The common interests of health protection and the economy: evidence from scenario calculations of COVID-19 containment policies

We develop a novel approach integrating epidemiological and economic models that allows data-based simulations during a pandemic. We examine the economically optimal opening strategy that can be reconciled with the containment of a pandemic. The empirical evidence is based on data from Germany during the SARS-CoV-2 pandemic. Our empirical findings reject the view that there is necessarily a conflict between health protection and economic interests and suggest a non-linear U-shape relationship: it is in the interest of public health and the economy to balance non-pharmaceutical interventions in a manner that further reduces the incidence of infections. Our simulations suggest that a prudent strategy that leads to a reproduction number of around 0.75 is economically optimal. Too restrictive policies cause massive economic costs. Conversely, policies that are too loose lead to higher death tolls and higher economic costs in the long run. We suggest this finding as a guide for policy-makers in balancing interests of public health and the economy during a pandemic.

Automated Detection of Cerebral Aneurysms on TOF-MRA Using a Deep Learning Approach: An External Validation Study

BACKGROUND AND PURPOSE

Cerebral aneurysms yield the risk of rupture, severe disability and death. Thus, early detection of cerebral aneurysms is crucial to ensure timely treatment, if necessary. AI-based software tools are expected to enhance radiologists' performance in detecting pathologies like cerebral aneurysms in the future. Our aim was to evaluate the diagnostic performance of an artificial intelligence-based software designed to detect intracranial aneurysms on TOF-MRA.

MATERIALS AND METHODS

One hundred ninety-one MR imaging data sets were analyzed using the software mdbrain for the presence of intracranial aneurysms on TOF-MRA obtained using two 3T MR imaging scanners or a 1.5T MR imaging scanner according to our clinical standard protocol. The results were compared with the reading of an experienced radiologist as a criterion standard to measure the sensitivity, specificity, positive and negative predictive values, and accuracy of the software. Additionally, detection rates depending on size, morphology, and location of the aneurysms were evaluated.

RESULTS

Fifty-four aneurysms were detected by the expert reader. The overall sensitivity of the software for the detection of cerebral aneurysms was 72.6%, the specificity was 87.2%, and the accuracy was 82.6%. The positive predictive value was 67.9%, and the negative predictive value was 88.5%. We observed a sensitivity of 100% for saccular aneurysms of >5 mm without signs of thrombosis and low detection rates for fusiform or thrombosed aneurysms of 33.3% and 16.7%, respectively. Of 8 aneurysms that were not included in the initial written reports but were detected by the expert reader, retrospectively, 4 were detected by the software.

CONCLUSIONS

Our data suggest that the software can assist radiologists in reporting TOF-MRA. The software was highly reliable in detecting saccular aneurysms, while for fusiform or thrombosed aneurysms, further improvements are needed. Further studies are necessary to investigate the impact of the software on detection rates, interrater reliability, and reading times.

The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach

Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.

Treatment of Proximal Posterior Inferior Cerebellar Artery Aneurysms by Intrasaccular Flow Disruption: A Multicenter Experience

BACKGROUND AND PURPOSE

Treatment of PICA aneurysms can be technically challenging by either surgical or endovascular means. Our aim was to report our preliminary experience with intrasaccular flow disruption using the Woven EndoBridge (WEB) for the treatment of proximal PICA aneurysms.

MATERIALS AND METHODS

Sixteen PICA aneurysms treated with the WEB at 3 institutions were retrospectively reviewed. Baseline patient and aneurysm characteristics, procedural specifics, clinical outcomes, and angiographic results were evaluated.

RESULTS

All aneurysms were located at the proximal, anteromedullary segment of the PICA. Seven aneurysms were ruptured. The median aneurysm size was 3.9 mm (range, 2-12 mm), and all aneurysms were wide-neck. WEB deployment failed in 1 case due to WEB protrusion in a small PICA aneurysm. Additional stent implantation was required for 2 aneurysms to improve intra-aneurysmal WEB positioning. One patient developed a partial posterior cerebral artery territory infarction with transient hemianopsia. Intraoperative rerupture of a ruptured aneurysm could be immediately stopped by WEB deployment due to intrasaccular stasis; however, it might have contributed to a slight disability of the patient. At last angiographic follow-up, 12/15 aneurysms (80%) were completely occluded and 3/15 (20%) had a neck remnant.

