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Xu J, Guo SH, Xu MZ, Li C, Gong YQ, Lu K. The association between the triglyceride-glucose index and bone turnover markers in osteoporotic fractures patients aged 50 and above who are hospitalized for surgical intervention: a retrospective cross-sectional study. Front Endocrinol (Lausanne) 2024; 15:1418271. [PMID: 39359411 PMCID: PMC11445018 DOI: 10.3389/fendo.2024.1418271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/30/2024] [Indexed: 10/04/2024] Open
Abstract
Objective To evaluate the correlation between the triglyceride-glucose (TyG) index and bone turnover markers (BTMs) in osteoporotic fractures (OPFs) patients hospitalized for surgical intervention. Methods A retrospective cross-sectional study was conducted on 3558 OPFs patients hospitalized for surgical intervention between January 2017 and July 2022. The study obtained baseline values for various biomarkers and covariates, including fasting blood glucose, β-C-terminal telopeptide of type I collagen (β-CTX), procollagen type 1 N-terminal propeptide (P1NP), triglycerides, age, sex, body mass index, smoking, drinking, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase, uric acid, the score of American society of anesthesiologists, homocysteine, parathyroid hormone, apolipoprotein B, apolipoprotein A, magnesium, phosphorus and calcium. Multiple linear regression, curve fitting, threshold effects, and subgroup analyses were also applied. Results After adjusting for covariates in the regression analysis, the results revealed a negative correlation between β-CTX and P1NP levels and the baseline TyG index. Specifically, a one-unit increase in the TyG index was associated with a reduction in β-CTX levels of -0.06 (95% CI: -0.10, -0.01; P-value = 0.012) and a reduction in P1NP levels of -4.70 (95% CI: -9.30, -0.09; P-value = 0.046). Additionally, the inflection points for the nonlinear correlation between the TyG index and β-CTX and P1NP were found to be K = 6.31 and K = 6.63, respectively. Conclusion The study demonstrated a negative, non-linear relationship among the TyG index, β-CTX and P1NP in OPFs patients hospitalized for surgical intervention. These findings suggest that elevated TyG index levels may adversely affect bone turnover, potentially contributing to the progression of OP.
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Affiliation(s)
- Jian Xu
- Department of Orthopedics, The First People’s Hospital of Kunshan, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Shao-han Guo
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Min-zhe Xu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Ya-qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
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Valter K, Tedford SE, Eells JT, Tedford CE. Photobiomodulation use in ophthalmology - an overview of translational research from bench to bedside. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1388602. [PMID: 39211002 PMCID: PMC11358123 DOI: 10.3389/fopht.2024.1388602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024]
Abstract
Photobiomodulation (PBM) refers to the process in which wavelengths of light are absorbed by intracellular photoacceptors, resulting in the activation of signaling pathways that culminate in biological changes within the cell. PBM is the result of low-intensity light-induced reactions in the cell in contrast to thermal photoablation produced by high-intensity lasers. PBM has been effectively used in the clinic to enhance wound healing and mitigate pain and inflammation in musculoskeletal conditions, sports injury, and dental applications for many decades. In the past 20 years, experimental evidence has shown the benefit of PBM in increasing numbers of retinal and ophthalmic conditions. More recently, preclinical findings in ocular models have been translated to the clinic with promising results. This review discusses the preclinical and clinical evidence of the effects of PBM in ophthalmology and provides recommendations of the clinical use of PBM in the management of ocular conditions.
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Affiliation(s)
- Krisztina Valter
- Clear Vision Laboratory, John Curtin School of Medical Research, Eccles Institute of Neuroscience, Canberra, ACT, Australia
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | | | - Janis T. Eells
- College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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Wang D, Zhang Y, Lin F, Song Y, Jin L, Wang Z, Chen M, Jiang J, Wang P, Yang Z, Yuan S, Zhang X. Peripheral Ganglion Cell Complex Thickness and Retinal Microvasculature in Myopia Using Wide-Field Swept-Source OCT. Transl Vis Sci Technol 2024; 13:4. [PMID: 39093295 PMCID: PMC11305429 DOI: 10.1167/tvst.13.8.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/19/2024] [Indexed: 08/04/2024] Open
Abstract
Purpose This study aims to investigate the impact of axial elongation on ganglion cell complex thickness (GCCT) and retinal capillary density (CD) using wide-field swept-source optical coherence tomography angiography. Methods A retrospective cross-sectional analysis was conducted involving 506 eyes. Fovea-centered scans were obtained to assess the subregional GCCT and capillary density across the whole retina, the superficial capillary plexus (SCP), and deep capillary plexus (DCP) among three groups: normal control, high myopia (HM) eyes with axial length < 28 mm, and HM eyes with axial length > 28 mm. Regional variations (central vs. peripheral, quadrants difference [superior, inferior, nasal, and temporal]) were analyzed. Results In HM eyes with axial length > 28 mm, GCCT and retinal CD exhibit a general decline in most regions (P < 0.05). In HM eyes with axial length < 28 mm, significant reductions were observed specifically in peripheral regions, as in the GCCT beyond the 3 × 3 mm2 area and CD in the 9-12 mm whole retina, 9-12 mm superior SCP, and 6-12 mm DCP (P < 0.05). Maximum GCCT and retinal CD reduction with axial elongation was observed in subregions beyond 6 × 6 mm2. Conclusions GCCT beyond the 3 × 3 mm2 area and peripheral retinal CD beyond the 6 × 6 mm2 area were more susceptible to axial elongation and are thereby deserving of particular attention. Translational Relevance It is necessary to evaluate different regions during the clinical assessment of the effect of myopia on the fundus and pay close attention to the peripheral retina.
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Affiliation(s)
- Deming Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yinhang Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Meiling Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jiaxuan Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Peiyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zefeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shaojie Yuan
- Law School, Liaoning Normal University, Dalian, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Meng L, Wang Y, Yang Z, Lin S, Wang Y, Chen H, Zhao X, Chen Y. Ocular fundus changes and association with systemic conditions in systemic lupus erythematosus. Front Immunol 2024; 15:1395609. [PMID: 39091490 PMCID: PMC11291259 DOI: 10.3389/fimmu.2024.1395609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs and systems. Ocular involvement is estimated to manifest in one-third of individuals with SLE, of which lupus retinopathy and choroidopathy represent the severe subtype accompanied by vision impairment. Advancements in multimodal ophthalmic imaging have allowed ophthalmologists to reveal subclinical microvascular and structural changes in fundus of patients with SLE without ocular manifestations. Both ocular manifestations and subclinical fundus damage have been shown to correlate with SLE disease activity and, in some patients, even precede other systemic injuries as the first presentation of SLE. Moreover, ocular fundus might serve as a window into the state of systemic vasculitis in patients with SLE. Given the similarities of the anatomy, physiological and pathological processes shared among ocular fundus, and other vital organ damage in SLE, such as kidney and brain, it is assumed that ocular fundus involvement has implications in the diagnosis and evaluation of other systemic impairments. Therefore, evaluating the fundus characteristics of patients with SLE not only contributes to the early diagnosis and intervention of potential vision damage, but also holds considerate significance for the evaluation of SLE vasculitis state and prediction of other systemic injuries.
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Affiliation(s)
- Lihui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinhan Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhikun Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiqun Lin
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Wang H, Deng M, Cheng D, Feng R, Liu H, Hu T, Liu D, Chen C, Zhu P, Shen J. Comparative analysis of medical glue and positioning hooks for preoperative localization of pulmonary nodules. Front Oncol 2024; 14:1392213. [PMID: 39070140 PMCID: PMC11273236 DOI: 10.3389/fonc.2024.1392213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024] Open
Abstract
Background Through preoperative localization, surgeons can easily locate ground glass nodules (GGNs) and effectively control the extent of resection. Therefore, it is necessary to choose an appropriate puncture positioning method. The purpose of this study was to evaluate the effectiveness and safety of medical glue and positioning hooks in the preoperative positioning of GGNs and to provide a reference for clinical selection. Methods From March 30, 2020 to June 13, 2022, a total of 859 patients with a CT diagnosis of GGNs requiring surgical resection were included in our study at the hospital. Among them, 21 patients who either opted out or could not undergo preoperative localization for various reasons were excluded. Additionally, 475 patients who underwent preoperative localization using medical glue and 363 patients who underwent preoperative localization through positioning hooks were also excluded. We conducted statistical analyses on the baseline data, success rates, complications, and pathological results of the remaining patients. The success rates, complication rates, and pathological results were compared between the two groups-those who received medical glue localization and those who received positioning hook localization. Results There was no statistically significant difference between the two groups of patients in terms of age, body mass index, smoking history, location of the nodule, distance of the nodule from the pleura, or postoperative pathological results (P > 0.05). The success rate of medical glue and positioning hooks was 100%. The complication rates of medical glue and positioning hooks during single nodule positioning were 39.18% and 23.18%, respectively, which were significantly different (p < 0.001); the complication rates during multiple nodule positioning were 49.15% and 49.18%, respectively, with no statistically significant differences (p > 0.05). In addition, the method of positioning and the clinical characteristics of the patients were not found to be independent risk factors for the occurrence of complications. The detection rate of pulmonary nodules also showed some positive correlation with the spread of COVID-19 during the 2020-2022 period when COVID-19 was prevalent. Conclusion When positioning a single node, the safety of positioning hooks is greater than when positioning multiple nodes, the safety of medical glue and positioning hooks is comparable, and the appropriate positioning method should be chosen according to the individual situation of the patient.
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Affiliation(s)
- Haowen Wang
- Interventional Radiology Department, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Min Deng
- Interventional Radiology Department, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Dexin Cheng
- Interventional Radiology Department, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Rui Feng
- Interventional Radiology Department, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Hanbo Liu
- Interventional Radiology Department, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tingyang Hu
- Interventional Radiology Department, Zhejiang Provincial People’s Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Dongdong Liu
- Thoracic Surgery Department, Zhejiang Provincial People 's Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Cheng Chen
- Thoracic Surgery Department, Zhejiang Provincial People 's Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Peilin Zhu
- Thoracic Surgery Department, Zhejiang Provincial People 's Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jian Shen
- Thoracic Surgery Department, Zhejiang Provincial People 's Hospital, Hangzhou, China
- Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
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Ding X, Romano F, Garg I, Gan J, Overbey KM, Garcia MD, Vingopoulos F, Cui Y, Zhu Y, Baldwin G, Choi H, Rodriguez JM, Finn MJ, Razavi P, Vavvas DG, Husain D, Wu DM, Patel NA, Kim LA, Miller JW, Miller JB. Longitudinal Assessment of Intraretinal Microvascular Abnormalities in Diabetic Retinopathy Using Swept-Source Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2024; 65:29. [PMID: 39023441 PMCID: PMC11262475 DOI: 10.1167/iovs.65.8.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/29/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose To longitudinally investigate the changes in intraretinal microvascular abnormalities (IRMAs) over time, employing swept-source optical coherence tomography angiography in eyes with diabetic retinopathy. Methods In this retrospective, longitudinal study, we evaluated 12 × 12-mm swept-source optical coherence tomography angiography centered on the macula at baseline and last available follow-up visit for (1) IRMA changes during follow-up, defined as (a) stable, (b) regressed, (c) obliterated, and (d) progressed; and the (2) development of new neovascularization (NV) and their origins. Competing-risk survival analysis was used to assess the factors associated with these changes. Results In total, 195 eyes from 131 participants with diabetic retinopathy were included. Stable, regressed, obliterated, and progressed IRMA were observed in 65.1%, 12.8%, 11.3%, and 19% of eyes with diabetic retinopathy, respectively. Anti-VEGF injections during the follow-up periods and a slower increase of foveal avascular zone were associated with IRMA regression (P < 0.001 and P = 0.039). Obliterated IRMA were correlated with previous panretinal photocoagulation (P < 0.001) and a lower deep capillary plexus vessel density at baseline (P = 0.007), as well as with follow-up anti-VEGF injections (P = 0.025). A higher baseline ischemia index (ISI) and panretinal photocoagulation during the follow-up periods were associated with IRMA progression (P = 0.049 and P < 0.001). A faster increase in ISI predicted the development of NV elsewhere (NVE) from veins (P < 0.001). No significant factors were found to be associated with NVE originating from IRMA. Conclusions Changes in IRMA closely correlated with the severity of retinal ischemia and treatment. Notably, our study confirmed the potential, yet relatively rare, development of NVE from IRMA in a large cohort; however, the risk factors associated with this transformation require further exploration.
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Affiliation(s)
- Xinyi Ding
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Francesco Romano
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Itika Garg
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana, United States
| | - Jenny Gan
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Katherine M. Overbey
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Mauricio D. Garcia
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Ying Cui
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Grace Baldwin
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Hanna Choi
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Jocelyn M. Rodriguez
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew J. Finn
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Peyman Razavi
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Demetrios G. Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - David M. Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Nimesh A. Patel
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Leo A. Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Joan W. Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - John B. Miller
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
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Romano F, Ding X, Yuan M, Vingopoulos F, Garg I, Choi H, Alvarez R, Tracy JH, Finn M, Ravazi P, Stettler IVM, Laìns I, Vavvas DG, Husain D, Miller JW, Miller JB. Progressive Choriocapillaris Changes on Optical Coherence Tomography Angiography Correlate With Stage Progression in AMD. Invest Ophthalmol Vis Sci 2024; 65:21. [PMID: 38990069 PMCID: PMC11246100 DOI: 10.1167/iovs.65.8.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
Purpose We investigated the association between inner choroid flow deficit percentage (IC-FD%) using swept-source optical coherence tomography angiography (SS-OCTA) and progression of AMD. Methods Retrospective, observational study including 64 eyes (42 participants) with early or intermediate AMD at baseline. Participants had two or more consecutive swept-source optical coherence tomography angiography covering a period of at least 18 months. Demographics, visual acuity, and AMD staging based on Beckman classification were reviewed. OCT was analyzed for hyperreflective foci, subretinal drusenoid deposits, hyporeflective drusen cores, and subfoveal choroidal thickness. IC-FD% was measured within the central 3- and 6-mm using a 16-µm slab, after compensation and binarization (Phansalkar method). Mixed-effects Cox regression models assessed the association between imaging biomarkers and AMD progression. Results During follow-up (37 ± 9 months), 4 eyes with early AMD (31%) progressed to intermediate AMD and 30 (59%) eyes with intermediate AMD developed late AMD (19 geographic atrophy; 11 wet AMD). Baseline hyporeflective drusen core was associated with geographic atrophy development (P < 0.01), whereas greater IC-FD% (3-mm) was associated with wet AMD (P = 0.03). Time-varying analysis showed that faster subfoveal choroidal thickness reduction and IC-FD% (6-mm) increase were associated with geographic atrophy onset (P < 0.05), whereas IC-FD% (3-mm) increase was associated with wet AMD (P = 0.03). Notably, greater IC-FD% increases in the 3 mm (area under the curve = 0.72) and 6 mm (area under the curve = 0.89) were better predictive of wet AMD and geographic atrophy development, respectively. Conclusions Our longitudinal IC-FD% assessment emphasizes the role of progressive choriocapillaris changes as a biomarker for AMD progression. Our findings support that widespread choriocapillaris alterations (6 mm) may precede progression to geographic atrophy, whereas more central choriocapillaris loss (3 mm) may provide an ischemic stimulus for wet AMD.
