scholarly journals A precision medicine framework for personalized simulation of hemodynamics in cerebrovascular disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dietmar Frey ◽  
Michelle Livne ◽  
Heiko Leppin ◽  
Ela M. Akay ◽  
Orhun U. Aydin ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Precision Medicine ◽  
High Specificity ◽  
Cerebral Hemodynamics ◽  
Brain Vessels ◽  
Vessel Imaging ◽  
Blood Pressures ◽  
Novel Biomarkers ◽  
Public Health Challenge ◽  
Moderate Sensitivity

Abstract Background Cerebrovascular disease, in particular stroke, is a major public health challenge. An important biomarker is cerebral hemodynamics. To measure and quantify cerebral hemodynamics, however, only invasive, potentially harmful or time-to-treatment prolonging methods are available. Results We present a simulation-based approach which allows calculation of cerebral hemodynamics based on the patient-individual vessel configuration derived from structural vessel imaging. For this, we implemented a framework allowing segmentation and annotation of brain vessels from structural imaging followed by 0-dimensional lumped simulation modeling of cerebral hemodynamics. For annotation, a 3D-graphical user interface was implemented. For 0D-simulation, we used a modified nodal analysis, which was adapted for easy implementation by code. The simulation enables identification of areas vulnerable to stroke and simulation of changes due to different systemic blood pressures. Moreover, sensitivity analysis was implemented allowing the live simulation of changes to simulate procedures and disease progression. Beyond presentation of the framework, we demonstrated in an exploratory analysis in 67 patients that the simulation has a high specificity and low-to-moderate sensitivity to detect perfusion changes in classic perfusion imaging. Conclusions The presented precision medicine approach using novel biomarkers has the potential to make the application of harmful and complex perfusion methods obsolete.

scholarly journals A Precision Medicine Framework for Personalized Simulation of Hemodynamics in Cerebrovascular Disease

2021 ◽  
Author(s):  
Dietmar Frey ◽  
Michelle Livne ◽  
Heiko Leppin ◽  
Ela Marie Akay ◽  
Orhun Aydin ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Precision Medicine ◽  
High Specificity ◽  
Simulation Modelling ◽  
Cerebral Hemodynamics ◽  
Brain Vessels ◽  
Vessel Imaging ◽  
Blood Pressures ◽  
Novel Biomarkers ◽  
Public Health Challenge

Abstract Cerebrovascular disease, in particular stroke, is a major public health challenge. An important biomarker is cerebral hemodynamics. To measure and quantify cerebral hemodynamics, however, only invasive, potentially harmful or time-to-treatment prolonging methods are available. We present a simulation-based approach which allows calculation of cerebral hemodynamics based on the patient-individual vessel configuration derived from structural vessel imaging. For this, we implemented a framework allowing segmentation and annotation of brain vessels from structural imaging followed by 0-dimensional lumped simulation modelling of cerebral hemodynamics. For annotation, a 3D-graphical user interface was implemented. For 0D-simulation, we used a modified nodal analysis, which was adapted for easy implementation by code. The simulation enables identification of areas vulnerable to stroke and simulation of changes due to different systemic blood pressures. Moreover, sensitivity analysis was implemented allowing the live simulation of changes to simulate procedures and disease progression. Beyond presentation of the framework, we demonstrated in an exploratory analysis in 67 patients that the simulation has a high specificity and low to moderate sensitivity to detect perfusion changes in classic perfusion imaging. The presented precision medicine approach using novel biomarkers has the potential to make the application of harmful and complex perfusion methods obsolete.

scholarly journals A Precision Medicine Framework for Personalized Simulation of Hemodynamics in Cerebrovascular Disease

2020 ◽  
Author(s):  
Dietmar Frey ◽  
Michelle Livne ◽  
Heiko Leppin ◽  
Ela M Akay ◽  
Orhun U Aydin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cerebrovascular Disease ◽  
Precision Medicine ◽  
Cerebral Hemodynamics ◽  
Successful Implementation ◽  
Dynamic Susceptibility ◽  
Brain Vessels ◽  
Vessel Lumen ◽  
Vessel Imaging ◽  
Simulation Results

