Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 95
Filtrar
1.
Abdom Radiol (NY) ; 2024 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-38916616

RESUMEN

PURPOSE: The Reporting and Data System (RADS) has proven successful in various medical settings, but a standardized reporting system for abdominal emergencies is lacking. In this study, the Abdominal Emergency Reporting and Data System (AEM-RADS) for urgent findings on abdominal CT scans is introduced to address the need for consistency in emergency radiology. METHODS: In this prospective observational study, conducted over a six-month period, the urgency of abdominal CT scans was assessed using the proposed AEM-RADS scoring system. The committee developed a scale ranging from AEM-RADS 1 (normal) to AEM-RADS 5 (urgent disease). Interobserver agreement between two observers with different experience was evaluated, and robust AEM-RADS reference values were established by radiologists who were not observers. Statistical analysis used mean, standard deviations and Kendall's tau analysis for interobserver agreement. RESULTS: Among 2656 patients who underwent CT for abdominal emergencies, the AEM-RADS distribution was 17.50% AEM-RADS 1, 28.57% AEM-RADS 2, 7.22% AEM-RADS 3, 35.61% AEM-RADS 4, and 11.06% AEM-RADS 5. Interobserver agreement was high, especially for urgent and emergent cases (p < 0.0001). Notable discrepancies were observed in AEM-RADS categories 2C-D and 3B-C, emphasizing the influence of radiologists' experience on interpretation. However, the interobserver agreement for both AEM-RADS 2C-D and 3B-C were statistically significant (p < 0.001). CONCLUSIONS: AEM-RADS showed promising reliability, particularly in identifying urgent and emergent cases. Despite some inter-observer discrepancies, the system showed potential for standardized emergency workups. AEM-RADS could significantly enhance diagnostic accuracy in abdominal emergencies and provide a structured framework for shared decision-making between clinicians and radiologists.0.

2.
Artículo en Inglés | MEDLINE | ID: mdl-38685479

RESUMEN

BACKGROUND: Asthma classification into different subphenotypes is important to guide personalized therapy and improve outcomes. OBJECTIVES: To further explore asthma heterogeneity through determination of multiple patient groups by using novel machine learning (ML) approaches and large-scale real-world data. METHODS: We used electronic health records of patients with asthma followed at the Cleveland Clinic between 2010 and 2021. We used k-prototype unsupervised ML to develop a clustering model where predictors were age, sex, race, body mass index, prebronchodilator and postbronchodilator spirometry measurements, and the usage of inhaled/systemic steroids. We applied elbow and silhouette plots to select the optimal number of clusters. These clusters were then evaluated through LightGBM's supervised ML approach on their cross-validated F1 score to support their distinctiveness. RESULTS: Data from 13,498 patients with asthma with available postbronchodilator spirometry measurements were extracted to identify 5 stable clusters. Cluster 1 included a young nonsevere asthma population with normal lung function and higher frequency of acute exacerbation (0.8 /patient-year). Cluster 2 had the highest body mass index (mean ± SD, 44.44 ± 7.83 kg/m2), and the highest proportion of females (77.5%) and Blacks (28.9%). Cluster 3 comprised patients with normal lung function. Cluster 4 included patients with lower percent of predicted FEV1 of 77.03 (12.79) and poor response to bronchodilators. Cluster 5 had the lowest percent of predicted FEV1 of 68.08 (15.02), the highest postbronchodilator reversibility, and the highest proportion of severe asthma (44.9%) and blood eosinophilia (>300 cells/µL) (34.8%). CONCLUSIONS: Using real-world data and unsupervised ML, we classified asthma into 5 clinically important subphenotypes where group-specific asthma treatment and management strategies can be designed and deployed.

3.
Echocardiography ; 40(12): 1350-1355, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37955614

RESUMEN

OBJECTIVE: Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients. METHODS: A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two-dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three-dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated. RESULTS: Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR-derived volumes and RVEF (r = .91, r = .79, r = .64; p < .0001 for each, respectively). Among other parameters, RV fractional area change (r = .439; p < .001) and RV free wall longitudinal strain (RVFW-LS) (r = -.34; p < .05) correlated moderately with CMR-RVEF, whereas tricuspid annulus S' velocity (r = .29; p < .05) and tricuspid annular systolic plane excursion (r = .27; p < .05) correlated weakly with CMR-RVEF. Additionally, 3D-RVEF and RVFW-LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p = .04 and -15.5 ± 3.1 vs. -17.5 ± 3, p = .03, respectively). CONCLUSION: The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW-LS and 3D-RVEF in these patients.


