Brain 18 F-FDG PET reveals cortico-subcortical hypermetabolic dysfunction in juvenile neuropsychiatric systemic lupus erythematosus.

BACKGROUND: In juvenile systemic lupus erythematosus (j-SLE) with neuropsychiatric (NP) symptoms, there is a lack of diagnostic biomarkers. Thus, we study whether PET-FDG may identify any metabolic dysfunction in j-NPSLE. METHODS: A total of 19 18FDG-PET exams were consecutively performed using PET-MRI system in 11 non-sedated patients presenting with j-NPSLE (11-18y) for less than 18 months (m) and without any significant lesion at MRI. Psychiatric symptoms were scored from 0 (none) to 3 (severe) at PET time. PET images were visually analyzed and voxel-based analyses of cerebral glucose metabolism were performed using statistical parametric mapping (spm) with an age-matched control group, at threshold set > 50 voxels using both p < 0.001 uncorrected (unc.) and p < 0.05 corrected family wise error (FWE). RESULTS: Patients exhibited mainly psychiatric symptoms, with diffuse inflammatory j-NPSLE. First PET (n = 11) was performed at a mean of 15y of age, second/third PET (n = 7/n = 1) 6 to 19 m later. PET individual analysis detected focal bilateral anomalies in 13/19 exams visually but 19/19 using spm (unc.), mostly hypermetabolic areas (18/19). A total of 15% of hypermetabolic areas identified by spm had been missed visually. PET group analysis (n = 19) did not identify any hypometabolic area, but a large bilateral cortico-subcortical hypermetabolic pattern including, by statistical decreasing order (unc.), thalamus, subthalamic brainstem, cerebellum (vermis and cortex), basal ganglia, visual, temporal and frontal cortices. Mostly the subcortical hypermetabolism survived to FWE analysis, being most intense and extensive (51% of total volume) in thalamus and subthalamus brainstem. Hypermetabolism was strictly subcortical in the most severe NP subgroup (n = 8, scores 2-3) whereas it also extended to cerebral cortex, mostly visual, in the less severe subgroup (n = 11, scores 0-1), but difference was not significant. Longitudinal visual analysis was inconclusive due to clinical heterogeneity. CONCLUSIONS: j-NPSLE patients showed a robust bilateral cortico-subcortical hypermetabolic network, focused subcortically, particularly in thalamus, proportionally to psychiatric features severity. Further studies with larger, but homogeneous, cohorts are needed to determine the sensitivity and specificity of this dysfunctional pattern as a potential biomarker in diffuse inflammatory j-NPSLE with normal brain MRI.

Parametric Imaging of P-Glycoprotein Function at the Blood-Brain Barrier Using kE,brain-maps Generated from [11C]Metoclopramide PET Data in Rats, Nonhuman Primates and Humans.

PURPOSE: PET imaging using [11C]metoclopramide revealed the importance of P-glycoprotein (P-gp, ABCB1) in mediating the brain-to-blood efflux of substrates across the blood-brain barrier (BBB). In this work, the elimination rate constant from the brain (kE,brain), calculated from dynamic PET images without the need for arterial blood sampling, was evaluated as an outcome parameter for the interpretation of [11C]metoclopramide PET data. PROCEDURES: kE,brain parameter was obtained by linear regression of log-transformed brain time-activity curves (TACs). kE,brain values (h-1) obtained under baseline conditions were compared with values obtained after complete P-gp inhibition using tariquidar in rats (n = 4) and baboons (n = 4) or after partial inhibition using cyclosporine A in humans (n = 10). In baboons, the sensitivity of kE,brain to measure complete P-gp inhibition was compared with outcome parameters derived from kinetic modeling using a 1-tissue compartment model (1-TCM). Finally, kE,brain-maps were generated in each species using PMOD software. RESULTS: The linear part of the log-transformed brain TACs occurred from 10 to 30 min after radiotracer injection in rats, from 15 to 60 min in baboons, and from 20 to 60 min in humans. P-gp inhibition significantly decreased kE,brain values by 39 ± 12% in rats (p < 0.01), by 32 ± 6% in baboons (p < 0.001), and by 37 ± 22% in humans (p < 0.001). In baboons, P-gp inhibition consistently decreased the brain-to-plasma efflux rate constant k2 (36 ± 9%, p < 0.01) leading to an increase in the total brain volume of distribution (VT, 101 ± 12%, p < 0.001). In all studied species, brain kE,brain-maps displayed decreased P-gp-mediated efflux across the BBB. CONCLUSIONS: kE,brain of [11C]metoclopramide provides a simple outcome parameter to describe P-gp function in the living brain when arterial input function data are unavailable, although less sensitive than VT. kE,brain-maps represent easy to compute parametric images reflecting the effect of P-gp on [11C]metoclopramide elimination from the brain.

