Quantitative Evaluation Of Function Research Articles

A 2D echocardiographic method for accurate right ventricular quantification using deep learning

Abstract Background/Introduction Transthoracic two-dimensional echocardiography (2DE) remains the backbone for non-invasive assessment of the right ventricle (RV) size and function. However, calculation of RV end-diastolic (RVEDV), end-systolic volume (RVESV) and ejection fraction (RVEF) cannot be performed using 2DE due to the complex RV shape (1), whereas currently used, respective 2DE indices lack diagnostic accuracy. Deep learning (DL) may be able to assist in developing new 2DE methods for RV quantification. Purpose To develop a novel DL-based 2DE method for quantitative evaluation of RV size and function without geometric assumptions. Methods 50 adult patients underwent 2DE and CMR within 30 days as part of routine cardiac care between 6/2020 – 9/2021 at a medical center. We excluded patients with prior cardiac surgery of the RV, tricuspid or pulmonic valve repair or replacement, complex congenital heart disease, more than small pericardial effusion, cardiac tamponade, atrial fibrillation at the time of either study, severe RV dysfunction or inadequate imaging quality. End-diastolic and end-systolic areas derived from planimetry of 8 2DE RV views, along with patient age and gender, were to used to train and test a DL algorithm, namely the Feature-Tokenizer and Transformer (Figure 1) in order to predict the corresponding, CMR-derived, RVEDV or RVESV, and subsequently calculate RVEF. We used 5-fold cross-validation for training and evaluation. We assessed the relative importance of each 2DE view using gain metric-powered explainability analysis and subsequently performed a sensitivity analysis to identify optimal combinations of views. Variability analysis was performed for a random subcohort of 10 patients. Results Median age was 51 (interquartile range 32-62) and 42% were women. Mean RVEDV, RVESV and RVEF) by CMR were 163±70ml, 82±42ml and 51±8% respectively. Six patients (12%) had RV dilatation and 9 (18%) had RV dysfunction when using published CMR criteria. Explainability analysis showed that the 3 most important views were parasternal long axis (PLAX) (relative feature importance [RFI] = 0.197), 4-chamber (RFI=0.145) and parasternal short axis at the base (PSAX-base) (RFI=0.112). The 3-view combination of PLAX, 4-chamber and PSAX-base achieved high accuracy when compared to CMR (R2=0.964, absolute percentage error [APE]=8.09±12.07% for RV volumes and APE=9.86±10.68% for RVEF). Good (intraclass correlation coefficient [ICC]>0.75) to excellent (ICC>0.90) intra- and interobserver variability was found for these 3 views. Conclusions We propose an innovative, clinically applicable DL-based 2DE method for quantification of RV size and function that requires manual RV planimetry of 3 views, namely 4-chamber, PLAX and PSAX-base (Figure 2). This method may revolutionize 2DE RV assessment. Further studies with largest number of patients and wider range of RV size and function are needed to validate this method.Deep learning architectureGraphical abstract

Predictive ability and prognostic correlation of global longitudinal strain in patients with negative dipyridamole stress echocardiography by wall motion criteria

