Manganverstärkte Niederfeld-MRT bei 0,2 Tesla versus Spiral–CT–Arterioportographie zur Detektion maligner fokaler Leberläsionen

Ziel: Prospektive Evaluation des Stellenwertes der MnDPDP-verstärkten MRT am offenen Niederfeldgerät im Nachweis fokaler maligner Leberläsionen im Vergleich zur Spiral CT-Arterioportograhie (CTAP). Material und Methode: Im Rahmen einer Phase III Studie konnten zunächst insgesamt 27 konsekutive Patienten in die Studie eingeschlossen werden. 7 Patienten erfüllten im weiteren Verlauf nicht alle Einschlusskriterien und kamen nicht zur Auswertung. Bei allen Patienten wurde in einem Abstand von maximal 1 Woche eine native und eine manganverstärkte (MnDPDP) MRT der Leber bei 0,2 Tesla Feldstärke (Siemens Magnetom Open) sowie eine DSA mit unmittelbar folgender Spiral-CTAP (Siemens Somatom Plus 4) durchgeführt. Die Gesamtzahl und die nach Größe (a) 2 cm) aufgeschlüsselte Anzahl der gefundenen Läsionen wurde verglichen. Bei der statistischen Auswertung kam der Vorzeichentest mit einem Signifikanzniveau von p < 0,05 zur Anwendung. Ergebnisse: In der CTAP konnten wir insgesamt 114 Läsionen, in der nativen MRT 62 Läsionen und in der MRT nach MnDPDP-Gabe 69 Läsionen nachweisen. Der Unterschied war signifikant für die Gesamtzahl der Läsionen, für die Läsionsgröße b und für die zusammengefassten Läsionsgrößen a und b. Für die native und manganverstärkte MRT ergab sich kein signifikanter Unterschied. Schlussfolgerung: Mangafodipir sollte dem Einsatz an Hochfeldgeräten vorbehalten bleiben, da ein zuverlässiger Ausschluss bzw. Nachweis fokaler maligner Leberläsionen bei niedriger Feldstärke nicht zu erwarten ist

Optimally truncated WKB approximation for the 1D stationary Schr\"odinger equation in the highly oscillatory regime

This paper is dedicated to the efficient numerical computation of solutions to the 1D stationary Schr\"odinger equation in the highly oscillatory regime. We compute an approximate solution based on the well-known WKB-ansatz, which relies on an asymptotic expansion w.r.t. the small parameter $\varepsilon$. Assuming that the coefficient in the equation is analytic, we derive an explicit error estimate for the truncated WKB series, in terms of $\varepsilon$ and the truncation order $N$. For any fixed $\varepsilon$, this allows to determine the optimal truncation order $N_{opt}$ which turns out to be proportional to $\varepsilon^{-1}$. When chosen this way, the resulting error of the optimally truncated WKB series behaves like $\mathcal{O}(\varepsilon^{-2}\exp(-r/\varepsilon))$, with some parameter $r>0$. The theoretical results established in this paper are confirmed by several numerical examples.Comment: 38 pages, 10 figure

Entwicklung und aktuelle Situation der Verlandungsvegetation des Dümmers (Niedersachsen)

