Two- versus three-dimensional dual gradient-echo MRI of the liver: a technical comparison

Objective: To compare 2D spoiled dual gradient-echo (SPGR-DE) and 3D SPGR-DE with fat and water separation for the assessment of focal and diffuse fatty infiltration of the liver. Methods: A total of 227 consecutive patients (141 men; 56 ± 14years) underwent clinically indicated liver MRI at 1.5T including multiple-breath-hold 2D SPGR-DE and single-breath-hold 3D SPGR-DE with automatic reconstruction of fat-only images. Two readers assessed the image quality and number of fat-containing liver lesions on 2D and 3D in- and opposed-phase (IP/OP) images. Liver fat content (LFC) was quantified in 138 patients without chronic liver disease from 2D, 3D IP/OP, and 3D fat-only images. Results: Mean durations of 3D and 2D SPGR-DE acquisitions were 23.7 ± 2.9 and 97.2 ± 9.1s respectively. The quality of all 2D and 3D images was rated diagnostically. Three-dimensional SPGR-DE revealed significantly more breathing artefacts resulting in lower image quality (P < 0.001); 2D and 3D IP/OP showed a similar detection rate of fat-containing lesions (P = 0.334) and similar LFC estimations (mean: +0.4%; P = 0.048). LFC estimations based on 3D fat-only images showed significantly higher values (mean: 2.7% + 3.5%) than those from 2D and 3D IP/OP images (P < 0.001). Conclusion: Three dimensional SPGR-DE performs as well as 2D SPGR-DE for the assessment of focal and diffuse fatty infiltration of liver parenchyma. The 3D SPGR-DE sequence used was quicker but more susceptible to breathing artefacts. Significantly higher LFC values are derived from 3D fat-only images than from 2D or 3D IP/OP images. Key Points: • Magnetic resonance imaging can assess focal and diffuse hepatic fatty infiltration • Both 2D and 3D dual-echo MRI techniques can be used for chemical shift imaging of the liver. • The single breath-hold 3D dual-echo technique is faster but more susceptible to breathing artefacts. • Three-dimensional fat-only images show higher fat estimates than in- and out-of-phase image

Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial

BACKGROUND: Cardiac arrests are handled by teams rather than by individual health-care workers. Recent investigations demonstrate that adherence to CPR guidelines can be less than optimal, that deviations from treatment algorithms are associated with lower survival rates, and that deficits in performance are associated with shortcomings in the process of team-building. The aim of this study was to explore and quantify the effects of ad-hoc team-building on the adherence to the algorithms of CPR among two types of physicians that play an important role as first responders during CPR: general practitioners and hospital physicians. METHODS: To unmask team-building this prospective randomised study compared the performance of preformed teams, i.e. teams that had undergone their process of team-building prior to the onset of a cardiac arrest, with that of teams that had to form ad-hoc during the cardiac arrest. 50 teams consisting of three general practitioners each and 50 teams consisting of three hospital physicians each, were randomised to two different versions of a simulated witnessed cardiac arrest: the arrest occurred either in the presence of only one physician while the remaining two physicians were summoned to help ("ad-hoc"), or it occurred in the presence of all three physicians ("preformed"). All scenarios were videotaped and performance was analysed post-hoc by two independent observers. RESULTS: Compared to preformed teams, ad-hoc forming teams had less hands-on time during the first 180 seconds of the arrest (93 +/- 37 vs. 124 +/- 33 sec, P > 0.0001), delayed their first defibrillation (67 +/- 42 vs. 107 +/- 46 sec, P > 0.0001), and made less leadership statements (15 +/- 5 vs. 21 +/- 6, P > 0.0001). CONCLUSION: Hands-on time and time to defibrillation, two performance markers of CPR with a proven relevance for medical outcome, are negatively affected by shortcomings in the process of ad-hoc team-building and particularly deficits in leadership. Team-building has thus to be regarded as an additional task imposed on teams forming ad-hoc during CPR. All physicians should be aware that early structuring of the own team is a prerequisite for timely and effective execution of CPR

