2015 Update on Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Large Multi-National and Multi-Ethnical Population Experience With 37788 Patients From the EuroCMR Registry

OBJECTIVES

Specifically we aim to demonstrate that the results of our earlier safety data hold true in this much larger multi-national and multi-ethnical population.

BACKGROUND

We sought to re-evaluate the frequency, manifestations, and severity of acute adverse reactions associated with administration of several gadolinium- based contrast agents during routine CMR on a European level.

METHODS

Multi-centre, multi-national, and multi-ethnical registry with consecutive enrolment of patients in 57 European centres.

RESULTS

During the current observation 37,788 doses of Gadolinium based contrast agent were administered to 37,788 patients. The mean dose was 24.7 ml (range 5-80 ml), which is equivalent to 0.123 mmol/kg (range 0.01 - 0.3 mmol/kg). Forty-five acute adverse reactions due to contrast administration occurred (0.12%). Most reactions were classified as mild (43 of 45) according to the American College of Radiology definition. The most frequent complaints following contrast administration were rashes and hives (15 of 45), followed by nausea (10 of 45) and flushes (10 of 45). The event rate ranged from 0.05% (linear non-ionic agent gadodiamide) to 0.42% (linear ionic agent gadobenate dimeglumine). Interestingly, we also found different event rates between the three main indications for CMR ranging from 0.05% (risk stratification in suspected CAD) to 0.22% (viability in known CAD).

CONCLUSIONS

The current data indicate that the results of the earlier safety data hold true in this much larger multi-national and multi-ethnical population. Thus, the "off-label" use of Gadolinium based contrast in cardiovascular MR should be regarded as safe concerning the frequency, manifestation and severity of acute events.

[Vaccine Preventable Diseases: Knowledge, Attitudes and Vaccination Status of Medical Students]

Study Objective: Health-care workers (HCW) have an increased risk of acquiring infectious diseases and constitute a risk of transmission to their patients. Medical students working as HCW should therefore have the same immunity against vaccine preventable diseases as HCW. The aim of the study was to assess medical students' knowledge and attitudes towards occupationally indicated vaccinations as well as their vaccination status. Methods: Questionnaires were anonymously answered by medical students of the fourth preclinical semester at the Goethe-University Frankfurt. Results and Conclusion: Despite a high acceptance among medical students concerning vaccinations in general, the knowledge and vaccination status of the students should be improved. For instance, only 46.4% of the medical students knew that there is a general recommendation for HCW to receive the influenza vaccination and only 76.8% of the students stated to have received 2 measles vaccinations. Overall, 2/3 of the students were "very much in favour of vaccinations" or "completely in favour of vaccinations" and estimated the probability for unvaccinated HCW to acquire an occupationally associated infectious disease to be "quite high" or "very high". Having observed a positive attitude among medical students towards vaccinations, it should be possible to reach high vaccination coverage amongst students by offering them occupationally indicated vaccinations. Further knowledge concerning vaccine preventable diseases and the occupation-related increased risk for infectious diseases should be offered, as well.

When ignorance is bliss: weight perception, body mass index and quality of life in adolescents

Background/Objectives:

Body weight is negatively associated with adolescent Health-Related Quality of Life (HRQoL). Despite this well-established relationship, some adolescents with obesity do not display the expected HRQoL decreases. This study hypothesised weight perception as a moderator of the association between weight status and adolescent HRQoL.

Subjects/Methods:

Subjects were secondary school students from an obesity prevention project in the Barwon South-West region of Victoria, Australia, entitled It's Your Move (N=3040). Measures included standardised body mass index (BMI-z; World Health Organization growth standards), weight perception and HRQoL, measured by the Paediatric Quality of Life Inventory. Linear regression and average marginal effect analyses were conducted on cross-sectional baseline data to determine the significance of any interaction between weight perception and measured weight status in shaping adolescent HRQoL.

Results:

The BMI-z/perceived weight status interaction was significantly associated with adolescent HRQoL outcomes. Adolescents with BMI z-scores in the overweight/obesity range who perceived themselves as overweight had lower HRQoL than those who perceived themselves as ‘about right.' Conversely, adolescents with BMI scores in the lower end of the normal range or in the thinness range who perceived themselves as underweight had lower HRQoL than those with ‘about right' perceptions.

