Structural barriers can promote discordant action potential (AP) duration alternans, T wave alternans (TWA) and tachyarrhythmia in animal hearts and simulation studies. We hypothesized that heterogeneous scar (gray zone) and dense midwall scar (midwall core) would promote TWA in patients with cardiomyopathy by slowing conduction and uncoupling transmural APs, respectively. Scar core and gray zone were quantified in 40 cardiomyopathy patients using late gadolinium enhanced cardiac magnetic resonance imaging and related to the results of a clinically validated TWA test. The percentages of gray zone, epicardial core and midwall core were greater in the +TWA group, correlated with TWA magnitude and related to a lower heart rate onset for TWA. These specific scar patterns contribute to the genesis and severity of TWA in cardiomyopathy. Greater knowledge of the substrates that promote TWA in cardiomyopathy patients is valuable in determining those at risk of lethal ventricular arrhythmias.

Hole-doped maganite with middle to narrow bandwidth La1-xCaxMnO3 was extensively studied because of its colossal magnetoresistance (CMR) characteristic under a magnetic field. These kind of materials show un- common magnetic and electric properties. The charge order phase only happens to the region x> 0.5, and along with decreasing temperature, its phase goes from para-insulator to charge-ordered then to antiferromagne- tism. In our studies, we apply correlation function of Green¡¦s function to LCMO and get susceptibility of charge and spin. Then we can get the cri- tical value of Coulomb repulsion inside the material by substituting the experimental values of phase transition temperature. This critical values is the key point of charge-ordered. Then we can also get the size of char- ge gap which decides the stability of charge-ordered phase. After know- ing the Coulomb repulsion and charge gap, we can picture the relation of inside and on-site Coulomb repulsion qualitatively while the transition happens. Here the on-site Coulomb repulsion means to the Hund¡¦s coupl- ing between d electrons. And by this we¡¦ll understand the physics inside CMR materials.

Šio baigiamojo darbo esmė yra atlikti ir pateikti visapusišką bei sistemingą krovinių gabenimo transporto priemonėmis atsakomybės ypatumų analizę, kurio tikslas yra atskleisti šio teisinio instituto atitinkamus svarbiausius aspektus reguliuojančių nuostatų sampratą ir pritaikomumą praktikoje, nustatyti problematinius aspektus. Taip pat darbe yra pristatoma išsami atitinkamų teisės norminių aktų analizė ir teisės doktrinoje išreikšta nuomonių įvairovė nagrinėjama tema. Galiausiai, aptariami svarbiausi ir aktualiausi nagrinėjama tema teismų precedentai siekiant atskleisti pagrindines teisinio reguliavimo problemas, su kuriomis yra susiduriama praktikoje bei pateikiami jų sprendimo pasiūlymai. / The essence of this thesis is to conduct and submit a comprehensive and systematic means of road transport analysis of the characteristics of responsibility, whose aim is to institute the appropriate legal provisions governing the main aspects of the applicability of the concept and practical aspects of the suspect. Also at work is presented in detail the relevant legal regulations and legal analysis of the doctrine of diversity of views expressed by the subject. Finally, it covers the most important and topical subject of judicial precedents at issue in order to uncover key regulatory issues that are encountered in practice and present their solution.

This thesis revers to the Legal relations in transport of people and goods. The introducy chapters are described types of transports. The major part of this text is dedicated to the international and inland treaties. In the practical part of this thesis directs its attention at clarifying essential parts of Agreement ADR and shows the application of Agreement ADR.In the closing part the autor indicates the necessity for a collaborative development of contracting states in Agreement ADR.

Class of 2013 Abstract / Specific Aims: To compare the Comprehensive Medication Review (CMR) rate for Workflow Model #1 (used in 2010) to the CMR rate for Workflow Model #2 (used in 2011) at the Medication Management Center (MMC). Methods: A retrospective database analysis was completed in which Comprehensive Medication Review (CMR) completion rates for 2010 and 2011 were assessed. Comparison included only Center for Medicare and Medicaid Services (CMS) contracts that the Medication Management Center (MMC) provided Medication Therapy Management (MTM) services for both in 2010 and 2011. Data was used to determine the effect a process change had on CMR participation rate at the MMC and best practices for improving the rate of Medication Therapy Management Program (MTMP) beneficiaries participating in a CMR. Main Results: In 2010, patient participation and response to a CMR offer letter was low (0.2%). The changes in process yielded an increase in the CMR completion rate (6.93%); this in turn yielded higher performance measurements for prescription drug plans. Conclusion: Workflow modifications, including a pro-active secondary CMR offer, led to a marked increase in member participation and CMR rates. Patients are more apt to consent to a CMR if they are called for a specific medication related problem. It is recommended to continue to convert TMR calls to CMRs whenever possible, monitor CMR rates at least quarterly, and make cold calls where needed to increase CMR percentages.

