Delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI

Objectives: To evaluate the accuracy of high-pitch delayed enhancement (DE) CT for the assessment of myocardial viability with MRI as the reference standard. Methods: Twenty-four patients (mean age 66.9 ± 9.2years) with coronary artery disease underwent DE imaging with 128-slice dual-source CT (prospective electrocardiography (ECG)-triggering) and MRI at 1.5T. Two observers assessed DE transmurality per segment, and measured signal intensity (MRI) or attenuation (CT) in infarcted and healthy myocardium and noise in the left ventricular blood pool for calculating contrast-to-noise ratios (CNR). Results: 75/408 (18.4%) segments in 18/24 patients (75.0%) showed DE in MRI, of which 28 segments in 10/24 (41.7%) patients were non-viable (scar tissue transmurality >50%). Sensitivity, specificity and accuracy of CT for diagnosis of non-viability were 60.7%, 96.8% and 94.4% per segment, and 90.0%, 92.9% and 91.7% per patient. CNR was significantly higher in MR (7.4 ± 3.0 vs. 4.6 ± 1.5; p = 0.018), and image noise significantly lower (11.6 ± 5.7 vs.15.0 ± 4.5; p = 0.019). Radiation dose of DECT was 0.89 ± 0.07mSv. Conclusions: CTDE imaging in the high-pitch mode enables myocardial viability assessment at a low radiation dose and good accuracy compared with MR, although associated with a lower CNR and higher nois

Dual-step prospective ECG-triggered 128-slice dual-source CT for evaluation of coronary arteries and cardiac function without heart rate control: a technical note

Purpose: To describe prospective ECG-triggered dual-source CT dual-step pulsing (pECGdual_step) for evaluation of coronary arteries and cardiac function. Methods: Fifty-one consecutive patients pre- or post-cardiovascular surgery were examined with adaptive sequential tube current modulated (pECGdual-step) 128-slice dual-source CT without heart rate control (main padding window: 40% RR interval >65bpm/70% RR interval <65bpm). Image quality of coronary arteries was graded (4-point scale), and cardiac function was evaluated. Results: Mean HR was 68bpm. Thirty-seven patients were in stable sinus rhythm (SR); 14 had arrhythmia. Image quality of coronary arteries was diagnostic in 804/816 (98%) of segments. The number of non-diagnostic segments was higher in patients with arrhythmia as compared to those in SR (4% vs. 0.5%; p = 0.01), and there were fewer segments with excellent image quality (79% vs. 94%; p < 0.001) and more segments with impaired image quality (p < 0.001 and p = 0.002). Global and regional LV function could be evaluated in 41 (80%) and 47 (92%) patients, and valvular function in 48 (94%). In 11/14 of patients with arrhythmia, the second step switched to full mAs, increasing radiation exposure to 8.6mAs (p < 0.001). The average radiation dose was 3.8mSv (range, 1.7-7.9) in patients in SR. Conclusion: pECGdual-step128-slice DSCT is feasible for the evaluation of coronary arteries and cardiac function without heart rate control in patients in stable sinus rhythm at a low radiation dos

Is It Safe to Irradiate the Newest Generation of Ventricular Assist Devices? A Case Report and Systematic Literature Review.

An increasing number of mechanical assist devices, especially Left Ventricular Assist Devices (VAD), are being implanted for prolonged periods and as destination therapy. Some VAD patients require radiotherapy due to concomitant oncologic morbidities, including thoracic malignancies. This raises the potential of VAD malfunction via radiation-induced damage. So far, only case reports and small case series on radiotherapy have been published; most of them on HeartMate IITM (HMII, Abbott, North Chicago, IL, USA). Significantly, the effects of irradiation on the HeartMate 3TM (HM3, Abbott, North Chicago, IL, USA) remain undefined, despite the presence of controller components engineered within the pump itself. We report the first case of a patient with a HM3 who successfully underwent stereotactic hypo-fractionated radiotherapy due to an early stage non-small-cell lung cancer. The patient did not suffer from any complications; including toxicity or VAD malfunction. Based on this case report and on published literature, we think that performing radiotherapy after VAD implantation with the aid of a multidisciplinary team could be performed, but more in-vitro and cases series are needed to reinforce this statement

