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The development of L-lactate biosensors has been hampered in recent years by the lack of availability and knowledge about a wider range and diversity of L-lactate-oxidizing enzymes that can be used as bioelements in these sensors. For decades, L-lactate oxidase of

Introduction The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and to ensure that its active duty medical personnel maintain readiness for deployment. Knowledge, skills, and attitudes (KSA) is a metric evaluating the transferrable skills incorporated into a given surgery or medical procedure that are most relevant for surgeons deployed to a theatre of war. Procedures carrying a high KSA value are those utilizing skills with high relevance for maintaining deployment readiness. Given ongoing concerns regarding surgical volumes at MTFs and the potential adverse impact on military surgeon mission readiness were high-value surgeries to be lost to the civilian sector, we evaluated trends in the setting of high-value surgeries for beneficiaries within the MHS. Methods We retrospectively analyzed inpatient admissions data from MTFs and TRICARE claims data from civilian hospitals, 2005-2019, to identify TRICARE-covered patients covered under “purchased care” (referred to civilian facilities) or receiving “direct care” (undergoing treatment at MTFs) and undergoing seven high-value/high-KSA surgeries: colectomy, pancreatectomy, hepatectomy, open carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, esophagectomy, and coronary artery bypass grafting (CABG). Overall and procedure-specific counts were captured, MTFs were categorized into quartiles by volume, and independence between trends was tested with a Cochran–Armitage test, hypothesizing that the proportion of cases referred for purchased care was increasing. Results We captured 292,411 cases, including 7,653 pancreatectomies, 4,177 hepatectomies, 3,815 esophagectomies, 112,684 colectomies, 92,161 CABGs, 26,893 AAA repairs, and 45,028 carotid endarterectomies. The majority of cases included were referred for purchased care (90.3%), with the proportion of cases referred increasing over the study period (P Conclusion On examining volume and referral trends for high-value surgeries within the MHS, we found low surgical volumes at the vast majority of included MTFs and an increasing proportion of cases referred to civilian hospitals over the last 15 years. Our findings illustrate missed opportunities for maintaining the mission readiness of military surgical personnel. Prioritizing the recapture of lost surgical volume may improve the surgical teams’ mission readiness.

Health literacy affects how patients behave within the healthcare system. Overutilization of screening procedures inconsistent with the U.S. Preventive Services Task Force guidelines contributes to the high cost of health care. The authors hypothesize that higher health literacy supports guideline-concordant screening. This study assesses the effect of health literacy on nonrecommended prostate, breast, and cervical cancer screening in patients older than the recommended screening age limit.The 2016 Behavioral Risk Factor Surveillance System included health literacy modules. Respondents self-reported their ability to obtain and understand health information, resulting in 4 health literacy rankings. The authors calculated the population-weighted proportion of respondents in each health literacy category who underwent screening past the Task Force‒recommended age limit. The ORs of nonrecommended screening for each malignancy were calculated, with low health literacy as the ref category.Individuals with higher health literacy underwent more nonrecommended screening. Nonrecommended prostate cancer screening was performed in 27.4% (95% CI=23.7%, 31.4%) and 47.7% (95% CI=44.1%, 51.3%) of respondents with low and high health literacy, respectively (p0.001). Nonrecommended breast cancer screening was performed in 46.8% (95% CI=42.6%, 51.1%) and 67.7% (95% CI=64.2%, 71.1%) of respondents with low and high health literacy, respectively (p=0.002). Nonrecommended cervical cancer screening was performed in 33.8% (95% CI=31.1%, 36.5%) and 48.4% (95% CI=46.3%, 50.5%) of respondents with low and high health literacy, respectively (p0.001). Individuals with high health literacy were significantly more likely than those with low health literacy to screen against the recommendations for prostate (OR=1.73, 95% CI=1.34, 2.23, p0.001), cervical (OR=1.533, 95% CI=1.31, 1.80, p0.001), and breast (OR=8.213, 95% CI=4.90, 13.76, p0.001) cancer.Higher health literacy correlates with increased rates of screening beyond the recommended age, contrary to the study hypothesis. Breast cancer demonstrated the highest rates of nonrecommended screening.

