Endovascular Intervention for Critical Lower Limb Ischemia; a Review of Outcomes after Percutaneous Transluminal Angioplasty using Balloon Catheter

Peripheral Arterial Disease (PAD) of lower limb with variable morbidity can be manifested as an asymptomatic, sever or life threatening disease. It is also a major cause of disability in many cases. The management of patients with PAD can be defined from a number of different treatment options in the terms of conservative-, interventional- and surgical therapies.Percutaneous Transluminal Angioplasty (PTA) using balloon catheter as a revascularization procedure has been used with acceptable outcomes. The method results are highlighted with comparable success—and patency rates, low complications, improving the quality of life and survival. We reviewed published studies and found that PTA is an appropriate alternative in the management of patient with Critical Limb Ischemia (CLI). Better outcomes have been achieved using Drug Coated Balloons (DCB) as well as Drug Eluting Stents (DES). Atherectomy remains with controversial results. Patient characteristics, the presence of associated risk factors, characteristics of lesions and accompanied cardiopulmonary disease may be the main challenges to use of these treatment options in the future

Stable Isotope Phosphate Labelling of Diverse Metabolites is Enabled by a Family of 18O-Phosphoramidites

Stable isotope labelling is state-of-the-art in quantitative mass spectrometry, yet often accessing the required standards is cumbersome and very expensive. Here, a unifying synthetic concept for 18O-labelled phosphates is presented, based on a family of modified 18O2-phosphoramidite reagents. This toolbox offers access to major classes of biologically highly relevant phosphorylated metabolites as their isotopologues including nucleotides, inositol phosphates, -pyrophosphates, and inorganic polyphosphates. 18O-enrichment ratios >95 % and good yields are obtained consistently in gram-scale reactions, while enabling late-stage labelling. We demonstrate the utility of the 18O-labelled inositol phosphates and pyrophosphates by assignment of these metabolites from different biological matrices. We demonstrate that phosphate neutral loss is negligible in an analytical setup employing capillary electrophoresis electrospray ionisation triple quadrupole mass spectrometry

Culture theory: The developing synthesis from biology

We believe that a useful, complete theory of culture is simpler than the dichotomies promoted by the coevolutionary approach suggest. Culture can be regarded as an aspect of the environment into which each human is born and must succeed or fail, developed gradually by the succession of humans who have lived throughout history. We hypothesize that culture results from the inclusive-fitness-maximizing efforts of all humans who have lived. We think the evidence suggests that cultural traits are, in general, vehicles of genic survival, and that the heritability of cultural traits depends on the judgments (conscious and unconscious) of individuals with regard to their effects on the individual's inclusive fitness.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44477/1/10745_2005_Article_BF01531192.pd

Artificial Intelligence in Senology - Where Do We Stand and What Are the Future Horizons?

Artificial Intelligence (AI) is defined as the simulation of human intelligence by a digital computer or robotic system and has become a hype in current conversations. A subcategory of AI is deep learning, which is based on complex artificial neural networks that mimic the principles of human synaptic plasticity and layered brain architectures, and uses large-scale data processing. AI-based image analysis in breast screening programmes has shown non-inferior sensitivity, reduces workload by up to 70% by pre-selecting normal cases, and reduces recall by 25% compared to human double reading. Natural language programs such as ChatGPT (OpenAI) achieve 80% and higher accuracy in advising and decision making compared to the gold standard: human judgement. This does not yet meet the necessary requirements for medical products in terms of patient safety. The main advantage of AI is that it can perform routine but complex tasks much faster and with fewer errors than humans. The main concerns in healthcare are the stability of AI systems, cybersecurity, liability and transparency. More widespread use of AI could affect human jobs in healthcare and increase technological dependency. AI in senology is just beginning to evolve towards better forms with improved properties. Responsible training of AI systems with meaningful raw data and scientific studies to analyse their performance in the real world are necessary to keep AI on track. To mitigate significant risks, it will be necessary to balance active promotion and development of quality-assured AI systems with careful regulation. AI regulation has only recently included in transnational legal frameworks, as the European Union’s AI Act was the first comprehensive legal framework to be published, in December 2023. Unacceptable AI systems will be banned if they are deemed to pose a clear threat to people’s fundamental rights. Using AI and combining it with human wisdom, empathy and affection will be the method of choice for further, fruitful development of tomorrow’s senology

Global warming leads to larger bats with a faster life history pace in the long-lived Bechstein’s bat (Myotis bechsteinii)

Whether species can cope with environmental change depends considerably on their life history. Bats have long lifespans and low reproductive rates which make them vulnerable to environmental changes. Global warming causes Bechstein’s bats (Myotis bechsteinii) to produce larger females that face a higher mortality risk. Here, we test whether these larger females are able to offset their elevated mortality risk by adopting a faster life history. We analysed an individual-based 25-year dataset from 331 RFID-tagged wild bats and combine genetic pedigrees with data on survival, reproduction and body size. We find that size-dependent fecundity and age at first reproduction drive the observed increase in mortality. Because larger females have an earlier onset of reproduction and shorter generation times, lifetime reproductive success remains remarkably stable across individuals with different body sizes. Our study demonstrates a rapid shift to a faster pace of life in a mammal with a slow life history

