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Despite considerable advancements over the last couple of years, research on the Anthropocene still faces at least two challenges: (1) integrating different approaches from natural, social and cultural sciences, and (2) clarifying the political relevance of this concept. To address these challenges, we propose an interdisciplinary approach from Social Ecology and Political Economy which combines research on social metabolism with a historical approach to capitalist development. We argue that such an interdisciplinary approach can help to better understand the Great Acceleration of production and consumption and the related surge in global resource flows. The observation of such an acceleration in the physical growth of societies, in turn, is perceived as the most convincing argument to explain fundamental shifts in the state and functioning of the Earth system, the Anthropocene. Our approach emphasizes that the Great Acceleration was not homogeneous, neither in space nor in time. Instead, spatial varieties and different historical trajectories must be considered which allow for the differentiation of two phases of accelerated resource use, taking place in different world regions. In this article, we propose an integrated research framework for the study of the Great Acceleration, illustrate the insights to which its application leads and discuss the political relevance of the Anthropocene for further research on social-ecological transformations.

The planetary boundaries concept has profoundly changed the vocabulary and representation of global environmental issues. We bring a critical social science perspective to this framework through the notion of societal boundaries and aim to provide a more nuanced understanding of the social nature of thresholds. We start by highlighting the strengths and weaknesses of planetary boundaries from a social science perspective. We then focus on capitalist societies as a heuristic for discussing the expansionary dynamics, power relations, and lock-ins of modern societies that impel highly unsustainable societal relations with nature. While formulating societal boundaries implies a controversial process ‒ based on normative judgments, ethical concerns, and socio-political struggles ‒ it has the potential to offer guidelines for a just, social-ecological transformation. Collective autonomy and the politics of self-limitation are key elements of societal boundaries and are linked to important proposals and pluriverse experiences to integrate well-being and boundaries. The role of the state and propositions for radical alternative approaches to well-being have particular importance. We conclude with reflections on social freedom, defined as the right not to live at others’ expense. Toward the aim of defining boundaries through transdisciplinary and democratic processes, we seek to open a dialogue on these issues.

© 2019 The Author(s)., This article analyzes the roles, relations, and positions of scholar-activists in the European food sovereignty movement. In doing so, we document, make visible and question the political dimensions of researchers' participation in the movement. We argue that scholar-activists are part of the movement, but are distinct from the affected constituencies, put in place to ensure adequate representation of key movement actors. This is because scholar-activists lack a collective identity, have no processes to formulate collective demands, and no mechanisms for inter-researcher and researchers-movement communication. We reflect on whether and how scholar-activists could organize, and discuss possible pathways for a more cohesive and stronger researcher engagement in the movement.

Partial penectomy (glansectomy with/or without distal corporectomy) is an acceptable alternative for smaller distal pT3 penile carcinoma lesions in highly motivated and compliant patients. The authors describe a novel technique of neo-glans reconstruction using a tunica vaginalis (TV) testis allograft. However, due to an unclear resection margin on final histology, the patient underwent re-do surgery with a neo-glans revision using the well-established mesh split-thickness skin graft (STSG) technique. The penile length was preserved and the penile and bulbar part of the urethra was additionally mobilised in order to obtain a natural and aesthetic result for the meatus. Neo-glans reconstruction with TV coverage may be another promising alternative, which certainly requires further evaluation. We believe that the donor-site associated morbidity is minimal when compared to other harvesting sites. However, this is just an assumption, because direct comparison data on grafting techniques and neo-glans reconstruction are not available. Nevertheless, we think that for re-do procedures a standardised approach using a STSG technique should be the treatment method of choice.

The development of an economically viable biofuel industry rests on strong state subsidies for production and processing, creation of markets through government procurement, fuel-blending mandates, price controls, as well as foreign trade tariffs and quotas, and multiple interventions in agricultural, ecological, and other regulations. We use an approach grounded in agrarian political economy to critically analyze the literature on how biofuel policies interact with broader production, trade, and agro-ecological processes. We focus on policies involving the most prominent crops in the places where biofuel production has advanced the most (i.e. USA, Brazil, and the EU), but also extend analysis to their relations with broader transformations in production, commercial, and even governance practices around the world. We investigate the political and economic interests driving biofuel policies, and how these set the terms in which state interventions and policies are conceived and implemented. We find that these are not developed and implemented according to environmental or inclusive pro-poor development purposes, but according to state interests in energy security and its intersection with a tense alliance between corporate sectors, rendering many policy mechanisms ineffective or even outright counterproductive to effectively facilitate more socially and environmentally sustainable energy production and agricultural practices.

Dementia contributes substantially to the burden of disability experienced at old age, and mitochondrial dysfunction (MD) was identified as common final pathway in brain aging and Alzheimer's disease. Due to its early appearance, MD is a promising target for nutritional prevention strategies and polyphenols as potential neurohormetic inducers may be strong neuroprotective candidates. This study aimed to investigate the effects of a polyphenol-rich grape skin extract (PGE) on age-related dysfunctions of brain mitochondria, memory, life span and potential hormetic pathways in C57BL/6J mice. PGE was administered at a dose of 200 mg/kg body weight/d in a 3-week short-term, 6-month long-term and life-long study. MD in the brains of aged mice (19-22 months old) compared to young mice (3 months old) was demonstrated by lower ATP levels and by impaired mitochondrial respiratory complex activity (except for mice treated with antioxidant-depleted food pellets). Long-term PGE feeding partly enhanced brain mitochondrial respiration with only minor beneficial effect on brain ATP levels and memory of aged mice. Life-long PGE feeding led to a transient but significant shift of survival curve toward higher survival rates but without effect on the overall survival. The moderate effects of PGE were associated with elevated SIRT1 but not SIRT3 mRNA expressions in brain and liver tissue. The beneficial effects of the grape extract may have been influenced by the profile of bioavailable polyphenols and the starting point of interventions.