Previous studies have found an association between androgen deprivation therapy (ADT) and an increased risk of dementia and depression in elderly men. This association remains controversial, and little is known about the effects of ADT in younger men.To examine the association between the receipt of ADT and these outcomes in young men aged 40-64 yr presenting with nonmetastatic prostate cancer (PCa).For this observational study, we identified 9117 men aged 40-64 yr diagnosed with localized PCa between 2007 and 2014, without a pre-existing neurocognitive diagnosis, using the TRICARE military database.Kaplan-Meier curves were fitted to compare ADT versus no ADT. We also performed a subgroup analysis in patients undergoing ADT for ≥12 mo. The association between ADT and new-onset dementia or depression was evaluated using inverse-probability-of treatment-weight-adjusted Cox proportional hazards regression analysis.Patients receiving ADT had a significantly higher incidence of depression (30.2 vs 15.8 per 1000 person years) and dementia (17.9 vs 7.5 per 1000 person years). The risk of developing either outcome was higher in the ADT cohort (depression: hazard ratio [HR] 2.07, p 0.001; dementia: HR 1.70, p = 0.052). Additionally, there was a dose-response relationship between the duration of ADT and either outcome.In our cohort of young men with PCa, the receipt of ADT was associated with an increased risk of developing dementia and depression. Long-term use of ADT was associated with the highest risk of neurocognitive outcomes.In this study, we looked at the risk of dementia and depression in patients65 yr of age undergoing androgen deprivation therapy (ADT) for prostate cancer. We found that these patients had a higher risk of dementia and depression than those who did not undergo ADT.

We examined the effect of veteran status on prostate specific antigen (PSA) screening and whether health coverage available to veterans mitigates racial disparities in PSA screening.We conducted a cross-sectional analysis of non-Hispanic White (NHW) and non-Hispanic Black (NHB) men aged between 55 and 69 years who responded to the PSA screening survey in the 2018 Behavioral Risk Factor Surveillance System data. Complex weighted logistic regression models were used to evaluate predictors of PSA screening.Screening prevalence was 43% in veterans (95% CI 42%-45%) versus 40% in nonveterans (95% CI 39%-40%, p0.001). Among nonveterans, the prevalence of PSA screening was significantly lower in NHB (34%, 95% CI 31%-37%) versus NHW men (40%, 95% CI 39%-41%, p0.001). Among veterans, NHB men had a significantly higher screening prevalence (48%, 95% CI 43%-54%) versus NHW men (42%, 95% CI 41%-44%, p=0.04). In adjusted analysis, veteran status (OR 1.11, 95% CI 1.01-1.21, p=0.02) and NHB race (OR 1.29, 95% CI 1.12-1.48, p0.001) were significantly associated with receipt of PSA screening. Given that we found an interaction between veteran status and race (pVeteran status and NHB race were found to be independent predictors of PSA screening. The interaction between veteran status and race suggests that access to health coverage available to veterans may mitigate racial differences in prostate cancer screening behaviors. Further studies are needed to translate such findings into the civilian health care system.

Conflicting evidence exists regarding whether hormone therapy for prostate cancer is associated with neurotoxicity. Thus, we aim to characterize the association between different types of hormone therapy and neurocognitive impairment in a real-world pharmacovigilance database.We queried VigiBase, the World Health Organization's international pharmacovigilance database, for reports of neurocognitive impairment among men who took hormone therapy from 1968 to 2021. We performed disproportionality analysis comparing rates of neurocognitive impairment with different types of hormone therapy versus other VigiBase drugs. Traditional hormonal therapy was defined as androgen deprivation therapy (ADT: gonadotropin-releasing-hormone agonists or antagonists) or first-generation androgen receptor (AR) antagonists. Novel AR signaling inhibitors (ARSIs) were defined as ARSIs with or without ADT. Differences were assessed using reporting odds ratio (ROR) with 95% confidence intervals (CI) and Empirical Bayes Estimator (EBE) values ≥1.0 signifying statistical significance.Odds of neurocognitive impairment were significantly elevated with traditional hormone therapy (ROR 1.47, 95% CI 1.34-1.62, EBE = 1.35) and novel ARSIs (ROR 2.40, 95% CI 2.28-2.54, EBE = 2.26). Odds of neurocognitive impairment were significantly elevated with enzalutamide (ROR 2.89, 95% CI 2.73-3.05, EBE = 2.70) and numerically increased with apalutamide (ROR 3.31, 95% CI 1.57-7.00, EBE = 0.98), but were decreased with abiraterone (ROR 0.68, 95% CI 0.55-0.84, EBE = 0.57).This study demonstrates elevated odds of neurocognitive impairment with hormone therapy in a real-world data set. Neurotoxicity risk was higher with novel ARSIs than traditional agents, and higher with enzalutamide than abiraterone. Due to limitations inherent to disproportionality analysis (measuring associations, not risk) and incomplete data prohibiting the ability to control for factors such as age or use of secondary drugs (e.g., concurrent use of novel ARSIs with ADT), results are exploratory in nature. The amalgamation of these and other conflicting data may contribute to clinical decision-making for men with prostate cancer eligible for treatment with these therapies, especially those with significant neurologic comorbidities.

INTRODUCTION AND OBJECTIVE:Finasteride, a 5α-reductase inhibitor, is used in the management of alopecia and benign prostatic hyperplasia (BPH). Previous reports suggest that some men taking finaste...

INTRODUCTION AND OBJECTIVE:Massachusetts (MA) is a northeastern state with universally mandated health insurance since 2006. Although Black men have generally worse prostate cancer outcomes, emergi...

