Complications After Dental Sedation: A Myotonic Mystery Case Report.

Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.

A record of igneous evolution in Elysium, a major martian volcanic province.

A major knowledge gap exists on how eruptive compositions of a single martian volcanic province change over time. Here we seek to fill that gap by assessing the compositional evolution of Elysium, a major martian volcanic province. A unique geochemical signature overlaps with the southeastern flows of this volcano, which provides the context for this study of variability of martian magmatism. The southeastern lava fields of Elysium Planitia show distinct chemistry in the shallow subsurface (down to several decimeters) relative to the rest of the martian mid-to-low latitudes (average crust) and flows in northwest Elysium. By impact crater counting chronology we estimated the age of the southeastern province to be 0.85 ± 0.08 Ga younger than the northwestern fields. This study of the geochemical and temporal differences between the NW and SE Elysium lava fields is the first to demonstrate compositional variation within a single volcanic province on Mars. We interpret the geochemical and temporal differences between the SE and NW lava fields to be consistent with primary magmatic processes, such as mantle heterogeneity or change in depth of melt formation within the martian mantle due to crustal loading.

In vivo optical analysis of quantitative changes in collagen and elastin during arterial remodeling.

Altered collagen and elastin content correlates closely with remodeling of the arterial wall after injury. Optical analytical approaches have been shown to detect qualitative changes in plaque composition, but the capacity for detection of quantitative changes in arterial collagen and elastin content in vivo is not known. We have assessed fluorescence spectroscopy for detection of quantitative changes in arterial composition in situ, in rabbit models of angioplasty and stent implant. Fluorescence emission intensity (FEI) recorded at sites remote from the primary implant site was correlated with immunohistochemical (IH) analysis and extracted elastin and collagen. FEI was significantly decreased (P<0.05) after treatment with anti-inflammatory agents, and plaque area decreased on comparison with saline-treated rabbits after stent implant or angioplasty (Por=0.961) analysis were detected by multiple regression (MR) analysis. Good correlations also were found for FEI with elastin and collagen measured by high-performance liquid chromatography; MR analysis provided highly predictive values for collagen and elastin (R2>or=0.994). Fluorescence spectroscopic analysis detects quantitative compositional changes in arterial connective tissue in vivo, demonstrating changes at sites remote from primary angioplasty and stent implant sites.

Reproduction and offspring competitiveness of Senna obtusifolia are influenced by nutrient availability.

• Senna obtusifolia (sicklepod) is a troublesome weed in many agronomic cropping systems in the southeastern USA with varying fertility regimes. This series of experiments was initiated to determine the impact of nutrient availability on reproductive output and maternal effects. • Experiments were conducted with plants growing in soil in growth chambers for 120 d. Offspring growth was evaluated in hydroponics. • Plants grown under higher nutrient conditions had greater reproductive biomass, number of seeds and total seed biomass. Individual seed mass distributions were slightly affected, with negative skewness decreased at higher nutrition. Seed germination rates were influenced primarily by seed size, as small seeds germinated faster than large seeds. The nitrogen content of seeds increased with increasing seed size and was higher in the high nutrition treatment. Seedlings arising from maternal plants grown under high nutrition grew more rapidly than did seedlings arising from maternal plants grown in a low nutrient regime. • The results suggest that S. obtusifolia reproduction and offspring competitiveness can be strongly influenced by the fertilization regimes used in different agronomic crops and rotations.