Radiation dose reduction in CT with adaptive statistical iterative reconstruction (ASIR) for patients with bronchial carcinoma and intrapulmonary metastases.

AIM: To compare the radiation dose and image quality of 64-row chest computed tomography (CT) in patients with bronchial carcinoma or intrapulmonary metastases using full-dose CT reconstructed with filtered back projection (FBP) at baseline and reduced dose with 40% adaptive statistical iterative reconstruction (ASIR) at follow-up. MATERIALS AND METHODS: The chest CT images of patients who underwent FBP and ASIR studies were reviewed. Dose-length products (DLP), effective dose, and size-specific dose estimates (SSDEs) were obtained. Image quality was analysed quantitatively by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurement. In addition, image quality was assessed by two blinded radiologists evaluating images for noise, contrast, artefacts, visibility of small structures, and diagnostic acceptability using a five-point scale. RESULTS: The ASIR studies showed 36% reduction in effective dose compared with the FBP studies. The qualitative and quantitative image quality was good to excellent in both protocols, without significant differences. There were also no significant differences for SNR except for the SNR of lung surrounding the tumour (FBP: 35±17, ASIR: 39±22). DISCUSSION: A protocol with 40% ASIR can provide approximately 36% dose reduction in chest CT of patients with bronchial carcinoma or intrapulmonary metastases while maintaining excellent image quality.

Insect emergence in relation to floods in wet meadows and swamps in the River Dalälven floodplain.

Annual variation in flood frequency and hydroperiod during the vegetation season has ecological impacts on the floodplain biota. Although many insect groups may have a lower emergence during a flood event, it is poorly known how annual emergence of insects in temporary wetlands is related to the variation in hydrology. Between May and September, we studied the weekly emergence of 18 insect taxa over six consecutive years, 2002-2007, in six temporary flooded wetlands (four wet meadows and two forest swamps) in the River Dalälven floodplains, Central Sweden. We used emergence traps to collect emerging insects from terrestrial and aquatic parts of wet meadows and swamp forests. In all wetlands, the insect fauna was numerically dominated by the orders Diptera, Hymenoptera, Coleoptera and Homoptera. On a weekly basis, 9 out of the 18 insect taxa had lower emergence in weeks with flood than in weeks with no flood, whereas no taxon had a higher emergence in weeks with flood. Over the seasons, we related insect emergence to seasonal flood frequency and length of hydroperiod. The emergence of most studied taxa decreased with increasing hydroperiod, which suggests that emergence after floods do not compensate for the reduced emergence during floods. Only Culicidae and the aquatic Chironomidae sub-families Tanypodinae and Chironominae showed an increase in emergence with increasing hydroperiod, whereas Staphylinidae peaked at intermediate hydroperiod. We conclude that a hydroperiod covering up to 40% of the vegetation season has a significant negative effect on the emergence of most taxa and that only a few taxa occurring in the temporary wetlands are actually favoured by a flood regime with recurrent and unpredictable floods.

A six-year study of insect emergence from temporary flooded wetlands in central Sweden, with and without Bti-based mosquito control.

In temporary wetlands in the River Dalälven floodplains, recurrent but irregular floods induce massive hatching of the flood-water mosquito Aedes sticticus, which causes enormous nuisance. Flood-water mosquito control using the biological larvicide Bacillus thuringiensis var. israelensis (Bti) was commenced in parts of the floodplains during 2002, and here we report the first six years of full-season monitoring of general insect emergence from temporary wetlands with and without treatment. Emergence traps, which were emptied weekly, were used from May to September each year. A total of 137,153 insects of 13 taxonomic orders were collected. Diptera was highly dominating and especially the sub-order Nematocera with 18 families was a very prominent taxon. Bti-treatment effects were analysed by taxonomic order, by sub-order in Diptera and Hemiptera, and by family for Nematocera and Coleoptera for the whole study period. We found no significant negative effects of Bti treatments on the production of insects by taxonomic order, with the exception of Coleoptera in the long term. However, no significant negative effects were found for the Coleoptera families, neither in the short term nor in the long term. There was no significant negative treatment effect on Nematocera production, neither when analyzed for the whole sub-order nor when analyzed by family. However, abundance of Ceratopogonidae was significantly higher in experimental than in reference wetlands. We conclude that Bti-treatment effects on insect production may be minute in comparison to other environmental factors structuring the insect fauna of the temporary wetlands studied.

