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Background: Aim of this study was to identify factors associated with patients using the internet to find information about their upcoming surgery in general, and more specifically about anaesthesia. Methods: With Ethics committee approval, 1000 consecutive patients seen before elective surgery in the anaesthesia preoperative clinic of a Swiss Level 2 hospital were asked to complete a questionnaire. Primary outcome were patients using the internet to gather any medical information related to their upcoming hospital stay, secondary outcome patients using the internet to gather information regarding the upcoming anaesthesia. Multiple regression was performed to identify independent factors associated with internet use. Results: Eighty-two percent of the patients (n = 815) participated. 97% of those were ASA physical status 1 or 2; 83% (n = 676) had experience with previous anaesthetics, 86% (n = 700) reported to use the internet in general. Overall, about one-third of the participants used the internet to learn more about their medical condition, 26% regarding their upcoming surgical procedure. Only 7% (n = 55) obtained information about the anaesthetic. In multivariate analyses, factors associated with internet use were generally doing so, and planned moderate compared to minor surgery; not using the internet was associated with previous anaesthetic experience. Of those who did not use the Internet to learn about their anaesthetic, 34% indicated that they would have visited a trusted website. Conclusion: Only few patients used the internet to obtain information about their upcoming procedure and the anaesthetic part played an even smaller role. However, many patients would have appreciated guidance to find trustworthy internet sites. Trial registration: German Clinical Trials Register (DRKS00005434; date of registration: 27th December 2013); date of enrolment of first patient: 1st August 2013; study retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Midazolam is commonly used as a pre-anesthesia anxiolytic. It's elimination may not be fast enough for short procedures. In orally premedicated patients we obtained midazolam plasma concentrations at the end of surgical procedures and compared those to concentrations at anesthesia induction. Methods: The study was conducted prospectively with consent of the local ethics committee (Ethikkomission Kanton Thurgau, Switzerland) and carried out with written informed consent of each patient. Female patients aged 20 to 60 years undergoing elective procedures with general anesthesia were included, and were divided in two groups according to the planned surgical time: group S (<30 min) and group L (90-120 min), respectively. All patients received 7.5 mg Midazolam po as premedication. Blood samples were drawn at anesthesia induction, and at the end of surgery. Data were compared with t-test (independent samples; significance level p <0.05). Results: Twenty-five patients per group were included. Four patients were excluded from analysis, since midazolam was not detectable in any samples. Time of premedication to the 1st blood sample was not statistically different between groups, neither were Midazolam plasma levels at this time point (p = 0.94). None of the patients from group L (n = 24), but five patients in group S (n = 22) did have a higher plasma level of Midazolam at the end of the case compared to the beginning. Conclusions: The elimination half-life of oral Midazolam can lead to higher plasma levels at the end of a short procedure compared to those at induction of anesthesia. Trial registration: German Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00005429; date of registration 3rd January 2014 [ABSTRACT FROM AUTHOR]

Background: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumour of the skin with growing incidence. To better understand the biology of this malignant disease, immortalized cell lines are used in research for in vitro experiments. However, a comprehensive quantitative proteome analysis of these cell lines has not been performed so far., Methods: Stable isotope labelling by amino acids in cell culture (SILAC) was applied to six MCC cell lines (BroLi, MKL-1, MKL-2, PeTa, WaGa, and MCC13). Following tryptic digest of labelled proteins, peptides were analysed by mass spectrometry. Proteome patterns of MCC cell lines were compared to the proteome profile of an immortalized keratinocyte cell line (HaCaT)., Results: In total, 142 proteins were upregulated and 43 proteins were downregulated. Altered proteins included mitoferrin-1, histone H2A type 1-H, protein-arginine deiminase type-6, heterogeneous nuclear ribonucleoproteins A2/B1, protein SLX4IP and clathrin light chain B. Furthermore, several proteins of the histone family and their variants were highly abundant in MCC cell lines., Conclusions: The results of this study present a new protein map of MCC and provide deeper insights in the biology of MCC. Data are available via ProteomeXchange with identifier PXD008181., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2019.)