CONCLUSIONS

The preliminary results indicate that WEB treatment of proximal PICA aneurysms is feasible with a reasonable safety and efficacy profile. The advantages of intrasaccular flow disruption include preservation of the PICA, durable aneurysm occlusion, and omission of antiplatelet therapy. The low-profile WEB 17 delivery system might enable navigation to distal PICA aneurysms, which needs to be addressed further.

[Debate about Accural Accounting - Reply and Response]

In its September 2020 issue, Wirtschaftsdienst published an article entitled "Bremst die Doppik öffentliche Investitionen? Ergebnisse aus drei aktuellen Evaluationsstudien" by Désirée Christofzik, Florian Dorn, Stefanie Gäbler, Christian Raffer and Felix Rösel. Stephan Stüber takes a different view in a reply, and Christofzik et al. explain their point of view in a response.

Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement

BACKGROUND AND PURPOSE

There are only few data and lack of consensus regarding antiplatelet management for carotid stent placement in the setting of endovascular stroke treatment. We aimed to develop a consensus-based algorithm for antiplatelet management in acute ischemic stroke patients undergoing endovascular treatment and simultaneous emergent carotid stent placement.

MATERIALS AND METHODS

We performed a literature search and a modified Delphi approach used Web-based questionnaires that were sent in several iterations to an international multidisciplinary panel of 19 neurointerventionalists from 7 countries. The first round included open-ended questions and formed the basis for subsequent rounds, in which closed-ended questions were used. Participants continuously received feedback on the results from previous rounds. Consensus was defined as agreement of ≥70% for binary questions and agreement of ≥50% for questions with >2 answer options. The results of the Delphi process were then summarized in a draft manuscript that was circulated among the panel members for feedback.

RESULTS

A total of 5 Delphi rounds were performed. Panel members preferred a single intravenous aspirin bolus or, in jurisdictions in which intravenous aspirin is not available, a glycoprotein IIb/IIIa receptor inhibitor as intraprocedural antiplatelet regimen and a combination therapy of oral aspirin and a P2Y12 inhibitor in the postprocedural period. There was no consensus on the role of platelet function testing in the postprocedural period.

CONCLUSIONS

More and better data on antiplatelet management for carotid stent placement in the setting of endovascular treatment are urgently needed. Panel members preferred intravenous aspirin or, alternatively, a glycoprotein IIb/IIIa receptor inhibitor as an intraprocedural antiplatelet agent, followed by a dual oral regimen of aspirin and a P2Y12 inhibitor in the postprocedural period.

Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

BACKGROUND AND PURPOSE

There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This study aimed to identify current challenges in antiplatelet management during stent-assisted coiling/flow diversion for ruptured intracranial aneurysms and to outline possible antiplatelet management strategies.

MATERIALS AND METHODS

The modified DELPHI approach with an on-line questionnaire was sent in several iterations to an international, multidisciplinary panel of 15 neurointerventionalists. The first round consisted of open-ended questions, followed by closed-ended questions in the subsequent rounds. Responses were analyzed in an anonymous fashion and summarized in the final manuscript draft. The statement received endorsement from the World Federation of Interventional and Therapeutic Neuroradiology, the Japanese Society for Neuroendovascular Therapy, and the Chinese Neurosurgical Society.

RESULTS

Data were collected from December 9, 2019, to March 13, 2020. Panel members achieved consensus that platelet function testing may not be necessary and that antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms can follow the same principles. Preprocedural placement of a ventricular drain was thought to be beneficial in cases with a high risk of hydrocephalus. A periprocedural dual, intravenous, antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor was preferred as a standard approach. The panel agreed that intravenous medication can be converted to oral aspirin and an oral P2Y12 inhibitor within 24 hours after the procedure.

CONCLUSIONS

More and better data on antiplatelet management of patients with ruptured intracranial aneurysms undergoing stent-assisted coiling or flow diversion are urgently needed. Panel members in this DELPHI consensus study preferred a periprocedural dual-antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor.

Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility

BACKGROUND AND PURPOSE

The Woven EndoBridge 17 has recently been introduced to the market for facilitated endovascular treatment of small bifurcation aneurysms (≤7 mm) with low-profile microcatheters. We compared the Woven EndoBridge 17 with its predecessor versions in terms of procedural safety and feasibility.

MATERIALS AND METHODS

This was a multicenter review of aneurysms ranging from 3 to 7 mm treated with the Woven EndoBridge between 2011 and 2019. Aneurysm characteristics, procedural parameters, and complications were retrospectively compared between treatment with the Woven EndoBridge 17 and a control group that was treated with its predecessor versions, using inverse probability of treatment weighting.

