28 results on '"Eyal Lotan"'
Search Results
2. Cultural Differences between American and Israeli Medical Students Regarding Their Perceptions of the Medical Profession and Satisfaction with Studies
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Eyal Lotan, Louis Shenkman, and Netta Notzer
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Education (General) ,L7-991 ,Medicine (General) ,R5-920 - Abstract
Background: Cultural differences have been discussed as a potential factor influencing students' perception and motivation towards their studies. At the Sackler Faculty of Medicine, Tel-Aviv University, two separate programs coexist for American and Israeli medical students. Both are taught at the same sites and by the same faculty, thus enabling cultural comparisons. Our aim was to examine the differences of two medical student groups, American and Israeli, regarding their satisfaction with studies, view of the educational workload, and their perceptions of physician characteristics. Methods: During the academic year 2007-2008 we administered an anonymous questionnaire to the two groups immediately after their first clinical clerkship in internal medicine. The response rate was 82% (90 out of 110) for the Israelis and 93% (53 out of 57) for the Americans. Results: Americans, compared to the Israelis, are significantly more satisfied with their medical studies, consider fewer alternatives to future careers in clinical medicine, feel less of a workload, and hold a more positive opinion of physician characteristics. Conclusions: Cultural differences affect students' perception of their studies, mentors and future careers. Medical educators should be sensitive to the effects of students' background which influence academic and professional attitudes and find ways to strengthen their commitment to the profession.
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- 2010
3. Baroreflex sensitivity is associated with markers of hippocampal gliosis and dysmyelination in patients with psychosis
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Bridget Mueller, Jessica Robinson-Papp, Maria Suprun, Mayte Suarez-Farinas, Eyal Lotan, Oded Gonen, and Dolores Malaspina
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Endocrine and Autonomic Systems ,Neurology (clinical) - Published
- 2023
4. <scp>MP‐RAVE</scp> : <scp> IR‐Prepared T 1 ‐Weighted </scp> Radial <scp>Stack‐of‐Stars 3D GRE</scp> imaging with retrospective motion correction
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Eddy Solomon, Eyal Lotan, Elcin Zan, Daniel K. Sodickson, Kai Tobias Block, and Hersh Chandarana
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Radiology, Nuclear Medicine and imaging - Published
- 2023
5. Distinguishing Brain Metastasis Progression From Radiation Effects After Stereotactic Radiosurgery Using Longitudinal GRASP Dynamic Contrast-Enhanced MRI
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Assaf Berger, Matthew D. Lee, Eyal Lotan, Kai Tobias Block, Girish Fatterpekar, and Douglas Kondziolka
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Surgery ,Neurology (clinical) - Published
- 2022
6. Volumetric brain changes in MOGAD: A cross-sectional and longitudinal comparative analysis
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Itay Lotan, Thibo Billiet, Annemie Ribbens, Wim Van Hecke, Benny Huang, Ilya Kister, and Eyal Lotan
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Neurology ,Neurology (clinical) ,General Medicine - Abstract
Relatively little is known about how global and regional brain volumes changes in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) compare with Multiple Sclerosis (MS), Neuromyelitis optica spectrum disorder (NMOSD), and healthy controls (HC).To compare global and regional brain volumes in MOGAD, MS, NMOSD, and HC cross-sectionally as well as longitudinally in a subset of patients.We retrospectively reviewed all adult MOGAD and NMOSD patients with brain MRI performed in stable remission and compared them with MS patients and HC. Volumetric parameters were assessed using the FDA-approved icobrain software. adjusted for age and sex.Twenty-four MOGAD, 47 NMOSD, 40 MS patients, and 37 HC were included in the cross-sectional analyses. Relative to HC, the age-adjusted whole brain (WB) volume was significantly lower in patients with MOGAD (p=0.0002), NMOSD (p=0.042), and MS (p=0.01). Longitudinal analysis of a subset of 8 MOGAD, 22 NMOSD, and 34 MS patients showed a reduction in the WB and cortical gray matter (CGM) volumes over time in all three disease groups, without statistically significant differences between groups. The MOGAD group had a greater loss of thalamic volume compared to MS (p=0.028) and NMOSD (p=0.023) and a greater loss of hippocampal volumes compared to MS (p=0.007).Age-adjusted WB volume loss was evident in all neuroinflammatory conditions relative to HC in cross-sectional comparisons. In longitudinal analyses, MOGAD patients had a higher thalamic atrophy rate relative to MS and NMOSD, and a higher hippocampal atrophy rate relative to MS. Larger studies are needed to validate these findings and to investigate their clinical implications.
