scholarly journals Artificial intelligence in medical imaging: A radiomic guide to precision phenotyping of cardiovascular disease

2020 ◽  
Vol 116 (13) ◽  
pp. 2040-2054 ◽  
Author(s):  
Evangelos K Oikonomou ◽  
Musib Siddique ◽  
Charalambos Antoniades
Keyword(s):  
Artificial Intelligence ◽  
Cardiovascular Disease ◽  
Computational Models ◽  
Cardiac Computed Tomography ◽  
Clinical Care ◽  
Cardiovascular Imaging ◽  
Current Status ◽  
Current Evidence ◽  
Scientific Validity ◽  
Non Invasive

Abstract Rapid technological advances in non-invasive imaging, coupled with the availability of large data sets and the expansion of computational models and power, have revolutionized the role of imaging in medicine. Non-invasive imaging is the pillar of modern cardiovascular diagnostics, with modalities such as cardiac computed tomography (CT) now recognized as first-line options for cardiovascular risk stratification and the assessment of stable or even unstable patients. To date, cardiovascular imaging has lagged behind other fields, such as oncology, in the clinical translational of artificial intelligence (AI)-based approaches. We hereby review the current status of AI in non-invasive cardiovascular imaging, using cardiac CT as a running example of how novel machine learning (ML)-based radiomic approaches can improve clinical care. The integration of ML, deep learning, and radiomic methods has revealed direct links between tissue imaging phenotyping and tissue biology, with important clinical implications. More specifically, we discuss the current evidence, strengths, limitations, and future directions for AI in cardiac imaging and CT, as well as lessons that can be learned from other areas. Finally, we propose a scientific framework in order to ensure the clinical and scientific validity of future studies in this novel, yet highly promising field. Still in its infancy, AI-based cardiovascular imaging has a lot to offer to both the patients and their doctors as it catalyzes the transition towards a more precise phenotyping of cardiovascular disease.

Weight Loss in Breast Cancer Patient Management

2002 ◽  
Vol 20 (4) ◽  
pp. 1128-1143 ◽  
Author(s):  
Rowan T. Chlebowski ◽  
Erin Aiello ◽  
Anne McTiernan
Keyword(s):  
Breast Cancer ◽  
Weight Loss ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Clinical Care ◽  
Current Status ◽  
Current Evidence ◽  
Dietary Therapy ◽  
Breast Cancer Patients ◽  
Breast Cancer Outcome

PURPOSE: To systematically review and summarize evidence relevant to obesity and breast cancer clinical outcome, potential hormonal mediating mechanisms, and the current status of weight loss interventions for chronic disease management. METHODS: A comprehensive, formal literature review was conducted to identify 5,687 citations with key information from 159 references summarized in text and tables. This process included a search for all breast cancer studies exploring associations among survival or recurrence and obesity at diagnosis or weight gain after diagnosis using prospective criteria. RESULTS: On the basis of observational studies, women with breast cancer who are overweight or gain weight after diagnosis are found to be at greater risk for breast cancer recurrence and death compared with lighter women. Obesity is also associated with hormonal profiles likely to stimulate breast cancer growth. Recently, use of weight loss algorithms proven successful in other clinical settings that incorporate dietary therapy, physical activity, and ongoing behavior therapy have been endorsed by the National Institutes of Health and other health agencies. CONCLUSION: Although definitive weight loss intervention trials in breast cancer patients remain to be conducted, the current evidence relating increased body weight to adverse breast cancer outcome and the documented favorable effects of weight loss on clinical outcome in other comorbid conditions support consideration of programs for weight loss in breast cancer patients. Recommendations for the clinical care of overweight or obese breast cancer patients are offered.

scholarly journals Functional assessment of coronary plaques using CT based hemodynamic simulations: current status, technical principles and clinical value

Imaging ◽  
2020 ◽  
Author(s):  
Melinda Boussoussou ◽  
Borbála Vattay ◽  
Bálint Szilveszter ◽  
Márton Kolossváry ◽  
Judit Simon ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Rapid Evolution ◽  
Current Status ◽  
Current Evidence ◽  
Fractional Flow ◽  
Clinical Value ◽  
Non Invasive ◽  
Flow Reserve ◽  
Stable Chest Pain ◽  
European Society Of Cardiology

