7 research outputs found
Effectiveness of Bailouts in the EU
No full textGovernments in the EU frequently bail out firms in distress by granting state aid. I use data from 86 cases during the years 1995-2003 to examine two issues: the impact of bailouts on bankruptcy probability and the determinants of bailout policy. I have three main results. First, the estimated discrete-time hazard rate increases during the first four years after the subsidy and drops after that, suggesting that some bailouts only delayed exit instead of preventing it. The number of failing bailouts could be reduced if European control was tougher. Second, governments’ bailout decisions favored public firms, even though public firms did not outperform private ones in the survival chances. Third, subsidy choice is an endogenous variable in the analysis of the hazard rate. Treating it as exogenous underestimates its impact on the bankruptcy probability. ZUSAMMENFASSUNG - (Die Wirksamkeit von Beihilfe in der EU) Europäische Unternehmen, die in Schwierigkeiten geraten sind, werden regelmäßig von den Regierungen in der EU durch Rettungs- und Restrukturierungsbeihilfen (R&R-Beihilfen) unterstützt. Im vorliegenden Paper werden 86 von der Europäischen Kommission überprüfte Fälle von R&RBeihilfen zwischen 1995 und 2003 herangezogen, um zwei Probleme zu untersuchen: die Auswirkung von R&R-Beihilfen auf die Bankrotthäufigkeit und die bestimmenden Faktoren für Subventionspolitik der Regierungen. Dabei kommt die Studie zu drei Ergebnissen. Es zeigt sich, dass sich die geschätzte Bankrottwahrscheinlichkeit während der ersten vier Jahre nach der Beihilfe erhöht und danach sinkt. Dies deutet darauf hin, dass einige Beihilfen den Marktaustritt nur verzögern, anstatt ihn zu verhindern. Die Zahl der Firmen, die erfolglos Beihilfe bekommen, könnte durch eine strengere europäische Beihilfekontrolle verringert werden. Das zweite Ergebnis besagt, dass die Regierungen bei der Beihilfevergabe staatliche Unternehmen bevorzugt haben, obwohl staatliche Unternehmen gegenüber den privaten keine bessere Überlebenswahrscheinlichkeit haben. Drittens ist die Beihilfewahl eine endogene Variable in der Analyse der Bankrottwahrscheinlichkeit. Sie als exogen zu behandeln bedeutet, ihre Auswirkung auf die Bankrottwahrscheinlichkeit zu unterschätzen.AState aid, European Union, Discrete-time hazard, Bivariate probit
Myogenic constriction in renal failure : cause and therapy
No full textIn bloeddruk regulerende vaten, de zogenaamde weerstandsvaten, wordt myogene constrictie geactiveerd door verhoogde transmurale druk. De verhoogde transmurale druk zorgt voor contractie van het arteriële
gladde spierweefsel, met vernauwing van het lumen en daardoor verminderde bloeddoorstroming naar de organen als gevolg. Myogene constrictie is een belangrijk autoregulatoir mechanisme van vaten: het draagt bij aan een constante doorbloeding van organen, ondanks variaties in systemische bloeddruk. In de nier is een toename van de intraglomerulaire druk een belangrijke factor in de ontwikkeling van nierschade. Vele factoren dragen bij aan de verslechtering van myogene constrictie, zoals hypertensie en diabetes mellitus. Ook de myogene constrictie in perifere arteriën verslechtert door nierfalen.
Onze belangrijkste waarnemingen waren: hogere myogene constrictie van renale preglomerulaire vaten, is geassocieerd met een verminderde kwetsbaarheid voor nierschade in drie ratmodellen van chronische
nierziekten: de 5/6 nefrectomie; de diabetische Zucker Diabetic Fatty rat; en een genetisch model voor hypertensie en nierschade: de Fawn Hooded rat. Verder hebben we in deze modellen de myogene constrictie onderzocht in mesenterische vaten, als maat voor de perifere vasculaire autoregulatie. Hierin lieten we zien dat de ontwikkeling van hypertensie, maar niet die van chronische nierziekten, geassocieerd is met verminderde myogene constrictie in deze arteriën. Tenslotte hebben we laten zien dat verschillende
behandelingen myogene constrictie in zowel renale als perifere vaten van ratten met chronische nierziekten kan verbeteren. De studies tonen aan dat een goede werking van de vasculaire gladde spiercontractie in kleine nierslagaders cruciaal is in het beperken van nierschade en de progressie van nierziekte.
