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The cell cycle, over which cells grow and divide, is a fundamental process of life. Its dysregulation has devastating consequences, including cancer1–3. The cell cycle is driven by precise regulation of proteins in time and space, which creates variability between individual proliferating cells. To our knowledge, no systematic investigations of such cell-to-cell proteomic variability exist. Here we present a comprehensive, spatiotemporal map of human proteomic heterogeneity by integrating proteomics at subcellular resolution with single-cell transcriptomics and precise temporal measurements of individual cells in the cell cycle. We show that around one-fifth of the human proteome displays cell-to-cell variability, identify hundreds of proteins with previously unknown associations with mitosis and the cell cycle, and provide evidence that several of these proteins have oncogenic functions. Our results show that cell cycle progression explains less than half of all cell-to-cell variability, and that most cycling proteins are regulated post-translationally, rather than by transcriptomic cycling. These proteins are disproportionately phosphorylated by kinases that regulate cell fate, whereas non-cycling proteins that vary between cells are more likely to be modified by kinases that regulate metabolism. This spatially resolved proteomic map of the cell cycle is integrated into the Human Protein Atlas and will serve as a resource for accelerating molecular studies of the human cell cycle and cell proliferation.

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The causes of chronic pelvic pain (CPP) in women can be multifactorial and significantly affect quality of life. Finding the cause(s) for CPP often takes a multidisciplinary approach. One commonly overlooked cause of CPP is pelvic venous disease (PVD). The causal relationship between PVD and CPP has been well-documented in the literature, but with limited assessment or treatment guidelines to advise health care providers, there continues to be a limited understanding of PVD. This article aims to ensure nurse practitioners are well equipped to recognize women presenting with symptoms suggestive of PVD and expedite referral when needed for further evaluation.

Using a quasi‐experimental design, the authors examined whether career indecision could be reduced by participation in a values‐based career webinar designed to translate various types of psychological data (e.g., Holland‐type themes) into values‐based language. Participants (N= 67; 36 women, 31 men; mean age = 36 years) were divided into 1 control and 2 treatment groups. The 1st treatment group received an interest‐based intervention. The 2nd received a values‐based intervention. Both interventions consisted of 1 additional webinar spanning 1 hour in length. This study demonstrated a statistical significance of career indecision decrease through use of the values‐based, process‐oriented webinar intervention, which is particularly helpful to career counselors working with adults. The study also illustrated the effective application of online technology as a service delivery tool. Future research might examine the efficacy of this intervention in a variety of settings (e.g., K–12, postsecondary, agency, mental health, corporate).

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Objectives: Mechanical circulatory support for pediatric heart failure patients with the Berlin Heart EXCOR ventricular assist system is the only approved and established bridging strategy for recovery or heart transplantation. In recent years, the burden of thromboembolic events has led to modifications of the recommended antithrombotic therapy. Therefore, we aimed to assess modifications of antithrombotic practice among the European EXCOR Pediatric Investigator Group members.Methods: We sent a questionnaire assessing seven aspects of antithrombotic therapy to 18 European hospitals using the EXCOR device for children. Returned questionnaires were analyzed and identified antithrombotic strategies were descriptively compared to “Edmonton protocol” recommendations developed for the US EXCOR pediatric approval study.Results: Analysis of 18 received surveys revealed substantial deviations from the Edmonton protocol, including earlier start of heparin therapy at 6–12 h postoperatively and in 50% of surveyed centers, monitoring of heparin effectiveness with aPTT assay, administering vitamin K antagonists before 12 months of age. About 39% of centers use higher international normalized ratio targets, and platelet inhibition is changed in 56% including the use of clopidogrel instead of dipyridamole. Significant inter-center variability with multiple deviations from the Edmonton protocol was discovered with only one center following the Edmonton protocol completely.Conclusion: Current antithrombotic practice among European EXCOR users representing the treatment of more than 600 pediatric patients has changed over time with a trend toward a more aggressive therapy. There is a need for systematic evidence-based evaluation and harmonization of developmentally adjusted antithrombotic management practices in prospective studies toward revised recommendations.

