Una imagen PET amiloide estática del primer minuto (FMF) se correlaciona con [18F]FDG PET en pacientes con afasia progresiva primaria / Static first-minute-frame (FMF) PET imaging after 18F-labeled amyloid tracer injection is correlated to [18F]FDG PET in patients with primary progressive aphasia

Objetivo Estudiar la correlación entre una imagen PET estática del primer minuto (FMF) adquirida con radiotrazadores de amiloide marcados con flúor-18 y la PET cerebral con [18F]FDG en pacientes con afasia primaria progresiva (APP). Material y métodos La cohorte de estudio incluyó a 17 pacientes diagnosticados de APP con la siguiente distribución: 9APP variante no fluente, 4APP variante logopénica, 1APP variante semántica, 3APP inclasificables. Se extrajeron los SUVR regionales de las FMF y sus correspondientes imágenes PET con [18F]FDG y se calcularon los coeficientes de correlación de Pearson. Resultados Los SUVR de ambas imágenes mostraron patrones similares de alteración cerebral regional. Los análisis de correlación intrapaciente dieron como resultado un coeficiente medio de r=0,94 ±0,06. Los coeficientes de correlación regional entre pacientes de la cohorte del estudio fueron superiores a 0,81. Las subcohortes específicas según el radiotrazador y la variante de APP no mostraron diferencias en la similitud de las imágenes. Conclusiones La FMF estática podría ser una alternativa válida a la PET dinámica de amiloide en fase inicial propuesta en la literatura, así como un biomarcador de neurodegeneración para el diagnóstico y la clasificación de la APP en los estudios de PET amiloide (AU)

Objective To study the correlation between a static PET image of the first-minute-frame (FMF) acquired with 18F-labeled amyloid-binding radiotracers and brain [18F]FDG PET in patients with primary progressive aphasia (PPA). Material and methods The study cohort includes 17 patients diagnosed with PPA with the following distribution: 9nonfluent variant PPA, 4logopenic variant PPA, 1semantic variant PPA, 3unclassifiable PPA. Regional SUVRs are extracted from FMFs and their corresponding [18F]FDG PET images and Pearson's correlation coefficients are calculated. Results SUVRs of both images show similar patterns of regional cerebral alterations. Intrapatient correlation analyses result in a mean coefficient of r=.94 ±.06. Regional interpatient correlation coefficients of the study cohort are greater than 0.81. Radiotracer-specific and variant-specific subcohorts show no difference in the similarity between the images. Conclusions The static FMF could be a valid alternative to dynamic early-phase amyloid PET proposed in the literature, and a neurodegeneration biomarker for the diagnosis and classification of PPA in amyloid PET studies (AU)

Screening, diagnosis and monitoring of sarcopenia: When to use which tool?

BACKGROUND & AIMS: Sarcopenia is a muscle disorder associated with loss of muscle mass, strength and function. Early screening, diagnosis and treatment may improve outcome in different disease conditions. A wide variety of tools for estimation of muscle mass is available and each tool has specific technical requirements. However, different investigational settings and lack of homogeneity of populations influence the definition of gold standards, proving it difficult to systematically adopt these tools. Recently, the European Working Group on Sarcopenia in Older People (EWGSOP) published a revised recommendation (EWGSOP-2) and algorithm for using tools for screening and diagnosing sarcopenia. However, agreement of the EWGSOP2 criteria with other classifications is poor and although an overview of available tools is valuable, for the purpose of clinical decision-making the reverse is useful; a given scenario asks for the most suitable tools. RESULTS: Tools were identified for screening, diagnostics and longitudinal monitoring of muscle mass. For each of these clinical scenarios the most appropriate tools were listed and for each technique their usability is specified based on sensitivity and specificity. Based on this information a specific recommendation is made for each clinical scenario. CONCLUSION: This narrative review provides an overview of currently available tools and future developments for different clinical scenarios such as screening, diagnosis and longitudinal monitoring of alterations in muscle status. It supports clinical decision-making in choosing the right tools for muscle mass quantification depending on the need within a given clinical scenario as well as the local availability and expertise.

