Tommi Jeskanen, Venla Ylinen, Rasmus I. P. Valtonen, Mikko P. Tulppo
Significance
Near-infrared spectroscopy (NIRS) measurement is a widely used technique to measure muscle oxygenation. A knowledge of the reproducibility of NIRS measurements is essential for the correct interpretation of data.
Aim
Our aim was to test the reproducibility and sex differences of NIRS measurements during brachial artery occlusion in healthy participants.
Approach
An NIRS device was used to measure muscle oxygenation and microvascular function during a 5 min brachial occlusion. Muscle oxygen consumption (mVO2) and tissue saturation index (TSI%) were used. The occlusion test was performed three times on separate days for males (n = 13, 28 ± 8 years) and females (n = 13, 29 ± 7 years).
Results
During the occlusion phase, the reproducibility of mVO2 was excellent (intraclass correlation; ICC = 0.90). During the reperfusion phase, the maximal change in TSI% revealed the best reproducibility (ICC = 0.77). There were no sex differences in reproducibility. Male participants had higher muscle oxygenation during occlusion (mVO2, 0.054 ± 0.010 vs. 0.038 ± 0.012 mLO2/min/100 g, p = 0.001, male and female, respectively). There were no sex differences during the reperfusion phase.
Conclusion
The reproducibility of NIRS to measure muscle oxygenation and microvascular function during circulation occlusion and reperfusion is good to excellent. Muscle oxygen capacity measured during occlusion is higher in males compared to females, and there are no sex differences in microvascular function during the reperfusion phase.
{"title":"Reproducibility and sex differences in muscle oxygenation during brachial artery occlusion in healthy participants","authors":"Tommi Jeskanen, Venla Ylinen, Rasmus I. P. Valtonen, Mikko P. Tulppo","doi":"10.1111/cpf.12886","DOIUrl":"10.1111/cpf.12886","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>Near-infrared spectroscopy (NIRS) measurement is a widely used technique to measure muscle oxygenation. A knowledge of the reproducibility of NIRS measurements is essential for the correct interpretation of data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Our aim was to test the reproducibility and sex differences of NIRS measurements during brachial artery occlusion in healthy participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>An NIRS device was used to measure muscle oxygenation and microvascular function during a 5 min brachial occlusion. Muscle oxygen consumption (mVO<sub>2</sub>) and tissue saturation index (TSI%) were used. The occlusion test was performed three times on separate days for males (<i>n</i> = 13, 28 ± 8 years) and females (<i>n</i> = 13, 29 ± 7 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the occlusion phase, the reproducibility of mVO<sub>2</sub> was excellent (intraclass correlation; ICC = 0.90). During the reperfusion phase, the maximal change in TSI% revealed the best reproducibility (ICC = 0.77). There were no sex differences in reproducibility. Male participants had higher muscle oxygenation during occlusion (mVO<sub>2</sub>, 0.054 ± 0.010 vs. 0.038 ± 0.012 mLO<sub>2</sub>/min/100 g, <i>p</i> = 0.001, male and female, respectively). There were no sex differences during the reperfusion phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The reproducibility of NIRS to measure muscle oxygenation and microvascular function during circulation occlusion and reperfusion is good to excellent. Muscle oxygen capacity measured during occlusion is higher in males compared to females, and there are no sex differences in microvascular function during the reperfusion phase.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 5","pages":"388-395"},"PeriodicalIF":1.3,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joel Toftgård, Henrik Hedskog, Lars Rune, Jan Svedenhag, Gabriel Riva
Background
Postsystolic shortening (PSS) is one of the proposed quantitative measures to predict myocardial ischaemia in the stress echocardiographic (SE) evaluation. It is previously known that hypo-/akinesia (HA) correlates well with coronary stenosis. However, some patients undergoing SE only present with PSS, and their risk of significant coronary stenosis is less clear. This study aimed to evaluate the association between PSS and significant coronary stenosis compared with HA.
