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Haider SP, Zeevi T, Sharaf K, Gross M, Mahajan A, Kann BH, Judson BL, Prasad ML, Burtness B, Aboian M, Canis M, Reichel CA, Baumeister P, Payabvash S. Impact of 18F-FDG PET Intensity Normalization on Radiomic Features of Oropharyngeal Squamous Cell Carcinomas and Machine Learning-Generated Biomarkers. J Nucl Med 2024; 65:803-809. [PMID: 38514087 DOI: 10.2967/jnumed.123.266637] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
We aimed to investigate the effects of 18F-FDG PET voxel intensity normalization on radiomic features of oropharyngeal squamous cell carcinoma (OPSCC) and machine learning-generated radiomic biomarkers. Methods: We extracted 1,037 18F-FDG PET radiomic features quantifying the shape, intensity, and texture of 430 OPSCC primary tumors. The reproducibility of individual features across 3 intensity-normalized images (body-weight SUV, reference tissue activity ratio to lentiform nucleus of brain and cerebellum) and the raw PET data was assessed using an intraclass correlation coefficient (ICC). We investigated the effects of intensity normalization on the features' utility in predicting the human papillomavirus (HPV) status of OPSCCs in univariate logistic regression, receiver-operating-characteristic analysis, and extreme-gradient-boosting (XGBoost) machine-learning classifiers. Results: Of 1,037 features, a high (ICC ≥ 0.90), medium (0.90 > ICC ≥ 0.75), and low (ICC < 0.75) degree of reproducibility across normalization methods was attained in 356 (34.3%), 608 (58.6%), and 73 (7%) features, respectively. In univariate analysis, features from the PET normalized to the lentiform nucleus had the strongest association with HPV status, with 865 of 1,037 (83.4%) significant features after multiple testing corrections and a median area under the receiver-operating-characteristic curve (AUC) of 0.65 (interquartile range, 0.62-0.68). Similar tendencies were observed in XGBoost models, with the lentiform nucleus-normalized model achieving the numerically highest average AUC of 0.72 (SD, 0.07) in the cross validation within the training cohort. The model generalized well to the validation cohorts, attaining an AUC of 0.73 (95% CI, 0.60-0.85) in independent validation and 0.76 (95% CI, 0.58-0.95) in external validation. The AUCs of the XGBoost models were not significantly different. Conclusion: Only one third of the features demonstrated a high degree of reproducibility across intensity-normalization techniques, making uniform normalization a prerequisite for interindividual comparability of radiomic markers. The choice of normalization technique may affect the radiomic features' predictive value with respect to HPV. Our results show trends that normalization to the lentiform nucleus may improve model performance, although more evidence is needed to draw a firm conclusion.
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Affiliation(s)
- Stefan P Haider
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany;
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Tal Zeevi
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Kariem Sharaf
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
| | - Moritz Gross
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
- Charité Center for Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Amit Mahajan
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L Judson
- Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut; and
| | - Barbara Burtness
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Mariam Aboian
- Section of Neuroradiology, Yale School of Medicine, New Haven, Connecticut
| | - Martin Canis
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
| | - Christoph A Reichel
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, LMU Clinic of Ludwig Maximilians University of Munich, Munich, Germany
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Gross M, Huber S, Arora S, Ze'evi T, Haider SP, Kucukkaya AS, Iseke S, Kuhn TN, Gebauer B, Michallek F, Dewey M, Vilgrain V, Sartoris R, Ronot M, Jaffe A, Strazzabosco M, Chapiro J, Onofrey JA. Automated MRI liver segmentation for anatomical segmentation, liver volumetry, and the extraction of radiomics. Eur Radiol 2024:10.1007/s00330-023-10495-5. [PMID: 38217704 DOI: 10.1007/s00330-023-10495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To develop and evaluate a deep convolutional neural network (DCNN) for automated liver segmentation, volumetry, and radiomic feature extraction on contrast-enhanced portal venous phase magnetic resonance imaging (MRI). MATERIALS AND METHODS This retrospective study included hepatocellular carcinoma patients from an institutional database with portal venous MRI. After manual segmentation, the data was randomly split into independent training, validation, and internal testing sets. From a collaborating institution, de-identified scans were used for external testing. The public LiverHccSeg dataset was used for further external validation. A 3D DCNN was trained to automatically segment the liver. Segmentation accuracy was quantified by the Dice similarity coefficient (DSC) with respect to manual segmentation. A Mann-Whitney U test was used to compare the internal and external test sets. Agreement of volumetry and radiomic features was assessed using the intraclass correlation coefficient (ICC). RESULTS In total, 470 patients met the inclusion criteria (63.9±8.2 years; 376 males) and 20 patients were used for external validation (41±12 years; 13 males). DSC segmentation accuracy of the DCNN was similarly high between the internal (0.97±0.01) and external (0.96±0.03) test sets (p=0.28) and demonstrated robust segmentation performance on public testing (0.93±0.03). Agreement of liver volumetry was satisfactory in the internal (ICC, 0.99), external (ICC, 0.97), and public (ICC, 0.85) test sets. Radiomic features demonstrated excellent agreement in the internal (mean ICC, 0.98±0.04), external (mean ICC, 0.94±0.10), and public (mean ICC, 0.91±0.09) datasets. CONCLUSION Automated liver segmentation yields robust and generalizable segmentation performance on MRI data and can be used for volumetry and radiomic feature extraction. CLINICAL RELEVANCE STATEMENT Liver volumetry, anatomic localization, and extraction of quantitative imaging biomarkers require accurate segmentation, but manual segmentation is time-consuming. A deep convolutional neural network demonstrates fast and accurate segmentation performance on T1-weighted portal venous MRI. KEY POINTS • This deep convolutional neural network yields robust and generalizable liver segmentation performance on internal, external, and public testing data. • Automated liver volumetry demonstrated excellent agreement with manual volumetry. • Automated liver segmentations can be used for robust and reproducible radiomic feature extraction.
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Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Sandeep Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Tal Ze'evi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Tom Niklas Kuhn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Gebauer
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Michallek
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dewey
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valérie Vilgrain
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Riccardo Sartoris
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Maxime Ronot
- Université Paris Cité, Île-de-France, Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Department of Radiology, Île-de-France, Clichy, France
| | - Ariel Jaffe
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - John A Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
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Gross M, Arora S, Huber S, Kücükkaya AS, Onofrey JA. LiverHccSeg: A publicly available multiphasic MRI dataset with liver and HCC tumor segmentations and inter-rater agreement analysis. Data Brief 2023; 51:109662. [PMID: 37869619 PMCID: PMC10587725 DOI: 10.1016/j.dib.2023.109662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
Accurate segmentation of liver and tumor regions in medical imaging is crucial for the diagnosis, treatment, and monitoring of hepatocellular carcinoma (HCC) patients. However, manual segmentation is time-consuming and subject to inter- and intra-rater variability. Therefore, automated methods are necessary but require rigorous validation of high-quality segmentations based on a consensus of raters. To address the need for reliable and comprehensive data in this domain, we present LiverHccSeg, a dataset that provides liver and tumor segmentations on multiphasic contrast-enhanced magnetic resonance imaging from two board-approved abdominal radiologists, along with an analysis of inter-rater agreement. LiverHccSeg provides a curated resource for liver and HCC tumor segmentation tasks. The dataset includes a scientific reading and co-registered contrast-enhanced multiphasic magnetic resonance imaging (MRI) scans with corresponding manual segmentations by two board-approved abdominal radiologists and relevant metadata and offers researchers a comprehensive foundation for external validation, and benchmarking of liver and tumor segmentation algorithms. The dataset also provides an analysis of the agreement between the two sets of liver and tumor segmentations. Through the calculation of appropriate segmentation metrics, we provide insights into the consistency and variability in liver and tumor segmentations among the radiologists. A total of 17 cases were included for liver segmentation and 14 cases for HCC tumor segmentation. Liver segmentations demonstrates high segmentation agreement (mean Dice, 0.95 ± 0.01 [standard deviation]) and HCC tumor segmentations showed higher variation (mean Dice, 0.85 ± 0.16 [standard deviation]). The applications of LiverHccSeg can be manifold, ranging from testing machine learning algorithms on public external data to radiomic feature analyses. Leveraging the inter-rater agreement analysis within the dataset, researchers can investigate the impact of variability on segmentation performance and explore methods to enhance the accuracy and robustness of liver and tumor segmentation algorithms in HCC patients. By making this dataset publicly available, LiverHccSeg aims to foster collaborations, facilitate innovative solutions, and ultimately improve patient outcomes in the diagnosis and treatment of HCC.
