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Stewart JK, Hipolito Canario DA, Daso G, Thapa D, Montgomery S, Kohi M. Use of n-Butyl-2-Cyanoacrylate for Fallopian Tube Embolization via Selective Catheterization in a Rabbit Model: Feasibility Study for Potential Nonsurgical Sterilization. J Vasc Interv Radiol 2023; 34:225-233. [PMID: 36306987 DOI: 10.1016/j.jvir.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To determine whether fallopian tube embolization with n-butyl-2-cyanoacrylate (nBCA) administered via a microcatheter in a rabbit model was technically feasible and resulted in short-term tubal occlusion. MATERIALS AND METHODS In 10 female New Zealand white rabbits, the 2 cervices were cannulated using a 5-F catheter and hydrophilic guide wire transvaginally. Salpingography confirmed tubal patency bilaterally. A 2.4-F microcatheter was advanced to the distal fallopian tube, and nBCA/ethiodized oil was administered as the microcatheter was withdrawn to fill the length of the tube. A metallic coil was deployed prior to nBCA administration in half of the fallopian tubes. Rabbits were evaluated for tubal occlusion with salpingography at 1 month, followed by euthanasia and histopathologic analysis. Inflammation and fibrosis were graded from 0 (normal) to 3 (severe). RESULTS Fallopian tube embolization was technically successful in 17 (85%) of 20 fallopian tubes. Thirteen (76%) of 17 embolized fallopian tubes were occluded at 1 month on salpingography (nBCA only, 7/9; nBCA and coil, 6/8). On histopathologic analysis, direct or indirect evidence of occlusion was observed in 14 (82%) of 17 fallopian tubes. Mild or early fibrosis was observed in 65% of the tubes. The mean inflammation and fibrosis scores for the embolized tubes were 0.62 and 0.94, respectively. CONCLUSIONS This pilot study demonstrated that embolization of rabbit fallopian tubes using nBCA administered via a microcatheter is technically feasible and results in occlusion of most fallopian tubes in the short term with minimal inflammation. Investigation of efficacy in preventing pregnancy over the long term is warranted.
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Affiliation(s)
- Jessica K Stewart
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Diego A Hipolito Canario
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gabrielle Daso
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Diwash Thapa
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Maureen Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Hipolito Canario DA, Fromke E, Patetta MA, Eltilib MT, Reyes-Gonzalez JP, Rodriguez GC, Fusco Cornejo VA, Duncker S, Stewart JK. Using artificial intelligence to risk stratify COVID-19 patients based on chest X-ray findings. Intell Based Med 2022; 6:100049. [PMID: 35039806 PMCID: PMC8755446 DOI: 10.1016/j.ibmed.2022.100049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Deep learning-based radiological image analysis could facilitate use of chest x-rays as a triaging tool for COVID-19 diagnosis in resource-limited settings. This study sought to determine whether a modified commercially available deep learning algorithm (M-qXR) could risk stratify patients with suspected COVID-19 infections. METHODS A dual track clinical validation study was designed to assess the clinical accuracy of M-qXR. The algorithm evaluated all Chest-X-rays (CXRs) performed during the study period for abnormal findings and assigned a COVID-19 risk score. Four independent radiologists served as radiological ground truth. The M-qXR algorithm output was compared against radiological ground truth and summary statistics for prediction accuracy were calculated. In addition, patients who underwent both PCR testing and CXR for suspected COVID-19 infection were included in a co-occurrence matrix to assess the sensitivity and specificity of the M-qXR algorithm. RESULTS 625 CXRs were included in the clinical validation study. 98% of total interpretations made by M-qXR agreed with ground truth (p = 0.25). M-qXR correctly identified the presence or absence of pulmonary opacities in 94% of CXR interpretations. M-qXR's sensitivity, specificity, PPV, and NPV for detecting pulmonary opacities were 94%, 95%, 99%, and 88% respectively. M-qXR correctly identified the presence or absence of pulmonary consolidation in 88% of CXR interpretations (p = 0.48). M-qXR's sensitivity, specificity, PPV, and NPV for detecting pulmonary consolidation were 91%, 84%, 89%, and 86% respectively. Furthermore, 113 PCR-confirmed COVID-19 cases were used to create a co-occurrence matrix between M-qXR's COVID-19 risk score and COVID-19 PCR test results. The PPV and NPV of a medium to high COVID-19 risk score assigned by M-qXR yielding a positive COVID-19 PCR test result was estimated to be 89.7% and 80.4% respectively. CONCLUSION M-qXR was found to have comparable accuracy to radiological ground truth in detecting radiographic abnormalities on CXR suggestive of COVID-19.
