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PubMed2004

Multivariate statistical model for 3D image segmentation with application to medical images.

In this article we describe a statistical model that was developed to segment brain magnetic resonance images. The statistical segmentation algorithm was applied after a pre-processing stage involving the use of a 3D anisotropic filter along with histogram equalization techniques. The segmentation algorithm makes use of prior knowledge and a probability-based multivariate model designed to semi-automate the process of segmentation. The algorithm was applied to images obtained from the Center for Morphometric Analysis at Massachusetts General Hospital as part of the Internet Brain Segmentation Repository (IBSR). The developed algorithm showed improved accuracy over the k-means, adaptive Maximum Apriori Probability (MAP), biased MAP, and other algorithms. Experimental results showing the segmentation and the results of comparisons with other algorithms are provided. Results are based on an overlap criterion against expertly segmented images from the IBSR. The algorithm produced average results of approximately 80% overlap with the expertly segmented images (compared with 85% for manual segmentation and 55% for other algorithms).

Algorithms↗
PubMed2005

Automatic colon segmentation with dual scan CT colonography.

We present a fully automated three-dimensional (3-D) segmentation algorithm to extract the colon lumen surface in CT colonography. Focusing on significant-size polyp detection, we target at an efficient algorithm that maximizes overall colon coverage, minimizes the extracolonic components, maintains local shape accuracy, and achieves high segmentation speed. Two-dimensional (2-D) image processing techniques are employed first, resulting in automatic seed placement and better colon coverage. This is followed by near-air threshold 3-D region-growing using an improved marching-cubes algorithm, which provides fast and accurate surface generation. The algorithm constructs a well-organized vertex-triangle structure that uniquely employs a hash table method, yielding an order of magnitude speed improvement. We segment two scans, prone and supine, independently and with the goal of improved colon coverage. Both segmentations would be available for subsequent polyp detection systems. Segmenting and analyzing both scans improves surface coverage by at least 6% over supine or prone alone. According to subjective evaluation, the average coverage is about 87.5% of the entire colon. Employing near-air threshold and elongation criteria, only 6% of the data sets include extracolonic components (EC) in the segmentation. The observed surface shape accuracy of the segmentation is adequate for significant-size (6 mm) polyp detection, which is also verified by the results of the prototype detection algorithm. The segmentation takes less than 5 minutes on an AMD 1-GHz single-processor PC, which includes reading the volume data and writing the surface results. The surface-based segmentation algorithm is practical for subsequent polyp detection algorithms in that it produces high coverage, has a low EC rate, maintains local shape accuracy, and has a computational efficiency that makes real-time polyp detection possible. A fully automatic or computer-aided polyp detection system using this technique is likely to benefit future colon cancer early screening.

Algorithms↗
PubMed1993

Precordial ST segment depression in patients with Q wave inferior myocardial infarction: role of infarction-associated pericarditis.

To examine the diagnostic significance of precordial ST segment depression in Q wave inferior myocardial infarction, 157 consecutive patients were examined carefully by means of auscultation, ECG, and two-dimensional echocardiography. Precordial ST segment depression was transient (lasting < 72 hours from the onset of myocardial infarction) in 63 patients and persistent (> or = 72 hours) in 40. Twenty-eight patients with persistent, 19 patients with transient, and 14 patients without precordial ST segment depression had advanced asynergy (akinesia or dyskinesia) in the posterior segments, whereas 13 patients with persistent, six with transient, and six without precordial ST segment depression had pericardial rub. Patients with persistent precordial ST segment depression had a significantly higher incidence of severe wall motion abnormality (p < 0.01) and inflammation (p < 0.05) of the posterior wall than the other two groups. In 5 of 40 patients with persistent ST segment depression, pericardial rub was detected in the absence of advanced asynergy in the posterior segments. Although not highly sensitive, persistent precordial ST segment depression appeared to be a fairly specific indicator (specificity 92%) of concomitant posterior involvement with severe wall motion abnormality, inflammation, or both.

Aged↗
PubMed1976

Significance of S-T segment elevations in acute myocardial ischemia. Evaluation with intracoronary electrode technique.