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Affiliation(s)
- Francesco Romano
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Xinyi Ding
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Melissa Yuan
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana, United States
| | - Hanna Choi
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Rodrigo Alvarez
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Jack H. Tracy
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew Finn
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Peyman Ravazi
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Isabella V. M. Stettler
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Inês Laìns
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Demetrios G. Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Joan W. Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - John B. Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
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İnam O, El-Baz A, Kaplan HJ, Tezel TH. Colorimetric Analyses of the Optic Nerve Head and Retina Indicate Increased Blood Flow After Vitrectomy. Transl Vis Sci Technol 2024; 13:12. [PMID: 39007833 PMCID: PMC467108 DOI: 10.1167/tvst.13.7.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of vitrectomy and posterior hyaloid (PH) peeling on color alteration of optic nerve head (ONH) and retina as a surrogate biomarker of induced perfusion changes. Methods Masked morphometric and colorimetric analyses were conducted on preoperative (<1 month) and postoperative (<18 months) color fundus photographs of 54 patients undergoing vitrectomy, either with (44) or without (10) PH peeling and 31 years of age and gender-matched control eyes. Images were calibrated according to the hue and saturation values of the parapapillary venous blood column. Chromatic spectra of the retinal pigment epithelium and choroid were subtracted to avoid color aberrations. Red, green, and blue (RGB) bit values over the ONH and retina were plotted within the constructed RGB color space to analyze vitrectomy-induced color shift. Vitrectomy-induced parapapillary vein caliber changes were also computed morphometrically. Results A significant post-vitrectomy red hue shift was noted on the ONH (37.1 degrees ± 10.9 degrees vs. 4.1 degrees ± 17.7 degrees, P < 0.001), which indicates a 2.8-fold increase in blood perfusion compared to control (2.6 ± 1.9 vs. 0.9 ± 1.8, P < 0.001). A significant post-vitrectomy increase in the retinal vein diameter was also noticed (6.8 ± 6.4% vs. 0.1 ± 0.3%, P < 0.001), which was more pronounced with PH peeling (7.9 ± 6.6% vs. 3.1 ± 4.2%, P = 0.002). Conclusions Vitrectomy and PH peeling increase ONH and retinal blood flow. Colorimetric and morphometric analyses offer valuable insights for future artificial intelligence and deep learning applications in this field. Translational Relevance The methodology described herein can easily be applied in different clinical settings and may enlighten the beneficial effects of vitrectomy in several retinal vascular diseases.
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Affiliation(s)
- Onur İnam
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Biophysics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY, USA
| | - Henry J. Kaplan
- Department of Ophthalmology & Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, KY, USA
- Department of Ophthalmology, Saint Louis University, School of Medicine, St. Louis, MO, USA
| | - Tongalp H. Tezel
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Ophthalmology & Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, KY, USA
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Guo Y, Hormel TT, Gao M, You Q, Wang J, Flaxel CJ, Bailey ST, Hwang TS, Jia Y. Multi-Plexus Nonperfusion Area Segmentation in Widefield OCT Angiography Using a Deep Convolutional Neural Network. Transl Vis Sci Technol 2024; 13:15. [PMID: 39023443 PMCID: PMC11262538 DOI: 10.1167/tvst.13.7.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/05/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose To train and validate a convolutional neural network to segment nonperfusion areas (NPAs) in multiple retinal vascular plexuses on widefield optical coherence tomography angiography (OCTA). Methods This cross-sectional study included 202 participants with a full range of diabetic retinopathy (DR) severities (diabetes mellitus without retinopathy, mild to moderate non-proliferative DR, severe non-proliferative DR, and proliferative DR) and 39 healthy participants. Consecutive 6 × 6-mm OCTA scans at the central macula, optic disc, and temporal region in one eye from 202 participants in a clinical DR study were acquired with a 70-kHz OCT commercial system (RTVue-XR). Widefield OCTA en face images were generated by montaging the scans from these three regions. A projection-resolved OCTA algorithm was applied to remove projection artifacts at the voxel scale. A deep convolutional neural network with a parallel U-Net module was designed to detect NPAs and distinguish signal reduction artifacts from flow deficits in the superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Expert graders manually labeled NPAs and signal reduction artifacts for the ground truth. Sixfold cross-validation was used to evaluate the proposed algorithm on the entire dataset. Results The proposed algorithm showed high agreement with the manually delineated ground truth for NPA detection in three retinal vascular plexuses on widefield OCTA (mean ± SD F-score: SVC, 0.84 ± 0.05; ICP, 0.87 ± 0.04; DCP, 0.83 ± 0.07). The extrafoveal avascular area in the DCP showed the best sensitivity for differentiating eyes with diabetes but no retinopathy (77%) from healthy controls and for differentiating DR by severity: DR versus no DR, 77%; referable DR (rDR) versus non-referable DR (nrDR), 79%; vision-threatening DR (vtDR) versus non-vision-threatening DR (nvtDR), 60%. The DCP also showed the best area under the receiver operating characteristic curve for distinguishing diabetes from healthy controls (96%), DR versus no DR (95%), and rDR versus nrDR (96%). The three-plexus-combined OCTA achieved the best result in differentiating vtDR and nvtDR (81.0%). Conclusions A deep learning network can accurately segment NPAs in individual retinal vascular plexuses and improve DR diagnostic accuracy. Translational Relevance Using a deep learning method to segment nonperfusion areas in widefield OCTA can potentially improve the diagnostic accuracy of diabetic retinopathy by OCT/OCTA systems.
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Affiliation(s)
- Yukun Guo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Min Gao
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Qisheng You
- Kresge Eye Institute, Wayne State University, Detroit, MI, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Steven T. Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Thomas S. Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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10
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Safai A, Froines C, Slater R, Linderman RE, Bogost J, Pacheco C, Voland R, Pak J, Tiwari P, Channa R, Domalpally A. Quantifying Geographic Atrophy in Age-Related Macular Degeneration: A Comparative Analysis Across 12 Deep Learning Models. Invest Ophthalmol Vis Sci 2024; 65:42. [PMID: 39046755 PMCID: PMC11271806 DOI: 10.1167/iovs.65.8.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024] Open
Abstract
Purpose AI algorithms have shown impressive performance in segmenting geographic atrophy (GA) from fundus autofluorescence (FAF) images. However, selection of artificial intelligence (AI) architecture is an important variable in model development. Here, we explore 12 distinct AI architecture combinations to determine the most effective approach for GA segmentation. Methods We investigated various AI architectures, each with distinct combinations of encoders and decoders. The architectures included three decoders-FPN (Feature Pyramid Network), UNet, and PSPNet (Pyramid Scene Parsing Network)-and serve as the foundation framework for segmentation task. Encoders including EfficientNet, ResNet (Residual Networks), VGG (Visual Geometry Group) and Mix Vision Transformer (mViT) have a role in extracting optimum latent features for accurate GA segmentation. Performance was measured through comparison of GA areas between human and AI predictions and Dice Coefficient (DC). Results The training dataset included 601 FAF images from AREDS2 study and validation included 156 FAF images from the GlaxoSmithKline study. The mean absolute difference between grader measured and AI predicted areas ranged from -0.08 (95% CI = -1.35, 1.19) to 0.73 mm2 (95% CI = -5.75,4.29) and DC between 0.884-0.993. The best-performing models were UNet and FPN frameworks with mViT, and the least-performing models were PSPNet framework. Conclusions The choice of AI architecture impacts GA segmentation performance. Vision transformers with FPN and UNet architectures demonstrate stronger suitability for this task compared to Convolutional Neural Network- and PSPNet-based models. Selecting an AI architecture must be tailored to the specific goals of the project, and developers should consider which architecture is ideal for their project.
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Affiliation(s)
- Apoorva Safai
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
- Depts of Radiology and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, United States
| | - Colin Froines
- Wisconsin Reading Center, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Robert Slater
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Rachel E. Linderman
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
- Wisconsin Reading Center, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Jacob Bogost
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Caleb Pacheco
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Rickie Voland
- Wisconsin Reading Center, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Jeong Pak
- Wisconsin Reading Center, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Pallavi Tiwari
- Depts of Radiology and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, United States
| | - Roomasa Channa
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
| | - Amitha Domalpally
- A-EYE Research Unit, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
- Wisconsin Reading Center, Dept of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
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11
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Sallam M, Mohammadi M, Sainsbury F, Nguyen NT, Kimizuka N, Muyldermans S, Benešová-Schäfer M. Bibliometric and scientometric analysis of PSMA-targeted radiotheranostics: knowledge mapping and global standing. Front Oncol 2024; 14:1397790. [PMID: 39011478 PMCID: PMC11246987 DOI: 10.3389/fonc.2024.1397790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose Bibliometric and scientometric analyses provide a structured approach to large amounts of data, enabling the prediction of research theme trends over time, the detection of shifts in the boundaries of disciplines, and the identification of the most productive countries, institutions and scholars. In the context of prostate-specific membrane antigen (PSMA)-targeted radiotheranostics, no bibliometric or scientometric analysis has been published thus far. Therefore, this study was conducted to identify key contributors to the literature, assess the global scientific production of related research, and possibly predict future development patterns. Methods Scientometrics and bibliometrics were utilized to analyze the current body of knowledge while tracking its evolution to support scientific decision-making comprehensively and systematically. Science mapping techniques were employed to visualize research activities. Two different tools, Tableau and VOSviewer, were utilized, with VOSviewer being deemed the most suitable for the research objectives. The Web of Science (WoS) was used as the principal database for the searches. Results Through the search process over a period of 30 years (January 1993-January 2023), 694 original studies in the English language were subjected to comprehensive analysis. By employing bibliometric and scientometric methods, multiple networks were created that mapped various concepts, such as publication trends, leading countries, cocitations, coauthorship among researchers and scientists, as well as coauthorship among organizations and funding agencies. This study revealed the evolutionary patterns, trends, outliers, and key players in the PSMA field, which enabled a more nuanced understanding of the research landscape. Conclusion This research contributes to the enrichment of knowledge on PSMA-targeted radiotheranostics through detailed global bibliometric and scientometric analyses. It stresses the necessity for the development of communication platforms, the establishment of supportive infrastructures, and the implementation of proactive solutions to address emerging challenges. This study offers a significant resource for delineating effective strategies and identifying prominent funding bodies essential for continuous advancements in the field of PSMA-based diagnosis and therapy for prostate cancer. It is vital to sustain this momentum to ensure further progress in this pioneering area.
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Affiliation(s)
- Mohamed Sallam
- Queensland Micro- and Nanotechnology Centre (QMNC), Griffith University, Nathan, QLD, Australia
- School of Environment and Science (ESC), Griffith University, Nathan, QLD, Australia
- Griffith Institute for Drug Discovery (GRIDD), Griffith University, Nathan, QLD, Australia
| | - Mahan Mohammadi
- Centre for Environment and Population Health (CEPH), School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Frank Sainsbury
- School of Environment and Science (ESC), Griffith University, Nathan, QLD, Australia
- Griffith Institute for Drug Discovery (GRIDD), Griffith University, Nathan, QLD, Australia
| | - Nam-Trung Nguyen
- Queensland Micro- and Nanotechnology Centre (QMNC), Griffith University, Nathan, QLD, Australia
| | - Nobuo Kimizuka
- Department of Applied Chemistry, Graduate School of Engineering, Kyushu University, Fukuoka, Japan
- Center for Molecular Systems (CMS), Kyushu University, Fukuoka, Japan
- Research Center for Negative Emissions Technologies (K-NETs), Kyushu University, Fukuoka, Japan
| | - Serge Muyldermans
- Laboratory of Cellular and Molecular Immunology (CMIM), Vrije Universiteit Brussel, Brussels, Belgium
| | - Martina Benešová-Schäfer
- Research Group Molecular Biology of Systemic Radiotherapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Wang W, Guo XL, Qiu XP, Yu YJ, Tu M. Systemic immune-inflammation index mediates the association between metabolic dysfunction-associated fatty liver disease and sub-clinical carotid atherosclerosis: a mediation analysis. Front Endocrinol (Lausanne) 2024; 15:1406793. [PMID: 38957443 PMCID: PMC11217321 DOI: 10.3389/fendo.2024.1406793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024] Open
Abstract
Background Limited research has been conducted to quantitatively assess the impact of systemic inflammation in metabolic dysfunction-associated fatty liver disease (MAFLD) and sub-clinical carotid atherosclerosis (SCAS). The systemic immune-inflammation index (SII), which integrates inflammatory cells, has emerged as a reliable measure of local immune response and systemic inflammation Therefore, this study aims to assess the mediating role of SII in the association between MAFLD and SCAS in type 2 diabetes mellitus (T2DM). Method This study prospectively recruited 830 participants with T2DM from two centers. Unenhanced abdominal CT scans were conducted to evaluate MAFLD, while B-mode carotid ultrasonography was performed to assess SCAS. Weighted binomial logistic regression analysis and restricted cubic splines (RCS) analyses were employed to analyze the association between the SII and the risk of MAFLD and SCAS. Mediation analysis was further carried out to explore the potential mediating effect of the SII on the association between MAFLD and SCAS. Results The prevalence of both MAFLD and SCAS significantly increased as the SII quartiles increased (P<0.05). MAFLD emerged as an independent factor for SCAS risk across three adjusted models, exhibiting odds ratios of 2.15 (95%CI: 1.31-3.53, P < 0.001). Additionally, increased SII quartiles and Ln (SII) displayed positive associations with the risk of MAFLD and SCAS (P < 0.05). Furthermore, a significant dose-response relationship was observed (P for trend <0.001). The RCS analyses revealed a linear correlation of Ln (SII) with SCAS and MAFLD risk (P for nonlinearity<0.05). Importantly, SII and ln (SII) acted as the mediators in the association between MAFLD and SCAS following adjustments for shared risk factors, demonstrating a proportion-mediated effect of 7.8% and 10.9%. Conclusion SII was independently correlated with MAFLD and SCAS risk, while also acting as a mediator in the relationship between MAFLD and SCAS.
