Predictores radiológicos del volumen final del infarto cerebral en pacientes con obstrucción vascular proximal / Radiological predictors of final infarct volume in patients with proximal vascular occlusion

Introducción: Múltiples variables clínicas y radiológicas están involucradas en el pronóstico neurológico de los pacientes con accidente cerebrovascular (ACV) isquémico. Alrededor del 30% de los ACV isquémicos son causados por la obstrucción vascular proximal del circuito anterior; en estos casos, la utilidad de la trombólisis sistémica es limitada. La angiotomografía está indicada en los pacientes que pueden ser candidatos a tratamiento endovascular. Diferentes factores radiológicos como el grado de colaterales leptomeníngeas, o el largo, la densidad o la extensión del trombo, fueron descritos como predictores del pronóstico neurológico tras un ACV isquémico con compromiso vascular proximal. El volumen final del infarto cerebral se correlaciona con la mortalidad y el grado funcional a largo plazo de estos pacientes. El propósito de este estudio es determinar los mejores predictores radiológicos del volumen final del infarto cerebral en pacientes con ACV isquémico con compromiso proximal, utilizando angiotomografía. Materiales y métodos: Realizamos un estudio observacional retrospectivo. Incluimos pacientes adultos con ACV isquémico causado por la obstrucción de un vaso proximal, diagnosticados mediante angiotomografía en el período de junio de 2009 a diciembre de 2019. Medimos la densidad y el largo del trombo en la adquisición sin contraste, registramos el grado de colaterales leptomeníngeas y la extensión del trombo utilizando el clot burden score. Luego medimos el volumen final del infarto en una tomografía de control y analizamos el grado de correlación entre estos factores radiológicos en el volumen infartado. Resultados: Incluimos 54 pacientes con ACV isquémico por compromiso vascular proximal; 41 (75%) fueron mujeres. La mediana de edad fue de 82 años. Alrededor del 60% de los ACV comprometieron el hemisferio derecho y el vaso más afectado fue el segmento M1 de la arteria cerebral media (40,7%)...(AU)

Introduction: Various clinical and radiologic variables impact the neurologic prognosis of patients with ischemic cerebrovascular accidents. About 30% of ischemic cerebrovascular accidents are caused by proximal obstruction of the anterior circulation; in these cases, systemic thrombolysis is of limited usefulness. CT angiography is indicated in candidates for endovascular treatment. Various radiologic factors, including the grade of leptomeningeal collateral circulation, as well as the length, density, and extension of the thrombus, have been identified as predictors of neurologic prognosis after anterior ischemic cerebrovascular accidents due to proximal vascular obstruction. Final infarct volume correlations with mortality and long-term functional outcome in these patients. This study aimed to determine the best predictors of final infarct volume on CT angiography in patients with ischemic cerebral accidents due to proximal occlusion. Materials and methods: This retrospective observational study included adults with ischemic cerebrovascular accidents due to obstruction of the anterior circulation diagnosed by CT angiography in the period comprising June 2009 through December 2019. We measured the length and density of the thrombus in unenhanced CT images, and we used the clot burden score to record the grade of leptomeningeal collateral circulation and the extension of the thrombus. Then we measured the final infarct volume on follow-up CT and analyzed the correlations among these radiologic factors in the infarct volume. Results: We included 54 patients [mean age, 82 y; 41 (75%) women] with ischemic cerebrovascular accidents due to proximal occlusion. About 60% of the cerebrovascular accidents affected the right cerebral hemisphere, and the most commonly affected vessel was the M1 segment of the medial cerebral artery (40.7%)...(AU)

Radiological predictors of final infarct volume in patients with proximal vascular occlusion.

