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1.
Ther Adv Neurol Disord ; 14: 17562864211039648, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422112

RESUMO

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).

2.
Nervenarzt ; 92(8): 773-801, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34297142

RESUMO

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland).


Assuntos
Esclerose Múltipla , Sistema Nervoso Central , Consenso , Europa (Continente) , Alemanha , Humanos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/tratamento farmacológico
3.
J Neuroimmunol ; 351: 577469, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33387829

RESUMO

Daclizumab (DAC), a humanized monoclonal antibody that binds to the interleukin (IL)-2-receptor alpha chain, was approved in May 2016 for treatment of relapsing-remitting multiple sclerosis (RRMS). Approval was suspended in March 2018 after occurrence of severe liver failure and fatal meningoencephalitis in several patients treated with DAC. We report the clinical, laboratory and neuroimaging findings of 2 patients, who developed hypophysitis about 4 months after cessation of therapy with DAC. This report identifies delayed onset hypophysitis as a previously unrecognized severe side effect of DAC, highlighting the importance of continuous pharmacovigilance and patient monitoring even after cessation of DAC therapy.


Assuntos
Daclizumabe/efeitos adversos , Hipofisite/induzido quimicamente , Imunossupressores/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade
4.
Artigo em Inglês | MEDLINE | ID: mdl-31186995

RESUMO

Accurate measurement of knee alignment, quantified by the hip-knee-ankle (HKA) angle (varus-valgus), serves as an essential biomarker in the diagnosis of various orthopaedic conditions and selection of appropriate therapies. Such angular deformities are assessed from standing X-ray panoramas. However, the limited field-of-view of traditional X-ray imaging systems necessitates the acquisition of several sector images to capture an individual's standing posture, and their subsequent 'stitching' to reconstruct a panoramic image. Such panoramas are typically constructed manually by an X-ray imaging technician, often using various external markers attached to the individual's clothing and visible in two adjacent sector images. To eliminate human error, user-induced variability, improve consistency and reproducibility, and reduce the time associated with the traditional manual 'stitching' protocol, here we propose an automatic panorama construction method that only relies on anatomical features reliably detected in the images, eliminating the need for any external markers or manual input from the technician. The method first performs a rough segmentation of the femur and the tibia, then the sector images are registered by evaluating a distance metric between the corresponding bones along their medial edge. The identified translations are then used to generate the standing panorama image. The method was evaluated on 95 patient image datasets from a database of X-ray images acquired across 10 clinical sites as part of the screening process for a multi-site clinical trial. The panorama reconstruction parameters yielded by the proposed method were compared to those used for the manual panorama construction, which served as gold-standard. The horizontal translation differences were 0:43 ± 1:95 mm 0:26 ± 1:43 mm for the femur and tibia respectively, while the vertical translation differences were 3:76 ± 22:35 mm and 1:85 ± 6:79 mm for the femur and tibia, respectively. Our results showed no statistically significant differences between the HKA angles measured using the automated vs. the manually generated panoramas, and also led to similar decisions with regards to the patient inclusion/exclusion in the clinical trial. Thus, the proposed method was shown to provide comparable performance to manual panorama construction, with increased efficiency, consistency and robustness.

5.
Drug Des Devel Ther ; 10: 3379-3386, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27799738

RESUMO

Multiple sclerosis (MS) is among the most common chronic inflammatory diseases of the central nervous system. Although not curable, the constantly increasing armamentarium of disease-modifying drugs now allows control of disease activity in many patients. The humanized monoclonal antibody alemtuzumab is a powerful drug licensed for the treatment of MS. Upon binding to the CD52 surface protein on CD4+ and CD8+ T cells, B cells, and monocytes, circulating CD52+ cells are eliminated via antibody- and complement-mediated lysis, and a less autoreactive adaptive immune system is reconstituted. The efficacy of alemtuzumab in terms of both clinical and magnetic resonance imaging outcomes has been demonstrated in several phase II/III trials including long-term extensions and follow-up studies. Treatment response to alemtuzumab is strongest as long as active inflammation is the predominant pathophysiological feature, and it is becoming less efficacious in neurodegeneration-dominated later stages of the disease. Thus, the optimal placement of alemtuzumab within treatment algorithms of MS is crucial. The impressive efficacy of alemtuzumab is counteracted by a less favorable safety profile. Besides usually manageable infusion-associated side effects, development of secondary autoimmunity in almost half of treated patients is the most disconcerting risk of alemtuzumab. The high frequency, the delayed occurrence, and the potentially severe course of secondary autoimmune diseases require awareness and a close long-term monitoring of patients treated with alemtuzumab. Biomarkers that would allow prediction of treatment response to alemtuzumab on the one hand and identification of patients at risk for the development of secondary autoimmune diseases on the other are not yet available. Thus, the overall success of alemtuzumab treatment critically depends on the patient selection. The aim of this article is therefore, to characterize the significance of alemtuzumab in the treatment of MS with a focus on the selection of the optimal patient.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Seleção de Pacientes , Alemtuzumab , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Humanos
7.
J Digit Imaging ; 21 Suppl 1: S59-68, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17960461

