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Freidin D, Har-Even M, Rubovitch V, Murray KE, Maggio N, Shavit-Stein E, Keidan L, Citron BA, Pick CG. Cognitive and Cellular Effects of Combined Organophosphate Toxicity and Mild Traumatic Brain Injury. Biomedicines 2023; 11:1481. [PMID: 37239152 PMCID: PMC10216664 DOI: 10.3390/biomedicines11051481] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is considered the most common neurological disorder among people under the age of 50. In modern combat zones, a combination of TBI and organophosphates (OP) can cause both fatal and long-term effects on the brain. We utilized a mouse closed-head TBI model induced by a weight drop device, along with OP exposure to paraoxon. Spatial and visual memory as well as neuron loss and reactive astrocytosis were measured 30 days after exposure to mild TBI (mTBI) and/or paraoxon. Molecular and cellular changes were assessed in the temporal cortex and hippocampus. Cognitive and behavioral deficits were most pronounced in animals that received a combination of paraoxon exposure and mTBI, suggesting an additive effect of the insults. Neuron survival was reduced in proximity to the injury site after exposure to paraoxon with or without mTBI, whereas in the dentate gyrus hilus, cell survival was only reduced in mice exposed to paraoxon prior to sustaining a mTBI. Neuroinflammation was increased in the dentate gyrus in all groups exposed to mTBI and/or to paraoxon. Astrocyte morphology was significantly changed in mice exposed to paraoxon prior to sustaining an mTBI. These results provide further support for assumptions concerning the effects of OP exposure following the Gulf War. This study reveals additional insights into the potentially additive effects of OP exposure and mTBI, which may result in more severe brain damage on the modern battlefield.
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Affiliation(s)
- Dor Freidin
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Meirav Har-Even
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Vardit Rubovitch
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Kathleen E. Murray
- Laboratory of Molecular Biology, VA New Jersey Health Care System, Research & Development, East Orange, NJ 07018, USA
- Rutgers School of Graduate Studies, Newark, NJ 07103, USA
| | - Nicola Maggio
- Department of Neurology, The Chaim Sheba Medical Center, Ramat Gan 52626202, Israel
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, The Chaim Sheba Medical Center, Ramat Gan 52626202, Israel
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lee Keidan
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
| | - Bruce A. Citron
- Laboratory of Molecular Biology, VA New Jersey Health Care System, Research & Development, East Orange, NJ 07018, USA
- Rutgers School of Graduate Studies, Newark, NJ 07103, USA
- Department of Pharmacology, Physiology & Neuroscience, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Chaim G. Pick
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (D.F.); (M.H.-E.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv 6997801, Israel
- The Dr. Miriam and Sheldon G. Adelson Chair and Center for the Biology of Addictive Diseases, Tel Aviv University, Tel Aviv 6997801, Israel
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Tejman-Yarden S, Freidin D, Nagar N, Parmet Y, Abed M, Vazhgovsky O, Yogev D, Ganchrow BID D, Mazor-Drey E, Chatterji S, Beinart R, Barbash I, Guetta V, Goitein O. Virtual reality utilization for left atrial appendage occluder device size prediction. Heliyon 2023; 9:e14790. [PMID: 37089380 PMCID: PMC10114146 DOI: 10.1016/j.heliyon.2023.e14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
Aim To explore the feasibility and accuracy of virtual reality (VR) derived from cardiac computed angiography (CCTA) data to predict left atrial appendage occlusion (LAAO) device size. Method Retrospective data of patients who underwent LAAO according to clinical indication were reviewed; all patients underwent a pre-procedural CCTA. Measurements of the left atrial appendage (LAA) orifice diameters by CCTA, VR, and transesophageal echocardiography (TEE) (acquired during the procedure) were compared to the implanted device size. The LAA perimeter was calculated using the Ramanujan approximation. Statistical analyses included Lin's Concordance Correlation Coefficient (ρ c ), the mean difference, and the mean square error (MSE). Results The sample was composed of 20 patients (mean age 75.7 ± 7.5 years, 60% males) who underwent successful LAAO insertion (ACP™ N = 8, Watchman™ N = 12). The CCTA, VR, and TEE maximal diameter ρ c was 0.52, 0.78 and 0.60, respectively with mean differences of +0.92 ± 4.0 mm, -1.12 ± 2.3 mm, and -3.45 ± 2.69 mm, respectively. The CCTA, VR, and TEE perimeter calculations ρ c were 0.49, 0.54, and 0.39 respectively with mean differences of +4.69 ± 11.5 mm, -9.88 ± 8.0 mm, and -16.79 ± 7.8 respectively. Discussion A VR visualization of the LAA ostium in different perspectives allows for a better understanding of its funnel-shaped structure. VR measurement of the maximal ostium diameter had the strongest correlation with the diameter of the inserted device. VR may thus provide new imaging possibilities for the evaluation of complex pre-procedural structures such as the LAA.
