Deep learning-assisted radiomics facilitates multimodal prognostication for personalized treatment strategies in low-grade glioma.

Determining the optimal course of treatment for low grade glioma (LGG) patients is challenging and frequently reliant on subjective judgment and limited scientific evidence. Our objective was to develop a comprehensive deep learning assisted radiomics model for assessing not only overall survival in LGG, but also the likelihood of future malignancy and glioma growth velocity. Thus, we retrospectively included 349 LGG patients to develop a prediction model using clinical, anatomical, and preoperative MRI data. Before performing radiomics analysis, a U2-model for glioma segmentation was utilized to prevent bias, yielding a mean whole tumor Dice score of 0.837. Overall survival and time to malignancy were estimated using Cox proportional hazard models. In a postoperative model, we derived a C-index of 0.82 (CI 0.79-0.86) for the training cohort over 10 years and 0.74 (Cl 0.64-0.84) for the test cohort. Preoperative models showed a C-index of 0.77 (Cl 0.73-0.82) for training and 0.67 (Cl 0.57-0.80) test sets. Our findings suggest that we can reliably predict the survival of a heterogeneous population of glioma patients in both preoperative and postoperative scenarios. Further, we demonstrate the utility of radiomics in predicting biological tumor activity, such as the time to malignancy and the LGG growth rate.

[Lay version of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis : Translation into German and linguistic validation in German-speaking countries with people affected]. / Die laienverständliche Version der 2018 EULAR Empfehlungen zu körperlicher Aktivität von Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen : Übersetzung ins Deutsche und sprachliche Validierung im deutschsprachigen Raum mit Betroffenen.

BACKGROUND: Physical activity and exercise are beneficial for people with rheumatic diseases; however, recommendations for the management of rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip- and knee osteoarthritis (HOA/KOA) are usually unspecific with respect to mode and dose of exercise. This is why the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis were formulated. The recommendations consist of 4 overarching principles and 10 recommendations. These were also published as a lay version in the English language. AIM: Translation of the lay version into German and its linguistic validation in Austria, Germany and Switzerland. METHODS: A professional translation was reviewed by the authors, including people with, RA, SpA, HOA/KOA from the three German-speaking countries, which provided a prefinal lay version. Subsequently, eight interviews with people with RA, SpA, HOA/KOA were conducted in each country to evaluate understandability, wording, completeness and feasibility of the prefinal lay version. Finally, the authors, i.e. those with RA, SpA, and osteoarthritis, anonymously rated their agreement to the final lay version on a 0-10 scale. RESULTS: The professional translation was substantially revised by the authors and based on the interviews. Formulations were adapted to increase readability and understandability and specify statements. Comments that would have changed content or structure were not considered. Average agreement with the particular recommendations was between 10 (SD 0) and 7.6 (SD 1.67). DISCUSSION: For people with RA/SpA/HOA/KOA the EULAR physical activity recommendations should be available in their mother language. The final German lay version is valid and accepted across all three German-speaking countries. Thus, the physical activity recommendations can be provided to people with rheumatic diseases in an understandable and feasible way.

Conceptual design of Thomson scattering diagnostics for the COMPASS-U tokamak.

The Thomson scattering (TS) diagnostic, one of the key diagnostics used on the tokamaks around the world, is planned for the COMPASS-U tokamak, which is recently under design and construction in the Institute of Plasma Physics in Prague, Czech Republic. This tokamak is supposed to be a world-unique, high magnetic field device with hot walls, allowing for the study of the plasma exhaust in advanced operational scenarios and testing cutting-edge technologies relevant to future fusion reactors, e.g., use of liquid metals. The core and edge TS systems are planned to be designed and operational, with a limited performance, already in the early stage of the tokamak operation. In this contribution, requirements and the most important constraints defining the TS system design are presented. The impact of both the possible collection lens location and spatial resolution on the plasma pedestal observation is simulated. Design considerations also take into account the high-resolution TS core and edge systems available from the COMPASS tokamak, which will be reused. The collection lenses will be newly built. Extension of the detection system will complete the plasma radius coverage in the future. The divertor TS is considered for later periods.

Thomson scattering synthetic diagnostic module for the Cherab framework.

This contribution presents a Thomson scattering module developed for the Raysect and Cherab framework. Detailed models of spectroscopic diagnostic systems can be created in the framework, which deliver synthetic data with high precision due to accurate physical treatment of ray propagation and radiation phenomena. The addition of the presented module will allow us to model Thomson scattering systems that can aid both data validation and design. Two examples of such application are given. The first example shows the application of the module on the COMPASS tokamak edge Thomson scattering diagnostic and experimental data. The second example shows the possibility to use the framework and the Thomson scattering module as a design support tool.

