Search

Background: Heart failure (HF) due to myocarditis might not respond in the same way to standard therapy as HF due to other aetiologies. The aim of this study was to investigate the value of endomyocardial biopsies (EMB) for clinical decision-making and its relation to the outcome of paediatric patients with myocarditis. Methods: Clinical and EMB data of children with myocarditis collected for the MYKKE-registry between 2013 and 2020 from 23 centres were analysed. EMB studies included histology, immunohistology, and molecular pathology. The occurrence of major adverse cardiac events (MACE) including mechanical circulatory support (MCS), heart transplantation, and/or death was defined as a combined endpoint. Results: Myocarditis was diagnosed in 209/260 patients: 64% healing/chronic lymphocytic myocarditis, 23% acute lymphocytic myocarditis (AM), 14% healed myocarditis, no giant cell myocarditis. The median age was 12.8 (1.4-15.9) years. Time from symptom-onset to EMB was 11.0 (4.0-29.0) days. Children with AM and high amounts of mononuclear cell infiltrates were significantly younger with signs of HF compared to those with healing/chronic or healed myocarditis. Myocardial viral DNA/RNA detection had no significant effect on outcome. The worst event-free survival was seen in patients with healing/chronic myocarditis (24%), followed by acute (31%) and healed myocarditis (58%, p=0.294). A weaning rate of 64% from MCS was found in AM. Conclusions: EMB provides important information on the type and stage of myocardial inflammation and supports further decision-making. Children with fulminant clinical presentation, high amounts of mononuclear cell infiltrates or healing/chronic inflammation and young age have the highest risk for MACE.

Ayme-Gripp syndrome is a multisystemic disorder caused by a heterozygous variation in the MAF gene (OMIM*177075). Key features are congenital cataracts, sensorineural hearing loss, and a characteristic facial appearance. In a proportion of individuals, pericardial effusion or pericarditis has been reported as part of the phenotypic spectrum. In the present case, a large persistent cytokine-enriched pericardial effusion was the main pre- and postnatal symptom that led to the clinical and later molecular diagnosis of Ayme-Gripp syndrome. In the postnatal course, the typical Ayme-Gripp syndrome-associated features bilateral cataracts and hearing loss were diagnosed. We propose that activating dominant variants in the cytokine-modulating transcription factor c-MAF causes cytokine-enriched pericardial effusions possibly representing a key feature of Ayme-Gripp syndrome.

BACKGROUND Metabolic and bariatric surgery (MBS) can be a well tolerated and effective treatment option for severe obesity in adolescents. We compared outcomes for adolescents that did and did not proceed to surgery. METHODS A single-center longitudinal study (2015-2020). Patients were identified as LSG if they completed laparoscopic sleeve gastrectomy within 6 months of initial visit and NoLSG if they did not. Chi-square, Fisher exact, nonparametric Kruskal-Wallis tests, and Linear Mixed Models (LMM) were used to compare outcomes over 2 years. RESULTS Three hundred fifty-two adolescents were referred with a mean age of 15.6 ± 1.4, 69% girls, 38% Hispanic, and 78% had noncommercial insurance. The median baseline weight was 135 kg and body mass index (BMI) was 48 kg/m2; 42% had a BMI >50. Seventy-nine (22%) underwent LSG whereas 273 (78%) did not complete MBS primarily because of lack of interest. LSG patients had 21% total weight loss and 22% total BMI loss at 24 months whereas NoLSG patients had 4% total weight gain and 3% BMI gain (P

This is the first published case report of a child with acute lymphatic leukemia developing a fatal mucormycosis during blinatumomab treatment. The patient showed multiple, systemic thromboembolic lesions with ischemia, bleeding and infarction in almost all organs. The child succumbed to increased brain pressure resulting in cerebral herniation. This case particularly illustrates the fulminant progression and huge challenges of diagnosing and treating mucormycosis in children with hemato-oncological diseases during treatment with targeted therapeutic antibodies (blinatumomab).

