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1.
Artículo en Inglés | MEDLINE | ID: mdl-33528453

RESUMEN

In everyday practice, surgeons have to deal with bone atrophy. These rehabilitations are even more complex in the posterior mandible, and it is still unclear in the literature which fixed rehabilitation option is best. The purpose of this article was to help oral surgeons to choose the proper and updated treatment for their atrophic patients. Posterior mandible bone atrophies were divided into four main groups depending on the bone height measured above the inferior alveolar nerve: (1) ≤ 4 mm; (2) > 4 mm ≤ 5 mm; (3) > 5 mm ≤ 6 mm; (4) > 6 mm < 7 mm. Different approaches were proposed for each group, considering patient expectations. If ≤ 4 mm of bone height was available, guided bone regeneration was used as the adequate approach. For bone heights > 4 mm and ≤ 6 mm, the "sandwich" technique and/or short implants were used, depending on esthetics. In cases with > 6 mm and < 7 mm above the mandibular canal, short implants might be the proper option. The authors' clinical experience and the literature were considered in order to suggest a possible correct treatment decision based on the residual bone height in the posterior mandible.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Atrofia/patología , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/patología , Mandíbula/cirugía , Resultado del Tratamiento
2.
Int J Oral Maxillofac Implants ; 36(1): 30-37, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33600520

RESUMEN

PURPOSE: This study aimed to assess the survival rate, marginal bone levels, and prosthetic success of short implants when placed in posterior areas of severely reabsorbed mandibles. MATERIALS AND METHODS: A systematic review was performed of all randomized controlled trials with at least 10 patients with a control group where bone augmentations were performed that were published between January 2015 and February 2020. From 77 pertinent studies, 14 full-text publications were studied, and 6 studies fulfilled the inclusion criteria. RESULTS: The implant survival rates of short dental implants ranged from 92% to 96.9% with a follow-up from 1 to 5 years, and the prosthetic success rate ranged from 90% to 100% during the same follow-up. The mean marginal bone level values of involved short implants ranged from -0.51 to -2.30 mm. CONCLUSION: The obtained data showed that short dental implants are a valid therapeutic choice to rehabilitate severe mandibular atrophy in the medium to long term.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Atrofia/patología , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Humanos , Mandíbula/patología , Mandíbula/cirugía , Resultado del Tratamiento
5.
Lakartidningen ; 1182021 01 21.
Artículo en Sueco | MEDLINE | ID: mdl-33491762

RESUMEN

Posterior cortical atrophy (PCA) is a neurodegenerative disease which was described originally in 1988 by dr Frank Benson. PCA is characterized by progressive deficits in higher visual functions while episodic memory and speech are relatively preserved. Studies have shown that the neuropathologic findings in most cases are consistent with Alzheimer's disease (AD). However, patients with PCA show greater occipitoparietal atrophy on neuroimaging compared with the more prominent mesiotemporal atrophy in patients with amnestic AD. Until recently, diagnostics were based mainly on clinical experience due to the lack of validated diagnostic criteria. In 2017, new consensus criteria for the diagnosis and classification of PCA were published. In this article we make a brief review of the disease and describe a 58 year old man with complex visual deficits and apraxia who was ultimately diagnosed with PCA.


Asunto(s)
Enfermedad de Alzheimer , Enfermedades Neurodegenerativas , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/diagnóstico por imagen , Atrofia/patología , Corteza Cerebral/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/diagnóstico por imagen
6.
Neurology ; 96(11): e1561-e1573, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33441452