A method is described for measuring intracoronary S-T segment elevations in the closed chest, a technique that appears to provide more reliable measurements of myocardial ischemia. Electrodes were inserted through intracoronary balloon catheters that were placed within a coronary artery and its adjoining vein both proximal and at several points distal to a coronary occlusion. Intracoronary arterial and adjacent venous electrocardiograms produced equivalent tracings. The intracoronary S-T segment elevations after coronary occlusion resembled those recorded from the epicardial surface but were free of artifacts noted in open chest studies. Study of progressive alterations of the intracoronary S-T segment after proximal occlusion of the left anterior descending coronary artery in 18 closed chest dogs revealed a peak segment elevation of 3.2 +/- 0.6 mv within 5 minutes, followed within 2 to 3 hours by spontaneous reduction by more than 40% of the S-T elevation over the occluded zone. In 44% of these animals, the S-T elevation decreased spontaneously to less than 1 mv, and in 22% it decreased to the preocclusion control level within 2 hours of occlusion. This spontaneous decrease in S-T elevation was frequently followed by a secondary increase and then S-T segment fluctuations. Reperfusion of the left anterior descending coronary artery after 30 to 60 minutes of occlusion generally led to a prompt reduction in S-T elevation. In some cases S-T elevations persisted up to 14 hours of occlusion, were reduced after reperfusion and exhibited a renewed pronounced increase after subsequent reocclusion of the left anterior descending coronary artery. During the 1st hour after occlusion, the early S-T segment elevation followed by spontaneous reduction reduction generally corresponded temporally with the derangements in myocardial lactate extraction and potassium loss. However, after 1 hour of occlusion no clear-cut correlation could be established between S-T fluctuations and changes in hemodynamic or myocardial metabolic measurements. We conclude that the new closed chest intracoronary electrocardiographic S-T technique might be of use for monitoring the early ischemic myocardial derangements and to assess benefits or drawbacks of treatment in both the experimental animal and man. Correspondence of S-T segment elevation with lactate and potassium alterations in the coronary-occluded region in the 1st hour after occlusion indicates that S-T segment elevation might represent an index of early myocardial ischemia. The spontaneous S-T changes that follow coronary occlusion must be taken into consideration when investigators utilize S-T segment modification as a sign of effectiveness of treatment.

Acute Disease↗
PubMed1994

Prognostic significance of maximal precordial ST-segment depression in right (V1 to V3) versus left (V4 to V6) leads in patients with inferior wall acute myocardial infarction.

This study examines whether patients with inferior wall acute myocardial infarction (AMI) and maximal ST-segment depression in left precordial leads are at higher risk for in-hospital mortality. The charts of patients (n = 213) with inferior wall AMI and an initial electrocardiogram that displayed peaked, tall T waves or ST-segment elevation with upright T waves in inferior leads were reviewed, after excluding patients with inverted T waves in inferior leads (n = 75). ST-segment deviation from baseline was measured for all leads. Patients were classified into 3 types: I = no precordial ST-segment depression; II = sum of ST-segment depression in leads V1 to V3 equal to or more than the sum of ST-segment depression in leads V4 to V6; and III = maximal precordial ST-segment depression in leads V4 to V6. Thirty-six patients (17%) died in the hospital. In-hospital mortality rates for patients with types I and II were 12% and 10%, respectively, compared with 41% for those with type III (p < 0.0001). Mortality rates in surviving patients were similar for all types up to 1 year after infarction. Multivariate logistic regression models for in-hospital mortality by ST-segment depression type adjusted for age, previous AMI, diabetes mellitus, and thrombolytic therapy revealed that type III pattern was a strong predictive factor for in-hospital mortality (odds ratio = 4.9, p = 0.0008, 95% confidence interval 1.93 to 12.26). Thus, patients with inferior wall AMI and maximal precordial ST-segment depression in leads V4 to V6 are at high risk for in-hospital mortality.

Aged↗
PubMed1992

Glutamate antagonists applied to midbody spinal cord segments reduce the excitability of the fictive rostral scratch reflex in the turtle.