Background Massachusetts is a northeastern state with universally mandated health insurance since 2006. Although Black men have generally worse prostate cancer outcomes, emerging data suggest that they may experience equivalent outcomes within a fully insured system. In this setting, the authors analyzed treatments and outcomes of non-Hispanic White and Black men in Massachusetts. Methods White and Black men who were 20 years old or older and had been diagnosed with localized intermediate- or high-risk nonmetastatic prostate cancer in 2004-2015 were identified in the Massachusetts Cancer Registry. Adjusted logistic regression models were used to assess predictors of definitive therapy. Adjusted and unadjusted survival models compared cancer-specific mortality. Interaction terms were then used to assess whether the effect of race varied between counties. Results A total of 20,856 men were identified. Of these, 19,287 (92.5%) were White. There were significant county-level differences in the odds of receiving definitive therapy and survival. Survival was worse for those with high-risk cancer (adjusted hazard ratio [HR], 1.50; 95% CI, 1.4-1.60) and those with public insurance (adjusted HR for Medicaid, 1.69; 95% CI, 1.38-2.07; adjusted HR for Medicare, 1.2; 95% CI, 1.14-1.35). Black men were less likely to receive definitive therapy (adjusted odds ratio, 0.78; 95% CI, 0.74-0.83) but had a 17% lower cancer-specific mortality (adjusted HR, 0.83; 95% CI, 0.7-0.99). Conclusions Despite lower odds of definitive treatment, Black men experience decreased cancer-specific mortality in comparison with White men in Massachusetts. These data support the growing body of research showing that Black men may achieve outcomes equivalent to or even better than those of White men within the context of a well-insured population. Lay summary There is a growing body of evidence showing that the excess risk of death among Black men with prostate cancer may be caused by disparities in access to care, with few or no disparities seen in universally insured health systems such as the Veterans Affairs and US Military Health System. Therefore, the authors sought to assess racial disparities in prostate cancer in Massachusetts, which was the earliest US state to mandate universal insurance coverage (in 2006). Despite lower odds of definitive treatment, Black men with prostate cancer experience reduced cancer-specific mortality in comparison with White men in Massachusetts. These data support the growing body of research showing that Black men may achieve outcomes equivalent to or even better than those of White men within the context of a well-insured population.

Assessing perioperative risk is essential for surgical decision-making. Our study compares the accuracy of comorbidity indices to predict morbidity and mortality.Analyzing the National Surgical Quality Improvement Program, 16 major procedures were identified and American Society of Anesthesiologists (ASA), Charlson Comorbidity Index and modified Frailty Index were calculated. We fit models with each comorbidity index for prediction of morbidity, mortality, and prolonged length of stay (pLOS). Decision Curve Analysis determined the effectiveness of each model.Of 650,437 patients, 11.7%, 6.0%, 17.0% and 0.75% experienced any, major complication, pLOS, and mortality, respectively. Each index was an independent predictor of morbidity, mortality, and pLOS (p 0.05). While the indices performed similarly for morbidity and pLOS, ASA demonstrated greater net benefit for threshold probabilities of 1-5% for mortality.Models including readily available factors (age, sex) already provide a robust estimation of perioperative morbidity and mortality, even without considering comorbidity indices. All comorbidity indices show similar accuracy for prediction of morbidity and pLOS, while ASA, the score easiest to calculate, performs best in prediction of mortality.

Background TRICARE military beneficiaries are increasingly referred for major surgeries to civilian hospitals under “purchased care.” This loss of volume may have a negative impact on the readiness of surgeons working in the “direct-care” setting at military treatment facilities and has important implications under the volume-quality paradigm. The objective of this study is to assess the impact of care source (direct versus purchased) and surgical volume on perioperative outcomes and costs of colorectal surgeries. Methods We examined TRICARE claims and medical records for 18- to 64-year-old patients undergoing major colorectal surgery from 2006 to 2015. We used a retrospective, weighted estimating equations analysis to assess differences in 30-day outcomes (mortality, readmissions, and major or minor complications) and costs (index and total including 30-day postsurgery) for colorectal surgery patients between purchased and direct care. Results We included 20,317 patients, with 24.8% undergoing direct-care surgery. Mean length of stay was 7.6 vs 7.7 days for direct and purchased care, respectively (P = .24). Adjusted 30-day odds between care settings revealed that although hospital readmissions (odds ratio 1.40) were significantly higher in direct care, overall complications (odds ratio 1.05) were similar between the 2 settings. However, mean total costs between direct and purchased care differed ($55,833 vs $30,513, respectively). Within direct care, mean total costs ($50,341; 95% confidence interval $41,509–$59,173) were lower at very high-volume facilities compared to other facilities ($54,869; 95% confidence interval $47,822–$61,916). Conclusion Direct care was associated with higher odds of readmissions, similar overall complications, and higher costs. Contrary to common assumptions regarding volume and quality, higher volume in the direct-care setting was not associated with fewer complications.

