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PURPOSE Accurate and artifact-free T1ρ quantification is still a major challenge due to a susceptibility of the spin-locking module to B0 and/or B1 field inhomogeneities. In this study, we present a novel spin-lock preparation module (B-SL) that enables an almost full compensation of both types of inhomogeneities. METHODS The new B-SL module contains a second 180° refocusing pulse to compensate each pulse in the preparation block by a corresponding pulse with opposite phase. For evaluation and validation of B-SL, extensive simulations as well as phantom measurements were performed. Furthermore, the new module was compared to three common established compensation methods. RESULTS Both simulations and measurements demonstrate a much lower susceptibility to artifacts for the B-SL module, therefore providing an improved accuracy in T1ρ quantification. In the presence of field inhomogeneities, measurements revealed an increased banding compensation by 79% compared with the frequently used composite module. The goodness of the mono-exponential T1ρ fitting procedure was improved by 58%. CONCLUSION The B-SL preparation enables the generation of accurate relaxation maps with significantly reduced artifacts, even in the case of large field imperfections. Therefore, the B-SL module is suggested to be highly beneficial for in vivo T1ρ quantification.

Purpose T1ρ dispersion quantification can potentially be used as a cardiac magnetic resonance index for sensitive detection of myocardial fibrosis without the need of contrast agents. However, dispersion quantification is still a major challenge, because T1ρ mapping for different spin lock amplitudes is a very time consuming process. This study aims to develop a fast and accurate T1ρ mapping sequence, which paves the way to cardiac T1ρ dispersion quantification within the limited measurement time of an in vivo study in small animals. Methods A radial spin lock sequence was developed using a Bloch simulation-optimized sampling pattern and a view-sharing method for image reconstruction. For validation, phantom measurements with a conventional sampling pattern and a gold standard sequence were compared to examine T1ρ quantification accuracy. The in vivo validation of T1ρ mapping was performed in N = 10 mice and in a reproduction study in a single animal, in which ten maps were acquired in direct succession. Finally, the feasibility of myocardial dispersion quantification was tested in one animal. Results The Bloch simulation-based sampling shows considerably higher image quality as well as improved T1ρ quantification accuracy (+ 56%) and precision (+ 49%) compared to conventional sampling. Compared to the gold standard sequence, a mean deviation of − 0.46 ± 1.84% was observed. The in vivo measurements proved high reproducibility of myocardial T1ρ mapping. The mean T1ρ in the left ventricle was 39.5 ± 1.2 ms for different animals and the maximum deviation was 2.1% in the successive measurements. The myocardial T1ρ dispersion slope, which was measured for the first time in one animal, could be determined to be 4.76 ± 0.23 ms/kHz. Conclusion This new and fast T1ρ quantification technique enables high-resolution myocardial T1ρ mapping and even dispersion quantification within the limited time of an in vivo study and could, therefore, be a reliable tool for improved tissue characterization.

Fast and accurate TThe new signal equation was derived by solving a recursion problem for spin-lock prepared fast gradient echo readouts. Based on Bloch simulations, we compared quantification errors using the common monoexponential model and our corrected model. The method was validated in phantom experiments and tested in vivo for myocardial TSimulations indicate that a correction is necessary, since systematically underestimated values are measured under in vivo conditions. In the phantom study, the mean quantification error could be reduced from - 7.4% to - 0.97%. In vivo, a correlation of uncorrected TThe suggested quantification formalism enables fast and precise myocardial T

TA radial spin lock sequence was developed using a Bloch simulation-optimized sampling pattern and a view-sharing method for image reconstruction. For validation, phantom measurements with a conventional sampling pattern and a gold standard sequence were compared to examine TThe Bloch simulation-based sampling shows considerably higher image quality as well as improved TThis new and fast T

