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Article ; Online: An in silico study of the effects of cardiovascular aging on carotid flow waveforms and indexes in a virtual population.

Suriani, Irene / Bouwman, R Arthur / Mischi, Massimo / Lau, Kevin D

American journal of physiology. Heart and circulatory physiology

2024 Volume 326, Issue 4, Page(s) H877–H899

Abstract: Cardiovascular aging is strongly associated with increased risk of cardiovascular disease and mortality. Moreover, health and lifestyle factors may accelerate age-induced alterations, such as increased arterial stiffness and wall dilation, beyond ... ...

Abstract	Cardiovascular aging is strongly associated with increased risk of cardiovascular disease and mortality. Moreover, health and lifestyle factors may accelerate age-induced alterations, such as increased arterial stiffness and wall dilation, beyond chronological age, making the clinical assessment of cardiovascular aging an important prompt for preventative action. Carotid flow waveforms contain information about age-dependent cardiovascular properties, and their ease of measurement via noninvasive Doppler ultrasound (US) makes their analysis a promising tool for the routine assessment of cardiovascular aging. In this work, the impact of different aging processes on carotid waveform morphology and derived indexes is studied in silico, with the aim of establishing the clinical potential of a carotid US-based assessment of cardiovascular aging. One-dimensional (1-D) hemodynamic modeling was employed to generate an age-specific virtual population (VP) of
MeSH term(s)	Humans ; Aged ; Aging ; Carotid Arteries/diagnostic imaging ; Hemodynamics ; Cardiovascular Diseases ; Ultrasonography
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	603838-4
ISSN	1522-1539 ; 0363-6135
ISSN (online)	1522-1539
ISSN	0363-6135
DOI	10.1152/ajpheart.00304.2023
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Article ; Online: Adaptive higher-order singular value decomposition clutter filter for ultrafast Doppler imaging of coronary flow under non-negligible tissue motion.

Huang, Yizhou / Chen, Xufei / Badescu, Emilia / Kuenen, Maarten / Bonnefous, Odile / Mischi, Massimo

Ultrasonics

2024 Volume 140, Page(s) 107307

Abstract: Background and objective: With the development of advanced clutter-filtering techniques by singular value decomposition (SVD) and leveraging favorable acquisition settings such as open-chest imaging by a linear high-frequency probe and plane waves, ... ...

Abstract	Background and objective: With the development of advanced clutter-filtering techniques by singular value decomposition (SVD) and leveraging favorable acquisition settings such as open-chest imaging by a linear high-frequency probe and plane waves, several studies have shown the feasibility of cardiac flow measurements during the entire cardiac cycle, ranging from coronary flow to myocardial perfusion. When applying these techniques in a routine clinical setting, using transthoracic ultrasound imaging, new challenges emerge. Firstly, a smaller aperture is needed that can fit between ribs. Consequently, diverging waves are employed instead of plane waves to achieve an adequate field of view. Secondly, to ensure imaging at a larger depth, the maximum pulse repetition frequency has to be reduced. Lastly, in comparison to the open-chest scenario, tissue motion induced by the heartbeat is significantly stronger. The latter complicates substantially the distinction between clutter and blood signals. Methods: This study investigates a strategy to overcome these challenges by diverging wave imaging with an optimal number of tilt angles, in combination with dedicated clutter-filtering techniques. In particular, a novel, adaptive, higher-order SVD (HOSVD) clutter filter, which utilizes spatial, temporal, and angular information of the received ultrasound signals, is proposed to enhance clutter and blood separation. Results: When non-negligible tissue motion is present, using fewer tilt angles not only reduces the decorrelation between the received waveforms but also allows for collecting more temporal samples at a given ensemble duration, contributing to improved Doppler performance. The addition of a third angular dimension enables the application of HOSVD, providing greater flexibility in selecting blood separation thresholds from a 3-D tensor. This differs from the conventional threshold selection method in a 2-D spatiotemporal space using SVD. Exhaustive threshold search has shown a significant improvement in Contrast and Contrast-to-Noise ratio for Power Doppler images filtered with HOSVD compared to the SVD-based clutter filter. Conclusion: With the improved settings, the obtained Power Doppler images show the feasibility of measuring coronary flow under the influence of non-negligible tissue motion in both in vitro and ex vivo.
Language	English
Publishing date	2024-03-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	200839-7
ISSN	1874-9968 ; 0041-624X
ISSN (online)	1874-9968
ISSN	0041-624X
DOI	10.1016/j.ultras.2024.107307
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Article ; Online: Ultrasound viscoelastography by acoustic radiation force: A state-of-the-art review.

