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1.
J Vasc Interv Radiol ; 2024 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-39047934

RESUMO

PURPOSE: To evaluate the feasibility of intraoperative neurophysiological monitoring (IONM) during magnetic resonance (MR) imaging-guided ablations and identify strategies to reduce IONM electrode radiofrequency (RF) heating during MR imaging. MATERIALS AND METHODS: Ex vivo experiments with a porcine tissue phantom simulating a typical high RF heating risk IONM setup during an MR imaging-guided ablation procedure on the shoulder were performed using a 1.5-T scanner. Mutual interference between MR imaging and IONM was evaluated. To assess RF heating risks, 4 pairs of IONM electrodes were inserted into the phantom at regions corresponding to the shoulders, midarm, and wrist. MR imaging of the "shoulder" was performed at 3 different specific absorption rates (SARs) with electrode wires positioned in various geometric configurations. Different combinations of electrode connections to the IONM system were investigated. Temperatures of each electrode were recorded using fiber-optic sensors. RESULTS: Simultaneous IONM readout and MR imaging resulted in distortion of the IONM signal, but interleaving MR imaging and IONM without moving electrodes was feasible. During MR imaging, temperature elevations greater than 60°C at the electrode insertion sites were observed. Temperature reductions were achieved by routing electrode wires along the scanner central axis, reducing the wire length within the scanner bore, or lowering the SAR of the imaging sequence. Altering the electrode connection with the IONM system did not result in consistent changes in RF heating. CONCLUSIONS: With electrodes in the scanner bore, interleaving IONM and MR imaging is desired to avoid signal interference, and several strategies identified herein can reduce risk of electrode RF heating during MR imaging-guided ablation.

2.
Arch Biochem Biophys ; 749: 109802, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37913856

RESUMO

Efficient and non-invasive techniques of cargo delivery to biological cells are the focus of biomedical research because of their great potential importance for targeted drug therapy. Therefore, much effort is being made to study the characteristics of using nano-based biocompatible materials as systems that can facilitate this task while ensuring appropriate self-sealing of the cell membrane. Here, we study the effects of indentation and withdrawal of nanocone on phospholipid membrane by applying steered molecular dynamics (SMD) technique. Our results show that the withdrawal process directly depends on the initial position of the nanocone. The average force and work are considerably more significant in case of the withdrawal starting from a larger depth. This result is attributed to stronger hydrophobic interactions between the nanocone and lipid tails of the membrane molecules. Furthermore, when the indenter was started from the lower initial depth, the number of lipids removed from the membrane was several times smaller than the deeper indentation. The choice of the least invasive method for nanostructure-assisted drug delivery is crucial for possible applications in medicine. Therefore, the results presented in this work might be helpful in efficient and safe drug delivery with nanomaterials.


Assuntos
Sistemas de Liberação de Medicamentos , Silício , Simulação por Computador , Membrana Celular/metabolismo , Fosfolipídeos/metabolismo , Simulação de Dinâmica Molecular
3.
J Vasc Interv Radiol ; 34(1): 46-53.e4, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36202337

RESUMO

PURPOSE: To investigate the effect of simultaneous use of dual applicators on the image quality of real-time magnetic resonance (MR) thermometry and to characterize the dual-applicator treatment zone pattern during MR imaging-guided microwave ablation (MWA). MATERIALS AND METHODS: MWA experiments were performed on a 1.5-T MR scanner with 2 commercial microwave systems (902-928 MHz). Phantom experiments were first performed to evaluate the effect of dual-applicator MWA on the image quality of MR. Then, porcine tissue model experiments were conducted with real-time MR thermometry using either a single applicator or dual applicators inserted 2.6, 3.6, and 4.6 cm apart. Fiberoptic thermal probes were used to measure the temperature changes at the tissue surface. RESULTS: Simultaneous use of dual applicators resulted in a decrease in the relative signal-to-noise ratio (SNR) in the MR thermometry images to 55% ± 2.9% when compared with that of a single applicator (86.2% ± 2.0%). Despite the lower SNR, the temperature and ablation zone maps were of adequate quality to allow visualization of the ablation zone(s). The extents of increase in the temperature at the tissue surface using dual applicators (19.7 °C ± 2.6 °C) and a single applicator (18.2 °C ± 3.3 °C) were not significantly different (P = .40). Treatment zones were significantly larger (P < .05) in dual-applicator ablations (29.4 ± 0.4, 39.9 ± 0.6, and 42.6 ± 0.9 cm2 with 2.6-, 3.6-, and 4.6-cm spacing, respectively) at the end of the ablation procedure than in the single-applicator MWA (18.6 ± 0.9 cm2). CONCLUSIONS: MR imaging-guided dual-applicator MWA produced larger ablation zones while allowing adequate real-time MR thermometry image quality for monitoring the evolution of the treatment zone.


