Calf circumference as a surrogate indicator for detecting low muscle mass in hospitalized geriatric patients.

BACKGROUND: Sarcopenia is characterized by low muscle strength, decreased muscle mass, and decline in physical performance. While the measurements of muscle strength and physical performance are easy to perform, an accurate evaluation of muscle mass is technically more demanding. We therefore evaluated the suitability of calf circumference (CC) as a clinical indicator for muscle mass. METHODS: In a cross-sectional single-centre study, geriatric inpatients were assessed for sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus. Calf circumference was tested for correlation with appendicular skeletal muscle mass index (ASMI). Receiver operating characteristic curves (ROC) were used to calculate the discriminatory value of the CC cut-off values to differentiate patients above and below ASMI cut-offs for sarcopenia. RESULTS: In this study population (n = 305, age 83.5 ± 7.0 years, BMI 25.7 kg/m2, 65.6% female), the prevalence of sarcopenia was 22.6%. In subjects with low ASMI, mean CC was 29.5 ± 3.4 cm for females and 32.0 ± 3.4 cm for males. A positive relationship between CC and ASMI was found. The optimized cut-off value for CC to identify patients with low ASMI was <31.5 cm for females (sensitivity 78%, specificity 79%), and <33.5 cm for males (sensitivity 71%, specificity 62%). CONCLUSION: In clinical settings where imaging technology for muscle mass quantification is not available, simple calf circumference measurement may be used as a dependable indicator for low muscle mass in older adults.

Enhanced proteostasis, lipid remodeling, and nitrogen remobilization define barley flag leaf senescence.

Leaf senescence is a developmental process allowing nutrient remobilization to sink organs. We characterized flag leaf senescence at 7, 14, and 21 d past anthesis in two near-isogenic barley lines varying in the allelic state of the HvNAM1 transcription factor gene, which influences senescence timing. Metabolomics and microscopy indicated that, as senescence progressed, thylakoid lipids were transiently converted to neutral lipids accumulating in lipid droplets. Senescing leaves also exhibited an accumulation of sugars including glucose, while nitrogen compounds (nucleobases, nucleotides, and amino acids) decreased. RNA-Seq analysis suggested lipid catabolism via ß-oxidation and the glyoxylate cycle, producing carbon skeletons and feeding respiration as a replacement of the diminished carbon supply from photosynthesis. Comparison of the two barley lines highlighted a more prominent up-regulation of heat stress transcription factor- and chaperone-encoding genes in the late-senescing line, suggesting a role for these genes in the control of leaf longevity. While numerous genes with putative roles in nitrogen remobilization were up-regulated in both lines, several peptidases, nucleases, and nitrogen transporters were more highly induced in the early-senescing line; this finding identifies processes and specific candidates which may affect nitrogen remobilization from senescing barley leaves, downstream of the HvNAM1 transcription factor.

Quiescent-Interval Slice-Selective MRA Accurately Estimates Intravascular Stent Dimensions Prior to Intervention in Patients With Peripheral Artery Disease.

BACKGROUND: Quiescent-interval slice-selective (QISS) magnetic resonance angiography (MRA) is a non-contrast alternative for the pre-procedural assessment of patients with peripheral artery disease (PAD). However, the feasibility of pre-procedural stent size estimation using QISS MRA would merit investigation. PURPOSE: To evaluate the feasibility of QISS MRA for pre-procedural stent size estimation in PAD patients compared to computed tomography angiography (CTA). STUDY TYPE: Retrospective. SUBJECTS: Thirty-three PAD patients (68 ± 9 years, 18 men, 15 women). FIELD STRENGTH/SEQUENCE: Two-dimensional balanced steady-state free precession QISS MRA at 1.5 T and 3 T. ASSESSMENT: All patients received QISS MRA and CTA of the lower extremity run-off followed by interventional digital subtraction angiography (DSA). Stenotic lesion length and diameter were quantified (AMF and AVS with 3 and 13 years of experience in cardiovascular imaging, respectively) to estimate the dimensions of the stent necessary to restore blood flow in the treated arteries. Measured dimensions were adjusted to the closest stent size available. STATISTICAL TESTS: The Friedman test with subsequent pairwise Wilcoxon signed-rank test was used to compare the estimated stent dimensions between QISS MRA, CTA, and the physical stent size used for intervention. Intra-class correlation (ICC) analysis was performed to assess inter-reader agreement. Significant differences were considered at P < 0.05. RESULTS: No significant difference was observed between estimated stent diameter by QISS MRA or CTA compared to physical stent diameter (8.9 ± 2.9 mm, 8.8 ± 3.0 mm, and 8.8 ± 3.8 mm, respectively; χ2  = 1.45, P = 0.483). There was a significant underestimation of stent length for both QISS MRA and CTA, compared to physical stent length (45.8 ± 27.8 mm, 46.4 ± 29.3 mm, and 50.4 ± 34.0 mm, respectively; χ2  = 11.96) which could be corrected when measurements were adjusted to the next available stent length (χ2  = 2.38, P = 0.303). Inter-reader assessment showed good to excellent agreement between the readers (all ICC ≥0.81). DATA CONCLUSION: QISS MRA represents a reliable method for pre-procedural lesion assessment and stent diameter and length estimation in PAD patients. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