Acretismo placentario en gestaciones tempranas. Presentación de un caso / Placental accreta in early pregnancies. Case presentation

El acretismo placentario es la invasión de las vellosidades coriales al miometrio, siendo mayor el riesgo de presentarse en casos de placenta previa o antecedente de una o más cesáreas, causando hemorragia obstétrica mayoritariamente durante el tercer trimestre. Se presenta el caso de una paciente de 39 años de edad, con hemorragia obstétrica secundaria a acretismo placentario, en un embarazo de 19 semanas resuelto mediante histerectomía, con lo que se hace énfasis en la importancia de la sospecha y diagnóstico de acretismo en embarazos tempranos, ofreciendo así un tratamiento oportuno y disminución de la morbimortalidad materna.(AU)

Placental accreta is the invasion of the chorionic villi into the myometrium. It has a higher risk of occurring in cases of placenta previa, or a history of one or more caesarean sections, causing obstetric haemorrhage mainly during the third trimester. The case is presented of a 39-year-old patient with obstetric haemorrhage secondary to placental accreta in a 19-week pregnancy. It was resolved by hysterectomy. The importance of suspicion and diagnosis of accreta in early pregnancies is emphasised, as well as offering a timely treatment and reducing the maternal morbidity and mortality.(AU)

Automated hexahedral meshing of knee cartilage structures - application to data from the osteoarthritis initiative.

We propose a fully automated methodology for hexahedral meshing of patient-specific structures of the human knee obtained from magnetic resonance images, i.e. femoral/tibial cartilages and menisci. We select eight patients from the Osteoarthritis Initiative and validate our methodology using MATLAB on a laptop computer. We obtain the patient-specific meshes in an average of three minutes, while faithfully representing the geometries with well-shaped elements. We hope to provide a fundamentally different means to test hypotheses on the mechanisms of disease progression by integrating our patient-specific FE meshes with data from individual patients. Download both our meshes and software at http://im.engr.uconn.edu/downloads.php .

Modelling Ecological Cognitive Rehabilitation Therapies for Building Virtual Environments in Brain Injury.

BACKGROUND: Brain Injury (BI) has become one of the most common causes of neurological disability in developed countries. Cognitive disorders result in a loss of independence and patients' quality of life. Cognitive rehabilitation aims to promote patients' skills to achieve their highest degree of personal autonomy. New technologies such as virtual reality or interactive video allow developing rehabilitation therapies based on reproducible Activities of Daily Living (ADLs), increasing the ecological validity of the therapy. However, the lack of frameworks to formalize and represent the definition of this kind of therapies can be a barrier for widespread use of interactive virtual environments in clinical routine. OBJECTIVES: To provide neuropsychologists with a methodology and an instrument to design and evaluate cognitive rehabilitation therapeutic interventions strategies based on ADLs performed in interactive virtual environments. METHODS: The proposed methodology is used to model therapeutic interventions during virtual ADLs considering cognitive deficit, expected abnormal interactions and therapeutic hypotheses. It allows identifying abnormal behavioural patterns and designing interventions strategies in order to achieve errorless-based rehabilitation. RESULTS: An ADL case study ('buying bread') is defined according to the guidelines established by the ADL intervention model. This case study is developed, as a proof of principle, using interactive video technology and is used to assess the feasibility of the proposed methodology in the definition of therapeutic intervention procedures. CONCLUSIONS: The proposed methodology provides neuropsychologists with an instrument to design and evaluate ADL-based therapeutic intervention strategies, attending to solve actual limitation of virtual scenarios, to be use for ecological rehabilitation of cognitive deficit in daily clinical practice. The developed case study proves the potential of the methodology to design therapeutic interventions strategies; however our current work is devoted to designing more experiments in order to present more evidence about its values.

Automated Delineation of Vessel Wall and Thrombus Boundaries of Abdominal Aortic Aneurysms Using Multispectral MR Images.

