Transcranial Doppler could help to differentiate the types of dementia? A pilot study when CSF biomarkers are not available.

Our objective was to find a mean flow velocity (MFV) cut-off point to differentiate between normal and cognitive impaired patients using Clinical Dementia Rating (CDR) as a comparison method. To evaluate MFV (in cm/s) and pulsatility index (PI) from the left middle cerebral artery (MCA) and basilar artery using transcranial Doppler in a pilot study from an outpatient cognition unit and compare with cognitively normal older adults (at the age of sixty or older) from the Geriatric Ambulatory of Fluminense Federal University. We hypothesized that there is a MFV and PI cut-off point to potentially distinguish between normal and impaired cognition. Sixty-one patients with cognitive decline, including 18 with amnestic mild cognitive impairment (aMCI), 31 with probable Alzheimer disease (AD), 12 with vascular dementia (VD), and 10 cognitively normal older adults were included in the study. Patients with dementia (both AD and VD, p < 0.01) and aMCI (p < 0.05) had lower MFV than the control group in the MCA (32.2 cm/s, 31.9 cm/s, and 36.6 cm/s, respectively) and dementia patients had higher PI compared to control (AD and VD, both p < 0.05). Basilar MFV showed to be no difference between the patients and the control group. A cut off value of 39.1 cm/s was found in a ROC curve (area under de curve value 0.85, 95% CI 0.75-0.95) for mean MCA MFV to be predictive of cognitive impairment (CDR ≥ 0.5). In this study, the values of MCA MFV below 39.1 cm/s were predictive of cognitive impairment according to CDR. TCD is an inexpensive method that could be used in a clinical scenario to help differentiate normal cognition from cognitive decline. Multicentric and longitudinal studies should be done to validate that.

Experiencia en la atención nutricional en los primeros 100 pacientes con trasplante de células progenitoras hematopoyéticas / Experience in nutritional care in the first 100 patients with hematopoietic progenitor cell transplantation

OBJETIVO: Conocer el estado nutricional y la terapia nutricional recibida durante la internación de los pacientes sometidos a TCPH. MATERIAL Y MÉTODOS: Estudio observacional, de corte transversal, comprendido en el período de enero de 2012 a octubre de 2017. Se incluyeron 100 pacientes mayores de 15 años internados en la unidad de trasplante de médula ósea, que se encontraban realizando tratamiento acondicionante y posterior TCPH, que respondieron voluntariamente al interrogatorio realizado por el Servicio de Nutrición. En una base de datos se registró el estado nutricional y el tipo de terapia nutricional, con los motivos de indicación, la duración y las causas de finalización de la misma. RESULTADOS: De la totalidad de los pacientes, el 84% se mantuvo con alimentación oral exclusiva, adecuándose la dieta a la sintomatología referida por el paciente; y de éstos, el 62% (52 pacientes) tuvieron indicación de suplementos orales como complemento. Sólo 16 pacientes tuvieron indicación de NP. La mediana de duración de NP fue de 9 días (IIC 6-24,5) CONCLUSIONES: La mayoría de los pacientes no presentó desnutrición a su ingreso, pero a pesar de ello, hubo un gran número de pacientes que requirió el uso de alguna terapia nutricional, lo que denota la importancia del monitoreo diario de estos pacientes a pesar de no presentar riesgo nutricional al ingreso.

OBJECTIVE: To know the nutritional status and nutritional therapy received during hospitalization of patients undergoing TCPH. MATERIAL AND METHODS: Observational, cross-sectional study, included in the period from January 2012 to October 2017. We included 100 patients older than 15 years admitted to the bone marrow transplant unit, who were undergoing conditioning treatment and subsequent TCPH, who voluntarily responded to the interrogation conducted by the Nutrition Service. In a database, the nutritional status and type of nutritional therapy were recorded, with the reasons for indication, the duration and the causes of the end of it. RESULTS: Of the totality of the patients, 84% remained with exclusive oral feeding, adapting the diet to the symptomatology referred by the patient; and of these, 62% (52 patients) had an indication for oral supplements as a complement. Only 16 patients had an NP indication. The median duration of NP was 9 days (IIC 6-24.5) CONCLUSIONS: The majority of patients did not present malnutrition at admission, but despite this, there was a large number of patients that required the use of some nutritional therapy, which indicates the importance of daily monitoring of these patients despite not present nutritional risk to income.