Chen, Xufei / Li, Xueting / Turco, Simona / Van Sloun, Ruud J G / Mischi, Massimo

IEEE transactions on ultrasonics, ferroelectrics, and frequency control

2024 Volume PP

Abstract: Ultrasound elastography (USE) is a promising tool for tissue characterization as several diseases result in alterations of tissue structure and composition, which manifest as changes in tissue mechanical properties. By imaging the tissue response to an ... ...

Abstract	Ultrasound elastography (USE) is a promising tool for tissue characterization as several diseases result in alterations of tissue structure and composition, which manifest as changes in tissue mechanical properties. By imaging the tissue response to an applied mechanical excitation, USE mimics the manual palpation performed by clinicians to sense the tissue elasticity for diagnostic purposes. Next to elasticity, viscosity has recently been investigated as an additional, relevant, diagnostic biomarker. Moreover, since biological tissues are inherently viscoelastic, accounting for viscosity in the tissue characterization process enhances the accuracy of the elasticity estimation. Recently, methods exploiting different acquisition and processing techniques have been proposed to perform ultrasound viscoelastography. After introducing the physics describing viscoelasticity, a comprehensive overview of the currently available USE acquisition techniques is provided, followed by a structured review of the existing viscoelasticity estimators classified according to the employed processing technique. These estimators are further reviewed from a clinical usage perspective, and current outstanding challenges are discussed.
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article
ISSN	1525-8955
ISSN (online)	1525-8955
DOI	10.1109/TUFFC.2024.3381529
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Article ; Online: Automatic Optimization of Multichannel Electrode Configurations for Robust Fetal Heart Rate Detection by Blind Source Separation.

Galli, Alessandra / Peri, Elisabetta / Rabotti, Chiara / Ouzounov, Sotir / Mischi, Massimo

IEEE transactions on bio-medical engineering

2023 Volume 70, Issue 4, Page(s) 1196–1207

Abstract: Objective: Fetal heart rate (fHR) evaluation is fundamental to guarantee timely medical intervention in case of pregnancy complications. Due to the limitations of traditional cardiotocography, multichannel electrophysiological recording was proposed as ... ...

Abstract	Objective: Fetal heart rate (fHR) evaluation is fundamental to guarantee timely medical intervention in case of pregnancy complications. Due to the limitations of traditional cardiotocography, multichannel electrophysiological recording was proposed as a viable alternative, which requires Blind Source Separation (BSS) techniques. Yet effective and reliable separation of the fetal ECG remains challenging due to multiple noise sources and the effects of varying fetal position. In this work, we demonstrate that the adopted electrode configuration plays a key role in the effectiveness of BSS and propose guidelines for optimal electrode positioning. Moreover, a model is proposed to automatically predict the most suited configuration for accurate BSS-based fHR estimation with a minimal number of leads, to facilitate practical implementation. Methods: We compared fHR estimation accuracy with different electrode configurations on in-silico data, identifying the optimal configuration for a recent BSS method. Based on features extracted from raw signals, we proposed a support vector regression model to automatically identify the best electrode configuration in terms of fHR estimation accuracy and to dynamically adjust it to varying fetal presentation. Evaluation was performed on real and synthetic data. Results: Guidelines for the optimal electrode configuration are proposed by using 4 leads. Prediction of configuration quality shows 80.9% accuracy; the optimal configurat- ion is recognized in 92.2% of the subjects. Conclusion: The proposed method successfully predicts the quality of the configurations, demonstrating the impact of the electrode configuration on the BSS performance. Significance: The method holds potential for long-term fetal monitoring, by dynamically choosing the optimal configuration.
MeSH term(s)	Female ; Pregnancy ; Humans ; Heart Rate, Fetal ; Fetal Monitoring/methods ; Cardiotocography/methods ; Electrocardiography/methods ; Electrodes
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2022.3212587
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Article ; Online: Re: Multiparametric Ultrasound Versus Multiparametric MRI to Diagnose Prostate Cancer (CADMUS): A Prospective, Multicentre, Paired-cohort, Confirmatory Study.

