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At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2000

Subendocardial motion in hypertrophic cardiomyopathy: assessment from long- and short-axis views by pulsed tissue Doppler imaging

BACKGROUND: Tissue Doppler imaging (TDI) is a recently developed technique that allows the instantaneous measurement of intrinsic regional myocardial motion velocity. Pulsed TDI is capable of separately assessing left ventricular (LV) regional motion velocity caused by circumferential and longitudinal fiber contraction. This particular feature of function is still controversial in patients with hypertrophic cardiomyopathy (HC). METHODS: To better characterize intrinsic circumferential and longitudinal LV systolic myocardial function in HC, we used pulsed TDI to measure short- and long-axis LV motion velocities, respectively. The subendocardial motion velocity patterns at the middle of the LV posterior wall (PW) and ventricular septum (IVS) in LV parasternal and apical long-axis views were recorded by pulsed TDI in 19 patients with nonobstructive HC and in 21 normal controls (NC). RESULTS: Peak short- and long-axis systolic subendocardial velocities in both the LV PW and IVS were significantly smaller in the HC group than in the NC group, and the time to peak velocity was significantly delayed. Furthermore, peak PW systolic velocity was significantly greater along the long axis than along the short axis in the NC group (8.8 +/- 1.5 cm/s vs 8.2 +/- 1.4 cm/s, P <.05), whereas the opposite was observed in the HC group (6.1 +/- 1.2 cm/s vs 7.5 +/- 1.0 cm/s, P <.0001). No significant differences were found in either group between the long- and short-axis IVS velocities (HC: 5.9 +/- 1.4 cm/s vs 5.5 +/- 1.3 cm/s; NC: 7.8 +/- 1.3 cm/s vs 7.9 +/- 1.6 cm/s). CONCLUSIONS: By using the capability of pulsed TDI for the evaluation of intrinsic myocardial velocity instantaneously in a specific region and direction, we found impairment of LV myocardial systolic function in patients with HC not only in the hypertrophied IVS but also in the nonhypertrophied LV PW. We also found a greater decrease in LV PW velocities along the long axis than the short axis, suggesting greater impairment of long-axis contraction in patients with HC. Because our HC patients did not appear to have excessive intracavitary pressure, these results suggest that the relatively normal-appearing PW is directly affected by the HC pathologic process.

NASA Program Biomedical Research and Countermeasur↗
NASA NTRS2011

Tissue Doppler Imaging Combined with Advanced 12-Lead ECG Analysis Might Improve Early Diagnosis of Hypertrophic Cardiomyopathy in Childhood

Optimization of early diagnosis of childhood hypertrophic cardiomyopathy (HCM) is essential in lowering the risk of HCM complications. Standard echocardiography (ECHO) has shown to be less sensitive in this regard. In this study, we sought to assess whether spatial QRS-T angle deviation, which has shown to predict HCM in adults with high sensitivity, and myocardial Tissue Doppler Imaging (TDI) could be additional tools in early diagnosis of HCM in childhood. Methods: Children and adolescents with familial HCM (n=10, median age 16, range 5-27 years), and without obvious hypertrophy but with heredity for HCM (n=12, median age 16, range 4-25 years, HCM or sudden death with autopsy-verified HCM in greater than or equal to 1 first-degree relative, HCM-risk) were additionally investigated with TDI and advanced 12-lead ECG analysis using Cardiax(Registered trademark) (IMED Co Ltd, Budapest, Hungary and Houston). Spatial QRS-T angle (SA) was derived from Kors regression-related transformation. Healthy age-matched controls (n=21) were also studied. All participants underwent thorough clinical examination. Results: Spatial QRS-T angle (Figure/ Panel A) and septal E/Ea ratio (Figure/Panel B) were most increased in HCM group as compared to the HCM-risk and control groups (p less than 0.05). Of note, these 2 variables showed a trend toward higher levels in HCM-risk group than in control group (p=0.05 for E/Ea and 0.06 for QRS/T by ANOVA). In a logistic regression model, increased SA and septal E/Ea ratio appeared to significantly predict both the disease (Chi-square in HCM group: 9 and 5, respectively, p less than 0.05 for both) and the risk for HCM (Chi-square in HCM-risk group: 5 and 4 respectively, p less than 0.05 for both), with further increased predictability level when these 2 variables were combined (Chi-square 10 in HCM group, and 7 in HCM-risk group, p less than 0.01 for both). Conclusions: In this small material, Tissue Doppler Imaging and spatial mean QRS-T angle deviation, particularly when combined, appear to be sensitive in predicting the risk for developing childhood HCM. Large-scale, prospective studies are needed to confirm this hypothesis.

