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SamenvattingDe MRI-scan van de prostaat heeft de bioptstrategie sterk beïnvloed. Toch kunnen bij een normale MRI biopten geïndiceerd blijven: zowel gerichte als systematische. In deze studie werd geanalyseerd welke prostaattumoren gemist zouden worden in de hypothetische situatie dat er geen systematische biopten genomen waren in ons cohort, en dat de MRI volledig leidend zou zijn geweest in het diagnostisch pad. Als referentie dienden de uitkomsten van het standaardprotocol, waarin alle verwezen patiënten (n = 496) een MRI krijgen, er bij een verhoogde kans op prostaatkanker volgens de ERSPC-prostaatwijzer óf afwijkende MRI biopten worden genomen, en er altijd systematische, plusgerichte biopten worden verricht, indien mogelijk. Uit de analyse bleek dat 16 % van de tumoren met een ISUP-graad ≥2 (≥3 + 4 = 7) gemist zou zijn, maar ook dat slechts 66 % van de patiënten gebiopteerd zou hoeven worden, met 50–75 % minder cores, en dat 52 % van de ISUP-gr 1 (3 + 3 = 6)-tumoren ongedetecteerd zouden blijven.

Introduction Use of serial coronary computed tomography angiography (CCTA) allows for the early assessment of coronary plaque progression which may aid in the prevention of major adverse cardiac events (MACE). However, assessment of serial CCTA is done by using anatomical landmarks for matching baseline and follow-up scans. Recently, a tool has been developed allowing for automatic quantification of plaque progression dynamics in serial CCTA utilizing plaque delineation. Purpose The aim of this study was to determine the thresholds that define whether there is plaque progression and/or regression. These thresholds depend on the contrast to noise ratio (CNR) which is an objective marker for scan quality as the latter impacts the plaque delineation. Methods Thresholds and CNR ratios were determined on 50 patients referred for a CCTA due to thoracic complaints. Two scan phases were selected from each patient in which maximum and minimum differences in plaque delineation were measured. Also, CNR was calculated separately for all three major epicardial coronary vessels. A total of 100 scans were analyzed in the current analysis accounting for a total of 300 coronary vessels. First, vessel and lumen wall delineation was done semi-automatically for all major epicardial coronary vessels. Secondly, manual drawings of 7 regions of interest (ROI) per scan were used to quantify scan quality which was defined using the CNR and calculated for each vessel separately. As plaque differences of two scans at the same moment in time should always be zero, the minimum and maximum difference in plaque delineation was used in these scans along with the CNR in order to create calibration graphs on which a linear regression analysis was performed (Figure 1, charts A & B). Inter-observer measurements were calculated using Pearson's correlation coefficient. Results A total of 300 coronary vessels were assessed at CCTA. Semi-automatic vessel and lumen wall delineation as well as CNR calculation was successful in all cases. Subsequent linear regression analysis performed on the CNR and maximal and minimal plaque delineation differences and taking into account the standard error of the estimate revealed the following formulas for minimum and maximum cut-off values: Max = [(0.660 − (002 × CNR)] + 0.349 Min = [(−1.028 + (0.012 × CNR)) − 0.61 The average CNR values was 13.4±3.6. Average maximum and minimum difference in plaque delineation was 0.7±0.3mm and −0.9±0.6mm respectively. The inter-observer correlation for CNR values was excellent yielding a correlation coefficient of 0.872 (p Conclusion Development of vessel-specific quality-based thresholds for the quantification and visualization of plaque progression dynamics as assessed by serial CCTA seems feasible and may aid in the early detection of atherosclerosis progression. Funding Acknowledgement Type of funding sources: None.

Introduction Cardiovascular disease is an independent contributor to cognitive impairment. With an imminent rise in chronic cardiovascular disease, a better understanding of its effects on brain health is warranted. Impaired blood flow to the brain is one of the main hypothesized mechanisms linking cardiovascular disease with abnormal brain aging. Purpose To investigate relations between (subclinical) cardiac dysfunction and vascular brain injury, cognitive impairment and depressive symptoms, with a side-by-side comparison of cardiac biomarkers and imaging parameters. Methods Multicenter, cross-sectional, observational cohort study among 559 participants: 431 with manifest cardiovascular disease (heart failure [HF], carotid occlusive disease or vascular cognitive impairment) and 128 control participants, all without dementia. Participants underwent 3T heart-brain MRI and cognitive testing. Determinants were cardiac biomarkers (NT-proBNP and high-sensitive Troponin-I) and left ventricular (LV) functional parameters by MRI (LV ejection fraction, cardiac output, LV global function index). Outcome measures were cerebral small vessel disease (CSVD) by MRI (presence of white matter hyperintensities, microbleeds, lacunar infarcts or perivascular spaces), CSVD score (0–4), cognitive impairment in ≥1 domain (memory, language, attention-psychomotor speed and executive functioning) and depressive symptoms (Geriatric Depression Scale-15 score >5). Interaction analyses were used to investigate effect modification by patient group; results are reported pooled or stratified accordingly. Results In patients with cardiovascular disease and controls, but not in those with manifest HF, LV functional parameters were associated with CSVD and cognitive impairment, with the following associations: LVEF Conclusion This study indicates that subclinical cardiac dysfunction, as assessed by cardiovascular MRI, is independently associated with vascular brain injury, cognitive impairment and depressive symptoms. Of all parameters, LV global function index showed the most robust relations, indicating that global cardiac performance is more closely related to poorer brain outcome than merely LV systolic function. In those with clinically manifest HF, the severity of cardiac dysfunction was related to depressive symptoms but not to other brain outcome measures. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Netherlands CardioVascular Research Initiative; The Dutch Heart Foundation

Introduction According to recent 2021 ESC prevention guidelines arterial stiffness (aortic pulse wave velocity – PWV, augmentation index - Aix) predicts future major adverse cardiovascular events (MACE). Both parameters have a prognostic relevance, however due to the various technical approaches the level of high stiffness values show significant differences and resulting an argue against widespread use. Purpose We evaluated the cut-off PWV and Aix values for MACE prediction using cardiac magnetic resonance imaging (CMR) and oscillometric methods for validating the prognostic value of high stiffness parameters in post-infarcted patients. Methods CMR phase contrast imaging (Siemens Avanto, 1,5 T CMR device) and an invasively validated oscillometric based Arteriograph (AG) method were compared in this 6 years follow-up study, including 49 patients suffered previous ST-elevation myocardial infarction (STEMI). Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Results 49 patients (37 male, average age: 57±8 years) were investigated. An acceptable agreement and significant correlation (Spearman's rho: 0.332, p Conclusions Arterial stiffness, particularly elevated PWV predicts MACE in postinfarcted patients. Our study showed both CMR and oscillometric techniques are feasible for MACE prediction, however, adjusted cut-off values of PWV are recommended for different methods to improve individual risk stratification. All these findings emphasize the clinical relevance for the future measurement of arterial stiffness might contribute to improved risk stratification after MI, which is crucial for the assessment of prognosis and guidance of secondary prevention treatment. Funding Acknowledgement Type of funding sources: None.