Involving patients as research partners exemplified by the development and evaluation of a communication-skills training programme (KOKOS-Rheuma).

Despite widespread recommendations for involving patient research partners (PRPs), there is little information about how patients have been involved in research. Our aim was to describe and assess the contributions of four PRPs in a project on communication-skills training funded by Deutsche Rheuma-Liga Bundesverband e. V. (German League Against Rheumatism [GLR] is a patient organisation for people with rheumatic and musculoskeletal diseases). The PRPs' participation was beneficial with regards to content and organisation. Thanks to their participation, we could enlarge our sample by over a third, and they contributed their own ideas to the training. Four PRPs added their perspective of various regional organisations. Outside this project, they were also very active within GLR and experienced in managing their rheumatic disease. To achieve more representativeness, future studies might also employ strategies to engage individuals with less experience in dealing with their disease, e.g. newly diagnosed patients. While the collaboration between PRPs and researchers proved very successful, more regular discussions about tasks and responsibilities would be worthwhile.

Observation and evaluation of the alignment of Thomson scattering systems.

Concerning plasma diagnostics based on Thomson scattering (TS), precise adjustment and proper alignment is of great importance in order to provide reliable and accurate measurements. Any misalignment could result in an incorrectly determined plasma density or prevent the measurement with this type of diagnostic altogether. Suitable means of alignment monitoring should be integrated into each TS diagnostic system. Variations of commonly used methods are discussed in this article. Correlation of results from alignment control with performed measurements of vibrations on the COMPASS tokamak is presented. Various techniques of optimization of alignment monitoring are shown. The optimal technique, which could be accommodated during the construction of TS diagnostic systems in future fusion devices, is proposed.

Fitting of the Thomson scattering density and temperature profiles on the COMPASS tokamak.

A new technique for fitting the full radial profiles of electron density and temperature obtained by the Thomson scattering diagnostic in H-mode discharges on the COMPASS tokamak is described. The technique combines the conventionally used modified hyperbolic tangent function for the edge transport barrier (pedestal) fitting and a modification of a Gaussian function for fitting the core plasma. Low number of parameters of this combined function and their straightforward interpretability and controllability provide a robust method for obtaining physically reasonable profile fits. Deconvolution with the diagnostic instrument function is applied on the profile fit, taking into account the dependence on the actual magnetic configuration.

Profile measurements of the electron temperature on the ASDEX Upgrade, COMPASS, and ISTTOK tokamak using Thomson scattering, triple, and ball-pen probes.

The ball-pen probe (BPP) technique is used successfully to make profile measurements of the electron temperature on the ASDEX Upgrade (Axially Symmetric Divertor Experiment), COMPASS (COMPact ASSembly), and ISTTOK (Instituto Superior Tecnico TOKamak) tokamak. The electron temperature is provided by a combination of the BPP potential (ΦBPP) and the floating potential (Vfl) of the Langmuir probe (LP), which is compared with the Thomson scattering diagnostic on ASDEX Upgrade and COMPASS. Excellent agreement between the two diagnostics is obtained for circular and diverted plasmas and different heating mechanisms (Ohmic, NBI, ECRH) in deuterium discharges with the same formula Te = (ΦBPP - Vfl)/2.2. The comparative measurements of the electron temperature using BPP/LP and triple probe (TP) techniques on the ISTTOK tokamak show good agreement of averaged values only inside the separatrix. It was also found that the TP provides the electron temperature with significantly higher standard deviation than BPP/LP. However, the resulting values of both techniques are well in the phase with the maximum of cross-correlation function being 0.8.

Cardiovascular risk and fitness in veteran football players.

