Leaf-spring suspension provides accurate parallel displacements

Leaf-spring suspension device with the springs symmetrically mounted on suspension frames provides accurate parallel displacements of loads over short linear distances

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

5-HT(2) receptors differentially modulate dopamine-mediated auto-inhibition in A9 and A10 midbrain areas of the rat

5-HT (20 microM) enhanced dopamine (DA) D2-like receptor mediated reduction of the firing rate of DA neurons in the substantia nigra pars compacta (A9) and ventral tegmental area (A10) in a rat midbrain slice preparation. Quinpirole (30 nM) induced a mean reduction of the firing rate in A9 and A10 DA neurons to 64 +/- 4%, respectively, 71 +/- 5% of the baseline value. Bath application of 5-HT in the presence of quinpirole further reduced the firing rate to 37 +/- 7% in A9 and 33 +/- 13% in A10. The 5-HT2 receptor agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane hydrochloride (DOI, 500 nM) enhanced quinpirole-induced reduction of firing rate of A10 DA neurons, but not of A9 DA neurons, suggesting that different 5-HT receptor subtypes are involved in modulation of dopamine D2-like receptor mediated inhibition in the two regions. The selective 5-HT2A receptor antagonist MDL100907 and the selective 5-HT2C receptor antagonist SB242084 (50 and 500 nM) both abolished the enhancement of quinpirole-induced reduction by either 5-HT or DOI, suggesting the involvement of direct and indirect (possibly via interneurons) modulation pathways in A10. The involvement of 5-HT and specific 5-HT2 receptors in augmentation of auto-inhibition in A10 could have important implications for our understanding of the mechanism of atypical antipsychotic drug action