Abstract:In recent years, coronary computed tomography angiography (CCTA) has emerged as an accurate and safe non-invasive imaging modality in terms of detecting and excluding coronary artery disease (CAD). In the latest European Society of Cardiology Guidelines CCTA received Class I recommendation for the evaluation of patients with stable chest pain with low to intermediate clinical likelihood of CAD. Despite its high negative predictive value, the diagnostic performance of CCTA is limited by the relatively low specificity, especially in patients with heavily calcified lesions. The discrepancy between the degree of stenosis and ischemia is well established based on both invasive and non-invasive tests. The rapid evolution of computational flow dynamics has allowed the simulation of CCTA derived fractional flow reserve (FFR-CT), which improves specificity by combining anatomic and functional information regarding coronary atherosclerosis. FFR-CT has been extensively validated against invasively measured FFR as the reference standard. Due to recent technological advancements FFR-CT values can also be calculated locally, without offsite processing. Wall shear stress (WSS) and axial plaque stress (APS) are additional key hemodynamic elements of atherosclerotic plaque characteristics, which can also be measured using CCTA images. Current evidence suggests that WSS and APS are important hemodynamic features of adverse coronary plaques. CCTA based hemodynamic calculations could therefore improve prognostication and the management of patients with stable CAD.

scholarly journals KNOWLEDGE, ATTITUDE AND PERCEPTION TOWARD EVIDENCE BASED MEDICINE AMONG MEDICAL STUDENTS IN SHENDI UNIVERSITY- SUDAN

2021 ◽  
Vol 9 (3) ◽  
pp. 149-155
Author(s):  
Naba’a Alkhair ALshaikh ◽  
Haghamad Allzain ◽  
Bashier Eltayeb Shumo
Keyword(s):  
Medical Students ◽  
Evidence Based Medicine ◽  
Clinical Care ◽  
Current Status ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Cross Sectional ◽  
Poor Knowledge ◽  
Based Medicine

Evidence-based medicine (EBM) is the “conscientious, explicit, and judicious use of current best evidence (Thamer Z. et al. 2018 .It is the evolving science of clinical care. It is the judicious use of the best current evidence in making decisions about the care of the individual patient.  It also integrates clinical expertise, patient desires, values, and needs .  (Michael LeFevre.2014 ) The current study intended to assess Knowledge, attitude and perception toward EBM among medical students in Shendi University in Sudan. It was descriptive cross-sectional one, from October to December 2020; It included one hundred and twenty one (121) medical students. Data was collected employing structural self –administered questionnaire and the data collected was analyzed by SPSS. The findings of the study described the current status of level of awareness and use of EBM .More than half of students have poor knowledge toward EBM. Approximately half or less have good attitude compared with their poor knowledge, while the perception of the importance of evidence based medicine was good (72%).

scholarly journals Cardiovascular Imaging in South Africa

2011 ◽  
Vol 15 (3) ◽  
pp. 66
Author(s):  
Leonie Scholtz
Keyword(s):  
South Africa ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
Cardiovascular Imaging ◽  
Diagnostic Tools ◽  
Coronary Cta ◽  
Non Invasive ◽  
High Incidence ◽  
Role Players ◽  
Very High

Approximately 17 million people die every year from cardiovascular disease or stroke. South Africa has a very high incidence of ischemic heart disease. We have access to superb diagnostic tools that enable us to play a pivotal role in the non-invasive diagnosis of heart disease. I believe the time is ripe for renewed discussions between the role players (the RSSA, cardiologists, radiologists and the reimbursing companies) in order to elevate coronary CTA and CMR to the level where they belong: undoubtedly enormously valuable diagnostic tools which are currently shamelessly underutilized, to the detriment of many patients who have an enhanced chance of dying of a cardiovascular condition as a result of being investigated by inferior and/or invasive tests.

scholarly journals Seizure Diaries and Forecasting With Wearables: Epilepsy Monitoring Outside the Clinic

2021 ◽  
Vol 12 ◽  
Author(s):  
Benjamin H. Brinkmann ◽  
Philippa J. Karoly ◽  
Ewan S. Nurse ◽  
Sonya B. Dumanis ◽  
Mona Nasseri ◽  
...  
Keyword(s):  
Electrodermal Activity ◽  
Clinical Care ◽  
Wearable Devices ◽  
Current Evidence ◽  
Computer Assisted ◽  
Non Invasive ◽  
Probabilistic Forecasts ◽  
Essential Components ◽  
Epilepsy Monitoring

