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Ashe J, Graf J, Madhavan R, Wallace K, Cotero V, Abate S, Pandey RK, Herzog R, Porindla SN, Shoudy D, Fan Y, Kao TJ, Puleo C. Investigation of liver-targeted peripheral focused ultrasound stimulation (pFUS) and its effect on glucose homeostasis and insulin resistance in type 2 diabetes mellitus: a proof of concept, phase 1 trial. QJM 2023; 116:667-685. [PMID: 37243693 DOI: 10.1093/qjmed/hcad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/26/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Mechanical waves produced by ultrasound pulses have been shown to activate mechanosensitive ion channels and modulate peripheral nerves. However, while peripheral ultrasound neuromodulation has been demonstrated in vitro and in pre-clinical models, there have been few reports of clinical tests. AIM We modified a diagnostic imaging system for ultrasound neuromodulation in human subjects. We report the first safety and feasibility outcomes in subjects with type 2 diabetes (T2D) mellitus and discuss these outcomes in relation to previous pre-clinical results. DESIGN The study was performed as an open label feasibility study to assess the effects of hepatic ultrasound (targeted to the porta hepatis) on glucometabolic parameters in subjects with T2D. Stimulation (peripheral focused ultrasound stimulation treatment) was performed for 3 days (i.e. 15 min per day), preceded by a baseline examination and followed by a 2-week observation period. METHODS Multiple metabolic assays were employed including measures of fasting glucose and insulin, insulin resistance and glucose metabolism. The safety and tolerability were also assessed by monitoring adverse events, changes in vital signs, electrocardiogram parameters and clinical laboratory measures. RESULTS AND CONCLUSION We report post-pFUS trends in several outcomes that were consistent with previous pre-clinical findings. Fasting insulin was lowered, resulting in a reduction of HOMA-IR scores (P-value 0.01; corrected Wilcoxon signed-rank test). Additional safety and exploratory markers demonstrated no device-related adverse impact of pFUS. Our findings demonstrate that pFUS represents a promising new treatment modality that could be used as a non-pharmaceutical adjunct or even alternative to current drug treatments in diabetes.
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Affiliation(s)
- J Ashe
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - J Graf
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - R Madhavan
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - K Wallace
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - V Cotero
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - S Abate
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - R K Pandey
- General Electric (GE) Research, Bengaluru, India
| | - R Herzog
- Yale Endocrinology & Metabolism, Yale School of Medicine, New Haven, CT, USA
| | - S N Porindla
- General Electric (GE) Research, Bengaluru, India
| | - D Shoudy
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Y Fan
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - T-J Kao
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - C Puleo
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
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2
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Zanos S, Ntiloudi D, Pellerito J, Ramdeo R, Graf J, Wallace K, Cotero V, Ashe J, Moon J, Addorisio M, Shoudy D, Coleman TR, Brines M, Puleo C, Tracey KJ, Chavan SS. Focused ultrasound neuromodulation of the spleen activates an anti-inflammatory response in humans. Brain Stimul 2023; 16:703-711. [PMID: 37055009 PMCID: PMC10330863 DOI: 10.1016/j.brs.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
Focused ultrasound stimulation (FUS) activates mechanosensitive ion channels and is emerging as a method of noninvasive neuromodulation. In preclinical studies, FUS of the spleen (sFUS) activates an anti-inflammatory neural pathway which suppresses acute and chronic inflammation. However, the relevance of sFUS for regulating inflammatory responses in humans is unknown. Here, we used a modified diagnostic ultrasound imaging system to target the spleen of healthy human subjects with 3 min of continuously swept or stationary focused pulsed ultrasound, delivered at three different energy levels within allowable safety exposure limits. Potential anti-inflammatory effects of sFUS were assessed by measuring sFUS-elicited changes in endotoxin-induced tumor necrosis factor (TNF) production in whole blood samples from insonified subjects. We found that stimulation with either continuously swept or focused pulsed ultrasound has an anti-inflammatory effect: sFUS lowers TNF production for >2 h, with TNF returning to baseline by 24 h following sFUS. This response is independent of anatomical target (i.e., spleen hilum or parenchyma) or ultrasound energy level. No clinical, biochemical, or hematological parameters are adversely impacted. This is the first demonstration that sFUS suppresses the normal inflammatory response in humans, with potential implications for noninvasive bioelectronic therapy of inflammatory disorders.
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Affiliation(s)
- Stavros Zanos
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Despoina Ntiloudi
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Pellerito
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Radiology, Northwell Health, Manhasset, NY, 11030, USA
| | - Richard Ramdeo
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Graf
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Kirk Wallace
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | | | - Jeff Ashe
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Jessica Moon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Meghan Addorisio
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - David Shoudy
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Thomas R Coleman
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Michael Brines
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Chris Puleo
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Kevin J Tracey
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sangeeta S Chavan
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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3
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Hoerig C, Wallace K, Wu M, Mamou J. Classification of Metastatic Lymph Nodes In Vivo Using Quantitative Ultrasound at Clinical Frequencies. Ultrasound Med Biol 2023; 49:787-801. [PMID: 36470739 DOI: 10.1016/j.ultrasmedbio.2022.10.018] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 06/17/2023]
Abstract
Quantitative ultrasound (QUS) methods characterizing the backscattered echo signal have been of use in assessing tissue microstructure. High-frequency (30 MHz) QUS methods have been successful in detecting metastases in surgically excised lymph nodes (LNs), but limited evidence exists regarding the efficacy of QUS for evaluating LNs in vivo at clinical frequencies (2-10 MHz). In this study, a clinical scanner and 10-MHz linear probe were used to collect radiofrequency (RF) echo data of LNs in vivo from 19 cancer patients. QUS methods were applied to estimate parameters derived from the backscatter coefficient (BSC) and statistics of the envelope-detected RF signal. QUS parameters were used to train classifiers based on linear discriminant analysis (LDA) and support vector machines (SVMs). Two BSC-based parameters, scatterer diameter and acoustic concentration, were the most effective for accurately detecting metastatic LNs, with both LDA and SVMs achieving areas under the receiver operating characteristic (AUROC) curve ≥0.94. A strategy of classifying LNs based on the echo frame with the highest cancer probability improved performance to 88% specificity at 100% sensitivity (AUROC = 0.99). These results provide encouraging evidence that QUS applied at clinical frequencies may be effective at accurately identifying metastatic LNs in vivo, helping in diagnosis while reducing unnecessary biopsies and surgical treatments.
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Affiliation(s)
- Cameron Hoerig
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.
| | | | - Maoxin Wu
- Department of Pathology, Stony Brook University, Stony Brook, New York, USA
| | - Jonathan Mamou
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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4
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Wallace K. S-29-03 Silencing mitochondrial toxicity; an age-old problem. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Machado P, Gupta I, Fenkel JM, Gummadi S, Stanczak M, Wessner CE, Shaw CM, Schultz S, Soulen MC, Wallace K, Eisenbrey JR, Forsberg F. Ultrasound Pressure Estimation for Diagnosing Portal Hypertension in Patients Undergoing Dialysis for Chronic Kidney Disease. J Ultrasound Med 2022; 41:2181-2189. [PMID: 34850412 PMCID: PMC9156659 DOI: 10.1002/jum.15897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Hepatic venous pressure gradient (HVPG) is considered the standard in quantifying portal hypertension, but can be unreliable in dialysis patients. A noninvasive ultrasound technique, subharmonic-aided pressure estimation (SHAPE), may be a valuable surrogate of these pressure estimates. This study compared SHAPE and HVPG with pathology findings for fibrosis in dialysis patients. METHODS This was a subgroup study from an IRB-approved trial that included 20 patients on dialysis undergoing SHAPE examinations of portal and hepatic veins using a modified Logiq 9 scanner (GE, Waukesha, WI), during infusion of Sonazoid (GE Healthcare, Oslo, Norway). SHAPE was compared to HVPG and pathology findings using the Ludwig-Batts scoring system for fibrosis. Logistic regression, ROC analysis, and t-tests were used to compare HVPG and SHAPE with pathological findings of fibrosis. RESULTS Of 20 cases, 5 had HVPG values corresponding to subclinical and clinical portal hypertension (≥6 and ≥10 mmHg, respectively) while 15 had normal HVPG values (≤5 mmHg). SHAPE and HVPG correlated moderately (r = 0.45; P = .047). SHAPE showed a trend toward correlating with fibrosis (r = 0.42; P = .068), while HVPG did not (r = 0.18; P = .45). SHAPE could differentiate between mild (stage 0-1) and moderate to severe (stage 2-4) fibrosis (-10.4 ± 4.9 dB versus -5.4 ± 3.2 dB; P = .035), HVPG could not (3.0 ± 0.6 mmHg versus 4.8 ± 0.7 mmHg; P = .30). ROC curves showed a diagnostic accuracy for SHAPE of 80%, while HVPG reached 76%. CONCLUSION Liver fibrosis staging in dialysis patients evaluated for portal hypertension appears to be more accurately predicted by SHAPE than by HVPG; albeit in a small sample size.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ipshita Gupta
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan M Fenkel
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Maria Stanczak
- Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Colette M Shaw
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan Schultz
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Soulen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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6
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Forsberg F, Piccoli CW, Sridharan A, Wilkes A, Sevrukov A, Ojeda-Fournier H, Mattrey RF, Machado P, Stanczak M, Merton DA, Wallace K, Eisenbrey JR. 3D Harmonic and Subharmonic Imaging for Characterizing Breast Lesions: A Multi-Center Clinical Trial. J Ultrasound Med 2022; 41:1667-1675. [PMID: 34694019 PMCID: PMC9884499 DOI: 10.1002/jum.15848] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Breast cancer is the most frequent type of cancer among women. This multi-center study assessed the ability of 3D contrast-enhanced ultrasound to characterize suspicious breast lesions using clinical assessments and quantitative parameters. METHODS Women with suspicious breast lesions scheduled for biopsy were enrolled in this prospective, study. Following 2D grayscale ultrasound and power Doppler imaging (PDI), a contrast agent (Definity; Lantheus) was administrated. Contrast-enhanced 3D harmonic imaging (HI; transmitting/receiving at 5.0/10.0 MHz), as well as 3D subharmonic imaging (SHI; transmitting/receiving at 5.8/2.9 MHz), were performed using a modified Logiq 9 scanner (GE Healthcare). Five radiologists independently scored the imaging modes (including standard-of-care imaging) using a 7-point BIRADS scale as well as lesion vascularity and diagnostic confidence. Parametric volumes were constructed from time-intensity curves for vascular heterogeneity, perfusion, and area under the curve. Diagnostic accuracy was determined relative to pathology using receiver operating characteristic (ROC) and reverse, step-wise logistical regression analyses. The κ-statistic was calculated for inter-reader agreement. RESULTS Data were successfully acquired in 219 cases and biopsies indicated 164 (75%) benign and 55 (25%) malignant lesions. SHI depicted more anastomoses and vascularity than HI (P < .021), but there were no differences by pathology (P > .27). Ultrasound achieved accuracies of 82 to 85%, which was significantly better than standard-of-care imaging (72%; P < .03). SHI increased diagnostic confidence by 3 to 6% (P < .05), but inter-reader agreements were medium to low (κ < 0.52). The best regression model achieved 97% accuracy by combining clinical reads and parametric SHI. CONCLUSIONS Combining quantitative 3D SHI parameters and clinical assessments improves the characterization of suspicious breast lesions.