Background: Delirium has become better studied, but is still only partially understood and significantly underestimated. There are some well-known risk factors, but little is known about the incidence of delirium in the diverse patient population of a post anesthesia care unit (PACU). The aim of this study was to investigate the presence of delirium using the Nursing Delirium Screening Scale (NU-DESC)., Methods: 1000 consecutive patients in the PACU were prospectively evaluated at the point when being ready to be transferred to the normal ward by the registered nurses of the PACU., Results: The data of 1,000 patients was recorded. 242 of the patients (24.2%) were preoperatively classified as ASA I physical status, 664 patients (66.4%) as ASA II. A total of 43 patients (4.3%) presented with a delirium at the time point where they would have been transferred to the normal ward (138.4 ± 55.2 min after arrival in the PACU). 287 patients (28.7%) of the entire group were over the age of 70 years. Considering only this subgroup, delirium was diagnosed in 30 individuals (10.5%)., Conclusions: Delirium screening with the NU-DESC, collected by nursing staff of a PACU is easily feasible and demonstrated a low incidence of delirium in the presented setting., Trial Registration: German Clinical Trials Register (Deutsches Register Klinischer Studien, www.drks.de ; DRKS 000005426 ; date of registration 4th December 2013).

Background: The murine homologue of human vasohibin (mVASH1), a putative antiangiogenic protein, was investigated for its effects on in vitro and in vivo angiogenesis., Methods: Cell growth and migration were analyzed in murine fibroblasts, smooth muscle cells and endothelial cells. Angiogenic sprouting was studied in human umbilical vein endothelial cells (HUVECs) in the spheroid sprouting assay. In vivo effects on blood vessel formation were investigated in the chorioallantoic membrane (CAM) assay and in the C57BL/6 melanoma xenograft model., Results: Purified murine and human VASH1 protein induced apoptosis of murine fibroblasts in vitro, but not of vascular aortic smooth muscle cells (AoSMC) or endothelial cells. Adenoviral overexpression of murine and human VASH1 inhibited capillary sprouting of HUVECs in the spheroid assay. Administration of recombinant murine and human VASH1 inhibited growth of large vessels in the CAM assay and promoted the formation of a dense, fine vascular network. Murine VASH1-overexpressing B16F10 melanomas displayed a reduction in large vessels and vascular area. Moreover, tumors showed more microvessels that stained positive for the mural cell markers alpha-smooth muscle cell actin (ASMA) and proteoglycan (NG2)., Conclusion: Our data imply that murine VASH1 causes angiogenic remodelling by inhibiting angiogenic sprouting and large vessel growth, thereby supporting the formation of a vascular bed consisting predominantly of mature microvessels.

Background: Circulating endothelial cells (CEC) and endothelial precursor cells (CEP) have been suggested as markers for angiogenesis in cancer. However, CEC/CEP represent a tiny and heterogeneous cell population, rendering a standardized monitoring in peripheral blood difficult. Thus, we investigated whether a PCR-based detection method of CEC/CEP might overcome the limitations of rare-event flow cytometry., Findings: To test the sensitivity of both assays endothelial colony forming cell clones (ECFC) and cord blood derived CD45- CD34+ progenitor cells were spiked into peripheral blood mononuclear cells (PBMNC) of healthy volunteers. Samples were analyzed for the expression of CD45, CD31, CD34, KDR or CD133 by 4-color flow cytometry and for the expression of CD34, CD133, KDR and CD144 by qPCR. Applying flow cytometry, spiked ECFC and progenitor cells were detectable at frequencies >/= 0.01%, whereas by qPCR a detection limit of 0.001% was achievable. Furthermore, PBMNC from healthy controls (n = 30), patients with locally advanced rectal cancer (n = 20) and metastatic non-small cell lung cancer (NSCLC, n = 25) were analyzed. No increase of CEC/CEP was detectable by flow cytometry. Furthermore, only CD34 and KDR gene expression was significantly elevated in patients with metastatic NSCLC. However, both markers are not specific for endothelial cells., Conclusion: QPCR is more sensitive, but less specific than 4-channel flow cytometry for the detection of CEC/CEP cell types. However, both methods failed to reliably detect an increase of CEC/CEP in tumor patients. Thus, more specific CEC/CEP markers are needed to validate and improve the detection of these rare cell types by PCR-based assays.