Methods
This was a retrospective cohort study at the hospital of S:t Görans, Stockholm, Sweden. All patients who underwent SE to investigate inducible ischaemia between 1 January 2018 and 15 October 2021 were eligible for inclusion. Exclusion criteria were normal SE and inconclusive test. Pathological SE were divided into two groups, patients with HA and those with PSS. Outcome was significant coronary artery stenosis visualized by invasive coronary angiography.
Results
The final study population consisted of 108 patients (73 PSS, 35 HA). The presence of HA was associated with a higher risk of significant stenosis compared to those with PSS (63% vs. 23%, p < 0.001). This relationship was observed among males (p < 0.001), but not among females (p = 0.133). Nonsignificant stenosis trended to be more common among patients with PSS (21% vs. 6%, p = 0.053)
Conclusions
The finding of PSS without HA was associated with a lower risk of significant coronary stenosis than HA. However, patients with PSS still often had nonsignificant coronary stenosis and PSS in the evaluation for nonobstructive coronary artery disease (CAD) should be further investigated.
{"title":"Association of postsystolic shortening on stress echocardiography and significant coronary artery stenosis: A single-centre retrospective cohort study","authors":"Joel Toftgård, Henrik Hedskog, Lars Rune, Jan Svedenhag, Gabriel Riva","doi":"10.1111/cpf.12883","DOIUrl":"10.1111/cpf.12883","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postsystolic shortening (PSS) is one of the proposed quantitative measures to predict myocardial ischaemia in the stress echocardiographic (SE) evaluation. It is previously known that hypo-/akinesia (HA) correlates well with coronary stenosis. However, some patients undergoing SE only present with PSS, and their risk of significant coronary stenosis is less clear. This study aimed to evaluate the association between PSS and significant coronary stenosis compared with HA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study at the hospital of S:t Görans, Stockholm, Sweden. All patients who underwent SE to investigate inducible ischaemia between 1 January 2018 and 15 October 2021 were eligible for inclusion. Exclusion criteria were normal SE and inconclusive test. Pathological SE were divided into two groups, patients with HA and those with PSS. Outcome was significant coronary artery stenosis visualized by invasive coronary angiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final study population consisted of 108 patients (73 PSS, 35 HA). The presence of HA was associated with a higher risk of significant stenosis compared to those with PSS (63% vs. 23%, <i>p</i> < 0.001). This relationship was observed among males (<i>p</i> < 0.001), but not among females (<i>p</i> = 0.133). Nonsignificant stenosis trended to be more common among patients with PSS (21% vs. 6%, <i>p</i> = 0.053)</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The finding of PSS without HA was associated with a lower risk of significant coronary stenosis than HA. However, patients with PSS still often had nonsignificant coronary stenosis and PSS in the evaluation for nonobstructive coronary artery disease (CAD) should be further investigated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 5","pages":"371-380"},"PeriodicalIF":1.3,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew C. D'Lugos, Nathan J. Skotak, Jacquelyn J. Faris, Nicholas T. Thomas, Corey E. Mazo, Jonathan J. Dickinson, Jessy G. Moore, Theresa M. Jorgensen, Jared M. Dickinson
Objective
To assess intrarater reliability of ultrasound-determined measurements of skeletal muscle characteristics across different measurement outcomes, imaging techniques, and age groups.
Methods
2D ultrasound images (B-mode) of the quadriceps were obtained from young (26 ± 4 year, n = 8 M, 8 F) and older (70 ± 7 year, n = 7 M, 5 F) adults on two occasions, separated by 6 ± 3 days. With participants in both standing and supine postures, images were collected from five anatomical sites along the anterior (two sites) and lateral (three sites) compartments of the thigh corresponding to 56%, 39%, and 22% (lateral only) of femur length. Images were analysed for muscle thickness, pennation angle, and echogenicity. Intraclass correlation coefficients (ICC) were used to assess reliability.