Asunto(s)
Trasplante de Corazón , Hipertensión Pulmonar , Disfunción Ventricular Derecha , Humanos , Función Ventricular Derecha , Imagen por Resonancia Cinemagnética/métodos , Ecocardiografía/métodos , Hipertensión Pulmonar/diagnóstico por imagen , Trasplante de Corazón/efectos adversos , Hemodinámica , Volumen Sistólico , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología
4.
J Biomech Eng ; 145(12)2023 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-37796636

RESUMEN

Model reproducibility is a point of emphasis for the National Institutes of Health (NIH) and in science, broadly. As the use of computational modeling in biomechanics and orthopedics grows, so does the need to assess the reproducibility of modeling workflows and simulation predictions. The long-term goal of the KneeHub project is to understand the influence of potentially subjective decisions, thus the modeler's "art", on the reproducibility and predictive uncertainty of computational knee joint models. In this paper, we report on the model calibration phase of this project, during which five teams calibrated computational knee joint models of the same specimens from the same specimen-specific joint mechanics dataset. We investigated model calibration approaches and decisions, and compared calibration workflows and model outcomes among the teams. The selection of the calibration targets used in the calibration workflow differed greatly between the teams and was influenced by modeling decisions related to the representation of structures, and considerations for computational cost and implementation of optimization. While calibration improved model performance, differences in the postcalibration ligament properties and predicted kinematics were quantified and discussed in the context of modeling decisions. Even for teams with demonstrated expertise, model calibration is difficult to foresee and plan in detail, and the results of this study underscore the importance of identification and standardization of best practices for data sharing and calibration.


Asunto(s)
Articulación de la Rodilla , Flujo de Trabajo , Reproducibilidad de los Resultados , Calibración , Fenómenos Biomecánicos , Simulación por Computador , Análisis de Elementos Finitos
5.
Emerg Radiol ; 30(5): 659-666, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37535144

RESUMEN

Two major earthquakes measuring 7.8 and 7.7 on the Richter scale struck Turkey and Northern Syria on February 6, claiming more than 50,000 lives. In such an unprecedented disaster, radiologists were confronted with very critical tasks of stepping out of the routine reporting process, performing radiological triage, managing acute adverse events, and optimizing imaging protocols. In our experience, radiologists can take three different positions in such disasters: (1) in the scene of the disaster, (2) serving in teleradiology, and (3) working in tertiary hospital for transported patients. With this article, we aimed to describe the challenges radiologists face on the three main fronts and how we manage these challenges.


Asunto(s)
Desastres , Terremotos , Humanos , Triaje , Radiólogos , Centros de Atención Terciaria
6.
Ulus Travma Acil Cerrahi Derg ; 29(6): 717-723, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37278081

RESUMEN

BACKGROUND: Examination of all 24 ribs on axial computed tomography (CT) slices might become a leeway and rib fractures (RF) may easily overlook in daily practice. Rib unfolding (RU), a computer-assisted software, that promises rapid assessment of the ribs in a two-dimensional plan, was developed to facilitate rib evaluation. We aimed to evaluate the reliability and reproducibility of RU software for RF detection on CT and to determine the accelerating effect to determine any drawback of RU application. METHODS: Fifty-one patients with thoracic trauma formed the sample to be assessed by the observers. The characterization and distribution of RFs on CT images in this sample were recorded independently by the non-observers. Regarding the presence or ab-sence of RF, CT images were assessed blindedly by two radiologists with 5 years (observer-A) and 18 years (observer-B) of experience in thoracic radiology. Each observer assessed the axial CT and RU images on different days under non-observer supervision. RESULTS: A total of 113 RFs were detected in 22 patients. The mean evaluation time for the axial CT images was 146.64 s for ob-server-A and 119.29 s for observer-B. The mean evaluation time for RU images was 66.44 s for observer-A and 32.66 s for observer-B. A statistically significant decrease was observed between the evaluation periods of observer-A and observer-B with RU software compared to the axial CT image assessment (p<0.001). The inter-observer κ value was 0.638, while the intra-observer results showed moderate (κ: 0.441) and good (κ: 0.752) reproducibility comparing the RU and axial CT assessments. Observer-A detected 47.05% non-displaced fractures, 48.93% minimally displaced (≤2 mm) fractures, and 38.77% displaced fractures on RU images (p=0.009). Ob-server-B detected 23.52% non-displaced fractures, 57.44% minimally displaced (≤2 mm) fractures, and 48.97% displaced fractures on RU images (p=0.045). CONCLUSION: RU software accelerates fracture evaluation, while it has drawbacks including low sensitivity in fracture detection, false negativity, and underestimation of displacement.