RESUMEN

OBJECTIVES: Gay matter (GM) involvement is clinically relevant in multiple sclerosis (MS). Using source-based morphometry (SBM), we characterized GM atrophy and its 1-year evolution across different MS phenotypes. METHODS: Clinical and MRI data were obtained at 8 European sites from 170 healthy controls (HCs) and 398 patients with MS (34 with clinically isolated syndrome [CIS], 226 with relapsing-remitting MS [RRMS], 95 with secondary progressive MS [SPMS], and 43 with primary progressive MS [PPMS]). Fifty-seven HCs and 144 with MS underwent 1-year follow-up. Baseline GM loss, atrophy progression, and correlations with disability and 1-year clinical worsening were assessed. RESULTS: SBM identified 26 cerebellar, subcortical, sensory, motor, and cognitive GM components. GM atrophy was found in patients with MS vs HCs in almost all components (p range <0.001-0.04). Compared to HCs, patients with CIS showed circumscribed subcortical, cerebellar, temporal, and salience GM atrophy, while patients with RRMS exhibited widespread GM atrophy. Cerebellar, subcortical, sensorimotor, salience, and frontoparietal GM atrophy was found in patients with PPMS vs HCs and in patients with SPMS vs those with RRMS. At 1 year, 21 (15%) patients had clinically worsened. GM atrophy progressed in MS in subcortical, cerebellar, sensorimotor, and fronto-temporo-parietal components. Baseline higher disability was associated (R 2 = 0.65) with baseline lower normalized brain volume (ß = -0.13, p = 0.001), greater sensorimotor GM atrophy (ß = -0.12, p = 0.002), and longer disease duration (ß = 0.09, p = 0.04). Baseline normalized GM volume (odds ratio 0.98, p = 0.008) and cerebellar GM atrophy (odds ratio 0.40, p = 0.01) independently predicted clinical worsening (area under the curve 0.83). CONCLUSION: GM atrophy differed across disease phenotypes and progressed at 1 year in MS. In addition to global atrophy measures, sensorimotor and cerebellar GM atrophy explained baseline disability and clinical worsening.


Asunto(s)
Encéfalo/patología , Sustancia Gris/patología , Esclerosis Múltiple/patología , Adulto , Atrofia/patología , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fenotipo
7.
Clin Imaging ; 69: 238-242, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32977196

RESUMEN

PURPOSE: The present study was carried out to investigate any possible linkage between cerebral grey matter volumetric, iron changes, white matter's lesions load and serum iron levels in a group of relapsing-remitting multiple sclerosis (RRMS) patients. MATERIALS AND METHODS: Sixty-five RRMS patients along with thirty-four age-matched healthy controls (HCs) were recruited. Serum samples were isolated from blood samples which were collected in vacutainer plain tubes individually from both groups. Both groups were scanned at 1.5 T magnetic resonance imaging (MRI) using the following 3D sequences; T1-weighted gradient echo (MPRAGE), T2*-weighted gradient echo and T2-weighted fluid-attenuated inversion recovery (FLAIR). RESULTS: Significant differences were observed between the RRMS patients and HCs for cortical and deep grey matter (dGM) volumes where cortical and dGM volumes in RRMS patient were significantly smaller than those in HCs. While iron deposition in the cortex, putamen (PT) and globus pallidus (GP) of RRMS patients were significantly higher than those of HCs, iron levels in thalamus (TH) and serum were significantly lower in RRMS compared to those in HCs. Except for T2 lesion load, none of volumetric measures showed any association with patients' disability status. Cerebral grey matter's iron changes did not show any association with those of serum. CONCLUSION: Smaller cortical and subcortical grey matter volumes in RRMS patients compared to HCs were detected. None of the volumetric measures showed any association with patients' disability status. RRMS patients showed increased iron levels in the PT, GP and cortex and decreased levels in the TH and serum.


Asunto(s)
Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Atrofia/patología , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Humanos , Hierro , Imagen por Resonancia Magnética , Esclerosis Múltiple/patología , Esclerosis Múltiple Recurrente-Remitente/diagnóstico por imagen
8.
Zhonghua Yi Xue Za Zhi ; 100(43): 3397-3401, 2020 Nov 24.
Artículo en Chino | MEDLINE | ID: mdl-33238668

RESUMEN

Objective: To investigate the association of age-related white matter hyperintensity (WMH) with brain atrophy and cognitive impairment in patients with Parkinson's disease (PD). Methods: Consecutive samples of a prospective PD cohort with complete 3-dimensional magnetic resonance imaging in the Department of Movement Disorders in Beijing Tiantan Hospital, Capital Medical University, from October 2018 to August 2019 was retrospectively analyzed. Cognition was evaluated by Mini-Mental State Scale (MMSE) and Montreal Cognitive Assessment (MoCA). The severity of WMH was semi-quantitatively measured by Fazekas scale (0-6 points), and the mean cortical thickness and thalamus volume were calculated by FreeSurfer software. The demographic and disease characteristics, the severity of WMH, the mean cortical thickness and thalamus volume were respectively compared between PD patients with and without dementia. Moreover, univariate and multivariate generalized linear models were used to analyze the correlation of the severity of WMH with brain atrophy and MoCA. Results: A total of 225 patients with PD were included in the study, with a median age of 66 years old. Comparisons between groups suggested that patients with dementia were with severer WMH, older, and had lower levels of serum cholesterol and low-density lipoprotein and more reduced mean cortical thickness than those without dementia (all P<0.05), but no significant difference in the thalamus volume was found between the two groups. The generalized linear model showed that the cognitive impairment of PD patients was significantly correlated with WMH (ß=-0.021, 95%CI:-0.040--0.002, P=0.032), but independent of age, cortical thickness, and levels of serum cholesterol and low-density lipoprotein. Conclusion: WMH may worsen PD cognitive impairment independent of brain atrophy. Clinical prevention and treatment of cerebral small vessel disease may have protective effects on cognitive function in patients with PD.


