On-Line Assessment (OLA) como preparación al Examen del Diploma Europeo de Anestesia y Cuidados Intensivos (EDAIC): estudio retrospectivo observacional sobre los resultados y el impacto sobre el examen Parte-I / On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination

Introducción: El Examen del Diploma Europeo de Anestesia y Cuidados Intensivos (EDAIC) es un diploma de la Sociedad Europea de Anestesia y Cuidados intensivos (ESAIC), obtenido tras aprobar dos exámenes, una primera parte escrita con preguntas de tipo test y una segunda parte oral estructurada. En 2011, otra prueba formativa en línea (el OnLine Assessment [OLA]) fue introducida para ayudar los candidatos a prepararse para el primer examen (EDAIC-I). Este estudio retrospectivo observacional fue diseñado para evaluar los resultados del OLA y su impacto sobre el EDAIC-I entre 2013 y 2019. Métodos: Después de obtener la autorización del comité examinador de la ESAIC, todos los resultados de los candidatos registrados para el OLA y/o el EDAIC-I entre 2013 y 2019 fueron incluidos. El número total de inscripciones y los resultados fueron analizados y comparados para ambas pruebas. Resultados: Más de 17.000 candidatos (17.401) presentaron cualquiera de los exámenes escritos del EDAIC. La tasa de aprobados en el EDAIC-I fue del 68,95%. La nota en el OLA aumentó de manera significativa en intentos sucesivos para el Paper A (Ciencias Básicas) (p = 0,006). La tasa global de aprobados en el EDAIC-I fue más alta en los candidatos que habían presentado el OLA antes (72,9 vs. 68,3%; OR: 1,25; IC 95% [1,12; 1,39]; p < 0,001). Los candidatos que fallaron en el primer intento al EDAIC-I repitieron más el examen si habían realizado el OLA (OR: 1.396, IC 95% [1.237; 1.574]; p < 0,001). Conclusión: El OLA fue asociado a un aumento de los resultados en ciencias básicas y de la tasa de aprobados en el EDAIC-I.(AU)

Background: The EDAIC is a diploma of the European Society of Anaesthesiology and Intensive Care (ESAIC). which is obtained after passing two a written MCQ-based (Part1) and a structured oral (part2) examinationIn 2011, a formative On-Line Assessment (OLA) was introduced to help candidates to prepare for EDAIC Part1 examination (EDAIC-I). This retrospective observational study evaluated the results of the OLA and its impact on the EDAIC-1 between 2013 and 2019. : Methods: After obtaining the authorisation from the ESAIC Examinations Committee, all the results of candidates registered to OLA and/or EDAIC-I between 2013 and 2019 were included. The total number of registrations and the results were analysed and compared for both. Results: Over 17,000 candidates (17,401) sat any of the written exams of the EDAIC. The overall pass-rate for the EDAIC-1 was 68.95%. The OLA score increased significantly with the number of attempts for Paper A (Basic Science) (p = 0.006). Overall success of the EDAIC-I was higher in candidates who took the OLA before (72.9% versus 68.3%; OR: 1.25; 95% CI [1.12; 1.39]; p< 0.001). Candidates who failed in their first attempt for EDAIC-I were more likely to sit the exam again if they had performed the OLA before (OR: 1.396, 95% CI [1.237; 1.574]; p< 0.001). Conclusion: The OLA was associated with an improvement of the results in basic science and success rate in the EDAIC-I.(AU)

On-Line Assessment (OLA) as a preparation for the European Diploma in Anaesthesiology and Intensive Care (EDAIC), a retrospective observational study on the results and the potential impact on the Part-I examination.

