Wnt-1 regulation of connexin43 in cardiac myocytes

Gap junction channels composed of connexin43 (Cx43) are essential for normal heart formation and function. We studied the potential role of the Wnt family of secreted polypeptides as regulators of Cx43 expression and gap junction channel function in dissociated myocytes and intact hearts. Neonatal rat cardiomyocytes responded to Li(+), which mimics Wnt signaling, by accumulating the effector protein beta-catenin and by inducing Cx43 mRNA and protein markedly. Induction of Cx43 expression was also observed in cardiomyocytes cocultured with Rat-2 fibroblasts or N2A neuroblastoma cells programmed to secrete bioactive Wnt-1. By transfecting a Cx43 promoter-reporter gene construct into cardiomyocytes, we demonstrated that the inductive effect of Wnt signaling was transcriptionally mediated. Enhanced expression of Cx43 increased cardiomyocyte cell coupling, as determined by Lucifer Yellow dye transfer and by calcium wave propagation. Conversely, in a transgenic cardiomyopathic mouse model that exhibits ventricular arrhythmias and gap junctional remodeling, beta-catenin and Cx43 expression were downregulated concordantly. In response to Wnt signaling, the accumulating Cx43 colocalized with beta-catenin in the junctional membrane; moreover, forced expression of Cx43 in cardiomyocytes reduced the transactivation potential of beta-catenin. These findings demonstrate that Wnt signaling is an important modulator of Cx43-dependent intercellular coupling in the heart, and they support the hypothesis that dysregulated signaling contributes to altered impulse propagation and arrhythmia in the myopathic heart.

Phosphatidylinositol 3-kinase activity in murine erythroleukemia cells during DMSO-induced differentiation

We have used murine erythroleukemia cells (MEL cells) to investigate the role of phosphatidylinositol 3-kinase (PI 3-kinase) in erythroid differentiation. When treated with dimethyl sulfoxide (DMSO), MEL cells grown on a fibronectin matrix become committed to erythroid differentiation asynchronously, with 90% of cells becoming committed by Day 3 of treatment. We found that during the first 3 days of DMSO treatment MEL cells showed a twofold increase in total PI 3-kinase activity and a fourfold increase in the highly phosphorylated PI 3-kinase product, PIP3. At the same time there was no change in the content of p85, the PI 3-kinase regulatory subunit. After Day 3, PI 3-kinase activity declined, in parallel with a disappearance of p85 antigen from the cells. Inclusion of the PI 3-kinase inhibitor Wortmannin in the culture medium resulted in an inhibition of cellular PI 3-kinase activity and a delay in DMSO-induced erythroid differentiation. These data suggest that PI 3-kinase may play a critical role during commitment of MEL cells to erythroid differentiation.

The association between vitamin D receptor FokI gene polymorphism and osteoporosis in postmenopausal women: a meta-analysis

OBJECTIVE

This study aimed to quantitatively summarize the evidence for vitamin D receptor (VDR) FokI gene polymorphism and osteoporosis risk in Caucasian and Asian postmenopausal women.

MATERIALS AND METHODS

The PubMed, EMBASE, Weipu, CNKI, and Wanfang databases were searched for eligible studies. Case-control studies containing available genotype frequencies for F/f were chosen, and the odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of this association.

RESULTS

In total, 3349 osteoporosis cases and 3202 controls were identified in our meta-analysis. In the stratified analysis, a significant association was observed between VDR FokI gene polymorphism and postmenopausal osteoporosis susceptibility in Asian subjects (additive model: OR = 1.529, 95% CI 1.053-2.219, p = 0.026; dominant model: OR 2.711, 95% CI 1.693-4.342 p < 0.001; co-dominant model: ff vs. FF, OR 2.796, 95% CI 1.439-5.433 p = 0.002), and we failed to find any significant relationship in Caucasian populations.

CONCLUSION

The present meta-analysis suggests that the VDR FokI genotype is associated with increased risk of osteoporosis in Asian women but not in Caucasian women. To draw comprehensive and true conclusions, further prospective studies with larger numbers of participants worldwide are needed to examine associations between VDR FokI polymorphism and osteoporosis.