Background Long-term course after atrial switch operation is determined by increasing right ventricular (RV) insufficiency. The aim of our study was to investigate subtle functional parameters by invasive measurements with conductance technique and noninvasive examinations with cardiac magnetic resonance imaging (CMR). Methods We used invasive (pressure–volume loops under baseline conditions and dobutamine) and noninvasive techniques (CMR with feature tracking [FT] method) to evaluate RV function. All patients had cardiopulmonary exercise testing (CPET). Results From 2011 to 2013, 16 patients aged 28.2 ± 7.3 (22–50) years after atrial switch surgery (87.5% Senning and 12.5% Mustard) were enrolled in this prospective study. All patients were in New York Heart Association (NYHA) class I to II and presented mean peak oxygen consumption of 30.1 ± 5.7 (22.7–45.5) mL/kg/min. CMR-derived end-diastolic volume was 110 ± 22 (78–156) mL/m2 and RV ejection fraction 41 ± 8% (25–52%). CMR-FT revealed lower global systolic longitudinal, radial, and circumferential strain for the systemic RV compared with the subpulmonary left ventricle. End-systolic elastance (Ees) was overall reduced (compared with data from the literature) and showed significant increase under dobutamine (0.80 ± 0.44 to 1.89 ± 0.72 mm Hg/mL, p ≤ 0.001), whereas end-diastolic elastance (Eed) was not significantly influenced (0.11 ± 0.70 to 0.13 ± 0.15 mm Hg/mL, p = 0.454). We found no relevant relationship between load-independent conductance indices and strain or CPET parameters. Conductance analysis revealed significant mechanical dyssynchrony, higher during diastole (mean 30 ± 4% baseline, 24 ± 6% dobutamine) than during systole (mean 17 ± 6% baseline, 19 ± 7% dobutamine). Conclusions Functional assessment of a deteriorating systemic RV remains demanding. Conductance indices as well as the CMR-derived strain parameters showed overall reduced values, but a significant relationship was not present (including CPET). Our conductance analysis revealed intraventricular and predominantly diastolic RV dyssynchrony.

PurposeThe purpose of this paper is to evaluate officer and civilian race/ethnicity disparities during ten years of officer-involved shootings (OIS).Design/methodology/approachInternal affairs, personnel and geospatial data were triangulated for 253 OIS at the Dallas Police Department from 2005 to 2015. Multinomial regression models were used to evaluate the relationship between civilian and officer race/ethnicity in OIS, controlling for officer, situational and neighborhood factors.FindingsIn total, 48 percent of unique OIS involved a non-Hispanic black civilian and most OIS occurred in Hispanic majority neighborhoods (48 percent). Officer age and number of shooters on scene were the only variables significantly associated with officer race/ethnicity. Most notably, officer race/ethnicity was not associated with the race/ethnicity of the civilian during OIS incidents.Originality/valueThere is limited scientific evidence on whether officers of certain races/ethnicities are disproportionately likely to engage in OIS with civilians of a particular race/ethnicity due to the relative rarity of such events.

Due to their high transparency, electrodes fabricated from conductive polymers are often implemented in semitransparent organic solar cells. Opaque solar cells usually employ metal back electrodes with high reflectivity for best photon confinement in the light-harvesting layer. Herein, a bilayer back electrode comprising conductive polymers and nanofoamed poly(methyl methacrylate) (PMMA) is investigated, the latter of which creates diffuse reflection of the incoming light. By tuning the thickness of the nanofoamed PMMA layer, absorption and transmission of the solar cells can be tailored from opaque to vastly transparent. Due to its diffusive character, this versatile electrode enhances the light absorption in the wavelength regimes with lower absorption coefficient. The solar cells are particularly suited for deployment in frosted window applications.

