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  1. Article: Validation of an automated method for studying retinal capillary blood flow.

    Neriyanuri, Srividya / Bedggood, Phillip / Symons, R C Andrew / Metha, Andrew B

    Biomedical optics express

    2024  Volume 15, Issue 2, Page(s) 802–817

    Abstract: Two major approaches for tracking cellular motion across a range of biological tissues are the manual labelling of cells, and automated analysis of spatiotemporal information represented in a kymograph. Here we compare these two approaches for the ... ...

    Abstract Two major approaches for tracking cellular motion across a range of biological tissues are the manual labelling of cells, and automated analysis of spatiotemporal information represented in a kymograph. Here we compare these two approaches for the measurement of retinal capillary flow, a particularly noisy application due to the low intrinsic contrast of single red blood cells (erythrocytes). Image data were obtained using a flood-illuminated adaptive optics ophthalmoscope at 750 nm, allowing the acquisition of flow information over several cardiac cycles which provided key information in evaluating tracking accuracy. Our results show that in addition to being much faster, the automated method is more accurate in the face of rapid flow and reduced image contrast. This study represents the first validation of commonly used kymograph approaches to capillary flow analysis.
    Language English
    Publishing date 2024-01-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2572216-5
    ISSN 2156-7085
    ISSN 2156-7085
    DOI 10.1364/BOE.504074
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  2. Article ; Online: Mapping the human parafoveal vascular network to understand flow variability in capillaries.

    Neriyanuri, Srividya / Bedggood, Phillip / Symons, R C Andrew / Metha, Andrew

    PloS one

    2023  Volume 18, Issue 10, Page(s) e0292962

    Abstract: Capillary flow is known to be non-homogenous between vessels and variable over time, for reasons that are poorly understood. The local properties of individual vessels have been shown to have limited explanatory power in this regard. This exploratory ... ...

    Abstract Capillary flow is known to be non-homogenous between vessels and variable over time, for reasons that are poorly understood. The local properties of individual vessels have been shown to have limited explanatory power in this regard. This exploratory study investigates the association of network-level properties such as vessel depth, branch order, and distance from the feeding arteriole with capillary flow. Detailed network connectivity analysis was undertaken in 3 healthy young subjects using flood-illuminated adaptive optics retinal imaging, with axial depth of vessels determined via optical coherence tomography angiography. Forty-one out of 70 vessels studied were of terminal capillary type, i.e. fed from an arterial junction and drained by a venous junction. Approximately half of vessel junctions were amenable to fitting with a model of relative branch diameters, with only a few adhering to Murray's Law. A key parameter of the model (the junction exponent) was found to be inversely related to the average velocity (r = -0.59, p = 0.015) and trough velocity (r = -0.67, p = 0.004) in downstream vessels. Aspects of cellular flow, such as the minimum velocity, were also moderately correlated (r = 0.46, p = 0.009) with distance to the upstream feeding arteriole. Overall, this study shows that capillary network topology contributes significantly to the flow variability in retinal capillaries in human eyes. Understanding the heterogeneity in capillary flow is an important first step before pathological flow states can be properly understood. These results show that flow within capillary vessels is not affected by vessel depths but significantly influenced by the upstream feeder distance as well as the downstream vessel junction exponents, but there remains much to be uncovered regarding healthy capillary flow.
    MeSH term(s) Humans ; Capillaries/diagnostic imaging ; Capillaries/pathology ; Retinal Vessels/diagnostic imaging ; Retinal Vessels/pathology ; Arteries ; Retina ; Angiography ; Tomography, Optical Coherence ; Fluorescein Angiography
    Language English
    Publishing date 2023-10-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0292962
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  3. Article ; Online: Flow Heterogeneity and Factors Contributing to the Variability in Retinal Capillary Blood Flow.

    Neriyanuri, Srividya / Bedggood, Phillip / Symons, R C Andrew / Metha, Andrew B

    Investigative ophthalmology & visual science

    2023  Volume 64, Issue 10, Page(s) 15

    Abstract: Purpose: Capillary flow plays an important role in the nourishment and maintenance of healthy neural tissue and can be observed directly and non-invasively in the living human retina. Despite their importance, patterns of normal capillary flow are not ... ...

