Transition bei angeborenen Herzfehlern in der Schweiz

Die Chance, mit einem angeborenen Herzfehler erwachsen zu werden, liegt mittlerweile bei über 90 %. Trotz aller Erfolge der Medizin können Herzfehler auch nach erfolgreicher Korrektur nicht als geheilt betrachtet werden. Langzeitkomplikationen im Sinn von Herzrhythmusstörungen, Herzinsuffizienz, embolischen Ereignissen, Endokarditis, oder Reoperationen aufgrund residualer Befunde oder Klappendegenerationen sind häufig. Aus diesem Grund wird für eine Vielzahl angeborener Herzfehler eine lebenslange spezialisierte Betreuung empfohlen. Jugendliche mit Herzfehlern müssen darauf vorbereitet werden, im Erwachsenenalter Eigenverantwortung zu übernehmen. Dazu ist eine strukturierte Transition ein entscheidender Vorteil. Dadurch werden einerseits Jugendliche selbst auf ihre Erwachsenenrolle vorbereitet und andererseits kann ein adäquater Transfer der Betreuung vom Kinder- zum Erwachsenenmediziner gewährleistet werden. Jugendliche ohne Transfer und ohne spezialisierte Betreuung im Erwachsenenalter haben ein erhöhtes Risiko, kardiovaskuläre Komplikationen zu erleiden. Es wurde gezeigt, dass die Mortalität bei angeborenen Herzfehlern bei Erwachsenen mit spezialisierter Betreuung geringer ist als bei Patienten ohne entsprechende Betreuung. Am Beispiel des Zentrums für angeborene Herzfehler in Bern wird aufgezeigt, wie eine pflegegeleitete Transitionssprechstunde aufgebaut und erfolgreich umgesetzt werden kann.

Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region.

BACKGROUND Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) region can be inaccessible for ablation because of epicardial fat or overlying coronary arteries. OBJECTIVE We describe surgical cryoablation of this type of VA. METHODS From March 2009 to 2014, 190 consecutive patients with VAs originating from the LVOT underwent ablation at our institution. Four patients (2%) underwent surgical cryoablation for highly symptomatic VAs after failing catheter ablation. RESULTS In all patients, endocardial or percutaneous epicardial mapping was consistent with origin in the LVOT. In 2 patients, the points of earliest activation during VAs were marked with a bipolar pacing lead in the overlying cardiac vein for guidance during surgery. Surgical cryoablation was successful in 3 of the 4 patients. The fourth patient subsequently had successful endocardial catheter ablation. During a mean follow-up of 22 ± 16 months (range 4-42 months), all patients showed abolition of or marked reduction in symptomatic VA. However, 1 patient subsequently required percutaneous intervention to the left anterior descending coronary artery; another developed progressive left ventricular systolic dysfunction caused by nonischemic cardiomyopathy; and a third patient underwent permanent pacemaker implantation because of complete atrioventricular block after concomitant aortic valve replacement. CONCLUSION Surgical cryoablation is an option for highly symptomatic drug-resistant VAs emanating from the LVOT region. Despite extensive preoperative mapping, the procedure is not effective for all patients, and coronary injury is a risk.

Biometric measurements of Fragilariopsis kerguelensis

The valve area of Fragilariopsis kerguelensis, the most abundant diatom species in the Southern Ocean, strongly changes in size in response to varying conditions in the surface ocean. We examined the link, both in two iron fertilization experiments and in sediment samples covering several glacial Terminations, between size variability in this species and environmental conditions across the Antarctic Polar Front, including sea ice extent, sea surface temperature, and the input of eolian dust. The iron fertilization experiments show valve area to be positively correlated with iron concentrations in ambient waters, which suggests the possibility of a causal relation between valve size of Fragilariopsis kerguelensis and ambient surface water iron concentration. Larger valves are usually found during glacial times and thus seem to be related to lower sea surface temperature and wider sea ice coverage. Moreover, our results indicate that there usually is a strong correlation between larger valve size and increased input of eolian dust to the Southern Ocean. However, this correlation, obvious for the fertilization experiments and for glacial Terminations I, II, III, and V, does not seem to be valid for Termination VI, where size appears to be inversely correlated to dust input.