Die Verlandungsvegetation des Dümmers wurde seit Beginn des 20. Jahrhunderts mehrfach untersucht. 2006 erfolgte erstmals eine flächendeckende Kartierung der gesamten Verlandungszone. Seit der 1953 abgeschlossenen Eindeichung war diese massiven Veränderungen unterworfen. Bereits kurz nach Deichschluss kam es zu einer massiven Reduktion der seeseitigen, durchfluteten Schilfbestände (Phragmites australis). Weite Röhrichtpartien entwickelten sich zunächst zu Wasserschwaden-Beständen (Glyceria maxima), dann wieder zu Schilfröhrichten. Nach einer zwischenzeitlichen Stagnation der Röhrichtabbrüche in den 1980er Jahren kam es in den letzten 15-20 Jahren zu erneuten erheblichen Flächenverlusten. Die ehemals typischen Teichbinseninseln (Schoenoplectus spp.) sind inzwischen weitestgehend verschwunden. Die Wasserrosenfelder (Nuphar lutea, Nymphaea alba) verloren seit den 1990er Jahren erheblich an Fläche. Alle Verluste an der Verlandungsvegetation dürften zunächst durch die Gewässerbelastung, in neuerer Zeit vor allem durch zu hoch gehaltene Sommerwasserstände verursacht sein. Die ehemals üppige und artenreiche submerse Vegetation starb nach der Eindeichung vollständig ab. Nach einer unerwartet eingetretenen Klarwasserphase wurde 2001 erstmals wieder Potamogeton pectinatus nachgewiesen, seitdem wurden weitere Laichkraut-Arten, zwei Arten der Armleuchteralgen (Chara fragilis, Nitella mucronata) und weitere Tauch- und Schwimmblattpflanzen nachgewiesen. Die voraussichtlich 2009 erfolgende Umleitung des Bornbaches, über den ein Großteil der heutigen Nährstofffracht in den Dümmer gelangt, dürfte die Bedingungen für die submerse Vegetation entscheidend verbessern.The silting vegetation of Lake Dümmer has been investigated at different times throughout the 20th century. In 2006 we made the first complete mapping of all vegetation types. Since embanking had been finished in 1953, the vegetation changed dramatically. Reedbanks reduced much and the vegetation changed from dominance of Phragmites australis to Glyceria maxima, later Phragmites took back large parts. After a stagnation of devastion of reedbanks, after the 1980ties again large areas of reedbanks disappeared. Small islands of Schoenoplectus spp., which were very typical for the lake, nearly disappeared. The vegetation of the emergent plants Nuphar lutea and Nymphaea alba has started to disappear in the 1990ties. All devastation of silting vegetation seem to correlate with water pollution in the first decades, in recent years the water levels in summer are too high for reproduction of plants. The submerse vegetation was quite rich in species and biomass before embanking, then it completely disappeared. Since 2001, there is a slight recovery of such vegetation, including some species of Potamogeton spp. and Characeae. After the diversion of the Bornbach, a highly polluted stream in 2009, nitrification will be reduced giving good perspectives for a further recovery of submerse vegetation

Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams

BACKGROUND: Team effectiveness is often explained on the basis of input-process-output (IPO) models. According to these models a relationship between organizational culture (input = I), interprofessional teamwork (process = P) and job satisfaction (output = O) is postulated. The aim of this study was to examine the relationship between these three aspects using structural analysis. METHODS: A multi-center cross-sectional study with a survey of 272 employees was conducted in fifteen rehabilitation clinics with different indication fields in Germany. Structural equation modeling (SEM) was carried out using AMOS software version 20.0 (maximum-likelihood method). RESULTS: Of 661 questionnaires sent out to members of the health care teams in the medical rehabilitation clinics, 275 were returned (41.6 %). Three questionnaires were excluded (missing data greater than 30 %), yielding a total of 272 employees that could be analyzed. The confirmatory models were supported by the data. The results showed that 35 % of job satisfaction is predicted by a structural equation model that includes both organizational culture and teamwork. The comparison of this predictive IPO model (organizational culture (I), interprofessional teamwork (P), job satisfaction (O)) and the predictive IO model (organizational culture (I), job satisfaction (O)) showed that the effect of organizational culture is completely mediated by interprofessional teamwork. The global fit indices are a little better for the IO model (TLI: .967, CFI: .972, RMSEA .052) than for the IPO model (TLI: .934, CFI: .943, RMSEA: .61), but the prediction of job satisfaction is better in the IPO model (R(2) = 35 %) than in the IO model (R(2) = 24 %). CONCLUSIONS: Our study results underpin the importance of interprofessional teamwork in health care organizations. To enhance interprofessional teamwork, team interventions can be recommended and should be supported. Further studies investigating the organizational culture and its impact on interprofessional teamwork and team effectiveness in health care are important. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-0888-y) contains supplementary material, which is available to authorized users

FTO obesity risk variants are linked to adipocyte IRX3 expression and BMI of children: relevance of FTO variants to defend body weight in lean children?

