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1.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598960

RESUMO

An 85-year-old man was referred for an MRI scan of the pelvis for further evaluation of a suspected left neck of femur fracture, which was regarded as equivocal on plain radiograph and CT. The initial MRI demonstrated unusual appearances of the visualised bone marrow and subcutaneous adipose tissue and was initially misinterpreted as a technical malfunction of the scanner. However, a repeat study on a different scanner the following day once again demonstrated the same appearances. The appearances were consistent with serous atrophy of bone marrow, a non-neoplastic disorder of the bone marrow, which is most commonly seen in severe anorexia nervosa or cachexia. These unusual, but distinct, bone marrow and subcutaneous adipose tissue appearances, which are specific to MRI, have been colloquially termed as the 'flip-flop' effect.


Assuntos
Medula Óssea , Imageamento por Ressonância Magnética , Idoso de 80 Anos ou mais , Atrofia , Medula Óssea/diagnóstico por imagem , Caquexia , Humanos , Masculino , Pelve
2.
Neurol India ; 69(4): 1010-1013, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507431

RESUMO

Rasmussen's encephalopathy (RE) is an uncommon neurological disease of inflammatory origin which is characterized by intractable focal epilepsy, progressive limb weakness, and cognitive deterioration. RE presenting as movement disorder like hemidystonia or hemichorea is a rare occurrence. The duration of prodromal stage of RE is usually in weeks or months. Prolonged prodromal stage like in years is rarely reported. Magnetic resonance imaging (MRI) is a good biomarker in RE and it also suggests the sequential progression of disease. Here we report two cases of RE, one presenting with hemidystonia and other case with unusually prolonged prodromal stage duration of 7 years. In spite of severe hemi-atrophy of brain in second case response to immunomodulators was dramatic.


Assuntos
Encefalite , Epilepsias Parciais , Atrofia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalite/diagnóstico por imagem , Encefalite/patologia , Humanos , Imageamento por Ressonância Magnética
3.
Int J Periodontics Restorative Dent ; 41(5): e199-e204, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34547071

RESUMO

The paper presents the inferior alveolar nerve transposition as a successful surgical technique when other treatment options are not possible in the severely resorbed posterior mandible. Based on three clinical cases, this technique is presented in conjunction with implant placement and immediate loading. The paper aims to present the mandibular nerve transposition as a therapeutic method and an important approach, engaging clinicians to use it when other opportunities are impossible.


Assuntos
Implantação Dentária Endo-Óssea , Implantes Dentários , Atrofia/patologia , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Mandíbula/cirurgia , Nervo Mandibular/diagnóstico por imagem , Nervo Mandibular/cirurgia
5.
Arq Neuropsiquiatr ; 79(8): 666-675, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34550187

RESUMO

BACKGROUND: Multiple sclerosis exhibits specific neuropathological phenomena driving to both global and regional brain atrophy. At the clinical level, the disease is related to functional decline in cognitive domains as the working memory, processing speed, and verbal fluency. However, the compromise of social-cognitive abilities has concentrated some interest in recent years despite the available evidence suggesting the risk of disorganization in social life. Recent studies have used the MiniSEA test to assess the compromise of social cognition and have found relevant relationships with memory and executive functions, as well as with the level of global and regional brain atrophy. OBJECTIVE: The present article aimed to identify structural changes related to socio-cognitive performance in a sample of patients with relapsing-remitting multiple sclerosis. METHODS: 68 relapsing-remitting multiple sclerosis Chilean patients and 50 healthy control subjects underwent MRI scans and neuropsychological evaluation including social-cognition tasks. Total brain, white matter, and gray matter volumes were estimated. Also, voxel-based morphometry was applied to evaluate regional structural changes. RESULTS: Patients exhibited lower scores in all neuropsychological tests. Social cognition exhibited a significant decrease in this group mostly related to the declining social perception. Normalized brain volume and white matter volume were significantly decreased when compared to healthy subjects. The regional brain atrophy analysis showed that changes in the insular cortex and medial frontal cortices are significantly related to the variability of social-cognitive performance among patients. CONCLUSIONS: In the present study, social cognition was only correlated with the deterioration of verbal fluency, despite the fact that previous studies have reported its link with memory and executive functions. The identification of specific structural correlates supports the comprehension of this phenomenon as an independent source of cognitive disability in these patients.


Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Atrofia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Cognição , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Testes Neuropsicológicos , Cognição Social
6.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404670

RESUMO

A family of three siblings affected with gyrate atrophy of the choroid and retina is presented. Ultrawide field fundus imaging was used to monitor the progression of the disease objectively over 5 years.


Assuntos
Atrofia Girata , Adolescente , Atrofia/patologia , Criança , Corioide/diagnóstico por imagem , Corioide/patologia , Diagnóstico por Imagem , Feminino , Fundo de Olho , Atrofia Girata/complicações , Atrofia Girata/diagnóstico por imagem , Humanos , Masculino , Ornitina , Retina/diagnóstico por imagem , Retina/patologia
7.
Transl Psychiatry ; 11(1): 428, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400604

RESUMO

Sleep disturbances are prominent in patients with alcohol use disorder (AUD) and predict relapse. So far, the mechanisms underlying sleep disruptions in AUD are poorly understood. Because sleep-related regions vastly overlap with regions, where patients with AUD showed pronounced grey matter (GM) reduction; we hypothesized that GM structure could contribute to sleep disturbances associated with chronic alcohol use. We combined sleep EEG recording and high-resolution structural brain imaging to examine the GM-sleep associations in 36 AUD vs. 26 healthy controls (HC). The patterns of GM-sleep associations differed for N3 vs. REM sleep and for AUD vs. HC. For cortical thickness (CT), CT-sleep associations were significant in AUD but not in HC and were lateralized such that lower CT in right hemisphere was associated with shorter N3, whereas in left hemisphere was associated with shorter REM sleep. For the GM density (GMD), we observed a more extensive positive GMD-N3 association in AUD (right orbitofrontal cortex, cerebellum, dorsal cingulate and occipital cortex) than in HC (right orbitofrontal cortex), and the GMD-REM association was positive in AUD (midline, motor and paralimbic regions) whereas negative in HC (the left supramarginal gyrus). GM structure mediated the effect of chronic alcohol use on the duration of N3 and the age by alcohol effect on REM sleep. Our findings provide evidence that sleep disturbances in AUD were associated with GM reductions. Targeting sleep-related regions might improve sleep in AUD and enhance sleep-induced benefits in cognition and emotional regulation for recovery.


Assuntos
Alcoolismo , Transtornos do Sono-Vigília , Alcoolismo/complicações , Alcoolismo/diagnóstico por imagem , Alcoolismo/patologia , Atrofia/patologia , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Imageamento por Ressonância Magnética , Sono , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/diagnóstico por imagem
9.
Nutrients ; 13(8)2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34444799

RESUMO

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.


Assuntos
Nutrição Enteral , Oxidantes , Nutrição Parenteral , Antioxidantes , Atrofia , Cisteína , Glutationa/metabolismo , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Peroxidação de Lipídeos , Hepatopatias , Estresse Oxidativo , Nutrição Parenteral Total , Nascimento Prematuro , Espécies Reativas de Oxigênio , Vitaminas
10.
BMC Womens Health ; 21(1): 322, 2021 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454465

RESUMO

BACKGROUND: Vulvo-vaginal atrophy (VVA) is one of the common consequences of estrogen deficiency especially after the menopause. Several studies have assessed the effects of Hyaluronic acid (HA) on physical and sexual symptoms associated with VVA with promising results. However, most of these studies have focused on subjective assessment of symptom response to topically administered preparations. Nonetheless, HA is an endogenous molecule and it is logical that its effects are best realized if injected in the superficial epithelial layers. Desirial® is the first crosslinked HA that is administered by injection in the vaginal mucosa. The aim of this study was to explore the effect of multipoint vaginal intra-mucosal injections of specific cross-linked hyaluronic acid (DESIRIAL®, Laboratoires VIVACY) on several clinical and patient reported core outcomes. METHODS: A cohort bi-centric pilot study. The chosen outcomes included change in vaginal mucosa thickness, biological markers for collagen formation, vaginal flora, vaginal pH, vaginal health index, vulvo-vaginal atrophy symptoms and sexual function 8 weeks post Desirial® injection. Patients' satisfaction was also assessed using the patient global impression of improvement (PGI-I) scale. RESULTS: A total of 20 participants were recruited between 19/06/2017 and 05/07/2018. At the end of the study, there was no difference in the median total thickness of the vaginal mucosa or in procollagen I, III or Ki67 fluorescence. However, there was a statistically significant increase in COL1A1 and COL3A1 gene expression (p = 0.0002 and p = 0.0010 respectively). There was also a significant reduction in reported dyspareunia, vaginal dryness, vulvar pruritus, vaginal chafing and significant improvement in all female sexual function index dimensions. Based on PGI-I, 19 patients (95%) reported varying degrees of improvement where, 4 (20%) felt slightly better; 7 (35%) better and 8 (40%) much better. CONCLUSIONS: Multi-point vaginal intra-mucosal injections, of Desirial® (a crosslinked HA) was significantly associated with the expression of CoL1A1 and CoL3A1 suggesting stimulation of collagen formation. Furthermore, there was a significant reduction in VVA symptomatology and a significant improvement in patient satisfaction and sexual function scores. However, there was no demonstrable change in the total vaginal mucosal thickness. Study registration ID-RCB: 2016-A00124-47, Protocol code number: LOCAL/2016/PM-001.