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- 2022
7. Gut and oral microbiome modulate molecular and clinical markers of schizophrenia-related symptoms: A transdiagnostic, multilevel pilot study
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Jakleen J. Lee, Enrica Piras, Sabrina Tamburini, Kevin Bu, David S. Wallach, Brooke Remsen, Adam Cantor, Jennifer Kong, Deborah Goetz, Kevin W. Hoffman, Mharisi Bonner, Peter Joe, Bridget R. Mueller, Jessica Robinson-Papp, Eyal Lotan, Oded Gonen, Dolores Malaspina, and Jose C. Clemente
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Psychiatry and Mental health ,Biological Psychiatry - Published
- 2023
8. Larger hippocampal and brainstem volumes in high volume lumbar puncture responders as a predictor of shunt response in normal pressure hydrocephalus
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Eyal Lotan, Brianna E. Damadian, Henry Rusinek, Benjamin ades‐Aron, James Golomb, and Ajax George
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Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Epidemiology ,Health Policy ,Neurology (clinical) ,Geriatrics and Gerontology - Published
- 2021
9. Quantitative imaging features predict spinal tap response in normal pressure hydrocephalus
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Henry Rusinek, Benjamin Ades-Aron, Eyal Lotan, James Golomb, Brianna E. Damadian, Ajax E. George, Ning Lu, and Megan Griffin
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Male ,medicine.medical_specialty ,Spinal tap ,Neuroimaging ,Logistic regression ,Spinal Puncture ,Lumbar ,Normal pressure hydrocephalus ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Lumbar puncture ,medicine.disease ,Gait ,Magnetic Resonance Imaging ,film.actor ,Hydrocephalus, Normal Pressure ,Hydrocephalus ,film ,Cardiology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Gait improvement following high-volume lumbar puncture (HVLP) and continuous lumbar drain (cLD) is widely used to predict shunt response in patients with suspected normal pressure hydrocephalus (NPH). Here, we investigate differences in MRI volumetric and traditional measures between HVLP/cLD responders and non-responders to identify imaging features that may help predict HVLP/cLD response. Eighty-two patients with suspected NPH were studied retrospectively. Gait testing was performed before and immediately/24 h/72 h after HVLP/cLD. A positive response was defined as improvement in gait post-procedure. Thirty-six responders (26 men; mean age 79.3 ± 6.3) and 46 non-responders (25 men; mean age 77.2 ± 6.1) underwent pre-procedure brain MRI including a 3D T1-weighted sequence. Subcortical regional volumes were segmented using FreeSurfer. After normalizing for total intracranial volume, two-way type III ANCOVA test and chi-square test were used to characterize statistical group differences. Evans’ index, callosal angle (CA), and disproportionately enlarged subarachnoid space hydrocephalus were assessed. Multivariable logistic regression models were tested using Akaike information criterion to determine which combination of metrics most accurately predicts HVLP/cLD response. Responders and non-responders demonstrated no differences in total ventricular and white/gray matter volumes. CA (men only) and third and fourth ventricular volumes were smaller; and hippocampal volume was larger in responders (p
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- 2021
10. Selective atrophy of the connected deepest cortical layers following small subcortical infarct
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Eyal Lotan, Daniel Barazany, David Tanne, Shani Ben-Amitay, Chen Hoffmann, Galia Tsarfaty, Yaniv Assaf, and Ido Tavor
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Male ,0301 basic medicine ,Pyramidal Tracts ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,Cortex (anatomy) ,medicine ,Humans ,Stroke ,Aged ,Cerebral Cortex ,business.industry ,Neurodegeneration ,Motor Cortex ,Cerebral Infarction ,Anatomy ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Diffusion Tensor Imaging ,030104 developmental biology ,medicine.anatomical_structure ,Case-Control Studies ,Corticospinal tract ,Female ,Neurology (clinical) ,Primary motor cortex ,business ,030217 neurology & neurosurgery ,Tractography ,Diffusion MRI - Abstract
ObjectiveTo explore whether in patients with chronic small subcortical infarct the cortical layers of the connected cortex are differentially affected and whether these differences correlate with clinical symptomatology.MethodsTwenty patients with a history of chronic small subcortical infarct affecting the corticospinal tracts and 15 healthy controls were included. Connected primary motor cortex was identified with tractography starting from infarct. T1-component probability maps were calculated from T1 relaxation 3T MRI, dividing the cortex into 5 laminar gaussian classes.ResultsFocal cortical thinning was observed in the connected cortex and specifically only in its deepest laminar class compared to the nonaffected mirrored cortex (p < 0.001). There was loss of microstructural integrity of the affected corticospinal tract with increased mean diffusivity and decreased fractional anisotropy compared to the contralateral nonaffected tract (p ≤ 0.002). Clinical scores were correlated with microstructural damage of the corticospinal tracts and with thinning of the cortex and specifically only its deepest laminar class (p < 0.001). No differences were found in the laminar thickness pattern of the bilateral primary motor cortices or in the microstructural integrity of the bilateral corticospinal tracts in the healthy controls.ConclusionOur results support the concept of secondary neurodegeneration of connected primary motor cortex after a small subcortical infarct affecting the corticospinal tract, with observations that the main cortical thinning occurs in the deepest cortex and that the clinical symptomatology is correlated with this cortical atrophy pattern. Our findings may contribute to a better understanding of structural reorganization and functional outcomes after stroke.