A correct patient-specific identification of the abdominal aortic aneurysm is useful for both diagnosis and treatment stages, as it locates the disease and represents its geometry. The actual thickness and shape of the arterial wall and the intraluminal thrombus are of great importance when predicting the rupture of the abdominal aortic aneurysms. The authors describe a novel method for delineating both the internal and external contours of the aortic wall, which allows distinguishing between vessel wall and intraluminal thrombus. The method is based on active shape model and texture statistical information. The method was validated with eight MR patient studies. There was high correspondence between automatic and manual measurements for the vessel wall area. Resulting segmented images presented a mean Dice coefficient with respect to manual segmentations of 0.88 and a mean modified Hausdorff distance of 1.14 mm for the internal face and 0.86 and 1.33 mm for the external face of the arterial wall. Preliminary results of the segmentation show high correspondence between automatic and manual measurements for the vessel wall and thrombus areas. However, since the dataset is small the conclusions cannot be generalized.

Cognitive neurorehabilitation based on interactive video technology.

Cognitive impairment is the main cause of disability in developed societies. New interactive technologies help therapists in neurorehabilitation in order to increase patients' autonomy and quality of life. This work proposes Interactive Video (IV) as a technology to develop cognitive rehabilitation tasks based on Activities of Daily Living (ADL). ADL cognitive task has been developed and integrated with eye-tracking technology for task interaction and patients' performance monitoring.

Minimally invasive surgical video analysis: a powerful tool for surgical training and navigation.

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery.

AMELIE: Authoring Multimedia-Enhanced Learning Interactive Environment for medical contents.

This paper presents the AMELIE Authoring Tool for medical e-learning applications. The tool allows for the creation of enhanced-video based didactic contents, and can be adjusted to any number of platforms and applications. Validation provides preliminary good results on its acceptance and usefulness.

Validation of SINERGIA as training tool: a randomized study to test the transfer of acquired basic psychomotor skills to LapMentor.

PURPOSE: Laparoscopic surgery is commonly used in many surgical procedures but requires a learning process to develop the necessary skills. Virtual reality simulators play an essential role within the training curricula. This paper aims to determine whether training in SINERGIA VR simulator allows novice surgeons to improve their basic psychomotor laparoscopic skills. METHODS: Forty-two people participated in this study, including 28 unexperience medical students and 14 expert surgeons who developed previously more than 100 laparoscopic procedures. Medical students made a pre-training test in LapMentor II; then, they trained in SINERGIA and they finally accomplished a post-training test in LapMentor II. Experts just made one trial in LapMentor II. A statistical analysis was carried out and results of pre- and post-training tests of novices were compared with Wilcoxon signed-rank test. Pre- and post-training tests of novices were also compared with results of experts with Mann-Whitney U test. RESULTS: Most metrics provided by LapMentor II and included in this study show significant differences when comparing pre- and post-training tests of novices. Analysis of pre-training test of novices and experts results show significant differences in all analyzed metrics for all studied tasks. On the other hand, LapMentor was not able to distinguish between experts and novices after training in SINERGIA for any metric in the camera manipulation task and for some metrics of the other tasks. CONCLUSIONS: Training in SINERGIA VR simulator allows improvement of basic psychomotor laparoscpic skills and transferring them to another virtual simulator. Therefore, it could be used in laparoscopic surgery training programs.

Effect of the flavonoid quercetin on cadmium-induced hepatotoxicity.

The present study was designed to evaluate whether treatment with quercetin exerts any beneficial effect on cadmium (Cd)-induced hepatotoxicity in order to establish the possible protective mechanisms of quercetin. Wistar rats were distributed in four experimental groups: control, Cd, quercetin, and Cd+quercetin. Hepatic toxicity was evaluated by measuring plasma concentrations of markers of hepatic injury. The activity of antioxidant enzymes in liver was also measured. Hepatic expression of metallothioneins (MT), and endothelial nitric oxide synthase (eNOS) was assayed by Western and Northern blot. Our results demonstrated that Cd administration induced an increased marker enzyme activity in plasma. This effect was not inhibited by quercetin. However, the administration of quercetin softened Cd-induced oxidative damage. MT levels in liver were substantially increased when the animals received Cd and quercetin. Hepatic eNOS expression was significantly increased after treatment with Cd and quercetin, being this increase higher than in animals receiving Cd alone. In conclusion, in this experimental model, quercetin was not able to prevent the Cd-induced liver damage although the animals that received both, Cd and quercetin showed a marked improvement in oxidative stress and an increase in the MT and eNOS expression. These results suggest that other mechanisms different to oxidative stress could be involved in hepatic damage.