Assuntos
Micro-Ondas , Termometria , Suínos , Animais , Micro-Ondas/uso terapêutico , Fígado/patologia , Termometria/métodos , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética
4.
Pain Med ; 24(11): 1219-1223, 2023 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-37478345

RESUMO

OBJECTIVE: To evaluate the safety and tolerability of MRI-guided focused ultrasound (MRgFUS) for the treatment of facet joint-mediated pain in human subjects for whom conventional treatment had failed. Secondarily, to evaluate effectiveness of the procedure. METHODS: Consecutive patients who underwent MRgFUS at our institution were retrospectively identified. Chart review was performed to obtain relevant clinical and technical data. All patients had chronic low back pain and positive comparative medial branch blocks. RESULTS: Twenty-six MRgFUS treatments in 20 patients were included. Mean sonication energy was 1436.6 Joules. The procedure was technically successful in all patients. Of the treated patients, 29.6% experienced short-term worsening of low back pain immediately after the procedure, all by 1-4 points on a 0-10 scale. One patient (3.8%) reported temporary worsening of preexisting radicular symptoms after the procedure. Of 21 treatments with clinical follow-up of at least 3 months available, 12 (57.1%) had >3 months' pain relief, 2 (10%) had <3 months' benefit, 6 (30%) reported no benefit, and 1 (5%) patient was lost to follow-up. In patients who reported at least some benefit with prior conventional radiofrequency ablation, 8/10 (80%) benefited from the MRgFUS procedure. CONCLUSION: The present study demonstrates that MRgFUS ablation of the lumbar facet joints is a safe and tolerable procedure in human subjects and could provide another option for patients for whom radiofrequency ablation had failed. More than half of all patients received significant durable pain relief, which jumped to 80% for patients who had experienced at least some benefit from prior radiofrequency ablations.


Assuntos
Dor Lombar , Bloqueio Nervoso , Articulação Zigapofisária , Humanos , Dor Lombar/terapia , Bloqueio Nervoso/métodos , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Resultado do Tratamento
5.
Int J Mol Sci ; 24(22)2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-38003646

RESUMO

Mixed manganese-zinc ferrite nanoparticles coated with PEG were studied for their potential usefulness in MRI thermometry as temperature-sensitive contrast agents. Particles in the form of an 8.5 nm core coated with a 3.5 nm layer of PEG were fabricated using a newly developed, one-step method. The composition of Mn0.48Zn0.46Fe2.06O4 was found to have a strong thermal dependence of magnetization in the temperature range between 5 and 50 °C. Nanoparticles suspended in an agar gel mimicking animal tissue and showing non-significant impact on cell viability in the biological test were studied with NMR and MRI over the same temperature range. For the concentration of 0.017 mg/mL of Fe, the spin-spin relaxation time T2 increased from 3.1 to 8.3 ms, while longitudinal relaxation time T1 shows a moderate decrease from 149.0 to 125.1 ms. A temperature map of the phantom exposed to the radial temperature gradient obtained by heating it with an 808 nm laser was calculated from T2 weighted spin-echo differential MR images. Analysis of temperature maps yields thermal/spatial resolution of 3.2 °C at the distance of 2.9 mm. The experimental relaxation rate R2 data of water protons were compared with those obtained from calculations using a theoretical model incorporating the motion averaging regime.


Assuntos
Meios de Contraste , Nanopartículas , Animais , Temperatura , Meios de Contraste/química , Imageamento por Ressonância Magnética/métodos , Água , Nanopartículas/química
6.
J Vasc Interv Radiol ; 32(5): 721-728.e2, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663924