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Affiliation(s)
- Wei Wang
- National Metabolic Management Center, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Xiu Li Guo
- National Metabolic Management Center, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Xiu Ping Qiu
- National Metabolic Management Center, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Yun Jie Yu
- Fuqing City Hospital Affiliated with Fujian Medical University, Fuqin, Fujian, China
| | - Mei Tu
- National Metabolic Management Center, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
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13
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Cheng Y, Hiya F, Li J, Shen M, Liu J, Herrera G, Berni A, Morin R, Joseph J, Zhang Q, Gregori G, Rosenfeld PJ, Wang RK. Calcified Drusen Prevent the Detection of Underlying Choriocapillaris Using Swept-Source Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2024; 65:26. [PMID: 38884553 PMCID: PMC11185265 DOI: 10.1167/iovs.65.6.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose In age-related macular degeneration (AMD), choriocapillaris flow deficits (CCFDs) under soft drusen can be measured using established compensation strategies. This study investigated whether CCFDs can be quantified under calcified drusen (CaD). Methods CCFDs were measured in normal eyes (n = 30) and AMD eyes with soft drusen (n = 30) or CaD (n = 30). CCFD density masks were generated to highlight regions with higher CCFDs. Masks were also generated for soft drusen and CaD based on both structural en face OCT images and corresponding B-scans. Dice similarity coefficients were calculated between the CCFD density masks and both the soft drusen and CaD masks. A phantom experiment was conducted to simulate the impact of light scattering that arises from CaD. Results Area measurements of CCFDs were highly correlated with those of CaD but not soft drusen, suggesting an association between CaD and underlying CCFDs. However, unlike soft drusen, the detected optical coherence tomography (OCT) signals underlying CaD did not arise from the defined CC layer but were artifacts caused by the multiple scattering property of CaD. Phantom experiments showed that the presence of highly scattering material similar to the contents of CaD caused an artifactual scattering tail that falsely generated a signal in the CC structural layer but the underlying flow could not be detected. Similarly, CaD also caused an artifactual scattering tail and prevented the penetration of light into the choroid, resulting in en face hypotransmission defects and an inability to detect blood flow within the choriocapillaris. Upon resolution of the CaD, the CC perfusion became detectable. Conclusions The high scattering property of CaD leads to a scattering tail under these drusen that gives the illusion of a quantifiable optical coherence tomography angiography signal, but this signal does not contain the angiographic information required to assess CCFDs. For this reason, CCFDs cannot be reliably measured under CaD, and CaD must be identified and excluded from macular CCFD measurements.
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Affiliation(s)
- Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Farhan Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jianqing Li
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Gissel Herrera
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alessandro Berni
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalyn Morin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Joan Joseph
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Qinqin Zhang
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States
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14
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Yang X, Gao C, Sun N, Qin X, Liu X, Zhang C. An interpretable clinical ultrasound-radiomics combined model for diagnosis of stage I cervical cancer. Front Oncol 2024; 14:1353780. [PMID: 38846980 PMCID: PMC11153703 DOI: 10.3389/fonc.2024.1353780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Objective The purpose of this retrospective study was to establish a combined model based on ultrasound (US)-radiomics and clinical factors to predict patients with stage I cervical cancer (CC) before surgery. Materials and methods A total of 209 CC patients who had cervical lesions found by transvaginal sonography (TVS) from the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, patients were divided into the training set (n = 146) and internal validation set (n = 63), and 52 CC patients from Anhui Provincial Maternity and Child Health Hospital and Nanchong Central Hospital were taken as the external validation set. The clinical independent predictors were selected by univariate and multivariate logistic regression analyses. US-radiomics features were extracted from US images. After selecting the most significant features by univariate analysis, Spearman's correlation analysis, and the least absolute shrinkage and selection operator (LASSO) algorithm, six machine learning (ML) algorithms were used to build the radiomics model. Next, the ability of the clinical, US-radiomics, and clinical US-radiomics combined model was compared to diagnose stage I CC. Finally, the Shapley additive explanations (SHAP) method was used to explain the contribution of each feature. Results Long diameter of the cervical lesion (L) and squamous cell carcinoma-associated antigen (SCCa) were independent clinical predictors of stage I CC. The eXtreme Gradient Boosting (Xgboost) model performed the best among the six ML radiomics models, with area under the curve (AUC) values in the training, internal validation, and external validation sets being 0.778, 0.751, and 0.751, respectively. In the final three models, the combined model based on clinical features and rad-score showed good discriminative power, with AUC values in the training, internal validation, and external validation sets being 0.837, 0.828, and 0.839, respectively. The decision curve analysis validated the clinical utility of the combined nomogram. The SHAP algorithm illustrates the contribution of each feature in the combined model. Conclusion We established an interpretable combined model to predict stage I CC. This non-invasive prediction method may be used for the preoperative identification of patients with stage I CC.
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Affiliation(s)
- Xianyue Yang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chuanfen Gao
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Nian Sun
- Department of Ultrasound, Anhui Provincial Maternity and Child Health Hospital, Hefei, Anhui, China
| | - Xiachuan Qin
- Department of Ultrasound, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Xiaoling Liu
- Department of Ultrasound, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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15
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Meng K, Gong G, Liu R, Du S, Yin Y. Advances in gross tumor target volume determination in radiotherapy for patients with hepatocellular carcinoma. Front Oncol 2024; 14:1346407. [PMID: 38841160 PMCID: PMC11150548 DOI: 10.3389/fonc.2024.1346407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Hepatocellular Carcinoma (HCC) is one of the most common malignant neoplasms. With the advancement of technology, the precision of radiotherapy (RT) for HCC has considerably increased, and it is an indispensable modality in the comprehensive management of HCC. Some RT techniques increase the radiation dose to HCC, which decreases the radiation dose delivered to the surrounding normal liver tissue. This approach significantly improves the efficacy of HCC treatment and reduces the incidence of Radiation-induced Liver Disease (RILD). Clear imaging and precise determination of the Gross Target Volume (GTV) are prerequisites of precise RT of HCC. The main hindrances in determining the HCC GTV include indistinct tumor boundaries on imaging and the impact on respiratory motion. The integration of multimodal imaging, four-dimensional imaging, and artificial intelligence (AI) techniques can help overcome challenges for HCC GTV. In this article, the advancements in medical imaging and precise determination for HCC GTV have been reviewed, providing a framework for the precise RT of HCC.
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Affiliation(s)
- Kangning Meng
- Department of Graduate, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Jinan, China
| | - Guanzhong Gong
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Jinan, China
| | - Rui Liu
- Department of Graduate, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Jinan, China
| | - Shanshan Du
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Jinan, China
| | - Yong Yin
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Jinan, China
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Chen D, Zhou J, Lin C, Li J, Zhu Z, Rao X, Wang J, Li J, Chen H, Wang F, Li X, Gao M, Zhou Z, Xi Y, Li S. A causal examination of the correlation between hormonal and reproductive factors and low back pain. Front Endocrinol (Lausanne) 2024; 15:1326761. [PMID: 38800490 PMCID: PMC11116661 DOI: 10.3389/fendo.2024.1326761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background The relationship between hormonal fluctuations in the reproductive system and the occurrence of low back pain (LBP) has been widely observed. However, the causal impact of specific variables that may be indicative of hormonal and reproductive factors, such as age at menopause (ANM), age at menarche (AAM), length of menstrual cycle (LMC), age at first birth (AFB), age at last live birth (ALB) and age first had sexual intercourse (AFS) on low back pain remains unclear. Methods This study employed Bidirectional Mendelian randomization (MR) using publicly available summary statistics from Genome Wide Association Studies (GWAS) and FinnGen Consortium to investigate the causal links between hormonal and reproductive factors on LBP. Various MR methodologies, including inverse-variance weighted (IVW), MR-Egger regression, and weighted median, were utilized. Sensitivity analysis was conducted to ensure the robustness and validity of the findings. Subsequently, Multivariate Mendelian randomization (MVMR) was employed to assess the direct causal impact of reproductive and hormone factors on the risk of LBP. Results After implementing the Bonferroni correction and conducting rigorous quality control, the results from MR indicated a noteworthy association between a decreased risk of LBP and AAM (OR=0.784, 95% CI: 0.689-0.891; p=3.53E-04), AFB (OR=0.558, 95% CI: 0.436-0.715; p=8.97E-06), ALB (OR=0.396, 95% CI: 0.226-0.692; p=0.002), and AFS (OR=0.602, 95% CI: 0.518-0.700; p=3.47E-10). Moreover, in the reverse MR analysis, we observed no significant causal effects of LBP on ANM, AAM, LMC and AFS. MVMR analysis demonstrated the continued significance of the causal effect of AFB on LBP after adjusting for BMI. Conclusion Our study explored the causal relationship between ANM, AAM, LMC, AFB, AFS, ALB and the prevalence of LBP. We found that early menarche, early age at first birth, early age at last live birth and early age first had sexual intercourse may decrease the risk of LBP. These insights enhance our understanding of LBP risk factors, offering valuable guidance for screening, prevention, and treatment strategies for at-risk women.
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Affiliation(s)
- Dafu Chen
- Laboratory of Bone Tissue Engineering, Beijing Laboratory of Biomedical Materials, National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengkai Lin
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Junhong Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Zhengya Zhu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xuezhi Rao
- Beijing University of Chinese Medicine, Beijing, China
| | - Jianmin Wang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jianfeng Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongkun Chen
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Fuan Wang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xianlong Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Manman Gao
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Department of Sport Medicine, Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzho, China
- Shenzhen Key Laboratory of Anti-aging and Regenerative Medicine, Department of Medical Cell Biology and Genetics, Health Sciences Center, Shenzhen University, Shenzhen, China
| | - Zhiyu Zhou
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzho, China
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shufen Li
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
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Sun W, Yin X, Liu X, Wei J, Yu M, Li W, Ding X, Chen J. The clinical significance of sarcopenia in patients with hepatocellular carcinoma treated with lenvatinib and PD-1 inhibitors. Front Immunol 2024; 15:1380477. [PMID: 38698848 PMCID: PMC11063286 DOI: 10.3389/fimmu.2024.1380477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Background and aim Sarcopenia has gained considerable attention in the context of hepatocellular carcinoma, as it has been correlated with a poorer prognosis among patients undergoing sorafenib or lenvatinib treatment for hepatocellular carcinoma (HCC). The clinical significance of sarcopenia in first-line advanced HCC patients treated with lenvatinib and programmed death-1 (PD-1) inhibitors needs to be clarified. Methods Sarcopenia was diagnosed using CT (Computed tomography) or MRI (Magnetic Resonance Imaging), with the psoas muscle index (PMI) as the surrogate marker. Patients were grouped based on sarcopenia presences, and a comparative analysis examined characteristics, adverse events, and prognosis. The Cox regression analysis was applied to identify independent prognostic factors for survival, while nomograms were constructed to predict 1-year survival. Results Among 180 patients, 46 had sarcopenia. Patients with baseline sarcopenia demonstrated significantly inferior median progression-free survival (mPFS) (3.0 vs. 8.3 months) and median overall survival (mOS) (7.3 vs. 21.6 months). The same results for mPFS (3.3 vs. 9.2 months) and mOS (9.4 vs. 24.2 months) were observed in patients who developed sarcopenia after treatment. Furthermore, significantly higher grade 3 or higher adverse events (AEs) (73.91% vs 41.79%, p<0.001) were recorded in the sarcopenia group compared to the non-sarcopenia group. In the multivariate analysis, distant metastasis, elevated PLR and CRP levels, and low PMI remained independent predictive factors for poor OS. Additionally, skeletal muscle loss remained a significant independent risk factor for PFS. We developed a nomogram incorporating these four indicators, which predicted 12-month survival with a C-index of 0.853 (95% CI, 0.791 - 0.915), aligning well with actual observations. Conclusion The prognosis of patients with HCC and sarcopenia is significantly worse when treated with lenvatinib and PD-1 inhibitors. The combination regimen of lenvatinib plus PD-1 inhibitors should be cautiously recommended due to the inferior prognosis and higher AEs.
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Affiliation(s)
| | | | | | | | | | | | - Xiaoyan Ding
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinglong Chen
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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18
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Huang M, Zhang F, Li Z, Luo Y, Li J, Wang Z, Ma L, Chen G, Hu X. Fat fraction quantification with MRI estimates tumor proliferation of hepatocellular carcinoma. Front Oncol 2024; 14:1367907. [PMID: 38665944 PMCID: PMC11044697 DOI: 10.3389/fonc.2024.1367907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Purpose To assess the utility of fat fraction quantification using quantitative multi-echo Dixon for evaluating tumor proliferation and microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Methods A total of 66 patients with resection and histopathologic confirmed HCC were enrolled. Preoperative MRI with proton density fat fraction and R2* mapping was analyzed. Intratumoral and peritumoral regions were delineated with manually placed regions of interest at the maximum level of intratumoral fat. Correlation analysis explored the relationship between fat fraction and Ki67. The fat fraction and R2* were compared between high Ki67(>30%) and low Ki67 nodules, and between MVI negative and positive groups. Receiver operating characteristic (ROC) analysis was used for further analysis if statistically different. Results The median fat fraction of tumor (tFF) was higher than peritumor liver (5.24% vs 3.51%, P=0.012). The tFF was negatively correlated with Ki67 (r=-0.306, P=0.012), and tFF of high Ki67 nodules was lower than that of low Ki67 nodules (2.10% vs 4.90%, P=0.001). The tFF was a good estimator for low proliferation nodules (AUC 0.747, cut-off 3.39%, sensitivity 0.778, specificity 0.692). There was no significant difference in tFF and R2* between MVI positive and negative nodules (3.00% vs 2.90%, P=0.784; 55.80s-1 vs 49.15s-1, P=0.227). Conclusion We infer that intratumor fat can be identified in HCC and fat fraction quantification using quantitative multi-echo Dixon can distinguish low proliferative HCCs.
