Fetal MRI as complement to US in the diagnosis and characterization of anomalies of the genito-urinary tract.

The purpose of this study is to compare the accuracy of prenatal ultrasound (US) and prenatal magnetic resonance imaging (MRI) in the diagnosis and characterization of congenital abnormalities of the genito-urinary tract and to determine if the additional information obtained by MRI may influence the management of the fetus. We retrospectively evaluate 15 cases of congenital genito-urinary tract anomalies detected by prenatal US and with echographic inconclusive diagnosis. We compare the MRI findings with the US findings and the final diagnosis, obtained from neonatal outcomes, imaging studies and pathology records. Fetal US diagnosis was correct in 9 cases (60%) and MRI in 13 cases (86.7%). Prenatal MRI revealed additional information to US in 9 cases (60%), which modified the initial US diagnosis in 5 cases (33.3%) and changed the therapeutic approach in 5 fetuses (33.3%). Fetal MRI was better than US in cases of oligoamnios and in fetuses with genito-urinary pathology concerning the pelvic and perineum region. We believe that MRI should be considered as a complementary diagnostic method in cases of echographic suspicion of congenital pathology of the genito-urinary tract and inconclusive prenatal US.

Comparison of foetal US and MRI in the characterisation of congenital lung anomalies.

OBJECTIVES: To compare the accuracy of prenatal ultrasonography (US) to magnetic resonance imaging (MRI) in the characterisation of congenital lung anomalies, and to assess their agreement with final diagnosis. To evaluate the influence of additional MRI information on therapeutic management. METHODS: 26 prenatal congenital lung anomalies detected consecutively between 2006 and 2012 were retrospectively evaluated. Lesions were initially observed at prenatal US and further investigated with MRI. Prenatal US and MRI imaging findings, and suggested diagnosis were compared with the final diagnosis, obtained from autopsies (4), pathological evaluation following surgical resection (15) and postnatal imaging studies (7). RESULTS: Postnatal diagnoses included 7 congenital pulmonary airway malformations, 8 complex lesions, 7 overinflations, 1 sequestration, 1 bronchogenic cyst, 1 blastoma and 1 bilateral lymphangioma. Suggested prenatal US and MRI diagnosis was correct in 34.6% and 46.2% of patients, respectively, mainly isolated lung lesions with typical imaging findings. Nonspecific imaging findings at US and MRI studies were observed in 38.4% of cases. In 42% of the operated anomalies, pathological dissection revealed the presence of complex anomalies. MRI changed the US diagnosis, but not the further management in 9.7% of the lesions. CONCLUSIONS: Prenatal US and MRI showed a high accuracy in the diagnosis of isolated congenital lung lesions with typical imaging findings. However, overall characterisation rates were low, because of both a high percentage of complex lesions and of lesions with nonspecific imaging findings. MRI was better than US in characterising complex lesions, but its additional information did not influence therapy decisions.

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011).

The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.

Deregulation of Railroads and Future Development Scenarios in Europe - Literature Analysis of Privatization Process Taken Place in US, UK and Sweden