RESUMO

PURPOSE: To investigate cryoneedle heating risks during magnetic resonance (MR)-guided cryoablation and potential strategies to mitigate these risks. MATERIALS AND METHODS: Ex vivo experiments were performed on a 1.5-Tesla (T) MR scanner using an MR conditional cryoablation system on porcine tissue phantoms. Cryoneedles were placed inside the tissue phantom either with or without an angiocatheter. Typical cryoneedle geometric configurations (including gas supply line) encountered in clinical procedures with low to high expected heating risks were investigated. Up to 4 fiber optic temperature sensors were attached to the cryoneedle/angiocatheter to measure the MR-induced cryoneedle heating at different locations during MR with different estimated specific absorption rates (SARs). The impact of cryoneedle heating on cryoablation treatment was studied by comparing temperature changes during 10-min freeze-thaw cycles with and without MR. RESULTS: Rapid temperature increases of >100 °C in < 2 minutes were observed during MR with a SAR of 2.1 W/kg. The temperature changes during a typical freeze-thaw cycle were also affected by cryoneedle heating when MR was used to monitor the ice-ball evolution. The observed cryoneedle heating was affected by multiple factors; including cryoneedle geometric configurations, sequence SAR, whether an angiocatheter was used, and whether the cryoneedle was connected to the rest of the cryoablation system. CONCLUSIONS: The ex vivo experiments demonstrated that MR could induce significant cryoneedle heating risks. Furthermore, MR-induced cryoneedle heating can affect temperatures in the ice-ball evolution during the freeze-thaw cycle. Several practical strategies to reduce the cryoneedle heating have been proposed.


Assuntos
Criocirurgia/instrumentação , Imagem por Ressonância Magnética Intervencionista , Agulhas , Temperatura , Animais , Catéteres , Criocirurgia/efeitos adversos , Imagem por Ressonância Magnética Intervencionista/efeitos adversos , Carne de Porco , Medição de Risco , Fatores de Risco , Sus scrofa , Fatores de Tempo
7.
Radiographics ; 41(6): 1785-1801, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34597216

RESUMO

Clinical use of MRI for guidance during interventional procedures emerged shortly after the introduction of clinical diagnostic MRI in the late 1980s. However, early applications of interventional MRI (iMRI) were limited owing to the lack of dedicated iMRI magnets, pulse sequences, and equipment. During the 3 decades that followed, technologic advancements in iMRI magnets that balance bore access and field strength, combined with the development of rapid MRI pulse sequences, surface coils, and commercially available MR-conditional devices, led to the rapid expansion of clinical iMRI applications, particularly in the field of body iMRI. iMRI offers several advantages, including superior soft-tissue resolution, ease of multiplanar imaging, lack of ionizing radiation, and capability to re-image the same section. Disadvantages include longer examination times, lack of MR-conditional equipment, less operator familiarity, and increased cost. Nonetheless, MRI guidance is particularly advantageous when the disease is best visualized with MRI and/or when superior soft-tissue contrast is needed for treatment monitoring. Safety in the iMRI environment is paramount and requires close collaboration among interventional radiologists, MR physicists, and all other iMRI team members. The implementation of risk-limiting measures for personnel and equipment in MR zones III and IV is key. Various commercially available MR-conditional needles, wires, and biopsy and ablation devices are now available throughout the world, depending on the local regulatory status. As such, there has been tremendous growth in the clinical applications of body iMRI, including localization of difficult lesions, biopsy, sclerotherapy, and cryoablation and thermal ablation of malignant and nonmalignant soft-tissue neoplasms. Online supplemental material is available for this article. ©RSNA, 2021.


Assuntos
Imagem por Ressonância Magnética Intervencionista , Biópsia , Previsões , Humanos , Imageamento por Ressonância Magnética , Radiologistas
8.
Sensors (Basel) ; 21(21)2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34770317

RESUMO

Due to the semi-liquid nature and uneven morphologies of biological membranes, indentation may occur in a range of non-ideal conditions. These conditions are relatively unstudied and may alter the physical characteristics of the process. One of the basic challenges in the construction of nanoindenters is to appropriately align the nanotube tip and approach the membrane at a perpendicular angle. To investigate the impact of deviations from this ideal, we performed non-equilibrium steered molecular dynamics simulations of the indentation of phospholipid membranes by homogeneous CNT and non-homogeneous SiCNT indenters. We used various angles, rates, and modes of indentation, and the withdrawal of the relative indenter out of the membrane in corresponding conditions was simulated.


Assuntos
Simulação de Dinâmica Molecular , Nanotubos , Carbono , Fosfolipídeos , Silício , Incerteza
9.
Int J Mol Sci ; 22(22)2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34830249

RESUMO

The lubrication mechanism in synovial fluid and joints is not yet fully understood. Nevertheless, intermolecular interactions between various neutral and ionic species including large macromolecular systems and simple inorganic ions are the key to understanding the excellent lubrication performance. An important tool for characterizing the intermolecular forces and their structural consequences is molecular dynamics. Albumin is one of the major components in synovial fluid. Its electrostatic properties, including the ability to form molecular complexes, are closely related to pH, solvation, and the presence of ions. In the context of synovial fluid, it is relevant to describe the possible interactions between albumin and hyaluronate, taking into account solution composition effects. In this study, the influence of Na+, Mg2+, and Ca2+ ions on human serum albumin-hyaluronan interactions were examined using molecular dynamics tools. It was established that the presence of divalent cations, and especially Ca2+, contributes mostly to the increase of the affinity between hyaluronan and albumin, which is associated with charge compensation in negatively charged hyaluronan and albumin. Furthermore, the most probable binding sites were structurally and energetically characterized. The indicated moieties exhibit a locally positive charge which enables hyaluronate binding (direct and water mediated).