Veteran football players above 40 years have rarely been subject to scientific investigations. This is worrisome because their number is considerable and their cardiovascular risk probably increased. Therefore, a cross-sectional study was conducted in 100 football players between 40 and 63 years of age. This included a medical history and physical examination, venous blood sampling, measurement of resting blood pressure, a resting electrocardiogram (ECG), an exhaustive cycle ergometry and a multistage field test. Also, measurements of heart rate and blood lactate concentration were carried out during one typical training session and one match. Participants trained 1.0 ± 0.6 sessions per week and played 27 ± 8 matches per season. Of them, 19% were smokers. Resting blood pressure was 138 ± 15/88 ± 8 mmHg. Hypertension prevalence (WHO definition) was 66%. Total cholesterol averaged 220 ± 41 mg . dl(-1), HDL 46 ± 13 mg . dl(-1) and LDL 134 ± 33 mg . dl(-1). The average 10-year risk for cardiovascular events (Framingham score) was 6%. Mean maximal power output on the cycle ergometer was 2.8 ± 0.6 W . kg(-1), mean VO2peak 40.0 ± 7.3 ml . min(-1) . kg(-1). Comparing training and competition, no significant differences in cardiovascular and metabolic load were found. In summary, their cardiovascular risk was similar to age-adjusted reference values. However, they showed slightly better ergometric performance. More frequent training stimuli might be necessary to reach more favourable risk factor profiles. Training and competition lead to similar cardiocirculatory and metabolic stress which is considerably high and might put players into danger who have pre-existing cardiac disease.

Edge Thomson scattering diagnostic on COMPASS tokamak: installation, calibration, operation, improvements.

The core Thomson scattering diagnostic (TS) on the COMPASS tokamak was put in operation and reported earlier. Implementation of edge TS, with spatial resolution along the laser beam up to ∼1/100 of the tokamak minor radius, is presented now. The procedure for spatial calibration and alignment of both core and edge systems is described. Several further upgrades of the TS system, like a triggering unit and piezo motor driven vacuum window shutter, are introduced as well. The edge TS system, together with the core TS, is now in routine operation and provides electron temperature and density profiles.

First results from EBW emission diagnostics on COMPASS.

COMPASS tokamak shots at low magnetic field feature overdense plasmas during the extended current flat-top phase. The first harmonic of the electron cyclotron emission is completely cutoff for O and X modes and so the emission caused by electron Bernstein waves (EBWs) propagating obliquely with respect to the magnetic field and undergoing so called EBW-X-O conversion process can be observed. We perform an angular scan of the EBW emission during a set of comparable shots in order to determine the optimum antenna direction. A weak dependence of the radiative temperature on the antenna angles indicates an influence of multiple reflections from the vessel wall. The low temperature at the mode conversion region is responsible for the collisional damping of EBW, which can explain several times lower measured radiative temperature than the electron temperature measured by the Thomson scattering system.

High-resolution Thomson scattering system on the COMPASS tokamak: evaluation of plasma parameters and error analysis.

The electron density and temperature profiles measured by the Thomson scattering diagnostic on the COMPASS tokamak are used for estimation of electron kinetic energy, energy confinement time, and effective charge number Z(eff). Data are compared with the line-integrated electron density measured by a microwave interferometer in an ohmically heated plasma with a circular cross section. An error analysis of both electron temperature and density are performed by two methods-a constant chi-square boundaries method and a Monte Carlo simulation, determining asymmetrical error bars for the electron temperature.

[Curricula oriented inclusion of children and adolescents with haemophilia in school sports--a new approach within the project "fit for life"]. / Lehrplanorientierte Inklusion hämophiler Kinder und Jugendlicher im Sportunterricht. Ein neuer Ansatz innerhalb des Projekts "fit for life"

Inclusive paedagogic thinking and acting is a modern and increasingly important topic in school sports. It will affect teachers as well as parents and students. The new international guidelines and national curricula enable new ways of inclusion especially for students with chronic illnesses like haemophilia. Special help from the sport teachers is of vital importance. In our project "fit for life" where we advice children and young adults with haemophilia to find their appropriate sport, we developed a new approach for an optimised inclusion of children with haemophilia into sport lessons. The whole project is running in corporation with the German Sport Teachers Association/Hessen. We analysed and rated the actual curricula of the different school years and looked at the specific needs, risks and necessary abilities for persons with haemophilia. By this means we gathered about 600 typical movements and/or exercises for school sports and developed individual advice and adapted exercise solutions for sport lessons.

[Analysis of muscle function with kinetic superficial EMG in children with haemophilia - recognizing subclinical changes, establishing individual therapy, quality control]. / Muskelfunktionsmessung mit kinetischem Oberflächen-EMG bei Kindern mit Hämophilie. Erkennung subklinischer Veränderungen, Etablierung individueller Therapie, Qualitätskontrolle.

