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Einstein (Säo Paulo) ; 20: eAO6724, 2022. tab
Article in English | LILACS | ID: biblio-1364793


ABSTRACT Objective Despite the development of endovascular procedures, open repair remains the gold standard for the treatment of aortic thoracoabdominal aneurysms and some type B dissections, with well-established good outcomes and long-term durability at high-volume centers. The present study described and analyzed public data from patients treated in the public system in a 12-year interval, in a city where more than 5 million inhabitants depend on the Public Health System. Methods Public data from procedures performed between 2008 and 2019 were extracted using web scraping techniques. The variables available in the database include sex, age, elective or emergency hospital admission, number of surgeries, in-hospital mortality, length of stay, and information on reimbursement values. Results A total of 556 procedures were analyzed. Of these, 60.79% patients were men, and 41.18% were 65 years of age or older. Approximately 60% had a residential address registered in the municipality. Of all surgeries, 65.83% were elective cases. There were 178 in-hospital deaths (mortality of 32%). In the elective context, there were 98 deaths 26.78% versus 80 deaths (42.10%) in the emergency context (p=0.174). Mortality was lower in the hospitals that performed more surgeries. A total of USD 3,038,753.92 was paid, an average of USD 5,406.95 for elective surgery and USD 5,074.76 for emergency surgery (p=0.536). Conclusion Mortality was no different between groups, and hospitals with higher volume presented more favorable outcomes. Specialized referral centers should be considered by health policy makers.

Humans , Male , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/epidemiology , Aortic Aneurysm, Abdominal/surgery , Brazil/epidemiology , Public Health , Length of Stay
Int. arch. otorhinolaryngol. (Impr.) ; 25(3): 355-364, Jul.-Sept. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1340004


Abstract Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

Clinics ; 76: e2890, 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1286064


OBJECTIVES: In Brazil, descending thoracic aorta disease, including aneurysms and dissections, is managed preferentially by endovascular treatment, owing to its feasibility and good results. In this study, we analyzed endovascular treatment of isolated descending thoracic aortic disease cases in the Brazilian public health system over a 12-year period. METHODS: Public data from procedures performed from 2008 to 2019 were extracted using web scraping techniques to assess procedure type frequency (elective or urgency), mortality, and governmental costs. RESULTS: A total of 5,595 procedures were analyzed, the vast majority of which were urgent procedures (61.82% vs. 38.18%). In-hospital mortality was lower for elective than for urgent surgeries (4.96 vs.10.32% p=0.008). An average of R$16,845.86 and R$20,012.04 was paid per elective and emergency procedure, respectively, with no statistical difference (p=0.095). CONCLUSION: Elective procedures were associated with lower mortality than urgent procedures. There was no statistically significant difference between elective and urgent procedures regarding costs.

Clinics ; 76: e2332, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153976


OBJECTIVES: In Brazil, descending thoracic aorta disease (TAD), including aneurysms and dissection, are preferentially managed by endovascular treatment (TEVAR) due to the feasibility and good results of this technique. In this study, we analyzed endovascular treatment of isolated TAD (ITAD) in the public health system over a 10-year period in São Paulo, a municipality in Brazil in which more than 5 million inhabitants depend on the governmental health system. METHODS: Public data from procedures performed between 2008 and 2019 were extracted using web scraping techniques. The following types of data were analyzed: demographic data, operative technique, elective or urgent status, number of surgeries, in-hospital mortality, length of hospital stay, mean length of stay in the intensive care unit, and reimbursement values paid by the government. Trauma cases and congenital diseases were excluded. RESULTS: A total of 1,344 procedures were analyzed; most patients were male and aged ≥65 years. Most individuals had a residential address registered in the city. Approximately one-third of all surgeries were urgent cases. There were 128 in-hospital deaths (9.52%), and in-hospital mortality was lower for elective than for urgent surgeries (7.29% vs. 14.31%, p=0.031). A total of R$ 24.766.008,61 was paid; an average of R$ 17.222,98 per elective procedure and R$ 18.558,68 per urgent procedure. Urgent procedures were significantly more expensive than elective surgeries (p=0.029). CONCLUSION: Over a 10-year period, the total cost of ITAD interventions was R$ 24.766.008,61, which was paid from the governmental system. Elective procedures were associated with lower mortality and lower investment from the health system when compared to those performed in an urgent scenario.