Background Post-myocardial infarction (MI) left ventricular (LV) remodeling emerges as a compensatory mechanism and leads to complex pathophysiological changes in LV blood flow hemodynamics. The interplay, if any, between LV blood flow energetics and remodeling remains unknown. We hypothesized that LV blood flow energetics early after MI are independently related to the temporal changes in LV end-diastolic volume (LVEDV). Methods In this prospective cohort study, 69 patients with acute re-perfused ST-segment elevation MI (STEMI) were included. The patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart 4D flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction (MVO), mitral inflow, and 4D blood flow kinetic energy (KE) characteristics were obtained. LV mean and peak KEi (indexed to LVEDV) were quantified for all time parameters (entire cardiac cycle, during systole/diastole, at E- and A-waves). Results In univariable linear regression analysis, peak KEi (R-R interval), mean systolic KEi, A-wave KEi, MVO presence were all associated with the relative change (%) of LVEDV (p=0.03, p=0.01, p Conclusion Late diastolic LV blood flow energetics early after acute MI are independently associated with both absolute and relative longitudinal changes in LVEDV and may provide incremental value over infarct and mitral inflow characteristics to be associated with post-MI LV remodeling. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

To analyze the diagnostic accuracy of abdominal computed tomography (CT) in diagnosing internal herniation (IH) following Rouxen-Y gastric bypass (RYGB) surgery.IH is one of the most important and challenging complications following RYGB. Therefore, early and adequate diagnosis of IH is necessary. Currently, exploratory surgery is considered the gold standard in diagnosing IH. Although CT scans are frequently being used, the true diagnostic accuracy in diagnosing IH remains unclear.PubMed, Embase, and Cochrane databases were systematically searched for relevant articles describing the diagnostic accuracy of abdominal CT in diagnosing IH after RYGB. Data were extracted, recalculated, and pooled to report on the overall diagnostic accuracy of CT in diagnosing IH, and the diagnostic accuracy of specific radiological signs.A total of 20 studies describing 1637 patients were included. seventeen studies provided data regarding the overall diagnostic accuracy: pooled sensitivity of 82.0%, specificity of 84.8%, positive predictive value of 82.7%, and negative predictive value of 85.8% were calculated. Eleven studies reported on specific CT signs and their diagnostic accuracy. The radiological signs with the highest sensitivity were the signs of venous congestion, swirl, and mesenteric oedema (sensitivity of 78.7%, 77.8%, and 67.2%, respectively).This meta-analysis demonstrates that CT is a reliable imaging modality for the detection of IH. Therefore, abdominal CT imaging should be added to the diagnostic work-up for RYGB patients who present themselves with abdominal pain suggestive of IH to improve patient selection for explorative surgery.

To present an overview of studies using serial coronary computed tomography angiography (CCTA) as a tool for finding both quantitative (changes) and qualitative plaque characteristics as well as epicardial adipose tissue (EAT) volume changes as predictors of plaque progression and/or major adverse cardiac events (MACE) and outline the challenges and advantages of using a serial non-invasive imaging approach for assessing cardiovascular prognosis.A literature search was performed in PubMed, Embase, Web of Science, Cochrane Library and Emcare. All observational cohort studies were assessed for quality using the Newcastle-Ottawa Scale (NOS). The NOS score was then converted into Agency for Healthcare Research and Quality (AHRQ) standards: good, fair and poor.A total of 36 articles were analyzed for this review, 3 of which were meta-analyses and one was a technical paper. Quantitative baseline plaque features seem to be more predictive of MACE and/or plaque progression as compared to qualitative plaque features.A critical review of the literature focusing on studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. Significant questions regarding the clinical implications of these specific quantitative and qualitative plaque features as well as the challenges of using serial CCTA have yet to be resolved in studies using this imaging technique.• Use of (serial) CCTA can identify plaque characteristics and plaque changes as well as changes in EAT volume that are predictive of plaque progression and/or major adverse events (MACE) at follow-up. • Studies utilizing serial CCTA revealed that mainly quantitative baseline plaque features and quantitative plaque changes are predictive of MACE and/or plaque progression contrary to qualitative plaque features. • Ultimately, serial CCTA is a promising technique for the evaluation of cardiovascular prognosis, yet technical details remain to be refined.

Item does not contain fulltext BACKGROUND: Gender differences in the thrombotic and bleeding risk have been suggested to condition the benefits of antithrombotic therapies in Acute Coronary Syndrome (ACS) patients, and mainly among those undergoing percutaneous coronary interventions with drug eluting stents (DES). The impact of gender on the optimal duration of dual antiplatelet therapy (DAPT) in ACS patients is still unexplored and was, therefore, the aim of the present sub-study. METHODS: REDUCE was a prospective, multicenter, randomized investigator-initiated study designed to enroll 1500 ACS patients after treatment with the COMBO Dual Stent Therapy, based on a noninferiority design. Patients were randomized in a 1:1 fashion to either 3 or 12 months of DAPT. Primary study endpoint was a composite of all-cause mortality, myocardial infarction, definite/probable stent thrombosis (ST), stroke, target-vessel revascularization (TVR) and bleedings (BARC II, III, V) at 12 months. Secondary endpoints were cardiovascular mortality and the individual components of the primary endpoint within 24 months. RESULTS: From June 2014 to May 2016 300 women and 1196 men were included in the study. Among them, 43.7% of females and 51.9% of males were assigned to the 3 months DAPT treatment. Baseline characteristics were well matched between the two arms, with the exception of a lower rate of TIMI flow

Aims Absorb bioresorbable scaffold (BRS) related events were noticed between 1 and 3 years – the approximate time of active scaffold bioresorption. This resulted in the recommendation for 3 year DAPT after Absorb BRS implantation. We aimed to evaluate the safety and efficacy of the Absorb BRS in comparison with Xience everolimus-eluting stent (EES) at 4 years follow-up in large unselected population. In addition, we aimed to assess the value of prolonged DAPT against scaffold thrombosis. Methods AIDA was an investigator-initiated, non-inferiority, multicenter, randomized, all-comers trial. Target vessel failure (a composite of cardiac death, target-vessel myocardial infarction and target-vessel revascularization) and device thrombosis at 4-year follow-up are the primary focus of this analysis. During the trial recommendation for DAPT was changed to up to 3-years post Absorb BVS implantation. Whether this adaption influenced the results after Absorb BVS will be assessed. Results Between August 2013 and December 2015, 1,845 patients were enrolled, of whom 924 were randomized to treatment with Absorb BRS and 921 to Xience EES. The baseline characteristics in the two study arms were well balanced. Of all patients, 18% had diabetes mellitus, more than 50% presented with ACS and the median SYNTAX score was 11. In the Absorb BRS arm, 97% of lesions were predilated and in 74% post-dilatation was performed. Four-year clinical outcomes are currently being adjudicated by an independent clinical event committee. The results will be available at EuroPCR 2020. Conclusions Absorb BRS is associated with higher rates of scaffold thrombosis throughout 3-year of follow-up. The performance of Absorb BRS beyond 3-years, in comparison with the Xience EES, in a large unselected population will be presented. (ClinicalTrials.gov Identifier: NCT01858077) Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Abbott

An amendment to this paper has been published and can be accessed via the original article.