Results
Muscle thickness values were higher (p < 0.05) on images collected in the stand versus supine posture only for muscles of the anterior compartment, independent of age. Echogenicity values were higher (p < 0.05) in the vastus intermedius on images collected in the supine versus stand posture only in older adults. Pennation angle values were not impacted by imaging posture (p > 0.05). ICC values for thickness, echogenicity, and pennation angle were generally higher for analyses conducted on images collected in the supine versus stand posture. Imaging posture generated a greater difference in ICC values in the lateral versus anterior muscles and in older versus younger participants.
Conclusion
Our findings suggest that participant posture during imaging impacts the absolute values and intrarater reliability of ultrasound-determined muscle characteristics in a muscle-specific fashion, and this effect is greater in older compared to younger individuals.
{"title":"Skeletal muscle architecture and aging: A comparison of ultrasound techniques and an assessment of intrarater reliability","authors":"Andrew C. D'Lugos, Nathan J. Skotak, Jacquelyn J. Faris, Nicholas T. Thomas, Corey E. Mazo, Jonathan J. Dickinson, Jessy G. Moore, Theresa M. Jorgensen, Jared M. Dickinson","doi":"10.1111/cpf.12882","DOIUrl":"10.1111/cpf.12882","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess intrarater reliability of ultrasound-determined measurements of skeletal muscle characteristics across different measurement outcomes, imaging techniques, and age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>2D ultrasound images (B-mode) of the quadriceps were obtained from young (26 ± 4 year, <i>n</i> = 8 M, 8 F) and older (70 ± 7 year, <i>n</i> = 7 M, 5 F) adults on two occasions, separated by 6 ± 3 days. With participants in both standing and supine postures, images were collected from five anatomical sites along the anterior (two sites) and lateral (three sites) compartments of the thigh corresponding to 56%, 39%, and 22% (lateral only) of femur length. Images were analysed for muscle thickness, pennation angle, and echogenicity. Intraclass correlation coefficients (ICC) were used to assess reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Muscle thickness values were higher (<i>p</i> < 0.05) on images collected in the stand versus supine posture only for muscles of the anterior compartment, independent of age. Echogenicity values were higher (<i>p</i> < 0.05) in the vastus intermedius on images collected in the supine versus stand posture only in older adults. Pennation angle values were not impacted by imaging posture (<i>p</i> > 0.05). ICC values for thickness, echogenicity, and pennation angle were generally higher for analyses conducted on images collected in the supine versus stand posture. Imaging posture generated a greater difference in ICC values in the lateral versus anterior muscles and in older versus younger participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that participant posture during imaging impacts the absolute values and intrarater reliability of ultrasound-determined muscle characteristics in a muscle-specific fashion, and this effect is greater in older compared to younger individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 5","pages":"359-370"},"PeriodicalIF":1.3,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140577152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suvi Hartikainen, Tuomo Tompuri, Tiina Laitinen, Tomi Laitinen
Aims
The aims of our study were to evaluate whether point-of-care β-hydroxybutyrate (BHB) measurement can be used to identify patients with adequate cardiac glucose metabolism suppression for cardiac [18F]-fluoro-2-deoxy-d-glucose-positron emission tomography with computerized tomography (FDG-PET/CT) and to develop a pretest probability calculator of myocardial suppression using other metabolic factors attainable before imaging.
Methods and Results
We recruited 193 patients with any clinical indication for whole body [18F]-FDG-PET/CT. BHB level was measured with a point-of-care device. Maximal myocardial standardized uptake value using lean body mass (SULmax) was measured from eight circular regions of interest with 1 cm circumference and background from left ventricular blood pool. Correlations SULmax and point-of-care measured BHB were analysed. The ability of BHB test to predict adequate suppression was evaluated with receiver operating characteristic analysis. Liver and spleen attenuation in computed tomography were measured to assess the presence of fatty liver. BHB level correlated with myocardial uptake and, using a cut-off value of 0.35 mmol/L to predict adequate myocardial suppression, we reached specificity of 90% and sensitivity of 56%. Other variables to predict adequate suppression were diabetes, obesity, ketogenic diet and fatty liver. Using information attainable before imaging, we created a pretest probability calculator of inadequate myocardial glucose metabolism suppression. The area under the curve for BHB test alone was 0.802 and was 0.857 for the pretest calculator (p = 0.319).