CO Observations of the Interacting Galaxy Pair NGC 5394/95

BIMA CO 1-0 observations are presented of the spiral galaxies NGC 5394 and NGC 5395 that have undergone a recent, grazing encounter. In NGC 5394, 80% of the CO emission detected by BIMA is concentrated in the central 800 pc (FWHM) starburst region.In an encounter simulation that reproduces some of the main features of this galaxy pair, a considerable amount of gas in NGC 5394 falls into the central region early in the collision. The observed total gas distribution in the disk of NGC 5394 is lopsided, with more HI, CO, and H-alpha emission coming from the western or southwestern side. The innermost western arm of NGC 5394 is seen in CO and H-alpha emission, but the eastern inner-disk arm, which is very bright in the optical continuum, is not detected in CO or H-alpha emission. From a comparison of the radio continuum, H-alpha, 60 micron, and CO luminosities, we estimate that the average visual extinction of the starburst is 3 - 4 mag and the conversion factor N(H2)/I(CO) in the starburst is a factor of 3 - 4 below the standard value. Comparison of NGC 5394 with two other systems previously studied suggests that in prograde grazing encounters a central starburst may not develop until near the end of the ocular phase. Very little of the CO emission from NGC 5395 found in previous single-dish observations is detected by BIMA.Comment: AAS-Latex, v5.0, 45 pages including embedded .ps figures. AJ, in pres

Third-generation continuous-flow left ventricular assist devices: a comparative outcome analysis by device type.

AIMS Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard of care in end-stage heart failure. Limited data exist comparing outcomes of HeartMate3 (HM3) and HeartWare HVAD (HW). We aimed to compare midterm outcomes of these devices. METHODS AND RESULTS Investigator-initiated retrospective-observational comparative analysis of all patients who underwent primary LVAD implantation of either HM3 or HW at our centre between January 2010 and December 2020. Data were derived from a prospective registry. Primary endpoints were all-cause mortality and heart transplantation. Secondary endpoints included device-related major adverse cardiac and cerebrovascular events, which included major bleeding, major neurological dysfunction (defined as persisting neurological impairment for ≥24 h), device-related major infection (excluding driveline infections), major device malfunctions leading to re-intervention or partial device exchange (pump failure, outflow-graft twist or failure, controller failure, battery failure, patient cable failure, but excluding pump thrombosis), and pump thrombosis. Further secondary endpoints included right heart failure, gastrointestinal bleeding, driveline infections, and surgical re-interventions. The secondary outcomes were analysed not only for the first event but also for recurrent events. The analysis included competing risks analysis and recurrent event regression analysis, with adjustment for confounders age, gender, body mass index (BMI), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Out of 106 primary CF-LVAD implantations, 36 (34%) received HM3 and 70 (66%) received HW. Median follow-up was 1.48 years [interquartile range 0.67, 2.41]. HM3 was more often implanted in men (91.7% vs. 72.9%, P = 0.024); patients were older (median 61 years [54, 66.5] vs. 52.5 years [43, 60], P < 0.001), had a higher BMI (median 26.7 kg/m2 [23.4, 29.0] vs. 24.3 kg/m2 [20.7, 27.4], P = 0.013), had more comorbidities, and were more likely targeted for destination therapy (36.1% vs. 14.3%, P = 0.010). Death occurred in 33.3% of HM3 patients, compared with 22.9% of HW patients, P = 0.247 (probability of survival at 4 years, 54.7% vs. 74.1%, P = 0.296). After adjustment for confounders, we observed a significant six-fold risk increase in device malfunctions for HW [hazard ratio (HR) 6.49, 95% confidence interval (CI) [1.89, 22.32], P = 0.003], but no significant differences in pump thrombosis (P = 0.173) or overall survival (P = 0.801). CONCLUSIONS Comparing midterm outcomes between HM3 and HW for LVAD support from a prospective registry, HW patients had a significantly higher risk of device malfunctions. No significant differences were evident between devices in overall survival and in respect to most outcomes

RENEB accident simulation exercise

Purpose: The RENEB accident exercise was carried out in order to train the RENEB participants in coordinating and managing potentially large data sets that would be generated in case of a major radiological event. Materials and methods: Each participant was offered the possibility to activate the network by sending an alerting email about a simulated radiation emergency. The same participant had to collect, compile and report capacity, triage categorization and exposure scenario results obtained from all other participants. The exercise was performed over 27 weeks and involved the network consisting of 28 institutes: 21 RENEB members, four candidates and three non-RENEB partners. Results: The duration of a single exercise never exceeded 10 days, while the response from the assisting laboratories never came later than within half a day. During each week of the exercise, around 4500 samples were reported by all service laboratories (SL) to be examined and 54 scenarios were coherently estimated by all laboratories (the standard deviation from the mean of all SL answers for a given scenario category and a set of data was not larger than 3 patient codes). Conclusions: Each participant received training in both the role of a reference laboratory (activating the network) and of a service laboratory (responding to an activation request). The procedures in the case of radiological event were successfully established and tested

