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Nawapun K, Eastwood M, Sandaite I, DeKoninck P, Claus F, Richter J, Rayyan M, Deprest J. Correlation of observed-to-expected total fetal lung volume with intrathoracic organ herniation on magnetic resonance imaging in fetuses with isolated left-sided congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2015; 46:162-167. [PMID: 25331381 DOI: 10.1002/uog.14701] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 09/24/2014] [Accepted: 10/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess using fetal magnetic resonance imaging (MRI) the relationship between the position of the stomach as well as the volume of herniation of organs into the thorax, and the observed-to-expected total fetal lung volume (o/e-TFLV), as a measure of pulmonary hypoplasia, in fetuses with isolated left-sided congenital diaphragmatic hernia (LCDH). METHODS This was a single-center retrospective study using archived MR images from fetuses > 20 weeks' gestation evaluated for isolated LCDH over an 11-year period between July 2002 and September 2013. We retrieved data on the gestational age at MRI, o/e-TFLV and liver position. Images were also reviewed by a single operator to determine retrospectively the position of the stomach as well as the proportion of the total thorax volume occupied by the herniated fetal liver, stomach and other viscera. Following confirmation of reproducibility, we assessed the correlation of intrathoracic organ volumes and stomach position with o/e-TFLV. RESULTS The study included 205 fetuses which underwent a total of 259 MR examinations. The reproducibility of organ volume measurements was excellent (intraclass correlation coefficient range, 0.928-0.997). The average time spent to obtain intrathoracic organ volumes ranged from 2.28 to 5.13 min. Of all herniated organ-to-thoracic volume ratios, the liver-to-thoracic volume ratio had the strongest correlation with o/e-TFLV (ρ = -0.429, P<0.0001). Stomach volume did not correlate, although, when categorized by the position and extent of stomach herniation, there was an inverse relationship to o/e-TFLV. No intrathoracic organ-to-thoracic volume ratio was related to gestational age. CONCLUSIONS We observed in fetuses with isolated LCDH an inverse relationship between lung volume and the amount of liver herniated as well as the position of the stomach in the chest.
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Affiliation(s)
- K Nawapun
- Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - M Eastwood
- Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - I Sandaite
- Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
- Division of Medical Imaging, Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P DeKoninck
- Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - F Claus
- Division of Medical Imaging, Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - J Richter
- Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - M Rayyan
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
| | - J Deprest
- Cluster Organ Systems, Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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Claus F, Ried W. [Incentives of German Rehabilitation Centers to Implement Screening Strategies for the Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) Transmissions and Infections]. REHABILITATION 2015; 54:198-204. [PMID: 26091495 DOI: 10.1055/s-0035-1545361] [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: 10/23/2022]
Abstract
OBJECTIVE The colonization with Methicillin-resistant Staphylococcus aureus (MRSA) imposes a risk on the patient herself as well as on other patients and on healthcare professionals because, in the case of an infection, substantial health problems will arise. Moreover, additional costs for health care will occur as well. This paper examines the incentives of German rehabilitation centers to implement prevention measures in order to avert MRSA transmissions and infections. METHODS Relying on a decision tree analysis, the expected healthcare cost per capita is calculated for the 3 strategies general screening, risk-based screening, both upon admission, and no screening at all. The values of the relevant parameters are identified by a review of the published literature. RESULTS From the perspective of a rehabilitation center, undertaking no screening at all minimizes the expected cost of treatment while the first strategy causes the highest cost. This ordering is robust with respect to multivariate sensitivity analyses. CONCLUSION In Germany, rehabilitation centers currently are not reimbursed for the implementation of additional prevention measures against MRSA. Hence, as our analysis demonstrates, the financial incentive to implement MRSA screening turns out to be rather weak. This could well be inefficient for society because a substantial part of the benefit arising on other agents is not taken into account. Our results can be used to indicate changes in the remuneration system that would provide rehabilitation centers with an appropriate incentive for MRSA prevention. Moreover, hygiene regulations enacted recently such as the change in the Infection Prevention Act or the Medical Hygiene regulations emphasize the significance of an appropriate hygiene regimen, thus fostering MRSA prevention.
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Affiliation(s)
- F Claus
- Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Rechts- und Staatswissenschaftliche Fakultät, Ernst-Moritz-Arndt-Universität Greifswald
| | - W Ried
- Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Rechts- und Staatswissenschaftliche Fakultät, Ernst-Moritz-Arndt-Universität Greifswald
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De Keersmaecker B, Ramaekers P, Claus F, Witters I, Ortibus E, Naulaers G, Van Calenbergh F, De Catte L. Outcome of 12 antenatally diagnosed fetal arachnoid cysts: case series and review of the literature. Eur J Paediatr Neurol 2015; 19:114-21. [PMID: 25599983 DOI: 10.1016/j.ejpn.2014.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/30/2014] [Accepted: 12/09/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the natural history, associated abnormalities and outcome of 12 fetuses with arachnoid cyst diagnosed antenatally by ultrasound and magnetic resonance imaging and to compare the outcome with cases in the literature. METHODS A retrospective study of all cases of antenatally detected fetal arachnoid cysts was performed in patients referred to a tertiary unit between 2007 and 2013. Associated abnormalities, pregnancy outcome and postnatal follow-up were analyzed. All papers about prenatally diagnosed arachnoid cysts, of the last 30 years, were evaluated (search terms in Pubmed: "prenatal diagnosis", "Arachnoid Cysts"). RESULTS Fetal arachnoid cysts were diagnosed in 12 fetuses, 9 were females. The mean gestational age of diagnosis was 28 1/7 (range 19 1/7-34 2/7 weeks). A total of 9 cases were supratentorial, 3 were located in the posterior fossa. In 10 cases a fetal MRI was performed which confirmed brain compression in 4 out of 5 supratentorial arachnoid cyst. MRI did not reveal other malformations nor signs of nodular heterotopia. Only one fetus presented with additional major anomalies (bilateral ventricumomegaly of >20 mm and rhombencephalosynapsis) leading to a termination of pregnancy. Two neonates underwent endoscopic fenestration of the arachnoid cyst in the first week of life with no additional intervention in childhood. All but one (10/11) had a favorable postnatal outcome. This child suffered from visual impairment at autism was diagnosed at the age of 5. One child had a surgical correction of strabismus later in childhood. In one child the infratentorial arachnoid cyst regressed spontaneously on ultrasound and MRI in the postnatal period. CONCLUSIONS The majority of arachnoid cysts in this series are of benign origin and remain stable. Based on the current series and the review of the literature, in the absence of other associated anomalies and when the karyotype is normal, the postnatal overall and neurological outcome is favorable. Large suprasellar arachnoid cysts however, may cause visual impairment and endocrinological disturbances. Rarely associated cerebral or cerebellar malformations are present. Modern postnatal management of suprasellar arachnoid cyst consists of endoscopic cystoventriculostomy.
