Update PONV – Was gibt es Neues bei der Prophylaxe und Therapie von postoperativer Übelkeit und postoperativem Erbrechen?

Die Anaesthesiologie - Auch wenn für Anästhesiologen über Jahrzehnte die Prophylaxe und Therapie postoperativer Schmerzen im Rahmen des postoperativen Patientenkomforts an vorderster...     

Structural and functional limits for oxygen supply to muscle

Environmental oxygen is transported by the respiratory cascade to the site of oxidation in active tissues. Under conditions of heavy exercise it is ultimately the working skeletal muscle cells that determine the aerobic demand as over 90% of energy is spent in muscle cells. Oxygen is transported in the circulation bound to haemoglobin of erythrocytes while substrates are transported in the plasma. The supply of oxygen must be continuous because there are only minimal oxygen stores in the body of most mammalian species while substrates are stored in significant quantities both within muscle cells as also in organismic substrate stores. The pathways for oxygen and substrates ultimately converge in muscle mitochondria. In mammals, a structural limitation of carbohydrate and lipid transfer from the microvascular system to muscle cells is reached at a moderate work intensity (i.e. at less than 50% of VO2max). At higher work rates intracellular substrate stores must be used for oxidation. It is therefore not surprising to find larger intramyocellular carbohydrate and lipid stores in 'athletic' species as well as in endurance-trained human athletes. The transfer limitations for carbohydrates and lipids presumably occur on the level of the sarcolemma. These findings imply that the design of the respiratory cascade from lungs to muscle mitochondria has to be analysed with regard to satisfying the demand for oxygen of the working muscle cells. Substrate stores are replenished at low flux rates during periods of rest and are stored intracellularly. They are therefore locally available to mitochondria for aerobic work at high intensities.     

Detection of viral-specific nucleic acid and intracellular virions in ventral horn neurons of lactate dehydrogenase-elevating virus infected C58 mice

C58 mice which have been immunosuppressed by treatment with cyclophosphamide (200 mg/kg) one day prior to infection with the C strain of lactate dehydrogenase-elevating virus (LDV-C) develop poliomyelitis. Using in situ hybridisation, we found that some ventral horn neurons in these mice contain cytoplasmic viral-specific nucleic acid. Viral-specific nucleic acid was also found within a few small cells located near inflammatory foci. In addition, mature virus particles were observed by electron microscopy in some ventral horn neurons, indicating that these cells are productively infected in C58 mice. Neither viral nucleic acid nor virions were found in the ventral horn neurons of poliomyelitis-resistant mouse strains or C58 mice that were not immunosuppressed prior to infection. Ventral horn neurons which contained viral nucleic acid or virions within cytoplasmic vesicles generally were normal in appearance and were not located within poliomyelitis inflammatory foci. Our data are consistent with the hypothesis that infected neurons first replicate virus and subsequently are attacked and cleared by inflammatory cells.     

Effect of polyamine deprivation on the survival of intracranial glioblastoma bearing rats

It has previously been shown that systematic polyamine deprivation results in the almost complete inhibition of the growth of several solid tumors. The same polyamine deficient diet (containing antibiotics for the decontamination of the gastrointestinal tract, the ornithine decarboxylase inhibitor 2-(difluoromethyl)ornithine, and the polyamine oxidase inhibitor N1, N4-bis-(2,3-butadienyl)putrescine; "drug-containing polyamine deficient chow", DC-PDC) was applied for the first time to the treatment of rats with an intracranial tumor. Rats received intracortical grafts of C6 rat glioblastoma cells, and the length of their survival was determined. Treatment with DC-PDC, starting four days after tumor cell inoculation, significantly prolonged the median survival of the glioblastoma-bearing rats. The results underline the general growth inhibitory effect of systematic polyamine deprivation. Since the effect of polyamine restriction on tumor growth is reversible, combinations with cytotoxic drugs have to be found which exploit the changed functions of polyamine deficient tumor cells.     

