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  1. Clinical use of the Mayo-Portland Adaptability Inventory in rehabilitation after paediatric acquired brain injury.

    Science.gov (United States)

    Oddson, Bruce; Rumney, Peter; Johnson, Patricia; Thomas-Stonell, Nancy

    2006-11-01

    The Mayo-Portland Adaptability Inventory (MPAI; designed to be administered by clinicians) is a popular measure of disability following head injury in adults. Its acceptability, validity, and reliability were assessed for use with children. There were 335 children and adolescents (215 males, 120 females) aged between 1 and 19 years at injury (median age 9y 8mo [SD 5y]) in our sample. The test was acceptable to respondents, rapidly and easily administered, and required only small modifications. It demonstrated validity against client and parent reports of major symptoms. It demonstrated test-retest reliability within the limitations of our data and excellent interrater accord. Consequently, the MPAI is recommended for paediatric use for evaluating rehabilitation needs and therapy outcome.

  2. Multiple sclerosis, brain radiotherapy, and risk of neurotoxicity: The Mayo Clinic experience

    International Nuclear Information System (INIS)

    Miller, Robert C.; Lachance, Daniel H.; Lucchinetti, Claudia F.; Keegan, B. Mark; Gavrilova, Ralitza H.; Brown, Paul D.; Weinshenker, Brian G.; Rodriguez, Moses

    2006-01-01

    Purpose: The aim of this study was a retrospective assessment of neurotoxicity in patients with multiple sclerosis (MS) receiving external beam radiotherapy (EBRT) to the brain. Methods and Materials: We studied 15 consecutively treated patients with MS who received brain EBRT. Neurologic toxicity was assessed with the Common Toxicity Criteria v.3.0. Results: Median follow-up for the 5 living patients was 6.0 years (range, 3.3-27.4 years). No exacerbation of MS occurred in any patient during EBRT. Five patients had Grade 4 neurologic toxicity and 1 had possible Grade 5 toxicity. Kaplan-Meier estimated risk of neurotoxicity greater than Grade 4 at 5 years was 57% (95% confidence interval, 27%-82%). Toxicity occurred at 37.5 to 54.0 Gy at a median of 1.0 year (range, 0.2-4.3 years) after EBRT. Univariate analysis showed an association between opposed-field irradiation of the temporal lobes, central white matter, and brainstem and increased risk of neurotoxicity (p < 0.04). Three of 6 cases of toxicity occurred in patients treated before 1986. Conclusions: External beam radiotherapy of the brain in patients with MS may be associated with an increased risk of neurotoxicity compared with patients without demyelinating illnesses. However, this risk is associated with treatment techniques that may not be comparable to modern, conformal radiotherapy

  3. International market research at the Mayo Clinic.

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    Hathaway, M; Seltman, K

    2001-01-01

    Mayo Clinic has a long international history and has been providing care to international patients since its inception. Despite its history and reputation, however, the marketing staff continues to monitor the international market to gauge the level of awareness, reputation, and attractiveness of Mayo Clinic around the world. Here's a look at how one institution has used word-of-mouth marketing to maintain its global reputation.

  4. The Mayo Clinic Value Creation System.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Harper, C Michel; Noseworthy, John H

    2012-01-01

    The authors present Mayo Clinic's Value Creation System, a coherent systems engineering approach to delivering a single high-value practice. There are 4 tightly linked, interdependent phases of the system: alignment, discovery, managed diffusion, and measurement. The methodology is described and examples of the results to date are presented. The Value Creation System has been demonstrated to improve the quality of patient care while reducing costs and increasing productivity.

  5. Mayo Clinic Care Network: A Collaborative Health Care Model.

    Science.gov (United States)

    Wald, John T; Lowery-Schrandt, Sherri; Hayes, David L; Kotsenas, Amy L

    2018-01-01

    By leveraging its experience and expertise as a consultative clinical partner, the Mayo Clinic developed an innovative, scalable care model to accomplish several strategic goals: (1) create and sustain high-value relationships that benefit patients and providers, (2) foster relationships with like-minded partners to act as a strategy against the development of narrow health care networks, and (3) increase national and international brand awareness of Mayo Clinic. The result was the Mayo Clinic Care Network. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. Empowering Mayo Clinic Individualized Medicine with Genomic Data Warehousing

    Directory of Open Access Journals (Sweden)

    Iain Horton

    2017-08-01

    Full Text Available Individualized medicine enables better diagnoses and treatment decisions for patients and promotes research in understanding the molecular underpinnings of disease. Linking individual patient’s genomic and molecular information with their clinical phenotypes is crucial to these efforts. To address this need, the Center for Individualized Medicine at Mayo Clinic has implemented a genomic data warehouse and a workflow management system to bring data from institutional electronic health records and genomic sequencing data from both clinical and research bioinformatics sources into the warehouse. The system is the foundation for Mayo Clinic to build a suite of tools and interfaces to support various clinical and research use cases. The genomic data warehouse is positioned to play a key role in enhancing the research capabilities and advancing individualized patient care at Mayo Clinic.

  7. Empowering Mayo Clinic Individualized Medicine with Genomic Data Warehousing.

    Science.gov (United States)

    Horton, Iain; Lin, Yaxiong; Reed, Gay; Wiepert, Mathieu; Hart, Steven

    2017-08-22

    Individualized medicine enables better diagnoses and treatment decisions for patients and promotes research in understanding the molecular underpinnings of disease. Linking individual patient's genomic and molecular information with their clinical phenotypes is crucial to these efforts. To address this need, the Center for Individualized Medicine at Mayo Clinic has implemented a genomic data warehouse and a workflow management system to bring data from institutional electronic health records and genomic sequencing data from both clinical and research bioinformatics sources into the warehouse. The system is the foundation for Mayo Clinic to build a suite of tools and interfaces to support various clinical and research use cases. The genomic data warehouse is positioned to play a key role in enhancing the research capabilities and advancing individualized patient care at Mayo Clinic.

  8. Optimizing the patient transport function at Mayo Clinic.

    Science.gov (United States)

    Kuchera, Dustin; Rohleder, Thomas R

    2011-01-01

    In this article, we report on the implementation of a computerized scheduling tool to optimize staffing for patient transport at the Mayo Clinic. The tool was developed and implemented in Microsoft Excel and Visual Basic for Applications and includes an easy-to-use interface. The tool allows transport management to consider the trade-offs between patient waiting time and staffing levels. While improved staffing efficiency was a desire of the project, it was important that patient service quality was also maintained. The results show that staffing could be reduced while maintaining historical patient service levels.

  9. Dr Albert L. Rhoton Jr's Time at the Mayo Clinic: The Beginnings of a Remarkable Career.

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    Rayan, Tarek; Carlson, Matthew L; Piepgras, David G; Link, Michael J; Van Gompel, Jamie J

    2017-08-09

    Dr Albert L. Rhoton Jr became the focal point of neurosurgery's evolution in understanding the intricate and complex microanatomy of the human brain over the last 4 decades. His pioneering work on cadaveric specimens proved to be a pivotal endeavor in the pursuit to better understand the complex microsurgical anatomy of cranial surgery. This paper details his early career at the Mayo Clinic in Rochester, Minnesota. A comprehensive review and synthesis of data acquired from the institutional historical archives including the Annual Reports to the Executive Committee, the Reports to the Board of Directors, the MAYOVOX Newsletter, the illustration archives of the Mayo Clinic Division of Creative Media, staff biographies, curriculum vitae, personal interviews, as well as full-text journal articles, and book publications was performed. Dr Rhoton was engaged in a busy clinical practice as a young staff at the Mayo Clinic. Records show he focused on tackling complex intracranial pathologies along with numerous basic research and neuroanatomy projects that became a major part of his life's work and passion. He was a great teacher and friend to countless individuals and his work will continue to impact and improve the care provided to neurosurgery patients for generations to come. Copyright © 2017 by the Congress of Neurological Surgeons.

  10. Clinical aspects of the Mayo/IBM PACS project

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    Forbes, Glenn S.; Morin, Richard L.; Pavlicek, William

    1991-07-01

    A joint project between Mayo Clinic and IBM to develop a picture archival and communications system has been under development for three years. This project began as a potential solution to a pressing archival problem in magnetic resonance imaging. The project has grown to encompass a much larger sphere of activity including workstations, image retrieval, and report archival. This report focuses on the clinical aspects involved in the design, development, and implementation of such a system. In particular, emphasis is placed on the clinical impact of the system both inside and outside of the radiology department. The primary concerns have centered on fidelity of archival data, ease of use, and diagnostic efficacy. The project to date has been limited to neuroradiology practice. This group consists of nine staff radiologists and fellows. Administrative policy decisions regarding the accessibility and available of digital data in the clinical environment have been much more difficult and complex than originally conceived. Based on the observations thus far, the authors believe the system will become a useful and valuable adjunct to clinical practice of radiology.

  11. Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

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    Scott Okuno

    2011-08-01

    Full Text Available Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.

  12. Current Perspectives on Desmoid Tumors: The Mayo Clinic Approach

    International Nuclear Information System (INIS)

    Joglekar, Siddharth B.; Rose, Peter S.; Sim, Franklin; Okuno, Scott; Petersen, Ivy

    2011-01-01

    Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation

  13. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases

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    Weatherby, R.P.; Dahlin, D.C.; Ivins, J.C.

    1981-05-01

    Postradiation sarcoma of bone is an uncommon but serious sequela of radiation therapy. Seventy-eight Mayo Clinic patients have been treated for sarcomas arising in irradiated bones. They received their initial radiotherapy for a wide variety of nonneoplastic and neoplastic conditions, both benign and malignant. Thirty-five sarcomas arose in bone that was normal at the time of radiotherapy, and 43 arose in irradiated preexisting osseous lesions. The latent period between radiotherapy and diagnosis of sarcoma averaged 14.3 years. Ninety percent of the postradiation sarcomas were either osteosarcomas or fibrosarcomas; chondrosarcoma, malignant (fibrous) histiocytoma, malignant lymphoma, Ewing's tumor, and metastasizing chondroblastoma also occurred. Prompt radical surgery, when feasible, is usually the treatment of choice for the sarcoma. About 30% of patients with sarcomas of the extremities or craniofacial bones survived 5 years without recurrence; there were no disease-free survivors among patients with tumors of the vertebral column, pelvis, or shoulder girdle. The low risk of sarcoma following radiotherapy for the treatment of cancer should not be a contraindication to its use in these patients; however, radiation therapy for benign bone tumors should be reserved for lesions that are not amenable to surgical treatment. An unusual case is also reported herein in which a fibrosarcoma was discovered in the humerus of a patient who had received radiotherapy 55 years previously for a verified osteosarcoma in the same site.

  14. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases

    International Nuclear Information System (INIS)

    Weatherby, R.P.; Dahlin, D.C.; Ivins, J.C.

    1981-01-01

    Postradiation sarcoma of bone is an uncommon but serious sequela of radiation therapy. Seventy-eight Mayo Clinic patients have been treated for sarcomas arising in irradiated bones. They received their initial radiotherapy for a wide variety of nonneoplastic and neoplastic conditions, both benign and malignant. Thirty-five sarcomas arose in bone that was normal at the time of radiotherapy, and 43 arose in irradiated preexisting osseous lesions. The latent period between radiotherapy and diagnosis of sarcoma averaged 14.3 years. Ninety percent of the postradiation sarcomas were either osteosarcomas or fibrosarcomas; chondrosarcoma, malignant (fibrous) histiocytoma, malignant lymphoma, Ewing's tumor, and metastasizing chondroblastoma also occurred. Prompt radical surgery, when feasible, is usually the treatment of choice for the sarcoma. About 30% of patients with sarcomas of the extremities or craniofacial bones survived 5 years without recurrence; there were no disease-free survivors among patients with tumors of the vertebral column, pelvis, or shoulder girdle. The low risk of sarcoma following radiotherapy for the treatment of cancer should not be a contraindication to its use in these patients; however, radiation therapy for benign bone tumors should be reserved for lesions that are not amenable to surgical treatment. An unusual case is also reported herein in which a fibrosarcoma was discovered in the humerus of a patient who had received radiotherapy 55 years previously for a verified osteosarcoma in the same site

  15. The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory.

    Science.gov (United States)

    Malec, James F; Kean, Jacob; Monahan, Patrick O

    To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention. Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings. Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings. MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement. Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement. 5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID.

  16. Mayo-Portland adaptability inventory: comparing psychometrics in cerebrovascular accident to traumatic brain injury.

    Science.gov (United States)

    Malec, James F; Kean, Jacob; Altman, Irwin M; Swick, Shannon

    2012-12-01

    (1) To evaluate the measurement reliability and construct validity of the Mayo-Portland Adaptability Inventory, 4th revision (MPAI-4) in a sample consisting exclusively of patients with cerebrovascular accident (CVA) using single parameter (Rasch) item-response methods; (2) to examine the differential item functioning (DIF) by sex within the CVA population; and (3) to examine DIF and differential test functioning (DTF) across traumatic brain injury (TBI) and CVA samples. Retrospective psychometric analysis of rating scale data. Home- and community-based brain injury rehabilitation program. Individuals post-CVA (n=861) and individuals with TBI (n=603). Not applicable. MPAI-4. Item data on admission to community-based rehabilitation were submitted to Rasch, DIF, and DTF analyses. The final calibration in the CVA sample revealed satisfactory reliability/separation for persons (.91/3.16) and items (1.00/23.64). DIF showed that items for pain, anger, audition, and memory were associated with higher levels of disability for CVA than TBI patients; whereas, self-care, mobility, and use of hands indicated greater overall disability for TBI patients. DTF analyses showed a high degree of association between the 2 sets of items (R=.92; R(2)=.85) and, at most, a 3.7 point difference in raw scores. The MPAI-4 demonstrates satisfactory psychometric properties for use with individuals with CVA applying for interdisciplinary posthospital rehabilitation. DIF reveals clinically meaningful differences between CVA and TBI groups that should be considered in results at the item and subscale level. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data.

    Science.gov (United States)

    Chute, Christopher G; Beck, Scott A; Fisk, Thomas B; Mohr, David N

    2010-01-01

    Mayo Clinic's Enterprise Data Trust is a collection of data from patient care, education, research, and administrative transactional systems, organized to support information retrieval, business intelligence, and high-level decision making. Structurally it is a top-down, subject-oriented, integrated, time-variant, and non-volatile collection of data in support of Mayo Clinic's analytic and decision-making processes. It is an interconnected piece of Mayo Clinic's Enterprise Information Management initiative, which also includes Data Governance, Enterprise Data Modeling, the Enterprise Vocabulary System, and Metadata Management. These resources enable unprecedented organization of enterprise information about patient, genomic, and research data. While facile access for cohort definition or aggregate retrieval is supported, a high level of security, retrieval audit, and user authentication ensures privacy, confidentiality, and respect for the trust imparted by our patients for the respectful use of information about their conditions.