Conclusions
BHB level measured with a point-of-care device is useful in predicting adequate myocardial glucose metabolism suppression. More detailed assessment of other factors potentially contributing to cardiac metabolism is needed.
{"title":"Point-of-care β-hydroxybutyrate measurement predicts adequate glucose metabolism suppression in cardiac FDG-PET/CT","authors":"Suvi Hartikainen, Tuomo Tompuri, Tiina Laitinen, Tomi Laitinen","doi":"10.1111/cpf.12881","DOIUrl":"10.1111/cpf.12881","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aims of our study were to evaluate whether point-of-care β-hydroxybutyrate (BHB) measurement can be used to identify patients with adequate cardiac glucose metabolism suppression for cardiac [<sup>18</sup>F]-fluoro-2-deoxy-<span>d</span>-glucose-positron emission tomography with computerized tomography (FDG-PET/CT) and to develop a pretest probability calculator of myocardial suppression using other metabolic factors attainable before imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We recruited 193 patients with any clinical indication for whole body [<sup>18</sup>F]-FDG-PET/CT. BHB level was measured with a point-of-care device. Maximal myocardial standardized uptake value using lean body mass (SULmax) was measured from eight circular regions of interest with 1 cm circumference and background from left ventricular blood pool. Correlations SULmax and point-of-care measured BHB were analysed. The ability of BHB test to predict adequate suppression was evaluated with receiver operating characteristic analysis. Liver and spleen attenuation in computed tomography were measured to assess the presence of fatty liver. BHB level correlated with myocardial uptake and, using a cut-off value of 0.35 mmol/L to predict adequate myocardial suppression, we reached specificity of 90% and sensitivity of 56%. Other variables to predict adequate suppression were diabetes, obesity, ketogenic diet and fatty liver. Using information attainable before imaging, we created a pretest probability calculator of inadequate myocardial glucose metabolism suppression. The area under the curve for BHB test alone was 0.802 and was 0.857 for the pretest calculator (<i>p</i> = 0.319).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BHB level measured with a point-of-care device is useful in predicting adequate myocardial glucose metabolism suppression. More detailed assessment of other factors potentially contributing to cardiac metabolism is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 5","pages":"349-358"},"PeriodicalIF":1.3,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140577084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emelie Bäcklin, Adrian Gonon, Magnus Sköld, Örjan Smedby, Eva Breznik, Birgitta Janerot-Sjoberg
Background
Computed tomography (CT) offers pulmonary volumetric quantification but is not commonly used in healthy individuals due to radiation concerns. Chronic airflow limitation (CAL) is one of the diagnostic criteria for chronic obstructive pulmonary disease (COPD), where early diagnosis is important. Our aim was to present reference values for chest CT volumetric and radiodensity measurements and explore their potential in detecting early signs of CAL.
Methods
From the population-based Swedish CArdioPulmonarybioImage Study (SCAPIS), 294 participants aged 50–64, were categorized into non-CAL (n = 258) and CAL (n = 36) groups based on spirometry. From inspiratory and expiratory CT images we compared lung volumes, mean lung density (MLD), percentage of low attenuation volume (LAV%) and LAV cluster volume between groups, and against reference values from static pulmonary function test (PFT).