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Affiliation(s)
| | - P Ramaekers
- Dep of Obstet Gyn, University Hospital Antwerp, Antwerp, Belgium; Dep of Obstet Gyn, University Hospital Ghent, Ghent, Belgium
| | - F Claus
- Dep of Radiology, University Hospital Leuven, Leuven, Belgium
| | - I Witters
- Dep of Obstet Gyn, St Jans Hospitaal Genk, Genk, Belgium
| | - E Ortibus
- Dep of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium
| | - G Naulaers
- Dep of Neonatology, University Hospital Leuven, Leuven, Belgium
| | - F Van Calenbergh
- Dep of Pediatric Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - L De Catte
- Dep of Obstet Gyn, University Hospital Leuven, Leuven, Belgium.
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Nawapun K, Sandaite I, Dekoninck P, Claus F, Richter J, De Catte L, Deprest J. Comparison of matching by body volume or gestational age for calculation of observed to expected total lung volume in fetuses with isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2014; 44:655-660. [PMID: 24604531 DOI: 10.1002/uog.13356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the bias induced by matching fetuses according to gestational age (GA) or fetal body volume (FBV) when calculating the observed to expected total fetal lung volume (o/e TFLV) in cases of isolated congenital diaphragmatic hernia (CDH). METHODS This was a single-center, retrospective study on archived magnetic resonance (MR) images of fetuses with isolated CDH over a 10-year period. We retrieved the TFLV, GA and o/e TFLVGA , and delineated FBV to obtain TFLVFBV in each case. We evaluated the relationship between o/e TFLVFBV and o/e TFLVGA by Bland-Altman analysis. All outliers were manually identified, and their specific clinical features were retrieved. RESULTS Records of a total of 377 MR examinations of 225 fetuses were identified and included in the analysis. The mean ( ± SD) time spent on FBV measurement was 16.12 ± 4.95 min. On reproducibility analysis of FBV measurement (n = 10), the intraobserver intraclass correlation coefficient (ICC) was 0.998 and the interobserver ICC was 0.999. FBV was highly correlated with GA (R(2) = 0.899; P < 0.0001). There was good agreement between o/e TFLVGA and o/e TFLVFBV , with a mean difference of -1.10% and 95% limits of agreement of -8.58 to 6.39. There were no outliers in fetuses that had an o/e TFLV < 25%. Discrepancies induced by different methods were more likely in women with a body mass index ≥ 25 kg/m(2) (+16.5%), fetuses with an estimated fetal weight (EFW) ≤ 10(th) centile (+21.3%) or an EFW > 90(th) centile (+14.7%). CONCLUSIONS Discrepancies in matching by FBV and GA when calculating o/e TFLV are more likely in fetuses with an abnormal EFW or in fetuses carried by overweight women. The clinical relevance of using FBV rather than GA for calculation of the o/e TFLV might be limited, as there was no discrepancy between the two methods in fetuses with small lungs ( < 25%), which is the group of most interest for lung volume assessment.
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Affiliation(s)
- K Nawapun
- Fetal Medicine Unit, Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
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Abstract
INTRODUCTION Methicillin-resistant S. aureus (MRSA) usually exhibits resistance not only against β-lactam antibiotics but also against other classes of antibiotics with the result that infections caused by this bacterium are difficult to treat. Due to additional morbidity and mortality a high economic burden can be expected. AIM The aim of this study was to outline the cost effects caused by MRSA colonisation and infections and to quantify the annual economic burden in Germany by using published data in order to assess the costs due to MRSA in Germany. METHODS Based on the available literature we estimated tangible and intangible costs per patient associated with MRSA. Total costs were calculated using data of the MRSA-KISS and the Federal Bureau of Statistics as well as other prevalence data. These costs are shown in prices of the year 2011. RESULTS Direct costs occurring in German hospitals are estimated to be between 354.29 million € and 1.55 billion €. Productivity losses due to an extended duration of disease are evaluated to be at least 92.77 million € while lost quality adjusted life years due to MRSA infections are estimated at 0.292 * t per infected patient (where t denotes the time of the associated health impairment). CONCLUSION It is not possible to quantify the total cost of illness caused by MRSA in Germany due to a lack of data on some of the direct costs (e. g., in rehabilitation facilities) as well as on the indirect and intangible costs. Nevertheless it can be shown that colonisation and infections caused by MRSA impose high costs on the health-care system and the whole economy as well.