BACKGROUND: The EDAIC is a diploma of the European Society of Anaesthesiology and Intensive Care (ESAIC). which is obtained after passing two a written MCQ-based (Part1) and a structured oral (part2) examinationIn 2011, a formative On-Line Assessment (OLA) was introduced to help candidates to prepare for EDAIC Part1 examination (EDAIC-I). This retrospective observational study evaluated the results of the OLA and its impact on the EDAIC-1 between 2013 and 2019. METHODS: After obtaining the authorisation from the ESAIC Examinations Committee, all the results of candidates registered to OLA and/or EDAIC-I between 2013 and 2019 were included. The total number of registrations and the results were analysed and compared for both. RESULTS: Over 17,000 candidates (17,401) sat any of the written exams of the EDAIC. The overall pass-rate for the EDAIC-1 was 68.95%. The OLA score increased significantly with the number of attempts for Paper A (Basic Science) (p=0.006). Overall success of the EDAIC-I was higher in candidates who took the OLA before (72.9% versus 68.3%; OR: 1.25; 95% CI [1.12; 1.39]; p<0.001). Candidates who failed in their first attempt for EDAIC-I were more likely to sit the exam again if they had performed the OLA before (OR: 1.396, 95% CI [1.237; 1.574]; p<0.001). CONCLUSION: The OLA was associated with an improvement of the results in basic science and success rate in the EDAIC-I.

Diploma Europeo en Anestesiología y Cuidados Intensivos en España: resultados de los exámenes de las partes 1 y 2 de los últimos cinco años. ¿Vamos por el buen camino? / European Diploma in Anaesthesiology and Intensive Care in Spain: Results for the part 1 and part 2 exams in the last five years. Are we going in the right direction?

Antecedentes: El Diploma Europeo en Anestesiología y Cuidados Intensivos (EDAIC) se ha convertido en un estándar de calidad entre los anestesiólogos españoles. El objetivo de este estudio retrospectivo observacional fue valorar los resultados de los participantes españoles en los dos exámenes -parte1 y parte2- en un periodo reciente de 5años, entre 2012 y 2016 y entre 2013 y 2017, respectivamente. Material y métodos: Después de obtener la autorización de la European Society of Anaesthesiology, los resultados de los dos exámenes del EDAIC fueron analizados de manera anónima en un periodo de 5años. Analizamos el número de inscripciones, la tasa de aprobados, la causa de suspensos y la nota media en ciencias básicas (cuadernilloA de la parte1 del examen y las dos primeras mesas de la parte2 del examen) y en anestesiología clínica y cuidados intensivos (cuadernilloB de la parte1 del examen y las dos últimas mesas de la parte2 del examen). Las variables cuantitativas fueron analizadas con análisis de varianza y las variables cualitativas con test de chi-cuadrado para tendencias. El nivel de significación estadística fue establecido en p<0,05. Resultados: Para la parte 1 del examen escrito, 1.189 de un total de 10.954 candidatos (10,85%) fueron inscritos en centros españoles, reflejando el crecimiento global del examen (p=0,29). La tasa de aprobados fue del 62,1%, sin diferencias significativas con los demás países (p=0,38). Las ciencias básicas supusieron el 84,1% de los suspensos. La nota media fue de 71,74+/-5,98% para las ciencias básicas (cuadernilloA) y de 74,48+/-4,29% para la anestesiología clínica (cuadernilloB). En relación con la parte2 del examen, el 72,4% de los candidatos aprobados en la parte1 del examen se inscribieron en la parte2, con una tasa de aprobados del 62,7%, versus el 62,2% en el resto del mundo (p=0,91). Los suspensos en las mesas de ciencias básicas de la parte2 del examen supusieron el 93,8% de los candidatos suspensos en la parte2 del examen. Los suspensos eliminatorios en una mesa fueron registrados en 56 (31,5%) de los candidatos suspensos, de los que el 71,3% se produjeron en las mesas de ciencias básicas. Los suspensos eliminatorios aislados se produjeron solo en 7 (3,9%) de los candidatos. Conclusiones: La evolución del EDAIC en España ha sido muy similar a la del resto del mundo. En el futuro, los esfuerzos persistentes de los anestesiólogos españoles para mejorar sus conocimientos en ciencias básicas y preparar mejor la técnica del examen oral podrían mejorar la tasa de aprobados en el EDAIC en una cohorte de candidatos en constante aumento

Background: The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. Material and methods: After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P<.05. Results: For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74+/-5.98% for basic science (paperA) and 74.48+/-4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. Conclusions: The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates

European Diploma in Anaesthesiology and Intensive Care in Spain: Results for the part 1 and part 2 exams in the last five years. Are we going in the right direction? / Diploma Europeo en Anestesiología y Cuidados Intensivos en España: resultados de los exámenes de las partes 1 y 2 de los últimos cinco años. ¿Vamos por el buen camino?