High species richness of Chironomidae (Diptera) in temporary flooded wetlands associated with high species turn-over rates.

Species richness and species turn-over of Chironomidae was studied in irregularly flooded wetlands of the River Dalälven flood-plains in central Sweden. The chironomid fauna, sampled with emergence traps in six wetlands over six summers, contained as much as 135 species, and the cumulative species curves indicated that the regional species pool contain several more species. Recurrent irregular floods may have induced this high chironomid species richness and the high species turn-over in the temporary wetlands, as the dominance between terrestrial and aquatic species shifted between years. Half of the wetlands were treated with Bacillus thuringiensis var. israelensis (Bti) against larvae of the flood-water mosquito Aedes sticticus. These treatments had no significant effect on chironomid species richness, but there was a higher species turn-over between years of primarily low abundance species in the treated wetlands. The cumulative number of species was also higher in the Bti-treated experimental wetlands than in the untreated reference wetlands. Thus, Bti treatment against mosquito larvae seemed to have only small effects on chironomid species richness but seemed to increase the colonisation-extinction dynamics.

Production of wetland Chironomidae (Diptera) and the effects of using Bacillus thuringiensis israelensis for mosquito control.

Massive mosquito nuisance problems, caused by the flood-water mosquito Aedes sticticus, occur after floods in the flood plains of the River Dalälven, central Sweden. Since 2002, the biological mosquito larvicide Bacillus thuringiensis var. israelensis (Bti) has been used to control these mosquitoes. Here, we report results from the first six years of monitoring Chironomidae, the most susceptible non-target organisms, in three wetlands with Bti-treatment against mosquitoes and in three wetlands without treatment. Emergence traps were used for continuous insect sampling from May to September each year, 2002-2007, and were emptied once a week. A total of 21,394 chironomids of 135 species were collected, and the subfamily Orthocladiinae dominated the fauna followed by Chironominae and Tanypodinae. The annual chironomid production in the wetlands was low, with an average of 1917 individuals per m(2), and 42 g ash-free dry weight per m(2). We found no reduced production of chironomids at neither family, nor subfamily level, in Bti-treated as compared to untreated wetlands. This is the first long-term follow-up study of the possible effects of Bti-based mosquito larval control on chironomid species production. In the short-term view, one species had higher production in treated areas. In the long-term view, four species had higher and one species had lower production in treated areas. We conclude that the Bti-based control of flood-water mosquitoes does not cause any major direct negative effects on chironomid production, and therefore does not seem to induce any risk for indirect negative effects on birds, bats or any other predators feeding on chironomids.

Endrin: use of concentration in blood to diagnose acute toxicity to fish.

Channel catfish, Ictalurus punctatus (Rafinesque), were exposed to continuously renewed solutions of endrin in water. Analyses of the fish blood by gas chromatography revealed a well-defined threshold concentration of endrin in the blood, approximately 0.30 microgram per gram, that, if exceeded, results in death. Fish exposed to lethal concentrations of endrin in water for periods of time insufficient to cause death had blood-endrin concentrations markedly lower than those that died from exposture to the same water. There was little overlap in range of endrin concentration in blood between dead and living exposed fish.

Effects of long-term immobilisation on cortical bone mass after traumatic amputation of the phalanges estimated by digital X-ray radiogrammetry.