In biopsy naïve men suspected for prostate cancer (PCa), it is uncertain how a risk-calculator and bi-parametric (bp) MRI should be combined to decide on prostate biopsy, balancing cancer detection rates and diagnostic burden.Prospective, single centre cohort study (August 2018-April 2019). All patients referred with serum PSA ≥ 3 ng/ml or abnormal digital rectal examination received bpMRI and risk for PCa was calculated using the ERSPC risk-calculator. Men with either PI-RADS ≥ 3 or calculator risk-score 20% were recommended to undergo systematic biopsy (SB) and targeted biopsy (TB) of any visible lesion (reference pathway). Eight different derived diagnostic pathways were compared to the reference pathway regarding cancer detection, number of biopsies and bpMRIs performed.Of 496 patients; 233 (47%) had a risk-calculator score of 20%; 201 (41%) had PI-RADS score ≥ 3. The reference pathway detected PCa in 32.1%, clinically significant (cs) PCa in 19.4%, with 41% avoided biopsies, but 0% avoided bpMRI. Stratification with only risk-calculator: 76% csPCa diagnosed, 53% avoided biopsies and 100% avoided bpMRI. Stratification with only bpMRI: 97% csPCa diagnosed, 59% avoided biopsies, but 0% avoided bpMRI. A pathway with risk-calculator first, followed only with bpMRI when high-risk: 81% csPCa diagnosed, 72% avoided biopsies and 53% avoided bpMRI.Upfront bpMRI as a risk stratification tool outperforms risk-calculator in detecting significant disease. Applying the risk-calculator first to decide on performing an MRI, avoids 1 out of 2 MRIs, but up to 1 out of 5 significant cancers are missed.

New high quality satellite measurements of nitrogen dioxide (NO2) of the TROPOspheric Monitoring Instrument (TROPOMI) over snow-covered regions of Siberia reveal previously undocumented but significant NO2 emissions associated with the natural gas industry in Western Siberia. Besides gas drilling and natural gas power plants, also gas compressor stations for the transport of natural gas are sources of high amounts of nitrogen oxides (NOx = NO + NO2), which are emitted in otherwise pristine regions. The emissions per station from these remote gas compressor stations are at least an order of magnitude larger than those reported for North American gas compressor stations, possibly related to less stringent environmental regulations in Siberia compared to the United States. This discovery was made possible thanks to a newly developed technique for discriminating snow covered surfaces from clouds, which allows for satellite measurements of tropospheric NO2 columns over large boreal snow-covered areas. While retrievals over snow-covered areas were traditionally filtered out, we used the retrieved column of air in these observations to distinguish clouds higher in the atmosphere from the snow at the surface. This results in 23% more TROPOMI observations on an annual basis. Furthermore, these observations have a precision four times better than nearly any TROPOMI observation over other areas and surfaces around the world. These new results highlight the potential of TROPOMI on Sentinel 5P as well as future satellite missions for monitoring small-scale emissions and emissions at high latitudes.

Background Many CpGs become hyper or hypo-methylated with age. Multiple methods have been developed by Horvath et al. to estimate DNA methylation (DNAm) age including Pan-tissue, Skin & Blood, PhenoAge, and GrimAge. Pan-tissue and Skin & Blood try to estimate chronological age in the normal population whereas PhenoAge and GrimAge use surrogate markers associated with mortality to estimate biological age and its departure from chronological age. Here, we applied Horvath’s four methods to calculate and compare DNAm age in 499 subjects with type 1 diabetes (T1D) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study using DNAm data measured by Illumina EPIC array in the whole blood. Association of the four DNAm ages with development of diabetic complications including cardiovascular diseases (CVD), nephropathy, retinopathy, and neuropathy, and their risk factors were investigated. Results Pan-tissue and GrimAge were higher whereas Skin & Blood and PhenoAge were lower than chronological age (p < 0.0001). DNAm age was not associated with the risk of CVD or retinopathy over 18–20 years after DNAm measurement. However, higher PhenoAge (β = 0.023, p = 0.007) and GrimAge (β = 0.029, p = 0.002) were associated with higher albumin excretion rate (AER), an indicator of diabetic renal disease, measured over time. GrimAge was also associated with development of both diabetic peripheral neuropathy (OR = 1.07, p = 9.24E−3) and cardiovascular autonomic neuropathy (OR = 1.06, p = 0.011). Both HbA1c (β = 0.38, p = 0.026) and T1D duration (β = 0.01, p = 0.043) were associated with higher PhenoAge. Employment (β = − 1.99, p = 0.045) and leisure time (β = − 0.81, p = 0.022) physical activity were associated with lower Pan-tissue and Skin & Blood, respectively. BMI (β = 0.09, p = 0.048) and current smoking (β = 7.13, p = 9.03E−50) were positively associated with Skin & Blood and GrimAge, respectively. Blood pressure, lipid levels, pulse rate, and alcohol consumption were not associated with DNAm age regardless of the method used. Conclusions Various methods of measuring DNAm age are sub-optimal in detecting people at higher risk of developing diabetic complications although some work better than the others.

Atmospheric ozone plays a key role in air quality and the radiation budget of the Earth, both directly and through its chemical influence on other trace gases. Assessments of the atmospheric ozone distribution and associated climate change therefore demand accurate vertically resolved ozone observations with both stratospheric and tropospheric sensitivity, on both global and regional scales, and both in the long term and at shorter timescales. Such observations have been acquired by two series of European nadir-viewing ozone profilers, namely the scattered-light UV-visible spectrometers of the GOME family, launched regularly since 1995 (GOME, SCIAMACHY, OMI, GOME-2A/B, TROPOMI, and the upcoming Sentinel-5 series), and the thermal infrared emission sounders of the IASI type, launched regularly since 2006 (IASI on Metop platforms and the upcoming IASI-NG on Metop-SG). In particular, several Level-2 retrieved, Level-3 monthly gridded, and Level-4 assimilated nadir ozone profile data products have been improved and harmonized in the context of the ozone project of the European Space Agency's Climate Change Initiative (ESA Ozone-cci). To verify their fitness for purpose, these ozone datasets must undergo a comprehensive quality assessment (QA), including (a) detailed identification of their geographical, vertical, and temporal domains of validity; (b) quantification of their potential bias, noise, and drift and their dependences on major influence quantities; and (c) assessment of the mutual consistency of data from different sounders. For this purpose we have applied to the Ozone-cci Climate Research Data Package (CRDP) released in 2017 the versatile QA and validation system Multi-TASTE, which has been developed in the context of several heritage projects (ESA's Multi-TASTE, EUMETSAT's O3M-SAF, and the European Commission's FP6 GEOmon and FP7 QA4ECV). This work, as the second in a series of four Ozone-cci validation papers, reports for the first time on data content studies, information content studies and ground-based validation for both the GOME- and IASI-type climate data records combined. The ground-based reference measurements have been provided by the Network for the Detection of Atmospheric Composition Change (NDACC), NASA's Southern Hemisphere Additional Ozonesonde programme (SHADOZ), and other ozonesonde and lidar stations contributing to the World Meteorological Organisation's Global Atmosphere Watch (WMO GAW). The nadir ozone profile CRDP quality assessment reveals that all nadir ozone profile products under study fulfil the GCOS user requirements in terms of observation frequency and horizontal and vertical resolution. Yet all L2 observations also show sensitivity outliers in the UTLS and are strongly correlated vertically due to substantial averaging kernel fluctuations that extend far beyond the kernel's 15km FWHM. The CRDP typically does not comply with the GCOS user requirements in terms of total uncertainty and decadal drift, except for the UV-visible L4 dataset. The drift values of the L2 GOME and OMI, the L3 IASI, and the L4 assimilated products are found to be overall insignificant, however, and applying appropriate altitude-dependent bias and drift corrections make the data fit for climate and atmospheric composition monitoring and modelling purposes. Dependence of the Ozone-cci data quality on major influence quantities - resulting in data screening suggestions to users - and perspectives for the Copernicus Sentinel missions are additionally discussed., SCOPUS: ar.j, info:eu-repo/semantics/published