Introduction Over the past decade, CMRI has become the method of choice for characterizing fibrotic scars. Native T1ρ mapping offers an alternative to conventional T1 and T2 quantification techniques due to its high sensitivity to low-frequency processes. In addition, there is the possibility of T1ρ dispersion imaging, which could be used as a sensitive biomarker for assessing myocardial fibrosis [1]. However, due to a very long measurement time, T1ρ dispersion quantification in myocardium can hardly be done in the limited time of a small animal study. In this work we present a concept for rapid T1ρ dispersion quantification based on the new approach of synthetic dispersion reconstruction (SynDR). Theory A T1ρ map is calculated by measuring Nt T1ρ weighted images using different spin lock (SL) times. T1ρ dispersion quantification requires Nf T1ρ maps with different SL amplitudes. Hence the measurement time is very time consuming, because it requires the acquisition of Nt*Nf images (full mapping). With our new approach (SynDR), only a single T1ρ reference map and a series of dispersion weighted images need to be acquired. The T1ρ dispersion can be reconstructed by synthetically generated maps, whereby each map is calculated from the reference map and the dispersion weighted images, only requiring Nt+Nf images. Methods All measurements were performed on a 7T small animal scanner. The method was based on an optional cartesian/radial gradient echo sequence using large flip angles (45°) and an optimized readout sorting. The quantification accuracy of SynDR was compared with full mapping measurements in a phantom experiment and validated in vivo on mice. The synthetic T1ρ maps were used to perform a dispersion analysis in myocardium. Results The comparison between SynDR and the full mapping reference in phantoms showed a very high quantification accuracy with a mean/maximum deviation of 1.1% and 1.7%. Fig. 1 shows synthetic T1ρ maps (a) in healthy mice and the obtained dispersion map (b) using SynDR. In the dispersion analysis (c) a T1ρ slope of 5.6±1.5ms/kHz was obtained for myocardium. Here an acceleration factor of 4 could be realized in comparison to full mapping. In further measurements, an acceleration of 7.4 could be reached using a radial readout with KWIC filter view sharing. Discussion In this work, a novel T1ρ dispersion imaging method was presented that far exceeds the speed of conventional full mapping methods. The acceleration is based on avoiding unnecessary measurements of T1ρ weighted images through more efficient mathematical modeling. Further acceleration could be achieved using an optimized radial data acquisition. The method shows good image quality and high quantification accuracy both in phantom and in vivo. Based on the promising results, further studies in mice are planned to investigate the dispersion character of healthy and diseased tissues. Reference [1] Yin Q et al. Magn Reson Imaging. 2017 Oct; 42:69–73. SynDR method and T1ρ dispersion analysis Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): BRD, Bundesministerium für Bildung und Forschung

Accurate and artifact-free TThe new B-SL module contains a second 180° refocusing pulse to compensate each pulse in the preparation block by a corresponding pulse with opposite phase. For evaluation and validation of B-SL, extensive simulations as well as phantom measurements were performed. Furthermore, the new module was compared to three common established compensation methods.Both simulations and measurements demonstrate a much lower susceptibility to artifacts for the B-SL module, therefore providing an improved accuracy in TThe B-SL preparation enables the generation of accurate relaxation maps with significantly reduced artifacts, even in the case of large field imperfections. Therefore, the B-SL module is suggested to be highly beneficial for in vivo T

PURPOSE Cardiac T1 mapping has become an increasingly important imaging technique, contributing novel diagnostic options. However, currently utilized methods are often associated with accuracy problems because of heart rate variations and cardiac arrhythmia, limiting their value in clinical routine. This study aimed to introduce an improved arrhythmia-related robust T1 mapping sequence called RT-TRASSI (real-time Triggered RAdial Single-Shot Inversion recovery). METHODS All measurements were performed on a 3.0T whole-body imaging system. A real-time feedback algorithm for arrhythmia detection was implemented into the previously described pulse sequence. A programmable motion phantom was constructed and measurements with different simulated arrhythmias arranged. T1 mapping accuracy and susceptibility to artifacts were analyzed. In addition, in vivo measurements and comparisons with 3 prevailing T1 mapping sequences (MOLLI, ShMOLLI, and SASHA) were carried out to investigate the occurrence of artifacts. RESULTS In the motion phantom measurements, RT-TRASSI showed excellent agreement with predetermined reference T1 values. Percentage scattering of the T1 values ranged from -0.6% to +1.9% in sinus rhythm and -1.0% to +3.1% for high-grade arrhythmias. In vivo, RT-TRASSI showed diagnostic image quality with only 6% of the acquired T1 maps including image artifacts. In contrast, more than 40% of the T1 maps acquired with MOLLI, ShMOLLI, or SASHA included motion artifacts. CONCLUSION Accuracy issues because of heart rate variability and arrhythmia are a prevailing problem in current cardiac T1 mapping techniques. With RT-TRASSI, artifacts can be minimized because of the short acquisition time and effective real-time feedback, avoiding potential data acquisition during systolic heart phase.