Figure 2. Downcore variations of total diatom concentration in core MD02-2529

The modern eastern equatorial Pacific (EEP) is a major natural source for atmospheric carbon dioxide and is thought to be connected to high-latitude ocean dynamics by oceanic teleconnections on glacial-interglacial timescales. A wealth of sedimentary records aiming at reconstructing last Quaternary changes in primary productivity and nutrient utilization have been devoted to understanding those linkages between the EEP and other distant oceanic areas. Most of these records are, however, clustered in the pelagic EEP cold tongue, with comparatively little attention devoted to coastal areas. Here we present downcore measurements of the composition and concentration of the diatom assemblage together with opal (biogenic silica) concentration at site MD02-2529 recovered in the coastal Panama Basin. Piston core MD02-2529, collected in an area affected by a multitude of processes, provides evidence for strong variations in diatom production at the millennial timescale during the last glacial cycle. The maxima in total diatom concentration occurred during the early marine isotopic stage (MIS) 4 as well as during the MIS 4/3 transition and MIS 3. Rapid changes in diatom concentrations during the MIS 3 mimics Bond cycles as independently recorded by the SSS estimation derived from planktonic foraminifera from the same core. Such patterns indicate a clear linkage between diatom production in the coastal EEP and rapid climate changes in the high-latitude North Atlantic. In parallel, the long-term succession of the diatom community from coastal diatoms, predominantly thriving during MIS 5 and 4, towards pelagic diatoms, dominant during MIS 3 and 2, points to a long-term change in the surface hydrology. During Heinrich Events, diatoms strongly reduced their production, probably due to enhanced stratification in the upper water column. After the last glacial maximum, diatom production and valve preservation strongly decreased in response to the advection of nutrient (H2SiO4)-depleted, warmer water masses. Our high-resolution record highlights how regional climatic processes can modulate rapid changes in siliceous primary production as triggered by wind-induced local upwelling, indicating that millennial climatic variability can overtake other prominent hydrological processes such as those related to silicic acid leakage.

(Table 2) Rate of reduction in cell size (apical length) and growth rate for seven Fragilariopsis kerguelensis strains sampled during POLARSTERN cruise ANT-XXI/3

The planktonic diatom Fragilariopsis kerguelensis plays an important role in the biogeochemical cycles of the Southern Ocean, where remains of its frustules form the largest deposit of biogenic silica anywhere in the world. We assessed the genetic identity of 26 strains, from cells collected at various sites in the Southern Ocean, using three molecular markers, LSU and ITS rDNA and rbcL. The LSU sequences were identical among the tested strains, ITS sequences were highly similar, and only one base pair difference was detected among the rbcL sequences. These results, together with a large number of successful mating experiments demonstrated that the strains belong to a single biological species. We investigated the mating system and life cycle traits of F. kerguelensis. Cell size diminished gradually in clonal strains. Gamete formation only occurred when strains of opposite mating type - within a cell size range of 7-36 µm - were mixed together. Two binucleate gametes were formed in each gametangium and gamete conjugation produced a zygote that had four nuclei and was surrounded by thin siliceous scales. Two out of the four nuclei subsequently degenerated and the zygote expanded to form an auxospore surrounded by a transverse and a longitudinal perizonium. Staining with the fluorochrome PDMPO provided for the first time a clear demonstration that the longitudinal perizonium is formed after auxospore expansion is complete. Initial cells produced within the mature auxospores were 78-101 µm in length. Various authors have shown that the average valve size of F. kerguelensis varies in sediment samples collected in regions and seasons with different primary production regimes and this parameter has thus been proposed as a biological proxy for palaeo-productivity. A better understanding of the life cycle of F. kerguelensis should help the design of future investigations aimed at testing the link between cell size distribution in the natural environment and the role that environmental factors might have in the regulation of population cell size.

