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Lidén, M., Spahr, A., Hjelmgren, O., Bendazzoli, S., Sundh, J., Sköld, M., . . . Thunberg, P. (2023). Machine learning slice-wise whole-lung CT emphysema score correlates with airway obstruction. European Radiology
Open this publication in new window or tab >>Machine learning slice-wise whole-lung CT emphysema score correlates with airway obstruction
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2023 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Quantitative CT imaging is an important emphysema biomarker, especially in smoking cohorts, but does not always correlate to radiologists' visual CT assessments. The objectives were to develop and validate a neural network-based slice-wise whole-lung emphysema score (SWES) for chest CT, to validate SWES on unseen CT data, and to compare SWES with a conventional quantitative CT method.

MATERIALS AND METHODS: Separate cohorts were used for algorithm development and validation. For validation, thin-slice CT stacks from 474 participants in the prospective cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) were included, 395 randomly selected and 79 from an emphysema cohort. Spirometry (FEV1/FVC) and radiologists' visual emphysema scores (sum-visual) obtained at inclusion in SCAPIS were used as reference tests. SWES was compared with a commercially available quantitative emphysema scoring method (LAV950) using Pearson's correlation coefficients and receiver operating characteristics (ROC) analysis.

RESULTS: SWES correlated more strongly with the visual scores than LAV950 (r = 0.78 vs. r = 0.41, p < 0.001). The area under the ROC curve for the prediction of airway obstruction was larger for SWES than for LAV950 (0.76 vs. 0.61, p = 0.007). SWES correlated more strongly with FEV1/FVC than either LAV950 or sum-visual in the full cohort (r =  - 0.69 vs. r =  - 0.49/r =  - 0.64, p < 0.001/p = 0.007), in the emphysema cohort (r =  - 0.77 vs. r =  - 0.69/r =  - 0.65, p = 0.03/p = 0.002), and in the random sample (r =  - 0.39 vs. r =  - 0.26/r =  - 0.25, p = 0.001/p = 0.007).

CONCLUSION: The slice-wise whole-lung emphysema score (SWES) correlates better than LAV950 with radiologists' visual emphysema scores and correlates better with airway obstruction than do LAV950 and radiologists' visual scores.

CLINICAL RELEVANCE STATEMENT: The slice-wise whole-lung emphysema score provides quantitative emphysema information for CT imaging that avoids the disadvantages of threshold-based scores and is correlated more strongly with reference tests than LAV950 and reader visual scores.

KEY POINTS: • A slice-wise whole-lung emphysema score (SWES) was developed to quantify emphysema in chest CT images. • SWES identified visual emphysema and spirometric airflow limitation significantly better than threshold-based score (LAV950). • SWES improved emphysema quantification in CT images, which is especially useful in large-scale research.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Deep learning, Lung, Pulmonary disease, chronic obstructive, Pulmonary emphysema, Tomography, X-ray computed
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-107501 (URN)10.1007/s00330-023-09985-3 (DOI)37552259 (PubMedID)2-s2.0-85167352439 (Scopus ID)
Available from: 2023-08-10 Created: 2023-08-10 Last updated: 2024-01-02Bibliographically approved
Krauss, W., Janusz, F., Heydorn Lagerlöf, J., Lidén, M. & Thunberg, P. (2023). Radiomics from multisite MRI and clinical data to predict clinically significant prostate cancer. Acta Radiologica, Article ID 2841851231216555.
Open this publication in new window or tab >>Radiomics from multisite MRI and clinical data to predict clinically significant prostate cancer
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2023 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, article id 2841851231216555Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Magnetic resonance imaging (MRI) is useful in the diagnosis of clinically significant prostate cancer (csPCa). MRI-derived radiomics may support the diagnosis of csPCa. PURPOSE: To investigate whether adding radiomics from biparametric MRI to predictive models based on clinical and MRI parameters improves the prediction of csPCa in a multisite-multivendor setting.

