Comparison of β-Hydroxylase Enzyme 11 Serum in Obese, Overweight, and Normoweight Young Men

Background: Previous studies showed that cardiovascular risk factor was increased in obese and overweight subjects. Obesity and cardiovascular risk factor are associated with hypothalamic-pituitary-adrenal (HPA) axis hyperactivity that causes hypercortisolism, cortisol level is associated with cardiovascular risk factor on obesity. 11 β-hydroxylase is an enzyme that involved in cortisol synthesis. The aim of this study was to investigate 11 β-Hydroxylase concentration in obesity, overweight, and normal weight young men.Subjects and Method: This was analytic-observational study using cross-sectional design. The study was conducted at HKBP Nommensen University, Medan. The study subjects included by 76 young men aged 18-28 years old, consisting of 25 obese subjects, 25 overweight, and 25 normoweight. The concentration of 11 β-Hydroxylase was evaluated in blood sample after 10 hours fasting. The data was analyzed bivariately.Results: Mean of 11 β-Hydroxylase concentration was 52.76 ± 44.27 in obese subjects, 70.16 ± 46.83 in overweight subjects, and 43.42 ± 27.75 in normoweight subjects. The 11 β-Hydroxylase concentration in overweight subjects was statistically higher than normoweight subjects (p = 0.007), but the 11 β-Hydroxylase concentration on obese subjects statistically was not different from normoweight subjects (p = 0.362).Conclusion: The 11 β-Hydroxylase concentration on overweight subject is higher than normoweight subject. There is no difference of 11 β-Hydroxylase concentration on obese and normoweight subject. Mitochondrial stress and mitochondrial failure mechanism on overweight and obesity merit further investigation

Comparison of hepatic MDCT, MRI, and DSA to explant pathology for the detection and treatment planning of hepatocellular carcinoma

BACKGROUND/AIMS: The diagnosis and treatment plan for hepatocellular carcinoma (HCC) can be made from radiologic imaging. However, lesion detection may vary depending on the imaging modality. This study aims to evaluate the sensitivities of hepatic multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) in the detection of HCC and the consequent management impact on potential liver transplant patients. METHODS: One hundred and sixteen HCC lesions were analyzed in 41 patients who received an orthotopic liver transplant (OLT). All of the patients underwent pretransplantation hepatic DSA, MDCT, and/or MRI. The imaging results were independently reviewed retrospectively in a blinded fashion by two interventional and two abdominal radiologists. The liver explant pathology was used as the gold standard for assessing each imaging modality. RESULTS: The sensitivity for overall HCC detection was higher for cross-sectional imaging using MRI (51.5%, 95% confidence interval [CI]=36.2-58.4%) and MDCT (49.8%, 95% CI=43.7-55.9%) than for DSA (41.7%, 95% CI=36.2-47.3%) (P=0.05). The difference in false-positive rate was not statistically significant between MRI (22%), MDCT (29%), and DSA (29%) (P=0.67). The sensitivity was significantly higher for detecting right lobe lesions than left lobe lesions for all modalities (MRI: 56.1% vs. 43.1%, MDCT: 55.0% vs. 42.0%, and DSA: 46.9% vs. 33.9%; all P<0.01). The sensitivities of the three imaging modalities were also higher for lesions ≥2 cm vs. <2 cm (MRI: 73.4% vs. 32.7%, MDCT: 66.9% vs. 33.8%, and DSA: 62.2% vs. 24.1%; all P<0.01). The interobserver correlation was rated as very good to excellent. CONCLUSION: The sensitivity for detecting HCC is higher for MRI and MDCT than for DSA, and so cross-sectional imaging modalities should be used to evaluate OLT candidacy

Utility of adenosine stress perfusion CMR to assess paediatric coronary artery disease

AIMS: Cardiovascular magnetic resonance (CMR), using adenosine stress perfusion and late-gadolinium enhancement (LGE), is becoming the 'gold standard' non-invasive imaging modality in the assessment of adults with coronary artery disease (CAD). However, despite its proved feasibility in paediatric patients, clinical utility has not been demonstrated. Therefore, this study aims to establish the role of adenosine stress perfusion CMR as a screening test in paediatric patients with acquired or congenital CAD. METHODS AND RESULTS: A total of 58 paediatric patients underwent 61 consecutive clinically indicated coronary artery assessments for diagnostic and clinical decision-making purposes. The diagnosis was based on X-ray or computed tomography coronary angiography for anatomy, adenosine stress CMR imaging for myocardial perfusion and LGE for tissue characterization. Two studies were aborted because of unwanted side effects of adenosine stress, thus 59 studies were completed in 56 patients [median age 14.1 years (interquartile range 10.9-16.2)]. When compared with coronary anatomical imaging, adenosine stress perfusion CMR performed as follows: sensitivity 100% (95% confidence interval, CI: 71.6-100%), specificity 98% (95% CI: 86.7-99.9%), positive predictive value (PPV) 92.9% (95% CI: 64.2-99.6%), and negative predictive value 100% (95% CI: 89.9-100%). CONCLUSION: In paediatric CAD, adenosine stress perfusion CMR imaging is adequate as an initial, non-invasive screening test for the identification of significant coronary artery lesions, with anatomical imaging used to confirm the extent of the culprit lesion