Assuntos
Dispareunia , Doenças Vaginais , Atrofia , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Membrana Mucosa , Projetos Piloto , Pós-Menopausa , Estudos Prospectivos , Resultado do Tratamento , Vagina/patologia , Doenças Vaginais/patologia
11.
BMC Med Res Methodol ; 21(1): 170, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404346

RESUMO

BACKGROUND: To model the progression of geographic atrophy (GA) in patients with age-related macular degeneration (AMD) by building a suitable statistical regression model for GA size measurements obtained from fundus autofluorescence imaging. METHODS: Based on theoretical considerations, we develop a linear mixed-effects model for GA size progression that incorporates covariable-dependent enlargement rates as well as correlations between longitudinally collected GA size measurements. To capture nonlinear progression in a flexible way, we systematically assess Box-Cox transformations with different transformation parameters λ. Model evaluation is performed on data collected for two longitudinal, prospective multi-center cohort studies on GA size progression. RESULTS: A transformation parameter of λ=0.45 yielded the best model fit regarding the Akaike information criterion (AIC). When hypertension and hypercholesterolemia were included as risk factors in the model, they showed an association with progression of GA size. The mean estimated age-of-onset in this model was 67.21±6.49 years. CONCLUSIONS: We provide a comprehensive framework for modeling the course of uni- or bilateral GA size progression in longitudinal observational studies. Specifically, the model allows for age-of-onset estimation, identification of risk factors and prediction of future GA size. A square-root transformation of atrophy size is recommended before model fitting.


Assuntos
Atrofia Geográfica , Degeneração Macular , Idoso , Atrofia , Progressão da Doença , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
12.
Vestn Oftalmol ; 137(4): 24-30, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34410053

RESUMO

Various animal models of atrophy of retinal pigment epithelium (RPE) are created in order to study certain aspects of geographical atrophy in humans. To study the effects of new methods of therapy, it is necessary to determine the objective functional markers of structural changes in the retina. PURPOSE: To determine the alterations in activity of the retina that characterize its remodeling in induction of RPE atrophy. MATERIAL AND METHODS: Full-field electroretinograms (ERG), pattern ERG, and multifocal ERG were recorded according to the ISCEV standards from the right eyes of twenty rabbits of the New Zealand albino breed 6-7 weeks after induction of RPE atrophy by subretinal administration of 0.9% sodium chloride or bevacizumab solution. RESULTS: Characteristic electroretinographic signs of RPE atrophy and retinal remodeling are described. Changes in ERG indicate a predominant inhibition of the functional activity of photoreceptors compared with bipolar cells, which objectively reflects an impairment of their metabolism associated with RPE pathology. With the injection of bevacizumab, a sharp weakening of the functional symbiosis of Mueller cells with bipolar cells was observed. According to pattern ERG, the function of the retinal ganglion cells was reduced. The reaction of the paired eyes after induction of RPE atrophy included a moderate decrease in the amplitude of b-wave of photopic ERG and activation of glia-neuronal relationships. CONCLUSION: Subretinal injections of 0.9% sodium chloride and bevacizumab trigger changes in the retina that reflect specific remodeling of retinal neurons of the second and third orders, which characterizes the used models of RPE atrophy.