[18F]DPA-714 PET Imaging in the Presurgical Evaluation of Patients With Drug-Resistant Focal Epilepsy.

BACKGROUND AND OBJECTIVES: Translocator protein 18 kDa (TSPO) PET imaging is used to monitor glial activation. Recent studies have proposed TSPO PET as a marker of the epileptogenic zone (EZ) in drug-resistant focal epilepsy (DRFE). This study aims to assess the contributions of TSPO imaging using [18F]DPA-714 PET and [18F]FDG PET for localizing the EZ during presurgical assessment of DRFE, when phase 1 presurgical assessment does not provide enough information. METHODS: We compared [18F]FDG and [18F]DPA-714 PET images of 23 patients who had undergone a phase 1 presurgical assessment, using qualitative visual analysis and quantitative analysis, at both the voxel and the regional levels. PET abnormalities (increase in binding for [18F]DPA-714 vs decrease in binding for [18F]FDG) were compared with clinical hypotheses concerning the localization of the EZ based on phase 1 presurgical assessment. The additional value of [18F]DPA-714 PET imaging to [18F]FDG for refining the localization of the EZ was assessed. To strengthen the visual analysis, [18F]DPA-714 PET imaging was also reviewed by 2 experienced clinicians blind to the EZ location. RESULTS: The study included 23 patients. Visual analysis of [18F]DPA-714 PET was significantly more accurate than [18F]FDG PET to both, show anomalies (95.7% vs 56.5%, p = 0.022), and provide additional information to refine the EZ localization (65.2% vs 17.4%, p = 0.019). All 10 patients with normal [18F]FDG PET had anomalies when using [18F]DPA-714 PET. The additional value of [18F]DPA-714 PET seemed to be greater in patients with normal brain MRI or with neocortical EZ (especially if insula is involved). Regional analysis of [18F]DPA-714 and [18F]FDG PET provided similar results. However, using voxel-wise analysis, [18F]DPA-714 was more effective than [18F]FDG for unveiling clusters whose localization was more often consistent with the EZ hypothesis (87.0% vs 39.1%, p = 0.019). Nonrelevant bindings were seen in 14 of 23 patients in visual analysis and 9 patients of 23 patients in voxel-wise analysis. DISCUSSION: [18F]DPA-714 PET imaging provides valuable information for presurgical assessments of patients with DRFE. TSPO PET could become an additional tool to help to the localization of the EZ, especially in patients with negative [18F]FDG PET. TRIAL REGISTRATION INFORMATION: Eudract 2017-003381-27. Inclusion of the first patient: September 24, 2018. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence on the utility of [18F]DPA-714 PET compared with [18F]FDG PET in identifying the epileptic zone in patients undergoing phase 1 presurgical evaluation for intractable epilepsy.

Presencia de los Kinesiólogos y Kinesiólogas en los Medios de Comunicación durante la Crisis Sanitaria por COVID-19 en Chile / Presence of Physiotherapist in The Media during the Sanitary Crisis due to Covid-19 in Chile

