[Troponin elevation in acute ischemic stroke-unspecific or acute myocardial infarction? : Diagnostics and clinical implications]. / Troponinerhöhung beim akuten ischämischen Schlaganfall ­ unspezifisch oder Ausdruck eines akuten Myokardinfarkts? : Diagnostik und klinische Implikationen.

Routine determination of troponin levels is recommended for all patients with acute ischemic stroke. In 20-55% of these patients the troponin levels are elevated, which may be caused by ischemic as well as non-ischemic myocardial damage and particularly neurocardiogenic myocardial damage. In patients with acute ischemic stroke, the prevalence of previously unknown coronary heart disease is reported to be up to 27% and is prognostically relevant for these patients; however, relevant coronary stenoses are less frequently detected in stroke patients with troponin elevation compared to patients with non-ST elevation myocardial infarction. The risk of secondary intracerebral hemorrhage due to the necessity for dual platelet aggregation inhibition illustrates the challenging indication for invasive coronary diagnostics and revascularization. Therefore, a diagnostic work-up and interdisciplinary risk evaluation appropriate to the urgency are necessary in order to be able to determine a reasonable treatment approach with timing of the intervention, type and duration of blood thinning. In addition to conventional examination methods, multimodal cardiac imaging is increasingly used for this purpose. This review article aims to provide a pragmatic and clinically oriented approach to diagnostic and therapeutic procedures, taking into account the available evidence.

Towards a better understanding of sewer exfiltration.

This paper gives a full review of the importance of sewer leakage, which has received increased attention throughout the last decades. Despite the intensive interdisciplinary research that has been invested, its magnitude is still unclear and a comprehensive solution for the assessment of sewer exfiltration does not seem to be at hand. However, given that mechanisms of exfiltration and the factors influencing its extent are similar all over the world, it seems possible to develop a generic leakage approach. Several methods for modelling sewer leakage are reviewed and the available measuring techniques are critically evaluated. Based on this evaluation, we suggest a unifying framework to facilitate focused model building. Specifically, we identify open research questions and propose to (i) standardise measurement results to enable better understanding, (ii) perform more long-term experiments under realistic field conditions, and (iii) assess the uncertainty of measurement and model results so that findings are not over-interpreted.

Long-term treatment with sildenafil in chronic thromboembolic pulmonary hypertension.

For chronic thromboembolic pulmonary hypertension not amenable to pulmonary endarterectomy, effective medical therapy is desired. In an open-label uncontrolled clinical trial, 104 patients (mean +/- sem age 62 +/- 11 yrs) with inoperable chronic thromboembolic pulmonary hypertension were treated with 50 mg sildenafil t.i.d. At baseline, patients had severe pulmonary hypertension (pulmonary vascular resistance 863 +/- 38 dyn.s.cm(-5)) and a 6-min walking distance of 310 +/- 11 m. Eight patients were in World Health Organization functional class II, 76 in class III and 20 in class IV. After 3 months' treatment, there was significant haemodynamic improvement, with reduction of pulmonary vascular resistance to 759 +/- 62 dyn.s.cm(-5). The 6-min walking distance increased significantly to 361 +/- 15 m after 3 months' treatment, and to 366 +/- 18 m after 12 months' treatment. A subset of 67 patients received a single dose of 50 mg sildenafil during initial right heart catheterisation. The acute haemodynamic effect of this was not predictive of long-term outcome. In this large series of patients with inoperable chronic thromboembolic pulmonary hypertension, open-label treatment with sildenafil led to significant long-term functional improvement. The acute effect of sildenafil may not predict the long-term outcome of therapy.

Quantification of sewer leakage: a review.

One of the goals of the APUSS project (assessing infiltration and exfiltration on the performance of urban sewer systems) is to assess sewer exfiltration, in order to support cities and operators to define problem-oriented rehabilitation strategies. In this paper, we review various methods currently used for the estimation of exfiltration and discuss data needs and applicability for rehabilitation planning. Although each approach has its individual advantages and drawbacks, we identified pressure tests and tracer methods to have the highest potential for decision support in rehabilitation planning. With regard to future challenges (e.g., micropollutants) such methods might play a key role in integrated sewer management.

Dynamics of rain-induced pollutographs of solubles in sewers.

When looking at acute receiving water impacts due to combined sewer overflows the characteristics of the background diurnal sewage flux variation may influence the peak loads from combined sewer overflows (CSO) and wastewater treatment plant (WWTP) effluent significantly. In this paper, effects on the dynamic compounds transported in the sewer, on CSO discharges and WWTP loading are evaluated by means of hydrodynamic simulations. The simulations are based on different scenarios for diurnal dry-weather flow variations induced by different infiltration rates.

EXAFS as a tool for bond-length determination in the environment of heavy atoms.

Single crystal X-ray diffraction measurements are complicated in the presence of heavy atoms. In these cases the structure factors are mainly influenced by the heavy scatterers and the error in determination of atomic coordinates increases for light atoms. The difficulties grow if the unit cell dimensions or the space group symmetry remain uncertain. If the structure model is similar to the correct structure, it is difficult to find an independent criterion for the accuracy of the bond-length determination. We demonstrate that extended X-ray absorption fine structure (EXAFS) spectroscopy is a useful tool for the investigation of local bond lengths in the environment of heavy atoms.

Inflammation markers and cytokines in breast milk of atopic and nonatopic women.

BACKGROUND: Breast milk is thought to contain its own complex immune system. Whether or not this is altered in allergic individuals is not yet known. METHODS: By ELISA techniques, inflammatory markers (MIP-1alpha, sICAM-1) and T(H)1 (interferon-gamma [IFN-gamma]), as well as T(H)2 cytokines (interleukin [IL]-4, IL-10), were investigated in serum and milk samples from nonallergic (n = 23) lactating women and those with respiratory allergies (n = 19) during the first week postpartum. RESULTS: IFN-gamma was not detected in either serum or milk. IL-10 was more often found to be above the detection limit in both milk and serum samples from allergic mothers. IL-4 was detected in almost all serum samples with a wide variation. In milk, IL-4 was found in about 20% of the samples. MIP-1alpha was not detected in the serum but was detected in the milk of 23% of the nonatopic and 53% of the allergic mothers. Soluble ICAM-1 was present in all samples. Surprisingly, serum levels of sICAM-1 in allergic mothers (271+/-97 ng/ml) were significantly lower (P<0.001) than in nonatopic subjects (375+/-86 ng/ml). Concentrations of sICAM-1 in milk were similar in both groups. CONCLUSIONS: The concentrations of proinflammatory markers and cytokines in breast milk did not differ significantly between allergic and nonatopic mothers. In some individuals, high levels of MIP-1alpha, IL-10, and sICAM-1 could be found. However, the significance of these components for the breastfed infant is still unclear.