A joint ventricle and WMH segmentation from MRI for evaluation of healthy and pathological changes in the aging brain

Funding Information: This work was supported by the Icelandic Centre for Research (RANNIS, https://en.rannis.is/) through grant 173942-051 (PI:Ellingsen). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study. The authors would like to thank Dr. Jerry Prince and Mr. Aaron Carass for providing pre-processed and manually delineated NPH data from Johns Hopkins University. Publisher Copyright: © 2022 Atlason et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Age-related changes in brain structure include atrophy of the brain parenchyma and white matter changes of presumed vascular origin. Enlargement of the ventricles may occur due to atrophy or impaired cerebrospinal fluid (CSF) circulation. The co-occurrence of these changes in neurodegenerative diseases and in aging brains often requires investigators to take both into account when studying the brain, however, automated segmentation of enlarged ventricles and white matter hyperintensities (WMHs) can be a challenging task. Here, we present a hybrid multi-atlas segmentation and convolutional autoencoder approach for joint ventricle parcellation and WMH segmentation from magnetic resonance images (MRIs). Our fully automated approach uses a convolutional autoencoder to generate a standardized image of grey matter, white matter, CSF, and WMHs, which, in conjunction with labels generated by a multi-atlas segmentation approach, is then fed into a convolutional neural network to parcellate the ventricular system. Hence, our approach does not depend on manually delineated training data for new data sets. The segmentation pipeline was validated on both healthy elderly subjects and subjects with normal pressure hydrocephalus using ground truth manual labels and compared with state-of-the-art segmentation methods. We then applied the method to a cohort of 2401 elderly brains to investigate associations of ventricle volume and WMH load with various demographics and clinical biomarkers, using a multiple regression model. Our results indicate that the ventricle volume and WMH load are both highly variable in a cohort of elderly subjects and there is an independent association between the two, which highlights the importance of taking both the possibility of enlarged ventricles and WMHs into account when studying the aging brain.Peer reviewe

Alle 3-vuotiaiden siirtymä- ja odotustilanteiden kehittäminen : käsikirja varhaiskasvattajalle

Tämän kehittämistyön tehtävänä oli luoda käsikirja siirtymä- ja odotustilanteisiin Raisiossa sijaitsevaan päiväkoti Satusaaren alle 3-vuotiaiden ryhmään. Tavoitteena on kehittää siirtymä- ja odotustilanteiden sisältämää pedagogiikkaa, huomioiden erityisesti kielen kehityksen tukeminen ja leikin merkitys. Tuotoksesta haluttiin tehdä selkeä ja helposti luettava. Kehittämistyön teoreettisena viitekehyksenä ovat alle 3-vuotiaan lapsen kehitys ja oppiminen, kielen kehitys ja sen tukeminen, pedagoginen työote perustoiminnoissa, sekä siirtymä- ja odotustilanteet varhaiskasvatuksessa. Kehittämismenetelminä käytettiin dialogista keskustelua, osallistuvaa havainnointia ja kokeilevaa toimintaa. Kehittämistyön tuotoksena syntyi käsikirja alle 3-vuotiaiden siirtymä- ja odotustilanteisiin. Käsikirja sisältää teoriatietoa perustoimintojen hyödyntämisestä pedagogisesti, siirtymä- ja odotustilanteista, kielen kehityksestä ja sen tukemisesta, sekä leikin merkityksestä. Lisäksi käsikirja sisältää materiaalipankin, jossa on konkreettista materiaalia siirtymä- ja odotustilanteiden tueksi, kuten loruja ja lauluja

Angiographic findings and survival in patients undergoing coronary angiography due to sudden cardiac arrest in Western Sweden

AIM: Sudden cardiac arrest (SCA) accounts for more than half of all deaths from coronary heart disease. Time to return of spontaneous circulation is the most important determinant of outcome but successful resuscitation also requires percutaneous coronary intervention in selected patients. However, proper selection of patients is difficult. We describe data on angiographic finding and survival from a prospectively followed SCA patient cohort.METHODS: We merged the RIKS-HIA registry (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) and SCAAR (Swedish Coronary Angiography and Angioplasty Registry) for patients hospitalized in cardiac care units in Western Sweden between January 2005 and March 2013. We performed propensity score-adjusted logistic and Cox proportional-hazards regression analyses on complete-case data as well as on imputed data sets.RESULTS: 638 consecutive patients underwent coronary angiography due to SCA. Severity of coronary artery disease was similar among SCA patients and patients undergoing coronary angiography due to suspected coronary artery disease (n=37,142). An acute occlusion was reported in the majority of SCA patients and was present in 37% of patients who did not have ST-elevation on the post resuscitation ECG. 31% of SCA patients died within 30 days. Long-term risk of death among patients who survived the first 30 days was higher in patients with SCA compared to patients with acute coronary syndromes (P&lt;0.001).CONCLUSIONS: Coronary artery disease and acute coronary occlusions are common among patients who undergo coronary angiography after sudden cardiac arrest. These patients have a substantial mortality risk both short- and long-term.</p