INTRODUCTION AND OBJECTIVE:Recognizing the burden posed by unplanned hospital readmissions, the Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) in 2013, whereby ho...

OBJECTIVE To examine recent treatment trends for non-muscle-invasive bladder cancer (NMIBC), and specifically, to assess whether there was a change in use radical cystectomy (RC) between 2008 and 2015 using data from the Surveillance, Epidemiology, and End Results database. METHODS We identified patients presenting with high-grade T1 (T1HG) NMIBC at diagnosis during the study period. Treatment was dichotomized into “RC” and “local treatment” (which included transurethral resection and intravesical therapies). We then employed multivariable logistic regression models to assess the odds of undergoing RC across the study period. Additionally we examined the rates of RC for T1HG NMIBC during the period of BCG-shortage, defined as 2012-2015. RESULTS We identified 21,817 individuals diagnosed with T1HG bladder cancer during the study period. The majority of patients underwent local treatment (94.5%). During the shortage period, the rate of RC for T1HG NMIBC was significantly lower compared to the preshortage era (5.1% vs 5.9%, P = .007). Across the study period, the utilization of RC for T1HG NMIBC decreased significantly (odds ratio 0.99 per quarter, 95% confidence interval 0.98-0.99, P = .017). CONCLUSION In our cohort of patients diagnosed with T1HG bladder cancer, we found a significant decrease in the use of radical cystectomy across the study period. Contrary to the hypothesis of increasing rates of RC in the face of BCG shortage, the rate of RC was significantly higher in the pre-shortage era. Further examination of NMIBC treatment patterns will be necessary to assess the impact of BCG availability on therapeutic pathways and oncologic outcomes in patients with high-grade NMIBC.

Background Penile prosthesis surgery has witnessed a migration from the inpatient to ambulatory surgical care setting. However, little is known about the cost savings afforded by this change in care setting and whether or not these savings come at the expense of worse perioperative outcomes. Aim The aim of this study was to identify predictors of index penile prosthesis (PP) surgery care setting, and whether ambulatory vs inpatient surgery is associated with comparable perioperative outcomes and costs. Methods This was a retrospective cohort study using all-payer claims data from the 2014 Healthcare Cost and Utilization Project State Databases from Florida and New York. Patient demographics, regional data, total charges (converted to costs), and 30-day revisit rates were abstracted for all patients undergoing index placement of an inflatable or malleable PP. Multivariable logistic and linear regression adjusted for facility clustering was utilized. Outcomes The outcomes were index surgical and 30-day postoperative costs, as well as 30-day revisit rates. Results Of the 1,790 patients undergoing an index surgery, 394 (22.0%) received care in the inpatient setting compared to 1,396 (78.0%) in the ambulatory setting. Adjusted index procedural ($9,319.66 vs $ 10,191.35; P < .001) and 30-day acute care costs ($9,461.74 vs $10,159.42; P < .001) were lower in the ambulatory setting. The underinsured experienced lower odds of receiving surgery in the ambulatory setting (Medicaid vs private: odds ratio [OR] 0.19; 95% CI 0.06−0.55; P < .001). There was no difference in risk-adjusted odds of experiencing a 30-day revisit between patients undergoing surgery in the ambulatory vs inpatient settings (OR 1.31; 95% CI 0.78−2.21; P = .3). Clinical Translation Ambulatory PP surgery confers significant cost savings and is associated with comparable perioperative outcomes relative to inpatient-based surgery. Conclusions Both clinical and nonclinical factors predict the care setting of index PP surgery. Notably, underinsured patients experienced lower odds of undergoing ambulatory surgery. Ambulatory surgery was less costly with similar 30-day revisit rates relative to inpatient-based care.

Major challenges in the welding of copper are high reflectivity for infrared wavelengths and insufficient reproducibility of the welds. Studies have shown that the surface conditioning of copper materials with pulsed green laser radiation stabilizes process conditions, as well as significantly increases absorption of pulsed infrared laser radiation. Experimental results are presented, which illustrate how advantages of this conditioning can be transferred to welding with continuous IR radiation. It is possible to significantly reduce the necessary IR laser power and to optimize the weld appearance. In this regard, the influence of inert gas and the conditioning parameters is analyzed.

