15 results on '"Winoto L"'
Search Results
2. Interferometer-based structured-illumination microscopy utilizing complementary phase relationship through constructive and destructive image detection by two cameras
- Author
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SHAO, L., WINOTO, L., AGARD, D. A., GUSTAFSSON, M. G.L., and SEDAT, J. W.
- Published
- 2012
- Full Text
- View/download PDF
3. Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: protocol for a multi-centre cohort study
- Author
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Cardona, M ; https://orcid.org/0000-0001-6499-2705, Lewis, ET ; https://orcid.org/0000-0002-9260-3727, Turner, RM, Alkhouri, H ; https://orcid.org/0000-0002-5569-704X, Asha, S, Mackenzie, J, Perkins, M, Suri, S, Holdgate, A, Winoto, L, Hillman, Kenneth ; https://orcid.org/0000-0001-8241-0166, McCarthy, Sally ; https://orcid.org/0000-0001-7367-8232, Gallego Luxan, Blanca ; https://orcid.org/0000-0002-3704-7975, Cardona, M ; https://orcid.org/0000-0001-6499-2705, Lewis, ET ; https://orcid.org/0000-0002-9260-3727, Turner, RM, Alkhouri, H ; https://orcid.org/0000-0002-5569-704X, Asha, S, Mackenzie, J, Perkins, M, Suri, S, Holdgate, A, Winoto, L, Hillman, Kenneth ; https://orcid.org/0000-0001-8241-0166, McCarthy, Sally ; https://orcid.org/0000-0001-7367-8232, and Gallego Luxan, Blanca ; https://orcid.org/0000-0002-3704-7975
- Abstract
Background: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. Methods: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death. Discussion: The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians’ prognostic uncertainty on the time to patients’ death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices.
- Published
- 2018
4. Live Structured Illumination Microscopy
- Author
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Kner, P, primary, Thomas, B, additional, Chhun, B, additional, Griffis, E, additional, Winoto, L, additional, and Gustafsson, M, additional
- Published
- 2011
- Full Text
- View/download PDF
5. Live TIRF microscopy at 100nm resolution through structured illumination
- Author
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Kner, P., primary, Chhun, B., additional, Griffis, E., additional, Winoto, L., additional, Shao, L., additional, and Gustafsson, M. G. L., additional
- Published
- 2009
- Full Text
- View/download PDF
6. Real world validation of an AI-based CT hemorrhage detection tool.
- Author
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Wang D, Jin R, Shieh CC, Ng AY, Pham H, Dugal T, Barnett M, Winoto L, Wang C, and Barnett Y
- Abstract
Introduction: Intracranial hemorrhage (ICH) is a potentially life-threatening medical event that requires expedited diagnosis with computed tomography (CT). Automated medical imaging triaging tools can rapidly bring scans containing critical abnormalities, such as ICH, to the attention of radiologists and clinicians. Here, we retrospectively investigated the real-world performance of VeriScout
™ , an artificial intelligence-based CT hemorrhage detection and triage tool., Methods: Ground truth for the presence or absence of ICH was iteratively determined by expert consensus in an unselected dataset of 527 consecutively acquired non-contrast head CT scans, which were sub-grouped according to the presence of artefact, post-operative features and referral source. The performance of VeriScout™ was compared with the ground truths for all groups., Results: VeriScout™ detected hemorrhage with a sensitivity of 0.92 (CI 0.84-0.96) and a specificity of 0.96 (CI 0.94-0.98) in the global dataset, exceeding the sensitivity of general radiologists (0.88) with only a minor relative decrement in specificity (0.98). Crucially, the AI tool detected 13/14 cases of subarachnoid hemorrhage, a potentially fatal condition that is often missed in emergency department settings. There was no decrement in the performance of VeriScout™ in scans containing artefact or postoperative change. Using an integrated informatics platform, VeriScout™ was deployed into the existing radiology workflow. Detected hemorrhage cases were flagged in the hospital radiology information system (RIS) and relevant, annotated, preview images made available in the picture archiving and communications system (PACS) within 10 min., Conclusion: AI-based radiology worklist prioritization for critical abnormalities, such as ICH, may enhance patient care without adding to radiologist or clinician burden., Competing Interests: DW, CS and CW are part-time employees at the Sydney Neuroimaging Analysis Centre (SNAC). MB has received institutional support for research, speaking and/or participation in advisory boards for Biogen, Merck, Novartis, Roche, and Sanofi Genzyme, and is a research consultant to RxPx and research director for the SNAC. YB and TD are consulting radiologists for SNAC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wang, Jin, Shieh, Ng, Pham, Dugal, Barnett, Winoto, Wang and Barnett.)- Published
- 2023
- Full Text
- View/download PDF
7. Prospective Validation of a Checklist to Predict Short-term Death in Older Patients After Emergency Department Admission in Australia and Ireland.