Palm oil is used in human nutrition and industrial products including cosmetics and biodiesel. Exponential growth in oil palm land and palm oil production in Indonesia currently make the country the world’s largest producer of this vegetable oil. The expansion of oil palm plantations is linked to processes of territorialization and reterritorialization from the 1960s until today. Under the so-called New Order of Suharto from 1966 onwards, territorialization processes were geared toward achieving centralization. Oil palm plantations were instrumental in exercising this central control over the Outer Islands and simultaneously provided an important export commodity for the opening of the Indonesian economy. In the wake of the 1997/1998 Asian economic crisis and with the end of Suharto’s rule, Indonesia entered a period of reform marked by decentralization and related reterritorialization processes. Oil palm plantations continued to grow as foreign investment and plantation ownership by private businesses became increasingly relevant. Based on the size and composition of Indonesian material use, the argument can be made that territorialization and reterritorialization processes played a decisive role in establishing and upholding extractivism as a development pathway. The specific forms of (re)territorialization in the expansion of plantation agriculture in Indonesia, however, are contested and associated with competing claims for alternative forms of territorialization.

Ukraine was once considered the breadbasket of the Soviet Union, its agriculture subject to both extensification and intensification measures. Following the dissolution of the Soviet Union, both these processes were reversed, giving modern-day Ukraine the image of untapped agricultural potential. Alongside the country's proximity to the European Union and its access to the Black Sea, this has made Ukraine a key candidate as a global supplier of feedstock for biofuel. Demand for the latter is rising noticeably, especially in the wake of current European and international blending targets for liquid biofuels. Ukraine has responded with a number of initiatives to further biofuel feedstock production. We have compiled a material flow account for Ukraine, focusing especially on the development of the agricultural sector since the early 1990s. By complementing this physical account with an in-depth analysis of political and economic developments, we are able to trace the impact of rising demand for biofuel feedstock on Ukraine. We find that the attempt to establish a biofuel sector based largely on rapeseed was not successful but has nonetheless left the country at a cross-road in the development of both its economy and its resource use.

Exponential growth in oil palm land and palm oil production in Indonesia currently makes the country the world’s largest producer of this vegetable oil. Throughout its tumultuous political past from the 1960s until today, conditions were created which enabled the expansion of oil palm plantations. Under President Suharto’s “New Order,” territorialization processes were used to bring land and people under the control of an increasingly powerful central government. Plantations were instrumental in this regard and additionally formed the basis for the production of palm oil as an important export commodity in the opening of the Indonesian economy. In the wake of the 1997/1998 Asian economic crisis and with the end of Suharto’s rule, Indonesia entered a period of reform marked by decentralization and reterritorialization processes. Oil palm plantations continued to grow as foreign investment and plantation ownership by private businesses became increasingly relevant. Throughout both of these periods, the land-use decisions, which fostered the expansion of oil palm plantations, were not made by the people on the ground, but at a spatial, temporal, and functional “distance.” While distal drivers strongly shaped the development of land use, the consequences of these changes had little impact on the drivers. As plantations expanded farther into territories already claimed for other forms of land use (e.g., rainforest, subsistence agriculture land, indigenous land), they were increasingly likely to confront competing claims to land. Under the perceived greater political freedom of the reform period, the competing claims more often triggered conflicts, which, however, had limited bearing on these distal drivers.

Primary hyperaldosteronism due to aldosterone secreting adrenal adenomas is an important and potentially curable cause for hypertension. The differentiation between unilateral or bilateral adrenal adenomas is crucial, as unilateral adenomas can easily be cured by surgery whereas bilateral adenomas have to be treated conservatively. Exact diagnosis can be made when unilateral or bilateral hormone production is proven with adrenal vein sampling. We present an effective step-by-step technique how to perform an adrenal vein sampling with a special emphasis on how to reliably catheterize the right adrenal vein using Dyna CT.

Multidetector CT angiography (CTA) is a non-invasive imaging technique for evaluation of peripheral vascular disease. CTA might be particularly useful for assessment of intermediate- and long-term morphological outcome after endovascular treatment. Validation of CTA vs. the current imaging standard, colour Doppler ultrasonography (CDUS), for quantification of native and in-stent re-stenosis in the superficial femoral artery (SFA) is required.Seventy randomized patients who underwent stent implantation (n=47) or balloon angioplasty (n=23) underwent 6-month follow-up with CDUS and CTA. CTA was compared with CDUS in both sub-groups of patients in terms of binary re-stenosis (50% lumen narrowing) and re-occlusion. Agreement between CTA and CDUS was assessed using Kappa (κ) statistics with 95% confidence intervals, and correlation coefficients.Binary re-stenosis was detected in 16/70 (22.9%) patients by CTA and 17/70 (24.3%) patients by CDUS (κ=0.88, 95% CI: 0.80-0.96). Re-stenosis rates after balloon angioplasty were 39.1% (9/23) on CTA and CDUS (κ=0.82, 95% CI: 0.66-0.98), and after stent implantation 14.9% (7/47) on CTA and 17.0% (8/47) on CDUS (κ=0.92, 95% CI: 0.84-1.00). Re-occlusions were detected in 3/70 (4.3%) patients by both CTA and CDUS (κ=0.65; 95% CI 0.54-0.76). Significant correlations (r=0.85, p0.001) were noted between degree of re-stenosis on CTA and peak velocity ratio on CDUS. The correlation coefficient was higher in patients after balloon angioplasty (r=0.94, p0.001) than in patients after stent implantation (r=0.71, p0.001).CTA and CDUS show excellent agreement for evaluation of native and in-stent re-stenosis after endovascular treatment of SFA obstructions. CTA is an appropriate non-invasive imaging modality for follow-up after endovascular therapy.