Objectives: The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. Materials and Methods: This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean +/- SD total volume and number of treated fibroids (per patient) were 89 +/- 94 cm(3) and 2.2 +/- 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Results: Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% +/- 15% (range, 38%-100%). Mean applied energy level was 5400 +/- 1200 J, and mean number of sonications was 74 +/- 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. Conclusions: With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

PurposeMechanical systems in library environments are typically designed to run continuously in order to maintain the desired environmental conditions for preservation purposes, often resulting in a high cost in dollars and energy consumption. Altering these conditions through changed HVAC operating schedules is a risk many librarians and institutions are hesitant to take. This study aims to introduce the methodology and early findings of current research into the question of whether energy usage can be significantly reduced in libraries by carefully monitored and risk‐managed shutdowns of air handling units (AHUs) during unoccupied hours in selected spaces without compromising the quality of the preservation environment.Design/methodology approachAs part of the project, the authors are monitoring up to three air handling units (AHUs) at each of five partner institutions, three of which are university libraries or repositories, as well as the associated collections spaces served by the units.FindingsEarly findings show the potential value of systems shutdowns in various parts of the country, while also identifying regions that are less favorable.Practical implicationsIn all cases, the experimentation with and successful implementation of a shutdown schedule, without adversely affecting preservation conditions, was preceded by careful documentation and risk management, as described.Originality/valueUnlike unilateral HVAC equipment shutdowns and setbacks conducted solely for energy management, with little regard for collections, this risk‐managed and documented approach potentially allows for the reduction of energy usage without placing collections' health at risk.

The gold standard for identification of the dead is the visual dental record. In this context, several authors emphasize computed tomography (CT) as valuable supportive tool for forensic medicine. However, studies focusing on diagnostic accuracy of post-mortem computed tomography (PMCT) are still missing. Therefore, the aim of this study was to compare diagnostic accuracy of the visual dental record and post-mortem computed tomography (PMCT) of the dentition for identification of the dead. Ten whole skulls were included into the study. The entire dentition of each skull was first examined with the visual dental record as a gold standard and second using dental PMCT scans, performed on a 64-multi-detector CT (MDCT). 3D reformations, multi-planar reformations (MPR), and CT-orthopantomography (OPG) were performed in the post-processing. All examinations were analyzed by three independent investigators regarding the criteria for identification of the dead, e.g., in case of disaster. PMCT for the dental identification of the dead was difficult to perform and time consuming. Due to dental overlays and corresponding artifacts, the definite periphery of the dental fillings/inlays was not accurately defined resulting in 2.9% incorrect and 64.1% false negative findings, especially synthetic inlays were hardly or not recognizable at all. For the identification of the dead especially in case of disasters with large numbers of victims, the visual dental record is still to be considered the gold standard. In the identification process itself, there is no room for error at all, although some non-concordant information may occur. Thus, PMCT should only be performed for identification in individual cases due to the relatively high error rate.

Der zunehmende Einsatz der MRT in der Mammadiagnostik erhoht den Stellenwert geeigneter Biopsieverfahren fur abklarungsbedurftige Befunde, die ausschlieslich im MRT sichtbar werden. MR-gestutzte Biopsieverfahren sind kostenaufwandig und zeitintensiv. Die standardisierte Qualitat der indikationsstellenden MRT-Untersuchung ist deshalb von entscheidender Bedeutung fur den sinnvollen Einsatz MR-gestutzter Biopsieverfahren. Bei geeigneter Indikationsstellung ist die MR-gefuhrte Vakuumbiopsie eine sehr sichere Abklarungsmethode, die auch bei kleinen Herdbefunden eine zuverlassige histopathologische Diagnose erlaubt. Bislang war der Biopsievorgang bei einer MR-gefuhrten Vakuumbiopsie aufgrund der fehlenden Kompatibilitat der Nadeln nicht der Bildgebung zuganglich. Besondere Sorgfalt gilt daher der Uberprufung der Reprasentativitat der Probengewinnung durch postinterventionelle Aufnahmen und die histopathologische Korrelation der bildgebenden Befunde. Kunftige Entwicklungen werden MR-kompatible Biopsienadeln in Herdlokalisation abbilden konnen und damit Lokalisationsunsicherheiten und Zeitaufwand der Methode weiter minimieren. Fur die Abklarung von Zweitherden bei bereits bestehender Operationsindikation bleibt die MR-gestutzte Nadelmarkierung ipsi- und kontralateraler Zweitherde eine technisch einfache und schnell durchfuhrbare Methode.

Four Gram-negative, rod-shaped, non-spore-forming and non-motile bacterial strains were isolated from surfaces and biofilms associated with beer-bottling plants. Based on their 16S rRNA gene sequences these isolates were allocated to the genus Chryseobacterium. The sequence similarities of the isolates to the next most closely related type strains of this genus ranged from 96.4 to 98.3%. The presence of menaquinone MK-6 and predominant fatty acids 15:0 iso, 17:1 iso cis9, 15:0 iso 2-OH and 17:0 iso 3-OH supported the affiliation of these strains to the genus. The results of DNA-DNA hybridization, biochemical tests and chemotaxonomic properties allowed genotypic and phenotypic differentiation of the strains from the next most closely related Chryseobacterium species with validly published names. Therefore, the isolates represent four novel species for which the names Chryseobacterium ureilyticum (type strain F-Fue-04IIIaaaa(T)=DSM 18017(T)=CCUG 52546(T)), Chryseobacterium gambrini (type strain 5-1St1a(T)=DSM 18014(T)=CCUG 52549(T)), Chryseobacterium pallidum (type strain 26-3St2b(T)=DSM 18015(T)=CCUG 52548(T)) and Chryseobacterium molle (type strain DW3(T)=DSM 18016(T)=CCUG 52547(T)) are proposed.