  18. Validation of the Mayo Clinic Staging System in Determining Prognoses of Patients With Perihilar Cholangiocarcinoma

    NARCIS (Netherlands)

    Coelen, Robert J. S.; Gaspersz, Marcia P.; Labeur, Tim A.; van Vugt, Jeroen L. A.; van Dieren, Susan; Willemssen, François E. J. A.; Nio, Chung Y.; Ijzermans, Jan N. M.; Klümpen, Heinz-Josef; Groot Koerkamp, Bas; van Gulik, Thomas M.

    2017-01-01

    BACKGROUND & AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiologic variables, but has not yet been validated. We

  19. The Mayo-Portland Participation Index: A brief and psychometrically sound measure of brain injury outcome.

    Science.gov (United States)

    Malec, James F

    2004-12-01

    To evaluate the internal consistency, interrater agreement, concurrent validity, and floor and ceiling effects of the 8-item Participation Index (M2PI) of the Mayo-Portland Adaptability Inventory (MPAI). M2PI data derived from MPAIs completed independently by the people with acquired brain injury undergoing evaluation, their significant others, and rehabilitation staff were submitted to Rasch Facets analysis to determine the internal consistency of each independent rater group and of composite measures that combined rater groups. Correlations with the full-scale MPAI were examined to assess concurrent validity, as was interrater agreement. Outpatient rehabilitation in academic physical medicine and rehabilitation department. People with acquired brain injury (N=134) consecutively seen for evaluation, significant others, and evaluating staff. Not applicable. The MPAI and M2PI. The M2PI showed satisfactory internal consistency, concurrent validity, interrater agreement, and minimal floor and ceiling effects, although evidence of rater bias was also apparent. Composite indices showed more desirable psychometric properties than ratings by individual rater groups. The M2PI, particularly in composite indices and with attention to rater biases, provides an outcome measure with satisfactory psychometric qualities and the potential to represent the varying perspectives of people with acquired brain injury, significant others, and rehabilitation staff.

  20. Patient quality of life in the Mayo Clinic Care Transitions program: a survey study

    Directory of Open Access Journals (Sweden)

    Faucher J

    2016-08-01

    Full Text Available Joshua Faucher,1 Jordan Rosedahl,2 Dawn Finnie,3 Amy Glasgow,3 Paul Takahashi4 1Mayo Medical School, Mayo Clinic College of Medicine, 2Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, 3Center for the Science of Health Care Delivery, 4Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA Background: Transitional care programs are common interventions aimed at reducing medical complications and associated readmissions for patients recently discharged from the hospital. While organizations strive to reduce readmissions, another important related metric is patient quality of life (QoL. Aims: To compare the relationship between QoL in patients enrolled in the Mayo Clinic Care Transitions (MCCT program versus usual care, and to determine if QoL changed in MCCT participants between baseline and 1-year follow-up. Methods: A baseline survey was mailed to MCCT enrollees in March 2013. Those who completed a baseline survey were sent a follow-up survey 1 year later. A cross-sectional survey of usual care participants was mailed in November 2013. We included in our analysis 199 participants (83 in the MCCT and 116 in usual care aged over 60 years with multiple comorbidities and receiving primary care. Primary outcomes were self-rated QoL; secondary outcomes included self-reported general, physical, and mental health. Intra- and intergroup comparisons of patients were evaluated using Pearson’s chi-squared analysis. Results: MCCT participants had more comorbidities and higher elder risk assessment scores than those receiving usual care. At baseline, 74% of MCCT participants reported responses of good-to-excellent QoL compared to 64% after 1 year (P=0.16. Between MCCT and usual care, there was no significant difference in self-reported QoL (P=0.21. Between baseline and follow-up in MCCT patients, and compared to usual care, there were no significant

  1. Building a protocol expressway: the case of Mayo Clinic Cancer Center.

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    McJoynt, Terre A; Hirzallah, Muhanad A; Satele, Daniel V; Pitzen, Jason H; Alberts, Steven R; Rajkumar, S Vincent

    2009-08-10

    Inconsistencies and errors resulting from nonstandard processes, together with redundancies, rework, and excess workload, lead to extended time frames for clinical trial protocol development. This results in dissatisfaction among sponsors, investigators, and staff and restricts the availability of novel treatment options for patients. A team of experts from Mayo Clinic formed, including Protocol Development Unit staff and management from the three Mayo Clinic campuses (Florida, Minnesota, and Arizona), a systems and procedures analyst, a quality office analyst, and two physician members to address the identified deficiencies. The current-state process was intensively reviewed, and improvement steps were taken to accelerate the development and approval of cancer-related clinical trials. The primary goal was to decrease the time from receipt of a new protocol through submission to an approving authority, such as the National Cancer Institute or institutional review board. Using the Define, Measure, Analyze, Improve, Control (DMAIC) framework infused with Lean waste-reduction methodologies, areas were identified for improvement, including enhancing first-time quality and processing new studies on a first-in/first-out basis. The project was successful in improving the mean turnaround time for internally authored protocols (P Lean methodologies is an effective tool to structure the definition, planning, analysis, and implementation of significant process changes.

  2. Bringing human resources to the table: utilization of an HR balanced scorecard at Mayo Clinic.

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    Fottler, Myron D; Erickson, Eric; Rivers, Patrick A

    2006-01-01

    Rather than viewing HR as a critical driver of organizational strategy and outcomes, most health care organizations see HR as a drain on the organization's bottom line. Only by aligning HR with the organizational strategy will HR leaders truly get a seat at the leadership table. HR professionals can overcome impediments and gain a seat at the table by learning the language of business and the ways in which organizational leaders use data to drive their decisions. This article shows how Mayo Clinic uses the popular Balanced Scorecard approach to align its measures of HR performance to the organization's strategic plan.

  3. Strategic performance management: development of a performance measurement system at the Mayo Clinic.

    Science.gov (United States)

    Curtright, J W; Stolp-Smith, S C; Edell, E S

    2000-01-01

    Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

  4. The Prince Edward Island-Mayo Clinic connection: Malcolm B. Dockerty and Lewis B. Woolner.

    Science.gov (United States)

    Wright, James R

    2014-03-01

    Malcolm B. Dockerty and Lewis B. Woolner, 2 preeminent mid-20th-century surgical pathologists, spent their entire careers at the Mayo Clinic. Both were raised in poverty on potato farms only 49 miles apart in Canada's smallest province (Prince Edward Island); both were educated in 1-room schools and graduated as gold medalists from Prince Edward Island's only college and then from Maritime Canada's only medical school; both then trained at the Mayo Clinic. To explore the lives and accomplishments of these 2 important surgical pathologists. Standard historiographic methods were used to explore primary and secondary historical sources. Both became world-renowned general surgical pathologists, one developing subspecialty expertise in gynecologic pathology and the other in cytopathology, pulmonary pathology, and thyroid/parathyroid pathology. Both were prolific authors with h-indices higher than 40, and between them, they published more than 750 peer-reviewed papers and book chapters. As educators, they trained hundreds of pathology and surgery residents/fellows who disseminated their knowledge around the world. Both were fascinated by poetry from childhood and could quote the classics from memory. One wrote poetry throughout his entire life and even used it to teach pathology and serve as his memoir; the other strongly preferred the classics and in jest called his colleague "a (minor) poet." Both received postretirement honorary doctorates from their alma maters. Dockerty died in 1987; Woolner celebrates his 100th birthday on November 17, 2013. Every pathologist should know of these 2 pioneering surgical pathologists.

  5. Comparability of Mayo-Portland Adaptability Inventory ratings by staff, significant others and people with acquired brain injury.

    Science.gov (United States)

    Malec, James F

    2004-06-01

    To determine the internal consistency, reliability and comparability of the Mayo-Portland Adaptability Inventory (MPAI-4) and sub-scales completed by people with acquired brain injury (ABI), family and significant others (SO) and rehabilitation staff. 134 people with ABI consecutively seen for outpatient rehabilitation evaluation. MPAI-4 protocols based on independent ratings by the people with ABI undergoing evaluation, SO and rehabilitation staff were submitted to Rasch Facets analysis to determine the internal consistency of the overall measure and sub-scales (Ability, Adjustment and Participation indices) for each rater group and for a composite measure based on all rater groups. Rater agreement for individual items was also examined. Rasch indicators of internal consistency were entirely within acceptable limits for 3-rater composite full scale and sub-scale measures; these indicators were generally within acceptable limits for measures based on a single rater group. Item agreement was generally acceptable; disagreements suggested various sources of bias for specific rater groups. The MPAI-4 possesses satisfactory internal consistency regardless of rating source. A composite measure based on ratings made independently by people with ABI, SO and staff may serve as a 'gold standard' for research purposes. In the clinical setting, assessment of varying perspectives and biases may not only best represent outcome as evaluated by all parties involved but be essential to developing effective rehabilitation plans.

  6. Utility of the Mayo-Portland adaptability inventory-4 for self-reported outcomes in a military sample with traumatic brain injury.

    Science.gov (United States)

    Kean, Jacob; Malec, James F; Cooper, Douglas B; Bowles, Amy O

    2013-12-01

    To investigate the psychometric properties of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) obtained by self-report in a large sample of active duty military personnel with traumatic brain injury (TBI). Consecutive cohort who completed the MPAI-4 as a part of a larger battery of clinical outcome measures at the time of intake to an outpatient brain injury clinic. Medical center. Consecutively referred sample of active duty military personnel (N=404) who suffered predominantly mild (n=355), but also moderate (n=37) and severe (n=12), TBI. Not applicable. MPAI-4 RESULTS: Initial factor analysis suggested 2 salient dimensions. In subsequent analysis, the ratio of the first and second eigenvalues (6.84:1) and parallel analysis indicated sufficient unidimensionality in 26 retained items. Iterative Rasch analysis resulted in the rescaling of the measure and the removal of 5 additional items for poor fit. The items of the final 21-item Mayo-Portland Adaptability Inventory-military were locally independent, demonstrated monotonically increasing responses, adequately fit the item response model, and permitted the identification of nearly 5 statistically distinct levels of disability in the study population. Slight mistargeting of the population resulted in the global outcome, as measured by the Mayo-Portland Adaptability Inventory-military, tending to be less reflective of very mild levels of disability. These data collected in a relatively large sample of active duty service members with TBI provide insight into the ability of patients to self-report functional impairment and the distinct effects of military deployment on outcome, providing important guidance for the meaningful measurement of outcome in this population. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Mayo Alliance Prognostic Model for Myelodysplastic Syndromes: Integration of Genetic and Clinical Information.

    Science.gov (United States)

    Tefferi, Ayalew; Gangat, Naseema; Mudireddy, Mythri; Lasho, Terra L; Finke, Christy; Begna, Kebede H; Elliott, Michelle A; Al-Kali, Aref; Litzow, Mark R; Hook, C Christopher; Wolanskyj, Alexandra P; Hogan, William J; Patnaik, Mrinal M; Pardanani, Animesh; Zblewski, Darci L; He, Rong; Viswanatha, David; Hanson, Curtis A; Ketterling, Rhett P; Tang, Jih-Luh; Chou, Wen-Chien; Lin, Chien-Chin; Tsai, Cheng-Hong; Tien, Hwei-Fang; Hou, Hsin-An

    2018-06-01

    To develop a new risk model for primary myelodysplastic syndromes (MDS) that integrates information on mutations, karyotype, and clinical variables. Patients with World Health Organization-defined primary MDS seen at Mayo Clinic (MC) from December 28, 1994, through December 19, 2017, constituted the core study group. The National Taiwan University Hospital (NTUH) provided the validation cohort. Model performance, compared with the revised International Prognostic Scoring System, was assessed by Akaike information criterion and area under the curve estimates. The study group consisted of 685 molecularly annotated patients from MC (357) and NTUH (328). Multivariate analysis of the MC cohort identified monosomal karyotype (hazard ratio [HR], 5.2; 95% CI, 3.1-8.6), "non-MK abnormalities other than single/double del(5q)" (HR, 1.8; 95% CI, 1.3-2.6), RUNX1 (HR, 2.0; 95% CI, 1.2-3.1) and ASXL1 (HR, 1.7; 95% CI, 1.2-2.3) mutations, absence of SF3B1 mutations (HR, 1.6; 95% CI, 1.1-2.4), age greater than 70 years (HR, 2.2; 95% CI, 1.6-3.1), hemoglobin level less than 8 g/dL in women or less than 9 g/dL in men (HR, 2.3; 95% CI, 1.7-3.1), platelet count less than 75 × 10 9 /L (HR, 1.5; 95% CI, 1.1-2.1), and 10% or more bone marrow blasts (HR, 1.7; 95% CI, 1.1-2.8) as predictors of inferior overall survival. Based on HR-weighted risk scores, a 4-tiered Mayo alliance prognostic model for MDS was devised: low (89 patients), intermediate-1 (104), intermediate-2 (95), and high (69); respective median survivals (5-year overall survival rates) were 85 (73%), 42 (34%), 22 (7%), and 9 months (0%). The Mayo alliance model was subsequently validated by using the external NTUH cohort and, compared with the revised International Prognostic Scoring System, displayed favorable Akaike information criterion (1865 vs 1943) and area under the curve (0.87 vs 0.76) values. We propose a simple and contemporary risk model for MDS that is based on a limited set of genetic and clinical variables

  8. The conversion to electronic hospital notes at Mayo Clinic. Overcoming barriers and challenges.

    Science.gov (United States)

    Andreen, Debra L; Dobie, Linda J; Jasperson, Jan C; Lucas, Thomas A; Wubbenhorst, Cathryn L

    2010-01-01

    This article describes the conversion to electronic hospital notes at a large, multi-specialty group practice: Mayo Clinic in Rochester, Minnesota. Because of the size of the institution and the barriers to the adoption of electronic notes, the process was a gradual one that took several years. Making a convincing case for change to institutional leaders and maintaining their support was crucial to success. Equally vital was the careful investigation of user requirements and the development of software features that allowed providers to complete their notes quickly in the fast-paced hospital environment. Care providers discovered the value of having immediate access to legible hospital notes throughout the campus and from remote locations.

  9. The Social Media DNA of Mayo Clinic-and Health Care.

    Science.gov (United States)

    Kotsenas, Amy L; Aase, Lee; Arce, Makala; Timimi, Farris K; Dacy, Matthew; Young, Colleen; Wald, John T

    2018-01-01

    Hippocrates' admonition and the medical community's aversion to risk have caused many physicians and institutions to resist participation in modern social media sites such as Facebook (Facebook, Inc, Menlo Park, California, USA), Twitter (Twitter Inc, San Francisco, California, USA), and YouTube (San Mateo, California, USA). However, because Mayo Clinic's founders were champions of analog social networking, it was among the earliest hospitals worldwide to create official accounts on these digital platforms. A proper understanding of the traditional mechanisms of knowledge diffusion in medicine and of the nature of social media sites should help professionals see and embrace the opportunities for positive engagement in social media. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

    Science.gov (United States)

    Patel, Alpen B; Bansberg, Stephen F; Adler, Charles H; Lott, David G; Crujido, Lisa

    2015-11-01

    Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies. Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded. Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%). Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias. © The Author(s) 2015.