INTRODUCTION: Various clinical and radiologic variables impact the neurologic prognosis of patients with ischemic cerebrovascular accidents. About 30% of ischemic cerebrovascular accidents are caused by proximal obstruction of the anterior circulation; in these cases, systemic thrombolysis is of limited usefulness. CT angiography is indicated in candidates for endovascular treatment. Various radiologic factors, including the grade of leptomeningeal collateral circulation, as well as the length, density, and extension of the thrombus, have been identified as predictors of neurologic prognosis after anterior ischemic cerebrovascular accidents due to proximal vascular obstruction. Final infarct volume correlations with mortality and long-term functional outcome in these patients. This study aimed to determine the best predictors of final infarct volume on CT angiography in patients with ischemic cerebral accidents due to proximal occlusion. MATERIALS AND METHODS: This retrospective observational study included adults with ischemic cerebrovascular accidents due to obstruction of the anterior circulation diagnosed by CT angiography in the period comprising June 2009 through December 2019. We measured the length and density of the thrombus in unenhanced CT images, and we used the clot burden score to record the grade of leptomeningeal collateral circulation and the extension of the thrombus. Then we measured the final infarct volume on follow-up CT and analyzed the correlations among these radiologic factors in the infarct volume. RESULTS: We included 54 patients [mean age, 82 y; 41 (75%) women] with ischemic cerebrovascular accidents due to proximal occlusion. About 60% of the cerebrovascular accidents affected the right cerebral hemisphere, and the most commonly affected vessel was the M1 segment of the medial cerebral artery (40.7%). Final infarct volume correlated with the grade of leptomeningeal collateral circulation (p=0.03) and with the clot burden score (p=0.01). Neither the length nor the density of the thrombus correlated with final infarct volume. CONCLUSION: The final infarct volume can be estimated on the initial CT angiogram. Nevertheless, we found no useful predictive factors in unenhanced CT images. The best independent radiologic predictors of the final infarct volume are the grade of collateral circulation and the clot burden score, especially in patients who did not undergo mechanical thrombectomy, because mechanical thrombectomy improves outcomes. These factors are important for decision making in the management of patients with ischemic cerebrovascular accidents due to proximal occlusion.

Prevalence of Intracranial Aneurysms in Hereditary Hemorrhagic Telangiectasia: Report from a Single Reference Center.

BACKGROUND AND PURPOSE: Neurologic manifestations in hereditary hemorrhagic telangiectasia include an increased incidence of brain abscesses and ischemic strokes due to paradoxic embolization in addition to a wide spectrum of symptoms and complications due to typical brain vascular malformations. Intracranial aneurysms are not part of this brain vascular malformation spectrum. The aim of this study was to determine their prevalence in patients with hereditary hemorrhagic telangiectasia. MATERIALS AND METHODS: This was a single-center, retrospective study. Adult patients from the institutional Hereditary Hemorrhagic Telangiectasia registry with a definitive diagnosis of hereditary hemorrhagic telangiectasia and an available report or angiographic imaging study were included and reviewed to determine the intracranial aneurysm prevalence. In addition, the morphologic characteristics of intracranial aneurysms and possible associated risk factors were collected. RESULTS: Two hundred twenty-eight patients were analyzed. Thirty-seven aneurysms in 33 patients (14.5%; 95% CI, 9.9%-19%) were found. The median diameter of intracranial aneurysms was 3.2 mm (interquartile range, 2.6-4.4 mm). No association between intracranial aneurysm and sex, age, or genetic background was noted. There were no subarachnoid hemorrhagic events due to intracranial aneurysm rupture. CONCLUSIONS: Due to the high prevalence of intracranial aneurysms in adult patients with hereditary hemorrhagic telangiectasia, further studies regarding bleeding risks and monitoring should be addressed.

Consumer perception of situational appropriateness for fresh, dehydrated and fresh-cut fruits.

In recent years, a decreasing trend in fruit consumption has been detected in Mediterranean countries, with the consequent risk for the population's health. The objective of this study was to obtain consumer knowledge that can be useful to promote fruit consumption by designing specific interventions. This study was conducted in Spain as its inhabitants have traditionally adhered to the Mediterranean diet. Firstly, four fresh fruit types were identified based on the consumer perception of the fruit characteristics that condition the eating process (fruit size, the need for cutlery to peel/eat fruit, and susceptibility to be spoiled during transportation). Then consumer perception of situational appropriateness of six different fruit types (the 4 types of fresh fruit previously identified, dehydrated non-traditional fruit (DF), and fresh-cut fruit ready to eat on the go (FCF)) was investigated by the Item-By-Use method using Check-All-That Apply (CATA) questions. The potential of DF and FCF to broaden fruit consumption situations, and barriers for their consumption, were evaluated. Fresh fruits, particularly 'easy-to-peel' ones like mandarins or bananas, were those preferred by consumers in most evaluated contexts. DF were considered mainly appropriate to be consumed 'As an ingredient' and 'As a healthy snack', while FCF were more suitable 'To be included in school lunchboxes' and 'To eat immediately'. According to our results, these two processed fruit types can help to increase the fruit consumption of a non-negligible percentage of the population (38% of participants), but it is necessary to overcome the barriers related mostly to sensory properties, plastic packaging and consumer misperception of fewer healthy properties compared to fresh fruit.