Asunto(s)
Disfunción Cognitiva , Enfermedad de Parkinson , Sustancia Blanca , Anciano , Atrofia/patología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/patología , Humanos , Imagen por Resonancia Magnética , Pruebas Neuropsicológicas , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/patología , Estudios Prospectivos , Estudios Retrospectivos , Sustancia Blanca/patología
9.
Neurol Neurochir Pol ; 54(5): 410-415, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33085075

RESUMEN

Magnetic resonance imaging (MRI) is a widely used method for the diagnosis of multiple sclerosis that is essential for the detection and follow-up of the disease. OBJECTIVE: The Polish Medical Society of Radiology (PLTR) and the Polish Society of Neurology (PTN) present the second version of their recommendations for investigations routinely conducted in magnetic resonance imaging departments in patients with multiple sclerosis. This version includes new data and practical comments for electroradiology technologists and radiologists. The recommended protocol aims to improve the MRI procedure and, most importantly, to standardise the method of conducting scans in all MRI departments. This is crucial for the initial diagnostics necessary for establishing a diagnosis, as well as for MS patient monitoring, which directly translates into significant clinical decisions. INTRODUCTION: Multiple sclerosis (MS) is a chronic immune mediated inflammatory demyelinating disease of the central nervous system (CNS), the aetiology of which is still unknown. The nature of the disease lies in a CNS destruction process disseminated in time (DIT) and space (DIS). MRI detects focal lesions in the white and grey matter with high sensitivity (although with significantly lower specificity in the latter). It is also the best tool to assess brain atrophy in patients with MS in terms of grey matter volume (GMV) and white matter volume (WMV) as well as local atrophy (by measuring the volume of thalamus, corpus callosum, subcortical nuclei, and hippocampus) as parameters that correlate with disability progression and cognitive dysfunctions. Progress in MR techniques, as well as advances in postprocessing the obtained data, has driven the dynamic development of computer programs that allow for a more repeatable assessment of brain atrophy in both cross-sectional and longitudinal studies. MR imaging is unquestionably the best diagnostic tool available to follow up the course of the disease and support clinicians in choosing the most appropriate treatment strategy for their MS patient. However, to diagnose and follow up MS patients on the basis of MRI in accordance with the latest standards, the MRI study must adhere to certain quality criteria. Such criteria are the subject of this paper.


Asunto(s)
Esclerosis Múltiple , Neurología , Atrofia/patología , Encéfalo/patología , Estudios Transversales , Humanos , Imagen por Resonancia Magnética , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/patología , Polonia , Sociedades Médicas
10.
Brain Nerve ; 72(9): 923-930, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-32934181

RESUMEN

Marie et al. (1922) first proposed a disease entity "late cortical cerebellar atrophy (LCCA)", which is characterized neuropathologically by pure cerebello-olivary degeneration. LCCA was originally described as sporadic, late-onset, pure cerebellar ataxia of unknown etiology; however, it has occasionally been used to denote familial or secondary ataxias, particularly alcoholic cerebellar degeneration. Sporadic ataxia is classified mainly into LCCA or CCA and olivo-ponto-cerebellar atrophy (OPCA) in Japan. OPCA, now multiple system atrophy with predominant cerebellar ataxia, has characteristic brain imaging features and is clearly diagnosed based on the consensus criteria. On the other hand, there is no specific biomarker for LCCA/CCA, and neuropathological examination is required for a definitive diagnosis. Therefore, the clinical diagnosis of LCCA/CCA depends on the exclusion of other diseases manifesting as cerebellar ataxia. However the differential diagnosis for LCCA/CCA is not necessarily made carefully. As a result, the LCCA/CCA category in Japan is a "waste basket," including OPCA, hereditary ataxias, and secondary ataxias, which are unidentified yet. To refine the LCCA/CCA category, we proposed the clinically-defined term "idiopathic cerebellar ataxia (IDCA)" and established its diagnostic criteria. By nationwide screening, we have identified 51 patients with probable IDCA according to the criteria so far. Here we review the clinical characteristics of IDCA patients.


