Postoperative Qualitätsanalyse bei Kindern: Schmerz sowie postoperative Übelkeit und Erbrechen

Zusammenfassung: Hintergrund: Zur Evaluation des postoperativen Behandlungskonzepts beteiligt sich das Kinderspital Luzern am Projekt für Qualitätsanalyse in PONV ("postoperative nausea and vomiting", postoperative Übelkeit und Erbrechen) und Schmerzen bei Kindern (QUIPSi; i: "infants"). Erste Resultate und eine Möglichkeit der postoperativen Qualitätsanalyse bei Kindern werden dargestellt. Dabei waren zentrale Fragen entscheidend: Ist das hausinterne postoperative Behandlungskonzept adäquat genug, und ist QUIPSi ein hilfreiches postoperatives Qualitätsevaluationsprojekt? Material und Methoden: Innerhalb von 1,5Jahren wurden 460Kinder im Alter von 4 bis 17Jahren bezüglich Schmerzen, Wunsch nach mehr Schmerzmitteln, Schmerzmitteldosis und PONV am 1.postoperativen Tag mithilfe eines standardisierten Fragebogens erfasst. Ergebnisse: Die teilnehmenden Kinder ließen sich in 5 ambulante Operationsgruppen (Hernie, Knochen, Metallentfernung, Penis, Weichteil) und 9 stationäre (Appendektomie, Knochen, Metallentfernung, Orchidopexie, Kombinationsoperation: Orchidopexie und Hernienoperation oder Zirkumzision, Otoplastik, Tonsillektomie, Trichterbrustoperation, Weichteil) einteilen. Folgende Operationsgruppen gaben insuffizient behandelte Maximalschmerzen (Skala nach Hicks 0-10) und/oder den Wunsch nach mehr Schmerzmitteln an: ambulant versorgte Kinder: Zirkumzision 5,1/19 %, stationär versorgte Kinder: Appendektomie 6,5/43 %, Tonsillektomie 6,4/32 %, Trichterbrustoperation 7,7/33 %, Orchidopexie 4,2/19,4 % und Otoplastik 3,1/22,2 %. Die Ursachen hierfür waren ungenügende postoperative Schmerzmittelverabreichung trotz der maximal verordneten Tagesdosis sowie wahrscheinlich verspätete Verabreichung der Schmerzmittel. Die Inzidenz des PONV fiel bei stationär behandelten Kindern (Übelkeit 14-50 %/Erbrechen 0-37 %) höher aus als bei ambulant versorgten Kindern (Übelkeit 0-29 %/Erbrechen 3-17 %). Schlussfolgerung: Besonders die Kinder mit dem Wunsch nach mehr Schmerzmitteln sowie einer hohen PONV-Inzidenz der stationären Operationsgruppe bedürfen einer qualitativen Verbesserung des postoperativen Behandlungskonzepts. Durch QUIPSi werden unerkannte Schwächen im postoperativen Behandlungskonzept aufgedeckt; es trägt zu deren Vermeidung bei und ist ein bereicherndes Werkzeug in der Führung eines Klinikbetrieb

Activated protein C improves intestinal microcirculation in experimental endotoxaemia in the rat

INTRODUCTION: Successful treatment of severe sepsis and septic shock remains a major challenge in critical care medicine. The recently introduced recombinant human activated protein C (APC) remarkably improved the outcome of septic patients. The influence of APC on intestinal circulation is still poorly understood. Therefore, the present study aimed to investigate the effects of APC on intestinal microcirculation during experimental endotoxaemia in rats by using intravital microscopy. METHODS: A total of 44 male Lewis rats were randomly assigned to receive intravenous injections of 15 mg/kg lipopolysaccharide alone (LPS) (n = 11) or LPS followed by subsequent injection of 2 mg/kg recombinant human APC (LPS + APC) (n = 11), whereas control animals received either APC (n = 11) or saline (n = 11). Animals underwent observations of functional capillary density and leucocyte adherence on venular endothelium in the microcirculation of the intestinal wall by means of intravital fluorescence microscopy. Indicators of macrocirculation as well as plasma levels of tumour necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-10 were measured. RESULTS: Although APC administration of both LPS-treated and control rats did not change macrocirculation or release of inflammatory cytokines, it increased mucosal and muscular functional capillary density (p < 0.001 and p < 0.05, respectively) and reduced the number of firmly adhering leucocytes in intestinal submucosal V1 and V3 venules (p < 0.01) in LPS + APC-treated compared with LPS-treated animals, which did not receive APC. No remarkable differences that could be attributed to APC treatment were observed between the two control groups. CONCLUSION: APC administration during experimental endotoxaemia improved intestinal microcirculation by protecting functional capillary density as a measure of microvascular perfusion and exerted anti-inflammatory effects by reducing leucocyte adherence to the endothelium in submucosal venules. Therefore, beneficial effects of APC in septic patients might be due, in part, to improved intestinal microcirculation