  11. Mohs micrographic surgery for the treatment of hidradenocarcinoma: the Mayo Clinic experience from 1993 to 2013.

    Science.gov (United States)

    Tolkachjov, Stanislav N; Hocker, Thomas L; Hochwalt, Phillip C; Camilleri, Michael J; Arpey, Christopher J; Brewer, Jerry D; Otley, Clark C; Roenigk, Randall K; Baum, Christian L

    2015-02-01

    Hidradenocarcinoma (HAC) is a rare malignant adnexal neoplasm with reported metastatic potential and undefined optimal treatment. To review clinical characteristics and outcomes of patients with HAC treated with Mohs micrographic surgery (MMS). The authors performed a retrospective chart review of patients with HAC treated by MMS at Mayo Clinic from 1993 to 2013, recording patient demographics, tumor characteristics, MMS stages to clearance, follow-up, recurrence, metastasis, and mortality. Ten patients underwent MMS for HAC more than 20 years. The average age was 62.8 years, with 6 females and 4 males. Occipital scalp was the most common location (40%), followed by extremities (30%) and face (20%). In 5 of 7 cases (71%), "cyst" was the working clinical diagnosis. The average preoperative lesion area was 3.18 cm, with an average of 1.5 MMS stages required for clearance. Mean postoperative follow-up was 7 years (range, 5-205 months). No tumors treated with MMS recurred, metastasized, or led to disease-related mortality. Mohs micrographic surgery seems to be a useful treatment modality for HAC. This is the largest reported series of HAC treated with MMS with long-term follow-up.

  12. Laryngeal Schwannoma: A Case Presentation and Review of the Mayo Clinic Experience.

    Science.gov (United States)

    Romak, Jonathan J; Neel, H Bryan; Ekbom, Dale C

    2017-01-01

    The aim of this study was to clarify the nature of laryngeal schwannomas through review of the experience of a single institution during a 104-year period. This is a retrospective case series. The Mayo Clinic, Rochester, Minnesota clinical and surgical pathology database was reviewed for the years 1985-2011. Four cases of laryngeal schwannoma were identified. These cases were pooled with a previously published series of laryngeal schwannomas treated at our institution between 1907 and 1986. The characteristics of all 11 cases were studied, and relevant literature was reviewed. A total of 11 cases of schwannoma of the larynx were identified. The mean age at presentation was 48 years (range 12-73 years). The most common presenting symptoms were dysphonia and dysphagia. The most frequently involved primary site was the false vocal fold (six patients), followed by the aryepiglottic fold (three), epiglottis (two), subglottis (two), ventricle (one), true vocal fold (one) and postcricoid region (one). The mean maximal tumor diameter was 2.5 cm. In all but one case, surgical excision was curative with no recurrence during recorded follow up ranging from 1 to 17 years. Laryngeal schwannomas, although rare, should be considered in the differential diagnosis of laryngeal tumors. They occur most frequently in the false vocal fold and present most commonly with dysphonia and/or dysphagia. Surgical excision is the treatment of choice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  13. Lichen planus affecting the female genitalia: A retrospective review of patients at Mayo Clinic.

    Science.gov (United States)

    Fahy, Caoimhe M R; Torgerson, Rochelle R; Davis, Mark D P

    2017-12-01

    Genital or vulval lichen planus (VLP) may have a disabling effect on a patient's quality of life. Evidence-based management guidelines are lacking for VLP. We sought to review clinical presentation and treatment of patients who received a diagnosis of VLP. The 100 consecutive patients who received a diagnosis of VLP at Mayo Clinic between January 1, 1997, and December 31, 2015, were reviewed retrospectively. Descriptive statistics were used for data analysis. Fisher's exact test and the Wilcoxon rank sum test were used for analysis of categorical and continuous variables, respectively. All statistical tests were 2 sided, with the α level set at .05 for statistical significance. The time to diagnosis for 49% of patients was more than 1 year. Three patients (3%) had vulval dysplasia, including invasive squamous cell carcinoma. Sixty-eight patients (68%) had multisite lichen planus disease. Eleven patients (11%) had disease remission. Dermatology was the lead specialty for 9 of these cases of remission. This was a retrospective, small-cohort study. A low frequency of disease remission was seen in patients with VLP. Patients with lichen planus benefit considerably from dermatology consultation. Further research is warranted to establish high-quality, evidence-based guidelines for multidisciplinary management of this challenging disease. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital - Mayo Clinic collaborative study

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    Narang, Amol K; Haddock, Michael G; Donohue, John H; Schulick, Richard D; Wolfgang, Christopher L; Cameron, John L; Herman, Joseph M; Miller, Robert C; Hsu, Charles C; Bhatia, Sumita; Pawlik, Timothy M; Laheru, Dan; Hruban, Ralph H; Zhou, Jessica; Winter, Jordan M

    2011-01-01

    The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n = 290; 1992-2007) and at the Mayo Clinic (n = 130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n = 104 Johns Hopkins, n = 82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR = 1.86, p = 0.002), node positive status (RR = 3.18, p < 0.001), and poor histological grade (RR = 1.69, p = 0.011). Patients who received adjuvant chemoradiation (n = 66) vs. surgery alone (n = 120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P < 0.001), lymph node involvement (72.7% vs. 30.0%, P < 0.001), and close or positive margins (4.6% vs. 0.0%, P = 0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5 yr OS: 27.5% vs. 5.9%; RR = 0.47, P = 0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR = 0.40, P < 0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic

  15. Brief Report: Cancer Immunotherapy in Patients With Preexisting Rheumatic Disease: The Mayo Clinic Experience.

    Science.gov (United States)

    Richter, Michael D; Pinkston, Olga; Kottschade, Lisa A; Finnes, Heidi D; Markovic, Svetomir N; Thanarajasingam, Uma

    2018-03-01

    To determine the risk of rheumatic disease flare and adverse effects in patients with preexisting rheumatic disease who were receiving immune checkpoint inhibitor (ICI) therapy. A retrospective medical record review was performed to identify all patients who received ICI therapy at Mayo Clinic in Rochester, Minnesota between 2011 and 2016 (~700 patients). Those with a preexisting rheumatic disease were identified using specific diagnostic codes. Sixteen patients were identified (81% female, median age 68.5 years). The most common rheumatic diseases were rheumatoid arthritis (n = 5), polymyalgia rheumatica (n = 5), Sjögren's syndrome (n = 2), and systemic lupus erythematosus (n = 2). Seven patients were receiving immunosuppressive therapy or glucocorticoids for their rheumatic disease at the time of initiation of the ICI. The primary malignancies were melanoma (n = 10), pulmonary (n = 4), or hematologic (n = 2). In most cases, ICIs were offered only after failure of several other therapies. Immune-related adverse effects (IRAEs) occurred in 6 patients, and all were treated successfully with glucocorticoids and discontinuation of the ICI therapy. There were no significant differences in time from cancer diagnosis to immunotherapy, duration of immunotherapy, age, or sex between the patients with and those without IRAEs. To our knowledge, this represents the largest single-center cohort of patients with rheumatic diseases who were exposed to modern cancer immunotherapy. Only a minority of these patients experienced a flare of their preexisting rheumatic disease or any other IRAE. © 2017, American College of Rheumatology.

  16. Nurse practitioners and physician assistants: preparing new providers for hospital medicine at the mayo clinic.

    Science.gov (United States)

    Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S

    2014-01-01

    Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.

  17. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

    Science.gov (United States)

    Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

    2012-01-01

    Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  18. Think big, start small, move fast a blueprint for transformation from the Mayo Clinic Center for Innovation

    CERN Document Server

    LaRusso, Nicholas; Farrugia, Gianrico

    2015-01-01

    The Only Innovation Guide You Will Ever Need--from the Award-Winning Minds at Mayo Clinic. A lot of businesspeople talk about innovation, but few companies have achieved the level of truly transformative innovation as brilliantly--or as famously--as the legendary Mayo Clinic. Introducing Think Big, Start Small, Move Fast, the first innovation guide based on the proven, decade-long program that’s made Mayo Clinic one of the most respected and successful organizations in the world. This essential must-have guide shows you how to: Inspire and ignite trailblazing innovation in your workplace Design a new business model that’s creative, collaborative, and sustainable Apply the traditional scientific method to the latest innovations in "design thinking" Build a customized toolkit of the best practices, project portfolios, and strategies Increase your innovation capacity--and watch how quickly you succeed These field-tested techniques grew out of the health care industry but are designed ...

  19. Outcome prediction in home- and community-based brain injury rehabilitation using the Mayo-Portland Adaptability Inventory.

    Science.gov (United States)

    Malec, James F; Parrot, Devan; Altman, Irwin M; Swick, Shannon

    2015-01-01

    The objective of the study was to develop statistical formulas to predict levels of community participation on discharge from post-hospital brain injury rehabilitation using retrospective data analysis. Data were collected from seven geographically distinct programmes in a home- and community-based brain injury rehabilitation provider network. Participants were 642 individuals with post-traumatic brain injury. Interventions consisted of home- and community-based brain injury rehabilitation. The main outcome measure was the Mayo-Portland Adaptability Inventory (MPAI-4) Participation Index. Linear discriminant models using admission MPAI-4 Participation Index score and log chronicity correctly predicted excellent (no to minimal participation limitations), very good (very mild participation limitations), good (mild participation limitations), and limited (significant participation limitations) outcome levels at discharge. Predicting broad outcome categories for post-hospital rehabilitation programmes based on admission assessment data appears feasible and valid. Equations to provide patients and families with probability statements on admission about expected levels of outcome are provided. It is unknown to what degree these prediction equations can be reliably applied and valid in other settings.

  20. Outcomes and patterns of failure of sarcomatoid carcinoma of the larynx: The Mayo Clinic experience.

    Science.gov (United States)

    Gamez, Mauricio E; Jeans, Elizabeth; Hinni, Michael L; Moore, Eric; Young, Geoffrey; Ma, Daniel; McGee, Lisa; Buras, Matthew R; Patel, Samir H

    2018-02-01

    Sarcomatoid carcinoma is a rare variant of squamous cell carcinoma of the head and neck. No consensus exists on its management. Our aim was to present our outcomes. Retrospective study. Median follow-up 45 months. There were 38 patients with pathologically confirmed sarcomatoid carcinoma of the larynx treated at the Mayo Clinic from 1990 to 2014. Statistical analysis of overall survival (OS), progression-free survival (PFS), and local control (LC) were conducted using the Kaplan-Meier method. The majority of patients were elderly males (92%) with a smoking history (74%) presenting with early-stage disease (71%). Surgery alone was the primary treatment in 27 patients (71%). Nine patients (25%) were treated with adjuvant radiation due to initial stage or high-risk pathologic features. Median radiation dose to the primary/surgical bed was 65 Gy (range, 60.3-75.0 Gy). A total of 15 patients (39%) had tumor recurrence, majority being local (n = 12). Sixty percent (n = 9) had multiple local recurrences. Five-year OS, PFS, and LC were 63%, 46%, and 72%, respectively. Subgroup analysis by stage I versus higher stages (II-IV) showed an OS of 80% versus 43% (P = .030), PFS of 65% versus 18% (P = .003), and LC of 84% versus 57% (P = .039). Sarcomatoid carcinoma of the larynx is rare, and frequently presents at an early stage in older men with history of smoking. Based on our outcomes and patterns of failure, it appears early-stage tumors are treated appropriately with single-modality therapy, whereas more advanced tumors require multimodality therapy. Validation in a larger cohort is warranted. 4. Laryngoscope, 128:373-377, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient

    Directory of Open Access Journals (Sweden)

    M. A. C. Onuigbo

    2014-01-01

    Full Text Available Despite decades of research, a full understanding of chronic kidney disease (CKD-end stage renal disease (ESRD progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34% patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92 years. Precipitating AKI followed pneumonia (8, acutely decompensated heart failure (7, pyelonephritis (4, post-operative (5, sepsis (3, contrast-induced nephropathy (2, and others (2. Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

  2. Complex Fibroadenoma and Breast Cancer Risk: A Mayo Clinic Benign Breast Disease Cohort Studya

    Science.gov (United States)

    Nassar, Aziza; Visscher, Daniel W.; Degnim, Amy C.; Frank, Ryan D.; Vierkant, Robert A.; Frost, Marlene; Radisky, Derek C.; Vachon, Celine M.; Kraft, Ruth A.; Hartmann, Lynn C.; Ghosh, Karthik

    2015-01-01

    Purpose To examine the breast cancer risk overall among women with simple fibroadenoma or complex fibroadenoma and to examine the association of complex fibroadenoma with breast cancer through stratification of other breast cancer risks. Methods The study included women aged 18 to 85 years from the Mayo Clinic Benign Breast Disease Cohort who underwent excisional breast biopsy from 1967 through 1991. Within this cohort, women who had fibroadenoma were compared to women who did not have fibroadenoma. Breast cancer risk (observed vs expected) across fibroadenoma levels was assessed through standardized incidence ratios (SIRs) by using age- and calendar-stratified incidence rates from the Iowa Surveillance, Epidemiology, and End Results registry. Analyses were performed overall, within subgroups of involution status, with other demographic characteristics (age, year of biopsy, indication for biopsy, and family history), and with histologic characteristics, including overall impression (nonproliferative disease, proliferative disease without atypia [PDWA], or atypical hyperplasia). Results Fibroadenoma was identified in 2,136 women (noncomplex, 1,835 [85.9%]; complex, 301 [14.1%]). SIR for noncomplex fibroadenoma was 1.49 (95% CI, 1.26–1.74); for complex fibroadenoma, it was 2.27 (95% CI, 1.63–3.10) (test for heterogeneity in SIR, P=.02). However, women with complex fibroadenoma were more likely to have other, concomitant high-risk histologic characteristics (eg, incomplete involution and PDWA). In analyses stratified by involution status and PDWA, complex fibroadenoma was not an independent risk marker for breast cancer. Conclusions Complex fibroadenoma does not confer increased breast cancer risk beyond other established histologic characteristics. PMID:26264469

  3. Complex fibroadenoma and breast cancer risk: a Mayo Clinic Benign Breast Disease Cohort Study.

    Science.gov (United States)

    Nassar, Aziza; Visscher, Daniel W; Degnim, Amy C; Frank, Ryan D; Vierkant, Robert A; Frost, Marlene; Radisky, Derek C; Vachon, Celine M; Kraft, Ruth A; Hartmann, Lynn C; Ghosh, Karthik

    2015-09-01

    The purpose of this study is to examine the breast cancer risk overall among women with simple fibroadenoma or complex fibroadenoma and to examine the association of complex fibroadenoma with breast cancer through stratification of other breast cancer risks. The study included women aged 18-85 years from the Mayo Clinic Benign Breast Disease Cohort who underwent excisional breast biopsy from 1967 through 1991. Within this cohort, women who had fibroadenoma were compared to women who did not have fibroadenoma. Breast cancer risk (observed versus expected) across fibroadenoma levels was assessed through standardized incidence ratios (SIRs) by using age- and calendar-stratified incidence rates from the Iowa Surveillance, Epidemiology, and End Results registry. Analyses were performed overall, within subgroups of involution status, with other demographic characteristics (age, year of biopsy, indication for biopsy, and family history), and with histologic characteristics, including overall impression [nonproliferative disease, proliferative disease without atypia (PDWA), or atypical hyperplasia]. Fibroadenoma was identified in 2136 women [noncomplex, 1835 (85.9%); complex, 301 (14.1%)]. SIR for noncomplex fibroadenoma was 1.49 (95% CI 1.26-1.74); for complex fibroadenoma, it was 2.27 (95% CI 1.63-3.10) (test for heterogeneity in SIR, P = .02). However, women with complex fibroadenoma were more likely to have other, concomitant high-risk histologic characteristics (e.g., incomplete involution and PDWA). In analyses stratified by involution status and PDWA, complex fibroadenoma was not an independent risk marker for breast cancer. Complex fibroadenoma does not confer increased breast cancer risk beyond other established histologic characteristics.