Asunto(s)
Fracturas de las Costillas , Costillas , Humanos , Reproducibilidad de los Resultados , Variaciones Dependientes del Observador , Costillas/lesiones , Fracturas de las Costillas/diagnóstico por imagen , Programas Informáticos
7.
Emerg Radiol ; 30(4): 513-523, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37270438

RESUMEN

On February 6, two major earthquakes with magnitudes of 7.8 and 7.7 on the Richter scale hit Turkey and Northern Syria causing more than 50,000 deaths. In the immediate aftermath of the earthquakes, our major tertiary medical referral center received dozens of cases of crush syndrome, presenting with a variety of imaging findings. Crush syndrome is characterized by hypovolemia, hyperkalemia, and myoglobinuria that can lead to rapid death of victims, despite their survival of staying under wreckage for days. The typical triad of crush syndrome consists of the acute tubular necrosis, paralytic ileus, and third-space edema. In this article, we focus primarily on characteristic imaging findings of earthquake-related crush syndrome and divided them into two distinct subsections: myonecrosis, rapid hypovolemia, excessive third-space edema, acute tubular necrosis, and paralytic ileus, which are directly related to crush syndrome, and typical accompanying findings of earthquake-related crush syndrome. Lower extremity compression in earthquake survivors results in the typical third-space edema. In addition to the lower extremities, other skeletal muscle regions are also affected, especially rotator muscles, trapezius, and pectoral muscles. Although it may be relatively easy to better detect myonecrosis with contrast-enhanced CT scans, changing the windowing of the images may be helpful.


Asunto(s)
Síndrome de Aplastamiento , Terremotos , Humanos , Síndrome de Aplastamiento/diagnóstico por imagen , Síndrome de Aplastamiento/complicaciones , Hipovolemia/complicaciones , Tomografía Computarizada por Rayos X , Necrosis/complicaciones
8.
J Orthop Res ; 41(12): 2569-2578, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37350016

RESUMEN

Stakeholders in the modeling and simulation (M&S) community organized a workshop at the 2019 Annual Meeting of the Orthopaedic Research Society (ORS) entitled "Reproducibility in Modeling and Simulation of the Knee: Academic, Industry, and Regulatory Perspectives." The goal was to discuss efforts among these stakeholders to address irreproducibility in M&S focusing on the knee joint. An academic representative from a leading orthopedic hospital in the United States described a multi-institutional, open effort funded by the National Institutes of Health to assess model reproducibility in computational knee biomechanics. A regulatory representative from the United States Food and Drug Administration indicated the necessity of standards for reproducibility to increase utility of M&S in the regulatory setting. An industry representative from a major orthopedic implant company emphasized improving reproducibility by addressing indeterminacy in personalized modeling through sensitivity analyses, thereby enhancing preclinical evaluation of joint replacement technology. Thought leaders in the M&S community stressed the importance of data sharing to minimize duplication of efforts. A survey comprised 103 attendees revealed strong support for the workshop and for increasing emphasis on computational modeling at future ORS meetings. Nearly all survey respondents (97%) considered reproducibility to be an important issue. Almost half of respondents (45%) tried and failed to reproduce the work of others. Two-thirds of respondents (67%) declared that individual laboratories are most responsible for ensuring reproducible research whereas 44% thought that journals are most responsible. Thought leaders and survey respondents emphasized that computational models must be reproducible and credible to advance knee M&S.


