[Concept of an interdisciplinary emergency department at the Schwarzwald-Baar Hospital]. / Konzept einer interdisziplinären Notaufnahmeklinik am Schwarzwald-Baar Klinikum.

BACKGROUND: Numerous hospitals were combined years ago into a new Central Hospital for cost reasons in the Schwarzwald-Baar region. This also suggested the idea of a large central emergency department. The concept of a central emergency department is an organizational challenge, since they are directly engaged in the organizational structure of all medical departments that are involved in emergency treatment. Such a concept can only be enforced if it is supported by hospital management and all parties are willing to accept interdisciplinary and interprofessional work. OBJECTIVE: In this paper, the concept of a central emergency department in a tertiary care hospital which was rebuilt as an organizationally independent unit is described. Collaborations with various departments, emergency services, and local physicians are highlighted. The processes of a central emergency department with an integrated admission department and personnel structures are described. CONCLUSION: The analysis of the concept after almost a year has shown that the integration into the clinic has been successful, the central emergency department has proven itself as a central hub and has been accepted as a unit within the hospital.

The role of transient starch in acclimation to elevated atmospheric CO2.

Although increased concentrations of CO2 stimulate photosynthesis, this stimulation is often lost during prolonged exposure to elevated carbon dioxide, leading to an attenuation of the potential gain in yield. Under these conditions, a wide variety of species accumulates non-structural carbohydrates in leaves. It has been proposed that starch accumulation directly inhibits photosynthesis, that the rate of sucrose and starch synthesis limits photosynthesis, or that accumulation of sugars triggers changes in gene expression resulting in lower activities of Rubisco and inhibition of photosynthesis. To distinguish these explanations, transgenic plants unable to accumulate transient starch due to leaf mesophyll-specific antisense expression of AGP B were grown at ambient and elevated carbon dioxide. There was a positive correlation between the capacity for starch synthesis and the rate of photosynthesis at elevated CO2 concentrations, showing that the capability to synthesize leaf starch is essential for photosynthesis in elevated carbon dioxide. The results show that in elevated carbon dioxide, photosynthesis is restricted by the rate of end product synthesis. Accumulation of starch is not responsible for inhibition of photosynthesis. Although transgenic plants contained increased levels of hexoses, transcripts of photosynthetic genes were not downregulated and Rubisco activity was not decreased arguing against a role of sugar sensing in acclimation to high CO2.

Overexpression of pyrophosphatase leads to increased sucrose degradation and starch synthesis, increased activities of enzymes for sucrose-starch interconversions, and increased levels of nucleotides in growing potato tubers.

Overexpression of inorganic pyrophosphatase (PPase) from Escherichia coli in the cytosol of plants (ppa 1 plants) leads to a decrease of inorganic pyrophosphate (PPi; U. Sonnewald, 1992, Plant J 2: 571-581). The consequences for sucrose-starch interconversions have now been studied in growing potato (Solanum tuberosum L. cv. Desirée) tubers. Sucrose is degraded via sucrose synthase and UDP-glucose pyrophosphorylase in growing tubers, and it was expected that the low PPi in the ppa 1 transformants would restrict the mobilisation of sucrose and conversion to starch. Over-expression of PPase resulted in an accumulation of sucrose and UDP-glucose, and decreased concentrations of hexose phosphates and glycerate-3-phosphate in growing ppa 1 tubers. Unexpectedly, the rate of degradation of [14C] sucrose was increased by up to 30%, the rate of starch synthesis was increased, and the starch content was increased by 20-30% in ppa 1 tubers compared to wild-type tubers. Reasons for this unexpectedly efficient conversion of sucrose to starch in the ppa 1 tubers were investigated. (i) The transformed tubers contained increased activities of several enzymes required for sucrose-starch interconversions including two- to three-fold more sucrose synthase and 60% more ADP-glucose pyrophosphorylase. They also contained 30-100% increased activities of several glycolytic enzymes and amylase, increased protein, and unaltered or slightly decreased starch phosphorylase, acid invertase and mannosidase. (ii) The transformants contained higher pools of uridine nucleotides. As a result, although the UDP-glucose pool is increased two- to threefold, this does not lead to a decrease of UTP or UDP. (iii) The transformants contained twofold larger pools of ATP and ADP, and ADP-glucose was increased by up to threefold. In stored ppa 1 tubers, there were no changes in the activities of glycolytic enzymes, and nucleotides did not increase. It is concluded that in growing tubers PPi has a wider-significance than just being an energy donor for specific reactions in the cytosol. Increased rates of PPi hydrolysis also affect general aspects of cell activity including the levels of nucleotides and protein. Possible ways in which PPi hydrolysis could affect these processes are discussed.

Studies to determine if rat liver contains chain-length-specific acyl-CoA 6-desaturases.

According to the revised pathway for 22:6(n - 3) biosynthesis in liver (Voss et al. (1991) J. Biol. Chem. 266, 19995-20000) both 18:3(n - 3) and 24:5(n - 3) serve as substrates for desaturation at position-6. The present study was undertaken to determine whether microsomes contain chain-length-specific 6-desaturases. Addition of [1-14C]20:3(n - 6), a substrate for desaturation at position-5, did not depress desaturation of either [1-14C]18:3(n - 3) or [3-14C]24:5(n - 3). An unexplained observation was that both 18:3(n - 3) and 24:5(n - 3) inhibited the metabolism of 20:3(n - 6) to 20:4(n - 6). When an enzyme-saturating level of [3-14C]24:5(n - 3) was now incubated alone and with 40, 80 and 120 nmol of [1-14C]18:3(n - 3), the production of 24:6(n - 3) was inhibited by 43, 67 and 81%. Conversely, when [1-14C]18:3(n - 3) was incubated with 40, 80 or 120 nmol of [3-14C]24:5(n - 3), the synthesis of 18:4(n - 3) was inhibited by only 15, 20 and 27%. These and other competitive studies showed that there was always preferential desaturation of 18:3(n - 3) rather than 24:5(n - 3). In addition, competitive studies between 18:2(n - 6) and 18:3(n - 3), as well as with 24:4(n - 6) and 24:5(n - 3) showed that there was always preferential desaturation of the (n - 3) acid. Although our results are consistent with a single 6-desaturase, further studies, including the isolation of the 6-desaturases(s), is obviously required to determine whether multiple forms of the 6-desaturase exist.

[Catheter-induced modulation of the electric conductivity of the atrioventricular node by high-frequency current]. / Katheter-induzierte Modulation der elektrischen Leitfähigkeit des Atrioventrikularknotens mittels Hochfrequenzstroms.

A radio-frequency current was delivered via a catheter to the atrioventricular (AV) node in 13 patients with supraventricular arrhythmias (maximal heart rate 215/min). In nine patients with atrial fibrillation, three with AV nodal re-entry tachycardia and one with AV re-entry tachycardia, AV node conduction time was prolonged from 95 +/- 43 ms to 168 +/- 72 ms. In three patients the radio-frequency current had no lasting effect, necessitating AV node ablation with a direct-current shock. During a mean observation period of five months, all ten patients in whom the radio-frequency current had been successfully applied remained free of symptoms without any anti-arrhythmia treatment. There were no complications during or after treatment.