Purpose To compare perioperative and follow-up outcomes of symptomatic versus asymptomatic patients following endovascular repair of anastomotic pseudoaneurysms (APAs) of the abdominal aorta and iliac arteries. Methods We retrospectively evaluated 17 patients (two women), with a mean age of 66.2 years (range 30–83 years). Endovascular treatment was performed in ten symptomatic, and seven asymptomatic patients electively. Data included technical success, perioperative (within 30 days) mortality and morbidity, as well as stent graft-related complications, reinterventions, and survival in follow-up. Results Bifurcated ( n = 13), aortomonoiliac ( n = 3) endoprosthesis and one aortic cuff were implanted with a primary technical success rate of 100%. The overall in-hospital mortality and morbidity rate was 11.8% and 35.3%. The mean survival was 36.5 (range 0–111) months. There was a clear trend toward a lower overall survival within hospital and at one and three years for symptomatic patients compared to asymptomatic patients. (47.7 (CI: 0–138.8) versus 52.6 (CI: 28.5–76.8) months ( p = 0.274)). During follow-up, late stent graft related complications were observed in six patients (35.3%) necessitating eight endovascular reinterventions. Additional three patients with primary fistulas between the APA and the intestine were treated by late surgical revision. Conclusion Endovascular therapy of APAs represents a considerable alternative to open surgical repair. Short proximal anchoring zones still pose a risk for endoleaks and unintentional overstenting of side branches with commercially available devices, but this might be overcome by use of fenestrated and branched stent grafts in elective cases.

To evaluate the frequency of type II endoleaks after endovascular aneurysm repair (EVAR) and to compare sac diameter and neck changes in patients with type II endoleak to endoleak-free patients with at least 3-year imaging follow-up.Among 407 consecutive EVAR patients, 109 patients (101 men; mean age 72.1 years, range 55-86) had at least 3-year computed tomography (CT) data and no type I or III endoleak. In this cohort, 49 patients presented with a type II endoleak at some time and 60 patients had no endoleak. Patients with type II endoleaks were further divided into subgroups based on the vessel origin and the perfusion status (persistent or transient). The course of the perfusion status of type II endoleaks and changes in the aneurysm sac diameters, neck diameters, and renal to stent-graft distances (RSD) were evaluated in the defined groups. Reintervention and death rates were also reported.The mean follow-up was 68.1 ± 23.8 months. Compared to the no endoleak group, overall sac diameter increased significantly in the type II endoleak group (p = 0.007), but vessel origin did not have any influence. With regard to the perfusion status of type II endoleaks, aneurysm sac changes were significantly higher (p = 0.002) in the persistent endoleak group. During the study period, the increase in the proximal neck diameter was significantly higher in the no endoleak group compared to the type II endoleak group (p = 0.025). No significant difference was found in RSD changes between the defined groups. Reinterventions were performed in 20 (18.3%) patients (13 for type II endoleak); 2 (1.8%) patients without type II endoleak died of ruptured aneurysm.Persistent type II endoleaks led to significant aneurysm sac enlargement, but without increased mortality or rupture rates.

Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure ≥25 mm Hg at rest and occurs in a majority of patients with heart failure. Diagnostic imaging targets the right ventricle and the pulmonary vasculature. Although echocardiography is cost-effective for screening and follow-up, right heart catheterization is still mandatory to differentiate pre- from post-capillary disease and to directly measure pressure and flow. An important goal is to rule out chronic thromboembolic pulmonary hypertension. This diagnostic step can be achieved by perfusion scintigraphy, whereas computed tomography and cardiac magnetic resonance have become indispensable ancillary methods for the diagnostic allocation to other World Health Organization subtypes of pulmonary hypertension.

The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT).In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated.Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p0.05) and high Pearsons correlation coefficients (r=0.94, r=0.94, r=0.82 and r=0.85, p0.0001), respectively. The automated method was significantly faster (p0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p0.0001).Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.

To evaluate coronary stents in vitro using 128-slice-dual-source computed tomography (CT).Twelve different coronary stents placed in a non-moving cardiac/chest phantom were examined by 128-slice dual-source CT using three CT protocols [high-pitch spiral (HPS), sequential (SEQ) and conventional spiral (SPIR)]. Artificial in-stent lumen narrowing (ALN), visible inner stent area (VIA), artificial in-stent lumen attenuation (ALA) in percent, image noise inside/outside the stent and CTDIvol were measured.Mean ALN was 46% for HPS, 44% for SEQ and 47% for SPIR without significant difference. Mean VIA was similar with 31% for HPS, 30% for SEQ and 33% for SPIR. Mean ALA was, at 5% for HPS, significantly lower compared with -11% for SPIR (p = 0.024), but not different from SEQ with -1%. Mean image noise was significantly higher for HPS compared with SEQ and SPIR inside and outside the stent (p0.001). CTDIvol was lower for HPS (5.17 mGy), compared with SEQ (9.02 mGy) and SPIR (55.97 mGy), respectively.The HPS mode of 128-slice dual-source CT yields fewer artefacts inside the stent lumen compared with SPIR and SEQ, but image noise is higher. ALN is still too high for routine stent evaluation in clinical practice. Radiation dose of the HPS mode is markedly (less than about tenfold) reduced.