- Author
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Cardona M, O'Sullivan M, Lewis ET, Turner RM, Garden F, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang DCW, Gallego-Luxan B, McCarthy S, Hillman K, and Breen D
- Subjects
- Aged, Aged, 80 and over, Australia, Emergency Service, Hospital statistics & numerical data, Female, Hospitalization statistics & numerical data, Humans, Ireland, Logistic Models, Male, Predictive Value of Tests, Prospective Studies, ROC Curve, Risk Factors, Checklist standards, Frailty diagnosis, Hospital Mortality, Triage methods
- Abstract
Background: Emergency departments (EDs) are pressured environment where patients with supportive and palliative care needs may not be identified. We aimed to test the predictive ability of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist to flag patients at risk of death within 3 months who may benefit from timely end-of-life discussions., Methods: Prospective cohorts of >65-year-old patients admitted for at least one night via EDs in five Australian hospitals and one Irish hospital. Purpose-trained nurses and medical students screened for frailty using two instruments concurrently and completed the other risk factors on the CriSTAL tool at admission. Postdischarge telephone follow-up was used to determine survival status. Logistic regression and bootstrapping techniques were used to test the predictive accuracy of CriSTAL for death within 90 days of admission as primary outcome. Predictability of in-hospital death was the secondary outcome., Results: A total of 1,182 patients, with median age 76 to 80 years (IRE-AUS), were included. The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% confidence interval [CI] = 7.7-8.6) versus 5.7 (95% CI = 5.1-6.2) and Irish mean of 7.7 (95% CI = 6.9-8.5) versus 5.7 (95% CI = 5.1-6.2). The model with Fried frailty score was optimal for the derivation (Australian) cohort but prediction with the Clinical Frailty Scale (CFS) was also good (areas under the receiver-operating characteristic [AUROC] = 0.825 and 0.81, respectively). Values for the validation (Irish) cohort were AUROC = 0.70 with Fried and 0.77 using CFS. A minimum of five of 29 variables were sufficient for accurate prediction, and a cut point of 7+ or 6+ depending on the cohort was strongly indicative of risk of death. The most significant independent predictor of short-term death in both cohorts was frailty, carrying a twofold risk of death. CriSTAL's accuracy for in-hospital death prediction was also good (AUROC = 0.795 and 0.81 in Australia and Ireland, respectively), with high specificity and negative predictive values., Conclusions: The modified CriSTAL tool (with CFS instead of Fried's frailty instrument) had good discriminant power to improve certainty of short-term mortality prediction in both health systems. The predictive ability of models is anticipated to help clinicians gain confidence in initiating earlier end-of-life discussions. The practicalities of embedding screening for risk of death in routine practice warrant further investigation., (© 2018 The Authors. Academic Emergency Medicine published by Wiley Periodicals, Inc. on behalf of Society for Academic Emergency Medicine (SAEM).)