Introducción. La pandemia por COVID-19 afectó el funcionamiento mundial de los seres humanos, en específico del personal de salud, como los kinesiólogos y kinesiólogas de Chile. Este fenómeno marco un aumento inaudito en la aparición en medios de comunicación de estos profesionales. No existe comunicación científica que haga referencia a la cuantía ni al tipo de aparición que se reporta de la kinesiología en estos medios de prensa. Objetivo. Describir y cuantificar el tipo y las fuentes de información que fueron reportadas en medios de comunicación sobre la participación de los kinesiólogos durante la pandemia por COVID-19. Métodos. Revisión exploratoria sensible de artículos periodísticos publicados en medios escritos y audiovisuales sobre la labor de la kinesiología durante la pandemia COVID-19 realizada por 3 investigadores independientes en Google Search, con aplicación de filtros y operadores Booleanos para búsqueda. Fueron excluidas comunicaciones asociadas a publicidad de empresas, publicidad de instituciones académicas, artículos de otros países, enlaces vinculados a redes sociales, estudios científicos y cualquier otro enlace que no constituyera una nota de prensa o la aparición del kinesiólogo en algún medio de comunicación. Resultados. Fueron identificados 332 reportes periodísticos relacionados con la labor kinesiológica durante la pandemia, proveniente de diversos medios de comunicación escritos como audiovisuales, siendo excluidos en 3 fases un total de 235 reportajes por duplicidad y falta de respuesta a preguntas de guías de investigación. Se incluyeron en la revisión final 97 reportes, publicados entre los años 2020 y 2021 donde el 28,9% provenía de la prensa digital, 26,8% de páginas web académicas, y 14,4% de instituciones de salud. Según el tema tratado, la labor clínica en UPC correspondió a un 64,9%, seguida por la labor clínica no UPC (18,1%), y la labor educativa (16,0%). Conclusión. Reportamos un aumento exponencial de notas de prensa y exposición de los kinesiólogos(as) en los medios de comunicación respecto al histórico, principalmente la kinesiología intensiva, brindando una vitrina de la labor de esta profesión al público en general.

Introduction. COVID-19 pandemic affected the global functioning of humans, specifically health personnel such as physiotherapists in Chile. This phenomenon marked an unprecedented increase in the appearance of these professionals in the media. There is no scientific communication that refers to amount or type of appearance of kinesiology reported in these media. Objetive. To describe and quantify type and sources of information reported in the media on the performance of kinesiology during COVID-19 pandemic. Methods. A sensitive exploratory review of journalistic articles published in written and audiovisual media on the work of physiotherapy during COVID-19 pandemic was carried out by 3 independent researchers in Google Search with the application of filters and Boolean search operators. Communications associated with company advertising, academic institution advertising, articles from other countries, links to social networks, scientific studies and any other link that did not constitute a press release or the appearance of the physiotherapy in any media were excluded. Results. 332 journalistic reports of work of physiotherapy in pandemics from various written and audiovisual media were identified. A total of 235 reports were excluded in 3 phases due to duplicity and lack of response to research questions. A total of 97 reports published between 2020 and 2021 were included in the final review, where 28.9% came from the digital press, 26.8% from academic websites, and 14.4% from health institutions. According to the topic covered, clinical work in UPC corresponded to 64.9%, followed by non-UPC clinical work (18.1%), and educational work (16.0%). Conclusion. we report an exponential increase in the number of reports in press about physiotherapy compared with historic reports, mainly intensive physiotherapy, providing a showcase for the work of this profession to the general public.

Could tau-PET imaging contribute to a better understanding of the different patterns of clinical progression in Alzheimer's disease? A 2-year longitudinal study.

BACKGROUND: Monitoring the progression of Tau pathology makes it possible to study the clinical diversity of Alzheimer's disease. In this 2-year longitudinal PET study, we aimed to determine the progression of [18F]-flortaucipir binding and of cortical atrophy, and their relationships with cognitive decline. METHODS: Twenty-seven AD patients at the mild cognitive impairment/mild dementia stages and twelve amyloid-negative controls underwent a neuropsychological assessment, 3 T brain MRI, and [18F]-flortaucipir PET imaging (Tau1) and were monitored annually over 2 years with a second brain MRI and tau-PET imaging after 2 years (Tau2). We analyzed the progression of tau standardized uptake value ratio (SUVr) and grey matter atrophy both at the regional and voxelwise levels. We used mixed effects models to explore the relations between the progression of SUVr values, cortical atrophy, and cognitive decline. RESULTS: We found an average longitudinal increase in tau SUVr values, except for the lateral temporoparietal cortex where the average SUVr values decreased. Individual analyses revealed distinct profiles of SUVr progression according to temporoparietal Tau1 uptake: high-Tau1 patients demonstrated an increase in SUVr values over time in the frontal lobe, but a decrease in the temporoparietal cortex and a rapid clinical decline, while low-Tau1 patients displayed an increase in SUVr values in all cortical regions and a slower clinical decline. Cognitive decline was strongly associated with the progression of regional cortical atrophy, but only weakly associated with SUVr progression. CONCLUSIONS: Despite a relatively small sample size, our results suggest that tau-PET imaging could identify patients with a potentially "more aggressive" clinical course characterized by high temporoparietal Tau1 SUVr values and a rapid clinical progression. In these patients, the paradoxical decrease in temporoparietal SUVr values over time could be due to the rapid transition to ghost tangles, for which the affinity of the radiotracer is lower. They could particularly benefit from future therapeutic trials, the neuroimaging outcome measures of which deserve to be discussed.