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Affiliation(s)
| | | | | | | | | | | | | | - Gen Chen
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Hu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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19
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Perrier Q, Moro C, Lablanche S. Diabetes in spotlight: current knowledge and perspectives of photobiomodulation utilization. Front Endocrinol (Lausanne) 2024; 15:1303638. [PMID: 38567306 PMCID: PMC10985212 DOI: 10.3389/fendo.2024.1303638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Diabetes is a global health concern characterized by chronic hyperglycemia resulting from insulinopenia and/or insulin resistance. The rising prevalence of diabetes and its associated complications (ulcers, periodontitis, healing of bone defect, neuropathy, retinopathy, cardiopathy and nephropathy) necessitate innovative therapeutic approaches. Photobiomodulation (PBM), involves exposing tissues and cells to low-energy light radiation, leading to biological effects, largely via mitochondrial activation. Methods This review evaluates preclinical and clinical studies exploring the potential of PBM in diabetes and its complications, as well all clinical trials, both planned and completed, available on ClinicalTrials database. Results This review highlights the variability in PBM parameters across studies, hindering consensus on optimal protocols. Standardization of treatment parameters and rigorous clinical trials are needed to unlock PBM's full therapeutic potential. 87 clinical trials were identified that investigated PBM in diabetes mellitus (with 5,837 patients planned to be treated with PBM). Clinical trials assessing PBM effects on diabetic neuropathy revealed pain reduction and potential quality of life improvement. Studies focusing on wound healing indicated encouraging results, with PBM enhancing angiogenesis, fibroblast proliferation, and collagen density. PBM's impact on diabetic retinopathy remains inconclusive however, requiring further investigation. In glycemic control, PBM exhibits positive effects on metabolic parameters, including glucose tolerance and insulin resistance. Conclusion Clinical studies have reported PBM-induced reductions in fasting and postprandial glycemia without an increased hypoglycemic risk. This impact of PBM may be related to its effects on the beta cells and islets in the pancreas. Notwithstanding challenges, PBM emerges as a promising adjunctive therapy for managing diabetic neuropathy, wound healing, and glycemic control. Further investigation into its impact on diabetic retinopathy and muscle recovery is warranted.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, INSERM U1055, Pharmacy Department, Grenoble Alpes University Hospital, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
| | - Cécile Moro
- Univ. Grenoble Alpes, CEA-Leti, Clinatec, Grenoble, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, INSERM U1055, Diabetology and Endocrinology Department, Grenoble Alpes University Hospital, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
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20
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Yang M, Tan Q, Tang Z. Bones on fire: illuminating osteomyelitis through the radiant lens of 18F-FDG PET/CT. Front Immunol 2024; 15:1378409. [PMID: 38533511 PMCID: PMC10963418 DOI: 10.3389/fimmu.2024.1378409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Osteomyelitis is an inflammatory process that is caused by an infecting microorganism and leads to progressive bone destruction and loss. Osteomyelitis can occur at any age and can involve any bone. The infection can be limited to a single portion of the bone or can involve several regions, such as marrow, cortex, periosteum, and the surrounding soft tissue. Early and accurate diagnosis plays a crucial role in reducing unnecessary treatment measures, improving the patient's prognosis, and minimizing time and financial costs. In recent years, the use of functional metabolic imaging has become increasingly widespread. Among them, 18F-FDG PET/CT has emerged as a cutting-edge imaging modality that combines anatomical and functional metabolic information. It has seen rapid development in the field of infectious diseases. 18F-FDG PET/CT has been demonstrated to yield acceptable diagnostic accuracy in a number of infectious and inflammatory diseases. This review aims to provide information about the 18F-FDGPET/CT in the use of chronic osteomyelitis,osteomyelitis secondary to a contiguous focus of infection and osteomyelitis associated with peripheral vascular disease.
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Affiliation(s)
| | | | - Zhenghao Tang
- Department of Infectious Diseases, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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Mohammadi S, Ghaderi S, Sayehmiri F, Fathi M. Quantitative susceptibility mapping for iron monitoring of multiple subcortical nuclei in type 2 diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1331831. [PMID: 38510699 PMCID: PMC10950952 DOI: 10.3389/fendo.2024.1331831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Iron accumulation in the brain has been linked to diabetes, but its role in subcortical structures involved in motor and cognitive functions remains unclear. Quantitative susceptibility mapping (QSM) allows the non-invasive quantification of iron deposition in the brain. This systematic review and meta-analysis examined magnetic susceptibility measured by QSM in the subcortical nuclei of patients with type 2 diabetes mellitus (T2DM) compared with controls. Methods PubMed, Scopus, and Web of Science databases were systematically searched [following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines] for studies reporting QSM values in the deep gray matter (DGM) regions of patients with T2DM and controls. Pooled standardized mean differences (SMDs) for susceptibility were calculated using fixed-effects meta-analysis models, and heterogeneity was assessed using I2. Sensitivity analyses were conducted, and publication bias was evaluated using Begg's and Egger's tests. Results Six studies including 192 patients with T2DM and 245 controls were included. This study found a significant increase in iron deposition in the subcortical nuclei of patients with T2DM compared to the control group. The study found moderate increases in the putamen (SMD = 0.53, 95% CI 0.33 to 0.72, p = 0.00) and dentate nucleus (SMD = 0.56, 95% CI 0.27 to 0.85, p = 0.00) but weak associations between increased iron levels in the caudate nucleus (SMD = 0.32, 95% CI 0.13 to 0.52, p = 0.00) and red nucleus (SMD = 0.22, 95% CI 0.00 0.44, p = 0.05). No statistical significance was found for iron deposition alterations in the globus pallidus (SMD = 0.19; 95% CI -0.01 to 0.38; p = 0.06) and substantia nigra (SMD = 0.12, 95% CI -0.10, 0.34, p = 0.29). Sensitivity analysis showed that the findings remained unaffected by individual studies, and consistent increases were observed in multiple subcortical areas. Discussion QSM revealed an increase in iron in the DGM/subcortical nuclei in T2DM patients versus controls, particularly in the motor and cognitive nuclei, including the putamen, dentate nucleus, caudate nucleus, and red nucleus. Thus, QSM may serve as a potential biomarker for iron accumulation in T2DM patients. However, further research is needed to validate these findings.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sayehmiri
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Yu J, Ran Y, Yi D, Yang C, Zhou X, Wang S, Li H, Yu W, Sun Z, Zhang Z, Yan M. Establishment and verification of a nomogram that predicts the risk for coronary slow flow. Front Endocrinol (Lausanne) 2024; 15:1337284. [PMID: 38501108 PMCID: PMC10944880 DOI: 10.3389/fendo.2024.1337284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024] Open
Abstract
Background Coronary slow flow (CSF) has gained significance as a chronic coronary artery disease, but few studies have integrated both biological and anatomical factors for CSF assessment. This study aimed to develop and validate a simple-to-use nomogram for predicting CSF risk by combining biological and anatomical factors. Methods In this retrospective case-control study, 1042 patients (614 CSF cases and 428 controls) were randomly assigned to the development and validation cohorts at a 7:3 ratio. Potential predictive factors were identified using least absolute shrinkage and selection operator regression and subsequently utilized in multivariate logistic regression to construct the nomogram. Validation of the nomogram was assessed by discrimination and calibration. Results N-terminal pro brain natriuretic peptide, high density lipoprotein cholesterol, hemoglobin, left anterior descending artery diameter, left circumflex artery diameter, and right coronary artery diameter were independent predictors of CSF. The model displayed high discrimination in the development and validation cohorts (C-index 0.771, 95% CI: 0.737-0.805 and 0.805, 95% CI: 0.757-0.853, respectively). The calibration curves for both cohorts showed close alignment between predicted and actual risk estimates, demonstrating improved model calibration. Decision curve analysis suggested high clinical utility for the predictive nomogram. Conclusion The constructed nomogram accurately and individually predicts the risk of CSF for patients with suspected CSF and may be considered for use in clinical care.
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Affiliation(s)
- Jiang Yu
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Yangshan Ran
- Department of Internal Medicine, Xuanhan Chinese Medicine Hospital, Dazhou, Sichuan, China
| | - Dan Yi
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Chengyu Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Zhou
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Sibin Wang
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Chinese People’s Liberation Army Medical School, Beijing, China
| | - Hao Li
- Department of General Medicine, Zhige Township Hospital, Meishan, Sichuan, China
| | - Wensi Yu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Zhijun Sun
- Department of Cardiology, The First Medical Centre of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhengbo Zhang
- Center for Artificial Intelligence, Medical Innovation and Research Department, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Muyang Yan
- Department of Hyperbaric Oxygen, The First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
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Hanafi I, Abo Samra D, Alsaqqa R, Naeem A, Shebli B, Ajlyakin G. Lung Cancer Diagnoses and Outcomes During the Syrian War, 2011-2018. JAMA Netw Open 2024; 7:e242091. [PMID: 38477917 PMCID: PMC10938179 DOI: 10.1001/jamanetworkopen.2024.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Importance Protracted wars, which disproportionately affect low-resource countries, exacerbate the challenges faced by cancer care systems, with lung cancer being the most affected as the most fatal oncological condition. Objective To characterize the presentation and survival of patients with lung cancer during the decade-long Syrian war. Design, Setting, and Participants This cohort study included patients at a large oncology center in Syria during the first 8 years of the Syrian armed conflict (2011-2018). All patients with a new diagnosis of lung cancer were included. Variables investigated included histological subtypes, TNM classification (tumor, lymph nodes, and metastasis), and staging at diagnosis as well as the yearly follow-ups up to 5 years after presentation. Exposure The Syrian war divided the country into temporary regions with different political influences and heterogeneously impacted health care accessibility among these regions. Main Outcomes and Measures Change in prevalence of advanced lung cancer cases at presentation; change in overall survival odds. Results The study included 5160 patients from all Syrian governorates (mean [SD] age, 59.6 [10.8] years; 4399 men [85.3%]). New diagnoses sharply declined during the first 3 years of the war, with partial recovery afterward. Regardless of their tempo-geographical regions, 60% to 80% of the yearly diagnoses presented with metastases. The 1-year and 5-year survival rates were 13.1% (423 of 3238 patients with follow-up results) and 0.1% (2 of 1853 patients), respectively. Patients who presented from regions more involved in the armed conflicts showed poorer survival rates with odds ranging between 0.51 (95% CI, 0.44-0.59) and 0.61 (95% CI, 0.49-0.74) across follow-ups for up to 2 years in comparison with patients presenting from safer regions. War-related health care inaccessibility explained a greater percentage of the variability in survival (Nagelkerke R2 = 7.5%; P < .001) than both patients' age and the stage of the disease combined (Nagelkerke R2 = 3.9%; P < .001). Conclusions and Relevance The Syrian war has been associated with a marked decline in the management of patients with lung cancer, with limited access to specialized care, delayed diagnoses, and substantial decrease in survival rates correlating with the intensity of armed conflict in the respective regions. The profound repercussions of the prolonged armed conflict on patients with lung cancer in Syria necessitates urgent comprehensive strategies to improve the accessibility and quality of health care services, especially in conflict-ridden zones.
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Affiliation(s)
- Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Dana Abo Samra
- Department of Oncology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rama Alsaqqa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Ahmad Naeem
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Baraa Shebli
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Aleppo, Aleppo, Syria
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Qin X, Lv J, Zhang J, Mu R, Zheng W, Liu F, Huang B, Li X, Yang P, Deng K, Zhu X. Amide proton transfer imaging has added value for predicting extraprostatic extension in prostate cancer patients. Front Oncol 2024; 14:1327046. [PMID: 38496759 PMCID: PMC10941336 DOI: 10.3389/fonc.2024.1327046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Background Prostate cancer invades the capsule is a key factor in selecting appropriate treatment methods. Accurate preoperative prediction of extraprostatic extension (EPE) can help achieve precise selection of treatment plans. Purpose The aim of this study is to verify the diagnostic efficacy of tumor size, length of capsular contact (LCC), apparent diffusion coefficient (ADC), and Amide proton transfer (APT) value in predicting EPE. Additionally, the study aims to investigate the potential additional value of APT for predicting EPE. Method This study include 47 tumor organ confined patients (age, 64.16 ± 9.18) and 50 EPE patients (age, 61.51 ± 8.82). The difference of tumor size, LCC, ADC and APT value between groups were compared. Binary logistic regression was used to screen the EPE predictors. The receiver operator characteristic curve analysis was performed to assess the diagnostic performance of variables for predicting EPE. The diagnostic efficacy of combined models (model I: ADC+LCC+tumor size; model II: APT+LCC+tumor size; and model III: APT +ADC+LCC+tumor size) were also analyzed. Results APT, ADC, tumor size and the LCC were independent predictors of EPE. The area under the curve (AUC) of APT, ADC, tumor size and the LCC were 0.752, 0.665, 0.700 and 0.756, respectively. The AUC of model I, model II, and model III were 0.803, 0.845 and 0.869, respectively. The cutoff value of APT, ADC, tumor size and the LCC were 3.65%, 0.97×10-3mm2/s, 17.30mm and 10.78mm, respectively. The sensitivity/specificity of APT, ADC, tumor size and the LCC were 76%/89.4.0%, 80%/59.6%, 54%/78.9%, 72%/66%, respectively. The sensitivity/specificity of model I, Model II and Model III were 74%/72.3%, 82%/72.5% and 84%/80.9%, respectively. Data conclusion Amide proton transfer imaging has added value for predicting EPE. The combination model of APT balanced the sensitivity and specificity.
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Affiliation(s)
- Xiaoyan Qin
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Jian Lv
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Jianmei Zhang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Ronghua Mu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Wei Zheng
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Fuzhen Liu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Bingqin Huang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
- Department of Radiology, Graduate School of Guilin Medical University, Guilin, China
| | - Xin Li
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Peng Yang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Kan Deng
- Philips (China) Investment Co., Ltd., Guangzhou Branch, Guangzhou, China
| | - Xiqi Zhu
- Department of Radiology, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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Ma JP, Robbins CB, Pead E, McGrory S, Hamid C, Grewal DS, Scott BL, Trucco E, MacGillivray TJ, Fekrat S. Ultra-Widefield Imaging of the Retinal Macrovasculature in Parkinson Disease Versus Controls With Normal Cognition Using Alpha-Shapes Analysis. Transl Vis Sci Technol 2024; 13:15. [PMID: 38231496 PMCID: PMC10795547 DOI: 10.1167/tvst.13.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose To investigate retinal vascular characteristics using ultra-widefield (UWF) scanning laser ophthalmoscopy in Parkinson disease (PD). Methods Individuals with an expert-confirmed clinical diagnosis of PD and controls with normal cognition without PD underwent Optos California UWF imaging. Patients with diabetes, uncontrolled hypertension, glaucoma, dementia, other movement disorders, or known retinal or optic nerve pathology were excluded. Images were analyzed using Vasculature Assessment and Measurement Platform for Images of the Retina (VAMPIRE-UWF) software, which describes retinal vessel width gradient and tortuosity, provides vascular network fractal dimensions, and conducts alpha-shape analysis to further characterize vascular morphology (complexity, Opαmin; spread, OpA). Results In the PD cohort, 53 eyes of 38 subjects were assessed; in the control cohort, 51 eyes of 33 subjects were assessed. Eyes with PD had more tortuous retinal arteries in the superotemporal quadrant (P = 0.043). In eyes with PD, alpha-shape analysis revealed decreased OpA, indicating less retinal vasculature spread compared to controls (P = 0.032). Opαmin was decreased in PD (P = 0.044), suggesting increased vascular network complexity. No differences were observed in fractal dimension in any region of interest. Conclusions This pilot study suggests that retinal vasculature assessment on UWF images using alpha-shape analysis reveals differences in retinal vascular network spread and complexity in PD and may be a more sensitive metric compared to fractal dimension. Translational Relevance Retinal vasculature assessment using these novel methods may be useful in understanding ocular manifestations of PD and the development of retinal biomarkers.