Asunto(s)
Ataxia Cerebelosa , Degeneraciones Espinocerebelosas , Atrofia/patología , Ataxia Cerebelosa/diagnóstico , Cerebelo , Humanos , Japón , Degeneraciones Espinocerebelosas/diagnóstico , Degeneraciones Espinocerebelosas/patología
11.
Brain Nerve ; 72(9): 931-937, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-32934182

RESUMEN

Cerebellar ataxia-predominant multiple system atrophy (MSA-C) and cortical cerebellar atrophy are representative diseases of adult-onset sporadic degenerative ataxia. Both diseases are distinctly different because of α-synuclein pathology. However, it takes approximately 2 years for cerebellar ataxia to progress to concomitant severe autonomic dysfunction in patients with MSA-C. The period of only cerebellar ataxia (mono system atrophy) may extend to more than 10 years. Understanding mono system atrophy is vital for the early diagnosis and drug development for MSA. In this review, we discuss mono system atrophy focusing on the concept and natural history and the possibility of the of early diagnosis and disease-modifying therapy for MSA.


Asunto(s)
Ataxia Cerebelosa , Atrofia de Múltiples Sistemas , Adulto , Ataxia , Atrofia/patología , Ataxia Cerebelosa/diagnóstico , Ataxia Cerebelosa/tratamiento farmacológico , Cerebelo , Humanos , Atrofia de Múltiples Sistemas/diagnóstico , Atrofia de Múltiples Sistemas/tratamiento farmacológico , Atrofia de Múltiples Sistemas/patología
12.
Brain Nerve ; 72(9): 947-959, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-32934184

RESUMEN

Cortical cerebellar atrophy (CCA) contains hereditary spinocerebellar degeneration (hSCD) and genetic testing is necessary for an accurate diagnosis. Screening for frequent hSCDs (triplet repeat disease and SCA31) was performed. Panel analysis and whole exome analysis using a next-generation sequencer were also performed. The Japan Consortium for Ataxias, J-CAT, contributes to the elucidation of the genetic epidemiology of CCA. The elucidation of CCA would be promoted by comprehensive gene analysis, including whole genome analysis.


Asunto(s)
Ataxias Espinocerebelosas , Degeneraciones Espinocerebelosas , Atrofia/patología , Cerebelo , Humanos , Japón , Degeneraciones Espinocerebelosas/patología
13.
PLoS One ; 15(9): e0237515, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32898138

RESUMEN

BACKGROUND: Regional variations in gastric cancer incidence are not explained by prevalence of Helicobacter pylori, the main cause of the disease, with several areas presenting high H. pylori prevalence but low gastric cancer incidence. The IARC worldwide H. pylori prevalence surveys (ENIGMA) aim at systematically describing age and sex-specific prevalence of H. pylori infection around the world and generating hypotheses to explain regional variations in gastric cancer risk. METHODS: We selected age- and sex-stratified population samples in two areas with different gastric cancer incidence and mortality in Chile: Antofagasta (lower rate) and Valdivia (higher rate). Participants were 1-69 years old and provided interviews and blood for anti-H. pylori antibodies (IgG, VacA, CagA, others) and atrophy biomarkers (pepsinogens). RESULTS: H. pylori seroprevalence (Age-standardized to world population) and antibodies against CagA and VacA were similar in both sites. H. pylori seroprevalence was 20% among children <10 years old, 40% among 10-19 year olds, 60% in the 20-29 year olds and close to or above 80% in those 30+ years. The comparison of the prevalence of known and potential H. pylori cofactors in gastric carcinogenesis between the high and the low risk area showed that consumption of chili products was significantly higher in Valdivia and daily non-green vegetable consumption was more common in Antofagasta. Pepsinogen levels suggestive of gastric atrophy were significantly more common and occurred at earlier ages in Valdivia, the higher risk area. In a multivariate model combining both study sites, age, chili consumption and CagA were the main risk factors for gastric atrophy. CONCLUSIONS: The prevalence of H. pylori infection and its virulence factors was similar in the high and the low risk area, but atrophy was more common and occurred at younger ages in the higher risk area. Dietary factors could partly explain higher rates of atrophy and gastric cancer in Valdivia. IMPACT: The ENIGMA study in Chile contributes to better understanding regional variations in gastric cancer incidence and provides essential information for public health interventions.


