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Li H, Deng Y, Sampani K, Cai S, Li Z, Sun JK, Karniadakis GE. Computational investigation of blood cell transport in retinal microaneurysms. PLoS Comput Biol 2022; 18:e1009728. [PMID: 34986147 PMCID: PMC8730408 DOI: 10.1371/journal.pcbi.1009728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
Microaneurysms (MAs) are one of the earliest clinically visible signs of diabetic retinopathy (DR). MA leakage or rupture may precipitate local pathology in the surrounding neural retina that impacts visual function. Thrombosis in MAs may affect their turnover time, an indicator associated with visual and anatomic outcomes in the diabetic eyes. In this work, we perform computational modeling of blood flow in microchannels containing various MAs to investigate the pathologies of MAs in DR. The particle-based model employed in this study can explicitly represent red blood cells (RBCs) and platelets as well as their interaction in the blood flow, a process that is very difficult to observe in vivo. Our simulations illustrate that while the main blood flow from the parent vessels can perfuse the entire lumen of MAs with small body-to-neck ratio (BNR), it can only perfuse part of the lumen in MAs with large BNR, particularly at a low hematocrit level, leading to possible hypoxic conditions inside MAs. We also quantify the impacts of the size of MAs, blood flow velocity, hematocrit and RBC stiffness and adhesion on the likelihood of platelets entering MAs as well as their residence time inside, two factors that are thought to be associated with thrombus formation in MAs. Our results show that enlarged MA size, increased blood velocity and hematocrit in the parent vessel of MAs as well as the RBC-RBC adhesion promote the migration of platelets into MAs and also prolong their residence time, thereby increasing the propensity of thrombosis within MAs. Overall, our work suggests that computational simulations using particle-based models can help to understand the microvascular pathology pertaining to MAs in DR and provide insights to stimulate and steer new experimental and computational studies in this area.
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Affiliation(s)
- He Li
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
| | - Yixiang Deng
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shengze Cai
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, United States of America
| | - Zhen Li
- Department of Mechanical Engineering, Clemson University, Clemson, South Carolina, United States of America
| | - Jennifer K. Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - George E. Karniadakis
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, United States of America
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Cai S, Li H, Zheng F, Kong F, Dao M, Karniadakis GE, Suresh S. Artificial intelligence velocimetry and microaneurysm-on-a-chip for three-dimensional analysis of blood flow in physiology and disease. Proc Natl Acad Sci U S A 2021; 118:e2100697118. [PMID: 33762307 PMCID: PMC8020788 DOI: 10.1073/pnas.2100697118] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Understanding the mechanics of blood flow is necessary for developing insights into mechanisms of physiology and vascular diseases in microcirculation. Given the limitations of technologies available for assessing in vivo flow fields, in vitro methods based on traditional microfluidic platforms have been developed to mimic physiological conditions. However, existing methods lack the capability to provide accurate assessment of these flow fields, particularly in vessels with complex geometries. Conventional approaches to quantify flow fields rely either on analyzing only visual images or on enforcing underlying physics without considering visualization data, which could compromise accuracy of predictions. Here, we present artificial-intelligence velocimetry (AIV) to quantify velocity and stress fields of blood flow by integrating the imaging data with underlying physics using physics-informed neural networks. We demonstrate the capability of AIV by quantifying hemodynamics in microchannels designed to mimic saccular-shaped microaneurysms (microaneurysm-on-a-chip, or MAOAC), which signify common manifestations of diabetic retinopathy, a leading cause of vision loss from blood-vessel damage in the retina in diabetic patients. We show that AIV can, without any a priori knowledge of the inlet and outlet boundary conditions, infer the two-dimensional (2D) flow fields from a sequence of 2D images of blood flow in MAOAC, but also can infer three-dimensional (3D) flow fields using only 2D images, thanks to the encoded physics laws. AIV provides a unique paradigm that seamlessly integrates images, experimental data, and underlying physics using neural networks to automatically analyze experimental data and infer key hemodynamic indicators that assess vascular injury.