Contains fulltext : 182904.pdf (Publisher’s version ) (Open Access) BACKGROUND: To eliminate some of the potential late limitations of permanent metallic stents, the bioresorbable coronary stents or 'bioresorbable vascular scaffolds' (BVS) have been developed. METHODS: We reviewed all currently available clinical data on BVS implantation. RESULTS: Since the 2015 position statement on the appropriateness of BVS in percutaneous coronary interventions, several large randomised trials have been presented. These have demonstrated that achieving adequate 1 and 2 year outcomes with these first-generation BVS is not straightforward. These first adequately powered studies in non-complex lesions showed worse results if standard implantation techniques were used for these relatively thick scaffolds. Post-hoc analyses hypothesise that outcomes similar to current drug-eluting stents are still possible if aggressive lesion preparation, adequate sizing and high-pressure postdilatation are implemented rigorously. As long as this has not been confirmed in prospective studies the usage should be restricted to experienced centres with continuous outcome monitoring. For more complex lesions, results are even more disappointing and usage should be discouraged. When developed, newer generation scaffolds with thinner struts or faster resorption rates are expected to improve outcomes. In the meantime prolonged dual antiplatelet therapy (DAPT, beyond one year) is recommended in an individualised approach for patients treated with current generation BVS. CONCLUSION: The new 2017 recommendations downgrade and limit the use of the current BVS to experienced centres within dedicated registries using the updated implantation protocol and advise the prolonged usage of DAPT. In line with these recommendations the manufacturer does not supply devices to the hospitals without such registries in place.

Aims Extent of coronary artery disease (CAD) may affect outcomes after percutaneous coronary intervention (PCI). In this pre-specified subgroup analysis of the AIDA trial we evaluated the impact of SXscore on clinical outcomes Methods and results AIDA was a multicenter trial comparing Absorb with Xience. SX score was assessed using the baseline diagnostic angiograms. Each coronary lesion with diameter stenosis ≥50% in vessels ≥1.5 mm was scored. All lesion scores were combined to provide the overall SXscore. The angiographic SXscore calculations were performed by core laboratory analysts who were blinded for clinical events (Cardialysis B.V., Rotterdam, The Netherlands). Clinical outcomes were subsequently stratified according to SXscore tertiles: SXlow (SXcore ≤8), SXmid (SXscore >8 and ≤15) and SXhigh (>15). The primary endpoint of this AIDA-trial substudy was target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction and target vessel revascularization. The SXscore was prospectively calculated in 1661 of the 1845 patients (90%). The SXscore ranged from 1 to 57, with a mean±SD of 12.9±8.5 and a median of 11 (Q1-Q3 7–17). In this analysis the SXscore tertiles were defined as SXlow (SXcore ≤8) (n=589), SXmid (SXscore >8 and ≤15) (n=538), and SXhigh (>15) (n=534). Patients in the SXhigh group were older, had a more extensive medical history for previous revascularizations (both PCI and coronary artery bypass grafting), and were more likely to present with a ST-elevation myocardial infarction. At 2 follow-up the Kaplan-Meier estimates of TVF for the overall AIDA study population was 15.5% in the SXhigh tertile, 10.4% in the SXmid tertile and 4.7% in the SXlow tertile (hazard ratio (HR) 3.53 95% CI 2.28–5.45; P8 had significantly higher event rates as compared to patients with a SXscore ≤8. The rates of TVF in the Absorb BVS population are 15.5% (SXhigh), 11.4% (SXmid), and 3.7% (SXlow), with a significant difference between the SXlow versus SXmid (HR 3.27; 95% CI 1.61–6.68; p=0.001) and SXlow versus SXhigh (HR 4.57; 95% CI 2.29–9.10; p Target Vessel Failure in Absorb BVS Conclusions This study demonstrates that implantation of the Absorb in patients with a SXscore ≤8 is associated with numerically lower TVF rates as compared to the Xience drug-eluting stent. The rate of scaffold thrombosis in this SXlow tertile, while still higher for Absorb, is more acceptable than in SXmid and SXhigh score tertiles. Higher SXscore (i.e. >8), both Sxmid and SXhigh, however, appears to be associated with markedly increased risk of device thrombosis, revascularization and myocardial infarction in patients treated with the Absorb. Acknowledgement/Funding The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular

AIMS Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention, might lead to better outcomes when compared to conventional treatment. ACS patients (STE-ACS patients in particular) are generally younger, and most often have lesions with softer plaques, a lower plaque burden and less extensive coronary artery disease. In this pre-specified subgroup analysis of the AIDA trial, we evaluated the clinical outcomes of Absorb BVS versus Xience EES treated patients presenting with or without ACS. Methods and results This analysis includes the 2-year outcomes of all 1845 patients randomized in the AIDA trial subdivided by clinical presentation, a pre-specified subgroup analysis. We compared patients presenting with ACS with those presenting without ACS (ACS versus no-ACS patients). Patients presenting with ACS were further sub-categorized according to the presence or absence of ST-segment elevation at presentation (STE-ACS versus NSTE-ACS patients). Baseline status by clinical presentation was known in all patients, and 842 (45.6%) patients presented with ACS, 456 (25.2%) with STE-ACS and 377 (20.4%) with NSTE-ACS.The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; p=0.49) and in no-ACS patients (11.7% versus 10.7% respectively; p=0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7% respectively, p=0.03) as well as in no-ACS patients (2.4% versus 0.2% respectively; p=0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (p=0.80) and for the endpoint of definite or probable device thrombosis (p=0.17). Conclusions In ACS patients within AIDA, we found no difference in rates of target vessel failure between the Absorb BVS and Xience EES groups. Rates of definite or definite/probable device thrombosis were higher in the Absorb BVS group throughout all clinical presentations. No significant interaction between ACS and no-ACS patients and the occurrence of TVF Acknowledgement/Funding The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular.

A methodology for the round-robin evaluation and the geophysical validation of ozone profile data retrieved from nadir UV backscatter satellite measurements is detailed and discussed, consisting of data set content studies, information content studies, co-location studies, and comparisons with reference measurements. Within the European Space Agency's Climate Change Initiative on ozone (Ozone_cci project), the proposed round-robin procedure is applied to two nadir ozone profile data sets retrieved at the Royal Netherlands Meteorological Institute (KNMI) and the Rutherford Appleton Laboratory (RAL, United Kingdom), using their respective OPERA v1.26 and RAL v2.1 optimal estimation algorithms, from MetOp-A GOME-2 (i.e. the second generation Global Ozone Monitoring Experiment on the first Meteorological Operational Satellite) measurements taken in 2008. The ground-based comparisons use ozonesonde and lidar profiles as reference data, acquired by the Network for the Detection of Atmospheric Composition Change (NDACC), Southern Hemisphere Additional Ozonesonde programme (SHADOZ), and other stations of the World Meteorological Organisation's Global Atmosphere Watch (WMO GAW). This direct illustration highlights practical issues that inevitably emerge from discrepancies in e.g. profile representation and vertical smoothing, for which different recipes are investigated and discussed. Several approaches for information content quantification, vertical resolution estimation, and reference profile resampling are compared and applied as well. The paper concludes with compliance estimates of the two GOME-2 ozone profile data sets with user requirements from the Global Climate Observing System (GCOS) and from climate modellers.