AbstractIntroductionCerebrovascular disease is a major public health challenge. An important biomarker is cerebral hemodynamics. To measure cerebral hemodynamics, however, only invasive, potentially harmful or time-to-treatment prolonging methods are available. We present a simulation-based alternative which allows calculation of cerebral hemodynamics based on the individual vessel con figuration of a patient derived from structural vessel imaging.MethodsWe implemented a framework allowing annotation of extracted brain vessels from structural imaging followed by 0-dimensional lumped modelling of cerebral hemodynamics. For annotation, a 3D-graphical user interface (GUI) was implemented. For 0D-simulation, we used a modified nodal analysis (MNA), which was adapted for easy implementation by code. The code was written in-house in java. The simulation GUI allows inspection of simulation results, identification of vulnerable areas, simulation of changes due to different systemic blood pressures. Moreover, sensitivity analysis was implemented allowing the live simulation of changes of variables such as vessel lumen to simulate procedures and disease courses. In two exemplary patients, simulation results were compared to dynamic-susceptibility-weighted-contrast-enhanced magnetic- resonance(DSC-MR) perfusion imaging.ResultsThe successful implementation of the framework allowing individualized annotation and simulation of patients is presented. In two exemplary patients, both the simulation as well as DSC- MRI showed the same results pertaining to the identification of areas vulnerable to ischemia. Sensitivity analysis allows the individualized simulation of changes in vessel lumen and the effect on hemodynamics.DiscussionWe present the first precision medicine pipeline for cerebrovascular disease which allows annotation of the arterial vasculature derived from structural vessel imaging followed by personalized simulation of brain hemodynamics. This paves the way for further development of precision medicine in stroke using novel biomarkers and might make the application of harmful and complex perfusion methods obsolete for certain use cases in the future.

Bladder cancer

2017 ◽  
Author(s):  
Richard P. Meijer ◽  
Alexandre R. Zlotta ◽  
Bas W.G. van Rhijn
Keyword(s):  
Bladder Cancer ◽  
High Specificity ◽  
Invasive Bladder Cancer ◽  
Urinary Cytology ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Non Invasive ◽  
Important Diagnostic Tool ◽  
Moderate Sensitivity ◽  
Muscle Invasive

High-grade non-muscle-invasive bladder cancer (HG-NMIBC) represents the most aggressive spectrum of this non-invasive cancer. This collective term includes all high-grade NMI urothelial carcinoma (UC), such as those without invasion (pTa), those with lamina propria invasion (pT1), and those that are only/have concomitant carcinoma in situ (CIS; pTis). These cancers have a high risk for intravesical recurrence (around 46–78% at five years) and progression (between 6–45% at five years) to muscle-invasive bladder cancer (MIBC). As with all UC, their presentation can be with visible haematuria or irritative lower urinary tract symptoms. The latter are common in patients with CIS. CIS may be detected in isolation (so-called primary CIS) or with a coexisting UC elsewhere (termed concomitant CIS). While urinary cytology has a moderate sensitivity and high specificity (>90%) for the detection of HG-NMIBC, cystoscopy is the most important diagnostic tool.

scholarly journals Diagnostic tests for tuberculous lymphadenitis: fine needle aspirations using tissue culture in mycobacteria growth indicator tube and tissue PCR

2010 ◽  
Vol 4 (5) ◽  
pp. 787-792 ◽  
Author(s):  
Pakpoom Supiyaphun ◽  
Somying Tumwasorn ◽  
Nibondh Udomsantisuk ◽  
Somboon Keelawat ◽  
Wilailuck Songsrisanga ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
High Specificity ◽  
Tuberculous Lymphadenitis ◽  
Open Biopsy ◽  
Fine Needle ◽  
Indicator Tube ◽  
Moderate Sensitivity ◽  
Growth Indicator

