Computed tomography segmental calcium score (SCS) to predict stenosis severity of calcified coronary lesions

To estimate the probability of a parts per thousand yen50 % coronary stenoses based on computed tomography (CT) segmental calcium score (SCS) and clinical factors. The Institutional Review Board approved the study. A training sample of 201 patients underwent CT calcium scoring and conventional coronary angiography (CCA). All patients consented to undergo CT before CCA after being informed of the additional radiation dose. SCS and calcification morphology were assessed in individual coronary segments. We explored the predictive value of patient's symptoms, clinical history, SCS and calcification morphology. We developed a prediction model in the training sample based on these variables then tested it in an independent test sample. The odds ratio (OR) for a parts per thousand yen50 % coronary stenosis was 1.8-fold greater (p = 0.006) in patients with typical chest pain, twofold (p = 0.014) greater in patients with acute coronary syndromes, twofold greater (p < 0.001) in patients with prior myocardial infarction. Spotty calcifications had an OR for a parts per thousand yen50 % stenosis 2.3-fold (p < 0.001) greater than the absence of calcifications, wide calcifications 2.7-fold (p < 0.001) greater, diffuse calcifications 4.6-fold (p < 0.001) greater. In middle segments, each unit of SCS had an OR 1.2-fold (p < 0.001) greater than in distal segments; in proximal segments the OR was 1.1-fold greater (p = 0.021). The ROC curve area of the prediction model was 0.795 (0.95 confidence interval 0.602-0.843). Validation in a test sample of 201 independent patients showed consistent diagnostic performance. In conjunction with calcification morphology, anatomical location, patient's symptoms and clinical history, SCS can be helpful to estimate the probability of a parts per thousand yen50 % coronary stenosis

The role of agency in the emergence and development of social innovations in rural areas. Analysis of two cases of social farming in Italy and the Netherlands

Social innovation is considered a relevant concept to tackle societal challenges and needs in rural areas and to promote smart, inclusive and sustainable growth. The characterising sector of rural areas is agriculture; therefore, the focus of this paper is on social innovation in the field of social farming. Among the many factors leading to the emergence and development of social innovation, agency has been considered relevant in the literature on transformability and transformative social innovation as it is the ability to turn contextual difficulties into opportunities for social innovation and for inclusive growth. This paper proposes an evaluation framework to assess the different dimensions of agency by triangulating quantitative with qualitative data and by using indicators. This paper adopts a case study approach, analysing two cases of social farming in Italy and the Netherlands. The results show that the social innovation idea and the resilience of the agency are among the most relevant dimensions for the emergence and development of social innovations. Finally, this paper discusses the three most relevant factors for agency to lead to social innovation: idea and embeddedness of the agency, transformability of the context through agencys resilience, and agency as catalyst for empowerment

Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

Objectives: To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Methods: Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Results: Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Conclusions: Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. Key Points: • The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease• Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow• The incremental value of the transmural perfusion ratio is limite

Studien uber heterogenetische Antigene der Hornmasse des Pferdes

Von den drei Hornmassenarten (Huf, Kastanie und Sporn), welche an der Oberhaut des Pferdes vorhanden sind, prufte ich das Vorkommen heterogenetischer Antigene und untersuchte zugleich das durch diese Antigene hervorgerufene Verwandtschaftsverhaltnis der Hornmassen zueinander. Die Kaninchen wurden entweder mit einem Extrakte immunisiert, das aus dem zu untersuchenden Material mit physiologischer Kochsalzlosung als Medium hergestellt war (Emulsion), oder mittels eines unter Erwarmung bereiteten alkoholischen Auszugs (Lipoide). Auf diese Weise wurde versucht, die Antigene in vivo festzustellen. Dann wurden die Antigene noch in vitro einer Untersuchung unterzogen. Die Ergebnisse dieser Studien sind kurz folgende: 1. Der Hornstoff des Hufes enthalt heterogenetisches Antigen. Besonderes Interesse beansprucht jedoch dabei die Beobachtung, dass selbst bei ein und demselben Huf je nach der Stelle der Antigen-Titer des Hornstoffes in weiten Grenzen schwankt. 2. Der Kastanienhornstoff hat heterogenetisches Antigen. 3. Auch beim Spornhornstoff findet sich heterogenetisches Antigen. 4. Wenn man die aus diesen drei Hornmassen gewonnenen heterogenetischen Antigene mit dem bekannten Antigen, welches den Organen des Meerschweinchens und den Erythrozyten des Schafes gemeinsam ist, vergleicht, so erkennt man, dass alle diese Antigene quantitativ wesentlich verschieden sind. Die ersten drei stehen namlich im allgemeinen dem letzteren nach, wahrend sie aber qualitativ miteinander in Einklang stehen. Uber die Verteilung des heterogenetischen Antigens in den Hornmassen soll folgende Tabelle nach dem Immunisierungsindex Aufschluss geben. 5. Das heterogenetische Antigen ist im Lipoid enthalten und stellt das sogenannte Hapten dar. Dieses Lipoid entfaltet im lebenden Korper als Schlepper erst durch Zusatz von Eiweissbestandteilen Vollantigenitat. 6. Alle Reaktionen mit heterogenetischen Antikorpern ergaben kein so zuverlassiges Resultat, aus dem man auf einen Verwandtschaftsgrad zwischen den Hornmassen hatte schliessen konnen. Kastan