CubeViz.js: A Lightweight Framework for Discovering and Visualizing RDF Data Cubes

In this paper we present CubeViz.js, the successor of CubeViz, as an approach for lightweight visualization and exploration of statistical data using the RDF Data Cube vocabulary. In several use cases, such as the European Unions Open Data Portal, in which we deployed CubeViz, we were able to gather various requirements that eventually led to the decision of reimplementing CubeViz as JavaScript-only application. As part of this paper we showcase major functionalities of CubeViz.js and its improvements in comparison to the prior version

Activation of Sphingomyelinase-Ceramide-Pathway in COVID-19 Purposes Its Inhibition for Therapeutic Strategies

Effective treatment strategies for severe coronavirus disease (COVID-19) remain scarce. Hydrolysis of membrane-embedded, inert sphingomyelin by stress responsive sphingomyelinases is a hallmark of adaptive responses and cellular repair. As demonstrated in experimental and observational clinical studies, the transient and stress-triggered release of a sphingomyelinase, SMPD1, into circulation and subsequent ceramide generation provides a promising target for FDA-approved drugs. Here, we report the activation of sphingomyelinase-ceramide pathway in 23 intensive care patients with severe COVID-19. We observed an increase of circulating activity of sphingomyelinase with subsequent derangement of sphingolipids in serum lipoproteins and from red blood cells (RBC). Consistent with increased ceramide levels derived from the inert membrane constituent sphingomyelin, increased activity of acid sphingomyelinase (ASM) accurately distinguished the patient cohort undergoing intensive care from healthy controls. Positive correlational analyses with biomarkers of severe clinical phenotype support the concept of an essential pathophysiological role of ASM in the course of SARS-CoV-2 infection as well as of a promising role for functional inhibition with anti-inflammatory agents in SARS-CoV-2 infection as also proposed in independent observational studies. We conclude that large-sized multicenter, interventional trials are now needed to evaluate the potential benefit of functional inhibition of this sphingomyelinase in critically ill patients with COVID-19

Fibroblast-Derived Induced Pluripotent Stem Cells Show No Common Retroviral Vector Insertions

Several laboratories have reported the reprogramming of mouse and human fibroblasts into pluripotent cells, using retroviruses carrying the Oct4, Sox2, Klf4, and c-Myc transcription factor genes. In these experiments the frequency of reprogramming was lower than 0.1% of the infected cells, raising the possibility that additional events are required to induce reprogramming, such as activation of genes triggered by retroviral insertions. We have therefore determined by ligation-mediated polymerase chain reaction (LM-PCR) the retroviral insertion sites in six induced pluripotent stem (iPS) cell clones derived from mouse fibroblasts. Seventy-nine insertion sites were assigned to a single mouse genome location. Thirty-five of these mapped to gene transcription units, whereas 29 insertions landed within 10 kilobases of transcription start sites. No common insertion site was detected among the iPS clones studied. Moreover, bioinformatics analyses revealed no enrichment of a specific gene function, network, or pathway among genes targeted by retroviral insertions. We conclude that Oct4, Sox2, Klf4, and c-Myc are sufficient to promote fibroblast-to-iPS cell reprogramming and propose that the observed low reprogramming frequencies may have alternative explanations

Mechanisms of oxygenation responses to proning and recruitment in COVID-19 pneumonia