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Affiliation(s)
- Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anush Sridharan
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Electrical and Computer Engineering, Drexel University, Philadelphia, PA, USA
| | - Annina Wilkes
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander Sevrukov
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert F Mattrey
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel A Merton
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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7
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Cotero V, Graf J, Miwa H, Hirschstein Z, Qanud K, Huerta TS, Tai N, Ding Y, Jimenez-Cowell K, Tomaio JN, Song W, Devarajan A, Tsaava T, Madhavan R, Wallace K, Loghin E, Morton C, Fan Y, Kao TJ, Akhtar K, Damaraju M, Barenboim L, Maietta T, Ashe J, Tracey KJ, Coleman TR, Di Carlo D, Shin D, Zanos S, Chavan SS, Herzog RI, Puleo C. Stimulation of the hepatoportal nerve plexus with focused ultrasound restores glucose homoeostasis in diabetic mice, rats and swine. Nat Biomed Eng 2022; 6:683-705. [PMID: 35361935 PMCID: PMC10127248 DOI: 10.1038/s41551-022-00870-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 10/26/2021] [Accepted: 02/18/2022] [Indexed: 12/17/2022]
Abstract
Peripheral neurons that sense glucose relay signals of glucose availability to integrative clusters of neurons in the brain. However, the roles of such signalling pathways in the maintenance of glucose homoeostasis and their contribution to disease are unknown. Here we show that the selective activation of the nerve plexus of the hepatic portal system via peripheral focused ultrasound stimulation (pFUS) improves glucose homoeostasis in mice and rats with insulin-resistant diabetes and in swine subject to hyperinsulinemic-euglycaemic clamps. pFUS modulated the activity of sensory projections to the hypothalamus, altered the concentrations of metabolism-regulating neurotransmitters, and enhanced glucose tolerance and utilization in the three species, whereas physical transection or chemical blocking of the liver-brain nerve pathway abolished the effect of pFUS on glucose tolerance. Longitudinal multi-omic profiling of metabolic tissues from the treated animals confirmed pFUS-induced modifications of key metabolic functions in liver, pancreas, muscle, adipose, kidney and intestinal tissues. Non-invasive ultrasound activation of afferent autonomic nerves may represent a non-pharmacologic therapy for the restoration of glucose homoeostasis in type-2 diabetes and other metabolic diseases.
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Affiliation(s)
- Victoria Cotero
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - John Graf
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Hiromi Miwa
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Khaled Qanud
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Tomás S Huerta
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Yuyan Ding
- Yale School of Medicine, New Haven, CT, USA
| | - Kevin Jimenez-Cowell
- Yale School of Medicine, New Haven, CT, USA
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Weiguo Song
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Alex Devarajan
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Tea Tsaava
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Radhika Madhavan
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Kirk Wallace
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Evelina Loghin
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Christine Morton
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Ying Fan
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Tzu-Jen Kao
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | | | | | | | | | - Jeffrey Ashe
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Dino Di Carlo
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Stavros Zanos
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | | | - Chris Puleo
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA.
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8
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Hume E, Muse H, Wallace K, Wilkinson M, Marshall KH, Nair A, Sanchez J, Benavent J, Rolden J, Clark S, Vogiatzis I. Feasibility of Smartphone-Based Physical Activity Tele-Coaching in Lung Transplant Recipients; an Interim Analysis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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Panaccione R, Ferrante M, Feagan BG, Sandborn W, Panes J, Peyrin-Biroulet L, Colombel J, Schreiber S, Dubinsky M, Baert F, Hisamatsu T, Neimark E, Huang B, Liao X, Song A, Berg S, Duan W, Pang Y, Pivorunas V, Kligys K, Wallace K, D’Haens G. A37 EFFICACY AND SAFETY OF RISANKIZUMAB AS MAINTENANCE THERAPY IN PATIENTS WITH CROHN’S DISEASE: 52 WEEK RESULTS FROM THE PHASE 3 FORTIFY STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859234 DOI: 10.1093/jcag/gwab049.036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Risankizumab (RZB), an anti-IL-23 p19 inhibitor, was well-tolerated and superior to placebo (PBO) in inducing clinical remission and endoscopic response in patients (pts) with moderate-to-severe Crohn’s disease (CD) in two phase 3 studies at 12 weeks. Aims FORTIFY (NCT03105102), was a 52-week (wk) phase 3 double-blind, re-randomized responder withdrawal study that evaluated the efficacy and safety of continuing RZB as subcutaneous (SC) maintenance therapy versus withdrawal to placebo in pts achieving induction response to RZB Methods Week 12 IV RZB responders were re-randomized 1:1:1 to: RZB SC 360mg (N=141), RZB 180mg (N=157), or PBO (withdrawal from IV RZB; N=164) every 8wks for 52wks. Co-primary endpoints were clinical remission (per CD Activity Index [CDAI] (US); or stool frequency/abdominal pain score [SF/APS] (OUS) and endoscopic response at wk52. Other clinical and endoscopic endpoints, inflammatory biomarkers, RZB serum levels, and safety were assessed over time. Results Rates of clinical remission (CDAI, SF/APS) and clinical response were similar for RZB and PBO groups through wk24, with rates lower for PBO thereafter. At wk52, clinical remission (CDAI, SF/APS) and endoscopic response rates were significantly higher with RZB 360mg than PBO ( P<0.01); RZB 180mg was superior to PBO for clinical remission per CDAI and endoscopic response ( P<0.01). Endoscopic remission and deep remission rates increased over time with 360mg, remained steady with 180mg, and decreased with PBO. Mean fecal calprotectin (FCP) and C-reactive protein (CRP) levels decreased with SC RZB, but increased with PBO, over 52wks. Exposure-adjusted event rates (per 100 pts-years) of serious adverse event (AE) were generally similar among groups (360mg, 21.0 E/100PY and 180mg, 19.5 E/100PY vs PBO, 19.3 E/100PY), as were AEs leading to drug discontinuation (4.8 E/100PY and 2.4 E/100PY vs 3.7 E/100PY), and serious infections (6.0 E/100PY and 3.0 E/100PY vs 5.0 E/100PY). Conclusions In pts with moderate-to-severe CD, a robust pharmacodynamic effect on the IL-23 pathway after 12wks RZB IV induction was maintained with RZB SC maintenance therapy. The durability of RZB was demonstrated with high rates of efficacy over the 52-wk study. RZB was superior to PBO for achieving clinical remission and endoscopic response at wk52. Results for the more stringent endpoints (endoscopic remission\deep remission) and persistent improvements in inflammatory biomarkers are consistent with a dose response relationship. Continued RZB SC maintenance treatment was generally safe and well-tolerated. Funding Agencies AbbVie
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Affiliation(s)
| | - M Ferrante
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
| | | | - W Sandborn
- University of California San Diego, La Jolla, CA
| | - J Panes
- Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | | | | | - S Schreiber
- Universitatsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | | | - F Baert
- AZ Delta vzw, Roeselare, West-Vlaanderen, Belgium
| | - T Hisamatsu
- Kyorin Daigaku Igakubu Daigakuin Igaku Kenkyuka, Mitaka, Tokyo, Japan
| | | | - B Huang
- AbbVie Inc, North Chicago, IL
| | - X Liao
- AbbVie Inc, North Chicago, IL
| | - A Song
- AbbVie Inc, North Chicago, IL
| | - S Berg
- AbbVie Inc, North Chicago, IL
| | - W Duan
- AbbVie Inc, North Chicago, IL
| | - Y Pang
- AbbVie Inc, North Chicago, IL
| | | | | | | | - G D’Haens
- Universiteit van Amsterdam, Amsterdam, Noord-Holland, Netherlands
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10
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Mitra J, Qiu J, MacDonald M, Venugopal P, Wallace K, Abdou H, Richmond M, Elansary N, Edwards J, Patel N, Morrison J, Marinelli L. Automatic Hemorrhage Detection From Color Doppler Ultrasound Using a Generative Adversarial Network (GAN)-Based Anomaly Detection Method. IEEE J Transl Eng Health Med 2022; 10:1800609. [PMID: 36051823 PMCID: PMC9423818 DOI: 10.1109/jtehm.2022.3199987] [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] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
Abstract
Hemorrhage control has been identified as a priority focus area both for civilian and military populations in the United States because exsanguination is the most common cause of preventable death in hemorrhagic injury. Non-compressible torso hemorrhage (NCTH) has high mortality rate and there are currently no broadly available therapies for NCTH outside of a surgical room environment. Novel therapies, which include High Intensity Focused Ultrasound (HIFU) have emerged as promising methods for hemorrhage control as they can non-invasively cauterize bleeding tissue deep within the body without injuring uninvolved regions. A major challenge in the application of HIFU with color Doppler US guidance is the interpretation and optimization of the blood flow images in real-time to identify the hemorrhagic focus. Today, this task requires an expert sonographer, limiting the utility of this therapy in non-clinical environments. In this work, we investigated the feasibility of an automated hemorrhage detection method using a Generative Adversarial Network (GAN) for anomaly detection that learns a manifold of normal blood flow variability and subsequently identifies anomalous flow patterns that fall outside the learned manifold. As an initial feasibility study, we collected ultrasound color Doppler images of femoral arteries in an animal model of vascular injury (N = 11 pigs). Velocity information of the blood flow were extracted from the color Doppler images that were used for training and testing the anomaly detection network. Normotensive images from 8 pigs were used for training, and testing was performed on normotensive, immediately after injury, 10 minutes post-injury and 30 minutes post-injury images from 3 other pigs. The residual images or the reconstructed error maps show promise in detecting hemorrhages with an AUC of 0.90, 0.87, 0.62 immediately, 10 minutes post-injury and 30 minutes post-injury respectively with an overall AUC of 0.83.