RESUMO

A new application, Fusion Viewer, available for free, has been designed and implemented with a modular object-oriented design. The viewer provides both traditional and novel tools to fuse 3D data sets such as CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), and SPECT (single photon emission tomography) of the same subject, to create maximum intensity projections (MIP) and to adjust dynamic range. In many situations, it is desirable and advantageous to acquire biomedical images in more than one modality. For example, PET can be used to acquire functional data, whereas MRI can be used to acquire morphological data. In some situations, a side-by-side comparison of the images provides enough information, but in most of the cases it may be necessary to have the exact spatial relationship between the modalities presented to the observer. To accomplish this task, the images need to first be registered and then combined (fused) to create a single image. In this paper, we discuss the options for performing such fusion in the context of multimodal breast imaging. Additionally, a novel spline-based dynamic range technique is presented in detail. It has the advantage of obtaining a high level of contrast in the intensity range of interest without discarding the intensity information outside of this range while maintaining a user interface similar to the standard window/level windowing procedure.


Assuntos
Apresentação de Dados , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Armazenamento e Recuperação da Informação/métodos , Intensificação de Imagem Radiográfica/métodos , Técnica de Subtração , Gráficos por Computador , Humanos , Interpretação de Imagem Assistida por Computador/instrumentação , Imageamento Tridimensional/instrumentação , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons/instrumentação , Tomografia por Emissão de Pósitrons/métodos , Sensibilidade e Especificidade , Software , Estatística como Assunto , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos
8.
J Digit Imaging ; 20 Suppl 1: 72-82, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17690935

RESUMO

SimSET is a package for simulation of emission tomography data sets. Condor is a popular distributed computing environment. Simple C/C++ applications and shell scripts are presented which allow the execution of SimSET on the Condor environment. This is accomplished without any modification to SimSET by executing multiple instances and using its combinebin utility. This enables research facilities without dedicated parallel computing systems to utilize the idle cycles of desktop workstations to greatly reduce the run times of their SimSET simulations. The necessary steps to implement this approach in other environments are presented along with sample results.


Assuntos
Redes de Comunicação de Computadores , Simulação por Computador , Modelos Biológicos , Tomografia por Emissão de Pósitrons , Sistemas de Informação em Radiologia , Tomografia Computadorizada de Emissão de Fóton Único , Sistemas Computacionais , Sistemas de Gerenciamento de Base de Dados , Humanos , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas , Software
9.
Phys Med ; 21 Suppl 1: 39-43, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17645992

RESUMO

We propose a finite-element method (FEM) deformable breast model that does not require elastic breast data for nonrigid PET/MRI breast image registration. The model is applicable only if the stress conditions in the imaged breast are virtually the same in PET and MRI. Under these conditions, the observed intermodality displacements are solely due the imaging/reconstruction process. Similar stress conditions are assured by use of an MRI breast-antenna replica for breast support during PET, and use of the same positioning. The tetrahedral volume and triangular surface elements are used to construct the FEM mesh from the MRI image. Our model requires a number of fiducial skin markers (FSM) visible in PET and MRI. The displacement vectors of FSMs are measured followed by the dense displacement field estimation by first distributing the displacement, vectors linearly over the breast surface and then distributing them throughout the volume. Finally, the floating MRI image is warped to a fixed PET image, by using an appropriate shape function in the interpolation from mesh nodes to voxels. We tested our model on an elastic breast phantom with simulated internal lesions and on a small number of patients imaged, with FMS using PET and MRI. Using simulated lesions (in phantom) and real lesions (in patients) visible in both PET and MRI, we established that the target registration error (TRE) is below two pet voxels.

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