Papel de la vía de Ras en un modelo de nefrotoxicidad inducida por cadmio. Efecto protector del antioxidante quercetina / Role of Ras signalling pathway in a model of cadmium-induced nephrotoxicity. Protective effect of the antioxidant quercetin

El cadmio (Cd) es un tóxico presente en el medio ambiente que afecta a los sistemas biológicos por varias rutas. Los mecanismos moleculares de su toxicidad no están bien definidos. Nosotros hemos demostrado recientemente en un modelo de administración crónica de Cd en ratas, que la quercetina, un potente “scavenger" de radicales libres de oxígeno, tiene un efecto protector sobre la nefrotoxicidad inducida por Cd. La potente actividad antioxidante de la quercetina pudiera ser la responsable de este efecto protector. Sin embargo, el Cd activa múltiples rutas de señalización relacionadas con respuestas celulares frente al estrés. Ras es un miembro de la familia de las pequeñas GTPasas, con una gran variedad de funciones que incluyen la regulación de genes de expresión y proliferación celular. Nuestro objetivo en este trabajo fue estudiar el efecto del cadmio y la quercetina en el proceso proliferativo relacionado con las vías de señalización mediadas por Ras. El estudio se realizó durante nueve semanas con ratas Wistar. Se dividieron en cuatro grupos: 1) Grupo control, 2) Grupo cadmio: 1,2 mg/Kg/día, s.c., 3) Grupo quercetina: 50 mg/Kg/día, i.p., 4) Grupo cadmio-quercetina: animales tratados con cadmio y quercetina a las dosis y vías de administración anteriormente descritas. Para valorar la toxicidad renal se determinó la excreción urinaria de proteínas y enzimas marcadoras de necrosis tubular, así como las concentraciones plasmáticas de creatinina y urea. La expresión y activación renal de Ras se evaluó mediante Western blot e inmunohistoquímica. La proliferación celular se determinó por detección del antígeno Ki-67. Los resultados mostraron que la co-administración de cadmio y quercetina mejoró la función renal alterada por la exposición a cadmio. Por otra parte, se observó una mayor activación de Ras y una mayor proliferación celular en los riñones de los animales tratados con cadmio. El tratamiento con quercetina redujo la activación renal de Ras y el número de células en proliferación. Nuestros resultados sugieren que el efecto protector de la quercetina sobre la nefrotoxicidad inducida por cadmio pudiera deberse a la inhibición de esta ruta de señalización (AU)

Cadmium (Cd) is an ubiquitous environmental toxicant that affects biological systems in various ways. The molecular mechanisms of its toxicity are not yet well defined. We have recently reported in an experimental model of chronic cadmium administration in rats, that quercetin, a potent oxygen free radical scavenger, has a protective effect on cadmium-induced nephrotoxicity. Quercetin´s strong antioxidant activity could be responsible for the protective effect. However, Cd activates multiple signal transduction pathways related to cellular responses to stress. Ras is a member of a family of small GTPases with a great variety of functions including regulation of gene expression and cell proliferation. Our aim in this work was to study the effect of Cd and quercetin on the proliferation related to Ras-mediated signal transduction pathways. Experiments were carried out in male Wistar rats during nine weeks. Rats were distributed in four experimental groups: 1) control rats; 2) cadmium group (1,2 mg Cd/Kg/day s.c.); 3) quercetin group (50 mg/Kg/day, i.p.) and 4) cadmium-quercetin group (Cd and quercetin at the same doses as in the groups 2 and 3 respectively). Renal toxicity was evaluated by measuring urinary excretion of proteins and enzyme markers of tubular necrosis, as well as plasma concentrations of creatinine and urea. Renal expression of Ras and Ras activation was assessed by Western blot and inmuhistochemistry. Assessment of cell proliferation was evaluated by detection of the Ki-67 antigen. Animals that received both Cd and quercetin showed a better renal function than those receiving Cd alone. On the other hand, Cd increased renal Ras activation and cell proliferation. Quercetin treatment reduced Ras activation and the number of cells in proliferation. Our results suggest that the protective effect of quercetin on cadmium-induced nephrotoxicity could be associated with the inhibition of Ras signal transduction pathway (AU)