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- 2019
11. 18F-FDG PET-CT postoperative changes after maxillectomy: Findings and pitfalls in interpretation
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Iris Gluck, Johnatan Nissan, Eyal Lotan, Paul Lawson, Tima Davidson, Ran Yahalom, Shay Duvdevani, Maria Krichmar, and Shai Shrot
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Head and neck ,General Dentistry ,Retrospective Studies ,Rehabilitation ,business.industry ,General Medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Positron-Emission Tomography ,Fdg pet ct ,Radiology ,Radiopharmaceuticals ,business ,Research Article - Abstract
Objective: We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre. Methods: Fourteen patients (10 males), aged 22–84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up. Results: Increased FDG uptake, mean SUVmax 2.4 ± 1.4 (range 0.3–4.3), was observed at the postoperative bed following 12 of 17 surgeries (71%; 10 obturators, two mesh reconstructions). Following the remaining 5/17 surgeries (three with a fat flap and two without any reconstructions), abnormal FDG uptake was not observed at the postoperative bed. CT features of postoperative sites included: non-homogeneous mixed iso/hyperdense structures (hollow or filled) with multiple surrounding and/or inside air bubbles (“sponge appearance”) and mucosal thickening along the postoperative bed wall (in all cases with obturator implants); rich fat density material in reconstructions with a fat flap and in closures without reconstruction, and radiopaque elongated structures in mesh reconstructions. No correlation was found of the mean SUVmax in initial scans, with the time from the surgery date (10 ± 6 months; r=0.04, P=0.90), or with the mean SUVmax in final scans (at 25± 17 months, P=0.17). Conclusions: : Increased FDG uptake, together with corresponding non-specific CT features, may persist for a prolonged period after surgery with obturators and mesh implantations, mimicking malignancy or infection. Awareness of variations in postoperative PET-CT appearance can help avoid false interpretations and redundant invasive procedures.
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- 2021
12. Vigabatrin Toxicity in a Patient with Infantile Spasms Treated with Concomitant Hormonal Therapy
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Eyal, Lotan, Judith, Bluvstein, and Elcin, Zan
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Brain Diseases ,Adrenocorticotropic Hormone ,Brain ,Humans ,Infant ,Anticonvulsants ,Drug Therapy, Combination ,Female ,Magnetic Resonance Imaging ,Spasms, Infantile ,Vigabatrin - Published
- 2020
13. Widespread cortical dyslamination in epilepsy patients with malformations of cortical development
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Ido Tavor, Galia Tsarfaty, Yaniv Assaf, Eyal Lotan, Omri Tomer, David Tanne, Hadassah Goldberg-Stern, Chen Hoffmann, and Ilan Blatt
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Pathology ,medicine.medical_specialty ,Neurology ,Epilepsy ,business.industry ,Periventricular Nodular Heterotopia ,Cortical dysplasia ,medicine.disease ,Epileptogenesis ,Magnetic Resonance Imaging ,030218 nuclear medicine & medical imaging ,Malformations of Cortical Development ,03 medical and health sciences ,0302 clinical medicine ,Cortical abnormalities ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,Neurosurgery ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Neuroradiology - Abstract
Recent research in epilepsy patients confirms our understanding of epilepsy as a network disorder with widespread cortical compromise. Here, we aimed to investigate the neocortical laminar architecture in patients with focal cortical dysplasia (FCD) and periventricular nodular heterotopia (PNH) using clinically feasible 3 T MRI. Eighteen epilepsy patients (FCD and PNH groups; n = 9 each) and age-matched healthy controls (n = 9) underwent T1 relaxation 3 T MRI, from which component probability T1 maps were utilized to extract sub-voxel composition of 6 T1 cortical layers. Seventy-eight cortical areas of the automated anatomical labeling atlas were divided into 1000 equal-volume sub-areas for better detection of cortical abnormalities, and logistic regressions were performed to compare FCD/PNH patients with healthy controls with the T1 layers composing each sub-area as regressors. Statistical significance (p < 0.05) was determined by a likelihood-ratio test with correction for false discovery rate using Benjamini-Hochberg method. Widespread cortical abnormalities were observed in the patient groups. Out of 1000 sub-areas, 291 and 256 bilateral hemispheric cortical sub-areas were found to predict FCD and PNH, respectively. For each of these sub-areas, we were able to identify the T1 layer, which contributed the most to the prediction. Our results reveal widespread cortical abnormalities in epilepsy patients with FCD and PNH, which may have a role in epileptogenesis, and likely related to recent studies showing widespread structural (e.g., cortical thinning) and diffusion abnormalities in various human epilepsy populations. Our study provides quantitative information of cortical laminar architecture in epilepsy patients that can be further targeted for study in functional and neuropathological studies.