Postema, Arnoud W / Jager, Auke / Mischi, Massimo / Salomon, Georg

European urology

2023 Volume 84, Issue 1, Page(s) 140–141

MeSH term(s)	Male ; Humans ; Multiparametric Magnetic Resonance Imaging ; Prospective Studies ; Prostatic Neoplasms/diagnostic imaging ; Prostate/diagnostic imaging ; Ultrasonography ; Magnetic Resonance Imaging ; Image-Guided Biopsy
Language	English
Publishing date	2023-03-09
Publishing country	Switzerland
Document type	Multicenter Study ; Journal Article
ZDB-ID	193790-x
ISSN	1873-7560 ; 1421-993X ; 0302-2838
ISSN (online)	1873-7560 ; 1421-993X
ISSN	0302-2838
DOI	10.1016/j.eururo.2023.02.025
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Article ; Online: Analysis of Interface Material Noise in Non-contact Capacitive Sensing.

Zhang, Yijing / Xu, Lin / Mischi, Massimo / Cantore, Eugenio / Harpe, Pieter

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2022 Volume 2022, Page(s) 1270–1274

Abstract: The thermal noise due to the resistivity of insulation materials can become a significant noise source in non-contact capacitive sensing, especially when measuring micro-volt-level physiological signals. Since both the impedance and the resistivity of ... ...

Abstract	The thermal noise due to the resistivity of insulation materials can become a significant noise source in non-contact capacitive sensing, especially when measuring micro-volt-level physiological signals. Since both the impedance and the resistivity of practical insulation materials may be strongly frequency dependent, their thermal noise is often frequency dependent. This paper studies the impedance and noise behavior of different interface materials as function of frequency, by means of modelling, simulations, and experimental measurements. The results show that the inherent resistive noise of some fabrics (e.g., cotton, polyester) could outweigh the typical noise level of circuits for physiological sensing; and as a result, the interface noise can limit the quality of low-amplitude signal detection. Clinical Relevance- This study gives a guideline for material selection from the noise perspective in case of capacitive electrode sensing.
MeSH term(s)	Electric Impedance ; Electrodes ; Noise
Language	English
Publishing date	2022-09-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC48229.2022.9871024
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Article: Editorial: Radiomics in prostate cancer imaging.

Brunese, Luca / Martino, Pasquale / Mischi, Massimo / Prasad, Mukesh / Santone, Antonella

Frontiers in oncology

2022 Volume 12, Page(s) 1010901

Language	English
Publishing date	2022-09-23
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.1010901
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Article ; Online: Development and Validation of an Interpretable Conformal Predictor to Predict Sepsis Mortality Risk: Retrospective Cohort Study.

Yang, Meicheng / Chen, Hui / Hu, Wenhan / Mischi, Massimo / Shan, Caifeng / Li, Jianqing / Long, Xi / Liu, Chengyu

Journal of medical Internet research

2024 Volume 26, Page(s) e50369

Abstract: Background: Early and reliable identification of patients with sepsis who are at high risk of mortality is important to improve clinical outcomes. However, 3 major barriers to artificial intelligence (AI) models, including the lack of interpretability, ... ...

Abstract	Background: Early and reliable identification of patients with sepsis who are at high risk of mortality is important to improve clinical outcomes. However, 3 major barriers to artificial intelligence (AI) models, including the lack of interpretability, the difficulty in generalizability, and the risk of automation bias, hinder the widespread adoption of AI models for use in clinical practice. Objective: This study aimed to develop and validate (internally and externally) a conformal predictor of sepsis mortality risk in patients who are critically ill, leveraging AI-assisted prediction modeling. The proposed approach enables explaining the model output and assessing its confidence level. Methods: We retrospectively extracted data on adult patients with sepsis from a database collected in a teaching hospital at Beth Israel Deaconess Medical Center for model training and internal validation. A large multicenter critical care database from the Philips eICU Research Institute was used for external validation. A total of 103 clinical features were extracted from the first day after admission. We developed an AI model using gradient-boosting machines to predict the mortality risk of sepsis and used Mondrian conformal prediction to estimate the prediction uncertainty. The Shapley additive explanation method was used to explain the model. Results: A total of 16,746 (80%) patients from Beth Israel Deaconess Medical Center were used to train the model. When tested on the internal validation population of 4187 (20%) patients, the model achieved an area under the receiver operating characteristic curve of 0.858 (95% CI 0.845-0.871), which was reduced to 0.800 (95% CI 0.789-0.811) when externally validated on 10,362 patients from the Philips eICU database. At a specified confidence level of 90% for the internal validation cohort the percentage of error predictions (n=438) out of all predictions (n=4187) was 10.5%, with 1229 (29.4%) predictions requiring clinician review. In contrast, the AI model without conformal prediction made 1449 (34.6%) errors. When externally validated, more predictions (n=4004, 38.6%) were flagged for clinician review due to interdatabase heterogeneity. Nevertheless, the model still produced significantly lower error rates compared to the point predictions by AI (n=1221, 11.8% vs n=4540, 43.8%). The most important predictors identified in this predictive model were Acute Physiology Score III, age, urine output, vasopressors, and pulmonary infection. Clinically relevant risk factors contributing to a single patient were also examined to show how the risk arose. Conclusions: By combining model explanation and conformal prediction, AI-based systems can be better translated into medical practice for clinical decision-making.
MeSH term(s)	Adult ; Humans ; Artificial Intelligence ; Clinical Decision-Making ; Hospitals, Teaching ; Retrospective Studies ; Sepsis/diagnosis ; Multicenter Studies as Topic
Language	English
Publishing date	2024-03-18
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/50369
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Article: Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study.