Abstract Background: The diagnosis of tuberculous lymphadenitis (TBLN) ranges from therapeutic diagnosis to open biopsy with tissue culture. The open biopsies are accepted as the gold standard to diagnose TBLN, but it requires skin incision that leaves unwanted scars. Objective: Test the sensitivity and specificity of fine needle aspiration (FNA) using tissue culture in mycobacteria growth indicator tube (MGIT) and tissue polymerase chain reaction (PCR) for comparison with open biopsy using tissue culture. Subject and methods: Forty patients with clinically suspected cervical tuberculous lymphadenitis were recruited at King Chulalongkorn Memorial Hospital. The patients underwent FNA followed by open biopsies either excisional or incisional. Specimens from FNA were collected for tissue culture in MGIT and for tissue PCR. The specimens from open biopsies were divided into two portions for tissue culture in MGIT (the gold standard) and for hispathology. Results: FNA for tissue culture in MGIT had a moderate sensitivity (65%) but high specificity (83%) (73% positive and 76% negative predictive value). FNA for tissue PCR had a moderate sensitivity (53%) but very high specificity (96%) (90% positive and 73% negative predictive values). Combination of either FNA for tissue culture or FNA tissue PCR revealed an increase in sensitivity and specificity to 83.6% and 80.0%, respectively. However, a combination of both FNA for tissue culture and FNA tissue PCR revealed a decrease in sensitivity (34.5%) but a highly increase in specificity (99.0%). Conclusion: Either the FNA using tissue culture in MGIT or tissue PCR had a moderate sensitivity but high specificity. FNA using tissue culture or FNA tissue PCR may be used as an alternative test for diagnosis TBLN. The techniques may replace the open biopsies because of its effectiveness and low complication rate.

Role of Sediment Cytology in the Early Diagnosis of Bone Lesions and Its Comparison with Histopathological Findings

2021 ◽  
Vol 8 (03) ◽  
pp. 162-167
Author(s):  
Aiswarya K.P. ◽  
Priya V.S ◽  
Deepthi Raj M.L ◽  
Indira K
Keyword(s):  
Early Diagnosis ◽  
High Specificity ◽  
Final Diagnosis ◽  
Bone Lesions ◽  
Diagnostic Efficacy ◽  
Moderate Sensitivity ◽  
Malignant Lesions ◽  
Very High ◽  
Rapid Tool

BACKGROUND Though histopathology is the gold standard investigation for diagnosing most benign and malignant lesions of bone, the decalcification process required for removing bone hardness makes it a time-consuming process. Sediment cytology is a rapid investigative procedure utilising the cells in the specimen containers after proper fixation, processing and staining. The objective of this study was to compare the diagnostic efficacy of sediment cytology of bone lesions with the histopathology. METHODS The study was conducted in 50 samples of bony tissues received in the histopathology lab during the study time. The fixative fluid containing specimens were first agitated for procuring the cells from the sample. The sediment obtained was processed and stained as a cytology sample and studied under microscope. Based on cytology findings they were classified into benign, malignant, inflammatory and inconclusive. The specimen was processed as routine histopathologic sample and final diagnosis was made from it. RESULTS Sediment cytology of malignant bone lesions showed a very high specificity (100 %) but only a moderate sensitivity of 80 %. Sediment cytology of benign bone lesions also showed a higher specificity of 100 % but only a moderate sensitivity of 84.6 %. CONCLUSIONS If adequately cellular, biopsy sediment cytology is a simple, inexpensive, rapid tool for the early diagnosis of bone lesions. Sediment cytology can act as a good complementary test to histopathology. KEYWORDS Bone Lesions, Cytology, Sediment Cytology, Histopathology

EVALUATION OF SERUM URIC ACID AND ITS CORRELATION IN YOUNG NEWLY DIAGNOSED ESSENTIAL HYPERTENSIVES

2021 ◽  
pp. 65-66
Author(s):  
Atindra Narayan ◽  
Kuber Sharma ◽  
D.K. Sharma
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Newly Diagnosed ◽  
Blood Pressures ◽  
Public Health Challenge ◽  
Prognostic Importance ◽  
Control Study

Background: Hypertension is a major public health challenge and is the third leading killer in the World. The serum uric acid has shown some prognostic importance in essential hypertension Methodology: Acase control study was undertaken in a tertiary care hospital in Gurugram. Seventy ve cases of hypertension and equal number of controls were studied for the hypertension and serum uric acid levels. Results:This study had shown that, majority of the cases and controls were aged 31 – 40 years and females. The blood pressures were signicantly more in the cases than controls. Serum uric acid levels were also signicantly higher in cases than controls. There was no statistically signicant difference in serum uric acid levels between different stages of hypertension. Conclusion:The serum uric acid levels were signicantly higher in cases of hypertension than controls.

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