Metabolic and bariatric surgery (MBS) can be a well tolerated and effective treatment option for severe obesity in adolescents. We compared outcomes for adolescents that did and did not proceed to surgery.A single-center longitudinal study (2015-2020). Patients were identified as LSG if they completed laparoscopic sleeve gastrectomy within 6 months of initial visit and NoLSG if they did not. Chi-square, Fisher exact, nonparametric Kruskal-Wallis tests, and Linear Mixed Models (LMM) were used to compare outcomes over 2 years.Three hundred fifty-two adolescents were referred with a mean age of 15.6 ± 1.4, 69% girls, 38% Hispanic, and 78% had noncommercial insurance. The median baseline weight was 135 kg and body mass index (BMI) was 48 kg/m2; 42% had a BMI50. Seventy-nine (22%) underwent LSG whereas 273 (78%) did not complete MBS primarily because of lack of interest. LSG patients had 21% total weight loss and 22% total BMI loss at 24 months whereas NoLSG patients had 4% total weight gain and 3% BMI gain (P 0.01). Obesity-associated conditions improved in the LSG group (P 0.01). Follow-up in both groups was poor (≤30% at 24 months). Patients with public insurance and those with BMI from 50 to 59.9 kg/m2 were high performing LSG patients.A minority (22%) of adolescents referred for MBS proceeded to surgery, despite its demonstrated efficacy and safety in adolescence. Those that did not undergo surgery continued to gain weight. Further research is needed to understand patient preferences or concerns related to MBS utilization during adolescence.

Essentials Bleeding complications during congenital heart disease surgery in neonatal age are very common. We report the perioperative incidence of acquired von Willebrand syndrome (aVWS) in 12 infants. aVWS was detected in 8 out of 12 neonates and infants intraoperatively after cardiopulmonary bypass. Ten patients received von Willebrand factor concentrate intraoperatively and tolerated it well. SUMMARY: Background Cardiac surgery of the newborn and infant with complex congenital heart disease (CHD) is associated with a high rate of intraoperative bleeding complications. CHD-related anatomic features such as valve stenoses or patent arterial ducts can lead to enhanced shear stress in the blood stream and thus cause acquired von Willebrand syndrome (aVWS). Objective To evaluate the intraoperative incidence and impact of aVWS after cardiopulmonary bypass (CPB) in neonates and infants with complex CHD. Patients/Methods We conducted a survey of patients aged < 12 months undergoing complex cardiac surgery in our tertiary referral center. Twelve patients, whose blood samples were analyzed for aVWS before CPB and immediately after discontinuation of CPB on a routine basis, were eligible for the analysis. von Willebrand factor antigen (VWF:Ag), ristocetin cofactor activity (VWF:RCo), collagen binding activity (VWF:CB), VWF:multimers and factor VIII activity (FVIII:C) were determined. Results aVWS was diagnosed by VWF multimer analysis in 10 out of 12 patients (83%) prior to surgery and intraoperatively at the end of CPB in 8 out of 12 patients (66%). Ten patients received VWF/FVIII concentrate intraoperatively as individual treatment attempts during uncontrolled bleeding. They tolerated it well without intraoperative thrombotic events. One patient suffered a transient postoperative cerebral sinuous vein thrombosis. Conclusions aVWS is of underestimated incidence in complex CHD surgery. These data may offer a new approach to reduce the risk of severe bleedings and to achieve hemostasis during high-risk pediatric cardiac surgery by tailoring the substitution with von Willebrand factor concentrate.

Purpose The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access. Methods Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions. Results Median age at intervention was 47months (interquartile range (IQR),29–74), median time for interventions was 66min (IQR,42–111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm 2 (IQR, 0.2–0.6), no complications occurred during or after interventions. Conclusions Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients. Type of study Treatment Study. Level of evidence Level IV.

