Myocardial CT perfusion imaging for the detection of obstructive coronary artery disease: multisegment reconstruction does not improve diagnostic performance

Background: Multisegment reconstruction (MSR) was introduced to shorten the temporal reconstruction window of computed tomography (CT) and thereby reduce motion artefacts. We investigated whether MSR of myocardial CT perfusion (CTP) can improve diagnostic performance in detecting obstructive coronary artery disease (CAD) compared with halfscan reconstruction (HSR). Methods: A total of 134 patients (median age 65.7 years) with clinical indication for invasive coronary angiography and without cardiac surgery prospectively underwent static CTP. In 93 patients with multisegment acquisition, we retrospectively performed both MSR and HSR and searched both reconstructions for perfusion defects. Subgroups with known (n = 68) or suspected CAD (n = 25) and high heart rate (n = 30) were analysed. The area under the curve (AUC) was compared applying DeLong approach using >= 50% stenosis on invasive coronary angiography as reference standard. Results: Per-patient analysis revealed the overall AUC of MSR (0.65 [95% confidence interval 0.53, 0.78]) to be inferior to that of HSR (0.79 [0.69, 0.88]; p = 0.011). AUCs of MSR and HSR were similar in all subgroups analysed (known CAD 0.62 [0.45, 0.79] versus 0.72 [0.57, 0.86]; p = 0.157; suspected CAD 0.80 [0.63, 0.97] versus 0.89 [0.77, 1.00]; p = 0.243; high heart rate 0.46 [0.19, 0.73] versus 0.55 [0.33, 0.77]; p = 0.389). Median stress radiation dose was higher for MSR than for HSR (6.67 mSv versus 3.64 mSv, p < 0.001). Conclusions: MSR did not improve diagnostic performance of myocardial CTP imaging while increasing radiation dose compared with HSR

Autonomie der Trauer

Funeral culture is changing rapidly. In recent years, graveyards and burial rituals in Germany have altered significantly. They no longer reflect mechanisms of collective sense-making; instead, they represent individual lifeworlds. Death and the decisions and actions surrounding it have, in effect, become characterised by pluralism.When it comes to legal regulations, however, no change is visible. The law does not interpret the aforementioned cultural transformation from the perspective of the bereaved. It is thus not surprising that graveyard rules and especially the stipulation that human remains may only be interred in a cemetery have come under criticism.Yet today, practices have evolved by which the bereaved can sidestep the rules and keep the ashes of their deceased relatives with them, or scatter them at alternative locations. The trigger for this silent revolution is individualisation. However much individual decisions play a role in this respect, this development is also the result of changes within the cultural mind. They both mark a shift towards mourning becoming more autonomous

Creating application-specific metadata profiles while improving interoperability and consistency of research data for the engineering sciences

Due to the heterogeneity of data, methods, experiments, and research questions and the necessity to describe flexible and short-lived setups, no widely used subject-specific metadata schemata or terminologies have been established for the field of engineering (as well as for other disciplines facing similar challenges). Nevertheless, it is highly desirable to realize consistent and machine-actionable documentation of research data via structured metadata. In this article, we introduce a way to create subject specific RDF-compliant metadata profiles (in the sense of SHACL shapes) that allow precise and flexible documentation of research processes and data. We introduce a hierarchical inheritance concept for the profiles that we combine with a strategy that uses composition of relatively simple modular profiles to model complex setups. As a result, the individual profiles are highly reusable and can be applied in different contexts, which, in turn, increases the interoperability of the resulting data. We also demonstrate that it is possible to achieve a level of detail that is sufficiently specific for most applications, even when only general terms are available within existing terminologies, avoiding the need to create highly specific terminologies that would only have limited reusability

第913回千葉医学会例会・第28回麻酔科例会・第56回千葉麻酔懇話会

Introduction Pulmonary Surfactant reduces surface tension in the terminal airways thus facilitating breathing and contributes to host’s innate immunity. Surfactant Proteins (SP) A, B, C and D were recently identified as inherent proteins of the CNS. Aim of the study was to investigate cerebrospinal fluid (CSF) SP levels in hydrocephalus patients compared to normal subjects. Patients and Methods CSF SP A-D levels were quantified using commercially available ELISA kits in 126 patients (0–84 years, mean 39 years). 60 patients without CNS pathologies served as a control group. Hydrocephalus patients were separated in aqueductal stenosis (AQS, n = 24), acute hydrocephalus without aqueductal stenosis (acute HC w/o AQS, n = 16) and idiopathic normal pressure hydrocephalus (NPH, n = 20). Furthermore, six patients with pseudotumor cerebri were investigated. Results SP A—D are present under physiological conditions in human CSF. SP-A is elevated in diseases accompanied by ventricular enlargement (AQS, acute HC w/o AQS) in a significant manner (0.67, 1.21 vs 0.38 ng/ml in control, p<0.001). SP-C is also elevated in hydrocephalic conditions (AQS, acute HC w/o AQS; 0.87, 1.71 vs. 0.48 ng/ml in controls, p<0.001) and in Pseudotumor cerebri (1.26 vs. 0.48 ng/ml in controls, p<0.01). SP-B and SP-D did not show significant alterations. Conclusion The present study confirms the presence of SPs in human CSF. There are significant changes of SP-A and SP-C levels in diseases affecting brain water circulation and elevation of intracranial pressure. Cause of the alterations, underlying regulatory mechanisms, as well as diagnostic and therapeutic consequences of cerebral SP’s requires further thorough investigations