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Affiliation(s)
- Justin P. Ma
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Cason B. Robbins
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Emma Pead
- VAMPIRE Project, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Sarah McGrory
- VAMPIRE Project, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Charlene Hamid
- VAMPIRE Project, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Dilraj S. Grewal
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Burton L. Scott
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Tom J. MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Science, University of Edinburgh, Edinburgh, UK
| | - Sharon Fekrat
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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Corradetti G, Oncel D, Kadomoto S, Arakaki X, Kloner RA, Sadun AA, Sadda SR, Chan JW. Choriocapillaris and Retinal Vascular Alterations in Presymptomatic Alzheimer's Disease. Invest Ophthalmol Vis Sci 2024; 65:47. [PMID: 38294804 PMCID: PMC10839815 DOI: 10.1167/iovs.65.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose To compare optical coherence tomography angiography (OCTA) retina metrics between cognitively healthy subjects with pathological versus normal cerebrospinal fluid (CSF) Aβ42/tau ratios. Methods Swept-source OCTA scans were collected using the Zeiss PLEX Elite 9000 and analyzed on 23 cognitively healthy (CH) subjects who had previously undergone CSF analysis. Thirteen subjects had a pathological Aβ42/tau (PAT) ratio of <2.7132, indicative of presymptomatic Alzheimer's disease (AD), and 10 had a normal Aβ42/tau (NAT) ratio of ≥2.7132. OCTA en face images of the superficial vascular complex (SVC) and deep vascular complex were binarized and skeletonized to quantify the perfusion density (PD), vessel length density (VLD), and fractal dimension (FrD). The foveal avascular zone (FAZ) area was calculated using the SVC slab. Choriocapillaris flow deficits (CCFDs) were computed from the en face OCTA slab of the CC. The above parameters were compared between CH-PATs and CH-NATs. Results Compared to CH-NATs, CH-PATs showed significantly decreased PD, VLD, and FrD in the SVC, with a significantly increased FAZ area and CCFDs. Conclusions Swept-source OCTA analysis of the SVC and CC suggests a significant vascular loss at the CH stage of pre-AD that might be an indicator of a neurodegenerative process initiated by the impaired clearance of Aβ42 in the blood vessel wall and by phosphorylated tau accumulation in the perivascular spaces, a process that most likely mirrors that in the brain. If confirmed in larger longitudinal studies, OCTA retinal and inner choroidal metrics may be important biomarkers for assessing presymptomatic AD.
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Affiliation(s)
- Giulia Corradetti
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Deniz Oncel
- Doheny Eye Institute, Pasadena, California, United States
| | - Shin Kadomoto
- Doheny Eye Institute, Pasadena, California, United States
| | - Xianghong Arakaki
- Cognition and Brain Integration Laboratory, Department of Neurosciences, Huntington Medical Research Institutes, Pasadena, California, United States
| | - Robert A. Kloner
- Clinical Neuroscience, Department of Neurosciences, Huntington Medical Research Institutes, Pasadena, California, United States
- Cardiovascular Research Institute, Huntington Medical Research Institutes, Pasadena, California, United States
- Cardiovascular Division, Department of Medicine Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Alfredo A. Sadun
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Jane W. Chan
- Doheny Eye Institute, Pasadena, California, United States
- Department of Ophthalmology David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
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Domdei N, Ameln J, Gutnikov A, Witten JL, Holz FG, Wahl S, Harmening WM. Cone Density Is Correlated to Outer Segment Length and Retinal Thickness in the Human Foveola. Invest Ophthalmol Vis Sci 2023; 64:11. [PMID: 38064229 PMCID: PMC10709802 DOI: 10.1167/iovs.64.15.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose Assessment of the relationship between in vivo foveolar cone density, cone outer segment length (OSL), and foveal retinal thickness (RT). Methods Foveolar cone density maps covering the central ±300 µm of the retina were derived from adaptive optics scanning laser ophthalmoscopy images. The corresponding maps of foveal cone OSL and RT were derived from high-resolution optical coherence tomography volume scans. Alignment of the two-dimensional maps containing OSL and RT with the cone density map was achieved by placing the location of maximum OSL on the cone density centroid (CDC). Results Across 10 participants (27 ± 9 years; 6 female), cone density at the CDC was found to be between 147,038 and 215,681 cones/mm². The maximum OSL and minimum RT were found to lie between 31 and 40, and 193 and 226 µm, respectively. A significant correlation was observed between cone density at the CDC and maximum OSL (P = 0.001), as well as the minimal RT (P < 0.05). Across all participants, the best fit for the relationship between normalized cone density and normalized OSL within the central 300 µm was given by a quadratic function. Conclusions Using optical coherence tomography-derived measurements of OSL enables to estimate CDC cone density and two-dimensional foveal cone density maps for example in patient eyes unsuitable for adaptive optics imaging. Furthermore, the observation of a fixed relationship between the normalized OSL and cone density points to a conserved mechanism shaping the foveal pit.
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Affiliation(s)
- Niklas Domdei
- Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Julius Ameln
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Jenny L Witten
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Siegfried Wahl
- Carl Zeiss Vision International GmbH, Aalen, Germany
- Institute for Ophthalmic Research, Eberhard Karls University Tübingen, Tübingen, Germany
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Zhou SW, Zhang Y, Noam N, Rabinovitch D, Bar D, Yousif BS, O'Brien R, Hiya FE, Lin Y, Berni A, Gregori G, Wang RK, Rosenfeld PJ, Trivizki O. The Impact of Carotid Endarterectomy on Choriocapillaris Perfusion. Invest Ophthalmol Vis Sci 2023; 64:42. [PMID: 38153750 PMCID: PMC10756242 DOI: 10.1167/iovs.64.15.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose The impact of carotid endarterectomy (CEA) on choriocapillaris (CC) perfusion was investigated using swept-source optical coherence tomography angiography (SS-OCTA) imaging before and after surgery in patients with clinically significant carotid artery stenosis (CAS). Methods In this prospective observational study, patients with clinically significant CAS undergoing unilateral CEA had SS-OCTA imaging performed in both eyes before and within 1 week after surgery. The percent CC flow deficits (CC FD%) and CC thickness were assessed using previously validated algorithms. Multivariable regression analysis was conducted to evaluate the impact of variables on the change in CC measurements. Results A total of 112 eyes from 56 patients with an average age of 72.6 ± 6.9 years were enrolled. At baseline, significantly higher CC FD% and thinner CC thickness were observed on the surgical side (eyes ipsilateral to the side of CEA) versus the nonsurgical side (eyes contralateral to the side of CEA) (P = 0.001 and P = 0.03, respectively). Following CEA, a significant reduction in CC FD% and a significant increase in CC thickness were detected on the surgical as compared with the nonsurgical side (P = 0.008 and P = 0.01, respectively). Smoking status positively affected CC FD% change (coefficient of variation [CV] = 0.84, P = 0.01) on the surgical side and negatively affected CC thickness change on both the surgical side (CV = -0.382, P = 0.009) and the nonsurgical side (CV = -0.321, P = 0.04). The degree of stenosis demonstrated a positive influence on CC FD% change (CV = 0.040, P = 0.02) on the surgical side. Conclusions Unilateral CEA on the side of clinically significant CAS increases carotid blood flow, which further results in improved CC perfusion.
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Affiliation(s)
- Sandy W. Zhou
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, Tan Tock Seng Hospital, National Health Group Eye Institute, Singapore
| | - Yi Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Natalie Noam
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - David Rabinovitch
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Davidov Bar
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Basheer S. Yousif
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Robert O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Farhan E. Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Yufen Lin
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Alessandro Berni
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
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29
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Miao Y, Jung H, Hsu D, Song J, Ni S, Ma D, Jian Y, Makita S, Yasuno Y, Sarunic MV, Stephenson KAJ, Paton K, Mammo Z, Ju MJ. Polarization-Diversity Optical Coherence Tomography Assessment of Choroidal Nevi. Invest Ophthalmol Vis Sci 2023; 64:6. [PMID: 37930688 PMCID: PMC10629548 DOI: 10.1167/iovs.64.14.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose The purpose of this study was to demonstrate the utility of polarization-diversity optical coherence tomography (PD-OCT), a noninvasive imaging technique with melanin-specific contrast, in the quantitative and qualitative assessment of choroidal nevi. Methods Nevi were imaged with a custom-built 55-degree field-of-view (FOV) 400 kHz PD-OCT system. Imaging features on PD-OCT were compared to those on fundus photography, auto-fluorescence, ultrasound, and non-PD-OCT images. Lesions were manually segmented for size measurement and metrics for objective assessment of melanin distributions were calculated, including degree of polarization uniformity (DOPU), attenuation coefficient, and melanin occupancy rate (MOR). Results We imaged 17 patients (mean age = 69.5 years, range = 37-90) with 11 pigmented, 3 non-pigmented, and 3 mixed pigmentation nevi. Nevi with full margin acquisition had an average longest basal diameter of 5.1 mm (range = 2.99-8.72 mm) and average height of 0.72 mm (range = 0.37 mm-2.09 mm). PD-OCT provided clear contrast of choroidal melanin content, distribution, and delineation of nevus margins for melanotic nevi. Pigmented nevi were found to have lower DOPU, higher attenuation coefficient, and higher MOR than non-pigmented lesions. Melanin content on PD-OCT was consistent with pigmentation on fundus in 15 of 17 nevi (88%). Conclusions PD-OCT allows objective assessment of choroidal nevi melanin content and distribution. In addition, melanin-specific contrast by PD-OCT enables clear nevus margin delineation and may improve serial growth surveillance. Further investigation is needed to determine the clinical significance and prognostic value of melanin characterization by PD-OCT in the evaluation of choroidal nevi.
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Affiliation(s)
- Yusi Miao
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hoyoung Jung
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Destiny Hsu
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jun Song
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shuibin Ni
- Case Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Da Ma
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
| | - Yifan Jian
- Case Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Shuichi Makita
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiaki Yasuno
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Marinko V. Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Medical Physics and Biomedical Engineering, University College London, London, England, United Kingdom
- Institute of Ophthalmology, University College London, London, England, United Kingdom
| | - Kirk A. J. Stephenson
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Paton
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zaid Mammo
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Myeong Jin Ju
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
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30
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Korot E, Gonçalves MB, Huemer J, Beqiri S, Khalid H, Kelly M, Chia M, Mathijs E, Struyven R, Moussa M, Keane PA. Clinician-Driven AI: Code-Free Self-Training on Public Data for Diabetic Retinopathy Referral. JAMA Ophthalmol 2023; 141:1029-1036. [PMID: 37856110 PMCID: PMC10587830 DOI: 10.1001/jamaophthalmol.2023.4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/23/2023] [Indexed: 10/20/2023]
Abstract
Importance Democratizing artificial intelligence (AI) enables model development by clinicians with a lack of coding expertise, powerful computing resources, and large, well-labeled data sets. Objective To determine whether resource-constrained clinicians can use self-training via automated machine learning (ML) and public data sets to design high-performing diabetic retinopathy classification models. Design, Setting, and Participants This diagnostic quality improvement study was conducted from January 1, 2021, to December 31, 2021. A self-training method without coding was used on 2 public data sets with retinal images from patients in France (Messidor-2 [n = 1748]) and the UK and US (EyePACS [n = 58 689]) and externally validated on 1 data set with retinal images from patients of a private Egyptian medical retina clinic (Egypt [n = 210]). An AI model was trained to classify referable diabetic retinopathy as an exemplar use case. Messidor-2 images were assigned adjudicated labels available on Kaggle; 4 images were deemed ungradable and excluded, leaving 1744 images. A total of 300 images randomly selected from the EyePACS data set were independently relabeled by 3 blinded retina specialists using the International Classification of Diabetic Retinopathy protocol for diabetic retinopathy grade and diabetic macular edema presence; 19 images were deemed ungradable, leaving 281 images. Data analysis was performed from February 1 to February 28, 2021. Exposures Using public data sets, a teacher model was trained with labeled images using supervised learning. Next, the resulting predictions, termed pseudolabels, were used on an unlabeled public data set. Finally, a student model was trained with the existing labeled images and the additional pseudolabeled images. Main Outcomes and Measures The analyzed metrics for the models included the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, and F1 score. The Fisher exact test was performed, and 2-tailed P values were calculated for failure case analysis. Results For the internal validation data sets, AUROC values for performance ranged from 0.886 to 0.939 for the teacher model and from 0.916 to 0.951 for the student model. For external validation of automated ML model performance, AUROC values and accuracy were 0.964 and 93.3% for the teacher model, 0.950 and 96.7% for the student model, and 0.890 and 94.3% for the manually coded bespoke model, respectively. Conclusions and Relevance These findings suggest that self-training using automated ML is an effective method to increase both model performance and generalizability while decreasing the need for costly expert labeling. This approach advances the democratization of AI by enabling clinicians without coding expertise or access to large, well-labeled private data sets to develop their own AI models.
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Affiliation(s)
- Edward Korot
- Retina Specialists of Michigan, Grand Rapids
- Moorfields Eye Hospital, London, United Kingdom
- Stanford University Byers Eye Institute, Palo Alto, California
| | - Mariana Batista Gonçalves
- Moorfields Eye Hospital, London, United Kingdom
- Federal University of Sao Paulo, Sao Paulo, Brazil
- Instituto da Visão, Sao Paulo, Brazil
| | | | - Sara Beqiri
- Moorfields Eye Hospital, London, United Kingdom
- University College London Medical School, London, United Kingdom
| | - Hagar Khalid
- Moorfields Eye Hospital, London, United Kingdom
- Ophthalmology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Gharbia, Egypt
| | - Madeline Kelly
- Moorfields Eye Hospital, London, United Kingdom
- University College London Medical School, London, United Kingdom
- UCL Centre for Medical Image Computing, London, United Kingdom
| | - Mark Chia
- Moorfields Eye Hospital, London, United Kingdom
| | - Emily Mathijs
- Michigan State University College of Osteopathic Medicine, East Lansing
| | | | - Magdy Moussa
- Ophthalmology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Gharbia, Egypt
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Li S, Wang Y, Yu C, Li Q, Chang P, Wang D, Li Z, Zhao Y, Zhang H, Tang N, Guan W, Fu Y, Zhao YE. Unsupervised Learning Based on Meibography Enables Subtyping of Dry Eye Disease and Reveals Ocular Surface Features. Invest Ophthalmol Vis Sci 2023; 64:43. [PMID: 37883092 PMCID: PMC10615148 DOI: 10.1167/iovs.64.13.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose This study aimed to establish an image-based classification that can reveal the clinical characteristics of patients with dry eye using unsupervised learning methods. Methods In this study, we analyzed 82,236 meibography images from 20,559 subjects. Using the SimCLR neural network, the images were categorized. Data for each patient were averaged and subjected to mini-batch k-means clustering, and validated through consensus clustering. Statistical metrics determined optimal category numbers. Using a UNet model, images were segmented to identify meibomian gland (MG) areas. Clinical features were assessed, including tear breakup time (BUT), tear meniscus height (TMH), and gland atrophy. A thorough ocular surface evaluation was conducted on 280 cooperative patients. Results SimCLR neural network achieved clustering patients with dry eye into six image-based subtypes. Patients in different subtypes harbored significantly different noninvasive BUT, significantly correlated with TMH. Subtypes 1 and 5 had the most severe MG atrophy. Subtype 2 had the highest corneal fluorescent staining (CFS). Subtype 4 had the lowest TMH, whereas subtype 5 had the highest. Subtypes 3 and 6 had the largest MG areas, and the upper MG areas of a person's bilateral eyes were highly correlated. Image-based subtypes are related to meibum quality, CFS, and morphological characteristics of MG. Conclusions In this study, we developed an unsupervised neural network model to cluster patients with dry eye into image-based subtypes using meibography images. We annotated these subtypes with functional and morphological clinical characteristics.
