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BACKGROUND: Glioblastoma (GB) is a malignant brain tumour that is challenging to treat, often relapsing even after aggressive therapy. Evaluating therapy response relies on magnetic resonance imaging (MRI) following the Response Assessment in Neuro-Oncology (RANO) criteria. However, early assessment is hindered by phenomena such as pseudoprogression and pseudoresponse. Magnetic resonance spectroscopy (MRS/MRSI) provides metabolomics information but is underutilised due to a lack of familiarity and standardisation. METHODS: This study explores the potential of spectroscopic imaging (MRSI) in combination with several machine learning approaches, including one-dimensional convolutional neural networks (1D-CNNs), to improve therapy response assessment. Preclinical GB (GL261-bearing mice) were studied for method optimisation and validation. RESULTS: The proposed 1D-CNN models successfully identify different regions of tumours sampled by MRSI, i.e., normal brain (N), control/unresponsive tumour (T), and tumour responding to treatment (R). Class activation maps using Grad-CAM enabled the study of the key areas relevant to the models, providing model explainability. The generated colour-coded maps showing the N, T and R regions were highly accurate (according to Dice scores) when compared against ground truth and outperformed our previous method. CONCLUSIONS: The proposed methodology may provide new and better opportunities for therapy response assessment, potentially providing earlier hints of tumour relapsing stages.
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La hiperplasia suprarrenal congénita (HSC) es un trastorno genético que produce déficit en la síntesis del cortisol. Esta enfermedad se presenta en ambos géneros, puede ser diagnosticada prenatalmente y recibir tratamiento desde esta etapa. A nivel fisiológico presenta ambigüedad en los órganos sexuales internos y externos que afectan el desarrollo emocional y social. En el nivel cognitivo se pueden encontrar dos posturas una donde se afirma que en pacientes con HSC se presentan puntuaciones bajas en el Coeficiente Intelectual (CI), especialmente en el (CI)verbal y diferencias significativas en pacientes que no han recibido tratamiento a tiempo, la otra considera que esta enfermedad no afecta los procesos cognitivos. En el presente artículo se realiza un estudio de caso único de un adolescente de 13 años con HSC, con el objetivo de describir el perfil cognitivo de un adolescente con hiperplasia suprarrenal congénita y compararlo con los estudios existentes en la actual literatura. Se obtuvo un perfil cognitivo por medio de diferentes pruebas neuropsicológicas, encontrando en el paciente un retardo mental moderado CI 50 y alteraciones importantes del lenguaje y del aprendizaje.
Congenital adrenal hyperplasia (CAH) is a genetic disorder that causes deficits in the synthesis of cortisol. This disease occurs in both genders, it can be diagnosed prenatally and treated from this stage. Physiologically presents ambiguity in the internal and external sex organs that affect the emotional and social development. In the cognitive level can be found two positions one where it is stated that in patients with CAH low scores are presented on IQ (IQ), especially (IQ) verbal and significant differences in patients who have not received treatment in initially time, the other believes that this disease does not affect cognitive processes. In this paper, a single case study of a 13-year HSC is performed in order to describe the cognitive profile of a teenage boy with congenital adrenal hyperplasia and compared with existing studies in the current literature. a cognitive profile was obtained through different neuropsychological tests, finding the patient moderate mental retardation (5Congenital adrenal hyperplasia (CAH) is a genetic disorder that causes deficits in the synthesis of cortisol. This disease occurs in both genders, it can be diagnosed prenatally and treated from this stage. Physiologically presents ambiguity in the internal and external sex organs that affect the emotional and social development. In the cognitive level can be found two positions one where it is stated that in patients with CAH low scores are presented on IQ (IQ), especially (CI) verbal and significant differences in patients who have not received treatment in time, the other believes that this disease does not affect cognitive processes. In this paper, a single case study of a 13-year HSC is performed in order to describe the cognitive profile of a teenage boy with congenital adrenal hyperplasia and compared with existing studies in the current literature. a cognitive profile was obtained through different neuropsychological tests, finding the patient moderate mental retardation and (50 IQ) with major disorders in language and learning.
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Introducción: la depresión es una enfermedad de alta prevalencia en adultos mayores. En Colombia su prevalencia se ha descrito entre 1,2 a 12% en mayores que viven en comunidad. Objetivo: estimar la prevalencia de depresión en un muestra de adultos mayores de Bogotá y describir los factores de riesgo psicosocial asociados. Material y métodos: se realizó un estudio de corte transversal observacional-descriptivo, en 889 adultos mayores autónomos. La depresión fue evaluada con el test de depresión geriátrica Yesavage y los factores de riesgo con la sección de acontecimientos vitales del cuestionario Predict. Resultados: el 74% de la muestra estuvo constituida por mujeres, la media de edad fue de 72,51 (DS 9,4) años y la escolaridad promedio en años fue de 7,50 (DS 5,64). Así mismo, se estimó una prevalencia de depresión del 18,6%, siendo mayor en mujeres (20%) y (18%) en sujetos entre 70 y 79 años, los adultos con baja escolaridad sumaron un 43%, y el 22% lo constituyeron personas dependientes económicamente. Por otra parte, se encontró relación entre la depresión y cinco de los factores de riesgo psicosocial conocidos como acontecimientos vitales adversos: insomnio, vivir solo, padecer enfermedades crónicas, haber sufrido una crisis económica, y la muerte de un familiar o amigo cercano en el último año. Conclusión: la prevalencia de depresión en un grupo de personas mayores de la comunidad en Bogotá es más alta que lo descrito previamente en Colombia y por la Organización Mundial de la Salud (OMS). Programas que reduzcan la soledad en la vejez y protejan a la mujer y a los mayores con menos escolaridad podrían mitigar esta condición.