Asunto(s)
Articulación de la Rodilla , Estados Unidos , Reproducibilidad de los Resultados , Simulación por Computador , Fenómenos Biomecánicos
9.
PLoS One ; 18(4): e0284721, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37083580

RESUMEN

Emergent mechanics of musculoskeletal extremities (surface indentation stiffness and tissue deformation characteristics) depend on the underlying composition and mechanics of each soft tissue layer (i.e. skin, fat, and muscle). Limited experimental studies have been performed to explore the layer specific relationships that contribute to the surface indentation response. The goal of this study was to examine through statistical modeling how the soft tissue architecture contributed to the aggregate mechanical surface response across 8 different sites of the upper and lower extremities. A publicly available dataset was used to examine the relationship of soft tissue thickness (fat and muscle) to bulk tissue surface compliance. Models required only initial tissue layer thicknesses, making them usable in the future with only a static ultrasound image. Two physics inspired models (series of linear springs), which allowed reduced statistical representations (combined locations and location specific), were explored to determine the best predictability of surface compliance and later individual layer deformations. When considering the predictability of the experimental surface compliance, the physics inspired combined locations model showed an improvement over the location specific model (percent difference of 25.4 +/- 27.9% and 29.7 +/- 31.8% for the combined locations and location specific models, respectively). While the statistical models presented in this study show that tissue compliance relies on the individual layer thicknesses, it is clear that there are other variables that need to be accounted for to improve the model. In addition, the individual layer deformations of fat and muscle tissues can be predicted reasonably well with the physics inspired models, however additional parameters may improve the robustness of the model outcomes, specifically in regard to capturing subject specificity.


Asunto(s)
Extremidades , Sistema Musculoesquelético , Piel/diagnóstico por imagen , Ultrasonografía , Músculos
10.
Diagn Interv Radiol ; 2023 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-36994643

RESUMEN

PURPOSE: Colorectal cancer liver metastasis (CRLM) and hepatocellular carcinoma (HCC) are widely treated using microwave and radiofrequency ablation. Local tumor progression (LTP) may develop depending on the shortest vascular distance and large lesion diameter. This study aims to explore the effect of these spatial features and to investigate the correlation between tumor-specific variables and LTP. METHODS: This is a retrospective study covering the period between January 2007 and January 2019. One hundred twenty-five patients (CRLM: HCC: 64:61) with 262 lesions (CRLM: HCC: 142:120) were enrolled. The correlation between LTP and the variables was analyzed using the chi-square test, Fischer's exact test, or the Fisher-Freeman-Halton test where applicable. The local progression-free survival (Loc-PFS) was analyzed using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. RESULTS: Significant correlations were observed for LTP in both CRLM and HCC at a lesion diameter of 30-50 mm (P = 0.019 and P < 0.001, respectively) and SVD of ≤3 mm (P < 0.001 for both). No correlation was found between the ablation type and LTP (CRLM: P = 0.141; HCC: P = 0.771). There was no relationship between residue and the ablation type, but a strong correlation with tumor size was observed (P = 0.127 and P < 0.001, respectively). In CRLM, LTP was associated with mutant K-ras and concomitant lung metastasis (P < 0.001 and P = 0.003, respectively). In HCC, a similar correlation was found for Child-Pugh B, serum alpha-fetoprotein (AFP) level of >10 ng/mL, predisposing factors, and moderate histopathological differentiation (P < 0.001, P = 0.008, P = 0.027, and P <0.001, respectively). In CRLM, SVD of ≤3 mm proved to be the variable with the greatest negative effect on Loc-PFS (P = 0.007), followed by concomitant lung metastasis (P = 0.027). In HCC, a serum AFP level of >10 ng/mL proved to be the variable with the greatest negative effect on Loc-PFS (P = 0.045). CONCLUSION: In addition to the lesions' spatial features, tumor-specific variables may also have an impact on LTP.