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Affiliation(s)
- Siyan Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Yiyi Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chunyu Yu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Qiyuan Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pingjun Chang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Dandan Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Zhangliang Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Yinying Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Hongfang Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Ning Tang
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Weichen Guan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yana Fu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Yun-e Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
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Shen M, Zhou H, Lu J, Li J, Jiang X, Trivizki O, Laiginhas R, Liu J, Zhang Q, de Sisternes L, Feuer WJ, O'Brien R, Gregori G, Wang RK, Rosenfeld PJ. Choroidal Changes After Anti-VEGF Therapy in AMD Eyes With Different Types of Macular Neovascularization Using Swept-Source OCT Angiography. Invest Ophthalmol Vis Sci 2023; 64:16. [PMID: 37819744 PMCID: PMC10573575 DOI: 10.1167/iovs.64.13.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 07/12/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose Choroidal changes before and after anti-VEGF therapy were investigated in eyes with exudative AMD to determine if there was a difference between eyes with macular neovascularization (MNV) that arises from the choroid (type 1 or 2) versus the retinal circulation (type 3). Methods Patients with treatment-naïve AMD were imaged with swept-source optical coherence tomography angiography using a 12 × 12-mm scan pattern. The mean choroidal thickness and choroidal vascularity index (CVI) were measured within 5-mm and 11-mm fovea-centered circles before, at the onset of, and after anti-VEGF therapy. Results Forty-one eyes of 37 patients were included; 24 eyes with type 1 MNV, 4 eyes with type 2 MNV, and 13 eyes with type 3 MNV. Within the 5-mm and 11-mm circles, the mean choroidal thickness and CVI measurements increased from pretreatment to the onset of exudation (P ≤ 0.03). The mean choroidal thickness and CVI measurements decreased from the onset of exudation to after treatment (P < 0.001). No significant changes in mean choroidal thickness or CVI were observed when comparing measurements before or after treatment (P ≥ 0.38). No significant differences in mean choroidal thickness or CVI measurements were observed between eyes with type 1 or 2 MNV and type 3 MNV. Conclusions In treatment-naïve AMD eyes with MNV, the choroidal thickness and vascularity increased at the onset of exudation and then decreased after anti-VEGF therapy. This finding suggests that these choroidal changes develop in response to the proangiogenic milieu before treatment and in response to treatment, regardless of the site of origin for the MNV.
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Affiliation(s)
- Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Jie Lu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Jianqing Li
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Xiaoshuang Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Rita Laiginhas
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Qinqin Zhang
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - Luis de Sisternes
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - William J. Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Robert O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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Kaushik SS, Bylund M, Cozzini C, Shanbhag D, Petit SF, Wyatt JJ, Menzel MI, Pirkl C, Mehta B, Chauhan V, Chandrasekharan K, Jonsson J, Nyholm T, Wiesinger F, Menze B. Region of interest focused MRI to synthetic CT translation using regression and segmentation multi-task network. Phys Med Biol 2023; 68:195003. [PMID: 37567235 DOI: 10.1088/1361-6560/acefa3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/10/2023] [Indexed: 08/13/2023]
Abstract
Objective. In MR-only clinical workflow, replacing CT with MR image is of advantage for workflow efficiency and reduces radiation to the patient. An important step required to eliminate CT scan from the workflow is to generate the information provided by CT via an MR image. In this work, we aim to demonstrate a method to generate accurate synthetic CT (sCT) from an MR image to suit the radiation therapy (RT) treatment planning workflow. We show the feasibility of the method and make way for a broader clinical evaluation.Approach. We present a machine learning method for sCT generation from zero-echo-time (ZTE) MRI aimed at structural and quantitative accuracies of the image, with a particular focus on the accurate bone density value prediction. The misestimation of bone density in the radiation path could lead to unintended dose delivery to the target volume and results in suboptimal treatment outcome. We propose a loss function that favors a spatially sparse bone region in the image. We harness the ability of the multi-task network to produce correlated outputs as a framework to enable localization of region of interest (RoI) via segmentation, emphasize regression of values within RoI and still retain the overall accuracy via global regression. The network is optimized by a composite loss function that combines a dedicated loss from each task.Main results. We have included 54 brain patient images in this study and tested the sCT images against reference CT on a subset of 20 cases. A pilot dose evaluation was performed on 9 of the 20 test cases to demonstrate the viability of the generated sCT in RT planning. The average quantitative metrics produced by the proposed method over the test set were-(a) mean absolute error (MAE) of 70 ± 8.6 HU; (b) peak signal-to-noise ratio (PSNR) of 29.4 ± 2.8 dB; structural similarity metric (SSIM) of 0.95 ± 0.02; and (d) Dice coefficient of the body region of 0.984 ± 0.Significance. We demonstrate that the proposed method generates sCT images that resemble visual characteristics of a real CT image and has a quantitative accuracy that suits RT dose planning application. We compare the dose calculation from the proposed sCT and the real CT in a radiation therapy treatment planning setup and show that sCT based planning falls within 0.5% target dose error. The method presented here with an initial dose evaluation makes an encouraging precursor to a broader clinical evaluation of sCT based RT planning on different anatomical regions.
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Affiliation(s)
- Sandeep S Kaushik
- GE Healthcare, Munich, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Mikael Bylund
- Department of Radiation Sciences, UmeåUniversity, Umea, Sweden
| | | | | | - Steven F Petit
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jonathan J Wyatt
- Translational and Clinical Research Institute, Newcastle University and Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Marion I Menzel
- GE Healthcare, Munich, Germany
- Dept. of Physics, Technical University of Munich, Munich, Germany
| | | | | | - Vikas Chauhan
- Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Joakim Jonsson
- Department of Radiation Sciences, UmeåUniversity, Umea, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, UmeåUniversity, Umea, Sweden
| | | | - Bjoern Menze
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
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Kar D, Corradetti G, Swain TA, Clark ME, McGwin G, Owsley C, Sadda SR, Curcio CA. Choriocapillaris Impairment Is Associated With Delayed Rod-Mediated Dark Adaptation in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2023; 64:41. [PMID: 37768273 PMCID: PMC10540875 DOI: 10.1167/iovs.64.12.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose Progress toward treatment and prevention of age-related macular degeneration (AMD) requires imaging end points that relate to vision. We investigated choriocapillaris flow signal deficits (FD%) and visual function in eyes of individuals aged ≥60 years, with and without AMD. Methods One eye of each participant in the baseline visit of the Alabama Study on Early Age-Related Macular Degeneration 2 (ALSTAR2; NCT04112667) was studied. AMD presence and severity was determined using the Age-Related Eye Disease Study (AREDS) grading system. FD% was quantified using macular spectral domain optical coherence tomography angiography (OCTA) scans. Vision tests included rod-mediated dark adaptation (RMDA), best-corrected visual acuity, and contrast sensitivity (photopic and mesopic), and microperimetric light sensitivity (scotopic, mesopic, and photopic). Presence of subretinal drusenoid deposits (SDD) was determined using multimodal imaging. Results In 410 study eyes of 410 participants (mean [SD] age = 71.7 years [5.9]), FD% was higher in early AMD (mean [SD] = 54.0% [5.5], N = 122) and intermediate AMD (59.8% [7.4], N = 92), compared to normal (52.1% [5.3], N = 196) eyes. Among visual functions evaluated, RMDA showed the strongest association with FD% (r = 0.35, P < 0.0001), followed by contrast sensitivity (r = -0.22, P < 0.0001). Eyes with SDD had worse FD% (58.3% [7.4], N = 87), compared to eyes without SDD (53.4% [6.0], N = 323, P = < 0.0001). Conclusions Choriocapillaris FD% were associated with AMD severity and with impaired vision, especially RMDA. Reduced metabolic transport and exchange across the choriocapillaris-Bruch's membrane retinal pigment epithelium (RPE) complex, a causal factor for high-risk soft drusen formation, also may impair photoreceptor sustenance from the circulation. This includes retinoid resupply, essential to dynamic rod function.
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Affiliation(s)
- Deepayan Kar
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Thomas A. Swain
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mark E. Clark
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Legocki AT, Lee AY, Ding L, Moshiri Y, Zepeda EM, Gillette TB, Grant LE, Shariff A, Touch P, Lee CS, Tarczy-Hornoch K, Cabrera MT. Multivariate Models to Diagnose Early Referral-Warranted Retinopathy of Prematurity With Handheld Optical Coherence Tomography. Transl Vis Sci Technol 2023; 12:26. [PMID: 37223917 PMCID: PMC10214879 DOI: 10.1167/tvst.12.5.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/23/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose The purpose of this study was to create multivariate models predicting early referral-warranted retinopathy of prematurity (ROP) using non-contact handheld spectral-domain optical coherence tomography (OCT) and demographic data. Methods Between July 2015 and February 2018, infants ≤1500 grams birth weight or ≤30 weeks gestational age from 2 academic neonatal intensive care units were eligible for this study. Infants were excluded if they were too unstable to participate in ophthalmologic examination (2), had inadequate image quality (20), or received prior ROP treatment (2). Multivariate models were created using demographic variables and imaging findings to identify early referral-warranted ROP (referral-warranted ROP and/or pre-plus disease) by routine indirect ophthalmoscopy. Results A total of 167 imaging sessions of 71 infants (45% male infants, gestational age 28.2+/-2.8 weeks, and birth weight 995.6+/-292.0 grams) were included. Twelve of 71 infants (17%) developed early referral-warranted ROP. The area under the receiver operating characteristic curve (AUC) was 0.94 for the generalized linear mixed model (sensitivity = 95.5% and specificity = 80.7%) and 0.83 for the machine learning model (sensitivity = 91.7% and specificity = 77.8%). The strongest variables in both models were birth weight, image-based Vitreous Opacity Ratio (an estimate of opacity density), vessel elevation, and hyporeflective vessels. A model using only birth weight and gestational age yielded an AUC of 0.68 (sensitivity = 77.3% and specificity = 63.4%), and a model using only imaging biomarkers yielded 0.88 (sensitivity = 81.8% and specificity = 84.8%). Conclusions A generalized linear mixed model containing handheld OCT biomarkers can identify early referral-warranted ROP. Machine learning produced a less optimal model. Translational Relevance With further validation, this work may lead to a better-tolerated ROP screening tool.
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Affiliation(s)
- Alex T. Legocki
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- The Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Yasman Moshiri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Emily M. Zepeda
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Thomas B. Gillette
- Department of Ophthalmology, University of South Florida Eye Institute, Tampa, FL, USA
| | - Laura E. Grant
- Department of Ophthalmology, Millman-Derr Center for Eye Care, Rochester Hills, MI, USA
| | - Ayesha Shariff
- Department of Ophthalmology, New Mexico Veterans Affairs Medical Center, University of New Mexico, Albuquerque, NM, USA
| | - Phanith Touch
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- The Roger and Angie Karalis Johnson Retina Center, Seattle, WA, USA
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA
| | - Michelle T. Cabrera
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA
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Lawson SE, Tam EK, Zheng Y, Liu T, Monger TR, Lee KE, Legocki A, Kelly J, Ding L, Wang RK, Tarczy-Hornoch K, Cabrera MT. Semi-Automated Analysis of Foveal Maturity in Premature and Full-Term Infants Using Handheld Swept-Source Optical Coherence Tomography. Transl Vis Sci Technol 2023; 12:5. [PMID: 36881403 PMCID: PMC10010441 DOI: 10.1167/tvst.12.3.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Purpose To develop a semi-automated method of measuring foveal maturity using investigational handheld swept source-optical coherence tomography (SS-OCT). Methods In this prospective, observational study, full-term newborns and preterm infants undergoing routine retinopathy of prematurity screening were imaged. Semi-automated analysis measured foveal angle and chorioretinal thicknesses at the central fovea and average two-sided parafovea by three-grader consensus, correlating with OCT features and demographics. Results One hundred ninety-four imaging sessions from 70 infants were included (47.8% girls, 37.6 ± 3.4 weeks postmenstrual age, 26 preterm infants with birth weight 1057 ± 325.0, gestational age 29.0 ± 3.0 weeks). Foveal angle (96.1 ± 22.0 degrees) steepened with increasing birth weight (P = 0.003), decreasing inner retinal layer thickness, and increasing gestational age, postmenstrual age, and foveal and parafoveal choroidal thickness (all P < 0.001). Inner retinal fovea/parafovea ratio (0.4 ± 0.2) correlated with increasing inner foveal layers, decreasing postmenstrual age, gestational age, and birth weight (all P < 0.001). Outer retinal F/P ratio (0.7 ± 0.2) correlated with ellipsoid zone presence (P < 0.001), increased gestational age (P = 0.002), and birth weight (P = 0.003). Foveal (447.8 ± 120.6 microns) and parafoveal (420.9 ± 109.2) choroidal thicknesses correlated with foveal ellipsoid zone presence (P = 0.007 and P = 0.01, respectively), postmenstrual age, birth weight, gestational age, and decreasing inner retinal layers (all P < 0.001). Conclusions Foveal development is dynamic and partially observed through semi-automated analysis of handheld SS-OCT imaging. Translational Relevance Semi-automated analysis of SS-OCT images can identify measures of foveal maturity.