Pulmonary Kaposi's sarcoma after heart transplantation: a case report

ABSTRACT: INTRODUCTION: Kaposi's sarcomas have been associated with different conditions of immunosuppression and are also known to be a typical complication of solid organ transplantations. CASE PRESENTATION: We report of a 65 year old man of Turkish origin with a history of heart transplantation 10 months ago who presented for clarification of his dyspnoea. The patient had a known history of chronic obstructive pulmonary disease and a smoking history of 40 pack years. Radiologically, three progressively growing intrapulmonary nodules were detected. The histology was diagnostic for a Kaposi's sarcoma. Visceral and especially primary intrapulmonary Kaposi's sarcomas are very rare and have been described to have a rather unfavourable prognosis. CONCLUSION: Even with a history suggestive for conventional lung cancer, Kaposi's sarcomas should be considered in patients after transplantation of solid organs. It should be noticed that in a minority of cases this tumour exists in the absence of the typical cutaneous lesions

A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever

BACKGROUND: Physicians fear missing cases of pneumonia and treat many patients with signs of respiratory infection unnecessarily with antibiotics. This is an avoidable cause for the increasing worldwide problem of antibiotic resistance. We developed a user-friendly decision aid to rule out pneumonia and thus reduce the rate of needless prescriptions of antibiotics. METHODS: This was a prospective cohort study in which we enrolled patients older than 18 years with a new or worsened cough and fever without serious co-morbidities. Physicians recorded results of a standardized medical history and physical examination. C-reactive protein was measured and chest radiographs were obtained. We used Classification and Regression Trees to derive the decision tool. RESULTS: A total of 621 consenting eligible patients were studied, 598 were attending a primary care facility, were 48 years on average and 50% were male. Radiographic signs for pneumonia were present in 127 (20.5%) of patients. Antibiotics were prescribed to 234 (48.3%) of patients without pneumonia. In patients with C-reactive protein values below 10 μg/ml or patients presenting with C-reactive protein between 11 and 50 μg/ml, but without dyspnoea and daily fever, pneumonia can be ruled out. By applying this rule in clinical practice antibiotic prescription could be reduced by 9.1% (95% confidence interval (CI): 6.4 to 11.8). CONCLUSIONS: Following validation and confirmation in new patient samples, this tool could help rule out pneumonia and be used to reduce unnecessary antibiotic prescriptions in patients presenting with cough and fever in primary care. The algorithm might be especially useful in those instances where taking a medical history and physical examination alone are inconclusive for ruling out pneumonia

From landscape resources to landscape commons: focussing on the non-utility values of landscape

Landscape is increasingly conceptualized as a resource. We argue that although a resource-based approach may be positive in terms of conservation outcomes, focusing on use value does not do sufficient justice to the many complex facets of landscape. Reiterating the Florence Declaration on Landscape, which considers that “landscape is a common good”, we suggest that the conceptualization of landscape as a commons will resolve the discrepancy. However, a conceptual shift towards a more holistic commons-based approach requires a detailed understanding of the different values of landscape. Based on a phenomenological conceptualization of the landscape, this article explores the theoretical roots of the definition of the different values of landscape. It distinguishes between use, existence (e.g. aesthetic) and intrinsic values. This exercise is not an end in itself, but is intended to establish a theoretical framework promoting a dialogue between these values and show how they complement each other. A precise understanding of the different landscape values contributes not only to the conceptualization of landscape as a commons, but also to a better understanding of real-life landscape conflicts. Drawing on the empirical example of the Lavaux UNESCO World Heritage Site in Switzerland, the article demonstrates that, in practice, landscape conservation projects that avoid deadlock succeed in striking a balance between the three conceptions of landscape value

Untersuchungen zur mikrobiologischen Qualität von erhitzten Lebensmitteln aus Bataillonsküchen der Schweizer Armee

