Untersuchung des sympatisch unterhaltenen Schmerzes in verschiedenen Modellen des Kälteschmerzes

Abhängigkeit experimentell (Menthol-Modell, A-Faser-Blockade-Modell) evozierte Kältehyperalgesie von der Aktivität sympathischer Haut-Vasokonstriktor-Neurone am Probanden

Dissipative Dynamics with Trapping in Dimers

The trapping of excitations in systems coupled to an environment allows to study the quantum to classical crossover by different means. We show how to combine the phenomenological description by a non-hermitian Liouville-von Neumann Equation (LvNE) approach with the numerically exact path integral Monte-Carlo (PIMC) method, and exemplify our results for a system of two coupled two-level systems. By varying the strength of the coupling to the environment we are able to estimate the parameter range in which the LvNE approach yields satisfactory results. Moreover, by matching the PIMC results with the LvNE calculations we have a powerful tool to extrapolate the numerically exact PIMC method to long times.Comment: 5 pages, 2 figure

Hemihypertrophy of one leg and congenital retroperitoneal tumor: Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) belongs to the so-called imprinting disorders and has an incidence of 1:15’000 – 26’000. It is characterized as an overgrowth syndrome with variable expression of symptoms such as exomphalos, macroglossia, neonatal hypoglycemia, earlobe creases, hemihypertrophy, perinatal overgrowth and an increased risk of embryonic tumors. Genomic imprinting leads to an altered expression of gene parts dependent on parental heredity due to DNA-methylation. The affected (imprinted) regions in BWS are typically located on chromosome 11p15.5. The respective genes have regulatory function for cellular growth with the epigenetic changes leading to either decreased inhibition or increased expression of growth promoting genes. In BWS, about 50 % of the infants show a loss of methylation in the Imprinting Control Region (ICR)-2, normally expressed by the maternal chromosome only, leading to a reduced expression of a growth inhibitor gene (CDKN1C). In 5 –10 % of BWS, gain of methylation in the telomeric ICR-1 results in an increased expression of the insulin-growth-factor-2 gene (usually only expressed by the paternal allele) and a reduced expression of the oncosuppressor gene H19 which is usually expressed by the maternal allele. 20 –25 % of patients with BWS show paternal uniparental disomy (UPD) of chromosome 11 (patUPD11) resulting in an altered methylation at both regions ICR-1 and ICR-2 with only paternal alleles. In 10 % of all BWS cases, the reason remains unclear with unknown molecular defects

Early prediction of pulmonary outcomes in preterm infants using electrical impedance tomography

INTRODUCTION Electrical impedance tomography (EIT) allows assessment of ventilation and aeration homogeneity which may be associated with respiratory outcomes in preterm infants. METHODS This was a secondary analysis to a recent randomized controlled trial in very preterm infants in the delivery room (DR). The predictive value of various EIT parameters assessed 30 min after birth on important respiratory outcomes (early intubation <24 h after birth, oxygen dependency at 28 days after birth, and moderate/severe bronchopulmonary dysplasia; BPD) was assessed. RESULTS Thirty-two infants were analyzed. A lower percentage of aerated lung volume [OR (95% CI) = 0.8 (0.66-0.98), p = 0.027] as well as a higher aeration homogeneity ratio (i.e., more aeration in the non-gravity-dependent lung) predicted the need for supplemental oxygen at 28 days after birth [9.58 (5.16-17.78), p = 0.0028]. Both variables together had a similar predictive value to a model using known clinical contributors. There was no association with intubation or BPD, where numbers were small. DISCUSSION In very preterm infants, EIT markers of aeration at 30 min after birth accurately predicted the need for supplemental oxygen at 28 days after birth but not BPD. EIT-guided individualized optimization of respiratory support in the DR may be possible

Organische Bodenschadstoffe (POPs) entlang eines Höhenprofils im Nationalpark Berchtesgaden

