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Background: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI.
Methods: In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission.
Results: Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold.
Conclusion: cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.
Background: Temporary occlusal changes and their influence on the upper body statics are still controversially discussed. Furthermore, concrete statements on whether age- or gender-specific differences in neurophysiological reactions exist are missing. Therefore, it is the aim of this study to evaluate the immediate effects of a symmetrical occlusion blocking on the upper body posture. These effects shall be investigated for both genders and for a larger age range.
Methods: In this study, 800 (407f/393 m) subjects volunteered aged from 21 to 60 years. Both genders were divided into four age groups according to decades. The three-dimensional upper body posture was measured by using the rasterstereography (ABW-Bodymapper). The habitual static posture was measured in two dental occlusion conditions (a) in rest position and (b) symmetrical blocking in the bicuspid region by cotton rolls.
Results: A significant reduction of the trunk length (0.72 mm; p < 0.001), an increase of the lumbar (0.30°; p < 0.001) and the thoracic bending angle (0.14°; p = 0.001), a reduction of the spinal forward decline (0.16°; p < 0.001) and a reduction of the scapular distance (0.36 mm; p = 0.001) was found. Gender-specific reactions can only be recorded in scapular distance, in that regard men reduce this distance while over all age groups women did not show a significant change.
Discussion: Slight gender- and age-independent reactions due to a symmetric occlusion blockade are shown: A gender independent reaction of the spinal related variables in the sagittal plane (thoracic and lumbar flexion angle, trunk length, spinal forward decline). In addition, a gender specific change of the shoulder blade distance could be observed, where men reduced the distance while female did not show a change. However, since these reactions are of a minimum amount, it can be concluded that neurophysiological compensation mechanisms work equally well regardless of age and sex, and the upper body posture of healthy people changes only very slightly due to a temporarily symmetrical altered bite position.
Objectives: Symmetrical dental occlusion blocking is used in dentistry as a quick diagnostic tool to test for potential influences of the craniomandibular system on body sway and weight distribution. This study presents the changes of body sway and pressure distribution in healthy subjects, free of a temporomandibular dysfunction (TMD). Immediate effects between occlusal blocking and rest position on body sway and body weight distribution in general, as well as for both genders and for four age decades will be evaluated.
Materials and methods: 725 (396f/329 m) subjects (neither subjective signs of TMD nor acute/chronic complaints in the musculoskeletal system) volunteered (21 to 60 years) while both genders were divided into four age groups according to decades. A pressure measuring platform was used. Body sway and weight distribution were recorded in two dental occlusion conditions (a) in rest position and (b) symmetrical blocking (bicuspid region) by cotton rolls.
Results: Both, the frontal sway and the sagittal sway reduced by 0.67 mm (t(724) = − 3.9 (p < 0.001)) and by 0.33 mm (t(724) = − 3.4 (p < 0.001)). The relative pressure under the left forefoot increased by 0.33% (t(724) = 2.88 (p < 0.001)) and the relative pressure overall under the forefoot increased by 0.67% (t(724) = − 3.4 (p < 0.001)). Gender-specific, age-specific and BMI-specific reactions could not be identified.
Conclusions: Subjects, free of any TMD and with no complaints of the musculoskeletal system, show small changes of the body sway and weight distribution when biting symmetrically on a cotton roll. These changes are independent of age, gender or body mass index (BMI). Due to the relative large sample size, the presented results can also be seen as norm values when body sway is used as an additional assessment of a TMD.