Background: Genome-wide association studies have identified variants within the FTO (fat mass and obesity associated) locus as the strongest predictors of obesity amongst all obesity-associated gene loci. Recent evidence suggests that variants in FTO directly affect human adipocyte function through targeting IRX3 and IRX5 and thermogenesis regulation. Aim: We addressed the relevance of this proposed FTO-IRX pathway in adipose tissue (AT) of children. Results: Expression of IRX3 was higher in adipocytes compared to SVF. We found increased adipocyte-specific expression of IRX3 and IRX5 with the presence of the FTO risk haplotype in lean children, whereas it was unaffected by risk variants in obese peers. We further show that IRX3 expression was elevated in isolated adipocytes and AT of lean compared to obese children, particularly in UCP1-negative adipocytes, and inversely correlated with BMI SDS. Independent of BMI, IRX3 expression in adipocytes was significantly related to adipocyte hypertrophy, and subsequent associations with AT inflammation and HOMA-IR in the children. Conclusion: One interpretation of our observation of FTO risk variants linked to IRX3 expression and adipocyte size restricted to lean children, along with the decreased IRX3 expression in obese compared to lean peers, may reflect a defense mechanism for protecting body-weight, which is pertinent for lean children

Harmonization of growth hormone measurements with different immunoassays by data adjustment

Background: The aim of our study was to evaluate the between-assay variability of commercially available immunoassays for the measurement of human growth hormone (hGH). In addition, we asked whether the comparability of the diagnosis of childhood onset growth hormone deficiency could be improved by adjusting hGH results by statistical methods, such as linear regression, conversion factors, and quantile transformation. Methods: In archived sera from 312 children and adolescents (age: 17 days-17 years) hGH values between 0.01 and 16.5 ng/mL were determined by using the following immunoassays: AutoDELFIA (PerkinElmer), BC-IRMA (Beckman-Coulter), ELISA (Mediagnost), IMMULITE 2000 (Siemens), iSYS (IDS), Liaison (DiaSorin), UniCel DxI 800 Access (BeckmanCoulter) and "In house"-RIA (Tubingen). Results: The assays differed in median hGH concentrations by as much as 5.44 ng/mL (Immulite), and as little as 2.67 ng/mL (BC-IRMA). The mean difference between assays ranged from 0.35 to 2.71 ng/mL, whereas several samples displayed differences up to 11.4 ng/mL. The best correlation (r=0.992) was found between AutoDELFIA and Liasion, the lowest (r=0.864) was between an in-house RIA and iSYS. The between-assay CV (mean +/- SD) of values within the cut-off range was 24.3%+/- 7.4%, resulting in an assay-dependent diagnosis of growth hormone deficiency (GHD) in more than 27% of patients. Yet, adjustment of this data by linear regression or a conversion factor reduced the CV below 14%, and the ratio of assay-dependent diagnoses below 8%. Using quantile transformation, the CV and ratio were reduced to 11.4% and &lt; 1%, respectively. Conclusions: hGH measurements using different assays vary significantly. Linear regression, conversion factors, or particularly quantile transformation are useful tools to improve comparability in the diagnostic procedure for the confirmation of GHD in childhood and adolescence

The necessity of a global binding framework for sustainable management of chemicals and materials — interactions with climate and biodiversity