There are many complex cardiac malformations that are characterized by a functionally univentricular physiology. Staged surgical repair according to the Fontan principle separates the systemic and pulmonary circulations by connecting the systemic venous return to the pulmonary arteries. However, long-term follow-up studies demonstrate a gradual deterioration of cardiac function, particularly from the second or third decade. Noninvasive evaluation of the cardiac function is, therefore, important in the follow-up of these patients. The cardiac index (CI) is a reliable hemodynamic parameter and represents an important marker of cardiac function. We compared CI values determined by cardiac MRI (CMRI) with values obtained by noninvasive inert gas rebreathing (IGR; Innocor® system). Sixteen patients (age range: 7.2–32.7 years) with functionally univentricular hearts (UVH) following total cavopulmonary connection (TCPC) were compared with 12 healthy subjects (age range: 8.5–18.6 years). The standard treadmill protocol of the German Society of Pediatric Cardiology was used for exercise testing. CI was determined at rest and at two standardized submaximal exercise levels. In all subjects, CI increased under exercise conditions, but the values were significantly lower in patients with UVH. There was no significant difference between patients with UVH and predominantly right- or left-ventricular morphology. In comparison with CMRI measurements, the CI values obtained by the IGR method tended to be lower, with a mean difference of 1.02 l/min/m2. Noninvasive measurement of CI with the IGR method is feasible at rest and during exercise, and appears to be suited for routine determination of CI in patients with UVH following TCPC.

The RASopathies are developmental syndromes caused by germline gain-of-function mutations in genes of the RAS/MAPK signaling pathway. RIT1 mutations are particularly associated with cardiovascular disease, including hypertrophic cardiomyopathy (HCM) distinct from that seen in sarcomeric mutations.

Background: Inspired by structural hierarchies and the related excellent mechanical properties of biological materials, we created a smoothly graded micro- to nanoporous structure from a thermoplastic polymer.Results: The viscoelastic properties for the different pore sizes were investigated in the glassy regime by dynamic flat-punch indentation. Interestingly, the storage modulus was observed to increase with increasing pore-area fraction.Conclusion: This outcome appears counterintuitive at first sight, but can be rationalized by an increase of the pore wall thickness as determined by our quantitative analysis of the pore structure. Therefore, our approach represents a non-chemical way to tune the elastic properties and their local variation for a broad range of polymers by adjusting the pore size gradient.

Achieving good light management is key for quantum dots (QDs) - polymer hybrid films, which are increasingly used in display and lighting applications in tandem with light emitting diodes. To overcome the insufficient absorption of blue light by the QDs and light trapping of downshifted emission, we propose an approach based on microcellular foaming in order to engineer porous hybrid films with improved green and red emission.

We use the CO2 foaming method to control the introduction of pores in polymer/quantum dots light converting films, whose photoluminescence efficiency is improved owing to an efficient light management scheme.

The AMPLATZERTM Vascular Plug 4 (AVP4) is a self-expandable, replaceable occluder made of Nitinol wire mesh, which allows the safe and effective interventional occlusion of medium size vessels. This report describes an infant diagnosed with pulmonary atresia, ventricular septal defect, and multifocal collateral lung perfusion through four major aortopulmonary collateral arteries (MAPCAs). A central aorto-pulmonary shunt was performed at 4 months of age. Because of postoperative pulmonary hyperperfusion, one of the MAPCAs was closed interventionally using a 5 mm AVP4. This MAPCA originated from the descending aorta (DAO) near the fifth thoracic vertebra and ran behind the esophagus to the lower lobe of the right lung. The MAPCA was closed near its origin from the DAO. Four weeks later, the patient presented with severe gastrointestinal bleeding, caused by perforation of the AVP4 into the esophagus. The occluder was extracted surgically, the MAPCA was clipped and the esophageal injury was sutured. To date, there have been no reports describing esophageal perforation due to an AVP4. The perforation in this patient may have been due to implantation of the AVP4 near the aorta in a MAPCA segment located directly in front of the spine and behind the esophagus. Another possible factor may have been the requirement for a gastrointestinal feeding tube. Although the occluder is soft and flexible, the spindle-shaped ends may cause trauma if they are located close to other structures. © 2016 Wiley Periodicals, Inc.