Introduction: depression is one of the most prevalent diseases in the elderly. In Colombia, the prevalence of depression in this population ranges from 1,2 to 12%. Objective: to estimate the prevalence of depression in a group of independent elderly subjects in Bogota and describe the psychosocial risk factors associated with it. Material and methods: a cross-observational and descriptive study was done. The sample was constituted of 889 autonomous elderly subjects of Bogota city. Depression was assessed by applying the Test of Geriatric Depression-Yesavage-. Besides, the psychosocial risk factors were measured through the life events section, which is part of the Predict Questionnaire. Results: 74% of the sample was made up of women, the mean age was 72,51 years old (DS.9,4) and the average of education was of 7.50 years (DS.5,64). Besides, it was found a prevalence of depression of 18,6%. This prevalence was higher in the women (20%) and elderly between 70 and 79 years old (18%), adults with low education with 43% or 22% in economically dependent people. A relationship between depression and five psychosocial risk factors, known as adverse life events-insomnia, living alone, suffering a chronic disease or economic crisis or the death of the couple, a close friend or a relative. Conclusion: results showed a higher prevalence of depression in this sample in comparison to the findings yielded in previous studies developed in Colombia and the WHO. Programs that help to reduce the long lines protect women and older with less schooling ageing could mitigate the condition.
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Sono , Idoso , Fatores de Risco , DepressãoRESUMO
Introducción. Diferentes pruebas neuropsicológicas permiten explorar las funciones cognitivas del adulto mayor, en un tiempo corto. En Colombia se dispone de pocos estudios sobre puntuaciones y puntos de corte para el MMSE y para el MoCA en relación al diagnóstico de deterioro cognitivo. Objetivo. Describir la distribución de las puntuaciones del MMSE y el MoCA y los puntos de corte con mejor discriminación, para el diagnóstico de deterioro cognitivo leve y demencia, en una muestra de pacientes de Bogotá. Material y métodos. Se evaluaron 248 pacientes por un equipo multidisciplinario, que consultaron a la Clínica de Memoria del HIUSJ entre 2009-2012, siguiendo un protocolo establecido. Se identificaron las puntuaciones del MoCA y MMSE, que permitieron obtener el mayor porcentaje de pacientes correctamente clasificados. Resultados. En el 70% de los pacientes con DCL y en el 69 % de los sujetos normales, se encontraron puntuaciones del MMSE inferiores o iguales a 28. En 91% de pacientes con DCL y 84% de los sujetos normales, se presentaron puntuaciones del MoCA inferiores o iguales a 25. Los pacientes con cualquier tipo de demencia, presentaron puntuaciones del MMSE inferiores o iguales a 27 e inferiores o iguales a 24 en el MoCA. Conclusión. Según el presente estudio, el tamizaje de funciones cognitivas, utilizando el MoCA, clasifica de manera más acertada que el MMSE, a los sujetos con deterioro cognitivo. Creemos que en atención primaria, estos puntos de corte del MoCA, pueden ser considerados por ahora, cuando se trate especialmente de sujetos con alta escolaridad.
Introduction. Some cognitive tests allow the evaluation of cognitive functions on the elderly in a short period of time. There are few studies in Colombia about cut-off point for the MMSE and the MoCA test. Objectives. To describe the distribution on scores on MMSE and MoCA test and the cut-off point with a better discrimination criteria for the diagnosis of mild cognitive impairment and dementia, in a sample of patients from Bogotá. Materials and methods. Two hundred forty eight patients were included in this study, being evaluated by a multidisciplinary team that followed an established protocol, on patients who attended to the Memory Clinic of HIUSJ between 2009-2012. MoCA test and MMSE scores that allow higher percentages of correctly classified patients were identified. Results. Seventy percent of patients with mild cognitive impairment and 69% of normal individuals had scores on MMSE below or equal to 28. Ninety-one percent of patients with MCI and 89% of normal patients, had scores below or equal to 25. Patients with any type of dementia had scores on MMSE below or equal to 27 and below or equal to 24 in MoCA test. Conclusion. According to the study, the screening of cognitive functions, using MoCA test, is more accurate than MMSE in patients with cognitive decline. The cut-off points, identified in our study, can be considered useful until now in primary attention, in patients with a high level of education.