Investigation of microfossils on sediment core CRP-2 from the Ross Sea, Antarctica

Marine diatoms are the primary biostratigraphical and paleoenvironmental tool for interpreting the upper Palaeogene and lower Neogene strata recovered during the second drilling season of the Cape Roberts Project at site CRP-2 in the western Ross Sea, Antarctica. Silicoflagellates, ebridians, and a chrysophyte cyst provide supporting biostratigraphical information. More than 100 dominantly planktic diatom taxa are recognised. Of these, more than 30 are treated informally, pending SEM examination and formal description. Many other taxa are noted only to generic level. Lower Oligocene (c. 31 Ma) through lower Miocene (c. 18.5 Ma) diatoms occur from 28 mbsf down to 565 mbsf. Below this level, to the bottom of the hole at 624.15 mbsf, diatom assemblages are poorly-preserved and many samples are barren. A biostratigraphic zonal framework, consisting of ten diatom zones, is proposed for the Antarctic continental shelf. Ages inferred from the diatom biostratigraphy correspond well with geochronological data from argon dating of volcanic materials and strontium dating of calcareous macrofossils, as well as nannofossil biochronological datums. The biochronostratigraphical record from CRP-2/2A provides an important record of diatom events and mid-Cenozoic environmental changes in the Antarctic neritic zone.

Micropaleontology and stable isotope record of ODP Hole 178-1098C

Detailed study of four Holocene sediment intervals from Ocean Drilling Program Site 1098 (Palmer Deep, Antarctic Peninsula) reveals that in situ dissolution of calcareous foraminifers in the core repository has significantly altered and in some cases eliminated calcareous foraminifers. Despite dissolution, the foraminifer and supporting diatom data show that the most open-ocean and reduced sea-ice conditions occurred in the early Holocene. The influence of Circumpolar Deep Water was greatest during the early Holocene but continued to be important throughout the Holocene. An increase in sea-ice proximal diatoms at 3500 cal. BP documents an expansion in the amount of persistent sea ice. The inferred increase in sea ice corresponds with an overall increase in magnetic susceptibility values. Benthic foraminifers are present in all samples from the Palmer Deep, including the middle Holocene pervasively laminated sediments with low magnetic susceptibility values. The consistent presence of mobile epifaunal benthic foraminifers in the laminated sediments demonstrates that the laminations do not represent anoxic conditions. The uniform composition of the agglutinated foraminifer fauna throughout the late Holocene suggests that the Palmer Deep did not experience bottom-water-mass changes associated with the alternating deposition of bioturbated or laminated sediments.

Kirkman's science of railways.

[v. 1] The locomotive -- [v. 1 portfolio] Locomotive portfolio -- [v. 2] Engineers' and firemen's handbook -- [v. 3] Locomotive appliances -- [v. 3 suppl.] Supplement to volume Locomotive appliances -- [v. 4] Electricity applied to railways -- [v. 5] Cars, their construction and handling -- [v. 5 suppl. 2] Cars, their construction and handling : supplement --[v. 5 portfolio 1] Supplement to Kirkman's Science of railways : cars, their construction and handling -- [v. 5 portfolio 2] Portfolio of cars -- [v. 6-7] The air brake -- [v. 6-7 portfolio 1] Air brake portfolio : Westinghouse diagrammatic & sectional views air brake & air signal instruction charts -- [v. 6-7 portfolio 2] Air brake portfolio : New York diagrammatic and sectional views air brake instruction charts -- [v. 7 suppl. 1] Westinghouse universal common standard U.C. two-cylinder brake equipment with U-12 universal valve -- [v. 7 suppl. 2] Auxiliary devices governor -- [v. 8] Operating trains -- [v. 9-10] Shops and shop practice.

