Nodal staging in head and neck squamous cell carcinoma by combining different imaging techniques

Head and neck cancer accounts for around 4% of all malignancies. The presence of cervical lymph node metastases will reduce expected survival with approximately 50%. Therapy should thus be as effective as possible with a minimum of therapeutic side effects and depends next to tumour size on the presence or absence of nodal metastases. Physical examination and imaging with magnetic resonance imaging (MRI), positron emission tomography – computed tomography (PET-CT), ultrasound (US), ultrasound guided fine needle aspiration (USgFNAC) are commonly used to examine cervical lymph node metastases, but in 30% of the cases, they are still overlooked. New imaging techniques such as real time image fusion of ultrasound and PET-CT and micro flow imaging (MFI) are thus developed. The aim of this thesis was to improve the detection rate of lymph node metastases by improving the selection criteria of nodes for ultrasound guided fine needle aspiration to prove cytological malignancy.<br/

Augmented Reality in der Stadt: Neue Potenziale durch die Entwicklung einer Lichtmarker- Technologie

Panta Rhei – Städte befinden sich in kontinuierlicher Bewegung. In einem unaufhörlichen Prozess, der immer stärker der Digitalisierung unterworfen ist, findet eine Weiterentwicklung baulicher und kultureller Strukturen statt. Die Augmented Reality (AR)-Technologie eröffnet in diesem Kontext Möglichkeiten zur visuellen Unterstützung von Planungsprozessen und zur Erweiterung des städtischen Kulturgutes. Aktive Lichtmarker ermöglichen den Außeneinsatz der AR-Technologie im großen Maßstab. Eine AR-Technologie mit aktiven Lichtmarkern befindet sich derzeit in der Entwicklung. Der folgende Beitrag geht systematisch auf die theoretischen Grundlagen ein, welche für die Entwicklung der Technologie zu berücksichtigen sind. Im ersten Schritt werden mögliche Anwendungsszenarien für die AR-Technologie mit aktiven Lichtmarkern im städtischen Kontext vorgestellt. Es werden Potenziale und Chancen aufgezeigt, welche sich für Stadtplanung und kulturelle Entwicklung ergeben. Im zweiten Schritt werden anhand der einzelnen Szenarien technische Anforderungen betrachtet, die jeweils an die Technologie gestellt werden. Der städtische Kontext umfasst lediglich einen Teilbereich des Anwendungsspektrums der Lichtmarker- Technologie. Daher ist dieser Beitrag als Auszug eines Katalogs von Anwendungsszenarien zu verstehen, der einführend einen Überblick für den Einsatz der Technologie in der Stadt bietet. Die im Beitrag vorgestellten Ansätze erarbeitet das Fachgebiet Building Lifecycle Management (BLM) an der Architekturfakultät des Karlsruher Institutes für Technologie (KIT) derzeit im Rahmen eines Projektes, das sich mit der theoretischen Betrachtung von Anwendungsszenarien einer zu entwickelnden Lichtmarker- Technologie für die Darstellung von Augmented Reality Szenen befasst. Das durch das Zentrale Innovationsprogramm Mittelstand (ZIM) geförderte Forschungsprojekt ist eine Kooperation zwischen dem Karlsruher Institut für Technologie und der Firma iXpoint Informationssysteme GmbH, welche die Produktentwicklung der Lichtmarker-Technologie durchführt. Eine Grundlagenforschung erfolgte bereits im Rahmen des Projektes „Flying Augmented Reality“ (s. Koch 2013)

Feldtest der Augmented Reality Lichtmarker-Technologie

Augmented Reality (AR) eröffnet durch die Ergänzung der Realität um virtuelle Inhalte in Echtzeit auf handelsüblichen Smartphones im Bauwesen vielfältige Potenziale zur visuellen Unterstützung des digitalen Planungs- und Bauprozesses. Im Bauwesen besonders relevant sind passgenaue, realmaßstäbliche Abbildungen in Außenraumszenarien, die vor Ort anschaulich Planungsinhalte an Projektbeteiligte und Interessensgruppen vermitteln und frühzeitig Baumängel während des Bauprozesses sichtbar machen können. Eine Lichtmarker-Technologie, welche derzeit im Rahmen eines Forschungsprojektes entwickelt wird, soll die erforderliche Positionsgenauigkeit in sehr unterschiedlichen Lichtverhältnissen bei geringem Installationsaufwand unter Nutzung von handelsüblichen Smartphones erreichen und die AR-Technologie für das Bauwesen im Außenraum professionell einsetzbar machen. Dieser Beitrag gibt einen Einblick in die Hintergründe der AR Lichtmarker- Technologie und stellt den Versuchsablauf und die Ergebnisse des ersten Feldtests vor

Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep

ObjectiveSome patients with significant arteriosclerosis of the heart are not amenable to revascularization of a coronary artery because they have a combination of microangiopathy and significant macroangiopathy. We investigated the benefit of arterialization of a cardiac vein under these circumstances in an acute animal model.MethodsIn the hearts of 8 sheep, microspheres were injected into the left coronary artery; 60 minutes later, a stenosis of the left anterior descending artery was performed. After 45 minutes, retrograde venous revascularization was performed by sewing the left internal thoracic artery to the concomitant vein of the left anterior descending artery in a beating-heart technique. For flow reversal, the vein was ligated proximally to the anastomosis. The efficiency of the bypass graft was evaluated by coronary angiography and flow measurement. Cardiac output, electrocardiography, and mean arterial blood pressure were assessed in each phase of the experiment.ResultsThe ischemic state of the myocardium was confirmed by a significant decrease of cardiac output, stroke volume, and mean arterial blood pressure, and a significant elevation of the ST segment in the electrocardiography. After retrograde venous revascularization was established, cardiac output and stroke volume increased and ST elevations decreased. The grafts showed adequate flow (26.15 ± 2.08 mL/min), and reversed blood flow in the grafted vein was proved by coronary angiography.ConclusionRetrograde venous revascularization is possible and improves cardiac function in a state of acute ischemia caused by a combination of microangiopathy and macroangiopathy

Ground water and climate change

As the world’s largest distributed store of fresh water, ground water plays a central part in sustaining ecosystems and enabling human adaptation to climate variability and change. The strategic importance of ground water for global water and food security will probably intensify under climate change as more frequent and intense climate extremes (droughts and floods) increase variability in precipitation, soil moisture and surface water. Here we critically review recent research assessing the impacts of climate on ground water through natural and human-induced processes as well as through groundwater-driven feedbacks on the climate system. Furthermore, we examine the possible opportunities and challenges of using and sustaining groundwater resources in climate adaptation strategies, and highlight the lack of groundwater observations, which, at present, limits our understanding of the dynamic relationship between ground water and climate

Global sea-level budget and ocean-mass budget, with a focus on advanced data products and uncertainty characterisation

Studies of the global sea-level budget (SLB) and the global ocean-mass budget (OMB) are essential to assess the reliability of our knowledge of sea-level change and its contributors. Here we present datasets for times series of the SLB and OMB elements developed in the framework of ESA's Climate Change Initiative. We use these datasets to assess the SLB and the OMB simultaneously, utilising a consistent framework of uncertainty characterisation. The time series, given at monthly sampling and available at https://doi.org/10.5285/17c2ce31784048de93996275ee976fff (Horwath et al., 2021), include global mean sea-level (GMSL) anomalies from satellite altimetry, the global mean steric component from Argo drifter data with incorporation of sea surface temperature data, the ocean-mass component from Gravity Recovery and Climate Experiment (GRACE) satellite gravimetry, the contribution from global glacier mass changes assessed by a global glacier model, the contribution from Greenland Ice Sheet and Antarctic Ice Sheet mass changes assessed by satellite radar altimetry and by GRACE, and the contribution from land water storage anomalies assessed by the global hydrological model WaterGAP (Water Global Assessment and Prognosis). Over the period January 1993–December 2016 (P1, covered by the satellite altimetry records), the mean rate (linear trend) of GMSL is 3.05 ± 0.24 mm yr−1. The steric component is 1.15 ± 0.12 mm yr−1 (38 % of the GMSL trend), and the mass component is 1.75 ± 0.12 mm yr−1 (57 %). The mass component includes 0.64  ± 0.03 mm yr−1 (21 % of the GMSL trend) from glaciers outside Greenland and Antarctica, 0.60 ± 0.04 mm yr−1 (20 %) from Greenland, 0.19 ± 0.04 mm yr−1 (6 %) from Antarctica, and 0.32 ± 0.10 mm yr−1 (10 %) from changes of land water storage. In the period January 2003–August 2016 (P2, covered by GRACE and the Argo drifter system), GMSL rise is higher than in P1 at 3.64 ± 0.26 mm yr−1. This is due to an increase of the mass contributions, now about 2.40 ± 0.13 mm yr−1 (66 % of the GMSL trend), with the largest increase contributed from Greenland, while the steric contribution remained similar at 1.19 ± 0.17 mm yr−1 (now 33 %). The SLB of linear trends is closed for P1 and P2; that is, the GMSL trend agrees with the sum of the steric and mass components within their combined uncertainties. The OMB, which can be evaluated only for P2, shows that our preferred GRACE-based estimate of the ocean-mass trend agrees with the sum of mass contributions within 1.5 times or 0.8 times the combined 1σ uncertainties, depending on the way of assessing the mass contributions. Combined uncertainties (1σ) of the elements involved in the budgets are between 0.29 and 0.42 mm yr−1, on the order of 10 % of GMSL rise. Interannual variations that overlie the long-term trends are coherently represented by the elements of the SLB and the OMB. Even at the level of monthly anomalies the budgets are closed within uncertainties, while also indicating possible origins of remaining misclosures

