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The present study entails the phytoremediation potential of different bamboo species on 5-year-old FA-dumped site near Koradi thermal power plant of Nagpur, Maharashtra, India. The selected FA-dumped site was treated with farmyard manure, press mud, and bio fertilizer followed by plantation of six promising species of bamboo namely Bambusa balcooa Roxb., Dendrocalamus stocksii (Munro.) M. Kumar, Remesh and Unnikrishnan, Bambusa bambos (L.) Voss, Bambusa wamin E.G. Camus, Bambusa vulgaris var. striata (Lodd. ex Lindl.) Gamble, and Bambusa vulgaris var. vittata Riviere and Riviere. The experimental results indicated that the organic input in the FA-dumped site nourished the soil by improving its physico-chemical, and biological characteristics. The results revealed the contamination of the site with different trace elements in varied quantity including Cr (89.29 mg kg−1), Zn (84.77 mg kg−1), Ni (28.84 mg kg−1), Cu (22.91 mg kg−1), Li (19.65 mg kg−1), Pb (13.47 mg kg−1), and Cd (2.35 mg kg−1). A drastic reduction in concentration of heavy metals in FA was observed after 1 year of bamboo plantation as compared to the initial condition. The results showed that bamboo species are good excluders of Ba, Co, Cr, Li, Ni, Mn, and Zn, whereas they are good accumulators of Cd, Pb, and Cu. The values of biochemical parameters, such as pH, total chlorophyll, ascorbic acid (AA), and relative water content of all the bamboo leaves ranged from 5.11–5.70, 1.56-6.33 mg g−1, 0.16-0.19 mg g−1, and 60.23–76.68%, respectively. It is thereby concluded that the bamboo plantation with biofertilizers and organic amendments may indicate adaptive response to environmental pollution on FA-dumped site.

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.

Bamboo is a non-timber forest product and one of the most important grass plants of industrial and domestic use. It is widely distributed in tropical countries including India, China and Southeast Asian countries with wide genetic diversity. The diversity in the available genotypes becomes an important resource for the selection and improvement of the plants for ecological and commercial use. This study investigates eight commercially and ecologically important bamboo species of six genera (Bambusa, Dendrocalamus, Thyrsostachys, Vietnamosasa, Cephalostachyum and Indocalamus) from India, Thailand and Laos. These were evaluated for genetic differences by molecular makers, chemo-morphological variation and ability of silicon accumulation. The genetic cluster analyses of eight RAPD primers revealed genetic similarities in the ranges of 24-55%. The total silica content varied from 18.34 to 40.08 ppm in leaves of different bamboo species. Chemical analysis of the silicon content by ICP-OES and secondary metabolite profiling on TLC depicted the prominent distinction among the species. The PCA analysis of quantitative morphological data grouped the species in two major clusters and found to correlate with chemical pattern and genetic similarity to some extent. This is the first report that summarizes species-specific variability of leaf silica content, secondary metabolites, and quantitative morphological data towards delineation of genetic phylogeny of bamboo species.

Objectives To analyse prenatal parameters predicting biventricular (BV) outcome in pulmonary atresia with intact ventricular septum/critical pulmonary stenosis (PAIVS/CPS). Methods We evaluated 82 foetuses from 01/08 to 10/18 in 3 centres in intervals 1 ( 30 weeks). Results 61/82 (74.4%) were livebirths, 5 (8.2%) lost for follow-up, 3 (4.9%) had compassionate care leaving 53 (64.6% of the whole cohort and 86.9% of livebirths) with intention to treat. 9 died, 44/53 (83.0%) survived. 24/38 (63.2%) with information on postnatal outcome had BV outcome, 14 (36.8%) non-BV outcome (2 × 1.5 circulation). One with BV outcome had prenatal valvuloplasty. Best single parameter for BV outcome was tricuspid/mitral valve (TV/MV) ratio (AUC 0.93) in intervals 2 and 3 (AUC 0.92). Ventriculo-coronary-arterial communications (VCAC) were present in 11 (78.6%) in non-BV outcome group vs. 2 (8.3%) in BV outcome group (p 2.5 m/s was present in BV outcome group in75.0% (18/24) vs. 14.3% (2/14) in non-BV outcome group. Including the most predictive markers (VCAC presence, TI- Vmax 1 criterion was fulfilled in all cases. After recently published criteria for foetal intervention, only 4/9 (44.4%) and 5/14 (35.7%) in our interval 2 + 3 with predicted non-BV outcome would have been candidates for intervention. Two (1 × intrauterine intervention) in interval 2, two in interval 3 reached BV outcome and one 1.5 circulation without intervention. Conclusion TV/MV ratio as simple parameter has high predictive value. After our score, non-BV outcome was correctly predicted in all cases. Criteria for foetal intervention must further be evaluated.