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- 2020
14. Medical Imaging and Privacy in the Era of Artificial Intelligence: Myth, Fallacy, and the Future
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Mary Bruno, Daniel K. Sodickson, Charlotte Tschider, Arthur L. Caplan, Yvonne W. Lui, Eyal Lotan, and Ben Zhang
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Fallacy ,Diagnostic Imaging ,medicine.medical_specialty ,MEDLINE ,Mythology ,Article ,Radiography ,Artificial Intelligence ,Privacy ,Medical imaging ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Psychology ,Forecasting - Published
- 2020
15. Brain 18F-FDG-PET: Utility in the Diagnosis of Dementia and Epilepsy
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Eyal, Lotan, Kent P, Friedman, Tima, Davidson, and Timothy M, Shepherd
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Epilepsy ,Fluorodeoxyglucose F18 ,Positron-Emission Tomography ,Brain ,Humans ,Dementia - Abstract
The authors reviewed the two most common current uses of brain 18F-labeled fluoro-2-deoxyglucose positron emission tomography (FDG-PET) at a large academic medical center. For epilepsy patients considering surgical management, FDG-PET can help localize epileptogenic lesions, discriminate between multiple or discordant EEG or MRI findings, and predict prognosis for post-surgical seizure control. In elderly patients with cognitive impairment, FDG-PET often demonstrates lobar-specific patterns of hypometabolism that suggest particular underlying neurodegenerative pathologies, such as Alzheimer's disease. FDG-PET of the brain can be a key diagnostic modality and contribute to improved patient care.
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- 2020
16. Fat necrosis after abdominal surgery: A pitfall in interpretation of FDG-PET/CT
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Bar Chikman, Johnatan Nissan, Tima Davidson, Simona Ben-Haim, Elinor Goshen, Eyal Klang, Sara Apter, Eyal Lotan, and Jeffrey Goldstein
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,Lesion ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Laparotomy ,Abdomen ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Fat necrosis ,Fat Necrosis ,Laparoscopy ,Aged ,Retrospective Studies ,Neuroradiology ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Interventional radiology ,General Medicine ,Middle Aged ,medicine.disease ,Abdominal Neoplasms ,030220 oncology & carcinogenesis ,Female ,Radiology ,Radiopharmaceuticals ,medicine.symptom ,business ,Abdominal surgery - Abstract
We describe FDG-PET/CT findings of postoperative fat necrosis in patients following abdominal surgery, and evaluate their changes in size and FDG uptake over time. FDG-PET/CT scans from January 2007–January 2016 containing the term ‘fat necrosis’ were reviewed. Lesions meeting radiological criteria of fat necrosis in patients with prior abdominal surgery were included. Forty-four patients, 30 males, mean age 68.4 ± 11.0 years. Surgeries: laparotomy (n=37; 84.1 %), laparoscopy (n=3; 6.8 %), unknown (n=4; 9.1 %). CTs of all lesions included hyperdense well-defined rims surrounding a heterogeneous fatty core. Sites: peritoneum (n=34; 77 %), omental fat (n=19; 43 %), subcutaneous fat (n=8; 18 %), retroperitoneum (n=2; 5 %). Mean lesion long axis: 33.6±24.9 mm (range: 13.0–140.0). Mean SUVmax: 2.6±1.1 (range: 0.6–5.1). On serial CTs (n=34), lesions decreased in size (p=0.022). Serial FDG-PET/CT (n=24) showed no significant change in FDG-avidity (p=0.110). Mean SUVmax did not correlate with time from surgery (p=0.558) or lesion size (p=0.259). Postsurgical fat necrosis demonstrated characteristic CT features and may demonstrate increased FDG uptake. However, follow-up of subsequent imaging scans showed no increases in size or FDG-avidity. Awareness of this entity is important to avoid misinterpretation of findings as recurrent cancer. • Postsurgical fat necrosis may mimic cancer in FDG-PET/CT. • Follow-up of fat necrosis showed no increase in FDG intensity. • CT follow-up showed a decrease in lesion size. • FDG uptake did not correlate with time lapsed from surgery.
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- 2017
17. Incorporation of relative cerebral blood flow into CT perfusion maps reduces false ’at risk' penumbra
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Shlomi Peretz, David Orion, David Last, Yael Mardor, Yotam Kimmel, Shelly Yehezkely, Eyal Lotan, Ze’ev Itsekson-Hayosh, Sylvia Koton, David Guez, and David Tanne
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Male ,Perfusion scanning ,Multimodal Imaging ,Brain Ischemia ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Penumbra ,Philips healthcare ,General Medicine ,Blood flow ,Middle Aged ,medicine.disease ,Multimodal ct ,Cerebral Angiography ,Cerebral blood flow ,Cerebrovascular Circulation ,Female ,Surgery ,Neurology (clinical) ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Perfusion ,030217 neurology & neurosurgery - Abstract
PurposeThe region defined as ‘at risk’ penumbra by current CT perfusion (CTP) maps is largely overestimated. We aimed to quantitate the portion of true ‘at risk’ tissue within CTP penumbra and to determine the parameter and threshold that would optimally distinguish it from false ‘at risk’ tissue, that is, benign oligaemia.MethodsAmong acute stroke patients evaluated by multimodal CT (NCCT/CTA/CTP) we identified those that had not undergone endovascular/thrombolytic treatment and had follow-up NCCT. Maps of absolute and relative CBF, CBV, MTT, TTP and Tmax as well as summary maps depicting infarcted and penumbral regions were generated using the Intellispace Portal (Philips Healthcare, Best, Netherlands). Follow-up CT was automatically co-registered to the CTP scan and the final infarct region was manually outlined. Perfusion parameters were systematically analysed – the parameter that resulted in the highest true-negative-rate (ie, proportion of benign oligaemia correctly identified) at a fixed, clinically relevant false-negative-rate (ie, proportion of ‘missed’ infarct) of 15%, was chosen as optimal. It was then re-applied to the CTP data to produce corrected perfusion maps.ResultsForty seven acute stroke patients met selection criteria. Average portion of infarcted tissue within CTP penumbra was 15%±2.2%. Relative CBF at a threshold of 0.65 yielded the highest average true-negative-rate (48%), enabling reduction of the false ‘at risk’ penumbral region by ~half.ConclusionsApplying a relative CBF threshold on relative MTT-based CTP maps can significantly reduce false ‘at risk’ penumbra. This step may help to avoid unnecessary endovascular interventions.