Femlund, E.↗
NASA NTRS1977

Multispectral imaging for medical diagnosis

Photography technique determines amount of morbidity present in tissue. Imaging apparatus incorporates numerical filtering. Overall system operates in near-real time. Information gained from this system enables physician to understand extent of injury and leads to accelerated treatment.

Anselmo, V. J.↗
NASA NTRS2002

Is Doppler tissue velocity during early left ventricular filling preload independent?

BACKGROUND: Transmitral Doppler flow indices are used to evaluate diastolic function. Recently, velocities measured by Doppler tissue imaging have been used as an index of left ventricular relaxation. OBJECTIVE: To determine whether Doppler tissue velocities are influenced by alterations in preload. METHODS: Left ventricular preload was altered in 17 patients (all men, mean (SD) age, 49 (8) years) during echocardiographic measurements of left ventricular end diastolic volume, maximum left atrial area, peak early Doppler filling velocity, and left ventricular myocardial velocities during early filling. Preload altering manoeuvres included Trendelenberg (stage 1), reverse Trendelenberg (stage 2), and amyl nitrate (stage 3). Systolic blood pressure was measured at each stage. RESULTS: In comparison with baseline, left ventricular end diastolic volume (p = 0.001), left atrial area (p = 0.003), peak early mitral Doppler filling velocity (p = 0.01), and systolic blood pressures (p = 0.001) were all changed by preload altering manoeuvres. Only left ventricular myocardial velocity during early filling remained unchanged by these manoeuvres. CONCLUSIONS: In contrast to standard transmitral Doppler filling indices, Doppler tissue early diastolic velocities are not significantly affected by physiological manoeuvres that alter preload. Thus Doppler tissue velocities during early left ventricular diastole may provide a better index of diastolic function in cardiac patients by providing a preload independent assessment of left ventricular filling.

Non-NASA Center↗
NASA NTRS2000

Monitoring Astronaut Health at the Nanoscale Cellular Level Through the Eye

A user friendly goggles-like head-mounted device equipped with a suite of instruments for several non-invasive and quantitative medical evaluation of the eye, skin, and brain is desired for monitoring the health of astronauts during space travel and exploration of neighboring and distant planets. Real-time non-invasive evaluation of the different structures within the above organs can provide indices of the health of not just these organs, but the entire body. The techniques such as dynamic light scattering (for the early detection of uveitis, cholesterol levels, cataract, changes in the vitreous and possibly Alzheimer's disease), corneal autofluorescence (to assess extracellular matrix biology e.g., in diabetes), optical activity measurements (of anterior ocular fluid to evaluate blood-glucose levels), laser Doppler velocimetry (to assess retinal, optic nerve, and choroidal blood flow), reflectometry/oximetry (for assessing ocular and central nervous system oxygen metabolism), optical coherence tomography (to determine retinal tissue microstructure) and possibly scanning laser technology (for intraocular tissue imaging and scanning) will he integrated into this compact device. Skin sensors will also be mounted on the portion of the device in contact with the periocular region. This will enable monitoring of body temperature, EEG, and electrolyte status. This device will monitor astronaut health during long-duration space travel by detecting aberrations from pre-established "nonns", enabling prompt diagnosis and possibly the initiation of early preventative/curative therapy. The non-invasive nature of the device technologies permits frequent repetition of tests, enabling real-time complete crew health monitoring. This device may ultimately be useful in tele-medicine to bring modern healthcare to under-served areas on Earth as well as in so-called "advanced" care settings (e.g. diabetes in the USA).