RESULTS

Thirty-eight aneurysms treated with a Woven EndoBridge 17 (mean size, 4.9 ± 1.5 mm) and 70 treated with a predecessor version of the Woven EndoBridge 17 (mean size, 5.6 ± 1.4 mm) were included. The predecessor version of the Woven EndoBridge 17 had a higher failure rate (10.3%) than the Woven EndoBridge 17 (0%, P = .05). Additional stent placement was performed more often with the predecessor version of the Woven EndoBridge 17 (10.0%) than with the Woven EndoBridge 17 (2.6%, adjusted P = .005). The predecessor version of the Woven EndoBridge 17 was associated with a higher thromboembolic event rate (14.3%) than the Woven EndoBridge 17 (5.3%, adjusted P = .002). Neurologic complications (Woven EndoBridge 17: 2.6%; predecessor version of the Woven EndoBridge 17: 2.9%, adjusted P = 1.0) and immediate complete aneurysm occlusion rates (Woven EndoBridge 17: 57.9%; predecessor version of the Woven EndoBridge 17: 54.3%, adjusted P = .21) did not differ significantly between groups.

CONCLUSIONS

In the current study, the Woven EndoBridge 17 was associated with a potentially lower thromboembolic event rate than the predecessor version of the Woven EndoBridge 17, without compromising the immediate aneurysm occlusion rate. Long-term clinical and angiographic outcome analysis will be necessary to draw a definite conclusion.

Effects of standardized acoustic stimulation in premature infants: a randomized controlled trial

OBJECTIVE

The objective of this study was to investigate the effects of recorded lullabies and taped maternal voice in premature infants.

STUDY DESIGN

Sixty-two preterm infants in a stable condition with 30<37 weeks of gestation and <10 days of postnatal age were randomly assigned to hear (A) recorded lullabies or (B) taped maternal voice for 30 min each evening during 14 consecutive days or (C) receive no standardized acoustic stimulation (control group). Heart rate and respiratory rate were recorded daily before, during and after the intervention (A and B) or a comparable period with no intervention (C), whereas activity was measured on days 1, 7 and 14 of the intervention using accelerometers.

RESULTS

Both interventions led to a significant decrease in heart rate and respiratory rate during and after the stimulation when compared with the control group. The changes were more pronounced in infants with higher gestational ages (P=0.001). Lower activity was measured during the intervention when compared with the control group (P<0.01).

CONCLUSIONS

Standardized acoustic stimulation with recorded lullabies and taped maternal voice led to a decrease in heart rate and respiratory rate, and was associated with lower activity. Whether this indicates a reduced stress reaction needs to be investigated in further studies.

Stent Retriever Thrombectomy in Patients Who Are Ineligible for Intravenous Thrombolysis: A Multicenter Retrospective Observational Study

BACKGROUND AND PURPOSE

Intravenous thrombolysis with rtPA is the standard of care for patients with acute ischemic stroke within 4.5 hours after symptom onset. However, a considerable number of patients are ineligible for IV thrombolysis due to various contraindications. Recent studies have proved the superiority of mechanical thrombectomy for patients with large-vessel occlusions in combination with IV rtPA compared with IV rtPA alone. We aimed to demonstrate the efficacy of mechanical thrombectomy for patients who are ineligible for IV rtPA.

MATERIALS AND METHODS

Patients from the stroke registries of 4 dedicated centers who were treated with mechanical thrombectomy from January 2010 to October 2014 were retrospectively evaluated. Inclusion criteria were the following: acute stroke due to proved large-artery occlusion, ineligibility for IV thrombolysis, and a timeframe of ≤4.5 hours between stroke and the start of mechanical thrombectomy. Recanalization success, periprocedural complications, clinical outcome, and hemorrhages were evaluated.

RESULTS

One hundred thirty endovascular recanalization procedures were identified. The locations were the following: proximal ICA in 17 (13.1%), terminus ICA in 25 (19.2%), M1 segment in 77 (59.2%), and M2 segment in 11 (8.5%). TICI 2b/3 results were achieved in 101 (77.7%), and an mRS score of 0-2 in 47 patients (37.9%). There was a significant correlation between TICI 2b/3 results and good clinical outcomes (87.2% versus 6.8%; P = .048). A good clinical result was most frequent when recanalization was achieved within 4.5 hours (37/74 = 50% versus 10/50 = 20.0%; P = .001). Symptomatic hemorrhage occurred in 13.1% of patients; mortality was 24.2%. Periprocedural complications were recorded in 10 patients (7.7%).