Bei der chronischen Lungenembolie sind Abschnitte der arteriellen Lungenstrombahn dauerhaft verschlossen. Dies kann zu einer Erhohung des pulmonal-arteriellen Drucks mit den Folgen einer Rechtsherzbelastung und strukturellen Veranderungen der Pulmonalarterien fuhren. Bildmorphologisch nachzuweisen sind Gefasverschlusse (Pulmonalisangiographie, MSCT, MRT) und die Minderperfusion des Lungenparenchyms (Szintigraphie, MSCT, MRT). Nach den bisherigen Empfehlungen gelten fur die Diagnostik der chronischen Lungenembolie die Lungenszintigraphie (Ventilation/Perfusion) und die Pulmonalisangiographie als Methoden der ersten Wahl. Die MSCT und MRT (Angiographie/Perfusion) stellen technische Alternativen dar. Differenzialdiagnostisch sind andere Formen der pulmonalen Hypertonie abzugrenzen. Trotz medikamentoser und chirurgischer Therapiemasnahmen (z. B. pulmonale Thrombendarterektomie) bleibt die Prognose der chronischen Lungenembolie ungunstig.

Rationale and Objectives To evaluate the performance of a prototype computer-aided diagnosis (CAD) tool using artificial intelligence techniques for the detection of pulmonary embolism (PE) and the possible benefit for general radiologists. Materials and Methods Forty multidetector row computed tomography datasets (16/64- channel scanner) using 100 kVp, 100 mAs effective/slice, and 1-mm axial reformats in a low-frequency reconstruction kernel were evaluated. A total of 80 mL iodinated contrast material was injected at a flow rate of 5 mL/seconds. Primarily, six general radiologists marked any PE using a commercially available lung evaluation software with simultaneous, automatic processing by CAD in the background. An expert panel consisting of two chest radiologists analyzed all PE marks from the readers and CAD, also searching for additional finding primarily missed by both, forming the ground truth. Results The ground truth consisted of 212 emboli. Of these, 65 (31%) were centrally and 147 (69%) were peripherally located. The readers detected 157/212 emboli (74%) leading to a sensitivity of 97% (63/65) for central and 70% (103/147) for peripheral emboli with 9 false-positive findings. CAD detected 168/212 emboli (79%), reaching a sensitivity of 74% for central (48/65) and 82%(120/147) for peripheral emboli. A total of 154 CAD candidates were considered as false positives, yielding an average of 3.85 false positives/case. Conclusions The CAD software showed a sensitivity comparable to that of the general radiologists, but with more false positives. CAD detection of findings incremental to the radiologists suggests benefit when used as a second reader. Future versions of CAD have the potential to further increase clinical benefit by improving sensitivity and reducing false marks.

Modern spark ignition and compression ignition engine solutions have been characterized in the paper The requirements that the modern engines are currently facing are a compromise between the expectations of the clients and the technological capability of obtaining a significant reduction in the fuel consumption and emissions. The solutions applied in the CI and SI engines contribute to the above expectations and constitute a basis for further development i.e. hybrid propulsion combining SI and CI engines with electric machines providing much higher fuel economy and comfort.

Die MRT des Lungenparenchyms ist wegen des extrem niedrigen Protonengehalts des Lungengewebes und den starken Grenzflachen zwischen Luft und Parenchym prinzipiell sehr problematisch. Allerdings liegt bei pathologischen Lungengewebeveranderungen eine andere Situation vor, da infolge von Odem, Entzundung bzw. Tumorwachstum der Protonengehalt erhoht und die Grenzflachen reduziert sind. Viele Erkrankungen der Lunge fuhren dazu, dass der Patient den Atem nicht lange anzuhalten vermag. Daher sind MRT-Pulssequenzen erforderlich, die eine Datenakquisition in wenigen Sekunden gestatten. Aus technischer Sicht werden die vom CT bekannten Submillimeterschichten vielleicht nie realisierbar sein, sodass sicher auch in Zukunft kleine Rundherde mit einem Durchmesser deutlich unterhalb der Schichtdicke nicht mehr zuverlassig erfasst werden konnen. Auch Verkalkungen sind nicht mit der gleichen Sicherheit wie im CT zu identifizieren. Gleiches gilt fur den Nachweis von Luftsicheln und -einschlussen in Lasionen. Mit Hilfe der parallelen Bildgebung konnen beide Lungenflugel in 1–2 Atemstillstanden mit einer Ortsauflosung von 6 mm in der z-Achse und Submillimeterauflosung in der x- und y-Ebene untersucht werden. Raumzeiten