In this study heated food was collected in kitchens on battalion’s level to verify whether the kitchen teams comply with the accurate procedures written in the regulations. Based on these baseline data it would be possible to take corrective actions where necessary and to educate the kitchen team. In the months of September and October 2015 ten battalions with a total of 35 kitchens at 36 different locations were sampled over a period of one week. The samples (n=480) were analyzed with cultural standard methods for the parameters: total aerobic mesophilic viable counts, Enterobacteriaceae, B. cereus, coagulase positive Staphylococci and C. perfringens. In general, the results suggest a good microbiological quality of heated food produced in these kitchens. However, some kitchens and some products, for example mashed potatoes (B. cereus), showed striking results. Such data are important for building up a risk-based microbiological monitoring system. Moreover, the detection of B. cereus in 5% of the 480 heated food samples highlights the importance of cooling the pre-produced heated food as fast as possible and to keep it refrigerated. Otherwise, the heated products have to be stored before serving at enough high temperature (≥65°C) to prevent multiplication of B. cereus. This study points a benefit out of such microbiological examinations. Therefore, a risk-based implementation of product examinations within the self-control system of the Swiss army kitchens should be pursued

Symmetry representation theory and its applications: in honor of Nolan R. Wallach

Symmetry has served as an organizing principle in Nolan R. Wallach's fundamental contributions to representation theory, harmonic analysis, algebraic geometry, combinatorics, number theory, differential equations, Riemannian geometry, ring theory, and quantum information theory. This volume is a collection of 19 invited articles that pay tribute to the breadth and depth of Wallach's work. The mostly expository articles are written by distinguished mathematicians and contain sufficient preliminary material so as to reach the widest possible audience. Graduate students, mathematicians, and physicists interested in representation theory and its applications will find many gems in this volume that have not appeared in print elsewhere. Contributors:   D. Barbasch K. Baur M. Bhargava B. Casselman D. Ciubotaru M. Colarusso T. J. Enright S. Evens W. T. Gan A. M. Garsia R. Gomez G. Gour B. H. Gross G. Han P. E. Harris J. Hong R. E. Howe     M. Hunziker B. Kostant H. Kraft R. J. Miatello L. Ni W. A. Pruett G. W. Schwarz A. Touzé D. A. Vogan N. R. Wallach J. F. Willenbring F. L. Williams J. A. Wolf G. Xin O. Yacobi M. Zabrock

ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial

QUESTIONS UNDER STUDY: After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. METHODS: 108 teams, consisting of two physicians each, were randomized to receive a graphical display of either the ABC algorithm or the CAB algorithm. Subsequently teams had to treat a simulated cardiac arrest. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations. RESULTS: The time to execution of the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (P = 0.002). 18/53 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which caused a longer duration of the first cycle of 30 compressions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; P = 0.001). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P <0.0001).CONCLUSIONS: This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines

Performance of unenhanced respiratory-gated 3D SSFP MRA to depict hepatic and visceral artery anatomy and variants.

OBJECTIVES: To prospectively evaluate the performance of unenhanced respiratory-gated magnetization-prepared 3D-SSFP inversion recovery MRA (unenhanced-MRA) to depict hepatic and visceral artery anatomy and variants in comparison to contrast-enhanced dynamic gradient-echo MRI (CE-MRI) and to digital subtraction angiography (DSA). METHODS: Eighty-four patients (55.6±12.4 years) were imaged with CE-MRI (TR/TE 3.5/1.7ms, TI 1.7ms, flip-angle 15°) and unenhanced-MRA (TR/TE 4.4/2.2ms, TI 200ms, flip-angle 90°). Two independent readers assessed image quality of hepatic and visceral arteries on a 4-point-scale. Vessel contrast was measured by a third reader. In 28 patients arterial anatomy was compared to DSA. RESULTS: Interobserver agreement regarding image quality was good for CE-MRI (κ=0.77) and excellent for unenhanced-MRA (κ=0.83). Unenhanced-MRA yielded diagnostic image quality in 71.6% of all vessels, whereas CE-MRI provided diagnostic image quality in 90.6% (p<0.001). Vessel-based image quality was significantly superior for all vessels at CE-MRI compared to unenhanced-MRA (p<0.01). Vessel contrast was similar among both sequences (p=0.15). Compared to DSA, CE-MRI and unenhanced-MRA yielded equal accuracy of 92.9-96.4% for depiction of hepatic and visceral artery variants (p=0.93). CONCLUSIONS: Unenhanced-MRA provides diagnostic image quality in 72% of hepatic and visceral arteries with no significant difference in vessel contrast and similar accuracy to CE-MRI for depiction of hepatic and visceral anatomy