Humans , Male , Female , Aged , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aorta, Thoracic/surgery , Postoperative Complications , Time Factors , Brazil/epidemiology , Public Health , Retrospective Studies , Risk Factors , Treatment Outcome
Arq. neuropsiquiatr ; 78(4): 193-198, Apr. 2020. tab
Article in English | LILACS | ID: biblio-1098090


Abstract Objective: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. Methods: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children's subtraction performance, combining parts of these tests. Results: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. Conclusions: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Resumo Objetivo: Comparar as formas de avaliar as habilidades aritméticas em crianças brasileiras com TDAH, combinando três testes neuropsicológicos validados, e verificar se são sensíveis ao tratamento com metilfenidato. Métodos: Quarenta e duas crianças (9‒12 anos) participaram deste estudo: 20 eram crianças com TDAH (DSM-IV) e 22 eram controles pareados por idade. Usamos um critério de classificação para cada teste separadamente e outro para a combinação entre eles, visando detectar a presença de dificuldades aritméticas em dois momentos: início (tempo 1) e quando as crianças com TDAH estavam tomando 0,3‒0,5 mg/kg de metilfenidato (tempo 2). O estudo também avaliou o desempenho dessas crianças em operações de subtração, combinando partes desses testes. Resultados: Separadamente, os testes foram sensíveis apenas às diferenças entre os grupos sem medicação. Entretanto, ao combinar os três testes neuropsicológicos, foi possível observar uma diferença e detectar uma redução das dificuldades aritméticas associadas ao tratamento com metilfenidato. Os mesmos efeitos foram encontrados em exercícios de subtração que exigem o procedimento de empréstimo. Conclusões: O estudo foi capaz de detectar dificuldades aritméticas em crianças brasileiras com TDAH e os efeitos do metilfenidato. Dada essa melhora na sensibilidade, combinar testes poderia ser uma alternativa promissora ao trabalhar com amostras limitadas.

Humans , Child , Attention Deficit Disorder with Hyperactivity , Brazil , Central Nervous System Stimulants , Methylphenidate , Neuropsychological Tests
Einstein (Säo Paulo) ; 18: eAO6127, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142870


ABSTRACT Objective: To estimate coronavirus disease 2019-related information consumption and related implications for health care professionals (medical and nonmedical personnel) during the pandemic. Methods: A cross-sectional on-line survey was distributed to employees of a major health care institution located in São Paulo, Brazil between April 3 and April 10, 2020. Data were analyzed using descriptive statistics. Results: The sample comprised 2,646 respondents. Most participants (44.4%) reported excessive or almost excessive access to information about the novel coronavirus and 67.6% reported having increased their average time spent on social media. When asked how frequently they consider it was easy to determine the reliability of information, "sometimes" corresponded to 43.2% of the answers in contrast to 14.6% responding "always". Answers related to potential signs of information overload associated with the pandemic indicated that 31% of respondents felt stressed by the amount of information they had to keep up with almost every day or always. Overall, 80.0% of respondents reported having experienced at least one of the following symptoms: headache, eye twitching, restlessness or sleeping difficulty. The frequency of symptoms was higher among participants with a more negative information processing style regarding when dealing with large volumes of information relative to those with a positive information processing style. Likewise, symptoms were more frequently reported by participants who had increased their social media access relative to those reporting reduced access during the pandemic. Conclusion: Our survey provides a description of how health professionals consume COVID-19 related information during the pandemic, and suggests that excessive information exposure and high processing demands may impose psychological distress and affect mental health.

RESUMO Objetivo: Estimar o consumo de informações relacionadas com doença do novo coronavírus e seus efeitos em profissionais do setor da saúde durante a pandemia. Métodos: Um questionário on-line foi distribuído para funcionários de uma instituição de saúde em São Paulo, Brasil, entre 3 e 10 de abril de 2020. Os dados foram analisados com estatísticas descritivas. Resultados: Foram incluídos nas análises 2.646 participantes. A maioria (44,4%) reportou ter acessado uma quantidade excessiva ou próxima de excessiva sobre o novo coronavírus, e 67,6% reportaram ter aumentado seu tempo médio em mídias sociais. Quando perguntados se era fácil determinar o que era informação confiável, 43,2% responderam "às vezes", comparados com 14,6% que responderam "sempre". Sobre os possíveis sinais de sobrecarga de informação associada com a pandemia, 31% sempre ou quase todos os dias se sentiram estressados com a quantidade de informações que tinham que acompanhar. Entre os respondentes, 80,0% reportaram sentir pelo menos um sintoma como dor de cabeça, espasmos oculares, inquietação ou dificuldade para dormir. Participantes com um estilo mais negativo de lidar com muitas informações também reportaram maior proporção de sintomas que os participantes com estilo positivo. De forma semelhante, participantes que aumentaram seu acesso a mídias sociais reportaram maior proporção de sintomas do que os que diminuíram seu acesso durante a pandemia. Conclusão: Nossa pesquisa fornece uma descrição de como os indivíduos consomem informações relacionadas com a doença do novo coronavirus durante a pandemia e sugere que a exposição a uma quantidade excessiva de informações e as elevadas demandas podem impor sofrimento psicológico e afetar a saúde mental.