A fully automated software platform for structural mitral valve analysis.

OBJECTIVE: To evaluate a novel fully automated mitral valve analysis software platform for cardiac computer tomography angiography (CCTA)-based structural heart therapy procedure planning. METHODS: The study included 52 patients (25 women; mean age, 66.9 ± 12.4 years) who had undergone CCTA prior to transcatheter mitral valve replacement (TMVR) or surgical mitral valve intervention (replacement or repair). Therapeutically relevant mitral valve annulus parameters (projected area, circumference, trigone-to-trigone (T-T) distance, anterior-posterior (AP) diameter, and anterolateral-posteromedial (AL-PM) diameter) were measured. Results of the fully automated mitral valve analysis software platform with and without manual adjustments were compared with the reference standard of a user-driven measurement program (3mensio, Pie Medical Imaging). Measurements were compared between the fully automated software, both with and without manual adjustment, and the user-driven program using intraclass correlation coefficients (ICC). A secondary analysis included the time to obtain all measurements. RESULTS: Fully automated measurements showed a good to excellent agreement (circumference, ICC = 0.70; projected area, ICC = 0.81; T-T distance, ICC = 0.64; AP, ICC = 0.62; and AL-PM diameter, ICC = 0.78) compared with the user-driven analysis. There was an excellent agreement between fully automated measurement with manual adjustments and user-driven analysis regarding circumference (ICC = 0.91), projected area (ICC = 0.93), T-T distance (ICC = 0.80), AP (ICC = 0.78), and AL-PM diameter (ICC = 0.79). The time required for mitral valve analysis was significantly lower using the fully automated software with manual adjustments compared with the standard assessment (134.4 ± 36.4 s vs. 304.3 ± 77.7 s) (p < 0.01). CONCLUSION: The fully automated mitral valve analysis software, when combined with manual adjustments, demonstrated a strong correlation compared with the user-driven software while reducing the total time required for measurement. KEY POINTS: • The novel software platform allows for a fully automated analysis of mitral valve structures. • An excellent agreement was found between the fully automated measurement with manual adjustments and the user-driven analysis. • The software showed quicker measurement time compared with the standard analysis of the mitral valve.

Individualized coronary calcium scoring at any tube voltage using a kV-independent reconstruction algorithm.