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Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandeep Arora
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ahmet S. Kücükkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
- Charité Center for Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - John A. Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States of America
- Department of Urology, Yale University School of Medicine, New Haven, CT, United States of America
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States of America
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Haider SP, Qureshi AI, Jain A, Tharmaseelan H, Berson ER, Zeevi T, Werring DJ, Gross M, Mak A, Malhotra A, Sansing LH, Falcone GJ, Sheth KN, Payabvash S. Radiomic markers of intracerebral hemorrhage expansion on non-contrast CT: independent validation and comparison with visual markers. Front Neurosci 2023; 17:1225342. [PMID: 37655013 PMCID: PMC10467422 DOI: 10.3389/fnins.2023.1225342] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023] Open
Abstract
Objective To devise and validate radiomic signatures of impending hematoma expansion (HE) based on admission non-contrast head computed tomography (CT) of patients with intracerebral hemorrhage (ICH). Methods Utilizing a large multicentric clinical trial dataset of hypertensive patients with spontaneous supratentorial ICH, we developed signatures predictive of HE in a discovery cohort (n = 449) and confirmed their performance in an independent validation cohort (n = 448). In addition to n = 1,130 radiomic features, n = 6 clinical variables associated with HE, n = 8 previously defined visual markers of HE, the BAT score, and combinations thereof served as candidate variable sets for signatures. The area under the receiver operating characteristic curve (AUC) quantified signatures' performance. Results A signature combining select radiomic features and clinical variables attained the highest AUC (95% confidence interval) of 0.67 (0.61-0.72) and 0.64 (0.59-0.70) in the discovery and independent validation cohort, respectively, significantly outperforming the clinical (pdiscovery = 0.02, pvalidation = 0.01) and visual signature (pdiscovery = 0.03, pvalidation = 0.01) as well as the BAT score (pdiscovery < 0.001, pvalidation < 0.001). Adding visual markers to radiomic features failed to improve prediction performance. All signatures were significantly (p < 0.001) correlated with functional outcome at 3-months, underlining their prognostic relevance. Conclusion Radiomic features of ICH on admission non-contrast head CT can predict impending HE with stable generalizability; and combining radiomic with clinical predictors yielded the highest predictive value. By enabling selective anti-expansion treatment of patients at elevated risk of HE in future clinical trials, the proposed markers may increase therapeutic efficacy, and ultimately improve outcomes.
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Affiliation(s)
- Stefan P. Haider
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
- Department of Otorhinolaryngology, University Hospital of Ludwig-Maximilians-Universität München, Munich, Germany
| | - Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Abhi Jain
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Hishan Tharmaseelan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Elisa R. Berson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - David J. Werring
- Stroke Research Centre, University College London, Queen Square Institute of Neurology, London, United Kingdom
| | - Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Adrian Mak
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
| | - Lauren H. Sansing
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States
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Santana JG, Petukhova-Greenstein A, Gross M, Hyder F, Pekurovsky V, Gottwald LA, Boustani A, Walsh JJ, Kucukkaya AS, Malpani R, Madoff DC, Goldberg SN, Ahmed M, Joshi N, Coman D, Chapiro J. MR Imaging-Based In Vivo Macrophage Imaging to Monitor Immune Response after Radiofrequency Ablation of the Liver. J Vasc Interv Radiol 2023; 34:395-403.e5. [PMID: 36423815 PMCID: PMC11042914 DOI: 10.1016/j.jvir.2022.11.013] [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] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To establish molecular magnetic resonance (MR) imaging instruments for in vivo characterization of the immune response to hepatic radiofrequency (RF) ablation using cell-specific immunoprobes. MATERIALS AND METHODS Seventy-two C57BL/6 wild-type mice underwent standardized hepatic RF ablation (70 °C for 5 minutes) to generate a coagulation area measuring 6-7 mm in diameter. CD68+ macrophage periablational infiltration was characterized with immunohistochemistry 24 hours, 72 hours, 7 days, and 14 days after ablation (n = 24). Twenty-one mice were subjected to a dose-escalation study with either 10, 15, 30, or 60 mg/kg of rhodamine-labeled superparamagnetic iron oxide nanoparticles (SPIONs) or 2.4, 1.2, or 0.6 mg/kg of gadolinium-160 (160Gd)-labeled CD68 antibody for assessment of the optimal in vivo dose of contrast agent. MR imaging experiments included 9 mice, each receiving 10-mg/kg SPIONs to visualize phagocytes using T2∗-weighted imaging in a horizontal-bore 9.4-T MR imaging scanner, 160Gd-CD68 for T1-weighted MR imaging of macrophages, or 0.1-mmol/kg intravenous gadoterate (control group). Radiological-pathological correlation included Prussian blue staining, rhodamine immunofluorescence, imaging mass cytometry, and immunohistochemistry. RESULTS RF ablation-induced periablational infiltration (206.92 μm ± 12.2) of CD68+ macrophages peaked at 7 days after ablation (P < .01) compared with the untreated lobe. T2∗-weighted MR imaging with SPION contrast demonstrated curvilinear T2∗ signal in the transitional zone (TZ) (186 μm ± 16.9), corresponsing to Iron Prussian blue staining. T1-weighted MR imaging with 160Gd-CD68 antibody showed curvilinear signal in the TZ (164 μm ± 3.6) corresponding to imaging mass cytometry. CONCLUSIONS Both SPION-enhanced T2∗-weighted and 160Gd-enhanced T1-weighted MR imaging allow for in vivo monitoring of macrophages after RF ablation, demonstrating the feasibility of this model to investigate local immune responses.