Background Different lipid mediators may have opposing effects on vascular inflammation. For example, whereas leukotriene B4(LTB4) transduces inflammation, resolvin D1 (RvD1), which is synthesized from the omega-3 fatty acid docosahexaenoic acid, facilitates the resolution of inflammation. The aim of this study was to determine the association of the RvD1/LTB4ratio with subclinical atherosclerosis.Methods Saliva samples and ultrasound measurements of the intima media thickness of the carotid artery was obtained for 254 participants. The lipid mediators RvD1 and LTB4were measured by enzyme-linked immunosorbent assay.Results Participants with a salivary RvD1/LTB4ratio >1 had a significantly lower intima media thickness than those in whom LTB4prevailed. The salivary RvD1/LTB4 ratio independently predicted carotid intima media thickness.Conclusions The ratio between the proresolving and proinflammatory salivary lipid mediators RvD1 and LTB4may serve as a biomarker of non-resolving inflammation and its relation to intima media thickness in cardiovascular disease.

Indigo is the most important blue dye for textile dyeing and is biosynthesized in Polygonum tinctorium. Some biochemical studies related to biosynthesis are available. However, genomic and transcriptome studies have not received sufficient attention. Here, we report de novo assembly of transcriptome datasets and its comprehensive analysis. A total of 60,395 unigenes were annotated using BLAST search against the different databases. At least 23,721 unigenes mapped onto different pathways using KEGG database. We found that 3,323 genes are involved in biosynthesis of secondary metabolites, 117 phenylalanine, tyrosine and tryptophan biosynthesis and 147 tryptophan metabolisms. Apart from this, indigo biosynthesis pathway genes viz., dioxygenase, monooxygenase, and glucosyltransferase have also been identified. Fourteen genes encoding cytochrome P450 monooxygenase, 26 glucoside dioxygenase, 9 UDP-glucose D-glucosyltransferase and 52 were β-D-glucosidase. These findings provide a foundation for further analysis of this pathway with potential to enhance the synthesis of indican in P. tinctorium

Indigo is the most important blue dye for textile dyeing and is biosynthesized in Polygonum tinctorium. Some biochemical studies related to biosynthesis are available. However, genomic and transcriptome studies have not received sufficient attention. Here, we report de novoassembly of transcriptome datasets and its comprehensive analysis. A total of 60,395 unigenes were annotated using BLAST search against the different databases. At least 23,721 unigenes mapped onto different pathways using KEGG database. We found that 3,323 genes are involved in biosynthesis of secondary metabolites, 117 phenylalanine, tyrosine and tryptophan biosynthesis and 147 tryptophan metabolisms. Apart from this, indigo biosynthesis pathway genes viz., dioxygenase, monooxygenase, and glucosyltransferase have also been identified. Fourteen genes encoding cytochrome P450 monooxygenase, 26 glucoside dioxygenase, 9 UDP-glucose D-glucosyltransferase and 52 were β-D-glucosidase. These findings provide a foundation for further analysis of this pathway with potential to enhance the synthesis of indican in P. tinctorium.

Characteristics of the home and family have been associated with adolescents’ BMI and physical and sedentary activity, but few studies have examined how these characteristics vary across ethnic/ethnic groups. This study explores whether recommendations for activity promotion are equally relevant to different adolescent populations. Participants included 2,374 adolescents and their parent(s), recruited through 20 public schools in Minneapolis/St. Paul, MN, in 2009–2010. Ethnic/racial groups included African American, Asian (primarily Hmong), East African, Hispanic, Native American, White, and mixed/other race. Linear regression analysis modeled adolescents’ BMI z-scores and physical and sedentary activity based on six measures of the family/home activity environment, adjusted for covariates. Interactions of ethnicity/race and family/home environment were tested. All six family/home environment measures varied significantly across ethnicity/race. Family/home variables were significantly associated with adolescent physical activity and TV viewing in the expected directions, and these relationships were consistent across ethnic/racial groups in two thirds of the models. However, in one third of the cases, these associations were modified by ethnicity/race. For example, home access to a greater number of media devices was significantly associated with more TV viewing (β = .40, p= .015) only among White youth. Health promotion recommendations for adolescent physical activity are largely relevant across ethnic/racial groups. However, given differences found in the family/home environments of adolescents, cultural sensitivity is recommended in discussing these issues, and tailored recommendations may be appropriate for select groups or behaviors. Further mixed methods research is warranted to help identify key messages for specific groups.