Results
The CAL group exhibited larger lung volumes, higher LAV%, increased LAV cluster volume and lower MLD compared to the non-CAL group. Lung volumes significantly deviated from PFT values. Expiratory measurements yielded more reliable results for identifying CAL compared to inspiratory. Using a cut-off value of 0.6 for expiratory LAV%, we achieved sensitivity, specificity and positive/negative predictive values of 72%, 85% and 40%/96%, respectively.
Conclusion
We present volumetric reference values from inspiratory and expiratory chest CT images for a middle-aged healthy cohort. These results are not directly comparable to those from PFTs. Measures of MLD and LAV can be valuable in the evaluation of suspected CAL. Further validation and refinement are necessary to demonstrate its potential as a decision support tool for early detection of COPD.
{"title":"Pulmonary volumes and signs of chronic airflow limitation in quantitative computed tomography","authors":"Emelie Bäcklin, Adrian Gonon, Magnus Sköld, Örjan Smedby, Eva Breznik, Birgitta Janerot-Sjoberg","doi":"10.1111/cpf.12880","DOIUrl":"10.1111/cpf.12880","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Computed tomography (CT) offers pulmonary volumetric quantification but is not commonly used in healthy individuals due to radiation concerns. Chronic airflow limitation (CAL) is one of the diagnostic criteria for chronic obstructive pulmonary disease (COPD), where early diagnosis is important. Our aim was to present reference values for chest CT volumetric and radiodensity measurements and explore their potential in detecting early signs of CAL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From the population-based Swedish CArdioPulmonarybioImage Study (SCAPIS), 294 participants aged 50–64, were categorized into non-CAL (<i>n</i> = 258) and CAL (<i>n</i> = 36) groups based on spirometry. From inspiratory and expiratory CT images we compared lung volumes, mean lung density (MLD), percentage of low attenuation volume (LAV%) and LAV cluster volume between groups, and against reference values from static pulmonary function test (PFT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CAL group exhibited larger lung volumes, higher LAV%, increased LAV cluster volume and lower MLD compared to the non-CAL group. Lung volumes significantly deviated from PFT values. Expiratory measurements yielded more reliable results for identifying CAL compared to inspiratory. Using a cut-off value of 0.6 for expiratory LAV%, we achieved sensitivity, specificity and positive/negative predictive values of 72%, 85% and 40%/96%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We present volumetric reference values from inspiratory and expiratory chest CT images for a middle-aged healthy cohort. These results are not directly comparable to those from PFTs. Measures of MLD and LAV can be valuable in the evaluation of suspected CAL. Further validation and refinement are necessary to demonstrate its potential as a decision support tool for early detection of COPD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 4","pages":"340-348"},"PeriodicalIF":1.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12880","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elin Trägårdh, Johannes Ulén, Olof Enqvist, Lars Edenbrandt, Måns Larsson
Background
We developed a fully automated artificial intelligence (AI)AI-based-based method for detecting suspected lymph node metastases in prostate-specific membrane antigen (PSMA)(PSMA) positron emission tomography-computed tomography (PET-CT)(PET-CT) images of prostate cancer patients by using data augmentation that adds synthetic lymph node metastases to the images to expand the training set.
Methods
Synthetic data were derived from original training images to which new synthetic lymph node metastases were added. Thus, the original training set from a previous study (n = 420) was expanded by one synthetic image for every original image (n = 840), which was used to train an AI model. The performance of the AI model was compared to that of nuclear medicine physicians and a previously developed AI model. The human readers were alternately used as a reference and compared to either another reading or AI model.
Results
The new AI model had an average sensitivity of 84% for detecting lymph node metastases compared with 78% for human readings. Our previously developed AI method without synthetic data had an average sensitivity of 79%. The number of false positive lesions were slightly higher for the new AI model (average 3.3 instances per patient) compared to human readings and the previous AI model (average 2.8 instances per patient), while the number of false negative lesions was lower.
Conclusions
Creating synthetic lymph node metastases, as a form of data augmentation, on [18F]PSMA-1007F]PSMA-1007 PETPET-CT-CT images improved the sensitivity of an AI model for detecting suspected lymph node metastases. However, the number of false positive lesions increased somewhat.
