Frank Schaarschmidt

Magnetic resonance 4D flow characteristics of cerebrospinal fluid at the craniocervical junction and the cervical spinal canal

ObjectivesTo evaluate the applicability of 4D phase contrast (4D PC) MR imaging in the assessment of cerebrospinal fluid dynamics in healthy volunteers and patients with lesions at the craniocervical junction or the cervical spinal canal.MethodsTen healthy volunteers and four patients with lesions including Chiari I malformation and cervical canal stenoses were examined by a cardiac-gated 4D PC imaging sequence on 1.5T MRI. Phase contrast images were postprocessed allowing for flow quantification and flow pathline visualisation. Velocity data were compared with conventional axial 2D phase contrast images.ResultsThe 4D PC sequence allowed for flow quantification and visualisation in all individuals. Bland-Altman analysis showed good agreement of 2D and 4D PC velocity data. In healthy volunteers, CSF flow was homogeneously distributed in the anterior and anterolateral subarachnoid space with the flow directed caudally during systole and cranially during diastole. Flow velocities were closely related to the width of the subarachnoid space. Patients showed grossly altered CSF flow patterns with formation of flow jets with increased flow velocities.Conclusions4D PC MR imaging allows for a detailed assessment of CSF flow dynamics helping to distinguish physiological from complex pathological flow patterns at the craniocervical junction and the cervical spine.

Diagnostic implications of magnetic resonance feature tracking derived myocardial strain parameters in acute myocarditis

PURPOSE The present study aims to evaluate the diagnostic value of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain-analysis of both ventricles in patients with acute myocarditis (ACM) in order to improve its currently still challenging non-invasive diagnosis. METHODS CMR cine data of 31 patients with clinically suspected ACM and confirmation of diagnosis by CMR according to the Lake Louise criteria as well as 14 patients with clinically diagnosed ACM but inconspicuous CMR were retrospectively analyzed. 20 healthy volunteers (HV) served as a control. Analysis of global longitudinal, circumferential and radial strain and strain rate of both ventricles was performed in one long-axis and three short-axis slices using a dedicated FT-software (TomTec Imaging Systems). RESULTS Patients with ACM showed significantly reduced LV longitudinal strain (-12.7 ± 6.5 vs. -16.8 ± 5.9%, p=0.021) and LV circumferential strain (LVCirStrain; -22.9 ± 5.7 vs. -27.8 ± 4.4 %, p<0.001) compared to HV. Conversely, they showed improved basal RV circumferential strain rate (BasalRVCirSR; -0.70 ± 0.23 vs. -0.47 ± 0.31s(-1), p=0.009). In ACM patients with preserved EF, BasalRVCirSR was significantly increased compared to HV while LV strain was not significantly different between both groups. In multinominal logistic regression analysis, LVCirStrain and BasalRVCirSR proved to be the best independent predictors of ACM with preserved EF. A combined cut-off of -0.53s(-1) for BasalRVCirSR and of -29.0% for LVCirStrain allowed a classification of ACM patients with preserved EF with a sensitivity of 89% and a specificity of 80%. Also patients with clinical ACM but inconspicuous CMR showed a significantly improved BasalRVCirSR and a cut-off of -0.77s(-1) allowed a classification of ACM patients with a sensitivity of 70% and a specificity of 90%, while all other CMR parameters were normal. CONCLUSIONS The defined cut-offs for LVCirStrain and BasalRVCirSR allow a prediction of ACM with high sensitivity and specificity, even in patients with preserved EF and in patients with otherwise completely inconspicuous CMR. Our results point to a discriminative power especially of RV strain analysis in the CMR-based diagnosis of ACM.

A systematic evaluation of three different cardiac T2-mapping sequences at 1.5 and 3T in healthy volunteers