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Affiliation(s)
- F Claus
- Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Universität Greifswald, Greifswald
| | - A Sachse
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Universität Greifswald, Greifswald
| | - W Ried
- Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Universität Greifswald, Greifswald
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Claus F, Ried W. Coping with methicillin resistant staphylococcus aureus (MRSA) in german rehabilitation centers - are the incentives appropriate? Value Health 2014; 17:A684. [PMID: 27202532 DOI: 10.1016/j.jval.2014.08.2558] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- F Claus
- University of Greifswald, Greifswald, Germany
| | - W Ried
- University of Greifswald, Greifswald, Germany
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DeKoninck P, Gomez O, Sandaite I, Richter J, Nawapun K, Eerdekens A, Ramirez JC, Claus F, Gratacos E, Deprest J. Right-sided congenital diaphragmatic hernia in a decade of fetal surgery. BJOG 2014; 122:940-6. [DOI: 10.1111/1471-0528.13065] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P DeKoninck
- Fetal Medicine Unit; Department of Obstetrics and Gynaecology; University Hospitals Leuven; KU Leuven Leuven Belgium
- Department of Development and Regeneration; Cluster Organ Systems; KU Leuven Leuven Belgium
| | - O Gomez
- Maternal-Fetal Medicine Department; Institut Clínic de Ginecologia; Obstetrícia i Neonatologia (ICGON); Hospital Clínic; Institut d'Investigacions Biomédiques Augusto Pi i Sunyer (IDIBAPS); University of Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Barcelona Spain
| | - I Sandaite
- Fetal Medicine Unit; Department of Obstetrics and Gynaecology; University Hospitals Leuven; KU Leuven Leuven Belgium
- Department of Development and Regeneration; Cluster Organ Systems; KU Leuven Leuven Belgium
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
| | - J Richter
- Fetal Medicine Unit; Department of Obstetrics and Gynaecology; University Hospitals Leuven; KU Leuven Leuven Belgium
- Department of Development and Regeneration; Cluster Organ Systems; KU Leuven Leuven Belgium
| | - K Nawapun
- Fetal Medicine Unit; Department of Obstetrics and Gynaecology; University Hospitals Leuven; KU Leuven Leuven Belgium
- Department of Development and Regeneration; Cluster Organ Systems; KU Leuven Leuven Belgium
| | - A Eerdekens
- Department of Paediatrics; University Hospitals Leuven; KU Leuven Leuven Belgium
- Department of Development and Regeneration; Cluster Organ Systems; KU Leuven Leuven Belgium
| | - JC Ramirez
- Maternal-Fetal Medicine Department; Institut Clínic de Ginecologia; Obstetrícia i Neonatologia (ICGON); Hospital Clínic; Institut d'Investigacions Biomédiques Augusto Pi i Sunyer (IDIBAPS); University of Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Barcelona Spain
| | - F Claus
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
| | - E Gratacos
- Maternal-Fetal Medicine Department; Institut Clínic de Ginecologia; Obstetrícia i Neonatologia (ICGON); Hospital Clínic; Institut d'Investigacions Biomédiques Augusto Pi i Sunyer (IDIBAPS); University of Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER); Barcelona Spain
| | - J Deprest
- Fetal Medicine Unit; Department of Obstetrics and Gynaecology; University Hospitals Leuven; KU Leuven Leuven Belgium
- Department of Development and Regeneration; Cluster Organ Systems; KU Leuven Leuven Belgium
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Bonne L, Bex M, Oyen R, Claus F. Epididymal adrenal rest tissue in a patient with congenital adrenal hyperplasia. JBR-BTR 2014; 97:193-194. [PMID: 25223140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hübner C, Hübner NO, Muhr M, Claus F, Leesch H, Kramer A, Fleßa S. Kostenanalyse der stationär behandelten Clostridium-difficile-assoziierten Diarrhö (CDAD). Gesundh ökon Qual manag 2013. [DOI: 10.1055/s-0032-1330635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C. Hübner
- Lehrstuhl für ABWL und Gesundheitsmanagement, Universität Greifswald
| | - N.-O. Hübner
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald
| | - M. Muhr
- Lehrstuhl für ABWL und Gesundheitsmanagement, Universität Greifswald
| | - F. Claus
- Lehrstuhl für AVWL und Finanzwissenschaft, Universität Greifswald
| | - H. Leesch
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald
| | - A. Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald
| | - S. Fleßa
- Lehrstuhl für ABWL und Gesundheitsmanagement, Universität Greifswald
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Zanca F, Van Ongeval C, Claus F, Jacobs J, Oyen R, Bosmans H. Comparison of visual grading and free-response ROC analyses for assessment of image-processing algorithms in digital mammography. Br J Radiol 2012; 85:e1233-41. [PMID: 22844032 DOI: 10.1259/bjr/22608279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare two methods for assessment of image-processing algorithms in digital mammography: free-response receiver operating characteristic (FROC) for the specific task of microcalcification detection and visual grading analysis (VGA). METHODS The FROC study was conducted prior to the VGA study reported here. 200 raw data files of low breast density (Breast Imaging-Reporting and Data System I-II) mammograms (Novation DR, Siemens, Germany)-100 of which abnormal-were processed by four image-processing algorithms: Raffaello (IMS, Bologna, Italy), Sigmoid (Sectra, Linköping, Sweden), and OpView v. 2 and v. 1 (Siemens, Erlangen, Germany). Four radiologists assessed the mammograms for the detection of microcalcifications. 8 months after the FROC study, a subset (200) of the 800 images was reinterpreted by the same radiologists, using the VGA methodology in a side-by-side approach. The VGA grading was based on noise, saturation, contrast, sharpness and confidence with the image in terms of normal structures. Ordinal logistic regression was applied; OpView v. 1 was the reference processing algorithm. RESULTS In the FROC study all algorithms performed better than OpView v. 1. From the current VGA study and for confidence with the image, Sigmoid and Raffaello were significantly worse (p<0.001) than OpView v. 1; OpView v. 2 was significantly better (p=0.01). For the image quality criteria, results were mixed; Raffaello and Sigmoid for example were better than OpView v. 1 for sharpness and contrast (although not always significantly). CONCLUSION VGA and FROC discordant results should be attributed to the different clinical task addressed. ADVANCES IN KNOWLEDGE The method to use for image-processing assessment depends on the clinical task tested.
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Affiliation(s)
- F Zanca
- Leuven University Center of Medical Physics in Radiology, University Hospitals Leuven, Belgium.
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Van Mieghem T, Cruz-Martinez R, Allegaert K, Dekoninck P, Castanon M, Sandaite I, Claus F, Devlieger R, Gratacos E, Deprest J. Outcome of fetuses with congenital diaphragmatic hernia and associated intrafetal fluid effusions managed in the era of fetal surgery. Ultrasound Obstet Gynecol 2012; 39:50-55. [PMID: 21910146 DOI: 10.1002/uog.10097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions. METHODS This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions. RESULTS The incidence of effusions was 5.2% (n = 14) in 269 consecutive cases of left-sided CDH and 29.2% (n = 14) in 48 cases of right-sided CDH. Hydrothorax (n = 19 (68%)) and ascites (n = 16 (57%)) were the most common effusions. A combination of both was present in 11 (39%) fetuses. Of 20 ongoing pregnancies with CDH and fluid effusions, without other anomalies, five with moderate or mild pulmonary hypoplasia were managed without fetoscopic endoluminal tracheal occlusion (FETO). The 15 other cases underwent FETO because of severe pulmonary hypoplasia. Neonatal survival rate was similar in both groups (n = 2/5 and n = 6/15, respectively (P = 1.0)). Survival among those who underwent FETO was similar to previously published results concerning isolated cases undergoing FETO. CONCLUSIONS Our observations do not support the view that intrafetal effusions are an adverse prognostic factor in fetuses with CDH. In CDH fetuses with effusions and severe pulmonary hypoplasia treated with FETO, neonatal survival is similar to that in isolated cases undergoing the intervention. Whether pleural effusions should be addressed by thoracic drainage procedures remains unproven.