Integrate-and-fire networks have proven remarkably useful in modelling the dynamics of real world phenomena ranging from earthquakes, to synchrony in neural networks, to cascading activity in social networks. The reset process means that such models are inherently discontinuous. Moreover, for jump interactions, which are a common choice for many physical systems, the models are also nonsmooth. For synchronous network states these processes can occur simultaneously, and care must be taken with the mathematical analysis of solution stability. This leads to an ordering problem, that has no counterpart in smoothly coupled limit cycle systems. Here we develop a set of network saltation matrices that can be used with an appropriate ordering to determine the instability of a synchronous network state. Moreover, we show that smoothed versions of jump interactions do not capture the behaviour of the nonsmooth model. Synchrony in the smoothed model with reset is analysed using a generalised master stability function (MSF), and the eigenspectra for smooth and nonsmooth interactions are compared. We find that the one determined by the MSF organises that found from the analysis of the nonsmooth model, though the latter has further eigenvalues that can destabilise the synchronous state.

Citrus fruits are commercially important fruit crop all over the world. About 50–60% of citrus fruit is considered waste including peels and its handling is costly at municipal and industry levels. Citrus wastes in general show a low pH (3–4), relatively high water content and organic matter. Its composting is not recommended, as it has inherent low pH and presence of high concentration of limonene in essential oils that slow down its biological decomposition due to inhibitory activity. Anaerobic digestion for biogas production seems to be a technically sustainable way to valorise by suitable pre-treatment methods. Present study shows extraction of essential oil in minimum requirement of water (1:1 w/v) for hydro-distillation that yields about 2% essential oil from fresh peels. Further, pre-treatment of left over de-oiled biomass with of 30% Fenton’s reagent treatment show biogas and methane production up to 322.63 ml biogas/g VS feed and 122.48 ml methane/g VS feed, respectively under mesophilic condition which is superior to conventional treatment.

Hyperaccumulation of arsenic (As) by brake fern Pteris vittata has been described as an important genetic trait that provides an option for development of a sustainable phytoremediation process for As mitigation. Accumulation of very high concentration of arsenic in above-ground tissues may be the result of arsenic vacuole compartmentalization, but the mechanism(s) of arsenic uptake and transport by underground tissues are largely unknown. In this study, we made an attempt towards understanding the molecular mechanism of As hyperaccumulation in this plant. A time-dependent As accumulation study indicates an exponential accumulation of As from 7 to 30 days of arsenic exposure in fronds, and day 3-7 in roots. Root transcriptome analysis identified 554,973 transcripts. Further, subsets of 824 transcripts were differentially expressed between treated and control samples. Many of the genes of critical As-stress response, transcription factors and metal transporters, biosynthesis of chelating compounds involved in uptake and accumulation mechanisms were identified. The genes that were highly expressed such as cysteine-rich RLK, and ABC transporter G family member 26 needs further studies along with arsenite transmembrane transporter. The analysis of generated transcriptome dataset has provided valuable information and platform for further functional studies.

During a single heartbeat, muscle cells in the heart contract and relax. Under healthy conditions, the behaviour of these muscle cells is almost identical from one beat to the next. However, this regular rhythm can be disturbed giving rise to a variety of cardiac arrhythmias including cardiac alternans. Here, we focus on so-called microscopic calcium alternans and show how their complex spatial patterns can be understood with the help of the master stability function. Our work makes use of the fact that cardiac muscle cells can be conceptualised as a network of networks, and that calcium alternans correspond to an instability of the synchronous network state. In particular, we demonstrate how small changes in the coupling strength between network nodes can give rise to drastically different activity patterns in the network.

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.

Adults suffering from congenital heart diseases (CHD) represent a challenge to anesthesiologists because of the diverse pathologies, complex pathophysiology and special treatment strategies. Due to improved therapeutic options for CHD, patient quality of life and life expectancy is increasing, leaving them as a growing population including pregnant patients with CHD. This article presents the main principles of the pathophysiology and anesthesiological management of pregnant patients living with a Fontan circulation based on a case report, which was complicated by an aortic coarctation and atonic uterine hemorrhage.