Asunto(s)
Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Neoplasias Gástricas/etiología , Estómago/patología , Adolescente , Adulto , Anciano , Atrofia/etiología , Atrofia/microbiología , Atrofia/patología , Niño , Preescolar , Chile/epidemiología , Femenino , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estómago/microbiología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Adulto Joven
14.
Fortschr Neurol Psychiatr ; 88(8): 528-531, 2020 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-32634845

RESUMEN

Posterior cortical atrophy (PCA) is a rare neurodegenerative disease, which manifests with complex visual disturbances. PCA can present in isolation ('PCA-pure') or in association with other neurodegenerative disorders ('PCA-plus'). Diagnosis is nevertheless frequently delayed, as PCA is a less known disease entity and initially a primary ocular disease is taken into consideration.


Asunto(s)
Atrofia/patología , Corteza Cerebral/patología , Enfermedades Neurodegenerativas/diagnóstico , Enfermedades Neurodegenerativas/patología , Trastornos de la Visión/diagnóstico , Diagnóstico Tardío , Humanos , Enfermedades Raras/diagnóstico , Enfermedades Raras/patología , Síndrome , Trastornos de la Visión/patología
15.
Neurology ; 95(5): e554-e562, 2020 08 04.
Artículo en Inglés | MEDLINE | ID: mdl-32611644

RESUMEN

OBJECTIVE: We postulated that cerebral amyloid angiopathy (CAA) is associated with white matter atrophy (WMA) and that WMA can be related to cognitive changes in CAA. METHODS: White matter volume expressed as percent of intracranial volume (pWMV) of prospectively enrolled patients without dementia diagnosed with probable CAA was compared to age-matched healthy controls (HC) and patients with Alzheimer disease (AD). Cognitive scores were also sought to understand the potential effects of WMA on cognitive function. RESULTS: Patients with CAA (n = 72) had significantly lower pWMV (27.97% ± 2.63) when compared to age-matched HC (n = 72; mean difference [MD], 2.38%; p < 0.0001) and patients with AD (n = 72; MD, 1.57%; p < 0.0001). Differences were most pronounced in the posterior occipital regions in both comparisons. When comparisons were restricted to groups of patients with CAA but no intracerebral hemorrhage (n = 32) or hypertension (n = 32), and age-matched HC and AD, the significant differences were unaltered. Within the CAA cohort, higher age, lobar microbleed counts, and presence of hypertension were associated with lower pWMV (p = 0.0007, p = 0.031, and p = 0.003, respectively). All associations remained independent in multivariable analyses. Within the CAA cohort, higher pWMV independently correlated with better scores of executive function. CONCLUSIONS: Patients with CAA show WMA when compared to age-matched HC and patients with AD. WMA independently correlates with the number of lobar microbleeds, a marker of CAA severity. Consistent spatial patterns of WMA especially in posterior regions might be related to CAA. The association between WMA and measures of executive function suggests that WMA might represent an important mediator of CAA-related neurologic dysfunction.


Asunto(s)
Encéfalo/patología , Angiopatía Amiloide Cerebral/patología , Sustancia Blanca/patología , Anciano , Atrofia/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino
16.
Neurology ; 95(10): e1301-e1311, 2020 09 08.
Artículo en Inglés | MEDLINE | ID: mdl-32631924