MATERIAL AND METHODS: Clinical information (PSA, PSA density, prostate volume, and age), MRI reviews (PI-RADS 2.1), and radiomics (histogram and texture features) were retrieved from prospectively included patients examined at different radiology departments and with different MRI systems, followed by MRI-ultrasound fusion guided biopsies of lesions PI-RADS 3-5. Predictive logistic regression models of csPCa (Gleason score ≥7) for the peripheral (PZ) and transition zone (TZ), including clinical data and PI-RADS only, and combined with radiomics, were built and compared using receiver operating characteristic (ROC) curves.

RESULTS: In total, 456 lesions in 350 patients were analyzed. In PZ and TZ, PI-RADS 4-5 and PSA density, and age in PZ, were independent predictors of csPCa in models without radiomics. In models including radiomics, PI-RADS 4-5, PSA density, age, and ADC energy were independent predictors in PZ, and PI-RADS 5, PSA density and ADC mean in TZ. Comparison of areas under the ROC curve (AUC) for the models without radiomics (PZ: AUC = 0.82, TZ: AUC = 0.80) versus with radiomics (PZ: AUC = 0.82, TZ: AUC = 0.82) showed no significant differences (PZ: P = 0.366; TZ: P = 0.171).

CONCLUSION: PSA density and PI-RADS are potent predictors of csPCa. Radiomics do not add significant information to our multisite-multivendor dataset.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
PI-RADS, magnetic resonance imaging, multisite-multivendor, prostate cancer, radiomics
National Category
Urology and Nephrology Radiology, Nuclear Medicine and Medical Imaging Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-110453 (URN)10.1177/02841851231216555 (DOI)001127589000001 ()38115809 (PubMedID)2-s2.0-85180205504 (Scopus ID)
Funder
Region Örebro County
Available from: 2023-12-20 Created: 2023-12-20 Last updated: 2024-02-05Bibliographically approved
Humble, M. B., Eklund, D., Fresnais, D., Hylén, U., Sigra, S., Thunberg, P. & Bejerot, S. (2023). Rituximab for treatment-resistant schizophrenia and/or obsessive-compulsive disorder (OCD): functional connectivity and cytokines associated with symptomatic improvements. Paper presented at 31st European Congress of Psychiatry (EPA 2023), Paris, France, March 25-28, 2023. European psychiatry, 66(Suppl. 1), S629-S629, Article ID EPP1035.
Open this publication in new window or tab >>Rituximab for treatment-resistant schizophrenia and/or obsessive-compulsive disorder (OCD): functional connectivity and cytokines associated with symptomatic improvements
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2023 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 66, no Suppl. 1, p. S629-S629, article id EPP1035Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Immunological mechanisms may contribute to the causation of mental illness. Autoimmunity is most convincingly shown for anti-NMDA-R encephalitis and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS); disorders that overlap clinically with schizophrenia and OCD. Altered inflammatory cytokine production, glial activation and auto-antibodies have also been associated with schizophrenia and OCD. In these disorders, however, the treatment results with anti-inflammatory or immunomodulating drugs have hitherto been limited and inconsistent. Yet other targets within the immune system may still be effective and new options are warranted for treatment-resistant patients. Rituximab targets B-lymphocytes and is often used in autoimmune disorders such as rheumatoid arthritis, multiple sclerosis and anti-NMDA-R encephalitis.

Objectives: We aimed to investigate whether rituximab is clinically effective, safe and tolerable as add-on therapy in markedly ill, treatment-resistant adult psychiatric patients with schizophrenia or OCD. We also wanted to identify putative mediating mechanisms in treatment responders, such as cytokine changes and functional connectivity (FC).

Methods: In an open pilot study, adults (18-39 years) with treatment-resistant schizophrenia and/or OCD were included. They received an intravenous infusion of rituximab 1000 mg, once at baseline, in addition to their regular psychiatric medication and were followed for 1 year. The main outcome measures were the Positive and Negative Syndrome Scale (PANSS) or Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impression-Improvement scale (CGI-I) and the Personal and Social Performance scale (PSP). Treatment response was defined as ≥ 40 % decrease in PANSS or ≥ 35 % decrease in Y-BOCS, and much improved according to CGI-I. Resting-state fMRI was applied at baseline and after 5 months. Plasma cytokines were measured at 0, 3 and 5 months. Cognitive tests and the recently developed PsychoNeuroinflammatory Related Signs and Symptoms Inventory (PNISSI) were used to identify and measure symptoms related to neuro-inflammation and cognitive function.