Persistente Organische Schadstoffe (POPs) können auf eine Vielzahl an Emittenten zurückgeführt werden und sind mitt-lerweile global in der Umwelt anzutreffen. Im Projekt POP-Alp wurden die Bodenkonzentrationen von POPs, u.a. von Dioxinen und Furanen (PCDD/F), für ein Höhenprofil zwischen ca. 800 m und 1500 m Höhe erfasst. Im Auflagehumus steigen die PCDD/F-Gehalte mit zunehmender Geländehöhe an. Hierfür sind vermutlich sowohl klimatische als auch standortbezoge-ne Effekte verantwortlich. Diese beeinflussen Depositions- und Abbaumechanismen und spiegeln sich auch in einer entsprechenden Höhenverteilung des organischen Kohlenstoff-gehalts wider. Der spezifische Stoffabbau, die Re-Emission und kalte Kondensation von PCDD/F sollten für ein besseres Prozessverständnis näher untersucht werden

Ein grosses Bein, ein grosses Herz und ein grosser kongenitaler Tumor bei einem Frühgeborenen: Ein Fallbericht

Fallbericht Bei einer Schwangerschafts-Kontrolle mit 29 Schwangerschaftswochen (SSW) einer 35 Jahre alten Primipara fiel ein Gestationsdiabetes, Polyhydramnion und eine fetale hypertrophe Kardiomegalie auf. Die pränatale genetische Diagnostik ergab ein unauffälliges Karyogramm. Nach vorzeitigem Blasensprung mit 31 1/7 SSW erfolgte die stationäre Aufnahme am UniversitätsSpital Zürich, aufgrund Tokolyse-Durchbruchs erfolgte die sekundäre Sectio mit 31 4/7 SSW. Es zeigte sich postnatal eine isolierte Hypertrophie des linken Beins bei sonst unauffälligem klinischem Erscheinungsbild. Echokardiographisch bestätigte sich die linksventrikuläre myokardiale Hypertrophie bei unauffälliger Funktion. Die Abdomensonographie am ersten Lebenstag zeigte einen teils zystisch, teils soliden retroperitonealen Tumor kranial der linken Niere. In sonographischen Verlaufskontrollen am Kinderspital Zürich wandelte sich die Sonomorphologie in einen vorwiegend soliden, gestielten Tumor mit Involution bishin zum vollständigen Verschwinden im Alter von 16 Monaten. Der Tumor liess sich weder laborchemisch noch in einer erweiterten Bildgebung mittels MRI und MIBG-PET-Scan klassifizieren. Lokalisation und Verlauf sprechen am ehesten für ein Neuroblastom. Genetisch bestätigte sich ein Beckwith-Wiedemann Syndrom mit einer ausgedehnten paternalen uniparentalen Disomie. Diskussion Bei Vorliegen einer (auch nur teilweisen) Hypertrophie sollte das Beckwith-Wiedemann-Syndrom in Betracht gezogen werden. Es handelt sich um ein Makrosomie-Syndrom aus der Gruppe der epigenetischen Imprinting Erkrankungen. Betroffene Kinder haben ein variables klinisches Erscheinungsbild mit einem erhöhten Risiko für embryonale Tumore, weswegen engmaschige sonographische Verlaufskontrollen in den ersten Lebensjahren erfolgen sollten

Feasibility of ultrasound measurement in a human model of acute compartment syndrome

Abstract Background Early diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS. Methods A model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA). Results TFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8–4.0, p < 0.001). Conclusions We found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now

Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial.