Fish escapement is a largely overlooked challenge to managing reservoir fisheries. Physical barriers may help retain fish in reservoirs but are often not practical due to high reservoir debris loads and maintenance requirements of these structures. As an alternative, nonphysical barriers may also be successful at increasing fish retention in reservoirs through the use of negative stimuli that divert fish away from targeted locations. However, the effectiveness of nonphysical barriers can vary considerably among barrier stimuli and fish species because the barrier's success is dependent upon on a behavioral response from fish. We conducted a laboratory experiment to evaluate the effectiveness of a bioacoustic bubble–strobe light barrier at reducing Walleye Sander vitreusescapement rates. We hypothesized that increasing the number and frequency of barrier stimuli would result in Walleyes approaching the barrier less frequently, reduced escapement, and increased amount of time before escapement occurred. Walleyes approached the barrier and were successfully deterred most often when lights were off and sound was on. Walleye escapement rates declined from 89.3% with the barrier off to 44.1% with low and medium sound, whereas up to 100% of the fish escaped with the addition of light. Mean time before escapement and time to 50% escapement increased with the use of sound, whereas fish escaped in less time when light was used as a deterrent. Most Walleyes escaped around sunset indicating that fish were most active during the crepuscular period. Despite reductions in escapement associated with sound–bubble barriers, we recommend that alternative nonphysical barriers be evaluated for their potential to further increase retention of Walleyes before installation of sound barrier deterrent systems in reservoirs. Received December 23, 2013; accepted June 27, 2014

AbstractFish escapement is a largely overlooked challenge to managing reservoir fisheries. Physical barriers may help retain fish in reservoirs but are often not practical due to high reservoir debris loads and maintenance requirements of these structures. As an alternative, nonphysical barriers may also be successful at increasing fish retention in reservoirs through the use of negative stimuli that divert fish away from targeted locations. However, the effectiveness of nonphysical barriers can vary considerably among barrier stimuli and fish species because the barrier's success is dependent upon on a behavioral response from fish. We conducted a laboratory experiment to evaluate the effectiveness of a bioacoustic bubble–strobe light barrier at reducing Walleye Sander vitreusescapement rates. We hypothesized that increasing the number and frequency of barrier stimuli would result in Walleyes approaching the barrier less frequently, reduced escapement, and increased amount of time before escapement occurred. Walleyes approached the barrier and were successfully deterred most often when lights were off and sound was on. Walleye escapement rates declined from 89.3% with the barrier off to 44.1% with low and medium sound, whereas up to 100% of the fish escaped with the addition of light. Mean time before escapement and time to 50% escapement increased with the use of sound, whereas fish escaped in less time when light was used as a deterrent. Most Walleyes escaped around sunset indicating that fish were most active during the crepuscular period. Despite reductions in escapement associated with sound–bubble barriers, we recommend that alternative nonphysical barriers be evaluated for their potential to further increase retention of Walleyes before installation of sound barrier deterrent systems in reservoirs.Received December 23, 2013; accepted June 27, 2014

Adolescent confidentiality may present practice challenges for health care providers related to family, medical, ethical, legal, social and bureaucratic processes. It is unclear how health care providers understand and practice confidentiality with adolescents in Canada.

Abstract:Acorus calamusL. (Araceae), is a semi aquatic perennial herb extensively distributed in western Himalaya. To explore the variability in volatile constituents of rhizome essential oils of A. calamusgrowing wild in foot and mid hills of Uttarakhand, India; twenty one populations were collected during spring season from an altitude of 215 m to 1827 m. The essential oil yield was found to vary from 0.68 % to 5.80 % in the different populations of A. calamus. GC-FID and GC-MS analysis of oil samples resulted in identification of forty constituents comprising 94.0-99.9 % of oil compositions. Phenyl propanoids (81.9-96.9 %) represented by β-asarone (69.8-95.6 %), α-asarone (0.1-4.7 %), (Z)-methyl isoeugenol (<0.1-4.4 %), (E)-isoeugenol acetate (0.0-3.7 %), (E)-methyl isoeugenol (0.1-2.9 %) and γ-asarone (<0.1-1.6 %) constitute the major fraction of essential oil composition. Other major constituents identified were α-selinene (0.1-7.2 %), humulene epoxide II (<0.1-3.5 %), p-cymene (<0.1-1.9 %) and α-bisabolol (0.0-1.6 %). Comparative results and subsequent statistical analysis based on euclidean multidimensional distance scaling showed considerable variations in rhizome essential oils composition.