Presented is a retrospective outcome study of a 15-year single institutional experience with a contemporary cohort of patients with hypoplastic left heart syndrome and complex that underwent a “Giessen Hybrid” stage I as initial palliation. Hybrid approach consisting of surgical bilateral pulmonary artery banding and percutaneous duct stenting with or without atrial septum manipulation was developed from a rescue approach to a first-line procedure. Comprehensive Aristotle score defined pre-operative condition. Fifteen-year follow-up mortality is reported as occurring within the staged univentricular palliation or before and after biventricular repair. Hybrid stage I was performed in 154 patients; 107 should be treated by single ventricle palliation, 33 by biventricular repair (BVR), 7 received heart transplantation, and 7 were treated by comfort care, respectively. Overall 34 children died. The Aristotle score (mean value 18.2 ± 3) classified for univentricular circulations in newborns did not have statistical impact on the outcome. Two patients died during stage I (1.2 %), and the interstage I mortality was 6.7 %, and stage II mortality 9 %, respectively. Stage III was up to now performed in 57 patients without mortality. At 1 year, the overall unadjusted survival of HLHS and variants was 84 % and following BVR 89 %, respectively. The Fifteen-year survival rate for HLHS and variants was 77 %, with no significant impact of birth weight of less than 2.5 kg. In conclusion, Hybrid stage I fulfilled the criteria of life-saving approach. In our institution, Hybrid procedure replaced Norwood-staged palliation with a considerable mid- and long-term survival rate. Considering interstage mortality close surveillance is mandatory.

Endocannabinoids (eCBs) modulate both excitatory and inhibitory neurotransmission in hippocampus via activation of pre-synaptic cannabinoid receptors. Here, we present a model for cannabinoid mediated short-term depression of excitation (DSE) based on our recently developed model for the equivalent phenomenon of suppressing inhibition (DSI). Furthermore, we derive a simplified formulation of the calcium-mediated endocannabinoid synthesis that underlies short-term modulation of neurotransmission in hippocampus. The simplified model describes cannabinoid-mediated short-term modulation of both hippocampal inhibition and excitation and is ideally suited for large network studies. Moreover, the implementation of the simplified DSI/DSE model provides predictions on how both phenomena are modulated by the magnitude of the pre-synaptic cell's activity. In addition we demonstrate the role of DSE in shaping the post-synaptic cell's firing behaviour qualitatively and quantitatively in dependence on eCB availability and the pre-synaptic cell's activity. Finally, we explore under which conditions the combination of DSI and DSE can temporarily shift the fine balance between excitation and inhibition. This highlights a mechanism by which eCBs might act in a neuro-protective manner during high neural activity.

Retrospektive Auswertung der Erfolgsraten der interventionell-radiologischen Behandlung von Nierenarterienstenosen. Anhand der Krankenakten wurden die pra- und postinterventionellen Daten aller 104 Patienten ausgewertet, bei denen vom 01.01.1994 bis zum 31.12.2007 eine Nierenarterienstenose mittels einer perkutanen transluminalen Angioplastie (PTA; n=25 Patienten) oder einer Stent-PTA (n=79 Patienten) behandelt worden war. Die Angaben wurden mit einem strukturierten Erhebungsbogens elektronisch erfasst und anhand eines zeitlichen Rasters klassifiziert. Es erfolgten Subgruppenanalysen und Signifikanzberechnungen mittels des t-Tests fur verbundene Stichproben. Am 1. Tag nach der Intervention ergab sich fur alle Patienten eine signifikante Abnahme des mittleren systolischen [Gesamtgruppe (GG) p=0,002, Stent-PTA-Gruppe (SPG) p=0,023, PTA-Gruppe p=0,022] und eine tendenzielle Abnahme des mittleren diastolischen Blutdruckes. Im 1. und 2. postinterventionellen Jahr bestatigte sich im Mittel eine auffallige Reduktion des systolischen Blutdruckes (GG: p=0,009 bzw. 0,007; SPG: p=0,039 bzw. 0,015). Ansonsten waren die Blutdruckwerte stabil. Bei den Stent-PTA-Patienten der Jahre 2001–2007 lag eine signifikante Abnahme der verordneten Antihypertonika vor (p=0,023 bzw. p=0,046). Die Kreatininkonzentration im Serum sank zunachst im Mittel und stieg ab dem 3. Jahr wieder an. Bei prainterventionell erhohten Kreatininwerten nahm der Kreatininwert ab dem 5. Jahr signifikant zu. Die interventionell-radiologische Behandlung einer atherosklerotischen Nierenarterienstenose fuhrte in der Regel zu einer Verzogerung der Nierenfunktionsverschlechterung und zu einer Stabilisierung des Blutdruckes. In Anbetracht des meist chronisch progredienten Verlaufs ist dies als Therapieerfolg zu werten.