COVID-19 , Brazil/epidemiology , Cross-Sectional Studies , Surveys and Questionnaires , Reproducibility of Results , Health Care Sector , Internet , SARS-CoV-2 , Middle Aged
Adv Rheumatol ; 60: 46, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130794


Abstract Background Chronic low back pain (CLBP) represents a problem in the occupational environment, often associated with disability, sick-leave demands, loss of productivity, anxiety, depression and high socioeconomic cost. The emergence of functional neuroimaging allowed new insights into brain structure and physiology in normality and chronic pain. While occupational related aspects are recognized as important risk factors for chronicity there have not been thus far evaluated by fMRI experiments. The overall objective of this study is to compare the neuronal correlates between groups of individuals CLBP with or without sick-leave demands. Methods A total of 74 individuals were divided into three groups: chronic low back pain with sick-leave demands [CLBP_L]; chronic low back pain without sick-leave demands [CLBP_NL]; individuals without pain or sick-leave demands [Control]. Functional magnetic resonance imaging was used to assess brain function during moderate acute pain stimulation task (thumb controlled pressure). Results After acute painful stimulation, a higher brain response was found in the anterior cingulate and superior and medium frontal gyrus was observed in CLBP_NL vs. CLBP_L ( p < 0,001) and increased brain response in the frontal pole and paracingulate region in control vs. CLBP_L ( p < 0.001) during acute pain stimulation. Conclusion The modulation of acute pain participates in the mechanism propagating chronic pain perception. The lower activation in the superior frontal gyrus observed in the CLBP_L group compared to CLBP_NL, reinforces the idea of an already existing activation in this area.(AU)

Humans , Musculoskeletal Diseases , Low Back Pain/complications , Sick Leave , Functional Neuroimaging/instrumentation , Neuronal Plasticity
Radiol. bras ; 52(5): 293-298, Sept.-Oct. 2019. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1040949


Abstract Objective: To perform a quantitative analysis of the brain volume of elderly individuals in a population-based sample. Materials and Methods: This was a radiological assessment and voxel-based quantitative analysis, with surface alignment, of 525 magnetic resonance imaging scans of individuals between 60 and 103 years of age who participated in the Saúde, Bem-estar e Envelhecimento (Health, Well-being, and Aging) study in the city of São Paulo, Brazil. Results: We noted a median rate of reduction in total brain volume of 2.4% per decade after 60 years of age. Gray and white matter both showed volume reductions with age. The total brain volume/intracranial brain volume ratio differed between males and females. Conclusion: We have corroborated the findings of studies conducted in the United States and Europe. The total brain volume/intracranial brain volume ratio is higher in men, representing a potential bias for the conventional radiological assessment of atrophy, which is typically based on the evaluation of the cerebrospinal fluid spaces.

Resumo Objetivo: Analisar, quantitativamente, o volume cerebral de idosos em uma amostra de base populacional em São Paulo. Materiais e Métodos: O estudo é uma avaliação radiológica e análise quantitativa baseada em voxel com alinhamento de superfície de 525 imagens de ressonância magnética de participantes de uma coorte de idosos (SABE - Saúde, Bem-estar e Envelhecimento) em São Paulo, Brasil, com idades de 60 a 103 anos, dos dois sexos. Resultados: Observamos redução média do volume cerebral total de 2,4% por década após os 60 anos de idade. A redução de volume ocorreu na substância cinzenta e na substância branca com a idade. A relação entre volume cerebral intracraniano e volume cerebral total diferiu entre homens e mulheres. Conclusão: Nós reproduzimos os achados de estudos prévios em populações americanas e europeias. A relação entre volume intracraniano e volume cerebral é maior em homens, o que pode representar fonte de viés na avaliação de atrofia radiológica convencional, já que essa avaliação é usualmente baseada em análise de espaços liquóricos intracranianos.