This study presents a sensitivity analysis of multivariate regressions of recent springtime Antarctic vortex ozone trends using a "big data" ensemble approach. Our results indicate that the poleward heat flux (Eliassen–Palm flux) and the effective chlorine loading respectively explain most of the short-term and long-term variability in different Antarctic springtime total ozone records. The inclusion in the regression of stratospheric volcanic aerosols, solar variability and the quasi-biennial oscillation is shown to increase rather than decrease the overall uncertainty in the attribution of Antarctic springtime ozone because of large uncertainties in their respective records. Calculating the trend significance for the ozone record from the late 1990s onwards solely based on the fit of the effective chlorine loading is not recommended, as this does not take fit residuals into account, resulting in too narrow uncertainty intervals, while the fixed temporal change of the effective chlorine loading does not allow for any flexibility in the trends. When taking fit residuals into account in a piecewise linear trend fit, we find that approximately 30–60% of the regressions in the full ensemble result in a statistically significant positive springtime ozone trend over Antarctica from the late 1990s onwards. Analysis of choices and uncertainties in time series show that, depending on choices in time series and parameters, the fraction of statistically significant trends in parts of the ensemble can range from negligible to a complete 100% significance. We also find that, consistent with expectations, the number of statistically significant trends increases with increasing record length. Although our results indicate that the use multivariate regressions is a valid approach for assessing the state of Antarctic ozone hole recovery, and it can be expected that results will move towards more confidence in recovery with increasing record length, uncertainties in choices currently do not yet support formal identification of recovery of the Antarctic ozone hole.

Esophageal multiple intraluminal impedance baseline is an additional impedance parameter that was recently related to esophageal integrity. The aim of this study was to assess the relationship between mean esophageal impedance value and endoscopic findings in a large group of children. Children with symptoms of gastroesophageal reflux submitted to both endoscopy and impedance were included. Esophagitis was graded according to the Los Angeles classification. Mean impedance value was automatically calculated over 24-hour tracings. Data were adjusted for age through z-score transformation using percentiles normalized by the LMS (Lambda for the skew, Mu for the median, and Sigma for the generalized coefficient of variation) method. Nonparametric Mann-Whitney and Kruskal-Wallis tests, multiple, and stepwise regression were used. P-value

Disturbed expression of microRNAs (miRNAs) in regulatory T cells (Tregs) leads to development of autoimmunity in experimental mouse models. However, the miRNA expression signature characterizing Tregs of autoimmune diseases, such as rheumatoid arthritis (RA) has not been determined yet. In this study, we have used a microarray approach to comprehensively analyze miRNA expression signatures of both naive Tregs (CD4+CD45RO-CD25++) and memory Tregs (CD4+CD45RO+CD25++), as well as conventional naive (CD4+CD45RO+CD25+) and memory (CD4+CD45RO+CD25+) T cells (Tconvs) derived from peripheral blood of RA patients and matched healthy controls. Differential expression of selected miRNAs was validated by TaqMan-based quantitative reverse transcription-PCR. We found a positive correlation between increased expression of miR-451 in T cells of RA patients and disease activity score (DAS28), erythrocyte sedimentation rate levels and serum levels of interleukin-6. Moreover, we found characteristic, disease-and treatment-independent, global miRNA expression signatures defining naive Tregs, memory Tregs, naive Tconvs and memory Tconvs. The analysis allowed us to define miRNAs characteristic for a general naive phenotype (for example, miR-92a) and a general memory phenotype (for example, miR-21, miR-155). Importantly, the analysis allowed us to define miRNAs that are specifically expressed in both naive and memory Tregs, defining as such miRNA signature characterizing the Treg phenotype (that is, miR-146a, miR-3162, miR-1202, miR-1246 and miR-4281).

In this paper we evaluate the long-term changes in ozone depletion within the Antarctic ozone hole using a 37 years (1979-2015) of daily Ozone Mass Deficits (OMD) derived from assimilated total ozone column data. For each year an ‘average daily OMD’ is calculated over a 60-day preferential time period DOY (Day of Year) 220-280). Excluding years with a reduced Polar Stratospheric Cloud (PSC) volume (the so-called PSC-limited years), the 1979-2015 time series of spatially-integrated average daily OMD correlates very well with long-term changes in Equivalent Effective Stratospheric Chlorine (EESC; R2 = 0.89). We find a corresponding statistically highly significant post year-2000 decrease in OMD of -0.77 ± 0.17 MegaTon (Mt; trend significance of 9.8σ), with an associated post year-2000 change in OMD of approximately -30%, consistent with the post year-2000 change in EESC relative to 1980 EESC levels of approximately -30%. The post year-2000 trend significance is robust to the choice of start year. The spatial distribution of the average daily OMD trends reveals a vortex-core region (approximately covering the region [90°W – 0 ° – 90°E / 75°S – 85°S]) largely unaffected by dynamics with a post year-2000 trend significance of > 8σ, and a vortex-edge region in which the trend is locally strongly affected by vortex dynamics though not spatially integrated over the whole vortex-edge region (trend significance > 9σ). For the trend significance we do not find consistent evidence for long-term changes in wave driving, vortex mixing, pre-ozone hole conditions, or the applied assimilation method, playing a role. Our observation/assimilation-based analysis provides robust evidence of a post year-2000 statistically highly significant decrease in the average daily OMD that is consistent with the long-term decrease in ozone depleting substances since 2000 following international emission regulations.

[1] We used SCIAMACHY (10:00 LT) and OMI (13:30 LT) tropospheric NO2 columns to study diurnal and seasonal patterns in NO2 concentrations over India. Using characteristics of seasonal variability in tropospheric NO2 columns, we present a simple methodology to identify the dominant NOx source category for specific regions in India. Regions where the dominant source category is classified as biomass burning are found generally to agree with the ATSR fire count distribution. Relating OMI NO2 columns to surface NOx emission, we find that biomass burning emission account for an average flux of 1.55 × 1011 molecules cm−2 s−1 during the peak burning period. Furthermore, extrapolating this estimated flux to the total burned area for the year 2005, biomass burning is estimated to account for 72 Gg of N emissions. Additional analysis of fire events in Northeast India shows a marked increase in TES retrieved O3 concentrations, suggesting significant photochemical ozone formation during the peak biomass burning period. Regions where the dominant source type was categorized as anthropogenic are in good agreement with the distribution of major industrial regions and urban centers in India. Tropospheric NO2 columns over these anthropogenic source regions increased by 3.8% per year between 2003 and 2011, which is consistent with the growth in oil and coal consumption in India. The OMI-derived surface NO2 mixing ratios are indirectly validated with the surface in situ measurements (correlation r = 0.85, n = 88) obtained from the air quality monitoring network in Delhi during August 2010 to January 2011. Most of the OMI-derived surface NO2 values agree with surface-based measurements, supporting the direct utility of OMI observation for emission estimates. Finally, we use OMI NO2 columns to estimate NOx emissions for selected large cites and major thermal power plants in India and compare these estimates with the INTEX-B and EDGAR emission inventory. We find that, for a few locations, OMI-derived emission show fair agreement; however, for many locations, NOx emissions differ from INTEX-B and EDGAR inventories.