    Abstract Purpose: Capillary flow plays an important role in the nourishment and maintenance of healthy neural tissue and can be observed directly and non-invasively in the living human retina. Despite their importance, patterns of normal capillary flow are not well understood due to limitations in spatial and temporal resolution of imaging data.
    Methods: Capillary flow characteristics were studied in the retina of three healthy young individuals using a high-resolution adaptive optics ophthalmoscope. Imaging with frame rates of 200 to 300 frames per second was sufficient to capture details of the single-file flow of red blood cells in capillaries over the course of about 3 seconds.
    Results: Erythrocyte velocities were measured from 72 neighboring vessels of the parafoveal capillary network for each subject. We observed strong variability among vessels within a given subject, and even within a given imaged field, across a range of capillary flow parameters including maximum and minimum velocities, pulsatility, abruptness of the systolic peak, and phase of the cardiac cycle. The observed variability was not well explained by "local" factors such as the vessel diameter, tortuosity, length, linear cell density, or hematocrit of the vessel. Within a vessel, a moderate relation between the velocities and hematocrit was noted, suggesting a redistribution of plasma between cells with changes in flow.
    Conclusions: These observations advance our fundamental understanding of normal capillary physiology and raise questions regarding the potential role of network-level effects in explaining the observed flow heterogeneity.
    MeSH term(s) Humans ; Capillaries/physiology ; Retina ; Erythrocytes/physiology ; Blood Flow Velocity/physiology ; Veins ; Retinal Vessels/physiology
    Language English
    Publishing date 2023-07-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 391794-0
    ISSN 1552-5783 ; 0146-0404
    ISSN (online) 1552-5783
    ISSN 0146-0404
    DOI 10.1167/iovs.64.10.15
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  4. Article ; Online: Progress in the Treatment of Small Intestine Cancer.

    Symons, Rebecca / Daly, Daniel / Gandy, Robert / Goldstein, David / Aghmesheh, Morteza

    Current treatment options in oncology

    2023  Volume 24, Issue 4, Page(s) 241–261

    Abstract: Opinion statement: Small intestine cancer is rare, accounting for approximately 3% of all gastrointestinal malignancies. The most common histological subtypes include adenocarcinoma, neuroendocrine tumours (NETs) and gastrointestinal stromal tumours ( ... ...

    Abstract Opinion statement: Small intestine cancer is rare, accounting for approximately 3% of all gastrointestinal malignancies. The most common histological subtypes include adenocarcinoma, neuroendocrine tumours (NETs) and gastrointestinal stromal tumours (GISTs). In localised disease, surgery remains the mainstay of treatment and the best approach to improve survival. Current treatment for small intestine adenocarcinoma (SIA) is extrapolated from small studies and data from colorectal cancer (CRC). There is limited evidence to guide therapy in the adjuvant setting. However, there are small phase II studies in the advanced setting providing evidence for the role of chemotherapy and immunotherapy. There is also limited evidence assessing the efficacy of targeted therapies. Small intestine NETs are rare, with evidence for somatostatin analogue therapy, particularly in the low to intermediate-grade well-differentiated tumours. Poorly differentiated NETs are generally managed with chemotherapy but have worse outcomes compared with well-differentiated NETs. The management of small intestine GISTs is largely targeting KIT mutations with imatinib. Recent trials have provided evidence for effective therapies in imatinib-resistant tumours and the potential role of immunotherapy. The aim of this article was to review the evidence for the current management and recent advances in the management of small intestine adenocarcinoma, NETs and GISTs.
    MeSH term(s) Humans ; Imatinib Mesylate/therapeutic use ; Antineoplastic Agents/therapeutic use ; Intestine, Small/pathology ; Intestinal Neoplasms/diagnosis ; Intestinal Neoplasms/etiology ; Intestinal Neoplasms/therapy ; Duodenal Neoplasms ; Gastrointestinal Stromal Tumors/diagnosis ; Gastrointestinal Stromal Tumors/etiology ; Gastrointestinal Stromal Tumors/therapy ; Neuroendocrine Tumors/therapy ; Adenocarcinoma/drug therapy
    Chemical Substances Imatinib Mesylate (8A1O1M485B) ; Antineoplastic Agents
    Language English
    Publishing date 2023-02-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057351-0
    ISSN 1534-6277 ; 1527-2729
    ISSN (online) 1534-6277
    ISSN 1527-2729
    DOI 10.1007/s11864-023-01058-3
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    Zs.A 5523: Show issues Location:
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  5. Article ; Online: Rates of paclitaxel hypersensitivity reactions using a modified Markman's infusion protocol as primary prophylaxis.