Ansari, Rafat R.↗
NASA NTRSDate not supplied

Open Science for Life in Space: Data Sharing and Tools for Knowledge Discovery

The next era in human space exploration is rapidly approaching and will require the use of countermeasures to deep space health hazards. The development of countermeasures (or, the re-purposing of existing agents) will be highly dependent on our understanding of basic biological responses to space stressors (e.g. ionizing radiation, altered gravitational fields, altered day-night cycles, confinement, isolation, hostile-closed environments, distance-duration from Earth, exposure to celestial regolith, etc.). The fast-growing array of space biological data, which in the past was simply archived after minimal analysis, holds great potential if it can be reorganized and formatted for Open Science. Organizing the data for such analysis is a challenge because of its diverse nature (molecular, cellular, tissue, imaging, whole organism and behavior). We will discuss here several strategies that NASA’s Biological and Physical Science Division has put in place to maximize the return on investment for spaceflight bioscience data. Open Science, as a scientific philosophy, is the concept that the more people who have access to the data, the more knowledge will be gained from it. This guiding principle led NASA to develop GeneLab in 2015. GeneLab houses spaceflight and relevant ground-based multi-omics data, and has grown to ~400 transcriptomic, proteomic, metabolomic and epigenomic datasets from plant, rodent, small animal, and microbial space experiments. GeneLab provides users with various tools for data analysis and a visualization portal that allows users to interact with gene expression data from space-related ‘omics experiments. Open Science is also about building scientific communities, and with this spirit in mind, GeneLab has spawned several Analysis Working Groups (AWGs), comprised of more than 200 volunteer scientists. The AWGs initially provided feedback on the processing pipeline and metadata ‘omics standards for GeneLab. Over the last few years, they have become a community-driven science enterprise, engaging in large meta-analysis of GeneLab datasets, resulting in 10 publications (beyond the originally submitted research). Overall, the Open Science nature of GeneLab has resulted in a high degree of data re-use, resulting in 38 additional publications derived from the original 67 publication over the past four years. The enormous success and knowledge gained from GeneLab has led to a collection of sister NASA “Open Science Data Repositories (OSDR)” and research support groups. These include the NASA Ames Life Sciences Data Archive (ALSDA), the NASA Biological Institutional Scientific Collection (NBISC), and the Biospecimen Sharing Program (BSP). All are adopting the GeneLab data architecture system to maximize open-access, find-ability, accessibility, interoperability, and reusability (FAIR). ALSDA collects and curates phenotypic-physiological bioimaging-behavioral data from space and space-relevant non-human experiments, oftentimes coming from the same omics-associated experimental datasets found in GeneLab. Since 2021, a community of ~100 researchers have rallied around ALSDA, to provide feedback in a new ALSDA AWG focused on phenotypic-physiological investigation-sample-assay metadata standards (e.g., Micro-Computed Tomography, Light/Fluorescence Microscopy, Western Blot, Flow Cytometry, Novel Object Recognition, Elevated Plus Maze, etc. of ~50 assays collected). These standards are part of a new single point-of-entry data submission portal for all non-human Space Biology and Human Research Program principal investigators, to submit, curate, and share their research data. With open-access space biological data now collected and curated together with rich metadata, and with the potential for linkage to “big data” from the international biological and medical communities (NIH, EBI, etc.), the artificial intelligence and machine learning (AI/ML) era has started for Space Biology. Several other talks will cover these topics in this conference.