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Affiliation(s)
- T Van Mieghem
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Witters P, Reynaert N, Pattyn L, Vercammen L, Claus F, Debeer A, Naulaers G, Vanhole C. Intrauterine thrombosis of the ductus venosus leading to neonatal demise. Arch Dis Child Fetal Neonatal Ed 2012; 97:F17. [PMID: 21653674 DOI: 10.1136/archdischild-2011-300024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Witters
- Department of Neonatology, University hospitals Gasthuisberg, Kuleuven, Herestraat 49, Leuven, Belgium.
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Geuens G, Bellinck P, Mulkens T, Salgado R, de Gheldere C, Vanclooster P, Claus F. Revisiting the role of herniography in the preoperative work-up of groin hernias? Acta Chir Belg 2011; 111:370-3. [PMID: 22299323 DOI: 10.1080/00015458.2011.11680775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The diagnosis of groin hernia is based on clinical symptoms and physical examination. In the case of equivocal clinical findings, patients are often referred for subsequent diagnostic imaging. Accurate detection is important to minimize the inherent risk of complications or to avoid unnecessary surgery. Although herniography has been reported as a save and highly accurate procedure, it has not gained widespread acceptance in the diagnostic work-up of groin hernias. METHODS We retrospectively analysed 157 patients who underwent herniography in our department, which is to date the third largest study reporting on this technique. The diagnostic value of herniography was investigated--with laparascopic surgical findings serving as a gold standard--in comparison to clinical symptoms, physical examination and ultrasound. RESULTS Herniography showed a substantial agreement with the surgical findings, but only a slight to fair agreement was found between surgery and clinical symptoms and examination. Poor agreement was found between sonographic and surgical findings. CONCLUSION Based on the presented data and previously reported studies, we can conclude that herniography is a safe technique with a high accuracy to detect groin hernias in patients with equivocal clinical presentation, whereas ultrasound has a wide range in reported sensitivity. Clinicians and surgeons should take this into account when referring patients for subsequent imaging.
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Affiliation(s)
| | | | | | | | - C. de Gheldere
- Department of Surgery, Heilig Hart Ziekenhuis Lier, Belgium
| | - P. Vanclooster
- Department of Surgery, Heilig Hart Ziekenhuis Lier, Belgium
| | - F. Claus
- Department of Radiology, University Hospitals Leuven, Belgium
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Kotecha S, Barbato A, Bush A, Claus F, Davenport M, Delacourt C, Deprest J, Eber E, Frenckner B, Greenough A, Nicholson AG, Antón-Pacheco JL, Midulla F. Congenital diaphragmatic hernia. Eur Respir J 2011; 39:820-9. [PMID: 22034651 DOI: 10.1183/09031936.00066511] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.
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Affiliation(s)
- S Kotecha
- Dept of Child Health, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK.
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Isebaerl S, van den Bergh L, Haustermans K, Lerut E, de Wever L, Budiharto T, Slagmolen P, Joniau S, van Poppel H, Claus F, Oven R. 322 oral MULTI-MODALITY MR IMAGING FOR PROSTATE CANCER DETECTION IN CORRELATION TO WHOLE-MOUNT HISTOPATHOLOGY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70444-3] [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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De Keersmaecker B, Claus F, De Catte L. Imaging the fetal central nervous system. Facts Views Vis Obgyn 2011; 3:135-49. [PMID: 24753859 PMCID: PMC3991457] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The low prevalence of fetal central nervous system anomalies results in a restricted level of exposure and limited experience-- for most of the obstetricians involved in prenatal ultrasound. Sonographic guidelines for screening the fetal brain in a systematic way will probably increase the detection rate and enhance a correct referral to a tertiary care center, offering the patient a multidisciplinary approach of the condition. This paper aims to elaborate on prenatal sonographic and magnetic resonance imaging (MRI) diagnosis and outcome of various central nervous system malformations. Detailed neurosonographic investigation has become available through high resolution vaginal ultrasound probes and the development of a variety of 3D ultrasound modalities e.g. ultrasound tomographic imaging. In addition, fetal MRI is particularly helpful in the detection of gyration and neurulation-- anomalies and disorders of the gray and white matter.
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Affiliation(s)
- B. De Keersmaecker
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Hospital Leuven, Belgium
,Department of Obstetrics and Gynecology, AZ Groeninge, Kortrijk, Belgium
| | - F. Claus
- Department of Radiology, University Hospital Leuven, Belgium
| | - L. De Catte
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Hospital Leuven, Belgium
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D'Hauwe R, Lerut E, De Wever L, Oyen R, Claus F. Birt-Hogg-Dubé (BHD) syndrome. JBR-BTR 2011; 94:32-34. [PMID: 21466062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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18
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Toelen J, Carlon M, Claus F, Gijsbers R, Sandaite I, Dierickx K, Devlieger R, Devriendt K, Debeer A, Proesmans M, Debyser Z, Deprest AJ. The fetal respiratory system as target for antenatal therapy. Facts Views Vis Obgyn 2011; 3:22-35. [PMID: 24753844 PMCID: PMC3991409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The widespread use of prenatal ultrasound has made the fetus a patient. A number of conditions diagnosed as such may require therapy prior to birth. Herein we describe past, current and potential future procedures designed to treat pulmonary conditions in the antenatal period. When congenital cystic adenomatoid malformation (CCAM) is -associated with fetal hydrops, treatment is required. Prior to viability this may be in utero resection of the pathologic lung lobe or shunting of cystic lesions. More recently, fetuses with isolated congenital diaphragmatic hernia (CDH) with lethal lung hypoplasia have been offered percutaneous fetal tracheal occlusion to provoke lung growth. A very rare condition is laryngeal atresia, which requires peripartum re-establishment of the airways. As we get more -experience with access to the fetal airways, this may open the doors for novel therapies. One of these is gene delivery to treat fetuses with serious monogenic disorders or to induce transient overexpression of certain proteins. We review the individual hurdles that are being met by researchers when designing fetal gene therapeutic strategies, in particular for the fetal lung. Also the use of stem cells for pulmonary disorders is currently explored.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - A J Deprest
- Research Task Force on the "Fetal Lung Development": from the Department of Woman and Child, Obstetrics & Gynaecology
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Deprest J, Toelen J, Debyser Z, Rodrigues C, Devlieger R, De Catte L, Lewi L, Van Mieghem T, Naulaers G, Vandevelde M, Claus F, Dierickx K. The fetal patient -- ethical aspects of fetal therapy. Facts Views Vis Obgyn 2011; 3:221-7. [PMID: 24753868 PMCID: PMC3991449] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The pregnant patient is a vulnerable subject, and even more so when a serious fetal condition is diagnosed. (Invasive) fetal therapy should only be offered when there is a good chance that the life of the fetus will be saved, or irreversible damage by the disease or disability is prevented. Following diagnosis of a potentially treatable condition, the patient needs to be referred to a center with sufficient expertise in diagnosis and all therapeutic options. Preferences of the physician towards one or another antenatal intervention is not at stake prior to that moment. When fetal therapy is justified--, it should be offered with full respect for maternal choice and individual assessment and perception of potential-- risks, and should be at the location where there is sufficient expertise. For therapies of unproven benefit, the absence of evidence must be disclosed, and therapy should only be undertaken with full voluntary consent of the mother. These ought to be undertaken within well designed and approved trials and only by experts in the treatment modality. Potential risks and eventual morbidities in case of therapeutic failure should be part of the counselling, neither-- should fetal therapy be presented as an alternative to termination of pregnancy.