Stable isotope phosphate labelling of diverse metabolites is enabled by a family of 18O-phosphoramidites

Stable isotope labelling is state-of-the-art in quantitative mass spectrometry, yet often accessing the required standards is cumbersome and very expensive. As 18O can be derived from heavy water (H218O), it is comparably cheap and particularly suited for labelling of phosphorylated compounds, provided the introduction is straight-forward and phosphate neutral loss in the ion source can be avoided. Here, a unifying synthetic concept for 18O-labelled phosphates is presented, based on a family of modified 18O2‑phosphoramidite reagents. This flexible toolbox offers access to major classes of biologically highly relevant phosphorylated metabolites as their isotopologues including - but not limited to - nucleotides, inositol phosphates, -pyrophosphates, and inorganic polyphosphates. 18O-enrichment ratios >95% and good yields are obtained consistently in gram-scale reactions, while enabling late-stage labelling. We demonstrate the utility of the 18O labelled inositol phosphates and pyrophosphates by assignment of these metabolites from different biological matrices, such as mammalian cell lysates, slime mold and plant samples. We demonstrate that phosphate neutral loss is negligible in an analytical setup employing capillary electrophoresis electrospray ionization triple quadrupole mass spectrometry

Evaluation der DEGUM-Mammasonografiekurse nach objektivierbaren Kriterien

Ziel: Die Evaluation der DEGUM-Mammasonografiekurse nach objektivierbaren Kriterien war Ziel dieser Arbeit. Damit sollte die Qualität der Kurse überprüft werden, um eine flächendeckende Fort- und Weiterbildung auf hohem Niveau anzubieten. Material und Methoden: 10 Qualitätskriterien, orientierend an den Vorgaben der KBV-Ultraschallvereinbarungen wurden als Qualitätsparameter definiert. Alle Kursleiter des Arbeitskreises Mammasonografie der DEGUM wurden angeschrieben. Dabei wurden die 10 definierten Qualitätskriterien überprüft. Ergebnisse: Alle Kurse erfüllten die Voraussetzungen bezüglich der Qualität des Kursleiters, der Kursdauer und Unterrichtseinheiten sowie der Anzahl an Kursteilnehmern pro Ultraschallgerät. In 1 von 9 Kursen wurde die Zeit der praktischen Übungen, gefordert sind 50 %, unterschritten. Die Voraussetzungen für den Abschlusskurs (200 selbst durchgeführte und dokumentierte Fälle) sind in den Kursankündigungen zum Teil nicht klar definiert. Ein strukturierter Lehrkatalog fehlt. Schlussfolgerung: Die DEGUM-Mammasonografiekurse werden auf hohem Niveau angeboten und erfüllen zum größten Teil die Anforderungen der KBV. Trotz der hohen Qualität der DEGUM-Kurse sind Optimierungsoptionen im Bereich Kursankündigung und strukturierter Lehrkatalog möglich.Purpose: The aim of this study was to evaluate the quality standard of the nationwide breast ultrasound training program of the German Society of Ultrasound in Medicine (DEGUM) through objective parameters. Materials and methods: 10 quality criteria, based on the recommendations of The National Association of Statutory Health Insurance Physicians (KBV), were defined for this study. All training units of the DEGUM received a questionnaire. The questionnaires and training material were analyzed. Results: All units met the required criteria pertaining to the trainer's qualification, duration per training course and the maximum number of participants per ultrasound machine. Only 1 course did not fulfill the required 50 % practical training time. The requirements to participate in the graduate course (200 self-made and documented cases) were not clearly conceived and a defined training log could be improved. Conclusion: DEGUM breast ultrasound training offers trainees a high level of education based on the requirements of the KBV. Despite the high quality of training, the content of course announcements could be improved and an official and structured educational index could be meaningful

No damage of joint cartilage of the lower limbs in an ultra-endurance athlete - an MRI-study

BACKGROUND: Osteoarthritis is an increasing burden in an ageing population. Sports, especially when leading to an overstress of joints, is under suspicion to provoke or at least accelerate the genesis of osteoarthritis. We present the radiologic findings of a 49-years old ultra-endurance athlete with 35 years of training and competing, whose joints of the lower limbs were examined using three different types of magnetic resonance imaging, including a microscopic magnetic resonance imaging coil. To date no case report exists where an ultra-endurance athlete was examined such detailed regarding overuse-injuries of his joints. CASE PRESENTATION: A 49 years old, white, male ultra-endurance athlete reporting no pain during training and racing and with no significant injuries of the lower limbs in his medical history was investigated regarding signs of chronic damage or overuse injuries of the joints of his lower limbs. CONCLUSION: Despite the age of nearly 50 years and a training history of over 35 years, the athlete showed no signs of chronic damage or overuse injuries in the joints of his lower limbs. This leads to the conclusion that extensive sports and training does not compulsory lead to damages of the musculoskeletal system. This is a very important finding for all endurance-athletes as well as for their physicians