PURPOSE: We prospectively investigate the feasibility of a patient specific automated tube voltage selection (ATVS)-based coronary artery calcium scoring (CACS) protocol, using a kV-independent reconstruction algorithm, to achieve significant dose reductions while maintaining the overall cardiac risk classification. METHODS: Forty-three patients (mean age, 61.8 ± 9.0 years; 40% male) underwent a clinically indicated CACS scan at 120kVp, as well as an additional CACS acquisition using an individualized tube voltage between 70 and 130kVp based on the ATVS selection (CARE-kV). Datasets of the additional CACS scans were reconstructed using a kV-independent algorithm that allows for calcium scoring without changing the weighting threshold of 130HU, regardless of the tube voltage chosen for image acquisition. Agatston scores and radiation dose derived from the different ATVS-based CACS studies were compared to the standard acquisition at 120kVp. RESULTS: Thirteen patients displayed a score of 0 and were correctly identified with the ATVS protocol. Agatston scores derived from the standard 120kVp (median, 33.4; IQR, 0-289.7) and the patient-tailored kV-independent protocol (median, 47.5; IQR, 0-287.5) showed no significant differences (p = 0.094). The intra-class correlation for Agatston scores derived from the two different protocols was excellent (ICC = 0.99). The mean dose-length-product was 29.8 ± 11.9 mGy × cm using the ATVS protocol and 31.7 ± 11.4 mGy × cm using the standard 120kVp protocol (p < 0.001). Additionally, 95% of patients were classified into the same risk category (0, 1-10, 11-100, 101-400, or > 400) using the patient-tailored protocol. CONCLUSIONS: ATVS-based CACS, using a kV-independent algorithm, allows for high accuracy compared to the standard 120kVp scanning, while significantly reducing radiation dose parameters. KEY POINTS: • ATVS allows for CT scanning with reduced radiation dose values. • KV-independent CACS is feasible at any tube voltage between 70 and 130 kVp. • ATVS applied to kV-independent CACS can significantly reduce the radiation dose.

Comparison of Artificial Intelligence-Based Fully Automatic Chest CT Emphysema Quantification to Pulmonary Function Testing.

OBJECTIVE. The purpose of this study was to evaluate an artificial intelligence (AI)-based prototype algorithm for fully automated quantification of emphysema on chest CT compared with pulmonary function testing (spirometry). MATERIALS AND METHODS. A total of 141 patients (72 women, mean age ± SD of 66.46 ± 9.7 years [range, 23-86 years]; 69 men, mean age of 66.72 ± 11.4 years [range, 27-91 years]) who underwent both chest CT acquisition and spirometry within 6 months were retrospectively included. The spirometry-based Tiffeneau index (TI; calculated as the ratio of forced expiratory volume in the first second to forced vital capacity) was used to measure emphysema severity; a value less than 0.7 was considered to indicate airway obstruction. Segmentation of the lung based on two different reconstruction methods was carried out by using a deep convolution image-to-image network. This multilayer convolutional neural network was combined with multilevel feature chaining and depth monitoring. To discriminate the output of the network from ground truth, an adversarial network was used during training. Emphysema was quantified using spatial filtering and attenuation-based thresholds. Emphysema quantification and TI were compared using the Spearman correlation coefficient. RESULTS. The mean TI for all patients was 0.57 ± 0.13. The mean percentages of emphysema using reconstruction methods 1 and 2 were 9.96% ± 11.87% and 8.04% ± 10.32%, respectively. AI-based emphysema quantification showed very strong correlation with TI (reconstruction method 1, ρ = -0.86; reconstruction method 2, ρ = -0.85; both p < 0.0001), indicating that AI-based emphysema quantification meaningfully reflects clinical pulmonary physiology. CONCLUSION. AI-based, fully automated emphysema quantification shows good correlation with TI, potentially contributing to an image-based diagnosis and quantification of emphysema severity.

Evaluation of a Tube Voltage-Tailored Contrast Medium Injection Protocol for Coronary CT Angiography: Results From the Prospective VOLCANIC Study.

OBJECTIVE. The purpose of this study was to prospectively evaluate, using software support, the feasibility and the quantitative and qualitative image quality parameters of a tube voltage-tailored contrast medium (CM) application protocol for patient-specific injection during coronary CT angiography (CCTA). SUBJECTS AND METHODS. In the Voltage-Based Contrast Media Adaptation in Coronary Computed Tomography Angiography (VOLCANIC-CTA) study, a single-center trial, 120 patients referred for CCTA were prospectively assigned to a tube voltage-tailored CM injection protocol. Automated tube voltage levels were selected in 10-kV intervals and ranged from 70 to 130 kV, and the iodine delivery rate (IDR) was adapted to the tube voltage level using dedicated software. The administered CM volume (370 mg I/mL) ranged from 33 mL at 70 kV (IDR, 0.7 g I/s) to 65 mL at 130 kV (IDR, 1.7 g I/s). Attenuation was measured in the aorta and coronary arteries to calculate quantitative signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and 5-point scales were used to evaluate overall image quality. Radiation metrics were also assessed and compared among the protocols. RESULTS. The mean age of the study patients was 62.5 ± 11.9 (SD) years. Image quality was rated as diagnostic in all patients. Contrast attenuation peaked at 70 kV (p < 0.001), whereas SNR and CNR parameters showed no significant differences between tube voltage levels (p ≥ 0.085). Additionally, no significant differences in subjective image quality parameters were found among the different protocols (p ≥ 0.139). The lowest radiation dose values were observed in the group assigned to the 70-kV protocol, which had a median radiation effective dose of 2.0 mSv (p < 0.001). CONCLUSION. The proposed tube voltage-tailored injection protocol allows individualized scanning of patients undergoing CCTA and significantly reduces CM and radiation dose while maintaining a high diagnostic image quality.