Glutamate antagonists applied to the cutaneous-processing region of the rostral scratch circuit in turtles reduced the excitability of the rostral scratch reflex. Segments D3-D6 (D3 = 3rd postcervical) of the midbody spinal cord receive cutaneous afferents from the rostral scratch receptive field and perform the initial integration of this cutaneous sensory input. These cutaneous-processing segments are located anterior to the rostral scratch motor pattern generator that resides mainly in segments D7-D10 located in and near the hindlimb enlargement. We prepared 1 or 2 of the midbody segments for bath application of glutamate antagonists in preparations with a complete transection of the spinal cord anterior to segment D3. Each preparation was immobilized by neuromuscular blockade and fictive scratch motor output was recorded from hindlimb muscle nerves. Application of the NMDA N-methyl-D-aspartate) antagonist APV (D-2-amino-5-phosphonovaleric acid, 50 microM) to a midbody segment significantly reduced the motor burst frequency of rostral scratch responses evoked by 3-Hz electrical stimulation of a site in that segment's dermatome. These data suggest that NMDA receptors contribute to cutaneous processing in the rostral scratch circuit. Application of APV to a midbody segment also reduced the magnitude of temporal summation in the scratch circuit in response to electrical stimuli delivered to the shell at 4- to 5-s intervals. Temporal summation was monitored at the level of hindlimb motor output as well as at the level of unit activity from 'long-afterdischarge' neurons in the midbody segments. Our observations are consistent with the hypothesis that NMDA receptors contribute to the prolonged activation of 'long-afterdischarge' neurons and the multisecond storage of excitation in the scratch reflex pathway.

2-Amino-5-phosphonovalerate↗
PubMed1983

An experimental study of the somitomeric organization of the avian segmental plate.

The segmental plate mesoderm of chicken and Japanese quail embryos HH stages 9 to 16 was studied with scanning electron microscopy (SEM) imaging. The segmental plates were found to exhibit a metameric pattern consisting of tandemly stacked somitomeres. It was found that the numbers of somitomeres in segmental plates removed from the same embryo were nearly identical. Furthermore, the number of somitomeres in a segmental plate was found to be quite consistent (10.0 +/- 1.5) and independent of the length of the segmental plate. These results are very similar to those obtained in previous experimental studies in which "prospective somites" were detected in avian segmental plates. Further experiments showed that for each somite that is formed by a cultured segmental plate-containing explant, the somitomere complement of the segmental plate is reduced by one. It was concluded that the segmental plate mesoderm is already organized into a metameric pattern consisting of somitomeres and that the somitomeres undergo further morphogenesis to become somites. The specification of the somite pattern in birds may occur at the level of Hensen's node and the cephalic primitive streak.

Animals↗
PubMed1989

Changes in segment inertia proportions between 4 and 20 years.

Growth between 4 and 20 yr produces an increase in body mass and a redistribution of that mass throughout the body. It is the purpose of this investigation to describe changes in the segment mass, radius to the mass centre and radius of gyration for a sample of males, 4-20 yr and the potential effects of these changes on joint reaction forces and moments. The data were collected annually over 9 yr in a mixed longitudinal study completed in 1985. Elliptical zones 2 cm wide were used to model the 16 segments of the body. From these and reported segment densities, mass, the coordinates of the mass centre and the principal moments of inertia were determined for the segments and the body. The parameters reported are the inertia parameters suitable for a sagittal planar analysis with the head and neck considered one segment and values given for other fused segments. The accuracy of the method was judged against the total body mass, and other accuracy estimates from the literature were examined. The parameters are presented as proportions of total mass or segment length. It is clear from the polynomial regressions that there is a substantial redistribution of the mass between segments and this is consistent with the principles of cephalo-caudal and distal-to-proximal development. The proportions for radius and radius of gyration indicate that mass redistribution within segments is comparatively small. The parameters for a 6 yr-old were compared to the parameters expected at 18, 24 and 54 yr and substantial differences noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

The application of segment axial density profiles to a human body inertia model.