Abstract Background Dipyridamole stress echocardiography (DSE) is an established technique to detect coronary artery disease (CAD) and for risk stratification. Speckle Tracking Echocardiography (STE), as an objective and quantitative evaluation of ventricular function, may add incremental value to conventional stress echo analysis. Purpose To assess the prognostic value of rest (Rest-GLS) and peak (Peak-GLS) stress global longitudinal strain (GLS) in patients with suspected CAD and negative DSE according to wall motion index (WMI) criteria. Methods We retrospectively enrolled patients who underwent DSE at our centre for suspected CAD, with normal WMI. Strain Reserve was calculated as Rest GLS – Peak-GLS (Delta-GLS). We also collected data regarding other conventional parameters such as coronary flow reserve (CFR) of left anterior descending (LAD), left ventricle contractile reserve (LVCR), delta left ventricular ejection fraction (Delta-LVEF), heart rate response (HRR). Our primary endpoint was a composite of all-cause death and coronary revascularization. Receiver operating characteristic (ROC) curves were used to compare the predictive ability of the parameters. Adjusted logistic regression analyses were used to assess associations, also modelled as a restricted cubic spline. Results A total of 355 patients were included in the analysis (median age 68.2, IQR 58.2-75.2, 38.0% female). At follow-up, 58 patients met the primary endpoint. Figure 1 shows the ROC curves of different DSE parameters. Delta-GLS and Peak-GLS showed high predictive ability of composite endpoint events (area under the curve [AUC] 0.87, 95% Confidence Interval [CI] 0.82-0.92, AUC, 0.85, 95% CI 0.79-0.91, respectively), which was significantly higher compared with other DSE parameters, included Basal-GLS (P for difference for all < 0.001). After adjustments for age, previous CAD, sex, and diabetes, reducing values of Rest-GLS, Peak-GLS and Delta-GLS were significantly associated with higher odds of experiencing composite endpoint events (Basal-GLS, odds ratio [OR] 1.13, 95% CI 1.04-1.24; Peak-GLS, OR 1.45, 95% CI 1.32-1.63; Delta-GLS, OR 1.73, 95% CI 1.50-2.04). Plotting the results of the logistic regression analysis on a restricted cubic spline, reducing values of Peak-GLS and Delta-GLS showed a linear increase for the risk of adverse events, while Rest-GLS showed a plateau for lower values. Conclusion The use of GLS parameters in DSE can help to better stratify the risk for the patients since they are associated with adverse cardiovascular events.Figure 1Figure 2

Speckle tracking of left ventricle in pediatric patients with hemodynamically significant patent ductus arteriosus (PDA): case–control study

BackgroundLeft ventricle (LV) volume overload is observed with hemodynamically significant PDA as it causes left to right shunting, leading to increased pulmonary blood flow. This overload causes LV remodeling as LV increases stroke volume in trial for compensation, but in larger shunts, patients may develop symptoms of congestive heart failure. Two-dimensional (2D) speckle-tracking echocardiography has emerged as a technique for objective and quantitative evaluation of global and regional myocardial function, independent of the angle of myocardial insonation.Aim of the workThis study aimed to evaluate left ventricular function by 2-dimensional speckle tracking in children with hemodynamically significant PDA.MethodsThis prospective controlled study was performed on 54 children divided into two groups (34 as cases and 20 as controls) to compare echocardiographic measurements. Conventional Echocardiography, tissue Doppler, and Speckle tracking were done for all patients, and measurements were compared.ResultsThere was a statistically significant difference (p value < 0.001) in global longitudinal strain (GLS) in the PDA group indicating a decrease in LV function in PDA patients. This difference was observed in several conventional echocardiographic parameters but not in tissue Doppler in our study.ConclusionLeft ventricle global strain is an important predictor of the myocardial performance index of the Left ventricle in patients with hemodynamically significant PDA and outweighs other conventional echocardiographic parameters and tissue Doppler indices.

Case Report: Quantitative Evaluation of Gait Function Following Treatment Progression in a Patient with Central Pontine Myelinolysis

Introduction: Central pontine myelinolysis (CPM) is a rare neurological disorder marked by symmetric nerve fiber damage, commonly following rapid hyponatremia correction, with no established treatment and a poor prognosis. The condition, often linked to alcoholism, malnutrition, and various diseases, lacks comprehensive studies on its impact on gait. This research aims to quantitatively analyze gait changes in CPM patients receiving both traditional Korean and conventional rehabilitation treatments, addressing a gap in current understanding of CPM management.Case presentation: A 56-year-old male diagnosed with CPM following an initial misdiagnosis underwent combined electoracupuncture and rehabilitative treatment at ○○ university Korean medical center, resulting in significant gait improvements. A treadmill gait analysis system was used to measure changes in key gait parameters at 2-week intervals, and the patient’s progress was documented.Conclusions: The quantitative analysis revealed significant gait improvements. Foot rotation decreased from 8.9° to 6.4° (right) and from 11.1° to 7.2° (left); lateral symmetry improved from -7.8 to 0.8; step length increased from 21 cm to 44 cm (right) and from 19 cm to 44 cm (left); and velocity increased from 1.2 m/s to 2.7 m/s. These findings highlight decreased foot rotation and lateral symmetry, along with increased step length and velocity, suggesting a positive outcome of the treatment regimen. Notably, the patient experienced no adverse effects related to the treatments. Despite limitations, including the singe case focus and lack of prior gait-focused CPM research, this case report provides valuable insights into effective CPM management strategies, paving the way for future research in this domain.