Structural and biochemical analysis of the Hordeum vulgare L. HvGR-RBP1 protein, a glycine-rich RNA-binding protein involved in the regulation of barley plant development and stress response.

The timing of whole-plant senescence influences important agricultural traits such as yield and grain protein content. Post-transcriptional regulation by plant RNA-binding proteins is essential for proper control of gene expression, development, and stress responses. Here, we report the three-dimensional solution NMR structure and nucleic acid-binding properties of the barley glycine-rich RNA-binding protein HvGR-RBP1, whose transcript has been identified as being >45-fold up-regulated in early-as compared to late-senescing near-isogenic barley germplasm. NMR analysis reveals that HvGR-RBP1 is a multidomain protein comprising a well-folded N-terminal RNA Recognition Motif (RRM) and a structurally disordered C-terminal glycine-rich domain. Chemical shift differences observed in 2D (1)H-(15)N correlation (HSQC) NMR spectra of full-length HvGR-RBP1 and N-HvGR-RBP1 (RRM domain only) suggest that the two domains can interact both in-trans and intramolecularly, similar to what is observed in the tobacco NtGR-RBP1 protein. Further, we show that the RRM domain of HvGR-RBP1 binds single-stranded DNA nucleotide fragments containing the consensus nucleotide sequence 5'-TTCTGX-3' with low micromolar affinity in vitro. We also demonstrate that the C-terminal glycine-rich (HvGR) domain of Hv-GR-RBP1 can interact nonspecifically with ssRNA in vitro. Structural similarities with other plant glycine-rich RNA-binding proteins suggest that HvGR-RBP1 may be multifunctional. Based on gene expression analysis following cold stress in barley and E. coli growth studies following cold shock treatment, we conclude that HvGR-RBP1 functions in a manner similar to cold-shock proteins and harbors RNA chaperone activity. HvGR-RBP1 is therefore not only involved in the regulation of barley development including senescence, but also functions in plant responses to environmental stress.

Senescence, nutrient remobilization, and yield in wheat and barley.

Cereals including wheat and barley are of primary importance to ensure food security for the 21st century. A combination of lab- and field-based approaches has led to a considerably improved understanding of the importance of organ and particularly of whole-plant (monocarpic) senescence for wheat and barley yield and quality. A delicate balance between senescence timing, grain nutrient content, nutrient-use efficiency, and yield needs to be considered to (further) improve cereal varieties for a given environment and end use. The recent characterization of the Gpc-1 (NAM-1) genes in wheat and barley demonstrates the interdependence of these traits. Lines or varieties with functional Gpc-1 genes demonstrate earlier senescence and enhanced grain protein and micronutrient content but, depending on the environment, somewhat reduced yields. A major effort is needed to dissect regulatory networks centred on additional wheat and barley transcription factors and signalling pathways influencing the senescence process. Similarly, while important molecular details of nutrient (particularly nitrogen) remobilization from senescing organs to developing grains have been identified, important knowledge gaps remain. The genes coding for the major proteases involved in senescence-associated plastidial protein degradation are largely unknown. Membrane transport proteins involved in the different transport steps occurring between senescing organ (such as leaf mesophyll) cells and protein bodies in the endosperm of developing grains remain to be identified or further characterized. Existing data suggest that an improved understanding of all these steps will reveal additional, important targets for continued cereal improvement.

AtWRKY1 at the intersection of plant development and defense: The cost of coping with adversity.