Impact of ethylene degreening treatment on sensory properties and consumer response to citrus fruits.

Degreening treatment is normally applied to early-season citrus varieties grown in the Mediterranean area in order to enhance the external colour when fruits have already reached internal maturity. Despite profound knowledge about the effect of ethylene on the physico-chemical quality of citrus fruit, less is known about its effect on consumers' expectations in the supermarket or consumer quality perceptions when they eat such fruit. In this study, three mandarin cultivars ('Owari', 'Clemenules' and 'Oronules') with two initial colours at harvest, and one orange cultivar, 'Navelina', were submitted to the degreening treatment under commercial conditions. The effect of treatment on both external and internal qualities perceived by consumers was evaluated. The main physico-chemical parameters were also determined. The degreening treatment slightly affected firmness, total soluble solids or acidity level in 'Owari' and 'Navelina'. However, sensory triangle tests, in which 100-122 consumers compared the internal quality of degreened fruit and control fruit, did not show significant differences between treatments for any of the studied cultivars. A survey based on images of citrus fruit was responded by 340 consumers; it showed that the degreening treatment strongly affected consumers' maturity expectations, which resulted in improved fruit liking expectations and increased the number of consumers willing to buy. The extent of this effect depended on the initial colour of the fruit submitted to degreening. In order to improve liking expectations, fruit should arrive on the market with an external colour index (CI = 1000a/Lb) between +10 and +20. We conclude that the ethylene degreening treatment, which did not have any effect on the internal quality that consumers perceive, is a potent postharvest tool to increase citrus fruit sales at the beginning of the season.

Volatile metabolite profiling reveals the changes in the volatile compounds of new spontaneously generated loquat cultivars.

In recent years, the advantageous traits of three new loquat cultivars have drawn the attention of breeders and growers. All three have spontaneously arisen from the 'Algerie' cultivar: the new 'Xirlero' cultivar is a bud mutant of 'Algerie', while 'Amadeo' and 'Raúl' arose as chance seedlings. Following a non-targeted approach based on HS-SPME-GC-MS, the volatile compounds profile of the fruits from the new cultivars were obtained and compared to the original 'Algerie' cultivar. Carboxylic acids clearly dominated the volatile profile of all the loquat cultivars, but esters, aldehydes, ketones and alcohols were also predominant compounds. Interestingly when the bud mutant event did not lead to marked changes in the volatile compounds complement, pronounced changes in the volatile composition of chance seedling-generated cultivars 'Amadeo' and 'Raúl' were observed. 'Amadeo' fruits showed lower levels of 2-methyl butanoic acid and much higher levels of methylhexanoate, methylbutanoate and 2-hydroxy-5-methylacetophenone. The 'Raúl' cultivar also had a distinctive volatile profile characterised by high levels of C6-aldehydes, (E)-2-hexanal, 2-hexenal, (Z)-3-hexenal and hexanal, and several carotenoid-derived volatiles; e.g. 2-pentene-1,4-dione 1-(1,2,2-trimethylcyclopentyl), (S)-dihydroactinidiolide, isodurene, cis-geranyl acetone, ß-damascenone, ß-ionone, α-ionone and 3,4-dehydro-ß-ionone. These changes in volatiles were associated with a more intense flavour in cultivars 'Amadeo' and 'Raúl', according to the sensory evaluation of the flavour intensity carried out by a semi-trained panel. A metabolomic correlation network analysis provided insights as to how volatiles were regulated, and revealed that the compounds modified in 'Amadeo' were uncoupled from the rest of the volatilome, while the volatiles modified in 'Raul' changed according to specific groups. To conclude, this work provides a holistic view of how the loquat volatilome was affected, and this information was integrated with the physical-chemical-sensory attributes to understand the changes that occur in the new cultivars.

Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia.

BACKGROUND: Around 47-74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. RESULTS: Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p < 0.001). IDA frequency was 90.3% versus 54% (p < 0.001). When IDA is present, estimated risk for BG-MnIL is remarkably high (OR 7.73, 95%CI 2.23-26.73). After adjustment for possible confounders (gender, age, presence of HVMs), IDA was still associated with increased risk of BG-MnIL (adjusted OR 6.32, 95% CI 2.32-17.20; p < 0.001). CONCLUSIONS: Physicians should assess BG-MnIL in HHT patients in CNS-MRI. IDA and HVMs present increased risk of lesions. Patients with BG-MnIL have neuropsychological impairment, and they might benefit from sparing IDA, or undergoing future therapeutic options. TRIAL REGISTRATION: NCT01761981 . Registered January 3rd 2013.

Brain structural changes in patients in the early stages of multiple sclerosis with depression.

Some studies suggest an inflammatory mechanism associated with the presence of depression in multiple sclerosis (MS); however, there is little data concerning these findings. The purpose of this study was to investigate the presence of brain structural changes in patients with MS and depression and to compare them with patients suffering from MS without depression and healthy controls. METHODS: A case-control study that included patients with relapsing-remitting MS (RRMS) defined by validated criteria, over 18 years of age, with less than three years from disease onset, EDSS ≤ 3, with no history of previous depression and under immunomodulatory treatment with interferon beta, if any. A control group paired by age and gender was also included. Patients were clinically assessed to determine the presence of depression. Demographic clinical and structural aspects of parameters from the scan, such as lesion volume, total brain volume (TBV), white matter volume (WMV), neocortical gray matter volume (NGMV), and fractional anisotropy (FA) were analyzed. RESULTS: Sixty-five individuals were enrolled: 20 healthy controls, 22 patients with MS without depression, and 23 patients with MS with depression. Patients with MS and depression showed a lower TBV (P = 0.01), NGMV (0.01) together with an increase in lesion burden in T2 (P < 0.01) but not in T1 (P = 0.09) and no differences in global FA among groups (P = 0.23) and in WMV (P = 0.12). CONCLUSION: Patients with RRMS and depression had a reduced total brain volume and a significantly increased lesion burden at T2 MR than patients with RRMS without depression.

Usefulness of the apparent diffusion coefficient for the evaluation of the white matter to differentiate between glioblastoma and brain metastases. / Utilidad del coeficiente de difusión aparente en la evaluación de la sustancia blanca para diferenciar glioblastoma de metástasis cerebral.

OBJECTIVE: To determine whether there are significant differences in the apparent diffusion coefficient (ADC) between the apparently normal peritumor white matter surrounding glioblastomas and that surrounding brain metastases. MATERIAL AND METHODS: We retrospectively reviewed 42 patients with histologically confirmed glioblastomas and 42 patients with a single cerebral metastasis. We measured the signal intensity in the apparently normal peritumor white matter and in the abnormal peritumor white matter on the ADC maps. We used mean ADC values in the contralateral occipital white matter as a reference from which to design normalized ADC indices. We compared mean values between the two tumor types. We calculated the area under the receiver operator characteristic curve and estimated the sensitivity and specificity of the measurements taken. RESULTS: Supratentorial lesions and compromise of the corpus callosum were more common in patients with glioblastoma than in patients with brain metastases. The maximum diameter of the enhanced area after injection of a contrast agent was greater in the glioblastomas (p<0.001). The minimum ADC value measured in the apparently normal peritumor white matter was higher for the glioblastomas than for the metastases (p=0.002). Significant differences in the ADC index were found only for the minimum ADC value in apparently normal peritumor white matter. The sensitivity and specificity were less than 70% for all variables analyzed. CONCLUSIONS: There are differences in the ADC values of apparently normal peritumor white matter between glioblastomas and cerebral metastases, but the magnitude of these differences is slight and the application of these differences in clinical practice is still limited.