UNLABELLED: Osteopenia of the cortical and trabecular bone partition is a common finding after immobilisation. Digital X-ray radiogrammetry (DXR) seems to quantify cortical demineralisation caused by circular saw amputation already few days after accident. INTRODUCTION: The study analyses the extent of demineralisation caused by immobilisation in patients with digital amputation after a circular saw injury, and elucidates the period of time which discloses a significant deprivation of bone mineral density estimated at the metacarpalia II-IV using DXR. METHODS: Twenty-eight patients with digital amputations underwent measurements of bone mineral density, cortical thickness, bone width and metacarpal index using DXR-technology in a follow-up up to 902 days. RESULTS: The data showed a significant decline of bone mineral density (-10.47%), the metacarpal index (-4.38%), the bone width (-12.06%) and the cortical thickness (-7.04%) after trauma-related amputation. The cortical demineralisation of the metacarpals could already be revealed in two patients after the second day, according to the amputation of phalanges (-3.65%). CONCLUSIONS: The inhibition of the periosteal bone formation detected by DXR-technique seems to be a specific finding caused by amputation, which thus differs from normal age-related (i.e., endosteal) bone loss and from demineralisation following acute immobilisation (i.e., trabecular osteopenia).

Comparison of mosquito (Diptera: Culicidae) populations by wetland type and year in the lower river Dalälven region, Central Sweden.

We studied adult mosquito assemblages in six wetlands, representing three types (wet meadow, alder swamp, and bog), in the lower part of the River Dalälven in Central Sweden during three consecutive years (2000-2002) and evaluated the influence of wetland type and year. Mosquito abundance differed significantly between years but not between wetland types. Mosquito species richness showed no significant variation between years or wetland types. Cluster analysis based on percentage of similarity resulted in three clusters, with high similarity between all wetlands in 2000. Ordination analysis showed that mosquito assemblages were mainly correlated with wetland type and water level increase in the previous month. Hydrological conditions varied between the years and between the wetland types, and our collections also included a year (2000) with extreme flood situations. The floodwater mosquito species Ochlerotatus sticticus was the predominant species with a strong influence on the whole study due to its long-range dispersal ability. The entire region suffered from enormous numbers of Oc. sticticus in 2000. The data from this study provided the basis for the initiation of a mosquito control project in the region.

Different responses of two floodwater mosquito species, Aedes vexans and Ochlerotatus sticticus (Diptera: Culicidae), to larval habitat drying.

Insect larvae that live in temporary ponds must cope with a rapidly diminishing resource. We tested the hypothesis that floodwater mosquitoes would react to diminishing water levels by accelerating larval development time and emerging as smaller adults. Since a reduction in habitat size leads to increased larval densities, we also included two larval densities. Newly-hatched floodwater mosquito larvae, Aedes vexans (87.9% of emerged adults) and Ochlerotatus sticticus (12.0% of emerged adults), were taken from the field and randomly assigned to one of three water level schedules. Survival to adult emergence was significantly affected by the water level schedule. Ae. vexans adults emerged later in the decreasing schedule than the constant water schedule, but time to emergence was not affected by larval density. In the drying water schedule, Ae. vexans adults emerged 6 to 14 days after complete water removal. Adult size was significantly affected by both water level schedule and larval density. Adults of Oc. sticticus emerged earlier in the decreasing than the constant water schedule which was in accordance with our hypothesis, but size was not affected. Our results indicate two different responses of two floodwater mosquito species to diminishing larval habitat. Oc. sticticus accelerated larval development while Ae. vexans larvae showed remarkable survival in humid soil. Both species are often numerous in inundation areas of large rivers, and climatic conditions after a flood might influence which species dominates the adult mosquito fauna.

Postinterventional MRI findings following MRI-guided laser ablation of osteoid osteoma.