Purpose This study aimed at investigating the mechanisms underlying the oxygenation response to proning and recruitment maneuvers in coronavirus disease 2019 (COVID-19) pneumonia. Methods Twenty-five patients with COVID-19 pneumonia, at variable times since admission (from 1 to 3 weeks), underwent computed tomography (CT) lung scans, gas-exchange and lung-mechanics measurement in supine and prone positions at 5 cmH(2)O and during recruiting maneuver (supine, 35 cmH(2)O). Within the non-aerated tissue, we differentiated the atelectatic and consolidated tissue (recruitable and non-recruitable at 35 cmH(2)O of airway pressure). Positive/negative response to proning/recruitment was defined as increase/decrease of PaO2/FiO(2). Apparent perfusion ratio was computed as venous admixture/non aerated tissue fraction. Results The average values of venous admixture and PaO2/FiO(2) ratio were similar in supine-5 and prone-5. However, the PaO2/FiO(2) changes (increasing in 65% of the patients and decreasing in 35%, from supine to prone) correlated with the balance between resolution of dorsal atelectasis and formation of ventral atelectasis (p = 0.002). Dorsal consolidated tissue determined this balance, being inversely related with dorsal recruitment (p = 0.012). From supine-5 to supine-35, the apparent perfusion ratio increased from 1.38 +/- 0.71 to 2.15 +/- 1.15 (p = 0.004) while PaO2/FiO(2) ratio increased in 52% and decreased in 48% of patients. Non-responders had consolidated tissue fraction of 0.27 +/- 0.1 vs. 0.18 +/- 0.1 in the responding cohort (p = 0.04). Consolidated tissue, PaCO2 and respiratory system elastance were higher in patients assessed late (all p < 0.05), suggesting, all together, "fibrotic-like" changes of the lung over time. Conclusion The amount of consolidated tissue was higher in patients assessed during the third week and determined the oxygenation responses following pronation and recruitment maneuvers

PRC2 Is Required to Maintain Expression of the Maternal Gtl2-Rian-Mirg Locus by Preventing De Novo DNA Methylation in Mouse Embryonic Stem Cells

Polycomb Repressive Complex 2 (PRC2) function and DNA methylation (DNAme) are typically correlated with gene repression. Here, we show that PRC2 is required to maintain expression of maternal microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) from the Gtl2-Rian-Mirg locus, which is essential for full pluripotency of iPSCs. In the absence of PRC2, the entire locus becomes transcriptionally repressed due to gain of DNAme at the intergenic differentially methylated regions (IG-DMRs). Furthermore, we demonstrate that the IG-DMR serves as an enhancer of the maternal Gtl2-Rian-Mirg locus. Further analysis reveals that PRC2 interacts physically with Dnmt3 methyltransferases and reduces recruitment to and subsequent DNAme at the IG-DMR, thereby allowing for proper expression of the maternal Gtl2-Rian-Mirg locus. Our observations are consistent with a mechanism through which PRC2 counteracts the action of Dnmt3 methyltransferases at an imprinted locus required for full pluripotency.This is the publisher’s final pdf. The published article is copyrighted by the author(s) and published by Elsevier. The published article can be found at: http://www.cell.com/cell-reports/hom

Les droits disciplinaires des fonctions publiques : « unification », « harmonisation » ou « distanciation ». A propos de la loi du 26 avril 2016 relative à la déontologie et aux droits et obligations des fonctionnaires

The production of tt‾ , W+bb‾ and W+cc‾ is studied in the forward region of proton–proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98±0.02 fb−1 . The W bosons are reconstructed in the decays W→ℓν , where ℓ denotes muon or electron, while the b and c quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions.The production of $t\overline{t}$, $W+b\overline{b}$ and $W+c\overline{c}$ is studied in the forward region of proton-proton collisions collected at a centre-of-mass energy of 8 TeV by the LHCb experiment, corresponding to an integrated luminosity of 1.98 $\pm$ 0.02 \mbox{fb}^{-1}. The $W$ bosons are reconstructed in the decays $W\rightarrow\ell\nu$, where $\ell$ denotes muon or electron, while the $b$ and $c$ quarks are reconstructed as jets. All measured cross-sections are in agreement with next-to-leading-order Standard Model predictions

Observation of the B0 → ρ0ρ0 decay from an amplitude analysis of B0 → (π+π−)(π+π−) decays

Proton–proton collision data recorded in 2011 and 2012 by the LHCb experiment, corresponding to an integrated luminosity of 3.0 fb−1 , are analysed to search for the charmless B0→ρ0ρ0 decay. More than 600 B0→(π+π−)(π+π−) signal decays are selected and used to perform an amplitude analysis, under the assumption of no CP violation in the decay, from which the B0→ρ0ρ0 decay is observed for the first time with 7.1 standard deviations significance. The fraction of B0→ρ0ρ0 decays yielding a longitudinally polarised final state is measured to be fL=0.745−0.058+0.048(stat)±0.034(syst) . The B0→ρ0ρ0 branching fraction, using the B0→ϕK⁎(892)0 decay as reference, is also reported as B(B0→ρ0ρ0)=(0.94±0.17(stat)±0.09(syst)±0.06(BF))×10−6