BACKGROUND Previous studies showed that myocardial T2 relaxation times measured by cardiac T2-mapping vary significantly depending on sequence and field strength. Therefore, a systematic comparison of different T2-mapping sequences and the establishment of dedicated T2 reference values is mandatory for diagnostic decision-making. METHODS Phantom experiments using gel probes with a range of different T1 and T2 times were performed on a clinical 1.5T and 3T scanner. In addition, 30 healthy volunteers were examined at 1.5 and 3T in immediate succession. In each examination, three different T2-mapping sequences were performed at three short-axis slices: Multi Echo Spin Echo (MESE), T2-prepared balanced SSFP (T2prep), and Gradient Spin Echo with and without fat saturation (GraSEFS/GraSE). Segmented T2-Maps were generated according to the AHA 16-segment model and statistical analysis was performed. RESULTS Significant intra-individual differences between mean T2 times were observed for all sequences. In general, T2prep resulted in lowest and GraSE in highest T2 times. A significant variation with field strength was observed for mean T2 in phantom as well as in vivo, with higher T2 values at 1.5T compared to 3T, regardless of the sequence used. Segmental T2 values for each sequence at 1.5 and 3T are presented. CONCLUSIONS Despite a careful selection of sequence parameters and volunteers, significant variations of the measured T2 values were observed between field strengths, MR sequences and myocardial segments. Therefore, we present segmental T2 values for each sequence at 1.5 and 3T with the inherent potential to serve as reference values for future studies.

Approximate Simultaneous Confidence Intervals for Multiple Contrasts of Binomial Proportions

Simultaneous confidence intervals for contrasts of means in a one-way layout with several independent samples are well established for Gaussian distributed data. Procedures addressing different hypotheses are available, such as all pairwise comparisons or comparisons to control, comparison with average, or different tests for order-restricted alternatives. However, if the distribution of the response is not Gaussian, corresponding methods are usually not available or not implemented in software. For the case of comparisons among several binomial proportions, we extended recently proposed confidence interval methods for the difference of two proportions or single contrasts to multiple contrasts by using quantiles of the multivariate normal distribution, taking the correlation into account. The small sample performance of the proposed methods was investigated in simulation studies. The simple adjustment of adding 2 pseudo-observations to each sample estimate leads to reasonable coverage probabilities. The methods are illustrated by the evaluation of real data examples of a clinical trial and a toxicological study. The proposed methods and examples are available in the R package MCPAN. ((c) 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim).

An evaluation of methods for assessing the impacts of Bt-maize MON810 cultivation and pyrethroid insecticide use on Auchenorrhyncha (planthoppers and leafhoppers)

1 Auchenorrhyncha (Planthoppers and Leafhoppers) are not only pests of many crops, but they are also nontarget organisms with respect to Bt‐protein expressing genetically modified plants. As herbivorous arthropods, planthoppers and leafhoppers ingest Cry proteins depending on their feeding behaviour. Consequently, they are directly exposed to these entomotoxic proteins and can also serve as a source of Cry protein exposure to predatory arthropods. Therefore, it is reasonable to use Auchenorrhyncha in the risk assessment of genetically modified crops.

Asymptotic simultaneous confidence intervals for many-to-one comparisons of binary proportions in randomized clinical trials.

The simultaneous comparison of proportions of success between many treatments and one control group is a common problem in randomized clinical trials or toxicity studies. In this article, three recently recommended asymptotic confidence interval approaches for the difference of proportions are adjusted for multiplicity, taking the correlation into account. The coverage probability of the resulting interval methods is compared in a simulation study using parameter settings relevant for clinical trials. For moderate to small sample sizes, a method adding two successes and two failures can be recommended. The usage of the proposed methods is illustrated by two examples; an R package is available.

Assessing group differences in biodiversity by simultaneously testing a user-defined selection of diversity indices

Comparing diversities between groups is a task biologists are frequently faced with, for example in ecological field trials or when dealing with metagenomics data. However, researchers often waver about which measure of diversity to choose as there is a multitude of approaches available. As Jost (2008, Molecular Ecology, 17, 4015) has pointed out, widely used measures such as the Shannon or Simpson index have undesirable properties which make them hard to compare and interpret. Many of the problems associated with the use of these ‘raw’ indices can be corrected by transforming them into ‘true’ diversity measures. We introduce a technique that allows the comparison of two or more groups of observations and simultaneously tests a user‐defined selection of a number of ‘true’ diversity measures. This procedure yields multiplicity‐adjusted P‐values according to the method of Westfall and Young (1993, Resampling‐Based Multiple Testing: Examples and Methods for p‐Value Adjustment, 49, 941), which ensures that the rate of false positives (type I error) does not rise when the number of groups and/or diversity indices is extended. Software is available in the R package ‘simboot’.