Reducing temperature sensitivity of gas measurement using chirped-modulated photoacoustic spectroscopy

Resonance frequency drift caused by a change in temperature greatly limits the application of high-Q resonators with high temperature sensitivity in photoacoustic (PA) gas detection systems. In this work, a chirp-wavelength combined modulation method was designed by incorporating a real-time frequency scanning in wavelength-modulated PA spectroscopy to reduce the influence of temperature changes on measurement. Theoretical analysis shows that the chirp rate depends on the precision requirements and the cutoff frequency of the cascaded low-pass filter. Trace acetylene measurement experiment at varying temperature verified that the proposed method can significantly reduce the temperature sensitivity within a preset temperature range. Thus, this method can effectively reduce the temperature sensitivity of a high-Q resonator for improving the measurement accuracy and detection limit in trace gas detection.

Fast algorithm for exact rendering of space-filling molecular models with shadows

An algorithm for accurate rendering of space-filling molecular models with shadows is presented. The intensity of light and cast shadows are computed to generate realistic pictures. Arbitrary numbers of light sources, which may be at infinite or finite distances can be applied. Hidden-surface removal, lighting, and shadowing are presented in detail.

Clinical value of deep learning image reconstruction on the diagnosis of pulmonary nodule for ultra-low-dose chest CT imaging

PURPOSE

To compare the image quality and pulmonary nodule detectability between deep learning image reconstruction (DLIR) and adaptive statistical iterative reconstruction-Veo (ASIR-V) in ultra-low-dose CT (ULD-CT).

METHODS

142 participants required lung examination who underwent simultaneously ULD-CT (UL-A, 0.57 ± 0.04 mSv or UL-B, 0.33 ± 0.03 mSv), and standard CT (SDCT, 4.32 ± 0.33 mSv) plain scans were included in this prospective study. SDCT was the reference standard using ASIR-V at 50% strength (50%ASIR-V). ULD-CT was reconstructed with 50%ASIR-V, DLIR at medium and high strength (DLIR-M, DLIR-H). The noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective scores were measured. The presence and accuracy of nodules were analyzed using a combination of a deep learning-based nodule evaluation system and a radiologist.

RESULTS

A total of 710 nodules were detected by SDCT, including 358 nodules in UL-A and 352 nodules in UL-B. DLIR-H exhibited superior noise, SNR, and CNR performance, and achieved comparable or even higher subjective scores compared to 50%ASIR-V in ULD-CT. Nodules sensitivity detection of 50%ASIR-V, DLIR-M, and DLIR-H in ULD-CT were identical (96.90%). In multivariate analysis, body mass index (BMI), nodule diameter, and type were independent predictors for the sensitivity of nodule detection (p<.001). DLIR-H provided a lower absolute percent error (APE) in volume (3.10% ± 95.11% vs 8.29% ± 99.14%) compared to 50%ASIR-V of ULD-CT (P<.001).

CONCLUSIONS

ULD-CT scanning has a high sensitivity for detecting pulmonary nodules. Compared with ASIR-V, DLIR can significantly reduce image noise, and improve image quality, and accuracy of the nodule measurement in ULD-CT.

A prediction model based on dual-layer spectral detector computed tomography for distinguishing nonluminal from luminal invasive breast cancer

Background

The identification of the molecular subtypes of breast cancer is critical to determining appropriate treatment strategies and assessing prognosis. This study aimed to evaluate the ability of dual-layer spectral detector computed tomography (DLCT) metrics to differentiate luminal from nonluminal invasive breast cancer.

Methods

A total of 220 patients with invasive breast cancer who underwent routine DLCT examination were included in the study. The molecular subtypes of breast cancer were identified through immunohistochemical staining of biopsies or postoperative pathological specimens. DLCT quantitative parameters were compared between the luminal and nonluminal types of breast cancer. The diagnostic efficacy of these parameters was determined via receiver operating characteristic (ROC) curves. Univariate and multivariate regression analyses were conducted to identify independent predictors that could differentiate nonluminal from luminal breast cancer. A nomogram prediction model was established based on multivariate regression analysis. The performance of the nomogram model was assessed with ROC curve and calibration curve analyses.