18F-FDG PET/MR in focal epilepsy: A new step for improving the detection of epileptogenic lesions.

PURPOSE: Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established. METHODS: We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 years) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), the confidence in results, the location of PET abnormalities and the presence of a structural lesion on MRI. Clinical impact on surgical strategy and outcome was assessed independently. RESULTS: The location of epileptic focus was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 patients. PET stand-alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. Compared to PET+MR, the PET/MR sensitivity was increased by 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 10 patients (40%), consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome (follow-up>1 year) was obtained in 12/14 patients who underwent a cortical resection. CONCLUSION: Hybrid PET/MR may improve the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.

18 F-FDG-PET hypometabolic pattern reveals multifocal epileptic foci despite limited unique stereotyped seizures.

PURPOSE: Interictal positron emission tomography (PET) with 18F-FDG has largely proved its utility in presurgical evaluation of drug-resistant epilepsies (DRE) and in the surgical outcomes. Interictal hypometabolism topography is related to the neuronal networks involved in the seizure onset zone (SOZ) and spread pathways. 18F-FDG PET has a good prognostic value for post-surgical outcome, especially in cases with unique focal ictal semiology and a limited extent of hypometabolism. Surprisingly few patients have similar limited ictal features but extended hypometabolism. The objective of this study is to show that stereoelectro encephalography (SEEG) provides an explanation for this large hypometabolism, which impacts the surgical strategy. METHODS: A cohort of 248 patients underwent 18F-FDG PET and SEEG to explore for refractory epilepsy in two close tertiary epilepsy centers between January 2009 and December 2017. From this cohort, a subset of patients was selected with extended PET metabolism despite showing unique and limited ictal features in scalp EEG. The surgical outcome of this subset of patients has been analysed with respect to their FDG-PET and SEEG to understand the relationship between PET/SEEG/ presentation and surgical outcome. RESULTS: We report a series of seven patients with DRE and unique stereotyped ictal semiology but extensive 18F-FDG-PET hypometabolism revealing unexpected multifocal SOZ using SEEG. All SOZ were encompassed by the hypometabolic area. CONCLUSION: Our results demonstrate the necessity of accounting for the discrepancy between limited symptoms and widespread hypometabolism which can reveal multifocal SOZ. In those patients, surgical possibilities should be considered carefully.

Concordance in Discriminating Recordings of Different Lung Sounds Between Physiotherapists.

BACKGROUND: Auscultation is a fundamental part of the physical examination, but its utility has been questioned due to the low inter-rater concordance. We therefore sought to evaluate the concordance of the discrimination of lung sound recordings between experienced physiotherapists. METHODS: Lung sound recordings were selected and validated by an expert panel when Fleiss κ concordance was > 0.75. Eleven recordings were played for subject recognition using a portable computer in their workplace. Results were analyzed using Fleiss κ when looking for concordance between physiotherapists. Univariate regression was performed to determine if there was an association with clinical training, years of experience, academic accomplishment, or university affiliation. RESULTS: Sixty-nine physiotherapists with a median of 4 years of working experience (interquartile range 2-6 y) completed the study. There was moderate concordance (κ = 0.562; 95% CI 0.462-0.605) for overall lung sound recording discrimination. For continuous and noncontinuous lung sound recordings, discrimination concordance was substantial (κ = 0.63 and κ = 0.76, respectively). A bivariate analysis revealed that years of experience presented an inverse association with stridor recognition. CONCLUSIONS: Concordance between physiotherapists in discriminating recorded lung sounds was moderate. The ability to recognize stridor was inversely associated with years of work experience.