Euroopan unionissa päätettiin jo yli vuosikymmen sitten, että rautatieliiketoiminta vapautetaan kilpailulle. Iso-Britanniasta olimäärä tulla esimerkkivaltio tämän prosessin käyttöönotossa. Pääideana oli säännöstelyn keventäminen, jolloin omistuspohja toimialalla laajenee ja rautateiden infrastruktuuri sekä toiminta parantuvat. Infrastruktuuri on määrä olla yhden organisaation hallinnassa ja raiteiden käyttöoikeus on kaikilla lupaehdot täyttävillä operaattoreilla, jotka kilpailevat keskenään matkustajista ja tavararahdeista. Kuitenkin Yhdysvalloissa ja eräissä Latinalaisen Amerikan maissa kilpailu on vapautettu siten, että rautatieyritys omistaa raideinfrastruktuurin, junat, tavarankuljetus- sekä matkustajavaunut. Iso-Britannian yksityistämistä pidettiin aluksi isonaepäonnistumisena: nopealla aikataululla sovellettiin jäykkiä transaktioperusteisia ulkoistamisstrategioita infrastruktuurin kunnossapitoon, jotka lopulta johtivat junien jatkuviin myöhästymisiin ja muutamaan tuhoisaan onnettomuuteen. Liiketoiminnallisessa mielessäkään ei oikein onnistuttu: infrastruktuurista vastaava yritys jouduttiin listaamaan pois Lontoon pörssistä, ja hallituksen oli pakko luoda tukipaketti pahasti velkaantuneen, vain marginaalisien investointien kohteena olleen yrityksen toimintaa varten (vaikka kapasiteettitarvetta oli markkinoilla). Myös rautatieoperaattorit olivat taloudellisessa ahdingossa ja vain määrätietoisten hallituksen laatimien pelastuspakettien avulla ala nousi syvimmästä kriisistään. Tästä huolimatta näiden negatiivisten sivuvaikutusten ohella koko ala pystyi kasvattamaan kysyntää, niin matkustaja- kuin rahtiliikenteenkin osalta. Vähenevän kysynnän trendi, joka alkoi 1970-luvulla, otti käännöksen parempaan. Toinen eurooppalaismaa, jolla on pitkät kokemukset yksityistämisestä, on Ruotsi. Tämä maatapaus on melko konservatiivinen verrattuna tilanteeseen edellisessä; vain rajattu määrä reittejä on avattu kilpailulle ja sopimukset tehdään kerralla pitkäksi aikaa eteenpäin. Ruotsin säännöstelyn purku osoittautui menestykseksi, koska tuottavuus onollut vakaassa kasvussa ja rautateiden markkinaosuus erityisesti matkustajapuolella on noussut merkittävästi, verrattuna muihin kuljetusmuotoihin. Kuitenkin kilpailua on käytännössä vähän tässä maassa ja parempiatuloksia on lupa odottaa, kun vain säännöstelyn purkaminen jatkuu. Viimeinen tutkimuksemme kohteena oleva maa on Yhdysvallat, joka alistutti rautatiet kilpailulle jo 1980-luvun alussa, käyttäen jo edellä mainittua vertikaalista integraatiota; tämä valinta on taas johtanut hyvin erilaisiin tuloksiin. Vaihtoehtoinen rakenteellinen uudistustapa on suosinut rahtivirtoja matkustajiin nähden, ja lopputuloksena tämä tapaus synnytti yrityksiä huolehtimaan toista näistä kahdesta pääasiakasryhmästä. Viimeaikaiset tulokset tästä yksityistämisprosessista ovat olleet hyviä: jäljellejääneiden yritysten voitot ovat kasvaneet, osinkoja ollaan kyetty jakamaan ja osakkeiden arvostus on noussut. Tässä tutkimusraportissa yritämme kolmen maatapauksen kautta esittää, miten yksityistämisprosessi tulee vaikuttamaan Euroopassa, kun kilpailu rautateillä vapautuu. Me käymmeläpi, mikä näistä kolmesta maaesimerkistä on kaikkein todennäköisin jaesitämme ehdotuksia siihen, miten valtiot voisivat välttää ei-haluttuja sivuvaikutuksia. Kolme maaesimerkkiä, ja lopuksi esitetty lyhyt tilastollinen analyysi osoittavat, että rautateillä on tulevaisuuden potentiaalia Euroopassa, ja kilpailun vapauttaminen on avain tämän potentiaalin realisointiin.

Eligibility to treatment and economic effect of the implementation of the new U.S. or European Society of Hypertension/European Society of Cardiology hypertension guidelines.

OBJECTIVE: To evaluate the population and economic impact of implementing the new Joint National Committee (JNC) or European Society of Hypertension (ESH)/European Society of Cardiology (ESC) hypertension guidelines in the Swiss population. METHODS: Cross-sectional, population-based sample (6708 participants) collected between 2003 and 2006 in the city of Lausanne, Switzerland. Blood pressure categories were defined according to both the JNC (JNC-7 and JNC-8) and the ESH/ESC (2007 and 2013) guidelines. RESULTS: The proportion of participants aged 35-60 years eligible for drug treatment was 25.6% [95% confidence interval (CI) 24.4-26.9%] and 24.8% (95% CI 23.6-26.0%) for the JNC-7 and the JNC-8 guidelines, respectively; for participants aged 60-75 years, the values were 62.3% (95% CI 60.1-64.5%) and 46.8% (95% CI 44.5-49.0%), respectively. Shifting from the JNC-7 to the JNC-8 guidelines would lead to an annual saving of 163.6 million Swiss francs (187.7 million US dollars or 134.5 million European euro). The proportion of participants aged 35-75 years without chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease and eligible for treatment was 30.2% (95% CI 29.0-31.4%) for the ESH/ESC 2007 and 2013 guidelines. For participants with chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease, the values were 73.6% (95% CI 70.8-76.3%) and 55.6% (95% CI 52.5-58.8%), respectively. Shifting from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would lead to an annual saving of 86.9 million Swiss francs (99.5 million US dollars or 71.4 million European euro). CONCLUSION: In Switzerland, shifting from the JNC-7 to the JNC-8 guidelines or from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would decrease the prevalence of patients eligible for treatment and increase the percentage of treated patients within blood pressure goals. Both strategies lead to potential savings in antihypertensive drug treatment.

