This paper presents the functionality and architecture of a new conference-control management system called Confman 2.0. It enables the user to initiate and participate in online conferences based on ...current Internet standards. Supported system platforms include Unix workstations and Microsoft operating systems as well. Starting with a short description of current Internet conferencing technology the paper describes Confman's conference-control functionality and gives a brief overview of Confman's distributed software architecture.
Background and aims
There is limited real‐world information on the effectiveness of antiviral treatment of chronic hepatitis C virus (HCV) infection with direct‐acting antivirals (DAA) in people on ...opioid substitution therapy (OST). This study compared sustained virological response (SVR) rates and proportion of lost to follow‐up (LTFU) between OST and non‐OST patients in the German Hepatitis C‐Registry (DHC‐R).
Design
National multi‐centre prospective real‐world registry (German Hepatitis C‐Registry, DHC‐R). Non‐OST patients comprised patients with former/current drug use (non‐OST/DU) and patients never consuming drugs (non‐OST/NDU).
Setting
A total of 254 medical centres in Germany, including 123 centres providing OST.
Participants
A total of 7747 chronic HCV patients started DAA therapy (739 OST and 7008 non‐OST; 1500 non‐OST/DU; 5508 non‐OST/NDU) patients. Five hundred and twenty‐eight OST and 5582 non‐OST patients had completed antiviral therapy and at least one follow‐up documentation intention‐to‐treat (ITT) population.
Measurements
Study outcomes were SVR, proportion of LTFU and safety of treatment.
Findings
SVR (ITT) was documented in 85% (450 of 528) OST patients versus 86% (969 of 1126) in non‐OST/DU (P = 0.651) and 92% (4113 of 4456) non‐OST/NDU (P < 0.001) patients. Independent predictors for SVR (P < 0.01 in multivariate analysis) included HCV genotype non‐3 adjusted odds ratio (aOR) = 1.11; 95% confidence interval (CI) = 1.07–1.15, female sex (aOR = 1.59; CI = 1.30–1.94), platelet counts >90 × 109/l (aOR = 1.51, CI = 1.14–2.01), cirrhosis (aOR = 0.77; CI = 0.62–0.96) and patient group (OST/DI (aOR = 0.58; CI = 0.42–0.78); non‐OST/DU (OR: 0.63; CI = 0.50–0.78). In per‐protocol analysis (PP), SVR rates were ≥ 94% in all patient groups. In OST the proportion of LTFU was higher (10.2%) than in non‐OST/DU (8.5%) and non‐OST/NDU (3.2%, P < 0.001) patients. Independent factors for LTFU (P < 0.01) were HCV genotype non‐3 (aOR = 0.92; CI = 0.88–0.96), female sex (aOR: 0.7; CI = 0.53–0.92), pre‐treatment (aOR = 0.64; CI = 0.50–0.82), OST/DI (aOR = 3.35; CI = 2.35–4.78) and non‐OST/DU (aOR = 2.38; CI = 1.80–3.14).
Conclusions
In Germany, direct‐acting antiviral treatment of former or current drug users with or without opioid substitution therapy can achieve equally high sustained virological response rates as in patients with no history of drug use.
Evidence based clinical guidelines are implemented to treat patients efficiently that include efficacy, tolerability but also health economic considerations. This is of particular relevance to the ...new direct acting antiviral agents that have revolutionized treatment of chronic hepatitis C. For hepatitis C genotypes 2/3 interferon free treatment is already available with sofosbuvir plus ribavirin. However, treatment with sofosbuvir-based regimens is 10-20 times more expensive compared to pegylated interferon alfa and ribavirin (PegIFN/RBV). It has to be discussed if PegIFN/RBV is still an option for easy to treat patients. We assessed the treatment of patients with chronic hepatitis C genotypes 2/3 with PegIFN/RBV in a real world setting according to the latest German guidelines. Overall, 1006 patients were recruited into a prospective patient registry with 959 having started treatment. The intention-to-treat analysis showed poor SVR (GT2 61%, GT3 47%) while patients with adherence had excellent SVR in the per protocol analysis (GT2 96%, GT3 90%). According to guidelines, 283 patients were candidates for shorter treatment duration, namely a treatment of 16 weeks (baseline HCV-RNA <800.000 IU/mL, no cirrhosis and RVR). However, 65% of these easy to treat patients have been treated longer than recommended that resulted in higher costs but not higher SVR rates. In conclusion, treatment with PegIFN/RBV in a real world setting can be highly effective yet similar effective than PegIFN± sofosbuvir/RBV in well-selected naïve G2/3 patients. Full adherence to guidelines could be further improved, because it would be important in the new era with DAA, especially to safe resources.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
It is known that aqueous keratin hydrolysate solutions can be produced from feathers using superheated water as solvent. This method is optimized in this study by varying the time and temperature of ...the heat treatment in order to obtain a high solute content in the solution. With the dissolved polypeptides, films are produced using methyl cellulose as supporting material. Thereby, novel composite membranes are produced from bio-waste. It is expected that these materials exhibit both protein and polysaccharide properties. The influence of the embedded keratin hydrolysates on the methyl cellulose structure is investigated using Fourier transform infrared spectroscopy (FTIR) and wide angle X-ray diffraction (WAXD). Adsorption peaks of both components are present in the spectra of the membranes, while the X-ray analysis shows that the polypeptides are incorporated into the semi-crystalline methyl cellulose structure. This behavior significantly influences the mechanical properties of the composite films as is shown by tensile tests. Since further processing steps, e.g., crosslinking, may involve a heat treatment, thermogravimetric analysis (TGA) is applied to obtain information on the thermal stability of the composite materials.