Only by characterising the growth medium's water retention characteristics and ability to supply water, can the irrigation technique for coir be improved. The study was conducted to describe the development of water stress of greenhouse tomatoes grown in coir, to identify different stages of water stress, and to determine the implication for irrigation management. From this study, mild water stress started as soon as the volumetric water content dropped below that of the well-watered mediums and lasted while the plant conditioned to the water stress. The onset of moderate water stress occurred from the point where the cucumber plants do not recover under continuous drying of the medium. Increased leaf water potential, stomatal resistance and the first signs of wilting confirmed moderate crop water stress. Severe water stress occurred where changes in the slope of transpiration of unwatered plants divided by reference transpiration became negligible over time and about 75% of all plants were irreversibly wilted. Based on plant response only, water depletion can be allowed to a point before moderate water stress is reached. Soil water sensors calibrated to measure volumetric water content in coir or tensiometer measurements converted to volumetric water content from a laboratory-determined retention curve for coir may be used to trigger irrigation.

It is difficult to quantify the degree to which terrestrial evaporation supports the occurrence of precipitation within a certain study region (i.e. regional moisture recycling) due to the scale- and shape-dependence of regional moisture recycling ratios. In this paper we present a novel approach to quantify the spatial and temporal scale of moisture recycling, independent of the size and shape of the region under study. In contrast to previous studies, which essentially used curve fitting, the scaling laws presented by us follow directly from the process equation. thus allowing a fair comparison between regions and seasons. The calculation is based on ERA-Interim reanalysis data for the period 1999 to 2008. It is shown that in the tropics or in mountainous terrain the length scale of recycling can be as low as 500 to 2000 km. In temperate climates the length scale is typically between 3000 to 5000 km whereas it amounts to more than 7000 km in desert areas. The time scale of recycling ranges from 3 to 20 days, with the exception of deserts, where it is much longer. The most distinct seasonal differences can be observed over the Northern Hemisphere: in winter, moisture recycling is insignificant, whereas in summer it plays a major role in the climate. The length and time scales of atmospheric moisture recycling can be useful metrics to quantify local climatic effects of land use change.

Scanning Imaging Absorption Spectrometer for Atmospheric Cartography (SCIAMACHY) tropospheric NO2 retrievals (average during March-April-May 2003-2006) were used to locate the major urban sources of NO2 in India. To show that tropospheric NO2 measurements from satellites can provide useful information on day-to-day changes in urban NO2 concentration, we compared 2-year (October 2004-October 2006) records of surface air NO2 concentrations obtained at one of the measurement sites in Delhi to retrievals of tropospheric NO2 columns from Ozone Monitoring Instrument (OMI) observations. The quality of correlation between satellite observations at the urban scale and surface measurements (45%) provided confidence to investigate the temporal changes in the local emission over major urban locations. Combined Global Ozone Monitoring Experiment (GOME) and SCIAMACHY measurements for the period March 1996-December 2007 were used to compute the trends over the selected urban locations. A statistical analysis was applied to derive trends for this period over these locations. The time series of the monthly NO2 columns for these 11 years were fitted with a linear function superposed on an annual seasonal cycle. We found a statistically significant increase in tropospheric NO2 levels over the major urban cities in India. Notable urban locations of positive trends were found to be the cities where the urban population is growing rapidly.

Tropospheric O3 column estimates are produced and evaluated from spaceborne O3 observations by the subtraction of assimilated O3 profile observations from total column observations, the so-called Tropospheric O3 ReAnalysis or TORA method. Here we apply the TORA method to six years (1996–2001) of ERS-2 GOME/TOMS total O3 and ERS-2 GOME O3 profile observations using the TM5 global chemistry-transport model with a linearized O3 photochemistry parameterization scheme. Free running TM5 simulations show good agreement with O3 sonde observations in the upper-tropospheric and lower stratospheric region (UTLS), both for short day-to-day variability as well as for monthly means. The assimilation of GOME O3 profile observations counteracts the mid-latitude stratospheric O3 drift caused by the overstrong stratospheric meridional circulation in TM5. Assimilation of GOME O3 profile observations also improves the bias and correlations in the tropical UTLS region but slightly degrades the model-to-sonde correlations and bias of extra-tropical UTLS. We suggest that this degradation is related to the large ground pixel size of the GOME O3 measurements (960×100 km) in combination with retrieval and calibration errors. The added value of the assimilation of GOME O3 profiles compared to stand-alone model simulations lays in the long term variations of stratospheric O3, not in short term synoptic variations. The evaluation of daily and monthly tropospheric O3 columns obtained from total column observations and using the TORA methodology shows that the use of GOME UV-VIS nadir O3 profiles in combination with the spatial resolution of the model does not result in satisfactory residual tropospheric ozone columns.