Einstein (Säo Paulo) ; 17(3): eAO4579, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012005


ABSTRACT Objective: To determine the value of ultrasonography in elbow ligament assessment compared to magnetic resonance imaging. Methods: A prospective single-center study involving 30 volunteers with no elbow joint changes. Two experienced ultrasound specialists evaluated both elbows of each volunteer, resulting in 60 evaluations per physician and totaling up 120 evaluations. Magnetic resonance images were obtained using a 3-Tesla machine and evaluated by two experienced radiologists, totaling up 120 exams. Each examiner assigned subjective, zero-to-5 scores to ligaments imaged, where zero corresponded to non-identified ligament and 5 to visualization of the entire ligament. The level of significance was set at 5%. Bland-Altman dispersions and plots were prepared for each pair of measurements obtained. Results: All ligaments were amenable to sonographic identification; scores of 4 or 5 were assigned by examiners based on ligament visibility. Ligaments could also be identified using magnetic resonance imaging and were assigned scores of 5 by examiners. All ligaments were described as intact and healthy by all four examiners. Comparative analysis of elbow ligament sonographic and magnetic resonance imaging findings did not differ significantly. Conclusion: Ultrasonography and magnetic resonance imaging can be considered equivalent modalities for elbow ligament assessment in the hands of experienced examiners.

RESUMO Objetivo: Avaliar o desempenho da ultrassonografia na avaliação dos ligamentos do cotovelo, comparando os achados com ressonância magnética. Métodos: Estudo prospectivo unicêntrico envolvendo 30 pacientes, sem alterações articulares nos cotovelos. Dois ultrassonografistas experientes avaliaram ambos os cotovelos de cada um dos pacientes, com 60 avaliações cada médico e 120 avaliações no total. As imagens de ressonância magnética foram obtidas em aparelhos 3 Tesla. Dois radiologistas experientes avaliaram as imagens, com total de 120 exames. Cada examinador deu uma nota subjetiva, de zero a 5, para os ligamentos avaliados; zero correspondeu a ligamento não identificado, e 5 a ligamento visualizado integralmente. Foi considerado nível de significância de 5%. Para cada par de medidas obtidas, construíram-se dispersões e parcelas de Bland-Altman. Resultados: Todos os ligamentos foram identificados pelos examinadores de ultrassonografia, recebendo pontuação 4 ou 5, em relação à sua visibilidade, e foram identificados pelos examinadores de ressonância magnética, com pontuação 5. Foram considerados intactos e saudáveis pelos quatro examinadores. As comparações entre ultrassonografia e ressonância magnética na avaliação dos ligamentos do cotovelo não demostraram diferenças significativas. Conclusão: Quando realizada por examinadores experientes, a ultrassonografia pode ser considerada semelhante à ressonância magnética na avaliação de ligamentos do cotovelo.

Humans , Magnetic Resonance Imaging/methods , Ultrasonography/methods , Elbow Joint/diagnostic imaging , Ligaments, Articular/diagnostic imaging , Reference Values , Prospective Studies , Reproducibility of Results , Elbow Joint/anatomy & histology , Ligaments, Articular/anatomy & histology
Einstein (Säo Paulo) ; 15(1): 17-23, Jan.-Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-840293


ABSTRACT Objective To assess changes in blood-oxygen-level-dependent activity after light deprivation compared to regular light exposure in subjects with migraine in the interictal state and in controls. Methods Ten subjects with migraine and ten controls participated in two sessions of functional magnetic resonance imaging. In each session, they performed a finger-tapping task with the right hand, cued by visual stimuli. They were scanned before and after 30 minutes of light deprivation or light exposure. In subjects with migraine, functional magnetic resonance imaging was performed interictally. Analysis of variance was made with the factors time (before or after), session (light deprivation or exposure), and group (migraine or control). Results There were significant “group” effects in a cluster in the bilateral cuneus encompassing the superior border of the calcarine sulcus and extrastriate cortex. There were no significant effects of “time”, “session”, or interactions between these factors. Conclusion The main result of this study is consistent with aberrant interictal processing of visual information in migraine. Light deprivation did not modulate functional magnetic resonance imaging activity in subjects with or without migraine.