Objectives To evaluate potential risk factors for stroke or transient ischemic attacks (TIA) and to test the feasibility and efficacy of a Fabry-specific stroke risk score in Fabry disease (FD) patients without atrial fibrillation (AF). Background FD patients often experience cerebrovascular events (stroke/TIA) at young age. Methods 159 genetically confirmed FD patients without AF (aged 40 ± 14 years, 42.1% male) were included, and risk factors for stroke/TIA events were determined. All patients were followed up over a median period of 60 (quartiles 35–90) months. The pre-defined primary outcomes included new-onset or recurrent stroke/TIA and all-cause death. Results Prior stroke/TIA (HR 19.97, P

Background Fabry disease is a lysosomal storage disorder with multiple organ involvement. Renal and cardiac symptoms can lead to dialysis and myocardial hypertrophy with fibrosis, responsible for heart failure with preserved ejection fraction (HFpEF). Enzyme replacement therapy (ERT) is available for all patients with Fabry disease since 2001, requiring infusions every other week. Since May 2016, the chaperone migalastat represents a novel form of specific therapy as the first oral therapy available for certain Fabry patients. Through this molecule the function of the mutated enzyme α-galactosidase A can be restored. Recent trials have shown positive cardiac effects of chaperone therapy using echocardiography; however, MRI investigations further evaluating these findings are not available yet. Objective To evaluate cardiac effects of migalastat therapy in patients with amenable α-galactosidase A mutations in the prospective monocentric HEAL-FABRY registry (NCT03362164). Methods and results Comprehensive clinical investigations including serial MRI were conducted at baseline before initiation of migalastat therapy and at least one year thereafter in all patients without contraindications such as pacemakers or ICDs. Out of 29 patients included in the study (mean age at start of therapy 52.8±14 years, total range 20–74 years), until then 12 patients with MRI data completed the 1-year follow-up. At 1 year, enzyme activity in leucocytes increased from 0.06 to 0.21 nmol/min/mg protein (p=0.001). Distinctive changes over time were observed not only in diastolic but also systolic parameters. The systolic myocardial mass index was reduced by 2.39% (p=0.10). In the AHA segment number 5, most important for classification of severe myocardial damage in Fabry patients, late gadolinium enhancement was reduced by 8.58% in all 5 patients with verified progressive fibrosis (p=0.14). One patient stopped migalastat therapy due to personal reasons. No significant side effects were observed. Analysis of LGE (systolic phase) Conclusion These preliminary MRI data show positive effects of migalastat therapy in patients with Fabry disease and cardiac involvement. Compared to echocardiography, MRI has the potential to allow for comprehensive additional analyses regarding both cardiac morphology and function.

Long-term effects of migalastat therapy in clinical practice are currently unknown. We evaluated migalastat efficacy and biomarker changes in a prospective, single-center study on 14 patients with Fabry disease (55 ± 14 years; 11 men). After 1 year of open-label migalastat therapy, patients showed significant changes in alpha-galactosidase-A activity (0.06–0.2 nmol/minute/mg protein; P = 0.001), left ventricular myocardial mass index (137–130 g/m ² ; P = 0.037), and serum creatinine (0.94–1.0 mg/dL; P = 0.021), accounting for deterioration in estimated glomerular filtration rate (87–78 mL/minute/1.73 m ² ; P = 0.012). The enzymatic increase correlated with myocardial mass reduction (r = −0.546; P = 0.044) but not with renal function (r = −0.086; P = 0.770). Plasma globotriaosylsphingosine was reduced in therapy-naive patients (10.9–6.0 ng/mL; P = 0.021) and stable (9.6–12.1 ng/mL; P = 0.607) in patients switched from prior enzyme-replacement therapy. These first real-world data show that migalastat substantially increases alpha-galactosidase-A activity, stabilizes related serum biomarkers, and improves cardiac integrity in male and female patients with amenable Fabry disease mutations.