{"title":"Improving sensitivity through data augmentation with synthetic lymph node metastases for AI-based analysis of PSMA PET-CT images","authors":"Elin Trägårdh, Johannes Ulén, Olof Enqvist, Lars Edenbrandt, Måns Larsson","doi":"10.1111/cpf.12879","DOIUrl":"10.1111/cpf.12879","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We developed a fully automated artificial intelligence (AI)AI-based-based method for detecting suspected lymph node metastases in prostate-specific membrane antigen (PSMA)(PSMA) positron emission tomography-computed tomography (PET-CT)(PET-CT) images of prostate cancer patients by using data augmentation that adds synthetic lymph node metastases to the images to expand the training set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Synthetic data were derived from original training images to which new synthetic lymph node metastases were added. Thus, the original training set from a previous study (<i>n</i> = 420) was expanded by one synthetic image for every original image (<i>n</i> = 840), which was used to train an AI model. The performance of the AI model was compared to that of nuclear medicine physicians and a previously developed AI model. The human readers were alternately used as a reference and compared to either another reading or AI model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The new AI model had an average sensitivity of 84% for detecting lymph node metastases compared with 78% for human readings. Our previously developed AI method without synthetic data had an average sensitivity of 79%. The number of false positive lesions were slightly higher for the new AI model (average 3.3 instances per patient) compared to human readings and the previous AI model (average 2.8 instances per patient), while the number of false negative lesions was lower.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Creating synthetic lymph node metastases, as a form of data augmentation, on [18F]PSMA-1007F]PSMA-1007 PETPET-CT-CT images improved the sensitivity of an AI model for detecting suspected lymph node metastases. However, the number of false positive lesions increased somewhat.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 4","pages":"332-339"},"PeriodicalIF":1.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Camila M. de A. Santos, Polyanna G. C. Quirino, José Â. Rizzo, Décio Medeiros, José J. de A. Ferreira, Manoel da C. Costa, Nádia Gaua, Bayne Freya, Marcelle de O. Martins, Marco A. C. V. Junior
Objective
To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH).
Materials and Methods
Cross-sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise-induced bronchospasm compatible response (EIB-cr) and 24 asthmatics with EIB-cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH.
Results
Twenty-four (52.1%) of asthmatics had EIB-cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB-cr compared to nonasthmatics in the rectus abdominis area (p < 0.05).
Conclusion
There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB-cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography.
目的比较年轻哮喘患者的呼吸肌感兴趣区（ROI）的热成像模式，有无由宽松自愿过度呼吸（EVH）诱发的支气管痉挛：横断面研究：55 名青少年（55% 为男性，45% 为女性），年龄为（12.5 ± 3.3）岁，分为 9 名非哮喘患者、22 名无运动诱发支气管痉挛相容反应（EIB-cr）的哮喘患者和 24 名有 EIB-cr 的哮喘患者。第一秒用力呼气容积（FEV1）比基线下降≥10%的受试者被诊断为EIB。呼吸肌的热成像记录以胸锁乳突肌（SCM）、胸肌和腹直肌意向区的 ROI 为界。分别在 EVH 前、EVH 后 5、10、15 和 30 分钟进行热捕获和 FEV1 采集：结果：24 名哮喘患者（52.1%）有 EIB-cr。所有组别中，EVH 试验后 10 分钟，SCM、胸肌和腹直肌 ROI 的温度均有所下降（均为 p 结论：EVH 试验后 10 分钟，SCM、胸肌和腹直肌 ROI 的温度均有所下降：不同肌群 ROI 的温度均有所下降，尤其是哮喘患者。在 EIB-cr 患者中观察到的 FEV1 下降幅度较大，最初与皮肤温度下降有关，在腹部肌肉区域与非哮喘患者存在差异。体温下降可能是由于血流暂时流向了最常用的肌肉群，导致热成像评估的皮肤区域温度下降。
{"title":"Respiratory muscles's thermographic analysis in asthmatic youth with and without bronchospasm induced by eucapnic voluntary hyperpnea","authors":"Camila M. de A. Santos, Polyanna G. C. Quirino, José Â. Rizzo, Décio Medeiros, José J. de A. Ferreira, Manoel da C. Costa, Nádia Gaua, Bayne Freya, Marcelle de O. Martins, Marco A. C. V. Junior","doi":"10.1111/cpf.12878","DOIUrl":"10.1111/cpf.12878","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Cross-sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise-induced bronchospasm compatible response (EIB-cr) and 24 asthmatics with EIB-cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV<sub>1</sub>) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV<sub>1</sub> were taken before and 5, 10, 15 and 30 min after EVH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four (52.1%) of asthmatics had EIB-cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with <i>p</i> < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB-cr compared to nonasthmatics in the rectus abdominis area (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV<sub>1</sub> observed in individuals with EIB-cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 4","pages":"324-331"},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults.