It is a major challenge in clinical epilepsy to diagnose and treat a disease characterized by infrequent seizures based on patient or caregiver reports and limited duration clinical testing. The poor reliability of self-reported seizure diaries for many people with epilepsy is well-established, but these records remain necessary in clinical care and therapeutic studies. A number of wearable devices have emerged, which may be capable of detecting seizures, recording seizure data, and alerting caregivers. Developments in non-invasive wearable sensors to measure accelerometry, photoplethysmography (PPG), electrodermal activity (EDA), electromyography (EMG), and other signals outside of the traditional clinical environment may be able to identify seizure-related changes. Non-invasive scalp electroencephalography (EEG) and minimally invasive subscalp EEG may allow direct measurement of seizure activity. However, significant network and computational infrastructure is needed for continuous, secure transmission of data. The large volume of data acquired by these devices necessitates computer-assisted review and detection to reduce the burden on human reviewers. Furthermore, user acceptability of such devices must be a paramount consideration to ensure adherence with long-term device use. Such devices can identify tonic–clonic seizures, but identification of other seizure semiologies with non-EEG wearables is an ongoing challenge. Identification of electrographic seizures with subscalp EEG systems has recently been demonstrated over long (>6 month) durations, and this shows promise for accurate, objective seizure records. While the ability to detect and forecast seizures from ambulatory intracranial EEG is established, invasive devices may not be acceptable for many individuals with epilepsy. Recent studies show promising results for probabilistic forecasts of seizure risk from long-term wearable devices and electronic diaries of self-reported seizures. There may also be predictive value in individuals' symptoms, mood, and cognitive performance. However, seizure forecasting requires perpetual use of a device for monitoring, increasing the importance of the system's acceptability to users. Furthermore, long-term studies with concurrent EEG confirmation are lacking currently. This review describes the current evidence and challenges in the use of minimally and non-invasive devices for long-term epilepsy monitoring, the essential components in remote monitoring systems, and explores the feasibility to detect and forecast impending seizures via long-term use of these systems.

Cardiovascular imaging in Turner syndrome: state-of-the-art practice across the lifespan

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1823-1831 ◽  
Author(s):  
Kristian H Mortensen ◽  
Luciana Young ◽  
Julie De Backer ◽  
Michael Silberbach ◽  
Ronnie Thomas Collins ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Turner Syndrome ◽  
State Of The Art ◽  
Clinical Care ◽  
Premature Death ◽  
Cardiovascular Imaging ◽  
Non Invasive ◽  
Increased Risk ◽  
High Incidence

Cardiovascular imaging is essential to providing excellent clinical care for girls and women with Turner syndrome (TS). Congenital and acquired cardiovascular diseases are leading causes of the lifelong increased risk of premature death in TS. Non-invasive cardiovascular imaging is crucial for timely diagnosis and treatment planning, and a systematic and targeted imaging approach should combine echocardiography, cardiovascular magnetic resonance and, in select cases, cardiac CT. In recent decades, evidence has mounted for the need to perform cardiovascular imaging in all females with TS irrespective of karyotype and phenotype. This is due to the high incidence of outcome-determining lesions that often remain subclinical and occur in patterns specific to TS. This review provides an overview of state-of-the-art cardiovascular imaging practice in TS, by means of a review of the most recent literature, in the context of a recent consensus statement that has highlighted the role of cardiovascular diseases in these females.

COVID-19 in children: Pathogenesis and current status

2020 ◽  
Author(s):  
Lawrence Frenkel ◽  
Fernando Gomez ◽  
Joseph A Bellanti
Keyword(s):  
Respiratory Disease ◽  
Respiratory Symptoms ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Current Status ◽  
Current Evidence ◽  
Initial Description ◽  
Relationship Of ◽  
Inflammatory Syndrome ◽  
The Relationship

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C).Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions.Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19–associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C.Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2–associated MIS-C similar to KD.

Use of Three-dimensional Printing in the Development of Optimal Cardiac CT Scanning Protocols

2020 ◽  
Vol 16 (8) ◽  
pp. 967-977
Author(s):  
Zhonghua Sun
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Computed Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Aortic Diseases ◽  
Clinical Value ◽  
Three Dimensional Printing ◽  
Doctor Patient Communication ◽  
Medical Education And Training ◽  
3D Printed

Three-dimensional (3D) printing is increasingly used in medical applications with most of the studies focusing on its applications in medical education and training, pre-surgical planning and simulation, and doctor-patient communication. An emerging area of utilising 3D printed models lies in the development of cardiac computed tomography (CT) protocols for visualisation and detection of cardiovascular disease. Specifically, 3D printed heart and cardiovascular models have shown potential value in the evaluation of coronary plaques and coronary stents, aortic diseases and detection of pulmonary embolism. This review article provides an overview of the clinical value of 3D printed models in these areas with regard to the development of optimal CT scanning protocols for both diagnostic evaluation of cardiovascular disease and reduction of radiation dose. The expected outcomes are to encourage further research towards this direction.

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