OBJECTIVE The effect of prophylactic surfactant nebulisation (SN) is unclear. We aimed to determine whether prophylactic SN improves early lung aeration. DESIGN Parallel, randomised clinical trial, conducted between March 2021 and January 2022. SETTING Delivery room (DR) of a tertiary neonatal centre in Zurich, Switzerland. PATIENTS Preterm infants between 26 $^{0/7}$ and 31 $^{6/7}$ weeks gestation INTERVENTIONS: Infants were randomised to receive positive distending pressure alone or positive distending pressure and additional SN (200 mg/kg; poractant alfa) using a customised vibrating membrane nebuliser. SN commenced with the first application of a face mask immediately after birth. MAIN OUTCOME MEASURES Primary outcome was the difference in end-expiratory lung impedance from birth to 30 min after birth (∆EELI$_{30min}$). EELI correlates well with functional residual capacity. Secondary outcomes included physiological and clinical outcomes. RESULTS Data from 35 infants were collected, and primary outcome data were analysed from 32 infants (n=16/group). Primary outcome was not different between intervention and control group (median (IQR): 25 (7-62) vs 10 (0-26) AU/kg, p=0.21). ∆EELI was slightly higher in the intervention group at 6 and 12 hours after birth, particularly in the central areas of the lung. There were no differences in cardiorespiratory and clinical parameters. Two adverse events were noted in the intervention group. CONCLUSIONS Prophylactic SN in the DR did not significantly affect ∆EELI$_{30min}$ and showed only minimal effects on lung physiology. Prophylactic SN in the DR was feasible. There were no differences in clinical outcomes. TRIAL REGISTRATION NUMBER NCT04315636

How to provide actionable information on weather and climate impacts?-A summary of strategic, methodological, and technical perspectives

Climate change will result in more intense and more frequent weather and climate events that will continue to cause fatalities, economic damages and other adverse societal impacts worldwide. To mitigate these consequences and to support better informed decisions and improved actions and responses, many National Meteorological and Hydrological Services (NMHSs) are discussing how to provide services on weather and climate impacts as part of their operational routines. The authors outline how a risk framework can support the development of these services by NMHSs. In addition to the hazard information, a risk perspective considers the propensity for a given hazard to inflict adverse consequences on society and environment, and attempts to quantify the uncertainties involved. The relevant strategic, methodological and technical steps are summarized and recommendations for the development of impact-related services are provided. Specifically, we propose that NMHSs adopt an integrated risk framework that incorporates a hazard-exposure-vulnerability model into operational services. Such a framework integrates all existing forecast and impact services, including the underlying impact models, and allows for flexible future extensions driven by the evolving collaboration with partners, stakeholders and users. Thereby, this paper attempts to unify existing work streams on impact-related services from different spatial and temporal scales (weather, climate) and disciplines (hydrology, meteorology, economics, social sciences) and to propose a harmonized approach that can create synergies within and across NMHSs to further develop and enhance risk-based services.ISSN:2624-955

How to provide actionable information on weather and climate impacts?–A summary of strategic, methodological, and technical perspectives

Climate change will result in more intense and more frequent weather and climate events that will continue to cause fatalities, economic damages and other adverse societal impacts worldwide. To mitigate these consequences and to support better informed decisions and improved actions and responses, many National Meteorological and Hydrological Services (NMHSs) are discussing how to provide services on weather and climate impacts as part of their operational routines. The authors outline how a risk framework can support the development of these services by NMHSs. In addition to the hazard information, a risk perspective considers the propensity for a given hazard to inflict adverse consequences on society and environment, and attempts to quantify the uncertainties involved. The relevant strategic, methodological and technical steps are summarized and recommendations for the development of impact-related services are provided. Specifically, we propose that NMHSs adopt an integrated risk framework that incorporates a hazard-exposure-vulnerability model into operational services. Such a framework integrates all existing forecast and impact services, including the underlying impact models, and allows for flexible future extensions driven by the evolving collaboration with partners, stakeholders and users. Thereby, this paper attempts to unify existing work streams on impact-related services from different spatial and temporal scales (weather, climate) and disciplines (hydrology, meteorology, economics, social sciences) and to propose a harmonized approach that can create synergies within and across NMHSs to further develop and enhance risk-based services