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Affiliation(s)
- Jessica G Santana
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Alexandra Petukhova-Greenstein
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Moritz Gross
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Fahmeed Hyder
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Vasily Pekurovsky
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Luzie A Gottwald
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Annemarie Boustani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - John J Walsh
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Ahmet S Kucukkaya
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Rohil Malpani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - S Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts; Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Nikhil Joshi
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel Coman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
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Iseke S, Zeevi T, Kucukkaya AS, Raju R, Gross M, Haider SP, Petukhova-Greenstein A, Kuhn TN, Lin M, Nowak M, Cooper K, Thomas E, Weber MA, Madoff DC, Staib L, Batra R, Chapiro J. Machine Learning Models for Prediction of Posttreatment Recurrence in Early-Stage Hepatocellular Carcinoma Using Pretreatment Clinical and MRI Features: A Proof-of-Concept Study. AJR Am J Roentgenol 2023; 220:245-255. [PMID: 35975886 PMCID: PMC10015590 DOI: 10.2214/ajr.22.28077] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND. Posttreatment recurrence is an unpredictable complication after liver transplant for hepatocellular carcinoma (HCC) that is associated with poor survival. Biomarkers are needed to estimate recurrence risk before organ allocation. OBJECTIVE. This proof-of-concept study evaluated the use of machine learning (ML) to predict recurrence from pretreatment laboratory, clinical, and MRI data in patients with early-stage HCC initially eligible for liver transplant. METHODS. This retrospective study included 120 patients (88 men, 32 women; median age, 60.0 years) with early-stage HCC diagnosed who were initially eligible for liver transplant and underwent treatment by transplant, resection, or thermal ablation between June 2005 and March 2018. Patients underwent pretreatment MRI and posttreatment imaging surveillance. Imaging features were extracted from postcontrast phases of pretreatment MRI examinations using a pretrained convolutional neural network. Pretreatment clinical characteristics (including laboratory data) and extracted imaging features were integrated to develop three ML models (clinical model, imaging model, combined model) for predicting recurrence within six time frames ranging from 1 through 6 years after treatment. Kaplan-Meier analysis with time to recurrence as the endpoint was used to assess the clinical relevance of model predictions. RESULTS. Tumor recurred in 44 of 120 (36.7%) patients during follow-up. The three models predicted recurrence with AUCs across the six time frames of 0.60-0.78 (clinical model), 0.71-0.85 (imaging model), and 0.62-0.86 (combined model). The mean AUC was higher for the imaging model than the clinical model (0.76 vs 0.68, respectively; p = .03), but the mean AUC was not significantly different between the clinical and combined models or between the imaging and combined models (p > .05). Kaplan-Meier curves were significantly different between patients predicted to be at low risk and those predicted to be at high risk by all three models for the 2-, 3-, 4-, 5-, and 6-year time frames (p < .05). CONCLUSION. The findings suggest that ML-based models can predict recurrence before therapy allocation in patients with early-stage HCC initially eligible for liver transplant. Adding MRI data as model input improved predictive performance over clinical parameters alone. The combined model did not surpass the imaging model's performance. CLINICAL IMPACT. ML-based models applied to currently underutilized imaging features may help design more reliable criteria for organ allocation and liver transplant eligibility.
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Affiliation(s)
- Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rajiv Raju
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tom N Kuhn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Department of Diagnostic and Interventional Radiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Clinical Research North America, Visage Imaging, Inc., San Diego, CA
| | - Michal Nowak
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Kirsten Cooper
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Elizabeth Thomas
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lawrence Staib
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
| | - Ramesh Batra
- Department of Surgery, Transplantation and Immunology, Yale University School of Medicine, New Haven, CT
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 300 Cedar St, New Haven, CT 06520
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Matovic-Miljanovic S, Cvjetkovic S, Jeremic-Stojkovic V, Mandic-Rajcevic S, Bjegovic-Mikanovic V, Gross M. Trust in societal factors and vaccine hesitancy in Western Balkans. Eur J Public Health 2022. [PMCID: PMC9594182 DOI: 10.1093/eurpub/ckac130.156] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Countries in the Western Balkans are facing vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus. Trust in science and institutions, namely political trust, plays an important role and can significantly affects vaccine acceptance. Methods Cross-sectional research was carried out from July to September 2021 in five countries of the Western Balkans (Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia) and included adult population aged 18 and older (1605 individuals). Convenience sampling was applied using anonymised online questionnaires and Likert scales, shared through online social media, and asking, among others, for trust in societal factors. Results In all countries people had more confidence in health authorities than in political officials. There are no gender differences found in showing trust in societal factors, except in Serbia where women compared to men showed greater trust in health authorities (50.6% vs. 34.4%), as well as in political officials (42.8% vs. 28.2%). The lowest trust in pharmaceutical companies was found in Albania where 34,9% respondents believe that vaccination against COVID-19 is largely promoted by pharmaceutical companies due to financial profits. People who put more trust in societal factors were vaccinated to a greater extent. In Serbia and Albania, the older respondents in general put more trust in societal factors. People who assessed themselves as more religious in Serbia and North Macedonia demonstrated less trust towards societal factors. Conclusions The study demonstrated moderate trust in societal factors in all countries, with greatest trust in health authorities. This implies that health authorities should have a pivotal role, together with physicians in primary health, in promoting vaccination and educating the general public in the Western Balkans. Key messages
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Affiliation(s)
| | - S Cvjetkovic
- Department of Humanities, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - V Jeremic-Stojkovic
- Department of Humanities, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - S Mandic-Rajcevic
- Institute for Social Medicine, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - V Bjegovic-Mikanovic
- Institute for Social Medicine, School of Medicine, University of Belgrade , Belgrade, Serbia
| | - M Gross
- Public Health, Euro Health Group , Copenhagen, Denmark
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Baum B, Gross M, Latham D, Crabtree L, Randolph K. Bridging the Service Gap: Branch Managers Talk about Social Workers in Public Libraries. Public Library Quarterly 2022. [DOI: 10.1080/01616846.2022.2113696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- B. Baum
- School of Information, Florida State University, Tallahassee, Florida, USA
| | - M. Gross
- School of Information, Florida State University, Tallahassee, Florida, USA
| | - D. Latham
- School of Information, Florida State University, Tallahassee, Florida, USA
| | - L. Crabtree
- School of Information, Florida State University, Tallahassee, Florida, USA
| | - K. Randolph
- College of Social Work, Florida State University, Tallahassee, Florida, USA
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Berz AM, Santana JG, Iseke S, Gross M, Pekurovsky V, Laage Gaupp F, Savic LJ, Borde T, Gottwald LA, Boustani AM, Gebauer B, Lin M, Zhang X, Schlachter T, Madoff DC, Chapiro J. Impact of Chemoembolic Regimen on Immune Cell Recruitment and Immune Checkpoint Marker Expression following Transcatheter Arterial Chemoembolization in a VX2 Rabbit Liver Tumor Model. J Vasc Interv Radiol 2022; 33:764-774.e4. [PMID: 35346859 PMCID: PMC9344951 DOI: 10.1016/j.jvir.2022.03.026] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To characterize the effects of commonly used transcatheter arterial chemoembolization (TACE) regimens on the immune response and immune checkpoint marker expression using a VX2 rabbit liver tumor model. MATERIALS AND METHODS Twenty-four VX2 liver tumor-bearing New Zealand white rabbits were assigned to 7 groups (n = 3 per group) undergoing locoregional therapy as follows: (a) bicarbonate infusion without embolization, (b) conventional TACE (cTACE) using a water-in-oil emulsion containing doxorubicin mixed 1:2 with Lipiodol, drug-eluting embolic-TACE with either (c) idarubicin-eluting Oncozene microspheres (40 μm) or (d) doxorubicin-eluting Lumi beads (40-90 μm). For each therapy arm (b-d), a tandem set of 3 animals with additional bicarbonate infusion before TACE was added, to evaluate the effect of pH modification on the immune response. Three untreated rabbits served as controls. Tissue was harvested 24 hours after treatment, followed by digital immunohistochemistry quantification (counts/μm2 ± SEM) of tumor-infiltrating cluster of differentiation 3+ T-lymphocytes, human leukocyte antigen DR type antigen-presenting cells (APCs), cytotoxic T-lymphocyte-associated protein-4 (CTLA-4), and programmed cell death protein-1 (PD-1)/PD-1 ligand (PD-L1) pathway axis expression. RESULTS Lumi-bead TACE induced significantly more intratumoral T-cell and APC infiltration than cTACE and Oncozene-microsphere TACE. Additionally, tumors treated with Lumi-bead TACE expressed significantly higher intratumoral immune checkpoint markers compared with cTACE and Oncozene-microsphere TACE. Neoadjuvant bicarbonate demonstrated the most pronounced effect on cTACE and resulted in a significant increase in intratumoral cluster of differentiation 3+ T-cell infiltration compared with cTACE alone. CONCLUSIONS This preclinical study revealed significant differences in evoked tumor immunogenicity depending on the choice of chemoembolic regimen for TACE.