Value of Assessing Peripheral Vascularization with Micro-Flow Imaging, Resistive Index and Absent Hilum Sign as Predictor for Malignancy in Lymph Nodes in Head and Neck Squamous Cell Carcinoma

Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in head and neck squamous cell cancer (HNSCC). Peripheral vascularity is a described feature for node metastasis. Micro-flow imaging (MFI) is a new sensitive technique to evaluate micro-vascularization. Our goal is to assess the additional value of MFI to detect malignancy in lymph nodes. A total of 102 patients with HNSCC were included prospectively. USgFNAC was performed with the Philips eL18–4 transducer. Cytological results served as a reference standard to evaluate the prediction of cytological malignancy depending on ultrasound features such as resistive index (RI), absence of fatty hilum sign, and peripheral vascularization. Results were obtained for all US examinations and for the subgroup of clinically node-negative neck (cN0). USgFNAC was performed in 211 nodes. Peripheral vascularization had a positive predictive value (PPV) of 83% (cN0: 50%) and the absence of a fatty hilum had a PPV of 82% (cN0 50%) The combination of peripheral vascularization and absent fatty hilum had a PPV of 94% (cN0: 72%). RI (threshold: 0.705) had a PPV of 61% (cN0: RI-threshold 0.615, PPV 20%), whereas the PPV of short axis diameter (threshold of 6.5mm) was 59% for all patients and 19% in cN0 necks (threshold of 4 mm). Peripheral vascularization assessed by MFI and absent hilum has a high predictive value for cytological malignancy in neck metastases. Next to size, both features should be used as additional selection criteria for USgFNAC

Integrated Scenarios of Regional Development in Two Semi-Arid States of North-Eastern Brazil

Scenario analysis of the future is an important tool for supporting sustainability-oriented regional planning. To assist regional planning in two federal states in semi-arid North-eastern Brazil, Cear&aacute; and Piau&iacute;, we developed integrated qualitative–quantitative scenarios that show potential developments of the agricultural and water resources situation as well as the internal migration until the year 2025. In these states, regional development is negatively influenced by the high seasonality of rainfall and El-Ni&ntilde;o-related drought years. Two reference scenarios, ‘‘Coastal Boom and Cash Crops’’ and ‘‘Decentralisation – Integrated Rural Development,’’ were developed. First, story lines were created and the development of the driving forces was quantified. Then, an integrated model, which includes modules for simulating water availability, water demand, and agricultural production and income, was applied to compute the temporal development of relevant system indicators in each of the 332 municipalities of Cear&aacute; and Piau&iacute;. These indicators encompass the fraction of the irrigation water demand than can be satisfied, the volume of water which is stored in the reservoirs at the beginning of the dry season, agricultural productivity and production as well as the internal migration among scenario regions. In addition, the impact of certain policy measures was assessed in the context of both reference scenarios. Reference and intervention scenarios were derived by an interdisciplinary group of scientists and were discussed and refined during policy workshops with planning agencies of Cear&aacute;