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Affiliation(s)
| | | | | | | | | | - Hossam Abdou
- School of Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Michael Richmond
- School of Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Noha Elansary
- School of Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Joseph Edwards
- School of Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Neerav Patel
- School of Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Jonathan Morrison
- School of Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
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Gupta I, Fenkel JM, Eisenbrey JR, Machado P, Stanczak M, Wessner CE, Shaw CM, Miller C, Soulen MC, Wallace K, Forsberg F. A Noninvasive Ultrasound Based Technique to Identify Treatment Responders in Patients with Portal Hypertension. Acad Radiol 2021; 28 Suppl 1:S128-S137. [PMID: 33341374 DOI: 10.1016/j.acra.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of ultrasound contrast microbubbles and ambient pressure. The aim of this study was to verify if SHAPE can accurately monitor disease progression in patients identified with portal hypertension. MATERIALS & METHODS A modified Logiq 9 scanner with a 4C curvi-linear probe (GE, Waukesha, WI) was used to acquire SHAPE data (transmitting and receiving at 2.5 and 1.25 MHz, respectively) using Sonazoid (GE Healthcare, Oslo, Norway; FDA IND 124,465). Twenty-one (median age 59 years; 12 Males) of the 178 patients enrolled in this institutional review board approved study (14F.113) were identified as having clinically significant portal hypertension based on their hepatic venous pressure gradient results ≥ 10 mmHg. Repeat SHAPE examinations were done every 6.2 months. Liver function tests and clinical indicators were used to establish treatment response. RESULTS Of the 21 portal hypertensive subjects, 11 had successful follow up scans with an average follow up time of 6.2 months. There was a significantly larger SHAPE signal reduction in the group who were classified as treatment responders (n = 10; -4.01±3.61 dB) compared to the single nonresponder (2.33 dB; p < 0.001). Results for responders matched the corresponding clinical outcomes of improved model for end stage liver disease (MELD) scores, improvement in underlying cause of portal hypertension, improved liver function tests and reduced ascites. CONCLUSION SHAPE can potentially monitor disease progression in portal hypertensive patients and hence, may help clinicians in patient management. A larger study would further validate this claim.
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Shaaya E, Calvert J, Wallace K, Parker S, Darie R, Syed S, Fridley J, Parthasarathy G, Duclos S, Borton DA. Intraoperative Monitoring of Spinal Cord Perfusion using Ultrasound in an Ovine Model. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:3813-3816. [PMID: 34892066 DOI: 10.1109/embc46164.2021.9631025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ultrasound imaging can be used to visualize the spinal cord and assess localized cord perfusion. We present in vivo data in an ovine model undergoing spinal cord stimulation and propose development of transcutaneous US imaging as a potential non-invasive imaging modality in spinal cord injury.Clinical Relevance- Ultrasound imaging can be used to aid in prognosis and diagnosis by providing qualitative and quantitative characterization of the spinal cord. This modality can be developed as a low cost, portable, and non-invasive imaging technique in spinal injury patients.
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Figueiroa S, Steffy M, Dourney A, Barber A, Delmerico P, Kelsey E, Park H, Taylor M, Wallace K. Sepsis, Malnutrition, and Hospital Readmission Risk. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Schultz CW, Ruiz de Garibay G, Langer A, Liu JB, Dhir T, Leitch C, Wessner CE, Mayoral M, Zhang B, Popa M, Huang C, Kotopoulis S, Luo X, Zhen Y, Niu S, Torkzaban M, Wallace K, Eisenbrey JR, Brody JR, McCormack E, Forsberg F. Selecting the optimal parameters for sonoporation of pancreatic cancer in a pre-clinical model. Cancer Biol Ther 2021; 22:204-215. [PMID: 33691611 DOI: 10.1080/15384047.2021.1881026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers in the modern world, in part due to poor delivery of chemotherapeutics. Sonoporation can be used to enhance the efficacy of standard of care therapies for PDAC. Using xenograft models of PDAC we investigate sonoporation using four ifferent ultrasound contrast agents (UCAs) and two ultrasound regimens to identify the ideal parameters to increase therapeutic efficacy. MIA-PaCa2 xenografts in over 175 immunodeficient mice were treated with gemcitabine and paclitaxel and subjected to low or high power ultrasound (60 and 200 mW/cm2 respectively) in conjunction with one of four different UCAs. The UCAs investigated were Definity®, SonoVue®, Optison™ or Sonazoid™. Tumor volumes, vascularity, hemoglobin, and oxygenation were measured and compared to controls. High power treatment in conjunction with Sonazoid sonoporation led to significantly smaller tumors when started early (tumors ~50mm3; p = .0105), while no UCAs significantly increased efficacy in the low power cohort. This trend was also found in larger tumors (~250mm3) where all four UCA agents significantly increased therapeutic efficacy in the high power group (p < .01), while only Definity and SonoVue increased efficacy in the low power cohort (p < .03). Overall, the higher power ultrasound treatment modality was more consistently effective at decreasing tumor volume and increasing vascularity characteristics. In conclusion, Sonazoid was the most consistently effective UCA at decreasing tumor volume and increasing vascularity. Thus, we are pursuing a larger phase II clinical trial to validate the increased efficacy of sonoporation in conjunction with chemotherapy in PDAC patients.
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Affiliation(s)
| | | | - Anika Langer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Teena Dhir
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Calum Leitch
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mireia Mayoral
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bo Zhang
- Department of Ultrasound, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mihaela Popa
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Chunwang Huang
- Department of Echocardiography, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Spiros Kotopoulis
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Ultrasound, National Center for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | - Yanhua Zhen
- Department of Ultrasound, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Sihua Niu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonathan R Brody
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Emmet McCormack
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Forsberg F, Gupta I, Machado P, Shaw CM, Fenkel JM, Wallace K, Eisenbrey JR. Contrast-Enhanced Subharmonic Aided Pressure Estimation (SHAPE) using Ultrasound Imaging with a Focus on Identifying Portal Hypertension. J Vis Exp 2020. [PMID: 33346203 DOI: 10.3791/62050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Noninvasive, accurate measurement of pressures within the human body has long been an important but elusive clinical goal. Contrast agents for ultrasound imaging are gas-filled, encapsulated microbubbles (diameter < 10 μm) that traverse the entire vasculature and enhance signals by up to 30 dB. These microbubbles also produce nonlinear oscillations at frequencies ranging from the subharmonic (half of the transmit frequency) to higher harmonics. The subharmonic amplitude has an inverse linear relationship with the ambient hydrostatic pressure. Here an ultrasound system capable of performing real-time, subharmonic aided pressure estimation (SHAPE) is presented. During ultrasound contrast agent infusion, an algorithm for optimizing acoustic outputs is activated. Following this calibration, subharmonic microbubble signals (i.e., SHAPE) have the highest sensitivity to pressure changes and can be used to noninvasively quantify pressure. The utility of the SHAPE procedure for identifying portal hypertension in the liver is the emphasis here, but the technique has applicability across many clinical scenarios.
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Affiliation(s)
| | - Ipshita Gupta
- Department of Radiology, Thomas Jefferson University; School of Biomedical Engineering, Sciences and Health Systems, Drexel University
| | | | | | - Jonathan M Fenkel
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University
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16
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Gupta I, Eisenbrey JR, Machado P, Stanczak M, Wessner CE, Shaw CM, Gummadi S, Fenkel JM, Tan A, Miller C, Parent J, Schultz S, Soulen MC, Sehgal CM, Wallace K, Forsberg F. Diagnosing Portal Hypertension with Noninvasive Subharmonic Pressure Estimates from a US Contrast Agent. Radiology 2020; 298:104-111. [PMID: 33201789 DOI: 10.1148/radiol.2020202677] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The current standard for assessing the severity of portal hypertension is the invasive acquisition of hepatic venous pressure gradient (HVPG). A noninvasive US-based technique called subharmonic-aided pressure estimation (SHAPE) could reduce risk and enable routine acquisition of these pressure estimates. Purpose To compare quantitative SHAPE to HVPG measurements to diagnose portal hypertension in participants undergoing a transjugular liver biopsy. Materials and Methods This was a prospective cross-sectional trial conducted at two hospitals between April 2015 and March 2019 (ClinicalTrials.gov identifier, NCT02489045). This trial enrolled participants who were scheduled for transjugular liver biopsy. After standard-of-care transjugular liver biopsy and HVPG pressure measurements, participants received an infusion of a US contrast agent and saline. During infusion, SHAPE data were collected from a portal vein and a hepatic vein, and the difference was compared with HVPG measurements. Correlations between data sets were determined by using the Pearson correlation coefficient, and statistical significance between groups was determined by using the Student t test. Receiver operating characteristic analysis was performed to determine the sensitivity and specificity of SHAPE. Results A total of 125 participants (mean age ± standard deviation, 59 years ± 12; 80 men) with complete data were included. Participants at increased risk for variceal hemorrhage (HVPG ≥12 mm Hg) had a higher mean SHAPE gradient compared with participants with lower HVPGs (0.79 dB ± 2.53 vs -4.95 dB ± 3.44; P < .001), which is equivalent to a sensitivity of 90% (13 of 14; 95% CI: 88, 94) and a specificity of 80% (79 of 99; 95% CI: 76, 84). The SHAPE gradient between the portal and hepatic veins was in good overall agreement with the HVPG measurements (r = 0.68). Conclusion Subharmonic-aided pressure estimation is an accurate noninvasive technique for detecting clinically significant portal hypertension. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kiessling in this issue.
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Affiliation(s)
- Ipshita Gupta
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - John R Eisenbrey
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Priscilla Machado
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Maria Stanczak
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Corinne E Wessner
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Colette M Shaw
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Sriharsha Gummadi
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Jonathan M Fenkel
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Alison Tan
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Cynthia Miller
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Julia Parent
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Susan Schultz
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Michael C Soulen
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Chandra M Sehgal
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Kirk Wallace
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
| | - Flemming Forsberg
- From the Department of Radiology (I.G., J.R.E., P.M., M.S., C.E.W., C. M. Shaw, A.T., C.M., F.F.) and Department of Medicine, Division of Gastroenterology and Hepatology (J.M.F.), Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, Pa (I.G.); Department of Surgery, Lankenau Medical Center, Wynnewood, Pa (S.G.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (S.S., M.C.S., C. M. Sehgal); and GE Global Research, Niskayuna, NY (K.W.)