  4. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience.

    Science.gov (United States)

    Grant, Clive S; Thompson, Geoffrey; Farley, David; van Heerden, Jon

    2005-05-01

    Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (HPT) has equal cure and recurrence rates as standard cervical exploration. Changes in the management of primary HPT have occurred since introducing MIP including localization, anesthesia, intraoperative parathyroid hormone monitoring, and indications for parathyroidectomy. Cohort analysis of 1361 consecutive patients with primary HPT operated on at the Mayo Clinic, Rochester, Minn, from June 1998 through March 2004. Mean follow-up, 25 months. Tertiary referral center. One thousand three hundred sixty-one patients operated on for primary HPT, excluding 160 patients who were reoperated on. Standard cervical exploration MIP. Cure, recurrence, localization, anesthesia, hospitalization, intraoperative parathyroid hormone level monitoring, contraindications to MIP, surgical indications, assessment of osteoporosis and osteopenia, postoperative patient assessment of general patient health, and operative satisfaction. Cure of primary HPT for both conventional exploration and MIP was 97%; only 1 patient who underwent MIP had a potential recurrence. Imaging sensitivity and positive predictive values were as follows: sestamibi scintigraphy, 86% and 93%; ultrasonography, 61% and 87%, respectively. Usage of general vs local anesthesia with intravenous sedation was 46% and 49%, respectively, in patients w ho underwent MIP; 46% were dismissed as outpatients, 49% had single-night stays. The accuracy of intraoperative parathyroid hormone level monitoring was as follows: 98% (8% had true-negative results); the frequency of multiple gland disease was 13%. Accounting for causes precluding MIP, an estimated 60% to 70% of all patients would be eligible for MIP. By preoperative assessment, 79% had osteoporosis-osteopenia; 58% with postoperative bone mineral density measurements were improved. More than 85% were satisfied with the results of their operation. With high-quality localization and intraoperative

  5. Quality improvement education incorporated as an integral part of critical care fellows training at the Mayo Clinic.

    Science.gov (United States)

    Kashani, Kianoush B; Ramar, Kannan; Farmer, J Christopher; Lim, Kaiser G; Moreno-Franco, Pablo; Morgenthaler, Timothy I; Dankbar, Gene C; Hale, Curt W

    2014-10-01

    The Accreditation Council for Graduate Medical Education emphasizes quality improvement (QI) education in residency/fellowship training programs. The Mayo Clinic Combined Critical Care Fellowship (CCF) program conducted a pilot QI education program to incorporate QI training as a required curriculum for the 2010-2011 academic year. CCF collaborated with the Mayo Quality Academy to customize and teach the existing Mayo Quality Fellows curriculum to the CCF fellows with the help of two quality coaches over five months starting July 2010. All fellows were to achieve Bronze and Silver certification prior to graduation. Silver required passing four written exams and submitting a health care QI project. Five projects were selected on the basis of the Impact-Effort Prioritization matrix, and DMAIC (Define, Measure, Analyze, Improve, and Control) methodology was used to complete the projects. The primary outcome was to assess learners' satisfaction, knowledge, and skill transfer. All 20 fellows were Bronze certified, and 14 (70%) were Silver certified by the time of graduation. All five QI projects were completed and showed positive impacts on patient safety and care. Surveys showed improved learner satisfaction. Graduates felt the QI training improved their QI skills and employment and career advancement. The QI curriculum had appropriate content and teaching pace and did not significantly displace other important clinical core curriculum topics. The pilot was successfully implemented in the CCF program and now is in the fourth academic year as an established and integral part of the fellowship core curriculum.

  6. Decline in Weight and Incident Mild Cognitive Impairment: Mayo Clinic Study of Aging

    Science.gov (United States)

    Alhurani, Rabe E.; Vassilaki, Maria; Aakre, Jeremiah; Mielke, Michelle M.; Kremers, Walter K.; Machulda, Mary M.; Geda, Yonas E.; Knopman, David S.; Peterson, Ronald C.; Roberts, Rosebud O.

    2016-01-01

    IMPORTANCE Unintentional weight loss has been associated with risk of dementia. Since mild cognitive impairment (MCI) is a prodromal stage for dementia, we sought to evaluate whether changes in weight and body mass index (BMI) may predict incident MCI. OBJECTIVE To investigate the association of change in weight and BMI with risk of MCI. DESIGN, SETTING, AND PARTICIPANTS A population-based, prospective study of participants aged 70 years and older from the Mayo Clinic Study of Aging. Maximum weight and height in midlife (aged 40 to 65 years old) were retrospectively ascertained from the medical records of participants using a medical records linkage system. MAIN OUTCOMES MEASURES Participants were evaluated for cognitive outcomes of normal cognition, MCI, or dementia at baseline and prospectively assessed for incident events at each 15-month evaluation. The association of rate of change in weight and body mass index with risk of MCI was investigated using proportional hazards models. RESULTS Over a mean follow-up of 4.4 years, 524 of 1895 cognitively normal participants developed incident MCI. The mean (standard deviation) rate of weight change per decade from midlife to study entry was greater for individuals who developed incident MCI vs. those who remained cognitively normal (−2.0 (5.1) vs. −1.2 (4.9) kg; p = 0.006). A greater decline in weight per decade was associated with an increased risk of incident MCI (hazard ratio [HR] 95% confidence interval [CI], 1.04 [1.02, 1.06], p weight loss of 5 kg/decade corresponds to a 24% increase in risk of MCI (HR=1.24). Higher decline in BMI per decade was also associated with incident MCI (HR, 1.08, 95% CI = [1.03, 1.13], p = 0.003). CONCLUSIONS AND RELEVANCE These findings suggest that declining weight from midlife to late-life is a marker for MCI and may help identify persons at increased risk for MCI. PMID:26831542

  7. Review of Adjuvant Radiochemotherapy for Resected Pancreatic Cancer and Results From Mayo Clinic for the 5th JUCTS Symposium

    International Nuclear Information System (INIS)

    Miller, Robert C.; Iott, Matthew J.; Corsini, Michele M.

    2009-01-01

    Purpose: To present an overview of Phase III trials in adjuvant therapy for pancreatic cancer and review outcomes at the Mayo Clinic after adjuvant radiochemotherapy (RT/CT) for resected pancreatic cancer. Methods and Materials: A literature review and a retrospective review of 472 patients who underwent an R0 resection for T1-3N0-1M0 invasive carcinoma of the pancreas from 1975 to 2005 at the Mayo Clinic, Rochester, MN. Patients with metastatic or unresectable disease at the time of surgery, positive surgical margins, or indolent tumors and those treated with intraoperative radiotherapy were excluded from the analysis. Median radiotherapy dose was 50.4Gy in 28 fractions, with 98% of patients receiving concurrent 5-fluorouracil- based chemotherapy. Results: Median follow-up was 2.7 years. Median overall survival (OS) was 1.8 years. Median OS after adjuvant RT/CT was 2.1 vs. 1.6 years for surgery alone (p = 0.001). The 2-y OS was 50% vs. 39%, and 5-y was 28% vs. 17% for patients receiving RT/CT vs. surgery alone. Univariate and multivariate analysis revealed that adverse prognostic factors were positive lymph nodes (risk ratio [RR] 1.3, p < 0.001) and high histologic grade (RR 1.2, p < 0.001). T3 tumor status was found significant on univariate analysis only (RR 1.1, p = 0.07). Conclusions: Results from recent clinical trials support the use of adjuvant chemotherapy in resected pancreatic cancer. The role of radiochemotherapy in adjuvant treatment of pancreatic cancer remains a topic of debate. Results from the Mayo Clinic suggest improved outcomes after the administration of adjuvant radiochemotherapy after a complete resection of invasive pancreatic malignancies.

  8. The Utility of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in US Military Veterans With a History of Mild Traumatic Brain Injury.

    Science.gov (United States)

    OʼRourke, Justin; Critchfield, Edan; Soble, Jason; Bain, Kathleen; Fullen, Chrystal; Eapen, Blessen

    2018-05-31

    To examine the utility of the Mayo-Portland Adaptability Inventory-4th Edition Participation Index (M2PI) as a self-report measure of functional outcome following mild traumatic brain injury (mTBI) in US Military veterans. Department of Veterans Affairs Polytrauma Rehabilitation Center specialty hospital. On hundred thirty-nine veterans with a history of self-reported mTBI. Retrospective cross-sectional examination of data collected from regular clinical visits. M2PI, Neurobehavioral Symptoms Inventory with embedded validity measures, Posttraumatic Stress Disorder Checklist-Military Version. Forty-one percent of the sample provided symptom reports that exceeded established cut scores on embedded symptom validity tests. Invalid responders had higher levels of unemployment and endorsed significantly greater functional impairment, posttraumatic stress symptoms, and postconcussive complaints. For valid responders, regression analyses revealed that self-reported functioning was primarily related to posttraumatic stress complaints, followed by postconcussive cognitive complaints. For invalid responders, posttraumatic stress complaints also predicted self-reported functioning. Caution is recommended when utilizing the M2PI to measure functional outcome following mTBI in military veterans, particularly in the absence of symptom validity tests.

  9. Assessment of anosognosia in persons with frontal lobe damage: clinical utility of the Mayo-Portland Adaptability Inventory (MPAI).

    Science.gov (United States)

    Murrey, G J; Hale, F M; Williams, J D

    2005-08-10

    To determine if the Mayo-Portland Adaptability Inventory (MPAI) demonstrates clinical utility in differentiating between persons with severe TBI and frontal lobe damage/anosognosia and persons with mild TBI and no frontal lobe damage. Forty-three persons with TBI and documented frontal lobe damage (mean age = 34; mean time since injury = 5.2 years) and 69 persons with mild TBI and no frontal lobe damage (mean age = 34.3; mean time since injury = 4.8 4.8 years). MPAI. Total inventory and select sub-category difference scores were significantly greater in the frontal lobe group than in the non-frontal lobe group. However, as expected, there was no significant difference between the two groups on the mobility sub-category difference scores. The MPAI appears to be potentially clinically useful in assessing for frontal lobe damage and associated anosognosia in patients with TBI.

  10. Harmonizing and consolidating the measurement of patient-reported information at health care institutions: a position statement of the Mayo Clinic

    Directory of Open Access Journals (Sweden)

    Eton DT

    2014-02-01

    Full Text Available David T Eton,1,2 Timothy J Beebe,1,2 Philip T Hagen,3 Michele Y Halyard,4 Victor M Montori,1,5 James M Naessens,1,2 Jeff A Sloan,6 Carrie A Thompson,7 Douglas L Wood1,81Division of Heath Care Policy and Research, Department of Health Sciences Research, 2Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 3Department of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, 4Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, 5Knowledge and Evaluation Research Unit, 6Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, 7Division of Hematology, Department of Medicine, 8Center for Innovation, Mayo Clinic, Rochester, MN, USAAbstract: Patient-reported outcomes (PROs capture how patients perceive their health and their health care; their use in clinical research is longstanding. Today, however, PROs increasingly are being used to inform the care of individual patients, and document the performance of health care entities. We recently wrote and internally distributed an institutional position statement titled "Harmonizing and Consolidating the Measurement of Patient-Reported Outcomes at Mayo Clinic: A Position Statement for the Center for the Science of Health Care Delivery". The statement is meant to educate clinicians, clinical teams, and institutional administrators about the merits of using PROs in a systematic manner for clinical care and quality measurement throughout the institution. The present article summarizes the most important messages from the statement, describing PROs and their use, identifying practical considerations for implementing them in routine practice, elucidating potential barriers to their use, and formulating strategies to overcome these barriers. The lessons learned from our experience – including pitfalls, challenges, and successes – may inform other health care institutions that are interested in

  11. Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome: rating scale analysis of the Mayo-Portland Adaptability Inventory.

    Science.gov (United States)

    Malec, J F; Moessner, A M; Kragness, M; Lezak, M D

    2000-02-01

    Evaluate the psychometric properties of the Mayo-Portland Adaptability Inventory (MPAI). Rating scale (Rasch) analysis of MPAI and principal component analysis of residuals; the predictive validity of the MPAI measures and raw scores was assessed in a sample from a day rehabilitation program. Outpatient brain injury rehabilitation. 305 persons with brain injury. A 22-item scale reflecting severity of sequelae of brain injury that contained a mix of indicators of impairment, activity, and participation was identified. Scores and measures for MPAI scales were strongly correlated and their predictive validities were comparable. Impairment, activity, and participation define a single dimension of brain injury sequelae. The MPAI shows promise as a measure of this construct.

  12. The Italian version of the Mayo-Portland Adaptability Inventory-4. A new measure of brain injury outcome.

    Science.gov (United States)

    Cattelani, R; Corsini, D; Posteraro, L; Agosti, M; Saccavini, M

    2009-12-01

    The assessment of major obstacles to community integration which may result from an acquired brain injury (ABI) is needed for rational planning and effective management of ABI patients' social adjustment. Currently, such a generally acceptable measure is not available for the Italian population. This paper reports the translation process, the internal consistency, and the inter-rater reliability data for the Italian version of the Mayo-Portland Adaptability Inventory-4 (MPAI-4), a useful measure with highly developed and well documented psychometric properties. The MPAI-4 is specifically designed to assess socially relevant aspects of physical status and cognitive-behavioural competence following ABI. It is a 29-item inventory which is divided into three subdomains (Abilities, Adjustment, and Participation indices) covering a reasonably representative range Twenty ABI patients with at least one-year discharge from the rehabilitation facilities were submitted to the Italian MPAI-4. They were independently rated by two different rehabilitation professionals and a family member/significant other serving as informant (SO). Internal consistency was assessed by calculating the Cronbach's alpha values. Inter-rater agreement for individual items was statistically examined by determining the interclass correlation coefficient (ICC). In addition to the 8% of perfectly correspondent sentences, a clear prevalence (75.5%) of minor semantic variations and formal variations with no semantic value at the sentence-to-sentence matching was found. Full-scale Cronbach's alpha was 0.951 and 0.947 for the two professionals (rater #1 and rater #2, respectively), and was 0.957 for the family member serving as informant (rater #3). Full-Scale ICC (2.1) between professionals and SOs was 0.804 (CI=95%; lower-upper bound=0.688-0.901). The Italian MPAI-4 shares many psychometric features with the original English version, demonstrates both good internal consistency and good inter

  13. Early experience of a fall and fracture prevention clinic at Mayo General Hospital.

    LENUS (Irish Health Repository)

    Hanley, A

    2010-06-01

    Falls in the elderly are a significant public health problem. Previous studies have shown that most falls are multifactorial and an efficacious way of reducing the risk of falling is provided by a falls clinic.