The intention of this study was to construct segment density profiles and compare segment inertias calculated when uniform densities and profile densities are used in a mathematical model. Axial densities from computerized tomography (CT) slices for the body segments of a sample of Chinese females (Zheng et al., Proceedings of the Beijing Asian Games Scientific Congress, 1990) were used to form profiles which could be employed in body segment models. Polynomials based on proportion of segment length were fitted to the reported mean slice densities. These profiles were then used with five widely divergent samples (n = 10); young adult females, young adult males, infants, male children and elderly adults. The mathematical model used is based on an assumption that all segments can be represented by stacked elliptic cylinders. The results show that when the profile densities were substituted for average cadaver densities the increase in the estimated total body mass was less than 0.85%. For the individual segments, use of the profile rather than average density increased the average segment mass estimate by up to 2.7%. The centres of mass and the principal moments were affected by the variations in density along the axis as well as the magnitudes, by up to 0.54 and 3.8%, respectively. Although the effects of using the profiles appear to be small the differences for individual samples, segments and parameters ranged up to 22.5%. It is not possible to decide if average or profile densities produce more accurate estimates of inertia, but the profile allows for axial variation in density and is therefore recommended.

Adolescent↗
PubMed1985

Analysis of the terminal sequences of the genome segments of four orbiviruses.

The dsRNA genome segments of bluetongue virus (BTV) types 1 and 20 and Ibaraki virus (a member of the epizootic haemorrhagic disease (EHD) serogroup) have conserved sequences of six bases at both of their 3' termini. One strand of all the genome segments analysed ends in 3'CAUUCA ... 5' while the other strand ends in 3'CAAUUU ... 5'. These conserved sequences are identical to those previously reported for BTV types 10 and 11 (A. Kiuchi, C. D. Rao, and P. Roy (1983), "Double-Stranded RNA Viruses" (R. W. Compans and D. H. L. Bishop, eds.), pp. 55-64. Elsevier, New York; C. D. Rao, A. Kiuchi, and P. Roy (1983), J. Virol. 46, 378-383). The 3' terminal sequences of segments 3 and 10 of the BTV type 1 genome were confirmed by the detection of exactly complementary sequences at the 5' termini of the ssRNA strands of opposite polarity. This also confirmed for these dsRNA segments (and by analogy for all the genome segments of these viruses) that the dsRNA molecules are fully base paired end to end. Using in vitro synthesised mRNA of BTV type 1 in annealing experiments with the two ssRNAs separated from each of the individual genome segments, it was shown that in each case the strand ending in 3'CAUUCA ... 5' is of the same polarity as the mRNA (+ve), while the strand ending in 3'CAAUUU ... 5' is of the opposite (-ve) polarity. The fourth virus analysed (Tilligerry virus, a member of the Eubenangee serogroup) only had five conserved bases at the 3' termini of one strand of its genome segments (3'CAU-CA ... 5') and three conserved bases at the 3' termini of the other strand (3'CA--U ... 5'). Considerable sequence homology was found in the near-terminal nonconserved regions of comparable genome segments from the different viruses, particularly between the different BTV types. There was little evidence, however, for absolute conservation of "segment specific" sequences in these regions of the RNA.

Animals↗
PubMed1989

Segment W of Campoletis sonorensis virus: expression, gene products, and organization.

Campoletis sonorensis virus (CsV, Polydnaviridae) is a segmented double-stranded DNA virus which has an apparently symbiotic relationship with the parasitic wasp, Campoletis sonorensis. CsV replicates in the oviducts of the parasitic wasp and is injected into the wasp's host, Heliothis virescens (Lepidoptera; Noctuiidae), during oviposition. In the parasitized lepidopteran host, the virus has a dramatic effect on host physiology and viral gene products are believed to play an essential role in the survival of the parasitic wasp's egg and larva. In the current study, we used Northern blot analyses to examine expression from segment W in the parasitized host and in the parasitic wasp. Segment W hybridized primarily to two relatively abundant mRNAs (1.6 and 1.0 kb) from the parasitized host. These 1.6- and 1.0-kb mRNAs, which were previously shown to be transcribed from two closely related genes (WHv1 and WHv2) on segment W (G. W. Blissard, O. P. Smith, and M. D. Summers, 1987, Virology 160, 120-134) increased in relative abundance between 2 and 24 hr postparasitization (pp) and were detected throughout parasitization (8 days). To study the proteins encoded by these closely related genes, the open reading frame from each of the related genes was cloned into a baculovirus expression vector. By pulse labeling in the presence and absence of tunicamycin, we examined secretion and glycosylation of these CsV proteins in infected lepidopteran cells (Spodoptera frugiperda). Expression of segment W in the oviducts of the female wasp was also examined. Segment W hybridized to at least five CsV mRNAs on Northern blots of poly(A) mRNA from C. sonorensis oviducts. To identify specific CsV mRNAs and map putative viral genes expressed in wasp oviduct tissues, segment W was used to screen a cDNA library of C. sonorensis oviduct mRNAs. Three cDNAs were used to identify CsV mRNAs by Northern blot analyses and to map the locations of three putative CsV genes on segment W. Cross-hybridization within the CsV genome was examined with cloned segment W and with the three cloned cDNAs.

