Schnittstelle Notaufnahme: Interdisziplinäre Perspektiven

Zusammenfassung: Die Notaufnahme des Basler Universitätsspitals wird interdisziplinär als "Notfallstation" geführt. Das dort praktizierte "Basler Modell" wird schlaglichtartig beleuchtet. Ethische Fragestellungen, insbesondere die Frage nach dem Sistieren einer Behandlung, sollten frühzeitig und interdisziplinär besprochen werden. Da das Ziel der Versorgung in der präklinischen Phase zumeist der möglichst rasche Transport in ein geeignetes Zielkrankenhaus ist, bietet sich oft erst im Reanimationsraum der Notfallstation erstmals die Chance, diese Fragen überhaupt auszusprechen. Hier können entscheidungsrelevante Zusatzinformationen berücksichtigt werden wie etwa der mutmaßliche Wille des Patienten, aber auch die Prognose. Die unterschiedlichen Standards der präklinischen und der klinischen Phase können an der Schnittstelle Notfallstation zu Konflikten führen. Hier ist die Kommunikation des Teamleaders mit dem Rettungsteam, aber auch mit den Kollegen der anderen Disziplinen von entscheidender Bedeutun

Corticospinal output and loss of force during motor fatigue

The objective of this study was to analyze central motor output changes in relation to contraction force during motor fatigue. The triple stimulation technique (TST, Magistris et al. in Brain 121(Pt 3):437-450, 1998) was used to quantify a central conduction index (CCI=amplitude ratio of central conduction response and peripheral nerve response, obtained simultaneously by the TST). The CCI removes effects of peripheral fatigue from the quantification. It allows a quantification of the percentage of the entire target muscle motor unit pool driven to discharge by a transcranial magnetic stimulus. Subjects (n=23) performed repetitive maximal voluntary contractions (MVC) of abductor digiti minimi (duration 1s, frequency 0.5Hz) during 2min. TST recordings were obtained every 15s, using stimulation intensities sufficient to stimulate all cortical motor neurons (MNs) leading to the target muscle, and during voluntary contractions of 20% of the MVC to facilitate the responses. TST was also repetitively recorded during recovery. This basic exercise protocol was modified in a number of experiments to further characterize influences on CCI of motor fatigue (4min exercise at 50% MVC; delayed fatigue recovery during local hemostasis, "stimulated exercise” by 20Hz trains of 1s duration at 0.5Hz during 2min). In addition, the cortical silent period was measured during the basic exercise protocol. Force fatigued to approximately 40% of MVC in all experiments and in all subjects. In all subjects, CCI decreased during exercise, but this decrease varied markedly between subjects. On average, CCI reductions preceded force reductions during exercise, and CCI recovery preceded force recovery. Exercising at 50% for 4min reduced muscle force more markedly than CCI. Hemostasis induced by a cuff delayed muscle force recovery, but not CCI recovery. Stimulated exercise reduced force markedly, but CCI decreased only marginally. Summarized, force reduction and reduction of the CCI related poorly quantitatively and in time, and voluntary drive was particularly critical to reduce the CCI. The fatigue induced reduction of CCI may result from a central inhibitory phenomenon. Voluntary muscle activation is critical for the CCI reduction, suggesting a primarily supraspinal mechanis

Oxidation and emission of methane in a monomictic lake (Rotsee, Switzerland)

The build-up of methane in the hypolimnion of the eutrophic Lake Rotsee (Lucerne, Switzerland) was monitored over a full year. Sources and sinks of methane in the water column were characterized by measuring concentrations and carbon isotopic composition. In fall, high methane concentrations (up to 1mM) were measured in the anoxic water layer. In the oxic layer, methane concentrations were much lower and the isotopic composition shifted towards heavy carbon isotopes. Methane oxidation rates peaked at the interface between oxic and anoxic water layers at around 8-10m depth. The electron balance between the oxidants oxygen, sulphate, and nitrate, and the reductants methane, sulphide and ammonium, matched very well in the chemocline during the stratified season. The profile of carbon isotopic composition of methane showed strong indications for methane oxidation at the chemocline (including the oxycline). Aerobic methane oxidizing bacteria were detected at the interface using fluorescence in situ hybridization. Sequencing the responsible organisms from DGGE bands revealed that aerobic methanotrophs type I closely related to Methylomonas were present. Sulphate consumption occurred at the sediment surface and, only towards the end of the stagnation period, matched with a zone of methane consumption. In any case, the flux of sulphate below the chemocline was not sufficient to oxidize all the methane and other oxidants like nitrate, iron or manganese are necessary for the observed methane oxidation. Although most of the methane was oxidized either aerobically or anaerobically, Lake Rotsee was still a source of methane to the atmosphere with emission rates between 0.2mgCH4m−2day−1 in February and 7mgCH4m−2day−1 in Novembe