- Published
- 2017
18. State of the Art: Machine Learning Applications in Glioma Imaging
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Yvonne W. Lui, Narges Razavian, Eyal Lotan, Girish M. Fatterpekar, and Rajan Jain
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business.industry ,Brain Neoplasms ,Deep learning ,General Medicine ,Glioma ,Machine learning ,computer.software_genre ,Prognosis ,Patient Care Planning ,030218 nuclear medicine & medical imaging ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,Radiomics ,030220 oncology & carcinogenesis ,Image Interpretation, Computer-Assisted ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,State (computer science) ,Artificial intelligence ,business ,computer ,Forecasting - Abstract
Machine learning has recently gained considerable attention because of promising results for a wide range of radiology applications. Here we review recent work using machine learning in brain tumor imaging, specifically segmentation and MRI radiomics of gliomas.We discuss available resources, state-of-the-art segmentation methods, and machine learning radiomics for glioma. We highlight the challenges of these techniques as well as the future potential in clinical diagnostics, prognostics, and decision making.
- Published
- 2018
19. A volcanic explosion of autoantibodies in systemic lupus erythematosus: A diversity of 180 different antibodies found in SLE patients
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Eyal Lotan, Avi Shina, Gilad Twig, Orna Komisar, Ariel Furer, Eyal Klang, Einat Slonimsky, Oshry Mozes, Yehuda Shoenfeld, Ibrahim Marai, Dana Ben-Ami Shor, Yaniv Sherer, Mike Welt, Howard Amital, and Gal Yaniv
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Autoimmune disease ,Lupus erythematosus ,biology ,business.industry ,Immunology ,Autoantibody ,medicine.disease ,Autoantigens ,Blood proteins ,Antigen ,immune system diseases ,Polyclonal antibodies ,medicine ,biology.protein ,Animals ,Humans ,Lupus Erythematosus, Systemic ,Immunology and Allergy ,Antibody ,skin and connective tissue diseases ,business ,Autoantibodies ,Anti-SSA/Ro autoantibodies - Abstract
Recent research in systemic lupus erythematosus (SLE) yielded new antigens and antibodies in SLE patients. We describe the various autoantibodies that can be detected in patients with SLE. A literature review, using the terms “autoantibody” and “systemic lupus erythematosus”, was conducted to search for articles on autoantibodies in SLE, their target antigens, association with disease activity and other clinical manifestations. One hundred and eighty autoantibodies were so far described in SLE patients. These include autoantibodies that target nuclear antigens, cytoplasmic antigens, cell membrane antigens, phospholipid-associated antigens, blood cells, endothelial cells, and nervous system antigens, plasma proteins, matrix proteins, and miscellaneous antigens. The target of an autoantibody, the autoantigen properties, autoantibody frequencies in SLE, as well as clinical associations, and correlation with disease activity are described for all 180 autoantibodies. SLE is so far the autoimmune disease with the largest number of detectable autoantibodies. Their production could be antigen-driven, the result of a polyclonal B cell activation, impaired apoptotic pathways, or the outcome of an idiotypic network dysregulation.