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Affiliation(s)
- Antonia M Berz
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology Berlin, Germany
| | - Jessica G Santana
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology Berlin, Germany
| | - Vasily Pekurovsky
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Fabian Laage Gaupp
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Lynn J Savic
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tabea Borde
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology Berlin, Germany
| | - Luzie A Gottwald
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology Berlin, Germany
| | - Anne Marie Boustani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Bernhard Gebauer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology Berlin, Germany
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Visage Imaging, Inc., San Diego, California
| | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
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Braun A, Xiang A, Chen M, Gross M, Simhan J. Innovative Findings Characterizing the Location and Severity of Postoperative Pain Following Inflatable Penile Prosthesis Surgery Managed With Multimodal Analgesia. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.029] [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: 11/26/2022]
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Swanton A, Munarriz R, Gross M. Does Partner Involvement Reduce Unanticipated Postop Visits Following Penile Prosthesis? J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.384] [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: 11/30/2022]
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Paredes-Bhushan V, Patel R, Saunders J, Rezaee M, Gross M. Analyzing the Quality of YouTube Videos on Inflatable Penile Prosthesis Surgery. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.248] [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: 11/30/2022]
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Wu S, Swanton A, Gross M. New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.226] [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]
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Qian H, Li X, Stephan F, Aboulbanine Z, Amirkhanyan Z, Gross M, Krasilnikov M, Oppelt A, Philipp S. FIRST PHYSICS DESIGN OF BEAMLINE FOR ELECTRON FLASH RADIATION THERAPY AT PITZ. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01697-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Stephan F, Aboulbanine Z, Amirkhanyan Z, Good J, Gross M, Krasilnikov M, Lishilin O, Oppelt A, Philipp S, Qian H, Stegmann C, Worm S, Leemans W, Schmitz M, Schnautz T, Weise H, Budach V, Ehrhardt V, Vozenin MC, Faus-Golfe A, Tsakanova G, Schüller A, Frohme M, Grebinyk A, Reindl J, Grüner F, Staufer T. FLASH Modalities Track (Oral Presentations) NEW R&D PLATFORM WITH UNIQUE CAPABILITIES FOR ELECTRON FLASH AND VHEE RADIATION THERAPY AND RADIATION BIOLOGY UNDER PREPARATION AT PITZ. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01512-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Aboulbanine Z, Amirkhanyan Z, Good J, Gross M, Li X, Krasilnikov M, Oppelt A, Philipp S, Qian H, Stephan F, Tayalati Y. FOCUSED ELECTRON BEAMS AS A POSSIBLE MODALITY FOR FLASH RADIATION THERAPY: TOPAS/GEANT4 DOSIMETRY SIMULATION STUDY AND PERFORMANCE INVESTIGATION. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01593-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Gross M, Spektor M, Jaffe A, Kucukkaya AS, Iseke S, Haider SP, Strazzabosco M, Chapiro J, Onofrey JA. Improved performance and consistency of deep learning 3D liver segmentation with heterogeneous cancer stages in magnetic resonance imaging. PLoS One 2021; 16:e0260630. [PMID: 34852007 PMCID: PMC8635384 DOI: 10.1371/journal.pone.0260630] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Accurate liver segmentation is key for volumetry assessment to guide treatment decisions. Moreover, it is an important pre-processing step for cancer detection algorithms. Liver segmentation can be especially challenging in patients with cancer-related tissue changes and shape deformation. The aim of this study was to assess the ability of state-of-the-art deep learning 3D liver segmentation algorithms to generalize across all different Barcelona Clinic Liver Cancer (BCLC) liver cancer stages. METHODS This retrospective study, included patients from an institutional database that had arterial-phase T1-weighted magnetic resonance images with corresponding manual liver segmentations. The data was split into 70/15/15% for training/validation/testing each proportionally equal across BCLC stages. Two 3D convolutional neural networks were trained using identical U-net-derived architectures with equal sized training datasets: one spanning all BCLC stages ("All-Stage-Net": AS-Net), and one limited to early and intermediate BCLC stages ("Early-Intermediate-Stage-Net": EIS-Net). Segmentation accuracy was evaluated by the Dice Similarity Coefficient (DSC) on a dataset spanning all BCLC stages and a Wilcoxon signed-rank test was used for pairwise comparisons. RESULTS 219 subjects met the inclusion criteria (170 males, 49 females, 62.8±9.1 years) from all BCLC stages. Both networks were trained using 129 subjects: AS-Net training comprised 19, 74, 18, 8, and 10 BCLC 0, A, B, C, and D patients, respectively; EIS-Net training comprised 21, 86, and 22 BCLC 0, A, and B patients, respectively. DSCs (mean±SD) were 0.954±0.018 and 0.946±0.032 for AS-Net and EIS-Net (p<0.001), respectively. The AS-Net 0.956±0.014 significantly outperformed the EIS-Net 0.941±0.038 on advanced BCLC stages (p<0.001) and yielded similarly good segmentation performance on early and intermediate stages (AS-Net: 0.952±0.021; EIS-Net: 0.949±0.027; p = 0.107). CONCLUSION To ensure robust segmentation performance across cancer stages that is independent of liver shape deformation and tumor burden, it is critical to train deep learning models on heterogeneous imaging data spanning all BCLC stages.
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Affiliation(s)
- Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Charité Center for Diagnostic and Interventional Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Spektor
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Ariel Jaffe
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Ahmet S. Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Charité Center for Diagnostic and Interventional Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Stefan P. Haider
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Mario Strazzabosco
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - John A. Onofrey
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States of America
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Haider SP, Qureshi AI, Jain A, Tharmaseelan H, Berson ER, Zeevi T, Majidi S, Filippi CG, Iseke S, Gross M, Acosta JN, Malhotra A, Kim JA, Sansing LH, Falcone GJ, Sheth KN, Payabvash S. Admission computed tomography radiomic signatures outperform hematoma volume in predicting baseline clinical severity and functional outcome in the ATACH-2 trial intracerebral hemorrhage population. Eur J Neurol 2021; 28:2989-3000. [PMID: 34189814 DOI: 10.1111/ene.15000] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Radiomics provides a framework for automated extraction of high-dimensional feature sets from medical images. We aimed to determine radiomics signature correlates of admission clinical severity and medium-term outcome from intracerebral hemorrhage (ICH) lesions on baseline head computed tomography (CT). METHODS We used the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial dataset. Patients included in this analysis (n = 895) were randomly allocated to discovery (n = 448) and independent validation (n = 447) cohorts. We extracted 1130 radiomics features from hematoma lesions on baseline noncontrast head CT scans and generated radiomics signatures associated with admission Glasgow Coma Scale (GCS), admission National Institutes of Health Stroke Scale (NIHSS), and 3-month modified Rankin Scale (mRS) scores. Spearman's correlation between radiomics signatures and corresponding target variables was compared with hematoma volume. RESULTS In the discovery cohort, radiomics signatures, compared to ICH volume, had a significantly stronger association with admission GCS (0.47 vs. 0.44, p = 0.008), admission NIHSS (0.69 vs. 0.57, p < 0.001), and 3-month mRS scores (0.44 vs. 0.32, p < 0.001). Similarly, in independent validation, radiomics signatures, compared to ICH volume, had a significantly stronger association with admission GCS (0.43 vs. 0.41, p = 0.02), NIHSS (0.64 vs. 0.56, p < 0.001), and 3-month mRS scores (0.43 vs. 0.33, p < 0.001). In multiple regression analysis adjusted for known predictors of ICH outcome, the radiomics signature was an independent predictor of 3-month mRS in both cohorts. CONCLUSIONS Limited by the enrollment criteria of the ATACH-2 trial, we showed that radiomics features quantifying hematoma texture, density, and shape on baseline CT can provide imaging correlates for clinical presentation and 3-month outcome. These findings couldtrigger a paradigm shift where imaging biomarkers may improve current modelsfor prognostication, risk-stratification, and treatment triage of ICH patients.