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Affiliation(s)
- Diego A. Hipolito Canario
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC, 27599-3280, United States,Corresponding author
| | - Eric Fromke
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC, 27599-3280, United States
| | - Matthew A. Patetta
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC, 27599-3280, United States
| | - Mohamed T. Eltilib
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC, 27599-3280, United States
| | - Juan P. Reyes-Gonzalez
- Department of Radiology, Angeles del Pedregal Hospital, Camino de Sta, Teresa 1055-S, Héroes de Padierna, La Magdalena Contreras, 10700, Ciudad de México, Mexico
| | - Georgina Cornelio Rodriguez
- Department of Radiology, Angeles del Pedregal Hospital, Camino de Sta, Teresa 1055-S, Héroes de Padierna, La Magdalena Contreras, 10700, Ciudad de México, Mexico
| | | | - Seymour Duncker
- Mindscale, 800 W El Camino Real Suite 180 Mountain View, CA, 94040, United States
| | - Jessica K. Stewart
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles. 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095, United States
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Bagla S, Piechowiak R, Sajan A, Orlando J, Canario DAH, Isaacson A. Angiographic Analysis of the Anatomical Variants in Genicular Artery Embolization. Journal of Clinical Interventional Radiology ISVIR 2021. [DOI: 10.1055/s-0041-1729464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Purpose Genicular artery embolization (GAE) has been proposed as a novel technique to treat painful synovitis related to osteoarthritis. An in-depth understanding of the genicular arterial anatomy is crucial to achieve technical success and avoid nontarget-related complications. Given the lack of previous angiographic description, the present study analyzes genicular arterial anatomy and proposes an angiographic classification system.
Materials and Methods Angiographic findings from 41 GAEs performed during two US clinical trials from January 2017 to July 2019 were reviewed to analyze the anatomical details of the following vessels: descending genicular artery (DGA), medial superior genicular artery (MSGA), medial inferior genicular artery (MIGA), lateral superior genicular artery (LSGA), lateral inferior genicular artery (LIGA), and anterior tibial recurrent artery (ATRA). The diameter, angle of origin, and anastomotic pathways were recorded for each vessel. The branching patterns were classified as: medially, M1 (3/3 arteries present) vs M2 (2/3 arteries present); and laterally, L1 (3/3 arteries present) vs L2 (2/3 arteries present).
Results A total of 91 genicular arteries were embolized: DGA (26.4%), MIGA (23.1%), MSGA (22.0%), LIGA (14.3%), and LSGA/ATRA (14.3%). The branching patterns were: medially = M1, 74.4% (n = 29), M2, 25.6% (n = 10); and laterally = L1, 94.9% (n = 37), L2, 5.1% (n = 2). A common origin for MSGA and LSGA was noted in 11 patients (28.2%). A direct DGA origin from the popliteal artery was reported in three patients (7.7%, n = 3).
Conclusions A thorough understanding of the geniculate arterial anatomy is important for maximizing postprocedural pain reduction while minimizing complications, procedure time, and radiation exposure during GAE.
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Affiliation(s)
- Sandeep Bagla
- Vascular Interventional Partners - NOVA, Falls Church, Virginia, United States
| | | | - Abin Sajan
- NYU Winthrop Hospital, Department of Surgery, St. Mineola, New York, United States
| | - Julie Orlando
- Fauquier Hospital, Warrenton, Virginia, United States
| | - Diego A. Hipolito Canario
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
| | - Ari Isaacson
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
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Alexander SM, Pogson KB, Friedman VE, Corley JL, Hipolito Canario DA, Johnson CS. Ultrasound as a Learning Tool in Bachelor-Level Anatomy Education. Med Sci Educ 2021. [PMID: 33262901 DOI: 10.1007/s40670-020-01170-1/figures/2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Point of care ultrasound (POCUS) has become an increasingly common diagnostic tool in the clinical environment. As a result, it is being used earlier for medical students in Undergraduate Medical Education (UME) as a learning tool for the basic sciences including gross anatomy. There is little literature, however, to support its utility for basic science education in students currently seeking a bachelor's degree. This study consisted of fourteen currently enrolled bachelor students with previous instruction in human anatomy and physiology. Students participated in an ultrasound didactic and an interactive ultrasound experience with volunteers. Before and after this session, students were asked to complete an assessment measuring their spatial understanding of the human anatomy and their ability to locate structures using ultrasound. Wilcoxon's signed-rank tests comparing assessment scores showed significant improvement on both portions of the assessment. Based on this improvement, we suggest that ultrasound is a valid educational tool which can be used at the bachelor-level to effectively enhance students' learning of anatomy and provide hands on experience with modern technology. Further research with larger samples will be necessary to determine whether it would supplement or replace more traditional teaching modalities.