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Affiliation(s)
- J. Deprest
- Department of Woman and Child, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - J. Toelen
- Department of Woman and Child, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - Z. Debyser
- Division of Molecular Medicine, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - C. Rodrigues
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, The Netherlands
| | - R. Devlieger
- Department of Woman and Child, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - L. De Catte
- Department of Woman and Child, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - L. Lewi
- Department of Woman and Child, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | | | - G. Naulaers
- Department of Woman and Child, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - M. Vandevelde
- Department of Anesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - F. Claus
- Department of Medical Imaging, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
| | - K. Dierickx
- Centre for Biomedical Ethics and Law, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium;
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Cardoen L, De Catte L, Demaerel P, Devlieger R, Lewi L, Deprest J, Claus F. The role of magnetic resonance imaging in the diagnostic work-up of fetal ventriculomegaly. Facts Views Vis Obgyn 2011; 3:159-63. [PMID: 24753861 PMCID: PMC3991458] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The indication for fetal magnetic resonance imaging (MRI) remains a subject of debate, partly because of questions concerning its diagnostic accuracy compared to ultrasound, partly because of practical factors such as accessibility, high costs and available expertise. Most studies advocate an added value for MRI in cases diagnosed with central nervous system pathology. MRI is a good modality to detect small foci of brain hemorrhage, to depict callosal anomalies, to add information about normal and pathological cortical development, and is a more sensitive imaging method to detect white matter pathology. This manuscript discusses the role of MRI as an adjunct to ultrasound for cases diagnosed-- with cerebral ventriculomegaly.
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Affiliation(s)
- L. Cardoen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
| | - L. De Catte
- Department of Woman and Child, University Hospitals Leuven, Leuven, Belgium.
| | - P. Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
| | - R. Devlieger
- Department of Woman and Child, University Hospitals Leuven, Leuven, Belgium.
| | - L. Lewi
- Department of Woman and Child, University Hospitals Leuven, Leuven, Belgium.
| | - J. Deprest
- Department of Woman and Child, University Hospitals Leuven, Leuven, Belgium.
| | - F. Claus
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
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Van Mieghem T, Sandaite I, Michielsen K, Gucciardo L, Done E, Dekoninck P, Claus F, Deprest J. Fetal cerebral blood flow velocities in congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2010; 36:452-7. [PMID: 20521239 DOI: 10.1002/uog.7703] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Left ventricular cardiac output is decreased in fetuses with congenital diaphragmatic hernia (CDH). Our aim was to assess whether this alters cerebral perfusion or growth in utero. METHODS Fetal head circumference, biparietal diameter, lung-to-head ratio and middle cerebral artery (MCA) Doppler flow patterns were assessed by ultrasonography in 103 fetuses with prenatally diagnosed CDH. Total fetal lung volume and cerebral volume were measured using magnetic resonance imaging. Values were transformed to gestational age-independent scores (multiples of the median (MoM)) and compared with controls. Subanalyses were made according to whether the CDH was left- (n = 86) or right-sided (n = 17) and to whether it was isolated (n = 86) or associated with other anomalies (n = 17). RESULTS MCA flow velocity was significantly lower in fetuses with CDH than in healthy fetuses (0.79 ± 0.19 MoM; P < 0.0001) but MCA pulsatility index was unchanged (0.99 ± 0.25 MoM; P = 0.79). Cranial biometry and cerebral volume in CDH fetuses fell in the normal range. Gestational age-adjusted lung area was correlated with MCA peak systolic velocity, which was in turn correlated with brain volume. CONCLUSIONS Fetal cerebral blood flow velocities are decreased in CDH yet cranial and cerebral growth are conserved. Further work will be needed to address whether part of the neurologic impairment observed in long-term survivors of CDH finds its origin in the prenatal period.
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Affiliation(s)
- T Van Mieghem
- Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Breysem L, Allewaert S, Claus F, De Beer A, Van Geet C, Rayyan M, Smet MH. The use of duplex doppler ultrasound in a case of multifocal hepatic hemangioma. JBR-BTR 2008; 91:145-148. [PMID: 18817086] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A one-month-old girl presented with multiple cutaneous hemangiomas, abnormal weight gain, hepatomegaly, and symptoms of bleeding disorder. Abdominal ultrasound and CT revealed a multifocal hypervascular hepatic tumor and signs of vascular overload. Biopsy confirmed the presence of an infantile hepatic hemangioma. Conservative treatment with high dose steroids showed regression of the hepatic lesions and the signs of vascular congestion. Ultrasound was used for follow-up and its role in treatment monitoring is discussed in this manuscript.
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Affiliation(s)
- L Breysem
- Department of Radiology, University Hospitals, Leuven, Belgium.
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Zhang M, Huang M, Le C, Zanzonico P, Claus F, Kolbert K, Martin K, Ling C, Koutcher J, Humm J. TU-C-332-07: Accuracy and Reproducibility of Tumor Position During Prolonged and Multi-Modality Animal Imaging Studies. Med Phys 2008. [DOI: 10.1118/1.2962526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Pugachev A, Claus F, Sun X, Ruan S, Cai S, Koziorowsky J, Finn R, O”Donoghue J, Ling C, Humm J. MO-D-I-609-08: Validation of PET Hypoxia Tracers by Autoradiography and Fluorescent Microscopy. Med Phys 2005. [DOI: 10.1118/1.1998244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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De Bruecker Y, Claus F, Demaerel P, Ballaux F, Sciot R, Lagae L, Buyse G, Wilms G. MRI findings in acute cerebellitis. Eur Radiol 2004; 14:1478-83. [PMID: 14968261 DOI: 10.1007/s00330-004-2247-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Revised: 10/17/2003] [Accepted: 01/05/2004] [Indexed: 11/25/2022]
Abstract
Acute cerebellitis is an inflammatory process involving the cerebellum. We report the clinical, CT and MRI features of four cases and a review of the literature. Bilateral diffuse hemispheric abnormalities represent the most common imaging presentations. Our observations demonstrate the various imaging appearances of acute cerebellitis. Simultaneous involvement of both hemispheres and the vermis has not been reported previously. The development of cerebellar atrophy following an initial normal MR imaging examination is also a new finding. In atypical clinical presentation, MR imaging can lead to the diagnosis. MR imaging findings have, however, no prognostic value.