The cataract related mutation N188T in human connexin46 (hCx46) revealed a critical role for residue N188 in the docking process of gap junction channels

The mutation N188T in human connexin46 (hCx46) correlates with a congenital nuclear pulverulent cataract. This mutation is in the second extracellular loop, a domain involved in docking of gap junction hemichannels. To analyze the functional consequences of this mutation, we expressed hCx46N188T and the wild type (hCx46wt) in Xenopus oocytes and HeLa cells. In Xenopus oocytes, hemichannels formed by hCx46wt and hCx46N188T had similar electrical properties. Additionally, a Ca(2+) and La(3+) sensitive current was observed in HeLa cells expressing eGFP-labeled hCx46wt or eGFP-labeled hCx46N188T. These results suggest that the N188T mutation did not alter apparent expression and the membrane targeting of the protein. Cells expressing hCx46wt-eGFP formed gap junction plaques, but plaques formed by hCx46N188T were extremely rare. A reduced plaque formation was also found in cells cotransfected with hCx46N188T-eGFP and mCherry-labeled hCx46wt as well as in cocultured cells expressing hCx46N188T-eGFP and hCx46wt-mCherry. Dye transfer experiments in cells expressing hCx46N188T revealed a lower transfer rate than cells expressing hCx46wt. We postulate that the N188T mutation affects intercellular connexon docking. This hypothesis is supported by molecular modeling of hCx46 using the crystal structure of hCx26 as a template. The model indicated that N188 is important for hemichannel docking through formation of hydrogen bonds with the residues R180, T189 and D191 of the opposing hCx46. The results suggest that the N188T mutation hinders the docking of the connexons to form gap junction channels. Moreover, the finding that a glutamine substitution (hCx46N188Q) could not rescue the docking emphasizes the specific role of N188.

Diabrotica-resistant Bt-maize DKc5143 event MON88017 has no impact on the field densities of the leafhopper Zyginidia scutellaris

Auchenorrhyncha (planthoppers and leafhoppers) are herbivorous organisms that can ingest Cry proteins from genetically engineered Bt-crops depending on their feeding behaviour. Consequently, they might be directly affected by non-target Bt-protein action and more importantly serve as a source of Cry protein exposure to beneficial predatory arthropods. During a three year field study, we surveyed the community of Auchenorrhyncha in Diabrotica-resistant Bt-maize DKc5143-Bt (event MON88017), its near-isogenic line and two conventional hybrids using sweep netting and custom made sticky traps. Zyginidia scutellaris (Herrich-Schäffer) (Hemiptera: Cicadellidae) represented more than 60% of all captured individuals, indicating that it is the dominant leafhopper within the maize community. The statistical analysis of Z. scutellaris data using confidence intervals for the ratios of mean abundance showed no consistent differences between the Bt-maize and the near-isogenic cultivar, indicating no negative impact of event MON88017. The two conventional hybrids Benicia and DK315 exhibited differences in terms of Z. scutellaris densities, which were greater than those observed between MON88017 and the near-isogenic line, but also not consistent over the years. Six more species accounted for an additional 39% of all captured specimens, while ten more species were found only as single individuals and can be considered vagrants from neighbouring habitats. These results inform future field work on the non-target impact of Bt-maize on this group of arthropods and monitoring approaches to assess biological control function by surveying herbivore communities.

Statistical approaches for the determination of cut points in anti-drug antibody bioassays.

Cut points in immunogenicity assays are used to classify future specimens into anti-drug antibody (ADA) positive or negative. To determine a cut point during pre-study validation, drug-naive specimens are often analyzed on multiple microtiter plates taking sources of future variability into account, such as runs, days, analysts, gender, drug-spiked and the biological variability of un-spiked specimens themselves. Five phenomena may complicate the statistical cut point estimation: i) drug-naive specimens may contain already ADA-positives or lead to signals that erroneously appear to be ADA-positive, ii) mean differences between plates may remain after normalization of observations by negative control means, iii) experimental designs may contain several factors in a crossed or hierarchical structure, iv) low sample sizes in such complex designs lead to low power for pre-tests on distribution, outliers and variance structure, and v) the choice between normal and log-normal distribution has a serious impact on the cut point. We discuss statistical approaches to account for these complex data: i) mixture models, which can be used to analyze sets of specimens containing an unknown, possibly larger proportion of ADA-positive specimens, ii) random effects models, followed by the estimation of prediction intervals, which provide cut points while accounting for several factors, and iii) diagnostic plots, which allow the post hoc assessment of model assumptions. All methods discussed are available in the corresponding R add-on package mixADA.