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Affiliation(s)
- Seth M Alexander
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC 27599-3280 USA
| | - Kaylyn B Pogson
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC 27599-3280 USA
| | - Vince E Friedman
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
| | - Janine L Corley
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
| | - Diego A Hipolito Canario
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC 27599-3280 USA
| | - Corey S Johnson
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
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Alexander SM, Pogson KB, Friedman VE, Corley JL, Hipolito Canario DA, Johnson CS. Ultrasound as a Learning Tool in Bachelor-Level Anatomy Education. Med Sci Educ 2021; 31:193-196. [PMID: 33262901 PMCID: PMC7688295 DOI: 10.1007/s40670-020-01170-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 05/28/2023]
Abstract
Point of care ultrasound (POCUS) has become an increasingly common diagnostic tool in the clinical environment. As a result, it is being used earlier for medical students in Undergraduate Medical Education (UME) as a learning tool for the basic sciences including gross anatomy. There is little literature, however, to support its utility for basic science education in students currently seeking a bachelor's degree. This study consisted of fourteen currently enrolled bachelor students with previous instruction in human anatomy and physiology. Students participated in an ultrasound didactic and an interactive ultrasound experience with volunteers. Before and after this session, students were asked to complete an assessment measuring their spatial understanding of the human anatomy and their ability to locate structures using ultrasound. Wilcoxon's signed-rank tests comparing assessment scores showed significant improvement on both portions of the assessment. Based on this improvement, we suggest that ultrasound is a valid educational tool which can be used at the bachelor-level to effectively enhance students' learning of anatomy and provide hands on experience with modern technology. Further research with larger samples will be necessary to determine whether it would supplement or replace more traditional teaching modalities.
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Affiliation(s)
- Seth M. Alexander
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC 27599-3280 USA
| | - Kaylyn B. Pogson
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC 27599-3280 USA
| | - Vince E. Friedman
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
| | - Janine L. Corley
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
| | - Diego A. Hipolito Canario
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
- UNC School of Medicine, University of North Carolina at Chapel Hill, Bondurant Hall, CB 9535, Chapel Hill, NC 27599-3280 USA
| | - Corey S. Johnson
- Department of Biology, University of North Carolina at Chapel Hill, Coker Hall, CB 3280, Chapel Hill, NC 27599-3280 USA
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Hipolito Canario DA, Isaacson AJ, Martissa JA, Stewart JK. Ultrasound-Guided Chemical Component Separation with Botulinum Toxin A prior to Surgical Hernia Repair. J Vasc Interv Radiol 2020; 32:256-261. [PMID: 33303339 DOI: 10.1016/j.jvir.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 10/22/2022] Open
Abstract
US-guided chemical component separation (CCS) of the abdominal musculature using botulinum toxin A can facilitate the surgical repair of large or complex hernias. Eight patients (2 women and 6 men with median age of 54 years [range, 34-78 years]) underwent preoperative US-guided CCS with hydrodissection before planned surgical repair of large or complex ventral (n = 4), inguinal (n = 2), and flank (n = 2) hernias by 2 interventional radiologists. Technical success rate of US-guided CCS procedures was 100%, and all patients achieved surgical closure a mean 34.1 days (range, 14-48 days) after US-guided CCS.
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Affiliation(s)
- Diego A Hipolito Canario
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510
| | - Jessica A Martissa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510
| | - Jessica K Stewart
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, 2017 Old Clinic Building CB #7510, Chapel Hill, NC 27599-7510.
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Patel TV, Canario DAH, Isaacson AJ, Mauro DM. Vascular Etiologies of the Acute Abdomen. Semin Roentgenol 2020; 55:417-426. [PMID: 33220787 DOI: 10.1053/j.ro.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tirth V Patel
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Ari J Isaacson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC.
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