Purpose The aim of this study was to evaluate the efficacy and safety of thoracic endovascular aortic repair with a newly designed Relay thoracic stent graft (Bolton Medical, Sunrise, FL). Description Between 2005 and 2007, 22 patients (71.8 ± 8.5) received 24 stent grafts. Indications were aneurysms (n = 13), penetrating atherosclerotic ulcers (n = 7), and dissections (n = 2). Due to the proximity of the lesions to the aortic arch, rerouting procedures (ie, subclavian transposition [n = 1], double transposition [n = 12], and total arch rerouting [n = 6] were performed pre-interventionally; three patients did not undergo rerouting). All patients were followed-up with a computed tomographic scan of the entire aorta at discharge, 3 months, 6 months, and annually thereafter (mean follow-up, 13 months). Evaluation Primary technical success was obtained in 20 of 22 patients, with one persisting type I endoleak and one asymptomatic type II endoleak. One patient died due to malignant arrhythmia 3 days after stent-graft placement. During follow-up, 1 nonaortic related death was observed. No additional endoleaks were observed. Finally, all supra-aortic rerouting procedures remained patent. Conclusions In the treatment of degenerative disease of the descending aorta and the aortic arch, the Bolton Relay stent graft offers acceptable efficacy and safety in short-term follow-up.

Objectives To compare iomeprol 400 and iodixanol 320 in pulmonary artery MDCTA in subjects with suspected pulmonary embolism. Methods Eighty randomized subjects received equi-iodine intravenous doses (48g) of iomeprol 400 ( n =40) or iodixanol 320 ( n =40), via power injector at 4mL/s. Four-row (35 subjects) and 64-row (45 subjects) scanners were used. Lumen attenuation was determined on-site and by two off-site blinded readers in the main, lobar, segmental and subsegmental pulmonary arteries. Statistical comparison between groups was performed for demographics and lumen attenuation. Results There were no between-group differences ( p >0.05) in demographics. Pulmonary artery attenuation was significantly ( p ≤0.03) higher with iomeprol 400 for all readers. Attenuation quality was excellent in more patients after iomeprol 400 than after iodixanol-320 (80% vs. 62.5%; 82.5% vs. 77.5%; off-site readers 1 and 2, respectively). No safety concerns were noted. Conclusion The greater iodine delivery rate achievable with iomeprol 400 compared to iodixanol-320 at equi-iodine dose and injection rate permits consistently greater attenuation at all levels of the pulmonary arterial tree.

Epidural spinal cord compression is one of the most critical emergency conditions requiring medical attention and requires prompt and adequate treatment. The aim of our study was to assess the role of diffusion-weighted magnetic resonance (MR) imaging (DWI) in the diagnosis and differentiation of epidural spinal lesions. Three patients with epidural lymphoma, two with sarcoma and three with epidural metastatic disease were imaged on a 1.5T MRI unit. DWI was performed using navigated, interleaved, multi-shot echo planar imaging (IEPI). Three region of interest (ROI)-measurements were obtained on corresponding apparent diffusion coefficient (ADC) maps, and the mean ADC value was used for further analysis. The cellularity of tumors was determined as the N/C ratio (nucleus/cytoplasma ratio) from histological samples. The ADC values and N/C ratios of lesions were compared using a Kruskal-Wallis test. The mean ADC of the lymphomas was 0.66 × 10−3 mm2/s, that of the sarcomas was 0.85 × 10−3 mm2/s and the ADC of the metastatic lesions was 1.05 × 10−3 mm2/s; however, the differences were not statistically significant. Mean N/C ratios in the lymphoma, sarcomas and metastases were 4:1, 2:1, and 2.6:1, respectively, with a statistically significant difference between the groups (p

The pancreas develops from ventral and dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum. MR cholangiopancreatography (MRCP) is the technique of choice for detecting it non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of this disease. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.

The non-signing of the association and free trade agreement with the EU by the former Ukrainian president Victor Janukovych triggered the on-going conflict in the Ukraine. By offering a deepening of the political and economic relations with the West, the EU did not consider Russia’s interests in the post-Soviet region. Drawing on Harvey, the article argues that within this process the territorial-geopolitical logic prevails over the capitalist logic of power. Economic interests of the European Union exist, but they are not sufficient to explain the conflict in Eastern Ukraine. Rather, the conflict can be understood as a non-intentional consequence of the EU’s politics concernging the Ukraine. In particular, three sectors – finance, energy and agriculture – are relevant for the EU in Ukraine. However, up to now the European capital factions are facing difficulties in asserting their interests in these sectors due to strong oligarchic structures in the country. Together with the territorial-geopolitical logic of power they have to be taken into account to explain the conflict. Ultimately, the armed conflict in the Eastern Ukraine endangers the EU’s economic ties with Russia. These are more important for the EU than its economic relations with Ukraine. As a result, the territorial-geopolitical logic unfolds as opposed to the capitalist logic in the conflict.