Methods
A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial.
Results
The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all p < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal-to-normal RR intervals, the square root of the mean squared difference of successive normal-to-normal RR intervals and high-frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end-diastolic volume and end-diastolic volume index, compared to other loaded protocols (all p < 0.001).
Conclusion
These findings highlight the acute effect of type-specific and load-dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations.
{"title":"Acute cardiac autonomic and hemodynamic responses to resistive breathing: Effect of loading type and intensity","authors":"Karan Pongpanit, Manta Korakot, Peerakan Nitilap, Nopparat Puplab, Noppawan Charususin, Kornanong Yuenyongchaiwat","doi":"10.1111/cpf.12877","DOIUrl":"10.1111/cpf.12877","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all <i>p</i> < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal-to-normal RR intervals, the square root of the mean squared difference of successive normal-to-normal RR intervals and high-frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end-diastolic volume and end-diastolic volume index, compared to other loaded protocols (all <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings highlight the acute effect of type-specific and load-dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 4","pages":"313-323"},"PeriodicalIF":1.8,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Søren Gam, Anders K. Petz, Lukas R. Bjerre, Jeppe Bøgild, Anders B. Nielsen, Rikke N. Sørensen, Mikkel I. Kolind, Bibi Gram, Stinus Hansen, Per Aagaard
Background
The aim of this study was to examine the test−retest reliability in lower limb muscle strength and rate of torque development (RTD) using isokinetic dynamometry in adults with obesity, with a body mass index (BMI) ≥ 35 kg/m2.
Method
Thirty-two adults with a BMI of 43.8 ± 6.6 kg/m2 eligible for bariatric surgery were enroled in the study. Isokinetic and isometric knee extensor (KE) and flexor (KF) strength were assessed in an isokinetic dynamometer (Biodex 4) during three test sessions separated by 3−7 days.
Results
There were no statistical differences in peak KE and KF torque for any test modalities between sessions. Intraclass correlation (ICC) was 0.91−0.94 between sessions 1 and 2 and 0.94−0.97 between sessions 2 and 3. Standard error of measurement (SEM%) and coefficient of variation (CV) ranged across test sessions from 4.3% to 7.3%. KE RTD showed high test−retest reliability following familiarization, with ICC, CV and SEM% values ranging from 0.84 to 0.90, 13.3%−20.3% and 14.6%−24.9%, respectively.
Conclusion
Maximal lower limb muscle strength measured by isokinetic dynamometry showed excellent test−retest reliability manifested by small measurement errors and low CV. Reliability was slightly improved by including a familiarization session. KE RTD but not KF RTD demonstrated high test−retest reliability following familiarization. The present data indicate that isokinetic dynamometry can be used to detect even small changes in lower limb muscle strength in adults with obesity.
