152 research outputs found
Respiratory-induced organ motion compensation for MRgHIFU
Summary: High Intensity Focused Ultrasound is an emerging non-invasive technology for the precise
thermal ablation of pathological tissue deep within the body. The fitful, respiratoryinduced
motion of abdominal organs, such as of the liver, renders targeting challenging.
The work in hand describes methods for imaging, modelling and managing respiratoryinduced
organ motion. The main objective is to enable 3D motion prediction of liver
tumours for the treatment with Magnetic Resonance guided High Intensity Focused Ultrasound
(MRgHIFU).
To model and predict respiratory motion, the liver motion is initially observed in 3D
space. Fast acquired 2D magnetic resonance images are retrospectively reconstructed
to time-resolved volumes, thus called 4DMRI (3D + time). From these volumes, dense
deformation fields describing the motion from time-step to time-step are extracted using
an intensity-based non-rigid registration algorithm. 4DMRI sequences of 20 subjects,
providing long-term recordings of the variability in liver motion under free breathing,
serve as the basis for this study.
Based on the obtained motion data, three main types of models were investigated and
evaluated in clinically relevant scenarios. In particular, subject-specific motion models,
inter-subject population-based motion models and the combination of both are compared
in comprehensive studies. The analysis of the prediction experiments showed that
statistical models based on Principal Component Analysis are well suited to describe
the motion of a single subject as well as of a population of different and unobserved
subjects. In order to enable target prediction, the respiratory state of the respective
organ was tracked in near-real-time and a temporal prediction of its future position is
estimated. The time span provided by the prediction is used to calculate the new target
position and to readjust the treatment focus. In addition, novel methods for faster
acquisition of subject-specific 3D data based on a manifold learner are presented and
compared to the state-of-the art 4DMRI method.
The developed methods provide motion compensation techniques for the non-invasive
and radiation-free treatment of pathological tissue in moving abdominal organs for
MRgHIFU. ---------- Zusammenfassung: High Intensity Focused Ultrasound ist eine aufkommende, nicht-invasive Technologie
für die präzise thermische Zerstörung von pathologischem Gewebe im Körper. Die
unregelmässige ateminduzierte Bewegung der Unterleibsorgane, wie z.B. im Fall der
Leber, macht genaues Zielen anspruchsvoll. Die vorliegende Arbeit beschreibt Verfahren
zur Bildgebung, Modellierung und zur Regelung ateminduzierter Organbewegung.
Das Hauptziel besteht darin, 3D Zielvorhersagen für die Behandlung von Lebertumoren
mittels Magnetic Resonance guided High Intensity Focused Ultrasound
(MRgHIFU) zu ermöglichen.
Um die Atembewegung modellieren und vorhersagen zu können, wird die Bewegung
der Leber zuerst im dreidimensionalen Raum beobachtet. Schnell aufgenommene 2DMagnetresonanz-
Bilder wurden dabei rückwirkend zu Volumen mit sowohl guter zeitlicher
als auch räumlicher Auflösung, daher 4DMRI (3D + Zeit) genannt, rekonstruiert.
Aus diesen Volumen werden Deformationsfelder, welche die Bewegung von Zeitschritt
zu Zeitschritt beschreiben, mit einem intensitätsbasierten, nicht-starren Registrierungsalgorithmus
extrahiert. 4DMRI-Sequenzen von 20 Probanden, welche Langzeitaufzeichungen
von der Variabilität der Leberbewegung beinhalten, dienen als Grundlage für
diese Studie.