    Symons, Rebecca / Heath, Fiona / Duggan, Jennifer / Bui, Kim Tam / Byun, Lily / Friedlander, Michael / Lee, Yeh Chen

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2024  Volume 32, Issue 5, Page(s) 292

    Abstract: Purpose: Markman's desensitisation protocol allows successful retreatment of patients who have had significant paclitaxel hypersensitivity reactions. We aimed to reduce the risk and severity of paclitaxel hypersensitivity reactions by introducing this ... ...

    Abstract Purpose: Markman's desensitisation protocol allows successful retreatment of patients who have had significant paclitaxel hypersensitivity reactions. We aimed to reduce the risk and severity of paclitaxel hypersensitivity reactions by introducing this protocol as primary prophylaxis.
    Methods: We evaluated all patients with a gynaecological malignancy receiving paclitaxel before (December 2018 to September 2019) and after (October 2019 to July 2020) the implementation of a modified Markman's desensitisation protocol. The pre-implementation group received paclitaxel over a gradually up-titrated rate from 60 to 180 ml/h. The post-implementation group received paclitaxel via 3 fixed-dose infusion bags in the first 2 cycles. Rates and severity of paclitaxel hypersensitivity reactions were compared.
    Results: A total of 426 paclitaxel infusions were administered to 78 patients. The median age was 64 years (range 34-81), and the most common diagnosis was ovarian, fallopian tube and primary peritoneal cancer (67%, n = 52/78). Paclitaxel hypersensitivity reaction rates were similar in the pre-implementation (8%, n = 16/195) and post-implementation groups (9%, n = 20/231; p = 0.87). Most paclitaxel hypersensitivity reactions occurred within 30 min (pre- vs. post-implementation, 88% [n = 14/16] vs. 75% [n = 15/20]; p = 0.45) and were grade 2 in severity (pre- vs. post-implementation, 81% [n = 13/16] vs. 75% [n = 15/20]; p = 0.37). There was one grade 3 paclitaxel hypersensitivity reaction in the pre-implementation group. All patients were successfully rechallenged in the post-implementation group compared to 81% (n = 13/16) in the pre-implementation group (p = 0.43).
    Conclusion: The modified Markman's desensitisation protocol as primary prophylaxis did not reduce the rate or severity of paclitaxel hypersensitivity reactions, although all patients could be successfully rechallenged.
    MeSH term(s) Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Drug Hypersensitivity/prevention & control ; Paclitaxel/adverse effects ; Genital Neoplasms, Female/drug therapy
    Chemical Substances Paclitaxel (P88XT4IS4D)
    Language English
    Publishing date 2024-04-17
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-024-08460-z
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    Zs.A 3697: Show issues Location:
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  6. Article ; Online: Myocardial T1 mapping and extracellular volume quantification as novel biomarkers in risk stratification of patients with systemic sclerosis.

    Bordonaro, V / Bivort, D / Dresselaers, T / De Langhe, E / Bogaert, J / Symons, R

    Clinical radiology

    2020  Volume 76, Issue 2, Page(s) 162.e1–162.e8

    Abstract: Aim: To study the prognostic value of myocardial native T1 and extracellular volume (ECV), measured by cardiovascular magnetic resonance (CMR), in patients with systemic sclerosis (SSc).: Materials and methods: Thirty-three SSc patients (16/33 male, ... ...