BACKGROUND: The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. MATERIAL AND METHODS: After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P<.05. RESULTS: For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74±5.98% for basic science (paperA) and 74.48±4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. CONCLUSIONS: The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates.

Increased levels of HPV16 E6*I transcripts in high-grade cervical cytology and histology (CIN II+) detected by rapid real-time RT-PCR amplification.

OBJECTIVE: As cervical dysplasia may regress to normal cytology or progress to cervical carcinoma, it would be valuable to have a diagnostic tool to help decide whether therapeutic conization should be performed. METHODS: Cervical samples of 301 HPV16 positive women were collected in RNAlater reagent to prevent RNA degradation. Relative levels of HPV16 DNA and HPV16 E6*I mRNA in the samples were determined using real-time polymerase chain reaction. Findings were correlated with histological diagnoses and cytological follow-up. RESULTS: HPV16 E6*I mRNA levels were significantly higher in women with cytologically diagnosed severe cervical dysplasia (mean normalized ratio = 0.25) than in those with mild-to-moderate dysplasia (mean norm. ratio = 0.12), atypical squamous cells of uncertain origin (mean norm. ratio = 0.071) or normal cytology (mean norm. ratio = 0.034). Viral DNA levels were not significantly different between severe and mild-to-moderate dysplasia (mean norm. ratios, 55.8 and 63.5, respectively). The PPV for a histological diagnosis of severe cervical dysplasia [cervical intraepithelial neoplasia (CIN) II+] increased with the amounts of E6*I mRNA to more than 90% whereas the sensitivity decreased. The absence of HPV16 E6*I transcripts as well as HPV16 DNA considerably increased the negative predictive value and the specificity. However, low concentrations (or complete absence) of E6*I mRNA did not preclude a CIN II+ diagnosis. CONCLUSIONS: Although the sensitivity is low, high levels of HPV16 E6*I mRNA are indicative of CIN II+ in cytologically diagnosed cervical dysplasia of individual patients. Thus, quantification of HPV16 E6*I mRNA could be helpful in managing follow-up and treatment in a subset of HPV16 positive women.

Absorption of short-chain fatty acids, sodium and water from the forestomach of camels.

In camelids the ventral parts of compartments 1 and 2 (C1/C2) and the total surface of compartment 3 of the forestomach are lined with tubular glands, whereas in ruminants the surface of the forestomach is composed entirely of stratified, squamous epithelium. Thus, differences in absorption rates between these foregut fermenters can be expected. In five camels C1/C2 was temporarily isolated, washed and filled with buffer solutions. Absorption of short-chain fatty acids (SCFA) and net absorption of sodium and water were estimated relative to Cr-ethylenediaminetetraacetic acid as a fluid marker. SCFA were extensively absorbed in the forestomach; clearance rates of SCFA with different chain lengths were equal. After lowering the pH of solutions SCFA absorption rates increased, but much less than the increase of the non-ionized fraction. Absorption of propionate was lower when acetate had been added. Findings suggest that most of the SCFA in camels are transported in the ionized form, most likely via an anion exchange mechanism. Net water absorption is closely related to net sodium absorption. Apparently water absorption results from an iso-osmotic process. Differences between absorption mechanisms of SCFA from the forestomach of camelids and ruminants are discussed.

Distribution patterns of the glucose transporters GLUT4 and GLUT1 in skeletal muscles of rats (Rattus norvegicus), pigs (Sus scrofa), cows (Bos taurus), adult goats, goat kids (Capra hircus), and camels (Camelus dromedarius).