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Affiliation(s)
- Sumner E Lawson
- University of Washington School of Medicine, Seattle, WA, USA
| | - Emily K Tam
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Yujiao Zheng
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Teng Liu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Tatiana R Monger
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA
| | - Karen E Lee
- Pediatric Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Alex Legocki
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - John Kelly
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Ruikang K Wang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kristina Tarczy-Hornoch
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Michelle T Cabrera
- Division of Ophthalmology Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Gao J, Rao CH, Li F, Liu L, Liu KJ. Ultra-Widefield Swept-Source Optical Coherence Tomography Angiography in the Assessment of Choroidal Changes in Young Adults With Myopia. Transl Vis Sci Technol 2022; 11:14. [PMID: 36580322 PMCID: PMC9804023 DOI: 10.1167/tvst.11.12.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To evaluate choroidal changes in young adults with myopia using ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA). Methods This study enrolled 105 eyes of 105 participants who underwent SS-OCTA imaging (24 mm × 20 mm) centered on the fovea. Eyes were categorized as low myopia, moderate myopia, or high myopia. Choroidal thickness, choroidal capillary plexus (CCP) vessel density, and choroidal Sattler's and Haller's layer (CSHL) vessel density were analyzed in nine grids using built-in angiography analysis software. Results A significant decrease in choroidal thickness was found in most grids (P < 0.01) in high myopia. The CSHL vessel density also showed a significant decrease in most grids (P < 0.05) in high myopia. Choroidal thickness was negatively correlated with axial length in most grids (P < 0.05). Choroidal thinning was most evident in the macular grid (β = -22.55, P < 0.001). CSHL vessel density was negatively correlated with axial length in most grids (P < 0.05). Conclusions Choroidal changes could be quantified using ultra-widefield SS-OCTA. Choroidal thinning with increasing axial length indicated regional differences in eyes with myopia, which were most evident in the macular area. Decreased CSHL vessel density with increasing axial length also indicated regional differences in eyes with myopia. Translational Relevance This study explored choroidal changes with a wider field of view than has been currently available.
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Affiliation(s)
- Jian Gao
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Cai-hua Rao
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Fang Li
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lun Liu
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ke-jun Liu
- Department of Ophthalmology, Dong Cheng District of The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Wu Z, Zhou X, Chu Z, Gregori G, Wang RK, Rosenfeld PJ, Guymer RH. Impact of Reticular Pseudodrusen on Choriocapillaris Flow Deficits and Choroidal Structure on Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2022; 63:1. [PMID: 36318196 PMCID: PMC9639673 DOI: 10.1167/iovs.63.12.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To examine the impact of reticular pseudodrusen (RPD) on choriocapillaris blood flow and choroidal structure in individuals with intermediate age-related macular degeneration (AMD). METHODS Individuals with bilateral large drusen underwent optical coherence tomography (OCT), color fundus photography, near-infrared reflectance, and fundus autofluorescence imaging to determine the presence of RPD. These participants also underwent swept-source OCT angiography (SS-OCTA) imaging to determine (1) choriocapillaris flow deficit (FD) parameters, including the percentage, mean size, and number of FDs present; and (2) choroidal structural parameters, including mean choroidal thickness and choroidal vascularity index. Differences in these parameters between eyes with and without coexistent RPD were examined with and without adjustment for potential key confounders such as drusen volume from the SS-OCTA scans and age. RESULTS This study included 102 eyes from 51 individuals with bilateral large drusen, and the analyses showed that there were no significant differences in the choriocapillaris FD parameters (P ≥ 0.062 for all) and choroidal structural parameters (P ≥ 0.059 for all), with or without adjustment for potential confounders in this cohort. However, the percentage of FDs and the mean FD size were both significantly greater with increasing drusen volume (P ≤ 0.038 for both). CONCLUSIONS The coexistence of RPD in eyes of individuals with intermediate AMD was not associated with significant impairments in choriocapillaris blood flow and choroidal vascular structural changes, with or without adjustment for key confounders. These findings suggest that macular changes in these vascular parameters may not be associated with the presence of RPD.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Xiao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Giovanni Gregori
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Philip J. Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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Jeong J, Kim Y. Postauricular Cyst in a 15-Year-Old Girl. JAMA Otolaryngol Head Neck Surg 2022; 148:1071-1072. [PMID: 36173640 DOI: 10.1001/jamaoto.2022.2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 15-year-old girl presented with a right-side postauricular mass, which showed high signal intensity on T2-weighted magnetic resonance imaging and lining by squamous epithelium on histopathological examination after surgical excision. What is your diagnosis?
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yeejeong Kim
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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40
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Nguyen TTP, Ni S, Ostmo S, Rajagopalan A, Coyner AS, Woodward M, Chiang MF, Jia Y, Huang D, Campbell JP, Jian Y. Association of Optical Coherence Tomography-Measured Fibrovascular Ridge Thickness and Clinical Disease Stage in Retinopathy of Prematurity. JAMA Ophthalmol 2022; 140:2797385. [PMID: 36227622 PMCID: PMC9562098 DOI: 10.1001/jamaophthalmol.2022.4173] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
Importance Accurate diagnosis of retinopathy of prematurity (ROP) is essential to provide timely treatment and reduce the risk of blindness. However, the components of an ROP examination are subjective and qualitative. Objective To evaluate whether optical coherence tomography (OCT)-derived retinal thickness measurements at the vascular-avascular junction are associated with clinical diagnosis of ROP stage. Design, Setting, and Participants This cross-sectional longitudinal study compared OCT-based ridge thickness calculated from OCT B-scans by a masked examiner to the clinical diagnosis of 2 masked examiners using both traditional stage classifications and a more granular continuous scale at the neonatal intensive care unit (NICU) of Oregon Health & Science University (OHSU) Hospital. Infants who met ROP screening criteria in the OHSU NICU between June 2021 and April 2022 and had guardian consent were included. One OCT volume and en face image per patient per eye showing at least 1 to 2 clock hours of ridge were included in the final analysis. Main Outcomes and Measures Comparison of OCT-derived ridge thickness to the clinical diagnosis of ROP stage using an ordinal and continuous scale. Repeatability was assessed using 20 repeated examinations from the same visit and compared using intraclass correlation coefficient (ICC) and coefficient of variation (CV). Comparison of ridge thickness with ordinal categories was performed using generalized estimating equations and with continuous stage using Spearman correlation. Results A total of 128 separate OCT eye examinations from 50 eyes of 25 patients were analyzed. The ICC was 0.87 with a CV of 7.0%. Higher ordinal disease classification was associated with higher axial ridge thickness on OCT, with mean (SD) thickness measurements of 264.2 (11.2) μm (P < .001), 334.2 (11.4) μm (P < .001), and 495.0 (32.2) μm (P < .001) for stages 1, 2, and 3, respectively and with continuous stage labels (ρ = 0.739, P < .001). Conclusions and Relevance These results suggest that OCT-based quantification of peripheral stage in ROP may be an objective and quantitative biomarker that may be useful for clinical diagnosis and longitudinal monitoring and may have implications for disease classification in the future.
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Affiliation(s)
| | - Shuibin Ni
- Casey Eye Institute, Oregon Health & Science University, Portland
- Department of Biomedical Engineering, Oregon Health & Science University, Portland
| | - Susan Ostmo
- Casey Eye Institute, Oregon Health & Science University, Portland
| | | | - Aaron S. Coyner
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Mani Woodward
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland
- Department of Biomedical Engineering, Oregon Health & Science University, Portland
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland
- Department of Biomedical Engineering, Oregon Health & Science University, Portland
| | | | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland
- Department of Biomedical Engineering, Oregon Health & Science University, Portland
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von Hanno T, Hareide LL, Småbrekke L, Morseth B, Sneve M, Erke MG, Mathiesen EB, Bertelsen G. Macular Layer Thickness and Effect of BMI, Body Fat, and Traditional Cardiovascular Risk Factors: The Tromsø Study. Invest Ophthalmol Vis Sci 2022; 63:16. [PMID: 35960516 PMCID: PMC9396695 DOI: 10.1167/iovs.63.9.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to investigate associations between cardiovascular risk factors and the thickness of retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and outer retina layers (ORL). Methods In this population-based study, we included participants from the Tromsø Study: Tromsø6 (2007 to 2008) and Tromsø7 (2015 to 2016). Persons with diabetes and/or diagnosed glaucoma were excluded from this study. Retinal thickness was measured on optical coherence tomography (Cirrus HD-OCT) macula-scans, segmented on RNFL, GCIPL, and ORL and associations were analyzed cross-sectionally (N = 8288) and longitudinally (N = 2595). We used directed acyclic graphs (DAGs) for model selection, and linear regression to adjust for confounders and mediators in models assessing direct effects. Factors examined were age, sex, blood pressure, daily smoking, serum lipids, glycated hemoglobin, body mass index (BMI), total body fat percentage (BFP), and the adjustment variables refraction and height. Results The explained variance of cardiovascular risk factors was highest in GCIPL (0.126). GCIPL had a strong negative association with age. Women had thicker GCIPL than men at higher age and thinner ORL at all ages (P < 0.001). Systolic blood pressure was negatively associated with RNFL/GCIPL (P = 0.001/0.004), with indication of a U-shaped relationship with GCIPL in women. The negative association with BMI was strongest in men, with significant effect for RNFL/GCIPL/ORL (P = 0.001/<0.001/0.019) and in women for GCIPL/ORL (P = 0.030/0.037). BFP was negatively associated with GCIPL (P = 0.01). Higher baseline BMI was associated with a reduction in GCIPL over 8 years (P = 0.03). Conclusions Cardiovascular risk factors explained 12.6% of the variance in GCIPL, with weight and blood pressure the most important modifiable factors.
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Affiliation(s)
- Therese von Hanno
- Department of Ophthalmology, Nordland Hospital Trust, Bodø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Lars Småbrekke
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Monica Sneve
- Hospital Administration, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Directorate of eHealth, Oslo, Norway
| | - Ellisiv Bøgeberg Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Geir Bertelsen
- Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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42
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Kim YH, Togloom A, Oh J. Correlation Between Hyperreflective Foci in the Choroid and Choroidal Discoloration in Vogt-Koyanagi-Harada Disease. Invest Ophthalmol Vis Sci 2022; 63:27. [PMID: 36006654 PMCID: PMC9428358 DOI: 10.1167/iovs.63.9.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the distribution of hyperreflective choroidal foci (HCF) in eyes with Vogt-Koyanagi-Harada (VKH) disease. Methods We included 22 eyes of 11 patients with VKH disease in the convalescent stages and 22 eyes of age- and sex-matched normal controls. HCF were quantified using en face optical coherence tomography (OCT) images of the choroid, and the degree of fundus pigmentation was determined by the color balance of the fundus photographs. The results were then analyzed between the eyes with and without sunset glow fundus (SGF). Results The median age of patients with VKH disease was 58.0 (range 54.0–65.0) years, and median disease duration was 66.4 (range 8.5–147.7) months. In 22 eyes with VKH, the number and total area of HCF were correlated with the degree of fundus pigmentation (ρ = −0.671, P < 0.001; ρ = −0.612, P = 0.002, respectively). The number of HCF was significantly smaller in VKH disease–affected eyes with SGF (median, interquartile range; 134.6, 110.0–159.2) than in those without SGF (229.0, 197.0–261.0) and the eyes of normal controls (211.8, 190.3–233.4). Conclusions HCF distributions correlated with the degree of fundus pigmentation in eyes with VKH disease. Quantitative measurements of HCF on en face OCT images can be a novel tool in evaluating choroidal pigmentation in patients with VKH disease.
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Affiliation(s)
- Young Ho Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Ariunaa Togloom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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43
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Zang P, Hormel TT, Wang X, Tsuboi K, Huang D, Hwang TS, Jia Y. A Diabetic Retinopathy Classification Framework Based on Deep-Learning Analysis of OCT Angiography. Transl Vis Sci Technol 2022; 11:10. [PMID: 35822949 PMCID: PMC9288155 DOI: 10.1167/tvst.11.7.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Reliable classification of referable and vision threatening diabetic retinopathy (DR) is essential for patients with diabetes to prevent blindness. Optical coherence tomography (OCT) and its angiography (OCTA) have several advantages over fundus photographs. We evaluated a deep-learning-aided DR classification framework using volumetric OCT and OCTA. Methods Four hundred fifty-six OCT and OCTA volumes were scanned from eyes of 50 healthy participants and 305 patients with diabetes. Retina specialists labeled the eyes as non-referable (nrDR), referable (rDR), or vision threatening DR (vtDR). Each eye underwent a 3 × 3-mm scan using a commercial 70 kHz spectral-domain OCT system. We developed a DR classification framework and trained it using volumetric OCT and OCTA to classify eyes into rDR and vtDR. For the scans identified as rDR or vtDR, 3D class activation maps were generated to highlight the subregions which were considered important by the framework for DR classification. Results For rDR classification, the framework achieved a 0.96 ± 0.01 area under the receiver operating characteristic curve (AUC) and 0.83 ± 0.04 quadratic-weighted kappa. For vtDR classification, the framework achieved a 0.92 ± 0.02 AUC and 0.73 ± 0.04 quadratic-weighted kappa. In addition, the multiple DR classification (non-rDR, rDR but non-vtDR, or vtDR) achieved a 0.83 ± 0.03 quadratic-weighted kappa. Conclusions A deep learning framework only based on OCT and OCTA can provide specialist-level DR classification using only a single imaging modality. Translational Relevance The proposed framework can be used to develop clinically valuable automated DR diagnosis system because of the specialist-level performance showed in this study.
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Affiliation(s)
- Pengxiao Zang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Kotaro Tsuboi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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44
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Cheng D, Ruan K, Wu M, Qiao Y, Gao W, Lian H, Shen M, Bao F, Yang Y, Zhu J, Huang H, Meng X, Shen L, Ye Y. Characteristics of the Optic Nerve Head in Myopic Eyes Using Swept-Source Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2022; 63:20. [PMID: 35731511 PMCID: PMC9233286 DOI: 10.1167/iovs.63.6.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To investigate the characteristics of the optic nerve head (ONH) in myopia using swept-source optical coherence tomography (SS-OCT). Methods Participants were divided into three groups according to the axial length (AL). The optic disc morphology, retinal nerve fiber layer (RNFL) thickness, and radial peripapillary capillary (RPC) vessel density (VD), optic disc tilt, rotation, Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle, focal lamina cribrosa (LC) defects, β- and γ-zone peripapillary atrophy (PPA), microvasculature dropout (MvD), choroidal thickness (CT), and the choroidal vascularity index (CVI) were compared. Linear regression analysis evaluated relationships between spherical equivalent, AL, and ONH parameters. Results One hundred five, 98, and 118 eyes were included in groups 1, 2, and 3, respectively. With AL increasing, the mean, superior and temporal CT, central mean and temporal, pericentral mean, inferior and nasal RPC VD, and temporal CVI decreased, whereas the mean and temporal RNFL thickness, optic disc, RIM and β-PPA area, presence and area of γ-PPA, BMOD and BL increased. Compared to other groups, group 3 depicted a larger cup area, more focal LC defect and total and juxtapapillary MvD; a lower central superior, inferior and nasal, pericentral superior, and temporal RPC VD. Group 1 demonstrated more tilted disc, larger inferior and nasal CT, mean, superior, inferior, and nasal CVI. Conclusions Myopia eyes have larger ONH changes, PPAs, regional RNFL, and MvD, but smaller regional CTs, RPC VD, and CVIs. SS-OCT may be useful in detecting ONH variations during myopia.