RESUMEN

OBJECTIVE: To study the neuropathologic correlates of cholinergic basal forebrain (BF) atrophy as determined using antemortem MRI in the Alzheimer disease (AD) spectrum. METHODS: We determined associations between BF volume from antemortem MRI brain scans and postmortem assessment of neuropathologic features, including neuritic plaques, neurofibrillary tangles (NFTs), Lewy body (LB) pathology, and TDP-43, in 64 cases of the Alzheimer's Disease Neuroimaging Initiative cohort. For comparison, we assessed neuropathologic features associated with hippocampal and parahippocampal gyrus atrophy. In addition to region of interest-based analysis, we determined the association of neuropathologic features with whole brain gray matter volume using regionally unbiased voxel-based volumetry. RESULTS: BF atrophy was associated with Thal amyloid phases (95% confidence interval [CI] -0.49 to -0.01, p = 0.049) and presence of LB pathology (95% CI -0.54 to -0.06, p = 0.015), as well as with the degree of LB pathology within the nucleus basalis Meynert (95% CI -0.54 to -0.07, p = 0.025). These effects were no longer significant after false discovery rate (FDR) correction. Hippocampal atrophy was significantly associated with the presence of TDP-43 pathology (95% CI -0.61 to -0.17, p = 0.003; surviving FDR correction), in addition to dentate gyrus NFT load (95% CI -0.49 to -0.01, p = 0.044; uncorrected). Voxel-based analysis confirmed spatially restricted effects of Thal phases and presence of LB pathology on BF volume. CONCLUSIONS: These findings indicate that neuropathologic correlates of regional atrophy differ substantially between different brain regions that are typically involved in AD-related neurodegeneration, including different susceptibilities to common comorbid pathologies.


Asunto(s)
Enfermedad de Alzheimer/patología , Prosencéfalo Basal/patología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico por imagen , Atrofia/patología , Prosencéfalo Basal/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino
17.
BMC Oral Health ; 20(1): 195, 2020 07 08.
Artículo en Inglés | MEDLINE | ID: mdl-32641041

RESUMEN

BACKGROUND: It is not well-known which pre-implantological procedures are preferred by maxillofacial (MFS) and oral surgeons (OS) for the narrow atrophic alveolar ridge under practice based conditions and, if different training paths in surgery lead to other pre-implantological techniques being preferred. This study aims to identify which procedures are preferred by the respective specialists in which indication. METHODS: A questionnaire was sent to a total of 300 MFS and OS in southern Germany. The questionnaire examined pre-implantological procedures (bone block, bone grafting material and/or particulate autogenous bone, titanium mesh, bone split, resection) in the edentulous severely atrophic mandible and in the severely atrophic single-tooth gap. Kendall's Tau-b test was used for statistical analyses. RESULTS: One hundred seventeen participants returned the questionnaire. 68 (58%) were OS and 49 (42%) were MFS. In the edentulous mandible, bone substitute material and resection were most preferred by both specialists. Bone blocks were statistically significantly more frequently associated with MFS and bone substitute materials with OS. Bone split was more frequently used in the atrophic single tooth gap than in the edentulous mandible. OS preferred bone blocks in the single tooth gap more often than in the edentulous mandible. MFS and OS preferred resection in the edentulous mandible significantly more frequently than in the single tooth gap. CONCLUSIONS: MFS in general prefer more invasive pre-implantological therapies with the same initial diagnosis than OS, which seems to be attributed to different training paths.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Cirujanos Oromaxilofaciales/psicología , Pautas de la Práctica en Medicina , Proceso Alveolar/patología , Atrofia/patología , Trasplante Óseo , Implantación Dental Endoósea , Alemania , Humanos , Masculino , Mandíbula/patología
18.
Neurology ; 95(12): e1672-e1685, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32675078

RESUMEN

OBJECTIVE: To determine whether atrophy relates to phenotypical variants of posterior cortical atrophy (PCA) recently proposed in clinical criteria (i.e., dorsal, ventral, dominant-parietal, and caudal) we assessed associations between latent atrophy factors and cognition. METHODS: We employed a data-driven Bayesian modeling framework based on latent Dirichlet allocation to identify latent atrophy factors in a multicenter cohort of 119 individuals with PCA (age 64 ± 7 years, 38% male, Mini-Mental State Examination 21 ± 5, 71% ß-amyloid positive, 29% ß-amyloid status unknown). The model uses standardized gray matter density images as input (adjusted for age, sex, intracranial volume, MRI scanner field strength, and whole-brain gray matter volume) and provides voxelwise probabilistic maps for a predetermined number of atrophy factors, allowing every individual to express each factor to a degree without a priori classification. Individual factor expressions were correlated to 4 PCA-specific cognitive domains (object perception, space perception, nonvisual/parietal functions, and primary visual processing) using general linear models. RESULTS: The model revealed 4 distinct yet partially overlapping atrophy factors: right-dorsal, right-ventral, left-ventral, and limbic. We found that object perception and primary visual processing were associated with atrophy that predominantly reflects the right-ventral factor. Furthermore, space perception was associated with atrophy that predominantly represents the right-dorsal and right-ventral factors. However, individual participant profiles revealed that the large majority expressed multiple atrophy factors and had mixed clinical profiles with impairments across multiple domains, rather than displaying a discrete clinical-radiologic phenotype. CONCLUSION: Our results indicate that specific brain behavior networks are vulnerable in PCA, but most individuals display a constellation of affected brain regions and symptoms, indicating that classification into 4 mutually exclusive variants is unlikely to be clinically useful.