The life cycle of many plants including our most important crops is short, with weeks to months between germination and death. Monocarpic plants flower only once, with seed/grain filling dependent on nutrient remobilization from senescing parental plants. A mature crop stand such as a harvest-ready wheat field is the result of mass suicide, with only the seeds/grains as living entities.

[The Impact of Nutrition on Muscle Health in Older Individuals]. / Die Rolle der Ernährung für die Muskelgesundheit im Alter.

The Impact of Nutrition on Muscle Health in Older Individuals Abstract: The age-related change in the importance of nutrition for muscle health starts at the age of 50. Considering its effects on the mobility and physical independence of older people, the aging of the musculoskeletal system represents one of the greatest public health challenges and tasks for a demographically aging Switzerland. In particular sarcopenia, a pathological decrease in muscle strength, muscle mass and muscle function beyond the physiological age-related changes, correlates with a significantly increased risk of falls as well as increasing morbidity and mortality. Common chronic diseases related to old age not only promote additional muscle loss but also frailty, leading to an additional decline of the quality of life. General practitioners play a crucial role in the initial assessment of changing life circumstances and activity profiles of older people. Thanks to their medical care over many years they are able to identify functional impairments of their aging patients at an early stage and address them in time. This is important because the combination of a high-protein diet and exercise may be extremely effective for improving muscle health and function. Eating more proteins (taking into account the newly revised and increased daily protein requirement for healthy seniors of 1,0-1,2g/kg body weight (bw)) can significantly slow down age-related muscle loss. Depending on age and comorbidities, the daily protein requirement might be even higher (1,5 to 2,0g/kg bw). According to current studies, a minimal protein amount of 25-35g per main dish is recommended for optimal muscle growth stimulation among older individiuals. Thanks to their highly potent boosting power on myofibrillar protein synthesis rates the amino acid L-leucine and L-leucine-rich foods play an important role in elderly people's diet.

CNN-based evaluation of bone density improves diagnostic performance to detect osteopenia and osteoporosis in patients with non-contrast chest CT examinations.

PURPOSE: As osteoporosis is still underdiagnosed by clinicians and radiologists, the aim of the present study was to assess the performance of an Artificial intelligence (AI)-based Convolutional Neuronal Network (CNN)-Algorithm for the detection of low bone density on routine non-contrast chest CT in comparison to clinical reports using DEXA scans as reference. METHOD: This retrospective cross-sectional study included patients who underwent non-contrast chest CT and DEXA between April 2018 and June 2018 (n = 109, 19 men, mean age: 67.7 years). CT studies were evaluated for thoracic vertebral bone pathologies using a CNN-Algorithm, which calculates the attenuation profile of the spine. The content of the radiological reports was evaluated for the description of osteoporosis or osteopenia. DEXA was used as the reference standard. To estimate correlation the Spearman test was used and the comparison of the different groups was performed using the Wilcoxon rank sum test. Diagnostic was evaluated by performing a receiver operating characteristic curve analysis. RESULTS: The DEXA examination revealed normal bone density in 42 patients, while 49 patients had osteopenia and 7 osteoporosis. There was a statistically significant correlation between the mean CNN-based attenuation of the thoracic spine and the bone density measured on the DEXA in the hip (r = 0.51, p < 0.001) and lumbar spine (r = 0.34, p = 0.01). The mean attenuation was significantly higher in patients with normal bone density (172 ± 44.5 HU) compared to those with osteopenia or osteoporosis (125.2 ± 33.8 HU), (p < 0.0001). Diagnostic performance in distinguishing normal from abnormal bone density was higher using the CNN-based vertebral attenuation (accuracy 0.75, sensitivity: 0.93, specificity: 0.61) compared to clinical reports (accuracy 0.51, sensitivity: 0.14, specificity: 0.53). CONCLUSION: CNN-based evaluation of bone density may provide additional value over standard clinical reports for the detection of osteopenia and osteoporosis in patients undergoing routine non-contrast chest CT scans. This additional value could improve identification of fracture risk and subsequent treatment.

Control of barley (Hordeum vulgare L.) development and senescence by the interaction between a chromosome six grain protein content locus, day length, and vernalization.