Amino Acid Sequence↗
PubMed1991

Effect of surface hydrophilicity on ex vivo blood compatibility of segmented polyurethanes.

The relationship between surface, bulk and ex vivo blood-contacting properties of segmented polyurethanes with various polyol soft segment was investigated. The polyols used in this study were poly(ethylene oxide), poly(tetramethylene oxide), hydrogenated poly(butadiene), poly(butadiene) and poly(dimethylsiloxane). The hard segment of these segmented polyurethanes was composed of 4,4' diphenylmethane diisocyanate and 1,4 butanediol, present at 50 wt%. An experimental polyurethane, Biostable PUR, which has shown excellent biostability, was used in this study. The segmented polyurethanes based on the hydrophobic polyols such as poly(dimethylsiloxane) and hydrogenated poly(butadiene) showed distinct microphase separation between hard and soft segments. X-ray photoelectron spectroscopy revealed the surface enrichment of the hydrophobic component at the air-solid interface. Dynamic contact angle measurements indicated that the poly(dimethylsiloxane)-based segmented polyurethane possessed a hydrophobic surface in water. The poly(dimethylsiloxane)-based segmented polyurethane had the lowest platelet adhesion among the segmented polyurethanes investigated in this study, whilst the platelet deposition on the poly(ethylene oxide)-based polymer increased with time.

Animals↗
PubMed1991

Spinal segmental sympathetic outflow to cervical sympathetic trunk, vertebral nerve, inferior cardiac nerve and sympathetic fibres in the thoracic vagus.

The spinal segmental localization of preganglionic neurons which convey activity to the sympathetic nerves, i.e. vertebral nerve, right inferior cardiac nerve, sympathetic fibres in the thoracic vagus and cervical sympathetic trunk, was determined on the right side in chloralose anaesthetized cats. For that purpose the upper thoracic white rami were electrically stimulated with a single pulse, suprathreshold for B and C fibres, and the evoked responses were recorded in the sympathetic nerves. The relative preganglionic input from each segment of the spinal cord to the four sympathetic nerves was determined from the size of the evoked responses. It was found that each sympathetic nerve receives a maximum preganglionic input from one segment of the spinal cord (dominant segment) and that the preganglionic input gradually decreased from neighbouring segments. The spinal segmental preganglionic outflow to the cervical sympathetic trunk, thoracic vagus, right inferior cardiac nerve and vertebral nerve gradually shifted from the most rostral to the most caudal spinal cord segments. In some cases, a marked postganglionic component was found in the cervical sympathetic trunk. It was evoked by preganglionic input from the same spinal cord segments which transmitted activity to the vertebral nerve. These results indicate that there is a fixed relation between the spinal segmental localization of preganglionic neurons and the branch of the stellate ganglion receiving the input from these neurons.

Animals↗
PubMed1995

ST segment reelevation after acute myocardial infarction: marked differences in the electrocardiographic pattern between early and late episodes.

This study assesses the electrocardiographic (ECG) morphologic differences between early (< 24 h) and late (> 24 h) episodes of ST segment reelevation after acute myocardial infarction. We studied the records of 101 consecutive patients with acute myocardial infarction whose admission ECG demonstrated ST segment elevation with positive T waves, without pathological Q waves in the relevant leads, and without signs of bundle branch block or left ventricular hypertrophy. Thirty-five patients had 44 episodes of early ST segment reelevation, while 22 patients experienced 26 late episodes of ST segment reelevation. Seven patients experienced both early and late episodes. Early episodes of ST segment reelevation was seen more often after thrombolytic therapy: 43% (32 of 74 patients) versus 11% (3 of 27 patients) (P < 0.006). No differences were found in the incidence of late episodes between those who underwent (23%) or did not undergo (19%) thrombolytic therapy. Two patterns of ST segment elevation were distinguished. Pattern A with positive T waves, ST segment elevation (> or = 0.1 mV), but without distortion of the terminal portion of the QRS complex. Pattern B characterized by positive T waves, ST segment elevation (> or = 0.1 mV) with distortion of the terminal portion of the QRS complex. Each ECG was categorized according to these two patterns. The admission ECG pattern was A in 75 patients, and B in 26. No significant differences were found between patients with early, late, or no episodes of ST segment reelevation in the appearance of pattern A or B on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Precordial ST segment depression predicts a worse prognosis in inferior infarction despite reperfusion therapy. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group.