An effort was made to determine the impact of geographic range on genetic richness and chemical constituents of Valeriana jatamansi Jones, an herb indigenous to the northwestern Himalaya. The genetic structure of 16 accessions from two major divisions of Uttarakhand state (Kumaon and Garhwal) was analyzed by ISSR markers. Overall genetic diversity among the populations was 45 %, with a cumulative range of 35-92 % similarity for most of the high-altitude plants and a comparatively narrow range, 50-88 %, for the population below the altitude of 1,800 m. Likewise, a remarkable predictability was evident from the chemical constituents on an individual basis. In principal component analysis, most of the accessions fall into two major groups and are classified as chemotypes based on the percentage of similar chemical constituents; these are mostly correlated to altitude. Geographic distance seems to influence the genetic and chemical variability, indicating the genetic inbreeding within the population.

We study here the early stage of Ca(2+)-induced Ca(2+) release (CICR) in the diadic cleft of cardiac ventricular myocytes. A crucial question for this mechanism is whether the activation of the ryanodine receptors (RyRs) is triggered by one or by multiple open L-type Ca(2+) channels (LCCs). We address the problem through a modelling approach that allows us to investigate both possibilities. The model is based on a spatially resolved description of a Ca(2+) release unit (CaRU), consisting of the junctional sarcoplasmic reticulum and the diadic cleft, with well-defined channel placement. By taking advantage of largely varying time scales of the Ca(2+) dynamics in the diadic cleft, the governing equations can be reduced to one ordinary differential equation that describes the Ca(2+) fluxes, the electric field due to surface charges and diffusion. Our study shows that the mechanisms of the early stage of CICR shape measurable properties of CICR in a characteristic way. From here we conclude that the activation of RyRs requires multiple open LCCs.

The taxonomic identity of Capsicum species is found to be difficult as it displays variations at morpho-chemical characters. Twenty-two accessions of six Capsicum species, namely, C. annuum, C. baccatum, C. chinense, C. eximium, C. frutescens, and C. luteum were investigated for phenotypic diversity based on flower color and for genetic differences by molecular makers. The genetic cluster analyses of 27 RAPD and eight ISSR primers, respectively, revealed genetic similarities in the ranges of 23-88% and 11-96%. Principal component analysis of the pooled RAPD and ISSR data further supports the genetic similarity and groupings. Different species showed variations in relation to corolla shade of flower. C. annuum accessions formed a single cluster in the molecular analysis as maintaining their flower characteristic. C. chinense accession shared flower features with the accessions of C. frutescens and were found to be closer at genotypic level. C. luteum was found to be rather closer to C. baccatum complex, both phenotypically and genetically. The only accession of C. eximium presenting purple flowers falls apart from the groupings. The floral characteristics and the molecular markers are found to be useful toward the delineation of the species specificity in Capsicum collection and identification of genetic stock.

A method was developed based on multiple approaches wherein DNA and chemical analysis was carried out toward differentiation of important species of Sida complex that is being used for commercial preparation. Isolated DNA samples were successfully performed through PCR amplification using ISSR markers and degree of genetic diversity among the different species of Sida is compared with that of chemical diversity. For genetic fingerprint investigation, selected 10 ISSR primers generating reproducible banding patterns were used. Among the total of 63 amplicons, 62 were recorded as polymorphic, genetic similarity index deduced from ISSR profiles ranged from 12 to 51%. Based on similarity index, S. acuta and S. rhombifolia found to be most similar (51%). High number of species-specific bands played pivotal role to delineate species at genetic level. Investigation based on HPTLC fingerprints analysis revealed 23 bands representing to characteristic chemicals and similarity index ranged from 73 to 91%. Prominent distinguishable bands were observed only in S. acuta, while S. cordifolia and S. rhombifolia shared most bands making them difficult to identify on chemical fingerprint basis. This report summarizes the genotypic and chemotypic diversity and the use of profiles for authentication of species of Sida complex.

