The influence of cardiac triggering time and an optimization strategy for improved cardiac MR spectroscopy

Purpose

To study how cardiac motion affects the spectral quality in cardiac MR spectroscopy and to establish an optimization strategy for the cardiac triggering time for improved quality and success rate of cardiac MRS.

Translation and cultural adaption of the decisions module for colorectal cancer screening into a Swedish version – the SCREESCO questionnaire

Objectives: Colorectal cancer (CRC) is suitable for population screening due to its high incidence and the recognizable and treatable prephase, and the present study is part of the larger study; Screening for Swedish Colons (SCREESCO). In Sweden, there is, to our knowledge, no questionnaire assessing shared decision making (SDM) with regard to CRC screening and, therefore, the aim of the study was to translate and culturally adapt the CRC screening module of the National Survey of Medical Decisions (DECISIONS) into a Swedish context.

Material and methods: A qualitative design inspired by guidelines based on methods for cross-cultural adaptation of questionnaires was used. In addition, focus group discussions, individual interviews and think-aloud (TA) sessions were performed.

Results: Of the 54 items included in the original DECISION survey, 32 were excluded, 22 were modified, and three were added as a result of the qualitative study. How the health care organization communicated and CRC screening knowledge was communicated were found to be the most important cultural differences between Sweden and the USA. The final questionnaire consists of 24 items.

Conclusion: The process of translation and cultural adaptation of the CRC screening module of the DECISIONS survey resulted in the removal and modifying of a considerable number of items. The major rationale for the removal and modifying of items can be explained by the different cultural traditions between Sweden and the USA when communicating with the health care system regarding screening participation and how CRC screening information and knowledge is communicated.     

Survey on Physicians' Knowledge and Training Needs in Genetic Counseling in Germany

BackgroundIn recent years, germline testing of women with a risk of developing breast and ovarian cancer has increased rapidly. This is due to lower costs for new high-throughput sequencing technologies and the manifold preventive and therapeutic options for germline mutation carriers. The growing demand for genetic counseling meets a shortfall of counselors and illustrates the need to involve the treating clinicians in the genetic testing process. This survey was undertaken to assess their state of knowledge and training needs in the field of genetic counseling and testing.MethodsA cross-sectional survey within the European Bridges Study (Breast Cancer Risk after Diagnostic Gene Sequencing) was conducted among physician members (n = 111) of the German Cancer Society who were primarily gynecologists. It was designed to examine their experience in genetic counseling and testing.ResultsOverall, the study revealed a need for training in risk communication and clinical recommendations for persons at risk. One-third of respondents communicated only relative disease risks (31.5%) instead of absolute disease risks in manageable time spans. Moreover, almost one-third of the respondents (31.2%) communicated bilateral and contralateral risk-reducing mastectomy as an option for healthy women and unilateral-diseased breast cancer patients without mutations in high-risk genes (e.g. BRCA1 or BRCA2). Most respondents expressed training needs in the field of risk assessment models, the clinical interpretation of genetic test results, and the decision-making process.ConclusionThe survey demonstrates a gap of genetic and risk literacy in a relevant proportion of physicians and the need for appropriate training concepts.     

Placement of Brånemark implants in the maxillary tuber region: anatomical considerations, surgical technique and long-term results

Background: Fixture placement in the tuber area is one way to overcome the problem of insufficient bone volume for routine implant surgery in the posterior maxilla due to severe resorption of jawbone and an extensive enlargement of the maxillary sinus. However, little is known about the long‐term results. Purpose: The aim of this study was to retrospectively evaluate the survival rate and marginal bone conditions at fixtures placed in the tuber region of the maxilla. Material and methods: Twenty‐one patients previously treated with at least one implant in the tuber region of the maxilla were included in this retrospective analysis. A total of 23 standard Brånemark System fixtures with a turned surface had been surgically placed in the tuber regions and 71 additional implants in adjacent areas to support fixed dental bridges. All implants were allowed to heal for 6–8 months before abutment connection and following prosthetic treatment. The patients were radiographed after 1–12 years for evaluation of marginal bone levels. In addition, the relation between the apex of the fixture in the tuberosity area and the posterior border of the maxilla was measured. Results: Twenty of the 21 patients representing 22 tuber and 64 additional implants were radiographically evaluated. No implants in the tuber areas were lost during the follow‐up whereas two fixtures in the anterior region had to be removed, one before loading and the other after 4 years of loading not interfering with the prosthesis stability. The mean marginal bone level at tuber implants was situated on average 1.6 mm (SD 1.1, n=22) from the abutment‐fixture junction, whilst the other implants showed an average bone level of 1.9 mm (SD 0.8, n=64). The results were similar when comparing partially and totally edentulous patients. Conclusion: The present retrospective study shows good clinical outcome with standard Brånemark fixtures placed in the tuber region of the posterior maxilla using a two‐stage procedure. In appropriate cases where bone of adequate volume and density is available, our data indicate that the technique can be used as an alternative to more extensive surgery and especially to the sinus lift procedure. However, prospective comparative studies are needed in order to evaluate the efficacy of the described technique for this purpose.     

Radiographic analyses of "advanced" marginal bone loss around Brånemark dental implants

Background: Dental implant failures have a multifactorial background; dependency within patient/jaw exists. Failures caused by bone loss are rare. Lately, advanced bone loss around implants has been discussed.
Purposes: Our aim was to study advanced bone level changes (≥2 mm) regarding "clustering effect," prediction, and dependency. Further, we also aimed to study if the number of radiographs/radiographic examinations could be reduced.
Materials and Methods: Six hundred and forty patients (3,462 Brånemark implants) with radiographic follow-ups ≥5 years were included, whereas patients with overdentures and augmentation procedures were excluded.
Results: Progression rate for implants with advanced bone loss was largest during the first year; thereafter, slow. A cluster effect was found with more advanced bone loss in few patients. Position was important for lower jaw implants with larger bone loss for implants placed close to midline. Age, jaw type, and implant placement were identified as predictors. The longer the follow-ups, the more bone loss around a randomly selected and examined implant, and the more implants per patient, the higher the risk for bone loss ≥2 mm around any other implant. Still, it seems safe to exclude radiographic follow-ups during the first 5 years. Dependency within the patient was found, hence the "one-implant-per-patient technique" can be applied.
Conclusion: The number of intraoral radiographs per examination and, more importantly, radiographic examinations can be reduced without jeopardizing good clinical management, a statement valid even for Brånemark implants with advanced bone loss.     

Imidazolopiperazines: hit to lead optimization of new antimalarial agents

Starting from a hit series from a GNF compound library collection and based on a cell-based proliferation assay of Plasmodium falciparum, a novel imidazolopiperazine scaffold was optimized. SAR for this series of compounds is discussed, focusing on optimization of cellular potency against wild-type and drug resistant parasites and improvement of physiochemical and pharmacokinetic properties. The lead compounds in this series showed good potencies in vitro and decent oral exposure levels in vivo. In a Plasmodium berghei mouse infection model, one lead compound lowered the parasitemia level by 99.4% after administration of 100 mg/kg single oral dose and prolonged mice survival by an average of 17.0 days. The lead compounds were also well-tolerated in the preliminary in vitro toxicity studies and represents an interesting lead for drug development.