Earlier studies demonstrated that forestomach herbivores are less insulin sensitive than monogastric omnivores. The present study was carried out to determine if different distribution patterns of the glucose transporters GLUT1 and GLUT4 may contribute to these different insulin sensitivities. Western blotting was used to measure GLUT1 and GLUT4 protein contents in oxidative (masseter, diaphragm) and glycolytic (longissimus lumborum, semitendinosus) skeletal muscle membranes of monogastric omnivores (rats and pigs), and of forestomach herbivores (cows, adult goats, goat kids, and camels). Muscles were characterized biochemically. Comparing red and white muscles, the isocitrate dehydrogenase (ICDH) activity was 1.5-15-times higher in oxidative muscles of all species, whereas lactate dehydrogenase (LDH) activity was 1.4-4.4-times higher in glycolytic muscles except in adult goats. GLUT4 levels were 1.5-6.3-times higher in oxidative muscles. GLUT1 levels were 2.2-8.3-times higher in glycolytic muscles in forestomach herbivores but not in monogastric animals. We conclude that GLUT1 may be the predominant glucose transporter in glycolytic muscles of ruminating animals. The GLUT1 distribution patterns were identical in adult and pre-ruminant goats, indicating that GLUT1 expression among these muscles is determined genetically. The high blood glucose levels of camels cited in literature may be due to an "NIDDM-like" impaired GLUT4 activity in skeletal muscle.

Feed intake, forestomach fluid volume, dilution rate and mean retention of fluid in the forestomach during water deprivation and rehydration in camels (Camelus sp.).

Camels were deprived of water for 11 days. Before and during water deprivation and during rehydration changes in body weight, feed and water intake were measured. Using the liquid marker Cr-EDTA forestomach fluid volume, mean fluid retention and fluid dilution in the forestomach were estimated. At the eleventh day of water deprivation hay intake had decreased to only 9.6% of controls, dilution rates had decreased to 31%, mean retention time of fluid in the forestomach had increased to 189%. At the end of dehydration flow of saliva of 2 l/h mainly contributed to the still rather high dilution rates. Thereby buffering capacity and flow of fluid into the forestomach for microbial digestion as well as the outflow from the forestomach were maintained. At the beginning of rehydration camels drank 97 l within a few minutes, and animals thereby replaced all the water lost. Following this first huge water intake water is rapidly absorbed from the forestomach, and forestomach volume decreased again to dehydration values. At the third day of rehydration control values were reached again. Although feed intake decreased dramatically during water deprivation, functions of the forestomach can be maintained sufficiently mainly due to saliva inflow. This explains the mostly rapid recovery of camels when water is available again.

Chewing activities and oesophageal motility during feed intake, rumination and eructation in camels.

It was the aim of this study to characterize rumination behaviour, eructation and oesophageal motility in camels to identify similarities and differences between camels and domestic ruminants. Recordings were carried out in five camels fed on a hay-based diet. On an average, the duration of rumination, feeding and resting was 8.3, 5.6 and 10.1 h per 24 h, respectively. Rumination activity peaked in the morning between 9:00 and 11:00 and in the night between 02:00 and 04:00 a.m. During rumination periods, on an average 67 boluses were regurgitated per hour. Each bolus was chewed for an average of 45 s with 68 chews per min. The pause between two rumination cycles lasted on an average 9 s. Hay intake took 61 min/kg dry matter (DM), rumination lasted 71 min/kg DM of hay consumed. The regurgitation of a bolus started with a contraction of cranial compartment 1 (C 1) during a B-sequence, followed by a deep inspiration with closed glottis. Digesta enters the oesophagus, and an antiperistaltic wave transported the bolus orally. Eructation starts with a contraction of the caudal C1 during a B-sequence when the cranial C1 is relaxed. After entering the oesophagus, a rapid antiperistaltic wave transports the gas orally. Results revealed that the parameter values obtained in the camels were remarkably similar to those in domestic ruminants despite profound morphological differences and different patterns of forestomach motility.