Evaluation of automated techniques for extraction of circulating cell-free DNA for implementation in standardized high-throughput workflows

AbstractAnalysis of circulating cell-free DNA (ccfDNA) is a suitable tool for detecting somatic mutations for the purpose of making decisions on treatment, monitoring treatment response, and predicting survival. High-throughput techniques for ccfDNA extraction are essential to implementing ccfDNA testing in the clinical setting. We set out to compare two automated techniques with regard to hands-on time, ccfDNA output and integrity, and circulating mitochondrial DNA (mtDNA). CcfDNA was isolated using the EZ1&amp;2 ccfDNA field test kit (EZ2 kit, QIAGEN) and the Maxwell RSC ccfDNA plasma kit (Maxwell kit, Promega). DNA was extracted from plasma of 30 breast cancer patients enrolled in the iMODE-B (#325_19B; 12.10.2020) study. Real-time PCR, fluorescence-based detection and automated electrophoresis were used to assess ccfDNA concentrations. The ccfDNA yield was significantly higher when extracted with the EZ2 kit. The EZ2 kit enabled the isolation of a higher proportion of short fragments and a lower proportion of long fragments, resulting in lower DNA integrity. Significantly lower mtDNA quantities were detected in the Maxwell eluate than in the EZ2 eluate. Thus, decisions on which extraction method to use should proceed on the basis of the required input for downstream applications, the anticipated fragment size and minimum hands-on time.</jats:p

Discordance between Primary Breast Cancer and Ipsilateral Breast Cancer Tumor Recurrence as a Function of Distance

Background: Risk factors for ipsilateral breast cancer tumor recurrence (IBTR) are well established and include grading, nodal status, and receptor status. Little is known about the influence of the local distance between the primary tumor and recurrences on changes in tumor characteristics and prognosis. Methods: In a retrospective setting, we analyzed primary breast cancers and their recurrences. Localizations of primary and recurrent breast cancer were recorded to calculate the relative distance in pixels. Analysis was performed regarding tumor characteristics, relative distance between both, and their impact on breast cancer prognosis. Results: In a cohort of 142 patients with ipsilateral recurrence, no statistically significant difference could be shown in the change in tumor characteristics depending on distance. Progesterone receptor (PR) and estrogene receptor (ER) status changed in 22.7% and 14.9% of cases, respectively. human epidermal growth factor receptor 2 (ERBB2, HER2) status changed in 18.3% of cases. Survival was in accordance with the literature, with luminal-A-like tumors as best and triple negative breast cancers (TNBC) as worst prognosis. With a threshold of 162 pixels, the survival was significantly better in the group with shorter distance. Conclusion: Change in tumor characteristics from primary breast cancer to recurrence occurs more often in PR than ER. In contrast to other work, in this dataset, recurrences with a larger distance to the primary tumor had a worse prognosis in univariate analysis. A Cox model might indicate the possibility that this influence is independent of other risk factors

Berufliche Stabilitäts- und Flexibilitätsorientierungen in Ostdeutschland: Ergebnisse eines Forschungspraktikums

Das im folgenden vorgestellte Projekt Stabilitäts- und Flexibilitätsorientierungen in ostdeutschen Lebensverläufen wurde am Institut für Soziologie der Universität Leipzig im Rahmen eines Lehrpraktikums durchgeführt. In dem Projekt wurden berufliche Stabilitäts- und Flexibilitätsorientierungen ostdeutscher Beschäftigter vor dem Hintergrund individueller Ressourcen und Gelegenheitsstrukturen untersucht. Anhand von 68 biographischen Interviews älterer und jüngerer Kohorten sollte gezeigt werden, in welchem Maße individuelle Merkmale sowie familiäre, arbeitsmarktliche, sozialpolitische und betriebliche Gelegenheitsstrukturen die individuellen Handlungsorientierungen beeinflussen. Vor dem Hintergrund der \"Entstandardisierung\" von Lebenslaufmustern und der \"Flexibilisierung\" von Erwerbsverläufen wurde dabei nach den Ursachen und Veränderungen kohortenspezifischer Unterscheidungen berufsbiographischer Entwürfe gefragt.:Vorbemerkung; Stabilität und Flexibilität im Lebensverlauf; Analytisches Modell und methodisches Vorgehen; Ergebnisse; Bewältigungsstrategien – Eine Zusammenfassung; Literatur, Anhan