Objectives To describe the efficacy and safety of stent-retriever thrombectomy in infants with thrombosis of the superior vena cava (SVC) and innominate vein. Background Thrombosis of the SVC and of the innominate vein is a potentially life threatening complication in infants during intensive care treatment following major surgical procedures. To avoid reoperations, we evaluated interventional revascularization by stent-retriever thrombectomy. Methods From 2015 to 2017, five infants were diagnosed with acute thrombosis of the SVC and innominate vein following major cardiac or pediatric surgery. Using a femoral venous access and 4 or 5 French guiding catheters stent-retriever systems (4/20 mm or 6/30 mm) were placed into the thrombus and retrieved under suction. We aimed to revascularize not only the SVC but also the innominate, jugular, and subclavian veins. Results Following repeated stent retrieving manoeuvers, we were able to reestablish flow in the major veins of all patients. Due to significant residual thrombotic material, we decided to perform additional balloon dilatation of the SVC and innominate vein in 3/5 patients. There were no complications related to the procedure and none of our patients required blood transfusion. Following the intervention, the patients received treatment with low-molecular-weight heparin. Interventional treatment achieved persistent patency of the SVC and innominate vein in all patients. Conclusion Stent-retriever thrombectomy is a safe and effective method for interventional treatment of acute thrombosis of the central veins in infants. Due to the large amount of thrombotic material, it is frequently required to combine this method with balloon compression of residual thrombotic material.

Purpose: The morphologic spectrum of aortic coarctation extends from discrete isthmic obstruction to tubular hypoplasia of the entire aortic arch. Neonates with coarctation frequently present with congestive heart failure and critically reduced perfusion of the descending aorta following ductal closure. During the recent years we observed several infants with coarctation who presented beyond the neonatal period with dilated cardiomyopathy (DCM). We reviewed our patients with coarctation to determine whether this presentation represents an exception or is relevant for the differential diagnosis of children with DCM. Materials and Methods: From 1/2001 to 12/2013 74 babies with isolated coarctation were diagnosed in our institution. 50 patients presented in the neonatal period and 24 patients beyond the first month. Results: 5/74 infants presented after the neonatal period with poorly contractile, dilated left ventricles. Echocardiographic detection of the coarctation was facilitated by application of the ductal view and by Doppler interrogation of the celiac artery revealing a significantly diminished systolic flow velocity. All patients underwent resection of the coarctation and end-to-end anastomosis of the aorta. Postoperative normalization of left ventricular function was observed within a median interval of 2 months. Conclusion: Coarctation of the aorta presenting as DCM accounted for 21 % of our infants with coarctation who presented beyond the neonatal period and 7 % of those in the first year of life. The stenosis was difficult to detect because of its distal location and normal configuration of the aortic arch. Isthmic coarctation should be included in the differential diagnosis of infants with DCM and requires careful examination of the isthmic region in these children.

This 48-week, randomized, placebo-controlled phase 3 study (DMD114044; NCT01254019) evaluated efficacy and safety of subcutaneous drisapersen 6 mg/kg/week in 186 ambulant boys aged >=5 years, with Duchenne muscular dystrophy (DMD) resulting from an exon 51 skipping amenable mutation. Drisapersen was generally well tolerated, with injection-site reactions and renal events as most commonly reported adverse events. A nonsignificant treatment difference (P = 0.415) in the change from baseline in six-minute walk distance (6MWD; primary efficacy endpoint) of 10.3 meters in favor of drisapersen was observed at week 48. Key secondary efficacy endpoints (North Star Ambulatory Assessment, 4-stair climb ascent velocity, and 10-meter walk/run velocity) gave consistent findings. Lack of statistical significance was thought to be largely due to greater data variability and subgroup heterogeneity. The increased standard deviation alone, due to less stringent inclusion/exclusion criteria, reduced the statistical power from pre-specified 90% to actual 53%. Therefore, a post-hoc analysis was performed in 80 subjects with a baseline 6MWD 300-400 meters and ability to rise from floor. A statistically significant improvement in 6MWD of 35.4 meters (P = 0.039) in favor of drisapersen was observed in this subpopulation. Results suggest that drisapersen could have benefit in a less impaired population of DMD subjects.