Espectroscopia y difusión por resonancia magnética para la caracterización del linfoma del sistema nervioso central

Objetivo: Mostrar los hallazgos de la resonancia magnética (RM) de cerebro, convencional y con técnicas funcionales (difusión y espectroscopia), del linfoma del sistema nervioso central (SNC), haciendo énfasis en los aportes que permiten aproximarse al diagnóstico y diferenciar la entidad de otros tumores. Materiales y métodos: Desde junio de 2008 hasta enero de 2012, se estudiaron 26 pacientes inmunocompetentes con diagnóstico de tumor del SNC, confirmado por anatomía patológica. En todos los casos se realizó, antes de la cirugía o de la toma de biopsia, una RM convencional de cerebro con gadolinio y técnicas funcionales. Resultados: Se incluyeron 26 pacientes inmunocompetentes: 13 hombres y 13 mujeres. Ocho tuvieron diagnóstico de linfoma primario del SNC y los 18 restantes presentaron otros tumores: glioblastoma con centro necrótico (n= 9), oligoastrocitoma anaplásico (n= 3), metástasis con necrosis (n=4) y meduloblastoma (n=2). De las 26 lesiones, 10 (8 linfomas y 2 medublastomas) mostraron restricción de la difusión, en coincidencia con la alta celularidad tumoral de ambas entidades histológicas. En el análisis espectral de los tumores, todos tuvieron un incremento de la curva de lípidos. El pico en los linfomas y meduloblastomas ocurrió en los sitios sólidos, mientras que en las demás lesiones los lípidos se observaron en los sitios de necrosis tumoral. Conclusión: El análisis de las secuencias de RM convencional sin y con contraste endovenoso, junto con las técnicas de difusión y espectroscopia, permite aproximarse al diagnóstico de linfoma de SNC.(AU)

Purpose: To show the imaging findings in cases of central nervous system (CNS) lymphoma with conventional and functional (diffusion and spectroscopy) magnetic resonance imaging (MRI) techniques, emphasizing the contributions that advanced imaging techniques provides to improve the diagnostic accuracy and rule out other tumors. Materials and methods: Between June 2008 and January 2012 we studied 26 inmunocompetent patients with diagnosis of central nervous system tumor, confirmed by pathology. These patients performed a brain MRI with conventional and functional techniques (diffusion and spectroscopy) and with gadolinium before surgery or biopsy. Results: We included 26 inmunocompetent patients, 13 men and 13 women. Eight patients with diagnosis of primary CNS lymphoma and 18 with other tumors: glioblastoma (n=9), anaplastic oligoastrocytoma (n=3), metastases with necrosis (n=4), and medulloblastoma (n=2). Ten of the 26 lesions showed restricted diffusion, this happened in all lymphomas and in both medulloblastomas. This is due to the high cellularity of the tumors. Spectroscopy showed increased lipids in all tumors. The difference among the tumors was the place of the measurement of lipids. Both medulloblastoma and lymphomas showed a lipid peak in the solid portion of the tumor while the remaining tumors showed lipids in the necrotic areas. Conclusion: The combination of conventional and functional MRI techniques with intravenous contrast improve the diagnostic accuracy of CNS lymphoma.(AU)

Espectroscopia y difusión por resonancia magnética para la caracterización del linfoma del sistema nervioso central / Central nervous system lymphomas characterization by MR spectroscopy and diffusion-weighted imaging

OBJETIVO: Mostrar los hallazgos de la resonancia magnética (RM) de cerebro, convencional y con técnicas funcionales (difusión y espectroscopia), del linfoma del sistema nervioso central (SNC), haciendo énfasis en los aportes que permiten aproximarse al diagnóstico y diferenciar la entidad de otros tumores. MATERIALES Y MÉTODOS: Desde junio de 2008 hasta enero de 2012, se estudiaron 26 pacientes inmunocompetentes con diagnóstico de tumor del SNC, confirmado por anatomía patológica. En todos los casos se realizó, antes de la cirugía o de la toma de biopsia, una RM convencional de cerebro con gadolinio y técnicas funcionales. Se incluyeron 26 pacientes inmunocompetentes: 13 hombres y 13 mujeres. Ocho tuvieron diagnóstico de linfoma primario del SNC y los 18 restantes presentaron otros tumores: glioblastoma con centro necrótico (n= 9), oligoastrocitoma anaplásico (n= 3), metástasis con necrosis (n=4) y meduloblastoma (n=2). De las 26 lesiones, 10 (8 linfomas y 2 medublastomas) mostraron restricción de la difusión, en coincidencia con la alta celularidad tumoral de ambas entidades histológicas. En el análisis espectral de los tumores, todos tuvieron un incremento de la curva de lípidos. El pico en los linfomas y meduloblastomas ocurrió en los sitios sólidos, mientras que en las demás lesiones los lípidos se observaron en los sitios de necrosis tumoral. CONCLUSIÓN: El análisis de las secuencias de RM convencional sin y con contraste endovenoso, junto con las técnicas de difusión y espectroscopia, permite aproximarse al diagnóstico de linfoma de SNC.