Predicting Antidepressant Effects of Ketamine: the Role of the Pregenual Anterior Cingulate Cortex as a Multimodal Neuroimaging Biomarker

Background: Growing evidence underscores the utility of ketamine as an effective and rapid-acting treatment option for major depressive disorder (MDD). However, clinical outcomes vary between patients. Predicting successful response may enable personalized treatment decisions and increase clinical efficacy. Methods: We here explored the potential of pregenual anterior cingulate cortex (pgACC) activity to predict antidepressant effects of ketamine in relation to ketamine-induced changes in glutamatergic metabolism. Prior to a single i.v. infusion of ketamine, 24 patients with MDD underwent functional magnetic resonance imaging during an emotional picture-viewing task and magnetic resonance spectroscopy. Changes in depressive symptoms were evaluated using the Beck Depression Inventory measured 24 hours pre- and post-intervention. A subsample of 17 patients underwent a follow-up magnetic resonance spectroscopy scan. Results: Antidepressant efficacy of ketamine was predicted by pgACC activity during emotional stimulation. In addition, pgACC activity was associated with glutamate increase 24 hours after the ketamine infusion, which was in turn related to better clinical outcome. Conclusions: Our results add to the growing literature implicating a key role of the pgACC in mediating antidepressant effects and highlighting its potential as a multimodal neuroimaging biomarker of early treatment response to ketamine. Keywords: antidepressant effects; ketamine; multimodal neuroimaging biomarker; pgACC; pregenual anterior cingulate cortex

Dirichlet Branes on Orientifolds

We consider the classification of BPS and non-BPS D-branes in orientifold models. In particular we construct all stable BPS and non-BPS D-branes in the Gimon-Polchinski (GP) and Dabholkar-Park-Blum-Zaffaroni (DPBZ) orientifolds and determine their stability regions in moduli space as well as decay products. We find several kinds of integrally and torsion charged non-BPS D-branes. Certain of these are found to have projective representations of the orientifold $\times$ GSO group on the Chan-Paton factors. It is found that the GP orientifold is not described by equivariant orthogonal K-theory as may have been at first expected. Instead a twisted version of this K-theory is expected to be relevant.Comment: 33 pages, LaTeX, 5 figures. v2 typos corrected, references included, (4,s)-branes re-examine

Kang-Redner Anomaly in Cluster-Cluster Aggregation

The large time, small mass, asymptotic behavior of the average mass distribution \pb is studied in a $d$-dimensional system of diffusing aggregating particles for $1\leq d \leq 2$. By means of both a renormalization group computation as well as a direct re-summation of leading terms in the small reaction-rate expansion of the average mass distribution, it is shown that \pb \sim \frac{1}{t^d} (\frac{m^{1/d}}{\sqrt{t}})^{e_{KR}} for $m \ll t^{d/2}$, where $e_{KR}=\epsilon +O(\epsilon ^2)$ and $\epsilon =2-d$. In two dimensions, it is shown that \pb \sim \frac{\ln(m) \ln(t)}{t^2} for $m \ll t/ \ln(t)$. Numerical simulations in two dimensions supporting the analytical results are also presented.Comment: 11 pages, 6 figures, Revtex

Роль количественной магнитно-резонансной томографии и спектроскопии скелетных мышц в оценке результатов клинических исследований (часть II)

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Orientifolds of Gepner Models

We systematically construct and study Type II Orientifolds based on Gepner models which have N=1 supersymmetry in 3+1 dimensions. We classify the parity symmetries and construct the crosscap states. We write down the conditions that a configuration of rational branes must satisfy for consistency (tadpole cancellation and rank constraints) and spacetime supersymmetry. For certain cases, including Type IIB orientifolds of the quintic and a two parameter model, one can find all solutions in this class. Depending on the parity, the number of vacua can be large, of the order of 10^{10}-10^{13}. For other models, it is hard to find all solutions but special solutions can be found -- some of them are chiral. We also make comparison with the large volume regime and obtain a perfect match. Through this study, we find a number of new features of Type II orientifolds, including the structure of moduli space and the change in the type of O-planes under navigation through non-geometric phases.Comment: 142 page

A Model for Force Fluctuations in Bead Packs

We study theoretically the complex network of forces that is responsible for the static structure and properties of granular materials. We present detailed calculations for a model in which the fluctuations in the force distribution arise because of variations in the contact angles and the constraints imposed by the force balance on each bead of the pile. We compare our results for force distribution function for this model, including exact results for certain contact angle probability distributions, with numerical simulations of force distributions in random sphere packings. This model reproduces many aspects of the force distribution observed both in experiment and in numerical simulations of sphere packings