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Sridharan A, Eisenbrey JR, Stanczak M, Machado P, Merton DA, Wilkes A, Sevrukov A, Ojeda-Fournier H, Mattrey RF, Wallace K, Forsberg F. Characterizing Breast Lesions Using Quantitative Parametric 3D Subharmonic Imaging: A Multicenter Study. Acad Radiol 2020; 27:1065-1074. [PMID: 31859210 DOI: 10.1016/j.acra.2019.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/16/2019] [Accepted: 10/30/2019] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES Breast cancer is the leading type of cancer among women. Visualization and characterization of breast lesions based on vascularity kinetics was evaluated using three-dimensional (3D) contrast-enhanced ultrasound imaging in a clinical study. MATERIALS AND METHODS Breast lesions (n = 219) were imaged using power Doppler imaging (PDI), 3D contrast-enhanced harmonic imaging (HI), and 3D contrast-enhanced subharmonic imaging (SHI) with a modified Logiq 9 ultrasound scanner using a 4D10L transducer. Quantitative metrics of vascularity derived from 3D parametric volumes (based on contrast perfusion; PER and area under the curve; AUC) were generated by off-line processing of contrast wash-in and wash-out. Diagnostic accuracy of these quantitative vascular parameters was assessed with biopsy results as the reference standard. RESULTS Vascularity was observed with PDI in 93 lesions (69 benign and 24 malignant), 3D HI in 8 lesions (5 benign and 3 malignant), and 3D SHI in 83 lesions (58 benign and 25 malignant). Diagnostic accuracy for vascular heterogeneity, PER, and AUC ranged from 0.52 to 0.75, while the best logistical regression model (vascular heterogeneity ratio, central PER, and central AUC) reached 0.90. CONCLUSION 3D SHI successfully detects contrast agent flow in breast lesions and characterization of these lesions based on quantitative measures of vascular heterogeneity and 3D parametric volumes is promising.
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Affiliation(s)
- Anush Sridharan
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107; Department of Electrical and Computer Engineering, Drexel University, Philadelphia, Pennsylvania
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107
| | - Daniel A Merton
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107
| | - Annina Wilkes
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107
| | - Alexander Sevrukov
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107
| | | | - Robert F Mattrey
- Department of Radiology, University of California, San Diego, California
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, 763H Main Building, 132 South 10th Street, Philadelphia, PA 19107.
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Delaney LJ, Machado P, Torkzaban M, Lyshchik A, Wessner CE, Kim C, Rosenblum N, Richard S, Wallace K, Forsberg F. Characterization of Adnexal Masses Using Contrast-Enhanced Subharmonic Imaging: A Pilot Study. J Ultrasound Med 2020; 39:977-985. [PMID: 31769529 PMCID: PMC7174081 DOI: 10.1002/jum.15183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 10/31/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVES This pilot study evaluated whether contrast-enhanced subharmonic imaging (SHI) could be used to characterize adnexal masses before surgical intervention. METHODS Ten women (with 12 lesions) scheduled for surgery of an ovarian mass underwent an SHI examination of their adnexal region using a modified LOGIQ E9 scanner (GE Healthcare, Waukesha, WI) with an endocavitary transducer, in which digital clips were acquired by pulse destruction-replenishment SHI across the lesions. Time-intensity curves were created offline to quantitatively evaluate SHI parameters (fractional tumor perfusion, peak contrast intensity, time to peak contrast enhancement, and area under the time-intensity curve), which were compared to pathologic characterizations of the lesions. RESULTS Of the 12 masses, 8 were benign, and 4 were malignant. A qualitative analysis of the SHI images by an experienced radiologist resulted in diagnostic accuracy of 70%, compared to 56% without contrast, whereas an inexperienced radiologist improved from 50% to 58% accuracy, demonstrating the benefit of SHI. A quantitative analysis of SHI parameters produced diagnostic accuracy as high as 81%. Peak contrast intensity was significantly greater in malignant than benign masses (mean ± SD, 0.109 ± 0.088 versus 0.046 ± 0.030 arbitrary units; P = .046). Malignant masses also showed significantly greater perfusion than benign masses (24.79% ± 25.34% versus 7.62% ± 6.50%; P = .045). When the radiologist reads were combined with the most predictive quantitative SHI parameter (percent perfusion), diagnostic accuracy improved to 84% for the experienced radiologist and 96% for the novice radiologist. CONCLUSIONS Results indicate that SHI for presurgical characterization of adnexal masses may improve the determination of malignancy and diagnostic accuracy, albeit based on a small sample size.
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Affiliation(s)
- Lauren J Delaney
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christine Kim
- Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Norman Rosenblum
- Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott Richard
- Division of Gynecologic Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, Erinjeri J, Anand R, Mazariegos GV, Martin A, Mannino D, Flynn L, Mohammad S, Alonso E, Superina R, Brandt K, Riordan M, Lokar J, Ito J, Elisofon S, Zapata L, Jain A, Foristal E, Gupta N, Whitlow C, Naik K, Espinosa H, Miethke A, Hawkins A, Hardy J, Engels E, Schreibeis A, Ovchinsky N, Kogan‐Liberman D, Cunningham R, Malik P, Sundaram S, Feldman A, Garcia B, Yanni G, Kohli R, Emamaullee J, Secules C, Magee J, Lopez J, Bilhartz J, Hollenbeck J, Shaw B, Bartow C, Forest S, Rand E, Byrne A, Linguiti I, Wann L, Seidman C, Mazariegos G, Soltys K, Squires J, Kepler A, Vitola B, Telega G, Lerret S, Desai D, Moghe J, Cutright L, Daniel J, Andrews W, Fioravanti V, Slowik V, Cisneros R, Faseler M, Hufferd M, Kelly B, Sudan D, Mavis A, Moats L, Swan‐Nesbit S, Yazigi N, Buranych A, Hobby A, Rao G, Maccaby B, Gopalareddy V, Boulware M, Ibrahim S, El Youssef M, Furuya K, Schatz A, Weckwerth J, Lovejoy C, Kasi N, Nadig S, Law M, Arnon R, Chu J, Bucuvalas J, Czurda M, Secheli B, Almy C, Haydel B, Lobritto S, Emand J, Biney‐Amissah E, Gamino D, Gomez A, Himes R, Seal J, Stewart S, Bergeron J, Truxillo A, Lebel S, Davidson H, Book L, Ramstack D, Riley A, Jennings C, Horslen S, Hsu E, Wallace K, Turmelle Y, Nadler M, Postma S, Miloh T, Economides J, Timmons K, Ng V, Subramonian A, Dharmaraj B, McDiarmid S, Feist S, Rhee S, Perito E, Gallagher L, Smith K, Ebel N, Zerofsky M, Nogueira J, Greer R, Gilmour S, Robert C, Cars C, Azzam R, Boone P, Garbarino N, Lalonde M, Kerkar N, Dokus K, Helbig K, Grizzanti M, Tomiyama K, Cocking J, Alexopoulos S, Bhave C, Schillo R, Bailey A, Dulek D, Ramsey L, Ekong U, Valentino P, Hettiarachchi D, Tomlin R. Society of pediatric liver transplantation: Current registry status 2011-2018. Pediatr Transplant 2020; 24:e13605. [PMID: 31680409 DOI: 10.1111/petr.13605] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/08/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies. OBJECTIVE To report the outcomes of the SPLIT registry from 2011 to 2018. METHODS This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period. RESULTS A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - John C Magee
- Division of Surgery, University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon P Horslen
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Vicki Fioravanti
- Section of Hepatology and Liver Transplantation, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | - George V Mazariegos
- Division of Pediatric Transplant Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Gupta I, Freid B, Masarapu V, Machado P, Trabulsi E, Wallace K, Halpern E, Forsberg F. Transrectal Subharmonic Ultrasound Imaging for Prostate Cancer Detection. Urology 2019; 138:106-112. [PMID: 31899231 DOI: 10.1016/j.urology.2019.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the prostate cancer (CaP) detection rates of contrast-enhanced, transrectal subharmonic ultrasound imaging (SHI). MATERIALS AND METHODS This IRB-approved study enrolled 55 subjects. The initial 5 subjects were studied for SHI optimization, while the remaining 50 were evaluated with contrast-enhanced sonography using continuous SHI, color, and power Doppler as well as conventional grayscale, continuous color, and power Doppler and SHI combined with maximum flash replenishment. A maximum of 6 directed biopsy cores were obtained from sites of greatest asymmetrical enhancement, followed by spatially distributed cores in a double sextant distribution. Subharmonic time-intensity parameters, including time to peak intensity, peak intensity, and estimated perfusion were also evaluated for each directed biopsy core. Receiver operating characteristic curve analysis and conditional logistic regression were employed to assess the benefit of each modality and the quantitative SHI parameters. RESULTS Cancer was detected in 22 of 50 subjects. Among subjects with clinically significant CaP (n = 11), targeted cores were more likely to be positive (odds ratio 1.39, P = .02). The majority of patients detected by SHI demonstrated significant CaP (5/8); SHI remained an independent marker of malignancy in a multivariate logistic regression model (P = .027). Receiver operating characteristic curve analysis of imaging findings compared to biopsy results yielded diagnostic accuracies ranging from 0.59 to 0.80 for all imaging modalities with the highest being for quantitative subharmonic perfusion estimates. CONCLUSION This first-in-humans study provides a preliminary estimate of the diagnostic accuracy of SHI for detection of clinically significant CaP (up to 80%).
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Affiliation(s)
- I Gupta
- Thomas Jefferson University, Philadelphia, PA
| | - B Freid
- Thomas Jefferson University, Philadelphia, PA
| | - V Masarapu
- Thomas Jefferson University, Philadelphia, PA
| | - P Machado
- Thomas Jefferson University, Philadelphia, PA
| | - E Trabulsi
- Thomas Jefferson University, Philadelphia, PA
| | | | - E Halpern
- Thomas Jefferson University, Philadelphia, PA
| | - F Forsberg
- Thomas Jefferson University, Philadelphia, PA.