PURPOSE: To show the imaging findings in cases of central nervous system (CNS) lymphoma with conventional and functional (diffusion and spectroscopy) magnetic resonance imaging (MRI) techniques, emphasizing the contributions that advanced imaging techniques provides to improve the diagnostic accuracy and rule out other tumors. MATERIALS AND METHODS: Between June 2008 and January 2012 we studied 26 inmunocompetent patients with diagnosis of central nervous system tumor, confirmed by pathology. These patients performed a brain MRI with conventional and functional techniques (diffusion and spectroscopy) and with gadolinium before surgery or biopsy. RESULTS: We included 26 inmunocompetent patients, 13 men and 13 women. Eight patients with diagnosis of primary CNS lymphoma and 18 with other tumors: glioblastoma (n=9), anaplastic oligoastrocytoma (n=3), metastases with necrosis (n=4), and medulloblastoma (n=2). Ten of the 26 lesions showed restricted diffusion, this happened in all lymphomas and in both medulloblastomas. This is due to the high cellularity of the tumors. Spectroscopy showed increased lipids in all tumors. The difference among the tumors was the place of the measurement of lipids. Both medulloblastoma and lymphomas showed a lipid peak in the solid portion of the tumor while the remaining tumors showed lipids in the necrotic areas. CONCLUSION: The combination of conventional and functional MRI techniques with intravenous contrast improve the diagnostic accuracy of CNS lymphoma.

Diferencias en la tasa de atrofia global y regional y del volumen lesional entre género en esclerosis múltiple / Sex-related differences in atrophy and lesion load in multiple sclerosis patients

Introducción: Algunos estudios demostraron una evolución clínica diferente de la esclerosis múltiple (EM) entre los varones y las mujeres. Son escasos los trabajos que muestran esta diferencia con técnicas no convencionales de resonancia magnética (RM). El objetivo es investigar las diferencias estructurales cerebrales en RM entre los varones y las mujeres con EM durante el curso de la enfermedad. Métodos: Se incluyeron pacientes con EM forma recaída-remisión (EMRR), con al menos 6 años de seguimiento desde el inicio, que tuviesen una RM basal y al sexto año del primer evento desmielinizante. Se midió: volumen cerebral total (VCT), volumen de sustancia gris neocortical (VSG), volumen de sustancia blanca (VSB), volumen lesional (VL) y tasa de atrofia cerebral global (TAg) y regional (TAr). Se analizaron las diferencias transversales (basal y al sexto año) y longitudinales entre sexos, utilizando SIENAXr®, SIENA®, SIENAr® y SepInria. Resultados: Se incluyeron 45 pacientes, 25 mujeres. El seguimiento fue de 7,3 ± 0,2 años. No hubo diferencias entre edad ni EDSS de inicio, tiempo de seguimiento o tratamiento, VCT, VSG, VSB ni de VL en la RM basal. A los 6 años no se observaron diferencias en EDSS ni en VSB; sin embargo los varones tuvieron una reducción del VCT (p = 0,002) y VSG (p ≤ 0,001) y un incremento del VL (p = 0,02) y de TAg (p < 0,001) respecto de las mujeres. Regionalmente, las mujeres presentaron mayor atrofia frontal subcortical que los varones. Discusión: Este es el primer estudio que muestra diferencias regionales de atrofia y de volumen lesional entre género en una población latinoamericana con EM (AU)