{"title":"Intersession reliability of lower limb muscle strength assessments in adults with obesity eligible for bariatric surgery","authors":"Søren Gam, Anders K. Petz, Lukas R. Bjerre, Jeppe Bøgild, Anders B. Nielsen, Rikke N. Sørensen, Mikkel I. Kolind, Bibi Gram, Stinus Hansen, Per Aagaard","doi":"10.1111/cpf.12876","DOIUrl":"10.1111/cpf.12876","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim of this study was to examine the test−retest reliability in lower limb muscle strength and rate of torque development (RTD) using isokinetic dynamometry in adults with obesity, with a body mass index (BMI) ≥ 35 kg/m<sup>2</sup>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Thirty-two adults with a BMI of 43.8 ± 6.6 kg/m<sup>2</sup> eligible for bariatric surgery were enroled in the study. Isokinetic and isometric knee extensor (KE) and flexor (KF) strength were assessed in an isokinetic dynamometer (Biodex 4) during three test sessions separated by 3−7 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no statistical differences in peak KE and KF torque for any test modalities between sessions. Intraclass correlation (ICC) was 0.91−0.94 between sessions 1 and 2 and 0.94−0.97 between sessions 2 and 3. Standard error of measurement (SEM%) and coefficient of variation (CV) ranged across test sessions from 4.3% to 7.3%. KE RTD showed high test−retest reliability following familiarization, with ICC, CV and SEM% values ranging from 0.84 to 0.90, 13.3%−20.3% and 14.6%−24.9%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Maximal lower limb muscle strength measured by isokinetic dynamometry showed excellent test−retest reliability manifested by small measurement errors and low CV. Reliability was slightly improved by including a familiarization session. KE RTD but not KF RTD demonstrated high test−retest reliability following familiarization. The present data indicate that isokinetic dynamometry can be used to detect even small changes in lower limb muscle strength in adults with obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 4","pages":"303-312"},"PeriodicalIF":1.8,"publicationDate":"2024-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12876","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christian Rodriguez, Jacob D. Mota, Ty B. Palmer, Steven B. Heymsfield, Grant M. Tinsley
Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.
骨骼肌大小的量化对于识别那些有可能导致虚弱、发病率和死亡率增加以及生活质量下降的疾病的人群来说是非常必要的。虽然肌肉力量、肌肉质量和体能表现已被认为是筛查、预防和管理肌肉疏松和肌肉萎缩患者的重要评估指标，但骨骼肌大小仍然是一个关键的客观指标。目前有几种估算骨骼肌大小的技术；然而，每种技术在简易性/复杂性、成本、辐射剂量、可及性和便携性方面都有其独特的特点，这些都是评估者在实际应用这些方法之前需要考虑的重要因素。这篇叙述性综述主要讨论了目前用于估计不同人群骨骼肌大小的无创技术的理论和应用。骨骼肌评估的常用仪器包括计算机断层扫描、磁共振成像、外周定量计算机断层扫描、双能 X 射线吸收测量和亮度模式超声等成像技术，以及生物电阻抗分析和人体测量等非成像技术。这些方法可通过全身和/或区域评估以及预测方程获得骨骼肌尺寸。在进行评估时，值得注意的问题包括缺乏标准化的图像采集/处理协议，以及临床医生和研究人员用于定义骨骼肌尺寸过小的临界值存在差异，这可能会影响诊断的准确性和普遍性。鉴于评估骨骼肌大小的重要性，从业人员必须了解每种技术及其各自的优缺点。
{"title":"Skeletal muscle estimation: A review of techniques and their applications","authors":"Christian Rodriguez, Jacob D. Mota, Ty B. Palmer, Steven B. Heymsfield, Grant M. Tinsley","doi":"10.1111/cpf.12874","DOIUrl":"10.1111/cpf.12874","url":null,"abstract":"<p>Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 4","pages":"261-284"},"PeriodicalIF":1.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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