11.
BMJ Support Palliat Care ; 13(4): 453-461, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34479960

RESUMEN

BACKGROUND: Several studies have suggested that sarcopenia is associated with an increased treatment toxicity in patients with cancer. The aim of this study is to evaluate the relationship between sarcopenia and anthracycline-related cardiotoxicity. METHODS: Patients who received anthracycline-based chemotherapy between 2014 and 2018 and had baseline abdominal CT and baseline and follow-up echocardiography after anthracycline treatment were included. European Society of Cardiology ejection fraction criteria and American Society of Echocardiography diastolic dysfunction criteria were used for definition of cardiotoxicity. Sarcopenia was defined on the basis of skeletal muscle index (SMI) and psoas muscle index (PMI) calculated on CT images at L3 and L4 vertebra levels. RESULTS: A total of 166 patients (75 men and 91 women) were included. Sarcopenia was determined in 33 patients (19.9%) according to L3-SMI, in 17 patients (10.2%) according to L4-SMI and in 45 patients (27.1%) according to PMI. 27 patients (16.3%) developed cardiotoxicity. PMI and L3-SMI were significantly associated with an increased risk of cardiotoxicity (L3-SMI: HR=3.27, 95% CI 1.32 to 8.11, p=0.01; PMI: HR=3.71, 95% CI 1.58 to 8.73, p=0.003). CONCLUSIONS: This is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify high-risk patients in whom closer follow-up or cardioprotective measures should be considered.


Asunto(s)
Neoplasias , Sarcopenia , Masculino , Humanos , Femenino , Sarcopenia/inducido químicamente , Sarcopenia/diagnóstico por imagen , Sarcopenia/complicaciones , Cardiotoxicidad/complicaciones , Antraciclinas/efectos adversos , Pronóstico , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Músculos Psoas/diagnóstico por imagen , Estudios Retrospectivos
12.
J Orthop Res ; 41(2): 325-334, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-35502762

RESUMEN

Reproducible research serves as a pillar of the scientific method and is a foundation for scientific advancement. However, estimates for irreproducibility of preclinical science range from 75% to 90%. The importance of reproducible science has not been assessed in the context of mechanics-based modeling of human joints such as the knee, despite this being an area that has seen dramatic growth. Framed in the context of five experienced teams currently documenting knee modeling procedures, the aim of this study was to evaluate reporting and the perceived potential for reproducibility across studies the teams viewed as important contributions to the literature. A cohort of studies was selected by polling, which resulted in an assessment of nine studies as opposed to a broader analysis across the literature. Using a published checklist for reporting of modeling features, the cohort was evaluated for both "reporting" and their potential to be "reproduced," which was delineated into six major modeling categories and three subcategories. Logistic regression analysis revealed that for individual modeling categories, the proportion of "reported" occurrences ranged from 0.31, 95% confidence interval (CI) [0.23, 0.41] to 0.77, 95% CI: [0.68, 0.86]. The proportion of whether a category was perceived as "reproducible" ranged from 0.22, 95% CI: [0.15, 0.31] to 0.44, 95% CI: [0.35, 0.55]. The relatively low ratios highlight an opportunity to improve reporting and reproducibility of knee modeling studies. Ongoing efforts, including our findings, contribute to a dialogue that facilitates adoption of practices that provide both credibility and translation possibilities.


Asunto(s)
Articulación de la Rodilla , Rodilla , Humanos , Fenómenos Biomecánicos , Reproducibilidad de los Resultados
13.
Acad Radiol ; 30(1): 77-82, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-35667979

RESUMEN

RATIONALE AND OBJECTIVES: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.


Asunto(s)
COVID-19 , Músculos Pectorales , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Músculos Pectorales/diagnóstico por imagen , Pronóstico , Tomografía Computarizada por Rayos X , Estudios Retrospectivos
14.
J Bone Joint Surg Am ; 105(6): 492-498, 2023 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-36574617

RESUMEN

ABSTRACT: As a result of an aging population, musculoskeletal disease is a growing source of health and economic burden in the United States. In 2019, musculoskeletal conditions affected approximately 127.4 million people (more than a third of the U.S. population); they were the top driver of health-care spending in 2016, with an estimated direct annual cost of $380.9 billion. While musculoskeletal conditions represent a substantial and growing burden in terms of prevalence, disability, and health-care costs, National Institutes of Health (NIH) research funding has remained disproportionately allocated to other disease conditions. Therefore, our purpose was to provide an assessment of the current burden of musculoskeletal disease in terms of prevalence, disability, and health-care costs, and compare the changing burden of disease to trends in NIH funding.