The drive of this study was to examine and investigate ARDS in paediatrics. Using the patient data during diagnosis among all representing relatively small percentages of total admission the most difficult patient population for a clinical to manage is ARDS. We present a 2-year-1-month-old female child with pneumonitis who developed ARDS. ARDS in pediatrics palicc suggested that for mild to severe pARDS, the consensus conference recommended "should be considered" after the peep has been optimized. Aching in the abdomen (in pancreatitis) coughing (often with white or pink frothy mucus) fatigue, fever, and shortness of breath are entirely indications of asthma. Tracheal intubation and mechanical ventilation are obligatory to advance the ailment of a patient with ARDS. Acute respiratory distress syndrome (ARDS) is prevalent in ventilated patient’s youngsters and is present in up to 30 percent of the overall of all paediatric intensive care unit casualties. Regardless of the circumstance that ARDS is diagnosed via medical criteria, inherited markers of acute lung injury have been comprehensively sightseen in adults and children. Anomalies of the flow of fluids in the body such as inflammatory markers, alveolar epithelial disruption, and high coagulation, along with other anomalous findings in the circulation such as bronchoalveolar lavage, have enriched our indulgent of ARDS pathologic variations.

Aquilaria agallocha Roxb. family, Thymelaeaceae, is an evergreen plant of South-East Asia, commonly described as aloe wood or agarwood. Traditionally, the bark, root and heartwood are used for their medicinal properties as a folk medicine for hundreds of years. Chemical analyses revealed that the bulk of the oil is constituted by agarospirol (12.5), jinkoh-eremol (11.8) and hinesol (8.9) as major contributor. In the present work, a QSAR model for antiinflammatory activity of 10-epi--Eudesmol, jinkoh-eremol, agarospirol and other compounds has been developed by multiple linear regression method. The r2 and rCV2 of a model were 0.89 and 0.81 respectively. In silico molecular docking study suggests that compound 10-epi--Eudesmol, jinkoh-eremol and agarospirol are preferentially more active than other identified compounds with strong binding affinity to major anti-inflammatory and immunomodulatory receptors. The oil displayed a significant and dose dependent reduction of 12-O-tetradecanoylphorobol-13 acetate (TPA)- induced ear edema and MDA activity when compared with vehicle treated mice. Pro-inflammatory cytokines (IL-1, IL-6 and TNF-) were also reduced significantly in a dose dependent manner in all the TPA treated groups as compared to control. The present study indicates that agarwood oil significantly reduced the skin thickness, ear weight, oxidative stress and pro-inflammatory cytokines production in TPA-induced mouse ear inflammation model and contributed towards validation of its traditional use to treat inflammation related ailments.

The structure glutamate pyruvate transaminase (GPT), glutamate oxaloacetate transaminase (GOT), acid phosphatase (ACP), alkaline phosphatase (ALP) and glutamate dehydrogenase (GlDH) activity relationships of 2H-pyran-2- ones polysubstitutes being a new class of hepatoprotective agents have been investigated by means of the Electronic- Topological Method (ETM) and two Statistical Analysis. Molecular fragments specific for active compounds were calculated for 2H-pyran-2-ones polysubstitutes by applying the ETM. QSAR descriptors such as molecular weight, EHOMO, ELUMO, E, chemical potential, softness, electrophilicity index, dipole moment, etc were calculated. In order to examine the relationship between independent and dependent variables, both Partial Least Squares Regression and ANNs are employed to determine the relationship since the data set consists of highly nonlinearity and multicolinearity. It is observed that ANN has surpassed both PLS2 and PLS1 in terms of better modeling and validation.