Biventricular function in preterm infants with patent ductus arteriosus ligation: A three-dimensional echocardiographic study

BackgroundThe detailed hemodynamics after patent ductus arteriosus (PDA) ligation in preterm infants remain unknown. We aimed to clarify the effect of surgical ligation on left ventricular (LV) and right ventricular (RV) volume and function.MethodsEchocardiography was performed in 41 preterm infants (median gestational age: 25 weeks) before and after PDA ligation. Global longitudinal strain was determined using three-dimensional speckle-tracking echocardiography. These values were compared with those in 36 preterm infants without PDA (non-PDA).ResultsPreoperatively, the PDA group had greater end-diastolic volume (EDV) and cardiac output (CO) in both ventricles, a higher LV ejection fraction (LVEF) (53% vs 44%) and LV global longitudinal strain, and a lower RVEF (47% vs 52%) than the non-PDA group. At 4–8 h postoperatively, the two groups had a similar LVEDV and RVEDV. However, the PDA group had a lower EF and CO in both ventricles than the non-PDA group. At 24–48 h postoperatively, the RVEF was increased, but the LVEF remained decreased, and LVCO was increased.ConclusionsPDA induces biventricular loading and functional abnormalities in preterm infants, and they dramatically change after surgery. Three-dimensional echocardiography may be beneficial to understand the status of both ventricles.ImpactPreterm infants are at high risk of hemodynamic compromise following a sudden change in loading conditions after PDA ligation.Three-dimensional echocardiography enables quantitative and serial evaluation of ventricular function and volume in preterm infants with PDA.PDA induces biventricular loading and functional abnormalities in preterm infants, and they dramatically change after surgery.

Penetration rates into the stratum corneum layer: A novel quantitative indicator for assessing skin barrier function.

The stratum corneum (SC), the outermost layer of the skin epidermis, acts as an effective bi-directional barrier, preventing water loss (inside-outside barrier) and entry of foreign substances (outside-inside barrier). Although transepidermal water loss (TEWL) is a widely-used measure of barrier function, it represents only inside-outside protection. Therefore, we aimed to establish a non-invasive method for quantitative evaluation of the outside-inside barrier function and visually present a skin barrier model. Skin barrier damage was induced by applying a closed patch of 1% sodium dodecyl sulfate to the forearms of eight participants; they were instructed to apply a barrier cream on a designated damaged area twice daily for 5 days. The SC barrier was evaluated by measuring TEWL and fluorescein sodium salt penetration rate before, immediately after, and 5 days after damage. The penetration rate was assessed using tape-stripping (TS) technique and fluorescence microscopy. The rates of fluorescein sodium salt penetration into the lower layers of SC differed significantly based on the degree of skin barrier damage. The correlation between penetration rate and TEWL was weak after two rounds of TS and became stronger after subsequent rounds. Five days after skin barrier damage, the penetration rate of all layers differed significantly between areas with and without the barrier cream application. Our findings demonstrated that the penetration rate was dependent on skin barrier conditions. The penetration rate and corresponding fluorescence images are suitable quantitative indicators that can visually represent skin barrier conditions.

Integrated Quantitative Evaluation of Spatial Cognition and Motor Function with HoloLens Mixed Reality.

The steady increase in the aging population worldwide is expected to cause a shortage of doctors and therapists for older people. This demographic shift requires more efficient and automated systems for rehabilitation and physical ability evaluations. Rehabilitation using mixed reality (MR) technology has attracted much attention in recent years. MR displays virtual objects on a head-mounted see-through display that overlies the user's field of vision and allows users to manipulate them as if they exist in reality. However, tasks in previous studies applying MR to rehabilitation have been limited to tasks in which the virtual objects are static and do not interact dynamically with the surrounding environment. Therefore, in this study, we developed an application to evaluate cognitive and motor functions with the aim of realizing a rehabilitation system that is dynamic and has interaction with the surrounding environment using MR technology. The developed application enabled effective evaluation of the user's spatial cognitive ability, task skillfulness, motor function, and decision-making ability. The results indicate the usefulness and feasibility of MR technology to quantify motor function and spatial cognition both for static and dynamic tasks in rehabilitation.