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Affiliation(s)
- Y De Bruecker
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
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de Neve W, Duthoy W, Claus F, de Gersem W, Coghe M, de Meerleer G, de Wagter C. Dose conformation in IMRT for head and neck tumors: which solution to apply? Cancer Radiother 2002; 6 Suppl 1:32s-36s. [PMID: 12587381 DOI: 10.1016/s1278-3218(02)00216-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
At Ghent University Hospital, IMRT for head and neck cancer is routinely performed. The desired dose distribution is defined upfront as a range of acceptable doses assigned to each voxel of volumes of interest. It was found important to specify the range of acceptable doses separately to areas of the PTV either in or outside the buildup zone as well as to areas which do or do not intersect with PTV-dose limiting organs at risk (OAR). To avoid high doses at distance from the PTV, the creation of a "surrounding" OAR which is the whole scanned volume minus the PTV was found efficient, especially if inside this OAR, subvolumes were created at increasing distance from the PTV. By specifying inside these subvolumes maximum dose constraints which decreased with distance from the PTV, conformality is secured. The creation of these additional PTV and OAR subvolumes allows comprehensive and unambiguous definition of the range of acceptable doses and thereby avoids user-interactive assignment of weights to the terms of the objective function during optimization. The efficiency of inverse planning is highly improved. Its outcome is predictable, plan evaluation is objective as the plan either does or does not comply with the predefined range of acceptable doses. Accurate reporting of the planned dose distribution is facilitated by description of the dose range to all volumes. The expense of this procedure is modest and lays mostly 1) in the creation of the subvolumes, which can be done semi-automatically by modern image segmentation tools and 2) in the inclusion of constraints to all subvolumes into the objective function.
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Affiliation(s)
- W de Neve
- Division of Radiotherapy, Ghent University Hospital, 185 De Pintelaan, 9000 Ghent, Belgium.
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De Neve W, Claus F, Duthoy W, De Meerleer G, De Wagter C. Intensity modulation techniques for improvement of normal tissue tolerance. Front Radiat Ther Oncol 2002; 37:163-73. [PMID: 11764658 DOI: 10.1159/000061317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- W De Neve
- Division of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Claus F, De Gersem W, Vanhoutte I, Duthoy W, Remouchamps V, De Wagter C, De Neve W. Evaluation of a leaf position optimization tool for intensity modulated radiation therapy of head and neck cancer. Radiother Oncol 2001; 61:281-6. [PMID: 11730998 DOI: 10.1016/s0167-8140(01)00441-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Since 1996, patients are treated at Ghent University Hospital with a multi-segment technique using MultiLeaf Collimators. The segments were obtained by using the Beam's eye view projections of the planning target volume (PTV) and the organs at risk (OARs), after which the segments weights were optimized. To investigate if optimization of the leaf positions would further improve the intensity modulated radiation therapy (IMRT) plans, a tool optimizing leaf positions and segment weights simultaneously, was developed. This tool is called SOWAT, which is the acronym for segment outline and weight adapting tool. MATERIAL AND METHODS The tool evaluates the effects of changing the position of each collimating leaf of all segments on the value of the objective function. Only changes that improve the value of the objective function are retained. Between December 1999 and January 2001, 30 head and neck patients were treated with IMRT. Two patient groups were distinguished: pharyngeal and laryngeal tumors (n=17) and sinonasal tumors (n=13). A specific set of physical endpoints was evaluated for each group. Dose statistics of the treatment plans without and with SOWAT were analyzed. RESULTS When using SOWAT for the pharyngeal and laryngeal cases, the PTV dose homogeneity increased with a median of 11% (range 2-27%), while the maximum dose to the spinal cord was decreased for 14 of the 17 patients. In four plans where parotid function preservation was a goal, the parotid mean dose was lower than 26 Gy in one plan without SOWAT, and in four plans with SOWAT. For the sinonasal tumors, the PTV dose homogeneity increased with a median of 7% (range 1-14%). SOWAT lowered the mean dose to 53 of the 63 optic pathway structures (retina, optic nerve and optic chiasm). SOWAT leaves the number of segments unchanged and has little or no effect on the delivery time. CONCLUSIONS SOWAT is a powerful tool to perform the final optimization of IMRT plans, without increasing the complexity of the plan or the delivery time.
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Affiliation(s)
- F Claus
- Division of Radiotherapy, Ghent University Hospital (GUH), De Pintelaan 185, 9000 Ghent, Belgium
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Abstract
PURPOSE To describe the theoretical basis, the algorithm, and implementation of a tool that optimizes segment shapes and weights for step-and-shoot intensity-modulated radiation therapy delivered by multileaf collimators. METHODS AND MATERIALS The tool, called SOWAT (Segment Outline and Weight Adapting Tool) is applied to a set of segments, segment weights, and corresponding dose distribution, computed by an external dose computation engine. SOWAT evaluates the effects of changing the position of each collimating leaf of each segment on an objective function, as follows. Changing a leaf position causes a change in the segment-specific dose matrix, which is calculated by a fast dose computation algorithm. A weighted sum of all segment-specific dose matrices provides the dose distribution and allows computation of the value of the objective function. Only leaf position changes that comply with the multileaf collimator constraints are evaluated. Leaf position changes that tend to decrease the value of the objective function are retained. After several possible positions have been evaluated for all collimating leaves of all segments, an external dose engine recomputes the dose distribution, based on the adapted leaf positions and weights. The plan is evaluated. If the plan is accepted, a segment sequencer is used to make the prescription files for the treatment machine. Otherwise, the user can restart SOWAT using the new set of segments, segment weights, and corresponding dose distribution. The implementation was illustrated using two example cases. The first example is a T1N0M0 supraglottic cancer case that was distributed as a multicenter planning exercise by investigators from Rotterdam, The Netherlands. The exercise involved a two-phase plan. Phase 1 involved the delivery of 46 Gy to a concave-shaped planning target volume (PTV) consisting of the primary tumor volume and the elective lymph nodal regions II-IV on both sides of the neck. Phase 2 involved a boost of 24 Gy to the primary tumor region only. SOWAT was applied to the Phase 1 plan. Parotid sparing was a planning goal. The second implementation example is an ethmoid sinus cancer case, planned with the intent of bilateral visus sparing. The median PTV prescription dose was 70 Gy with a maximum dose constraint to the optic pathway structures of 60 Gy. RESULTS The initial set of segments, segment weights, and corresponding dose distribution were obtained, respectively, by an anatomy-based segmentation tool, a segment weight optimization tool, and a differential scatter-air ratio dose computation algorithm as external dose engine. For the supraglottic case, this resulted in a plan that proved to be comparable to the plans obtained at the other institutes by forward or inverse planning techniques. After using SOWAT, the minimum PTV dose and PTV dose homogeneity increased; the maximum dose to the spinal cord decreased from 38 Gy to 32 Gy. The left parotid mean dose decreased from 22 Gy to 19 Gy and the right parotid mean dose from 20 to 18 Gy. For the ethmoid sinus case, the target homogeneity increased by leaf position optimization, together with a better sparing of the optical tracts. CONCLUSIONS By using SOWAT, the plans improved with respect to all plan evaluation end points. Compliance with the multileaf collimator constraints is guaranteed. The treatment delivery time remains almost unchanged, because no additional segments are created.