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Affiliation(s)
- Shengze Cai
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - He Li
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - Fuyin Zheng
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- School of Biological Sciences, Nanyang Technological University, 639798 Singapore
| | - Fang Kong
- School of Biological Sciences, Nanyang Technological University, 639798 Singapore
| | - Ming Dao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
| | - George Em Karniadakis
- Division of Applied Mathematics, Brown University, Providence, RI 02912;
- School of Engineering, Brown University, Providence, RI 02912
| | - Subra Suresh
- Nanyang Technological University, 639798 Singapore
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Ehlers JP, Jiang AC, Boss JD, Hu M, Figueiredo N, Babiuch A, Talcott K, Sharma S, Hach J, Le T, Rogozinski A, Lunasco L, Reese JL, Srivastava SK. Quantitative Ultra-Widefield Angiography and Diabetic Retinopathy Severity: An Assessment of Panretinal Leakage Index, Ischemic Index and Microaneurysm Count. Ophthalmology 2019; 126:1527-1532. [PMID: 31383482 PMCID: PMC6810836 DOI: 10.1016/j.ophtha.2019.05.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/11/2019] [Accepted: 05/24/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To investigate the relationship between the diabetic retinopathy (DR) severity and quantitative ultra-widefield angiographic metrics, including leakage index, ischemic index, and microaneurysm count. DESIGN Retrospective image analysis study. METHODS Eyes with DR that had undergone ultra-widefield fluorescein angiography (UWFA) with associated color photography were identified. All eyes were laser-naive and had not received any intravitreal pharmacotherapy within 6 months of UWFA. Each eye was graded for DR severity. Quantitative angiographic parameters were evaluated with a semiautomated analysis platform with expert reader correction, as needed. Angiographic parameters included panretinal leakage index, ischemic index, and microaneurysm count. Clinical characteristics analyzed included age, gender, race, hemoglobin A1C level, hypertension, systolic blood pressure, diastolic blood pressure, and smoking history. MAIN OUTCOME MEASURES Association of DR severity with panretinal leakage index, ischemic index, and microaneurysm count. RESULTS Three hundred thirty-nine eyes were included with mean age of 62±13 years. Forty-two percent of eyes were from women and 57.5% were from men. Distribution of DR severity was as follows: mild NPDR in 11.2%, moderate NPDR in 23.9%, severe NPDR in 40.1%, and PDR with 24.8%. Panretinal leakage index [mild NPDR (mean = 0.51%), moderate NPDR mean = 1.20%, severe NPDR (mean = 2.75%), and PDR (mean = 5.84%); P<2×10-16], panretinal ischemic index [mild NPDR (mean = 0.95%, moderate NPDR (mean = 1.37%), severe NPDR (mean = 2.80%), and PDR (mean = 9.53%); P<2×10-16], and panretinal microaneurysm count [mild NPDR (mean = 36), moderate NPDR (mean = 129), severe NPDR (mean = 203), and PDR (mean = 254); P<5×10-7] were strongly associated with DR severity. Multivariate analysis demonstrated that ischemic index and leakage index were the parameters associated most strongly with level of DR severity. CONCLUSIONS Panretinal leakage index, panretinal ischemic index, and panretinal microaneurysm count are associated with DR severity. Additional research is needed to understand the clinical implications of these parameters related to progression risk, prognosis, and implications for therapeutic response.