Purpose
To test the diagnostic performance of susceptibility-weighted MRI (sMRI) for the evaluation of vertebral body fractures versus standard MRI-sequences, using CT as reference standard.
Methods
...In this prospective study 88 vertebral fractures (45 healed, 43 non-healed) were detected in 39 patients who underwent T1/T2/TIRM MRI-sequences and sMRI. All fractures were evaluated with CT as reference standard. In all modalities/sequences, displacement and height of the posterior vertebral body cortex and visibility of fracture lines and cortical breaks were assessed. Sensitivity, specificity and inter-reader agreement between MRI and CT were calculated.
Results
sMRI demonstrated highest diagnostic accuracy for detection of posterior vertebral body cortex involvement (sensitivity: 98 %/specificity: 100 %), fracture lines (86 %/99 %) and cortical breaks (93 %/100 %) versus T1/T2/TIRM sequences. Regarding evaluation of posterior vertebral body cortex displacement and height, sMRI demonstrated the closest intermodality agreement (R
2
=0.96; 95 % CI -0.92–0.89/R
2
=0.97; 95 % CI -1.67–1.23) with CT and the closest interobserver agreement (R
2
=0.97; 95 % CI -0.71–1.01).
Conclusion
sMRI allows reliable evaluation of vertebral body fractures with regard to posterior vertebral body cortex displacement and height, cortical breaks and fracture lines with higher accuracy versus standard MRI, especially in patients with non-healed vertebral body fractures.
Key Points
•
sMRI allows a reliable evaluation of vertebral body fractures.
•
sMRI has higher accuracy than standard-MRI for evaluation of vertebral body fractures.
•
sMRI is especially useful in patients with non-healed vertebral body fractures.
To determine the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SWMR) for the detection of pineal gland calcifications (PGC) compared to conventional magnetic resonance ...imaging (MRI) sequences, using computed tomography (CT) as a reference standard.
384 patients who received a 1.5 Tesla MRI scan including SWMR sequences and a CT scan of the brain between January 2014 and October 2016 were retrospectively evaluated. 346 patients were included in the analysis, of which 214 showed PGC on CT scans. To assess correlation between imaging modalities, the maximum calcification diameter was used. Sensitivity and specificity and intra- and interobserver reliability were calculated for SWMR and conventional MRI sequences.
SWMR reached a sensitivity of 95% (95% CI: 91%-97%) and a specificity of 96% (95% CI: 91%-99%) for the detection of PGC, whereas conventional MRI achieved a sensitivity of 43% (95% CI: 36%-50%) and a specificity of 96% (95% CI: 91%-99%). Detection rates for calcifications in SWMR and conventional MRI differed significantly (95% versus 43%, p<0.001). Diameter measurements between SWMR and CT showed a close correlation (R2 = 0.85, p<0.001) with a slight but not significant overestimation of size (SWMR: 6.5 mm ± 2.5; CT: 5.9 mm ± 2.4, p = 0.02). Interobserver-agreement for diameter measurements was excellent on SWMR (ICC = 0.984, p < 0.0001).
Combining SWMR magnitude and phase information enables the accurate detection of PGC and offers a better diagnostic performance than conventional MRI with CT as a reference standard.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Detection of metastases can have a significant impact on therapy. Nevertheless, even in gadoxetate disodium-enhanced MR scans, very small hepatic metastases may be difficult to see.
To investigate ...the potential of a contrast-optimised (phase-sensitive) inversion recovery MR sequence in gadoxetate disodium-enhanced scans for detection of hepatic metastases.