Biodistribution of bone marrow mononuclear cells after intra-arterial or intravenous transplantation in subacute stroke patients.

AIMS: To assess the biodistribution of bone marrow mononuclear cells (BMMNC) delivered by different routes in patients with subacute middle cerebral artery ischemic stroke. PATIENTS & METHODS: This was a nonrandomized, open-label Phase I clinical trial. After bone marrow harvesting, BMMNCs were labeled with technetium-99m and intra-arterially or intravenously delivered together with the unlabeled cells. Scintigraphies were carried out at 2 and 24 h after cell transplantation. Clinical follow-up was continued for 6 months. RESULTS: Twelve patients were included, between 19 and 89 days after stroke, and received 1-5 × 10(8) BMMNCs. The intra-arterial group had greater radioactive counts in the liver and spleen and lower counts in the lungs at 2 and 24 h, while in the brain they were low and similar for both routes. CONCLUSION: BMMNC labeling with technetium-99m allowed imaging for up to 24 h after intra-arterial or intravenous injection in stroke patients.

Safety of autologous bone marrow mononuclear cell transplantation in patients with nonacute ischemic stroke.

AIMS: To assess the safety and feasibility of intra-arterial transplantation of autologous bone marrow mononuclear cells in patients with middle cerebral artery ischemic stroke within 90 days of symptom onset. PATIENTS & METHODS: Six patients were included in the study, and they received 1-5 × 10(8) bone marrow mononuclear cell and were evaluated using blood tests, neurological and imaging examination before treatment, and 1, 3, 7, 30, 60, 90, 120 and 180 days after transplantation. Scintigraphies were carried out 2 and 24 h after the procedure to analyze the biodistribution of labeled cells. Electroencephalogram was conducted within 7 days after transplantation. RESULTS: No patients exhibited any complication or adverse events during the procedure. There was no worsening in the neurological scales until the end of the follow-up. CONCLUSION: Intra-arterial bone marrow mononuclear cell transplantation is feasible and safe in patients with nonacute ischemic strokes of the middle cerebral artery. Further studies are required to evaluate the efficacy of this therapy.

Migration and homing of bone-marrow mononuclear cells in chronic ischemic stroke after intra-arterial injection.

Cell-based treatments have been considered a promising therapy for neurological diseases. However, currently there are no clinically available methods to monitor whether the transplanted cells reach and remain in the brain. In this study we investigated the feasibility of detecting the distribution and homing of autologous bone-marrow mononuclear cells (BMMCs) labeled with Technetium-99 m ((99m)Tc) in a cell-based therapy clinical study for chronic ischemic stroke. Six male patients (ages 24-65 years) with ischemic cerebral infarcts within the middle cerebral artery (MCA) between 59 and 82 days were included. Cell dose ranged from 1.25x10(8) to 5x10(8). Approximately 2x10(7) cells were labeled with (99m)Tc and intra-arterially delivered together with the unlabeled cells via a catheter navigated to the MCA. None of the patients showed any complications on the 120-day follow-up. Whole body scintigraphies indicated cell homing in the brain of all patients at 2 h, while the remaining uptake was mainly distributed to liver, lungs, spleen, kidneys and bladder. Moreover, quantification of uptake in Single-Photon Emission Computed Tomography (SPECT) at 2 h showed preferential accumulation of radioactivity in the hemisphere affected by the ischemic infarct in all patients. However, at 24 h homing could only distinguished in the brains of 2 patients, while in all patients uptake was still seen in the other organs. Taken together, these results indicate that labeling of BMMCs with (99m)Tc is a safe and feasible technique that allows monitoring the migration and engraftment of intra-arterially transplanted cells for at least 24 h.