Klinikum Wilhelmshaven

Handheld ultrasound (HHUS) devices are increasingly used in clinical practice due to their portability and cost-effectiveness. However, HHUS image quality remains variable, and a standardized expert-based evaluation protocol is lacking. This study compares the image quality of B-mode recordings of five HHUS models with a high-end reference system (HEUS) using a blinded assessment to identify differences, covariates, offering a standardized evaluation framework.In this blinded, multi-center study, video sequences of the liver, pancreas, and sigmoid colon were recorded in ten volunteers using 5 HHUS devices - Vscan Air, Butterfly iQ+, Philips Lumify, Clarius C3, and Clarius C3 HD3 - and one HEUS (GE Logiq E10). Twenty-two physicians with many years of abdominal ultrasound experience rated blinded clips for 5 image quality parameters.The HEUS consistently received the highest ratings. Image quality differed significantly between HHUS devices. Clarius systems showed the smallest deviation from the reference, followed by Vscan Air and Philips Lumify. All image parameters significantly correlated with the overall impression, without a single dominant factor. The patients' BMI had no relevant influence. Examiner experience was less impactful than device familiarity and personal preference.The image quality of HEUS remained superior to all tested HHUS devices. Further subdivision of image quality aspects did not provide additional information. Furthermore, we could not identify significant covariates in our setup. These findings could justify simplified setups with reduced questionnaires and requirements for examiners.

Organic falls, hydrothermal vent fields and seeps rely primarily on chemosynthetic organic production leading to a carbon enriched habitat set against the oligotrophic deep-sea background. These habitats are typically inhabited by novel faunal assemblages with similar functional characteristics and often show harsh environmental gradients over relatively small scales with severe effects on diversity and density compared to the benthic background fauna. While the importance of particulate organic matter (POM) has been pointed out, the presence of POM as local accumulated organic deposits within hydrothermal vent fields has not been studied. Here, we present the first observations of organic deposits within active vents in the Indian Ocean including observations of giant capitellid worms inhabiting these organic mats with a length of up to 30 cm. This potential new species occurred in shrimp carcasses, the exuvia of Rimicaris kairei , on two hydrothermal vent sites from the Indian Ocean. We used imagery to build a high-resolution 3D reconstruction model of one side of a chimney complex, including the 4.8 m 2 surface area of the exuvia deposit. The capitellids occurred in dense aggregations and may contribute significantly to the food web of active hydrothermal vent fields, representing a possible overlooked food source for benthic and demersal predators. In addition, we report on observations on further organic deposit types and compare their associated epifauna along the mid-ocean ridges of the Indian Ocean. The exuvia deposits where capitellids were present appeared to be compacted and compressed implicating a potential role in stabilizing seafloor habitat. This is the first record of the family Capitellidae in organic deposits at hydrothermal vent fields, where they may serve as ecosystem engineers. • First report of organic deposits and associated megafauna at hydrothermal vents. • Potential new species of polychaetes (Capitellidae). • Capitellids may act as engineering species and increase taxonomic richness. • High frequency of capitellids may influence food-web dynamics within active vents.

Zielsetzung Entwicklung eines Verfahrens zur automatischen Segmentierung des linken Atriums sowie Bestimmung linksatrialer struktureller Parameter und Fibrose zur Patientenselektion, Planung und Kontrolle der Katheterablation bei Vorhofflimmern.

Einleitung Die gekreuzte Nierendystopie ist mit einer Inzidenz von 1:2100-1:3000 angegeben, wobei die hier vorliegende links kreuzende fusionierte Dystopie etwas seltener ist [1]. Es kommt zu einer Verlagerung einer Niere bis hin zur partiellen Fusion beider Nieren bei normal erhaltener Einmündung des Ureters in die Harnblase. Die gekreuzte Dystopie ist eine zumeist asymptomatische Normvariante der Nieren ohne Einschränkung der Lebensqualität oder einer potentiellen Lebenszeitverkürzung [2] ([Abb. 1]), ([Abb. 2]).

Abstract Human Optimization versus ›Courage to be Imperfect‹ Following a contextualisation of the concept of optimization, the focus is on the development of a critical position inspired by Günther Anders’ studies on the antiquated nature of human beings and early Individual Psychology, from whose environment the plea for the ›courage to be imperfect‹ originates. From the mutual discussion of both positions, proposals are developed for linking to this plea, which also critically illuminate humanist-based efforts to revitalise repressed ideals of perfection.