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Goundan P, Korpaisarn S, Smith J, Rohrbach D, Mamou J, Patel H, Wallace K, Feleppa E, Lee S. MON-571 The Performance Of An Advanced Ultrasound Technique, Quantitative Ultrasound, Compared To Conventional Ultrasound In The Evaluation Of Thyroid Nodules. J Endocr Soc 2019. [PMCID: PMC6550744 DOI: 10.1210/js.2019-mon-571] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION: Thyroid cancer is the most common endocrine malignancy. While thyroid nodules (TN) can been seen in up to 50% of the adult population, only about 5 percent of the nodules are malignant. Currently, management of TN involves risk stratification prior to biopsy using B-mode grey-scale ultrasound (US) characteristics including echogenicity, micro- and macrocalcifications, and margins. A less-subjective method of TN evaluation, shear wave elastography, has been evaluated but both the grey-scale classification and elastography are subject to operator and machine variability. This study assesses the use of quantitative ultrasound (QUS) to differentiate between malignant and benign thyroid nodules. B-mode appearance based on the radiofrequency (RF) signal envelope and discards much of the information in the RF signal. QUS uses the normalized power spectrum and extracts discarded RF signal information to obtain parameters that reflect scatterer size, concentration and relative acoustic impedance. The advantage of using QUS is that the parameter values reflect the microarchitecture (<120 µm) of the tissue and are theoretically operator and machine independent. RESULTS: In this preliminary cohort, US data from 52 TN (with 57 data sets) were collected using a GE Logiq E9 US system and QUS estimates were obtained. 8 TN were diagnosed as malignant and 44 TN were benign as determined by cytology, molecular testing or surgical pathology. The B-mode images were reviewed by an experienced ultrasonologist and TI-RADS (Russ et al) scores were calculated. A combination of QUS parameters (EAC, I0, µ) produced an AUC value of 0.96. The AUC by using the TI-RADS scoring criteria alone was 0.94 and when combined with QUS parameters (EAC, µ) it was 0.97. When the grey-scale US images were reviewed by a senior fellow in training, the TI-RADS AUC was lower. This highlights the subjective variability and effect of operator experience in risk stratification of TN using conventional B-mode characteristics and the importance of investigating advanced US techniques that are operator and machine independent for better cancer detection and improved identification of benign TN to avoid unnecessary biopsy and surgery.
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Affiliation(s)
| | - Sira Korpaisarn
- Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Jason Smith
- Lizzi Center for Biomedical Engineering, New York, NY, United States
| | - Daniel Rohrbach
- Lizzi Center for Biomedical Engineering, New York, NY, United States
| | - Jonathan Mamou
- Lizzi Center for Biomedical Engineering, New York, NY, United States
| | | | - Kirk Wallace
- GE Global Research, Niskayuna, NY, United States
| | - Ernest Feleppa
- Lizzi Center for Biomedical Engineering, New York, NY, United States
| | - Stephanie Lee
- Dept of Endo Diabetes and Nutr, Boston Medical Center, Boston, MA, United States
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Bernardes TP, Zwertbroek EF, Broekhuijsen K, Koopmans C, Boers K, Owens M, Thornton J, van Pampus MG, Scherjon SA, Wallace K, Langenveld J, van den Berg PP, Franssen MTM, Mol BWJ, Groen H. Delivery or expectant management for prevention of adverse maternal and neonatal outcomes in hypertensive disorders of pregnancy: an individual participant data meta-analysis. Ultrasound Obstet Gynecol 2019; 53:443-453. [PMID: 30697855 PMCID: PMC6594064 DOI: 10.1002/uog.20224] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Hypertensive disorders affect 3-10% of pregnancies. Delayed delivery carries maternal risks, while early delivery increases fetal risk, so appropriate timing is important. The aim of this study was to compare immediate delivery with expectant management for prevention of adverse maternal and neonatal outcomes in women with hypertensive disease in pregnancy. METHODS CENTRAL, PubMed, MEDLINE and ClinicalTrials.gov were searched for randomized controlled trials comparing immediate delivery to expectant management in women presenting with gestational hypertension or pre-eclampsia without severe features from 34 weeks of gestation. The primary neonatal outcome was respiratory distress syndrome (RDS) and the primary maternal outcome was a composite of HELLP syndrome and eclampsia. The PRISMA-IPD guideline was followed and a two-stage meta-analysis approach was used. Relative risks (RR) and numbers needed to treat or harm (NNT/NNH) with 95% CI were calculated to evaluate the effect of the intervention. RESULTS Main outcomes were available for 1724 eligible women. Compared with expectant management, immediate delivery reduced the composite risk of HELLP syndrome and eclampsia in all women (0.8% vs 2.8%; RR, 0.33 (95% CI, 0.15-0.73); I2 = 0%; NNT, 51 (95% CI, 31.1-139.3)) as well as in the pre-eclampsia subgroup (1.1% vs 3.5%; RR, 0.39 (95% CI, 0.15-0.98); I2 = 0%). Immediate delivery increased RDS risk (3.4% vs 1.6%; RR, 1.94 (95% CI 1.05-3.6); I2 = 24%; NNH, 58 (95% CI, 31.1-363.1)), but depended upon gestational age. Immediate delivery in the 35th week of gestation increased RDS risk (5.1% vs 0.6%; RR, 5.5 (95% CI, 1.0-29.6); I2 = 0%), but immediate delivery in the 36th week did not (1.5% vs 0.4%; RR, 3.4 (95% CI, 0.4-30.3); I2 not applicable). CONCLUSION In women with hypertension in pregnancy, immediate delivery reduces the risk of maternal complications, whilst the effect on the neonate depends on gestational age. Specifically, women with a-priori higher risk of progression to HELLP, such as those already presenting with pre-eclampsia instead of gestational hypertension, were shown to benefit from earlier delivery. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T. P. Bernardes
- Epidemiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - E. F. Zwertbroek
- Obstetrics and Gynaecology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - K. Broekhuijsen
- ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - C. Koopmans
- Obstetrics and Gynaecology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - K. Boers
- Obstetrics and GynaecologyBronovo HospitalThe HagueThe Netherlands
| | - M. Owens
- Obstetrics and GynecologyUniversity of Mississippi Medical CenterJacksonMIUSA
| | - J. Thornton
- Obstetrics and GynaecologyUniversity of NottinghamNottinghamUK
| | - M. G. van Pampus
- Obstetrics and GynaecologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - S. A. Scherjon
- Obstetrics and Gynaecology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - K. Wallace
- Obstetrics and GynecologyUniversity of Mississippi Medical CenterJacksonMIUSA
| | - J. Langenveld
- Obstetrics and GynaecologyZuyderland Medical CentreHeerlenThe Netherlands
| | - P. P. van den Berg
- Obstetrics and Gynaecology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - M. T. M. Franssen
- Obstetrics and Gynaecology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - B. W. J. Mol
- Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - H. Groen
- Epidemiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Abstract
Subharmonic-aided pressure estimation (SHAPE) estimates hydrostatic pressure using the inverse relationship with subharmonic amplitude variations of ultrasound contrast agents (UCAs). We studied the impact of varying incident acoustic outputs (IAO), UCA concentration, and hematocrit on SHAPE. A Logiq 9 scanner with a 4C curvilinear probe (GE, Milwaukee, Wisconsin) was used with Sonazoid (GE Healthcare, Oslo, Norway) transmitting at 2.5 MHz and receiving at 1.25 MHz. An improved IAO selection algorithm provided improved correlations ( r from -0.85 to -0.95 vs. -0.39 to -0.98). There was no significant change in SHAPE gradient as the pressure increased from 10 to 40 mmHg and hematocrit concentration was tripled from 1.8 to 4.5 mL/L (Δ0.00-0.01 dB, p = 0.18), and as UCA concentration was increased from 0.2 to 1.2 mL/L (Δ0.02-0.05 dB, p = 0.75). The results for the correlation between the SHAPE gradient and hematocrit values for patients ( N = 100) in an ongoing clinical trial were also calculated showing a poor correlation value of 0.14. Overall, the SHAPE gradient is independent of hematocrit and UCA concentration. An improved algorithm for IAO selection will make SHAPE more accurate.
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Affiliation(s)
- Ipshita Gupta
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Abstract
Social information processing theory hypothesizes that aggressive children pay more attention to cues of hostility and threat in others' behavior, consequently leading to over-interpretation of others' behavior as hostile. While there is abundant evidence of aggressive children demonstrating hostile attribution biases, less well documented is whether such biases stem from over-attendance and hypersensitivity to hostile cues in social situations. Over-attendance to hostile cues would be typified by deviations at any stage of the multi-stage process of social information processing models. While deviations at later stages in social information processing models are associated with aggressive behavior in children, the initial step of encoding has historically been difficult to empirically measure, being a low level automatic process unsuitable for self-report. We employed eye-tracking methodologies to better understand the visual encoding of such social information. Eye movements of ten 13-18 year-old children referred from clinical and non-clinical populations were recorded in real time while the children viewed scenarios varying between hostile, non-hostile and ambiguous social provocation. In addition, the children completed a brief measure of risk of aggression. Aggressive children did attend more to the social scenarios with hostile cues, in particular attending longest to those hostile scenarios where the actor in the scenario had a congruent emotional response. These findings corroborate social information processing theory and the traditional bottom-up processing hypotheses that aggressive behavior relates to increased attention to hostile cues.
