[Pandemic influenza A/H1N1 2009 : Challenge for intensive care medicine]. / Neue Influenza-A/H1N1-2009-Virus-Pandemie : Herausforderung für die Intensivmedizin.

The novel pandemic influenza A/H1N1v has also led to a rapid increase in the number of new cases in Germany. In the majority of patients the disease has taken a mild clinical course. However, in isolated cases severe complications requiring hospitalization or intensive care treatment have occurred. Most of the current recommendations refer to outpatients or mild diseases and are not always suitable and practicable for the management of a life-threatening influenza A/H1N1v infection in an intensive care setting. The aim of this review is to present a reliable diagnostic and therapeutic approach for critically ill patients, considering the current literature, case-based experiences from our own intensive care unit and including relevant recommendations of public health authorities. Initial measures regarding therapeutic, diagnostic and isolation precautions arise from past medical history, current anamnesis and characteristic symptoms and their progression. Patients suspected of having acquired an influenza A/H1N1v infection should be isolated. Early laboratory diagnosis of A/H1N1v infection ideally utilizes the reverse transcriptase polymerase chain reaction (RT-PCR) as the most sensitive diagnostic method. Emerging evidence suggests that incidence and severity of life-threatening influenza A/H1N1v infection increase with several risk factors (e.g. pregnancy, immunosuppression, obesity). Treatment decisions should not be delayed to await laboratory confirmation in these patients as early initiation of antiviral therapy is recommended. Elements of supportive care depend on the presentation of complications and secondary organ failure. If rapidly progressive lung dysfunction occurs, refractory to routine mechanical ventilation, early reporting to centers experienced in the use of extracorporeal membrane oxygenation (ECMO) should be established.

Density functional theory based screening of ternary alkali-transition metal borohydrides: a computational material design project.

We present a computational screening study of ternary metal borohydrides for reversible hydrogen storage based on density functional theory. We investigate the stability and decomposition of alloys containing 1 alkali metal atom, Li, Na, or K (M(1)); and 1 alkali, alkaline earth or 3d/4d transition metal atom (M(2)) plus two to five (BH(4))(-) groups, i.e., M(1)M(2)(BH(4))(2-5), using a number of model structures with trigonal, tetrahedral, octahedral, and free coordination of the metal borohydride complexes. Of the over 700 investigated structures, about 20 were predicted to form potentially stable alloys with promising decomposition energies. The M(1)(Al/Mn/Fe)(BH(4))(4), (Li/Na)Zn(BH(4))(3), and (Na/K)(Ni/Co)(BH(4))(3) alloys are found to be the most promising, followed by selected M(1)(Nb/Rh)(BH(4))(4) alloys.

Effect of dilution degree of commercial nectar and provision of fruit on food, energy and nutrient intake in two rainbow lorikeet subspecies.

A feeding trial was performed on adult rainbow lorikeets of two subspecies: six green-naped lorikeets (Trichoglossus haematodus haematodus) and six red-breasted lorikeets (T. haematodus mitchellii). Throughout the entire trial, half of the birds from each subspecies had ad libitum access to water-diluted commercial nectar powder and drinking water only, whereas the other half also received ad libitum apple pieces. During three consecutive 14-d periods, the nectar powder was diluted to a different degree: 1:3 (low), 1:5 (high) and 1:4 (medium) (v:v). Diluting nectar to a higher degree resulted in both subspecies in a decrease in voluntary energy intake. Next, nectar intake significantly decreased when apple was available and apple intake significantly increased when fed higher-diluted nectar. In green-naped lorikeets fed nectar and apple, energy intake was similar between dilution degrees of nectar but was lower compared with feeding only low- or medium-diluted nectar. Whereas, in red-breasted lorikeets, provision of apple next to medium- or high-diluted nectar resulted in higher voluntary energy intake compared with feeding solely nectar of any degree. Overall, protein and thiamine intake as well as Ca:P ratio of the ingested ration were lowest when fed highly diluted nectar and apple. Yet, minimal requirements were still covered. Because energy content of fruit can be higher than liquid diets, in this case medium- or high-diluted nectar, ad libitum provision of fruit as a means to lower voluntary energy intake in lorikeets, for instance in case of obesity, needs to be considered with care.

Identification of the current path for a conductive molecular wire on a tripodal platform.