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Affiliation(s)
- W De Gersem
- Division of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Claus F, De Deene Y, Remouchamps V, De Wagter C, Van Vaerenbergh K, Schauvliege J, Van Duyse B, Speleers B, Duthoy W, De Neve W. An isocenter position verification device for electronic portal imaging: physical and dosimetrical characteristics. Cancer Radiother 2001; 5:759-65. [PMID: 11797297 DOI: 10.1016/s1278-3218(01)00137-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The physical and dosimetrical characteristics of a device, designed to visualize the isocenter position on electronic portal images, were examined. The device, to be mounted on the gantry head of the accelerator, containing five spheric lead markers, was designed in order to visualize the isocenter position on portal images. A quality control device was designed to check the reliability of this technique. The disturbance of the dose distribution by the markers was studied with gel dosimetry. The use of markers resulted in a precise and accurate method to visualize the isocenter on portal images. A maximum underdosage of 11%, due to attenuation by the markers, was observed. The use of markers to visualize the isocenter position on portal images, is a fast and reliable method when analyzing patient setup errors with online electronic portal imaging.
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Affiliation(s)
- F Claus
- Division of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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De Gersem W, Claus F, De Wagter C, De Neve W. An anatomy-based beam segmentation tool for intensity-modulated radiation therapy and its application to head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 51:849-59. [PMID: 11699497 DOI: 10.1016/s0360-3016(01)01727-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE In segmental intensity-modulated radiation therapy (IMRT), the beam fluences result from superposition of unmodulated beamlets (segments). In the inverse planning approach, segments are a result of ''clipping'' intensity maps. At Ghent University Hospital, segments are created by an anatomy-based segmentation tool (ABST). The objective of this report is to describe ABST. METHODS AND MATERIALS For each beam direction, ABST generates segments by a multistep procedure. During the initial steps, beam's eye view (BEV) projections of the planning target volumes (PTVs) and organs at risk (OARs) are generated. These projections are used to make a segmentation grid with negative values across the expanded OAR projections and positive values elsewhere inside the expanded PTV projections. Outside these regions, grid values are set to zero. Subsequent steps transform the positive values of the segmentation grid to increase with decreasing distance to the OAR projections and to increase with longer pathlengths measured along rays from their entrance point through the skin contours to their respective grid point. The final steps involve selection of iso-value lines of the segmentation grid as segment outlines which are transformed to leaf and jaw positions of a multileaf collimator (MLC). Segment shape approximations, if imposed by MLC constraints, are done in a way that minimizes overlap between the expanded OAR projections and the segment aperture. RESULTS The ABST procedure takes about 3 s/segment on a Compaq Alpha XP900 workstation. In IMRT planning problems with little complexity, such as laryngeal (example shown) or thyroid cancer, plans that are in accordance with the clinical protocol can be generated by weighting the segments generated by ABST without further optimization of their shapes. For complex IMRT plans such as paranasal sinus cancer (not shown), ABST generates a start assembly of segments from which the shapes and weights are further optimized. CONCLUSIONS ABST is a fast procedure to generate a set of segments for IMRT planning. The plan is finalized by assigning weights to the segments or by direct optimization of segment shapes and weights. ABST allows us to avoid the step of translating optimized intensity maps to sequences of segments.
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Affiliation(s)
- W De Gersem
- Division of Radiotherapy, Ghent University Hospital (GUH), Belgium
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Abstract
The delivery efficiency of step and shoot intensity modulated radiotherapy (IMRT) has been improved by the installation of fast-tuning magnetrons into three travelling wave linear accelerators. The IMRT delivery efficiency and the beam start-up performance have been compared before and after installation. Start-up and inter sub-field times were reduced by an average of 3.0 s. A typical start-up time from depression of the start button to beam on is now around 4 s. Delivery efficiency for a variety of clinical and quality control prescriptions was improved by an average of 30.7% (range 7.4-60.9%), depending on a complex combination of the number of sub-fields, distance moved by leaves and dose rate. For the oldest accelerator (7 years old), dosimetric accuracy was significantly improved for low dose sub-fields. The dose output was within 2% for a 1 monitor unit (MU) sub-field and 1% for a 2 MU sub-field. The two newer accelerators displayed similar or better dose characteristics even before fast-tuning magnetron installation. Beam symmetries and flatnesses were acceptable at all energies and dose rates, and showed no obvious degradation in low dose sub-fields. It is recommended that fast-tuning magnetrons are adopted for accelerators of this design performing step and shoot IMRT.
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Affiliation(s)
- G J Budgell
- North Western Medical Physics, Christie Hospital NHS Trust, Manchester, UK.