life sciences↗
NASA NTRSDate not supplied

Open Science for Life in Space: Data Sharing and Tools for Knowledge Discovery

The next era in human space exploration is rapidly approaching and will require the use of countermeasures to deep space health hazards. The development of countermeasures (or, there-purposing of existing agents) will be highly dependent on our understanding of basic biological responses to space stressors (e.g. ionizing radiation, altered gravitational fields, altered day-night cycles, confinement, isolation, hostile-closed environments, distance-duration from Earth, exposure to celestial regolith, etc.). The fast-growing array of space biological data, which in the past was simply archived after minimal analysis, holds great potential if it can be reorganized and formatted for Open Science. Organizing the data for such analysis is a challenge because of its diverse nature (molecular, cellular, tissue, imaging, whole organism and behavior). We will discuss here several strategies that NASA's Biological and Physical Science Division has put in place to maximize the return on investment for spaceflight bioscience data. Open Science, as a scientific philosophy, is the concept that the more people who have access to the data, the more knowledge will be gained from it. This guiding principle led NASA to develop GeneLab in 2015. GeneLab houses spaceflight and relevant ground-based multi-omics data, and has grown to ~400 transcriptomatic, proteomic, metabolomic and epigenomic datasets from plant, rodent, small animal, and microbial space experiments. GeneLab provides users with various tools for data analysis and a visualization portal that allows users to interact with gene expression data from space-related 'omics experiments. Open Science is also about building scientific communities, and with this spirit in mind, GeneLab has spawned several Analysis Working Groups (AWGs), comprised of more than 200 volunteer scientists. The AWGs initially provided feedback on the processing pipeline and metadata 'omics standards for GeneLab. Over the last few years, they have become a community-driven science enterprise, engaging in large meta-analysis of GeneLab datasets, resulting in 10 publications (beyond the originally submitted research). Overall, the Open Science nature of GeneLab has resulted in a high degree of data-use, resulting in 40 enabled publications by open data. The enormous success and knowledge gained from GeneLab has led to a collection of sister NASA "Open Science Data Repositories (OSDR)" and research support groups. These include the NASA Ames Life Sciences Data Archive (ALSDA), the NASA Biological Institutional Scientific Collection (NBISC), and the Biospecimen Sharing Program (BSP). All are adopting the GeneLab data architecture system to maximize open-access, find-ability, accessibility, interoperability, and reusability (FAIR). ALSDA collects and curates phenotypic-physiological bioimaging-behavioral data from space and space-relevant non-human experiments, oftentimes coming from the same omics-associated experimental datasets found in GeneLab. Since 2021, a community of ~100 researchers have rallied around ALSDA, to provide feedback in a new ALSDA AWG focused on phenotypic-physiological investigation-sample-assay metadata standards (e.g., Micro-Computed Tomography, Light/Flourescence Microscopy, Western Blot, Flow Cytometry, Novel Object Recognition, Elevated Plus Maze, etc. of ~50 assays collected). These standards are part of a new single point-of-entry data submission portal for all non-human Space Biology and Human Research Program principal investigators, to submit, curate, and share their research data. With open-access space biological data now collected and curated together with rich metadata, and with the potential for linkage to "big data" from the international biological and medical communities (NIH, EBI, etc.), the artificial intelligence and machine learning (AI/ML) era has started for Space Biology.

omics↗
NASA NTRSDate not supplied

NASA Open Science Data Repository: Maximizing Spaceflight Bioscience Data

The next era in human space exploration is rapidly approaching and will require the use of countermeasures to deep space health hazards. The development of countermeasures (or, the re-purposing of existing agents) will be highly dependent on our understanding of basic biological responses to space stressors (e.g. ionizing radiation, altered gravitational fields, altered day-night cycles, confinement, isolation, hostile-closed environments, distance-duration from Earth, exposure to celestial regolith, etc.). The fast-growing array of space biological data, which in the past was simply archived after minimal analysis, holds great potential if it can be reorganized and formatted for data re-analysis and re-use via Open Science. Organizing the data for such analysis is a challenge because of its diverse nature (molecular, cellular, tissue, imaging, whole organism and behavior). To address the challenges posed by gaining new knowledge from a vast and diverse amount of biological, health and environmental data in space, the NASA Open Science Data Repository (OSDR - osdr.nasa.gov/bio) plays a crucial role in curating and openly publishing biological data from space-related experiments. Its design incorporates successes and lessons from NASA GeneLab, encompassing not only high-throughput sequencing data but also physiological, phenotypic, and telemetry data. The OSDR makes space biological data FAIR (findable, accessible, interoperable, reusable), and facilitates effective data ingestion, dissemination, and Open Science collaborations. The OSDR also has the capability to integrate human astronaut data with state-of-the-art security and accessibility procedures. We will discuss here several strategies that NASA’s Biological and Physical Science Division have put in place to maximize the return on investment for spaceflight bioscience data.

space biology↗
NASA NTRS1999

Development and Feasibility Testing of Image-Guided Minimally Invasive Tissue for Diagnosis Treatment of Benign and Malignant Breast Disease

Dr. Robert Mah and Dr. Stefanie Jeffrey worked on the development of the NASA Smart Probe in its application as a device to measure and interpret physiologic and image-based parameters of breast tissue. To date the following has been achieved: 1 . Choice of candidate sensors to be tested in breast tissue. 2. Preliminary designs for probe tip, specifically use of different tip shapes, cutting edges, and sensor configuration. 3. Design of sonographic guidance system. 4. Design of data extraction and analysis tool using scanned information of images of the breast tissue to provide a higher dimension of information for breast tissue characterization and interpretation. 5. Initial ex-vivo (fruit and tofu) and in-vivo (rodent) testing to confirm unique substance and tissue characterization by the Smart Probe software.