- Published
- 2019
- Full Text
- View/download PDF
8. Which frailty scale for patients admitted via Emergency Department? A cohort study.
- Author
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Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S, Holdgate A, Mackenzie J, Winoto L, Fajardo-Pulido D, Ticehurst M, Hillman K, McCarthy S, Elcombe E, Rogers K, and Cardona M
- Subjects
- Aged, Aged, 80 and over, Female, Frail Elderly, Frailty epidemiology, Humans, Male, Prospective Studies, Emergency Service, Hospital, Frailty diagnosis
- Abstract
Objectives: To determine the prevalence of frailty in Emergency Departments (EDs); examine the ability of frailty to predict poor outcomes post-discharge; and identify the most appropriate instrument for routine ED use., Methods: In this prospective study we simultaneously assessed adults 65+yrs admitted and/or spent one night in the ED using Fried, the Clinical Frailty Scale (CFS), and SUHB (Stable, Unstable, Help to walk, Bedbound) scales in four Australian EDs for rapid recognition of frailty between June 2015 and March 2016., Results: 899 adults with complete follow-up data (mean (SD) age 80.0 (8.3) years; female 51.4%) were screened for frailty. Although different scales yielded vastly different frailty prevalence (SUHB 9.7%, Fried 30.4%, CFS 43.7%), predictive discrimination of poor discharge outcomes (death, poor self-reported health/quality of life, need for community services post-discharge, or reattendance to ED after the index hospitalization) for all identical final models was equivalent across all scales (AUROC 0.735 for Fried, 0.730 for CFS and 0.720 for SUHB)., Conclusion: This study confirms that screening for frailty in older ED patients can inform prognosis and target discharge planning including community services required. The CFS was as accurate as the Fried and SUHB in predicting poor outcomes, but more practical for use in busy clinical environments with lower level of disruption. Given the limitations of objectively measuring frailty parameters, self-report and clinical judgment can reliably substitute the assessment in EDs. We propose that in a busy ED environment, frailty scores could be used as a red flag for poor follow-up outcome., (Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
9. Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study.
- Author
-
Cardona M, Lewis ET, Turner RM, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang CW, Gallego-Luxan B, McCarthy S, Kristensen MR, O'Sullivan M, Skjøt-Arkil H, Ekmann AA, Nygaard HH, Jensen JJ, Jensen RO, Pedersen JL, Breen D, Petersen JA, Jensen BN, Mogensen CB, Hillman K, and Brabrand M
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Intensive Care Units, Logistic Models, Male, Prognosis, Prospective Studies, Risk Factors, Emergency Service, Hospital, Mortality
- Abstract
Background: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments., Methods: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death., Discussion: The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
10. Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study.
- Author
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Cardona M, Lewis ET, Kristensen MR, Skjøt-Arkil H, Ekmann AA, Nygaard HH, Jensen JJ, Jensen RO, Pedersen JL, Turner RM, Garden F, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang DCW, Gallego-Luxan B, McCarthy S, Petersen JA, Jensen BN, Backer Mogensen C, Hillman K, and Brabrand M
- Abstract
Abstract: To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients., Methods: Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy., Results: 2493 patients, with median age 78-80 years (DK-Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7-8.6 vs. 5.8 95% CI 5.6-5.9) and Danish mean 7.1 (95% CI 6.6-7.5 vs. 5.5 95% CI 5.4-5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL's accuracy was only modest for in-hospital death prediction in either setting., Conclusions: The modified CriSTAL tool (with CFS instead of Fried's frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician's confidence in initiating earlier end-of-life discussions., Competing Interests: MC and KH developed the risk prediction tool in 2015 and have tested it retrospectively in several hospitals. This might be perceived by readers as non-financial conflict of interest given their knowledge of the subject matter or materials discussed in this manuscript. However, they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; or expert testimony or patent-licensing arrangements), that may influence the validity of the study. All other authors certify that they have NO conflict of interest to report. The analyses were led by two co-authors (RMT and FG) who were not involved in the development of the tool, data collection or outcome ascertainment for this validation study.The study was approved in Australia by the hospital management teams and by the South Eastern Sydney Local Health District Ethics Committee [#15/026 HREC/15/POW/55 and data was stored in the UNSW secure server. The need for approval in Denmark was waivered by the Regional Ethics Committee of Southern Denmark, as this project was considered to be a quality improvement initiative without an intervention [42].Verbal information on the study preceded the request for written informed consent which was obtained from each individual if cognitively competent or their surrogate at the time of recruitment. Participants consented to being interviewed, giving access to hospital records during admission, and being contacted for follow-up outcome ascertainment. The original consent remained with the researchers and a copy went to the patient or their family.