Assuntos
Cálcio/química , Ácido Hialurônico/química , Magnésio/química , Albumina Sérica Humana/química , Sódio/química , Água/química , Sítios de Ligação , Cátions Bivalentes , Cátions Monovalentes , Humanos , Ligação de Hidrogênio , Modelos Biológicos , Simulação de Dinâmica Molecular , Ligação Proteica , Conformação Proteica em alfa-Hélice , Domínios e Motivos de Interação entre Proteínas , Soluções , Líquido Sinovial/química , Termodinâmica
10.
Neurosurg Focus ; 49(1): E8, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32610293

RESUMO

The thalamic ventral intermediate nucleus (VIM) can be targeted for treatment of tremor by several procedures, including deep brain stimulation (DBS) and, more recently, MR-guided focused ultrasound (MRgFUS). To date, such targeting has relied predominantly on coordinate-based or atlas-based techniques rather than directly targeting the VIM based on imaging features. While general regional differences of features within the thalamus and some related white matter tracts can be distinguished with conventional imaging techniques, internal nuclei such as the VIM are not discretely visualized. Advanced imaging methods such as quantitative susceptibility mapping (QSM) and fast gray matter acquisition T1 inversion recovery (FGATIR) MRI and high-field MRI pulse sequences that improve the ability to image the VIM region are emerging but have not yet been shown to have reliability and accuracy to serve as the primary method of VIM targeting. Currently, the most promising imaging approach to directly identify the VIM region for clinical purposes is MR diffusion tractography.In this review and update, the capabilities and limitations of conventional and emerging advanced methods for evaluation of internal thalamic anatomy are briefly reviewed. The basic principles of tractography most relevant to VIM targeting are provided for familiarization. Next, the key literature to date addressing applications of DTI and tractography for DBS and MRgFUS is summarized, emphasizing use of direct targeting. This literature includes 1-tract (dentatorubrothalamic tract [DRT]), 2-tract (pyramidal and somatosensory), and 3-tract (DRT, pyramidal, and somatosensory) approaches to VIM region localization through tractography.The authors introduce a 3-tract technique used at their institution, illustrating the oblique curved course of the DRT within the inferior thalamus as well as the orientation and relationship of the white matter tracts in the axial plane. The utility of this 3-tract tractography approach to facilitate VIM localization is illustrated with case examples of variable VIM location, targeting superior to the anterior commissure-posterior commissure plane, and treatment in the setting of pathologic derangement of thalamic anatomy. Finally, concepts demonstrated with these case examples and from the prior literature are synthesized to highlight several potential advantages of tractography for VIM region targeting.


Assuntos
Estimulação Encefálica Profunda , Tremor Essencial/terapia , Doença de Parkinson/terapia , Ultrassonografia , Estimulação Encefálica Profunda/métodos , Imagem de Tensor de Difusão/métodos , Substância Cinzenta/fisiopatologia , Humanos , Imageamento por Ressonância Magnética/métodos , Reprodutibilidade dos Testes , Tálamo/diagnóstico por imagem , Ultrassonografia/métodos , Substância Branca/fisiopatologia
11.
Molecules ; 25(17)2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32867196

RESUMO

Hyaluronan is an essential physiological bio macromolecule with different functions. One prominent area is the synovial fluid which exhibits remarkable lubrication properties. However, the synovial fluid is a multi-component system where different macromolecules interact in a synergetic fashion. Within this study we focus on the interaction of hyaluronan and phospholipids, which are thought to play a key role for lubrication. We investigate how the interactions and the association structures formed by hyaluronan (HA) and 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) are influenced by the molecular weight of the bio polymer and the ionic composition of the solution. We combine techniques allowing us to investigate the phase behavior of lipids (differential scanning calorimetry, zeta potential and electrophoretic mobility) with structural investigation (dynamic light scattering, small angle scattering) and theoretical simulations (molecular dynamics). The interaction of hyaluronan and phospholipids depends on the molecular weight, where hyaluronan with lower molecular weight has the strongest interaction. Furthermore, the interaction is increased by the presence of calcium ions. Our simulations show that calcium ions are located close to the carboxylate groups of HA and, by this, reduce the number of formed hydrogen bonds between HA and DPPC. The observed change in the DPPC phase behavior can be attributed to a local charge inversion by calcium ions binding to the carboxylate groups as the binding distribution of hyaluronan and 1,2-dipalmitoyl-sn-glycero-3-phosphocholine is not changed.