Die DOR-Plastik (Surgical Ventricular Reconstruction, SVR) ist ein chirurgisches Verfahren zur Rekonstruktion ventrikulärer kardialer Strukturen bei Herzinsuffizienz-Patienten mit apikaler A- und Dyskinesie. Jedoch gibt es spätestens seit dem negativen Ergebnis einer großen multizentrischen Studie (STICH-trial, Jones et al. 2009 [1]) eine Kontroverse über den tatsächlichen prognostischen Nutzen der Operation. Ziel dieser Arbeit war es in diesem Zusammenhang mittels kardialer Magnet-Resonanz-Tomographie (Cardiac Magnetic Resonance, CMR) generierte potentielle Prädiktoren der funktionellen Erholung nach der DOR-Plastik zu analysieren. Dafür wurden in dieser Arbeit bei 24 Patienten die kardialen Volumina, die kardiale Funktion, das lokale und totale myokardiale Narbengewebe und verschiedene geometrische Indizes bestimmt und ausgewertet. Es konnte gezeigt werden, dass die quantitative Ermittlung des basalen myokardialen Narbengewebes und des apikalen Volumenindex (AVI) dabei helfen könnten, eine Subgruppe von Patienten zu definieren, die von der DOR-Plastik profitiert.

Sector-Wise Golden Angle (SWIG) is a novel approach that was developed to address the limitations associated with Golden Angle radial imaging, commonly used for high temporal resolution flow measurements. Golden angle radial imaging is a time-efficient method that effectively reduces motion sensitivity. However, binned or retrospectively gated imaging where multiple heartbeats are utilized to acquire a single time series may lead to uneven coverage of k- space, ultimately resulting in poor image quality. In contrast, SWIG restricts the radial profiles to a sector of k-space per heartbeat, ensuring even distributions of spokes during retrospectively gated acquisitions. One drawback of SWIG is the loss of ability to reconstruct real-time images. The combination of sorted and unsorted acquisition simultaneously holds significant potential and could be applied in various domains. The goal of the thesis work was to design a trajectory that combines radial and spiral k-space sampling, enabling hybrid real-time and retrospectively gated imaging. The objective was to obtain an image series with comparable quality to a SWIG readout while retaining the ability to reconstruct a low-resolution real-time image series from the same data. To evaluate the hybrid trajectory, the numerical phantom XCAT was used to generate synthetic MRI images. Binned images were sampled using a hybrid-SWIG method, yielding similar image quality to a conventional SWIG image series, with the added benefit of being able to reconstruct a low-resolution real-time image series. Although the current method was only evaluated in a numerical phantom and may require additional adjustment to be suitable for a real MRI scanner, the results show that it is possible to combine radial and spiral imaging in a single readout.

Current evidence regarding the effect of intravenous morphine administration on reperfusion injury and/or cardioprotection in patients with myocardial infarction is conflicting. The aim of this study was to evaluate the impact of morphine administration, on infarct size and reperfusion injury assessed by cardiac magnetic resonance imaging (CMR) in a large multicenter ST-elevation myocardial infarction (STEMI) population. In total, 734 STEMI patients reperfused by primary percutaneous coronary intervention <12 h after symptom onset underwent CMR imaging at eight centers for assessment of myocardial damage. Intravenous morphine administration was recorded in all patients. CMR was completed within one week after infarction using a standardized protocol. The clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE) within 12 months after infarction. Intravenous morphine was administered in 61.8% (n = 454) of all patients. There were no differences in infarct size (17%LV, interquartile range [IQR] 8–25%LV versus 16%LV, IQR 8–26%LV, p = 0.67) and microvascular obstruction (p = 0.92) in patients with versus without morphine administration. In the subgroup of patients with early reperfusion within 120 min and reduced flow of the infarcted vessel (TIMI-flow ≤2 before PCI) morphine administration resulted in significantly smaller infarcts (12%LV, IQR 12–19 versus 19%LV, IQR 10–29, p = 0.035) and reduced microvascular obstruction (p = 0.003). Morphine administration had no effect on hard clinical endpoints (log-rank test p = 0.74) and was not an independent predictor of clinical outcome in Cox regression analysis. In our large multicenter CMR study, morphine administration did not have a negative effect on myocardial damage or clinical prognosis in acute reperfused STEMI. In patients, presenting early ( ≤120 min) morphine may have a cardioprotective effect as reflected by smaller infarcts; but this finding has to be assessed in further well-designed clinical studies

No description available.

