Impact of a 4th generation iterative reconstruction technique on image quality in low-dose computed tomography of the chest in immunocompromised patients

PURPOSE To determine the image quality of an iterative reconstruction (IR) technique in low-dose MDCT (LDCT) of the chest of immunocompromised patients in an intraindividual comparison to filtered back projection (FBP) and to evaluate the dose reduction capability. MATERIALS AND METHODS 30 chest LDCT scans were performed in immunocompromised patients (Brilliance iCT; 20-40 mAs; mean CTDIvol: 1.7 mGy). The raw data were reconstructed using FBP and the IR technique (iDose4™, Philips, Best, The Netherlands) set to seven iteration levels. 30 routine-dose MDCT (RDCT) reconstructed with FBP served as controls (mean exposure: 116 mAs; mean CDTIvol: 7.6 mGy). Three blinded radiologists scored subjective image quality and lesion conspicuity. Quantitative parameters including CT attenuation and objective image noise (OIN) were determined. RESULTS In LDCT high iDose4™ levels lead to a significant decrease in OIN (FBP vs. iDose7: subscapular muscle 139.4 vs. 40.6 HU). The high iDose4™ levels provided significant improvements in image quality and artifact and noise reduction compared to LDCT FBP images. The conspicuity of subtle lesions was limited in LDCT FBP images. It significantly improved with high iDose4™ levels (> iDose4). LDCT with iDose4™ level 6 was determined to be of equivalent image quality as RDCT with FBP. CONCLUSION iDose4™ substantially improves image quality and lesion conspicuity and reduces noise in low-dose chest CT. Compared to RDCT, high iDose4™ levels provide equivalent image quality in LDCT, hence suggesting a potential dose reduction of almost 80%.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Differences in coronary risk factors, procedural characteristics, mortality and stent thrombosis between two all-comers percutaneous coronary intervention registries from Europe and Japan: a patient-level data analysis of the Bern-Rotterdam and j-Cypher registries

Aims: The reported rate of stent thrombosis (ST) after drug-eluting stent (DES) implantation varies among registries. To investigate differences in baseline characteristics and clinical outcome in European and Japanese all-comers registries, we performed a pooled analysis of patient-level data. Methods and results: The j-Cypher registry (JC) is a multicentre observational study conducted in Japan, including 12,824 patients undergoing SES implantation. From the Bern-Rotterdam registry (BR) enrolled at two academic hospitals in Switzerland and the Netherlands, 3,823 patients with SES were included in the current analysis. Patients in BR were younger, more frequently smokers and presented more frequently with ST-elevation myocardial infarction (MI). Conversely, JC patients more frequently had diabetes and hypertension. At five years, the definite ST rate was significantly lower in JC than BR (JC 1.6% vs. BR 3.3%, p<0.001), while the unadjusted mortality tended to be lower in BR than in JC (BR 13.2% vs. JC 14.4%, log-rank p=0.052). After adjustment, the j-Cypher registry was associated with a significantly lower risk of all-cause mortality (HR 0.56, 95% CI: 0.49-0.64) as well as definite stent thrombosis (HR 0.46, 95% CI: 0.35-0.61). Conclusions: The baseline characteristics of the two large registries were different. After statistical adjustment, JC was associated with lower mortality and ST.

Regulation of the Telecommunications in Switzerland: A Network Approach to Assess the Regulatory Agencies' Independence

The liberalization process of the Swiss telecommunications sector follows a logic of ‘autonomous adaptation’ to the regulations of the European Union (EU). Switzerland, which is not a Member State of the EU, voluntarily adapts to the European policy without being for- mally required to do so (Sciarini et al., 2004). This process went hand in hand with the partial privatization of the legal statute and assets of the former monopolist and with the re-regulation of the liberalized telecommunications sector.

Expanding the Mutation Spectrum Affecting αIIbβ3 Integrin in Glanzmann Thrombasthenia: Screening of the ITGA2B and ITGB3 Genes in a Large International Cohort.

We report the largest international study on Glanzmann thrombasthenia (GT), an inherited bleeding disorder where defects of the ITGA2B and ITGB3 genes cause quantitative or qualitative defects of the αIIbβ3 integrin, a key mediator of platelet aggregation. Sequencing of the coding regions and splice sites of both genes in members of 76 affected families identified 78 genetic variants (55 novel) suspected to cause GT. Four large deletions or duplications were found by quantitative real-time PCR. Families with mutations in either gene were indistinguishable in terms of bleeding severity that varied even among siblings. Families were grouped into type I and the rarer type II or variant forms with residual αIIbβ3 expression. Variant forms helped identify genes encoding proteins mediating integrin activation. Splicing defects and stop codons were common for both ITGA2B and ITGB3 and essentially led to a reduced or absent αIIbβ3 expression; included was a heterozygous c.1440-13_c.1440-1del in intron 14 of ITGA2B causing exon skipping in 7 unrelated families. Molecular modeling revealed how many missense mutations induced subtle changes in αIIb and β3 domain structure across both subunits thereby interfering with integrin maturation and/or function. Our study extends knowledge of Glanzmann thrombasthenia and the pathophysiology of an integrin. This article is protected by copyright. All rights reserved.

An examination of the link between just world belief and schadenfreude

Schadenfreude is a pleasure derived from someone else’s misfortune. Just world belief is a desire to belief that people get what they deserve and deserve what they get (Lerner, 1965,1980). Interestingly, previous scholars documented the link between schadenfreude, responsibility and deservingness (e.g. van Dijk, Goslinga, & Ouwerkerk, 2008), i.e. the more failure is deserved, the more perceived responsibility for the failure, and subsequently more schadenfreude is evoked. Thus, the present study tested if a threat of a just world belief intensifies experience of schadenfreude. The participants (N=48, 31 women and 17 men, M age = 23.72), were randomly assigned to one of two experimental conditions (just world belief: threat versus no-threat) between-participant design. They read scenarios which were designed to threaten or maintain their just world belief. Next, they were transferred to an online magazine presenting funny stories about other peoples’ failures. The stories were selected in a pilot study in order to evoke schadenfreude. As presumed, the participants exposed to the threat of just world belief experienced more schadenfreude, i.e. spent more time on reading schadenfreude stories. The results confirmed the existence of a link between just world threat and schadenfreude.

The Role of the European Imperial Powers throughout the Armenian Schism in the 1870s

The Bull "Reversurus" (1867) and its dogmatic legitimization at the First Vatican Council in 1870 caused not only ecclesiastical controversy and Schism in the Armenian Catholic Church, but it had also wide political consequences for the Armenian Catholics in the Ottoman Empire. The conflict originally between the Armenian Catholics and Rome attracted very soon the attention of the European imperial Powers. France, the British Empire, the German Empire, Austria-Hungary and Russia were the main political powers who were involved in the Armenian affair. A full picture of the role of all these powers for the course of the Armenian Schism is missing. Mostly the role of France is foregrounded in the printed sources, as the main power, which supported the papacy to win during the Armenian affair. The role and the motives of the other imperial powers is almost missing. This article will try to describe as completely as possible the historical and political background, which brought to the escalation of the Armenian conflict beyond the national frontiers and led to number of conflicts at the international and transnational level. It will be shown that the imperial policy in Europe in the 19th century have played an enormous role throughout the Armenian Schism. It will be explained that several historical circumstances in Europe, especially the relation of the European imperial powers to each other as well as their expectations from the Ottoman Empire and its Armenian subjects were decisive for the duration and conclusion of the Armenian Schism.