Jeffrey, Stefanie S.↗
NASA NTRS1999

Magnetic Field Apparatus (MFA) Hardware Test

The objectives of this study are threefold: (1) Provide insight into water delivery in microgravity and determine optimal germination paper wetting for subsequent seed germination in microgravity; (2) Observe the behavior of water exposed to a strong localized magnetic field in microgravity; and (3) Simulate the flow of fixative (using water) through the hardware. The Magnetic Field Apparatus (MFA) is a new piece of hardware slated to fly on the Space Shuttle in early 2001. MFA is designed to expose plant tissue to magnets in a microgravity environment, deliver water to the plant tissue, record photographic images of plant tissue, and deliver fixative to the plant tissue.

Anderson, Ken↗
NASA NTRS2009

Right Ventricular Tissue Doppler Assessment in Space During Circulating Volume Modification using the Braslet-M Device

This joint U.S. - Russian work aims to establish a methodology for assessing cardiac function in microgravity in association with manipulation of central circulating volume. Russian Braslet-M occlusion cuffs were used to temporarily increase the volume of blood in the lower extremities, which effectively reduces the volume returning to the heart in the central circulation. A novel methodology was tested on the International Space Station (ISS) to assess the volume status of crewmembers by evaluating the responses to application and release of the Braslet-on-occlusion cuffs, as well as to modified Valsalva and Mueller maneuvers. Baseline echocardiographic tissue Doppler imaging (TDI) of the right ventricular free wall with no Braslet applied shows early diastolic E' (16 cm/sec), late diastolic A' (14 cm/sec), and systolic (12 cm/sec) velocities compatible with normal subjects on Earth. TDI of the RV free wall with Braslet applied shows that early diastolic E' decreased by 50% (8 cm/sec), late diastolic A' increased by 45%, and systolic S' remains unchanged. TDI of the RV free wall approximately 8 beats after the Braslet was released shows early diastolic E' (8 cm/sec), late diastolic A' (12 cm/sec), and systolic S' (13 cm/sec) velocities. During this portion of the release, early diastolic E' did not recover to baseline values but late diastolic A' and systolic S' recovered to pre-Braslet values. The pre-systolic cross-sectional area of the internal jugular vein with Braslet off was 1.07 cm(sup 2) and 1.13 cm(sup 2) 10 min after the Braslet was applied. The presystolic cross-sectional area of the common femoral vein with Braslet off was 0.50 cm(sup 2), and was 0.54 cm(sup 2) 10 min after the Braslet was applied. The right ventricular myocardial performance Tei index also was calculated for comparison with typical values found in healthy subjects on Earth. Baseline and Braslet-on values for Tei index were 0.25 and 0.22 respectively. Braslet Tei indices are within normal ranges found in healthy subjects and temporarily become greater than 0.4 during the dynamic Braslet release portion of this study. Tissue Doppler imaging of the right ventricle revealed that the Braslet influenced cardiac preload and that fluid was sequestered in the lower-extremity interstitial and vascular space after only 10 minutes of application. This report demonstrates that Braslet application affects right ventricular physiology in long-duration space flight based on TDI and that this effect is in part due to venous hemodynamics.

Hamilton, D. R.↗
NASA NTRS2010

Contrast enhanced spectroscopic optical coherence tomography

A method of forming an image of a sample includes performing SOCT on a sample. The sample may include a contrast agent, which may include an absorbing agent and/or a scattering agent. A method of forming an image of tissue may include selecting a contrast agent, delivering the contrast agent to the tissue, acquiring SOCT data from the tissue, and converting the SOCT data into an image. The contributions to the SOCT data of an absorbing agent and a scattering agent in a sample may be quantified separately.