- Published
- 2015
20. The Role of Liver Segment-to-Spleen Volume Ratio in the Staging of Hepatic Fibrosis in Patients with Hepatitis C Virus Infection
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Eyal, Lotan, Stephen P, Raskin, Michal M, Amitai, Yeruham, Kleinbaum, Ella, Veitsman, Peretz, Weiss, Oranit, Cohen-Ezra, Tania, Berdichevski, and Ziv, Ben-Ari
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Liver Cirrhosis ,Male ,Comparative Effectiveness Research ,Medication Therapy Management ,Patient Selection ,Organ Size ,Middle Aged ,Antiviral Agents ,Hepatitis C ,Sensitivity and Specificity ,Severity of Illness Index ,Liver ,Elasticity Imaging Techniques ,Humans ,Female ,Israel ,Spleen ,Monitoring, Physiologic ,Retrospective Studies - Abstract
Accurate assessment of liver fibrosis is crucial for the management of patients with hepatitis C virus (HCV) infection.To evaluate the performance of liver segment-to-spleen volume ratio in predicting the severity of liver fibrosis.Sixty-four consecutive HCV patients were enrolled in this retrospective study. All patients underwent contrast-enhanced computed tomography (CT) and were divided into three groups based on their hepatic fibrosis stage evaluated by shear-wave elastography (SWE): non-advanced (F0-F1, n=29), advanced (F2, n=19) and severe fibrosis (F3-F4, n=16). Using semi-automated liver segmentation software, we calculated the following liver segments and spleen volumes for each participant: total liver volume (TLV), caudate lobe (CV), left lateral segment (LLV), left medial segment (LMV), right lobe (RV) and spleen (SV), a well as their ratios: CV/SV, RV/SV, LLV/SV, LMV/SV and TLV/SV.RV/SV was found to discriminate between patients with non-advanced and advanced fibrosis (P = 0.001), whereas SV, CV, RV, TLV/SV, LMV/SV and RV/SV discriminated between patients with advanced and severe fibrosis (P0.05). RV/SV ≤ 3.6 and RV ≤ 2.9 were identified as the best cutoff values to differentiate non-advanced from advanced fibrosis and advanced from severe fibrosis with sensitivities of 72.2% and 92.7%, specificities of 72.7% and 77.8%, and with an area under the receiver operating characteristic (ROC) curve of 0.797 and 0.847, respectively (P ≤ 0.002).RV/SV may be used for the assessment and monitoring of liver fibrosis in HCV patients prior to the administration of antiviral therapy, considering SWE as the reference method.
- Published
- 2017
21. Can Unenhanced CT Findings Predict Interventional Versus Conservative Treatment in Acute Renal Colic?
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Orith Portnoy, Omer Weissman, Rachel Schor, Larisa Guranda, Harry Winkler, Nir Kleinmann, and Eyal Lotan
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Male ,medicine.medical_specialty ,Acute Renal Colic ,030232 urology & nephrology ,Conservative Treatment ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Adipose capsule of kidney ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Edema ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Leukocytosis ,Ct findings ,Renal Colic ,Hydronephrosis ,Retrospective Studies ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Conservative treatment ,Treatment Outcome ,Acute Disease ,Shivering ,Female ,Radiology ,medicine.symptom ,business ,Emergency Service, Hospital ,Tomography, X-Ray Computed - Abstract
The purpose of this study was to determine the value of clinical parameters and radiologic findings on unenhanced CT to the choice between interventional and conservative management for patients with acute renal colic.Unenhanced CT records of 183 consecutive patients with acute renal colic were retrospectively reviewed. Urolithiasis was confirmed at both unenhanced CT and clinical follow-up findings of 80 patients (study group). Clinical parameters (signs of infection and renal indexes) and unenhanced CT findings (tissue rim sign, hydronephrosis, perinephric and periureteral edema, ureteral dilatation, renal attenuation, and stone characteristics) were graded and correlated with the choice of clinical management. ROC analysis was constructed for the most statistically significant parameters.Forty-two patients (52%) were treated conservatively and 38 (48%) underwent interventional treatments. The relationship between shivering, fever, and leukocytosis and interventional treatment had low sensitivity (29%, 26%, and 16%, respectively) but very high specificity (98%, 95%, and 98%, respectively) (p0.05). Stone size and density were statistically significantly different between patients treated conservatively and those treated interventionally (size, 4.6 vs 6.7 mm; density, 730 vs 910 HU; p0.01). Stones larger than 6.5 mm with an attenuation value greater than 1100 HU and that were proximally located were more likely to be treated interventionally.Larger stone size, higher density, proximal location, and complaints of shivering, fever, and leukocytosis are the most important parameters for predicting invasive management of acute renal colic. Other clinical and radiologic information may be useful as supportive findings but do not predict the choice of patient management.
- Published
- 2016
22. Unrecognized renal insufficiency and chemotherapy-associated adverse effects among breast cancer patients
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David Pereg, Avi Leader, Maya Gottfried, Eyal Lotan, and Michael Lishner
- Subjects
Risk ,Oncology ,Cancer Research ,medicine.medical_specialty ,Neutropenia ,Fever ,Renal function ,Breast Neoplasms ,urologic and male genital diseases ,Cohort Studies ,chemistry.chemical_compound ,Breast cancer ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,Pharmacology (medical) ,Renal Insufficiency ,Adverse effect ,Prospective cohort study ,Cyclophosphamide ,Retrospective Studies ,Pharmacology ,Creatinine ,Dose-Response Relationship, Drug ,business.industry ,Incidence ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Hospitalization ,Logistic Models ,chemistry ,Doxorubicin ,Female ,business ,Glomerular Filtration Rate - Abstract
Several studies have shown that more than half of cancer patients have unrecognized renal insufficiency (RI), which is a reduced glomerular filtration rate (GFR) with normal serum creatinine. The aim of this study was to determine whether unrecognized RI is associated with an increased risk for chemotherapy-associated adverse effects in breast cancer patients treated with combined doxorubicin and cyclophosphamide treatment. GFR was estimated for 95 breast cancer patients from January 2005 to August 2009 using the Cockcroft-Gault formula. Unrecognized RI was defined as GFR less than 75 ml/min/1.73 m and the patients were grouped according to their estimated GFR. Logistic regression models were used to assess the effect of GFR on clinical outcomes. In total, 49 (52%) patients experienced at least one of the following chemotherapy-associated adverse effects during the course of treatment: an episode of neutropenic fever with hospital admission, a delay in chemotherapy treatment for a medical reason, a need for dose adjustment because of toxicity of the chemotherapeutic drugs, and the need for use of granulocyte colony-stimulating factor. The incidence of these adverse effects occurred more frequently in patients with GFR less than 75 compared with patients with GFR at least 75 (64 vs. 42%, odds ratio 5.29, 95% confidence interval 2.10-13.33) and remained statistically significant after adjustment for age, BMI, and initial doses of chemotherapeutic drugs (odds ratio 3.56, 95% confidence interval 1.08-11.67). Neutropenic fever, dose delay, and dose adjustment as separate outcomes occurred more frequently in the GFR less than 75 group but lost statistical significance after adjustment. Our results demonstrate that unrecognized RI is associated with an increased risk for chemotherapy-associated adverse events in this patient population. Further prospective studies are required to determine whether a dose reduction in patients with unrecognized RI reduces adverse effects without adversely affecting the benefit of treatment.