- Published
- 2018
- Full Text
- View/download PDF
11. Nonlinear structured-illumination microscopy with a photoswitchable protein reveals cellular structures at 50-nm resolution.
- Author
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Rego EH, Shao L, Macklin JJ, Winoto L, Johansson GA, Kamps-Hughes N, Davidson MW, and Gustafsson MG
- Subjects
- Actin Cytoskeleton metabolism, Animals, CHO Cells, Cricetinae, Cricetulus, Fluorescence, HEK293 Cells, Humans, Light, Microtubules metabolism, Nuclear Pore metabolism, Proteins, Cells metabolism, Luminescent Proteins metabolism, Microscopy methods, Nonlinear Dynamics
- Abstract
Using ultralow light intensities that are well suited for investigating biological samples, we demonstrate whole-cell superresolution imaging by nonlinear structured-illumination microscopy. Structured-illumination microscopy can increase the spatial resolution of a wide-field light microscope by a factor of two, with greater resolution extension possible if the emission rate of the sample responds nonlinearly to the illumination intensity. Saturating the fluorophore excited state is one such nonlinear response, and a realization of this idea, saturated structured-illumination microscopy, has achieved approximately 50-nm resolution on dye-filled polystyrene beads. Unfortunately, because saturation requires extremely high light intensities that are likely to accelerate photobleaching and damage even fixed tissue, this implementation is of limited use for studying biological samples. Here, reversible photoswitching of a fluorescent protein provides the required nonlinearity at light intensities six orders of magnitude lower than those needed for saturation. We experimentally demonstrate approximately 40-nm resolution on purified microtubules labeled with the fluorescent photoswitchable protein Dronpa, and we visualize cellular structures by imaging the mammalian nuclear pore and actin cytoskeleton. As a result, nonlinear structured-illumination microscopy is now a biologically compatible superresolution imaging method.
- Published
- 2012
- Full Text
- View/download PDF
12. Fast live simultaneous multiwavelength four-dimensional optical microscopy.
- Author
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Carlton PM, Boulanger J, Kervrann C, Sibarita JB, Salamero J, Gordon-Messer S, Bressan D, Haber JE, Haase S, Shao L, Winoto L, Matsuda A, Kner P, Uzawa S, Gustafsson M, Kam Z, Agard DA, and Sedat JW
- Subjects
- Algorithms, Animals, Cell Survival, Drosophila melanogaster cytology, Saccharomyces cerevisiae cytology, Software, Microscopy, Fluorescence methods
- Abstract
Live fluorescence microscopy has the unique capability to probe dynamic processes, linking molecular components and their localization with function. A key goal of microscopy is to increase spatial and temporal resolution while simultaneously permitting identification of multiple specific components. We demonstrate a new microscope platform, OMX, that enables subsecond, multicolor four-dimensional data acquisition and also provides access to subdiffraction structured illumination imaging. Using this platform to image chromosome movement during a complete yeast cell cycle at one 3D image stack per second reveals an unexpected degree of photosensitivity of fluorophore-containing cells. To avoid perturbation of cell division, excitation levels had to be attenuated between 100 and 10,000× below the level normally used for imaging. We show that an image denoising algorithm that exploits redundancy in the image sequence over space and time allows recovery of biological information from the low light level noisy images while maintaining full cell viability with no fading.