The use of supercritical CO2 as solvent for separation processes and chemical reactions is widespread. Many industrial extraction processes using CO2 consume a huge amount of energy and hence are very cost-intensive. In the past, the duration of extraction was often longer than required for an optimum result. Therefore, an inline monitoring device for terminating CO2 extraction processes at the right time has been desirable. In collaboration between KIT and SITEC-Sieber Engineering, Switzerland, a mobile near infrared (NIR) inline monitoring device has been developed to close this gap and to offer an opportunity to implement it into industrial extractions processes using CO2 and to use the data for process optimization. NIR spectroscopy with fiber optics adaption has been proven to be a very good choice, because the CO2 bands are well separated from all other bands of interest caused by the extracts (organics and water). The NIR inline monitoring device can easily be implemented into industrial plants to visualize the extraction progress and to terminate the process at the right time in order to save energy and money. Measurements on customer's demand are available for extraction and reaction processes in supercritical CO2. This paper will actually focus on two applications. Firstly, in collaboration with NATECO2, Germany, the NIR inline monitoring device has been implemented into a plant for hops extraction with supercritical CO2. Extractions have been performed and successfully monitored for the varieties Hallertauer Magnum, Hallertauer Herkules, and French Strisselspalter at 60 °C and 25 MPa, 28 MPa, and 50 MPa, respectively. The detectability was 0.1 wt% of hops in CO2. Secondly, the applicability of this NIR inline monitoring method on processes for the production of submicron particles in supercritical CO2 has been demonstrated in a feasibility study. For this purpose, a RESS (Rapid Expansion of Supercritical Solution) high pressure plant (160 ml, max. 35 MPa, max. 120 °C) was built and the NIR inline monitoring device integrated. Two syringe pumps were coupled for an almost pulsation-free-feeding. Benzoic acid was used as a reference solid. In this feasibility study, the focus has not been to perform an optimized RESS process, but rather to monitor the loading of the CO2 phase with benzoic acid continuously, as this information is crucial for the optimization of a RESS process and has not been available up to the present. The experiments have been carried out at 55 °C and 25 MPa as reference conditions. The performed calibration resulted in a detection limit of 0.1 mg benzoic acid per g CO2. The loading of the CO2 phase has been successfully and continuously monitored and can now be applied for other systems. A side effect of these investigations has been the finding that this NIR inline monitoring device can also be used for very precise solubility measurements and to visualize the establishment of thermodynamic phase equilibrium as a function of time, especially in cases of low solubility of a substance in CO2. The NIR inline monitoring device can also be used for the inline monitoring of reactions producing data for kinetic modeling and process optimization.

The aim of this registry is to provide data on age-related clinical features of suspected myocarditis and to create a study platform allowing for deriving diagnostic criteria and, at a later stage, testing therapeutic interventions in patients with myocarditis.After an initial 6-month pilot phase, MYKKE was opened in June 2014 as a prospective multicenter registry for patients from pediatric heart centers, university hospitals, and community hospitals with pediatric cardiology wards in Germany. Inclusion criteria consisted of age18 years and hospitalization for suspected myocarditis as leading diagnosis at the discretion of the treating physician. By December 31, 2015, fifteen centers across Germany were actively participating and had enrolled 149 patients. Baseline data reveal 2 age peaks (2 years,12 years), show higher proportions of males, and document a high prevalence of severe disease courses in pediatric patients with suspected myocarditis. Severe clinical courses and early adverse events were more prevalent in younger patients and were related to severely impaired leftventricular ejection fraction at initial presentation.MYKKE represents a multicenter registry and research platform for children and adolescents with suspected myocarditis that achieve steady recruitment and generate a wide range of real-world data on clinical course, diagnostic workup, and treatment of this group of patients. The baseline data reveal the presence of 2 age peaks and provide important insights into the severity of disease in children with suspected myocarditis. In the future, MYKKE might facilitate interventional substudies by providing an established collaborating network using common diagnostic approaches.