Conclusions:

This was the first study to report third-variable impacts of a body-perception variable on the relationship between adolescent weight status and HRQoL. Adolescents' weight perceptions significantly moderated the relationship between overweight/obesity and reduced HRQoL. Adolescents who were outside the normal weight range and misperceived their objectively measured weight status enjoyed a higher HRQoL than adolescents whose weight perception was concordant with their actual weight status. These findings suggest that practitioners may need to exercise caution when educating adolescents about their weight status, as such ‘reality checks' may negatively impact on adolescent HRQoL. It is suggested that more research be conducted to examine this potential effect.

[Limitations of surgery for rectal cancer]

This article presents and summarizes different treatment options for rectal cancer. The aim of this article is an historical review of treating primary and recurrent rectal cancer, highlighting the development and advancement in surgical and multimodal therapy. Limitations, specifically regarding recurrent rectal cancer are discussed and reviewed. A R0 resection can almost always be achieved in primary rectal cancer. In recurrent rectal cancer a R0 resection with extended surgical resection can be achieved in up to 70 % of the cases. In addition, surgical therapy plays a crucial role in the case of metastatic disease but should be incorporated into a multimodal network. The analysis of tumor genetics and predictive parameters will lead to the emergence of new treatment concepts shifting the limits of the current gold standard. Oncological long-term survival and improving the quality of life are the main focal points.

Relationship between overweight and health-related quality of life in secondary school children in Fiji: results from a cross-sectional population-based study

OBJECTIVE

To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity.

METHODS

The study comprised 8947 children from forms 3-6 (age 12-18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.

RESULTS

HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12-14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15-18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen's d 0.2-0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen's d <0.2).

DISCUSSION

The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.

Cooperation between scientists, NGOs and industry in support of sustainable fisheries: the South African hake Merluccius spp. trawl fishery experience

This paper examines the increasingly close interaction between natural and social scientists, non-governmental organizations (NGO) and industry, in pursuit of responsible ecosystem-based management of fisheries. South Africa has committed to implementing an ecosystem approach to fisheries management. Management advice stems from multi-stakeholder representation on government-led scientific and management working groups. In the hake Merluccius capensis and Merluccius paradoxus fishery, the primary management measure is an annual total allowable catch (TAC), the level of which is calculated using a management procedure (MP) that is revised approximately every 4 years. Revision of the MP is a consultative process involving most stakeholders, and is based on simulation modelling of projected probable scenarios of resource and fishery dynamics under various management options. NGOs, such as the Worldwide Fund for Nature in South Africa (WWF-SA), have played an important role in influencing consumers, the fishing industry and government to develop responsible fishing practices that minimize damage to marine ecosystems. Cooperation between industry, government and scientists has helped to improve sustainability and facilitated the meeting of market-based incentives for more responsible fisheries. Research includes ecosystem modelling, spatial analysis and ecosystem risk assessment with increasing research focus on social and economic aspects of the fishery. A four-year cooperative experiment to quantify the effect of trawling on benthic community structure is being planned. The food requirements of top predators still need to be included in the TAC-setting formulae and more social and economic research is needed. This paper also demonstrates how NGO initiatives such as Marine Stewardship Council certification and the Southern African Sustainable Seafood Initiative, a traffic light system of classifying seafood for consumers, have contributed to responsible fishing practices, increased ecosystem research and public awareness. This fishery appears to have a good future, provided that the monitoring, control and surveillance systems continue to function, TACs remain within ecologically sustainable limits and the effective collaboration between government, industry, scientists and NGOs continues to drive positive change.

Ultrathin reduced graphene oxide films as transparent top-contacts for light switchable solid-state molecular junctions

A new type of solid-state molecular junction is introduced, which employs reduced graphene oxide as a transparent top contact that permits a self-assembled molecular monolayer to be photoswitched in situ, while simultaneously enabling charge-transport measurements across the molecules. The electrical switching behavior of a less-studied molecular switch, dihydroazulene/vinylheptafulvene, is described, which is used as a test case.

A mathematical model of the mechanical link between shortening of the cardiomyocytes and systolic deformation of the left ventricular myocardium

BACKGROUND

Left ventricular myocytes are arranged in a complex three-dimensional mesh. Since all myocytes contract approximately to the same degree, mechanisms must exist to enable force transfer from each of these onto the framework as a whole, despite the transmural differences in deformation strain. This process has hitherto not been clarified in detail.

OBJECTIVE

To present a geometrical model that establishes a mechanical link between the three-dimensional architecture and the function of the left ventricular myocardium.

