Electrical Impedance Tomography (EIT) in a Patient Suffering from Post-COVID Syndrome with Dyspnea: A Case Report

Background: Long-term health consequences following COVID-19 disease constitute an increasing problem worldwide. A considerable number of patients still suffer from various symptoms, most commonly dyspnea, months or even years after the acute infection. In these patients, a classical pulmonary function test often yields no significant findings. Subsequently, treating those patients is a challenge for any physician as there are currently no evidence-based treatment plans. Case and methods: We reported the case of a 58-year-old patient who was still suffering from resting dyspnea six months after severe COVID-19 pneumonia. The dyspnea was so pronounced that the patient was supplied with home oxygen, which they used as needed. The regional distribution of ventilation in the lungs was studied twice utilizing noninvasive electrical impedance tomography (EIT). The first examination showed distinct inhomogeneities of regional ventilation, a regional ventilation delay (RVD) of 15%, and pronounced pendelluft phenomena. Seven weeks after treatment with budesonide and physical therapy, the patient reported a clear subjective improvement in complaints. Accordingly, the regional distribution of ventilation also improved. Conclusion: Electrical impedance tomography might be a promising method to assess lung function in post-COVID patients; however, controlled and larger studies are necessary

Impact of structured reporting on developing head and neck ultrasound skills

Background: Reports of head and neck ultrasound examinations are frequently written by hand as free texts. This is a serious obstacle to the learning process of the modality due to a missing report structure and terminology. Therefore, there is a great inter-observer variability in overall report quality. Aim of the present study was to evaluate the impact of structured reporting on the learning process as indicated by the overall report quality of head and neck ultrasound examinations within medical school education. Methods: Following an immersion course on head and neck ultrasound, previously documented images of three common pathologies were handed out to 58 medical students who asked to create both standard free text reports (FTR) and structured reports (SR). A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion and readability by two independent raters (Paired Wilcoxon test, 95% CI). Ratings were assessed for inter-rater reliability (Fleiss’ kappa). Additionally, a questionnaire was utilized to evaluate user satisfaction. Results: SRs received significantly better ratings in terms of report completeness (97.7% vs. 53.5%, p < 0.001) regarding all items. In addition, pathologies were described in more detail using SRs (70% vs. 51.1%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 54.4%, p < 0.001). Mean time to complete was significantly lower (79.6 vs. 205.4 s, p < 0.001) and user satisfaction was significantly higher when using SRs (8.5 vs. 4.1, p < 0.001). Also, inter-rater reliability was very high (Fleiss’ kappa 0.93). Conclusions: SRs of head and neck ultrasound examinations provide more detailed information with a better readability in a time-saving manner within medical education. Also, medical students may benefit from SRs in their learning process due to the structured approach and standardized terminology

Evaluation of optimal education level to implement structured reporting into ultrasound training

Aims: Reporting of head and neck ultrasound (TINU) has been outlined to be a major obstacle during ultrasound training due to a lack of standardized structure, content and terminology. Consequently, overall report quality differs significantly between various examiners posing a severe risk factor for information loss and misconununication. Therefore, the present study's purpose is to compare the overall quality of free text reports (FTR) and structured reports (SR) of HNU at various stages of training in order to determine the optimal educational level to implement SR. Material and methods: Typical pathologies in HNU were reported upon using SR and FTR by medical students, junior residents and senior residents. The reports were assessed for overall quality, time efficiency and readability. Additionally, user satisfaction was determined using a questionnaire. Results: SRs exhibited a significantly superior report quality (93.1% vs. 45.6%, p<0.001) at all training levels. Overall time efficiency was significantly better for SRs, especially at the stages of medical school and early residency (89.4 S vs.160.2s, p<0.001). Using structured reporting also increased user satisfaction significantly (VAS 8.6 vs. 3.9, p<0.001). Conclusions: Implementing structured reporting of IINU results in a superior report quality at all training stage. Greatest benefits for time efficiency are achieved by implementation during medical school. Therefore, structured reporting of HNU should be Unplemerited early on in the training of HNU

Disorder and residual helicity alter p53-Mdm2 binding affinity and signaling in cells.

Levels of residual structure in disordered interaction domains determine in vitro binding affinities, but whether they exert similar roles in cells is not known. Here, we show that increasing residual p53 helicity results in stronger Mdm2 binding, altered p53 dynamics, impaired target gene expression and failure to induce cell cycle arrest upon DNA damage. These results establish that residual structure is an important determinant of signaling fidelity in cells

Disorder and residual helicity alter p53-Mdm2 binding affinity and signaling in cells

Levels of residual structure in disordered interaction domains determine in vitro binding affinities, but whether they exert similar roles in cells is not known. Here, we show that increasing residual p53 helicity results in stronger Mdm2 binding, altered p53 dynamics, impaired target gene expression and failure to induce cell cycle arrest upon DNA damage. These results establish that residual structure is an important determinant of signaling fidelity in cells

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial

Objectives More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). Methods In this trial, patients with a low-to-intermediate pretest probability (10–60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Results Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. Conclusions The DISCHARGE trial will assess the comparative effectiveness of CT and ICA