The article discusses the Bills of Rights in Canada which consist of the Canadian Bill of Rights and the Alberta Bill of Rights. The authors state that a Bill of Rights contains only rights and freedoms guaranteed by the Crown which can truly be ensured by the public authority. They mention that individuals do not have any obligations under a Bill of Rights, they only have rights. They note that the Bill of Rights is reflected in the Canadian Charter of Rights and Freedoms of 1982.

The variability of neuronal firing has been an intense topic of study for many years. From a modelling perspective it has often been studied in conductance based spiking models with the use of additive or multiplicative noise terms to represent channel fluctuations or the stochastic nature of neurotransmitter release. Here we propose an alternative approach using a simple leaky integrate-and-fire model with a noisy threshold. Initially, we develop a mathematical treatment of the neuronal response to periodic forcing using tools from linear response theory and use this to highlight how a noisy threshold can enhance downstream signal reconstruction. We further develop a more general framework for understanding the responses to large amplitude forcing based on a calculation of first passage times. This is ideally suited to understanding stochastic mode-locking, for which we numerically determine the Arnol'd tongue structure. An examination of data from regularly firing stellate neurons within the ventral cochlear nucleus, responding to sinusoidally amplitude modulated pure tones, shows tongue structures consistent with these predictions and highlights that stochastic, as opposed to deterministic, mode-locking is utilised at the level of the single stellate cell to faithfully encode periodic stimuli.

Little is known about the beliefs, desires, and barriers related to physical activity of East African adolescent girls. The purpose of this study was to explore the experiences with and beliefs about physical activity of East African adolescent female participants and suggestions for promoting active living. A phenomenological research design was employed, which included semi-structured interviews with East African adolescent girls (n = 19) 12–18 years of age. Deductive and inductive content analysis revealed that East African girls desired to be physically active and perceived a wide range of physical activities to be culturally relevant and desirable, yet faced an array of personal, social, environmental, and cultural barriers to active living. To help increase physical activity, many culturally relevant programming strategies that align closely with the characteristics of optimal positive youth development settings outlined by the National Research Council and Institute of Medicine were offered by the adolescents in this study.

The need for higher data rates is ever rising as wireless communications standards move from the third to the fourth generation. Turbo-Codes are the prevalent channel codes for wireless systems due to their excellent forward error correction capability. So far research has mainly focused on componentsof high throughput Turbo-Decoders. In this paper we explore the Turbo-Decoder design space anew, both under system design and deep-submicron implementation aspects. Our approach incorporates all levels of design, from I/O behavior down to floorplaning taking deep-submicron effects into account. Its scalability allows to derive optimized architectures tailored to the given throughput and target technology. We present results for 3GPP compliant Turbo-Decoders beyond 100 Mbit/s synthesized on a 0.18 μm standard cell library.

We simulate currents and concentration profiles generated by Ca2+ release from the endoplasmic reticulum (ER) to the cytosol through IP3 receptor channel clusters. Clusters are described as conducting pores in the lumenal membrane with a diameter from 6nm to 36nm. The endoplasmic reticulum is modeled as a disc with a radius of 1–12μm and an inner height of 28nm. We adapt the dependence of the currents on the trans Ca2+ concentration (intralumenal) measured in lipid bilayer experiments to the cellular geometry. Simulated currents are compared with signal mass measurements in Xenopus oocytes. We find that release currents depend linearly on the concentration of free Ca2+ in the lumen. The release current is approximately proportional to the square root of the number of open channels in a cluster. Cytosolic concentrations at the location of the cluster range from 25μM to 170μM. Concentration increase due to puffs in a distance of a few micrometers from the puff site is found to be in the nanomolar range. Release currents decay biexponentially with timescales of <1s and a few seconds. Concentration profiles decay with timescales of 0.125–0.250s upon termination of release.

Zusammenfassung Epigastrische Schmerzen, Übelkeit, Erbrechen und eine obere gastrointestinale Blutung werden gelegentlich durch heterotopes Pankreasgewebe der Magenwand verursacht. Trotz moderner diagnostischer Verfahren gestaltet sich die Diagnose heterotopen Pankreasgewebes oftmals schwierig. Daher wird von vielen Autoren die Magenwandresektion und Schnellschnittuntersuchung als diagnostische und therapeutische Maßnahme befürwortet. Zwei typische Kasuistiken werden im Folgenden mit einer Literaturübersicht vorgestellt.