METHODS

The left ventricular equator was modeled as a cylindrical tube of deformable but incompressible material, composed of virtual cardiomyocytes with known diastolic helical and transmural angles. By imposing reference circumferential, longitudinal, and torsional strains onto the model, we created a three-dimensional deformation field to calculate passive shortening of the myocyte surrogates. We tested two diastolic architectures: 1) a simple model with longitudinal myocyte surrogates in the endo- and epicardium, and circular ones in the midwall, and 2) a more accurate architecture, with progressive helical angle distribution varying from -60° in the epicardium to 60° in the endocardium, with or without torsion and transmural cardiomyocyte angulation.

RESULTS

The simple model caused great transmural unevenness in cardiomyocyte shortening; longitudinal surrogates shortened by 15% at all depths equal to the imposed longitudinal strain, whereas circular surrogates exhibited a maximum shortening of 23.0%. The accurate model exhibited a smooth transmural distribution of cardiomyocyte shortening, with a mean (range) of 17.0 (13.2-20.8)%. Torsion caused a shortening of 17.0 (15.2-18.9)% and transmural angulation caused a shortening of 15.2 (12.4-18.2)%. Combining the effects of transmural angulation and torsion caused a change of 15.2 (13.2-16.5)%.

CONCLUSION

A continuous transmural distribution of the helical angle is obligatory for smooth shortening of the cardiomyocytes, but a combination of torsional and transmural angulation changes is necessary to execute systolic mural thickening whilst keeping shortening of the cardiomyocytes within its physiological range.

Linking geology, fluid chemistry, and microbial activity of basalt- and ultramafic-hosted deep-sea hydrothermal vent environments

Hydrothermal fluids passing through basaltic rocks along mid-ocean ridges are known to be enriched in sulfide, while those circulating through ultramafic mantle rocks are typically elevated in hydrogen. Therefore, it has been estimated that the maximum energy in basalt-hosted systems is available through sulfide oxidation and in ultramafic-hosted systems through hydrogen oxidation. Furthermore, thermodynamic models suggest that the greatest biomass potential arises from sulfide oxidation in basalt-hosted and from hydrogen oxidation in ultramafic-hosted systems. We tested these predictions by measuring biological sulfide and hydrogen removal and subsequent autotrophic CO2 fixation in chemically distinct hydrothermal fluids from basalt-hosted and ultramafic-hosted vents. We found a large potential of microbial hydrogen oxidation in naturally hydrogen-rich (ultramafic-hosted) but also in naturally hydrogen-poor (basalt-hosted) hydrothermal fluids. Moreover, hydrogen oxidation-based primary production proved to be highly attractive under our incubation conditions regardless whether hydrothermal fluids from ultramafic-hosted or basalt-hosted sites were used. Site-specific hydrogen and sulfide availability alone did not appear to determine whether hydrogen or sulfide oxidation provides the energy for primary production by the free-living microbes in the tested hydrothermal fluids. This suggests that more complex features (e.g., a combination of oxygen, temperature, biological interactions) may play a role for determining which energy source is preferably used in chemically distinct hydrothermal vent biotopes.

Association of P2X7 receptor polymorphisms with bone mineral density and osteoporosis risk in a cohort of Dutch fracture patients

The P2X7 receptor is thought to be involved in bone physiology in a pro-osteogenic manner. Therefore, we examined associations between genetic variations in the P2X7 receptor gene and bone mineral density (BMD). We found an association between four non-synonymous polymorphism of the human P2X7 receptor and the risk of osteoporosis.

INTRODUCTION

The purpose of this study was to determine whether genetic variation in the P2X7 receptor gene (P2RX7) is associated with decreased BMD and risk of osteoporosis in fracture patients.

METHODS

Six hundred ninety women and 231 men aged≥50 years were genotyped for 15 non-synonymous P2RX7 SNPs. BMD was measured at the total hip, lumbar spine and femoral neck.

RESULTS

Four non-synonymous SNPs were associated with BMD. The Ala348Thr gain-of-function polymorphism was associated with increased BMD values at the lumbar spine (p=0.012). Decreased hip BMD values were associated with two loss-of-function SNPs in the P2RX7, i.e., in subjects homozygous for the Glu496Ala polymorphism as well as in subjects carrying at least one variant allele of the Gly150Arg polymorphism (p=0.018 and p=0.011; respectively). In men, we showed that subjects either heterozygous or homozygous for the Gln460Arg gain-of-function polymorphism in the P2RX7 had a significantly 40% decrease in risk of a lower T-score value (OR=0.58 [95%CI, 0.33-1.00]).

CONCLUSION

Thus, genetic aberrations of P2X7R function are associated with lower BMD and increased osteoporosis risk. Therefore, detection of non-synonymous SNPs within the P2RX7 might be useful for osteoporosis risk estimation at an early stage, potentially enabling better osteoporosis prevention and treatment.