In order to minimize the potential for dental damage and to improve laryngeal visualization during tracheal intubation, two commonly used laryngoscope blades were modified and compared in a clinical setting: the Miller laryngoscope blade and the Macintosh laryngoscope blade. Modified versions of both laryngoscope blades with a lowered heel (Callander modification) at the proximal end of the blade were compared to standard blades. Forty patients scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. Preoperatively, the patients’ airways were evaluated according to Mallampati score, thyromental distance and interincisor gap. After induction of anesthesia laryngoscopy was performed with the original laryngoscope and its modified counterpart in random order. A lateral x-ray of the neck was taken after the optimal view had been obtained, and blade-tooth distance, laryngeal view, blade-tooth contact and need for assistance were measured. Using angular calculations the laryngoscopes were analyzed at different insertion depths on graph paper, and the results were compared with data from the lateral x-rays. With a modified Macintosh blade the blade-tooth distance was significantly greater in comparison to the original design (2.5 ± 2.1 cmvs 0.2 ± 0.1 cm,P < 0.01). Consequently the number of blade-tooth contacts was significantly lower (20%vs 75%,P < 0.05). The best laryngeal view could be obtained using a modified Macintosh laryngoscope. With a modified Miller laryngoscope laryngeal visibility was not improved and assistance was required more often to achieve adequate intubating conditions (35%vs 5%,P < 0.05). A reduction of the proximal flange of a Miller blade decreases the blade’s effectiveness for laryngeal visualization, whereas a similar modification of a Macintosh blade increases blade-tooth distance, decreases the number of blade tooth contacts and provides a better laryngeal view.

Adenocarcinoma is the most common malignant pancreatic tumor, affecting the head in 60-70% of cases. By the time of diagnosis, approximately 80% of tumors are unresectable. Helical CT is very effective in detection and staging of adenocarcinoma, with a sensitivity of 76-92% for detection and an accuracy of 80-90% for staging, but it has limitations in the detection of small cancers (< or =2 cm). Multidetector CT (MDCT) has brought substantial improvements with its inherent 3D imaging capability. Mangafodipir-enhanced MRI is a problem-solving tool in the depiction of small cancers following an equivocal CT imaging result. Gadolinium-enhanced 3D gradient-echo MRI is helpful in the assessment of vascular invasion of cancer and in determining the etiology of cystic lesions. Serous cystadenoma is benign, has a lobulated contour and contains innumerable small cysts of 0.1-2 cm in diameter. Mucinous cystic neoplasms are unilocular or multilocular (fewer than six cysts), and the cyst diameter exceeds 2 cm. The presence of solid nodular components should alert the radiologist to suspect cystadenocarcinoma. Neuroendocrine tumors are mostly hypervascular. Diagnosis of insulinoma is a challenge: they are

Pancreatic hemangioma is an extremely rare tumor, with only a very few cases reported in the literature. We present the case of a 36-year-old man admitted to the hospital with jaundice and abdominal pain. Contrast-enhanced CT showed a hypervascular mass with large vessels in the pancreatic head. The mass appeared moderately hypervascular on gadolinium-enhanced MRI, and, on mangafodipir-enhanced MRI, no contrast agent uptake into the mass could be detected. Despite the size of the lesion, no dilatation of the pancreatic and the common bile duct were seen. Pancreatic hemangioma should be included in the list of differential diagnoses in case of a hypervascular pancreatic lesion without signs of mass effect.

Over the past decade, a number of interventions for durable cartilage repair have emerged. Magnetic resonance (MR) tomography is an excellent noninvasive method for monitoring cartilage repair tissues throughout the postsurgical period. However, evaluating cartilage morphology after matrix-based autologous cartilage implantation (ACI) with MR imaging (MRI) still remains a challenge. In this study, we combined a high-resolution cartilage-sensitive fast-spin echo (FSE) sequence with intravenous application of a contrast agent for enhancing synovial fluid. Two independent musculoskeletal radiologists interpreted the pictures for the thickness, length and surface of the cartilage implants. A multivariate two-way analysis of variance with two repeated measures was performed and showed that evaluation of cartilage implant morphology was significantly improved after the application of gadodiamide on proton density FSE images. Contrast-enhanced MRI of articular cartilages is a promising technique in the postoperative follow-up of patients after ACI.

Elevated plasma asymmetrical dimethylarginine (ADMA) is suggested to contribute to hyperhomocyst(e)ine-related vascular dysfunction in patients with peripheral artery disease (PAD). The present trial investigated whether homocyst(e)ine (Hcy)-lowering therapy with vitamin-B (vit-B) and folic acid affects plasma concentrations of ADMA in patients with PAD and hyperhomocyst(e)inemia.Forty-nine subjects (15 women, 34 men) with PAD and fasting plasma total Hcy concentrations greater than 15 micromol/liter were randomized to receive either oral vit-B and folic acid therapy (n = 27) or placebo (n = 22) for 6 wk. Fasting venous blood samples were monitored for plasma total Hcy, vit-B12 and folate, ADMA, symmetric dimethylarginine, L-arginine, and high-sensitivity C-reactive protein.After 6 wk, plasma Hcy concentrations were decreased, and concentrations of vit-B12 and folate were elevated in patients with vitamin supplementation (all P0.05 vs. baseline) and unchanged in the placebo group. Dimethylarginine plasma concentrations were not affected by treatment. High-sensitivity C-reactive protein correlated with ADMA plasma concentrations (r = 0.29; P0.01).The lack of vit-B and folic acid therapy on plasma concentrations of ADMA renders a role of extracellular methylarginines unlikely to be involved in the pathophysiology of hyperhomocyst(e)inemia and its complications.

