Störungen des Metabolismus der extrazellularmatrix des Herzens bei der kaninen idiopathischen dilatativen Kardiomyopathie

While the pathogenesis of canine idiopathic dilative carchomyopathy (DCM) remains unclear, alterations of the composition and metabolism of the extracellularmatrix (ECM) are suspected to be involved. The normal hearts of 16 dogs and the hearts from 12 dogs with primary DCM were investigated grossly and histopathologically (H-E and pircrosirius red stain). The expression patterns of elastin, MMP-2, -9, -14 and of TIMP-2 and TIMP-3 were investigated immunohistochemically. Realtime PCR was used to measure the mRNA levels of MMP-2, MMP-9, TIMP-2 and TIMP-3. Histopathologically the "attenuated wavy fibre type" (wType; n = 6) and the "fatty infiltration-degeneration type" (fType; n = 6) of DCM were diagnosed. In areas of the fType morphology, collagen III was increased, while elastin deposits were seen in regions with attenuated wavy cardiomyocytes. Immunohistochemistry showed a significant increase of MMP-9 and a decrease of MMP-14 expression intensity in the cardiomyocytes of the DCM group. The immunhistochemical findings did not vary between the two histopathological types of DCM. The percentage of TIMP-3 positive fibrocytes was significantly increased in the DCM groups compared to the healthy controls. The mRNA analyses revealed a significant increase of MMP-9 mRNA in the DCM group compared to the controls. The mRNA levels of MMP-2, TIMP-2 and TIMP-3 did not vary significantly. In conclusion, the present study showed an alteration of the extracellularmatrix composition and a selective dysregulation of MMPs and TIMPs in canine idiopathic DCM. The increased MMP-9 expression is probably a major factor in the pathogenesis Of primary DCM. The two histopathological types of DCM are not characterized by different MMP/TIMP expression patterns but show variations in ECM composition

Early esophageal cancer detection using RF classiers

One of the fastest rising forms of cancer in the Western world is esophageal cancer. Using High-Denition (HD) endoscopy, gastroenterology experts can identify esophageal cancer at an early stage. Recent research shows that early cancer can be found using a state-of-the-art computer-aided detection (CADe) system based on analyzing static HD endoscopic images. Our research aims at extending this system by applying Random Forest (RF) classication which introduces a condence measure for detected cancer regions. To visualize this data, we propose a novel annotation system, employing the unique characteristics of the previous condence measure. This allows reliable modeling of multi-expert knowledge and provides essential data for real-time video processing, to enable future use of the system in a clinical setting. The performance of the CADe system is evaluated on a 39-patient ataset, containing 100 images annotated by ve expert gastroenterologists. The proposed system reaches a precision of 75% and recall of 90%, thereby improving the state-of-the-art results by 11 and 6 percentage points, espectively

[Care contacts of elderly patients in the emergency care pathway: a retrospective cohort study]

Item does not contain fulltextOBJECTIVE: To gain insight into the differences in emergency care offered to elderly (65+ years) and younger patients (20-64 years). The emergency care pathway includes: out-of-hours general practitioner cooperatives, regional ambulance services, psychiatric emergency medical services, accident and emergency departments and acute cardiac care units. DESIGN: Retrospective cohort study. METHOD: We used data from all emergency care contacts from the Emergency Care Monitor of April 2015 and April 2016 from an emergency care region in the east of the Netherlands ('Acute Zorgregio Oost'); this involved 84,647 care contacts with 55,061 patients. We defined pathway emergency care contacts as multiple emergency care contacts with different healthcare providers within the emergency care pathway, and differentiated between single or repeated care contacts with a single emergency healthcare provider. We investigated differences in presenting symptoms, diagnoses, lead time, hospital admissions and mortality in the chain care. RESULTS: Emergency care contact was more often pathway contact in elderly than in younger patients (26% vs. 16%; p < 0.0001). Elderly patients more often received a diagnosis of CVA, pneumonia or exacerbation of COPD, while younger patients more often had simple contusions or abdominal symptoms. Pathway lead time was longer in elderly than in younger patients (median difference: 33 minutes; 95% CI: 25-40. Elderly patients were admitted to hospital more often (71% vs. 39%, p < 0.0001) and their mortality rate was higher (2.0% vs. 0.5%; p < 0.0001). CONCLUSION: Elderly patients in the emergency care pathway have more frequent and longer pathway contact and present themselves with a more complicated and life-threatening clinical picture than younger patients. New solutions should be explored to ensure that the emergency care pathway remains accessible and available and offers sufficient quality for the increasing number of elderly

[Care contacts of elderly patients in the emergency care pathway: a retrospective cohort study]

OBJECTIVE: To gain insight into the differences in emergency care offered to elderly (65+ years) and younger patients (20-64 years). The emergency care pathway includes: out-of-hours general practitioner cooperatives, regional ambulance services, psychiatric emergency medical services, accident and emergency departments and acute cardiac care units. DESIGN: Retrospective cohort study. METHOD: We used data from all emergency care contacts from the Emergency Care Monitor of April 2015 and April 2016 from an emergency care region in the east of the Netherlands ('Acute Zorgregio Oost'); this involved 84,647 care contacts with 55,061 patients. We defined pathway emergency care contacts as multiple emergency care contacts with different healthcare providers within the emergency care pathway, and differentiated between single or repeated care contacts with a single emergency healthcare provider. We investigated differences in presenting symptoms, diagnoses, lead time, hospital admissions and mortality in the chain care. RESULTS: Emergency care contact was more often pathway contact in elderly than in younger patients (26% vs. 16%; p < 0.0001). Elderly patients more often received a diagnosis of CVA, pneumonia or exacerbation of COPD, while younger patients more often had simple contusions or abdominal symptoms. Pathway lead time was longer in elderly than in younger patients (median difference: 33 minutes; 95% CI: 25-40. Elderly patients were admitted to hospital more often (71% vs. 39%, p < 0.0001) and their mortality rate was higher (2.0% vs. 0.5%; p < 0.0001). CONCLUSION: Elderly patients in the emergency care pathway have more frequent and longer pathway contact and present themselves with a more complicated and life-threatening clinical picture than younger patients. New solutions should be explored to ensure that the emergency care pathway remains accessible and available and offers sufficient quality for the increasing number of elderly