With institutional review board approval and after written informed consent, 40 patients (18 male, 22 female) with suspected or known hepatic metastases were examined on a 1.5 T MR system. A T1-weighted gradient-echo volumetric-interpolated-breath-hold (VIBE) sequence was acquired as part of the standard imaging protocol 20 minutes after administration of gadoxetate disodium. Additionally, an IR sequence was acquired with an inversion time to suppress native signal from metastases. Overall image quality and delineation of lesions were assessed on VIBE as well as on magnitude-reconstructed (MAG) and phase-sensitive IR (PSIR) sequences. Lesion-to-liver contrast (LLC) was compared between VIBE and MAG images.
Overall image quality was high in both VIBE and MAG IR sequences (VIBE 4.275; MAG 4.313), yet significantly lower in PSIR (4.038). Subjective delineation of lesions was higher on MAG and PSIR images compared to VIBE in all size groups with an overall statistically significant difference for VIBE vs. MAG vs. PSIR (p < .001) in the variance analysis. Mean LLC was 0.35±0.01 for VIBE sequences, and 0.73±0.01 for MAG.
Contrast-optimised PSIR seems to improve imaging characteristics of hepatic metastases in gadoxetate disodium-enhanced scans compared to T1 gradient-echo VIBE sequences.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although sofosbuvir has been approved for patients with genotypes 2/3 (G2/3), many parts of the world still consider pegylated Interferon alpha (P) and ribavirin (R) as standard of care for G2/3. ...Patients with rapid virological response (RVR) show response rates >80%. However, SVR (sustained virological response) in non-RVR patients is not satisfactory. Longer treatment duration may be required but evidence from prospective trials are lacking. A total of 1006 chronic HCV genotype 2/3 patients treated with P/R were recruited into a German HepNet multicenter screening registry. Of those, only 226 patients were still HCV RNA positive at week 4 (non-RVR). Non-RVR patients with ongoing response after 24 weeks P-2b/R qualified for OPTEX, a randomized trial investigating treatment extension of additional 24 weeks (total 48 weeks, Group A) or additional 12 weeks (total 36 weeks, group B) of 1.5 μg/kg P-2b and 800-1400 mg R. Due to the low number of patients without RVR, the number of 150 anticipated study patients was not met and only 99 non-RVR patients (n=50 Group A, n=49 Group B) could be enrolled into the OPTEX trial. Baseline factors did not differ between groups. Sixteen patients had G2 and 83 patients G3. Based on the ITT (intention-to-treat) analysis, 68% 55%; 81% in Group A and 57% 43%; 71% in Group B achieved SVR (p= 0.31). The primary endpoint of better SVR rates in Group A compared to a historical control group (SVR 70%) was not met. In conclusion, approximately 23% of G2/3 patients did not achieve RVR in a real world setting. However, subsequent recruitment in a treatment-extension study was difficult. Prolonged therapy beyond 24 weeks did not result in higher SVR compared to a historical control group.
ClinicalTrials.gov NCT00803309.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To compare the potential of a gadoxetate disodium enhanced navigator-triggered 3D T1 magnetic-resonance cholangiography (MRC) sequence with a specific inversion recovery prepulse to T2-weighted MRCP ...for assessment of the hepatobiliary system.
30 patients (12 male, 18 female) prospectively underwent conventional navigator-triggered 3D turbo spin-echo T2-weighted MRCP and 3D T1 MRC with a specific inversion pulse to minimise signal from the liver 30 minutes after administration of gadoxetate disodium on a 1.5 T MRI system. For qualitative evaluation, biliary duct depiction was assessed segmentally following a 5-point Likert scale. Visualisation of hilar structures as well as image quality was recorded. Additionally, the extrahepatic bile ducts were assessed quantitatively by calculation of signal-to-noise ratios (SNR).
The advantages of T1 3D MRC include reduced affection of image quality by bowel movement and robust depiction of the relative position of the extrahepatic bile ducts in relation to the portal vein and the duodenum compared to T2 MRCP. However, overall T1 3D MRC did not significantly (p > 0.05) improve the biliary duct depiction compared to T2 MRCP in all segments: Common bile duct 4.1 vs. 4.4, right hepatic duct 3.6 vs. 4.2, left hepatic duct 3.5 vs. 4.1. Image quality did not differ significantly (p > 0.05) between both sequences (3.6 vs. 3.5). SNR measurements for the hepatobiliary system did not differ significantly (p > 0.05) between navigator-triggered T1 3D MRC and T2 MRCP.
This preliminary study demonstrates that T1 3D MRC of a specific inversion recovery prepulse has potential to complement T2 MRCP, especially for the evaluation of liver structures close to the hilum in the diagnostic work-up of the biliary system in patients receiving gadoxetate disodium.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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