Asunto(s)
Enfermedades Musculoesqueléticas , Humanos , Estados Unidos/epidemiología , Anciano , Enfermedades Musculoesqueléticas/epidemiología , Costos de la Atención en Salud , Costo de Enfermedad , Prevalencia , National Institutes of Health (U.S.)
15.
Ann Biomed Eng ; 51(1): 10-23, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36104640

RESUMEN

There is a growing interest in the use of virtual representations of the knee for musculoskeletal research and clinical decision making, and to generate digital evidence for design and regulation of implants. Accessibility to previously developed models and related digital assets can dramatically reduce barriers to entry to conduct simulation-based studies of the knee joint and therefore help accelerate scientific discovery and clinical innovations. Development of models for finite element analysis is a demanding process that is both time consuming and resource intensive. It necessitates expertise to transform raw data to reliable virtual representations. Modeling and simulation workflow has many processes such as image segmentation, surface geometry generation, mesh generation and finally, creation of a finite element representation with relevant loading and boundary conditions. The outcome of the workflow is not only the end-point knee model but also many other digital by-products. When all of these data, derivate assets, and tools are freely and openly accessible, researchers can bypass some or all the steps required to build models and focus on using them to address their research goals. With provenance to specimen-specific anatomical and mechanical data and traceability of digital assets throughout the whole lifecycle of the model, reproducibility and credibility of the modeling practice can be established. The objective of this study is to disseminate Open Knee(s), a cohort of eight knee models (and relevant digital assets) for finite element analysis, that are based on comprehensive specimen-specific imaging data. In addition, the models and by-products of modeling workflows are described along with model development strategies and tools. Passive flexion served as a test simulation case, demonstrating an end-user application. Potential roadmaps for reuse of Open Knee(s) are also discussed.


Asunto(s)
Articulación de la Rodilla , Rodilla , Humanos , Análisis de Elementos Finitos , Reproducibilidad de los Resultados , Fenómenos Biomecánicos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiología
16.
Insights Imaging ; 13(1): 147, 2022 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-36064860

RESUMEN

OBJECTIVE: To evaluate the magnetic resonance elastography (MRE)-derived liver stiffness measurement (LSM), T1 and T2 relaxation times, and hepatobiliary phase images in patients, who developed sinusoidal obstruction syndrome (SOS) after oxaliplatin-based chemotherapy. METHODS: Thirty-four patients (M/F:22/12) who underwent liver MRI-MRE and received oxaliplatin for colorectal, gastric, and pancreas cancer were included in the study. SOS was diagnosed by Gd-EOB-DTPA-enhanced MRI in 18 patients. MRE-LSM and T1-T2 maps were evaluated. Patients with SOS were grouped according to the amount of reticular hypointensity on the hepatobiliary phase images. RESULTS: The mean MRE-LSM in the patients with SOS was 3.14 ± 0.45 kPa, and the control group was 2.6 ± 0.5 kPa (p = 0.01). The mean-corrected T1 (cT1) relaxation time was 1181 ± 151 ms in the SOS group and 1032 ± 129 ms in the control group (p = 0.005). The mean T2 relaxation time was 50.29 ± 3.6 ms in the SOS group and 44 ± 3.9 ms in the control group (p = 0.01). Parenchymal stiffness values were 2.8 ± 0.22 kPa, 3 ± 0.33 kPa, and 3.65 ± 0.28 kPa in patients with mild, moderate, and advanced SOS findings, respectively (p = 0.002). Although cT1 and T2 relaxation times increased with increasing SOS severity, no statistical significance was found. CONCLUSIONS: We observed increased MRE-LSM in patients with SOS after chemotherapy compared to control group. T1 and T2 relaxation times were also useful in diagnosing SOS but were found inadequate in determining SOS severity. MRE is effective in diagnosing SOS and determining SOS severity in patients who cannot receive contrast agents, and it may be useful in the follow-up evaluation of these patients.