Results: Nineteen patients were treated with rituximab. 3-5 months after treatment, 6/9 patients with schizophrenia and 1/10 with OCD responded. One schizophrenia patient continues with rituximab every 6 months and has reportedly done well for almost 3 years. No severe side effects were reported apart from recurrent abdominal pain in a schizophrenia patient and one case of post-COVID-19 syndrome. Significant changes of FC were detected in responders only and correlated with PSP changes.

Conclusions: Aberrant B-cell activities may contribute to treatment-resistant schizophrenia and be amenable to treatment with rituximab. However, the results of this pilot study need confirmation in placebo-controlled trials.

Place, publisher, year, edition, pages
Cambridge University Press, 2023
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109391 (URN)10.1192/j.eurpsy.2023.1309 (DOI)001060676601588 ()
Conference
31st European Congress of Psychiatry (EPA 2023), Paris, France, March 25-28, 2023
Available from: 2023-10-25 Created: 2023-10-25 Last updated: 2024-02-23Bibliographically approved
Rode, J., Runnamo, R., Thunberg, P. & Msghina, M. (2023). Salience and hedonic experience as predictors of central stimulant treatment response in ADHD: A resting state fMRI study. Journal of Psychiatric Research, 163, 378-385
Open this publication in new window or tab >>Salience and hedonic experience as predictors of central stimulant treatment response in ADHD: A resting state fMRI study
2023 (English)In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 163, p. 378-385Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Roughly 20-30% of patients with Attention-deficit/hyperactivity disorder (ADHD) fail to respond to central stimulant (CS) medication. Genetic, neuroimaging, biochemical and behavioral biomarkers for CS response have been investigated, but currently there are no biomarkers available for clinical use that help identify CS responders and non-responders.

METHODS: In the present paper, we studied if incentive salience and hedonic experience evaluated after a single-dose CS medication could predict response and non-response to CS medication. We used a bipolar visual analogue 'wanting' and 'liking' scale to gauge incentive salience and hedonic experience in 25 healthy controls (HC) and 29 ADHD patients. HC received 30 mg methylphenidate (MPH) and ADHD patients received either MPH or lisdexamphetamine (LDX) as selected by their clinician, with dosage individually determined for optimal effect. Clinician-evaluated global impression - severity (CGI-S) and improvement (CGI-I) and patient-evaluated improvement (PGI-I) were used to assess response to CS medication. Resting state functional magnetic resonance imaging (fMRI) was conducted before and after single-dose CS to correlate wanting and liking scores to changes in functional connectivity.

RESULTS: Roughly 20% of the ADHD patients were CS non-responders (5 of 29). CS responders had significantly higher incentive salience and hedonic experience scores compared to healthy controls and CS non-responders. Resting state fMRI showed that wanting scores were significantly associated to changes in functional connectivity in ventral striatum including nucleus accumbens.

CONCLUSION: Incentive salience and hedonic experience evaluated after a single-dose CS medication segregate CS responders and non-responders, with corresponding neuroimaging biomarkers in the brain reward system.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Attention-deficit/hyperactivity disorder, Central stimulant treatment, Incentive salience, Pharmacological challenge, Resting state, Treatment prediction
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-106174 (URN)10.1016/j.jpsychires.2023.05.073 (DOI)001013035000001 ()37269772 (PubMedID)2-s2.0-85160538869 (Scopus ID)
Funder
Nyckelfonden, 93542Region Örebro County, OLL-787911
Available from: 2023-06-05 Created: 2023-06-05 Last updated: 2024-01-02Bibliographically approved
Bejerot, S., Eklund, D., Hesser, H., Hietala, M. A., Kariis, T., Lange, N., . . . Humble, M. B. (2023). Study protocol for a randomized controlled trial with rituximab for psychotic disorder in adults (RCT-Rits). BMC Psychiatry, 23(1), Article ID 771.
Open this publication in new window or tab >>Study protocol for a randomized controlled trial with rituximab for psychotic disorder in adults (RCT-Rits)
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2023 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 771Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The role of inflammation in the aetiology of schizophrenia has gained wide attention and research on the association shows an exponential growth in the last 15 years. Autoimmune diseases and severe infections are risk factors for the later development of schizophrenia, elevated inflammatory markers in childhood or adolescence are associated with a greater risk of schizophrenia in adulthood, individuals with schizophrenia have increased levels of pro-inflammatory cytokines compared to healthy controls, and autoimmune diseases are overrepresented in schizophrenia. However, treatments with anti-inflammatory agents are so far of doubtful clinical relevance. The primary objective of this study is to test whether the monoclonal antibody rituximab, directed against the B-cell antigen CD20 ameliorates psychotic symptoms in adults with schizophrenia or schizoaffective disorder and to examine potential mechanisms. A secondary objective is to examine characteristics of inflammation-associated psychosis and to identify pre-treatment biochemical characteristics of rituximab responders. A third objective is to interview a subset of patients and informants on their experiences of the trial to obtain insights that rating scales may not capture.