Sustainable chemicals and materials management deals with both the risks and the opportunities of chemicals and products. It is not only focused on hazards and risks of chemicals for human health and the environment but also includes the management of material flows from extraction of raw materials up to waste. It becomes apparent meanwhile that the ever-growing material streams endanger the Earth system. According to a recent publication of Persson et al., the planetary boundaries for chemicals and plastics have already been exceeded. Therefore, sustainable chemicals and materials management must become a third pillar of international sustainability policy. For climate change and biodiversity, binding international agreements already exist. Accordingly, a global chemicals and materials framework convention integrating the current fragmented and non-binding approaches is needed. The impacts of chemicals and materials are closely related to climate change. About one third of greenhouse gas (GHG) emissions are linked to the production of chemicals, materials and products and the growing global transport of goods. Most of it is assigned to the energy demand of production and transport. GHG emissions must be reduced by an expansion of the circular economy, i.e., the use of secondary instead of primary raw materials. The chemical industry is obliged to change its feedstock since chemicals based on mineral oil and natural gas are not sustainable. Climate change in turn has consequences for the fate and effects of substances in the environment. Rising temperature implies higher vapor pressure and may enhance the release of toxicants into the atmosphere. Organisms that are already stressed may react more sensitively when exposed to toxic chemicals. The increasing frequency of extreme weather events may re-mobilize contaminants in river sediments. Increasing chemical and material load also threatens biodiversity, e.g., by the release of toxic chemicals into air, water and soil up to high amounts of waste. Fertilizers and pesticides are damaging the biocoenoses in agrarian landscapes. In order to overcome these fatal developments, sustainable management of chemicals and materials is urgently needed. This includes safe and sustainable chemicals, sustainable chemical production and sustainable materials flow management. All these three sustainability strategies are crucial and complement each other: efficiency, consistency and sufficiency. This obligates drastic changes not only of the quantities of material streams but also of the qualities of chemicals and materials in use. A significant reduction in production volumes is necessary, aiming not only to return to a safe operating space with respect to the planetary boundary for chemicals, plastics and waste but also in order to achieve goals regarding climate and biodiversity

Quantification of paravalvular leaks associated with TAVI implants using 4D MRI in an aortic root phantom made possible by the use of 3D printing

IntroductionTranscatheter aortic valve implantation (TAVI) has become an alternative to surgical replacement of the aortic valve elderly patients. However, TAVI patients may suffer from paravalvular leaks (PVL). Detecting and grading is usually done by echocardiography, but is limited by resolution, 2D visualization and operator dependency. 4D flow magnetic resonance imaging (MRI) is a promising alternative, which did not reach clinical application in TAVI patients. The aim of this study was applying 3D printing technologies in order to evaluate flow patterns and hemodynamics of PVLs following TAVI, exploiting 4D flow MRI and standard ultrasound. Materials and methodsAn MR-compatible, anatomically left ventricle, aortic root, and ascending aorta model was fabricated by combining 3D-printed parts and various soft silicone materials to match physiological characteristics. An Abbott Portico (TM) valve was used in continuous antegrade flow (12-22 l/min), retrograde flow with varying transvalvular pressures (60-110 mmHg), and physiological pulsatile hemodynamics (aortic pressure: 120/80 mmHg, cardiac output: 5 l/min) Time-resolved MR measurements were performed above and below the TAVI stent and compared with color Doppler ultrasound measurements in exactly the same setup. ResultsThe continuous antegrade flow measurements from MRI largely agreed with the flowmeter measurements, and a maximum error of only 7% was observed. In the retrograde configuration, visualization of the paravalvular leaks was possible from the MR measurements, but flow was overestimated by up to 33%. The 4D MRI measurement in the pulsatile setup revealed a single main PVL, which was also confirmed by the color Doppler measurements, and velocities were similar (2.0 m/s vs. 1.7 m/s). Discussion4D MRI techniques were used to qualitatively assess flow in a patient-specific, MR-compatible and flexible model, which only became possible through the use of 3D printing techniques. Flow patterns in the ascending aorta, identification and quantification of PVLs was possible and the location and extent of PVLs were confirmed by ultrasound measurements. The 4D MRI flow technique allowed evaluation of flow patterns in the ascending aorta and the left ventricle below the TAVI stent with good results in identifying PVLs, demonstrating its capabilities over ultrasound by providing the ability to visualize the paravalvular jets in three dimensions at however, additional expenditure of time and money

(3R,4S,5S)-4-Hydr­oxy-3-methyl-5-[(2S,3R)-3-methyl­pent-4-en-2-yl]tetra­hydro­furan-2-one

The title compound, C11H18O3, was synthesized to prove the relative configuration of the corresponding acyclic C1—C8 stereopentade. It crystallizes with two mol­ecules in the asymmetric unit, which show only slight differences. The mol­ecules are linked via O—H⋯O hydrogen bonds, resulting in two crystallographically independent chains of mol­ecules propagating in the a-axis direction. The absolute configuration was known from the synthesis