The article contains sections titled: 1. Properties of Pure Water 1.1. Molecular Properties 1.1.1. Isotopic Composition 1.1.2. The Water Molecule 1.1.3. Hydrogen Bonding and Water Structure 1.2. The Phase Behavior of Water 1.2.1. Invariant Points 1.2.2. Liquid-Vapor Equilibria 1.2.3. Solid-Liquid and Solid-Solid Equilibria 1.2.4. Supercooled Water and Amorphous Ice 1.3. Properties of Liquid and Supercritical Water 1.3.1. Water over Wide Ranges in Temperature and Pressure 1.3.2. Equation of State and Volumetric Properties 1.3.3. Thermodynamic Properties 1.3.4. Transport Properties 1.3.5. Surface Tension 1.3.6. Auto-protolysis 1.3.7. Dielectric Properties 2.2.2. Transport Properties 2. Water as a Solvent 2.1. Solvent Properties of Water 2.2. Solutions of Nonpolar Gases and Hydrophobic Species 2.3. Hydrophilic Solutes 2.4. Electrolyte Solutions 2.5. Supercritical Water as a Solvent 3. Water Analysis 3.1. Sampling and Sample Preservation 3.2. Physicochemical and Sum Parameters 3.3. Inorganic Analysis 3.3.1. Determination of Cations 3.3.2. Anion Analysis 3.3.3. Determination of Dissolved Gases 3.3.4. Rapid Tests 3.4. Organic Analysis 3.4.1. Spectrometric Methods 3.4.2. Gas and Liquid Chromatography 3.5. Bioanalytical Methods 4. Hydrological Cycle and Water Use 4.1. World Water Balance 4.2. Hydrological Cycle 4.3. Demand for Water 4.4. Source of Water Used 4.5. Water Treatment

Am Beispiel der vergleichsweise einfachen autokatalytischen, partiellen Oxidation von Hexanal zu Hexansaure konnten die Vorteile des Einsatzes von CO2 als Losungsmittel erfolgreich herausgearbeitet werden und in eine Prozessentwicklung munden. Auf der Basis der ermittelten Stoff- und Reaktionsdaten wurde ein Prozessdesign erstellt und mittels einer Prozesssimulation Massen- und Energiebilanzen fur eine Anlagenauslegung berechnet. Schlieslich wurden die Kosten fur die Herstellung von Hexansaure nach dem vorgeschlagenen Verfahren abgeschatzt. The advantages of a process being carried out in carbon dioxide as a solvent could be demonstrated using the example of the relatively simple autocatalytic partial oxidation of hexanaol to hexanoic acid. Consequently, a promising process could be designed. Based on the experimentally determined phase equilibria and reaction data the process was simulated to obtain a reasonable mass and energy balance. From that, the costs for the hexanoic acid production have been estimated.

Standard methods for determination of cardiac output (CO) are either invasive or technically demanding. Measurement of CO by the inert gas-rebreathing (IGR) method, applied successfully in adults, uses a low-concentration mixture of an inert and a blood-soluble gas, respectively. This study tested the feasibility of this method for determining CO during exercise for pediatric patients with complete congenital atrioventricular block (CCAVB) stimulated with a VVI pacemaker. In this study, 5 CCAVB patients (age 9.2-17.4 years) were compared with 10 healthy age-matched boys and girls. Testing was performed with the Innocor system. The patients were instructed to breathe the test gas from a closed system. Pulmonary blood flow was calculated according to the washout of the soluble gas component. During standardized treadmill testing, CO was determined at three defined levels. The CO measurements were successful for all the study participants. The patients reached a lower peak CO than the control subjects (5.9 l/min/m(2) vs 7.3 [boys] and 7.2 [girls]). The stroke volume increase under exercise also was reduced in the patients compared with the control subjects. The feasibility of the IGR method for exercise CO testing in children was documented. Application of the IGR method for children requires careful instruction of the patients and appears restricted to subjects older than 8 years. The method offers new insights into mechanisms of cardiovascular adaptation in children with congenital heart disease.

Pressure−composition isotherms are obtained for the system CO2 + hexanal at (323.15, 353.15, and 383.15) K and pressures between (2.6 and 14.8) MPa. The phase equilibria measurements were carried out with an analytical method. The results were correlated by the Peng−Robinson (PR) equation of state using conventional mixing rules with two temperature-dependent interaction parameters.