III at 1, 5 and 10 sittings, suggesting that there is a definite interaction between the electro-acupuncture neural mechanism and the generators of brainstem auditory evoked responses in the lower brainstem.

[Eleven years in a specialist practice dealing with reporting of occupational diseases can be rewarding]. / Elleve år i speciallaegepraksis med anmeldelse af arbejdsbetingede lidelser--det kan nytte.

During a period of 11 years in specialist practice, the authors notified 309 cases of occupationally-conditioned disease and occupational accidents. The majority of diseases were in the locomotor system. The authors reviewed the sex and age distributions and the distribution of the conditions involved. Their share of notifications from specialist practice during the period 1983-1986 was also reviewed together with the relevant specialties and the action taken by the Workers Supervision Authorities. The authors found their share in the notifications was relatively excessive but that it was declining because a great number of specialists have begun to notify conditions in the locomotor system. In addition, the authors have observed a considerable reduction in the rime taken to analyse cases by the Workers Supervision Authorities and an increase in the number of factory visits. The number of factory visits on account of the authors' notifications constituted 11% which shows that notification of occupationally-conditioned diseases is worth while.

Effect of exercise on glucose metabolism in postmenopausal women.

A cross-sectional study was conducted to examine the effect of treadmill and muscle resistance training on glucose tolerance and insulin levels in a group of 25 normal-weight, naturally menopausal women. Subjects trained 20 minutes three times per week for at least 6 months to 70% to 85% of maximum heart rate on a treadmill, or to maximum effort for all major muscle groups on Nautilus equipment. A nonexercising age-height-weight--matched group was monitored as a control. All three groups were of above-average fitness for age as measured by aerobic capacity during initial testing. The treadmill group significantly increased its maximal oxygen uptake over the training period. Glucose tolerance and insulin response, measured as areas under the curve after a 75 gm oral glucose load, were improved in both exercise groups compared with controls, with more marked improvement in the treadmill group. The only difference achieving statistical significance was the insulin levels 30 minutes or less after glucose ingestion, representing the first phase of insulin release. Long-term exercise training that increases aerobic power thus maintains normoglycemia with lower insulin values than in otherwise physically fit postmenopausal women.