Nine-Tenths of the Law: The English Copyright Debates and the Rhetoric of the Public Domain

Background: The role of vitamin D supplementation as adjuvant treatment of tuberculosis (TB) has lately attracted increasing interest. Our aim was to investigate the capacity of alveolar macrophages (AMs) from patients with or without exposure to TB to control intracellular growth of virulent Mycobacterium tuberculosis (Mtb). Methods: AMs were freshly harvested from the bronchoalveolar lavage fluid of 7 patients with a history of TB (4 patients with previous TB and 3 patients with current TB) and 4 non-TB subjects. The H37Rv strain, genetically modified to express Vibrio harveyi luciferase, was used to determine the growth of Mtb by luminometry in the AMs from study subjects. Cytokine levels in culture supernatants were determined using a flow cytometry-based bead array technique. Results: AMs from patients with a TB history were less efficient in restricting Mtb growth. Stimulation with 100 nM1, 25-dihydroxyvitamin D (1,25D3) did not significantly influence the capacity of AMs from any study subjects to control the infection. Out of the cytokines evaluated (TNF-α, IL-1β, IL-10 and IL-12p40) only TNF-α demonstrated detectable levels in culture supernatants, but did not respond to stimulation with 1,25D3. Conclusions: We conclude that AMs of TB-patients show reduced ability to control mycobacterial growth in vitro, and, that AMs in this pilot study do no respond to 1, 25D3-stimulation. The former observation supports the concept that innate immunity is crucial for the control of TB infection

Can segmented 3D images be used for stenosis evaluation in

coronary CT angiography

Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study

Objectives The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. Design This was an intervention study conducted between September 2015 and December 2017. Setting Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. Intervention All patients were referred for CXR when the physician s suspicion of pneumonia was unsure, or quite sure after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. Subjects A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients >= 18 years, with respiratory symptoms for more than 24 h. Main outcome measure:Antibiotic prescribing rate. Results In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. Conclusion This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing

Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography

Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctors degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linkoping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p&amp;lt;0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP)50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p&amp;lt;0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on ones judgement without ordering CXR.Funding Agencies|County Council of ostergotland</p

Angiography and phlebography in a hemodialysis population : A retrospective analysis of interventional results

Objective: To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems. Material and methods: In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function. Results: Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p &lt; 0.001) and interstitial nephritis (p &lt; 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p &lt; 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses. Conclusion: Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis

Can segmented 3D images be used for stenosis evaluation in coronary CT angiography?

Purpose: To retrospectively evaluate the diagnostic accuracy of coronary CT angiography (CCTA) using segmented 3D data for the detection of significant stenoses with catheter angiography (CA) as the reference standard. Method: CCTA data sets from 30 patients were acquired with a 64-slice dual source CT scanner and segmented by an independent observer using the region growing (RG) method and the “virtual contrast injection” (VC) method. For every examination, each of the three types of images was  then reviewed by one of three reviewers in a blinded fashion for the presence of stenoses with diameter reduction of 50% or more. For the original series, the reviewer was allowed to use all the 2D or 3D visualization tools available (mixed method). For the segmented results (from RG and VC), the reviewer only used the 3D maximum intensity projection. Evaluation results were compared with CA for each artery. Results: Overall, 34 arteries with significant stenosis were identified by CA. The percentage of evaluable arteries, accuracy and negative predictive value (NPV) for detecting stenosis were, respectively, 86%, 74% and 93% for the mixed method, 83%, 71% and 92% for VC, and 64%, 56% and 93% for RG. Accuracy was significantly lower for the RG method than for the other two methods (p&lt;0.01), whereas there was no significant difference in accuracy between the VC method and the mixed method (p = 0.22). Excluding vessels with heavy calcification, all three methods had similar accuracy. Conclusion: Diagnostic accuracy when using segmented 3D data was lower than with access to 2D images. However, the high NPV of the 3D methods suggests a potential of using them as an initial step, with access to 2D reviewing techniques for suspected lesions and cases with heavy calcification. The VC method, which generates more evaluable arteries and has higher accuracy, seems more promising for this purpose than the RG method