[Large intestinal epithelium and short-chain fatty acids. Expected, unexpected, unexplained findings]. / Dickdarmepithel und kurzkettige Fettsäuren Erwartetes, Unerwartetes, Ungeklärtes.

Short-chain fatty acids (SCFA) are present in hindgut contents in high concentrations. SCFA are generated and also absorbed rapidly in the large intestine. Absorption results from diffusion of the undissociated and lipid soluble form or in exchange for bicarbonate. The controversial concepts concerning the extent of diffusion or the exchange for bicarbonate are partly due to contradictory findings and unequal mechanisms in different species and in different segments of the large intestine as well as in the different methods used. An almost neutral pH microclimate at the luminal surface is of importance for absorption of SCFA. The apical membranes of the epithelial cells in caecum and in proximal colon of guinea pigs are an substantial barrier for the diffusion of SCFA. After withdrawal of butyrate for only one hour from the perfusion or incubation solutions a massive apoptosis had been observed during the in situ perfusion of segments of guinea pig large intestine and also in in vitro studies with isolated epithelia in Ussing-chambers. In vitro apoptotic bodies and cells are emitted at the epithelial surface. However, in vivo induced by butyrate deprivation resident macrophages were tightly clustered below the surface epithelium. Aided by cytoplasmatic projections these macrophages phagocytose and transport apoptotic material from the epithelial intercellular spaces into their bodies. Obviously macrophages can be overloaded by this massive apoptosis, and some of the undigested apoptotic fragments are emitted into the lamina propria. Formation of a colitis ulcerosa may originate from these released undigested apoptotic bodies. Furthermore hints indicate aetiological interrelations between deprivation of butyrate and colon cancer. Butyrate-paradox denotes the contrarian effects on apoptosis and cell proliferation after addition or deprivation of butyrate in cultures of large intestinal tumour-cell-lines in comparison with the healthy, intact epithelium.

Apoptosis induction in vivo and fate of apoptotic material in the colon of the guinea pig.

Short-chain fatty acids (SCFA) in particular butyrate are regarded as an energy source acting in beneficial, protective manner on the colonic mucosa. Previous investigations showed that the colonic mucosa bathed in Ussing chamber with a solution lacking butyrate induced massive apoptosis of epithelial cells. The apoptotic material (bodies and cells) was shed at the mucosa surface. In the present study we aimed to investigate the effects caused in vivo on the colonic mucosa by the absence of butyrate. For this purpose the colon of guinea pigs was perfused in situ with solutions either containing or lacking butyrate. The results show that within 2h of perfusion without butyrate a large amount of epithelial cells underwent apoptosis as in the in vitro experiments. However, apoptotic material instead to be extruded at the epithelial surface accumulates into the intercellular spaces from which it becomes removed by an unusual high number of macrophages. These, engorged with phagocytozed material, lie assembled in a layer below the epithelium. Similar alterations have not been observed after perfusion in the presence of butyrate. The results suggest that this SCFA may protect the colonic mucosa in that it prevents apoptosis. The alterations occurring during 2h of its absence allow to assume that a protracted butyrate deprivation may lead to a breakdown of the integrity of the mucosa thus influencing differently the activity of the macrophages.

Insulin responsiveness of sheep, ponies, miniature pigs and camels: results of hyperinsulinemic clamps using porcine insulin.

It had been suggested that marked species differences in glucose tolerance tests were due to differences in insulin resistance. To compare insulin responsiveness, euglycemic hyperinsulinemic clamps were carried out in sheep, ponies, miniature pigs and camels. Porcine insulin was infused as primed-continuous infusions for 2 h (6 mU x kg(-1) x min(-1)). The steady state glucose infusion rates in the pigs, sheep, ponies and camels were 96.0, 18.6, 7.1 and 6.1 micromol x kg(-1) x min(-1), respectively. The maximal plasma insulin concentrations during the insulin infusions were 2,700 microU x ml(-1) in the camels, 1,400 microU x ml(-1) in the sheep and ponies and 600 microU x ml(-1) in the pigs. The rate of insulin removal from plasma was lowest in the camels as compared to the sheep, ponies and pigs (0.019, 0.038, 0.035 and 0.070 min(-1), respectively). In all species the concentrations of plasma non-esterified fatty acids dropped significantly 10-30 min after the start of the insulin infusion. However, the rates of non-esterified fatty acid reduction were higher in the pigs and sheep than in the camels and ponies. Results confirm a considerably higher insulin responsiveness in the pigs as compared to the sheep. The ponies and camels were found to be even more insulin-resistant than the sheep.

