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

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

Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain.

Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women. Clinicaltrials.gov, NCT02400229

Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain

Background Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. Methods From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 +/- 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. Results Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 +/- 8.8, 43.3 +/- 9.1, 46.2 +/- 9.0, 46.4 +/- 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 +/- 4.1, 7.5 +/- 4.1, 6.5 +/- 4.0, 4.7 +/- 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. Conclusions Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women