Background Long-term data on evolution and clinical impact of myocardial fibrosis in valvular heart disease are scarce. Methods and Results In this 10 years’ extension of a prospective study in patients undergoing conventional aortic valve replacement because of symptomatic severe aortic valve stenosis, the impact of myocardial replacement fibrosis (MRF) on long-term outcome was assessed. Endomyocardial biopsies were acquired during aortic valve replacement in 58 consecutive patients. MRF was graded using the calculated percentage area of fibrosis and patients categorized as severe (n=21), mild (n=15), and no fibrosis (n=22). Echocardiography including strain imaging, as well as cardiovascular magnetic resonance, to assess late gadolinium enhancement was performed at baseline, 1, and 10 years after aortic valve replacement. Death of any cause occurred in 21 patients (38.9%): 3 (14.3%) in the group without MRF, 6 (42.9%) in the mild MRF group, and 12 (63.2%) in the severe MRF group ( P =0.006), resulting in the lowest cumulative survival for patients with severe MRF (log-rank P =0.003). In the group without MRF, none died of cardiovascular cause. MRF was found to be an independent predictor of survival (hazard ratio, 1.271; 95% CI, 1.032–1.564; P =0.024). Conclusions This 10-year follow-up study underlines the profound impact of replacement fibrosis with regard to cardiac and all-cause mortality in patients undergoing aortic valve replacement for severe aortic valve stenosis. Integrating cardiovascular magnetic resonance and echocardiographic functional imaging beyond ejection fraction quantification could help in clinical decision making to stratify patient prognosis with regard to myocardial longitudinal function and prevalence of replacement fibrosis.

Therapists are often frustrated when they work with adolescents who do not talk about their experience. This article presents a way of working with these teens. The underlying theory assumes that most teenagers (including those who are often silent in therapy) are capable of being mutually engaged with someone else. This capability is seen as a self-state that can be dissociated by anxiety and replaced with another self-state that is withdrawn and unengaged. Three clinical vignettes describe silent teenagers with whom the therapist eventually can activate self-states that allow for engagement; in these cases, through mutual help, fair play, projective identification, controlling or sadomasochistic connections. Other self-states are withdrawn and silent. For a long initial period, the family and developmental histories that create these self-states are usually more unknown than known, and the shifts in self-states are dealt with in the therapist-patient interaction more than in psychodynamic interpretation...

To develop and validate a fast cardiac magnetic resonance imaging T1 mapping technique with high spatial resolution based on a radial inversion-recovery (IR) spoiled gradient-echo acquisition.Approval for the study was granted by the local institutional review board, and all subjects gave written informed consent. An electrocardiographically triggered radial single-shot IR (TRASSI) sequence was developed in conjunction with a custom-written fitting algorithm. The proposed imaging technique was validated in phantom measurements and then used for cardiac T1 mapping in 62 subjects with or without cardiac disease. The study population included 51 healthy subjects, three patients with arrhythmia, and eight patients with myocardial infarction. The potential heart rate dependency of the TRASSI method was tested by using linear regression analysis. Statistically significant differences between the sexes and various section orientations were analyzed with a Student t test for independent groups and a repeated-measures analysis of variance for dependent groups.High-spatial-resolution T1 maps (1.17 × 1.17 mm) without motion artifacts and without heart rate dependency (slope = -0.0303, R(2) = 0.0000887, P = .899) were acquired with an acquisition time of less than 6 seconds in all subjects. The mean T1 of healthy left ventricular myocardium across all examined subjects was 1031 msec ± 33 (standard deviation). Testing for reproducibility in three individuals with 34 repetitive measurements revealed a mean standard deviation of 4.1 msec (0.412%). Subacute and chronic myocardial infarction could be detected in all eight patients. T1 disturbances due to arrhythmia proved to be minimal in three patients (standard deviation,1.2%).Fast and accurate cardiac T1 mapping is feasible within a single-shot IR experiment.