Intravenous drug users and AIDS: risk behaviors

Risk-taking behaviors were studied in this assessment of 345 intravenous drug users from Baltimore, El Paso, and Denver. Over 50% reported injecting drugs daily and 70% shared needles with others, averaging 6.3 partners. In addition, 86% had shared a "cooker" and nearly 50% injected in a "shooting gallery." More than half of the males sampled had two or more sex partners, including 18% with five or more. Females averaged 19 sex partners in the preceding 6 months, with 22% reporting sex with five or more. Two-thirds of the total sample never used a condom, while only 6% always used this form of protection. On the other end of this risk continuum were those subjects who did not share needles or always cleaned their needles with an effective agent, had no sexual relations or always used a condom. Subjects following such practices could be considered low risk if they adopted safe behaviors in other associated areas of their lives. However, in an analysis of total risk, it was found that only 14 subjects (4%) practiced safe needle use and safe sex. Despite these findings, some encouraging results were seen. In an analysis of risk according to location, Baltimore subjects were significantly less at risk according to number of needle-sharing partners, borrowing needles, sharing a "cooker," injection in a "shooting gallery," cleaning needles, use of disinfectants, number of sexual partners, and use of condoms than either their cohorts in El Paso or Denver. Street outreach to modity risk behaviors among IVDUs began in Baltimore approximately 2 years prior to funding in El Paso and Denver. These results suggest that there may be a potential to moderate risk through intervention.     

Roadmap for the international collaborative epidemiologic monitoring of safety and effectiveness of new high priority vaccines

With the advent of new vaccines targeted to highly endemic diseases in low- and middle-income countries (LMIC) and with the expansion of vaccine manufacturing globally, there is an urgent need to establish an infrastructure to evaluate the benefit-risk profiles of vaccines in LMIC. Fortunately the usual decade(s)-long time gap between introduction of new vaccines in high and low income countries is being significantly reduced or eliminated due to initiatives such as the Global Alliance for Vaccines and Immunizations (GAVI) and the Decade of Vaccines for the implementation of the Global Vaccine Action Plan. While hoping for more rapid disease control, this time shift may potentially add risk, unless appropriate capacity for reliable and timely evaluation of vaccine benefit-risk profiles in some LMIC's are developed with external assistance from regional or global level. An ideal vaccine safety and effectiveness monitoring system should be flexible and sustainable, able to quickly detect possible vaccine-associated events, distinguish them from programmatic errors, reliably and quickly evaluate the suspected event and its association with vaccination and, if associated, determine the benefit-risk of vaccines to inform appropriate action. Based upon the demonstrated feasibility of active surveillance in LMIC as shown by the Burkina Faso assessment of meningococcal A conjugate vaccine or that of rotavirus vaccine in Mexico and Brazil, and upon the proof of concept international GBS study, we suggest a sustainable, flexible, affordable and timely international collaborative vaccine safety monitoring approach for vaccines being newly introduced. While this paper discusses only the vaccine component, the same system could also be eventually used for monitoring drug effectiveness (including the use of substandard drugs) and drug safety.     

EUV photofragmentation study of hybrid nonchemically amplified resists containing antimony as an absorption enhancer

A detailed investigation to understand the mechanism of the resist action at a fundamental level is essential for future Extreme Ultraviolet Lithography (EUVL) resists. The photodynamics study of a newly developed hybrid nonchemically amplified 2.15%-MAPDSA–MAPDST resist using synchrotron radiation excitation at 103.5 eV (12 nm) is presented. Antimony was incorporated in the resist as a heavy metal absorption center in the form of antimonate (2.15%). The results showed the fast decomposition rate of the radiation sensitive sulfonium triflate. HR-XPS and sulfur L-NEXAFS spectra of the copolymer films revealed that after irradiation the Ar–S⁺–(CH₃)₂ sulfonium group bonded to the phenyl ring resisted the EUV excitation. Those results confirmed the polarity switching mechanism from hydrophilic sulfonium triflates to hydrophobic aromatic sulfides obtained in previous results. The inorganic component SbF₆⁻ included in the resist formulations as an EUV absorption enhancer was particularly illustrative of the photofragmentation process. F 1s and O 1s HR-XPS spectra showed that fluorine remains linked to the antimony, even after 15 min of irradiation. A change of the antimony oxidation state was also observed with an increase in irradiation time. The presence of the heavy metal may control the high energy deposited on the resist which finally led to very well resolved 20 nm isolated line patterns by EUVL. The 10 times improved sensitivity compared with previous poly-MAPDST resists studied in the past showed the potential of this class of hybrid resists for next generation semiconductor industry applications.

Understanding the EUV photofragmentation mechanism in a highly sensitive hybrid n-CAR containing SbF₆⁻ as an absorption enhancer.