ObjectiveTo prospectively evaluate image quality and radiation dose using a low-dose computed tomography angiography protocol and iterative image reconstruction for high-pitch dual-source CT-angiography (DSCTA) of the supraaortic arteries.Material and methodsDSCTA was performed in 42 patients, using either 120 kVp tube voltage, 120 mAS tube current, 2.4 pitch and filtered back projection, or 100 kVp tube voltage, 100 mAs tube current, 3.2 pitch, and sinogram affirmed iterative reconstruction. Measurements of vessel attenuation, of the contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were performed to objectively evaluate image quality. Two readers evaluated subjective image quality and image noise, using a four-point scale. Effective dose was used to compare the differences in radiation dose.ResultsLow-dose protocol application showed significantly higher vessel opacification (p = 0.013), and non-significantly higher CNR and SNR values. There was no difference in the subjective image quality and image noise reading between the protocols. Effective dose was significantly lower using the low-dose protocol (1.29 ± 0.21 mSv vs. 2.92 ± 0.72 mSv; p < 0.001).ConclusionThe combined use of reduced tube voltage, reduced tube current, and iterative reconstruction reduces radiation dose by 55.4% in high-pitch DSCTA of the supraaortic arteries without impairment of image quality.

A gas chromatographic procedure for the simultaneous determination of glycerol, mono-, di- and triglycerides in vegetable oil methyl esters has been developed. Quantitative information about this group of organic contaminants is very important for the quality of these oleochemical products when used as automotive diesel fuel substitutes. Trimethylsilylation of glycerol, mono- and diglycerides, followed by GC using a 10-m capillary column coated with a 0.1-μm film of DB-5 allows the determination of all analytes in a single GC run. Calibration is performed by analysis of standard solutions containing glycerol, mono-, di- and triolein as well as two internal standards, 1,2,4-butanetriol and tricaprin. The recovery of the procedure at different concentration levels and the repeatability of the quantitative results are evaluated.

To compare tumour-to-liver contrast (TLC) of C-arm CT during hepatic arteriography (CACTHA) acquired using three protocols in patients with HCC. This prospective study was IRB approved and informed consent was obtained from each patient. Twenty-nine patients (mean age, 68 ± 7 years; 27 men) with 55 HCCs (mean diameter, 2.6 ± 1.5 cm) underwent three different CACTHA protocols in random order before chemoembolisation. Contrast medium (100 mg iodine/ml) was injected into the common hepatic artery (flow rate 4 ml/s). The imaging delay for the start of the CACTHA examination was 4 s (protocol A), 8 s (protocol B) and 12 s (protocol C) (total amount of injected contrast medium: 48 ml, 64 ml, 80 ml). TLC was measured by placing regions of interest (ROIs) in the HCC and liver parenchyma. Mixed model ANOVAs and Bonferroni corrected post hoc tests were used for statistical analysis. Mean values for TLC were 132 ± 3.3 HU, 186 ± 5.8 HU and 168 ± 2.8 HU for protocols A, B and C. Protocol B provided significantly higher TLC than protocols A and C (p

Rape seed oil methyl ester (RME), a diesel fuel substitute and a technical product of increasing importance, contains a number of minor components, which may influence its technical properties in various ways, Sterols, the main constituents of the unsaponifiable matter in rape seed oil, represent an important group of such minor components, which are then found in rape seed oil methyl ester. The concentration and composition of the total sterols in the fraction of unsaponifiables were determined in several RME samples of different origin by the usual procedure of saponification and isolation of the sterol fraction, followed by gas chromatographic analysis. The concentration and composition of the free sterols present in RME and the content of sterol esters were also determined by on-line LC-GC. The total sterol content in the RME samples varied between 0.70% and 0.81%. The sterol fraction of RME composed as follows: 0.4% cholesterol, 9.0% brassicasterol, 37.7% campesterol, 0.4% stigmasterol, 48.0% β-sitosterol, 2.8% Δ5-avenasterol, and 0.5% Δ7-stigmasterol. By on-line LC-GC 0.24-0.34% free sterols and 0.55-0.71% sterol esters have been found in the RME samples. Minorkomponenten in Pflanzenolmethylestern I: Sterine in Rapsolmethylester Rapsolmethylester (RME), ein Kraftstoff fur Dieselmotoren und ein technisches Produkt von zunehmender Bedeutung, enthalt eine Vielzahl von Minorkomponenten, die seine technischen Eigenschaften auf unterschiedliche Weise beeinflussen konnen. Die Sterine stellen als Hauptbestandteile des Unverseifbaren in Rapsol eine wichtige Gruppe solcher Minorkomponenten dar, welche in Rapsolmethylestern wiedergefunden werden. In mehreren RME-Proben unterschiedlichen Ursprungs wurden die Konzentration und die Zusammensetzung der Gesamtsterine aus der Fraktion des Unverseifbaren nach der klassischen Methode bestimmt, basierend auf Verseifung und Isolierung der Sterinfraktion mit anschliesender gaschromatographischer Analyse. Konzentration und Zusammensetzung der in RME vorliegenden freien Sterine und der Gehalt an Sterinestern wurden auserdem mittels on-line LC-GC ermittelt. Der Gesamtsteringehalt der untersuchten RME-Proben lag zwischen 0.70% und 0.81%. Die Zusammensetzung der Sterinfraktion in RME betrug im Mittel 0.4% Cholesterin, 9.0% Brassicasterin, 37.7% Campesterin, 0.4% Stigmasterin, 49.0% β-Sitosterin, 2.8% Δ5-Avenasterin und 0.5% Δ7-Stigmasterin. In den untersuchten RME-Proben wurden mittels on-line LC-GC 0.24-0.34% freie Sterine und 0.55-0.71% Sterinester gefunden.