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Affiliation(s)
- Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.,Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Abhi Jain
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Hishan Tharmaseelan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Elisa R Berson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Julian N Acosta
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer A Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Lauren H Sansing
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
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Van Renterghem K, Jacobs B, Yafi F, Osmonov D, Ralph D, Venturino L, Barnard J, Ziegelmann M, Wang R, Kannady C, Lentz A, Lledo Garcia E, Andrianne R, Bettochi C, Hatzichristodoulou G, Gross M, Faix A, Romero Otero J, Martinez Salamanca J, Sedigh O, Albersen M, Dinkelman-Smit M, Mikoniatis I. Current practices in high and low volume centers regarding corporotomy localization during penoscrotal inflatable penile implant surgery. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00881-2] [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: 11/25/2022]
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La J, Chung E, Gross M, Hatzichristodoulou G, Park S, Perito P, Sarmiento A, van Renterghem K, Yafi F. 069 Satisfaction Rates of Inflatable Penile Prostheses in Men who have Sex with Men. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.039] [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: 11/30/2022]
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Chai NX, Chapiro J, Petukhova A, Gross M, Kucukkaya A, Raju R, Zeevi T, Elbanan M, Lin M, Perez-Lozada JC, Schlachter T, Strazzabosco M, Pollak JS, Madoff DC. Thermal ablation alone vs thermal ablation combined with transarterial chemoembolization for patients with small (<3 cm) hepatocellular carcinoma. Clin Imaging 2021; 76:123-129. [PMID: 33592550 DOI: 10.1016/j.clinimag.2021.01.043] [Citation(s) in RCA: 4] [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: 10/05/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Thermal ablation (TA) and transarterial chemoembolization (TACE) may be used alone or in combination (TACE+TA) for the treatment of hepatocellular carcinoma (HCC). The aim of our study was to compare the time to tumor progression (TTP) and overall survival (OS) for patients who received TA alone or TACE+TA for HCC tumors under 3 cm. MATERIALS AND METHODS This HIPAA-compliant IRB-approved retrospective analysis included 85 therapy-naïve patients from 2010 to 2018 (63 males, 22 females, mean age 62.4 ± 8.5 years) who underwent either TA alone (n = 64) or TA in combination with drug-eluting beads (DEB)-TACE (n = 18) or Lipiodol-TACE (n = 3) for locoregional therapy of early stage HCC with maximum tumor diameter under 3 cm. Kaplan-Meier analysis was performed using the log-rank test to assess TTP and OS. RESULTS All TA and TACE+TA treatments included were technically successful. TTP was 23.0 months in the TA group and 22.0 months in the TACE+TA group. There was no statistically significant difference in TTP (p = 0.64). Median OS was 69.7 months in the TA group and 64.6 months in the TACE+TA group. There was no statistically significant difference in OS (p = 0.14). The treatment cohorts had differences in AFP levels (p = 0.03) and BCLC stage (p = 0.047). Complication rates between patient groups were similar (p = 0.61). CONCLUSION For patients with HCC under 3 cm, TA alone and TACE+TA have similar outcomes in terms of TTP and OS, suggesting that TACE+TA may not be needed for these tumors unless warranted by tumor location or other technical consideration.
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Affiliation(s)
- Nathan X Chai
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Alexandra Petukhova
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Ahmet Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Rajiv Raju
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Mohamed Elbanan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Juan Carlos Perez-Lozada
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Mario Strazzabosco
- Department of Internal Medicine, Sections of Digestive Diseases, Yale School of Medicine, New Haven, CT, United States of America
| | - Jeffrey S Pollak
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America; Medical Oncology, Yale School of Medicine, New Haven, CT, United States of America.
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Towe M, Osman M, Huynh L, El-Khatib F, Andrianne R, Broderick G, Burnett A, Clavell-Hernandez J, Gross M, Guise A, Hatzichristodoulou G, Henry G, Hsieh T, Jenkins L, Lentz A, Munarriz R, Osmonov D, Sung Hun P, Perito P, Sadeghi-Nejad H, Simhan J, Wang R, Yafi F. Effect of antimicrobial dipping solutions on post-operative infection rates in diabetic patients undergoing primary insertion of a Coloplast titan inflatable penile prosthesis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33090-1] [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: 12/01/2022] Open
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Gross M, Patel R, Schwartz SW, Sebastião YV, Foulis P, Scheer D, Taylor KA, Anderson W. 0806 Prescription Correlates of Nightmare Disorder Among Veterans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.802] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
In the James A. Haley Veterans Administration (JAHVA) Vista database, the ICD-9 code 307.47 for Nightmare disorder (ND) is infrequently used and appears independently of codes for PTSD. We wanted to determine if certain drugs that may affect sleep are associated with ND.
Methods
All patients with ND visiting JAHVA between 2007 and 2011 were selected along with control patients who visited JAHVA on one of 20 random days, one day each quarter year. Controls were assigned an index date reflecting their selection quarter. Associations with prescriptions for opioids, antidepressants (SSRI’s, SSNI’s, Tricyclics), antihistamines and benzodiazepine/Z-drugs were initially investigated. Two analyses were performed: risk factor analysis- patients with ND diagnosis dates (cases) or index dates (controls) prior to 2008 were excluded and only prescription dates that preceded the ND diagnosis or index date were considered; treatment analysis- cases and controls with a ND diagnosis date or index date after 2010 were excluded and only prescription dates that were subsequent to the ND diagnosis or index date respectively were considered. Logistic regression adjusting for age, gender, race and Hispanic ethnicity was used to determine the association between drug groups and ND.
Results
In risk factor analysis (667 cases, 14,739 controls), opioids and antihistamines were significantly less prevalent among would-be ND patients than controls (OR=0.627 and 0.610 respectively); no drug group was predictive of ND. In contrast, all drug groups were significantly associated with ND in treatment analysis (803 cases, 15,530 controls). The strongest associations were seen with benzodiazepine (OR=3.026; 95% CI: 2.472, 3.703) and SSRI (OR=2.789; 95% CI=2.316, 3.358) prescriptions.
Conclusion
Our data suggest that some JAHVA providers may be treating ND with medication, most notably with benzodiazepines/Z-drugs and antidepressants. The role of anti-histamine and opioid prescriptions needs further elucidation. The ramifications of these treatment decisions should be explored.
Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
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Affiliation(s)
- M Gross
- University of South Florida, College of Public Health, Tampa, FL
| | - R Patel
- University of South Florida, College of Public Health, Tampa, FL
- James A. Haley Veteran’s Hospital, Tampa, FL
| | - S W Schwartz
- University of South Florida, College of Public Health, Tampa, FL
| | | | - P Foulis
- University of South Florida, College of Public Health, Tampa, FL
- James A. Haley Veteran’s Hospital, Tampa, FL
| | - D Scheer
- University of South Florida, College of Public Health, Tampa, FL
- Biotech Research Group Inc., Tampa, FL
| | - K A Taylor
- University of South Florida, College of Public Health, Tampa, FL
- Gannon University, Ruskin, FL
| | - W Anderson
- University of South Florida, College of Public Health, Tampa, FL
- James A. Haley Veteran’s Hospital, Tampa, FL
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D'Amico M, Pan S, Rodriguez D, Bearelly P, Reinstatler L, Rezaee M, Witthaus M, Carrasquillo R, Thirumavalavan N, Gross M, Munarriz R. 364 Current Practice in the Treatment of Infected Penile Prostheses: An Anonymous Survey of ISSM and GURS members. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.209] [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: 10/25/2022]
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Reinstatler L, Gross M. 143 Successful Treatment of Recurrent Bilateral Corpora Cavernosal Abscesses using the Carrion Cast: A Novel Case Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.088] [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: 11/30/2022]
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Swanton A, Goddard B, Krughoff K, Reinstatler L, Rezaee M, Munarriz R, Gross M. 129 Emerging Data Regarding Online Search Behaviors for Common Sexual Medicine Conditions. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.075] [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: 10/25/2022]
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Reinstatler L, Goddard B, Krughoff K, Rezaee M, Swanton A, Munarriz R, Gross M. 383 An Updated Evaluation of Provider Utilization and Medicare Reimbursement for Commonly Treated Sexual Medicine Conditions. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.228] [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: 11/26/2022]
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Rezaee M, Goddard B, Munarriz R, Gross M. 125 Regional Variation in Penile Prosthesis Utilization among Medicare Patients Diagnosed with Erectile Dysfunction. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.071] [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: 11/25/2022]
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Apoj M, Biebel M, Rajender A, Rodriguez D, Didi T, Gross M, Munarriz R. 030 Postoperative Penile Prosthesis Pain: Is it Worse in Diabetic Patients? J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.041] [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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Rezaee M, Johnson H, Munarriz R, Gross M. 237 Bibliometric Analysis of Erectile Dysfunction Publications in Urology and Sexual Medicine Journals. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.244] [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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Barbosa P, Apoj M, Rodriquez D, Biebel M, Rajender A, Gross M, Munarriz R. 244 Closed Suction Drain Outputs at 12 and 24 Hours After Primary Three-Piece Inflatable Penile Prosthesis Surgery. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.250] [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: 11/24/2022]
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Rodríguez D, Gross M, Eid F, Munarriz R. 223 Penile Prosthesis Salvage with Saline or Antibiotic Solutions: A Review of the Different Irrigation Solutions, their Rational, and Effects in Wound Healing. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.231] [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: 11/26/2022]
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Salmen T, Ermakova T, Schindler A, Ko SR, Göktas Ö, Gross M, Nawka T, Caffier PP. Efficacy of microsurgery in Reinke's oedema evaluated by traditional voice assessment integrated with the Vocal Extent Measure (VEM). ACTA ACUST UNITED AC 2019; 38:194-203. [PMID: 29984795 DOI: 10.14639/0392-100x-1544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 07/26/2017] [Indexed: 12/15/2022]
Abstract
SUMMARY There are few data analysing to what specific extent phonomicrosurgery improves vocal function in patients suffering from Reinke's oedema (RE). The recently introduced parameter vocal extent measure (VEM) seems to be suitable to objectively quantify vocal performance. The purpose of this clinical prospective study was to investigate the outcomes of phonomicrosurgery in 60 RE patients (6 male, 54 female; 56 ± 8 years ([mean ± SD]) by analysing its effect on subjective and objective vocal parameters with particular regard to VEM. Treatment efficacy was evaluated at three months after surgery by comparing pre- and postoperative videolaryngostroboscopy (VLS), auditory-perceptual assessment (RBH-status), voice range profile (VRP), acoustic-aerodynamic analysis and patient's self-assessment using the voice handicap index (VHI-9i). Phonomicrosurgically, all RE were carefully ablated. VLS revealed removal or substantial reduction of oedema with restored periodic vocal fold vibration. All subjective and most objective acoustic and aerodynamic parameters significantly improved. The VEM increased on average from 64 ± 37 to 88 ± 25 (p #x003C; 0.001) and the dysphonia severity index (DSI) from 0.5 ± 3.4 to 2.9 ± 1.9. Both parameters correlated significantly with each other (rs = 0.70). RBH-status revealed less roughness, breathiness and overall grade of hoarseness (2.0 ± 0.7 vs 1.3 ± 0.7). The VHI-9i-score decreased from 18 ± 8 to 12 ± 9 points. The average total vocal range enlarged by 4 ± 7 semitones, and the mean speaking pitch rose by 2 ± 4 semitones. These results confirm that: (1) the use of VEM in RE patients objectifies and quantifies their vocal capacity as documented in the VRP, and (2) phonomicrosurgery is an effective, objectively and subjectively satisfactory therapy to improve voice in RE patients.
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Affiliation(s)
- T Salmen
- Department of Audiology and Phoniatrics of Charité, University Medicine Berlin, Berlin, Germany
| | - T Ermakova
- Department of Business Informatics, Social Media and Data Science, University of Potsdam, Potsdam, Germany
| | - A Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - S-R Ko
- Department of Audiology and Phoniatrics of Charité, University Medicine Berlin, Berlin, Germany
| | - Ö Göktas
- Department of Audiology and Phoniatrics of Charité, University Medicine Berlin, Berlin, Germany
| | - M Gross
- Department of Audiology and Phoniatrics of Charité, University Medicine Berlin, Berlin, Germany
| | - T Nawka
- Department of Audiology and Phoniatrics of Charité, University Medicine Berlin, Berlin, Germany
| | - P P Caffier
- Department of Audiology and Phoniatrics of Charité, University Medicine Berlin, Berlin, Germany
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Kõrgmaa V, Tenno T, Kivirüüt A, Kriipsalu M, Gross M, Tamm P, Karabelnik K, Terase H, Värk V, Lepik N, Pachel K, Iital A. A novel method for rapid assessment of the performance and complexity of small wastewater treatment plants. Proc Estonian Acad Sci 2019. [DOI: 10.3176/proc.2019.1.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tovi H, Ovadia H, Eliashar R, de Jong MA, Gross M. Prestin autoantibodies screening in idiopathic sudden sensorineural hearing loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 136:99-101. [PMID: 30606654 DOI: 10.1016/j.anorl.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To define the clinical association of serum prestin autoantibodies and their impact on prognosis, as specific serum diagnostic markers in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). DESIGN Sera from 63 patients with ISSNHL were screened prospectively for the presence of prestin autoantibodies by an enzyme-linked immunosorbent assay (Elisa) test. Serum was assayed for anti-prestin IgG antibodies using recombinant human prestin (SLC26 A5). Demographic, clinical, and audiometric variables were analyzed. RESULTS Two patients (3.17%) had demonstrable anti-prestin antibodies in serum (exact 95% CI: -1.16% to 7.5%). No statistically significant association was found between prestin autoantibodies and demographic or audiologic parameters. CONCLUSIONS This preliminary and novel study does not support the presence of an active humoral immune reaction against prestin in ISSNHL.