Practical instructions relating to the construction and use of the steam engine indicator. In two parts ....

Mode of access: Internet.

Anatomy of a hemiramphid pharyngeal mill with reference to arrhamphus sclerolepis krefftii (steindachner) (teleostei: hemiramphidae)

The structure and function of the pharyngeal jaw apparatus (PJA) and postpharyngeal alimentary tract of Arrhamphus sclerolepis krefftii, an herbivorous hemiramphid, were investigated by dissection, light and scanning electron microscopy, and X-ray analysis of live specimens. A simple model of PJA operation is proposed, consisting of an adductive power stroke of the third pharyngobranchial that draws it posteriorly while the fifth ceratobranchial is adducted, and a return stroke in which the third pharyngobranchial bone is drawn anteriorly during abduction of the fifth ceratobranchial. Teeth in the posteromedial region of the PJA are eroded into an occlusion zone where the teeth of the third pharyngobranchial are spatulate incisiform and face posteriorly in opposition to the rostrally oriented spatulate incisiform teeth in the wear zone of the fifth ceratobranchial. The shape of the teeth and their pedestals (bone of attachment) is consistent with the model and with the forces likely to operate on the elements of the PJA during mastication. The role of pharyngeal tooth replacement in maintaining the occlusal surfaces in the PJA during growth is described. The postpharyngeal alimentary tract of A. sclerolepis krefftii comprises a stomachless cylinder that attenuates gradually as it passes straight to the anus, interrupted only by a rectal valve. The ratio of gut length to standard length is about 0.5. Despite superficial similarities to the cichlid PJA (Stiassny and Jensen [1987] Bull Mus Comp Zool 151: 269-319), the hemiramphid PJA differs in the fusion of the third pharyngobranchial bones, teeth in the second pharyngobranchials and the fifth ceratobranchial face anteriorly, the presence of a slide-like diarthroses between the heads of the fourth epibranchials and the third pharyngobranchial, the occlusion zone of constantly wearing teeth, and the unusual form of the muscularis craniopharyngobranchialis. The functional relationship between these structures is explained and the consequence for the fish of a complex PJA and a simple gut is discussed. (C) 2002 Wiley-Liss, Inc.

Quantitative assessment of aortic sclerosis using ultrasonic backscatter

Background. The development of therapeutic interventions to prevent progressive valve damage is more likely to limit the progression of structural damage to the aortic valve with normal function (aortic sclerosis [ASC]) than clinically apparent aortic stenosis. Currently, the ability to appreciate the progression of ASC is compromised by the subjective and qualitative evaluation of sclerosis severity. Methods: We sought to reveal whether the intensity of ultrasonic backscatter could be used to quantify sclerosis severity in 26 patients with ASC and 23 healthy young adults. images of the aortic valve were obtained in the parasternal long-axis view and saved in raw data format. Six square-shaped 11 X 11 pixel regions of interest were placed on the anterior and posterior leaflets, and calibrated backscatter values were obtained by subtracting the regions of interest in the blood pool from the averaged backscatter values obtained from the leaflets. Results. Mean ultrasonic backscatter values for sclerotic valves exceeded the results in normal valve tissue (16.3 +/- 4.4 dB vs 9.8 +/- 3.3 dB, P < .0001). Backscatter values were greater (22.0 +/- 3.5 dB) in a group of 6 patients with aortic stenosis. Within the sclerosis group, the magnitude of backscatter was directly correlated (P < .05) with a subjective sclerosis score, and with transvalvular pressure gradient. mean reproducibility was 2.4 +/- 1.8 dB (SD) between observers, and 2.3 +/- 1.7 dB (SD) between examinations. Conclusion: Measurement of backscatter from the valve leaflets of patients with ASC may be a feasible means of following the progression and treatment response of aortic sclerosis.