Assuntos
1,2-Dipalmitoilfosfatidilcolina/química , Cálcio/química , Ácido Hialurônico/química , Fricção , Ligação de Hidrogênio , Lubrificação , Peso Molecular , Propriedades de Superfície
12.
Am J Obstet Gynecol ; 220(2): 174.e1-174.e13, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30696556

RESUMO

BACKGROUND: Uterine leiomyomas (fibroid tumors) cause considerable symptoms in 30-50% of women and are the leading cause of hysterectomy in the United States. Women with uterine fibroid tumors often seek uterine-preserving treatments, but comparative effectiveness trials are lacking. OBJECTIVE: The purpose of this study was to report treatment effectiveness and ovarian function after uterine artery embolization vs magnetic resonance imaging-guided focused ultrasound surgery from the Fibroid Interventions: Reducing Symptoms Today and Tomorrow study. STUDY DESIGN: The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study, which is a randomized controlled trial of uterine artery embolization vs magnetic resonance imaging-guided focused ultrasound surgery, enrolled premenopausal women with symptomatic uterine fibroid tumors; women who declined randomization were enrolled in a parallel observational cohort. A comprehensive cohort design was used for outcomes analysis. Our target enrollment was 220 women, of which we achieved 41% (n=91) in the randomized and parallel arms of the trial. Primary outcome was reintervention for uterine fibroid tumors within 36 months. Secondary outcomes were change in serum anti-Müllerian hormone levels and standardized measures of fibroid symptoms, quality of life, pain, and sexual function. RESULTS: From 2010-2014, 83 women (mean age, 44.4 years) were treated in the comprehensive cohort design (43 for magnetic resonance imaging-guided focused ultrasound surgery [27 randomized]; 40 for uterine artery embolization [22 randomized]); baseline clinical and uterine characteristics were similar between treatment arms, except for higher fibroid load in the uterine artery embolization arm. The risk of reintervention was higher with magnetic resonance imaging-guided focused ultrasound surgery than uterine artery embolization (hazard ratio, 2.81; 95% confidence interval, 1.01-7.79). Uterine artery embolization showed a significantly greater absolute decrease in anti-Müllerian hormone levels at 24 months compared with magnetic resonance imaging-guided focused ultrasound surgery. Quality of life and pain scores improved in both arms but to a greater extent in the uterine artery embolization arm. Higher pretreatment anti-Müllerian hormone level and younger age at treatment increased the overall risk of reintervention. CONCLUSION: Our study demonstrates a lower reintervention rate and greater improvement in symptoms after uterine artery embolization, although some of the effectiveness may come through impairment of ovarian reserve. Both pretreatment anti-Müllerian hormone level and age are associated with risk of reintervention. CLINICAL TRIAL REGISTRATION NUMBER: NCT00995878, clinicaltrials.gov.


Assuntos
Leiomioma/terapia , Imagem por Ressonância Magnética Intervencionista , Terapia por Ultrassom/métodos , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Feminino , Seguimentos , Humanos , Leiomioma/diagnóstico por imagem , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico por imagem
13.
MAGMA ; 32(6): 607-615, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31486009

RESUMO

OBJECTIVE: The Goutallier classification system is the most commonly used method for grading intramuscular fatty infiltration in rotator cuff tears. This grading system presents low inter-observer reliability and an inability to provide quantitative and repeatable outcomes for intramuscular fat. We determined the correlation and reliability of two methods, the Lava Flex and Ideal IQ MRI techniques, in quantifying volumetric intramuscular fat, while also comparing to the Goutallier method. MATERIALS AND METHODS: The supraspinatus muscles of seventeen cadaveric shoulders were scanned using the Lava Flex and Ideal IQ MRI imaging protocols. Histological analysis was performed on the same muscles. Agreement, reliability, and correlation analyses were performed to compare all outcomes. RESULTS: The Lava Flex protocol took an average of ~ 4 min, while the Ideal IQ required about ~ 11 min to complete. Bland-Altman analysis showed good agreement between the Lava Flex and Ideal IQ [LOA (- 0.10 and 0.05)], and ICC analyses showed excellent reliability (ICC (1,1) 0.948; ICC (2,1) 0.947). There was a 91% correlation between the Lava Flex and Ideal IQ MR protocols. Weighted Kappa analysis between histology and the Goutallier classification showed fair-to-moderate agreement. DISCUSSION: The Lava Flex technique, taking about 30% of the acquisition time, may prevent motion artifacts in outcomes associated with the longer Ideal IQ technique. However, potential magnetic field inhomogeneities should be considered. The Lava Flex technique may be a faster and valid alternative to the Goutallier classification system.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Manguito Rotador/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
14.
Biochim Biophys Acta Biomembr ; 1860(2): 310-318, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29100891