Purpose To provide a robust method for the simultaneous quantification of T1 and T2* in the human lung during free breathing. Breathing pure oxygen accelerates T1 and T2* relaxation in the lung. While T1 shortening reflects an increased amount of dissolved molecular oxygen in lung tissue, T2* shortening shows an increased concentration of oxygen in the alveolar gas. Therefore, both parameters reflect different aspects of the oxygen uptake and provide complementary lung functional information. Materials and Methods A segmented inversion recovery Look–Locker multiecho sequence based on a multiecho 2D ultrashort TE (UTE) was employed for simultaneous T1 and T2* quantification. The radial projections follow a modified golden angle ordering, allowing for respiratory self-gating and thus the reconstruction of a series of differently T1 and T2*-weighted images in arbitrary breathing states. The method was evaluated in nine healthy volunteers while breathing room air and pure oxygen, with two volunteers examined at five oxygen concentrations. Results Relative differences of ΔT1 between 7.9% and 12.7% and of ΔT2* between 13.2% and 6.0% were found. Conclusion The proposed method provides inherently coregistered, quantitative T1 and T2* maps in both expiration and inspiration from a single measurement acquired during free breathing and is thus well suited for clinical application.J. Magn. Reson. Imaging 2015;41:1708–1714. © 2014 Wiley Periodicals, Inc.

This article examines the diagnosis of autism as it has been presented in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and is expected to be presented in the next revision of the DSM. Then I look at the relationship of autism and other labels and conditions, including Asperger's disorder, sensory processing disorder, social communication disorder, mental retardation, social anxiety, obsessive-compulsive disorder, narcissistic disorder of childhood, and psychosis. I consider how to describe these relationships, looking at concepts of co-morbidity, overlapping borders, a range of functioning, and changes over time due to therapy, maturation, and other influences. Two vignettes illustrate these ideas.

There are serious concerns regarding safety when performing magnetic resonance imaging in patients with implanted conductive medical devices, such as cardiac pacemakers, and associated leads, as severe incidents have occurred in the past. In this study, several approaches for altering an implant's lead design were systematically developed and evaluated to enhance the safety of implanted medical devices in a magnetic resonance imaging environment. The individual impact of each design change on radiofrequency heating was then systematically investigated in functional lead prototypes at 1.5 T. Radiofrequency-induced heating could be successfully reduced by three basic changes in conventional pacemaker lead design: (1) increasing the lead tip area, (2) increasing the lead conductor resistance, and (3) increasing outer lead insulation conductivity. The findings show that radiofrequency energy pickup in magnetic resonance imaging can be reduced and, therefore, patient safety can be improved with dedicated construction changes according to a "safe by design" strategy. Incorporation of the described alterations into implantable medical devices such as pacemaker leads can be used to help achieve favorable risk-benefit-ratios when performing magnetic resonance imaging in the respective patient group.

Determining the MR compatibility of medical implants and devices is becoming increasingly relevant. In most cases, the heating of conductive implants due to radiefrequency (RF) excitation pulses is measured by fluoroptic temperature sensors in relevant tests for approval. Another common method to determine these heating effects is MR thermometry using the proton resonance frequency. This method gives good results in homogeneous phantoms. However in many cases, technical shortcomings such as susceptibility artifacts prohibit exact proton resonance frequency thermometry near medical implants. Therefore, this work aimed at developing a fast T₁-based method which allows controlled MR-related heating of a medical implant while simultaneously quantifying the spatial and temporal temperature distribution. To this end, an inversion recovery snapshot Fast Low-Angle Shot (FLASH) sequence was modified with additional off-resonant heating pulses. With an accelerated imaging method and a sliding-window technique, every 7.6 s a new temperature map could be generated with a spatial in-plane resolution of 2 mm. The temperature deviation from calculated temperature values to reference fluoroptic probe was found to be smaller than 1 K.

Using electronic media during adolescent psychotherapy sessions allows a patient to communicate particular information, to communicate in a certain way, not to communicate in another way, or not to communicate at all. Use of electronic media is not the only way to accomplish these kinds of communications, which also occur without electronic communication. The case presented in this paper illustrates forms of communication—including electronic communication—that are intermediate between communing with oneself, as in private thoughts or in writing in a journal, and sharing thoughts with another person, as in conversation. The case is of a girl with experiences of loss and a tendency to alexithymia (trouble expressing feelings with words). After the case presentation, I will offer some thoughts of Winnicott's to give a conceptual framework for the discussion.