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Affiliation(s)
- Cameron Laue
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Marcus Griffey
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ping-I Lin
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Kirk Wallace
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Menno van der Schoot
- Division of Behavioral & Health Sciences, Vrije Universiteit Amsterdam, Amersterdam, Netherlands
| | - Paul Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ernest Pedapati
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Drew Barzman
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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Williams C, Mpofu H, Samuel J, Wallace K, Gould K. Contaminated Ice. How Clean is Your Machine? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gupta I, Eisenbrey J, Stanczak M, Sridharan A, Dave JK, Liu JB, Hazard C, Wang X, Wang P, Li H, Wallace K, Forsberg F. Effect of Pulse Shaping on Subharmonic Aided Pressure Estimation In Vitro and In Vivo. J Ultrasound Med 2017; 36:3-11. [PMID: 27943411 PMCID: PMC5191985 DOI: 10.7863/ultra.15.11106] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/15/2016] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Subharmonic imaging (SHI) is a technique that uses the nonlinear oscillations of microbubbles when exposed to ultrasound at high pressures transmitting at the fundamental frequency ie, fo and receiving at half the transmit frequency (ie, fo /2). Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of the microbubbles and the ambient pressure change. METHODS Eight waveforms with different envelopes were optimized with respect to acoustic power at which the SHAPE study is most sensitive. The study was run with four input transmit cycles, first in vitro and then in vivo in three canines to select the waveform that achieved the best sensitivity for detecting changes in portal pressures using SHAPE. A Logiq 9 scanner with a 4C curvi-linear array was used to acquire 2.5 MHz radio-frequency data. Scanning was performed in dual imaging mode with B-mode imaging at 4 MHz and a SHI contrast mode transmitting at 2.5 MHz and receiving at 1.25 MHz. Sonazoid, which is a lipid stabilized gas filled bubble of perfluorobutane, was used as the contrast agent in this study. RESULTS A linear decrease in subharmonic amplitude with increased pressure was observed for all waveforms (r from -0.77 to -0.93; P < .001) in vitro. There was a significantly higher correlation of the SHAPE gradient with changing pressures for the broadband pulses as compared to the narrowband pulses in both in vitro and in vivo results. The highest correlation was achieved with a Gaussian windowed binomial filtered square wave with an r-value of -0.95. One of the three canines was eliminated for technical reasons, while the other two produced very similar results to those obtained in vitro (r from -0.72 to -0.98; P <.01). The most consistent in vivo results were achieved with the Gaussian windowed binomial filtered square wave (r = -0.95 and -0.96). CONCLUSIONS Using this waveform is an improvement to the existing SHAPE technique (where a square wave was used) and should make SHAPE more sensitive for noninvasively determining portal hypertension.
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Affiliation(s)
- Ipshita Gupta
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - John Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Anush Sridharan
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Department of Electrical and Computer Engineering, Drexel University, Philadelphia, PA 19104, USA
| | - Jaydev K. Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Xinghua Wang
- Department of Ultrasound, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Ping Wang
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Huiwen Li
- Department of Ultrasound, Erdos Center Hospital, Erdos, Inner Mongolia 017000, China
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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MacLellan J, Wallace K, Vacchelli E, Roe J, Davidson R, Abubakar I, Southern J. A multi-perspective service evaluation exploring tuberculosis contact screening attendance among adults at a North London hospital. J Public Health (Oxf) 2015; 38:e362-e367. [PMID: 26364318 DOI: 10.1093/pubmed/fdv129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-attendance at TB contact screening clinics has been highlighted as a common phenomenon across a number of sites during recruitment to the PREDICT TB Study. This has obvious implications for the safety of patients, their communities and for NHS resources. The objective of this study was to explore why adults who have been in contact with TB do, and do not, attend their screening appointment, thereby allowing identification of interventions to reduce non-attendance. METHODS A multi-method approach was taken using 15 questionnaires with adults who attended for screening, 15 telephone questionnaires with adults who did not attend and in-depth interviews with 8 TB nurses. Interviews were coded to trace emerging descriptive themes, then refined through an iterative process of interpretation and recoding. RESULTS Findings from the questionnaires and interviews were categorized into three principle themes following analysis: awareness, hospital factors and leadership. These themes deconstruct the complex phenomena of patients' lack of attendance at this TB contact screening service. CONCLUSION Recommendations related to issues of leadership, outreach services, flexibility of clinic timing and awareness amongst both the local community and GPs were made.
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Affiliation(s)
- J MacLellan
- Royal Free Hospital, London, UK Department of Infection & Population Health, University College London, London, UK
| | | | - E Vacchelli
- Social Policy Research Centre, Middlesex University, London, UK
| | - J Roe
- TB Services, Northwick Park Hospital, Middlesex, UK
| | - R Davidson
- TB Services, Northwick Park Hospital, Middlesex, UK
| | - I Abubakar
- Department of Infection & Population Health, University College London, London, UK Tuberculosis Section, Public Health England, London, UK
| | - J Southern
- Tuberculosis Section, Public Health England, London, UK
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Geryak R, Geldmeier J, Wallace K, Tsukruk VV. Remote Giant Multispectral Plasmonic Shifts of Labile Hinged Nanorod Array via Magnetic Field. Nano Lett 2015; 15:2679-84. [PMID: 25757064 DOI: 10.1021/acs.nanolett.5b00342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a remotely mediated and fast responsive plasmonic-magnetic nanorod array with extremely large variability in optical appearance (up to 100 nm shifts in scattering maxima) and concurrently for multiple wavelengths in a broad range from UV-vis to near-infrared (at 450, 550, and 670 nm) with an external magnetic field with variable direction. The observed phenomenon demonstrates a rapid, wide-range response controlled via a noninvasive remote stimulus. The remotely controlled system suggested here is a magnetic field-directed assembly of an ordered monolayer array of unipolar oriented magnetic-plasmonic nickel-gold nanorods flexibly hinged to a sticky substrate. The unique geometry of the mobile nanorod array allows for the instant alteration of the surface plasmon polariton modes in the gold segment of the controllably tilting nanorods. This design demonstrates the utility of hybrid bimetallic nanoparticles and gives a novel approach to the design of fast-acting, remotely controlled color-changing nanomaterials for sensing and interfacial transport.
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Affiliation(s)
- R Geryak
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - J Geldmeier
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - K Wallace
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - V V Tsukruk
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
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Sridharan A, Eisenbrey JR, Machado P, Ojeda-Fournier H, Wilkes A, Sevrukov A, Mattrey RF, Wallace K, Chalek CL, Thomenius KE, Forsberg F. Quantitative analysis of vascular heterogeneity in breast lesions using contrast-enhanced 3-D harmonic and subharmonic ultrasound imaging. IEEE Trans Ultrason Ferroelectr Freq Control 2015; 62:502-10. [PMID: 25935933 PMCID: PMC4607037 DOI: 10.1109/tuffc.2014.006886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Ability to visualize breast lesion vascularity and quantify the vascular heterogeneity using contrast-enhanced 3-D harmonic (HI) and subharmonic (SHI) ultrasound imaging was investigated in a clinical population. Patients (n = 134) identified with breast lesions on mammography were scanned using power Doppler imaging, contrast-enhanced 3-D HI, and 3-D SHI on a modified Logiq 9 scanner (GE Healthcare). A region of interest corresponding to ultrasound contrast agent flow was identified in 4D View (GE Medical Systems) and mapped to raw slice data to generate a map of time-intensity curves for the lesion volume. Time points corresponding to baseline, peak intensity, and washout of ultrasound contrast agent were identified and used to generate and compare vascular heterogeneity plots for malignant and benign lesions. Vascularity was observed with power Doppler imaging in 84 lesions (63 benign and 21 malignant). The 3-D HI showed flow in 8 lesions (5 benign and 3 malignant), whereas 3-D SHI visualized flow in 68 lesions (49 benign and 19 malignant). Analysis of vascular heterogeneity in the 3-D SHI volumes found benign lesions having a significant difference in vascularity between central and peripheral sections (1.71 ± 0.96 vs. 1.13 ± 0.79 dB, p < 0.001, respectively), whereas malignant lesions showed no difference (1.66 ± 1.39 vs. 1.24 ± 1.14 dB, p = 0.24), indicative of more vascular coverage. These preliminary results suggest quantitative evaluation of vascular heterogeneity in breast lesions using contrast-enhanced 3-D SHI is feasible and able to detect variations in vascularity between central and peripheral sections for benign and malignant lesions.
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Affiliation(s)
- Anush Sridharan
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA. Department of Electrical and Computer Engineering, Drexel University, Philadelphia, PA 19104, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Annina Wilkes
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alexander Sevrukov
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Robert F. Mattrey
- Department of Radiology, University of California, San Diego, CA 92103, USA
| | | | | | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Ong LP, Tristan Z, Muse H, Wallace K, Whitehead S, Parry G, Clark S. 248 * BLOOD TRANSFUSION AFTER LUNG TRANSPLANTATION: IMPACT ON EARLY FUNCTION AND SURVIVAL. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Cremer SE, Singletary GE, Olsen LH, Wallace K, Häggström J, Ljungvall I, Höglund K, Reynolds CA, Pizzinat N, Oyama MA. Serotonin concentrations in platelets, plasma, mitral valve leaflet, and left ventricular myocardial tissue in dogs with myxomatous mitral valve disease. J Vet Intern Med 2014; 28:1534-40. [PMID: 25146933 PMCID: PMC4895588 DOI: 10.1111/jvim.12420] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/08/2014] [Accepted: 06/19/2014] [Indexed: 11/29/2022] Open
Abstract
HYPOTHESIS/OBJECTIVES Altered serotonin (5-hydroxytryptamine, 5HT) signaling is postulated in development and progression of canine myxomatous mitral valve disease (MMVD). Little is known regarding platelet, plasma, valvular, or myocardial 5HT concentration ([5HT]) in affected dogs. We quantified [5HT] in platelet-rich plasma (PRP), platelet-poor plasma (PPP), mitral valve leaflets (MV), and left ventricular myocardium (LV). ANIMALS Forty-five dogs comprised 4 plasma groups of Cavalier King Charles Spaniels (CKCS) or non-CKCS, either healthy (CON) or MMVD affected: CKCS CON (n = 12); non-CKCS CON (n = 8); CKCS MMVD (n = 14); non-CKCS MMVD (n = 11). Twenty-four dogs comprised 3 tissue groups: MMVD (n = 8); other-HD (heart disease) (n = 7); non-HD, extracardiac disease (n = 9). METHODS High-performance liquid chromatography measured PRP, PPP, MV, and LV [5HT]. RESULTS Platelet-rich plasma platelet [5HT] was greater in CKCS CON (1.83 femtograms/platelet [fg/plt]; range, 0.20-4.76; P = .002), CKCS MMVD (1.58 fg/plt; range, 0.70-4.03; P = .005), and non-CKCS MMVD (1.72 fg/plt; range, 0.85-4.44; P = .003) versus non-CKCS CON (0.92 fg/plt; range, 0.63-1.30). There was no group difference in PPP [5HT]. MV [5HT] was significantly higher in MMVD (32.4 ng/mg; range, 8.4-106.7) versus non-HD (3.6 ng/mg; range, 0-28.3; P = .01) and LV [5HT] was significantly higher in MMVD (11.9 ng/mg; range, 4.0-104.8) versus other-HD (0.9 ng/mg; range, 0-10.1; P = .011) and non-HD (2.5 ng/mg; range, 0-6.9; P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE Platelet [5HT] was highest in healthy CKCS and both MMVD groups, but plasma [5HT] showed no group differences. Tissue [5HT] was highest in MV and LV of MMVD-affected dogs, suggesting altered 5HT signaling as a potential feature of MMVD. Interactions of platelet, valvular, and myocardial 5HT signaling warrant further investigation.