The impact of associated precordial ST segment depression in inferior myocardial infarction on angiographic and clinical outcomes after thrombolytic therapy and selective coronary angioplasty was studied in 583 patients with acute myocardial infarction. Anterior infarction (Group I), inferior infarction with precordial ST segment depression (Group II) and inferior infarction without precordial ST segment depression (Group III) were present in 289, 135 and 159 patients, respectively. Precordial ST segment depression was more frequent in circumflex than right coronary infarct-related arteries (44 [71%] of 62 versus 91 [40%] of 230; p = 0.000). Although acute patency rates were not statistically different, there was a trend toward different patency rates at day 7 (Group I 88%, Group II 84%, Group III 80%; p = 0.089) partly because of insignificantly higher reocclusion rates in inferior infarction without precordial ST segment depression (Group I 11%, Group II 10%, Group III 18%, p = 0.104). Infarct zone regional wall motion (standard deviations/chord) in inferior infarction was lower with precordial ST segment depression, both acutely (Group I -2.8 +/- 0.9, Group II -2.5 +/- 1.2, Group III 2.0 +/- 1.1; p = 0.000) and at day 7 (Group I -2.2 +/- 1.1, Group II -2.3 +/- 1.1, Group III -1.9 +/- 1.3; p = 0.011). Precordial ST segment depression was associated with a lower ejection fraction in inferior infarction both acutely (Group I 47 +/- 11%, Group II 53 +/- 11%, Group III 58 +/- 9%; p = 0.000) and at day 7 (Group I 49 +/- 12%, Group II 53 +/- 10%, Group III 58 +/- 8%; p = 0.000). Complication rates tended to be higher in inferior infarction when precordial ST segment depression was present. Mortality rates for Groups I, II and III were 8%, 6% and 5%, respectively. These results suggest that precordial ST segment depression in inferior infarction predicts a worse ventriculographic and clinical outcome despite reperfusion therapy.

Angioplasty, Balloon, Coronary↗
PubMed1992

Segmental systolic responses to brief ischemia and reperfusion in the hypertrophied canine left ventricle.

OBJECTIVES AND BACKGROUND: Left ventricular hypertrophy is associated with increased mortality, increased myocardial infarct size and an increased incidence of sudden death. Although reperfusion after ischemia has been shown to result in decreased infarct size and recovery of systolic thickening, it is unknown how left ventricular hypertrophy might influence recovery of regional systolic thickening after ischemia and reperfusion. We hypothesized that left ventricular hypertrophy might attenuate or abolish the functional response to reperfusion. METHODS: Three groups of chronically instrumented, conscious dogs (dogs with left ventricular hypertrophy and hypertension; dogs with left ventricular hypertrophy and reduced blood pressure and a control group without hypertrophy and with normal blood pressure) underwent 15 min of ischemia and 24 h of reperfusion. Segmental systolic thickening was measured by sonomicrometers and myocardial segments were grouped by percent of control segmental systolic thickening retained at 15 min of ischemia (class 1 greater than or equal to 67%, class 2 from 0% to 66%, class 3 less than 0% control systolic thickening). The recovery of each class of segment was measured serially during reperfusion. Hemodynamic variables and regional myocardial blood flow were also measured. RESULTS: There were no differences among groups in recovery of segmental systolic thickening for class 1 segments. Systolic thickening in class 2 (hypokinetic) segments was significantly depressed (p less than 0.05 compared with control value) in the group with left ventricular hypertrophy and reduced blood pressure (but not in the group with hypertrophy and hypertension) during early reperfusion; systolic thickening in class 3 (dyskinetic) segments showed a similar trend in the group with hypertrophy and reduced pressure. CONCLUSIONS: Although left ventricular hypertrophy with hypertension did not attenuate the contractile response to reperfusion, hypertrophy with reduced blood pressure was associated with significantly greater depression of segmental systolic thickening early during reperfusion.

