Perioperative Strategien zur Regulierung des Sympathikotonus

Zusammenfassung: Obwohl für verschiedene therapeutische Konzepte zur Verminderung der kardialen perioperativen Morbidität und Mortalität zunehmend Evidenz vorliegt, bleibt die tatsächliche Umsetzung solcher Konzepte im klinischen Alltag oft aus. Zwar ist einem großen Teil der klinisch tätigen Ärzte die wachsende Literatur bekannt; dieses Wissen wird aber nur in einem Teil der Fälle angewendet, selbst wenn allgemein akzeptierte Indikationen bestehen. Die vorliegende Übersichtsarbeit hat deshalb zum Ziel, die Gründe für die mangelnde Umsetzung aufzuzeigen und nochmals die wesentlichen Grundlagen sowie die klinische Bedeutung einzelner Strategien einschließlich des α2-Agonismus, der β-adrenergen Blockade und der Regionalanästhesien zusammenzufassen. Dies insbesondere im Hinblick auf die klinische Anwendung dieser Konzepte in einem allgemeinanästhesiologischen Umfeld. Zudem wird ein Ausblick in die auf "gene profiling" basierende individualisierte Pharmakotherapie der perioperativen Medizin von morgen gegebe

Surface structure of i-Al(68)Pd(23)Mn(9): An analysis based on the T*(2F) tiling decorated by Bergman polytopes

A Fibonacci-like terrace structure along a 5fold axis of i-Al(68)Pd(23)Mn(9) monograins has been observed by T.M. Schaub et al. with scanning tunnelling microscopy (STM). In the planes of the terraces they see patterns of dark pentagonal holes. These holes are well oriented both within and among terraces. In one of 11 planes Schaub et al. obtain the autocorrelation function of the hole pattern. We interpret these experimental findings in terms of the Katz-Gratias-de Boisseu-Elser model. Following the suggestion of Elser that the Bergman clusters are the dominant motive of this model, we decorate the tiling T*(2F) by the Bergman polytopes only. The tiling T*(2F) allows us to use the powerful tools of the projection techniques. The Bergman polytopes can be easily replaced by the Mackay polytopes as the decoration objects. We derive a picture of ``geared'' layers of Bergman polytopes from the projection techniques as well as from a huge patch. Under the assumption that no surface reconstruction takes place, this picture explains the Fibonacci-sequence of the step heights as well as the related structure in the terraces qualitatively and to certain extent even quantitatively. Furthermore, this layer-picture requires that the polytopes are cut in order to allow for the observed step heights. We conclude that Bergman or Mackay clusters have to be considered as geometric building blocks of the i-AlPdMn structure rather than as energetically stable entities

Encoding dynamics for multiscale community detection: Markov time sweeping for the Map equation

The detection of community structure in networks is intimately related to finding a concise description of the network in terms of its modules. This notion has been recently exploited by the Map equation formalism (M. Rosvall and C.T. Bergstrom, PNAS, 105(4), pp.1118--1123, 2008) through an information-theoretic description of the process of coding inter- and intra-community transitions of a random walker in the network at stationarity. However, a thorough study of the relationship between the full Markov dynamics and the coding mechanism is still lacking. We show here that the original Map coding scheme, which is both block-averaged and one-step, neglects the internal structure of the communities and introduces an upper scale, the `field-of-view' limit, in the communities it can detect. As a consequence, Map is well tuned to detect clique-like communities but can lead to undesirable overpartitioning when communities are far from clique-like. We show that a signature of this behavior is a large compression gap: the Map description length is far from its ideal limit. To address this issue, we propose a simple dynamic approach that introduces time explicitly into the Map coding through the analysis of the weighted adjacency matrix of the time-dependent multistep transition matrix of the Markov process. The resulting Markov time sweeping induces a dynamical zooming across scales that can reveal (potentially multiscale) community structure above the field-of-view limit, with the relevant partitions indicated by a small compression gap.Comment: 10 pages, 6 figure

AutoFolio: An Automatically Configured Algorithm Selector (Extended Abstract)

Article in monograph or in proceedingsLeiden Inst Advanced Computer Science

AutoFolio: An Automatically Configured Algorithm Selector (Extended Abstract)

Article in monograph or in proceedingsLeiden Inst Advanced Computer Science

Anaesthetics and cardiac preconditioning. Part I. Signalling and cytoprotective mechanisms