Results

Among the DLCT quantitative values, eight were significantly lower in the luminal type than in the nonluminal type of breast cancer (P<0.001-0.011). The area under the curve (AUC) values for these significant DLCT quantitative parameters ranged from 0.604 to 0.694. Multivariate logistic regression analysis identified CT-reported lymph node metastasis status [hazard ratio (HR) =4.214; P<0.001], the Hounsfield unit (HU) value of the virtual monoenergetic image at 40 keV (HUVMI40) (HR =2.628; P=0.012), and the normalized iodine concentration (nIC) (HR =2.182; P=0.041) as independent predictors of the nonluminal type, with an AUC of 0.754 [95% confidence interval (CI): 0.688-0.820]. The nomogram based on multivariate logistic regression analysis exhibited good discrimination and calibration (Hosmer-Lemeshow test; P=0.835). An average AUC value of 0.75 was obtained for the internal validation data.

Conclusions

DLCT quantitative parameters are valuable noninvasive indexes for differentiating between the luminal and nonluminal types of invasive breast cancer. Furthermore, the nomogram constructed in this study could guide individualized predictions of molecular subtypes in patients with invasive breast cancer.

Antineoplastic mechanism of Octreotide action in human hepatoma

OBJECTIVES

To investigate whether apoptosis can be induced by Octreotide in human hepatoma cells in vitro and elucidate the antineoplastic mechanism of Octreotide in hepatoma.

METHODS

A cultured human hepatoma cell line, BEL-7402, was exposed to Octreotide and apoptosis was evaluated by cytochemical staining (Hochesst 33,258), transmission electron microscopy, agarose gel electrophoresis and flow cytometry (FCM).

RESULTS

After exposure to 0.2 microgram/ml Octreotide, apoptosis with nuclear chromatin condensation as well as fragmentation, cell shrinkage and the formation of apoptotic bodies was observed using cytochemical staining and transmission electron microscopy. A DNA ladder in agarose gel electrophoresis was also displayed. FCM showed that the apoptotic cell number rose with an increase in the concentration of Octreotide (0-2 micrograms/ml). There was a positive correlation between Octreotide concentration and apoptotic rate in BEL-7402 cells (r = 0.809, P < 0.05).

CONCLUSION

Apoptosis in human hepatoma cells can be induced by Octreotide, which may be related to the mechanism of antineoplastic action of Octreotide in hepatoma.

Evolution of radiation-induced temporal lobe injury after intensity-modulated radiation therapy in nasopharyngeal carcinoma: a large cohort retrospective study

BACKGROUND

Previous studies have demonstrated conflicting findings regarding the initial MRI patterns of radiotherapy-induced temporal lobe injury (RTLI) and the evolution of different RTLI patterns. The aim of this study was to evaluate the initial MRI pattern and evolution of RTLI in patients with nasopharyngeal carcinoma (NPC) by means of a large cohort study.

METHODS

Data of patients with RTLI were retrospectively collected from two hospitals between January 2011 and December 2021. The injured lobes were categorized into three patterns based on initial MRI patterns: isolated white matter lesions (WMLs), isolated contrast-enhanced lesions (CELs), and combined WMLs and CELs. The latency period, MRI appearances, and temporal changes in WMLs and CELs were evaluated.

RESULTS

A total of 913 RTLI patients with 1092 injured lobes were included in this study. The numbers of isolated WMLs, isolated CELs, and combined WMLs and CELs identified at the first MRI detection were 7 (0.6%), 172 (15.8%), and 913 (83.6%), respectively. The evolution of bilateral RTLI was different in the same patient, and that of unilateral RTLI combined with WMLs and CELs also may occur asynchronously. The time intervals from the initial MRI detection of isolated WMLs, isolated CELs, combined WMLs and CELs to the last negative MRI scan were 8.6, 8.9 and 11.0 months, respectively. A significant difference was observed in the time intervals between the three patterns (H = 14.287, P = 0.001). And the time interval was identified as an independent factor influencing the initial MRI pattern of RTLI after Poisson regression (P = 0.002).

CONCLUSION

Both WMLs and CELs could be the initial and only MRI abnormalities in patients with RTLI. This study is of great significance in accurately diagnosing RTLI early and providing timely treatment options. Additionally, it provides clinical evidence for guidelines on NPC, emphasizing the importance of regular follow-up of NPC patients.