Asunto(s)
Atrofia/patología , Corteza Cerebral/patología , Enfermedades Neurodegenerativas/clasificación , Enfermedades Neurodegenerativas/patología , Anciano , Atrofia/clasificación , Teorema de Bayes , Estudios de Cohortes , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Fenotipo
19.
Neurology ; 95(7): e847-e855, 2020 08 18.
Artículo en Inglés | MEDLINE | ID: mdl-32699140

RESUMEN

OBJECTIVE: To investigate evidence of the potential role of early cortical vulnerability in the development of primary progressive aphasia (PPA). METHOD: A woman with a diagnosis of PPA and her 9 adult siblings, 7 with developmental language disabilities, underwent neuropsychological testing, structural MRI, and resting-state fMRI. Whole-exome sequencing was conducted for genes associated with dyslexia or with neurodegenerative dementia. RESULTS: The siblings demonstrated lower verbal than nonverbal cognitive test scores in a developmental dyslexia pattern. On structural MRI, although the siblings did not differ from controls in total brain volume, the left hemisphere language area volume was significantly smaller than the right. Furthermore, cortical connectivity between the left superior temporal area, previously identified as the region of peak atrophy in the proband early in the course of illness, and adjacent language network components, including the planum temporale, was decreased in the siblings. No distinctive genetic signatures were identified. CONCLUSION: This report further supports the hypothesis that at least some cases of PPA may be based on a familial language network vulnerability that interferes with the acquisition of language in some members and that makes the language network a locus of least resistance to the effects of an independently late-arising neurodegenerative disease in others. This association offers a conceptual model to explain why identical neurodegenerative diseases may selectively target the language network in some individuals while targeting networks that regulate memory or behavior in others. The genetic basis for this vulnerability remains to be determined.


Asunto(s)
Afasia Progresiva Primaria/patología , Lenguaje , Red Nerviosa/patología , Enfermedades Neurodegenerativas/patología , Afasia Progresiva Primaria/diagnóstico , Atrofia/patología , Encéfalo/patología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Memoria/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas
20.
Am J Pathol ; 190(9): 1943-1959, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32562655

RESUMEN

Acoustic trauma disrupts cochlear blood flow and damages sensory hair cells. Damage and regression of capillaries after acoustic trauma have long been observed, but the underlying mechanism of pathology has not been understood. We show herein that loud sound causes change of phenotype from neural/glial antigen 2 positive/α-smooth muscle actin negative to neural/glial antigen 2 positive/α-smooth muscle actin positive in some pericytes (PCs) on strial capillaries that is strongly associated with up-regulation of transforming growth factor-ß1. The acoustic trauma also reduced capillary density and increased deposition of matrix proteins, particularly in the vicinity of transformed PCs. In a newly established in vitro three-dimensional endothelial cell (EC) and PC co-culture model, transformed PCs induced thicker capillary-like branches in ECs and increased collagen IV and laminin expression. Transplantation of exogenous PCs derived from neonatal day 10 mouse cochleae to acoustic traumatized cochleae, however, significantly attenuated the decreased vascular density in the stria. Transplantation of PCs pretransfected with adeno-associated virus 1-vascular endothelial growth factor-A165 under control of a hypoxia-response element markedly promotes vascular volume and blood flow, increased proliferation of PCs and ECs, and attenuated loud sound-caused loss in endocochlear potential and hearing. Our results indicate that loud sound-triggered PC transformation contributes to capillary wall thickening and regression, and young PC transplantation effectively rehabilitates the vascular regression and improves hearing.


Asunto(s)
Capilares/patología , Cóclea/patología , Pérdida Auditiva Provocada por Ruido/patología , Pericitos/patología , Pericitos/trasplante , Animales , Atrofia/patología , Transdiferenciación Celular , Cóclea/irrigación sanguínea , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Transgénicos , Miofibroblastos/patología
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