CONCLUSIONS

Mechanical thrombectomy can achieve good clinical outcomes in patients with acute large-artery occlusion ineligible for IV thrombolysis, in particular when recanalization is reached early.

Initial Clinical Experience with a New Self-Expanding Nitinol Microstent for the Treatment of Wide-Neck Intracranial Cerebral Aneurysms: The Acandis Acclino Stent

BACKGROUND AND PURPOSE

The Acclino is a laser-cut closed-cell microstent composed of nitinol. It was developed for stent-assisted coiling of wide-neck intracranial aneurysms. The key feature of the stent is its deployability via low-profile microcatheters with an inner diameter of 0.0165 inch, which are also suited for coil deployment. The objective of this study was to evaluate the safety and feasibility as well as the immediate and mid-term results of this new device.

MATERIALS AND METHODS

Our database was screened for all Acclino-based stent-assisted intracranial coil embolizations since its introduction to the European market in June 2012. Case files and imaging data were retrospectively analyzed for angiographical and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications.

RESULTS

Fourteen patients comprising 14 aneurysms (9 unruptured and 5 ruptured) were treated with the Acclino. All except for a dissecting one were wide-neck saccular aneurysms. Immediate complete occlusion (RROC1) was observed in 8/14 cases (57%), a residual neck (RROC2) in 4/14 (29%), and a persistent filling of the dome (RROC 3) in 1/14 cases (7%). An in-stent thrombus formation in one case (7%) was medically resolved without neurological deficit. Follow-up was available in 9/14 cases (64%) after a mean of 137 days (SD ± 50). All followed cases depicted a complete occlusion (RROC1).

CONCLUSIONS

The Acclino microstent showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization in wide-neck intracranial aneurysms, warranting further investigation of the device.

Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results

INTRODUCTION

Acute tandem occlusions of the cervical and distal internal carotid artery (ICA) or middle cerebral artery (MCA) are associated with major stroke with intravenous (i.v.) thrombolysis alone in approximately 90 % of patients. The data on endovascular management of tandem occlusions is still limited. The purpose of this study was to review technical aspects and the current state of the literature on acute ICA stenting in combination with stent retriever-based intracranial thrombectomy.

METHODS

We retrospectively reviewed the data of 37 consecutive patients with tandem occlusions including clinical parameters, angiographic results, procedural aspects, complications, and hemorrhages.

RESULTS

Median National Institutes of Health Stroke Scale (NIHSS) on admission was 17 (3-30). Intracranial thrombectomy was performed prior to ICA stenting in 25/37 (67.6 %) and after stenting in 12/37 (32.4 %) patients. ICA stenting was successful in all cases, and a thrombolysis in cerebral infarction (TICI) scale 2b/3 result was achieved in 27/37 (73 %) cases. The mean angiography time was significantly shorter in the "thrombectomy first" group (43.1 ± 30.8 vs. 110.8 ± 43.0 min, p < 0.001), and more patients had favorable outcomes after 3 months (13/25 = 52.0 vs. 4/12 = 33.3 %, p = 0.319). In this group, intermediate catheters were used and successfully prevented embolism to unaffected territories in all cases.

CONCLUSION

Acute stenting of the cervical ICA in combination with intracranial thrombectomy was technically feasible and safe in our series. Thrombectomy prior to proximal stenting was associated with shorter reperfusion times and a tendency towards better clinical outcome leading to a good outcome in about 50 % of the patients. Therefore, we recommend this approach in tandem occlusion requiring stent angioplasty.

Über die intrazelluläre Mg-Ionenaktivität von E. coli-Zellen

Die Mg-Ionenaktivität in E. coli-Zellen wurde mit einer Mg-empfindlichen Elektrode bestimmt.

Die intrazelluläre Mg-Ionenaktivität ist bei einer extrazellulären Mg-Konzentration unter 10-3 M wesentlich höher als die extrazelluläre und nahezu unabhängig von der extrazellulären Mg-Konzentration. Bei hohen extrazellulären Mg-Konzentrationen ist die intrazelluläre Mg-Ionenaktivität niedriger als die extrazelluläre. Wachsende Zellen haben eine etwas höhere intrazelluläre Mg-Ionenaktivität als nichtwachsende. Beim Wachsen in Mg-armen Medien bleibt die intracelluläre Mg-Ionenaktivität nahezu konstant, obwohl der Mg-Gehalt abnimmt.