Therapy of hypoplastic left heart syndrome (HLHS) consists of the staged Norwood procedure or cardiac transplantation. Stenting the ductus arteriosus and subsequent banding of the pulmonary arteries allows the combination of neoaortic reconstruction with the establishment of a bidirectional cavopulmonary connection (combined stage 1 and 2 procedure) in a later session. We report the anaesthetic management in eight infants ranging from 107 to 195 days undergoing a combined stage 1 and 2 procedure. Nonselective pulmonary vasodilators and nitric oxide were needed in all cases to improve oxygen saturation in the postbypass period. Phosphodiesterase inhibitors and epinephrine were required in all patients for inotropic support during and after weaning off cardiopulmonary bypass. The procedure was successful in seven patients. One patient died intraoperatively because of right heart failure. The physiological changes of this new surgical strategy for palliation of HLHS offers a challenge for the anaesthetist primarily in the early postbypass period.

In a prospective investigation of perioperative cardiac edema formation requiring a delayed sternal closure, we identified thrombin increase combined with a simultaneous decrease of factor XIII as a probable cause. After experimental studies additionally revealed that factor XIII could protect endothelial barrier function, we did another prospective randomized trial in which factor XIII or placebo was preoperatively substituted. The substitution finally showed distinct effects minimizing the incidence of myocardial swelling. Therefore, the clinical application of factor XIII may have a valuable therapeutic benefit in cases of leakage syndrome during extracorporeal circulation in congenital heart surgery.

BackgroundPerioperative myocardial damage is an important determinant for postoperative cardiac function and recovery. Cardiac troponin I (cTNI) is a specific marker for myocardial damage. The aim of our study was to evaluate pre- and postoperative cTNI levels, the pattern of elevation in the first four postoperative days and the prognostic value after pediatric cardiac operation. MethodsCardiac troponin I levels were measured in 115 children mean age 36±45 months (range 4 days to 189 months) undergoing elective operation of a congenital heart defect. Routine measurements were made preoperatively, immediately after cardiopulmonary bypass and serially 8, 18, 42, 90, 138 hours thereafter. Data from 13 patients undergoing surgery without cardiopulmonary bypass served as controls. Postoperative cTNI levels were correlated with intra- and postoperative parameters (such as duration of aortic crossclamping, cardiopulmonary bypass time and need for postoperative inotropic support). ResultsAll preoperative cTNI levels were in the normal range. Postoperatively, the highest median cTNI levels were found in patients after repair of tetralogy of Fallot (TOF), atrioventricular septal defect (AVSD) and implantation of a homo- or xenograft. Postoperative cTNI levels correlated significantly with duration of cardiopulmonary bypass and aortic crossclamping, operative approach (ventriculotomy versus atriotomy) and inotropic support (p<0.0001). Peak cTNI levels were found immediately after surgery in 77.4% of our patients, 8 hours postoperative in 13.9% and at 18 hours after the surgery in 5.2% of the patients. In three children cTNI continued to increase; a secondary increase was found in one patient. Two of these children died, two had a prolonged postoperative recovery. ConclusionThe postoperative level of cardiac troponin I could be used as a marker of perioperative myocardial injury caused by ischemia and operative trauma. Peak levels usually could be obtained immediately after surgery, but a further increase of cTNI during the following 18 hours may occur and is not necessarily related to impaired recovery. However still increasing cTNI levels after 18 hours postoperatively and a secondary increase as well may be used as indicators of poor outcome. Hintergrund und ZielDer perioperative Myokardzellschaden ist ein wichtiger Faktor für die postoperative kardiale Funktion und Erholung. Neben bekannten biochemischen Markern für einen myokardialen Zellschaden (Myoglobin, CKMB) ist das für den Herzmuskelschaden zu 100% spezifische kardiale Troponin I (cTNI) in der Routinediagnostik bestimmbar. Ziel der Untersuchung war den prä- und postoperativen Verlauf und die Bedeutung von cTNI als Marker einer myokardialen Schädigung nach kardiochirurgischer Korrektur angeborener Herzfehler zu bestimmen. MethodenProspektiv untersucht wurden cTNI Werte bei insgesamt 115 Kindern im Alter von 36±45 Monaten (4Tage bis 189 Monate), die an einem angeborenen Herzfehler operiert wurden. Ermittelt wurden die cTNI-Werte direkt präoperativ sowie 8, 18, 42, 90 und 138 Stunden nach kardiopulmonalem Bypass. Eine Kontrollgruppe bestand aus 13 ohne Herz-Lungen-Maschine operierten Patienten. Die postoperativen cTNI-Werte wurden mit intra- und postoperativen Parametern (Dauer der kardiopulmonalen Bypass- und Aortenabklemmzeit sowie dem postoperativen Katecholaminbedarf) korreliert. ErgebnisseBei allen Patienten befanden sich die präoperativen cTNI-Werte im Normbereich. Patienten nach Korrektur einer Fallot‘schen Tetralogie, eines atrioventrikulären Septumdefekts und nach Homo- bzw. Xenograftimplantation wiesen im Median die höchsten postoperativen cTNI Werte auf. Die Höhe des postoperativen cTNI-Wertes korrelierte signifikant mit der Dauer der kardialen Bypass- und Aortenabklemmzeit, dem operativen Zugang (Ventrikulotomie versus Atriotomie) und dem postoperativen Bedarf an Katecholaminen (p<0,0001). In 77,4% der Fälle wurden die im Verlauf höchsten cTNI-Werte direkt nach der Operation gemessen, in 13,9% zum Zeitpunkt 8 Stunden und in 5,2% zum Zeitpunkt 18 Stunden nach Beendigung der Operation. Drei Patienten wiesen auch im weiteren Verlauf einen weiteren Anstieg auf, ein Patient einen sekundären Anstieg nach initialem Abfall. Zwei dieser Patienten verstarben, die anderen beiden hatten einen protrahierten stationären Verlauf. SchlussfolgerungNach kardiochirurgischer Korrekturoperation im Kindesalter korrelierte die Höhe der postoperativ ermittelten cTNI-Werte mit der Dauer der Ischämie, der Art der Operation und dem Katecholaminbedarf und ermöglichte eine Abschätzung des perioperativen myokardialen Zellschadens. In der Mehrzahl der Patienten war der erste postoperative cTNI-Wert der im Verlauf höchste, ein weiterer Anstieg, bei klinisch unauffälligem Verlauf, ist bis 18 Stunden nach Operation möglich. In unserem Kollektiv erwies sich ein weiterer cTNI-Anstieg nach diesem Zeitpunkt oder ein sekundärer Anstieg als prognostisch ungünstig.

