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In pathology, tissue images are evaluated using a light microscope, relying on the expertise and experience of pathologists. There is a great need for computational methods to quantify and standardize histological observations. Computational quantification methods become more and more essential to evaluate tissue images. In particular, the distribution of tumor cells and their microenvironment are of special interest. Here, we systematically investigated tumor cell properties and their spatial neighborhood relations by a new application of statistical analysis to whole slide images of Hodgkin lymphoma, a tumor arising in lymph nodes, and inflammation of lymph nodes called lymphadenitis. We considered properties of more than 400, 000 immunohistochemically stained, CD30-positive cells in 35 whole slide images of tissue sections from subtypes of the classical Hodgkin lymphoma, nodular sclerosis and mixed cellularity, as well as from lymphadenitis. We found that cells of specific morphology exhibited significant favored and unfavored spatial neighborhood relations of cells in dependence of their morphology. This information is important to evaluate differences between Hodgkin lymph nodes infiltrated by tumor cells (Hodgkin lymphoma) and inflamed lymph nodes, concerning the neighborhood relations of cells and the sizes of cells. The quantification of neighborhood relations revealed new insights of relations of CD30-positive cells in different diagnosis cases. The approach is general and can easily be applied to whole slide image analysis of other tumor types.
Bioinformatics analysis quantifies neighborhood preferences of cancer cells in Hodgkin lymphoma
(2017)
Motivation Hodgkin lymphoma is a tumor of the lymphatic system and represents one of the most frequent lymphoma in the Western world. It is characterized by Hodgkin cells and Reed-Sternberg cells, which exhibit a broad morphological spectrum. The cells are visualized by immunohistochemical staining of tissue sections. In pathology, tissue images are mainly manually evaluated, relying on the expertise and experience of pathologists. Computational quantification methods become more and more essential to evaluate tissue images. In particular, the distribution of cancer cells is of great interest.
Results Here, we systematically quantified and investigated cancer cell properties and their spatial neighborhood relations by applying statistical analyses to whole slide images of Hodgkin lymphoma and lymphadenitis, which describes a non-cancerous inflammation of the lymph node. We differentiated cells by their morphology and studied the spatial neighborhood relation of more than 400,000 immunohistochemically stained cells. We found that, according to their morphological features, the cells exhibited significant preferences for and aversions to cells of specific profiles as nearest neighbor. We quantified differences between Hodgkin lymphoma and lymphadenitis concerning the neighborhood relations of cells and the sizes of cells. The approach can easily be applied to other cancer types.
Die digitale Pathologie ist ein neues, aber stetig wachsendes, Feld in der Medizin. Die kontinuierliche Entwicklung von verbesserten digitalen Scannern erlaubt heute das Abscannen von kompletten Gewebeschnitten und Whole Slide Images gewinnen an Bedeutung. Ziel dieser Arbeit ist die Methodenentwicklung zur Analyse von Whole Slide Images des klassischen Hodgkin Lymphoms. Das Hodgkin-Lymphom, oder Morbus Hodgkin, ist eine Tumorerkrankung des Lymphsystems, bei der die monoklonalen Tumorzellen in der Regel von B-Lymphozyten im Vorläuferstadium abstammen.
Etwas mehr als 9.000 Hodgkin-Lymphom-Fälle werden jährlich in den USA diagnostiziert. Zwar ist die 5-Jahre-Überlebensrate für Hodgkin-Lymphome mit 85,3 % vergleichsweise hoch, dennoch werden etwa 1.100 Todesfälle pro Jahr in den USA registriert. Auf mikroskopischer Ebene sind die Hodgkin-Reed-Sternberg Zellen (HRS-Zellen) typisch für das klassische Hodgkin Lymphom. HRS-Zellen haben einen oder mehrere Zellkerne, die stark vergrößert sind und eine grobe Chromatinstruktur aufweisen. Immunhistologisch gibt es für HRS-Zellen charakterisierende Marker, so sind HRS-Zellen positiv für den Aktivierungsmarker CD30.
Neben der konventionellen Mikroskopie, ermöglichen Scanner das Digitalisieren von ganzen Objektträgern (Whole Slide Image). Whole Slide Images werden bisher wenig in der Routinediagnostik eingesetzt. Ein großer Vorteil von digitalisierten Gewebeschnitten bietet sich bei der computergestützten Analyse. Automatisierte Bildanalyseverfahren wie Zellerkennung können Pathologen bei der Diagnose unterstützen, indem sie umfassende Statistiken zur Anzahl und Verteilung von immungefärbten Zellen bereitstellen.