  14. Patterns in deer-related traffic injuries over a decade: the Mayo clinic experience

    Directory of Open Access Journals (Sweden)

    Smoot Dustin L

    2010-08-01

    Full Text Available Abstract Background Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC. We characterized injury patterns between motorcycle/all-terrain vehicles (MCC and automobile (MVC crashes related to dMVC (deer motor vehicle crash with the hypotheses that MCC will present with higher Injury Severity Score (ISS and that it would be related to whether the driver struck the deer or swerved. Methods The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS. Results Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5 and AIS of all body regions. Conclusions Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained.

  15. Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank.

    Science.gov (United States)

    Ryu, Euijung; Takahashi, Paul Y; Olson, Janet E; Hathcock, Matthew A; Novotny, Paul J; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R; Sloan, Jeff A

    2015-07-03

    Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits. Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain. The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females. Comorbid health burden has the

  16. The Arabic Version of the Mayo-Portland Adaptability Inventory 4: A Validation Study

    Science.gov (United States)

    Hamed, Razan; Tariah, Hashem Abu; Malkawi, Somaya; Holm, Margo B.

    2012-01-01

    The Mayo-Portland Adaptability Inventory 4 (MPAI-4) is a valid and reliable assessment tool to detect clinical impairments in patients with acquired brain injury. The tool is widely used by rehabilitation therapists worldwide, given its good psychometric properties and its availability in several languages. The purpose of this study was to…

  17. Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post-inpatient rehabilitation brain injury programs.

    Science.gov (United States)

    Eicher, Vicki; Murphy, Mary Pat; Murphy, Thomas F; Malec, James F

    2012-01-01

    To compare progress in 4 types of post-inpatient rehabilitation brain injury programs. Quasiexperimental observational cohort study. Community and residential. Individuals (N=604) with acquired brain injury. Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments. Mayo-Portland Adaptability Inventory (MPAI-4). Program types differed in participant age (F=10.69, PMPAI-4 score (F=6.89, PMPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores. Results are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. The association between peripheral total IGF-1, IGFBP-3, and IGF-1/IGFBP-3 and functional and cognitive outcomes in the Mayo Clinic Study of Aging.

    Science.gov (United States)

    Wennberg, Alexandra M V; Hagen, Clinton E; Machulda, Mary M; Hollman, John H; Roberts, Rosebud O; Knopman, David S; Petersen, Ronald C; Mielke, Michelle M

    2018-06-01

    Levels of insulin-like growth factor (IGF)-1, IGF-binding protein (IGFBP)-3, and their ratio in the blood may be useful for monitoring those at risk of cognitive and functional decline. However, the association between IGF measures and functional and cognitive outcomes has been mixed, and the associations may vary by sex. The present study investigated the cross-sectional, sex-specific associations between serum measures total IGF-1, IGFBP-3, and the IGF-1/IGFBP-3 ratio, gait speed, and cognition in 1320 cognitively unimpaired participants aged 50-95 years enrolled in the Mayo Clinic Study of Aging. We used multivariable linear regression models to determine the association between IGF measures and gait speed or cognitive test performance by sex. IGF measures were not associated with cognitive or functional performance among men. Among women, higher levels of log total IGF-1 and IGFBP-3 were associated with better performance in attention, visuospatial, and global cognitive domains, independent of the gait speed. These findings suggest that among women, IGF measures are associated with cognition, and these associations are independent of function. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Ecological validity of the screening module and the Daily Living tests of the Neuropsychological Assessment Battery using the Mayo-Portland Adaptability Inventory-4 in postacute brain injury rehabilitation.

    Science.gov (United States)

    Zgaljardic, Dennis J; Yancy, Sybil; Temple, Richard O; Watford, Monica F; Miller, Rebekah

    2011-11-01

    The assessment of ecological validity of neuropsychological measures is an area of growing interest, particularly in the postacute brain injury rehabilitation (PABIR) setting, as there is an increasing demand for clinicians to address functional and real-world outcomes. In the current study, we assessed the predictive value of the Screening module and the Daily Living tests of the Neuropsychological Assessment Battery (NAB) using clinician ratings from the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in patients with moderate to severe traumatic brain injury. Forty-seven individuals were each administered the NAB Screening module (NAB-SM) and the NAB Daily Living (NAB-DL) tests following admission to a residential PABIR program. MPAI-4 ratings were also obtained at admission. Linear regression analysis was used to examine the association between these functional and neuropsychological assessment measures. We replicated prior work (Temple at al., 2009) and expanded evidence for the ecological validity of the NAB-SM. Furthermore, our findings support the ecological validity of the NAB-DL Bill Payment, Judgment, and Map Reading tests with regards to functional skills and real-world activities. The current study supports prior work from our lab assessing the predictive value of the NAB-SM, as well as provides evidence for the ecological validity for select NAB-DL tests in patients with moderate to severe traumatic brain injury admitted to a residential PABIR program.

  20. Staged residential post-acute rehabilitation for adults following acquired brain injury: A comparison of functional gains rated on the UK Functional Assessment Measure (UK FIM+FAM) and the Mayo-Portland Adaptability Inventory (MPAI-4).

    Science.gov (United States)

    Jackson, Diana; Seaman, Karla; Sharp, Kristylee; Singer, Rachel; Wagland, Janet; Turner-Stokes, Lynne

    2017-01-01

    To compare the UK Functional Assessment Measure (UK FIM+FAM) and Mayo-Portland Adaptability Inventory (MPAI-4) as measures of functional change in patients with brain injury receiving a staged residential post-acute community-based rehabilitation programme. Longitudinal cohort study of consecutive admissions (N = 42) over 3 years. Patients were assessed at admission and discharge/annual review. We examined groups according to stage of independence on admission: Maximum support (stages 1 and 2: N = 17); moderate/maximum self-care/household support (stage 3: N = 15); minimal self-care and moderate household/community support (stages 4-6: N = 10). Median (IQR) age: 50 (37-56) years. Male:female ratio: (71%:29%). Aetiology: stroke (50%), traumatic (36%) and other brain injuries (14%). Both tools demonstrated significant gains in overall scores and all subscales (p MPAI-4 was more sensitive to changes in adjustment and participation for clients admitted in the later stages (4-6). The UK FIM+FAM and MPAI-4 provide complementary evaluation across functional tasks ranging from self-care to participation. This study supports their use for longitudinal outcome evaluation in community residential rehabilitation services that take patients at different stages of recovery.

  1. The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry

    Directory of Open Access Journals (Sweden)

    Moo-Sik Lee

    2014-07-01

    Full Text Available Objectives: This study aims to investigate trends of cardiovascular disease (CVD risk factor profiles over 17 years in percutaneous coronary intervention (PCI patients at the Mayo Clinic. Methods: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Results: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

  2. Functional brain imaging - baric and clinical questions

    International Nuclear Information System (INIS)

    Mager, T.; Moeller, H.J.

    1997-01-01

    The advancing biological knowledge of disease processes plays a central part in the progress of modern psychiatry. An essential contribution comes from the functional and structural brain imaging techniques (CT, MRI, SPECT, PET). Their application is important for biological oriented research in psychiatry and there is also a growing relevance in clinical aspects. This development is taken into account by recent diagnostic classification systems in psychiatry. The capabilities and limitations of functional brain imaging in the context of research and clinic will be presented and discussed by examples and own investigations. (orig.) [de

  3. Performance characteristics of the Mayo/IBM PACS

    Science.gov (United States)

    Persons, Kenneth R.; Gehring, Dale G.; Pavicic, Mark J.; Ding, Yingjai

    1991-07-01

    The Mayo Clinic and IBM (at Rochester, Minnesota) have jointly developed a picture archiving system for use with Mayo's MRI and Neuro CT imaging modalities. The communications backbone of the PACS is a portion of the Mayo institutional network: a series of 4-Mbps token rings interconnected by bridges and fiber optic extensions. The performance characteristics of this system are important to understand because they affect the response time a PACS user can expect, and the response time for non-PACS users competing for resources on the institutional network. The performance characteristics of each component and the average load levels of the network were measured for various load distributions. These data were used to quantify the response characteristics of the existing system and to tune a model developed by North Dakota State University Department of Computer Science for predicting response times of more complex topologies.

  4. The 2 + 1 paradigm: an efficient algorithm for central reading of Mayo endoscopic subscores in global multicenter phase 3 ulcerative colitis clinical trials.

    Science.gov (United States)

    Ahmad, Harris A; Gottlieb, Klaus; Hussain, Fez

    2016-02-01

    Despite its importance and potential impact in clinical trials, central reading continues to be an under-represented topic in the literature about inflammatory bowel disease (IBD) clinical trials. Although several IBD studies have incorporated central reading to date, none have fully detailed the specific methodology with which the reads were conducted. Here we outline key principles for designing an efficient central reading paradigm for an ulcerative colitis (UC) study that addresses regulatory, operational and clinical expectations. As a step towards standardization of read methodology for the growing number of multicenter phase 3 clinical trials in IBD, we have applied these principles to the design of an optimal read methodology that we call the '2 + 1 paradigm.' The 2 + 1 paradigm involves the use of both site and central readers, validated scoring criteria and multiple measures for blinding readers, all of which contribute to reducing bias and generating a reliable endoscopic subscore that reflects endoscopic disease severity. The paradigm can be utilized while maintaining a practical workflow compatible with an operationally feasible clinical trial. The 2 + 1 paradigm represents a logical approach to endoscopic assessment in IBD clinical trials, one that should be considered attractive to prospective sponsors, contract research organizations, key opinion leaders and regulatory authorities and be ready for implementation and further evaluation. © The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

  5. Burning mouth syndrome: results of screening tests for vitamin and mineral deficiencies, thyroid hormone, and glucose levels-experience at Mayo Clinic over a decade.

    Science.gov (United States)

    Morr Verenzuela, Claudia S; Davis, Mark D P; Bruce, Alison J; Torgerson, Rochelle R

    2017-09-01

    Burning mouth syndrome (BMS) is a disorder characterized by chronic mouth pain in the absence of objective clinical abnormalities. Vitamin or mineral deficiencies may have a role in BMS, but data regarding the prevalence and relevance of hematinic deficiencies are conflicting. We aimed to determine the frequency of specific laboratory abnormalities in patients with BMS. We retrospectively reviewed the results of screening blood tests in patients with BMS at our institution between January 2003 and December 2013. Among 659 patients with BMS, the most common decreased values or deficiencies were vitamin D 3 (15%), vitamin B 2 (15%), vitamin B 6 (5.7%), zinc (5.7%), vitamin B 1 (5.3%), thyrotropin (TSH) (3.2%), vitamin B 12 (0.8%), and folic acid (0.7%). Laboratory values for fasting blood glucose and TSH were increased in 23.7% and 5.2%, respectively. In patients with symptoms of BMS, our results suggest it is reasonable to screen for fasting blood glucose, vitamin D (D 2 and D 3 ), vitamin B 6 , zinc, vitamin B 1 , and TSH. Deficiencies of vitamin B 12 and folic acid were rare (<1% abnormal). © 2017 The International Society of Dermatology.

  6. STUDY ABOUT CLINICAL APPLICATION OF BRAIN ATLAS IN PAEDIATRICS

    Institute of Scientific and Technical Information of China (English)

    MENG Fanhang; LIU Cuiping; RENG Xiaoping; JIANG Lian

    2002-01-01

    Objectives To explore clinical application on brain atlas in paediatrics. Methode: Brain atlas was applied in diagnosis and treatment of paediatric diseases and its clinical value was discussed in 1990 ~2001. The manifestation of these diseases in brain atlas were analysed and the manifestation of CT of 67 cases and manifestations of EEG of 37 cases with that of BA were compared. Results The changes of cerebral electrical activity of these diseases were reflected objectively and showed directly in BA. Conclusion Brain atlas not only can point out quality of disease but also define position of disease. Therefore, brain atlas has important clinical value in paediatrics.

  7. Transforming Research Management Systems at Mayo Clinic

    Science.gov (United States)

    Smith, Steven C.; Gronseth, Darren L.

    2011-01-01

    In order for research programs at academic medical centers and universities to survive and thrive in the increasingly challenging economic, political and regulatory environment, successful transformation is extremely important. Transformation and quality management techniques are increasingly well established in medical practice organizations. In…

  8. Brain microbleeds: Epidemiology and clinical implications.

    Science.gov (United States)

    Boyano, I; Bravo, N; Miranda, J; Gil-Gregorio, P; Olazarán, J

    2016-06-22

    Brain microbleeds (BMB) are haemosiderin deposits contained within macrophages, which are displayed as hypointense images in some T2-weighted magnetic resonance imaging sequences. There are still many questions to be answered about the pathophysiology and clinical relevance of BMB. We conducted a literature review of the main epidemiological, clinical, and anatomical pathology studies of BMB performed in the general population, in patients at risk of or already suffering from a vascular disease, and in patients with cognitive impairment. We analysed the prevalence of BMB, risk factors, and potential pathophysiological mechanisms and clinical implications. The prevalence of BMB is highly variable (3%-27% in the general population, 6%-80% in patients with vascular risk factors or vascular disease, and 16%-45% in patients with cognitive impairment). BMB are associated with ageing, Alzheimer disease (AD), and in particular haemorrhagic or ischaemic cerebrovascular disease. The pathological substrate of BMB is either lipohyalinosis (subcortical BMB) or cerebral amyloid angiopathy (lobar BMB). BMB exacerbate cognitive impairment, possibly through cortical-subcortical and intracortical disconnection, and increase the risk of death, mostly due to vascular causes. BMB also increase the risk of cerebral haemorrhage, particularly in patients with multiple lobar BMB (probable erebral amyloid angiopathy). Therefore, anticoagulant treatment may be contraindicated in these patients. In patients with lower risk of bleeding, the new oral anticoagulants and the combination of clinical and magnetic resonance imaging follow-up could be helpful in the decision-making process. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  9. The clinical diagnosis of brain death

    African Journals Online (AJOL)

    Key words: brain death, diagnostic criteria, heartbeat. Death has been analysed in a heterogeneous .... angiography studies have also been used in order to evaluate brain circulation. According to some authors, the elective ... reflex response of spinal origin provoked by a sudden flexion of the neck and characterised by a.

  10. Elton Mayo and Carl Rogers: A Tale of Two Techniques.

    Science.gov (United States)

    Mahoney, Kevin T.; Baker, David B.