The introduction of innovative services to promote Ltd. "Autogarant” development

Purpose: To retrospectively evaluate the diagnostic accuracy of coronary CT angiography (CCTA) using segmented 3D data for the detection of significant stenoses with catheter angiography (CA) as the reference standard. Method: CCTA data sets from 30 patients were acquired with a 64-slice dual source CT scanner and segmented by an independent observer using the region growing (RG) method and the “virtual contrast injection” (VC) method. For every examination, each of the three types of images was  then reviewed by one of three reviewers in a blinded fashion for the presence of stenoses with diameter reduction of 50% or more. For the original series, the reviewer was allowed to use all the 2D or 3D visualization tools available (mixed method). For the segmented results (from RG and VC), the reviewer only used the 3D maximum intensity projection. Evaluation results were compared with CA for each artery. Results: Overall, 34 arteries with significant stenosis were identified by CA. The percentage of evaluable arteries, accuracy and negative predictive value (NPV) for detecting stenosis were, respectively, 86%, 74% and 93% for the mixed method, 83%, 71% and 92% for VC, and 64%, 56% and 93% for RG. Accuracy was significantly lower for the RG method than for the other two methods (p&lt;0.01), whereas there was no significant difference in accuracy between the VC method and the mixed method (p = 0.22). Excluding vessels with heavy calcification, all three methods had similar accuracy. Conclusion: Diagnostic accuracy when using segmented 3D data was lower than with access to 2D images. However, the high NPV of the 3D methods suggests a potential of using them as an initial step, with access to 2D reviewing techniques for suspected lesions and cases with heavy calcification. The VC method, which generates more evaluable arteries and has higher accuracy, seems more promising for this purpose than the RG method

Alveolar macrophages from patients with tuberculosis exhibit reduced capacity of restricting growth of Mycobacterium tuberculosis : a pilot study of vitamin D stimulation in vitro

Background: The role of vitamin D supplementation as adjuvant treatment of tuberculosis (TB) has lately attracted increasing interest. Our aim was to investigate the capacity of alveolar macrophages (AMs) from patients with or without exposure to TB to control intracellular growth of virulent Mycobacterium tuberculosis (Mtb). Methods: AMs were freshly harvested from the bronchoalveolar lavage fluid of 7 patients with a history of TB (4 patients with previous TB and 3 patients with current TB) and 4 non-TB subjects. The H37Rv strain, genetically modified to express Vibrio harveyi luciferase, was used to determine the growth of Mtb by luminometry in the AMs from study subjects. Cytokine levels in culture supernatants were determined using a flow cytometry-based bead array technique. Results: AMs from patients with a TB history were less efficient in restricting Mtb growth. Stimulation with 100 nM1, 25-dihydroxyvitamin D (1,25D3) did not significantly influence the capacity of AMs from any study subjects to control the infection. Out of the cytokines evaluated (TNF-α, IL-1β, IL-10 and IL-12p40) only TNF-α demonstrated detectable levels in culture supernatants, but did not respond to stimulation with 1,25D3. Conclusions: We conclude that AMs of TB-patients show reduced ability to control mycobacterial growth in vitro, and, that AMs in this pilot study do no respond to 1, 25D3-stimulation. The former observation supports the concept that innate immunity is crucial for the control of TB infection

Vitamin D enhances IL-1β secretion and restricts growth of Mycobacterium tuberculosis in macrophages from TB patients

The emergence of multidrug-resistant strains of Mycobacterium tuberculosis (MTB), the bacterium responsible for tuberculosis (TB), has rekindled the interest in the role of nutritional supplementation of micronutrients, such as vitamin D, as adjuvant treatment. Here, the growth of virulent MTB in macrophages obtained from the peripheral blood of patients with and without TB was studied. The H37Rv strain genetically modified to express Vibrio harveyi luciferase was used to determine the growth of MTB by luminometry in the human monocyte-derived macrophages (hMDMs) from study subjects. Determination of cytokine levels in culture supernatants was performed using a flow cytometry-based bead array technique. No differences in intracellular growth of MTB were observed between the different study groups. However, stimulation with 100nM 1,25-dihydroxyvitamin D significantly enhanced the capacity of hMDMs isolated from TB patients to control the infection. This effect was not observed in hMDMs from the other groups. The interleukin (IL)-1β and IL-10 release by hMDMs was clearly increased upon stimulation with 1,25-dihydroxyvitamin D. Furthermore, the 1,25-dihydroxyvitamin D stimulation also led to elevated levels of TNF-α (tumor necrosis factor-alpha) and IL-12p40. It was concluded that vitamin D triggers an inflammatory response in human macrophages with enhanced secretion of cytokines, as well as enhancing the capacity of hMDMs from patients with active TB to restrict mycobacterial growth