METHODS: A proof-of-concept study employing a randomised, parallel-group, double-blind, placebo-controlled design testing the effect of B-cell depletion in patients with psychosis. 120 participants with a diagnosis of schizophrenia spectrum disorders (SSD) (ICD-10 codes F20, F25) will receive either one intravenous infusion of rituximab (1000 mg) or saline. Psychiatric measures and blood samples will be collected at baseline, week 12, and week 24 post-infusion. Brief assessments will also be made in weeks 2 and 7. Neuroimaging and lumbar puncture, both optional, will be performed at baseline and endpoints. Approximately 40 of the patients and their informants will be interviewed for qualitative analyses on the perceived changes in well-being and emotional qualities, in addition to their views on the research.

DISCUSSION: This is the first RCT investigating add-on treatment with rituximab in unselected SSD patients. If the treatment is helpful, it may transform the treatment of patients with psychotic disorders. It may also heighten the awareness of immune-psychiatric disorders and reduce stigma.

TRIAL REGISTRATION: NCT05622201, EudraCT-nr 2022-000220-37 version 2.1. registered 14th of October 2022.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Clinical trials, Immunology, Inflammation, Magnetic resonance imaging, Monoclonal antibodies, Schizophrenia & psychotic disorders
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109377 (URN)10.1186/s12888-023-05250-5 (DOI)001095789000002 ()37872497 (PubMedID)2-s2.0-85174826025 (Scopus ID)
Funder
Örebro UniversitySwedish Research Council, 2022-00288The Swedish Brain Foundation, FO2022-0073Torsten Söderbergs stiftelse, MT4/22
Available from: 2023-10-24 Created: 2023-10-24 Last updated: 2024-01-17Bibliographically approved
Rode, J., Edebol Carlman, H. M. T., König, J., Hutchinson, A., Thunberg, P., Persson, J. & Brummer, R. J. (2022). Multi-Strain Probiotic Mixture Affects Brain Morphology and Resting State Brain Function in Healthy Subjects: An RCT. Cells, 11(18), Article ID 2922.
Open this publication in new window or tab >>Multi-Strain Probiotic Mixture Affects Brain Morphology and Resting State Brain Function in Healthy Subjects: An RCT
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2022 (English)In: Cells, E-ISSN 2073-4409, Vol. 11, no 18, article id 2922Article in journal (Refereed) Published
Abstract [en]