    2002-01-01

    Compares the simultaneous emergence of Mayo's nonauthoritarian interviewing approach and Rogers' nondirective counseling approach. Examines the influence of Piaget on Mayo and reviews the Hawthorne studies. Concludes that differences in the approaches outweigh similarities. (Contains 21 references.) (SK)

  11. Clinical impact of anatomo-functional evaluation of brain function during brain tumor surgery

    International Nuclear Information System (INIS)

    Mikuni, Nobuhiro; Kikuchi, Takayuki; Matsumoto, Atsushi; Yokoyama, Yohei; Takahashi, Jun; Hashimoto, Nobuo

    2009-01-01

    To attempt to improve surgical outcome of brain surgery, clinical significance of anatomo-functional evaluation of brain function during resection of brain tumors was assessed. Seventy four patients with glioma located near eloquent areas underwent surgery while awake. Intraoperative tractography-integrated functional neuronavigation and cortical/subcortical electrical stimulation were correlated with clinical symptoms during and after resection of tumors. Cortical functional areas were safely removed with negative electric stimulation and eloquent cortices could be removed in some circumstances. Subcortical functional mapping was difficult except for motor function. Studying cortical functional compensation allows more extensive removal of brain tumors located in the eloquent areas. (author)

  12. Chimeric brain: theoretical and clinical aspects.

    Science.gov (United States)

    Saveliev, S V; Lebedev, V V; Evgeniev, M B; Korochkin, L I

    1997-12-01

    Using xeno-transplantation, interactions of neural tissues of vertebrates and insects were studied. Ventral neurogenic primordium of Notch Drosophila melanogaster embryos was transplanted into neural tube of amphibian and mammalian embryos with the aid of microhydrofeeding. Embryos of four different amphibian species, random bred mice and rats were used as graft recipients. It was concluded that there is a possibility to incorporate nerve cells of insects into the brain of vertebrates. Morphological and functional contacts can be established between the transplanted cells and host brain tissues. Transplanted Drosophila cells preserve their viability for a long time, so that a prolonged influence of the transplant upon the recipient can be predicted, which may be used in medical practice. A mixture of human fetal brain and Notch Drosophila melanogaster neural embryonic tissues were transplanted into the ventro-lateral nucleus of the thalamus of the patients of Parkinson' disease. As a result, tremor and constrained movements disappeared. Post-operation patients have been observed within 13-38 months. No side effects were noted during this time.

  13. Clinical Relevance of Brain Volume Measures in Multiple Sclerosis

    DEFF Research Database (Denmark)

    De Stefano, Nicola; Airas, Laura; Grigoriadis, Nikolaos

    2014-01-01

    Multiple sclerosis (MS) is a chronic disease with an inflammatory and neurodegenerative pathology. Axonal loss and neurodegeneration occurs early in the disease course and may lead to irreversible neurological impairment. Changes in brain volume, observed from the earliest stage of MS...... therefore have important clinical implications affecting treatment decisions, with several clinical trials now demonstrating an effect of disease-modifying treatments (DMTs) on reducing brain volume loss. In clinical practice, it may therefore be important to consider the potential impact of a therapy...

  14. Clinical implementation of stereotaxic brain implant optimization

    International Nuclear Information System (INIS)

    Rosenow, U.F.; Wojcicka, J.B.

    1991-01-01

    This optimization method for stereotaxic brain implants is based on seed/strand configurations of the basic type developed for the National Cancer Institute (NCI) atlas of regular brain implants. Irregular target volume shapes are determined from delineation in a stack of contrast enhanced computed tomography scans. The neurosurgeon may then select up to ten directions, or entry points, of surgical approach of which the program finds the optimal one under the criterion of smallest target volume diameter. Target volume cross sections are then reconstructed in 5-mm-spaced planes perpendicular to the implantation direction defined by the entry point and the target volume center. This information is used to define a closed line in an implant cross section along which peripheral seed strands are positioned and which has now an irregular shape. Optimization points are defined opposite peripheral seeds on the target volume surface to which the treatment dose rate is prescribed. Three different optimization algorithms are available: linear least-squares programming, quadratic programming with constraints, and a simplex method. The optimization routine is implemented into a commercial treatment planning system. It generates coordinate and source strength information of the optimized seed configurations for further dose rate distribution calculation with the treatment planning system, and also the coordinate settings for the stereotaxic Brown-Roberts-Wells (BRW) implantation device

  15. Clinical review: Brain-body temperature differences in adults with severe traumatic brain injury

    Science.gov (United States)

    2013-01-01

    Surrogate or 'proxy' measures of brain temperature are used in the routine management of patients with brain damage. The prevailing view is that the brain is 'hotter' than the body. The polarity and magnitude of temperature differences between brain and body, however, remains unclear after severe traumatic brain injury (TBI). The focus of this systematic review is on the adult patient admitted to intensive/neurocritical care with a diagnosis of severe TBI (Glasgow Coma Scale score of less than 8). The review considered studies that measured brain temperature and core body temperature. Articles published in English from the years 1980 to 2012 were searched in databases, CINAHL, PubMed, Scopus, Web of Science, Science Direct, Ovid SP, Mednar and ProQuest Dissertations & Theses Database. For the review, publications of randomised controlled trials, non-randomised controlled trials, before and after studies, cohort studies, case-control studies and descriptive studies were considered for inclusion. Of 2,391 records identified via the search strategies, 37 were retrieved for detailed examination (including two via hand searching). Fifteen were reviewed and assessed for methodological quality. Eleven studies were included in the systematic review providing 15 brain-core body temperature comparisons. The direction of mean brain-body temperature differences was positive (brain higher than body temperature) and negative (brain lower than body temperature). Hypothermia is associated with large brain-body temperature differences. Brain temperature cannot be predicted reliably from core body temperature. Concurrent monitoring of brain and body temperature is recommended in patients where risk of temperature-related neuronal damage is a cause for clinical concern and when deliberate induction of below-normal body temperature is instituted. PMID:23680353

  16. Exploring the uncertainties of early detection results: Model-based interpretation of mayo lung project

    NARCIS (Netherlands)

    L. Shi (Lu); H. Tian (Haijun); W.J. McCarthy (William); B. Berman (Barbara); S. Wu (Shinyi); R. Boer (Rob)

    2011-01-01

    textabstractBackground: The Mayo Lung Project (MLP), a randomized controlled clinical trial of lung cancer screening conducted between 1971 and 1986 among male smokers aged 45 or above, demonstrated an increase in lung cancer survival since the time of diagnosis, but no reduction in lung cancer

  17. Clinical evaluation of FMPSPGR sequence of the brain MR imaging

    International Nuclear Information System (INIS)

    Takahashi, Mitsuyuki; Hasegawa, Makoto; Mori, Naohiko; Yamanoguchi, Minoru; Matsubara, Tadashi

    1998-01-01

    In order to apply the FMPSPGR (fast multi planar spoiled GRASS) method to diagnose brain diseases, authors obtained the optimal condition for imaging by the phantom experiments and examined the clinical usefulness. Six kinds of the phantom, which were 4 of diluted Gd solution with different concentrations, olive oil and physiological saline solution were used. From the phantom experiments, TR/TE/FR=300/3.3/90 degrees was the optimal condition. The evaluation of the clinical images was performed on the same section by the ST method and the FMPSPGR method. Fifteen patients (9 men and 6 women, aged from 17 to 80 years) suspected of brain diseases were examined, including 8 of cerebral infarction, 1 of pontine infarction, 1 of brain contusion, 1 of intracerebral bleeding and 4 of brain tumors. Four cases of brain tumor were evaluated on the contrast imaging and the others were on the plain imaging. In the plain imaging, the FMPSPGR method was better than the SE method on the low signal region in the T1 weighted imaging. Furthermore, in the contrast imaging, it could give more clear images of the lesion in anterior cranial pit by suppressing artifacts of blood flow. The present results indicate that the FMPSPGR method is useful to diagnose brain diseases. (K.H.)

  18. Bottlenecks to Clinical Translation of Direct Brain-Computer Interfaces

    Directory of Open Access Journals (Sweden)

    Mijail Demian Serruya

    2014-12-01

    Full Text Available Despite several decades of research into novel brain-implantable devices to treat a range of diseases, only two- cochlear implants for sensorineural hearing loss and deep brain stimulation for movement disorders- have yielded any appreciable clinical benefit. Obstacles to translation include technical factors (e.g., signal loss due to gliosis or micromotion, lack of awareness of current clinical options for patients that the new therapy must outperform, traversing between federal and corporate funding needed to support clinical trials, and insufficient management expertise. This commentary reviews these obstacles preventing the translation of promising new neurotechnologies into clinical application and suggests some principles that interdisciplinary teams in academia and industry could adopt to enhance their chances of success.

  19. Normal feline brain: clinical anatomy using magnetic resonance imaging.

    Science.gov (United States)

    Mogicato, G; Conchou, F; Layssol-Lamour, C; Raharison, F; Sautet, J

    2012-04-01

    The purpose of this study was to provide a clinical anatomy atlas of the feline brain using magnetic resonance imaging (MRI). Brains of twelve normal cats were imaged using a 1.5 T magnetic resonance unit and an inversion/recovery sequence (T1). Fourteen relevant MRI sections were chosen in transverse, dorsal, median and sagittal planes. Anatomic structures were identified and labelled using anatomical texts and Nomina Anatomica Veterinaria, sectioned specimen heads, and previously published articles. The MRI sections were stained according to the major embryological and anatomical subdivisions of the brain. The relevant anatomical structures seen on MRI will assist clinicians to better understand MR images and to relate this neuro-anatomy to clinical signs. © 2011 Blackwell Verlag GmbH.

  20. Clinical Relevance of Discourse Characteristics after Right Hemisphere Brain Damage

    Science.gov (United States)

    Blake, Margaret Lehman

    2006-01-01

    Purpose: Discourse characteristics of adults with right hemisphere brain damage are similar to those reported for healthy older adults, prompting the question of whether changes are due to neurological lesions or normal aging processes. The clinical relevance of potential differences across groups was examined through ratings by speech-language…

  1. Functional brain imaging in the clinical assessment of consciousness.

    Directory of Open Access Journals (Sweden)

    Michael S Rafii

    2010-11-01

    Full Text Available Recent findings suggest that functional brain imaging might be used to identify consciousness in patients diagnosed with persistent vegetative state and minimally conscious state. Michael Rafii and James Brewer discuss the potential for fMRI's wider implementation in clinical practice, and associated caveats.

  2. Clinical practice in BNCT to the brain

    International Nuclear Information System (INIS)

    Nakagawa, Y.

    2001-01-01

    Our concept of Boron Neutron Capture Therapy (BNCT) is to selectively destroy tumour cells using the high LET particles yielded from the 10B(n,α)7Li reactions. The effort of clinical investigators has concentrated on how to escalate the radiation dose at the target point. BNCT in Japan combines thermal neutrons and BSH (Na 2 B 12 H 11 SH). The radiation dose is determined by the neutron fluence at the target point and the boron concentration in the tumour tissue. According to the recent analysis, the ratio of boron concentration (BSH) in tumour tissue and blood is nearly stable at around 1.2 to 1.69. Escalation of the radiation dose was carried out by means of improving the penetration of the thermal neutron beam. Since 1968, 175 patients with glioblastoma (n=83), anaplastic astrocytoma (n=44), low grade astrocytoma (n=16) or other types of tumour (n=32) were treated by BNCT at 5 reactors (HTR n=13, JRR-3 n=1, MulTR n=98, KUR n=30, JRR-2 n=33). The retrospective analysis revealed that the important factors related to the clinical results and QOL of the patients were minimum tumour volume radiation dose, more than 18Gy of physical dose and maximum vascular radiation dose (less than 15Gy) in the normal cortex. We have planned several trials to escalate the target radiation dose. One trial makes use of a cavity in the cortex following debulking surgery of the tumour tissue to improve neutron penetration. The other trial is introduction of epithermal neutron. KUR and JRR-4 were reconstructed and developed to be able to irradiate using epithermal neutrons. The new combination of surgical procedure and irradiation using epithermal neutrons should remarkably improve the target volume dose compared to the radiation dose treated by thermal neutrons. (author)

  3. Further psychometric evaluation and revision of the Mayo-Portland Adaptability Inventory in a national sample.

    Science.gov (United States)

    Malec, James F; Kragness, Miriam; Evans, Randall W; Finlay, Karen L; Kent, Ann; Lezak, Muriel D

    2003-01-01

    To evaluate the internal consistency of the Mayo-Portland Adaptability Inventory (MPAI), further refine the instrument, and provide reference data based on a large, geographically diverse sample of persons with acquired brain injury (ABI). 386 persons, most with moderate to severe ABI. Outpatient, community-based, and residential rehabilitation facilities for persons with ABI located in the United States: West, Midwest, and Southeast. Rasch, item cluster, principal components, and traditional psychometric analyses for internal consistency of MPAI data and subscales. With rescoring of rating scales for 4 items, a 29-item version of the MPAI showed satisfactory internal consistency by Rasch (Person Reliability=.88; Item Reliability=.99) and traditional psychometric indicators (Cronbach's alpha=.89). Three rationally derived subscales for Ability, Activity, and Participation demonstrated psychometric properties that were equivalent to subscales derived empirically through item cluster and factor analyses. For the 3 subscales, Person Reliability ranged from.78 to.79; Item Reliability, from.98 to.99; and Cronbach's alpha, from.76 to.83. Subscales correlated moderately (Pearson r =.49-.65) with each other and strongly with the overall scale (Pearson r=.82-.86). Outcome after ABI is represented by the unitary dimension described by the MPAI. MPAI subscales further define regions of this dimension that may be useful for evaluation of clinical cases and program evaluation.

  4. Factor analysis of the Mayo-Portland Adaptability Inventory: structure and validity.

    Science.gov (United States)

    Bohac, D L; Malec, J F; Moessner, A M

    1997-07-01

    Principal-components (PC) factor analysis of the Mayo-Portland Adaptability Inventory (MPAI) was conducted using a sample of outpatients (n = 189) with acquired brain injury (ABI) to evaluate whether outcome after ABI is multifactorial or unifactorial in nature. An eight-factor model was derived which explained 64-4% of the total variance. The eight factors were interpreted as representing Activities of Daily Living, Social Initiation, Cognition, Impaired-Self-awareness/Distress, Social Skills/ Support, Independence, Visuoperceptual, and Psychiatric, respectively. Validation of the Cognition factor was supported when factor scores were correlated with various neuropsychological measures. In addition, 117 patient self-rating total scores were used to evaluate the Impaired Self-awareness/Distress factor. An inverse relationship was observed, supporting this factor's ability to capture the two-dimensional phenomena of diminished self-awareness or enhanced emotional distress. A new subscale structure is suggested, that may allow greater clinical utility in understanding how ABI manifests in patients, and may provide clinicians with a better structure for implementing treatment strategies to address specific areas of impairment and disability for specific patients. Additionally, more precise measurement of treatment outcomes may be afforded by this reorganization.

  5. The Pine Ridge-Mayo National Aeronautics and Space Administration Telemedicine Project: Program Activities and Participant Reactions

    Science.gov (United States)

    Kottke, T. E.; Little Finger, L.; Trapp, M. A.; Panser, L. A.; Novotny, P. J.