Silk and ink. What were silk wallets, and what can they, together with Jacobina Charlotta Munterhjelm’s diary, tell us about the gentry women’s lives in the 18th and 19th century?

The subject of this thesis is the elaborate silk wallets and what can they tell about the gentry women’s lives in the 18th and 19th century Finland together Jacobina Charlotta Munsterhjelm’s diary. Silk wallets were made of silk and decorated by embroidering, they were used to preserve memorabilia and letters. Making these lavish items took time, skills and materials, and the decorations usually contained symbols and messages. As main source there are silk wallets from the collections of the National Museum of Finland and Satakunta Museum, as well as the diary of Jacobina Munsterhjelm from 1799 to 1801. By interpreting these items we can build a picture of gentry women’s lives. The culture of silk wallets is European, the silk wallet phenomenon studied is Swedish-Finnish, and the research is limited mainly in Finland by its sources. This research has been carried out by constructing a cultural context to the silk wallets with the help of Ginzburg’s methods from his work Juusto ja madot - 1500-luvun myllärin maailmankuva. Silk wallets represent the gentry as well as the communication culture in the 18th and 19th centuries, but have remained unstudied. The thesis consists of two parts, the first focuses on the silk wallets, from where were they developed, how they were made, and to their decorations. The silk wallet culture developed among the gentry handicrafts during the 18th century and faded during the early 20th century. The making of the silk wallets demanded time, skills and materials. The decorations contain messages and symbols – they contain the possible affections the makers might have toward the receiver, and reflect the status and qualities of the receiver. The second part examines the makers, the gentry women, and the handicraft culture which played a big role in their lives, through silk wallets and the diary of Jacobina Munstehjelm. From there it continues to the affections and meanings which can be found from the silk wallets.

European CMBS pricing: bond, mortgage and real estate characteristics

The recent global economic crisis is often associated with the development and pricing of mortgage-backed securities (i.e. MBSs) and underlying products (i.e. sub-prime mortgages). This work uses a rich database of MBS issues and represents the first attempt to price commercial MBSs (i.e. CMBSs) in the European market. Our results are consistent with research carried out in the US market and we find that bond-, mortgage-, real estate-related and multinational characteristics show different degrees of significance in explaining European CMBS spreads at issuance. Multiple linear regression analysis using a databank of CMBSs issued between 1997 and 2007 indicates a strong relationship with bond-related factors, followed by real estate and mortgage market conditions. We also find that multinational factors are significant, with country of issuance, collateral location and access to more liquid markets all being important in explaining the cost of secured funding for real estate companies. As floater coupon tranches tend to be riskier and exhibit higher spreads, we also estimate a model using this sub-set of data and results hold, hence reinforcing our findings. Finally, we estimate our model for both tranches A and B and find that real estate factors become relatively more important for the riskier investment products.

The European storm Kyrill in January 2007: synoptic evolution, meteorological impacts and some considerations with respect to climate change

The synoptic evolution and some meteorological impacts of the European winter storm Kyrill that swept across Western, Central, and Eastern Europe between 17 and 19 January 2007 are investigated. The intensity and large storm damage associated with Kyrill is explained based on synoptic and mesoscale environmental storm features, as well as on comparisons to previous storms. Kyrill appeared on weather maps over the US state of Arkansas about four days before it hit Europe. It underwent an explosive intensification over the Western North Atlantic Ocean while crossing a very intense zonal polar jet stream. A superposition of several favourable meteorological conditions west of the British Isles caused a further deepening of the storm when it started to affect Western Europe. Evidence is provided that a favourable alignment of three polar jet streaks and a dry air intrusion over the occlusion and cold fronts were causal factors in maintaining Kyrill's low pressure very far into Eastern Europe. Kyrill, like many other strong European winter storms, was embedded in a pre-existing, anomalously wide, north-south mean sea-level pressure (MSLP) gradient field. In addition to the range of gusts that might be expected from the synoptic-scale pressure field, mesoscale features associated with convective overturning at the cold front are suggested as the likely causes for the extremely damaging peak gusts observed at many lowland stations during the passage of Kyrill's cold front. Compared to other storms, Kyrill was by far not the most intense system in terms of core pressure and circulation anomaly. However, the system moved into a pre-existing strong MSLP gradient located over Central Europe which extended into Eastern Europe. This fact is considered determinant for the anomalously large area affected by Kyrill. Additionally, considerations of windiness in climate change simulations using two state-of-the-art regional climate models driven by ECHAM5 indicate that not only Central, but also Eastern Central Europe may be affected by higher surface wind speeds at the end of the 21st century. These changes are partially associated with the increased pressure gradient over Europe which is identified in the ECHAM5 simulations. Thus, with respect to the area affected, as well as to the synoptic and mesoscale storm features, it is proposed that Kyrill may serve as an interesting study case to assess future storm impacts.