Stop looking angry and smile, please: start and stop of the very same facial expression differentially activate threat- and reward-related brain networks

Static pictures of emotional facial expressions have been found to activate brain structures involved in the processing of emotional stimuli. However, in everyday live, emotional expressions are changing rapidly, and the processing of the onset vs the offset of the very same emotional expression might rely on different brain networks, presumably leading to different behavioral and physiological reactions (e.g. approach or avoidance). Using functional magnetic resonance imaging, this was examined by presenting video clips depicting onsets and offsets of happy and angry facial expressions. Subjective valence and threat ratings clearly depended on the direction of change. Blood oxygen level dependent responses indicate both reward- and threat-related activations for the offset of angry expressions. Comparing onsets and offsets, angry offsets were associated with stronger ventral striatum activation than angry onsets. Additionally, the offset of happy and the onset of angry expressions showed strong common activity in the lateral orbitofrontal cortex bilaterally, the left amygdala and the left insula, whereas the onset of happy and the offset of angry expressions induced significant activation in the left dorsal striatum. In sum, the results confirm different activity in motivation-related brain areas in response to the onset and offset of the same emotional expression and highlight the importance of temporal characteristics of facial expressions for social communication

Die Rezeption der Medergeschichte

Auf der Grundlage eines Vergleiches der Medergeschichten in den Historien des Herodot und der Persika des Ktesias von Knidos wird die Deutungshoheit der beiden Autoren in den Universalgeschichten von Diodor, Iustin, Orosius und Otto von Freising untersucht.eingereicht von Monika WieserInnsbruck, Univ., Dipl.-Arb., 201

Próba oceny wpływu Brexitu na konkurencyjność Unii Europejskiej

Celem artykułu jest określenie wpływu procesu wyjścia Wielkiej Brytanii z Unii Europejskiej na aktualną i przyszłą konkurencyjność gospodarek Wspólnoty. Nadrzędnym problemem jest identyfikacja skutków referendum, jakie miało miejsce w czerwcu 2016 roku, a także prognozowanie rzeczywistych i potencjalnych następstw operacji wyjścia. Metodami wykorzystywanymi w artykule są: analiza literatury związanej z poruszaną tematyką, metoda analizy opisowej, a także analiza danych statystycznych. Proces wywodu obejmuje cztery części. Pierwszą z nich jest przegląd literatury obejmującej tematykę konkurencyjności gospodarki Unii Europejskiej. Część druga jest dyskusją na temat planowanego kierunku rozwojowego UE, ze szczególnym uwzględnieniem analizy strategii Europa 2020. Trzecia część artykułu zawiera opis dotychczasowych ogniw łańcucha zdarzeń związanych z operacją wyjścia Wielkiej Brytanii z UE. Analiza danych statystycznych stanowi czwartą, finalną część procesu wywodu. Przeprowadzona analiza wykazała podstawowe obszary wpływu operacji wyjścia Wielkiej Brytanii z UE. Najistotniejszymi zidentyfikowanymi skutkami gospodarczymi są: utrata części wpłat do budżetu unijnego oraz spadek wzrostu gospodarczego. Na podstawie analizy sieci wewnątrzunijnych powiązań handlowych Wielkiej Brytanii określono gospodarki, które najsilniej odczują skutki procesu wyjścia. Unię Europejską niewątpliwie czeka jedno z największych wyzwań, jakie miały miejsce od momentu jej utworzenia. Bezprecedensowy charakter tego zjawiska w połączeniu z siłą potencjalnych jego konsekwencji, niewątpliwie warunkuje konieczność zastosowania proaktywnej postawy przez decydentów UE, celem optymalizacji procesu ich niwelowania. Kluczowym etapem tego procesu i zasadniczą niewiadomą, na którą wpływ jednak nadal jest możliwy, będzie kształt przyszłych umów handlowych, oraz umów bilateralnych zawieranych między UE a Wielką Brytanią

Pump thrombosis and dynamic outflow graft compression: complications in left ventricular assist device therapy

Over the past decade, left ventricular assist device (VAD) therapy has become more prevalent and increasingly safe. Severe complications, such as VAD pump thrombosis and outflow graft obstruction, are rare, yet still associated with high morbidity and mortality. Clinical presentation, VAD alarm and log files, laboratory analysis, and non-invasive cardiac imaging are crucial for establishing the correct diagnosis and determining clinical management. Early intervention is critical to prevent adverse cardiac remodelling or VAD pump failure