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Affiliation(s)
- S E Cremer
- Department of Veterinary Disease Biology, University of Copenhagen, Frederiksberg, Denmark
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Wallace K, Chatman K, Johnson V, Matthew G, LaMarca B. Blockade of the endothelinA receptor prevents hypoxia induced smooth muscle cell proliferation and endothelin secretion in patients with uterine leiomyomas. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Milne M, Wallace K, Singh G, Miller J, Holland M. WE-E-134-07: Ultrasound Image Based Measurements of Myocardial Fiber Structure Within the Left and Right Ventricular Walls of the Heart. Med Phys 2013. [DOI: 10.1118/1.4815610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chelliah A, Jeelani R, Mert I, Wallace K, Coleman L. A Rare Complication of Robotic Assisted Laparoscopic Total Hysterectomy. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Martin JN, Owens MY, Thigpen B, Parrish MR, Keiser SD, Wallace K. OS011. Management of late preterm pregnancy complicated by mildpreeclampsia: A prospective randomized trial. Pregnancy Hypertens 2012; 2:180. [PMID: 26105225 DOI: 10.1016/j.preghy.2012.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In the absence of properly undertaken prospective randomized clinical trials, the optimal management of late preterm mild preeclampsia for best maternal and perinatal outcomes remains unclear for obstetricians worldwide. OBJECTIVES We desired to determine if immediate or expectant management of the late preterm mother presenting with mild preeclampsia was more beneficial to her without compromise to her newborn. METHODS This prospective randomized clinical trial of immediate versus expectant delivery for patients presenting with mild preeclampsia between the late preterm period of 34-0/7 to 36-6/7weeks gestation was undertaken using CONSORT guidelines. Patients were randomized to immediate delivery via induction of labor or cesarean delivery or inpatient expectant management with delivery at 37-0/7weeks gestation or earlier at onset of labor or progression to severe preeclampsia. The primary outcome was progression to severe preeclampsia; secondary outcomes were neonatal morbidity and mortality. Data were analyzed by appropriate tests for continuous or categorical outcomes with differences considered significant if p<0.05. RESULTS One hundred and sixty nine patients during 2002-2008 satisfied and sustained protocol criteria in the immediate delivery (n=94) or inpatient expectant management (n=75) arms of the study. A third (33%) of expectantly managed patients developed severe preeclampsia during significantly longer hospitalization versus 3% in the immediately delivered patients (p=0.001). Cesarean delivery rates were similar. No significant neonatal morbidity differences were observed between groups; there were no maternal or neonatal deaths. The study was stopped in 2008 at 74% of the enrollment target when hospital policy changed to discourage inpatient hospitalization for uncomplicated mild preterm preeclampsia and in view of growing national concern for increased late preterm/early term neonatal morbidity and cost of care. CONCLUSION Proceeding to delivery of the late preterm (⩾34weeks gestation) patient with mild preeclampsia lessens maternal risk without significantly increasing neonatal risk.
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Affiliation(s)
- J N Martin
- University of Mississippi Medical Center, Jackson, United States
| | - M Y Owens
- University of Mississippi Medical Center, Jackson, United States
| | - B Thigpen
- University of Mississippi Medical Center, Jackson, United States
| | - M R Parrish
- University of Mississippi Medical Center, Jackson, United States
| | - S D Keiser
- University of Mississippi Medical Center, Jackson, United States
| | - K Wallace
- University of Mississippi Medical Center, Jackson, United States
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Eisenbrey JR, Sridharan A, Machado P, Zhao H, Halldorsdottir VG, Dave JK, Liu JB, Park S, Dianis S, Wallace K, Thomenius KE, Forsberg F. Three-dimensional subharmonic ultrasound imaging in vitro and in vivo. Acad Radiol 2012; 19:732-9. [PMID: 22464198 DOI: 10.1016/j.acra.2012.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES Although contrast-enhanced ultrasound imaging techniques such as harmonic imaging (HI) have evolved to reduce tissue signals using the nonlinear properties of the contrast agent, levels of background suppression have been mixed. Subharmonic imaging (SHI) offers near complete tissue suppression by centering the receive bandwidth at half the transmitting frequency. The aims of this study were to demonstrate the feasibility of three-dimensional (3D) SHI and to compare it to 3D HI. MATERIALS AND METHODS Three-dimensional HI and SHI were implemented on a Logiq 9 ultrasound scanner with a 4D10L probe. Four-cycle SHI was implemented to transmit at 5.8 MHz and receive at 2.9 MHz, while two-cycle HI was implemented to transmit at 5 MHz and receive at 10 MHz. The ultrasound contrast agent Definity was imaged within a flow phantom and the lower pole of two canine kidneys in both HI and SHI modes. Contrast-to-tissue ratios and rendered images were compared offline. RESULTS SHI resulted in significant improvement in contrast-to-tissue ratios relative to HI both in vitro (12.11 ± 0.52 vs 2.67 ± 0.77, P< .001) and in vivo (5.74 ± 1.92 vs 2.40 ± 0.48, P = .04). Rendered 3D subharmonic images provided better tissue suppression and a greater overall view of vessels in a flow phantom and canine renal vasculature. CONCLUSIONS The successful implementation of SHI in 3D allows imaging of vascular networks over a heterogeneous sample volume and should improve future diagnostic accuracy. Additionally, 3D SHI provides improved contrast-to-tissue ratios relative to 3D HI.
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Richman S, Wallace K, Liu S, Sperling B. Final Results from the AVONEX(R) (Intramuscular Interferon Beta-1a) Pregnancy Exposure Registry (P06.191). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Farag A, Tsang J, Wallace K, Lytwyn M, Zeglinski M, Bohonis S, Walker J, Tam J, Strzelczyk J, Jassal D. 586 Multimodality imaging of the aortic root: Comparison of transthoracic echocardiography with multidetector gated computed tomography. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Hughes M, Marsh J, Lanza G, Wickline S, McCarthy J, Wickerhauser V, Maurizi B, Wallace K. Improved signal processing to detect cancer by ultrasonic molecular imaging of targeted nanoparticles. J Acoust Soc Am 2011; 129:3756-3767. [PMID: 21682399 PMCID: PMC3143678 DOI: 10.1121/1.3578459] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 03/24/2011] [Accepted: 03/25/2011] [Indexed: 05/30/2023]
Abstract
In several investigations of molecular imaging of angiogenic neovasculature using a targeted contrast agent, Renyi entropy [I(f)(r)] and a limiting form of Renyi entropy (I(f,∞)) exhibited significantly more sensitivity to subtle changes in scattering architecture than energy-based methods. Many of these studies required the fitting of a cubic spline to backscattered waveforms prior to calculation of entropy [either I(f)(r) or I(f,∞)]. In this study, it is shown that the robustness of I(f,∞) may be improved by using a smoothing spline. Results are presented showing the impact of different smoothing parameters. In addition, if smoothing is preceded by low-pass filtering of the waveforms, further improvements may be obtained.
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Affiliation(s)
- Michael Hughes
- Cardiovascular Division, Washington University School of Medicine, Campus Box 8215, 4320 Forest Park Avenue, St. Louis, Missouri 63108, USA.
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Bowes D, Crook JM, Wallace K, Evans A, Toi A, Finelli A, Jewett MA. Use of a surgically derived nomogram to predict high likelihood of Gleason score upgrading for favorable-risk prostate cancer treated with permanent seed brachytherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.114] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
114 Background: Crook et al have reported a 7-year disease-free survival (DFS) of 95.2% in 1,111 men with prostate cancer treated with Iodine-125 permanent seed brachytherapy (BT) at Princess Margaret Hospital. Two nomograms have been developed that estimate the likelihood of Gleason score (GS) upgrading for patients with favorable risk prostate cancer undergoing radical prostatectomy (RP). The purpose of this project was to apply these nomograms to a cohort treated with BT. Methods: Records were examined for all men receiving prostate BT in 2006-7. 217 had favorable risk disease. The likelihood of GS upgrading was predicted using RP-derived nomograms created by Kulkarni et al (PMH, 2007) and Budaus et al (2010). Clinical and pathologic information were available on 208 patients to allow completion of the Kulkarni nomogram, and on 193 patients for the Budaus nomogram. Results: The median age of the BT cohort was 62 years (range 44–77), and the median PSA level 4.68 ng/ml. Clinical stage was T1 in 65%, and 47.6% had positive findings on transrectal ultrasound. Median prostate volume was 33.3 cc (15.0–72.3). Uro-pathology review was available for 93%. 84.1% had extended biopsies, with 40.9% showing prostatic intraepithelial neoplasia and 10.1% inflammation. The median % of positive cores was 25%, with a median maximum % involvement per core of 20%. Two men received androgen deprivation therapy for prostate downsizing. The median predicted likelihood of GS upgrading was 51.6% using the Kulkarni nomogram, and 43.6% using the Budaus nomogram. The median PSA after 3.2 years median follow-up is 0.18 ng/mL. Conclusions: In a population of men with favorable risk prostate cancer treated with BT, the estimated likelihood of GS upgrading using two surgical nomograms was substantial. The study cohort was taken from a larger population of patients treated over 10 years for whom 7-year DFS is 95.2%. This suggests that permanent seed brachytherapy is a highly effective treatment option for patients with favorable risk disease despite unfavorable clinical and pathologic factors. Patients should not be discouraged from brachytherapy on the basis of a high likelihood of GS upgrading. No significant financial relationships to disclose.