Autocolorization of three-dimensional radiological data

It requires skill, effort, and time to visualize desired anatomic structures from radiological data in three-dimensions. There have been many attempts at automating this process and making it less labor intensive. The technique we have developed is based on mutual information for automatic multi-modality image fusion (MIAMI Fuse, University of Michigan). The initial development of our technique has focused on the autocolorization of the liver, portal vein, and hepatic vein. A standard dataset in which these structures had been segmented and assigned colors was created from the full color Visible Human Female (VHF) and then optimally fused to the fresh CT Visible Human Female. This semi-automatic segmentation and coloring of the CT dataset was subjectively evaluated to be reasonably accurate. The transformation could be viewed interactively on the ImmersaDesk, in an immersive Virtual Reality (VR) environment. This 3D segmentation and visualization method marks the first step to a broader, standardized automatic structure visualization method for radiological data. Such a method, would permit segmentation of radiological data by canonical structure information and not just from the data's intrinsic dynamic range.

Specific loss of protein kinase activities in senescent erythrocytes

Rabbit erythrocytes of progressively increasing age were isolated using an avidin-biotin affinity technique and the activity of protein kinases and other enzymes was analyzed in cytosols and membranes from the isolated cells. The activities of cytosolic protein kinase C (PKC), cAMP-dependent kinase (PKA), and casein kinase type I and II (CKI and II) were all found to undergo an age-dependent decrease of twofold to fourfold over the 8-week lifespan of the cells. Membrane-associated tyrosine kinase showed little or no decrease, but membrane-associated CKI showed a dramatic eightfold decrease over the 8-week period. By contrast, various cytosolic enzymes, including lactate dehydrogenase, phosphoglycerate kinase, pyruvate kinase, and acid phosphatase, showed no change in activity over the same time period. Density-separated human erythrocytes showed qualitatively similar decreases in cytosolic protein kinase activities in the densest fractions, which contain the oldest cells. Our results show that aging erythrocytes undergo progressive loss of protein kinases that may adversely affect various cellular processes. The age-dependent loss of kinase activity reported here is one of the most striking manifestations of erythrocyte senescence yet to be reported.

[Current status of hyperkalemia in dialysis patients in China]

Objective: To investigate the prevalence and associated factors of hyperkalemia in dialysis patients. Methods: Patients underwent hemodialysis (HD) and peritoneal dialysis (PD) from multi-center databases were recruited from January 2017 to December 2019, and those aged ≥18 years and with dialysis duration ≥3 months were included to analyze the prevalence and related factors of hyperkalemia. Results: A total of 12 364 patients were enrolled in the study, and 6 836 cases were men. The average age of the patients was (51±15) years. Among these patients, 4 230 cases underwent HD while 8 134 received PD. Hyperkalemia was detected in 20.7% (2 554/12 364) of the patients while hypokalemia was found in 17.0%(2 102/12 364) of the patients. Multivariate logistic regression showed that HD (OR=2.25, 95%CI: 1.54-3.30), diabetes mellitus (DM) (OR=1.65, 95%CI: 1.17-2.32), high body mass index (BMI) (OR=1.06, 95%CI: 1.03-1.09), high levels of serum albumin (OR=1.04, 95%CI: 1.01-1.07) and phosphorus (OR=3.12, 95%CI: 2.44-4.00), low levels of serum bicarbonate (OR=0.89, 95%CI: 0.87-0.92), triglycerides (OR=0.76, 95%CI: 0.68-0.85) and creatinine (OR=0.95, 95%CI: 0.90-0.99), usage of angiotensin converting enzyme inhibitor/Angiotensin Ⅱ receptor antagonist (ACEI/ARB, OR=1.38, 95%CI: 1.11-1.72) and beta-blocker (OR=1.32, 95%CI: 1.07-1.64) were associated with hyperkalemia. Conclusions: Hyperkalemia occurred in 20.7% of the dialysis patients. HD, DM, high BMI, high levels of serum albumin and phosphorus, low levels of serum bicarbonate, triglycerides and creatinine, use of ACEI/ARB were associated with hyperkalemia.

Effective early strategy to prevent olfactory and gustatory dysfunction in COVID-19: a randomized controlled trial

BACKGROUND

Olfactory and gustatory dysfunctions (OGDs) are key symptoms of coronavirus disease 2019 (COVID-19), which may lead to neurological complications, and lack of effective treatment. This may be because post-disease treatments may be too late to protect the olfactory and gustatory functions.

AIM

To evaluate the effectiveness of early use of saline nasal irrigation (SNI), corticosteroid nasal spray, and saline or chlorhexidine gluconate mouthwash for preventing OGDs in COVID-19.