Muerte súbita en el deporte. Carreras de calle y eventos de participación masiva. Propuesta de un protocolo de prevención primaria. 10K Life / Sudden death in sport. Street races and mass participation events. Proposal for a primary prevention protocol. 10K Life / Morte súbita no esporte. Corridas de rua e eventos de participação em massa. Proposta de um protocolo de prevenção primária. 10K Life

Resumen: Presentamos un protocolo de screening para muerte súbita en el deporte (MSD) de aplicación rápida, con el objetivo de evaluar un alto número de individuos en un corto período y de esta forma poder discriminar aquellos casos con riesgo significativo de MSD. Estos podrían ser enviados para evaluación médica preparticipativa (EMPP) completa. El test surge de la revisión de la evidencia actual y de la opinión de expertos sobre MSD y EMPP, con especial análisis del valor predictivo de cada ítem que compone el cuestionario, examen físico y electrocardiograma. Esta herramienta es aplicable en escenarios donde existe participación masiva de no profesionales, sin previa EMPP, como ocurre en las carreras de calle y en el fútbol amateur, entre otros, donde está latente la posibilidad de presentar MSD.

Summary: We present a screening protocol for sudden death in sports, of easy application, with the aim of evaluate a high number of individuals in a short period, being able to discriminate those with significant risk of sudden death and perform a complete medical evaluation. The test, arises from the review of current evidence and the opinion of experts on sudden death, with special analysis of the predictive value of each item, where epidemiological, semiological (questionnaire and physical examination) and electrocardiogram aspects are addressed. This tool is applicable in scenarios where there is massive participation of individuals without prior evaluation of risk, as in street popular races and amateur football among others, where the possibility of presenting sudden death is latent.

Resumo: Apresentamos um protocolo de triagem para morte súbita no esporte de aplicação rápida, com o objetivo de avaliar um elevado número de indivíduos em um curto período, e assim poder discriminar aqueles com risco significativo de morte súbita e, assim, realizar avaliação médica prévia completa. O teste surge da revisão das evidências atuais e da opinião de especialistas em morte súbita e avaliaçao médica, com análise especial do valor preditivo de cada item, onde são abordados aspectos epidemiológicos, semiológicos (questionário e exame físico) e eletrocardiograma. Esta ferramenta é aplicável em cenários em que há uma participação massiva de pessoas sem avaliaçao médica anterior, como em corridas de rua e futebol amador, entre outros, onde a possibilidade de apresentar morte súbita é latente.

Ontogénesis del sentido de justicia. El criterio de igualdad analizado desde la psicología del desarrollo / Ontogeny of the sense of justice. The criterion of equality analyzed by developmental psychology / Ontogênese do senso de justiça. O critério da igualdade analisado a partir da psicologia do desenvolvimento

Resumen: El objetivo del artículo es realizar un relevamiento de las investigaciones llevadas a cabo en el ámbito de la psicología del desarrollo en relación con la ontogénesis de la tendencia a recurrir en forma espontánea e inconsciente al criterio de igualdad en las evaluaciones de escenarios intersubjetivos. Como mostraré a lo largo del trabajo, existen dos modelos marcadamente diferentes (e incluso conflictivos en ciertos aspectos) para explicar dicho surgimiento. Un primer modelo (al que llamaré "modelo dual") propone interpretar la ontogénesis del sentido de justicia en base a dos momentos diferentes, claramente secuenciados, y expresión de mecanismos psicológicos distintos y relativamente independientes: el momento de manifestación de la Aversión a la Desigualdad Desventajosa (ADD) (alrededor de los cuatro años), y el de la Aversión a la Desigualdad Ventajosa (ADV) (alrededor de los ocho años). El segundo modelo (al que llamaré "modelo unitario") propone, por el contrario, que los niños comienzan a recurrir a criterios de igualdad cerca de los 12 meses de edad, y, fundamentalmente, que dicho criterio de igualdad es independiente de -o, al menos, lógicamente previo a- la distinción entre ADD y ADV. Sugeriré, no obstante, que la divergencia entre ambos modelos no es obstáculo para concluir que los resultados de las investigaciones realizadas durante la última década ofrecen fundamentos sólidos para comenzar a comprender la especificidad de la ontogénesis de nuestro sentido de justicia.