Zusammenfassung und Diskussion Auf Grund der beschriebenen Beobachtung in den Vorratszuchten des Ringelspinners (Malacosoma neustria L.) wurde angenommen, das fur die kleinen, kunstlich verspateten Raupchen, das gewohnliche, im Mai erschienene Blatt bereits zu hart war. Durch Storung des sychronen Entwicklungsverlaufs von Blattern und Raupen wurde das Uberleben der letzteren ernstlich gefahrdet. Die beiden ersten Versuche, in denen die Raupen gefuttert wurden mit Blattern von normal und zufallig spater ausgeschlagenen Eichen sowie mit normalen Blattern und Johannislaub, bestatigten bereits diese Annahme. Leider musten die Versuche, lange bevor die Raupen ausgewachsen waren, beendet werden. Im dritten und letzten Versuch gelang es, die Raupen sowohl mit Mai- als mit Johannislaub am Leben zu halten. Genau wie bei den beiden ersten Versuchen war die Mortalitat der mit dem frischen Laub gefutterten Raupen bedeutend kleiner und das Wachstum schneller als bei den mit alten Blattern ernahrten. Spater ergab sich, das auch Puppengewicht und Eiproduktion bedeutend hoher lagen sowie die Verpuppung eher begann. Bezuglich der Zuchten mit Maiblattern des letzten Versuches mas darauf hingewiesen werden, das von 60 Raupen (♂ und ♀) nur 1(!) Weibchen ubrigblieb, in dessen Ovarium 83 Eier gezahlt wurden. Wenn diese Eier alle befruchtet und tatsachlich abgelegt waren, wurde sich aus dieser Gruppe von 60 Stuck eine Gruppe von 83 Stuck im Ei-Stadium entwickelt haben. Hiervon durfte zweifellos noch eine Anzahl eingegangen sein, bevor sie das Stadium des ursprunglichen Versuchsmaterials erreicht hatte. Zudem wurden Predatoren und Parasiten durch den Maschendraht von den anfanglich 60 Tieren ferngehalten. Im Freien ware eine derartige Population also sicher eingegangen, auch weil das im Vergleich mit dem anderen verlangerte Larvenstadium (um ca. 21 Tage) die Gefahr von Predation und Parasitierung bedeutend vergrosert haben wurde. Jedoch mus bemerkt werden, das im Freien wahrscheinlich niemals eine derartig grose Storung in der synchronen Entwicklung auftreten durfte. Die Tatsache, das alte Blatter nur skelettiert wurden und junge ganzlich gefressen, zeigt uns, das Strukturunterschiede des Blattes eine der Ursachen, wahrscheinlich der Hauptgrund, sind fur die unterschiedlichen Zuchtergebnisse. Moglicherweise hat auch der hohere Wassergehalt des jungen Blattes gunstig gewirkt. Dieses ist um so wahrscheinlicher, weil die Versuchstiere aus dem Blatt ihr Wasser beziehen musten. Der gunstige Einflus des verspateten Maiblattes und des Johannislaubes konnte auftreten trotz dem im Vergleich mit dem Maiblatt geringeren Zukker- und Roheiweisgehalt. Naturlich ist es auch moglich, das noch andere Stoffe mitgewirkt haben, z. B. ein Ubermas von wachstumsfordernden Stoffen im jungen Blatt oder giftig wirkenden im alten Blatt. Wir haben jedoch diesbezuglich keine Beobachtungen gemacht. Im Zusammenhang mit dem geringeren Zuckergehalt sei darauf hingewiesen, das nach Schwenke (1962, 1963 und 1966) das Erscheinen phythophager Insekten gefordert wird durch hohen Zuckergehalt, u. a. bei Diprion pini L. Weil aber die Konditionen, mit denen Schwenke seine Resultate erhielt, grundverschieden waren von den meinigen, will ich den Einflus des Zuckers hier nicht weiter diskutieren. Aus allen Resultaten durfen wir den Schlus ziehen, das unsere ursprungliche Auffassung richtig war, das also eine Storung in der synchronen Entwicklung des Eichenlaubs und der Ringelspinnerpopulation eine geringere Populationsdichte des letzteren verursachen kann. Es ist jedoch nicht wahrscheinlich, das im Freien eine derartig grose Storung, die wir ungewollt erzielten, auftreten wird. Es ist Vorsicht geboten beim Verzogern der Entwicklung der Ringelspinnereier, wenn das Material dazu dienen soll, den Einflus der Nahrungspflanze auf die allgemeine Entwicklung des Insektes zu prufen. Summary The investigations described in this paper are the result of a coincidence occurring in rearing cages containing the stock of lackey moths (Malacosoma neustria L.), which was intended for other experiments. In these cages some of the caterpillars were observed to skeletonize the leaves while the others ate the entire leaves. The skeletonizing caterpillars grew little or not at all. As the eggs had been kept at 5° C for some three weeks in spring we suspected that the synchronization between the development of the caterpillars and of the food plant, viz. the pedunculate oak (Quercus robur L. = Q. pedunculata L.) had been disturbed, so that a proportion of the caterpillars starved. Three experiments were made in order to investigate the question. In the first experiment a group of caterpillars was fed with the soft leaves of some oaks which had budded late for some reason. These caterpillars grew much faster than the controls on May-leaves. This result confirmed the hypothesis stated above. It also led to the conclusion that in the field a population of the lackey moth will thrive better the more closely the development of the caterpillars is synchronized with that of the leaves. The experiment had to be discontinued because the caterpillars weakened too much and because soft leaves were no longer available in the vicinity of the laboratory. In the second experiment the midsummer growth, of oak, i. e. the shoots formed about the end of June, was used as food for the caterpillars. On this food the caterpillars also developed better than on the May-leaves. The experiment had to be discontinued because the controls (the caterpillars on May-leaves) died. In the last experiment we succeeded in keeping the caterpillars alive on the May-leaves as well as on the leaves of the midsummer growth. In this experiment the mortality of the caterpillars was also lower and the growth faster on the midsummer leaves than on the May-leaves. In addition it appeared that pupal weight and egg-production were greater and that pupation took place earlier on midsummer-leaves than on May-leaves. It has thus become likely that the differences in growth, mortality etc. are largely the result of differences in the structure of the leaves. Chemical analysis showed, that the midsummer-leaves contained more water and less sugar and protein than the May-leaves. Possibly also the high water content of the soft leaves was of advantage to the caterpillars. It is remarkable that the caterpillars thrived better on the young leaves and the midsummer-leaves, in spite of the low sugar and protein content. It is concluded that the hypothesis stated above is correct, and that a disturbance of the synchronization between the development of the leaves of the oak in spring and the development of the caterpillars of the lackey moth may cause a decrease of the population density of the insect. It is not to be expected, however, that in the field the disturbance will be as great as the one in the rearing cages. Care should be exercised when it seems necessary to slow down the development of the eggs of the lackey moth, when the caterpillars are to be used for investigations on the influence of the food on the development.

Zusammenfassung Die hier beschriebene Arbeit vom Einflus der Nahrung auf die Populationsdichte des Goldafters (Euproctis chrysorrhoea L. = Nygmia phaeorrhoea Don.) ist eine Fortsetzung von fruher veroffentlichten Untersuchungen. Als neues Element wird in der vorliegenden Veroffentlichung der Einflus ungleichwertiger Nahrung aus verschiedenen Teilen der Baumkrone gepruft. Die Raupen wurden mit Eichen- und Weisdornblattern aus verschiedenen Orten der Provinzen Nordbrabant und Gelderland gezuchtet. Von jedem Fundort wurde Material des Wipfels sowie der Nord- und Sudseite der Krone der Raupen in verschiedenen Zuchten verfuttert. Ebenso wie 1957 gediehen 1958 die Raupen mit Weisdorn besser als mit Eiche. Die Zuchten erbrachten deutliche Unterschiede in der Eignung der Nahrung der genannten Teile der Baumkrone. Dabei waren die mit Blattern der Nordseite gezuchteten Tiere am schwachsten. Bei den mit Eichenblattern gefutterten Tieren war die Zahl der auf Blattmaterial vom Wipfel produzierten Eier ca. funfmal so gros wie auf Material von der Nordseite (Schattenblatter). Regionale Unterschiede der Eignung zur Nahrung fur die Raupen des Goldafters traten in diesen Ergebnissen nicht deutlich ans Licht. Summary The investigations on the influence of the quality of the food on the population-density of the browntail moth (Euproctis chrysorrhoea L. = Nygmia phaeorrhoea Don.) described in this paper are a continuation of some introductary investigations published before. In this study the possibility was tested that the different parts of the crown of the tree would not have the same value as food for the caterpillars. The caterpillars were reared on the leaves of hawthorn and oak, which were collected in different localities in the provinces of Noordbrabant and Gelderland. At every locality material of these species from the top, the south- and northside of the crown was collected separately. This year, as the year before, the caterpillars developped better on hawthorn than on oak. Marked differences were found between caterpillars reared on material from the parts of the crown allready mentioned. So caterpillars reared on leaves from the north side were allways less vigorous than those reared on leaves from the top and the south side. As regards oak leaves, butterflies from caterpillars reared on leaves taken from the top of the crown produced about 5 times as many eggs as those from caterpillars reared on leaves from the north side. In these data, no pronounced regional differences were found in the suitability of the leaves as food for the caterpillars.

Quantitative pharmacokinetic modeling of dynamic contrast-enhanced (DCE)-MRI can be used to assess atherosclerotic plaque microvasculature, which is an important marker of plaque vulnerability. Purpose of the present study was (1) to compare magnitude- versus phase-based vascular input functions (m-VIF vs ph-VIF) used in pharmacokinetic modeling and (2) to perform model calculations and flow phantom experiments to gain more insight into the differences between m-VIF and ph-VIF.Population averaged m-VIF and ph-VIFs were acquired from 11 patients with carotid plaques and used for pharmacokinetic analysis in another 17 patients. Simulations, using the Bloch equations and the MRI scan geometry, and flow phantom experiments were performed to determine the effect of local blood velocity on the magnitude and phase signal enhancement.Simulations and flow phantom experiments revealed that flow within the lumen can lead to severe underestimation of m-VIF, while this is not the case for the ph-VIF. In line, the peak concentration of the m-VIF is significantly lower than ph-VIF (p0.001), in vivo. Quantitative model parameters for m- and ph-VIF differed in absolute values but were moderate to strongly correlated with each other [K(trans) Spearman's ρ0.93 (p0.001) and vp Spearman's ρ0.58 (p0.05)].m-VIF is strongly influenced by local blood velocity, which leads to underestimation of the contrast medium concentration. Therefore, it is advised to use ph-VIF for DCE-MRI analysis of carotid plaques for accurate quantification.