The value of TDI combined with myocardial strain parameters in quantitative evaluation of left heart function in parturient with pregnancy-induced hypertension

This study aimed to investigate the value of tissue doppler imaging (TDI) and 4D myocardial strain parameters in evaluating left heart function of pregnant women with hypertension and the association between these parameters and relevant factors. Forty-five pregnant women with hypertensive disorder, including 20 with hypertension, 15 with mild preeclampsia, and 10 with severe preeclampsia, were recruited, and their cardiac functions were compared with those of 30 healthy pregnant women as controls. High Left ventricular end-systolic volume (LVESV), Left atrial volume index (LAVI), E/e were observed in hypertensive disorder, while Mitral peak diastolic velocity(E), Early diastolic peak velocity(e), E/A, Left ventricularglobal longitudinal strain (LVGLS), Left ventricularglobal area strain (LVGAS), and Left atrialglobal longitudinal strain (LAGLS) were decreased; for pre-eclampsia, Left ventricular end-systolic diameter (LVESD), Left atrial anteroposterior diameter (LAD-ap), LVESV, LAVI were significantly increased, LVGLS, LAGLS were significantly decreased, Left ventricular end-diastolic diameter (LVEDD), Left ventricular end-diastolic volume (LVEDV), A peak, E/e were increased, while E peak, E/A, e, Left ventricle global radial strain (LVGRS), Left ventricle global circumferential strain (LVGCS), LVGAS were decreased but not significantly; for severe preeclampsia, Left ventricular end diastolic diameter (LVEDD), LVESD, LAD-ap, Left ventricular end-diastolic volume (LVEDV), LVESV, LAVI, A, and E/e were significantly increased, while LVGLS, LVGRS, LVGCS, LVGAS, LAGLS, E peak, E/A, and e were significantly reduced. TDI combined with 4D myocardial strain parameters can detect early changes in cardiac function of hypertensive disorders in pregnancy, with LVGLS, LVGAS, and LAGLS being the most sensitive indicators for early changes. Such findings provide a basis for effective clinical treatment of these symptoms.

Quantitative Assessment of Balance Function Characteristics in Older Patients with Orthostatic Hypotension.

Orthostatic hypotension (OH) is a common blood pressure abnormality in older adults that makes them prone to balance disorders and falls. The maintenance of balance relies on a complex regulatory system. The use of computerized dynamic posturography (CDP) can provide a quantitative evaluation of balance function. The objective of this study was to utilize CDP to measure balance indicators in older individuals with OH. A total of 303 older adults were divided into an OH group of 91 and a non-OH group of 212. Various factors, including chronic diseases, medication history, laboratory tests, and balance indicators, were compared between the two groups. ① Participants with OH had more chronic diseases, including coronary heart disease (p = 0.049) and a history of falls (p < 0.001), than those without OH. A history of multiple medications in the OH group was significantly more likely than in the non-OH group (p = 0.006). ② There was a significant reduction in the composite equilibrium score (SOT-COM) (p < 0.001), vision ratio score (VIS) (p < 0.001), vestibular ratio score (VEST) (p < 0.001), and directional control (DCL) (p = 0.028) in the OH group. ③ A logistic regression analysis revealed that SOT-COM was a significant independent factor associated with OH. The area under the curve (AUC) of SOT-COM was 0.833 (95% confidence interval: 0.778-0.887, p < 0.001), with a sensitivity of 0.826 and a specificity of 0.759. This study demonstrates that older individuals with OH are more prone to falls, due to decreased sensory integration for balance.

Estimation of generalized soil structure index based on differential spectra of different orders by multivariate assessment

Better soil structure promotes extension of plant roots thereby improving plant growth and yield. Differences in soil structure can be determined by changes in the three phases of soil, which in turn affect soil function and fertility levels. To compare the quality of soil structure under different conditions, we used Generalized Soil Structure Index (GSSI) as an indicator to determine the relationship between the “input” of soil three phases and the “output” of soil structure. To achieve optimum monitoring of comprehensive indicators, we used Successive Projections Algorithm (SPA) for differential processing based on 0.0–2.0 fractional orders and 3.0–10.0 integer orders and select important wavelengths to process soil spectral data. In addition, we also applied multivariate regression learning models including Gaussian Process Regression (GPR) and Artificial Neural Network (ANN), exploring potential capabilities of hyperspectral in predicting GSSI. The results showed that spectral reflection, mainly contributed by long-wave near-infrared radiation had an inverse relationship with GSSI values. The wavelengths between 404-418 nm and 2193–2400 nm were important GSSI wavelengths in fractional differential spectroscopy data, while those ranging from 543 to 999 nm were important GSSI wavelengths in integer differential spectroscopy data. Also, non-linear models were more accurate than linear models. In addition, wide neural networks were best suited for establishing fractional-order differentiation and second-order differentiation models, while fine Gaussian support vector machines were best suited for establishing first-order differentiation models. In terms of preprocessing, a differential order of 0.9 was found as the best choice. From the results, we propose that when constructing optimal prediction models, it is necessary to consider indicators, differential orders, and model adaptability. Above all, this study provided a new method for an in-depth analyses of generalized soil structure. This also fills the gap limiting the detection of soil three phases structural characteristics and their dynamic changes and provides a technical references for quantitative and rapid evaluation of soil structure, function, and quality.