UNLABELLED: Electromyography (EMG) measures muscle electricity. It depends on muscle contraction and central motor control. Muscles react very sensitive on external signals (e. g. bleeding), The resulting changes can be shown in EMG. PATIENTS, METHODS: A first study included 51 children and young adults from Costa Rica. They underwent a clinical examination and EMG of the hip, knee and ankle joints. Resting muscle tone, maximal isometric contraction and three typical isotonic movements of the joints were measured. First step of analysis was to characterize typical pathogenic changes in the muscles and to find a corresponding physical therapy to minimize these changes. RESULTS: It showed that EMG is a good marker for muscle condition. It helps to individualize therapy and improve effectivity of physical and physiotherapeutic treatment of the locomotive system of children and young adults with hemophilia. It can help to recognize early subclinical changes and to control the outcome of therapeutic modalities.

Laser system for high resolution Thomson scattering diagnostics on the COMPASS tokamak.

A new Thomson scattering diagnostic has been designed and is currently being installed on the COMPASS tokamak in IPP Prague in the Czech Republic. The requirements for this system are very stringent with approximately 3 mm spatial resolution at the plasma edge. A critical part of this diagnostic is the laser source. To achieve the specified parameters, a multilaser solution is utilized. Two 30 Hz 1.5 J Nd:YAG laser systems, used at the fundamental wavelength of 1064 nm, are located outside the tokamak area at a distance of 20 m from the tokamak. The design of the laser beam transport path is presented. The approach leading to a final choice of optimal focusing optics is given. As well as the beam path to the tokamak, a test path of the same optical length was built. Performance tests of the laser system carried out using the test path are described.

Progress of development of Thomson scattering diagnostic system on COMPASS.

A new Thomson scattering diagnostic system has been designed and is being built now on the COMPASS tokamak at the Institute of Plasma Physics ASCR in Prague (IPP Prague) in the Czech Republic. This contribution focuses on design, development, and installation of the light collection and detection system. High spatial resolution of 3 mm will be achieved by a combination of design of collection optics and connected polychromators. Imaging characteristics of both core and edge plasma collection objectives are described and fiber backplane design is presented. Several calibration procedures are discussed. The operational deployment of the Thomson scattering diagnostic is planned by the end of 2010.

The use of a femoral revision stem in the treatment of primary or secondary bone tumours of the proximal femur: a prospective study of 31 cases.

Endoprosthetic reconstruction following resection of 31 tumours of the proximal femur in 30 patients was performed using a Wagner SL femoral revision stem. The mean follow-up was 25.6 months (0.6 to 130.0). Of the 28 patients with a metastasis, 27 died within a mean follow-up period of 18.1 months (0.6 to 56.3) after the operation, and the remaining patient was excluded from the study 44.4 months post-operatively when the stem was removed. The two patients with primary bone tumours were still alive at the latest follow-up of 81.0 and 130.0 months, respectively. One stem only was removed for suspected low-grade infection 44.4 months post-operatively. The worst-case survival rate with removal of the stem for any cause and/or loss to follow-up was 80.0% (95% confidence interval 44.9 to 100) at 130.0 months. The mean Karnofsky index increased from 44.2% (20% to 70%) pre-operatively to 59.7% (0% to 100%) post-operatively, and the mean Merle d'Aubigné score improved from 4.5 (0 to 15) to 12.0 (0 to 18). The mean post-operative Musculoskeletal Tumour Society score was 62.4% (3.3% to 100%). The Wagner SL femoral revision stem offers an alternative to special tumour prostheses for the treatment of primary and secondary tumours of the proximal femur. The mid-term results are very promising, but long-term experience is necessary.

[How to manage the narrow pupil?]. / Ako zvládnut' úzku zrenicu?

I describe a new irrigating iris retractor for cataract surgery in small pupils. The retractor, a modified irrigating handpiece has a smooth button-like iris hook in the front. The hook is inserted into the margin of a small pupil and retract the pupil peripherally to allow visualisation of cortical remnant in the equatorial area of the lens capsule. The capsule can then be safely cleaned using the aspirating handpiece in the surgeon's other hand.

Cognitive performance in recreational ecstasy polydrug users: a two-year follow-up study.

There is important preclinical evidence of long lasting neurotoxic and selective effects of ecstasy MDMA on serotonin systems in non-human primates. In humans long-term recreational use of ecstasy has been mainly associated with learning and memory impairments. The aim of the present study was to investigate the neuropsychological profile associated with ecstasy use within recreational polydrug users, and describe the cognitive changes related to maintained or variable ecstasy use along a two years period. We administered cognitive measures of attention, executive functions, memory and learning to three groups of participants: 37 current polydrug users with regular consumption of ecstasy and cannabis, 23 current cannabis users and 34 non-users free of illicit drugs. Four cognitive assessments were conducted during two years. At baseline, ecstasy polydrug users showed significantly poorer performance than cannabis users and non-drug using controls in a measure of semantic word fluency. When ecstasy users were classified according to lifetime use of ecstasy, the more severe users (more than 100 tablets) showed additional deficits on episodic memory. After two years ecstasy users showed persistent deficits on verbal fluency, working memory and processing speed. These findings should be interpreted with caution, since the possibility of premorbid group differences cannot be entirely excluded. Our findings support that ecstasy use, or ecstasy/cannabis synergic effects, are responsible for the sub-clinical deficits observed in ecstasy polydrug users, and provides additional evidence for long-term cognitive impairment owing to ecstasy consumption in the context of polydrug use.