The aim of this analysis was to assess short and mid-term results of patients undergoing thoracic endovascular aortic repair (TEVAR) for 4 different indications.From 1996 to 2010, 300 patients (80 female, 220 male, median age 67 years [20 to 88]) underwent TEVAR at our department. Among them were 137 descending thoracic aneurysms (DTA), 80 type B dissections (60 acute, 20 chronic), 59 perforating aortic ulcer (PAU), and 24 traumatic aortic transections (ATAT). Hospital mortality and mid-term survival among different indications for TEVAR were evaluated.Overall hospital mortality in our series was 5% (n = 15). Seven patients with DTA (5%), 4 patients with type B dissections (5%), 2 patients with PAU (3.4%), and 2 ATAT (8%) patients died during their hospital stay. Kaplan-Meier survival analysis revealed significant differences in survival rates according to the various indications for TEVAR (p0.001). Overall long-term mortality was 86%, 63%, and 44% at 1, 5, and 10 years. Early and late endoleak rate was 18% and 8%, respectively.The TEVAR has evolved into a safe and effective therapy for different aortic pathology resulting in promising long-term results. Nevertheless, the indication for TEVAR has direct impact on the success of the procedure. Patients with acute type B aortic dissections and acute traumatic aortic lesions seem to benefit the most from TEVAR.

Transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) is one of the most frequently applied standard treatments for this disease. The role for TACE is fairly well defined within the most widely used treatment algorithm for HCC, die Barcelona Clinic Liver Cancer (BCLC) staging system and treatment algorithm. But no general treatment algorithm will go into the technical details of any procedure and several patients will not fit ideally into the patient groups predefined in BCLC or any other treatment algorithm. Furthermore, indications and contraindications sometimes are viewed differently by the various medical specialties involved in taking care of such patients. We present here the joint expert position statement of the Austrian Societies of Gastroenterology and Hepatology (OGGH), Interventional Radiology (OGIR), Hematology and Oncology (OGHO), and Surgical Oncology (ASSO) on the technical aspects, indications, and contraindication for the use of TACE in the management of HCC.

To compare the diagnostic performance (detection, local staging) of multiphasic 64-detector row computed tomography (CT) with that of gadobenate dimeglumine-enhanced 3.0-T magnetic resonance (MR) imaging in patients suspected of having pancreatic cancer.The institutional review board approved this prospective study, and all patients provided written informed consent. Multidetector CT and MR imaging were performed in 89 patients (48 women aged 46-89 years [mean, 65.6 years] and 41 men aged 46-86 years [mean, 65.3 years]) suspected of having pancreatic cancer on the basis of findings from clinical examination or previous imaging studies. Two readers independently assessed the images to characterize lesions and determine the presence of focal masses, vascular invasion, distant metastases, and resectability. Findings from surgery, biopsy, endosonography, or follow-up imaging were used as the standard of reference. Logistic regression, the McNemar test, and κ values were used for statistical analysis.Focal pancreatic masses were present in 63 patients; 43 patients had adenocarcinoma. For reader 1, the sensitivities and specificities in the detection of pancreatic adenocarcinoma were 98% (42 of 43 patients) and 96% (44 of 46 patients), respectively, for CT and 98% (42 of 43 patients) and 96% (44 of 46 patients) for MR imaging. For reader 2, the sensitivities and specificities were 93% (40 of 43 patients) and 96% (44 of 46 patients), respectively, for CT and 95% (41 of 43 patients) and 96% (44 of 46 patients) for MR imaging. Vessel infiltration was determined in 22 patients who underwent surgery, and reader 1 obtained sensitivities and specificities of 90% (nine of 10 vessels) and 98% (119 of 122 vessels), respectively, for CT and 80% (eight of 10 vessels) and 96% (117 of 122 vessels) for MR imaging; for reader 2, those values were 70% (seven of 10 vessels) and 98% (120 of 122 vessels) for CT and 50% (five of 10 vessels) and 98% (120 of 122 vessels) for MR imaging. Both readers correctly assessed resectability in 87% (13 of 15 patients) of cases with CT and 93% (14 of 15 patients) of cases with MR imaging. Nonresectability was assessed correctly with CT in 75% (six of eight patients) of cases by reader 1 and 63% (five of eight patients) of cases by reader 2; nonresectability was correctly assessed with MR imaging in 75% (six of eight patients) of cases by reader 1 and 50% (four of eight patients) of cases by reader 2. None of the differences between modalities and readers were statistically significant (P.05).Both CT and MR imaging are equally suited for detecting and staging pancreatic cancer.http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101189/-/DC1.

To assess radiation dose and diagnostic image quality of a low-dose (80 kV) versus a standard-dose (120 kV) protocol for computed tomography angiography (CTA) of the supra-aortic arteries.64-slice CTA of the supra-aortic arteries was performed in 42 consecutive patients using randomly either 80 or 120 kV at 300 absolute mAs. Intravascular attenuation values, contrast-to-noise (CNR) and signal-to-noise ratio (SNR) measurements were performed at three levels. Two readers assessed image quality by using a four-point scale. The effective dose (ED) was calculated to assess the differences in radiation exposure.Intravascular attenuation values at 80 kV were higher in the common carotid artery, the carotid bifurcation and the internal carotid artery (p 0.001). CNR and SNR differed at the internal carotid artery, with higher values in the 80-kV group (p 0.05). Both readers revealed a significantly better image quality at 120 kV only at the common carotid artery (p 0.001; p = 0.007). Mean ED was significantly lower at 80-kV (1.23 ± 0.09 vs. 3.99 ± 0.33 mSv; p 0.001).Tube voltage reduction to 80 kV in CTA of the supra-aortic arteries allows for significant radiation dose reduction but has limitations at the level of the common carotid artery.