Regulatory processes controlling traits such as anthesis timing and whole-plant senescence are of primary importance for reproductive success and for crop quality and yield. It has previously been demonstrated that the presence of alleles associated with high grain protein content (GPC) at a locus on barley chromosome six leads to accelerated leaf senescence, and to strong (>10-fold) up-regulation of several genes which may be involved in senescence control. One of these genes (coding for a glycine-rich RNA-binding protein termed HvGR-RBP1) exhibits a high degree of similarity to Arabidopsis glycine-rich RNA-binding protein 7 (AtGRP7), which has been demonstrated to accelerate flowering under both long-day (LD) and short-day (SD) conditions, but not after vernalization. Development of near-isogenic barley lines, differing in the allelic state of the GPC locus, was compared from the seedling stage to maturity under both SD and LD and after vernalization under LD. Intriguingly, pre-anthesis plant development [measured by leaf emergence timing and pre-anthesis (sequential) leaf senescence] was enhanced in high-GPC germplasm. Differences were more pronounced under SD than under LD, but were eliminated by vernalization, associating observed effects with floral induction pathways. By contrast, differences in post-anthesis flag leaf and whole-plant senescence between low- and high-GPC germplasm persisted under all tested conditions, indicating that the GPC locus, possibly through HvGR-RBP1, impacts on both developmental stages. Detailed molecular characterization of this experimental system may allow the dissection of cross-talk between signalling pathways controlling early plant and floral development on one side, and leaf/whole-plant senescence on the other side.

Performance of an Artificial Intelligence-Based Platform Against Clinical Radiology Reports for the Evaluation of Noncontrast Chest CT.

RATIONALE AND OBJECTIVES: Research on implementation of artificial intelligence (AI) in radiology workflows and its impact on reports remains scarce. In this study, we aim to assess if an AI platform would perform better than clinical radiology reports in evaluating noncontrast chest computed tomography (CT) scans. MATERIALS AND METHODS: Consecutive patients who had undergone noncontrast chest CT were retrospectively identified. The radiology reports were reviewed in a binary fashion for reporting of pulmonary lesions, pulmonary emphysema, aortic dilatation, coronary artery calcifications (CAC), and vertebral compression fractures (VCF). CT scans were then processed using an AI platform. The reports' findings and the AI results were subsequently compared to a consensus read by two board-certificated radiologists as reference. RESULTS: A total of 100 patients (mean age: 64.2 ± 14.8 years; 57% males) were included in this study. Aortic segmentation and calcium quantification failed to be processed by AI in 2 and 3 cases, respectively. AI showed superior diagnostic performance in identifying aortic dilatation (AI: sensitivity: 96.3%, specificity: 81.4%, AUC: 0.89) vs (Reports: sensitivity: 25.9%, specificity: 100%, AUC: 0.63), p <0.001; and CAC (AI: sensitivity: 89.8%, specificity: 100, AUC: 0.95) vs (Reports: sensitivity: 75.4%, specificity: 94.9%, AUC: 0.85), p = 0.005. Reports had better performance than AI in identifying pulmonary lesions (Reports: sensitivity: 97.6%, specificity: 100%, AUC: 0.99) vs (AI: sensitivity: 92.8%, specificity: 82.4%, AUC: 0.88), p = 0.024; and VCF (Reports: sensitivity:100%, specificity: 100%, AUC: 1.0) vs (AI: sensitivity: 100%, specificity: 63.7%, AUC: 0.82), p <0.001. A comparable diagnostic performance was noted in identifying pulmonary emphysema on AI (sensitivity: 80.6%, specificity: 66.7%. AUC: 0.74) and reports (sensitivity: 74.2%, specificity: 97.1%, AUC: 0.86), p = 0.064. CONCLUSION: Our results demonstrate that incorporating AI support platforms into radiology workflows can provide significant added value to clinical radiology reporting.

Optimization of contrast material administration for coronary CT angiography using a software-based test-bolus evaluation algorithm.