Clinical and Procedural Characteristics Associated With Higher Radiation Exposure During Percutaneous Coronary Interventions and Coronary Angiography

BACKGROUND: WE AIM TO STUDY THE CLINICAL AND PROCEDURAL CHARACTERISTICS ASSOCIATED WITH HIGHER RADIATION EXPOSURE IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS (PCIS) AND CORONARY ANGIOGRAPHY.METHODS AND RESULTS: OUR PRESENT STUDY INCLUDED ALL CORONARY ANGIOGRAPHY AND PCI PROCEDURES IN 5 PCI CENTERS IN THE WESTERN PART OF SWEDEN, BETWEEN JANUARY 1, 2008, AND JANUARY 19, 2012. THE RADIATION EXPOSURE AND CLINICAL DATA WERE COLLECTED PROSPECTIVELY IN THESE 5 PCI CENTERS IN SWEDEN AS PART OF THE SWEDISH CORONARY ANGIOGRAPHY AND ANGIOPLASTY REGISTRY (SCAAR). A PREDICTION MODEL WAS MADE FOR THE RADIATION EXPOSURE (DOSEAREA PRODUCT) EXPRESSED IN GYCM(2). A TOTAL OF 20 669 PROCEDURES WERE INCLUDED IN THE PRESENT STUDY, CONSISTING OF 9850 PCI AND 10 819 CORONARY ANGIOGRAPHY PROCEDURES. IN MULTIVARIABLE ANALYSES, BODY MASS INDEX (=1.04; CONFIDENCE INTERVAL [CI], 1.041.04; P0.001); HISTORY OF CORONARY ARTERY BYPASS GRAFT SURGERY (=1.32; CI, 1.281.32; P0.001); 2, 3, OR 4 TREATED LESIONS (2 TREATED LESIONS: =1.95; CI, 1.842.03; P0.001; 3 TREATED LESIONS: =2.34; CI, 2.162.53; P0.001; AND 4 TREATED LESIONS: =2.83; CI, 2.533.16; P0.001); AND CHRONIC TOTAL OCCLUSION LESIONS (=1.39; CI, 1.311.48; P0.001) WERE ASSOCIATED WITH THE HIGHEST RADIATION EXPOSURE. AFTER ADJUSTING FOR PROCEDURAL COMPLEXITY, RADIAL ACCESS ROUTE WAS NOT ASSOCIATED WITH INCREASED RADIATION EXPOSURE (=1.00; CI, 0.981.03; P=0.67).CONCLUSIONS: In the largest study population to assess radiation exposure, we found that high body mass index, history of coronary artery bypass graft surgery, number of treated lesions, and chronic total occlusions were associated with the highest patient radiation exposure. Radial access site was not associated with higher radiation exposure when compared with femoral approach

Bivalirudin versus heparin in ST and non-ST-segment elevation myocardial infarction-Outcomes at two years

The registry-based randomized VALIDATE-SWEDEHEART trial (NCT02311231) compared bivalirudin vs. heparin in patients undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI). It showed no difference in the composite primary endpoint of death, MI, or major bleeding at 180days. Here, we report outcomes at two years.Analysis of primary and secondary endpoints at two years of follow-up was prespecified in the study protocol. We report the study results for the extended follow-up time here.In total, 6006 patients were enrolled, 3005 with ST-segment elevation MI (STEMI) and 3001 with Non-STEMI (NSTEMI), representing 70% of all eligible patients with these diagnoses during the study. The primary endpoint occurred in 14.0% (421 of 3004) in the bivalirudin group compared with 14.3% (429 of 3002) in the heparin group (hazard ratio [HR] 0.97; 95% confidence interval [CI], 0.85-1.11; P=0.70) at one year and in 16.7% (503 of 3004) compared with 17.1% (514 of 3002), (HR 0.97; 95% CI, 0.96-1.10; P=0.66) at two years. The results were consistent in patients with STEMI and NSTEMI and across major subgroups.Until the two-year follow-up, there were no differences in endpoints between patients with MI undergoing PCI and allocated to bivalirudin compared with those allocated to heparin.URL: https://www.gov; Unique identifier: NCT02311231