    Abstract Aim: To study the prognostic value of myocardial native T1 and extracellular volume (ECV), measured by cardiovascular magnetic resonance (CMR), in patients with systemic sclerosis (SSc).
    Materials and methods: Thirty-three SSc patients (16/33 male, 48.5%) were studied using multiparametric CMR including native T1 mapping with ECV calculation, T2 mapping, and late gadolinium enhancement (LGE). Patients were followed-up for cardiac death, haemodynamically significant arrhythmia, or heart failure. Results were compared with 33 age- and gender-matched healthy controls.
    Results: When compared with controls, SSc patients had higher myocardial native T1 (1,058.9±71 versus 989.4±21.4 ms, p<0.001), higher T2 (54.9±5.7 versus 50±2.5 ms, p<0.001), and ECV values (27.9±5.4% versus 24.8±2%, p<0.004). LGE was present in eight patients (24%), two subendocardial, five midwall, and four subepicardial. LGE, native T1, and ECV were significantly associated with adverse events during follow-up in multivariate Cox regression analysis. Kaplan-Meier analysis demonstrated significant divergence of the survival curves based on the presence of elevated native T1 (≥1,069 ms) or ECV (≥31.4%) values.
    Conclusion: Cardiac involvement is frequent in SSc. Both native T1 mapping and ECV represent novel non-invasive markers of myocardial fibrosis and could be used in the risk stratification of patients with SSc. CMR mapping may provide a novel biomarker for disease monitoring and study of therapies aiming to reduce myocardial fibrosis in SSc.
    MeSH term(s) Biomarkers ; Female ; Heart/diagnostic imaging ; Heart Diseases/complications ; Heart Diseases/diagnostic imaging ; Humans ; Male ; Middle Aged ; Multiparametric Magnetic Resonance Imaging/methods ; Risk Assessment ; Scleroderma, Systemic/complications
    Chemical Substances Biomarkers
    Language English
    Publishing date 2020-10-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 391227-9
    ISSN 1365-229X ; 0009-9260
    ISSN (online) 1365-229X
    ISSN 0009-9260
    DOI 10.1016/j.crad.2020.09.023
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  7. Article ; Online: Performance of Automated ASPECTS Software and Value as a Computer-Aided Detection Tool.

    Lambert, J / Demeestere, J / Dewachter, B / Cockmartin, L / Wouters, A / Symons, R / Boomgaert, L / Vandewalle, L / Scheldeman, L / Demaerel, P / Lemmens, R

    AJNR. American journal of neuroradiology

    2023  Volume 44, Issue 8, Page(s) 894–900

    Abstract: Background and purpose: ASPECTS quantifies early ischemic changes in anterior circulation stroke on NCCT but has interrater variability. We examined the agreement of conventional and automated ASPECTS and studied the value of computer-aided detection.!## ...

    Abstract Background and purpose: ASPECTS quantifies early ischemic changes in anterior circulation stroke on NCCT but has interrater variability. We examined the agreement of conventional and automated ASPECTS and studied the value of computer-aided detection.
    Materials and methods: We retrospectively collected imaging data from consecutive patients with acute ischemic stroke with large-vessel occlusion undergoing thrombectomy. Five raters scored conventional ASPECTS on baseline NCCTs, which were also processed by RAPID software. Conventional and automated ASPECTS were compared with a consensus criterion standard. We determined the agreement over the full ASPECTS range as well as dichotomized, reflecting thrombectomy eligibility according to the guidelines (ASPECTS 0-5 versus 6-10). Raters subsequently scored ASPECTS on the same NCCTs with assistance of the automated ASPECTS outputs, and agreement was obtained.
    Results: For the total of 175 cases, agreement among raters individually and the criterion standard varied from fair to good (weighted κ = between 0.38 and 0.76) and was moderate (weighted κ = 0.59) for the automated ASPECTS. The agreement of all raters individually versus the criterion standard improved with software assistance, as did the interrater agreement (overall Fleiss κ = 0.15-0.23;
    Conclusions: Automated ASPECTS had agreement with the criterion standard similar to that of conventional ASPECTS. However, including automated ASPECTS during the evaluation of NCCT in acute stroke improved the agreement with the criterion standard and improved interrater agreement, which could, therefore, result in more uniform scoring in clinical practice.
    MeSH term(s) Humans ; Brain Ischemia/diagnostic imaging ; Ischemic Stroke ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Stroke/diagnostic imaging ; Software ; Computers
    Language English
    Publishing date 2023-07-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603808-6
    ISSN 1936-959X ; 0195-6108
    ISSN (online) 1936-959X
    ISSN 0195-6108
    DOI 10.3174/ajnr.A7956
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  8. Article: Financing adaptation for resilient livelihoods under food system transformation: the role of Multilateral Development Banks.

    Lipper, Leslie / Cavatassi, Romina / Symons, Ricci / Gordes, Alashiya / Page, Oliver

    Food security

    2021  Volume 13, Issue 6, Page(s) 1525–1540

    Abstract: Climate change is imposing a transformative process on agricultural and food systems, threatening the livelihoods of people dependent upon them which includes a large share of the world's poor people. Transformative adaptation that addresses the risks ... ...