    1996-01-01

    OBJECTIVE: To determine the response of participants to the Pine Ridge-Mayo National Aeronautics and Space Administration telemedicine project. DESIGN: We describe a 3-month demonstration project of medical education and clinical consultations conducted by means of satellite transmission. Postparticipation questionnaires and a postproject survey were used to assess the success of the activity. MATERIAL AND METHODS: Patients and employees at the Pine Ridge Indian Health Service Hospital in southwestern South Dakota and employees at Mayo Clinic Rochester participated in a telemedicine project, after which they completed exit surveys and a postproject questionnaire to ascertain the acceptability of this mode of health care. RESULTS: Almost all Pine Ridge and Mayo Clinic participants viewed the project as beneficial. The educational sessions received favorable evaluations, and almost two-thirds of the patients who completed evaluations thought the consultation had contributed to their medical care. More than 90% of the respondents from Pine Ridge and more than 85% of the respondents from Mayo Clinic Rochester said that they would recommend participation in this project to others. More than 90% of respondents from Pine Ridge and 80% of Mayo respondents agreed with the statement that the project should continue. CONCLUSION: These data suggest that a program of clinical consultation services, professional education, and patient education available by telemedicine might be viewed as beneficial.

  6. Brain metastasis of breast cancer: clinical and radiologic findings

    International Nuclear Information System (INIS)

    An, Jin Kyung; Oh, Ki Keun; Kim, Eun Kyung; Chung, Tae Sub

    2001-01-01

    To analyse the clinical and radiologic findings brain metastasis of breast cancer. Sixty-one of 1399 patients in whom breast cancer was diagnosed between 1983 and 1999 were affected by brain metastasis. Among these 1399, the stage of the breast cancer, in descending order of frequency, was IIA (n=508), I (n=366), IIB (n=247), IIIA (n=189), IIIB (n=45), 0 (n=33) and IV (n=11). The stage of the 61 brain metastases, similarly ordered, was IIB (12.5%), IIA (3.9%), IIIA (3.1%), IIIB (2.2%) and I (0.8%). In all confirmed breast cancers, the age distribution, in descending order of frequency, was 40-49years (n=610), 50-59 (n=301), 30-39 (n=291), 60-69 (n=124), 20-19 (n=41), 70-79 (n=28), and 80-89 (n=4). The age distribution of brain metastasis was 20-29 (14.6%), 30-39 (7.9%), 50-59 (4.6%). 40-49 (2.6%) and 60-69 (1.6%). Imaging findings were available for 35 of the 61 patients affected by brain metastasis, and symptoms from brain among the 35, analysis of the symptoms of this metastasis, the site of the first distant metastasis to an extracranial or cranial organ, the interval from the diagnosis of breast cancer to brain metastasis, the interval from brain metastasis to death, and the difference in survival time between patients with initial and succeeding brain metastasis was undertaken. Brain CT findings were analysed in 29 cases and MRI findings in eight. The most common symptoms were headache and vomiting. Among the 35 brain metastasis patients for whom imaging findings were available, other systemic metastasis occurred in 22. Initial brain metastasis occurred in the remaining 13, and in seven of these there was also coincident organ metastasis, while six showed only brain metastasis, The most frequent intervals from the diagnosis of breast cancer to brain metastasis were 1-2 years(8/35) and 2-3years(8/35). Twenty-six of 35 patients died within one year of brain metastasis. Patients in whom this occurred later survived for longer than those in whom it occurred

  7. Clinical applications of 7 T MRI in the brain

    International Nuclear Information System (INIS)

    Kolk, Anja G. van der; Hendrikse, Jeroen; Zwanenburg, Jaco J.M.; Visser, Fredy; Luijten, Peter R.

    2013-01-01

    This review illustrates current applications and possible future directions of 7 Tesla (7 T) Magnetic Resonance Imaging (MRI) in the field of brain MRI, in clinical studies as well as clinical practice. With its higher signal-to-noise (SNR) and contrast-to-noise ratio (CNR) compared to lower field strengths, high resolution, contrast-rich images can be obtained of diverse pathologies, like multiple sclerosis (MS), brain tumours, aging-related changes and cerebrovascular diseases. In some of these diseases, additional pathophysiological information can be gained compared to lower field strengths. Because of clear depiction of small anatomical details, and higher lesion conspicuousness, earlier diagnosis and start of treatment of brain diseases may become possible. Furthermore, additional insight into the pathogenesis of brain diseases obtained with 7 T MRI could be the basis for new treatment developments. However, imaging at high field comes with several limitations, like inhomogeneous transmit fields, a higher specific absorption rate (SAR) and, currently, extensive contraindications for patient scanning. Future studies will be aimed at assessing the advantages and disadvantages of 7 T MRI over lower field strengths in light of clinical applications, specifically the additional diagnostic and prognostic value of 7 T MRI

  8. Clinical applications of 7 T MRI in the brain

    Energy Technology Data Exchange (ETDEWEB)

    Kolk, Anja G. van der, E-mail: A.G.vanderKolk@umcutrecht.nl [Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA Utrecht (Netherlands); Hendrikse, Jeroen, E-mail: J.Hendrikse@umcutrecht.nl [Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA Utrecht (Netherlands); Zwanenburg, Jaco J.M., E-mail: J.J.M.Zwanenburg@umcutrecht.nl [Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA Utrecht (Netherlands); Image Sciences Institute, University Medical Center Utrecht (Netherlands); Visser, Fredy, E-mail: F.Visser-2@umcutrecht.nl [Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA Utrecht (Netherlands); Philips Healthcare, Best (Netherlands); Luijten, Peter R., E-mail: P.Luijten@umcutrecht.nl [Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA Utrecht (Netherlands)

    2013-05-15

    This review illustrates current applications and possible future directions of 7 Tesla (7 T) Magnetic Resonance Imaging (MRI) in the field of brain MRI, in clinical studies as well as clinical practice. With its higher signal-to-noise (SNR) and contrast-to-noise ratio (CNR) compared to lower field strengths, high resolution, contrast-rich images can be obtained of diverse pathologies, like multiple sclerosis (MS), brain tumours, aging-related changes and cerebrovascular diseases. In some of these diseases, additional pathophysiological information can be gained compared to lower field strengths. Because of clear depiction of small anatomical details, and higher lesion conspicuousness, earlier diagnosis and start of treatment of brain diseases may become possible. Furthermore, additional insight into the pathogenesis of brain diseases obtained with 7 T MRI could be the basis for new treatment developments. However, imaging at high field comes with several limitations, like inhomogeneous transmit fields, a higher specific absorption rate (SAR) and, currently, extensive contraindications for patient scanning. Future studies will be aimed at assessing the advantages and disadvantages of 7 T MRI over lower field strengths in light of clinical applications, specifically the additional diagnostic and prognostic value of 7 T MRI.

  9. Against the Corporate Culture Ideology: An Interview with Peter Mayo

    Science.gov (United States)

    Suoranta, Juha

    2010-01-01

    This article presents an interview with Peter Mayo, author and expert in the field of sociology of adult education, on his major influences in this area, his books, and his views on the role of radical adult education and radical scholarship in the future. In the interview, Peter Mayo states that his initial view of adult education was quite a…

  10. Clinical Application of Neuroplastic Brain Research in Eating Disorder Treatment

    Directory of Open Access Journals (Sweden)

    Abigail H. Natenshon

    2016-12-01

    Neurophysiological and psychophysiological treatment interventions, by carving new neuronal pathways and creating connectivity that augments brain circuitry, carry the potential to remediate body image and self-image distortions, reintegrating the fragmented eating disordered core self. To date, intentional partnering between therapist, ED patient, and neuroplastic brain has been rarely applied in the clinical milieu and minimally referenced in the treatment literature. By bringing current neuroplasticity research into frontline practice, ED practitioners not only bridge the research/practice gap, but redefine new directions for future ED research.

  11. Le nonne di Plaza de Mayo

    Directory of Open Access Journals (Sweden)

    Benedetta Calandra

    2006-11-01

    Full Text Available The article is focused on a specific case study of ‘motherist movement’ in Argentina during the last military rule (1976-1983: the Grandmothers of Plaza de Mayo. Blurring the boundaries between public and private realm, these old women, without a previous, soundly-based political conscience, were able to set up a transnational human rights movement, well known all over the world, while looking for their abducted grandchildren. A crucial issue, still, is: how far did this group go in terms of advocating womens’ rights? Could we really find a correspondence, as Jelin puts it, between ‘women for human rights’ and ‘women for women’s rights’? The answer, as the Argentinean case shows, seems to be not so straightforward.

  12. Clinical considerations for neutron capture therapy of brain tumors

    International Nuclear Information System (INIS)

    Madoc-Jones, H.; Wazer, D.E.; Zamenhof, R.G.; Harling, O.K.; Bernard, J.A. Jr.

    1990-01-01

    The radiotherapeutic management of primary brain tumors and metastatic melanoma in brain has had disappointing clinical results for many years. Although neutron capture therapy was tried in the US in the 1950s and 1960s, the results were not as hoped. However, with the newly developed capability to measure boron concentrations in blood and tissue both quickly and accurately, and with the advent of epithermal neutron beams obviating the need for scalp and skull reflection, it should not be possible to mount such a clinical trial of NCT again and avoid serious complications. As a prerequisite, it will be important to demonstrate the differential uptake of boron compound in brain tumor as compared with normal brain and its blood supply. If this can be done, then a trial of boron neutron capture therapy for brain tumors should be feasible. Because boronated phenylalanine has been demonstrated to be preferentially taken up by melanoma cells through the biosynthetic pathway for melanin, there is special interest in a trial of boron neutron capture therapy for metastatic melanoma in brain. Again, the use of an epithermal beam would make this a practical possibility. However, because any epithermal (or thermal) beam must contain a certain contaminating level of gamma rays, and because even a pure neutron beam cases gamma rays to be generated when it interacts with tissue, they think that it is essential to deliver treatments with an epithermal beam for boron neutron capture therapy in fractions in order to minimize the late-effects of low-LET gamma rays in the normal tissue

  13. A correlation of clinical, MRI and brain SPECT in dementia

    International Nuclear Information System (INIS)

    Shelley, S.; Indirani, M.; Gokhale, S.; Anirudhan, N.; Sivakumar, M.R.; Jaganathan, K.

    2004-01-01

    Background: Dementia is a clinical syndrome characterised by acquired impairment in multiple neuropsycologic and behavior domains including memory, language, speech, visuospatial ability, cognition and mood/personality. Dementia produces deficits in perfusion reflecting decreased metabolic needs. Neuroimaging techniques help in determining whether the cognitive symptoms are organic and in which pattern of cognitive loss the patient may evolve. AIM: To differentiate various types of Dementia, based on the regional perfusion abnormalities seen in Brain SPECT and correlate this with Clinical and MRI findings. Material and methods: Patients suffering from memory impairment and memory loss were referred to our department for Brain SPECT as a part of work up for Dementia. They had undergone a detailed clinical examination, psychometry, mini mental status examination (MMSE), memory/cognitive testing and an MRI. Brain SPECT was done after injecting Tc 99m ECD (Ethylene Cysteinate Dimer ) and imaging after 45 minutes. The images obtained were reconstructed in a conventional way. The various patterns of perfusion abnormalities seen in the SPECT images was studied and correlated with MRI and clinical findings. The patients were thus classified as having Multi Infarct Dementia, Alzheimer's disease, Fronto-Temporal Dementia and Mixed variety. Results: Twenty One Patients were included in our study from February 2003 to February 2004. The mean age of the patients was 73 years ( 37 to 81). 15 were males and 6 were females. Out of 21 patients, 12 had Multi Infarct Dementia, 4 had Alzheimer's disease, 1 had Fronto- Temporal Dementia and 4 had Mixed variety. Conclusion: Brain SPECT aids in substantiating the clinical findings and in correlation with MRI helps in distinguishing various types of Dementia and thus has prognostic implications and helps in instituting early appropriate treatment to the patient. In our study, the majority of the patients have Multi Infarct Dementia

  14. Clinical validation of synthetic brain MRI in children: initial experience

    International Nuclear Information System (INIS)

    West, Hollie; Leach, James L.; Jones, Blaise V.; Care, Marguerite; Radhakrishnan, Rupa; Merrow, Arnold C.; Alvarado, Enrique; Serai, Suraj D.

    2017-01-01

    The purpose of this study was to determine the diagnostic accuracy of synthetic MR sequences generated through post-acquisition processing of a single sequence measuring inherent R1, R2, and PD tissue properties compared with sequences acquired conventionally as part of a routine clinical pediatric brain MR exam. Thirty-two patients underwent routine clinical brain MRI with conventional and synthetic sequences acquired (22 abnormal). Synthetic axial T1, T2, and T2 fluid attenuation inversion recovery or proton density-weighted sequences were made to match the comparable clinical sequences. Two exams for each patient were de-identified. Four blinded reviewers reviewed eight patients and were asked to generate clinical reports on each exam (synthetic or conventional) at two different time points separated by a mean of 33 days. Exams were rated for overall and specific finding agreement (synthetic/conventional and compared to gold standard consensus review by two senior reviewers with knowledge of clinical report), quality, and diagnostic confidence. Overall agreement between conventional and synthetic exams was 97%. Agreement with consensus readings was 84% (conventional) and 81% (synthetic), p = 0.61. There were no significant differences in sensitivity, specificity, or accuracy for specific imaging findings involving the ventricles, CSF, brain parenchyma, or vasculature between synthetic or conventional exams (p > 0.05). No significant difference in exam quality, diagnostic confidence, or noise/artifacts was noted comparing studies with synthetic or conventional sequences. Diagnostic accuracy and quality of synthetically generated sequences are comparable to conventionally acquired sequences as part of a standard pediatric brain exam. Further confirmation in a larger study is warranted. (orig.)

  15. Clinical validation of synthetic brain MRI in children: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    West, Hollie; Leach, James L.; Jones, Blaise V.; Care, Marguerite; Radhakrishnan, Rupa; Merrow, Arnold C.; Alvarado, Enrique; Serai, Suraj D. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2017-01-15

    The purpose of this study was to determine the diagnostic accuracy of synthetic MR sequences generated through post-acquisition processing of a single sequence measuring inherent R1, R2, and PD tissue properties compared with sequences acquired conventionally as part of a routine clinical pediatric brain MR exam. Thirty-two patients underwent routine clinical brain MRI with conventional and synthetic sequences acquired (22 abnormal). Synthetic axial T1, T2, and T2 fluid attenuation inversion recovery or proton density-weighted sequences were made to match the comparable clinical sequences. Two exams for each patient were de-identified. Four blinded reviewers reviewed eight patients and were asked to generate clinical reports on each exam (synthetic or conventional) at two different time points separated by a mean of 33 days. Exams were rated for overall and specific finding agreement (synthetic/conventional and compared to gold standard consensus review by two senior reviewers with knowledge of clinical report), quality, and diagnostic confidence. Overall agreement between conventional and synthetic exams was 97%. Agreement with consensus readings was 84% (conventional) and 81% (synthetic), p = 0.61. There were no significant differences in sensitivity, specificity, or accuracy for specific imaging findings involving the ventricles, CSF, brain parenchyma, or vasculature between synthetic or conventional exams (p > 0.05). No significant difference in exam quality, diagnostic confidence, or noise/artifacts was noted comparing studies with synthetic or conventional sequences. Diagnostic accuracy and quality of synthetically generated sequences are comparable to conventionally acquired sequences as part of a standard pediatric brain exam. Further confirmation in a larger study is warranted. (orig.)