Phenotypic divergence among the 24 accessions belonging to a collection of six species of Capsicum from different geoclimatic regions available in field gene bank of CIMAP, Lucknow, India, was quantified by multivariate analysis for 12 quantitative and qualitative traits. Based on their values, all 24 accessions were grouped into six clusters such that the genetic stocks within cluster had smaller D 2 values among themselves than those belonging to different clusters. The accessions of Capsicum annuum were distributed in different clusters in morphotyping representing different species, suggesting that taxonomic characteristics are not always related to agronomic traits. No parallelism/association was found between geographical and phenotypic diversity. Accessions 15 and 23 (clusters V and VI, respectively) had distinct identity. The three characteristics that played the greatest role in differentiation were fruit diameter, number of fruits per plant, and leaf diameter, which can be utilized as conventional/morphological markers for the improvement of chilli yield and obtaining good segregants in chilli breeding programs.

Die Morbiditat im Langzeitverlauf nach einer Herztransplantation im Kindesalter manifestiert sich im Wesentlichen durch eine Erkrankung des transplantierten Herzens selbst, durch die Nebenwirkungen der lang dauernden medikamentosen Immunsuppression und schlieslich als psychosoziale Morbiditat, bedingt durch die Sondersituation des Lebens und Aufwachsens mit einem transplantierten Herzen. Die Transplantatvaskulopathie als eigenstandige Erkrankung des transplantierten Organs stellt eine haufige Komplikation nach Herztransplantation dar und ist ein wesentlicher Morbiditats- und Mortalitatsfaktor, der die Langzeitprognose erheblich limitiert. Progrediente Nierenfunktionsstorungen und die gehaufte Inzidenz von Malignomen sind weitere bedeutende prognoselimitierende Erkrankungen, deren Ursache die lang dauernde immunsuppressive Therapie darstellt.

We present a bidomain fire-diffuse-fire model that facilitates mathematical analysis of propagating waves of elevated intracellular calcium (Ca) in living cells. Modelling Ca release as a threshold process allows the explicit construction of travelling wave solutions to probe the dependence of Ca wave speed on physiologically important parameters such as the threshold for Ca release from the endoplasmic reticulum (ER) to the cytosol, the rate of Ca resequestration from the cytosol to the ER, and the total [Ca] (cytosolic plus ER). Interestingly, linear stability analysis of the bidomain fire-diffuse-fire model predicts the onset of dynamic wave instabilities leading to the emergence of Ca waves that propagate in a back-and-forth manner. Numerical simulations are used to confirm the presence of these so-called "tango waves" and the dependence of Ca wave speed on the total [Ca]. The original publication is available at www.springerlink.com (Journal of Mathematical Biology)

The outcome of patients with hypoplastic left heart (HLH) is determined by many factors, particularly by the first-step palliative procedure in newborns undergoing the Norwood procedure, its Sano modification, or, rarely, through challenging biventricular repairs. Duct stenting combined with bilateral pulmonary artery banding (PAB) is a new method employed as an alternative first-step approach in a number of centers worldwide. We describe this interventional-surgical "hybrid approach" as an additional strategy for the treatment of newborns with HLH syndrome and HLH complex. Between 1998 and April, 2006, 58 newborns underwent ductal stenting and bilateral PAB. These patients underwent surgical bilateral PAB initially, followed by percutaneous duct stenting; the only exception to this were patients in whom duct stenting was performed as a rescue procedure. Various balloon-expandable and self-expandable stents with different widths and lengths were used during the 8-year period of this study. Balloon dilatation of the atrial septum was performed when indicated. This included 5 patients in whom the atrial septum was stented. Aortic arch reconstruction (AAR) combined with a bidirectional cavopulmonary connection (BCPC) was performed at a median age of 4.8 months (range, 2.6-7.5), and total cavopulmonary connection (TCPC) was performed at a median age of 3.1 years (range, 2.5-4). Nine patients were listed for heart transplantation (HTX) and transplanted with AAR when a donor heart was available. Depending on growth of left ventricular structures, biventricular repair (BVR) was performed at a median age of 7.1 months (range, 3.5-10). Overall, 8 of 58 patients (13.8%) treated by the transcatheter-surgical hybrid approach died during the study period. The mortality rate for duct stenting was 1.7% (l/58), and it was 1.7% for bilateral PAB as well. Twenty-seven patients received an AAR/BCPC; 2 of them died (7.4%). Additionally, 1 of 2 patients with AAR/BCPC died while on the waiting list for HTX, resulting in a total mortality rate of 11% with an actuarial survival rate of 89%. One patient is still awaiting AAR + BCPC. Three patients died while on the waiting list for HTX despite successful bilateral PAB and duct stenting. The 30-day mortality rate for TCPC (n = 11), HTX (n = 8), and 18 patients with BVR was 0. The actuarial survival rate for patients with BVR is 93%. Postnatal transcatheter-surgical hybrid palliation expands the surgical options for newborns with HLH. Using hybrid palliation, Norwood stage I operation can be avoided in the neonatal period, the waiting period for children scheduled for cardiac transplantation can be extended, and observation for left ventricular growth suitable for biventricular repair as well.