Efflux in Acinetobacter baumannii can be determined by measuring accumulation of H33342 (bis-benzamide)

10.1093/jac/dkt052Journal of Antimicrobial Chemotherapy6871594-160

The Population Structure of Acinetobacter baumannii: Expanding Multiresistant Clones from an Ancestral Susceptible Genetic Pool

Outbreaks of hospital infections caused by multidrug resistant Acinetobacter baumannii strains are of increasing concern worldwide. Although it has been reported that particular outbreak strains are geographically widespread, little is known about the diversity and phylogenetic relatedness of A. baumannii clonal groups. Sequencing of internal portions of seven housekeeping genes (total 2,976 nt) was performed in 154 A. baumannii strains covering the breadth of known diversity and including representatives of previously recognized international clones, and in 19 representatives of other Acinetobacter species. Restricted amounts of diversity and a star-like phylogeny reveal that A. baumannii is a genetically compact species that suffered a severe bottleneck in the recent past, possibly linked to a restricted ecological niche. A. baumannii is neatly demarcated from its closest relative (genomic species 13TU) and other Acinetobacter species. Multilocus sequence typing analysis demonstrated that the previously recognized international clones I to III correspond to three clonal complexes, each made of a central, predominant genotype and few single locus variants, a hallmark of recent clonal expansion. Whereas antimicrobial resistance was almost universal among isolates of these and a novel international clone (ST15), isolates of the other genotypes were mostly susceptible. This dichotomy indicates that antimicrobial resistance is a major selective advantage that drives the ongoing rapid clonal expansion of these highly problematic agents of nosocomial infections

Ethnic differences in total and HDL cholesterol among Turkish, Moroccan and Dutch ethnic groups living in Amsterdam, the Netherlands.

<p>Abstract</p> <p>Background</p> <p>High total cholesterol and low HDL (high-density lipoprotein) cholesterol are important determinants of cardiovascular disease. Little is known about dyslipidemia among Turkish and Moroccan migrants, two of the largest ethnic minority groups in several European countries. This study examines ethnic differences in total and HDL cholesterol levels between Dutch, Turkish and Moroccan ethnic groups.</p> <p>Methods</p> <p>Data were collected in the setting of a general health survey, in Amsterdam, the Netherlands, in 2004. Total response rate was 45% (Dutch: 46%, Turks: 50%, Moroccans: 39%). From 1,220 adults information on history of hypercholesterolemia, lifestyle and demographic background was obtained via health interviews. In a physical examination measurements of anthropometry and blood pressure were performed and blood was collected. Total and HDL cholesterol were determined in serum.</p> <p>Results</p> <p>Total cholesterol levels were lower and hypercholesterolemia was less prevalent among the Moroccan and Turkish than the Dutch ethnic population. HDL cholesterol was also relatively low among these migrant groups. The resulting total/HDL cholesterol ratio was particularly unfavourable among the Turkish ethnic group. Controlling for Body Mass Index and alcohol abstinence substantially attenuated ethnic differences in HDL cholesterol levels and total/HDL cholesterol ratio.</p> <p>Conclusions</p> <p>Total cholesterol levels are relatively low in Turkish and Moroccan migrants. However part of this advantage is off-set by their relatively low levels of HDL cholesterol, resulting in an unfavourable total/HDL cholesterol ratio, particularly in the Turkish population. Important factors in explaining ethnic differences are the relatively high Body Mass Index and level of alcohol abstinence in these migrant groups.</p