Standard values of the upper body posture in healthy adults with special regard to age, sex and BMI
(2023)
In order to classify and analyze the parameters of upper body posture in clinical or physiotherapeutic settings, a baseline in the form of standard values with special regard to age, sex and BMI is required. Thus, subjectively healthy men and women aged 21–60 years were measured in this project. The postural parameters of 800 symptom-free male (n = 397) and female (n = 407) volunteers aged 21–60 years (Ø♀: 39.7 ± 11.6, Ø ♂: 40.7 ± 11.5 y) were studied. The mean height of the men was 1.8 ± 0.07 m, with a mean body weight of 84.8 ± 13.1 kg and an average BMI of 26.0 ± 3.534 kg/m2. In contrast, the mean height of the women was 1.67 ± 0.06 m, with a mean body weight of 66.5 ± 12.7 kg and an average BMI of 23.9 ± 4.6 kg/m2. By means of video rasterstereography, a 3-dimensional scan of the upper back surface was measured when in a habitual standing position. The means or medians, confidence intervals, tolerance ranges, the minimum, 2.5, 25, 50, 75, 97.5 percentiles and the maximum, plus the kurtosis and skewness of the distribution, were calculated for all parameters. Additionally, ANOVA and a factor analyses (sex, BMI, age) were conducted. In both sexes across all age groups, balanced, symmetrical upper body statics were evident. Most strikingly, the females showed greater thoracic kyphosis and lumbar lordosis angles (kyphosis: Ø ♀ 56°, Ø♂ 51°; lordosis: Ø ♀ 49°, Ø♂ 32°) and lumbar bending angles (Ø ♀ 14°, Ø♂ 11°) than the males. The distance between the scapulae was more pronounced in men. These parameters also show an increase with age and BMI, respectively. Pelvic parameters were independent of age and sex. The upper body postures of women and men between the ages of 21 and 60 years were found to be almost symmetrical and axis-conforming with a positive correlation for BMI or age. Consequently, the present body posture parameters allow for comparisons with other studies, as well as for the evaluation of clinical (interim) diagnostics and applications.
Standard reference values of the upper body posture in healthy middle-aged female adults in Germany
(2021)
In order to classify and analyze the parameters of upper body posture, a baseline in form of standard values is demanded. To this date, standard values have only been published for healthy young women. Data for female adults between 51 and 60 years are lacking. 101 symptom-free female volunteers aged 51–60 (55.16 ± 2.89) years. The mean height of the volunteers was 1.66 ± 0.62 m, with a mean body weight of 69.3 ± 11.88 kg and an average BMI of 25.02 ± 4.55 kg/m2. By means of video raster stereography, a 3D-scan of the upper back surface was measured in a habitual standing position. The confidence interval, tolerance range and ICCs were calculated for all parameters. The habitual standing position is almost symmetrical in the frontal plane the most prominent deviation being a slightly more ventral position of the left shoulder blade in comparison to the right. The upper body (spine position) is inclined ventrally with a minor tilt to the left. In the sagittal plane, the kyphosis angle of the thoracic spine is greater than the lordosis angle of the lumbar spine. The pelvis is virtually evenly balanced with deviations from an ideal position falling under the measurement error margin of 1 mm/1°. There were also BMI influenced postural variations in the sagittal plane and shoulder distance. The ICCs are calculated from three repeated measurements and all parameters can be classified as "almost perfect". Deflections from an ideally symmetric spinal alignment in women aged 51–60 years are small-scaled, with a minimal frontal-left inclination and accentuated sigmoidal shape of the spine. Postural parameters presented in this survey allow for comparisons with other studies as well as the evaluation of clinical diagnostics and applications.
An Hand der im einzelnen dargelegten Anschauungen der pflanzlichen Gesellschaftslehre der Neobotanik wird das Vorhaben verfolgt, gleichartige Wege für die Beantwortung soziologischer Fragen bei fossilen Floren auf paläobotanischer Grundlage zu finden. Geologisch-historisch ergeben sich dabei zwei Probleme, welche dem Neobotaniker als Zeitgenossen seiner Objekte unbekannt sind und für ihn aus der heute vorliegenden Situation gar nicht entstehen können. Um paläobotanische Soziologie überhaupt betreiben zu können, sind für die Realität einer fossilen Pflanzengemeinschaft erst zwei Voraussetzungen zu gewinnen: die Synchronie, die regionale Gleichaltrigkeit der Gesteinsschicht, in oder auf der die fossile Flora bis heute konserviert wurde, der Individuums beg riff, der erst auf Grund der jetzigen Fundumstände geprägt werden kann. Unter Auswertung von Untertage-Vorkommen von fossilreichen Pflanzenschichten im gefalteten Westfal A und B des mittleren und nördlichen Ruhrgebietes wurde von zwei Mitarbeitern des Autors eine größere Anzahl von Synchronen ermittelt und unter Formung und Präzisierung des Individuumsbegriffes die Möglichkeit qeschaffen. die Paläosoziologie für einen Teil der oberkarbonischen Pflanzenwelt der euramerischen Floraprovinz zu erarbeiten.