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Affiliation(s)
- Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Alice C Jiang
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Joseph D Boss
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ming Hu
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Natalia Figueiredo
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amy Babiuch
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Sharma
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jenna Hach
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alison Rogozinski
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leina Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie L Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Cho YH, Craig ME, Januszewski AS, Benitez-Aguirre P, Hing S, Jenkins AJ, Donaghue KC. Higher skin autofluorescence in young people with Type 1 diabetes and microvascular complications. Diabet Med 2017; 34:543-550. [PMID: 27770590 DOI: 10.1111/dme.13280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 01/06/2023]
Abstract
AIM To test the hypothesis that non-invasive skin autofluorescence, a measure of advanced glycation end products, would provide a surrogate measure of long-term glycaemia and be associated with early markers of microvascular complications in adolescents with Type 1 diabetes. METHODS Forearm skin autofluorescence (arbitrary units) was measured in a cross-sectional study of 135 adolescents with Type 1 diabetes [mean ± sd age 15.6 ± 2.1 years, diabetes duration 8.7 ± 3.5 years, HbA1c 72 ± 16 mmol/mol (8.7 ± 1.5%)]. Retinopathy, assessed using seven-field stereoscopic fundal photography, was defined as ≥1 microaneurysm or haemorrhage. Cardiac autonomic function was measured by standard deviation of consecutive RR intervals on a 10-min continuous electrocardiogram recording, as a measure of heart rate variability. RESULTS Skin autofluorescence was significantly associated with age (R2 = 0.15; P < 0.001). Age- and gender-adjusted skin autofluorescence was associated with concurrent HbA1c (R2 = 0.32; P < 0.001) and HbA1c over the previous 2.5-10 years (R2 = 0.34-0.43; P < 0.002). Age- and gender-adjusted mean skin autofluorescence was higher in adolescents with retinopathy vs those without retinopathy [mean 1.38 (95% CI 1.29, 1.48) vs 1.22 (95% CI 1.17, 1.26) arbitrary units; P = 0.002]. In multivariable analysis, retinopathy was significantly associated with skin autofluorescence, adjusted for duration (R2 = 0.19; P = 0.03). Cardiac autonomic dysfunction was also independently associated with skin autofluorescence (R2 = 0.11; P = 0.006). CONCLUSIONS Higher skin autofluorescence is associated with retinopathy and cardiac autonomic dysfunction in adolescents with Type 1 diabetes. The relationship between skin autofluorescence and previous glycaemia may provide insight into metabolic memory. Longitudinal studies will determine the utility of skin autofluorescence as a non-invasive screening tool to predict future microvascular complications.
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Affiliation(s)
- Y H Cho
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - M E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - A S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - P Benitez-Aguirre
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
| | - S Hing
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
| | - A J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - K C Donaghue
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia
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Wang L, Liu G, Fu S, Xu L, Zhao K, Zhang C. Retinal Image Enhancement Using Robust Inverse Diffusion Equation and Self-Similarity Filtering. PLoS One 2016; 11:e0158480. [PMID: 27388503 PMCID: PMC4936706 DOI: 10.1371/journal.pone.0158480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/17/2016] [Indexed: 11/18/2022] Open
Abstract
As a common ocular complication for diabetic patients, diabetic retinopathy has become an important public health problem in the world. Early diagnosis and early treatment with the help of fundus imaging technology is an effective control method. In this paper, a robust inverse diffusion equation combining a self-similarity filtering is presented to detect and evaluate diabetic retinopathy using retinal image enhancement. A flux corrected transport technique is used to control diffusion flux adaptively, which eliminates overshoots inherent in the Laplacian operation. Feature preserving denoising by the self-similarity filtering ensures a robust enhancement of noisy and blurry retinal images. Experimental results demonstrate that this algorithm can enhance important details of retinal image data effectively, affording an opportunity for better medical interpretation and subsequent processing.
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Affiliation(s)
- Lu Wang
- School of Public Health, Shandong University, Jinan 250012, China
| | - Guohua Liu
- Department of Ophthalmology, Qilu Children’s Hospital of Shandong University, Jinan 250022, China
| | - Shujun Fu
- School of Mathematics, Shandong University, Jinan 250100, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Kun Zhao
- Department of Medical Imaging, The Second Hospital of Shandong University, Jinan 250033, China
| | - Caiming Zhang
- School of Computer Science and Technology, Shandong University of Finance and Economics, Jinan 250061, China
- School of Computer Science and Technology, Shandong University, Jinan 250101, China
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