RESUMO Objetivo Avaliar mudanças na atividade cerebral por meio de ressonância magnética funcional após privação luminosa comparada à exposição à luz, em indivíduos com enxaqueca no estado interictal e em controles. Métodos Dez indivíduos com enxaqueca e dez controles participaram de duas sessões de ressonância magnética funcional. Em cada sessão, realizaram uma tarefa motora com a mão direita guiada por estímulos visuais. Foram colhidas imagens antes e após 30 minutos de privação luminosa ou exposição à luz. Em indivíduos com enxaqueca, a ressonância funcional foi realizada no período interictal. Foi feita a análise de variância com fatores tempo (antes ou depois), sessão (privação ou exposição à luz) e grupo (enxaqueca ou controle). Resultados Houve efeitos significativos de “grupo” em uma área no cúneo bilateral, incluindo a borda superior do sulco calcarino e o córtex extraestriado. Não houve efeitos significativos de “tempo”, “sessão” ou interações entre estes fatores. Conclusão O principal resultado deste estudo sugere um processamento interictal anormal das informações visuais em indivíduos com enxaqueca. A privação luminosa não modulou a atividade na ressonância magnética funcional em indivíduos com ou sem enxaqueca.

Humans , Female , Adult , Middle Aged , Young Adult , Photic Stimulation , Visual Cortex/physiopathology , Magnetic Resonance Imaging/methods , Migraine Disorders/physiopathology , Motor Activity/physiology , Reference Values , Sensory Deprivation/physiology , Time Factors , Visual Cortex/diagnostic imaging , Case-Control Studies , Analysis of Variance , Disability Evaluation , Functional Neuroimaging , Hemodynamics , Light , Migraine Disorders/blood , Migraine Disorders/diagnostic imaging
Einstein (Säo Paulo) ; 15(1): 115-118, Jan.-Mar. 2017. graf
Article in English | LILACS | ID: biblio-840296


ABSTRACT In recent years, medical imaging with hybrid techniques has widely accepted and employed in clinical routine. PET/MRI offers significant advantages, including excellent contrast and resolution and reduced ionizing radiation, as compared to well-established PET/CT. Therefore, PET/MRI is a promising modality for oncologic imaging of some regions, such as brain, head and neck, liver and pelvis. This article set out to analyze clinical conditions that could benefit from PET/MRI imaging based on our caseload. The potential of PET/MRI to become the imaging modality of choice for assessment of neurologic and oncologic conditions associated with soft tissues is highlighted. Clinical aspects of PET/MRI and its application to clinical cases are illustrated with examples extracted from the authors’ preliminary experience.

RESUMO Nos últimos anos, imagens médicas com tecnologias híbridas tornaram-se amplamente aceitas e utilizadas na prática clínica. O PET/RM possui vantagens importantes, incluindo excelentes contrastes e resolução, e menor radiação ionizante, em comparação ao PET/TC. Por isto, é uma modalidade promissora para exames de imagem de pacientes oncológicos, para avaliar o cérebro, cabeça e pescoço, o fígado e a pelve. O objetivo deste artigo foi analisar as situações clínicas que se beneficiariam de exames de PET/RM a partir de uma casuística. Destacamos o potencial desta técnica se tornar o método de imagem de escolha para doenças neurológicas e oncológicas que envolvam partes moles. Os aspectos clínicos de PET/RM e sua aplicação aos casos clínicos são ilustrados com exemplos da experiência inicial dos autores.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Parkinson Disease/diagnostic imaging , Pelvic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Positron-Emission Tomography/methods , Multimodal Imaging/methods , Head and Neck Neoplasms/diagnostic imaging , Multiple Myeloma/diagnostic imaging , Brazil , Carcinoma/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Reproducibility of Results , Neuroimaging/methods , Lymph Nodes/diagnostic imaging
Clinics ; 69(10): 683-687, 10/2014. tab, graf
Article in English | LILACS | ID: lil-730468


Objective: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. Method: Comparison between the findings of different methods: autopsy and postmortem computed tomography. Results: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. Conclusions: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations. .

Adult , Humans , Male , Autopsy/methods , Homicide , Multidetector Computed Tomography/methods , Wounds, Stab/pathology , Wounds, Stab , Feasibility Studies , Forensic Medicine/methods , Imaging, Three-Dimensional/methods , Observer Variation , Reproducibility of Results , Thoracic Injuries/pathology , Thoracic Injuries
Arq. neuropsiquiatr ; 72(9): 663-670, 09/2014. tab, graf
Article in English | LILACS | ID: lil-722139


Despite growing interest in developing cognitive training interventions to minimize the aging cognitive decline process, no studies have attempted to explore which brain regions support the application of semantic strategies during verbal memory encoding. Our aim was to investigate the behavioral performance and brain correlates of these strategies in elderly individuals using fMRI in healthy older subjects. Method Subjects were scanned twice on the same day, before and after, directed instructions to apply semantic strategies during the encoding of word lists. Results Improved memory performance associated to increased semantic strategy application and brain activity in the left inferior and middle and right medial superior prefrontal cortex were found after the directed instructions. There was also reduced activation in areas related to strategy mobilization. Conclusion Improved memory performance in older subjects after the application of semantic strategies was associated with functional brain reorganization involving regions inside and outside the typical memory network. .