Probiotics can alter brain function via the gut-brain axis. We investigated the effect of a probiotic mixture containing Bifidobacterium longum, Lactobacillus helveticus and Lactiplantibacillus plantarum. In a randomized, placebo-controlled, double-blinded crossover design, 22 healthy subjects (6 m/16 f; 24.2 ± 3.4 years) underwent four-week intervention periods with probiotics and placebo, separated by a four-week washout period. Voxel-based morphometry indicated that the probiotic intervention affected the gray matter volume of a cluster covering the left supramarginal gyrus and superior parietal lobule (p &lt; 0.0001), two regions that were also among those with an altered resting state functional connectivity. Probiotic intervention resulted in significant (FDR &lt; 0.05) functional connectivity changes between regions within the default mode, salience, frontoparietal as well as the language network and several regions located outside these networks. Psychological symptoms trended towards improvement after probiotic intervention, i.e., the total score of the Hospital Anxiety and Depression Scale (p = 0.056) and its depression sub-score (p = 0.093), as well as sleep patterns (p = 0.058). The probiotic intervention evoked distinct changes in brain morphology and resting state brain function alongside slight improvements of psycho(bio)logical markers of the gut-brain axis. The combination of those parameters may provide new insights into the modes of action by which gut microbiota can affect gut-brain communication and hence brain function.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
CO2 inhalation challenge, autonomic nervous system, brain-derived neurotrophic factor (BDNF), cortisol awakening response, gut microbiota, mental health, resting state functional connectivity, serotonin, sleep quality, structural changes
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-101446 (URN)10.3390/cells11182922 (DOI)000858164900001 ()36139496 (PubMedID)2-s2.0-85138356660 (Scopus ID)
Note

Funding agencies:

Global Medical Innovation

Pfizer Consumer Healthcare

General Electric 20150081

Available from: 2022-09-24 Created: 2022-09-24 Last updated: 2022-10-05Bibliographically approved
Edebol Carlman, H. M. T., Rode, J., König, J., Repsilber, D., Hutchinson, A., Thunberg, P., . . . Brummer, R. J. (2022). Probiotic Mixture Containing Lactobacillus helveticus, Bifidobacterium longum and Lactiplantibacillus plantarum Affects Brain Responses to an Arithmetic Stress Task in Healthy Subjects: A Randomised Clinical Trial and Proof-of-Concept Study. Nutrients, 14(7), Article ID 1329.
Open this publication in new window or tab >>Probiotic Mixture Containing Lactobacillus helveticus, Bifidobacterium longum and Lactiplantibacillus plantarum Affects Brain Responses to an Arithmetic Stress Task in Healthy Subjects: A Randomised Clinical Trial and Proof-of-Concept Study
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2022 (English)In: Nutrients, E-ISSN 2072-6643, Vol. 14, no 7, article id 1329Article in journal (Refereed) Published
Abstract [en]

Probiotics are suggested to impact physiological and psychological stress responses by acting on the gut-brain axis. We investigated if a probiotic product containing Bifidobacterium longum R0175, Lactobacillus helveticus R0052 and Lactiplantibacillus plantarum R1012 affected stress processing in a double-blinded, randomised, placebo-controlled, crossover proof-of-concept study (NCT03615651). Twenty-two healthy subjects (24.2 ± 3.4 years, 6 men/16 women) underwent a probiotic and placebo intervention for 4 weeks each, separated by a 4-week washout period. Subjects were examined by functional magnetic resonance imaging while performing the Montreal Imaging Stress Task (MIST) as well as an autonomic nervous system function assessment during the Stroop task. Reduced activation in regions of the lateral orbital and ventral cingulate gyri was observed after probiotic intervention compared to placebo. Significantly increased functional connectivity was found between the upper limbic region and medioventral area. Interestingly, probiotic intervention seemed to predominantly affect the initial stress response. Salivary cortisol secretion during the task was not altered. Probiotic intervention did not affect cognitive performance and autonomic nervous system function during Stroop. The probiotic intervention was able to subtly alter brain activity and functional connectivity in regions known to regulate emotion and stress responses. These findings support the potential of probiotics as a non-pharmaceutical treatment modality for stress-related disorders.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
Montreal Imaging Stress Task (MIST), autonomic nervous system, brain activity, functional magnetic resonance imaging (fMRI), gut microbiota, gut-brain axis
National Category
Nutrition and Dietetics Neurosciences
Identifiers
urn:nbn:se:oru:diva-98559 (URN)10.3390/nu14071329 (DOI)000781150400001 ()35405944 (PubMedID)2-s2.0-85126989886 (Scopus ID)
Note

Funding agencies:

Global Medical Innovation

Pfizer Consumer Healthcare

General Electric 20150081

Available from: 2022-04-13 Created: 2022-04-13 Last updated: 2023-08-28Bibliographically approved
Rode, J., Edebol Carlman, H. M. T., König, J., Repsilber, D., Hutchinson, A., Thunberg, P., . . . Brummer, R. J. (2022). Probiotic Mixture Containing Lactobacillus helveticus, Bifidobacterium longum and Lactiplantibacillus plantarum Affects Brain Responses Toward an Emotional Task in Healthy Subjects: A Randomized Clinical Trial. Frontiers in nutrition, 9, Article ID 827182.
Open this publication in new window or tab >>Probiotic Mixture Containing Lactobacillus helveticus, Bifidobacterium longum and Lactiplantibacillus plantarum Affects Brain Responses Toward an Emotional Task in Healthy Subjects: A Randomized Clinical Trial
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2022 (English)In: Frontiers in nutrition, E-ISSN 2296-861X, Vol. 9, article id 827182Article in journal (Refereed) Published
Abstract [en]

Background: Evidence from preclinical studies suggests that probiotics affect brain function via the microbiome-gut-brain axis, but evidence in humans remains limited.

Objective: The present proof-of-concept study investigated if a probiotic product containing a mixture of Bifidobacterium longum R0175, Lactobacillus helveticus R0052 and Lactiplantibacillus plantarum R1012 (in total 3 × 109 CFU/day) affected functional brain responses in healthy subjects during an emotional attention task.

Design: In this double-blinded, randomized, placebo-controlled crossover study (Clinicaltrials.gov, NCT03615651), 22 healthy subjects (24.2 ± 3.4 years, 6 males/16 females) were exposed to a probiotic intervention and a placebo for 4 weeks each, separated by a 4-week washout period. Subjects underwent functional magnetic resonance imaging while performing an emotional attention task after each intervention period. Differential brain activity and functional connectivity were assessed.

Results: Altered brain responses were observed in brain regions implicated in emotional, cognitive and face processing. Increased activation in the orbitofrontal cortex, a region that receives extensive sensory input and in turn projects to regions implicated in emotional processing, was found after probiotic intervention compared to placebo using a cluster-based analysis of functionally defined areas. Significantly reduced task-related functional connectivity was observed after the probiotic intervention compared to placebo. Fecal microbiota composition was not majorly affected by probiotic intervention.

Conclusion: The probiotic intervention resulted in subtly altered brain activity and functional connectivity in healthy subjects performing an emotional task without major effects on the fecal microbiota composition. This indicates that the probiotic effects occurred via microbe-host interactions on other levels. Further analysis of signaling molecules could give possible insights into the modes of action of the probiotic intervention on the gut-brain axis in general and brain function specifically. The presented findings further support the growing consensus that probiotic supplementation influences brain function and emotional regulation, even in healthy subjects. Future studies including patients with altered emotional processing, such as anxiety or depression symptoms are of great interest.

Clinical Trial Registration: [http://clinicaltrials.gov/], identifier [NCT03615651].

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
Brain activity, emotional attention task (EAT), functional connectivity, functional magnetic resonance imaging (fMRI), gut microbiota, gut-brain axis, probiotics, task-related
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-99027 (URN)10.3389/fnut.2022.827182 (DOI)000796705800001 ()35571902 (PubMedID)2-s2.0-85130241273 (Scopus ID)
Note

Funding agencies:

Global Medical Innovation 

Pfizer Consumer Healthcare 

General Electric

Available from: 2022-05-17 Created: 2022-05-17 Last updated: 2023-12-08Bibliographically approved
Jendeberg, J., Thunberg, P. & Lidén, M. (2021). Differentiation of distal ureteral stones and pelvic phleboliths using a convolutional neural network. Urolithiasis, 49, 41-49
Open this publication in new window or tab >>Differentiation of distal ureteral stones and pelvic phleboliths using a convolutional neural network
2021 (English)In: Urolithiasis, ISSN 2194-7228, Vol. 49, p. 41-49Article in journal (Refereed) Published
Abstract [en]