OBJECTIVES: To evaluate the benefit of a prototype circulation time-based test bolus evaluation algorithm for the individualized optimal timing of contrast media (CM) delivery in patients undergoing coronary CT angiography (CCTA). METHODS: Thirty-two patients (62 ± 16 years) underwent CCTA using a prototype bolus evaluation tool to determine the optimal time-delay for CM administration. Contrast attenuation, signal-to-noise ratio (SNR), objective, and subjective image quality were evaluated by two independent radiologists. Results were compared to a control cohort (matched for age, sex, body mass index, and tube voltage) of patients who underwent CCTA using the generic test bolus peak attenuation +4 s protocol as scan delay. RESULTS: In the study group, the mean time delay to CCTA acquisition was significantly longer (26.0 ± 2.9 s) compared to the control group (23.1 ± 3.5 s; p < 0.01). In the study group, SNR improvement was seen in the right coronary artery (17.5 vs 13; p = 0.028), the left main (15.3 vs 12.3; p = 0.027), and the left anterior descending artery (18.5 vs 14.1; p = 0.048). Subjective image quality was rated higher in the study group (4.75 ± 0.7 vs 3.64 ± 0.5; p < 0.001). CONCLUSIONS: The prototype test bolus evaluation algorithm provided a reliable patient-specific scan delay for CCTA that ensured homogenous vascular attenuation, improvement in objective and subjective image quality, and avoidance of beam hardening artifacts. ADVANCES IN KNOWLEDGE: The prototype contrast bolus evaluation and optimization tool estimated circulation time-based time-delay improves the overall quality of CCTA.

Non-invasive fractional flow reserve (FFRCT) in the evaluation of acute chest pain - Concepts and first experiences.

OBJECTIVE: To evaluate 30 day rate of major adverse cardiac events (MACE) utilizing cCTA and FFRCT for evaluation of patients presenting to the Emergency Department (ED) with acute chest pain. MATERIALS AND METHODS: Patients between the ages of 18-95 years who underwent clinically indicated cCTA and FFRCT in the evaluation of acute chest pain in the emergency department were retrospectively evaluated for 30 day MACE, repeat presentation/admission for chest pain, revascularization, and additional testing. RESULTS: A total of 59 patients underwent CCTA and subsequent FFRCT for the evaluation of acute chest pain in the ED over the enrollment period. 32 out of 59 patients (54 %) had negative FFRCT (>0.80) out of whom 18 patients (55 %) were discharged from the ED. Out of the 32 patients without functionally significant CAD by FFRCT, 32 patients (100 %) underwent no revascularization and 32 patients (100 %) had no MACE at the 30-day follow-up period. CONCLUSION: In this limited retrospective study, patients presenting to the ED with acute chest pain and with CCTA with subsequent FFRCT of >0.8 had no MACE at 30 days; however, for many of these patients results were not available at time of clinical decision making by the ED physician.

Evaluating a New Contrast Media Injection System in Coronary CT Angiography.

PURPOSE: To evaluate a new contrast media (CM) injection system in patients undergoing coronary computed tomography angiography (CCTA). METHODS: Seventy-one consecutive patients (33 men and 38 women, mean age 59.0 ± 14.5 years) who underwent CCTA between February and April 2019 using the CT injection system MEDRAD Stellant FLEX (Bayer) were included retrospectively in this single-center study. Quantitative and qualitative image quality parameters were assessed, and the injection system's usability and operational efficiency were evaluated. Results were compared with a matched control group. RESULTS: All examinations were rated as diagnostic. Usability and operational efficiency of the new injector were rated higher than that of the standard injector system, and no significant differences were found for quantitative and qualitative image quality parameters compared with the control group (P ≥ .05). DISCUSSION: Software-based injection facilitates individualized CM application while maintaining high image quality standards in CCTA. Diagnostic accuracy analysis was not performed, but as image quality analysis showed no significant differences, no discrepancies regarding this issue are expected. CONCLUSION: This study demonstrates that the MEDRAD Stellant FLEX CT injection system allows for consistent high-quality CCTA scanning with increased usability and operational efficiency.

Analysis of barley (Hordeum vulgare) leaf senescence and protease gene expression: a family C1A cysteine protease is specifically induced under conditions characterized by high carbohydrate, but low to moderate nitrogen levels.

