Radiomics-based machine learning model for diagnosis of acute pancreatitis using computed tomography

In the early diagnostic workup of acute pancreatitis (AP), the role of contrast-enhanced CT is to establish the diagnosis in uncertain cases, assess severity, and detect potential complications like necrosis, fluid collections, bleeding or portal vein thrombosis. The value of texture analysis/radiomics of medical images has rapidly increased during the past decade, and the main focus has been on oncological imaging and tumor classification. Previous studies assessed the value of radiomics for differentiating between malignancies and inflammatory diseases of the pancreas as well as for prediction of AP severity. The aim of our study was to evaluate an automatic machine learning model for AP detection using radiomics analysis. Patients with abdominal pain and contrast-enhanced CT of the abdomen in an emergency setting were retrospectively included in this single-center study. The pancreas was automatically segmented using TotalSegmentator and radiomics features were extracted using PyRadiomics. We performed unsupervised hierarchical clustering and applied the random-forest based Boruta model to select the most important radiomics features. Important features and lipase levels were included in a logistic regression model with AP as the dependent variable. The model was established in a training cohort using fivefold cross-validation and applied to the test cohort (80/20 split). From a total of 1012 patients, 137 patients with AP and 138 patients without AP were included in the final study cohort. Feature selection confirmed 28 important features (mainly shape and first-order features) for the differentiation between AP and controls. The logistic regression model showed excellent diagnostic accuracy of radiomics features for the detection of AP, with an area under the curve (AUC) of 0.932. Using lipase levels only, an AUC of 0.946 was observed. Using both radiomics features and lipase levels, we showed an excellent AUC of 0.933 for the detection of AP. Automated segmentation of the pancreas and consecutive radiomics analysis almost achieved the high diagnostic accuracy of lipase levels, a well-established predictor of AP, and might be considered an additional diagnostic tool in unclear cases. This study provides scientific evidence that automated image analysis of the pancreas achieves comparable diagnostic accuracy to lipase levels and might therefore be used in the future in the rapidly growing era of AI-based image analysis

Pulsed-field ablation-based pulmonary vein isolation:acute safety, efficacy and short-term follow-up in a multi-center real world scenario

Purpose: Pulsed-field ablation (PFA) is a new energy source to achieve pulmonary vein isolation (PVI) by targeted electroporation of cardiomyocytes. Experimental and controlled clinical trial data suggest good efficacy of PFA-based PVI. We aimed to assess efficacy, safety and follow-up of PFA-based PVI in an early adopter routine care setting. Methods: Consecutive patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) underwent PVI using the Farawave® PFA ablation catheter in conjunction with three-dimensional mapping at two German high-volume ablation centers. PVI was achieved by applying 8 PFA applications in each PV. Results: A total of 138 patients undergoing a first PVI (67 ± 12 years, 66% male, 62% persistent AF) were treated. PVI was achieved in all patients by deploying 4563 applications in 546 PVs (8.4 ± 1.0/PV). Disappearance of PV signals after the first application was demonstrated in 544/546 PVs (99.6%). More than eight PFA applications were performed in 29/546 PVs (6%) following adapted catheter positioning or due to reconnection as assessed during remapping. Mean procedure time was 78 ± 22 min including pre- and post PVI high-density voltage mapping. PFA catheter LA dwell-time was 23 ± 9 min. Total fluoroscopy time and dose area product were 16 ± 7 min and 505 [275;747] cGy*cm2. One pericardial tamponade (0.7%), one transient ST-elevation (0.7%) and three groin complications (2.2%) occurred. 1-year follow-up showed freedom of arrhythmia in 90% in patients with paroxysmal AF (n = 47) and 60% in patients with persistent AF (n = 82, p = 0.015). Conclusions: PFA-based PVI is acutely highly effective and associated with a beneficial safety and low recurrence rate. Graphical abstract

Kosten-Nutzen-Bewertungen in der gesetzlichen Krankenversicherung | Eine Perspektive zur Ausgestaltung des krankenversicherungsrechtlichen Wirtschaftlichkeitsgebots?

Kosten-Nutzen-Bewertungen stellen vor dem Hintergrund der Finanzierbarkeit der gesetzlichen Krankenversicherung ein vielfach diskutiertes Mittel zur Bewältigung von Verteilungsproblemen dar. Ethische, ökonomische und rechtliche Aspekte prallen in ihnen aufeinander, denn Kosten-Nutzen-Bewertungen werfen die Frage nach der Bewertbarkeit von Leben und Gesundheit auf und adressieren das Dilemma zwischen unbegrenzten Bedürfnissen und begrenzten Mitteln. Vor diesem Hintergrund untersucht Laura Münkler den bestehenden wie auch den verfassungsrechtlich möglichen Anwendungsbereich von Kosten-Nutzen-Bewertungen. Insbesondere analysiert sie das Zusammenspiel zwischen IQWiG und GBA, die verwendete ökonomische Methodik wie auch die rechtliche Umsetzbarkeit von Kosten-Nutzen-Bewertungen und erörtert, inwieweit das Wirtschaftlichkeitskriterium ein Einfallstor für derartige Bewertungen bildet

Der Nichtakt | Eine dogmatische Rekonstruktion

Was ist ein Nichtakt? Das Allgemeine Verwaltungsrecht bleibt die Antwort auf diese theoretisch wie praktisch relevante Frage schuldig. Dies ist umso erstaunlicher, als die dogmatischen Wurzeln dieser Rechtsfigur bis in die Entstehungsphase der Handlungsformen- und Fehlerfolgenlehre zurückreichen. Dennoch fehlt es bis heute an einer klaren rechtlichen Kontur der Rechtsfigur. Dies hat zu Ungereimtheiten im Umgang mit Nichtakten geführt.Die dogmatische Rekonstruktion der Figur zeigt, dass der Nichtakt auf das Verhältnis von Zivil- und Öffentlichem Recht zurückgeht und die verfassungsrechtlichen Möglichkeiten und Grenzen der Zurechnung von Handlungen zum Staat betrifft. Den Schlüssel für die materiell- und prozessrechtliche Einordnung von Nichtakten bildet seine Abgrenzung von Scheinakten: Während der Nichtakt allein Zurechnungsfragen betrifft, entfaltet die Figur des Scheinakts das dogmatische Spannungsverhältnis zwischen rechtlich relevanter Handlung und Rechtsformenwahl.»›Nichtakte‹ (Non-Existent Acts)«Although legal theory and practice have discussed the »Nichtakt« for over one hundred years, the dogmatic figure of the »non-existent act« has not yet found a clear legal cut. Especially with regard to legal practice, the normative reconstruction of the »non-existent act« in procedural and material law is a desideratum. How has to be dealt with »non-existent acts« in administrative practice and procedural law

Demokratie demokratisch denken

DEMOKRATIE DEMOKRATISCH DENKEN Demokratie demokratisch denken / Münkler, Laura (Rights reserved) (-