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Objective: We aimed to determine the effect of human SH2B1 variants on leptin and insulin signaling, which are major regulators of energy homeostasis, on the RNA level. Methods: We analyzed the expression of infrequent alleles of seven SH2B1 variants (Arg67Cys, Lys150Arg, Thr175Ala, Thr343Met, Thr484Ala, Ser616Pro, and Pro689Leu) in response to insulin or leptin cell stimulation. Two of these were identified in own mutation screens, the others were predicted to be deleterious or to serve as controls. The variants were analyzed in a homologous system of mouse hypothalamic cells. Changes in expression of downstream genes were measured. Student's t-test for independent samples was applied, and effect sizes using Cohen's d with 95% confidence intervals were therefore calculated. Results: In 34 of 54 analyzed genes involved in leptin (JAK/STAT or AKT) signaling, variants nominally changed expression. The expression of three genes was considerably increased (p values ≤ 0.001: Gbp2b (67Cys; d = 25.11 (-3.53, -2.70)), Irf9 (689Leu; d = 44.65 (-2.57, -2.26)), and Isg15 (150Arg; d = 20.35 (-2.19, -1.57))). Of 32 analyzed genes in the insulin signaling pathway, the expression of 10 genes nominally changed (p ≤ 0.05), three resulted in p values ≤ 0.01 (Cap1 (150Arg; d = 7.48 (-0.62, -0.24)), Mapk1 (343Met; d = -6.80 (0.17, 0.45)), and Sorbs1 (689Leu; d = 7.82 (-1.60, -0.64))). Conclusion: The increased expression of genes in the leptin (JAK/STAT or AKT) signaling pathway implies that the main mode of action for human SH2B1 mutations might affect leptin signaling rather than insulin signaling.

In a prospective study, 8-MHz unidirectional, continuous wave Doppler equipment was shown to improve the success rate of internal jugular vein catheterization. In the first series of 100 patients, punctures were randomly divided into two groups, via the anterior or posterior route, representing the standard technique. The second series of 50 patients underwent punctures guided by the Doppler technique. The Doppler route was successful in 48 test punctures with 47 catheter placements. Via the anterior route, 14 of 50 test punctures were positive, with 11 catheter placements; for the posterior route, test punctures were positive in 25 of 50 cases, with 18 catheter placements. With the Doppler technique, it should be possible to increase the rate of successful catheterization of the internal jugular vein while reducing complications.

Die Ultraschall-Doppler-Technik ist eine nichtinvasive, einfach erlernbare Methode zur Beurteilung der arteriellen und venosen Blutstromung. Sie kann in Anasthesie und Intensivmedizin in verschiedenen Bereichen nutzlich sein, so zur exakteren arteriellen Blutdruckmessung in schwierigen Fallen, bei Durchblutungsstorungen oder zur Unterstutzung der Punktion arterieller und venoser Gefase. Zur Objektivierung der Effekte der Periduralanasthesie auf den peripheren Widerstand, zur Ermittlung von Blutflusraten bei arteriovenoser Hamofiltration und als Screening-Methode fur den cerebralen Kreislaufstillstand ist die Doppler-Technik ebenfalls erfolgreich eingesetzt worden. The ultrasound Doppler technique is a non-invasive method for the evalution of arterial and venous blood flow. It can be useful in anaesthesia and in intensive medicine for different purposes, e.g. for more exact blood pressure determination in difficult cases, in cases of blood supply disorders or as a helpful guide for the puncture of arterial and venous vessels. This technique has also been used successfully as a screening method of cerebral death, for the evaluation of flow rates during arterio-venous hemofiltration and for the investigation of the effects of peridural anaesthesia on peripheral resistance.

A 23 year old primipara with EPH gestosis after caesarean section suffered massive disseminated intravascular coagulation resulting in anuria, respiratory failure, gastrointestinal bleeding and disturbance of liver function. By treatment with antithrombin-III concentrates, fresh blood and fresh frozen plasma we were able to normalise coagulation disorders and to restore organ functions. Causes and therapeutical management of these diseases are discussed.