Die untersuchten immunohistologischen Bilder wurden vom Dr. Senckenbergisches Institut für Pathologie des Universitätsklinikums Frankfurt bereit gestellt. Die betrachteten Gewebeschnitte sind gegen CD30 immungefärbt, einem Membranrezeptor, welcher in HRS-Zellen und aktivierten Lymphozyten exprimiert wird. Die Gewebeschnitte wurden mit einem Aperio ScanScope slide scanner digitalisiert und liegen mit einer hohen Auflösung von 0,25 μm pro Pixel vor. Bei den vorliegenden Gewebeschnittgrößen ergeben sich Bilder mit bis zu 90.000 x 90.000 Pixeln.
Der untersuchte Bilddatensatz umfasst 35 Bilder von Lymphknotengewebeschnitten der drei Krankheitsbilder: Gemischtzelliges klassisches Hodgkinlymphom, noduläres klassisches Hodgkinlymphom und Lymphadenitis. Die Bildverarbeitungspipeline wurden teils neu implementiert, teils von etablierten Bilderkennungssoftware und -bibliotheken wie CellProfiler und Java Advanced Imaging verwendet. CD30-positive Zellobjekte werden in den Gewebeschnitten automatisiert erkannt und neben der globalen Position im Whole Slide Image weitere Morphologiedeskriptoren berechnet, wie Fläche, Feret-Durchmesser, Exzentrität und Solidität. Die Zellerkennung zeigt mit 84 % eine hohe Präzision und mit 95 % eine sehr gute Sensitivität.
Es konnte gezeigt werden, dass in Lymphadenitisfällen im Schnitt deutlich weniger CD30- positive Zellen präsent sind als in klassisches Hodgkinlymphom. Während hier im Schnitt nur rund 3.000 Zellen gefunden wurden, lag der Durchschnitt für das Mischtyp klassisches Hodgkinlymphom bei rund 19.000 CD30 positiven Zellen. Während die CD30-positiven Zellen in Lymphadenitisfällen relativ gleichmäßig verteilt sind, bilden diese in klassischen Hodgkinlymphom-Fällen Zellcluster höherer Dichte.
Die berechneten Morphologiedeskriptoren bieten die Möglichkeit die Gewebeschnitte und den Krankheitsverlauf näher zu beschreiben. Zudem sind bisher Größe und Erscheinungsbild der HRS-Zellen hauptsächlich anhand manuell ausgewählter Zellen bestimmt worden. Ein Maß für die Ausdehnung der Zellen ist der maximale Feret-Durchmesser. Bei CD30-Zellen im klassischen Hodgkinlymphom liegt dieser im Durchschnitt bei 20 μm und ist somit deutlich größer als die durchschnittlich gemessenen 15 μm in Lymphadenitis.
Es wurde ein graphentheoretischer Ansatz gewählt, um die CD30 positiven Zellen und ihre räumliche Nachbarschaft zu modellieren. In CD30-Zellgraphen von klassischen Hodgkinlymphom-Gewebeschnitten ist der durchschnittliche Knotengrad gegenüber den von Lymphadenitis-Bildern stark erhöht. Der Vergleich mit Zufallsgraphen zeigt, dass die beobachteten Knotengradverteilungen nicht für eine zufällige Verteilung der Zellen im Gewebeschnitt sprechen. Eigenschaften und Verteilung von Communities in CD30-Zellgraphen können hinzugenommen werden, um klassisches Hodgkinlymphom Gewebeschnitte näher zu charakterisieren.
Diese Arbeit zeigt, dass die Auswertung von Whole Slide Image unterstützend zur Verbesserung der Diagnose möglich ist. Die mehr als 400.000 automatisch erkannten CD30-positiven Zellobjekte wurden morphologisch beschrieben, und zusammen mit ihrer Position im Gewebeschnitt ist die Betrachtung wichtiger Eigenschaften des klassischen Hodgkinlymphoms realisierbar. Zellgraphen können durch weitere Zelltypen erweitert werden und auf andere Krankheitsbilder angewendet werden.