Unter Mg- oder N-Mangel gewachsene Zellen nehmen bei hohen extrazellulären Mg-Konzentrationen mehr Mg auf als normale Kontrollzellen. Diese vermehrte Mg-Aufnahme wird durch 10-3 M 2.4 DNP in PO4-haltigen Medien oder durch Waschen mit NaCl-KCl-Lösung vermindert.

Über den K-Transport bei der K-Mangelmutante E. coli B 525

Der intracelluläre Na- und K-Gehalt von E. coli B 163 und seiner K-Mangelmutante B 525 wurde in Abhängigkeit von der extracellulären K-, Na- und H⊕-Konzentration sowie in Gegenwart verschiedener Substrate und Stoffwechselinhibitoren untersucht.

E. coli B 163 und seine K-Mangelmutante B 525 transportieren K aktiv in die Zelle. Durch die Mutation ist der Austritt des K aus der Zelle erhöht. Die Versuchsergebnisse lassen auf eine Carrier-begünstigste Diffusion des K aus der Zelle schließen. Dieser Carrier müßte durch die Mutation eine höhere Affinität für K bekommen haben und nun gleichzeitig mit Na reagieren

Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study

BACKGROUND AND PURPOSE

The endovascular treatment of intracranial aneurysms with unfavorable anatomy (large aneurysms, wide-neck) is frequently challenging and is also associated with a high incidence of significant recurrences. The WEB, an intrasaccular flow disrupter, was designed for use in this type of aneurysm. We report our early experience with this device in this multicenter study.

MATERIALS AND METHODS

Twenty patients with 21 aneurysms were treated by using the WEB in 3 European centers. The ability to successfully deploy the WEB, immediate posttreatment angiographic results, adverse events, clinical outcome, and angiographic follow-up results were recorded.

RESULTS

Aneurysm location was the ICA (4/21, 19.1%), MCA (8/21, 38.1%), AcomA (5/21, 23.8%), and BA (4/21, 19.1%). No treatment failures were reported. Treatment was performed exclusively with the WEB in 16/21 (76.2%) patients. Additional treatment (coiling and/or stent placement) was used in 5/21 (23.8%) patients. One patient (4.8%) experienced transient clinical worsening (mRS 1 at 1 month, mRS 0 at 3 months) related to a thromboembolic event. Inadvertent detachment of the WEB was observed, and the WEB was retrieved in 1 patient, without adverse effects. In the short-term follow-up (2-8 months), adequate occlusion (total occlusion or neck remnant) was observed in 80.0% of aneurysms.

CONCLUSIONS

Intrasaccular flow disruption is a new endovascular approach for aneurysm treatment. In our preliminary experience, this treatment was feasible and mostly used in bifurcation aneurysms (MCA, BA, ICA) with unfavorable anatomy. Further studies are needed to precisely evaluate the indications, safety, and efficacy of this new technique.

Stent angioplasty of intracranial stenosis: single center experience of 54 cases

PURPOSE

The aim of the study was to retrospectively evaluate the safety and efficacy of stent angioplasty of symptomatic intracranial stenosis in a single center experience.

MATERIALS AND METHODS

Between November 2006 and September 2009 a total of 54 stent angioplasties were performed in 49 patients and of these 46 were done for symptomatic intracranial high-grade (>70%) stenoses and 8 for complete vessel occlusions in acute stroke. All elective treatments were carried out with patients under antithrombotic/anticoagulant medication. Self-expandable stents were used in 42 cases and balloon-expandable stents in 12 cases.

RESULTS

Stent angioplasty was successful in 53 out of 54 cases (98%). Periprocedural complications occurred in 6 patients, including 2 dissections, 1 contrast-mediated toxic reaction and 1 thromboembolic event with transient neurological deficits but did not cause permanent neurological deficits, in any of the cases. Adverse events within 30 days after intervention occurred in 11 of the 49 patients (20.4%) of which 4 were scheduled patients (8.3%) and 7 were treated for acute stroke with complete vessel occlusions (87.5%). Overall there were 9 cases of restenosis (7 out of 9>90% stenoses and 2 complete vessel occlusions), 5 out of 9 were asymptomatic, 4 out of 9 had a transient ischemic attack and 1 developed a major stroke. Two complete in-stent thromboses were seen in acute stroke patients with initial complete occlusion within 24 h after recanalization. One restenosis and one complete occlusion occurred under double antiplatelet medication, 4 out of 9 restenoses occurred under aspisol medication and 3 out of 9 after antiplatelet medication was discontinued. In 2 out of 9 restenoses, balloon-expandable stents had been used, the remaining 7 had been treated with self-expanding stents, 5 out of 9 restenoses were treated by balloon-angioplasty alone, in 3 out of 9 an additional stent had to be placed and 1 asymptomatic occlusion was left untreated.