OBJECTIVE: To evaluate postinterventional magnetic resonance imaging (MRI) characteristics following MRI-guided laser ablation of osteoid osteoma (OO). MATERIALS AND METHODS: 35 patients treated with MRI-guided laser ablation underwent follow-up MRI immediately after the procedure, after 3, 6, 12, 24, 36, and up to 48 months. The imaging protocol included multiplanar fat-saturated T2w TSE, unenhanced and contrast-enhanced T1w SE, and subtraction images. MR images were reviewed regarding the appearance and size of treated areas, and presence of periablation bone and soft tissue changes. Imaging was correlated with clinical status. RESULTS: Mean follow-up time was 13.6 months. 28/35 patients (80%) showed a postinterventional "target-sign" appearance consisting of a fibrovascular rim zone and a necrotic core area. After an initial increase in total lesion diameter after 3 months, a subsequent progressive inward remodeling process of the zonal compartments was observed for up to 24 months. Periablation bone and soft tissue changes showed a constant decrease over time. MR findings correlated well with the clinical status. Clinical success was achieved in 32/35 (91%). CONCLUSIONS: Evaluation of long-term follow-up MRI after laser ablation of OO identified typical postinterventional changes and thus may contribute to the interpretation of therapeutic success and residual or recurrent OO in suspected cases.

Glioblastoma multiforme versus solitary supratentorial brain metastasis: differentiation based on morphology and magnetic resonance signal characteristics.

PURPOSE: To evaluate the diagnostic potential of a multi-factor analysis of morphometric parameters and magnetic resonance (MR) signal characteristics of a mass and peritumoral area to distinguish solitary supratentorial metastasis from glioblastoma multiforme (GBM). MATERIALS AND METHODS: MR examinations of 51 patients with histologically proven GBM and 44 with a single supratentorial metastasis were evaluated. A large variety of morphologic criteria and MR signal characteristics in different sequences were analyzed. The data were subjected to logistic regression to investigate their ability to discriminate between GBM and cerebral metastasis. Receiver-operating characteristic (ROC) analysis was used to select an optimal cut-off point for prediction and to assess the predictive value in terms of sensitivity, specificity, and accuracy of the final model. RESULTS: The logistic regression analysis revealed that the ratio of the maximum diameter of the peritumoral area measured on T2-weighted images (d T2) to the maximum diameter of the enhancing mass area (d T1, post-contrast) is the only useful criterion to distinguish single supratentorial brain metastasis from GBM with a lower ratio favoring GBM (accuracy 68 %, sensitivity 84 % and specificity 45 %). The cut-off point for the ratio d T2/d T1 post-contrast was calculated as 2.35. CONCLUSION: Measurement of maximum diameters of the peritumoral area in relation to the enhancing mass can be evaluated easily in the clinical routine to discriminate GBM from solitary supratentorial metastasis with an accuracy comparable to that of advanced MRI techniques.

Peripheral bone status in rheumatoid arthritis evaluated by digital X-ray radiogrammetry and compared with multisite quantitative ultrasound.

The development of secondary osteoporosis in rheumatoid arthritis (RA) has recently become well recognized, characterized by demineralization at axial and in particular periarticular peripheral bone sites. Our aim was to evaluate multisite quantitative ultrasound (QUS) compared to digital X-ray radiogrammetry (DXR) by the quantification of cortical bone loss dependent on the severity of RA. Fifty-three patients with verified RA underwent QUS measurements (Sunlight Omnisense 7000) with estimation of the speed of sound (QUS-SOS) at the distal radius and at the phalanx of the third digit. Also, bone mineral density (DXR-BMD) and metacarpal index (DXR-MCI) were estimated on metacarpals II-IV using DXR technology. Additionally, Larsen score and Steinbroker stage were assessed. Disease activity of RA was estimated by disease activity score 28 (DAS 28). For the group with minor disease activity (3.2 5.1), QUS-SOS of the radius revealed a significant correlation to DXR-BMD (R = 0.71) and DXR-MCI (R = 0.84), whereas for QUS-SOS (phalanx) no significant association to the DXR parameters was shown. The DXR parameters and, to a lesser extent, the QUS data also demonstrated pronounced declines in the case of accentuated disease activity (DAS > 5.1). Both DXR-BMD (-25.9 %, P < 0.01) and DXR-MCI (-38.6 %, P < 0.01) revealed a notable reduction dependent on the severity of RA. Otherwise, QUS-SOS marginally decreased, with -2.6% (radius) and -3.9% (phalanx). DXR revealed a significant reduction of DXR-BMD as well as DXR-MCI dependent on the severity of RA and surpassed multisite QUS as a promising diagnostic tool.