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Yogev D, Tejman-Yarden S, Feinberg O, Parmet Y, Goldberg T, Illouz S, Nagar N, Freidin D, Vazgovsky O, Chatterji S, Salem Y, Katz U, Goitein O. Proof of concept: Comparative accuracy of semiautomated VR modeling for volumetric analysis of the heart ventricles. Heliyon 2022; 8:e11250. [PMID: 36387466 PMCID: PMC9641195 DOI: 10.1016/j.heliyon.2022.e11250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Simpson's rule is generally used to estimate cardiac volumes. By contrast, modern methods such as Virtual Reality (VR) utilize mesh modeling to present the object's surface spatial structure, thus enabling intricate volumetric calculations. In this study, two types of semiautomated VR models for cardiac volumetric analysis were compared to the standard Philips dedicated cardiac imaging platform (PDP) which is based on Simpson's rule calculations. Methods This retrospective report examined the cardiac computed tomography angiography (CCTA) of twenty patients with atrial fibrillation obtained prior to a left atrial appendage occlusion procedure. We employed two VR models to evaluate each CCTA and compared them to the PDP: a VR model with Philips-similar segmentations (VR-PS) that included the trabeculae and the papillary muscles within the luminal volume, and a VR model that only included the inner blood pool (VR-IBP). Results Comparison of the VR-PS and the PDP left ventricle (LV) volumes demonstrated excellent correlation with a ρc of 0.983 (95% CI 0.96, 0.99), and a small mean difference and range. The calculated volumes of the right ventricle (RV) had a somewhat lower correlation of 0.89 (95% CI 0.781, 0.95), a small mean difference, and a broader range. The VR-IBP chamber size estimations were significantly smaller than the estimates based on the PDP. Discussion Simpson's rule and polygon summation algorithms produce similar results in normal morphological LVs. However, this correlation failed to emerge when applied to RVs and irregular chambers. Conclusions The findings suggest that the polygon summation method is preferable for RV and irregular LV volume and function calculations.
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Affiliation(s)
- David Yogev
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Tejman-Yarden
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
- Corresponding author.
| | - Omer Feinberg
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben Gurion University, Beer Sheva, Israel
| | - Tomer Goldberg
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Illouz
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Netanel Nagar
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
- Industrial Design Department, Bezalel Academy of Art and Design, Jerusalem, Israel
| | - Dor Freidin
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Oliana Vazgovsky
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Sumit Chatterji
- The Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel
- Interventional Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yishay Salem
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
- The Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Uriel Katz
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
- The Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Orly Goitein
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
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Freidin D, Zilka N, Horesh N, Saukhat O, Ram E, Tejman-Yarden S. Using Augmented Reality for Intraoperative Guidance During Sacral Neuromodulation System Implantation. Ann Surg Open 2022; 3:e138. [PMID: 37600095 PMCID: PMC10431399 DOI: 10.1097/as9.0000000000000138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to examine the feasibility of using augmented reality during lead placement for sacral nerve stimulation (SNS). Methods The study was a prospective case series performed in a single tertiary center. Patients with fecal incontinence or urinary retention eligible for SNS according to the American society of colon and rectal surgeon's guidelines were included. Each patient underwent a computerized tomography scan of the sacrum and pelvic floor before surgery; and a segmentation of the sacral bone, the skin, and three fiducial markers on the lower back was produced. Surgical planning included the design of an ideal virtual transmission tract leading to the S3 foramen using the most suitable location and needle trajectory for introducing the lead. During the surgical intervention, a needle was inserted into the S3 foramen using the aligned tract as visualized using the Microsoft HoloLens first generation head mounted unit. Results Overall, 11 patients were included. Mean operative time was 43.8 minutes (range 25-81 minutes). All patients reported a significant reduction from the preoperative level of the mean postoperative Cleveland Clinic Incontinence Score (CCIS) assessed 2 weeks after the temporary SNS implant (CCIS preoperative 13.3, postoperative 8.5; CI -7.35 to -2.25; P < 0.01). The surgeons reported the imaging useful, allowing accurate and easier approach. Conclusions Intraoperative augmented reality imaging for needle application during SNS appears to be feasible, practical, and may be useful in additional procedures.
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Affiliation(s)
- Dor Freidin
- From the The Engineering Medical Research Lab, The Edmond J. Safra International Congenital Heart Center, Safra Pediatric Hospital, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Zilka
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel
| | - Olga Saukhat
- Department of Radiology, Sheba Medical Center, Ramat Gan, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Tejman-Yarden
- From the The Engineering Medical Research Lab, The Edmond J. Safra International Congenital Heart Center, Safra Pediatric Hospital, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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