Assuntos
Degeneração Retiniana , Epitélio Pigmentado da Retina , Animais , Atrofia , Eletrorretinografia , Coelhos , Retina
13.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 42-46, maio-ago. 2021. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1283885

RESUMO

Introdução: Por sua posição na face, a mandíbula é frequentemente atingida pelos traumas, surgindo em algumas estatísticas como o osso fraturado com maior incidência em face. Em fraturas de mandíbulas atróficas o tratamento conservador, com fixação intermaxilar não costuma ser uma opção viável pela falta de dentes e pequena área de contato ósseo existente. Dessa forma, a redução aberta e fixação interna estável tem sido o tratamento de escolha sempre que a condição do paciente permitir. Objetivo: relatar um caso de osteossíntese de fratura de mandíbula atrófica por acesso extraoral. Relato de caso: Paciente 64 anos, faioderma, sexo feminino, procurou o serviço de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal da Bahia apresentando traumatismo facial por queda da própria altura, referindo severas queixas álgicas espontâneas em região mandibular. Ao exame físico notou-se edentulismo total em ambas as arcadas, edema, hematoma e degrau ósseo á palpação em região de corpo de mandíbula a direita, alémde mobilidade atípica a manipulação da mandíbula. Ao exame de imagem notou-se sinais de fratura em corpo mandibular direito e côndilo esquerdo. O tratamento instituído foiconservador para a fratura de côndilo e cirúrgico para a fratura de corpo, o acesso foi extraoral ea fixação rígida foi realizada com placa e parafusos dos dispositivos Load-Bearing. Considerações finais: A paciente não apresentou quaisquer déficits funcionais pós-procedimento cirúrgico, sendo o tratamento abertocom fixação interna estável bastante promissor por restabelecer a união de focos fraturados e deslocados, proporcionando estabilidade da fratura e conforto imediato para a paciente(AU)


Introduction: Due to its position on the face, the jaw is frequently affected by trauma, appearing in some statistics as the fractured bone with a higher incidence in the face. In fractures of atrophic jaws, conservative treatment, with intermaxillary fixation, is not usually a viable option due to the lack of teeth and small area of existing bone contact. Thus, open reduction and stable internal fixation have been the treatment of choice whenever the patient's condition permits. Objective: to report a case of osteosynthesis of atrophic mandible fracture through extraoral access. Case report: Patient 64-year-old, female, sought the service of Maxillofacial Surgery and Traumatology at the Federal University of Bahia presenting facial trauma due to falling from his own height, referring to severe spontaneous pain complaints in the mandibular region. On physical examination, total edentulism was noted in both arches, edema, hematoma and bone step on palpation in the right jaw body region, in addition to atypical mobility in the jaw manipulation. On imaging examination, signs of fracture were noted in the right mandibular body and left condyle. The treatment instituted was conservative for condyle fracture and surgical for body fracture, access was extraoral and rigid fixation was performed with plate and screws of the Load-Bearing devices. Final considerations: The patient did not presente any functional deficits after the surgical procedure, and the open treatment with stable internal fixation is very promising for restoring the union of fractured and displaced foci, providing fracture stability and immediate comfort for the patient(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fixação Interna de Fraturas , Fraturas Mandibulares , Atrofia , Arcada Edêntula , Mandíbula/cirurgia
14.
J Clin Neurosci ; 90: 273-278, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275563

RESUMO

OBJECTIVES: This study aimed to explore the association of homocysteine (Hcy) with third ventricle (V3) dilatation and mesencephalic area (MA) atrophy as determined by transcranial sonography (TCS) in Parkinson's disease (PD) with cognitive impairment. METHODS: The final statistical analysis included 101 PD patients and 20 age- and sex-matched controls. Using the Movement Disorder Society (MDS) level II criteria for PD with cognitive impairment, we categorized the PD patients into PD with normal cognition group (PD) and PD with cognitive impairment group (PDC). All subjects underwent TCS and laboratory analysis. RESULTS: The V3 width (r = 0.349, P = 0.005) and the MA (r = -0.484, P < 0.001) were significantly correlated with the Hcy concentration in the PDC patients. Binary logistic regression analysis revealed that age (OR [95% CI] = 1.114 [0.991-1.251], P = 0.002), and Hcy level (OR [95% CI] = 0.931 [0.752-1.153], P = 0.411) were independent risk factors for V3 dilatation. Hcy level (OR [95% CI] = 0.557 [0.323-0.967], P = 0.035) were independent risk factors for MA atrophy. After adjustment for confounding factors, the odds ratio of V3 dilatation was 3.50 (95% CI 1.054-11.399, P = 0.031) and the odds ratio of MA atrophy was 4.67 (95% CI 1.395-15.602, P = 0.012) in the patients with higher Hcy level compared with the lower level. CONCLUSIONS: The results revealed a close association between the V3 width, MA and Hcy concentration in PD patients with cognitive impairment. We hypothesized that increased Hcy concentration played a significant role in the development of brain atrophy in PD with cognitive impairment.