Native T1 mapping for non-invasive quantitative evaluation of renal function and renal fibrosis in patients with chronic kidney disease.

To investigate the role of native T1 mapping in the non-invasive quantitative assessment of renal function and renal fibrosis (RF) in chronic kidney disease (CKD) patients. A prospective analysis of 71 consecutive patients [no RF (0%): 9 cases; mild RF (<25%): 36 cases; moderate RF (25-50%): 17 cases; severe RF (>50%): 9 cases] who were clinically diagnosed with CKD that was pathologically confirmed and who underwent magnetic resonance imaging (MRI) examination between October 2021 and September 2022 was performed. T1-C (mean cortical T1 value), T1-M (mean medullary T1 value), ΔT1 (mean corticomedullary difference) and T1% (mean corticomedullary ratio) values were compared. Correlations between T1 parameters and clinical and histopathological values were analyzed. Regression analysis was performed to determine independent predictors of RF. The areas under the receiver operating characteristic curve (AUC) were calculated to assess the diagnostic value of RF. The T1-C, ΔT1 and T1% values (P<0.05) were significantly different in the CKD group, but T1-M was not (P>0.05). The ΔT1 and T1% values showed significant differences in pairwise comparisons among CKD subgroups (P<0.05) except for CKD 2 and 3. ΔT1 and T1% were moderately correlated with the estimated glomerular filtration rate (ΔT1: rs=-0.561; T1%: r=-0.602), serum creatinine (ΔT1: rs=0.591; T1%: rs=0.563), blood urea nitrogen (ΔT1: rs=0.433; T1%: rs=0.435) and histopathological score (ΔT1: rs=0.630; T1%: rs=0.658). ΔT1 and T1%, but not T1-C, were independent predictors of RF (P<0.05). ΔT1 and T1% were set as -410.07 ms and 0.8222 with great specificity [ΔT1: 91.7% (77.5-98.2%); T1%: 97.2% (85.5-99.9%)] to identify mild RF and moderate-severe RF. The optimal cutoff values for differentiating severe RF from mild-moderate RF were -343.81 ms (ΔT1) and 0.8359 (T1%) with high sensitivity [both 100% (66.4-100%)] and specificity [ΔT1: 90.6% (79.3-96.9%); T1%: 94.3% (84.3-98.8%)]. ΔT1 and T1% overwhelm T1-C for assessment of renal function and RF in CKD patients. ΔT1 and T1% identify patients with <25% and >50% fibrosis, which can guide clinical decision-making and help to avoid biopsy-related bleeding.

Dynamic CT Study on the Morphology and the Motor Ability of Unilateral Vocal Fold Paralysis

To investigate the morphological changes and motor functions of the larynx in unilateral vocal fold paralysis by using dynamic three-dimensional CT, and to explore the differences between vocal fold paralysis with different nerves involved. Twenty-five patients with unilateral vocal fold paralysis and 10 healthy subjects were selected as the paralytic group and the normal group, respectively. Tendynamic sequence images of laryngeal movement from inhalation to phonation were reviewed, and the glottic morphology at the coronal position, the minimum glottic area at the horizontal position, and the overall activity of the two groups were compared. The 25 patients with unilateral vocal fold paralysis were divided into the thyroarytenoid (TA)musclegroup, the TAand posterior cricoarytenoid (PCA) (TA+PCA) musclegroup, and the PCA musclegroup. The coronal and horizontal parameters of the three types were compared as noted above and the dynamic parameter changes were also compared between the groups. The height and thickness of bilateral vocal cords, the minimum glottic area, and the whole glottic activity were different in the paralysis group and were significantly different from those of the normal group (P<0.05). The value of the glottic gap ratio and its decrease rate in the TA+PCA group was smaller than those in the TA and PCA group, and the glottic gap ratio was the largest in the PCA group. Dynamic CT can provide a qualitative evaluation of laryngeal morphology and quantitative evaluation of motor function in vocal fold paralysis.