Abstract: The aim of the article is to offer a review of the research in developmental psychology concerning the first manifestations of our tendency to resort -in a spontaneous and unconscious manner- to the criterion of equality in our assessment of intersubjective situations. As I will show throughout the paper, two different (and even conflicting) models have been proposed to explain those early manifestations. The first model, (which I will call "dual model") suggests that we interpret the ontogenesis of our sense of justice through two distinct and clearly sequenced moments, which are the expression of two distinct and relatively independent psychological modules: the moments of manifestation of our Disadvantageous Inequality Aversion (DIA) (around four years of old) and our Advantageous Inequality Aversion (AIA) (around eight years old). The second model (which I will call "unitary model") suggests, on the contrary, that children begin to resort to the criterion of equality when they are around 12 months old, and that such criterion is independent from -or, at least, logically prior to- the distinction between DIA and AIA. I will suggest, nevertheless, that the differences between both models should not hinder us from concluding that the research produced throughout the last decade has provided us with a solid ground to begin to understand the specificity of the ontogeny of our sense of justice.

Resumo: O objetivo do artigo será fazer uma pesquisa das investigações do campo da psicologia do desenvolvimento em relação ao surgimento da tendência de se recorrer espontaneamente e inconscientemente ao critério de igualdade em nossas avaliações de cenários intersubjetivos. Embora, como vou mostrar durante todo o trabalho, há dois modelos diferentes para explicar esse surgimento, os resultados das pesquisas realizadas durante a última década oferecem bases sólidas para começar a entender a especificidade da ontogênese do nosso senso de justiça.

Pulmonary restriction secondary to cutaneous sclerosis caused by chronic graft versus host disease: Case Report / [Restricción pulmonar secundaria a esclerosis cutánea por enfermedad injerto contra huésped crónica: Reporte de Caso.]

Chronic graft versus host disease (GVHD) is a major complication of the allogeneic stem cell transplant. One of most frequent manifestations of GVHD is the cutaneous compromise with the sclerodermatous variety being the most severe. We considered that the restrictive respiratory compromise and its evolution are not well characterized. We described the functional respiratory alterations of a patient with sclerodermatous chronic GVHD and considered differential diagnosis of pulmonary restriction in this type of patient. We reported the case of a 21-year-old woman with pulmonary restriction secondary to cutaneous sclerosis which was caused by chronic GVHD. This report illustrates the importance of utilizing both functional respiratory tests and diagnosis images to accurately characterize the cause of the respiratory compromise. We believe that the functional alterations described in this case could be caused by the cutaneous disorder found.

La enfermedad injerto contra huésped crónica (EICH) es una complicación mayor del trasplante de células progenitoras alogénico. Una de sus manifestaciones más frecuentes es el compromiso cutáneo, siendo su variedad esclerodermiforme la más severa. El compromiso respiratorio, predominantemente restrictivo y su evolución no han sido bien caracterizados. El caso describe las alteraciones funcionales respiratorias de una paciente con EICH cutánea crónica tipo esclerodermiforme en dos momentos de su evolución y considera los diagnósticos diferenciales que producen restricción en estos pacientes. Se presenta el caso de una mujer de 21 años con restricción pulmonar secundaria a esclerosis cutánea por EICH. Este caso ilustra la relevancia de la utilización conjunta de las pruebas funcionales respiratorias y de los métodos diagnósticos por imágenes para caracterizar adecuadamente el compromiso respiratorio de estos pacientes. A nuestro juicio las alteraciones funcionales respiratorias descriptas pueden ser explicadas por el trastorno cutáneo hallado.

Language plasticity after hemispherotomy of the dominant hemisphere in 3 patients: Implication of non-linguistic networks.

The neural networks involved in language recovery following hemispherotomy of the dominant hemisphere after language acquisition in children remain poorly known. Twelve hemispherotomized children (mean age at surgery: 11.3years) with comparable post-operative neuropsychological patterns underwent multi-task language functional MRI. Three of them had recovered from an initial postoperative aphasia i.e., hemispherotomy was performed on the language-dominant hemisphere. Our main results revealed (1) perisylvian activations in all patients after either left or right hemispherotomy; (2) no differences in activations between groups regarding the side of hemispherotomy; (3) additional activations in pre-frontal (3/3) and hippocampal/parahippocampal and occipito-parietal (2/3) areas, when comparing language activation in each of the three subjects with hemispherotomy of the language-dominant hemisphere to the group of 9 non-dominant hemispherotomized patients. These neural networks support the stronger engagement of learning and memory during language recovery in a hemisphere that was not initially actively subserving language.

Differential Left Hippocampal Activation during Retrieval with Different Types of Reminders: An fMRI Study of the Reconsolidation Process.