RESUMO

The influence of the single-walled carbon nanotubes on the phospholipid bilayer has been studied using steered molecular dynamics (SMD) simulations. The impact of different nanotubes on the phospholipid bilayer structure is discussed as well as the speed of indentation. Additionally, a series of simulations with pulling out of the nanotubes from the membrane were performed. The deflection of the membrane in both nanoindenation and extraction processes is also discussed. The self-sealing ability of membrane during this process is examined. Complete degradation of the bilayer was not observed even for the most invasive nanoindentation process studied. The obtained results show that carbon nanotubes can be regarded as potential drug carriers for targeted therapy.


Assuntos
Bicamadas Lipídicas/química , Simulação de Dinâmica Molecular , Nanotubos de Carbono/química , Fosfolipídeos/química , Cinética , Bicamadas Lipídicas/metabolismo , Fosfolipídeos/metabolismo
15.
Muscle Nerve ; 57(1): 129-135, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28439938

RESUMO

INTRODUCTION: Rotator cuff (RC) tears result in muscle atrophy and fat infiltration within the RC muscles. An estimation of muscle quality and deformation, or extensibility, is useful in selecting the most appropriate surgical procedure. We determined if noninvasive quantitative assessment of intramuscular fat using MRI could be used to predict extensibility of the supraspinatus muscle. METHODS: Seventeen cadaveric shoulders were imaged to assess intramuscular fat infiltration. Extensibility and histological evaluations were then performed. RESULTS: Quantitative fat infiltration positively correlated with histological findings and presented a positive correlation with muscle extensibility (r = 0.69; P = 0.002). Extensibility was not significantly different between shoulders graded with a higher fat content versus those with low fat when implementing qualitative methods. DISCUSSION: A noninvasive prediction of whole-muscle extensibility may directly guide pre-operative planning to determine if the torn edge could efficiently cover the original footprint while aiding in postoperative evaluation of RC repair. Muscle Nerve 57: 129-135, 2018.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Tecido Adiposo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Atrofia Muscular/diagnóstico por imagem , Atrofia Muscular/patologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/patologia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , Tendões/diagnóstico por imagem , Tendões/patologia
16.
Cereb Cortex ; 27(3): 2183-2194, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-27001680

RESUMO

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is an investigational therapy for treatment-resistant obsessive-compulsive disorder. The ability of VC/VS DBS to evoke spontaneous mirth in patients, often accompanied by smiling and laughter, is clinically well documented. However, the neural correlates of DBS-evoked mirth remain poorly characterized. Patients undergoing VC/VS DBS surgery underwent intraoperative evaluation in which mirth-inducing and non-mirth-inducing stimulation localizations were identified. Using dynamic causal modeling (DCM) for fMRI, the effect of mirth-inducing DBS on functional and effective connectivity among established nodes in limbic cortico-striato-thalamo-cortical (CSTC) circuitry was investigated. Both mirth-inducing and non-mirth-inducing VC/VS DBS consistently resulted (conjunction, global null, family-wise error-corrected P < 0.05) in activation of amygdala, ventral striatum, and mediodorsal thalamus. However, only mirth-inducing DBS resulted in functional inhibition of anterior cingulate cortex. Dynamic causal modeling revealed that mirth-inducing DBS enhanced effective connectivity from anterior cingulate to ventral striatum, while attenuating connectivity from thalamus to ventral striatum relative to non-mirth-inducing stimulation. These results suggest that DBS-evoked mood elevation is accompanied by distinct patterns of limbic thalamocortical connectivity. Using the novel combination of DBS-evoked mood alteration and functional MRI in human subjects, we provide new insights into the network-level mechanisms that influence affect.