Rationale:Home Artificial Nutrition (HAN) has been an expanding area over the last 30 years. HAN programs have been often developed prior to the regulation by the National Health Systems (NHS) leading to different policies within European countries. The aim of this study was to compare legislation regarding HAN in Europe.

Objective: To compare a system that continuously monitors cardiac output by the Fick principle with measurements by the thermodilution technique in pediatric patients. Design: Prospective direct comparison of the above two techniques. Setting: Pediatric intensive care unit of a university hospital. Patients: 25 infants and children, aged 1 week to 17 years (median 10 months), who had undergone open heart surgery were studied. Only patients without an endotracheal tube leak and without a residual shunt were included. Methods: The system based on the Fick principle uses measurements of oxygen consumption taken by a metabolic monitor and of arterial and mixed venous oxygen saturation taken by pulse- and fiberoptic oximetry to calculate cardiac output every 20 s. Interventions: In every patient one pair of measurements was taken. Continuous Fick and thermodilution cardiac output measurements were performed simultaneously, with the examiners remaining ignorant of the results of the other method. Results: Cardiac output measurements ranged from 0.21 to 4.55 l/min. A good correlation coefficient was found:r2=0.98;P&lt;0.001; SEE=0.14 l/min. The bias is absolute values and in percent of average cardiac output was −0.05 l/min or −4.4% with a precision of 0.32 l/ min or 21.3% at 2 SD, respectively. The difference was most marked in a neonate with low cardiac output. Conclusion: Continuous measurement of cardiac output by the Fick principle offers a convenient method for the hemodynamic monitoring of unstable infants and children.