Consolidated memories return to a labile state after the presentation of cues (reminders) associated with acquisition, followed by a period of stabilization (reconsolidation). However not all cues are equally effective in initiating the process, unpredictable cues triggered it, predictable cues do not. We hypothesize that the different effects observed by the different reminder types on memory labilization-reconsolidation depend on a differential neural involvement during reminder presentation. To test it, we developed a declarative task and compared the efficacy of three reminder types in triggering the process in humans (Experiment 1). Finally, we compared the brain activation patterns between the different conditions using functional magnetic resonance imaging (fMRI) (Experiment 2). We confirmed that the unpredictable reminder is the most effective in initiating the labilization-reconsolidation process. Furthermore, only under this condition there was differential left hippocampal activation during its presentation. We suggest that the left hippocampus is detecting the incongruence between actual and past events and allows the memory to be updated.

Exceptional verbal intelligence after hemispherotomy in a child with Rasmussen encephalitis.

We report a longitudinal case study of a left-handed girl who underwent left hemispherotomy at 7 years for Rasmussen encephalitis (RE). Presurgical evaluation showed mild hemiparesis, no visual defect, and light neuropsychological impairment with short-term memory weakness. Language fMRI showed a right hemispheric dominance. Postoperatively, the patient exhibited right hemiplegia and hemianopsia but preserved intellectual capacities. She became seizure-free, and antiepileptic medication was discontinued. Long-term follow-up showed very high verbal intelligence at 11 years of age (VCI of 155) and improvement in working memory as well as language and reading abilities. Furthermore, a significant visuoverbal discrepancy became increasingly pronounced. Thus, early surgical treatment of epilepsy avoided the global cognitive deterioration usually associated with RE. Finally, such a high level of verbal functioning combined with low spatial reasoning with a single hemisphere provides additional information on the neurocognitive profile of children with RE after hemispherotomy.

Pretherapeutic functional magnetic resonance imaging in children.

In this article, some specificities of functional magnetic resonance imaging (fMRI) in children (eg, blood-oxygen-level-dependent response and brain maturation, paradigm design, technical issues, feasibility, data analysis) are reviewed, the main knowledge on presurgical cortical mapping in children (motor, language, reading, memory) is summarized, and the emergence of resting state fMRI in presurgical cortical mapping is discussed.

Adenoma pleomorfo intraoral: presentación inusual en área retromolar / Intraoral pleomorphic adenoma: unusual presentation in retromolar area

Objetivo: presentar un caso clínico de adenoma pleomorfo de localización inusual en región retromolar. Caso clínico: se llevó a cabo el tratamiento quirúrgico de una tumoración indolora, firme, rosada, adyacente al tercer molar inferior derecho. Se efectuó exéresis de la tumoración, junto con la exodoncia de la pieza dentaria involucrada, para su posterior análisis anatomopatolólgico. Conclusiones: es necesario considerar la posibilidad de la existencia de este tipo de neoplasias en cualquier zona de la cavidad bucal que presente glándulas salivales menores, a fin de realizar el diagnóstico, tratamiento y seguimiento adecuados.

Optimizing statistical parametric mapping analysis of 18F-FDG PET in children.

BACKGROUND: Statistical parametric mapping (SPM) procedure is an objective tool to analyze 18F-fluoro-2-deoxy-d-glucose-positron-emission tomography (FDG-PET) images and a useful complement to visual analysis. However, SPM requires a comparison to control data set that cannot be obtained in healthy children for ethical reasons. Using adults as controls showed some limitations. The purpose of the present study was to generate and validate a group of pseudo-normal children as a control group for FDG-PET studies in pediatrics. METHODS: FDG-PET images of 47 children (mean ± SD age 10.2 ± 3.1 years) with refractory symptomatic (MRI-positive, n = 20) and cryptogenic (MRI-negative, n = 27) focal epilepsy planned for surgery were analyzed using visual and SPM analysis. Performances of SPM analysis were compared using two different control groups: (1) an adult control group consisting of healthy young adults (n = 25, 30.5 ± 5.8 years, adult PET template) and (2) a pediatric pseudo-control group consisting of patients (n = 24, 10.6 ± 3.1 years, children PET template) with refractory focal epilepsy but with negative MRI and with PET considered normal not only on visual analysis but also on SPM. RESULTS: Among the 47 children, visual analysis succeeded detecting at least one hypometabolic area in 87% of the cases (interobserver kappa = 0.81). Regarding SPM analysis, the best compromise between sensitivity and specificity was obtained with a threshold of p less than 0.001 as an extent of more than 40 voxels. There was a significant concordance to detect hypometabolic areas between both SPM analyses [kappa (K) = 0.59; p < 0.005] and between both SPM and visual analyses (K = 0.45; p < 0.005), in symptomatic (K = 0.74; p < 0.005) as in cryptogenic patients (K = 0.26; p < 0.01). The pediatric pseudo-control group dramatically improved specificity (97% vs. 89%; p < 0.0001) by increasing the positive predictive value (86% vs. 65%). Sensitivity remained acceptable although it was not better (79% vs. 87%, p = 0.039). The main impact was to reduce by 41% the number of hypometabolic cortical artifacts detected by SPM, especially in the younger epileptic patients, which is a key point in clinical practice. CONCLUSIONS: This age-matched pseudo-control group is a way to optimize SPM analysis of FDG-PET in children with epilepsy. It might also be considered for other brain pathologies in pediatrics in the future.