Introduction: Previous studies showed gender-associated clinical and MRI differences in multiple sclerosis (MS) evolution. However, only few studies were done with non conventional MRI techniques and no one was done in a South American MS population. The aim of this study was to investigate gender differences according to nonconventional MRI measures in patients with MS from Buenos Aires, Argentina. Methods: Relapsing-remitting MS patients (RRMS) with at least 6 years of follow up and an MRI at onset and at 6 years were included. Patients were assessed using nonconventional MRI measures: total brain volume (TBV), neocortical grey brain volume (GBV), white brain volume (WBV), lesion load (LL), % of brain volume change between onset and year 6 (% BVC) and regional brain volume change. Gender-related MRI differences were investigated using general linear model analysis. Results: The 45 patients were included (25 female). Mean follow up time was 7.3±0.2 years. No differences in age, EDSS at onset, DMD treatment, TBV, GBV, WBV neither LL were found between gender at baseline. Six years later, males showed a decrease in TBV (P=.002) and GBV (P≤0.001) and an increase in LL (P=.02) and % BVC (P<.001) vs. females. Female patients showed a decrease in the volume of frontal subcortical region. Discussion: This is the first study showing differences in brain volume changes between gender in MS patients from South America. Future studies will confirm our initial findings (AU)

[Sex-related differences in atrophy and lesion load in multiple sclerosis patients]. / Diferencias en la tasa de atrofia global y regional y del volumen lesional entre género en esclerosis múltiple.

INTRODUCTION: Previous studies showed gender-associated clinical and MRI differences in multiple sclerosis (MS) evolution. However, only few studies were done with non conventional MRI techniques and no one was done in a South American MS population. The aim of this study was to investigate gender differences according to nonconventional MRI measures in patients with MS from Buenos Aires, Argentina. METHODS: Relapsing-remitting MS patients (RRMS) with at least 6 years of follow up and an MRI at onset and at 6 years were included. Patients were assessed using nonconventional MRI measures: total brain volume (TBV), neocortical grey brain volume (GBV), white brain volume (WBV), lesion load (LL), % of brain volume change between onset and year 6 (% BVC) and regional brain volume change. Gender-related MRI differences were investigated using general linear model analysis. RESULTS: The 45 patients were included (25 female). Mean follow up time was 7.3 ± 0.2 years. No differences in age, EDSS at onset, DMD treatment, TBV, GBV, WBV neither LL were found between gender at baseline. Six years later, males showed a decrease in TBV (P=.002) and GBV (P ≤ 0.001) and an increase in LL (P=.02) and % BVC (P<.001) vs. females. Female patients showed a decrease in the volume of frontal subcortical region. DISCUSSION: This is the first study showing differences in brain volume changes between gender in MS patients from South America. Future studies will confirm our initial findings.

[Brain atrophy in clinically isolated syndrome]. / Atrofia cerebral en pacientes con síndrome desmielinizante aislado.

INTRODUCTION: Previous reports have shown that brain atrophy appears early in the course of multiple sclerosis (MS). The aim of the present study was to evaluate whether brain atrophy already exists in clinically isolated syndrome (CIS) by comparing with a control sample. METHODS: Patients with CIS were included prospectively from June 2008 to June 2009. A control group of healthy persons, matched by age and gender with CIS, was also included during the same period of time. An automated analysis tool, SIENAX, was used to obtain total brain volume (TBV), gray matter volume (GMV) and white matter volume (WMV). Mann-Whitney U test was used to analyze the data. RESULTS: Twenty CIS patients and 30 healthy controls were included (8 vs. 17 females, p=0.11). Mean age for CIS was 35 ± 6 years vs. 34.4±5 in controls (p=0.61). Mean EDSS in CIS was 1.1 ± 0.5. Eighteen patients with CIS (90%) had abnormal baseline MRI. The TBV in CIS was 1.6.l ± 0.22.l × 106 vs.1.65 ± 0.15 × 106 in controls (p=0.005), the GMV in CIS was 0.58 ± 0.05 × 106 vs. 0.67 ± 0.03 × 106 in controls (p ≤ 0.001) and the WMV in CIS was 1 ± 0.1 × 106 vs. 1.12 ± 0.02 × 106 in controls (p=0.03). CONCLUSIONS: This is the first study dealing with brain atrophy in a CIS sample from Latin America in which brain atrophy, mainly grey matter atrophy, was shown in early stages of the disease compared with healthy individuals.