Assuntos
Transtornos Cognitivos/etiologia , Homocisteína/sangue , Mesencéfalo/patologia , Doença de Parkinson/sangue , Doença de Parkinson/patologia , Terceiro Ventrículo/patologia , Idoso , Idoso de 80 Anos ou mais , Atrofia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Mesencéfalo/diagnóstico por imagem , Pessoa de Meia-Idade , Razão de Chances , Doença de Parkinson/psicologia , Fatores de Risco , Terceiro Ventrículo/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana
15.
J Clin Neurosci ; 90: 293-301, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275566

RESUMO

OBJECTIVE: To investigate the frequency of split hand (SI) and its diagnostic performance in amyotrophic lateral sclerosis (ALS). METHODS: PubMed, EMBASE, OVID and other databases were searched systematically up to March 2021 for relevant reports about the split hand syndrome. Two reviewers screened and selected the titles and abstracts of the studies independently during the database searches and performed full-text reviews and extracted available data. In our study, AACMAP was calculated by AACMAP = APBCMAP/ADMCMAP and split-hand index (SI) was calculated by SICMAP = (APBCMAP × FDICMAP)/ADMCMAP. The mean differences (MD) in APB/ADMCMAP and SICMAP between patients with ALS and control group were calculated (APB the abductor pollicis brevis muscle; ADM the abductor digiti minimi muscle; CMAP compound muscle action potentials). Meta-analysis was performed to determine summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI) for SICMAP. RESULTS: Pooled results of five studies including 339 patients showed that 50% (95%CI: 35%-65%) of patients with ALS presented split hand. APB/ADMCMAP in patients with ALS was significantly lower than healthy population (MD: -0.38, 95%CI: -0.48, -0.28). SICMAP in patients with ALS was significantly lower than healthy controls (MD: -5.87, 95%CI: -6.28, -5.46) and neuromuscular controls (MD: -5.60, 95%CI: -5.78, -5.42). Receiver operating characteristic curve analysis showed that the AUC was 0.860 [95%CI: 0.808, 0.911] for SICMAP. The sensitivity and specificity for SICMAP were 78% and 81% (cut-off value: 5.2-11.8), respectively. CONCLUSION: Half of ALS patients might show split hand sign. SICMAP could be a potential biomarker in the diagnosis of ALS.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/epidemiologia , Mãos/patologia , Atrofia , Humanos , Debilidade Muscular/epidemiologia , Debilidade Muscular/etiologia , Músculo Esquelético/patologia , Sensibilidade e Especificidade
17.
J Radiol Case Rep ; 15(6): 19-25, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34276877

RESUMO

A 66-year-old cachectic female with underlying anorexia nervosa and lower limb weakness was referred for a spinal Magnetic Resonance Imaging. Imaging appearances were initially thought to represent underlying systemic pathology involving bone marrow or inadvertent wrong selection of imaging sequences. It was, however, established that unique imaging appearances are secondary to 'Flip-Flop' phenomenon owing to underlying nutritional status of the patient. 'Flip-Flop' phenomenon on the Magnetic Resonance Imaging is result of an underlying pathological process of serous atrophy of bone marrow. Appreciation and recognition of this phenomenon will help in the correct interpretation of the images and leads a clinician toward appropriate management.


Assuntos
Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Erros de Diagnóstico , Imageamento por Ressonância Magnética , Idoso , Anorexia Nervosa/complicações , Atrofia/diagnóstico por imagem , Atrofia/patologia , Caquexia/complicações , Feminino , Humanos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia
18.
Neuropsychology ; 35(6): 643-655, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34292026