Cardiac preconditioning represents the most potent and consistently reproducible method of rescuing heart tissue from undergoing irreversible ischaemic damage. Major milestones regarding the elucidation of this phenomenon have been passed in the last two decades. The signalling and amplification cascades from the preconditioning stimulus, be it ischaemic or pharmacological, to the putative end‐effectors, including the mechanisms involved in cellular protection, are discussed in this review. Volatile anaesthetics and opioids effectively elicit pharmacological preconditioning. Anaesthetic‐induced preconditioning and ischaemic preconditioning share many fundamental steps, including activation of G‐protein‐coupled receptors, multiple protein kinases and ATP‐sensitive potassium channels (KATP channels). Volatile anaesthetics prime the activation of the sarcolemmal and mitochondrial KATP channels, the putative end‐effectors of preconditioning, by stimulation of adenosine receptors and subsequent activation of protein kinase C (PKC) and by increased formation of nitric oxide and free oxygen radicals. In the case of desflurane, stimulation of α‐ and β‐adrenergic receptors may also be of importance. Similarly, opioids activate δ‐ and κ‐opioid receptors, and this also leads to PKC activation. Activated PKC acts as an amplifier of the preconditioning stimulus and stabilizes, by phosphorylation, the open state of the mitochondrial KATP channel (the main end‐effector in anaesthetic preconditioning) and the sarcolemmal KATP channel. The opening of KATP channels ultimately elicits cytoprotection by decreasing cytosolic and mitochondrial Ca2+ overload. Br J Anaesth 2003; 91: 551-6

Evaluation Techniques and Systems for Answer Set Programming: a Survey

Answer set programming (ASP) is a prominent knowledge representation and reasoning paradigm that found both industrial and scientific applications. The success of ASP is due to the combination of two factors: a rich modeling language and the availability of efficient ASP implementations. In this paper we trace the history of ASP systems, describing the key evaluation techniques and their implementation in actual tools

Myosin isoenzymes in human hypertrophic hearts. Shift in atrial myosin heavy chains and in ventricular myosin light chains

The myosin light chain complement and proteolytic peptide patterns of myosin heavy chains were studied by two-dimensional and one-dimensional electrophoretic techniques respectively, in a total of 57 samples from ventricular and atrial tissues of normal and hypertrophied human hearts. Hypertrophies were classified haemodynamically as due to pressure-overload and volume-overload. In addition to the occurrence of ventricular light chains in hypertrophied atria we also observed the atrial light chain-1 (ALC-1) in hypertrophied ventricular tissues. On average over 6% of total light-chain-1 comprised ALC-1 in pressure-overloaded ventricles and around 3% in volume-overloaded ventricles. In single cases of pressure-overload ALC-1 amounted up to over 20% of total light chain-1. With regard to the myosin heavy chains limited digestion by two different proteinases produced over 200 clearly resoluble peptides. The absence of any detectable differences in the peptide patterns between myosin heavy chains from normal and hypertrophic tissues of left or right ventricle is in line with the findings of J. J. Schier and R. S. Adelstein (J Clin Invest 1982; 69: 816-825). In atrial tissues however, reproducible qualitative differences in the peptide patterns indicated that during hypertrophy a different type of myosin heavy chains becomes expressed. No differences were seen between the myosin heavy chains from normal left and right atri

Anaesthetics and cardiac preconditioning. Part II. Clinical implications

There is compelling evidence that preconditioning occurs in humans. Experimental studies with potential clinical implications as well as clinical studies evaluating ischaemic, pharmacological and anaesthetic cardiac preconditioning in the perioperative setting are reviewed. These studies reveal promising results. However, there are conflicting reports on the efficacy of preconditioning in the diseased and aged myocardium. In addition, many anaesthetics and a significant number of perioperatively administered drugs affect the activity of cardiac sarcolemmal and mitochondrial KATP channels, the end‐effectors of cardiac preconditioning, and thereby markedly modulate preconditioning effects in myocardial tissue. Although these modulatory effects on KATP channels have been investigated almost exclusively in laboratory investigations, they may have potential implications in clinical medicine. Important questions regarding the clinical utility and applicability of perioperative cardiac preconditioning remain unresolved and need more experimental work and randomized controlled clinical trials. Br J Anaesth 2003; 91: 566-7