Assuntos
Encéfalo/fisiopatologia , Estimulação Encefálica Profunda , Emoções , Adulto , Afeto , Teorema de Bayes , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Mapeamento Encefálico , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Período Intraoperatório , Riso/fisiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos Neurológicos , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Vias Neurais/cirurgia , Procedimentos Neurocirúrgicos , Oxigênio/sangue , Sorriso/fisiologia , Senso de Humor e Humor como Assunto , Adulto Jovem
17.
Adv Exp Med Biol ; 1096: 159-184, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30324353

RESUMO

In 2018, the American Cancer Society (ACS) estimates that 164,690 new cases of prostate cancer will be diagnosed and 29,430 will die due to the prostate cancer in the United States (Siegel et al., CA Cancer J Clin 67:7-30, 2018). Many men with prostate cancer are often managed with aggressive therapy including radiotherapy or surgery. No matter how expertly done, these therapies carry significant risk and morbidity to the patient's health related quality of life with impact on sexual, urinary and bowel function (Potosky et al., J Natl Cancer Inst 96:1358-1367, 2004). A recent meta-analysis of 19 studies reviewing the use of surgery and radiation for prostate cancer demonstrated patients who received radiation were more likely to die from their disease as compared to surgery (Wallis et al., Eur Urol 70:21-30, 2016). Furthermore, screening programs using prostatic specific antigen (PSA) and transrectal ultrasound (TRUS) guided systematic biopsy have identified increasing numbers of low risk, low grade "localized" prostate cancer. This indolent nature of many prostate cancers presents a difficult decision of when to intervene given the possible comorbidities of aggressive treatment. Active surveillance has been increasingly instituted in order to balance cancer control versus treatment side effects (Jemal et al., CA Cancer J Clin 56:106-130, 2006). Although active debate continues on the suitability of focal or regional therapy for these low or intermediate risk prostate cancer patients, many unresolved issues remain which complicate this approach of management. Some of the largest unresolved issues are: prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers and whether established curative therapies can be safely and effectively used following focal therapy for prostate cancer. In spite of these restrictions focal therapy continues to confront the current paradigm of therapy for low and even intermediate risk disease (Onik, Tech Vasc Interv Radiol 10:149-158, 2017). It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease (Vickers et al., BMJ 346:f2023, 2013). There is Level 1 evidence supporting detection and subsequent aggressive treatment of intermediate and high-risk prostate cancer (Bill-Axelson et al., N Engl J Med 370:932-942, 2014). Therefore accurate assessment of cancer risk (i.e. grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI have been accompanied with advances in MR guided therapy propelling prostate treatment solutions forward faster than ever.


Assuntos
Biópsia , Imageamento por Ressonância Magnética , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/terapia , Humanos , Masculino
18.
J Appl Clin Med Phys ; 19(2): 298-304, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29336119

RESUMO

We evaluated a commercially available software package that uses B-mode images to semi-automatically measure quantitative metrics of ultrasound image quality, such as contrast response, depth of penetration (DOP), and spatial resolution (lateral, axial, and elevational). Since measurement of elevational resolution is not a part of the software package, we achieved it by acquiring phantom images with transducers tilted at 45 degrees relative to the phantom. Each measurement was assessed in terms of measurement stability, sensitivity, repeatability, and semi-automated measurement success rate. All assessments were performed on a GE Logiq E9 ultrasound system with linear (9L or 11L), curved (C1-5), and sector (S1-5) transducers, using a CIRS model 040GSE phantom. In stability tests, the measurements of contrast, DOP, and spatial resolution remained within a ±10% variation threshold in 90%, 100%, and 69% of cases, respectively. In sensitivity tests, contrast, DOP, and spatial resolution measurements followed the expected behavior in 100%, 100%, and 72% of cases, respectively. In repeatability testing, intra- and inter-individual coefficients of variations were equal to or less than 3.2%, 1.3%, and 4.4% for contrast, DOP, and spatial resolution (lateral and axial), respectively. The coefficients of variation corresponding to the elevational resolution test were all within 9.5%. Overall, in our assessment, the evaluated package performed well for objective and quantitative assessment of the above-mentioned image qualities under well-controlled acquisition conditions. We are finding it to be useful for various clinical ultrasound applications including performance comparison between scanners from different vendors.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imagens de Fantasmas , Garantia da Qualidade dos Cuidados de Saúde/normas , Software , Transdutores , Ultrassonografia/instrumentação , Desenho de Equipamento , Humanos
19.
J Appl Clin Med Phys ; 19(4): 261-270, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29785834