Basierend auf den gewonnenen Bewegungsdaten wurden drei Arten von Modellen
in klinisch relevanten Szenarien untersucht und evaluiert. Personen-spezifische Bewegungsmodelle,
populationsbasierende Bewegungsmodelle und die Kombination beider
wurden in umfassenden Studien verglichen. Die Analyse der Vorhersage-Experimente
zeigte, dass statistische Modelle basierend auf Hauptkomponentenanalyse gut geeignet
sind, um die Bewegung einer einzelnen Person sowie einer Population von unterschiedlichen
und unbeobachteten Personen zu beschreiben. Die Bewegungsvorhersage basiert
auf der Abschätzung der Organposition, welche fast in Echtzeit verfolgt wird. Die durch
die Vorhersage bereitgestellte Zeitspanne wird verwendet, um die neue Zielposition zu
berechnen und den Behandlungsfokus auszurichten. Darüber hinaus werden neue Methoden
zur schnelleren Erfassung patienten-spezifischer 3D-Daten und deren Rekonstruktion
vorgestellt und mit der gängigen 4DMRI-Methode verglichen. Die entwickelten Methoden beschreiben Techniken zur nichtinvasiven und strahlungsfreien
Behandlung von krankhaftem Gewebe in bewegten Unterleibsorganen mittels
MRgHIFU
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Complete Genome Sequence of Luteibacter pinisoli MAH-14
Diverse strains of Luteibacter (Gammaproteobacteria) have been isolated from a variety of environments, most frequently in association with both plants and fungi. Motivated by the lack of genomic information for strains throughout the genus Luteibacter, we report here a complete genome sequence for Luteibacter pinisoli strain MAH-14.Indigo AgricultureOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
Dynamic OCT Signal Loss for Determining RPE Radiant Exposure Damage Thresholds in Microsecond Laser Microsurgery
Optical microsurgery of the retinal pigment epithelium (RPE) requires reliable real-time dosimetry to prevent unwanted overexposure of the neuroretina. The system used in this experiment implements optical coherence tomography (OCT) to detect the intentional elimination of RPE cells. We evaluated the performance of OCT dosimetry in terms of its ability to detect RPE cell damage caused by microsecond laser pulses of varying duration. Therefore, ex-vivo porcine RPE choroid sclera explants were embedded in an artificial eye and exposed to single laser pulses of 2–20 µs duration (wavelength: 532 nm, exposure area: 120 × 120 µm2, intensity modulation factor: 1.3). Simultaneously, time-resolved OCT M-scans were recorded (central wavelength: 870 nm, scan rate: 33 kHz). Post-irradiation, RPE cell damage was quantified using a calcein-AM viability assay and compared with an OCT-dosimetry algorithm. The results of our experiments show that the OCT-based analysis successfully predicts RPE cell damage. At its optimal operating point, the algorithm achieved a sensitivity of 89% and specificity of 94% for pulses of 6 µs duration and demonstrated the ability to precisely control radiant exposure of a wide range of pulse durations towards selective real-time laser microsurgery
Optical coherence tomography controlled selective retina therapy with a novel microsecond laser
Selective retina therapy (SRT) is a short pulse (μs-regime) alternative to conventional laser photocoagulation (LPC) for treatment of retinal diseases. LPC leads to collateral damage of retinal layers adjacent to the retinal pigment epithelium (RPE), including healthy, non-regenerative photoreceptors due to the high thermal load, whereas in SRT, RPE cells are destroyed by microbubbles without damaging the neuronal retina. A novel experimental SRT laser operating at 532 nm wavelength can deliver 2 – 20 μs pulse sequences. Its tight integration into an upgraded diagnostic SPECTRALIS system combines beam control for treatment planning with real-time optical coherence tomography (OCT) overexposure protection of the photoreceptors. This “Spectralis Centaurus” system, was built and preliminary tested on porcine ex-vivo samples, reaching an unprecedented accuracy with unique planning and follow-up capabilities for upcoming clinical cellular level micro-surgery. The combination of OCT with SRT selectively limits cell death to the RPE by precisely controlling energy deposition while optically monitoring tissue response
Bridging intravenous thrombolysis in patients with atrial fibrillation.
Background and purpose
40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome.
Materials and Methods
Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0-2).
Results
In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02-1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27-3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41-1.24]) nor bridging IVT (aOR 1.08 [0.67-1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24-2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92).
Conclusion
Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT.
Registration
clinicaltrials.gov; Unique identifier: NCT03496064
Mechanical thrombectomy in acute ischemic stroke : Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN
The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after acute stroke. The statement is supported by ESO, European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), and European Academy of Neurology (EAN).Peer reviewe
Hypocoercivity for Kolmogorov backward evolution equations and applications
In this article we extend the modern, powerful and simple abstract Hilbert
space strategy for proving hypocoercivity that has been developed originally by
Dolbeault, Mouhot and Schmeiser. As well-known, hypocoercivity methods imply an
exponential decay to equilibrium with explicit computable rate of convergence.
Our extension is now made for studying the long-time behavior of some strongly
continuous semigroup generated by a (degenerate) Kolmogorov backward operator
L. Additionally, we introduce several domain issues into the framework.
Necessary conditions for proving hypocoercivity need then only to be verified
on some fixed operator core of L. Furthermore, the setting is also suitable for
covering existence and construction problems as required in many applications.
The methods are applicable to various, different, Kolmogorov backward evolution
problems. As a main part, we apply the extended framework to the (degenerate)
spherical velocity Langevin equation. The latter can be seen as some kind of an
analogue to the classical Langevin equation in case spherical velocities are
required. This model is of important industrial relevance and describes the
fiber lay-down in the production process of nonwovens. For the construction of
the strongly continuous contraction semigroup we make use of modern
hypoellipticity tools and pertubation theory
Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS).
Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60 % men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73 %. Stroke aetiology was mostly cardioembolism (32 %) and of other defined origin (24 %), including cervicocerebral artery dissection (17 %). Fabry disease was diagnosed in 2 patients (0.3 %). Aetiology remained unknown in 20 %. Outcome at 3 months was favourable (mRS 0-1) in 61 % and fatal in 2.9 %. Stroke severity (p < 0.001) and diabetes mellitus (p = 0.023) predicted unfavourable outcome. Stroke recurrence rate at 3 months was 2.7 %. Previous stroke or TIA predicted recurrent cerebrovascular events (p = 0.012). In conclusion, most young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones
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