- Published
- 2010
- Full Text
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13. Closed loop adaptive optics for microscopy without a wavefront sensor.
- Author
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Kner P, Winoto L, Agard DA, and Sedat JW
- Abstract
A three-dimensional wide-field image of a small fluorescent bead contains more than enough information to accurately calculate the wavefront in the microscope objective back pupil plane using the phase retrieval technique. The phase-retrieved wavefront can then be used to set a deformable mirror to correct the point-spread function (PSF) of the microscope without the use of a wavefront sensor. This technique will be useful for aligning the deformable mirror in a widefield microscope with adaptive optics and could potentially be used to correct aberrations in samples where small fluorescent beads or other point sources are used as reference beacons. Another advantage is the high resolution of the retrieved wavefont as compared with current Shack-Hartmann wavefront sensors. Here we demonstrate effective correction of the PSF in 3 iterations. Starting from a severely aberrated system, we achieve a Strehl ratio of 0.78 and a greater than 10-fold increase in maximum intensity.
- Published
- 2010
- Full Text
- View/download PDF
14. Super-resolution video microscopy of live cells by structured illumination.
- Author
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Kner P, Chhun BB, Griffis ER, Winoto L, and Gustafsson MG
- Subjects
- Algorithms, Animals, Cell Line, Cytophotometry instrumentation, Drosophila melanogaster, Electronic Data Processing, Fourier Analysis, Image Processing, Computer-Assisted, Kinesins metabolism, Microscopy, Fluorescence methods, Microscopy, Video instrumentation, Microtubules metabolism, Spindle Apparatus metabolism, Tubulin metabolism, Cytophotometry methods, Lighting, Microscopy, Video methods
- Abstract
Structured-illumination microscopy can double the resolution of the widefield fluorescence microscope but has previously been too slow for dynamic live imaging. Here we demonstrate a high-speed structured-illumination microscope that is capable of 100-nm resolution at frame rates up to 11 Hz for several hundred time points. We demonstrate the microscope by video imaging of tubulin and kinesin dynamics in living Drosophila melanogaster S2 cells in the total internal reflection mode.
- Published
- 2009
- Full Text
- View/download PDF
15. Subdiffraction multicolor imaging of the nuclear periphery with 3D structured illumination microscopy.
- Author
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Schermelleh L, Carlton PM, Haase S, Shao L, Winoto L, Kner P, Burke B, Cardoso MC, Agard DA, Gustafsson MG, Leonhardt H, and Sedat JW
- Subjects
- Animals, Cell Line, Fluorescent Dyes, Heterochromatin ultrastructure, Imaging, Three-Dimensional instrumentation, Indoles, Interphase, Lamins ultrastructure, Mice, Microscopy, Confocal, Microscopy, Fluorescence instrumentation, Myoblasts, Nuclear Lamina ultrastructure, Nuclear Pore ultrastructure, Optics and Photonics, Cell Nucleus ultrastructure, Chromatin ultrastructure, Imaging, Three-Dimensional methods, Microscopy, Fluorescence methods, Nuclear Envelope ultrastructure
- Abstract
Fluorescence light microscopy allows multicolor visualization of cellular components with high specificity, but its utility has until recently been constrained by the intrinsic limit of spatial resolution. We applied three-dimensional structured illumination microscopy (3D-SIM) to circumvent this limit and to study the mammalian nucleus. By simultaneously imaging chromatin, nuclear lamina, and the nuclear pore complex (NPC), we observed several features that escape detection by conventional microscopy. We could resolve single NPCs that colocalized with channels in the lamin network and peripheral heterochromatin. We could differentially localize distinct NPC components and detect double-layered invaginations of the nuclear envelope in prophase as previously seen only by electron microscopy. Multicolor 3D-SIM opens new and facile possibilities to analyze subcellular structures beyond the diffraction limit of the emitted light.
- Published
- 2008
- Full Text
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