Liver transplantation in primary biliary cirrhosis: Risk assessment and 11-year follow-up

Background/Aims: Liver transplantation (LTx) is the only established treatment in patients with end-stage primary biliary cirrhosis (PBC). Although short-term survival after LTx in this group of patients is usually good, few data exist on the long-term survival. The optimal timing of transplantation is difficult. Thus, the aims of this study were to assess the long-term survival of patients with PBC after LTx and to identify potential predictive factors for a positive outcome. Methods: Survival of 28 patients with PBC who underwent LTx between 1985 and July 1999 in a single center was studied by Kaplan-Meier analysis and was compared to predicted survival without LTx using established prognostic models for PBC, the Mayo and European risk scores. Potential prognostic parameters obtained before LTx were tested for correlation to survival. Rates of bone fractures as markers of hepatic osteodystrophy were compared before and after LTx. Results: Median follow-up after LTx was 90 months with a maximum of 140 months. Actuarial survival of patients with PBC was 89% after 1, 5, and 10 years and was significantly better than estimated survival without LTx after 1-7 years as calculated by the Mayo and European risk scores. Of several parameters tested, only serum bilirubin and the prognostic scores, but no other liver function tests obtained immediately prior to transplantation were significantly correlated with survival after LTx. The duration of intensive care after LTx was not associated with any parameters obtained before LTx. Bone fractures were diagnosed in 43% of patients of whom the vast majority were osteopenic before LTx as determined by osteodensitometry. Conclusion: Longterm survival of a well-defined group of patients with PBC was excellent after LTx and was inversely correlated with preoperative serum bilirubin levels as well as Mayo and European risk scores. Copyright (C) 2000 S. Karger AG. Basel

Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules

Background: Thyroid Imaging Reporting and Data System (TIRADS) was developed to improve patient management and cost-effectiveness by avoiding unnecessary fine needle aspiration biopsy (FNAB) in patients with thyroid nodules. However, its clinical use is still very limited. Strain elastography (SE) enables the determination of tissue elasticity and has shown promising results for the differentiation of thyroid nodules. Methods: The aim of the present study was to evaluate the interobserver agreement (IA) of TIRADS developed by Horvath et al. and SE. Three blinded observers independently scored stored images of TIRADS and SE in 114 thyroid nodules (114 patients). Cytology and/or histology was available for all benign (n = 99) and histology for all malignant nodules (n = 15). Results: The IA between the 3 observers was only fair for TIRADS categories 2–5 (Coheńs kappa = 0.27,p = 0.000001) and TIRADS categories 2/3 versus 4/5 (ck = 0.25,p = 0.0020). The IA was substantial for SE scores 1–4 (ck = 0.66,p<0.000001) and very good for SE scores 1/2 versus 3/4 (ck = 0.81,p<0.000001). 92–100% of patients with TIRADS-2 had benign lesions, while 28–42% with TIRADS-5 had malignant cytology/histology. The negative-predictive-value (NPV) was 92–100% for TIRADS using TIRADS-categories 4&5 and 96–98% for SE using score ES-3&4 for the diagnosis of malignancy, respectively. However, only 11–42% of nodules were in TIRADS-categories 2&3, as compared to 58–60% with ES-1&2. Conclusions: IA of TIRADS developed by Horvath et al. is only fair. TIRADS and SE have high NPV for excluding malignancy in the diagnostic work-up of thyroid nodules

Acoustic radiation force impulse imaging for differentiation of thyroid nodules

Background: Acoustic Radiation Force Impulse (ARFI)-imaging is an ultrasound-based elastography method enabling quantitative measurement of tissue stiffness. The aim of the present study was to evaluate sensitivity and specificity of ARFI-imaging for differentiation of thyroid nodules and to compare it to the well evaluated qualitative real-time elastography (RTE). Methods: ARFI-imaging involves the mechanical excitation of tissue using acoustic pulses to generate localized displacements resulting in shear-wave propagation which is tracked using correlation-based methods and recorded in m/s. Inclusion criteria were: nodules $5 mm, and cytological/histological assessment. All patients received conventional ultrasound, real-time elastography (RTE) and ARFI-imaging. Results: One-hundred-fifty-eight nodules in 138 patients were available for analysis. One-hundred-thirty-seven nodules were benign on cytology/histology, and twenty-one nodules were malignant. The median velocity of ARFI-imaging in the healthy thyroid tissue, as well as in benign and malignant thyroid nodules was 1.76 m/s, 1.90 m/s, and 2.69 m/s, respectively. While no significant difference in median velocity was found between healthy thyroid tissue and benign thyroid nodules, a significant difference was found between malignant thyroid nodules on the one hand and healthy thyroid tissue (p = 0.0019) or benign thyroid nodules (p = 0.0039) on the other hand. No significant difference of diagnostic accuracy for the diagnosis of malignant thyroid nodules was found between RTE and ARFI-imaging (0.74 vs. 0.69, p = 0.54). The combination of RTE with ARFI did not improve diagnostic accuracy. Conclusions: ARFI can be used as an additional tool in the diagnostic work up of thyroid nodules with high negative predictive value and comparable results to RTE

