RESUMEN
A woman in her 80s with a history of congestive heart failure, atrial arrhythmia treated with atrioventricular nodal ablation and permanent pacemaker (PPM) placement, mitral valve disease status post-repair and colon cancer status post-treatment was admitted for further evaluation of severe dyspnea on exertion. Imaging revealed vegetation on both the prosthetic mitral valve and the PPM lead. Blood cultures were collected without growth, so a cell-free DNA Karius test was performed, which can detect over 1000 pathogens and has a sensitivity between 87% and 93%. Testing returned positive results for Streptococcus bovis subspecies pasteurianus Given its association with colorectal cancer, abdominal imaging and an endoscopic biopsy were performed, showing recurrent colonic malignancy. The patient underwent a right colon resection prior to cardiac intervention. This report describes the clinical application of the novel cell-free DNA Karius test, which led to the diagnosis of recurrent colon cancer associated with S. pasteurianus endocarditis.
Asunto(s)
Endocarditis Bacteriana , Streptococcus bovis , Humanos , Femenino , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Anciano de 80 o más Años , Streptococcus bovis/aislamiento & purificación , Infecciones Estreptocócicas/diagnóstico , Neoplasias del Colon/diagnóstico , Ácidos Nucleicos Libres de Células/sangre , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/microbiologíaRESUMEN
BACKGROUND: Accurate source localization from electroencephalography (EEG) requires electrode co-registration to brain anatomy, a process that depends on precise measurement of 3D scalp locations. Stylus digitizers and camera-based scanners for such measurements require the subject to remain still and therefore are not ideal for young children or those with movement disorders. NEW METHOD: Motion capture accurately measures electrode position in one frame but marker placement adds significant setup time, particularly in high-density EEG. We developed an algorithm, named MoLo and implemented as an open-source MATLAB toolbox, to compute 3D electrode coordinates from a subset of positions measured in motion capture using spline interpolation. Algorithm accuracy was evaluated across 5 different-sized head models. RESULTS: MoLo interpolation reduced setup time by approximately 10â¯min for 64-channel EEG. Mean electrode interpolation error was 2.95⯱â¯1.3â¯mm (range: 0.38-7.98â¯mm). Source localization errors with interpolated compared to true electrode locations were below 1â¯mm and 0.1â¯mm in 75 % and 35 % of dipoles, respectively. COMPARISON WITH EXISTING METHODS: MoLo location accuracy is comparable to stylus digitizers and camera-scanners, common in clinical research. The MoLo algorithm could be deployed with other tools beyond motion capture, e.g., a stylus, to extract high-density EEG electrode locations from a subset of measured positions. The algorithm is particularly useful for research involving young children and others who cannot remain still for extended time periods. CONCLUSIONS: Electrode position and source localization errors with MoLo are similar to other modalities supporting its use to measure high-density EEG electrode positions in research and clinical settings.