Mathematical analysis of DICOM CT datasets: Can endograft sizing be automated for complex anatomy?

OBJECTIVES: To validate the use of a novel mathematical algorithm applied to digital imaging and communication in medicine (DICOM) computed tomography (CT) data to automate the generation of complex endovascular graft planning. METHODS: An algorithm was developed enabling the creation of patient-specific mathematical model based upon DICOM CT data to allow for detailed efficient geometric analysis with repeatable results. This algorithm was applied to high resolution DICOM CT datasets of 15 patients, selected at random from 350 patients with aneurysms involving the visceral arteries. The longitudinal and rotational relationships of the visceral vessels were determined by the algorithm. For comparison purposes, the same measurements were acquired manually using centerline of flow software by a blinded investigator. The distance between the renal arteries, and location of the renal origins calculated with each method were then compared. RESULTS: Automated results were readily created for all 15 randomly selected patients. The measured versus calculated mean inter-renal artery distances were exceptionally close, differing by a mean of only 1.3 mm with a maximal range of 3.0 mm. The rotational position of the renal origins differed by only 10.5 degrees of arc (21 clock-face minutes) on average and by 32.5 degrees in the worst case. CONCLUSIONS: The generation of an automated mathematical model to represent complex aortic geometry is feasible and reproducible in the context of high-resolution CT data. This process has been validated in 15 patients, where results corresponded with manual measurements that were used to successfully implant customized devices that accommodate the imaged vessels. Additional attributes include the expression of the 3D aorta in a compact form (on the order of kilobytes) for purposes of data storage, transfer, and other manipulations. CLINICAL RELEVANCE: The construct of mathematical representation of patient specific anatomy from CT data is both feasible and applicable, allowing for automated endograft device design even in the setting of markedly tortuous anatomy where the repair must incorporate major aortic branches. The process has been validated in 15 patients, where results corresponded with manual measurements that were used to successfully implant customized devices that accommodate the imaged vessels. The application of this technology must now be studied in a prospective manner and incorporated into a system users may readily apply to patients undergoing evaluation. Additional attributes of a mathematical representation of the arterial tree include the 3D expression from a very compact set of parameters (on the order of kilobytes) for purposes of data storage, transfer, and other manipulations.     

Black tea reduces uric acid and C-reactive protein levels in humans susceptible to cardiovascular diseases

The effect of black tea on the level of uric acid (UA) and C-reactive proteins (CRP) in humans susceptible to ischemic heart diseases was assessed in a prospective randomized controlled study. The study group consumed 9 g of black tea (equivalent to three cups of tea) daily for 12 weeks without additives followed by a 3-week wash-out (with control group consuming equivalent volume of hot water). Black tea consumption induced a highly significant decrease in the high uric acid baseline groups >6 mg/dL by 8.5%; p < 0.05. For men and women in the base line group >7 mg/dL, the decrease was 9.4% and 7.1%, respectively. In the low baseline serum uric acid levels there was a non-significant increase of 3.7% and 15% in men and women, respectively. C-reactive protein in the high risk group >3 mg/L was significantly decreased by 53.4% and 41.1% in men and women, respectively. For the non-supplemented group in this range the changes were 3.7% decrease for men and 2.9% increase for women. Tea supplementation-associated decrease in plasma uric acid and C-reactive protein levels may benefit humans at high risk of cardiovascular events and may augment drug therapy.     

Lentiviral vector-mediated, in vivo gene transfer to the tracheobronchial tree in fetal rabbits

Background/Purpose

Fetal gene replacement is a novel, potential therapy for antenatally diagnosed monogenic disorders. The purpose of this study was to evaluate in vivo techniques of lentiviral (LV) vector-mediated gene transfer to the tracheobronchial tree in a rabbit model of fetal gene therapy.

Methods

Via triple plasmid transfection, vesicular stomatitis virus-G-pseudotyped LV vector containing green fluorescent protein (GFP) reporter gene under the control of a cytomegalovirus promoter was constructed.In vivo gene transfer of 5 × 10⁶ LV particles to fetuses of time-mated NZW rabbits (term = 31 days) was attempted using 2 techniques: (1) direct amniotic injection (gestation = 24-26 days) and (2) direct tracheal injection (gestation = 26 days). Injected fetuses and saline-injected littermate controls were delivered and killed on gestational day 30. Fetal and maternal tissues were analyzed.

Results

Both in vivo techniques produced gene transfer to fetal tissues (trachea, lung, liver, intestine), including those of some controls. In one prep, GFP DNA was identified in maternal lung.

Conclusions

Lentiviral vector-mediated GFP gene transfer to fetal rabbit tracheobronchial epithelium occurs within 4 days of transfection by both amniotic injection or direct fetal tracheal injection. This in vivo model confirms bioavailability of vector through amniotic fluid with some cross-infection of adjacent fetuses. Vector access to fetal tissues appears to be by both luminal and hematogenous routes. Transplacental gene transfer from fetus to mother may occur in this model.     

The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial

BACKGROUND: Approximately 10% to 16% of women experience a major depressive episode after childbirth. A significant proportion of these women also suffer from comorbid anxiety disorders. The purpose of this study was to evaluate whether the addition of cognitive-behavioral therapy (CBT) to standard antidepressant therapy offers additional benefits in the treatment of post-partum depression with comorbid anxiety disorders. METHOD: Thirty-five women referred to a tertiary care hospital outpatient program with a DSM-IV diagnosis of postpartum depression with comorbid anxiety disorder were randomly assigned to 1 of 2 treatment groups-paroxetine-only monotherapy group (N = 16) or paroxetine plus 12 sessions of CBT combination therapy group (N = 19)-for a 12-week trial. Progress was monitored by a psychiatrist blinded to treatment group, using the Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, Yale-Brown Obsessive Compulsive Scale, Clinical Global Impressions scale, and Edinburgh Postnatal Depression Scale. Data were analyzed using 2-tailed statistical tests at an alpha level of.05. The study was conducted from April 1, 2002, to June 30, 2003. RESULTS: Both treatment groups showed a highly significant improvement (p <.01) in mood and anxiety symptoms. Groups did not differ significantly in week of recovery, dose of paroxetine at remission, or measures of depression, anxiety, and obsessive-compulsive symptoms at outcome. CONCLUSION: Antidepressant monotherapy and combination therapy with antidepressants and CBT were both efficacious in reducing depression and anxiety symptoms. However, in this sample of acutely depressed/anxious postpartum women, there were no additional benefits from combining the 2 treatment modalities. Further research into the efficacy of combination therapy in the treatment of moderate-to-severe depression with comorbid disorders in postpartum women is recommended.