Systemic right ventricular failure after atrial switch operation: midterm results of conversion into an arterial switch.

BACKGROUND: Failure of the systemic right ventricle after atrial switch operation can be treated by conversion into an arterial switch operation. METHODS: Four patients, age 38 to 59 months, presented with right ventricular failure after Senning operation and ventricular septal defect closure. One patient had elevated left ventricular pressure; in the other three patients the left ventricle was retrained to a left ventricular/right ventricular pressure ratio of 0.8 or greater by pulmonary artery banding in 12 to 24 months. RESULTS: Postoperative course after arterial switch operation was prolonged, but clinical condition was good at discharge. Fractional shortening ranged from 20% to 28%. Trace-to-moderate aortic regurgitation was present; only 1 patient had preserved sinus rhythm. After a mean follow-up of 43.5 months 1 patient had died due to left ventricular dysfunction. The survivors are in New York Heart Association functional class I to II. Fractional shortening has improved (29% to 37%); aortic regurgitation has not increased. No patient has undisturbed sinus rhythm. CONCLUSIONS: Conversion of an atrial into an arterial switch is an alternative to cardiac transplantation in childhood. However, the procedure is demanding. Long-term morbidity is caused by rhythm disturbances. Aortic valve performance and left ventricular function require close observation.

Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation.

BACKGROUND: The arterial switch operation (ASO) is the treatment of choice for transposition of the great arteries. METHODS: Anatomical risk factors on mortality and morbidity were analyzed retrospectively in 312 patients who underwent ASO between 1982 and 1997. RESULTS: Survival was 95%, 92%, and 92% after 30 days, 5, and 10 years, respectively. Operative survival improved after 1990 to 97% (p < 0.001). Risk factors for operative mortality were complex anatomy (p = 0.018), coronary anomalies (p = 0.008), and prolonged bypass time (p < 0.001). Determinants of late mortality were coronary distribution (p = 0.03), position of the great arteries (p = 0.0095), bypass time (p = 0.047), and aortic coarctation (p = 0.046). After a follow-up of 3.6 +/- 2.7 years (0.1 to 14.9 years), 98% had good left ventricle function, 94% were in sinus rhythm, 2.4% had moderate to severe pulmonary stenosis, 0.3% had significant aortic regurgitation, and 1% had coronary stenosis. Freedom from reoperation was 100%, 96%, and 94% after 1, 5, and 10 years, respectively. No preoperative anatomic parameter correlated with long-term morbidity. CONCLUSIONS: ASO can be performed with low operative mortality (< 5%) and long-term morbidity. Malformations associated with complex transposition of the great arteries influence early and late mortality.

Maintenance and regulation of the pH microclimate at the luminal surface of the distal colon of guinea-pig.

1. The fluorescent dye 5-N-hexadecanoyl-aminofluorescein (HAF) was used to study the mechanisms involved in maintaining a relatively constant luminal surface pH (pHs) in the distal colon of the guinea-pig. The fatty acyl chain of the HAF molecule inserts into the apical membrane of epithelial cells. This allows a continuous measurement of the surface pH for several hours. 2. The localization of HAF was confirmed by confocal laser-scanning microscopy and by using monoclonal antibodies against fluorescein. The insertion of HAF into the apical membrane of the colonocytes did not change the transepithelial conductance or the short-circuit current of the epithelium. 3. With the HAF method a pH microclimate was confirmed at the colonic surface. Although the pH of the bulk luminal solution was decreased in bicarbonate-containing solution from 7.4 to 6.4 the pHs changed only in the range 7.54-6.98. 4. In the absence of bicarbonate pHs almost followed changes of bulk luminal pH. In the presence of bicarbonate there was a decrease in pHs after removal of chloride from the luminal side and an increase in pHs after addition of butyrate to the luminal solution. This suggests the involvement of a bicarbonate-anion exchange in bicarbonate secretion: a Cl--HCO3- as well as a short-chain fatty acid--HCO3- exchange. 5. The apical K+-H+-ATPase in the distal colon of guinea-pig has little influence on pHs in the presence of physiological buffer concentrations. 6. Our findings indicate that bicarbonate plays a major role in maintaining the pH microclimate at the colonic surface.