Handheld photoacoustic imaging of indocyanine green clearance for real-time quantitative evaluation of liver reserve function.

Preoperative assessment of liver function reserve (LFR) is essential for determining the extent of liver resection and predicting the prognosis of patients with liver disease. In this paper, we present a real-time, handheld photoacoustic imaging (PAI) system-based noninvasive approach for rapid LFR assessment. A linear-array ultrasound transducer was sealed in a housing filled with water; its front end was covered with a plastic wrap. This PAI system was first implemented on phantoms to confirm that the photoacoustic (PA) intensity of indocyanine green (ICG) in blood reflects the concentration of ICG in blood. In vivo studies on normal rabbits and rabbits with liver fibrosis were carried out by recording the dynamic PA signal of ICG in their jugular veins. By analyzing the PA intensity-time curve, a clear difference was identified in the pharmacokinetic behavior of ICG between the two groups. In normal rabbits, the mean ICG clearance rate obtained by PAI at 15 min after administration (PAI-R15) was below 21.6%, whereas in rabbits with liver fibrosis, PAI-R15 exceeded 62.0% because of poor liver metabolism. The effectiveness of the proposed method was further validated by the conventional ICG clearance test and pathological examination. Our findings suggest that PAI is a rapid, noninvasive, and convenient method for LFR assessment and has immense potential for assisting clinicians in diagnosing and managing patients with liver disease.

Quantitative assessment of plantar pressure patterns in relation to foot deformities in people with hereditary motor and sensory neuropathies

BackgroundHereditary motor and sensory neuropathies (HMSN), also known as Charcot-Marie-Tooth disease, are characterized by affected peripheral nerves. This often results in foot deformities that can be classified into four categories: (1) plantar flexed first metatarsal, neutral hindfoot, (2) plantar flexed first metatarsal, correctable hindfoot varus, (3) plantar flexed first metatarsal, uncorrectable hindfoot varus, and (4) hindfoot valgus. To improve management and for the evaluation of surgical interventions, a quantitative evaluation of foot function is required. The first aim of this study was to provide insight into plantar pressure of people with HMSN in relation to foot deformities. The second aim was to propose a quantitative outcome measure for the evaluation of surgical interventions based on plantar pressure.MethodsIn this historic cohort study, plantar pressure measurements of 52 people with HMSN and 586 healthy controls were evaluated. In addition to the evaluation of complete plantar pressure patterns, root mean square deviations (RMSD) of plantar pressure patterns from the mean plantar pressure pattern of healthy controls were calculated as a measure of abnormality. Furthermore, center of pressure trajectories were calculated to investigate temporal characteristics. Additionally, plantar pressure ratios of the lateral foot, toes, first metatarsal head, second/third metatarsal heads, fifth metatarsal head, and midfoot were calculated to measure overloading of foot areas.ResultsLarger RMSD values were found for all foot deformity categories compared to healthy controls (p < 0.001). Evaluation of the complete plantar pressure patterns revealed differences in plantar pressure between people with HMSN and healthy controls underneath the rearfoot, lateral foot, and second/third metatarsal heads. Center of pressure trajectories differed between people with HMSN and healthy controls in the medio-lateral and anterior-posterior direction. The plantar pressure ratios, and especially the fifth metatarsal head pressure ratio, differed between healthy controls and people with HMSN (p < 0.05) and between the four foot deformity categories (p < 0.05).ConclusionsSpatially and temporally distinct plantar pressure patterns were found for the four foot deformity categories in people with HMSN. We suggest to consider the RMSD in combination with the fifth metatarsal head pressure ratio as outcome measures for the evaluation of surgical interventions in people with HMSN.

Prediction of Early Postoperative Language Function by Quantitative Evaluation with Visual and Auditory Naming Tasks during Awake Craniotomy for Brain Tumor Resection: Significance of Auditory Naming Task.