Memory for fearful faces across development: specialization of amygdala nuclei and medial temporal lobe structures.

Enhanced memory for emotional faces is a significant component of adaptive social interactions, but little is known on its neural developmental correlates. We explored the role of amygdaloid complex (AC) and medial temporal lobe (MTL) in emotional memory recognition across development, by comparing fMRI activations of successful memory encoding of fearful and neutral faces in children (n = 12; 8-12 years) and adolescents (n = 12; 13-17 years). Memory for fearful faces was enhanced compared with neutral ones in adolescents, as opposed to children. In adolescents, activations associated with successful encoding of fearful faces were centered on baso-lateral AC nuclei, hippocampus, enthorhinal and parahippocampal cortices. In children, successful encoding of fearful faces relied on activations of centro-mesial AC nuclei, which was not accompanied by functional activation of MTL memory structures. Successful encoding of neutral faces depended on activations in anterior MTL region (hippocampal head and body) in adolescents, but more posterior ones (hippocampal tail and parahippocampal cortex) in children. In conclusion, two distinct functional specializations emerge from childhood to adolescence and result in the enhancement of memory for these particular stimuli: the specialization of baso-lateral AC nuclei, which is associated with the expertise in processing emotional facial expression, and which is intimately related to the specialization of MTL memory network. How the interplay between specialization of AC nuclei and of MTL memory structures is fundamental for the edification of social interactions remains to be elucidated.

White matter abnormalities revealed by DTI correlate with interictal grey matter FDG-PET metabolism in focal childhood epilepsies.

For patients with focal epilepsy scheduled for surgery, including MRI-negative cases, (18)FDG-PET was shown to disclose hypometabolism in the seizure onset zone. However, it is not clear whether grey matter hypometabolism is informative of the integrity of the surrounding white matter cerebral tissue. In order to study the relationship between metabolism of the seizure onset zone grey matter and the integrity of the surrounding white matter measured by diffusion tensor imaging (DTI), we performed a monocentric prospective study (from 2006 to 2009) in 15 children with pharmacoresistant focal epilepsy, suitable for interictal (18)FDG-PET, T1-, T2-, FLAIR sequence MRI and DTI. Children had either positive or negative MRI (eight with symptomatic and seven with cryptogenic epilepsies, respectively). Seven children subsequently underwent surgery. Standardised uptake values of grey matter PET metabolism were compared with DTI indices (fractional anisotropy [FA], apparent diffusion coefficient [ADC], parallel diffusion coefficient [PDC], and transverse diffusion coefficient [TDC]) in grey matter within the seizure onset zone and adjacent white matter, using regions of interest automatically drawn from individual sulcal and gyral parcellation. Hypometabolism correlated positively with white matter ADC, PDC, and TDC, and negatively with white matter FA. In the cryptogenic group of children, hypometabolism correlated positively with white matter ADC. Our results demonstrate a relationship between abnormalities of grey matter metabolism in the seizure onset zone and adjacent white matter structural alterations in childhood focal epilepsies, even in cryptogenic epilepsy. This relationship supports the hypothesis that microstructural alterations of the white matter are related to epileptic networks and has potential implications for the evaluation of children with MRI-negative epilepsy.