Surface pH at the basolateral membrane of the caecal mucosa of guinea pig.

Since the major mechanisms responsible for regulation of intracellular pH of enterocytes are located in the basolateral membrane, respective effects may be expected on pH in the compartment near the basolateral membrane. A method was established to estimate the pH at the basolateral membrane (pHb) of isolated caecal epithelia of guinea pig using pH-sensitive fluorescein attached to lectin (lens culinaris). In the presence of bicarbonate and a perfusion solution-pH of 7.4, pHb was 7.70 +/- 0.15. In the absence of bicarbonate or chloride as well as by inhibition of the basolateral Cl--HCO-3 exchange with H2-DIDS, pHb was reduced near to solution-pH. Inhibition of the basolateral Na+-H+ exchanger by adding a sodium- and bicarbonate-free, low-buffered solution increased pHb. Decrease of pH of serosal perfusion solution to 6.4 provoked a similar decrease of pHb to solution pH. Short-chain fatty acids (SCFA) added to the mucosal solution caused a slight decrease of pHb. SCFA added to the serosal side alkalized pHb. However, in the presence of bicarbonate pHb returned quickly to the initial pHb, and after removal of SCFA a transient acidification of pHb was seen. These responses could not be inhibited by MIA or H2-DIDS. We conclude that no constant pH-microclimate exists at the basolateral side. The regulation of the intracellular pH of enterocytes reflects pHb. The slightly alkaline pHb is due to the bicarbonate efflux. Data support the presence of an SCFA--HCO-3 exchange.

Experience with an adjustable pulmonary artery banding device in two cases: initial success--midterm failure.

Retraining of the left ventricle in congenitally corrected TGA or after Senning or Mustard operation is necessary when right-ventricular failure is developing and an arterial switch operation is indicated. As these hearts have little tolerance of marginal overbanding, a long-term adjustable pulmonary artery banding device would lower stress and risk of training. Although the inserted device (Osypka) allowed convenient intraoperative pressure ratio adjustment, mid-term adjustment failed due to dysfunction of the system.

Isolation and lipid composition of apical and basolateral membranes of colonic segments of guinea Pig.

In adapting several methods of membrane isolation we established a successful way to purify apical and basolateral membranes of guinea pig colon in a parallel procedure. The conventional purification control by marker enzymes was applied. In addition, luminal membrane proteins were stained with Texas Red. Apical and basolateral enterocyte membranes were enriched 10- to 12-fold by differential precipitation and via a continuous sorbitol gradient. The membrane fractions were examined with regard to their phospholipid (PL) and fatty acid patterns and to their cholesterol content. Fluorescence polarization studies were carried out using 1,6-diphenyl-1,3, 5-hexatrien. Remarkable differences in the fatty acid pattern of the proximal and the distal colon were seen. Due to a higher content of oleic acid the saturation index of the apical membranes of the proximal colon is lower compared to that of the apical membranes of the distal colon (0.34 +/- 0.03 vs 0.42 +/- 0.05). The cholesterol content of the apical membranes of the proximal colon is markedly higher than that of the apical membranes of the distal colon (3.42 +/- 0.14 vs 1.88 +/- 0.29 mol/mol PL). There are no differences in the fluidity of these apical membranes. We assume a balancing mechanism between the cholesterol content and the amount of saturated PL-fatty acids.