Atrofia cerebral en pacientes con síndrome desmielinizante aislado / Brain atrophy in clinically isolated syndrome

Introducción: Estudios previos demostraron que la atrofia cerebral (AC) aparece precozmente en esclerosis múltiple. Es nuestro objetivo evaluar la AC en pacientes con síndrome desmielinizante aislado (SDA) respecto a un grupo control en una población argentina.Métodos: Se incluyó prospectivamente a pacientes con SDA durante el período junio de 2008 a junio de 2009. El grupo control estaba formado por sujetos sanos apareados por edad y sexo. Se utilizó el programa SIENAX para medir el volumen cerebral total (VCT), el volumen de sustancia gris (VSG) y de sustancia blanca (VSB) en cada grupo. Los datos se compararon con la prueba de Mann-Whitney. Se consideró significativo p<0,05. Resultados: Se incluyó a 20 pacientes con SDA y 30 controles sanos (8 frente a 17 mujeres; p=0,11). La media de edad en SDA fue 35±6 frente a 34,4±5 años en controles (p=0.61). El EDSS de los pacientes con SDA fue 1,1±0,5; 18 pacientes (90%) con SDA tenían lesiones en la resonancia magnética cerebral. El VCT en SDA fue 1,6±0,22 μl×106 frente a 1,65±0,15×106 en controles (p=0,005); el VSG en SDA fue 0,58±0,05×106 frente a 0,67±0,03×106 en controles (p ≤ 0,001), y el VSB en SDA fue 1±0,1×106 frente a 1,12±0,02×106 en controles (p=0,03).Conclusiones: Éste es el primer estudio en una población latinoamericana con SDA que demostró atrofia cerebral con predomino en la sustancia gris, respecto a un grupo control. Esta herramienta es coste-efectiva para la medición de la AC, aspecto poco estudiado en nuestro medio (AU)

Introduction: Previous reports have shown that brain atrophy appears early in the course of multiple sclerosis (MS). The aim of the present study was to evaluate whether brain atrophy already exists in clinically isolated syndrome (CIS) by comparing with a control sample. Methods: Patients with CIS were included prospectively from June 2008 to June 2009. A control group of healthy persons, matched by age and gender with CIS, was also included during the same period of time. An automated analysis tool, SIENAX, was used to obtain total brain volume (TBV), gray matter volume (GMV) and white matter volume (WMV). Mann-Whitney U test was used to analyze the data.Results: Twenty CIS patients and 30 healthy controls were included (8 vs. 17 females, p=0.11). Mean age for CIS was 35±6 years vs. 34.4±5 in controls (p=0.61). Mean EDSS in CIS was 1.1±0.5. Eighteen patients with CIS (90%) had abnormal baseline MRI. The TBV in CIS was 1.6μl±0.22μl×106 vs.1.65±0.15×106 in controls (p=0.005), the GMV in CIS was 0.58±0.05×106 vs. 0.67±0.03×106 in controls (p ≤ 0.001) and the WMV in CIS was 1±0.1×106 vs. 1.12±0.02×106 in controls (p=0.03). Conclusions:This is the first study dealing with brain atrophy in a CIS sample from Latin America in which brain atrophy, mainly grey matter atrophy, was shown in early stages of the disease compared with healthy individuals (AU)

Effect of controlled atmospheres on maintaining quality of persimmon fruit cv. "Rojo Brillante".

Astringent "Rojo Brillante" persimmon fruits were stored in air or in 2 different controlled atmospheres: 10% CO(2)+ 90% N(2) (CA1) or 97 % N(2)+ air (CA2) for up 50 d at 15 degrees C. After different periods, the fruit were treated with 95% CO(2) for 24 h at 20 degrees C in order to remove astringency, and then transferred to 20 degrees C in air free of CO(2) for 5 d to simulate shelf life. Other fruits were directly transferred to shelf life without being submitted to deastringency treatment. Storage under CA2 allowed storability of persimmon "Rojo Brillante" during 30 d at 15 degrees C, maintaining commercial firmness. Moreover, CA2 had an effect on removing astringency when fruits were stored for 30 d at 15 degrees C, or after 20 d following to shelf life. As consequence, deastringency treatment could be avoided when the fruits were previously stored under this controlled atmosphere.