Attention can be compromised by various factors, including ADHD, emotional trouble, learning disability, language disorder, and executive function problems. When these factors are present they interact, each influencing the other. Therapists also have trouble maintaining a consistent, even focus because of selective inattention, countertransference, and pressure from parents and school. To illustrate, this article presents the background of a case of a seventh grade boy with attention problems. Neuropsychological and psychoanalytic concepts relevant to attention are then reviewed, before returning to a description of the treatment of that case. A summary uses the case to demonstrate a contextual, psychodynamic approach to the children with attention problems.

Implanted medical devices such as cardiac pacemakers pose a potential hazard in magnetic resonance imaging. Electromagnetic fields have been shown to cause severe radio frequency-induced tissue heating in some cases. Imaging exclusion zones have been proposed as an instrument to reduce patient risk. The purpose of this study was to further assess the impact of the imaging landmark on the risk for unintended implant heating by measuring the radio frequency-induced electric fields in a body phantom under several imaging conditions at 1.5T. The results show that global radio frequency-induced coupling is highest with the torso centered along the superior-inferior direction of the transmit coil. The induced E-fields inside the body shift when changing body positioning, reducing both global and local radio frequency coupling if body and/or conductive implant are moved out from the transmit coil center along the z-direction. Adequate selection of magnetic resonance imaging landmark can significantly reduce potential hazards in patients with implanted medical devices.

This paper describes the experience of parenting a child with a disability, starting with expectations while pregnant, moving on to first reactions, the experience of getting assessments, arranging interventions, evaluating interventions and changing them. The focus is on realizing the need to advocate vigorously for one's child in the midst of intense and mixed emotions that develop and change over time. Conceptual and clinical attention is given to relations within the marriage and the family, with doctors and educators, and with many other representatives of the society which parents are preparing their children to enter. Four cases are presented, ranging from infancy to college and beyond.

To provide a robust method for the simultaneous quantification of T1 and T2 * in the human lung during free breathing. Breathing pure oxygen accelerates T1 and T2 * relaxation in the lung. While T1 shortening reflects an increased amount of dissolved molecular oxygen in lung tissue, T2 * shortening shows an increased concentration of oxygen in the alveolar gas. Therefore, both parameters reflect different aspects of the oxygen uptake and provide complementary lung functional information.A segmented inversion recovery Look-Locker multiecho sequence based on a multiecho 2D ultrashort TE (UTE) was employed for simultaneous T1 and T2 * quantification. The radial projections follow a modified golden angle ordering, allowing for respiratory self-gating and thus the reconstruction of a series of differently T1 and T2 *-weighted images in arbitrary breathing states. The method was evaluated in nine healthy volunteers while breathing room air and pure oxygen, with two volunteers examined at five oxygen concentrations.Relative differences of ΔT1 between 7.9% and 12.7% and of ΔT2 * between 13.2% and 6.0% were found.The proposed method provides inherently coregistered, quantitative T1 and T2 * maps in both expiration and inspiration from a single measurement acquired during free breathing and is thus well suited for clinical application.

Background Surgical procedures in small animal models of heart disease might evoke alterations in cardiac morphology and function. The aim of this study was to reveal and quantify such potential artificial early or long term effects in vivo, which might account for a significant bias in basic cardiovascular research, and, therefore, could potentially question the meaning of respective studies. Methods Female Wistar rats (n = 6 per group) were matched for weight and assorted for sham left coronary artery ligation or control. Cardiac morphology and function was then investigated in vivo by cine magnetic resonance imaging at 7 Tesla 1 and 8 weeks after the surgical procedure. The time course of metabolic and inflammatory blood parameters was determined in addition. Results Compared to healthy controls, rats after sham surgery showed a lower body weight both 1 week (267.5±10.6 vs. 317.0±11.3 g, n