CONCLUSIONS

The results demonstrate the technical feasibility and satisfactory success rates of stent angioplasty in intracranial atherosclerotic stenoses. The procedural success rate was 98% and the overall rate of adverse events was 20.4%. The rate of adverse events was high in unstable patients (87.5%) treated without antiplatelet premedication, especially in the setting of an acute stroke. In stable patients the rate of adverse events was much lower (8.3%). Future development of dedicated stents and a better understanding of factors that predispose to restenosis may help to further decrease the rate of periprocedural and postprocedural adverse events thus helping to improve both short-term and long-term outcome after intracranial stent angioplasty.

Step and shoot coronary CT angiography using 256-slice CT: effect of heart rate and heart rate variability on image quality

OBJECTIVE

To evaluate the effect of heart rate variability (HRV) and heart rate (HR) on intra-image "motion" and inter-image "stairstep" artefacts in step-and-shoot coronary CT angiography (CCTA) using a wide detector CT scanner.

METHODS

66 patients underwent step-and-shoot CCTA using 256-slice CT. Patients were divided into two groups (Group 1: HR <65 bpm, Group 2 ≥65bpm). Motion artefacts were quantified using a 5-point-scale. Stairstep artefacts were defined by measurements of misalignment. Image noise, contrast-to-noise-ratio (CNR), signal-to-noise-ratio (SNR), and radiation dose were assessed.

RESULTS

Mean HR was 66 ± 16.7 bpm (range: 45-125 bpm) and mean HRV was 10.7 ± 17.5 bpm. A significant correlation between HR and stairstep artefacts (r = 0.46, p < 0.001) and motion artefacts (r = 0.63, p < 0.001) was found. Group 2 showed significantly increased step artefacts with a mean misalignment of 1.4 mm compared to 0.4 mm in Group 1 (p < 0.001). There was no significant effect of HRV on stairstep artefacts (r = 0.15, p = 0.416) and motion artefacts (r = 0.13, p = 0.311). No significant differences in image noise, CNR, SNR, and radiation dose were seen.

CONCLUSIONS

Unlike CCTA using narrow CT detectors, HRV has no significant effect on motion and stairstep artefacts using a wide CT detector with high z-coverage. However, a higher HR still increases stairstep and motion artefacts.

[Reduction of catecholamine liberation by drugs. Therapeutic alternative to beta sympathicolysis in coronary disease?]

Plasma catecholamines have been determined in 10 persons with healthy coronary circulation (group A) and in 10 patients with coronary cardiac illness (group B) before and immediately after ergometer loading. The loading dosis amounted on average to 177.5 watts for group A and 80 watts for group B. Under load, the catecholamines rose significantly for group A (p less than 0.01) and highly significantly for group B (p less than 0.001). After 10 days of therapy with a combination preparation (12 mg of diphenhydramine hydrochloride, 100 mg of meprobamate, 5 mg of nicotinic acid = Visano-mini), the catecholamines were again determined for groups A and B before and after loading. The catecholamines were not significantly changed by therapy, neither for group A nor B. Under the therapy, the rise in catecholamines caused by load was distinctly lower than before without therapy, namely significantly lowered for group A (p less than 0.01) and slightly significantly for group B (p less than 0.02). Also significantly lowered under therapy in terms of percentage was the catecholamine rise caused by the load, namely by 27% against 75% for group A, by 35% against 89% for group B. As the first results show, Visano-mini seems to constitute an interesting catecholamine inhibiting combination of substances. Whether this might possibly lead to a therapeutic alternative to the betasympathicolysis will have to be determined on the basis of further investigations.

[Significance of clinical and functional diagnostic findings for the physical rehabilitation ability of the patients with heart infarct]

In 75 patients with condition after myocardial infarction or chronic ischaemic heart disease, respectively, was tested to what extent from clinical and functional-diagnostic findings prognostic estimations concerning the regaining of a cardiocirculatory functional capacity corresponding to age are possible by a complex rehabilitation programme. A daily ergometer training lasting eight weeks which was individually dosed was in the centre of rehabilitation. It was shown that from the findings of ergometry with permanent ECG-registration the effect of rehabilitation, as a rule, can be predicted.