The introduction of quality standards for vegetable oil methyl esters is gaining in importance due to their increased use as diesel fuel substitutes and as technical products. Free and esterified sterols, the main constituents of the unsaponifiable matter in vegetable oils, are recovered in vegetable oil methyl esters and may influence the technical properties of vegetable oil methyl ester products. A rapid gas chromatographic method for the qualitative and quantitative determination of free and esterified sterols in vegetable oil methyl esters has therefore been developed. The concentration of the free sterols as well as their qualitative and quantitative composition and the concentration of the sterol esters have been determined in rape seed oil methyl ester samples by GC–FID. Prior to analysis, the free sterols were silylated with N,O-bis(trimethylsilyl)trifluoroacetamide with 1% of trimethylchlorosilane; betulinol was used as an internal standard. Calibration was performed by analysis of standard solutions containing β-sitosterol, cholesteryl stearate, and betulinol. The reproducibility of the quantitative results has been evaluated by repeated injections of the same test solution and by repeated complete analysis of the same sample.

Vegetable oil methyl esters are increasingly being used as substitutes for petroleum-based diesel fuels. Because the presence of triglycerides and partial glycerides in the fuel as a result of incomplete transesterification of vegetable oils can lead to serious engine problems, continuous quality control of the product is essential. A rapid gas chromatographic method has been developed for the quantitative determination of mono-, di-, and triglycerides in vegetable oil methyl esters. Prior to analysis, mono-, and diglycerides were silylated with N,O-bis(trimethylsilyl)trifluoroacetamide; tridecanoin was used as internal standard. Calibration was performed by analysis of standard solutions containing mono-, di-, and triolein: the calibration plots for mono- and diglycerides showed good linearity, whereas for triglycerides no linearity was observed for triolein concentrations below 0.05 mg/ml. When a non-linear multi level calibration was employed for the quantitation of triglycerides, the method gave excellent quantitative results for mono-, di-, and triglycerides in vegetable oil methyl esters.

Background. Few data are available on the safety and efficacy of sorafenib in patients with multifocal hepatocellular carcinoma (HCC) and advanced liver cirrhosis. Methods. Between May 2006 and December 2007, we treated 59 patients (Child-Pugh class A/B/C, 26/23/10) with unresectable HCC with sorafenib (daily target dose, 400 mg twice daily). Data were collected retrospectively. Survival curves were calculated via the Kaplan–Meier method. Results. One patient (Child-Pugh class B) had a partial response, 14 patients (Child-Pugh class A/B/C, 5/7/2) had stable disease, and 32 patients (Child-Pugh class A/B/C, 15/11/6) had progressive disease; 12 patients were not evaluable because they had no follow-up radiologic evaluation. In the intention-to-treat group, the median time to progression and overall survival (OS) time were 2.8 months (range, 1.4–6.5 months) and 6.5 months (range, 0.4–17.4 months), respectively. Well-preserved liver function and lower Barcelona Clinic Liver Cancer stage were associated with a longer OS time on univariate analysis. There were four severe gastrointestinal bleedings (grade 4–5; Child-Pugh class B/C, 2/2). Most drug-related side effects were low grade and manageable irrespective of liver function. Conclusions. Sorafenib is effective and safe in patients with multifocal HCC and Child-Pugh class A cirrhosis. Survival in Child-Pugh class B patients is significantly less than in Child-Pugh class A patients, warranting a prospective randomized trial with a placebo group. Child-Pugh class C patients have a limited life expectancy despite sorafenib treatment because of their severe underlying disease and derive little benefit from sorafenib treatment.

The term interstitial lung diseases (ILD) comprises a diverse group of diseases that lead to inflammation and fibrosis of the alveoli, distal airways, and septal interstitium of the lungs. The ILD consist of disorders of known cause (e.g., collagen vascular diseases, drug-related diseases) as well as disorders of unknown etiology. The latter include idiopathic interstitial pneumonias (IIPs), and a group of miscellaneous, rare, but nonetheless interesting, diseases. In patients with ILD, MDCT enriches the diagnostic armamentarium by allowing volumetric high-resolution scanning, i.e., continuous data acquisition with thin collimation and a high spatial frequency reconstruction algorithm. CT is a key method in the identification and management of patients with ILD. It not only improves the detection and characterization of parenchymal abnormalities, but also increases the accuracy of diagnosis. The spectrum of morphologic characteristics that are indicative of interstitial lung disease is relatively limited and includes the linear and reticular pattern, the nodular pattern, the increased attenuation pattern (such as ground-glass opacities and consolidation), and the low attenuation pattern (such as emphysema and cystic lung diseases). In the correct clinical context, some patterns or combination of patterns, together with the anatomic distribution of the abnormality, i.e., from the lung apex to the base, or peripheral subpleural versus central bronchovascular, can lead the interpreter to a specific diagnosis. However, due to an overlap of the CT morphology between the various entities, the final diagnosis of many ILD requires close cooperation between clinicians and radiologists and complementary lung biopsy is recommended in many cases.