Animals↗
PubMed1996

Prognostic value of heart rate adjustment of exercise-induced ST segment depression in the multiple risk factor intervention trial.

OBJECTIVES: We sought to assess the effect of heart rate adjustment of ST segment depression on risk stratification for the prediction of death from coronary artery disease. BACKGROUND: Standard analysis of the ST segment response to exercise based on a fixed magnitude of horizontal or downsloping ST segment depression has demonstrated only limited diagnostic sensitivity for the detection of coronary artery disease and has variable test performance in predicting coronary artery disease mortality. Heart rate adjustment of the magnitude of ST segment depression has been proposed as an alternative approach to increase the diagnostic and prognostic accuracy of the exercise electrocardiogram (ECG). METHODS: Exercise ECGs were performed in 5,940 men from the Usual Care Group of the Multiple Risk Factor Intervention Trial at entry into the study. An abnormal ST segment response to exercise was defined according to standard criteria as > or = 100 micro V of additional horizontal or downsloping ST segment depression at peak exercise. The ST segment/heart rate index was calculated by dividing the change in ST segment depression from rest to peak exercise by the exercise-induced change in heart rate. An abnormal ST segment/heart rate index was defined as >1.60 micro V/beats per min. RESULTS: After a mean follow-up of 7 years there were 109 coronary artery disease deaths. Using a Cox proportional hazards model, a positive exercise ECG by standard criteria was not predictive of coronary mortality (age-adjusted relative risk [RR] 1.5, 95% confidence interval [CI] 0.6 to 3.6, p = 0.39). In contrast, an abnormal ST segment/heart rate index significantly increased the risk of death from coronary artery disease (age-adjusted RR 4.1, 95% CI 2.7 to 6.0, p < 0.0001). Excess risk of death was confined to the highest quintile of ST segment/heart rate index values, and within this quintile, risk was directly related to the magnitude of test abnormality. After multivariate adjustment for age, diastolic blood pressure, serum cholesterol and cigarettes smoked per day, the ST segment/heart rate index remained a significant independent predictor of coronary death (RR 3.6, 95% CI 2.4 to 5.4, p < 0.001). CONCLUSIONS: Simple heart rate adjustment of the magnitude of ST segment depression improves the prediction of death from coronary artery disease in relatively high risk, asymptomatic men. These findings strongly support the use of heart rate-adjusted indexes of ST segment depression to improve the predictive value of the exercise ECG.

Coronary Disease↗
PubMed2004

Hybrid segmentation and virtual bronchoscopy based on CT images.

RATIONALE AND OBJECTIVES: Introduction of combination of the segmentation tool SegoMeTex and the virtual endoscopy system VIVENDI to perform virtual endoscopic inspections of the human lung. This virtual bronchoscopy system enables visualization of the tracheobronchial tree down to seventh generation. Furthermore, the modified virtual system visualizes hidden structures such as segmented vascular system or tumors. MATERIALS AND METHODS: The segmentation is based on image data acquired by a multislice computed tomography scanner. SegoMeTex is used to segment the tracheobronchial tree by a hybrid system with minimal user action. Similarly, the complementary pulmonary arterial can be segmented, whereas additional structures such as tumors are marked manually. On this dataset, subsequently, data structures of the inner surface for virtual endoscopy are generated. Finally, the dataset can be explored by a virtual bronchoscopy procedure using the VIVENDI system. RESULTS: The segmentation method was successfully tested on 22 patients. The hybrid segmentation system identified bronchi up to the sixth generation with a sensitivity of more than 58%, and a positive predictive value of more than 90%. After the segmentation, the datasets are explored interactively (>30 fps on a standard personal computer platform in real-time rendering) using the virtual endoscopy software. The exploration exposed a high-quality reconstruction, even of small structures throughout the dataset. CONCLUSION: Virtual bronchoscopy in combining with a highly sensitive segmentation is a valuable tool for the localization and measurement of stenosis for resection planning.

Bronchial Diseases↗