The operationalized psychodynamic diagnostics system. Clinical relevance, reliability and validity

In this paper, we present a multiaxial system for psychodynamic diagnosis, which has attained wide usage in Germany in the last 10 years. First we will discuss the 4 operationalized psychodynamic diagnostics (OPD) axes: illness experience and treatment assumptions, relationships, mental conflicts, and structure, then clinical applications will be outlined. Focus psychodynamic formulations can be employed both with inpatients and with outpatients. Studies show good reliability in a research context and acceptable reliability for clinical purposes. Validity will be separately summarized as content, criterion, and construct validity. Validity studies indicate good validity for the individual axes. Numerous studies on the OPD indicate areas of possible improvement, for example for clinical purposes the OPD should be more practically formulated

Cardiovascular magnetic resonance findings in repaired anomalous left coronary artery to pulmonary artery connection (ALCAPA)

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly. This study shows the role of cardiovascular magnetic resonance (CMR) in assessing young patients following surgical repair of ALCAPA.Methods: 6 patients, aged 9-21 years, with repaired ALCAPA (2 Tackeuchi method, 4 direct re-implantation) underwent CMR because of clinical suspicion of myocardial ischemia. Imaging used short and long axis cine images (assess ventricular function), late-gadolinium enhancement (LGE) (detect segmental myocardial fibrosis), adenosine stress perfusion (detect reversible ischaemia) and 3D whole-heart imaging (visualize proximal coronary arteries).Results: The left ventricular (LV) global systolic function was preserved in all patients (mean LV ejection fraction = 62.7% +/- 4.23%). The LV volumes were within the normal ranges, (mean indexed LVEDV = 75.4 +/- 3.5 ml/m(2), LVESV = 31.6 +/- 9.4 ml/m(2)). In 1 patient, hypokinesia of the anterior segments was visualized. Five patients showed subendocardial LGE involving the basal, antero-lateral wall and the anterior papillary muscle. Three patients had areas of reversible ischemia. In these 3, 3D whole-heart MRA showed that the proximal course of the left coronary artery was occluded (confirmed with cardiac catheterisation).Conclusions: CMR is a good, non-invasive, radiation-free investigation in the post-surgical evaluation of ALCAPA. In referred patients we show that basal, antero-lateral sub-endocardial myocardial fibrosis is a characteristic finding. Furthermore, stress adenosine CMR perfusion, can identify reversible ischemia in this group, and was indicative of left coronary artery occlusion

Rethinking Design Standards as Learning Frameworks

Standards align practice across the supply network whilst putting in place basic constraints to ensure quality, safety, compatibility, interoperability, and economy. In the construction industry, design standards are used to verify the adequacy of designs to meet fundamental requirements for safety, serviceability, durability and robustness. There are very few opportunities to prototype; thus design in the construction industry is fundamentally code or standard-driven. In the highly diverse built environment, design standards will never cover all possible situations encountered by designers. Hence, standard writers are expected to select, capture and codify technical knowledge, separate best practice from unsuccessful practice, and share the lessons learnt across the professional community. In this context, standards are representations of a community’s mental model about what ‘good’ looks like, and they serve powerfully to reinforce a particular way of doing things. However, in times of rapid change and increasing complexity, these mental models may no longer be fit for purpose. They need to be re-examined and modified in the light of new challenges and demands. The core argument of this White Paper is that design standards in the construction industry need to be explicitly reconceptualised, re-evaluated and redeveloped as learning frameworks, which encourage users’ adaptability and collaborative learning and improvement, as well as foster creativity and innovation. To support this statement, fundamental notions of contemporary learning theory are presented and key challenges in the way design standards are currently developed and used are discussed. The importance of considering standards from a learning perspective is emphasised by looking at mental models underlying the way design standards are developed and used and recognising the learning power of different users explicitly