New Exercise-Dipyridamole Combined Test for Nuclear Cardiology in Insufficient Effort: Appropriate Diagnostic Sensitivity Keeping Exercise Prognosis

AbstractBackground:Myocardial perfusion scintigraphy (MPS) in patients not reaching 85% of the maximum predicted heart rate (MPHR) has reduced sensitivity.Objectives:In an attempt to maintain diagnostic sensitivity without losing functional exercise data, a new exercise and dipyridamole combined protocol (EDCP) was developed. Our aim was to evaluate the feasibility and safety of this protocol and to compare its diagnostic sensitivity against standard exercise and dipyridamole protocols.Methods:In patients not reaching a sufficient exercise (SE) test and with no contraindications, 0.56 mg/kg of dipyridamole were IV administered over 1 minute simultaneously with exercise, followed by 99mTc-MIBI injection.Results:Of 155 patients, 41 had MPS with EDCP, 47 had a SE test (≥ 85% MPHR) and 67 underwent the dipyridamole alone test (DIP). They all underwent coronary angiography within 3 months. The three stress methods for diagnosis of coronary lesions had their sensitivity compared. For stenosis ≥ 70%, EDCP yielded 97% sensitivity, SE 90% and DIP 95% (p = 0.43). For lesions ≥ 50%, the sensitivities were 94%, 88% and 95%, respectively (p = 0.35). Side effects of EDCP were present in only 12% of the patients, significantly less than with DIP (p < 0.001).Conclusions:The proposed combined protocol is a valid and safe method that yields adequate diagnostic sensitivity, keeping exercise prognostic information in patients unable to reach target heart rate, with fewer side effects than the DIP.

Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

AbstractBackground:Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy.Objective:To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy.Methods:The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m2 for women or ≥ 116 g/m2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased.Results:A total of 47 patients with a mean left ventricular mass index of 141.1 g/m2 (± 28.5; 99.2 to 228.5 g/m2] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation.Conclusion:In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5).

integrated method for improving risk analysis using human factors methods and virtual reality

Magdeburg, Univ., Fak. für Informatik, Diss., 2009

Virtual separation of concerns : toward preprocessors 2.0 /von Christian Kästner

Software product line, variability, virtual separation, ifdef, preprocessor, cpp, annotative approaches, annotations

Design and control of combined chemical processes for the production of pure enantiomers

Magdeburg, Univ., Fak. für Elektrotechnik und Informationstechnik, Diss., 2013

Collaboration process design for ideation in distributed environments : approaches to support collaborative ideation in global virtual groups using technological support

Magdeburg, Univ., Fak. für Informatik, Diss., 2012

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

v. 12 (1843)

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

2nd ser. v. 17 (1856)

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

v. 15 (1845)

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

2nd ser. v. 10 (1852)

Virtual Reality zur Untersuchung neuronaler Prozesse : Entwicklung und Validierung einer adaptiven Hirn-Computer-Schnittstelle zur dynamischen Interaktion mit Virtual Reality Paradigmen

Magdeburg, Univ., Fak. für Informatik, Diss., 2013

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

2nd ser. v. 19 (1857)

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

2nd ser. v. 15 (1855)

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

2nd ser. v. 16 (1855)

The Annals and magazine of natural history; zoology, botany, and geology being a continuation of the Annals combined with Loudon and Charlesworth's Magazine of Natural History.

3rd ser. v. 2 (1858)