RESUMO

OBJECTIVE: Late-life changes in cognition and brain integrity are both highly multivariate, time-dependent processes that are essential for understanding cognitive aging and neurodegenerative disease outcomes. The present study seeks to identify a latent variable model capable of efficiently reducing a multitude of structural brain change magnetic resonance imaging (MRI) measurements into a smaller number of dimensions. We further seek to demonstrate the validity of this model by evaluating its ability to reproduce patterns of coordinated brain volume change and to explain the rate of cognitive decline over time. METHOD: We used longitudinal cognitive data and structural MRI scans, obtained from a diverse sample of 358 participants (Mage = 74.81, SD = 7.17), to implement latent variable models for measuring brain change and to estimate the effects of these brain change factors on cognitive decline. RESULTS: Results supported a bifactor model for brain change with four group factors (prefrontal, temporolimbic, medial temporal, and posterior association) and one general change factor (global atrophy). Atrophy in the global (ß = 0.434, SE = 0.070), temporolimbic (ß = 0.275, SE = 0.085), and medial temporal (ß = 0.240, SE = 0.085) factors were the strongest predictors of global cognitive decline. Overall, the brain change model explained 59% of the variance in global cognitive slope. CONCLUSIONS: The current results suggest that brain change across 27 bilateral regions of interest can be grouped into five change factors, three of which (global gray matter, temporolimbic, and medial temporal lobe atrophy) are strongly associated with cognitive decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Disfunção Cognitiva , Doenças Neurodegenerativas , Idoso , Atrofia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Cognição , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/patologia , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Doenças Neurodegenerativas/patologia
19.
BMC Neurol ; 21(1): 289, 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34301202

RESUMO

BACKGROUND: Visual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup. Most prior studies involved patients with known or probable Alzheimer's disease (AD). This study investigated the validity and reliability of MTA in a memory clinic population. METHODS: MTA was rated in 752 MRI examinations, of which 105 were performed in cognitively healthy participants (CH), 184 in participants with subjective cognitive impairment, 249 in subjects with mild cognitive impairment, and 214 in patients with dementia, including AD, subcortical vascular dementia and mixed dementia. Hippocampal volumes, measured manually or using FreeSurfer, were available in the majority of cases. Intra- and interrater reliability was tested using Cohen's weighted kappa. Correlation between MTA and quantitative hippocampal measurements was ascertained with Spearman's rank correlation coefficient. Moreover, diagnostic ability of MTA was assessed with receiver operating characteristic (ROC) analysis and suitable, age-dependent MTA thresholds were determined. RESULTS: Rater agreement was moderate to substantial. MTA correlation with quantitative volumetric methods ranged from -0.20 (p< 0.05) to -0.68 (p < 0.001) depending on the quantitative method used. Both MTA and FreeSurfer are able to distinguish dementia subgroups from CH. Suggested age-dependent MTA thresholds are 1 for the age group below 75 years and 1.5 for the age group 75 years and older. CONCLUSIONS: MTA can be considered a valid marker of medial temporal lobe atrophy and may thus be valuable in the assessment of patients with cognitive impairment, even in a heterogeneous patient population.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Lobo Temporal , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/patologia , Atrofia/patologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/patologia , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia
20.
Neuroradiology ; 63(9): 1531-1538, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34232334

RESUMO

PURPOSE: The aim of the study was to evaluate extraocular muscle (EOM) atrophy and fatty replacement in ocular myasthenia gravis (OMG) and generalized myasthenia gravis (GMG) patients with chronic and untreated ocular symptoms or with inadequate response to immunotherapy and unprovoked ocular exacerbations despite chronic immunotherapy. METHODS: Nineteen patients with either OMG or GMG and 19 healthy age-matched controls underwent an orbital MRI. Visually obvious muscle atrophy and muscle fatty replacement were evaluated by two raters independently. Maximum thickness of EOM was measured. Measurements of the muscles of each participant were added up, in order to calculate the total thickness. RESULTS: Eleven patients suffered from AChR-positive GMG, and 8 patients from OMG. All patients had chronic ocular symptoms or inadequate response to corticosteroids and unprovoked ocular exacerbations in spite of immunotherapy. Fatty replacement was reported in 6/19 (31.6%) patients and 0/19 (0%) controls (p = 0.02). Obvious atrophy in at least one muscle was reported in 8/19 (42.1%) patients and 1/19 (5.3%) controls (p = 0.019). Statistically significant differences between the two groups were also found in the mean total thickness, as well as in the thickness of superior recti, levator palpebrae, inferior recti, and superior oblique muscles. CONCLUSION: EOM atrophy and fatty replacement were seen frequently in our series of MG patients with treatment difficulties and frequent relapses of ocular involvement.


Assuntos
Miastenia Gravis , Músculos Oculomotores , Atrofia , Humanos , Imageamento por Ressonância Magnética , Miastenia Gravis/diagnóstico por imagem , Miastenia Gravis/terapia , Recidiva Local de Neoplasia , Músculos Oculomotores/diagnóstico por imagem
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