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Affiliation(s)
- Dan Cheng
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Kaiming Ruan
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Minhui Wu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Yilin Qiao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Weiqian Gao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Hengli Lian
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Meixiao Shen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Fangjun Bao
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Yizeng Yang
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Jun Zhu
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Haiying Huang
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Xianwei Meng
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Lijun Shen
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.,Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hanghzou, Zhejiang, China
| | - Yufeng Ye
- The Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
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45
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Musial G, Kohlfaerber T, Ahrens M, Schulz-Hildebrandt H, Steven P, Hüttmann G. Dynamic Contrast Microscopic Optical Coherence Tomography As a Novel Method for Assessing Corneal Epithelium During Exposure to Benzalkonium Chloride. Transl Vis Sci Technol 2022; 11:28. [PMID: 35622381 PMCID: PMC9145126 DOI: 10.1167/tvst.11.5.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Microscopic optical coherence tomography (mOCT) has an imaging resolution of 1 µm in all voxel dimensions, but individual epithelial cells are difficult to resolve due to lack of scattering contrast. Adding dynamic contrast processing to mOCT (dmOCT) results in color images that enable visualization of individual cells and possibly give information on cellular function via the calculation of a motility coefficient. We propose this technique as a novel method of evaluating the ocular surface after exposure to a toxic chemical, benzalkonium chloride (BAK). Methods Ex vivo cross-section images were acquired with a custom-built, frequency-domain mOCT system. Eyes were explanted from healthy adult C57BL/6 mice and imaged every 30 minutes with five sets of dmOCT scans at each imaging time. Total epithelium and stroma thicknesses were measured from a single mOCT B-scan, and measures of color changes (hue) and the motility coefficient were acquired from dmOCT scans. Results After 30-minute exposures to 0.005% BAK, local motility decreased and total epithelium thickness increased compared to controls. For basal epithelium cells, local motility decreased after 60-minute exposures, and the hue shifted red after 90-minute exposures. Stroma thickness did not significantly swell until 150-minute exposures to BAK. Conclusions dmOCT allows us to view the behavior of the cornea epithelium under toxic stress due to BAK, revealing parallel swelling of the extracellular matrix and changes in local subcellular motion. Translational Relevance The evaluation of the cornea epithelium using dmOCT is helpful to our understanding of the toxic effects of BAK.
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Affiliation(s)
- Gwen Musial
- University Hospital Cologne, Cologne, Germany
| | | | - Martin Ahrens
- Institute of Biomedial Optics, University of Lübeck, Lübeck, Germany
| | | | | | - Gereon Hüttmann
- Institute of Biomedial Optics, University of Lübeck, Lübeck, Germany.,Airway Research Center North Member of the German Center for Lung Research, DZL, 22927 Großhansdorf, Germany.,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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46
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Feola AJ, Girkin CA, Ethier CR, Samuels BC. A Potential Role of Acute Choroidal Expansion in Nonarteritic Anterior Ischemic Optic Neuropathy. Invest Ophthalmol Vis Sci 2022; 63:23. [PMID: 35481840 PMCID: PMC9055550 DOI: 10.1167/iovs.63.4.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Nonarteritic anterior ischemic optic neuropathy (NAION) has been associated with a thickened choroid at the optic nerve head (ONH). Here, we use computational modeling to better understand how choroidal expansion and choroidal geometry influence tissue deformation within the ONH relative to intraocular pressure (IOP) and intracranial pressure (ICP) effects. Methods Using a model of the posterior eye that included the sclera, peripapillary sclera, annular ring, pia mater, dura mater, neural tissues, Bruch's membrane, choroid, and lamina cribrosa, we examined how varying material properties of ocular tissues influenced ONH deformations under physiological and supra-physiological, or “pathological,” conditions. We considered choroidal expansion (c. 35 µL of expansion), elevated IOP (30 mm Hg), and elevated ICP (20 mm Hg), and calculated peak strains in the ONH relative to a baseline condition representing an individual in the upright position. Results Supra-physiological choroidal expansion had the largest impact on strains in the prelaminar neural tissue. In addition, compared to a tapered choroid, a “blunt” choroid insertion at the ONH resulted in higher strains. Elevated IOP and ICP caused the highest strains within the lamina cribrosa and retrolaminar neural tissue, respectively. Conclusions Acute choroidal expansion caused large deformations of the ONH and these deformations were impacted by choroid geometry. These results are consistent with the concept that compartment syndrome due to the choroid geometry and/or expansion at the ONH contributes to NAION. Prolonged deformations due to supra-physiological loading may induce a mechanobiological response or ischemia, highlighting the potential impact of choroidal expansion on biomechanical strains in the ONH.
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Affiliation(s)
- Andrew J Feola
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Atlanta, Georgia, United States.,Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States.,Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, United States
| | - Christopher A Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - C Ross Ethier
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, United States
| | - Brian C Samuels
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, United States
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47
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Cicinelli MV, Ritter M, Tausif H, Ghossein C, Aschauer C, Laccone F, Nagel M, Jampol LM, Gill MK. Characterization of Choriocapillaris and Choroidal Abnormalities in Alport Syndrome. Transl Vis Sci Technol 2022; 11:23. [PMID: 35311929 PMCID: PMC8944388 DOI: 10.1167/tvst.11.3.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To analyze the characteristics of the choriocapillaris and the choroid in patients with Alport syndrome (AS) and investigate their clinical and demographic associations. Methods Multicenter, cross-sectional study. Forty-two eyes with AS were consecutively enrolled. A cohort of 33 healthy eyes was included as controls. Demographics and medical history were collected for each participant. Each eye underwent 3 × 3 swept-source optical coherence tomography angiography (PLEX Elite 9000 2.0; Carl Zeiss Meditec, Dublin, CA, USA) and spectral-domain OCT (Spectralis HRA2; Heidelberg Engineering, Heidelberg, Germany). Choriocapillaris flow deficit (FD) number, mean FD size, total FD area, FD density, subfoveal choroidal thickness (CT), total CT, and choroidal vascularity index (CVI) were compared between AS and control eyes. Factors associated with the FD density and the CVI in AS were explored with multivariable linear mixed models. Results There was high intragroup variability in choriocapillaris and choroidal measurements in patients with AS. Choriocapillaris FD in patients with AS were more numerous compared to controls (P = 0.02). FD density in eyes with AS increased with older age (estimate = 0.31% for each year; 95% confidence interval [CI], 0.06−0.57; P = 0.02) and was higher in patients with a history of kidney transplant (estimate = 9.66% in case of positive history; 95% CI, 3.52−15.8; P = 0.006). The CVI was lower in eyes with dot maculopathy (estimate = −3.30% if present; 95% CI, −6.38 to −0.21; P = 0.04) and anterior lenticonus (estimate = −6.50% if present; 95% CI, −10.99 to −2.00; P = 0.006). Conclusions Patients with AS with kidney involvement requiring transplant may present with more severe choriocapillaris impairment. Lower choroidal vascularity was found in the presence of other ocular structural abnormalities. Translational Relevance An increased load of choriocapillaris flow deficits on optical coherence tomography angiography was found in patients with Alport syndrome who also had severe kidney disease requiring transplant.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Markus Ritter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Hassan Tausif
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cybele Ghossein
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Constantin Aschauer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Franco Laccone
- Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Mato Nagel
- Centre for Nephrology and Metabolic Medicine, Weisswasser, Germany
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manjot K Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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48
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Huang J, Guo J, Pedrosa I, Fei B. Deep Learning-based Deformable Registration of Dynamic Contrast-Enhanced MR Images of the Kidney. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12034:1203410. [PMID: 36793654 PMCID: PMC9928502 DOI: 10.1117/12.2611768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Respiratory motion is a major contributor to bias in quantitative analysis of magnetic resonance imaging (MRI) acquisitions. Deformable registration of three-dimensional (3D) dynamic contrast-enhanced (DCE) MRI data improves estimation of kidney kinetic parameters. In this study, we proposed a deep learning approach with two steps: a convolutional neural network (CNN) based affine registration network, followed by a U-Net trained for deformable registration between two MR images. The proposed registration method was applied successively across consecutive dynamic phases of the 3D DCE-MRI dataset to reduce motion effects in the different kidney compartments (i.e., cortex, medulla). Successful reduction in the motion effects caused by patient respiration during image acquisition allows for improved kinetic analysis of the kidney. Original and registered images were analyzed and compared using dynamic intensity curves of the kidney compartments, target registration error of anatomical markers, image subtraction, and simple visual assessment. The proposed deep learning-based approach to correct motion effects in abdominal 3D DCE-MRI data can be applied to various kidney MR imaging applications.
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Affiliation(s)
- James Huang
- University of Texas at Dallas, Dept of Bioengineering, Richardson, TX
- University of Texas at Dallas, Center for Imaging and Surgical Innovation, Richardson, TX
| | - Junyu Guo
- University of Texas Southwestern Medical Center, Dept of Radiology, Dallas, TX
| | - Ivan Pedrosa
- University of Texas Southwestern Medical Center, Dept of Radiology, Dallas, TX
| | - Baowei Fei
- University of Texas at Dallas, Dept of Bioengineering, Richardson, TX
- University of Texas at Dallas, Center for Imaging and Surgical Innovation, Richardson, TX
- University of Texas Southwestern Medical Center, Dept of Radiology, Dallas, TX
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49
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Li J, Zhou H, Feinstein M, Wong J, Wang RK, Chan L, Dai Y, Porco T, Duncan JL, Schwartz DM. Choriocapillaris Changes in Myopic Macular Degeneration. Transl Vis Sci Technol 2022; 11:37. [PMID: 35201337 PMCID: PMC8883151 DOI: 10.1167/tvst.11.2.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Myopic macular degeneration (MMD) can cause irreversible vision loss. Thinner choroid is associated with increased MMD severity. This cross-sectional study analyzed choriocapillaris (CC) alterations in MMD. Methods Axial length (AL), best-corrected visual acuity (BCVA), fundus photography, and swept-source optical coherence tomography angiography (SS-OCTA) were assessed in controls and high myopes (spherical equivalent ≤ −6 diopters). Myopic patients with grade 2 MMD (macular diffuse chorioretinal atrophy [MDCA]), high axial myopia (AL ≥ 26.5 mm), and BCVA ≥ 20/40 were compared with controls without MMD. CC mean thickness was measured from 3 × 3-mm SS-OCTA scans by identifying CC peaks in A-scan intensity profiles. CC flow deficit percent (CC FD%) was quantified using a fuzzy C-mean local thresholding method on en face OCTA images. Multivariate regressions compared CC thickness and CC FD% between myopic patients and controls, correcting for age and other confounders. Results Sixteen eyes with MDCA (AL, 26.96–33.93 mm; ages, 40–78 years) were compared with 51 control eyes (AL, 21.65–25.84 mm; ages, 19–88 years). CC thickness in patients with MDCA was 66% lower than that in controls (5.23 ± 0.68 µm [mean ± SD] vs. 15.46 ± 1.82 µm; P < 0.001). CC FD% in patients with MDCA was 237% greater than in controls (26.5 ± 4.3 vs. 11.2 ± 4.6; P < 0.001). Conclusions Patients with MDCA with good visual acuity had thinner CC and increased CC FD%, or reduced CC flow, compared with controls. Patients with grade 2 MMD and good visual acuity demonstrated significant choriocapillaris alterations, suggesting that choriocapillaris perfusion defects contribute to the pathogenesis of MMD. Translational Relevance Given the potential vascular etiology for MMD, current research about revascularization of ischemic retina likely has implications for the treatment of MMD.
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Affiliation(s)
- Jonathan Li
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Singapore National Eye Centre, Singapore
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Max Feinstein
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jessica Wong
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Lawrence Chan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Yining Dai
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Travis Porco
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Daniel M Schwartz
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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50
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Gao M, Hormel TT, Wang J, Guo Y, Bailey ST, Hwang TS, Jia Y. An Open-Source Deep Learning Network for Reconstruction of High-Resolution OCT Angiograms of Retinal Intermediate and Deep Capillary Plexuses. Transl Vis Sci Technol 2021; 10:13. [PMID: 34757393 PMCID: PMC8590160 DOI: 10.1167/tvst.10.13.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/06/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose We propose a deep learning-based image reconstruction algorithm to produce high-resolution optical coherence tomographic angiograms (OCTA) of the intermediate capillary plexus (ICP) and deep capillary plexus (DCP). Methods In this study, 6-mm × 6-mm macular scans with a 400 × 400 A-line sampling density and 3-mm × 3-mm scans with a 304 × 304 A-line sampling density were acquired on one or both eyes of 180 participants (including 230 eyes with diabetic retinopathy and 44 healthy controls) using a 70-kHz commercial OCT system (RTVue-XR; Optovue, Inc., Fremont, California, USA). Projection-resolved OCTA algorithm removed projection artifacts in voxel. ICP and DCP angiograms were generated by maximum projection of the OCTA signal within the respective plexus. We proposed a deep learning-based method, which receives inputs from registered 3-mm × 3-mm ICP and DCP angiograms with proper sampling density as the ground truth reference to reconstruct 6-mm × 6-mm high-resolution ICP and DCP en face OCTA. We applied the same network on 3-mm × 3-mm angiograms to enhance these images further. We evaluated the reconstructed 3-mm × 3-mm and 6-mm × 6-mm angiograms based on vascular connectivity, Weber contrast, false flow signal (flow signal erroneously generated from background), and the noise intensity in the foveal avascular zone. Results Compared to the originals, the Deep Capillary Angiogram Reconstruction Network (DCARnet)-enhanced 6-mm × 6-mm angiograms had significantly reduced noise intensity (ICP, 7.38 ± 25.22, P < 0.001; DCP, 11.20 ± 22.52, P < 0.001), improved vascular connectivity (ICP, 0.95 ± 0.01, P < 0.001; DCP, 0.96 ± 0.01, P < 0.001), and enhanced Weber contrast (ICP, 4.25 ± 0.10, P < 0.001; DCP, 3.84 ± 0.84, P < 0.001), without generating false flow signal when noise intensity lower than 650. The DCARnet-enhanced 3-mm × 3-mm angiograms also reduced noise, improved connectivity, and enhanced Weber contrast in 3-mm × 3-mm ICP and DCP angiograms from 101 eyes. In addition, DCARnet preserved the appearance of the dilated vessels in the reconstructed angiograms in diabetic eyes. Conclusions DCARnet can enhance 3-mm × 3-mm and 6-mm × 6-mm ICP and DCP angiogram image quality without introducing artifacts. Translational Relevance The enhanced 6-mm × 6-mm angiograms may be easier for clinicians to interpret qualitatively.
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Affiliation(s)
- Min Gao
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Yukun Guo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Steven T. Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Thomas S. Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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