Background: The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication – including prescription and over-the-counter (OTC) drugs – of elderly patients in primary care is still insufficient.
Objectives: This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort.
Methods: MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation.
Results: Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322–0.430; female: ρ = 0.301, CI 0.624–0.340).
Conclusion: The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.
During infection the SARS-CoV-2 virus fuses its viral envelope with cellular membranes of its human host. The viral spike (S) protein mediates both the initial contact with the host cell and the subsequent membrane fusion. Proteolytic cleavage of S at the S2′ site exposes its fusion peptide (FP) as the new N-terminus. By binding to the host membrane, the FP anchors the virus to the host cell. The reorganization of S2 between virus and host then pulls the two membranes together. Here we use molecular dynamics (MD) simulations to study the two core functions of the SARS-CoV-2 FP: to attach quickly to cellular membranes and to form an anchor strong enough to withstand the mechanical force during membrane fusion. In eight 10 μs long MD simulations of FP in proximity to endosomal and plasma membranes, we find that FP binds spontaneously to the membranes and that binding proceeds predominantly by insertion of two short amphipathic helices into the membrane interface. Connected via a flexible linker, the two helices can bind the membrane independently, yet binding of one promotes the binding of the other by tethering it close to the target membrane. By simulating mechanical pulling forces acting on the C-terminus of the FP, we then show that the bound FP can bear forces up to 250 pN before detaching from the membrane. This detachment force is more than 10-fold higher than an estimate of the force required to pull host and viral membranes together for fusion. We identify a fully conserved disulfide bridge in the FP as a major factor for the high mechanical stability of the FP membrane anchor. We conclude, first, that the sequential binding of two short amphipathic helices allows the SARS-CoV-2 FP to insert quickly into the target membrane, before the virion is swept away after shedding the S1 domain connecting it to the host cell receptor. Second, we conclude that the double attachment and the conserved disulfide bridge establish the strong anchoring required for subsequent membrane fusion. Multiple distinct membrane-anchoring elements ensure high avidity and high mechanical strength of FP–membrane binding.
Dual antiplatelet treatment (DAPT) increases the risk of tPA-associated hemorrhagic transformation (HT) in ischemic stroke. To investigate the effects of DAPT in rodents, reliable indicators of platelet function utilizing a minimally invasive procedure are required. We here established a fluorescence-based assay to monitor DAPT efficiency in a mouse model of ischemic stroke with HT. Male C57/BL6 mice were fed with aspirin and clopidogrel (ASA+CPG). Venous blood was collected, stimulated with thrombin, labeled with anti-CD41-FITC and anti-CD62P-PE, and analyzed by flow cytometry. Subsequently, animals were subjected to experimental stroke and tail bleeding tests. HT was quantified using NIH ImageJ software. In ASA+CPG mice, the platelet activation marker CD62P was reduced by 40.6 ± 4.2% (p < 0.0001) compared to controls. In vitro platelet function correlated inversely with tail bleeding tests (r = −0.8, p = 0.0033, n = 12). Twenty-four hours after drug withdrawal, platelet activation rates in ASA+CPG mice were still reduced by 20.2 ± 4.1% (p = 0.0026) compared to controls, while tail bleeding volumes were increased by 4.0 ± 1.4 μl (p = 0.004). Conventional tests using light transmission aggregometry require large amounts of blood and thus cannot be used in experimental stroke studies. In contrast, flow cytometry is a highly sensitive method that utilizes small volumes and can easily be incorporated into the experimental stroke workflow. Our test can be used to monitor the inhibitory effects of DAPT in mice. Reduced platelet activation is indicative of an increased risk for tPA-associated cerebral hemorrhage following experimental stroke. The test can be applied to individual animals and implemented flexibly prior and subsequent to experimental stroke.