DESIGN

This study was a double-blind randomized controlled trial.

METHODS

The study was conducted from 5 May to 16 June 2022. We recruited patients from three hospitals who were admitted with COVID-19 but without OGDs on the day of admission. Olfactory and gustatory functions were evaluated using the Taste and Smell Survey and the numerical visual analog scale. Participants were randomized to the saline, drug or control groups. The control group received no intervention, saline group received SNI plus saline nasal spray and mouthwash, and the trial group received SNI plus budesonide nasal spray and chlorhexidine gluconate mouthwash. Participants were assessed again on the day of discharge.

RESULTS

A total of 379 patients completed the trial. The prevalence of OGDs was significantly lower in the saline (11.8%, 95% CI, 6.6-19.0%; P < 0.001) and drug (8.3%, 95% CI, 4.1-14.8%; P < 0.001) groups than in the control group (40.0%, 95% CI, 31.8-48.6%). Additionally, both interventions reduced the severity of OGDs.

CONCLUSIONS

We demonstrated effective strategies for preventing COVID-19-related OGDs, and the findings may guide early management of severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection to reduce the incidence of COVID-19-related complications.

[Protective effects of prostacyclin on acute necrotizing pancreatitis and its renal damage in rats]

In a rat model with acute necrotizing pancreatitis (ANP), the administration of exogenous prostacyclin (PGI2) significantly increased the pancreatic and renal blood flow, brought the level of 6-keto-PGF1 alpha to TXB2 in renal vein blood back to normal, reduced the severity of pancreatic and renal histolcagic damage, decreased the mortality, and prolonged survival time. The study showed that exogenous PGI2 can increase pancreatic blood flow in rats with ANP, help to prevent ANP, and protect from renal damage following ANP.

Manipulation of volumetric patient data in a distributed virtual reality environment

Due to increases in network speed and bandwidth, distributed exploration of medical data in immersive Virtual Reality (VR) environments is becoming increasingly feasible. The volumetric display of radiological data in such environments presents a unique set of challenges. The shear size and complexity of the datasets involved not only make them difficult to transmit to remote sites, but these datasets also require extensive user interaction in order to make them understandable to the investigator and manageable to the rendering hardware. A sophisticated VR user interface is required in order for the clinician to focus on the aspects of the data that will provide educational and/or diagnostic insight. We will describe a software system of data acquisition, data display, Tele-Immersion, and data manipulation that supports interactive, collaborative investigation of large radiological datasets. The hardware required in this strategy is still at the high-end of the graphics workstation market. Future software ports to Linux and NT, along with the rapid development of PC graphics cards, open the possibility for later work with Linux or NT PCs and PC clusters.

Prognostic factors and adjuvant chemotherapy efficacy in stage I gastric cancer patients: a retrospective analysis

BACKGROUND

Although stage I gastric cancer (GC) presents a favorable survival rate, outcomes for patients experiencing recurrence remain poor. This research focuses on assessing the prognosis and identifying risk factors for stage I GC patients, further assessing the necessity of adjuvant chemotherapy (AC).

METHODS

The study involved a retrospective analysis of 902 patients with stage I GC who received curative resection from November 2010 to December 2020. Independent prognostic factors were identified using multivariate Cox regression analysis. Kaplan-Meier analysis was employed to compare recurrence-free survival (RFS) and disease-specific survival (DSS) across different groups.

RESULTS

During follow-up, 47 patients (5.2%) experienced recurrence or death, with the 3-, 5-, and 10-year survival rates exceeding 90%. Age ≥ 65 years and pT2 stage were independently associated with decreased RFS, while age ≥ 65 years, pT2 stage, and tumor diameter ≥ 5 cm was significantly associated with decreased DSS. Patients with an increasing number of risk factors exhibited lower 5-year RFS [97.4% (risk factors = 0) vs. 91.3% (risk factors = 1) vs. 85.0% (risk factors = 2) vs. 63.6% (risk factors = 3); P < 0.001] and DSS [97.5% (risk factors = 0) vs. 92.7% (risk factors = 1) vs. 85.1% (risk factors = 2) vs. 72.9% (risk factors = 3); P < 0.001]. The AC group had lower DSS for patients without risk factors than the non-AC group. However, there was no significant difference in survival outcomes among patients with risk factors between the AC and non-AC groups.

