Notes

Polyuria because of Force Natriuresis throughout Venoarterial Extracorporeal Membrane Oxygenation.
CONCLUSION Stepwise implementation and expansion of robotic HPB surgery within one unit over a three-and-half year period is feasible and associated with good clinical outcomes. Despite introducing new surgeons to the technique, operative times, an indicator of the learning process, remained stable over time. Marsupial reproduction shares many common features with the more familiar eutherian mammals but things are often done differently, in alternative ways. Like the eutherians marsupials are placental but the period and degree of development supported in the uterus is much shorter and the long growth phase of development is supported by lactation. But these different ways of achieving often similar outcomes are also seen in gamete formation and function, fertilization and early development. This review presents an overview of marsupial reproductive biology with an emphasis on gamete biology. It has been more than a hundred years that studies aiming to elucidate the processes involved in cyclicity and pregnancy pointed out the requirement of ovaries and corpora lutea for embryo survival and pregnancy establishment. For horses, luteal progesterone is essential for pregnancy only during the first trimester. This progestational support is complex among domestic animals as ovarian luteal function is further enhanced by the LH-action role of equine chorionic gonadotropin (eCG) starting ∼ on Day 35 of pregnancy. Increased eCG secretion leads to the formation of supplementary corpora lutea resulting from follicles that luteinize (accessory corpora lutea) or ovulate (secondary corpora lutea), thus increasing concentrations of blood progesterone. Physiological details of progesterone-driven embryo-maternal interactions continue to be elucidated. In recent years, researchers studying the transcriptomes and secretomes of uterine tubes, endometrium and early embryo provided insight into the composition of molecular and cellular events that enable embryo survival and remodeling of the endometrium before a functional placenta is formed. Aluteal pregnancy models have also shown that while fertilization and early embryo development until the early blastocyst stage can occur under a progesterone-deprived environment, dysregulation of important pregnancy-related genes occur; embryo development is compromised unless progestin supplementation is provided once the embryo arrives into the uterus. As the body of knowledge on embryo-maternal interactions in the horse continues to grow, a fact remains true luteal support is essential for embryo survival mainly at the uterine stage, driving directly or indirectly gene expression that promotes adequate embryo-maternal physiological interactions until a full competent placenta is formed, resulting in optimal chances of delivering a live foal at term. Spermatozoa are diverse in form and function and these differences impact on their fertilizing capacity. Because of considerable inter-male and inter-species differences in sperm traits, assessments of sperm quality demand that we consider variations at different levels. We should thus pay attention not only to average values but also intra- and inter-sperm population variations and subpopulation structure. Sperm shape and size evolve in reponse to postcopulatory sexual selection. Assessments of morphological variation, with conventional microscopy or with computer-assisted systems, should bear this in mind. In rodents sperm head shape is asymmetric so it requires more complex tools, such as geometric morphometrics. Sperm function also evolves under postcopulatory sexual selection and this could be used as a basis to assess sperm performance. Sperm cells swim actively to overcome barriers in the female tract and develop a peculiar motility pattern in the final stages prior to and during fertilization. Both types of movement can be analyzed by computer-assisted microscopy systems. Sperm have high energetic demands for cell homeostasis, motility, and signalling. Bioenergetics can be analyzed by various means, including extracellular flux analyses to characterize glycolysis and mitochondrial respiration. Finally, cell signalling during capacitation has received much attention and can be assessed by microscopy (conventional or computer-assisted) or flow cytometry. Recent advances in image-flow cytometry affords analyses of high cell numbers with spatial localization of subcellular changes, which will have a big impact in the development of functional tests for the andrology clinic and in sperm preservation and use in artificial insemination. OBJECTIVE Electrical cardioversion of ED patients is a well-described treatment strategy for certain patients presenting with atrial fibrillation (AF). The objective of this study was to describe the safety and outcomes of this practice in a cohort of patients undergoing ED electrical cardioversion for AF. METHODS This retrospective health records survey investigated a 5-year cohort of consecutive ED patients presenting with AF who underwent electrical cardioversion in an academic, tertiary ED. Electronic and manual abstraction strategies were used, extracting data on demographics, clinical features, interventions, complications, and return visits within 1 month. Data were analyzed using descriptive statistics and agreement between trained abstractors on key variables was excellent (k = 0.94-0.98). RESULTS Data from 887 patients were analyzed. Electrical cardioversion was successful in 781 (88%) encounters. There were 3 major complications (3/887; 0.3%) and 123 minor complications (123/887; 14%). A1874 chemical Major complications included one post-cardioversion stroke (1/887; 0.1%), one jaw thrust maneuver for hypoxia (0.1%), and one overnight observation for hypotension (0.1%). 741 patients (84%) were discharged following cardioversion with a mean ED LOS of 218 min (95% CI 206-231 min). 57 (6.4%) patients returned to the ED within 30 days; 43 (4.8%) returned with in AF or flutter. CONCLUSIONS In this cohort of ED patients with atrial fibrillation, ED electrical cardioversion followed by discharge to home was largely safe and effective. Most complications were transient and mild. There were remarkably few serious complications.
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