Valor diagnóstico y correlaciones funcionales de la escala ADAS-Cog en la enfermedad de Alzheimer: datos del proyecto NORMACODEM / Diagnostic value and functional correlations of the ADAS-Cog scale in Alzheimer's disease: data on NORMACODEM project

Introducción. El objetivo es estudiar la validez de criterio de la Alzheimer's Disease Assessment Scale (ADAS) y de su subescala cognitiva ADAS-Cog para el diagnóstico de la enfermedad de Alzheimer (EA) y determinar diferentes puntos de corte obteniendo la sensibilidad y especificidad diagnósticas respectivas. Además se pretenden estudiar las correlaciones de las puntuaciones de la escala ADAS con medidas funcionales.Métodos. Se estudiaron 451 sujetos (254 controles sanos,86 casos con deterioro cognitivo sin demencia y 111 sujetos afectos de EA). Se obtuvieron las puntuaciones de la escala ADAS-total. La puntuación global es la resultante de la suma de dos subtests: la subescala cognitiva (ADAS-Cog) y la subescala no cognitiva (ADAS-Nocog). Se aplicaron ajustes por edad y escolaridad correspondientes para cada sujeto. A fin de poder establecer la correlación con medidas funcionalesse administraron la Rapid Disability Rating Scale-2(RDRS-2), la Blessed Dementia Rating Scale (BDRS) y la escala Interview for Detererioration of Daily Living in Dementia (IDDD). El estudio estadístico se realizó mediante las curvas ROC y el coeficiente de correlación de Pearson. Resultados. El punto de corte más equilibrado para la ADAS-total ajustado por edad y escolaridad fue de >= 17 (sensibilidad: 90,09 %, y especificidad: 85,88%). El punto de corte más equilibrado del ADAS-Cog ajustado por edad y escolaridad fue de >= 12 (sensibilidad: 89,19 %, y especificidad: 88,53%). El área bajo la curva ROC fue, respectivamente, 0,95 y 0,94. La escala ADAS-total y ADAS-Cog presentan buenas correlaciones con las escalas funcionales estudiadas. Conclusiones. Tanto la ADAS-total como la ADAS-Cog presentan una buena validez discriminativa en términos de sensibilidad, especificidad y valor predictivo. Asimismo existe una buena correlación entre el deterioro funcional estudiado en los pacientes con EA y la puntuación obtenida en ambas escalas

Introduction. The aims of this study were to assessthe criterion validity of Alzheimer's Disease AssessmentScale (ADAS) and its cognitive subscale (ADAS-Cog) forthe diagnosis of Alzheimer’s disease (AD), and to determine their different cut-off scores and sensitivity and specificity values. In addition, we also attempted tostudy the possible correlations between cognitive scores(ADAS) and functional measures. Methods. 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with AD). ADAS total score was obtained by adding the cognitive (ADAS-Cog) and non-cognitive (ADAS-Nocog) scales. Scores were adjusted for age and formal education. For assessing the possible correlation between cognitive and functional measures, the following instruments were administered: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) and the Interview for the Deterioration of Daily Living in Dementia (IDDD). Statistical analysis: ROC curves and Pearson correlation coefficient. Results. ADAS best cut-off score for dementia was >=17 providing sensitivity and specificity values of 90.09% and 85.88 % respectively, while for the ADAS-Cog best cut-off score was >= 12 with sensitivity and specificity values of 89.19 % and 88.53 % respectively. In both cases scores were adjusted for age and formal education. The area under the ROC curve was 0.95 and 0.94 respectively. Highly significant correlations were found for ADAS and 19 ADAS-Cog with the functional scales studied. Conclusions. Both, ADAS and ADAS-Cog report good validity in terms of sensitivity, specificity and as predictive value for AD. Moreover, significant correlations were found between the functional impairment observed in patients with AD and the overall scores achieved in the ADAS and ADAS-Cog