Rediscovering Dr. Richard Eisenmann – A Microhistory of the Electrophonic Piano

This dissertation examines the life and work of the overlooked inventor Dr. Richard Eisenmann through a focused study of his electrophonic piano, combining the socio-cultural perspective of New Organology with the methodological precision of Microhistory, and Media Archaeology as a conceptual horizon. Drawing on a diverse array of sources—including patents, legal and ad-ministrative files, personal correspondence, photographs, contemporary newspapers, musicolog-ical writings, and the instrument itself—this research reconstructs the artifact’s development, iterations, and contemporary reception and presentation. More than a biographical recovery, the study reveals previously overlooked collaborations and technological intersections that led to the creation of the artifact, now housed at the Deutsches Museum Munich. By foregrounding a neglected figure and his now-obscure invention, the dissertation prepares the ground for broad-er debates surrounding historical epistemologies of sound, the cultural status of technological obsolescence, the critical interrogation of proclaimed novelty and the archival afterlives of for-gotten artifacts. In doing so, it not only enriches our understanding of Eisenmann’s legacy but also illustrates the critical potential of interdisciplinary methodologies for rethinking the role of history of media and technology from the margins. Diese Dissertation untersucht das Leben und Werk des weitgehend übersehenen Erfinders Dr. Richard Eisenmann anhand einer fokussierten Fallstudie zu seinem elektrophonischen Klavier. Sie verbindet die soziokulturelle Perspektive der New Organology mit der methodischen Präzi-sion der Mikrogeschichte, wobei die Medienarchäologie als konzeptueller Horizont dient. Auf Grundlage einer vielfältigen Quellengrundlage – darunter Patente, juristische und administrative Akten, persönliche Korrespondenzen, Fotografien, zeitgenössische Zeitungsartikel, musikwis-senschaftliche Schriften sowie das Instrument selbst – rekonstruiert die Arbeit die Entstehung, Weiterentwicklung und zeitgenössische Rezeption und Präsentation des Artefakts. Mehr als eine biografische Wiederentdeckung offenbart die Studie bislang unbeachtete Formen der Zu-sammenarbeit und technologische Verbindungen, die zur Entwicklung des Artefakts führten, das heute im Deutschen Museum München aufbewahrt wird. Indem sie eine vergessene Figur und deren inzwischen obsolet gewordene Erfindung ins Zentrum rückt, bereitet die Dissertati-on den Boden für weiterführende Debatten über historische Epistemologien von Sound, den kulturellen Status technologischer Obsoleszenz, die kritische Hinterfragung proklamierter Neu-heit sowie über die archivarische Existenz vergessener Artefakte. Auf diese Weise bereichert sie nicht nur das Verständnis von Eisenmanns Vermächtnis, sondern zeigt auch das kritische Potenzial interdisziplinärer Methodologien für eine Neubewertung der Medien- und Technikgeschichte aus ihren Randbereichen heraus

Revised Status of Rare and Endangered Unionaea (Mollusca: Margaritiferidae, Unionidae) in Arkansas

Harris and Gordon (1987) reviewed the distribution and status of 18 rare and /or endangered unionacean bivalve species (commonly referred to as clams, mussels, freshwater mussels, naiads) that occur or have occurred in Arkansas. They discussed four species that were federally listed as endangered, four species that were considered endangered or extirpated within Arkansas, four species considered threatened within Arkansas, four species of special concern within Arkansas, and two species for which the conservation status was considered uncertain due to questions regarding taxonomic validity. Numerous unionacean field surveys have been performed during 1986 1996, and a substantial database of new distributional and relative abundance information has been accumulated. Two additional unionacean species have been listed as federally endangered, one additional species has been listed as federally threatened, and one endangered species has been newly discovered within Arkansas bringing the total number of federally protected unionacean species occurring within Arkansas to eight. The conservation status of 16 additional unionacean species occurring in Arkansas is discussed also

Growth Curves of Four Species of Commercially Valuable Freshwater Mussels (Bivalva: Unionidae)

North American freshwater mussels (Bivalvia: Unionidae) have been exploited commercially for over 100 years and have been regulated using shell size limits and/or harvest seasons. Presently, freshwater mussels are considered a threatened faunal group in North America due to the large numbers of endangered, threatened or special concern species. Therefore, management of this fauna should emphasize their long-term sustainability. The objectives of this study were 1) to construct von Bertalanffy growth curves for selected commercially-most-valuable species, Fusconaia ebena, Megalonaias nervosa, Amblema plicata and Quadrula quadrula, from five rivers and two reservoirs, 2) to compare species-specific von Bertalanffy growth curves from different rivers and reservoirs, and 3) to provide information on size at onset of sexual maturity in F. ebena and A. plicata. Von Bertalanffy growth curves of four commercially valuable Ambleminae species were used in this study to compare drainage-specific growth. Growth curves for all four species investigated were significantly different between pairs of drainages. Approximate size at onset of sexual maturity was determined for Arkansas F. ebena and A. plicata. Von Bertalanffy growth curves, coupled with life history and population dynamics information, could be useful in assessing and determining national/state harvest sizes and/or drainage specific harvest sizes once annual growth line formation is confirmed

Geoscience after IT: Part L. Adjusting the emerging information system to new technology

Coherent development depends on following widely used standards that respect our vast legacy of existing entries in the geoscience record. Middleware ensures that we see a coherent view from our desktops of diverse sources of information. Developments specific to managing the written word, map content, and structured data come together in shared metadata linking topics and information types