We present the chemical synthesis as well as charge transport measurements and calculations for a new tripodal platform based on a rigid 9,9'-spirobifluorene equipped with a phenylene-ethynylene wire. The transport experiments are performed with the help of the low-temperature mechanically controlled break junction technique with gold electrodes. By combining experimental and theoretical investigations of elastic and inelastic charge transport, we show that the current proceeds through the designated molecular wire and identify a binding geometry that is compatible with the experimental observations. The conductive molecular wire on the platform features a well-defined and relatively high conductance of the order of 10(-3)G0 despite the length of the current path of more than 1.7 nm, demonstrating that this platform is suitable to incorporate functional units like molecular switches or sensors.

Evaluation of the indirect revascularization method after 3 months chronic myocardial ischemia.

OBJECTIVE: The long-term effectiveness of transmyocardial laser revascularization (TMLR) was evaluated in the setting of a severe left anterior descending artery (LAD) stenosis. METHODS: To employ the chronic ischemic model, pigs underwent three operative procedures over a 13-week period. In the first operation, an operative stenosis of the LAD was created. One week later, the animals were studied at baseline by analyzing different parameters of perfusion (microspheres), function and ECG changes. Afterwards, pigs were randomized into one of three different experimental groups: animals in laser group 1 received one laser channel (n=9) and laser group 2 two channels per cm(2) (n=6) in the LAD territory (using a CO(2)-laser). Animals of the ischemic group (n=12) underwent the same procedures without TMLR-treatment. Twelve weeks later, the animals were re-studied (third operation) and killed. Additional analysis of myocardial water content and histochemistry was performed. RESULTS: Chronic myocardial ischemia and regional myocardial blood flow (RMBF) in laser group 2 revealed relatively higher RMBF values compared with the ischemic group (P=0.015), after 3 months, but no absolute improvement of perfusion at rest compared with baseline was observed in all experimental groups. Left ventricular stroke work index (LVSWI) at rest and under stress did not show any improvement compared with initial values in all study groups (P not significant). However, laser group 1 demonstrated relatively higher LVSWI(max) values in comparison with the ischemic group (P=0.013) as did laser group 2 (P=0.017). Regional contractility of the laser groups recovered after 3 months (which was deteriorated shortly after TMLR, P<0.001) and increased under stress compared with baseline (laser 1: P=0.015, laser 2: P=0.017). In contrast, the ischemic group did not show any difference from initial values (P not significant). The lased pigs of group 2 were less prone to intractable ventricular fibrillation (P=0.036 vs. ischemic group), and showed a significant smaller area of necrosis in the area at risk (P=0.012 vs. ischemic group). CONCLUSIONS: This model of chronic regional ischemia demonstrates that CO(2)-laser revascularization significantly ameliorates microperfusion and regional contractility, and diminishes the incidence of ventricular fibrillation and necrosis in the area at risk. However, it does not change the overall perfusion and global LV function.

Basic data on food intake, nutrient digestibility and energy requirements of lorikeets.

Although knowledge of the nutrient requirements of pet birds has increased a lot over the last few years, basic data on food and water intake and the energy requirements of nectarivorous species, such as lorikeets, are scarce. Thus, the aim of this study was to try to generate some of these data for lorikeets kept at maintenance. Determination of the daily maintenance energy requirement enables calculation of the daily ration and thus, the appropriate nutrient concentrations in order to maintain body weight. Investigations were carried out with six Goldie's lorikeets (GL; Trichoglossus goldiei: 40-50 g BW; 1-4 years) and six rainbow lorikeets (RL; Trichoglossus haematodus haematodus: 120-140 g BW; 1-12 years). Three of the most commonly used diets/foods (commercial 'lory soup'/apples/pollen: crude ash - 52.9/17.8/18.8; crude protein - 178/32.5/191; crude fat - 52.8/0.89/73.1; crude fibre - 17.9/40.5/30.4; starch - 139/not detectable/127; sugar - 522/859/418 g/kg DM; ME - 13.9/14.6/10.9 MJ/kg DM) were individually offered ad libitum. The measured dry matter (DM) intake (g/100 g BW) corresponded well to the values reported for granivorous bird species of similar body mass. Both lorikeet species achieved an apparent digestibility of organic matter of more than 90% for apples, approximately 82% for 'lory soup' and approximately 55% for pollen. The water content of the food affected the DM content of the excreta; 8% when fed 'lory soup', 2% for apples and approximately 30% when fed pollen. Regression analysis of body weight change relative to energy intake demonstrated constant body mass (assuming no change in body composition) when the daily energy intakes were 860 (GL) or 650 (RL) kJ ME/kg BW(0.75).