    Abstract Climate change is imposing a transformative process on agricultural and food systems, threatening the livelihoods of people dependent upon them which includes a large share of the world's poor people. Transformative adaptation that addresses the risks and vulnerabilities to livelihoods that climate change imposes is essential for effective and inclusive transformation of food systems. Financing that is adequate, accessible and appropriate is essential to realizing these objectives. Multilateral Development Banks (MDBs) are already playing an important role in financing transformative adaptation in the agri-food sector and are well-placed to address some of the existing shortcomings. Expanding public sector climate finance and incentivizing private sector investments is needed to attain adequate levels of financing. Reconsidering the rules and procedures for obtaining public sector finance and the capacity to utilize already existent administrative structures, as well as better targeting of activities and communities is important for accessibility. Appropriate finance requires use of mechanisms that address characteristics of the investment, including riskiness, delayed returns, high social values and new and unproven activities. Utilizing blended finance integrated with development finance can generate financing appropriate to the investment needs. Some positive shifts in these directions are already being undertaken by MDBs but more is required.
    Language English
    Publishing date 2021-10-15
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2486755-X
    ISSN 1876-4525 ; 1876-4517
    ISSN (online) 1876-4525
    ISSN 1876-4517
    DOI 10.1007/s12571-021-01210-7
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  9. Article ; Online: CMR and CT of the Patient With Cardiac Devices: Safety, Efficacy, and Optimization Strategies.

    Symons, Rolf / Zimmerman, Stefan L / Bluemke, David A

    JACC. Cardiovascular imaging

    2019  Volume 12, Issue 5, Page(s) 890–903

    Abstract: Cardiac magnetic resonance (CMR) and cardiac CT (CCT) have evolved into powerful diagnostic tools in the evaluation of patients with cardiovascular diseases. However, the use of these imaging techniques poses potential safety concerns for patients with ... ...

    Abstract Cardiac magnetic resonance (CMR) and cardiac CT (CCT) have evolved into powerful diagnostic tools in the evaluation of patients with cardiovascular diseases. However, the use of these imaging techniques poses potential safety concerns for patients with implanted cardiac devices. These concerns result from the potential for electromagnetic interaction between the device and the CMR field or CCT x-ray radiation, which could lead to device heating, malfunction, or dislocation. Additionally, the presence of cardiac devices may induce significant image artifacts due to local magnetic field inhomogeneities (CMR) or photon starvation/beam hardening (CCT). In this review summarizes the safety issues regarding imaging in patients with cardiac devices. Optimization strategies to mitigate image artifacts and to improve imaging efficacy are discussed.
    MeSH term(s) Artifacts ; Cardiac Catheters ; Defibrillators, Implantable ; Heart Valve Prosthesis ; Heart-Assist Devices ; Humans ; Magnetic Resonance Imaging/adverse effects ; Pacemaker, Artificial ; Predictive Value of Tests ; Reproducibility of Results ; Septal Occluder Device ; Stents ; Tomography, X-Ray Computed/adverse effects
    Language English
    Publishing date 2019-05-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2491503-8
    ISSN 1876-7591 ; 1936-878X
    ISSN (online) 1876-7591
    ISSN 1936-878X
    DOI 10.1016/j.jcmg.2018.09.030
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  10. Article ; Online: A statistical framework to estimate diagnostic test performance for COVID-19.

    Symons, R / Beath, K / Dangis, A / Lefever, S / Smismans, A / De Bruecker, Y / Frans, J

    Clinical radiology

    2020  Volume 76, Issue 1, Page(s) 75.e1–75.e3

    MeSH term(s) COVID-19/diagnosis ; COVID-19/diagnostic imaging ; COVID-19 Nucleic Acid Testing/methods ; COVID-19 Nucleic Acid Testing/standards ; COVID-19 Nucleic Acid Testing/statistics & numerical data ; Humans ; Lung/diagnostic imaging ; Reproducibility of Results ; Tomography, X-Ray Computed/methods ; Tomography, X-Ray Computed/standards ; Tomography, X-Ray Computed/statistics & numerical data
    Keywords covid19
    Language English
    Publishing date 2020-10-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 391227-9
    ISSN 1365-229X ; 0009-9260
    ISSN (online) 1365-229X
    ISSN 0009-9260
    DOI 10.1016/j.crad.2020.10.004
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