Language tasks for monitoring intraoperative language symptoms have not yet been established. This study aimed to examine whether the quantitative evaluation of language function with visual and auditory naming during awake craniotomy predicts early postoperative language function in patients. Thirty-seven patients with brain tumors in the language-dominant hemisphere were included. They underwent visual and auditory naming preoperatively and at the end of tumor resection for intraoperative evaluation. Using the Western Aphasia Battery, their overall language functions were evaluated preoperatively, early postoperatively (within 1 week), and late postoperatively (after 1 month). The preoperative and intraoperative changes in the visual and auditory naming scores were significantly correlated with most of the Western Aphasia Battery score changes between the preoperative and early postoperative evaluations, which was more remarkable for auditory naming. Multiple linear regression analysis showed that changes in the auditory naming score predicted the preoperative to early postoperative changes in the aphasia quotient of the Western Aphasia Battery. Receiver operating characteristics analysis showed a higher area under the curve or discriminative power for auditory than visual naming in predicting the development or exacerbation of aphasia in the early postoperative period. Considering the analyses applied separately for low- and high-grade glioma, auditory naming, which taps into a wider range of linguistic functions, may be more informative than visual naming as language evaluation in awake craniotomy for the early postoperative development of aphasia, especially for patients with high-grade glioma.

Speckle tracking echocardiography: principles and clinical applications

Speckle Tracking Echocardiography is a relatively new, non-invasive ultrasound technique that allows an objective and quantitative evaluation of global and regional myocardial function. There is a lot of evidence that global longitudinal strain is more sensitive than the left ventricular ejection fraction for the assessment of left ventricular dysfunction, is used to follow-up cancer therapeutic-related cardiac dysfunction, stratify risks, classify and determine treatment in the asymptomatic left ventricular dysfunction. Thus, this technique can help identify ventricular function and subclinical cardiac dysfunction, even when the ejection fraction is normal. Currently, speckle tracking echocardiography has been standardized and applied to evaluate left ventricular function, right ventricular function and left atrial function according to the consensus of American Society Echocardiography and European Association of Cardiovascular Imaging. Key words: Speckle Tracking Echocardiography, left ventricular ejection fraction, global longitudinal strain

A dual-task-embedded virtual reality system for intelligent quantitative assessment of cognitive processing speed.

Processing speed is defined as the ability to quickly process information, which is generally considered as one of the affected cognitive functions of multiple sclerosis and schizophrenia. Paper-pencil type tests are traditionally used in the assessment of processing speed. However, these tests generally need to be conducted under the guidance of clinicians in a specific environment, which limits their application in cognitive assessment or training in daily life. Therefore, this paper proposed an intelligent evaluation method of processing speed to assist clinicians in diagnosis. We created an immersive virtual street embedded with Stroop task (VR-Street). The behavior and performance information was obtained by performing the dual-task of street-crossing and Stroop, and a 50-participant dataset was established with the label of standard scale. Utilizing Pearson correlation coefficient to find the relationship between the dual-task features and the cognitive test results, and an intelligent evaluation model was developed using machine learning. Statistical analysis showed that all Stroop task features were correlated with cognitive test results, and some behavior features also showed correlation. The estimated results showed that the proposed method can estimate the processing speed score with an adequate accuracy (mean absolute error of 0.800, relative accuracy of 0.916 and correlation coefficient of 0.804). The combination of Stroop features and behavior features showed better performance than single task features. The results of this work indicates that the dual-task design in this study better mobilizes participants' attention and cognitive resources, and more fully reflects participants' cognitive processing speed. The proposed method provides a new opportunity for accurate quantitative evaluation of cognitive function through virtual reality.

A Novel Experimental Rat Model for the In Vivo Assessment of Myocardial Ischemia Based on Single Photon Emission Computed Tomography.