Apesar do crescente interesse em intervenções de treinamento cognitivo para minimizar o declínio cognitivo do envelhecimento, nenhum estudo explorou quais regiões do cérebro estão relacionadas à aplicação de estratégias semânticas durante a codificação da memória verbal. Nosso objetivo foi investigar o comportamento e correlatos cerebrais associados a essas estratégias usando fMRI em idosos saudáveis. Método Os sujeitos foram examinados no mesmo dia, antes e depois, de instruções dirigidas para aplicar estratégias semânticas durante a codificação de palavras. Resultados Melhora da memória relacionada ao uso de estratégias semânticas e aumento da atividade no córtex prefrontal inferior e medial esquerdo e medial superior direito foram encontrados após as instruções. Também houve redução de ativação em áreas de mobilização de estratégias. Conclusão A melhora da memória em idosos após o uso de estratégias semânticas estava associada à reorganização cerebral funcional envolvendo regiões dentro e fora da rede de áreas cerebrais típicas da memória. .

Aged , Female , Humans , Male , Aging/physiology , Brain/anatomy & histology , Brain/physiology , Cognition/physiology , Memory, Episodic , Brain Mapping , Health Status , Magnetic Resonance Imaging , Mental Recall/physiology , Neuropsychological Tests , Reference Values , Semantics , Time Factors , Verbal Learning/physiology
Rev. bras. eng. biomed ; 30(1): 70-82, Mar. 2014. ilus, tab
Article in English | LILACS-Express | LILACS | ID: lil-707139


INTRODUCTION: Areas of the brain that are associated with the vestibular system can be activated using galvanic vestibular stimulation. These areas can be studied through a combination of galvanic vestibular stimulation with functional magnetic resonance imaging (fMRI). In order to provide an appropriate sequence of galvanic stimulation synchronous with the MRI pulse sequence, a specific electronic device that was built and assessed is presented. METHODS: The electronic project of the GVS is divided in analog and digital circuits. The analog circuits are mounted in an aluminum case, supplied by sealed batteries, and goes inside the MRI room near to the feet of the subject. The digital circuits are placed in the MRI control room. Those circuits communicate through each other by an optical fiber. Tests to verify the GVS-MRI compatibility were conducted. Silicone (in-house) and Ag/AgCl (commercial) electrodes were evaluated for maximum balance and minimal pain sensations. fMRI experiments were conducted in eight human volunteers. RESULTS: GVS-MRI compatibility experiments demonstrate that the GVS did not interfere with the MRI scanner functionality and vice versa. The circular silicone electrode was considered the most suitable to apply the galvanic vestibular stimulation. The 1 Hz stimulation sinusoid frequency produced the biggest balance and the less pain sensations when compared to 2 Hz. The GVS was capable of eliciting activation in the precentral and postcentral gyri, in the central sulcus, in the supplementary motor area, in the middle and inferior frontal gyri, in the inferior parietal lobule, in the insula, in the superior temporal gyrus, in the middle cingulate cortex, and in the cerebellum. CONCLUSION: This study shows the development and description of a neurovestibular stimulator that can be safely used inside the MRI scanner room without interfering on its operation and vice versa. The developed GVS could successfully activate the major areas involved with multimodal functions of the vestibular system, demonstrating its validity as a stimulator for neurovestibular research. To the best of our knowledge, this is the first work that shows the development and the construction of a galvanic vestibular stimulator that could be safely used inside the MRI room.

Einstein (Säo Paulo) ; 10(2)apr.-jun. 2012. ilus
Article in English, Portuguese | LILACS | ID: lil-644877


Objective: To evaluate tools for the fusion of images generated by tomography and structural and functional magnetic resonance imaging. Methods: Magnetic resonance and functional magnetic resonance imaging were performed while a volunteer who had previously undergone cranial tomography performed motor and somatosensory tasks in a 3-Tesla scanner. Image data were analyzed with different programs, and the results were compared. Results: We constructed a flow chart of computational processes that allowed measurement of the spatial congruence between the methods. There was no single computational tool that contained the entire set of functions necessary to achieve the goal. Conclusion: The fusion of the images from the three methods proved to be feasible with the use of four free-access software programs (OsiriX, Register, MRIcro and FSL). Our results may serve as a basis for building software that will be useful as a virtual tool prior to neurosurgery.