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Affiliation(s)
- D. Bowes
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - J. M. Crook
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - K. Wallace
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Evans
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Toi
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - A. Finelli
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | - M. A. Jewett
- British Columbia Cancer Agency, Kelowna, BC, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Urology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
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Wallace K, Veerisetty S, Paul I, May W, Miguel-Hidalgo JJ, Bennett W. Prenatal infection decreases calbindin, decreases Purkinje cell volume and density and produces long-term motor deficits in Sprague-Dawley rats. Dev Neurosci 2010; 32:302-12. [PMID: 20948182 DOI: 10.1159/000319506] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 07/19/2010] [Indexed: 11/19/2022] Open
Abstract
The cerebellum is involved in the control of motor functions with Purkinje cells serving as the only output from the cerebellum. Purkinje cells are important targets for toxic substances and are vulnerable to prenatal insults. Intrauterine infection (IUI) has been shown to selectively target the developing cerebral white matter through lesioning, necrosis and inflammatory cytokine activation. Developmental and cognitive delays have been associated with animal models of IUI. The aim of this study was to determine if IUI leads to damage to Purkinje cells in the developing cerebellum and if any damage is associated with decreases in calbindin and motor behaviors in surviving pups. Pregnant rats were injected with Escherichia coli (1 × 10⁵ colony-forming units) or sterile saline at gestational day 17. Beginning at postnatal day (PND) 2, the pups were subjected to a series of developmental tests to examine developmental milestones. At PND 16, some pups were sacrificed and their brains extracted and processed for histology or protein studies. Hematoxylin and eosin (HE) staining was done to examine the general morphology of the Purkinje cells and to examine Purkinje cell density, area and volume. Calbindin expression was examined in the cerebellum via immunohistochemistry and Western blot techniques. The remaining rat pups were used to examine motor coordination and balance on a rotating rotarod at the prepubertal and adult ages. Prenatal E. coli injection did not significantly change birth weight or delivery time, but did delay surface righting and negative geotaxis in pups. Pups in the E. coli group also had a decrease in the number of Purkinje cells, as well as a decrease in Purkinje cell density and volume. HE staining demonstrated a change in Purkinje cell morphology. Calbindin expression was decreased in rats from the E. coli group as well. Locomotor tests indicated that while there were no significant changes in gross motor activity, motor coordination and balance was impaired in both prepubertal and adult rats from the E. coli group. In this model of IUI, we observed changes in Purkinje cell development which were associated with alterations in cerebellum-dependent motor behaviors. The decreases in calbindin and Purkinje cells were associated with developmental delays. These data further support the importance of IUI in brain development.
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Affiliation(s)
- K Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA. kwallace2 @ umc.edu
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Parrish MR, Murphy SR, Rutland S, Wallace K, Wenzel K, Wallukat G, Keiser S, Ray LF, Dechend R, Martin JN, Granger JP, LaMarca B. The effect of immune factors, tumor necrosis factor-alpha, and agonistic autoantibodies to the angiotensin II type I receptor on soluble fms-like tyrosine-1 and soluble endoglin production in response to hypertension during pregnancy. Am J Hypertens 2010; 23:911-6. [PMID: 20431529 DOI: 10.1038/ajh.2010.70] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preeclampsia is considered a disease of immunological origin associated with abnormalities in inflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha), and activated lymphocytes secreting autoantibodies to the angiotensin II receptor (AT1-AA). Recent studies have also demonstrated that an imbalance of angiogenic factors, soluble fms-like tyrosine kinase (sFlt-1), and sEndoglin, exists in preeclampsia; however, the mechanisms that initiate their overproduction are unclear. METHODS To determine the role of immune regulation of these factors, circulating and placental sFlt-1 and/or sEndoglin was examined from pregnant rats chronically treated with TNF-alpha or AT1-AA. On day 19 of gestation blood pressure was analyzed and serum and tissues were collected. Placental villous explants were excised and cultured on matrigel coated inserts for 24 h and sFlt-1 and sEndoglin was measured from media. RESULTS In response to TNF-alpha-induced hypertension, sFlt-1 increased from 180 +/- 5 to 2,907 +/- 412 pg/ml. sFlt-1 was also increased from cultured placental explants of TNF-alpha induced hypertensive pregnant rats (n = 12) (2,544 +/- 1,132 pg/ml) vs. explants from normal pregnant (NP) rats (n = 12) (2,189 +/- 586 pg/ml) where as sEng was undetectable. Circulating sFlt-1 increased from 245 +/- 38 to 3,920 +/- 798 pg/ml in response to AT1-AA induced hypertension. sFlt-1 levels were higher (3,400 +/- 350 vs. 2,480 +/- 900 pg/ml) in placental explants from AT1-AA infused rats (n = 12) than NP rats (n = 7). In addition, sEndoglin increased from 30 +/- 2.7 to 44 +/- 3.3 pg/ml (P < 0.047) in AT1-AA infused rats but was undetectable in the media of the placental explants. CONCLUSIONS These data suggest that immune factors may serve as an important stimulus for both sFlt-1 and sEndoglin production in response to placental ischemia.
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Wallace K, Marek CJ, Hoppler S, Wright MC. Glucocorticoid-dependent transdifferentiation of pancreatic progenitor cells into hepatocytes is dependent on transient suppression of WNT signalling. Development 2010. [DOI: 10.1242/dev.054791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wallace K, Turnage E, Ray L, Cowan B, LaMarca B. Proliferation of uterine fibroids in hypoxia is associated with increased endothelin-1. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Popa M, Wallace K, Brunello A, Extermann M. The impact of polypharmacy on toxicity from chemotherapy in elderly patients: Focus on cytochrome P-450 inhibition and protein binding effects. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. OBJECTIVES To evaluate the effectiveness and side effects of localised cooling treatments compared with no treatment, other forms of cooling treatments and non-cooling treatments. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007), CINAHL (1982 to January 2007) and contacted experts in the field. SELECTION CRITERIA Published and unpublished randomised and quasi-randomised trials (RCTs) that compared localised cooling treatment applied to the perineum with no treatment or other treatments applied to relieve pain related to perineal trauma sustained during childbirth. DATA COLLECTION AND ANALYSIS At least two independent authors performed data extraction for each study. Analyses were performed on an intention-to-treat basis where data allowed. We sought additional information from the authors of three trials. MAIN RESULTS Seven published RCTs were included, comparing local cooling treatments (ice packs, cold gel pads or cold/iced baths) with no treatment, hamamelis water (witch hazel), pulsed electromagnetic energy (PET), hydrocortisone/pramoxine foam [Epifoam] or warm baths. The RCTs reported on a total of 859 women. Ice packs provided improved pain relief 24 to 72 hours after birth compared with no treatment (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.41 to 0.91). Women preferred the utility of the gel pads compared with ice packs or no treatment, although no differences in pain relief were detected between the treatments. None of our comparisons of treatments resulted in differences detected in perineal oedema or bruising. Women reported more pain (RR 5.60, 95% CI 2.35 to 13.33) and used more additional analgesia (RR 4.00, 95% CI 1.44 to 11.13) following the application of ice packs compared with PET. AUTHORS' CONCLUSIONS There is only limited evidence to support the effectiveness of local cooling treatments (ice packs, cold gel pads, cold/iced baths) applied to the perineum following childbirth to relieve pain.
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Affiliation(s)
- C E East
- University of Queensland, Perinatal Research Centre, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, Australia, 4029.
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Junker K, Wallace K, Leslie AJ, Boomker J. Gastric nematodes of Nile crocodiles, Crocodylus niloticus Laurenti, 1768, in the Okavango River, Botswana. ACTA ACUST UNITED AC 2006; 73:111-4. [PMID: 16958261 DOI: 10.4102/ojvr.v73i2.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The ascaridoid nematodes Dujardinascaris madagascariensis Chabaud & Caballero, 1966, Dujardinascaris dujardini (Travassos, 1920), Gedoelstascaris vandenbrandeni (Baylis, 1929) Sprent, 1978 and Multicaecum agile (Wedl, 1861) Baylis, 1923 were recovered from the stomach contents of Crocodylus niloticus Laurenti, 1768 from the Okavango River, Botswana, together with Eustrongylides sp., a dioctophymatoid nematode usually parasitizing piscivorous birds. Dujardinascaris madagascariensis was present in most of the infected hosts, while the remaining species were mostly represented in single collections in one to three hosts. All four ascaridoid nematodes represent new geographic records.
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Affiliation(s)
- K Junker
- Department of Veterinary Tropical Diseases, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
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D'Souza V, Melamed J, Habib D, Pullen K, Wallace K, Summers MF. Identification of a high affinity nucleocapsid protein binding element within the Moloney murine leukemia virus Psi-RNA packaging signal: implications for genome recognition. J Mol Biol 2001; 314:217-32. [PMID: 11718556 DOI: 10.1006/jmbi.2001.5139] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [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] [Indexed: 11/22/2022]
Abstract
Murine leukemia virus (MLV) is currently the most widely used gene delivery system in gene therapy trials. The simple retrovirus packages two copies of its RNA genome by a mechanism that involves interactions between the nucleocapsid (NC) domain of a virally-encoded Gag polyprotein and a segment of the RNA genome located just upstream of the Gag initiation codon, known as the Psi-site. Previous studies indicated that the MLV Psi-site contains three stem loops (SLB-SLD), and that stem loops SLC and SLD play prominent roles in packaging. We have developed a method for the preparation and purification of large quantities of recombinant Moloney MLV NC protein, and have studied its interactions with a series of oligoribonucleotides that contain one or more of the Psi-RNA stem loops. At RNA concentrations above approximately 0.3 mM, isolated stem loop SLB forms a duplex and stem loops SL-C and SL-D form kissing complexes, as expected from previous studies. However, neither the monomeric nor the dimeric forms of these isolated stem loops binds NC with significant affinity. Longer constructs containing two stem loops (SL-BC and SL-CD) also exhibit low affinities for NC. However, NC binds with high affinity and stoichiometrically to both the monomeric and dimeric forms of an RNA construct that contains all three stem loops (SL-BCD; K(d)=132(+/-55) nM). Titration of SL-BCD with NC also shifts monomer-dimer equilibrium toward the dimer. Mutagenesis experiments demonstrate that the conserved GACG tetraloops of stem loops C and D do not influence the monomer-dimer equilibrium of SL-BCD, that the tetraloop of stem loop B does not participate directly in NC binding, and that the tetraloops of stem loops C and D probably also do not bind to NC. These surprising results differ considerably from those observed for HIV-1, where NC binds to individual stem loops with high affinity via interactions with exposed residues of the tetraloops. The present results indicate that MLV NC binds to a pocket or surface that only exists in the presence of all three stem loops.
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Affiliation(s)
- V D'Souza
- Howard Hughes Medical Institute and Department of Chemistry and Biochemistry, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
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