Background: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.
Methods: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.
Results: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.
Conclusions: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.
Bei Osnabrück glazial übertiefter tertiärer geologischer Graben. Im oberen Teil mit pleistozäner Sand- oder Kiesfüllung. Örtlichkeit für einen Stau- oder Grundwassersee? Niederschlags- und Verdunstungsverhältnisse. Oberirdischer Abfluß. Grundwasserspiegelpläne für maximale Grundwasserstände. Bedeutung des unterirdischen Abflusses. Geologisch-hydrologische Voraussetzungen ließen nur Grundwassersee, den heutigen Rubbenbruchsee, zu.
Im Tecklenburger Land Nordwestfalens ist wie auch in anderen mitteleuropäischen Felslandschaften die Morphologie im großen und im kleinen durch ältere bruchtektonische und durch jüngere exogene, von der Verwitterung mit der Gravitation getragene Kräfte bestimmt. Sichtbare Zeichen für ihre Auswirkungen sind Lagestörungen im geschlossenen Gesteinskörper und an Felsen. Sie äußern sich in Texturen, bei denen zwischen Zeugen für bruchtektonische und für atektonische, felsmechanische Entstehung zu unterscheiden ist. Die bruchtektonischen Texturen treten als Längs- und Querklüfte und als Auf- und Oberschiebungen hervor, die im gewachsenen Gesteinskörper gebannt sind. Die felsmechanischen Texturen setzen über die heutige Erdoberfläche emporragende Felsen voraus, die in den Dörenther Klippen aus dem nach ihnen benannten Dörenther Sandstein der unterkretazischen Osning-Sandstein-Folge bestehen. Je nach dem Vorhandensein freier Flächen sind die Bewegung auslösenden felsmechanischen Texturen im oder gegen das Schichteinfallen und auch im Streichen angeordnet. Die Gravitation löste die Rißbildung aus und bestimmte den weiteren Verlauf und Zerfall nach Art der Hangzerreißung. Die felsmechanischen Bewegungen knüpfen teilweise an bruchtektonische Texturen an, die in reiner Form unter der Verwitterungszone im festen Gestein des Gravenhorster Sandsteins, ebenfalls der Osningsandstein-Folge zugehörig, erhalten sind. Abschließend wird die Entstehung der bruchtektonischen und der felsmechanischen Texturen in den geologischen Zeitablauf eingegliedert. Die Bruch-Tektonik fällt genetisch mit der Osning-Tektonik zusammen, die in der subherzynischen Faltungsphase am Ausgang der altalpidischen Faltungsära entstand. Die heute vorliegende Felsmechanik dürfte seit dem Abtauen des Saaleeises entstanden sein und bestimmt jetzt und weiter das morphologische Bild der Dörenther Klippen im Tecklenburger Land.
Die küstennahe Ausbildung des Osningsandsteins bei Bad Iburg im Liegenden der Osningüberschiebung
(1979)
Vor der Küste der Rheinischen Masse liegen im Gebiet des nordwestlichen Teutoburger Waldes bei Bad Iburg im Querschnitt linsenartige feinkörnige Sandsteinmassen mit einer Mächtigkeit bis zu 260 m. Sie gehören der Unterkreide an und bilden die Fazies des Osningsandsteins. Seitlich und landeinwärts werden sie von wattähnlichen, zum Teil gröberen, mit 15-20 m geringmächtigen und glaukonitführenden, z. T. tonigen Sandsteinen vertreten, in denen im Falle des Dörenberges Anzeichen für eine vom Festland kommende ehemalige Stromrinne völlig fehlen. Der Befund am Hohnsberg spricht dafür, daß er eine durch Tiefenerosion hervorgerufene Rinnenausfüllung, der Form nach Seegatten der friesischen Küste vergleichbar oder mehr noch dem ausgefüllten Bett eines dem Meere zufließenden Stromes, ist. Die bisherige Annahme, in den mächtigen Sandsteinvorkommen ehemalige Flußdelten zu sehen, kann nicht mehr gelten.