The objectives were to develop and validate a Convolutional Neural Network (CNN) using local features for differentiating distal ureteral stones from pelvic phleboliths, compare the CNN method with a semi-quantitative method and with radiologists' assessments and to evaluate whether the assessment of a calcification and its local surroundings is sufficient for discriminating ureteral stones from pelvic phleboliths in non-contrast-enhanced CT (NECT). We retrospectively included 341 consecutive patients with acute renal colic and a ureteral stone on NECT showing either a distal ureteral stone, a phlebolith or both. A 2.5-dimensional CNN (2.5D-CNN) model was used, where perpendicular axial, coronal and sagittal images through each calcification were used as input data for the CNN. The CNN was trained on 384 calcifications, and evaluated on an unseen dataset of 50 stones and 50 phleboliths. The CNN was compared to the assessment by seven radiologists who reviewed a local 5 × 5 × 5 cm image stack surrounding each calcification, and to a semi-quantitative method using cut-off values based on the attenuation and volume of the calcifications. The CNN differentiated stones and phleboliths with a sensitivity, specificity and accuracy of 94%, 90% and 92% and an AUC of 0.95. This was similar to a majority vote accuracy of 93% and significantly higher (p = 0.03) than the mean radiologist accuracy of 86%. The semi-quantitative method accuracy was 49%. In conclusion, the CNN differentiated ureteral stones from phleboliths with higher accuracy than the mean of seven radiologists' assessments using local features. However, more than local features are needed to reach optimal discrimination.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2021
Keywords
Computed tomography, Convolutional neural networks, Deep learning, Pelvic phlebolith, Ureteral calculi
National Category
Medical Image Processing
Identifiers
urn:nbn:se:oru:diva-80303 (URN)10.1007/s00240-020-01180-z (DOI)000516967900002 ()32107579 (PubMedID)2-s2.0-85080104058 (Scopus ID)
Note

Funding Agencies:

Region Örebro län OLL-684531

Nyckelfonden OLL-787911

Available from: 2020-03-03 Created: 2020-03-03 Last updated: 2024-01-16Bibliographically approved
Lidén, M., Adrian, D., Widell, J., Uggla, B. & Thunberg, P. (2021). Quantitative T2* imaging of iron overload in a non-dedicated center - Normal variation, repeatability and reader variation. European journal of radiology open, 8, Article ID 100357.
Open this publication in new window or tab >>Quantitative T2* imaging of iron overload in a non-dedicated center - Normal variation, repeatability and reader variation
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2021 (English)In: European journal of radiology open, E-ISSN 2352-0477, Vol. 8, article id 100357Article in journal (Refereed) Published
Abstract [en]

Background: Patients with transfusion dependent anemia are at risk of complications from iron overload. Quantitative T2* magnetic resonance imaging (MRI) is the best non-invasive method to assess iron deposition in the liver and heart and to guide chelation therapy.

Purpose: To investigate the image quality and inter-observer variations in T2* measurements of the myocardium and the liver, and to obtain the lower limit of cardiac and hepatic quantitative T2* values in patients without suspicion of iron overload.

Material and methods: Thirty-eight patients referred for cardiac MRI were prospectively included in the study. Three patients were referred with, and 35 without suspicion of iron overload. Quantitative T2* parametric maps were obtained on a 1.5 T MRI system in the cardiac short axis and liver axial view. Two readers independently assessed the image quality and the representative and the lowest T2* value in the myocardium and the liver.

Results: The normal range of representative T2* values in the myocardium and liver was 24-45 ms and 14-37 ms, respectively. None of the 35 participants (0 %, 95 % confidence interval 0-11 %) in the normal reference group demonstrated representative T2* values below previously reported lower limits in the myocardium (20 ms) or the liver (8 ms). Focal myocardial areas with T2* values near the lower normal range, 19-20 ms, were seen in two patients. The readers generally reported good image quality.

Conclusion: T2* imaging for assessing iron overload can be performed in a non-dedicated center with sufficient image quality.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Heart, Iron overload, Liver, Quantitative MRI, T2 star, Thalassemia
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:oru:diva-92234 (URN)10.1016/j.ejro.2021.100357 (DOI)000704351700003 ()34095355 (PubMedID)2-s2.0-85106373618 (Scopus ID)
Funder
Region Örebro County, OLL-878081
Available from: 2021-06-08 Created: 2021-06-08 Last updated: 2021-10-21Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-8351-3367

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