BackgroundNumerous studies have reported clinical endpoints following coronary revascularization using bioresorbable vascular scaffolds (BVS), while information about the impact on health-related quality of life is sparse. In this analysis of the German-Austrian ABSORB RegIstRy, the 2 year results concerning quality of life development in a large cohort of patients treated with BVS were reported.MethodsData were collected at baseline as well as 30 days, 6 and 24 months after coronary revascularization using BVS. The EQ-5D score, EQ visual analogue scale (VAS) and Seattle Angina Questionnaire (SAQ) were determined for each time point. Patients were categorized according to the indication for coronary revascularization [acute coronary syndrome (ACS), stable angina pectoris (SAP), silent myocardial ischemia (SMI), or other]. Binary logistic regression analysis was performed to determine factors that predict above-average scores two years after implantation.ResultsData from 1317 patients in 88 centres were included. Reasons for revascularization were: ACS (n = 643), SAP (n = 443), SMI (n = 52), and other (n = 179). Mean EQ-5D was significantly increased after six months, while a value comparable to baseline was found two years after implantation. EQ VAS and four of five dimensions of SAQ were significantly improved over baseline at all follow-up surveys. Particularly strong improvements were seen in SAQ scores angina frequency and quality of life. Binary regressions showed different statistically significant predictors in the respective models.ConclusionsFollowing coronary revascularization with BVS strong decrease in self-reported angina frequency and increase of self-reported quality of life were observed with continuous improvements over two years of follow-up.Trial registration ClinicalTrials.gov Identifier: NCT02066623.

Clinical guidelines recommend the development of ST-elevation myocardial infarction (STEMI) networks at community, regional and/or national level to ideally offer primary coronary angioplasty, or at least the best available STEMI care to all patients. However, there is a discrepancy between this clinical recommendation and daily practice, with no coordinated care for STEMI patients in many regions of the world. While this can be a consequence of lack of resources, in reality it is more frequently a lack of organisational power. In this paper, the Stent - Save a Life! Initiative (www.stentsavealife.com) proposes a practical methodology to set up a STEMI network effectively in any region of the world with existing resources, and to develop the STEMI network continuously once it has been established.

BackgroundThis prospective phase I/II trial assessed feasibility and efficacy of dose-escalated definitive chemoradiation after induction chemotherapy in locally advanced esophageal cancer. Primary study endpoint was loco-regional progression-free survival at 1 year.MethodsEligible patients received 2 cycles of induction chemotherapy with irinotecan, folinic acid and 5-fluorouracil weekly and cisplatin every 2 weeks (weeks 1–6, 8–13) followed by concurrent chemoradiation with cisplatin and irinotecan (weeks 14, 15, 17, 18, 20). Radiotherapy dose escalation was performed in three steps (60 Gy, 66 Gy, 72 Gy) using conventional fractionation, planning target volumes were delineated with the aid of 18F-FDG-PET/CT scans. During follow-up, endoscopic examinations were performed at regular intervals.ResultsBetween 09/2006 and 02/2010, 17 patients were enrolled (male/female:13/4, median age: 59 [range 48–66] years, stage uT3N0/T3N1/T4N1: 4/12/1). One patient progressed during induction chemotherapy and underwent surgery. Of 16 patients treated with definitive chemoradiotherapy, 9 (56%) achieved complete response after completion of chemoradiation. One-, 2-, 3- and 5-year overall survival rates (OS) were 77% [95%CI: 59–100], 53% [34–83], 41% [23–73], and 29% [14–61], respectively. Loco-regional progression-free survival at 1, 3, and 5 years was 59% [40–88], 35% [19–67], and 29% [14–61], corresponding cumulative incidences of loco-regional progressions were 18% [4–39%], 35% [14–58%], and 41% [17–64%]. No treatment related deaths occurred. Grade 3 toxicities during induction therapy were: neutropenia (41%), diarrhoea (41%), during combined treatment: neutropenia (62%) and thrombocytopenia (25%).ConclusionsDose-escalated radiotherapy and concurrent cisplatin/irinotecan after cisplatin/irinotecan/5FU induction chemotherapy was tolerable. The hypothesized phase II one-year loco-regional progression free survival rate of 74% was not achieved. Long-term survival compares well with other studies on definitive radiotherapy using irinotecan and cisplatin but is not better than recent trials using conventionally fractionated radiotherapy ad 50 Gy with concurrent paclitaxel or 5FU and platinum compound.Trial registration The present trial was registered as a phase I/II trial at the EudraCT database: Nr. 2005-006097-10 (https://www.clinicaltrialsregister.eu/ctr-search/trial/2005-006097-10/DE) and authorized to proceed on 2006-09-25.

The European-Commission-funded project 'Citclops' (Citizens' observatory for coast and ocean optical monitoring) developed methods, tools and sensors, which can be used by citizens to monitor natural waters, with a strong focus on long-term data series related to environmental sciences. The new sensors, based on optical technologies, respond to a number of scientific, technical and societal objectives, ranging from more precise monitoring of key environmental descriptors of the aquatic environment (water colour, transparency and fluorescence) to an improved management of data collected with citizen participation. The sensors were tested, calibrated, integrated on several platforms, scientifically validated and demonstrated in the field. The new methods and tools were tested in a citizen-science context. The general conclusion is that citizens are valuable contributors in quality and quantity to the objective of collecting, integrating and analysing fragmented and diverse environmental data. An integration of these data into data-analysis tools has a large potential to support authoritative monitoring and decision-making. In this paper, the project's objectives, results, technical achievements and lessons learned are presented.