A novel ureter phantom was developed for investigations of image quality and dose in CT urography. The ureter phantom consisted of a water box (14 cm x 32 cm x 42 cm) with five parallel plastic tubes (diameter 2.7 mm) filled with different concentrations of contrast media (1.88-30 mg iodine/ml). CT density of the tubes and noise of the surrounding water were determined using two multidetector scanners (Philips MX8000 with four rows, Siemens Sensation 16 with 16 rows) with varying tube current-time product (15-100 mAs per slice), voltage (90 kV, 100 kV, 120 kV), pitch (0.875-1.75), and slice thickness (1 mm, 2 mm, 3.2 mm). Contrast-to-noise ratio as a parameter of image quality was correlated with dose (CTDI) and was compared with image evaluation by two radiologists. The CT densities of different concentrations of contrast media and contrast-to-noise ratio were significantly higher when low voltages (90 kV versus 120 kV, 100 kV versus 120 kV) were applied. Smaller slice thickness (1 mm versus 2 mm) did not change CT density but decreased contrast-to-noise ratio due to increased noise. Contrast phantom studies showed favourable effects of low tube voltage on image quality in the low dose range. This may facilitate substantial dose reduction in CT urography.

The objective of this study was to compare the accuracy in staging of various malignant tumors with whole-body magnetic resonance imaging (WB-MRI) using parallel imaging (PAT) and positron emission tomography-computed tomography (PET-CT).In a prospective study, 41 patients withoncologic diseases underwent [F]-fluoro-2-deoxy-D-glucose PET-CT for tumor staging and WB-MRI on a 32-channel-scanner with the use of PAT. Coronal T1w and STIR sequences at 5 body levels, axial HASTE imaging of the lung, and contrast-enhanced T1w sequences of the liver, brain, and abdomen were performed. TNM stage was assessed for both modalities in a separate consensus reading using histologic results and radiologic follow up within 6 months as the standard of reference.Three primary and 4 recurrent tumors were detected; one recurrent tumor was missed with WB-MRI. Sixty benign and 60 malignant lymph nodes were detected with a sensitivity of 98% and specificity of 83% for PET-CT and 80%/75% for WB-MRI, respectively. One hundred ninety-one malignant and 77 benign distant lesions were detected with a sensitivity/specificity of 82% for PET-CT and 96%/82% for WB-MRI. Accuracy for correct TNM staging was 96% for PET-CT and 91% for WB-MRI.WB-MRI and PET-CT are reliable imaging modalities for tumor staging. WB-MRI is highly sensitive in detecting distant metastases; PET-CT is superior in lymph node staging. PAT makes high-resolution WB-MRI feasible within less than 1 hour.

Early detection of lung nodules is an important clinical indication for obtaining routine CT studies of the thorax. To date, research has mainly focused on the sensitivity of CAD compared with expert chest radiologists using data obtained from single or multi-detector CT scanners. But, beside sensitivity and specificity it is also import to know how well the CAD system does perform on datasets from different sites with different slice thicknesses and differences in the dosage. The present study focuses on the generalization ability of a prototype CAD system that is not yet commercially available. It describes the architecture of a recent CAD system and assesses the performance on a heterogeneous dataset collected from multiple geographically diverse sites.

Computed tomography (CT) has become an increasingly accepted technique and is the method of choice for direct visualization of pulmonary emboli (PE). The quantitative assessment of tissue perfusion may yield more important information for patient management than the direct visualization of emboli by CT alone. Several attempts have been made to measure pulmonary blood flow by administration of intravenous contrast material. In this article, various experimental CT approaches for visualization and quantification of pulmonary perfusion are discussed. Ideally, CT will be able to provide both structural and functional information. Simple measurement of lung density before and after intravenous contrast delivery has been performed with single-slice CT technology using region-of-interest methodology. For electron-beam CT, a repeated data acquisition on a 7.6-cm lung volume has proven to be technically feasible. Using such dynamic scanning, reduced blood flow was observed in occluded lung segments. Color-encoded parenchymal density distribution in the axial, coronal, and sagittal planes was derived from thin collimation data sets using four-row multi-slice spiral CT (MSCT). Initial animal data from 16-slice MSCT offer a real CT-subtraction technique of the entire chest for the first time.