The Nanjing Government has taken temporary environmental regulations to guarantee good air quality during the Youth Olympic Games (YOG) in 2014. We study the effect of those regulations by applying the emission estimate algorithm DECSO (Daily Emission estimates Constrained by Satellite Observations) to measurements of the Ozone Monitoring Instrument (OMI). We improved DECSO by updating the chemical transport model CHIMERE from v2006 to v2013 and by adding an Observation minus Forecast (OmF) criterion to filter outlying satellite retrievals due to high aerosol concentrations. The comparison of model results with both ground and satellite observations indicates that CHIMERE v2013 is better performing than CHIMERE v2006. After filtering the satellite observations with high aerosol loads that were leading to large OmF values, unrealistic jumps in the emission estimates are removed. Despite the cloudy conditions during the YOG we could still see a decrease of tropospheric NO2 column concentrations of about 32% in the OMI observations as compared to the average NO2 concentrations from 2005 to 2012. The results of the improved DECSO algorithm for NOx emissions show a reduction of at least 25% during the YOG period. This indicates that air quality regulations taken by the local government were successful. The algorithm is also able to detect an emission reduction of 10% during the Chinese Spring Festival. This study demonstrates the capacity of the DECSO algorithm to capture the change of NOx emissions on a monthly scale. We also show that the observed concentrations and the derived emissions show different patterns that provide complimentary information. For example, the Nanjing smog episode in December 2013 led to a strong increase in NO2 concentrations without an increase in NOx emissions. Furthermore, DECSO gives us important information of the non-trivial seasonal relation between NOx emissions and NO2 concentrations on a local scale.

BACKGROUND: Somatic disorders occur more often in psychiatric patients than in the general population. Somatic symptoms can cause or increase psychiatric symptoms. Psychiatric symptoms and their treatment can have an effect on the physical state of the patient. A pilot study involving an adult outpatient population has demonstrated that 62% of the patients studied had new clinically relevant symptoms. So far, no other data are available relating to somatic screening in child and adolescent psychiatry. AIM: To assess whether somatic screening of children and adolescents newly referred to a department of child and adolescent psychiatry in the Netherlands gives added value to the diagnosis and treatment policy. METHOD: In a pilot study 43 newly referred patients aged between 6 and 18 were screened by means of somatic history, a physical examination and blood parameters. On this basis we could calculate the percentage of somatic symptoms and , where necessary, follow-up treatment could be applied. RESULTS: One or more clinically relevant disorders were found in almost 56% of the children and adolescents investigated. The disorders included dysmorphic anomalies, weight and height deviations, raised thyroid hormone levels, dyslipidaemia, anaemia and vitamin D and B12 deficiency. Advice about a healthy lifestyle was given to 44% of the patients. An antipsychotic medication in 25% of the patients was changed, in the case of 16% of the patients a family doctor was contacted about subsequent treatment and 19% of the patients were referred to a medical specialist. CONCLUSION: Although the results of the pilot study indicate that somatic screening does provide added value, more research is needed in order to optimise the screening procedure.

In de afgelopen tien jaar – sinds de laatste Bijblijven over kinder- en jeugdpsychiatrie – waren er veel ontwikkelingen in het vakgebied van de kinder- en jeugdpsychiatrie. De ‘kijk op’ en ‘het denken over’ ontwikkelingspsychopathologie zijn in een stroomversnelling gekomen. Het werkveld van de jeugdhulpverlening is aan het veranderen. Maar de kinder- en jeugdpsychiatrie is in Nederland geen vak apart. Kinder- en jeugdpsychiaters zijn psychiaters met een aantekening wegens hun verdiepte kennis en ervaring op het fascinerende gebied van de ontwikkelingspsychopathologie. De huisarts zal in de praktijk nieuwe afwegingen moeten maken bij kinderen, jeugdigen en hun gezinnen als hij een verwijzing overweegt.

‘Autismespectrumstoornissen’ is een verzamelnaam voor ernstige ontwikkelingsstoornissen van de sociale wederkerigheid en de verbale en non-verbale communicatie, die gepaard gaan met een star en beperkt repertoire van gedrag en interesses. In 10-15% van de gevallen is er een bekende medische oorzaak. In de andere gevallen is de stoornis het gevolg van een complexe polygenetische overerving met zeer wisselende expressie. Autismespectrumstoornissen kunnen zich met zeer verschillende symptomen manifesteren en gaan vaak ook samen met een zeer grillig intelligentieprofiel, van hoog tot zeer laag functionerend. In de huisartsenpraktijk zal men veel te maken hebben met de mildere vormen, zoalspdd-nos en syndroom van Asperger. Ook dat betekent echter een niet te onderschatten problematiek. De stoornis persisteert tot in de volwassenheid en vraagt om levenslange aanpassingen en begeleiding.

SUMMARY Nadir ozone profiles retrieved from the GOME (Global Ozone Monitoring Experiment) instrument are assimilated with a global three-dimensional atmospheric ozone model. The assimilation procedure is based on the Kalman filter equations, and is an extension of an existing assimilation procedure for total ozone columns. As a novelty, a three-dimensional covariance model is developed using a single parameterisation for correlations in all directions, instead of the usually applied separation in horizontal and vertical directions. The parameterisation is anisotropic in all directions, accounting for the different correlation lengths of ozone with respect to altitude, latitude, and longitude. The assimilation procedure includes full use of the averaging kernel information provided with the GOME retrieval product. The averaging kernels account for the smaller sensitivity of the GOME instrument below the ozone maximum and the limited vertical resolution. A singular value decomposition of the kernels is used to reduce the large data volume. A one year data set of GOME ozone profiles is assimilated for the year 2000. Independent data from ozone sondes is used to validate the results. A case study shows that the assimilation of GOME profiles is able to improve the simulation of the vertical ozone distribution even in case of strong vertical gradients.

Bio-augmentation can be used to obtain nitrification in activated sludge processes that operate at ub-optimal solid retention times. A side-stream process, the so-called BABE® process that incorporates Nremoval and augmentation of nitrifiers has been developed. The principle is to implement a nitrification reactor in the sludge return line, the so-called BABE reactor. This reactor can be fed with an internal N-rich flow (e.g. effluent from the sludge treatment). Hence the nitrification capacity of an activated sludge process can be augmented by the addition of nitrifiers cultivated in the BABE reactor. A full-scale test of the BABE technology has been at the treatment plant Garmerwolde in Groningen, the Netherlands. The set-up allowed comparing between three different lines: with the BABE reactor, without rejectwater and with untreated rejectwater. Based on this, the two important tasks (N-removal and inoculation) performed by the BABE reactor could be quantified. The results of the practical work in Garmerwolde showed a higher nitrification rate in the water line where the BABE reactor was implemented and also lower effluent ammonia. The experiments on a practical scale have demonstrated univocally the effective and stable operation of the BABE technology. In addition, sludge samples in different streams as well as from the BABE reactor were analysed with FISH technique. The FISH results illustrated the augmentation effect of the BABE reactor on the stream with the BABE reactor. A mathematical model, based on ASM1 model and implemented in AQUASIM was developed and used for simulating the treatment plant of Garmerwolde. The simulation results indicated that better effect of the BABE technology is expected at lower ambient temperatures and smaller volume of the BABE reactor. The BABE reactor could also allow for providing more space for de-nitrification in the main water line when nitrification is efficient enough.