Epigastrische Schmerzen, Ubelkeit, 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 Masnahme befurwortet. Zwei typische Kasuistiken werden im Folgenden mit einer Literaturubersicht vorgestellt.

Hintergrund und Ziel Der perioperative Myokardzellschaden ist ein wichtiger Faktor fur die postoperative kardiale Funktion und Erholung. Neben bekannten biochemischen Markern fur einen myokardialen Zellschaden (Myoglobin, CKMB) ist das fur den Herzmuskelschaden zu 100% spezifische kardiale Troponin I (cTNI) in der Routinediagnostik bestimmbar. Ziel der Untersuchung war den pra- und postoperativen Verlauf und die Bedeutung von cTNI als Marker einer myokardialen Schadigung nach kardiochirurgischer Korrektur angeborener Herzfehler zu bestimmen. Methoden Prospektiv 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 praoperativ 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. Ergebnisse Bei allen Patienten befanden sich die praoperativen cTNI-Werte im Normbereich. Patienten nach Korrektur einer Fallot‘schen Tetralogie, eines atrioventrikularen Septumdefekts und nach Homo- bzw. Xenograftimplantation wiesen im Median die hochsten postoperativen cTNI Werte auf. Die Hohe 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

Background Intestinal failure is the outcome of a number of gastrointestinal diseases and characterized by significant reduction in functional gut mass. If not resolved patients often face long-term nutritional support. This study gathered information about how patients referred with intestinal failure are managed in specialised European centres. Methods A questionnaire was circulated in 7 European countries via representatives of the ESPEN-HAN working group to seek information about experience in treating patients with intestinal failure. We asked about clinical outcome, information about structure and organisation of the department, referral criteria, treatment procedures and guidelines. Results 17 centres in 6 European countries completed the questionnaire: UK, n = 6, France, n = 4, Spain, n = 3, Denmark, n = 2, Italy, n = 1, Poland, n = 1. The experience of the centres in treating patients was in the range 12–30 years. The total number of patients on HPN in all centres was 590. The number of patients referred to centres with intestinal failure during the period January to December 2000 was n = 882: UK, n = 375 (range 2–175), France, n = 308 (range 24–182), Italy and Spain, n = 43 (range 9–52), Denmark n = 51 (range 14–37), the centre in Poland included 53 patients. Comparing all centres the following distribution among patients (median % (range%)) with regard to the endpoints were reported: Oral nutrition 32% (23–50%), enteral/tube feeding 11% (4–23%), HPN 36% (15–57%), lost to follow up 10% (0–35%), dead 9% (5–18%). No patients had an intestinal transplant. Conclusion The study provides information about how patients with intestinal failure are managed across Europe and the data indicates that treatment practice varies between countries.

