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Objectives: To investigate the daily life experiences of sleep, mood, and pain in relation to appetite in community-dwelling older adults aged 75 years and older, stratified by sex. Design: Existing data from a daily experience study embedded in the Longitudinal Aging Study Amsterdam (LASA) among the oldest-old (≥75 years). Setting: LASA is an ongoing cohort study of a nationally representative sample of older adults aged ≥55 years from three culturally distinct regions in the Netherlands. Participants: 434 community-dwelling older adults aged ≥75 years. Measurements: Participants filled-out a one-week diary on daily experience of pain, mood, last night sleep (10-point Likert scale), and appetite (5-point Likert scale) on five measurement occasions between 2016 and 2021. (Hybrid) linear mixed models were used to investigate overall, within-subject and between-subject association between mood, sleep, and pain (independent variables) and appetite (dependent variable), while correcting between-subject associations for season, age, educational level, partner status, body mass index, alcohol consumption, physical activity level, smoking status, chronic diseases and use of nervous system medication, stratified by sex. Results: Averaged over all days, males reported a poor appetite on 12% of the days and females on 19% of the days. Statistically significant between-subject associations with a poorer appetite were found for lower mood (unstandardized b = 0.084 [95% CI 0.043–0.126] (males), (b = 0.126 [95% CI 0.082–0.170] (females)), poorer sleep (b = 0.045 [95% CI 0.007–0.083] (males), (b = 0.51 [95% CI 0.017–0.085] (females)) and more severe pain in males only (b = 0.026 [95% CI 0.002–0.051]). Except for pain, within-subject associations were somewhat weaker: mood: b = 0.038 [95% CI 0.016–0.060] (males), (b = 0.082 [95% CI 0.061–0.104] (females)); sleep: b = 0.029 [95% CI 0.008–0.050] (males), (b = 0.15 [95% CI 0.005–0.025] (females)); and pain (b = 0.032 [95% CI 0.004–0.059] (males)). Conclusions: This study found that poor sleep, low mood (more strongly in females) and more severe pain (males only) are associated with poor appetite in older adults on a daily level both within and between persons. Sex differences in factors related to poor appetite should be considered in future research.

Background: Novel audiovisual feedback methods were developed to improve image guidance during skull base surgery by providing audiovisual warnings when the drill tip enters a protective perimeter set at a distance around anatomic structures ("distance control") and visualizing bone drilling ("virtual drilling")., Objective: To benchmark the drill damage risk reduction provided by distance control, to quantify the accuracy of virtual drilling, and to investigate whether the proposed feedback methods are clinically feasible., Methods: In a simulated surgical scenario using human cadavers, 12 unexperienced users (medical students) drilled 12 mastoidectomies. Users were divided into a control group using standard image guidance and 3 groups using distance control with protective perimeters of 1, 2, or 3 mm. Damage to critical structures (sigmoid sinus, semicircular canals, facial nerve) was assessed. Neurosurgeons performed another 6 mastoidectomy/trans-labyrinthine and retro-labyrinthine approaches. Virtual errors as compared with real postoperative drill cavities were calculated. In a clinical setting, 3 patients received lateral skull base surgery with the proposed feedback methods., Results: Users drilling with distance control protective perimeters of 3 mm did not damage structures, whereas the groups using smaller protective perimeters and the control group injured structures. Virtual drilling maximum cavity underestimations and overestimations were 2.8 ± 0.1 and 3.3 ± 0.4 mm, respectively. Feedback methods functioned properly in the clinical setting., Conclusion: Distance control reduced the risks of drill damage proportional to the protective perimeter distance. Errors in virtual drilling reflect spatial errors of the image guidance system. These feedback methods are clinically feasible., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Early signs of efficacy are critical in drug development. Response Evaluation Criteria in Solid Tumors (RECIST) are commonly used to determine the efficacy of anti-cancer therapy in clinical trials. RECIST, however, emphasizes the value of tumor shrinkage, while many targeted agents induce prolonged tumor growth arrest. This limits its use for the detection of treatment efficacy for these more cytostatic regimens. Therefore, we designed an individualized variant of a time to progression (TTP) end point based on prospective volumetric measurements and an intra-patient control, the TTP ratio., Patients and Methods: Patients with any metastatic malignancy, without regular treatment options, were treated with the mTOR inhibitor everolimus. Treatment response was determined using both RECIST and the TTP ratio. The TTP ratio was defined as the volumetric pretreatment TTP divided by the volumetric on-treatment TTP. A patient was classified as a responder if the TTP ratio was <0.7. Consistency and reproducibility of volumetric measurements were determined., Results: Seventy-three patients were included of whom 59 started treatment. A TTP ratio could be established in 73% (n = 43) of the treated patients. The inter-observer agreement for volumetric progression was 0.78 (95% confidence interval 0.70-0.87) (Krippendorff's α-coefficient). According to RECIST, 35 patients (59%) had stable disease (SD) and 1 patient demonstrated a partial response (PR), whereas only 21 patients (36%) met the prespecified criteria for treatment efficacy according to the TTP ratio. Treatment response according to both the TTP ratio and RECIST (SD + PR) correlated with overall survival (OS) [P(log-rank) < 0.001]. The TTP ratio, however, was also able to differentiate which patients had a better OS within the RECIST SD group [P(log-rank) = 0.0496]., Conclusion: The TTP ratio had a high inter-observer agreement, correlated with OS and identified which patients within the RECIST SD group had a longer OS., Clinicaltrialsgov Identifier: NCT01566279., (© The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The analysis of echocardiograms, whether visual or automated, is often hampered by ultrasound artifacts which obscure the moving myocardial wall. In this study, a probabilistic framework for tracking the endocardial surface in 3D ultrasound images is proposed, which distinguishes between visible and artifact-obscured myocardium. Motion estimation of visible myocardium relies more on a local, data-driven tracker, whereas tracking of obscured myocardium is assisted by a global, statistical model of cardiac motion. To make this distinction, the expectation-maximization algorithm is applied in a stationary and dynamic frame-of-reference. Evaluation on 35 three-dimensional echocardiographic sequences shows that this artifact-aware tracker gives better results than when no distinction is made. In conclusion, the proposed tracker is able to reduce the influence of artifacts, potentially improving quantitative analysis of clinical quality echocardiograms., (Copyright 2010 Elsevier B.V. All rights reserved.)

This paper presents a novel model based segmentation technique for quantification of left ventricular (LV) function from sparse single-beat 3D echocardiographic data acquired with a fast rotating ultrasound (FRU) transducer. This transducer captures cardiac anatomy in a sparse set of radially sampled, curved cross-sections within a single cardiac cycle. The method employs a 3D Active Shape Model of the left ventricle (LV) in combination with local appearance models as prior knowledge to steer the segmentation. A set of local appearance patches generate the model update points for fitting the model to the LV in the curved FRU cross-sections. Updates are then propagated over the dense 3D model mesh to overcome correspondence problems due to the data sparsity, whereas the 3D Active Shape Model serves to retain the plausibility of the generated shape. Leave-one-out cross-validation was carried out on single-beat FRU data from 28 patients suffering from various cardiac pathologies. Detection succeeded in 24 cases, and failed in 4 cases due to large dropouts in echo signal. For the successful 24 cases, detection yielded Point to Point errors of 3.1+/-1.1mm, Point to Surface errors of 1.7+/-0.9mm and an EF error of 7.3+/-4.9%. Comparison of fitting on single-beat versus denser multi-beat data showed a similar performance for both types of data irrespective of frame angles of the intersections. Robustness tests with respect to different model initializations showed acceptable performance for initial positions within a range of 26mm for displacement and 12 degrees for orientation. Furthermore, a comparison study between the proposed method and global LV function measured from MR studies of the same patients showed an underestimation of volumes estimated from echocardiographic data compared to MR derived volumes, similar to other results reported in literature. All experiments demonstrate that the proposed method combines robustness with respect to initialization with an acceptable accuracy, while using sparse single-beat FRU data., (Copyright 2010 Elsevier B.V. All rights reserved.)