Multilokulare Metastasen von soliden Tumoren stellen haufig ein diagnostisches wie therapeutisches Problem dar. Sie entziehen sich haufig einer kurativen, chirurgischen Therapie. In diesen Fallen konnen nicht selten die Verfahren der minimal-invasiven, interventionellen Therapie eine sinnvolle Alternative sein. Problematisch ist, dass eine vorbehandelte Lasion haufig allein mit der morphologischen Bildgebung nicht in ihrer Vitalitat beurteilt wird. Die Kombination der Computertomographie mit der Positronenemissionstomographie kann insbesondere zur Planung, Steuerung und Nachkontrolle sehr wertvoll sein. So konnte die Indikation fur eine Intervention bestatigt oder auch verworfen werden. Die PET/CT erwies sich auch fur das Follow-up als geeignet. Daruber hinaus lieferte die PET/CT wichtige Informationen fur die Planung und Steuerung der interventionellen Verfahren, wie der Radiofrequenzablation und der Vertebroplastie. Ob dadurch auch eine hohere Ansprechrate und ein langeres Uberleben der Patienten erreicht werden kann, ist bisher nicht geklart.

Purpose To compare high-resolution T2-weigthed images of the liver with and without integrated parallel acquisition techniques (iPAT) using either breath-hold sequences in combination with prospective acquisition motion correction (PACE) or respiratory triggering. Materials and Methods Ten volunteers and 10 patients underwent each four different high-resolution fast spin echo (FSE) T2-weigthed sequences with 5 mm slice thickness and a full 320 matrix: a multi-breath-hold FSE sequence with and without iPAT and PACE and a respiratory-triggered FSE sequence with and without iPAT. Image quality was rated with a five-point scale by two independent readers. Signal intensity measurements were performed on a water phantom. Results The sequences with iPAT required a substantially shorter acquisition time without loss of image quality. Overall image quality was rated equal for all sequences by both readers. Image time for nine slices with iPAT was 13 seconds (19 seconds without iPAT) with multi-breath-hold and on average 4:00 minutes (7:02 minutes without iPAT) with respiratory triggering. Imaging with the PACE technique resulted in more correct positioning of the image stacks. Conclusion T2-weighted fast imaging with iPAT is feasible and results in high-quality images within a short acquisition time. Overall image quality is not negatively affected by iPAT. J. Magn. Reson. Imaging 2004;20:443–450. © 2004 Wiley-Liss, Inc.

Recent years have seen an increasing importance of computed tomography (CT) in the diagnosis of pulmonary embolism (PE), mainly brought about by the advent of fast CT image acquisition techniques (Kauczor et al. 1999; Remy-Jardin and Remy 1999; Schoepf et al. 2000a, b). Competing imaging modalities are in decline: nuclear scanning allows functional assessment of lung ventilation and perfusion but lacks spatial resolution (PIOPED-Investigators 1990). Once the first line of defense in the diagnostic algorithm of PE, this modality is currently withdrawing to diagnostic niches due to limited availability, poor inter-observer correlation (Blachere et al. 2000), and notorious lack of specificity (PIOPED-Investigators 1990). Pulmonary angiography, the one-time gold standard for the diagnosis of PE, is becoming increasingly tarnished (Diffin et al. 1998; Stein et al. 1999). Its ability to detect isolated peripheral emboli does not seem to exceed the accuracy of computed tomography (Diffin et al. 1998; Stein et al. 1999).

Die Mehrschichtcomputertomographie (MSCT) hat seit ihrer Einfuhrung vor wenigen Jahren eine weite Verbreitung erfahren und sich bei zahlreichen Indikationen als leistungsfahiges Verfahren etabliert. Problematisch ist die z. T. deutlich hohere Strahlenexposition der Patienten, sowohl im Vergleich zur Einzelschicht-CT wie auch im Vergleich zu anderen diagnostischen Verfahren.

Fragestellung. Ziel war die Implementierung eines Protokolls fur die abdominelle CT-Angiographie an einem 16-Detektorzeilen-CT. Zudem erfolgte der Vergleich mit der selektiven Katheterangiographie.

Fragestellung. Evaluation der Bildqualitat der koronaren CT-Angiographie (CTA) mit einem 16-Mehrzeilen-Spiral-CT (MSCT), bei einer Rekonstruktion von 0,75-mm-Schichten fur optimale raumliche Auflosung und Vergleich mit 1,3-mm-Schichten, die die raumliche Auflosung eines 4-MSCT simulieren.

To assess the technical and clinical results of MRgFUS treatment and factors affecting clinical treatment success. A total of 252 women (mean age, 42.1 ± 6.9 years) with uterine fibroids underwent MRgFUS. All patients underwent MRI before treatment. Results were evaluated with respect to post-treatment nonperfused volume (NPV), symptom severity score (SSS), reintervention rate, pregnancy and safety data. NPV ratio was significantly higher in fibroids characterized by low signal intensity in contrast-enhanced T1-weighted fat saturated MR images and in fibroids distant from the spine (>3 cm). NPV ratio was lower in fibroids with septations, with subserosal component and in skin-distant fibroids (p