Background: Surgical procedures in small animal models of heart disease, such as artificial ligation of the coronary arteries for experimental myocardial infarction, can evoke alterations in cardiac morphology and function. Such alterations might induce artificial early or long term effects in vivo that might account for a significant bias in basic cardiovascular research, and, therefore, could potentially question the meaning of respective studies in small animal models of heart disease. Methods: Female Wistar rats were matched for weight and distributed to sham left coronary artery ligation or untreated control. Cardiac parameters were then investigated in vivo by high-field MRI over time after the surgical procedure, determining left and right ventricular morphology and function. Additionally, the time course of several metabolic and inflammatory blood parameters was determined. Results: Rats after sham surgery showed a lower body weight for up to 8 weeks after the intervention compared to healthy controls. Left and right ventricular morphology and function were not different in absolute measures in both groups 1 week after surgery. However, there was a confined difference in several cardiac parameters normalized to the body weight (bw), such as myocardial mass (2.19±0.30/0.83±0.13 vs. 1.85±0.22/0.70±0.07 mg left/right per g bw, p Conclusion: There is a small distinct impact of cardio-thoracic surgical procedures on the global integrity of the organism, which in the long term also includes circumscribed repercussions on cardiac morphology and function. This impact has to be considered when analyzing data from respective studies and transferring the findings to conditions in patients.

Background One of the safety concerns when performing electrophysiological (EP) procedures under magnetic resonance (MR) guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF) field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating. Methods A two-step approach was chosen. Firstly, tests on passive catheter heating were performed in a 1.5 T Avanto system (Siemens Healthcare Sector, Erlangen, Germany) using a ASTM Phantom in order to determine a possible maximum temperature rise. Secondly, a phantom was designed for simulation of the interface between blood and the vascular wall. The MR-RF induced temperature rise was simulated by catheter tip heating via a standard ablation generator. Power levels from 1 to 6 W were selected. Ablation duration was 120 s with no tip irrigation during the first 60 s and irrigation at rates from 2 ml/min to 35 ml/min for the remaining 60 s (Biotronik Qiona Pump, Berlin, Germany). The temperature was measured with fluoroscopic sensors (Luxtron, Santa Barbara, CA, USA) at a distance of 0 mm, 2 mm, 4 mm, and 6 mm from the catheter tip. Results A maximum temperature rise of 22.4°C at the catheter tip was documented in the MR scanner. This temperature rise is equivalent to the heating effect of an ablator's power output of 6 W at a contact force of the weight of 90 g (0.883 N). The catheter tip irrigation was able to limit the temperature rise to less than 2°C for the majority of examined power levels, and for all examined power levels the residual temperature rise was less than 8°C. Conclusion Up to a maximum of 22.4°C, the temperature rise at the tissue surface can be entirely suppressed by using the catheter's own irrigation system. The irrigated tip system can be used to increase MR safety of EP catheters by suppressing the effects of unwanted passive catheter heating due to RF exposure from the MR scanner.

There are serious concerns regarding safety when performing magnetic resonance imaging in patients with implanted conductive medical devices, such as cardiac pacemakers, and associated leads, as severe incidents have occurred in the past. In this study, several approaches for altering an implant's lead design were systematically developed and evaluated to enhance the safety of implanted medical devices in a magnetic resonance imaging environment. The individual impact of each design change on radiofrequency heating was then systematically investigated in functional lead prototypes at 1.5 T. Radiofrequency-induced heating could be successfully reduced by three basic changes in conventional pacemaker lead design: (1) increasing the lead tip area, (2) increasing the lead conductor resistance, and (3) increasing outer lead insulation conductivity. The findings show that radiofrequency energy pickup in magnetic resonance imaging can be reduced and, therefore, patient safety can be improved with dedicated construction changes according to a "safe by design" strategy. Incorporation of the described alterations into implantable medical devices such as pacemaker leads can be used to help achieve favorable risk-benefit-ratios when performing magnetic resonance imaging in the respective patient group.

Learning disabilities are generally considered issues for children as they go through school. Yet their effect continues into adulthood in a person's cognitive style, use of defenses, interpersonal relations, character, self-image, and career development. With a few exceptions, the study of the impact of learning disabilities on personality has been extended beyond childhood and adolescence only in the last ten years. This article examines these effects on adult character, defensive style, and relationship patterns.