- Published
- 2012
23. Is There More to This Case than Mere Pulmonary Alveolar Proteinosis? A Clinical Case Presentation
- Author
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Gad Segal, Amir Dagan, Tal Frenkel-Rutenberg, Eyal Lotan, and Dor Lotan
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Pulmonary alveolar proteinosis, GATA2, miscarriage, myelodysplasia syndrome, surfactant ,GATA2 ,lcsh:R ,lcsh:Medicine ,medicine.disease ,Haematopoiesis ,Concomitant ,Immunology ,Internal Medicine ,medicine ,Clinical case ,Presentation (obstetrics) ,Pulmonary alveolar proteinosis ,business ,Rare disease - Abstract
Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disease, associated with excess accumulation of surfactant proteins and lipids in the alveoli. Clinical presentation: We report the case of a 46-year-old woman with a combined presentation of PAP, myelodysplasia and recurrent miscarriages. Conclusions: The concomitant presentation of the above might be compatible with a mutation of the haematopoietic transcription factor gene GATA2.
- Published
- 2015
24. The role of early postmortem CT in the evaluation of support-line misplacement in patients with severe trauma
- Author
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Eyal Lotan, Daniel Simon, Larisa Guranda, Orith Portnoy, and Eli Konen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Resuscitation ,Prosthesis Implantation ,medicine ,Intubation, Intratracheal ,Central Venous Catheters ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Nasogastric tubes ,Trauma victims ,Intubation, Gastrointestinal ,Aged ,Aged, 80 and over ,Chest drains ,business.industry ,Postmortem ct ,General Medicine ,Middle Aged ,Surgery ,Severe trauma ,Right Main Bronchus ,Wounds and Injuries ,Female ,Autopsy ,business ,Tomography, X-Ray Computed - Abstract
The purpose of this study was to retrospectively assess the role of early postmortem CT in evaluating support-line misplacement to improve future treatment in the trauma setting.We included all postmortem CT examinations that were performed for trauma patients within the 1st hour after declaration of death in our tertiary medical center between August 1, 2008, and August 31, 2013. Correct placement of the following support lines was evaluated: endotracheal tubes (ETTs), chest drains, central venous catheters (CVCs), and nasogastric tubes (NGTs). Prehospital resuscitation efforts were started in all cases.Early postmortem CT was performed on average 22 minutes after declaration of death in 25 consecutive patients with severe trauma. Overall, 14 subjects (56%) had suboptimal or misplaced support lines. Of ETTs inserted into 18 trauma victims; three (17%) were mislaid in the right main bronchus and five (28%) were near or at the level of the carina. Of chest drains inserted into 13 subjects, 10 were suboptimally positioned (77%). Of CVCs inserted into eight subjects (seven femoral and one brachiocephalic), one femoral CVC (13%) was malpositioned in the soft tissues of the pelvis. Of NGTs inserted in five trauma victims, one was folded within the pharynx.Early postmortem CT for patients who have experienced severe poly-trauma can be of important educational value to radiologists and the trauma teams, providing immediate feedback regarding the location of the support lines and possibly contributing to improved training and command of the learning curve by medical staff.