Myocardial infarction, an acute medical situation with a high mortality rate worldwide, has been extensively studied in modern cardiovascular research, using different experimental models. However, a deep understanding of myocardial activity loss has not been fully investigated. We have developed a novel experimental rat model for noninvasive assessment of myocardial ischemia based on single photon emission computed tomography (SPECT/CT), in order to further understand and evaluate myocardial activity before and after surgical induction of myocardial ischemia. Thirty adult female Wistar rats underwent open thoracotomy with (n=20) or without (n=10) surgical ligation of the left anterior descending coronary artery (LAD). The myocardial ischemia was confirmed with ECG and myocardial viability was evaluated via SPECT/CT at 7 days before as well as at 7 and 14 days post-surgery, after which animals were sacrificed and myocardial ischemic injury was further assessed histologically. All animals were evaluated with anatomical and functional criteria based on the SPECT/CT imaging results. A successful surgical technique causing ischemia and loss of myocardial function in all animals undergoing a LAD ligation was established. Furthermore, evaluation of the viable myocardium with SPECT/CT confirmed the reduction of functional myocardial cells of the left ventricle post-infarction, which was also documented histologically. Using our technique, the validity of this animal model to induce and evaluate myocardial ischemia was demonstrated. Our choice to apply SPECT-CT qualitative and quantitative evaluation of myocardial function leads to a new approach in experimentation with an anticipated significant impact in the ongoing cardiovascular laboratory research.

Multiparametric MRI combined with liver volume for quantitative evaluation of liver function in patients with cirrhosis.

PURPOSE We aimed to establish a liver function evaluation model by combining multiparametric magnetic resonance imaging (MRI) with liver volume (LV) and further verify the effectiveness of the model to evaluate liver function. METHODS This retrospective study included 101 consecutive cirrhosis patients (69 cases for modeling group and 32 cases for validation group) who underwent gadoxetic acid-enhanced MRI. Five signal intensity parameters were obtained by measuring the signal intensities of the liver, spleen, and erector spinae before and 20 minutes after gadoxetic acid disodium enhancement. The dif fusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were obtained from intravoxel incoherent motion diffusion-weighted imaging. The LV parameters (Vliver, Vspleen, and Vliver/Vspleen) were obtained using 3-dimensional image generation software. The most effec tive parameter was selected from each of the 3 methods, and a multivariate regression model for liver function evaluation was established and validated. RESULTS In the modeling group, relative enhancement (RE), D*, and Vliver/Vspleen showed significant dif ferences among the different liver function groups (P < .001). Receiver operating characteristic analysis showed that these parameters had the highest area under the curve (AUC) values for dis tinguishing Child-Pugh A from Child-Pugh B and C groups (0.917, 0.929, and 0.885, respectively). The following liver function model was obtained by multivariate regression analysis: F(x)=3.96 - 1.243 (RE) - 0.034 (D*) - 0.080 (Vliver/Vspleen) (R2=0.811, P < .001). In the patients with cirrhosis, the F(x) of Child-Pugh A, B, and C were 1.16 ± 0.44, 1.95 ± 0.29, and 2.79 ± 0.38, respectively. In the validation group, the AUC for F(x) to distinguish Child-Pugh A from Child-Pugh B and C was 0.973. CONCLUSION Combining multiparametric MRI with LV effectively distinguished patients with different Child Pugh grades. This model could hence be useful as a novel radiological marker to estimate the liver function.

Quantitative evaluation of skin barrier function using water evaporation time related to transepidermal water loss.

Transepidermal water loss (TEWL) is often used as an index for skin barrier function. The skin barrier tester, SBT-100 (Rousette Strategy Inc), measures the TEWL, water evaporation time, and time constant by contacting the skin and diffusing water into the closing measurement chamber. However, the relationship between the TEWL and time constant has not been sufficiently investigated. This study involved analyzing the underlying measurement principle and obtaining data through two experiments. The TEWL and time constant were measured using SBT-100. Experiment 1 produced a simple simulation model for continuous water evaporation from the skin using a moisture-permeable film. In experiment 2, four skin sites of 43 healthy volunteers were examined from May to September 2018. In experiment 1, the TEWL increased and time constant decreased, following an increase in humidity in the external environment. Both parameters demonstrated significant negative correlation (drying: ρ=-0.832, p<0.001). For the 43 healthy volunteers who participated in experiment 2, their TEWL increased and time constant decreased in summer. For all skin measurement sites, both data demonstrated significant negative correlation (forehead: ρ=-0.909, p<0.001; back of the left hand: ρ=-0.829, p<0.001; left lateral elbow: ρ=-0.896, p<0.001; left lateral malleolus: ρ=-0.865, p<0.001). Results indicated that the time constant is significantly correlated with TEWL. Furthermore, the time constant can be used as a parameter for evaluating skin barrier function.