Objetivo: Avaliar ferramentas de fusão de imagens geradas por tomografia, ressonância magnética estrutural e funcional. Métodos: Foram realizados exames de ressonância magnética e ressonância magnética funcional com paradigmas motor e somatossensitivo em aparelho de 3.0 Tesla em voluntário com tomografia de crânio prévia. Os dados de imagem foram analisados por diferentes programas e os resultados, comparados. Resultados: Determinamos um fluxograma de processos computacionais que permitiram mensurar a congruência espacial entre as modalidades. Não foi encontrada ferramenta computacional que, isoladamente, permitisse todo o conjunto de funcionalidades necessárias para atingir o objetivo. Conclusão: O processo de fusão das três modalidades mostrouse viável com a utilização de quatro softwares de acesso gratuito (OsiriX, Register, MRIcro e FSL) e pode servir de base para a construção de um software próprio para uso como ferramenta virtual pré-neurocirúrgica.

Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Neurosurgery , Tomography, X-Ray Computed
Einstein (Säo Paulo) ; 10(2)apr.-jun. 2012. ilus, tab
Article in English, Portuguese | LILACS | ID: lil-644878


Objective: To propose an automatic brain tumor segmentation system. Methods: The system used texture characteristics as its main source of information for segmentation. Results: The mean correct match was 94% of correspondence between the segmented areas and ground truth. Conclusion: Final results showed that the proposed system was able to find and delimit tumor areas without requiring any user interaction.

Objetivo: Propor um sistema para segmentação automática de tumores do encéfalo. Métodos: O sistema emprega parâmetros de textura como sua principal fonte de informação para a segmentação. Resultados: Os acertos chegaram a 94% na correspondência entre a segmentação obtida e o padrão-ouro. Conclusão: Os resultados obtidos mostram que o sistema é capaz de localizar e delimitar as áreas de tumor sem necessidade de interação com o operador.

Brain Neoplasms , Imaging, Three-Dimensional , Magnetic Resonance Imaging
Einstein (Säo Paulo) ; 10(2)apr.-jun. 2012. tab, ilus
Article in English, Portuguese | LILACS | ID: lil-644880


Objective: To identify the effect of levodopa in language areas in Parkinson's disease patients. Methods: We evaluated 50 patients with mild to moderate Parkinson's disease, age and gender paired to 47 healthy volunteers. We selected two homogeneous groups of 18 patients taking levodopa and 7 no levodopa patients. The functional magnetic resonance imaging verbal fluency task, with low and high cognitive demands, was performed at a 3T magnetic resonance imaging equipment. Data was analyzed with XBAM software for group maps and ANOVA comparison. Results: Patients without levodopa had more activation than the ones with levodopa in the medial frontal and in the left frontal and parieto-occipital areas. The striatal activation in patients taking levodopa had similar result of the activation detected in the healthy volunteer group. Parietooccipital areas were less activated in the levodopa group than in the no levodopa one. Conclusion: Parkinson's disease patients without levodopa replacement, during a verbal fluency effort, had more diffuse and intense cerebral activation in left hemisphere, mainly in the frontal and parieto-occipital areas. The striatal activation in verbal fluency of patients with levodopa intake was more similar to the activation found in healthy volunteers. These initial evidences suggested a role of levodopa inhibiting activation in parieto-occipital compensating areas.

Objetivo: Identificar o efeito da levodopa nas áreas de linguagem em pacientes com doença de Parkinson. Métodos: Foram avaliados 50 pacientes com doença de Parkinson leve a moderada e pareados, por gênero e idade, a 47 voluntários saudáveis. Foram selecionados dois grupos homogêneos de 18 pacientes que usavam e 7 que não usavam levodopa. O exame de ressonância magnética funcional, com tarefa de fluência verbal por geração de palavras de maiores e menores demandas cognitivas, foi realizado em equipamento de 3T. Os dados foram analisados pelo programa XBAM para os mapas de grupo e as comparações ANOVA. Resultados: Os pacientes sem utilização de levodopa tiveram maior ativação nas áreas frontais mediais e esquerdas e áreas parieto-occipitais que com levodopa. A ativação estriatal nos pacientes em uso de levodopa foi similar à detectada no grupo de voluntários saudáveis. Conclusão: Pacientes com doença de Parkinson, sem utilização de levodopa durante o esforço da fluência verbal, tiveram ativação mais difusa e intensa, principalmente no hemisfério esquerdo, em áreas frontais e parieto-occipitais. A atividade cerebral estriatal na fluência verbal de pacientes em uso de levodopa foi semelhante a dos voluntários saudáveis. Essas evidências iniciais sugerem um papel inibidor da levodopa na ativação compensatória de áreas parieto-occipitais.