- Published
- 2014
25. Ruptured intracranial mycotic aneurysm in infective endocarditis: radiological and clinical findings
- Author
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Eyal, Lotan, David, Orion, Mati, Bakon, Rafael, Kuperstein, and Gahl, Greenberg
- Subjects
Endocarditis ,Intracranial Aneurysm ,Aneurysm, Ruptured ,Subarachnoid Hemorrhage ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Anti-Bacterial Agents ,Cerebral Angiography ,Young Adult ,Treatment Outcome ,Enterococcus faecalis ,Humans ,Female ,Cardiac Surgical Procedures ,Tomography, X-Ray Computed ,Echocardiography, Transesophageal ,Gram-Positive Bacterial Infections - Published
- 2014
26. Percutaneous embolization of an incidentally diagnosed pulmonary aneurysm in a scleroderma patient
- Author
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Fereidoun Abtin, Joe Springer, Uri Rimon, Justin P. McWilliams, and Eyal Lotan
- Subjects
medicine.medical_specialty ,Percutaneous ,Thoracic Radiology ,medicine.medical_treatment ,Pulmonary Artery ,Aneurysm ,medicine.artery ,Biopsy ,Pulmonary fibrosis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Embolization ,Incidental Findings ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Thrombosis ,Treatment Outcome ,Scleroderma, Diffuse ,Angiography ,Pulmonary artery ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
A 59-year-old female with history of progressive scleroderma and pulmonary fibrosis was referred for biopsy of a pulmonary nodule that was discovered on computed-tomography (CT) chest surveillance, not present on prior CT- scan. Imaging was suspicious for granuloma, malignancy or aneurysm. CT- Angiography (CTA), performed immediately before the procedure, did not show enhancement of the mass, followed by placement of coaxial-needle into the mass. Suspicion of aneurysm was again raised and repeat CTA demonstrated contrast filling of the aneurysm. With the coaxial-needle in the aneurysm, embolization of the sac was performed using microfibrillar collagen, followed by confirmation of containment and thrombosis with CT.
- Published
- 2012
27. [Does the transition to clinical training change students' perception of career choice, physician's character and preclinical studies?]
- Author
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Eyal, Lotan, Oded, Kimhi, Michael, Lishner, and Netta, Notzer
- Subjects
Students, Medical ,Attitude ,Career Choice ,Reward ,Physicians ,Surveys and Questionnaires ,Clinical Clerkship ,Humans ,Perception ,Curriculum ,Personal Satisfaction ,Israel - Abstract
In Israel, the transition to clinical training in hospitals is the first direct encounter of the medical student with the reality of the profession. This is a significant socialization step for his upcoming professional decisions.This study aimed to identify how this encounter influences students' perceptions of career choice, physician's character and preclinical studies.Fourth year Israeli medical students at the Tel Aviv University voluntarily completed a questionnaire before and after their first clinical clerkship. The questionnaire was comprised of 30 5-point Likert scale statements and 3 multiple choice questions with the possibility to add remarks.The random response rate was 90% (81/90) before the clerkship and 82% (90/110) at its end. Results indicate that the students are satisfied with their medical studies at both junctures. However, after the clerkship, 23% of the students consider alternatives to clinical medicine compared with only 6% before, and 16% would rethink studying medicine. Physicians are perceived as professional, compassionate, respectful to colleagues and actively participating in students' education. Physicians' levels of workload and bitterness are evaluated as high and moderate, respectively, while their levels of reward and satisfaction with medicine are evaluated as low and moderate, respectively. Their evaluation of the contribution of preclinical studies as preparation for clinical studies had not changed after the clerkship and was moderate, and earlier exposure to patients and clinical relevancy of the learned subjects were preferred.The students enter the medical world highly satisfied, and this feeling shall be maintained until the stage of being independent physicians and choosing their specialties. The picture that evolved, in which a high proportion of the students consider alternatives to clinical medicine, is disappointing. Educators should be aware of their role model function not only in knowledge and skills, but also in behavior and communication with patients. The students pointed to necessary changes in the medical curriculum to make basic sciences more relevant to clinical medicine. A broader study at different stages of studies in the rest of the medical faculties in Israel may be needed.
- Published
- 2010
28. Cultural Differences between American and Israeli Medical Students Regarding Their Perceptions of the Medical Profession and Satisfaction with Studies
- Author
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Netta Notzer, Eyal Lotan, and Louis Shenkman
- Subjects
Clinical clerkship ,Response rate (survey) ,Medical education ,medicine.medical_specialty ,Medicine (General) ,Academic year ,business.industry ,media_common.quotation_subject ,education ,Workload ,Education (General) ,Affect (psychology) ,R5-920 ,Cultural diversity ,Perception ,Family medicine ,Medical profession ,Medicine ,General Materials Science ,L7-991 ,business ,media_common - Abstract
Background: Cultural differences have been discussed as a potential factor influencing students' perception and motivation towards their studies. At the Sackler Faculty of Medicine, Tel-Aviv University, two separate programs coexist for American and Israeli medical students. Both are taught at the same sites and by the same faculty, thus enabling cultural comparisons. Our aim was to examine the differences of two medical student groups, American and Israeli, regarding their satisfaction with studies, view of the educational workload, and their perceptions of physician characteristics. Methods: During the academic year 2007-2008 we administered an anonymous questionnaire to the two groups immediately after their first clinical clerkship in internal medicine. The response rate was 82% (90 out of 110) for the Israelis and 93% (53 out of 57) for the Americans. Results : Americans, compared to the Israelis, are significantly more satisfied with their medical studies, consider fewer alternatives to future careers in clinical medicine, feel less of a workload, and hold a more positive opinion of physician characteristics. Conclusions: Cultural differences affect students' perception of their studies, mentors and future careers. Medical educators should be sensitive to the effects of students' background which influence academic and professional attitudes and find ways to strengthen their commitment to the profession.
- Published
- 2010
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