Bester, Maretha / Nichting, Thomas J / Joshi, Rohan / Aissati, Lamyae / Oei, Guid S / Mischi, Massimo / van Laar, Judith O E H / Vullings, Rik

Journal of clinical medicine

2024 Volume 13, Issue 8

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2024-04-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13082442
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Article ; Online: The correlation of urea and creatinine concentrations in sweat and saliva with plasma during hemodialysis: an observational cohort study.

Adelaars, Sophie / Konings, Constantijn J A M / Cox, Lieke / Boonen, Eva / Mischi, Massimo / Bouwman, R Arthur / van de Kerkhof, Daan

Clinical chemistry and laboratory medicine

2024 Volume 62, Issue 6, Page(s) 1118–1125

Abstract: Objectives: Urea and creatinine concentrations in plasma are used to guide hemodialysis (HD) in patients with end-stage renal disease (ESRD). To support individualized HD treatment in a home situation, there is a clinical need for a non-invasive and ... ...

Abstract	Objectives: Urea and creatinine concentrations in plasma are used to guide hemodialysis (HD) in patients with end-stage renal disease (ESRD). To support individualized HD treatment in a home situation, there is a clinical need for a non-invasive and continuous alternative to plasma for biomarker monitoring during and between cycles of HD. In this observational study, we therefore established the correlation of urea and creatinine concentrations between sweat, saliva and plasma in a cohort of ESRD patients on HD. Methods: Forty HD patients were recruited at the Dialysis Department of the Catharina Hospital Eindhoven. Sweat and salivary urea and creatinine concentrations were analyzed at the start and at the end of one HD cycle and compared to the corresponding plasma concentrations. Results: A decrease of urea concentrations during HD was observed in sweat, from 27.86 mmol/L to 12.60 mmol/L, and saliva, from 24.70 mmol/L to 5.64 mmol/L. Urea concentrations in sweat and saliva strongly correlated with the concentrations in plasma (ρ 0.92 [p<0.001] and 0.94 [p<0.001], respectively). Creatinine concentrations also decreased in sweat from 43.39 μmol/L to 19.69 μmol/L, and saliva, from 59.00 μmol/L to 13.70 μmol/L. However, for creatinine, correlation coefficients were lower than for urea for both sweat and saliva compared to plasma (ρ: 0.58 [p<0.001] and 0.77 [p<0.001], respectively). Conclusions: The results illustrate a proof of principle of urea measurements in sweat and saliva to monitor HD adequacy in a non-invasive and continuous manner. Biosensors enabling urea monitoring in sweat or saliva could fill in a clinical need to enable at-home HD for more patients and thereby decrease patient burden.
MeSH term(s)	Humans ; Urea/analysis ; Urea/blood ; Saliva/chemistry ; Creatinine/blood ; Creatinine/analysis ; Renal Dialysis ; Sweat/chemistry ; Female ; Male ; Cohort Studies ; Middle Aged ; Aged ; Kidney Failure, Chronic/therapy ; Kidney Failure, Chronic/blood ; Adult ; Biomarkers/analysis ; Biomarkers/blood
Chemical Substances	Urea (8W8T17847W) ; Creatinine (AYI8EX34EU) ; Biomarkers
Language	English
Publishing date	2024-01-23
Publishing country	Germany
Document type	Journal Article ; Observational Study
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2023-1285
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