Ziele: Mittels kardialer Magnetresonanztomografie (CMR) erhobene Infarktcharakteristika ermöglichen eine umfassende Risikostratifizierung bei Patienten mit ST-Hebungsinfarkt (STEMI). Bei Patienten mit Nicht-ST-Hebungsinfarkt (NSTEMI) ist die prognostische Wertig-keit dieser Parameter unbekannt. Ziel der vorliegenden Arbeit war es, die langfristige prog-nostische Wertigkeit von CMR-basierten Infarktcharakteristika bei mit einer primären perku-tanen Koronar-Intervention (PCI) behandelten NSTEMI-Patienten zu untersuchen. Methoden und Ergebnisse: In dieser prospektiven Observationsstudie wurden 284 mittels PCI revaskularisierte NSTEMI-Patienten in drei Zentren untersucht. Die CMR-Bildgebung erfolgte 3 (Interquartilenabstand [IQR] 2–4) Tage nach Krankenhausaufnahme. Die Infarkt-größe (IS), der myocardial salvage-index (MSI) und die mikrovaskuläre Obstruktion (MVO) wurden hinsichtlich der klinischen und angiographischen Daten verblindet analysiert. Primä-rer klinischer Endpunkt waren schwerwiegende kardiovaskuläre Ereignisse (major adverse cardiac events MACE), definiert als eine Kombination aus Todesfällen jeglicher Ursache, Reinfarkt und neu aufgetretene Herzinsuffizienz. Die mediane Nachbeobachtungszeit lag bei 4,4 (IQR 3,6–4,9) Jahren. Die mediane IS betrug 7,2 % (IQR 2,2–13,7) der linksventrikulären (LV)-Myokardmasse (%LV) und der MSI betrug 65,7 (IQR 39,3–84,9). Das Alter (p<0,003), die Herzfrequenz (p<0,02), die Anzahl erkrankter Koronararterien (p<0,01) und der Thrombolysis In Myocardial Infarction-(TIMI)-Fluss-Grad vor der PCI (p<0,001) waren unabhängige Prä-diktoren für die IS und den MSI. 64 Patienten (22,5 %) erreichten den primären Endpunkt. Über die linksventrikuläre Ejektionsfraktion (LVEF) hinaus konnte in der multivariablen Ana-lyse keine unabhängige prognostische Wertigkeit der CMR-basierten Infarktcharakteristika identifiziert werden. Schlussfolgerung: In dieser prospektiven, multizentrischen NSTEMI Kohorte, die einer Re-vaskularisation unterzogen wurde, waren das Alter, die Herzfrequenz, die Anzahl erkrankter Koronararterien und der TIMI-Fluss-Grad vor der PCI unabhängige Prädiktoren für die IS und den MSI. Die mittels CMR-erhobenen Infarktcharakteristika lieferten über die LVEF hinaus keine zusätzlichen prognostischen Informationen.:Abkürzungsverzeichnis V Zusammenfassung VIII Abstract IX 1 Einleitung 1 1.1 Definition, Epidemiologie und Pathophysiologie 1 1.2 Etablierte Prognosemarker nach akutem Myokardinfarkt 4 1.2.1 Parameter in der Echokardiographie 4 1.2.2 Kardiale Biomarker als Prognosemarker 5 1.2.3 Parameter in der Koronarangiographie 5 1.2.4 Parameter der CMR nach Myokardinfarkt 6 1.2.4.1 LV-Funktion, LV-Volumina und Prognose 6 1.2.4.2 Infarktgröße (IS) und Prognose 7 1.2.4.3 Mikrovaskuläre Obstruktion (MVO) und Prognose 7 1.2.4.4 Intramyokardiale Hämorrhagie (IMH) und Prognose 8 1.2.4.5 Area at Risk (AAR) / Myokardialer Salvage-Index (MSI) und Prognose 8 1.2.4.6 T1/T2-Mapping und Prognose 9 1.3 Zielsetzung 10 2 Methoden und Material 11 2.1 Studienprotokoll 11 2.2 Klinische Endpunkte 12 2.3 CMR-Bilderfassung und Analyse 13 2.4 Statistische Analyse 15 3 Ergebnisse 16 3.1 Patienten- und angiographische Charakteristika 16 3.2 Ergebnisse der kardialen Magnetresonanztomographie (CMR) 19 3.3 Prognostische Wertigkeit der CMR-Parameter 23 4 Diskussion 28 4.1 NSTEMI vs. STEMI: Pathophysiologie, angiographische Charakteristika und Prognose 28 4.2 Prädiktoren von CMR-basierten Infarkt-Charakteristika 29 4.3 Prognostische Wertigkeit der CMR bei NSTEMI 31 4.4 Limitationen der Studie 33 5 Schlussfolgerung und Ausblick 35 Literaturverzeichnis 36 Abbildungsverzeichnis 48 Tabellenverzeichnis 49 Curriculum Vitae: Michael Nanos 50 Publikation der Arbeit 55 Erklärung 56 Erklärung über die eigenständige Abfassung der Arbeit 56 Danksagung 57