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Affiliation(s)
- H Tovi
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Hospital, 91120 Jerusalem, Israel
| | - H Ovadia
- Neurology Laboratory Unit, Hadassah Hebrew-University Hospital, Jerusalem, Israel
| | - R Eliashar
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Hospital, 91120 Jerusalem, Israel
| | - M A de Jong
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Hospital, 91120 Jerusalem, Israel
| | - M Gross
- Department of Otolaryngology-Head & Neck Surgery, Hadassah Hebrew-University Hospital, 91120 Jerusalem, Israel.
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Lüthi Corridori G, Martin B, Hans Georg K, Gross M. Who makes use of activities and events organized by a consumer organization in the Swiss tetraplegia population? Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1185] [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: 11/16/2022]
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Shen G, Li S, Cui W, Liu S, Liu Q, Yang Y, Gross M, Li W. Stabilization of warfarin-binding pocket of VKORC1 and VKORL1 by a peripheral region determines their different sensitivity to warfarin inhibition. J Thromb Haemost 2018; 16:1164-1175. [PMID: 29665197 PMCID: PMC6231229 DOI: 10.1111/jth.14127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/18/2018] [Indexed: 11/30/2022]
Abstract
Essentials VKORL1 and VKORC1 have a similar overall structure and warfarin-binding pocket. A peripheral region stabilizing this pocket controls warfarin sensitivity of the VKOR paralogs. A human single nucleotide polymorphism in this region renders VKORL1 sensitive to warfarin. A group of warfarin-resistant mutations in VKORC1 acts by disrupting peripheral interactions. SUMMARY Background The human genome encodes two paralogs of vitamin-K-epoxide reductase, VKORC1 and VKORL1, that support blood coagulation and other vitamin-K-dependent processes. Warfarin inhibits both enzymes, but VKORL1 is relatively resistant to warfarin. Objectives To understand the difference between VKORL1 and VKORC1, and the cause of warfarin-resistant (WR) mutations in VKORC1. Methods We performed systematic mutagenesis and analyzed warfarin responses with a cell-based activity assay. Mass spectrometry analyses were used to detect cellular redox state. Results VKORC1 and VKORL1 adopt a similar intracellular redox state with four-transmembrane-helix topology. Most WR mutations identified in VKORC1 also confer resistance in VKORL1, indicating that warfarin inhibits these paralogs at a common binding site. A group of WR mutations, distant from the warfarin-binding site, show significantly less resistance in VKORL1 than in VKORC1, implying that their different warfarin responses are determined by peripheral interactions. Remarkably, we identify a critical peripheral region in which single mutations, Glu37Lys or His46Tyr, drastically increase the warfarin sensitivity of VKORL1. In the background of these warfarin-sensitive VKORL1 mutants, WR mutations showing relative less resistance in wild-type VKORL1 become much more resistant, suggesting a structural conversion to resemble VKORC1. At this peripheral region, we also identified a human single nucleotide polymorphism that confers warfarin sensitivity of VKORL1. Conclusions Peripheral regions of VKORC1 and VKORL1 primarily maintain the stability of their common warfarin-binding pocket, and differences of such interactions determine their relative sensitivity to warfarin inhibition. This new model also explains most WR mutations located at the peripheral regions of VKORC1.
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Affiliation(s)
- G Shen
- Institute of Hemostasis and Thrombosis, College of Medicine, Henan University of Science and Technology, Luoyang, Henan, China
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
| | - S Li
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
| | - W Cui
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA
| | - S Liu
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
| | - Q Liu
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Y Yang
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
| | - M Gross
- Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA
| | - W Li
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
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Gross M, Engel J, Good J, Huck H, Isaev I, Koss G, Krasilnikov M, Lishilin O, Loisch G, Renier Y, Rublack T, Stephan F, Brinkmann R, Martinez de la Ossa A, Osterhoff J, Malyutin D, Richter D, Mehrling T, Khojoyan M, Schroeder CB, Grüner F. Observation of the Self-Modulation Instability via Time-Resolved Measurements. Phys Rev Lett 2018; 120:144802. [PMID: 29694120 DOI: 10.1103/physrevlett.120.144802] [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] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Indexed: 06/08/2023]
Abstract
Self-modulation of an electron beam in a plasma has been observed. The propagation of a long (several plasma wavelengths) electron bunch in an overdense plasma resulted in the production of multiple bunches via the self-modulation instability. Using a combination of a radio-frequency deflector and a dipole spectrometer, the time and energy structure of the self-modulated beam was measured. The longitudinal phase space measurement showed the modulation of a long electron bunch into three bunches with an approximately 200 keV/c amplitude momentum modulation. Demonstrating this effect is a breakthrough for proton-driven plasma accelerator schemes aiming to utilize the same physical effect.
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Affiliation(s)
- M Gross
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - J Engel
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - J Good
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - H Huck
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - I Isaev
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - G Koss
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - M Krasilnikov
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - O Lishilin
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - G Loisch
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - Y Renier
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - T Rublack
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - F Stephan
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - R Brinkmann
- Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22607 Hamburg, Germany
| | - A Martinez de la Ossa
- Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22607 Hamburg, Germany
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - J Osterhoff
- Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22607 Hamburg, Germany
| | - D Malyutin
- Helmholtz-Zentrum Berlin für Materialien & Energie, Albert-Einstein-Strasse 15, 12489 Berlin, Germany
| | - D Richter
- Helmholtz-Zentrum Berlin für Materialien & Energie, Albert-Einstein-Strasse 15, 12489 Berlin, Germany
| | - T Mehrling
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
- Instituto Superior Técnico, Avenida Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - M Khojoyan
- LLR (Laboratoire Leprince-Ringuet), CNRS and Ecole Polytechnique, Palaiseau UMR7638, France
| | - C B Schroeder
- Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA
| | - F Grüner
- Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
- Center for Free-Electron Laser Science, Notkestrasse 85, 22607 Hamburg, Germany
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Van Rijn-van Gelderen L, Bos HWM, Jorgensen TD, Ellis-Davies K, Winstanley A, Golombok S, Rubio B, Gross M, Vecho O, Lamb ME. Wellbeing of gay fathers with children born through surrogacy: a comparison with lesbian-mother families and heterosexual IVF parent families. Hum Reprod 2017; 33:101-108. [DOI: 10.1093/humrep/dex339] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/23/2017] [Indexed: 01/30/2023] Open
Affiliation(s)
- L Van Rijn-van Gelderen
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 VZ Amsterdam, The Netherlands
| | - H W M Bos
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 VZ Amsterdam, The Netherlands
| | - T D Jorgensen
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 VZ Amsterdam, The Netherlands
| | - K Ellis-Davies
- Division of Psychology, Nottingham Trent University, 50 Shakespeare St, Nottingham NG1 4FQ, UK
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - A Winstanley
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - S Golombok
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - B Rubio
- IFSTTAR Versailles, 25 Allée des Marronniers, F-78000 Versailles, France
| | - M Gross
- Centre d’études en sciences sociales du religieux, Centre National de la Recherche Scientifique, Ecole des Hautes études en Sciences Sociales, 10 Rue Monsieur le Prince, 75006 Paris, France
| | - O Vecho
- Université Paris Nanterre, 200 Avenue de la République, 92000 Nanterre, France
| | - M E Lamb
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
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Dorff T, Gross M, Quinn D, Pinski J, Schroeder T, Groshen S, Dieli-Conwright C, Kiwata J. Impact of resistance exercise on metabolic syndrome (MetS) parameters in men receiving androgen deprivation therapy (ADT) for prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.034] [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: 11/13/2022] Open
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Brinkmann R, Delbos N, Dornmair I, Kirchen M, Assmann R, Behrens C, Floettmann K, Grebenyuk J, Gross M, Jalas S, Mehrling T, Martinez de la Ossa A, Osterhoff J, Schmidt B, Wacker V, Maier AR. Chirp Mitigation of Plasma-Accelerated Beams by a Modulated Plasma Density. Phys Rev Lett 2017; 118:214801. [PMID: 28598675 DOI: 10.1103/physrevlett.118.214801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Indexed: 06/07/2023]
Abstract
Plasma-based accelerators offer the possibility to drive future compact light sources and high-energy physics applications. Achieving good beam quality, especially a small beam energy spread, is still one of the major challenges. Here, we propose to use a periodically modulated plasma density to shape the longitudinal fields acting on an electron bunch in the linear wakefield regime. With simulations, we demonstrate an on-average flat accelerating field that maintains a small beam energy spread.