Multi-site quantitative ultrasound compared to dual energy X-ray absorptiometry in rheumatoid arthritis: effects of body mass index and inflamed soft tissue on reproducibility.

The objective of the study is to evaluate multi-site quantitative ultrasound (QUS) in comparison to dual energy X-ray absorptiometry (DXA) considering the effects of body mass index (BMI) and disease activity on measurements in patients suffering from rheumatoid arthritis (RA). Sixty-eight patients underwent a cross-sectional analysis of bone mineral density measured by DXA (lumbar spine, total femur) and speed of sound estimated by QUS (phalanx III, distal radius). The short-term precision of QUS was investigated with regard to BMI of healthy individuals and with regard to the level of disease activity in patients suffering from RA. The patients with RA were divided into two BMI groups as well as into low and advanced disease activity groups. The short-term precision of QUS-SOS ranged from 0.90 to 2.55% (healthy controls) and from 0.64 to 1.89% (patients with RA). The association between DXA and QUS parameters were limited in the case of advanced disease activity and pronounced BMI. Low QUS-SOS was observed for advanced disease activity group (QUS-SOS phalanx: -2.5%; QUS-SOS distal radius: -2.1%) in comparison to low disease activity group, whereas only a slight change of DXA parameters was observed. DXA-BMD and QUS parameters revealed higher values with pronounced BMI. The system shows only a short-term precision with limitations in healthy controls with accentuated BMI, as well as in patients with active RA. The application of multi-site QUS seems to be restricted for patients with active inflammation based on soft tissue alteration in RA and for healthy individuals with pronounced body mass.

[The current mind-brain theories in analytical philosophy of mind and their epistemic significance for psychiatry]. / Die gegenwärtigen Geist-Gehirn-Theorien in der Analytischen Philosophie des Geistes und ihre epistemische Bedeutung für die Psychiatrie.

This article begins with an orientational survey of the historical evolution of analytical philosophy of mind (APM) which was formulated in the last 40 years as "philosophy of mind" in the Anglo-Saxon scientific-cultural world and which, in the meantime, dominates to a great extent contemporary German philosophy. Then there follows a discussion of the currently most popular mind-brain theories in philosophy. In comparison to the more marginal dualist variants (interactionism, epiphenomenalism, parallelism), it is mainly the monistic positions of non-reductive, reductive and eliminative materialism and the materialist functionalism underlying it, which determines analytical philosophy of mind and its influence on psychopathology and psychiatry. Under the additional influence of modern brain research methods, particularly neuroimaging, it is progressively developing into a subdiscipline of neuroscience, a complex and increasingly more firmly established scientific discipline which comprises the totality of all sciences dealing with neuronal functions, including the close epistemic associations of APM and neuroimaging. This is the effective epistemic central idea determining the theory of the neuronal network which, in the form of a connectionist psychopathology, is intended to make possible a fundamentally new access to the comprehension of psychiatric forms of illness. In this respect it is evident, however, that the perception of the naturality of the mind as the fundamental thesis of APM and thus of connectionism cannot be followed through, since, up to now, neither from the phenomenality of the mind (especially the quality of senses, "Qualia") nor from intentionality of the mind (i. e. the ability to act intentionally, free from the constraint of the causality of nature and thus in self-responsible fashion) has proved it possible to reconstruct a generally accepted naturalist theory. Furthermore, it has not been possible to reformulate it in an exclusively physical, i. e. non-phenomenological concept and terminology which is, above all, free from the intentionality idiom. The consequence of this, however, is that a connectionist psychopathology can only represent a subpersonal, i. e., subhuman area and that in order to establish a personal psychopathology, naturalistic unreduced theories of experience-qualities and intentional acts of completeness are absolutely essential. The neuroscientific-connectionist paradigm of psychopathology must therefore - at least for the present - be supplement by the paradigm of a non-natural (e. g. phenomenological-hermeneutic) psychopathology. This result can only encourage the relinquishing of epistemically one-sided materialist and other monistic mind-brain theories of APM in favour of an epistemically open pragmatic interactionist dualism as the scientific position which best represents the current state of knowledge.