Boppart, Stephen A.↗
NASA NTRS2009

Three-Dimensional Optical Coherence Tomography

Three-dimensional (3D) optical coherence tomography (OCT) is an advanced method of noninvasive infrared imaging of tissues in depth. Heretofore, commercial OCT systems for 3D imaging have been designed principally for external ophthalmological examination. As explained below, such systems have been based on a one-dimensional OCT principle, and in the operation of such a system, 3D imaging is accomplished partly by means of a combination of electronic scanning along the optical (Z) axis and mechanical scanning along the two axes (X and Y) orthogonal to the optical axis. In 3D OCT, 3D imaging involves a form of electronic scanning (without mechanical scanning) along all three axes. Consequently, the need for mechanical adjustment is minimal and the mechanism used to position the OCT probe can be correspondingly more compact. A 3D OCT system also includes a probe of improved design and utilizes advanced signal- processing techniques. Improvements in performance over prior OCT systems include finer resolution, greater speed, and greater depth of field.

Gutin, Mikhail↗
NASA NTRS2002

Contrast and harmonic imaging improves accuracy and efficiency of novice readers for dobutamine stress echocardiography

BACKGROUND: Newer contrast agents as well as tissue harmonic imaging enhance left ventricular (LV) endocardial border delineation, and therefore, improve LV wall-motion analysis. Interpretation of dobutamine stress echocardiography is observer-dependent and requires experience. This study was performed to evaluate whether these new imaging modalities would improve endocardial visualization and enhance accuracy and efficiency of the inexperienced reader interpreting dobutamine stress echocardiography. METHODS AND RESULTS: Twenty-nine consecutive patients with known or suspected coronary artery disease underwent dobutamine stress echocardiography. Both fundamental (2.5 MHZ) and harmonic (1.7 and 3.5 MHZ) mode images were obtained in four standard views at rest and at peak stress during a standard dobutamine infusion stress protocol. Following the noncontrast images, Optison was administered intravenously in bolus (0.5-3.0 ml), and fundamental and harmonic images were obtained. The dobutamine echocardiography studies were reviewed by one experienced and one inexperienced echocardiographer. LV segments were graded for image quality and function. Time for interpretation also was recorded. Contrast with harmonic imaging improved the diagnostic concordance of the novice reader to the expert reader by 7.1%, 7.5%, and 12.6% (P < 0.001) as compared with harmonic imaging, fundamental imaging, and fundamental imaging with contrast, respectively. For the novice reader, reading time was reduced by 47%, 55%, and 58% (P < 0.005) as compared with the time needed for fundamental, fundamental contrast, and harmonic modes, respectively. With harmonic imaging, the image quality score was 4.6% higher (P < 0.001) than for fundamental imaging. Image quality scores were not significantly different for noncontrast and contrast images. CONCLUSION: Harmonic imaging with contrast significantly improves the accuracy and efficiency of the novice dobutamine stress echocardiography reader. The use of harmonic imaging reduces the frequency of nondiagnostic wall segments.

Non-NASA Center↗
NASA NTRS2008

Second Harmonic Imaging improves Echocardiograph Quality on board the International Space Station

Ultrasound (US) capabilities have been part of the Human Research Facility (HRF) on board the International Space Station (ISS) since 2001. The US equipment on board the ISS includes a first-generation Tissue Harmonic Imaging (THI) option. Harmonic imaging (HI) is the second harmonic response of the tissue to the ultrasound beam and produces robust tissue detail and signal. Since this is a first-generation THI, there are inherent limitations in tissue penetration. As a breakthrough technology, HI extensively advanced the field of ultrasound. In cardiac applications, it drastically improves endocardial border detection and has become a common imaging modality. U.S. images were captured and stored as JPEG stills from the ISS video downlink. US images with and without harmonic imaging option were randomized and provided to volunteers without medical education or US skills for identification of endocardial border. The results were processed and analyzed using applicable statistical calculations. The measurements in US images using HI improved measurement consistency and reproducibility among observers when compared to fundamental imaging. HI has been embraced by the imaging community at large as it improves the quality and data validity of US studies, especially in difficult-to-image cases. Even with the limitations of the first generation THI, HI improved the quality and measurability of many of the downlinked images from the ISS and should be an option utilized with cardiac imaging on board the ISS in all future space missions.

Garcia, Kathleen↗
NASA NTRS2010

Right Ventricular Tissue Doppler in Space Flight

The presentation slides review normal physiology of the right ventricle in space, general physiology of the right ventricle; difficulties in imaging the heart in space, imaging methods, tissue Doppler spectrum, right ventricle tissue Doppler, and Rt Tei Index.

Garcia, Kathleen M.↗