In resistance arteries, myogenic constriction (MC) is activated by elevated transmural pressure, which causes contraction of arterial smooth muscle leading to reduction of vessel lumen thereby
reducing blood flow in target organs. Myogenic constriction, as a vascular autoregulatory mechanism, helps to maintain stable blood flow over a wide systemic pressure range. Failure of MC in preglomerular arteries causes increased glomerular pressure resulting in chronic kidney disease (CKD). Many factors may contribute to impairment of MC e.g. hypertension or diabetes
mellitus. Peripheral arteries MC is however, affected as well. Our key observations were: Higher MC of preglomerular vessels is associated with lower vulnerability of kidneys to damage in several rat models: reduced renal mass/hypertension – 5/6Nx, type 2 diabetes mellitus – ZDF rat, and in ageing induced hypertension with predisposition to kidney damage – FH rat. Furthermore, we examined MC of mesenteric artery, as a representative of the peripheral
vasculature, in these models and demonstrate that development of hypertension - but not CKD - is associated with decreased MC in this artery. Than we identifyed in vivo glomerular vascular contractility to Angiotensin II can predict individual susceptibility to CKD in the adriamycine model and in 5/6Nx model. Finally we showed that several types of treatment improve MC in both the renal and peripheral vascular bed of rats with CKD with and without hypertension. The studies presented in this thesis therefore demonstrate that the patency of vascular smooth
muscle contraction in small renal arteries is pivotal in limiting renal damage and limiting progression of renal disease.
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR) : a multicentre, prospective observational study
No full textBackground: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
No full textBackground Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged >= 18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARR(adj)). This study is registered with ClinicalTrials. gov, number NCT01865513.Findings Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7.6%] of 21 694); ORadj 1.86, 95% CI 1.53-2.26; ARR(adj) -4.4%, 95% CI -5.5 to -3.2). Only 2.3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1.31, 95% CI 1.15-1.49; ARR(adj) -2.6%, 95% CI -3.9 to -1.4) and the administration of reversal agents (1.23, 1.07-1.41; -1.9%, -3.2 to -0.7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1.03, 95% CI 0.85-1 center dot 25; ARR(adj) -0.3%, 95% CI -2.4 to 1.5) nor extubation at a train-of-four ratio of 0.9 or more (1.03, 0.82-1.31; -0.4%, -3.5 to 2.2) was associated with better pulmonary outcomes.Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): A multicentre, prospective observational study
No full textBackground: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology
ГАЗОМЕДИАТОРЫ: ОТ ТОКСИЧЕСКИХ ЭФФЕКТОВ К РЕГУЛЯЦИИ КЛЕТОЧНЫХ ФУНКЦИЙ И ИСПОЛЬЗОВАНИЮ В КЛИНИКЕ
No full textNitric oxide II (NO), carbon monoxide (СО) and hydrogen sulfide (H2S) for many decades were described as the toxic gases inducing damaging action in man’s organisms. Recently it was found that NO, CO and H2S endogenously synthesized and served as signaling molecules of autocrine and paracrine regulation in many systems. The properties, mechanisms of synthesis and action in excitable systems are presented in this paper. Besides we also descried our results concerning the effects and mechanisms of action of gaseous messengers in peripheral nervous system – in neuromuscular junction. В течение многих десятилетий оксид азота (II) (NO), монооксид углерода (СО) и сероводород (H2S) описывались как токсичные газы, оказывающие повреждающие эффекты на организм человека. Недавно было обнаружено, что NO, CO и H2S эндогенно синтезируются и являются сигнальными молекулами, выполняющими как аутокринную, так и паракринную регуляцию во многих системах организма. В настоящей статье представлены данные о свойствах, ферментах синтеза и механизмах действия газообразных посредников в возбудимых системах. Кроме того, описываются результаты собственных исследований по выявлению эффектов и механизмов действия NO, СО и H2S в периферической нервной системе – в области нервно-мышечного синапса
Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study
No full textBackground Results from retrospective studies suggest that use of neuromuscular blocking agents during general
anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use
of neuromuscular blocking agents is associated with postoperative pulmonary complications.
Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in
28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital
procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge
were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination
within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative
pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were
adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and
adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.
Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular
blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who
had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI
–5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised
without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49;
ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7)
were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex
instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at
a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes.
Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an
increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of
neuromuscular blockade against the increased risk of postoperative pulmonary complications