Language , Levodopa , Magnetic Resonance Spectroscopy , Parkinson Disease
Einstein (Säo Paulo) ; 10(2)apr.-jun. 2012. ilus, tab, graf
Article in English, Portuguese | LILACS | ID: lil-644886


Objective: To assess intracellular labeling and quantification by magnetic resonance imaging using iron oxide magnetic nanoparticles coated with biocompatible materials in rat C6 glioma cells in vitro. These methods will provide direction for future trials of tumor induction in vivo as well as possible magnetic hyperthermia applications. Methods: Aminosilane, dextran, polyvinyl alcohol, and starch-coated magnetic nanoparticles were used in the qualitative assessment of C6 cell labeling via light microscopy. The influence of the transfection agent poly-L-lysine on cellular uptake was examined. The quantification process was performed by relaxometry analysis in T1 and T2weighted phantom images. Results: Light microscopy revealed that the aminosilane-coated magnetic nanoparticles alone or complexed with poly-L-lysine showed higher cellular uptake than did the uncoated magnetic particles. The relaxivities of the aminosilane-coated magnetic nanoparticles with a hydrodynamic diameter of 50nm to a 3-T were r1=(6.1±0.3)×10-5 ms-1mL/mug, r2=(5.3±0.1)× 10-4 ms-1mL/mug, with a ratio of r2 / r1 approximately equal to 9. The iron uptake in the cells was calculated by analyzing the relaxation rates (R1 and R2) using a mathematical relationship. Conclusions: C6 glioma cells have a high uptake efficiency for aminosilane-coated magnetic nanoparticles complexed with the transfection agent poly-L-lysine. The large ratio r2 / r1 approximately equal to 9 indicates that these magnetic nanoparticles are ideal for quantification by magnetic resonance imaging with T2-weighted imaging techniques.

Objetivo: Avaliar a marcação intracelular e o processo de quantificação por imagem por ressonância magnética usando nanopartículas magnéticas à base de óxido de ferro recobertas com materiais biocompatíveis em células da linhagem de glioma de rato C6 em experimentos in vitro. Esses métodos visam orientar ensaios futuros de indução de tumor in vivo, bem como possíveis aplicações da técnica de magneto-hipertermia. Métodos: Na avaliação qualitativa da marcação de células C6, realizada mediante microscopia óptica comum, foram utilizadas nanopartículas magnéticas recobertas com aminosilana, dextrana, álcool polivinílico e amido. A influência do agente de transfecção poly-L-lisine na captação celular foi analisada. O processo de quantificação foi realizado mediante a análise de relaxometria em imagens ponderadas em T1 e T2 do phantom. Resultados: A avaliação por microscopia óptica comum mostrou que nanopartículas magnéticas recobertas com aminosilana complexadas e não complexadas com poly-L-lisine apresentam melhor captação pelas células. As relaxatividades de nanopartículas magnéticas recobertas com aminosilana com diâmetro hidrodinâmico de 50nm para um campo de 3T foram: r1=(6,1±0,3)×10-5ms-1mL/mig, r2=(5,3±0,1)×10-4ms-1mL/mig; com uma razão de r2 / r1 aproximadamente igual a 9. O ferro captado pelas células foi calculado pela análise das taxas de relaxação (R1 e R2) mediante relação matemática. Conclusões: Linhagem de células C6 marcadas com nanopartículas magnéticas revestidas com aminosilana e complexadas com o agente de transfecção poly-L-lisine tem uma alta eficiência de captação das nanopartículas magnéticas. A grande razão r2 / r1 aproximadamente igual a 9 determina que essas nanopartículas magnéticas sejam ideais para estudar o processo de quantificação por imagem por ressonância magnética com técnicas de imagem ponderadas em T2.

Cell Line, Tumor , Glioma , Magnetic Resonance Imaging , Nanoparticles