The central European floods of August 2002: Part 2 - Synoptic causes and considerations with respect to climatic change

In the first part of this paper (Ulbrich et al. 2003), we gave a description of the August 2002 rainfall events and the resultant floods, in particular of the flood wave of the River Elbe. The extreme precipitation sums observed in the first half of the month were primarily associated with two rainfall episodes. The first episode occurred on 6/7 August 2002. The main rainfall area was situated over Lower Austria, the south-western part of the Czech Republic and south-eastern Germany. A severe flash flood was produced in the Lower Austrian Waldviertel (`forest quarter’ ). The second episode on 11± 13 August 2002 most severely affected the Erz Mountains and western parts of the Czech Republic. During this second episode 312mm of rain was recorded between 0600GMT on 12 August and 0600GMT on 13 August at the Zinnwald weather station in the ErzMountains, which is a new 24-hour record for Germany. The flash floods resulting from this rainfall episode and the subsequent Elbe flood produced the most expensive weatherrelated catastrophe in Europe in recent decades. In this part of the paper we discuss the meteorological conditions and physical mechanisms leading to the two main events. Similarities to the conditions that led to the recent summer floods of the River Oder in 1997 and the River Vistula in 2001 will be shown. This will lead us to a consideration of trends in extreme rainfall over Europe which are found in numerical simulations of anthropogenic climate change.

Made in Italy. Made in Britain. Quality, brands and innovation in the European poultry market, 1950-1980.

This paper compares the development of the poultry industry in Italy with the UK. Earlier research has suggested that the UK poultry industry developed a symbiotic relationship with the emerging supermarket retailers. Italy had a retarded supermarket sector. Its distribution system favoured small-scale, independent butchers rather than chains of self-service supermarkets. Despite this the Italian poultry industry also modernised, adopting US technologies. The catalyst for this modernisation was technological innovation in refrigeration technologies that enabled Italian consumers and independent retailers to be persuaded of the merits of the new ‘technological’ chicken. While the Italian market has become dominated by AIA and Amadori in recent years, the key innovators were the entrepreneurs that created the company called Arena.

Assessment of the dietary intake of total flavan-3-ols, monomeric flavan-3-ols, proanthocyanidins and theaflavins in the European Union

Dietary interventions with flavan-3-ols have shown beneficial effects on vascular function. The translation of these findings into the context of the health of the general public requires detailed information on habitual dietary intake. However, only limited data are currently available for European populations. Therefore, in the present study, we assessed the habitual intake of flavan-3-ol monomers, proanthocyanidins (PA) and theaflavins in the European Union (EU) and determined their main food sources using the EFSA (European Food Safety Authority) Comprehensive European Food Consumption Database. Data for adults aged 18–64 years were available from fourteen European countries, and intake was determined using the FLAVIOLA Flavanol Food Composition Database, developed for the present study and based on the latest US Department of Agriculture and Phenol-Explorer databases. The mean habitual intake of flavan-3-ol monomers, theaflavins and PA ranged from 181 mg/d (Czech Republic) to 793 mg/d (Ireland). The highest intakes of flavan-3-ol monomers and theaflavins were observed in Ireland (191/505 mg/d) and the lowest intakes in Spain (24/9 mg/d). In contrast, the daily intake of PA was highest in Spain (175 mg/d) and lowest in The Netherlands (96 mg/d). Main sources were tea (62 %), pome fruits (11 %), berries (3 %) and cocoa products (3 %). Tea was the major single contributor to monomer intake (75 %), followed by pome fruits (6 %). Pome fruits were also the main source of PA (28 %). The present study provides important data on the population-based intake of flavanols in the EU and demonstrates that dietary intake amounts for flavan-3-ol monomers, PA and theaflavins vary significantly across European countries. The average habitual intake of flavan-3-ols is considerably below the amounts used in most dietary intervention studies.