SUMMARY: Senescence is the highly regulated last developmental phase of plant organs and tissues, and is optimized to allow nutrient remobilization to surviving plant parts, such as seeds of annual crops. High leaf carbohydrate to nitrogen (C : N) ratios have been implicated in the induction or acceleration of the senescence process. *A combination of phloem interruption in mature leaves (by steam-girdling, leading to carbohydrate accumulation from photosynthesis) and varied nitrate supply was used to analyse correlations between metabolite levels, leaf senescence parameters and induction of protease genes and proteolytic activities. *Its strong induction under conditions characterized by high C : N ratios, negative correlation of its transcript levels with chlorophylls and nitrates, its strong induction during developmental leaf senescence and its predicted localization to a lytic vacuolar compartment indicate that, among the genes tested, a family C1A cysteine protease is most likely to participate in bulk protein degradation during barley leaf senescence. *While all the genes analysed were selected based on upregulation during leaf senescence in a previous transcriptomic study, a considerably more detailed picture of protease gene regulation emerged from the data presented here, underlining the usefulness of this experimental approach for further (functional) protease characterization.

A major grain protein content locus on barley (Hordeum vulgare L.) chromosome 6 influences flowering time and sequential leaf senescence.

Timing of various developmental stages including anthesis and whole-plant ('monocarpic') senescence influences yield and quality of annual crops. While a correlation between flowering/seed filling and whole-plant senescence has been observed in many annuals, it is unclear how the gene networks controlling these processes interact. Using near-isogenic germplasm, it has previously been demonstrated that a grain protein content (GPC) locus on barley chromosome 6 strongly influences the timing of post-anthesis flag leaf senescence, with high-GPC germplasm senescing early. Here, it is shown that the presence of high-GPC allele(s) at this locus also accelerates pre-anthesis plant development. While floral transition at the shoot apical meristem (SAM; determined by the presence of double ridges) occurred simultaneously, subsequent development was faster in the high- than in the low-GPC line, and anthesis occurred on average 5 d earlier. Similarly, sequential (pre-anthesis) leaf senescence was slightly accelerated, but only after differences in SAM development became visible. Leaf expression levels of four candidate genes (from a list of genes differentially regulated in post-anthesis flag leaves) were much higher in the high-GPC line even before faster development of the SAM became visible. One of these genes may be a functional homologue of Arabidopsis glycine-rich RNA-binding protein 7, which has previously been implicated in the promotion of flowering. Together, the data establish that the GPC locus influences pre- and post-anthesis barley development and senescence, and set the stage for a more detailed analysis of the interactions between the molecular networks controlling these important life history traits.

Artificial Intelligence-based Fully Automated Per Lobe Segmentation and Emphysema-quantification Based on Chest Computed Tomography Compared With Global Initiative for Chronic Obstructive Lung Disease Severity of Smokers.

OBJECTIVES: The objective of this study was to evaluate an artificial intelligence (AI)-based prototype algorithm for the fully automated per lobe segmentation and emphysema quantification (EQ) on chest-computed tomography as it compares to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification of chronic obstructive pulmonary disease (COPD) patients. METHODS: Patients (n=137) who underwent chest-computed tomography acquisition and spirometry within 6 months were retrospectively included in this Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study. Patient-specific spirometry data, which included forced expiratory volume in 1 second, forced vital capacity, and the forced expiratory volume in 1 second/forced vital capacity ratio (Tiffeneau-Index), were used to assign patients to their respective GOLD stage I to IV. Lung lobe segmentation was carried out using AI-RAD Companion software prototype (Siemens Healthineers), a deep convolution image-to-image network and emphysema was quantified in each lung lobe to detect the low attenuation volume. RESULTS: A strong correlation between the whole-lung-EQ and the GOLD stages was found (ρ=0.88, P<0.0001). The most significant correlation was noted in the left upper lobe (ρ=0.85, P<0.0001), and the weakest in the left lower lobe (ρ=0.72, P<0.0001) and right middle lobe (ρ=0.72, P<0.0001). CONCLUSIONS: AI-based per lobe segmentation and its EQ demonstrate a very strong correlation with the GOLD severity stages of COPD patients. Furthermore, the low attenuation volume of the left upper lobe not only showed the strongest correlation to GOLD severity but was also able to most clearly distinguish mild and moderate forms of COPD. This is particularly relevant due to the fact that early disease processes often elude conventional pulmonary function diagnostics. Earlier detection of COPD is a crucial element for positively altering the course of disease progression through various therapeutic options.