Digital X-ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: a cross-sectional and longitudinal study.

OBJECTIVE: To evaluate digital x-ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease-related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA). METHODS: Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients. RESULTS: All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 < or = R < or = 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (-0.67 < or = R < or = -0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%). CONCLUSION: DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.

[On the history of the concept neurasthenia and its modern variants chronic-fatigue-syndrome, fibromyalgia and multiple chemical sensitivities]. / Zur Geschichte des Neurastheniekonzeptes und seiner modernen Varianten Chronic-Fatigue-Syndrom, Fibromyalgie sowie Multiple Chemische Sensitivität.

This article deals with the history of the terminological and nosological development of the concept neurasthenia introduced in 1869 by George Miller Beard and in particular with its reappearance in western medicine in the 1980 s. Beginning with its predecessors in antiquity and continuing with hypochondria, which became a fashionable disease in the 18 th century, the concept neurasthenia reached a high point and world-wide medical acceptance at the end of the 19 th/beginning of the 20 th century. However, between the 1930 s and 1960 s it declined in popularity and gradually disappeared until finally it only had a rudimentary nosological role in the term "pseudoneurasthenia". In the countries of the Far East, on the contrary, the concept of neurasthenia has been in continual use since its importation in the first decades of the last century. In the 1980 s, when an interest in the symptoms of chronic fatigue was reawakened in western medicine, the concept neurasthenia reappeared, this time to define the particular form of a neurotic disorder. Parallel to these developments increasing importance was attached to clinical descriptions of illnesses which on account of their similarity to the symptoms of neurasthenia could be termed modern variants of the concept neurasthenia. These are "Chronic-Fatigue-Syndrome", "Fibromyalgia" and "Multiple Chemical Sensitivities" which have more or less adopted the organic inheritance of Beard's former concept of neurasthenia, despite the fact that so far the question of organicity could not be decisively answered in a single case. In order to clarify possible influences on the development of the concept neurasthenia and its variants, the theories and ideas of E. Shorter, medical historian at the University of Toronto, are discussed in the final part of the article, whereby the particular cultural background in each case has a decisive influence on the manifestation of the psychosomatic symptoms.

Typus melancholicus as a personality characteristic of migraine patients.

The present study tests the hypothesis that persons suffering from migraine show personality traits of the "typus melancholicus" (melancholy type, Tellenbach). Ninety-six migraineurs were compared to 115 normal subjects, 36 neurotics, 38 psychosomatic patients, 52 patients suffering from other pain disorders and 38 unipolar depressives, matched for sex, age and social status. Several already standardized personality inventories were used (MP-T, D-S, FAPK, IAF, GT-S), as well as a questionnaire constructed especially to record typus-melancholicus traits in migraineurs. The results of univariate and multivariate methods of comparison clearly confirmed the hypothesis. In contrast to normal subjects, neurotic, psychosomatic and pain patients, migraineurs showed significantly higher levels of typus-melancholicus traits, whereas they did not differ from the unipolar depressives in this respect.