Fragestellung: Das hypoplastische Linksherz (HLH) ist eine komplexe Entwicklungsfehlbildung der linken Herzkammer, der Aorta und der assoziierten Herzklappen. Unbehandelt wird die Neonatalperiode nur selten uberlebt. Die Prognose ist jedoch nicht langer hoffnungslos. Eine postnatale Prostaglandin-E1-Therapie ist zur Stabilisierung des Neugeborenen mit HLH in jedem Fall berechtigt, bis auf der Basis eines ausfuhrlichen Elterngesprachs eine Entscheidung fur oder gegen eine chirurgische Behandlung getroffen werden kann. Methode: Zur Beurteilung der derzeitigen Behandlungsstrategie bei Neugeborenen mit HLH analysierten wir die prospektiv erhobenen Daten von 23 im Jahr 1996 zugewiesenen Neugeborenen mit HLH. Ergebnisse: Funf der 23 Patienten wurden nicht chirurgisch behandelt. Eine Norwood-I-Operation wurde bei 8 Kindern durchgefuhrt. Davon konnte ein spat postnatal operierter Saugling nicht von der Herz-Lungen-Maschine entwohnt werden. Ein weiteres Kind starb 6 Wochen nach der Norwood-I-Operation an einem Leberversagen. Neun Kinder wurden herztransplantiert, kein Kind starb nach der Transplantation. Somit betrug die Uberlebensrate aller zugewiesenen Neugeborenen 70%. Schlusfolgerungen: Unsere chirurgischen Strategien der stufenweisen Palliativrekonstruktion nach Norwood und der Herztransplantation im Sauglingsalter erlauben einen Behandlungsalgorithmus fur das HLH. Die Ergebnisse der Behandlungsmoglichkeiten reduzieren die traditionelle „do nothing” Haltung fur alle Neugeborenen mit HLH auf ausgewahlte Patienten.

Von Juni 1988 bis Dezember 1996 wurden am Kinderherzzentrum Giesen 36 Patienten, im Alter von weniger als einem Jahr, einer Herztransplantation zugefuhrt. Zugrundeliegende Diagnosen waren ein hypoplastisches Linksherzsyndrom (n = 26), Endokardfibroelastose (n = 4), Kardiomyopathie (n = 3) und komplexe Vitien (n = 3). Die mittlere Wartezeit von Transplantation betrug 52 Tage, das Verhaltnis der Korpergewichte von Spender zu Empfanger lag im Mittel bei 1,8. Sieben Patienten (19%) verstarben nach Transplantation, uberwiegend innerhalb des ersten Monats nach der Transplantation. Die kumulative Uberlebenswahrscheinlichkeit liegt im Geamtkollektiv bei 79%. Der Einflus zunehmender Erfahrung zeigt sich beim Vergleich der Patienten mit Transplantationen von 1988 bis 1993 (n ? 15) und von 1994 bis 1996 (n = 21). Wahrend im ersten Zeitraum lediglich 50% uberlebten, betrug die Uberlebensrate der spater transplantierten Kinder 92%, die 1-Jahres-Uberlebensrate lag bei 100%. Bei 20 Patienten traten insgesamt 31 Abstosungsepisoden auf, wobei 2 Sauglinge verstarben. 71% aller Abstosungen traten innerhalb des ersten Monats nach der Transplantation auf. Die Nierenfunktion ist ein Jahr nach der Transplantation nur masiggradig eingeschrankt ohne Tendenz zur Verschlechterung. Die somatische Entwicklung verlauft bei nahezu allen Kindern perzentilengerecht. Die Lebensqualitat der Patienten nach der Transplantation ist ausgezeichnet. Alle Patienten leben ohne Einschrankungen zu Hause. Bei zwei Patienten liegt allerdings ein neurologisches Defizit vor. Bislang gibt es im Gesamtkollektiv keine Anzeichen fur eine Transplantatvaskulopathie oder eine maligne Erkrankung. Eine Herztransplantation stellt nach diesen Ergebnissen eine uberdenkenswerte Alternative in der Behandlung sehr komplexer Vitien und Kardiomyopathien im Neugeborenen- und Sauglingsalter dar.

Der klinische Nutzen der perioperativen Ernahrungstherapie wurde auf der Basis von 28 kontrollierten Studien analysiert. Eine praoperative enterale oder parenterale Ernahrung ist nur bei Patienten mit hochgradiger Mangelernahrung indiziert und kann bei diesen zu einer Verminderung der postoperativen Komplikationsrate und Klinikletalitat beitragen. Bei nicht oder grenzwertig Mangelernahrten ist dagegen nicht auszuschliesen, das die supportive Ernahrung den postoperativen Verlauf negativ beeinflust. Ein klinischer Nutzen der postoperativen Ernahrungstherapie ist nur bei Patienten erkennbar, die sich operationsbedingt langer als eine Woche nicht ausreichend oral ernahren konnen. Dabei ist bei etwa 20 % von ihnen mit erheblichen kardiopulmonalen Nebenwirkungen zu rechnen. In der grosen Mehrzahl der chirurgischen Patienten ist auch nach grosen Operationen die Zufuhr einer Wasser- und Elektrolytlosung ausreichend.