RESUMO

We present the development of a two-component magnetic resonance (MR) fiducial system, that is, a fiducial marker device combined with an auto-segmentation algorithm, designed to be paired with existing ultrasound probe tracking and image fusion technology to automatically fuse MR and ultrasound (US) images. The fiducial device consisted of four ~6.4 mL cylindrical wells filled with 1 g/L copper sulfate solution. The algorithm was designed to automatically segment the device in clinical abdominal MR images. The algorithm's detection rate and repeatability were investigated through a phantom study and in human volunteers. The detection rate was 100% in all phantom and human images. The center-of-mass of the fiducial device was robustly identified with maximum variations of 2.9 mm in position and 0.9° in angular orientation. In volunteer images, average differences between algorithm-measured inter-marker spacings and actual separation distances were 0.53 ± 0.36 mm. "Proof-of-concept" automatic MR-US fusions were conducted with sets of images from both a phantom and volunteer using a commercial prototype system, which was built based on the above findings. Image fusion accuracy was measured to be within 5 mm for breath-hold scanning. These results demonstrate the capability of this approach to automatically fuse US and MR images acquired across a wide range of clinical abdominal pulse sequences.


Assuntos
Imageamento por Ressonância Magnética , Algoritmos , Marcadores Fiduciais , Humanos , Imagens de Fantasmas , Ultrassonografia
20.
Am J Obstet Gynecol ; 216(5): 500.e1-500.e11, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28063909

RESUMO

BACKGROUND: Uterine fibroids are a common problem for reproductive-aged women, yet little comparative effectiveness research is available to guide treatment choice. Uterine artery embolization and magnetic resonance imaging-guided focused ultrasound surgery are minimally invasive therapies approved by the US Food and Drug Administration for treating symptomatic uterine fibroids. The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study is the first randomized controlled trial to compare these 2 fibroid treatments. OBJECTIVE: The objective of the study was to summarize treatment parameters and compare recovery trajectory and adverse events in the first 6 weeks after treatment. STUDY DESIGN: Premenopausal women with symptomatic uterine fibroids seen at 3 US academic medical centers were enrolled in the randomized controlled trial (n = 57). Women meeting identical criteria who declined randomization but agreed to study participation were enrolled in a nonrandomized parallel cohort (n = 34). The 2 treatment groups were analyzed by using a comprehensive cohort design. All women undergoing focused ultrasound and uterine artery embolization received the same postprocedure prescriptions, instructions, and symptom diaries for comparison of recovery in the first 6 weeks. Return to work and normal activities, medication use, symptoms, and adverse events were captured with postprocedure diaries. Data were analyzed using the Wilcoxon rank sum test or χ2 test. Multivariable regression was used to adjust for baseline pain levels and fibroid load when comparing opioid medication, adverse events, and recovery time between treatment groups because these factors varied at baseline between groups and could affect outcomes. Adverse events were also collected. RESULTS: Of 83 women in the comprehensive cohort design who underwent treatment, 75 completed postprocedure diaries. Focused ultrasound surgery was a longer procedure than embolization (mean [SD], 405 [146] vs 139 [44] min; P <.001). Of women undergoing focused ultrasound (n = 43), 23 (53%) underwent 2 treatment days. Immediate self-rated postprocedure pain was higher after uterine artery embolization than focused ultrasound (median [interquartile range], 5 [1-7] vs 1 [1-4]; P = .002). Compared with those having focused ultrasound (n = 39), women undergoing embolization (n = 36) were more likely to use outpatient opioid (75% vs 21%; P < .001) and nonsteroidal antiinflammatory medications (97% vs 67%; P < .001) and to have a longer median (interquartile range) recovery time (days off work, 8 [6-14] vs 4 [2-7]; P < .001; days until return to normal, 15 [10-29] vs 10 [10-15]; P = .02). There were no significant differences in the incidence or severity of adverse events between treatment arms; 86% of adverse events (42 of 49) required only observation or nominal treatment, and no events caused permanent sequelae or death. After adjustment for baseline pain and uterine fibroid load, uterine artery embolization was still significantly associated with higher opioid use and longer time to return to work and normal activities (P < .001 for each). Results were similar when restricted to the randomized controlled trial. CONCLUSION: Women undergoing uterine artery embolization have longer recovery times and use more prescription medications, but women undergoing focused ultrasound have longer treatment times. These findings were independent of baseline pain levels and fibroid load.


Assuntos
Leiomioma/cirurgia , Procedimentos Cirúrgicos Ultrassônicos , Embolização da Artéria Uterina , Neoplasias Uterinas/cirurgia , Adulto , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antieméticos/uso terapêutico , Estudos de Coortes , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Imagem por Ressonância Magnética Intervencionista , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Recuperação de Função Fisiológica , Retorno ao Trabalho/estatística & dados numéricos , Escala Visual Analógica
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