The clinical value of optimising implant angles during transcatheter aortic valve replacements (TAVR) remains undefined. The Aortic Valve Guide (AVG) is a proprietary software that provides structured analysis of three-dimensional images from rotational angiography (DynaCT). This study compares AVG with preprocedural multislice computed tomography (MSCT) and DynaCT in optimal implant angle prediction for TAVR, and evaluates if an optimised implant angle is associated with reduced paravalvular regurgitation (PVR).One hundred and six consecutive patients were included, comprising three groups. Group 1 (n=19) underwent no preprocedural MSCT or DynaCT (or AVG); Group 2 (n=44) underwent periprocedural DynaCT, without AVG; Group 3 (n=43) had DynaCT with AVG. Implant angles yielded were graded as excellent, satisfactory or poor. Group 3 were more likely than Groups 2 and 1 to have excellent implant angles (83.7% vs. 52.3% vs. 42.1%, respectively, p=0.001). In 100 patients who had 30-day transthoracic echocardiogram follow-up, an excellent implant angle was significantly more likely to be associated with no PVR than a non-excellent angle (41.3% vs. 21.6%, respectively, p=0.045), independent of operator experience and THV used.Optimising implant angles may be important in reducing PVR. This is significantly more likely to be achieved with AVG rotational angiography.
The Gambro Lundia Major 1.36 m2 dialyzer was assessed in vivo in ten hemodialysis patients. Urea and creatinine clearances (measured as whole blood values at 60 minutes with a blood flow rate of 200 ml/minute) were 166 ± 8 m/minute (mean ± standard error of the mean, n = 9) and 115 ± 4 ml/minute (n = 11). The creatinine clearance is 15% lower than in vitro data. There was a marked decrease in urea and creatinine clearance with third use of the dialyzer. The ultrafiltration rate was 490 ml/hour/100 mmHg. The priming volume was 125 ml (at a transmembrane pressure of 100 mmHg) and residual blood volume in the dialyzer was 0.57 ± 0.11 ml (n = 5). The handling, storage and ease of disposal of the dialyzer is better than previous models and its performance characteristics are clinically acceptable.
We report a case of Perthes like changes in the rare disorder of Geleophysic dysplasia and add it to the world literature (24 cases). We found an increased incidence of Perthes at 12% (3/25). Geleophysic dysplasia is characterised by short stature with short limbs distally, normal intelligence, joint stiffness, hepatomegaly and happy facial characteristics. The disease has the clinical and histological appearance of a mucopolysaccharidosis. Perthes changes were seen at the age of 4 years and treated conservatively, with poor clinical results despite the early onset and reasonable radiological improvement. MRI scans of the affected hip did not show any unusual features that differentiate it from normal Perthes disease. The patient also developed carpal tunnel syndrome, which has been seen in with increasing frequency in mucopolysaccharidoses such as Hurlers syndrome, but has not been associated with Geleophysic dysplasia before.
199 Background: A more accurate diagnostic test is still needed to enhance decision-making regarding prostate biopsy. MiCheck is a triage test to assist in a decision to proceed to prostate biopsy. It measures multiple cancer related proteins in blood while combining this information with clinical factors. It has been optimised to differentiate between aggressive (AgCaP) and non-aggressive (non-AgCaP) prostate cancer. The MiCheck-01 clinical trial collected samples from patients who proceeded to biopsy on the basis of an elevated age adjusted PSA. The performance of MiCheck was compared with PSA, %free PSA and PHI. Methods: Serum samples were tested according to the MiCheck manufacturer’s instructions. Patient samples were also tested using a standard PSA assay and additionally underwent PHI and % free PSA measurement. A range of different MiCheck cutpoints were examined for test performance and one chosen following consultation with Urologists and Clinical Chemists. This algorithm was applied to all evaluable patients from the trial and the outputs used for the development of a health economic model. The net cost impact of using MiCheck was assessed. Results: The best performing MiCheck algorithm demonstrated a high AUC when differentiating AgCaP from non-AgCaP. MiCheck demonstrated a higher AUC than PSA, %free PSA and PHI in this population. Furthermore, the algorithm was superior to the other tests in PSA 4-10ng/ml range. The derived algorithm was applied to patients from the trial using a high sensitivity cutpoint. At this cutpoint, 25% of biopsies were avoided while only 5 (4%) AgCaP patients underwent a later diagnosis. A diagnostic workflow model of how the test might be employed by the clinician was constructed. This was applied to a health economic analysis demonstrating significant cost savings (between $2,744 and 5,047 per patient in year one) when incorporating MiCheck to standard of care. Conclusions: The MiCheck test demonstrates a superior ability to discriminate between AgCaP and non-AgCaP in comparison to PSA,PHI, and % free PSA. Use of the MiCheck test would assist clinicians in assessing the need for a prostate biopsy and provide significant healthcare cost savings.
Article Das mechanische Verhalten der Bewegungssegmente an der unteren Halswirbelsäule in Abhängigkeit von der axialen Vorlast unter funktioneller dynamischer Testung. was published on January 1, 1996 in the journal Biomedical Engineering / Biomedizinische Technik (volume 41, issue s1).
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