CONCLUSION

Stage I GC patients exhibited excellent long-term outcomes post-curative resection. Independent prognostic factors included age, pT stage, and tumor diameter. AC failed to provide any additional survival advantage for these patients.

Early prediction of progression-free survival of patients with locally advanced nasopharyngeal carcinoma using multi-parametric MRI radiomics

PURPOSE

Prognostic prediction plays a pivotal role in guiding personalized treatment for patients with locoregionally advanced nasopharyngeal carcinoma (LANPC). However, few studies have investigated the incremental value of functional MRI to the conventional MRI-based radiomic models. Here, we aimed to develop a radiomic model including functional MRI to predict the prognosis of LANPC patients.

METHODS

One hundred and twenty-six patients (training dataset, n = 88; validation dataset, n = 38) with LANPC were retrospectively included. Radiomic features were extracted from T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), contrast-enhanced T1WI (cT1WI), and diffusion-weighted imaging (DWI). Pearson correlation analysis and recursive feature elimination or Relief were used for identifying features associated with progression-free survival (PFS). Five machine learning algorithms with cross-validation were compared to develop the optimal single-layer and fusion radiomic models. Clinical and combined models were developed via multivariate Cox regression model.

RESULTS

The clinical model based on TNM stage achieved a C-index of 0.544 in the validation dataset. The fusion radiomic model, incorporating DWI-, T1WI-, and cT1WI-derived imaging features, yielded the highest C-index of 0.788, outperforming DWI-based (C-index = 0.739), T1WI-based (C-index = 0.734), cT1WI-based (C-index = 0.722), and T1WI plus cT1WI-based models (C-index = 0.747) in predicting PFS. The fusion radiomic model yielded the C-index of 0.786 and 0.690 in predicting distant metastasis-free survival and overall survival, respectively. However, the addition of TNM stage to the fusion radiomic model could not improve the predictive power.

CONCLUSION

The fusion radiomic model demonstrates favorable performance in predicting survival outcomes in LANPC patients, surpassing TNM staging alone. Integration of DWI-derived features into conventional MRI radiomic models could enhance predictive accuracy.

Radiological tele-immersion for next generation networks

Since the acquisition of high-resolution three-dimensional patient images has become widespread, medical volumetric datasets (CT or MR) larger than 100 MB and encompassing more than 250 slices are common. It is important to make this patient-specific data quickly available and usable to many specialists at different geographical sites. Web-based systems have been developed to provide volume or surface rendering of medical data over networks with low fidelity, but these cannot adequately handle stereoscopic visualization or huge datasets. State-of-the-art virtual reality techniques and high speed networks have made it possible to create an environment for clinicians geographically distributed to immersively share these massive datasets in real-time. An object-oriented method for instantaneously importing medical volumetric data into Tele-Immersive environments has been developed at the Virtual Reality in Medicine Laboratory (VRMedLab) at the University of Illinois at Chicago (UIC). This networked-VR setup is based on LIMBO, an application framework or template that provides the basic capabilities of Tele-Immersion. We have developed a modular general purpose Tele-Immersion program that automatically combines 3D medical data with the methods for handling the data. For this purpose a DICOM loader for IRIS Performer has been developed. The loader was designed for SGI machines as a shared object, which is executed at LIMBO's runtime. The loader loads not only the selected DICOM dataset, but also methods for rendering, handling, and interacting with the data, bringing networked, real-time, stereoscopic interaction with radiological data to reality. Collaborative, interactive methods currently implemented in the loader include cutting planes and windowing. The Tele-Immersive environment has been tested on the UIC campus over an ATM network. We tested the environment with 3 nodes; one ImmersaDesk at the VRMedLab, one CAVE at the Electronic Visualization Laboratory (EVL) on east campus, and a CT scan machine in UIC Hospital. CT data was pulled directly from the scan machine to the Tele-Immersion server in our Laboratory, and then the data was synchronously distributed by our Onyx2 Rack server to all the VR setups. Instead of permitting medical volume visualization at one VR device, by combining teleconferencing, tele-presence, and virtual reality, the Tele-Immersive environment will enable geographically distributed clinicians to intuitively interact with the same medical volumetric models, point, gesture, converse, and see each other. This environment will bring together clinicians at different geographic locations to participate in Tele-Immersive consultation and collaboration.