17.
PLoS One ; 17(8): e0272051, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35969593

RESUMEN

Capturing the surface mechanics of musculoskeletal extremities would enhance the realism of life-like mechanics imposed on the limbs within surgical simulations haptics. Other fields that rely on surface manipulation, such as garment or prosthetic design, would also benefit from characterization of tissue surface mechanics. Eight homogeneous tissue models were developed for the upper and lower legs and arms of two donors. Ultrasound indentation data was used to drive an inverse finite element analysis for individualized determination of region-specific material coefficients for the lumped tissue. A novel calibration strategy was implemented by using a ratio based adjustment of tissue properties from linear regression of model predicted and experimental responses. This strategy reduced requirement of simulations to an average of under four iterations. These free and open-source specimen-specific models can serve as templates for simulations focused on mechanical manipulations of limb surfaces.


Asunto(s)
Sistema Musculoesquelético , Brazo , Fenómenos Biomecánicos , Simulación por Computador , Análisis de Elementos Finitos , Modelos Biológicos , Estrés Mecánico , Ultrasonografía
19.
Turk J Med Sci ; 52(1): 175-187, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34544218

RESUMEN

BACKGROUND: The presence of atrial fibrosis has already been known as a risk factor for atrial fibrillation (AF) development. We aimed to evaluate atrial fibrosis with previously defined three different methods, which were cardiac magnetic resonance imaging (C-MRI), echocardiographic strain imaging, and biomarkers and show the relationship between these methods in patients with AF scheduled for cryoballoon ablation. METHODS: A total of 30 patients were enrolled. Atrial T1 relaxation durations were measured using C-MRI before the procedure of atrial fibrillation catheter ablation. Fibroblast growth factor-21 (FGF-21) and fibroblast growth factor-23 (FGF-23) levels were measured at serum derived from the femoral artery (Peripheral FGF 21 and 23) and left atrium blood samples (Central FGF 21 and 23) before catheter ablation. Preprocedural transthoracic echocardiography was performed. The median follow-up duration for atrial tachyarrhythmia (ATa) recurrence was 13 (12-18 months) months. RESULTS: The mean ages of the study group were 55.23 ± 12.37 years, and there were 17 (56.7%) female patients in study population. There were negative correlations between post contrast T1 relaxation durations of both posterior and posterosuperior atrium, and central FGF-23 (r: - 0.561; p = 0.003; r:-0.624; p = 0.001; Posterior T1 vs. central FGF-23 levels and Posterosuperior T1 vs central FGF-23 levels, respectively). The positive correlations were observed between postcontrast posterior T1 relaxation durations and left ventricle ejection fraction (r:0.671; p = 0.001); left atrial emptying fraction (r:0.482; p = 0.013); peak atrial longitudinal strain (r:0.605; p = 0.001), and peak atrial contraction strain (r:0.604; p = 0.001). Also negative correlation was observed between postcontrast posterior T1 relaxation durations, and left atrial volume index (r: - 0.467; p = 0.016).


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Masculino , Fibrilación Atrial/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Ablación por Catéter/métodos , Fibrosis , Función Ventricular Izquierda , Resultado del Tratamiento
20.
J Mech Behav Biomed Mater ; 125: 104927, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34740008

RESUMEN

Endovascular plaque composition is strongly related to stent strut stress and is responsible for strut fatigue, stent failure, and possible in-stent restenosis. To evaluate the effect of plaque on artery wall resistance to expansion we performed in silico analysis of atherosclerotic vessels. We generated finite element models from in vivo intravascular ultrasound virtual histology images to determine local artery surface stiffness and determined which plaque structures have the greatest influence. We validated the predictive capacity of our modeling approach by testing an atherosclerotic peripheral artery ex vivo with pressure-inflation testing at physiological pressures ranging from 10 to 200 mmHg. For this purpose, the in silico deformation of the arterial wall was compared to that observed ex vivo. We found that calcification had a positive effect on surface stiffness with fibrous plaque and necrotic core having negative effects. Additionally, larger plaque structures demonstrated significantly higher average surface stiffness and calcification located nearer the lumen was also shown to increase surface stiffness. Therefore, more developed plaques will have greater resistance to expansion and higher stent strut stress, with calcification located near the lumen further increasing stress in localized areas. Thus, it may be expected that such plaque structures may increase the likelihood of localized stent strut fracture.


Asunto(s)
Aterosclerosis , Análisis de Elementos Finitos , Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...