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Affiliation(s)
- R Brinkmann
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - N Delbos
- Center for Free-Electron Laser Science and Department of Physics, University of Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - I Dornmair
- Center for Free-Electron Laser Science and Department of Physics, University of Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - M Kirchen
- Center for Free-Electron Laser Science and Department of Physics, University of Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - R Assmann
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - C Behrens
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - K Floettmann
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - J Grebenyuk
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - M Gross
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - S Jalas
- Center for Free-Electron Laser Science and Department of Physics, University of Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - T Mehrling
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | | | - J Osterhoff
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - B Schmidt
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - V Wacker
- Deutsches Elektronen-Synchrotron DESY, Notkestrasse 85, 22607 Hamburg, Germany
| | - A R Maier
- Center for Free-Electron Laser Science and Department of Physics, University of Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
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Gross M, Ralph D, Phillips E, Carrasquillo R, Thornton A, Glina S, Becher E, Rosselló Gayá M, Rosselló Barbará M, Kalejaiye O, Ralph D, Munarriz R. PS-05-005 Multicenter investigation of the microorganisms involved in penile prosthesis infection: Are the AUA and EAU guidelines appropriate for penile prosthesis prophylaxis and infection management? J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.03.110] [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: 11/16/2022]
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Gross M. Selection of the tagged photons by off axis heterodyne holography in ultrasound-modulated optical tomography. Appl Opt 2017; 56:1846-1854. [PMID: 28248380 DOI: 10.1364/ao.56.001846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ultrasound-modulated optical tomography (UOT) is a technique that images optical contrast deep inside scattering media. Heterodyne holography is a promising tool that is able to detect UOT-tagged photons with high efficiency. In this work, we describe theoretically the detection of the tagged photon in heterodyne holography-based UOT, show how to filter the untagged photon, and discuss the effect of shot noise. The discussion also considers speckle decorrelation. We show that optimal detection sensitivity can be reached, if the frame exposure time of the camera used to perform the holographic detection is on the order of the decorrelation time.
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Craig J, Broghammer J, Kaufman M, Milam D, Cleves M, McClung C, Brady J, Jones L, Gross M, Henry G, Brant W. 011 Outcomes after AUS Replacement due to Cuff Erosion: Results from a Multicenter Retrospective Analysis. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.12.024] [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: 11/28/2022]
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Wegner S, Bauer J, Dietrich R, Märtlbauer E, Usleber E, Gottschalk C, Gross M. A highly specific competitive direct enzyme immunoassay for sterigmatocystin as a tool for rapid immunochemotaxonomic differentiation of mycotoxigenicAspergillusspecies. Lett Appl Microbiol 2017; 64:124-130. [DOI: 10.1111/lam.12702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022]
Affiliation(s)
- S. Wegner
- Chair of Dairy Science; Institute of Veterinary Food Science; Justus-Liebig-University; Giessen Germany
| | - J.I. Bauer
- Chair of Dairy Science; Institute of Veterinary Food Science; Justus-Liebig-University; Giessen Germany
| | - R. Dietrich
- Veterinary Faculty; Chair of Hygiene and Technology of Milk; Ludwig-Maximilians-University; Oberschleißheim Germany
| | - E. Märtlbauer
- Veterinary Faculty; Chair of Hygiene and Technology of Milk; Ludwig-Maximilians-University; Oberschleißheim Germany
| | - E. Usleber
- Chair of Dairy Science; Institute of Veterinary Food Science; Justus-Liebig-University; Giessen Germany
| | - C. Gottschalk
- Veterinary Faculty; Chair of Food Safety; Ludwig-Maximilians-University; Oberschleißheim Germany
| | - M. Gross
- Institute of Veterinary Food Science; Junior Professorship of Veterinary Food Diagnostics; Justus-Liebig-University; Giessen Germany
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Abstract
The effect of thermal fluctuations near a contact line of a liquid interface partially wetting an impenetrable substrate is studied analytically and numerically. Promoting both the interface profile and the contact line position to random variables, we explore the equilibrium properties of the corresponding fluctuating contact line problem based on an interfacial Hamiltonian involving a "contact" binding potential. To facilitate an analytical treatment, we consider the case of a one-dimensional interface. The effective boundary condition at the contact line is determined by a dimensionless parameter that encodes the relative importance of thermal energy and substrate energy at the microscopic scale. We find that this parameter controls the transition from a partial wetting to a pseudopartial wetting state, the latter being characterized by a thin prewetting film of fixed thickness. In the partial wetting regime, instead, the profile typically approaches the substrate via an exponentially thinning prewetting film. We show that, independently of the physics at the microscopic scale, Young's angle is recovered sufficiently far from the substrate. The fluctuations of the interface and of the contact line give rise to an effective disjoining pressure, exponentially decreasing with height. Fluctuations therefore provide a regularization of the singular contact forces occurring in the corresponding deterministic problem.
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Affiliation(s)
- D Belardinelli
- Department of Physics & INFN, University of Rome "Tor Vergata", Via della Ricerca Scientifica 1, 00133, Rome, Italy
| | - M Sbragaglia
- Department of Physics & INFN, University of Rome "Tor Vergata", Via della Ricerca Scientifica 1, 00133, Rome, Italy
| | - M Gross
- Max-Planck-Institut für Intelligente Systeme, Heisenbergstr. 3, 70569 Stuttgart, Germany and IV. Institut für Theoretische Physik, Universität Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany
| | - B Andreotti
- Physique et Mécanique des Milieux Hétérogènes, UMR 7636 ESPCI-CNRS, Université Paris-Diderot, 10 rue Vauquelin, 75005, Paris, France
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Emberley E, Bennett M, Chen J, Gross M, Huang T, Li W, Mackinnon A, Pan A, Rodriguez M, Steggerda S, Wang T, Zhang J, Zhang W, Parlati F. CB-839, a selective glutaminase inhibitor, has anti-tumor activity in renal cell carcinoma and synergizes with everolimus and receptor tyrosine kinase inhibitors. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32969-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Steggerda S, Bennett M, Chen J, Emberley E, Gross M, Huang T, Li W, MacKinnon A, Makkouk A, Marguier G, Neou S, Pan A, Wang T, Works M, Zhang J, Zhang W, Parlati F. Arginase inhibitor CB-1158 elicits immune-mediated anti-tumor responses as a single agent and enhances the efficacy of other immunotherapies. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32888-x] [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: 11/29/2022]
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