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Claus F, De Gersem W, De Wagter C, Van Severen R, Vanhoutte I, Duthoy W, Remouchamps V, Van Duyse B, Vakaet L, Lemmerling M, Vermeersch H, De Neve W. An implementation strategy for IMRT of ethmoid sinus cancer with bilateral sparing of the optic pathways. Int J Radiat Oncol Biol Phys 2001; 51:318-31. [PMID: 11567805 DOI: 10.1016/s0360-3016(01)01627-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a protocol for the irradiation of ethmoid sinus cancer, with the aim of sparing binocular vision; of developing a strategy of intensity-modulated radiation therapy (IMRT) planning that produces dose distributions that (1) are consistent with the protocol prescriptions and (2) are deliverable by static segmental IMRT techniques within a 15-minute time slot; of fine tuning the implementation strategy to a class solution approach that is sufficiently automated and efficient, allowing routine clinical application; of reporting on the early clinical implementation involving 11 patients between February 1999 and July 2000. patients and methods: Eleven consecutive T1-4N0M0 ethmoid sinus cancer patients were enrolled in the study. For Patients 1-8, a first protocol was implemented, defining a planning target volume prescription dose of 60 to 66 Gy in 30-33 fractions and a maximum dose (Dmax) of 50 Gy to optic pathway structures and spinal cord and limit of 60 Gy to brainstem. For Patients 9-11, an adapted (now considered mature) protocol was implemented, defining a (planning target volume) prescription dose of 70 Gy in 35 fractions and a Dmax to optic pathway structures and brainstem of 60 Gy and to spinal cord of 50 Gy. RESULTS The class solution-directed strategy developed during this study reduced the protocol translation process from a few days to about 2 hours of planner time. The mature class solution involved the use of 7 beam incidences (20-37 segments), which could be delivered within a 15-minute time slot. Acute side effects were limited and mild. None of the patients developed dry eye syndrome or other visual disturbances. The follow-up period is too short for detection of retinopathy or optic nerve and chiasm toxicity. CONCLUSION Conventional radiotherapy of ethmoid sinus tumors is associated with serious morbidity, including blindness. We hypothesize that IMRT has the potential to save binocular vision. The dose to the optic pathway structures can be reduced selectively by IMRT. Further enrollment of patients and longer follow-up will show whether the level of reduction tested by the clinical protocol is sufficient to save binocular vision. An adaptive strategy of IMRT planning was too inefficient for routine clinical practice. A class solution-directed strategy improved efficiency by eliminating human trial and error during the IMRT planning process.
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Affiliation(s)
- F Claus
- Division of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Claus F, Vakaet L, De Gersem W, Lemmerling M, Vanhoutte I, Vermael S, Van Severen R, Van Duyse B, Vermeersch H, Moerman M, De Neve W. Postoperative radiotherapy of paranasal sinus tumours: a challenge for intensity modulated radiotherapy. Acta Otorhinolaryngol Belg 2000; 53:263-9. [PMID: 10635406] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND PURPOSE Intensity modulated radiotherapy (IMRT) is used in our department for treatment of paranasal sinuses. We describe the methodology that was developed together with the clinical implementation, illustrated by a case report. MATERIAL AND METHODS Patient history, treatment and short follow-up are described. An IMRT, obtained by superposition of static beam segments was implemented. Electronic portal images, compared to digitally reconstructed radiographs (DRR) were used to evaluate and adjust patient positioning. RESULTS, DISCUSSION AND CONCLUSION IMRT is an appropriate and feasible treatment technique for head and neck cancer in anatomical regions that are difficult to treat. A high tumour dose can be combined with a good sparing of the surrounding organs at risk (OAR's).
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Affiliation(s)
- F Claus
- University Hospital Ghent, Belgium
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De Neve W, Claus F, Van Houtte P, Derycke S, De Wagter C. [Intensity modulated radiotherapy with dynamic multileaf collimator. Technique and clinical experience]. Cancer Radiother 1999; 3:378-92. [PMID: 10572508 DOI: 10.1016/s1278-3218(00)87976-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Since early 1997, dynamic multileaf collimators (DMLCs) have been used in our division for intensity modulated radiotherapy (IMRT). We have used IMRT to: irradiate concave targets (head and neck, paraspinal tumors); combine beams with shallow hinge angles (mediastinum, lung tumors); deliver intentionally inhomogeneous dose distributions (prostate, paranasal sinuses, brain tumors). IMRT is now our standard treatment for locoregional relapse (after high-dose radiotherapy) for head and neck cancer and for radical treatment of localized prostate cancer. For a variety of other tumors, conventional 3D-plans are compared with IMRT-plans, the latter being clinically implemented if superior. We developed a geometry based IMRT planning strategy to create assemblies of static intensity modulated (IM)-beams which consist of uniform (unmodulated) segments. By a translator program, segments are combined in a single prescription which allows delivery under computer control. Cost-containment is further improved by automation of the planning. After manual or semi-automated contouring of PTV and the organs at risk, prostate IMRT plans, based on a class solution, are generated and optimized by a computer. IMRT for pharyngeal relapses and most other tumor sites is planned semi-automatically. IMRT replaces gradually conventional treatments in our division. Interesting dose distributions generated by IMRT allow a better sparing of normal tissues with decreased acute and late toxicity, and offer a window for further dose escalation.
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Affiliation(s)
- W De Neve
- Département de radiothérapie et de médecine nucléaire, Hôpital universitaire de Gand (R-UZG), Belgique
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De Neve W, Claus F, De Wagter C. Intensity modulated radiotherapy with dynamic multileaf collimators. Technology and clinical potential. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81292-1] [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: 11/27/2022]
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Petter O, Claus F, Nitzsche H, Böduel S. [Diagnostic sensitivity of sonography in varicose and post-thrombotic venous insufficiency]. Z Hautkr 1987; 62:12-27. [PMID: 2953117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report on the application possibilities of sonography in phlebology. Sonographic examination of 131 lower legs showing various clinical forms of chronic venous insufficiency is discussed. Ultrasound offers a timesaving, non-invasive, and reproducible technique to detect insufficiencies concerning orifice or trunk of the great and lower saphenous veins as well as the perforating veins. The method allows varying diagnostic sensitivities. Thrombotic changes in the deep veins may be demonstrated with relative accurateness. As to insufficiencies concerning the epifascial and perforating venous system (in epifascial chronic venous insufficiency, stage I to IV), the question of surgical or sclerotherapeutic treatment can be settled in most cases according to the sonographical findings alone. Subfascial forms of chronic venous insufficiency require additional invasive diagnostic techniques, such as plethysmography, phlebography, and venous pressure measurements. In consideration of the high diagnostic importance of ultrasound, sonographic devices should be available and applied in a large number of phlebologic practices.
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Claus F, Glaser M, W�lfel V, Minkwitz R. Darstellung von Arsenchloridtetrafluorid, AsClF4, und schwingungsspektroskopische Betrachtungen innerhalb der Reihe AsClnF5?n. Z Anorg Allg Chem 1984. [DOI: 10.1002/zaac.19845171021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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