Previous studies in developing Xenopus and zebrafish reported that the phosphate transporter slc20a1a is expressed in pronephric kidneys. The recent identification of SLC20A1 as a monoallelic candidate gene for cloacal exstrophy further suggests its involvement in the urinary tract and urorectal development. However, little is known of the functional role of SLC20A1 in urinary tract development. Here, we investigated this using morpholino oligonucleotide knockdown of the zebrafish ortholog slc20a1a. This caused kidney cysts and malformations of the cloaca. Moreover, in morphants we demonstrated dysfunctional voiding and hindgut opening defects mimicking imperforate anus in human cloacal exstrophy. Furthermore, we performed immunohistochemistry of an unaffected 6-week-old human embryo and detected SLC20A1 in the urinary tract and the abdominal midline, structures implicated in the pathogenesis of cloacal exstrophy. Additionally, we resequenced SLC20A1 in 690 individuals with bladder exstrophy-epispadias complex (BEEC) including 84 individuals with cloacal exstrophy. We identified two additional monoallelic de novo variants. One was identified in a case-parent trio with classic bladder exstrophy, and one additional novel de novo variant was detected in an affected mother who transmitted this variant to her affected son. To study the potential cellular impact of SLC20A1 variants, we expressed them in HEK293 cells. Here, phosphate transport was not compromised, suggesting that it is not a disease mechanism. However, there was a tendency for lower levels of cleaved caspase-3, perhaps implicating apoptosis pathways in the disease. Our results suggest SLC20A1 is involved in urinary tract and urorectal development and implicate SLC20A1 as a disease-gene for BEEC.
Human lymph nodes play a central part of immune defense against infection agents and tumor cells. Lymphoid follicles are compartments of the lymph node which are spherical, mainly filled with B cells. B cells are cellular components of the adaptive immune systems. In the course of a specific immune response, lymphoid follicles pass different morphological differentiation stages. The morphology and the spatial distribution of lymphoid follicles can be sometimes associated to a particular causative agent and development stage of a disease. We report our new approach for the automatic detection of follicular regions in histological whole slide images of tissue sections immuno-stained with actin. The method is divided in two phases: (1) shock filter-based detection of transition points and (2) segmentation of follicular regions. Follicular regions in 10 whole slide images were manually annotated by visual inspection, and sample surveys were conducted by an expert pathologist. The results of our method were validated by comparing with the manual annotation. On average, we could achieve a Zijbendos similarity index of 0.71, with a standard deviation of 0.07.
Introduction: In this article three research questions are addressed: (1) Is there an association between socioeconomic status (SES) and patient-reported outcomes in a cohort of multimorbid patients? (2) Does the association vary according to SES indicator used (income, education, occupational position)? (3) Can the association between SES and patient-reported outcomes (self-rated health, health-related quality of life and functional status) be (partly) explained by burden of disease?
Methods: Analyses are based on the MultiCare Cohort Study, a German multicentre, prospective, observational cohort study of multimorbid patients from general practice. We analysed baseline data and data from the first follow-up after 15 months (N = 2,729). To assess burden of disease we used the patients’ morbidity data from standardized general practitioner (GP) interviews based on a list of 46 groups of chronic conditions including the GP’s severity rating of each chronic condition ranging from marginal to very severe.
Results: In the cross-sectional analyses SES was significantly associated with the patient-reported outcomes at baseline. Associations with income were more consistent and stronger than with education and occupational position. Associations were partly explained (17% to 44%) by burden of disease. In the longitudinal analyses only income (but not education and occupational position) was significantly related to the patient-reported outcomes at follow-up. Associations between income and the outcomes were reduced by 18% to 27% after adjustment for burden of disease.
Conclusions: Results indicate social inequalities in self-rated health, functional status and health related quality of life among older multimorbid patients. As associations with education and occupational position were inconsistent, these inequalities were mainly due to income. Inequalities were partly explained by burden of disease. However, even among patients with a similar disease burden, those with a low income were worse off in terms of the three patient-reported outcomes under study.
Background: Multimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients in primary care, and to discover which patient characteristics are associated with positive agreement.
Methods: The MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models were calculated to analyze which patient characteristics can be associated with positive agreement.
Results: We identified four chronic conditions with good agreement (e.g. diabetes mellitus κ = 0.80;PA = 0,87), seven with moderate agreement (e.g. cerebral ischemia/chronic stroke κ = 0.55;PA = 0.60), seventeen with fair agreement (e.g. cardiac insufficiency κ = 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problems κ = 0.05;PA = 0.10).Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income, disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41).
Conclusions: For multimorbidity research, the knowledge of diseases with high disagreement levels between the patients' perceived illnesses and their physicians' reports is important. The analysis shows that different patient characteristics have an impact on the agreement. Findings from this study should be included in the development of clinical guidelines for multimorbidity aiming to optimize health care. Further research is needed to identify more reasons for disagreement and their consequences in health care.