  16. Rasch measurement analysis of the Mayo-Portland Adaptability Inventory (MPAI-4) in a community-based rehabilitation sample.

    Science.gov (United States)

    Kean, Jacob; Malec, James F; Altman, Irwin M; Swick, Shannon

    2011-05-01

    The precise measurement of patient outcomes depends upon clearly articulated constructs and refined clinical assessment instruments that work equally well for all subgroups within a population. This is a challenging task in those with acquired brain injury (ABI) because of the marked heterogeneity of the disorder and subsequent outcomes. Although essential, the iterative process of instrument refinement is often neglected. This present study was undertaken to examine validity, reliability, dimensionality and item estimate invariance of the Mayo-Portland Adaptability Inventory - 4 (MPAI-4), an outcome measure for persons with ABI. The sampled population included 603 persons with traumatic ABI participating in a home- and community-based rehabilitation program. Results indicated that the MPAI-4 is a valid, reliable measure of outcome following traumatic ABI, which measures a broad but unitary core construct of outcome after ABI. Further, the MPAI-4 is composed of items that are unbiased toward selected subgroups except where differences could be expected [e.g., more chronic traumatic brain injury (TBI) patients are better able to negotiate demands of transportation than more acute TBI patients]. We address the trade-offs between strict unidimensionality and clinical applicability in measuring outcome, and illustrate the advantages and disadvantages of applying single-parameter measurement models to broad constructs.

  17. Incidental ferumoxytol artifacts in clinical brain MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Bowser, Bruce A.; Campeau, Norbert G.; Carr, Carrie M.; Diehn, Felix E.; McDonald, Jennifer S.; Miller, Gary M.; Kaufmann, Timothy J. [Mayo Clinic, Department of Radiology, Rochester, MN (United States)

    2016-11-15

    Ferumoxytol (Feraheme) is a parenteral therapy approved for treatment of iron deficiency anemia. The product insert for ferumoxytol states that it may affect the diagnostic ability of MRI for up to 3 months. However, the expected effects may not be commonly recognized among clinical neuroradiologists. Our purpose is to describe the artifacts we have seen at our institution during routine clinical practice. We reviewed the patients at our institution that had brain MRI performed within 90 days of receiving intravenous ferumoxytol. The imaging was reviewed for specific findings, including diffusion-weighted imaging vascular susceptibility artifact, gradient-echo echo-planar T2*-weighted vascular susceptibility artifact, SWI/SWAN vascular susceptibility artifact, hypointense vascular signal on T2-weighted images, pre-gadolinium contrast vascular enhancement on magnetization-prepared rapid acquisition gradient echo (MPRAGE) imaging, and effects on post-gadolinium contrast T1 imaging. Multiple artifacts were observed in patients having a brain MRI within 3 days of receiving intravenous ferumoxytol. These included susceptibility artifact on DWI, GRE, and SWAN/SWI imaging, pre-gadolinium contrast increased vascular signal on MPRAGE imaging, and decreased expected enhancement on post-gadolinium contrast T1-weighted imaging. Ferumoxytol can create imaging artifacts which complicate clinical interpretation when brain MRI is performed within 3 days of administration. Recognition of the constellation of artifacts produced by ferumoxytol is important in order to obviate additional unnecessary examinations and mitigate errors in interpretation. (orig.)

  18. Whole brain functional connectivity in clinically isolated syndrome without conventional brain MRI lesions

    International Nuclear Information System (INIS)

    Liu, Yaou; Dai, Zhengjia; Duan, Yunyun; Huang, Jing; Ren, Zhuoqiong; Li, Kuncheng; Liu, Zheng; Dong, Huiqing; Shu, Ni; He, Yong; Vrenken, Hugo; Wattjes, Mike P.; Barkhof, Frederik

    2016-01-01

    To investigate brain functional connectivity (FC) alterations in patients with clinically isolated syndromes (CIS) presenting without conventional brain MRI lesions, and to identify the FC differences between the CIS patients who converted to multiple sclerosis (MS) and those not converted during a 5-year follow-up. We recruited 20 CIS patients without conventional brain lesions, 28 patients with MS and 28 healthy controls (HC). Normalized voxel-based functional connectivity strength (nFCS) was determined using resting-state fMRI (R-fMRI) and compared among groups. Furthermore, 5-years clinical follow-up of the CIS patients was performed to examine the differences in nFCS between converters and non-converters. Compared to HC, CIS patients showed significantly decreased nFCS in the visual areas and increased nFCS in several brain regions predominately in the temporal lobes. MS patients revealed more widespread higher nFCS especially in deep grey matter (DGM), compared to CIS and HC. In the four CIS patients converting to MS, significantly higher nFCS was found in right anterior cingulate gyrus (ACC) and fusiform gyrus (FG), compared to non-converted patients. We demonstrated both functional impairment and compensation in CIS by R-fMRI. nFCS alteration in ACC and FG seems to occur in CIS patients at risk of developing MS. (orig.)

  19. [Brain-Computer Interface: the First Clinical Experience in Russia].

    Science.gov (United States)

    Mokienko, O A; Lyukmanov, R Kh; Chernikova, L A; Suponeva, N A; Piradov, M A; Frolov, A A

    2016-01-01

    Motor imagery is suggested to stimulate the same plastic mechanisms in the brain as a real movement. The brain-computer interface (BCI) controls motor imagery by converting EEG during this process into the commands for an external device. This article presents the results of two-stage study of the clinical use of non-invasive BCI in the rehabilitation of patients with severe hemiparesis caused by focal brain damage. It was found that the ability to control BCI did not depend on the duration of a disease, brain lesion localization and the degree of neurological deficit. The first step of the study involved 36 patients; it showed that the efficacy of rehabilitation was higher in the group with the use of BCI (the score on the Action Research Arm Test (ARAT) improved from 1 [0; 2] to 5 [0; 16] points, p = 0.012; no significant improvement was observed in control group). The second step of the study involved 19 patients; the complex BCI-exoskeleton (i.e. with the kinesthetic feedback) was used for motor imagery trainings. The improvement of the motor function of hands was proved by ARAT (the score improved from 2 [0; 37] to 4 [1; 45:5] points, p = 0.005) and Fugl-Meyer scale (from 72 [63; 110 ] to 79 [68; 115] points, p = 0.005).

  20. Clinical results of BNCT for malignant brain tumors in children

    International Nuclear Information System (INIS)

    Nakagawa, Yoshinobu; Kageji, Teruyoshi; Mizobuchi, Yoshifumi; Kumada, Hiroaki; Nakagawa, Yoshiaki

    2009-01-01

    It is very difficult to treat the patients with malignant brain tumor in children, especially under 3 years, because the conventional irradiation cannot be applied due to the damage of normal brain tissue. However, boron neutron capture therapy (BNCT) has tumor selectivity such that it can make damage only in tumor cells. We evaluated the clinical results and courses in patients with malignant glioma under 15 years. Among 183 patients with brain tumors treated by our group using BSH-based intra-operative BNCT, 23 patients were under 15 years. They included 4 patients under 3 years. There were 3 glioblastomas (GBM), 6 anaplastic astrocytomas(AAS), 7 primitive neuroectodermal tumors (PNET), 6 pontine gliomas and 1 anaplastic ependymoma. All GBM and PNET patients died due to CSF and/or CNS dissemination without local tumor regrowth. All pontine glioma patients died due to regrowth of the tumor. Four of 6 anaplastic astrocytoma and 1 anaplastic ependymoma patients alive without tumor recurrence. BNCT can be applied to malignant brain tumors in children, especially under 3 years instead of conventional radiation. Although it can achieve the local control in the primary site, it cannot prevent CSF dissemination in patients with glioblastoma.

  1. El paro estudiantil de mayo de 1938

    Directory of Open Access Journals (Sweden)

    Orlando Moreno Martínez

    2009-07-01

    Full Text Available El presente artículo tiene como propósito analizar los sucesos ocurridos en la ciudad de Bogotá durante el paro estudiantil de mayo de 1938, programado para oponerse a algunas medidas de modernización y secularización educativa impuestas por el gobierno liberal del presidente Alfonso López Pumarejo. Específicamente, los estudiantes se levantaron contra el examen de revisión que se aplicaba al terminar la secundaria y el curso preparatorio que era un requisito para poder ingresar a la universidad. El escrito aborda la problemática suscitada por la reforma educativa, el desencadenamiento de la protesta estudiantil, las acciones desarrolladas por los estudiantes en la capital de la República, el impacto del movimiento en otras partes del país y las tendencias ideológicas que apoyaron el paro de estudiantes. A propósito de este último punto, si bien fue evidente el respaldo de la oposición conservadora, muchos estudiantes universitarios y de secundaria lucharon con convicción por lo que consideraron en su momento una arbitrariedad por parte del gobierno liberal.

  2. Clinical observations of the brain abscesses, especially on the computed tomographic brain scan findings

    International Nuclear Information System (INIS)

    Kitano, Masahiko; Kuroda, Ryotaro; Yamada, Yasufumi; Yorimae, Akira; Akai, Fumiharu; Watanabe, Masaru; Nakatani, Jiro; Ioku, Masahiko

    1988-01-01

    Fifteen cases with pyogenic brain abscess were experienced in our clinic during the last 7 years. The records of these patients were examined to evaluate the clinical stage and the result of several treatments. In 12 operative cases, diagnosis was made by fluid aspirated from the abscess. Bacteria were cultured from the fluid in 5 among these cases. In 3 other non-operative patients, diagnosis was based on computed tomographic (CT) brain scans and laboratory studies. Each volume of the brain abscess and surrounding brain edema was measured on serial CT scans to evaluate the clinical stage and the abscess evolution. In symptoms and signs, it has been thought that one of the factors contributing to mortality was the level of consciousness. In this study, the disturbance of consciousness did not correlate with the size of abscess, but with that of edema. The cases reported here were divided into 3 groups according to the volume of abscess and of edema on initial CT scans. The cases of group A had small surrounding edema ( 50 ml) and small abscess ( 25 ml). The group A had slight change in the clinical status and the size of edema, but the others had severe change. Three phase changes in edema size were seen in the group B regardless of therapeutic modalities ; showing almost constant increase in first 2 weeks, great decrease in second 2 weeks and moderate decrease following these 4 weeks. In the group C, however, these phases were seen only in early operation cases. (J.P.N.)

  3. Markerless motion estimation for motion-compensated clinical brain imaging

    Science.gov (United States)

    Kyme, Andre Z.; Se, Stephen; Meikle, Steven R.; Fulton, Roger R.

    2018-05-01

    Motion-compensated brain imaging can dramatically reduce the artifacts and quantitative degradation associated with voluntary and involuntary subject head motion during positron emission tomography (PET), single photon emission computed tomography (SPECT) and computed tomography (CT). However, motion-compensated imaging protocols are not in widespread clinical use for these modalities. A key reason for this seems to be the lack of a practical motion tracking technology that allows for smooth and reliable integration of motion-compensated imaging protocols in the clinical setting. We seek to address this problem by investigating the feasibility of a highly versatile optical motion tracking method for PET, SPECT and CT geometries. The method requires no attached markers, relying exclusively on the detection and matching of distinctive facial features. We studied the accuracy of this method in 16 volunteers in a mock imaging scenario by comparing the estimated motion with an accurate marker-based method used in applications such as image guided surgery. A range of techniques to optimize performance of the method were also studied. Our results show that the markerless motion tracking method is highly accurate (brain imaging and holds good promise for a practical implementation in clinical PET, SPECT and CT systems.

  4. Neural imaginaries and clinical epistemology: Rhetorically mapping the adolescent brain in the clinical encounter.

    Science.gov (United States)

    Buchbinder, Mara

    2015-10-01

    The social work of brain images has taken center stage in recent theorizing of the intersections between neuroscience and society. However, neuroimaging is only one of the discursive modes through which public representations of neurobiology travel. This article adopts an expanded view toward the social implications of neuroscientific thinking to examine how neural imaginaries are constructed in the absence of visual evidence. Drawing on ethnographic fieldwork conducted over 18 months (2008-2009) in a United States multidisciplinary pediatric pain clinic, I examine the pragmatic clinical work undertaken to represent ambiguous symptoms in neurobiological form. Focusing on one physician, I illustrate how, by rhetorically mapping the brain as a therapeutic tool, she engaged in a distinctive form of representation that I call neural imagining. In shifting my focus away from the purely material dimensions of brain images, I juxtapose the cultural work of brain scanning technologies with clinical neural imaginaries in which the teenage brain becomes a space of possibility, not to map things as they are, but rather, things as we hope they might be. These neural imaginaries rely upon a distinctive clinical epistemology that privileges the creative work of the imagination over visualization technologies in revealing the truths of the body. By creating a therapeutic space for adolescents to exercise their imaginative faculties and a discursive template for doing so, neural imagining relocates adolescents' agency with respect to epistemologies of bodily knowledge and the role of visualization practices therein. In doing so, it provides a more hopeful alternative to the dominant popular and scientific representations of the teenage brain that view it primarily through the lens of pathology. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Clinical brain imaging with isopropyl-iodoamphetamine and SPECT

    International Nuclear Information System (INIS)

    Royal, H.D.; Hill, T.C.; Holman, B.L.

    1985-01-01

    In recent years, fierce competition has developed between the new high technology specialties of ultrasound, nuclear medicine, computerized transmission tomography, and most recently, nuclear magnetic resonance. Conventional brain scintigraphy, once the most common nuclear medicine procedure, has fallen victim to this rivalry despite the fact that routine scintigraphy remains a good diagnostic test. The agony of this defeat initially caused self-doubt among nuclear medicine physicians, but out of this gloom has emerged a number of radionuclide tests which have the potential to revolutionize how clinical neurology/psychiatry is practiced. 109 references

  6. Pituitary dysfunction following traumatic brain injury: clinical perspectives

    Science.gov (United States)

    Tanriverdi, Fatih; Kelestimur, Fahrettin

    2015-01-01

    Traumatic brain injury (TBI) is a well recognized public health problem worldwide. TBI has previously been considered as a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies. Based on data in the current literature, approximately 15%–20% of TBI patients develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions. This review summarizes the current data on TBI-induced hypopituitarism and briefly discusses some clinical perspectives on post-traumatic anterior pituitary hormone deficiency. PMID:26251600

  7. Clinical study on brain tumors in the aged

    International Nuclear Information System (INIS)

    Teramoto, Akira; Manaka, Shinya; Takakura, Kintomo

    1981-01-01

    In order to investigate the clinical features and the prognosis of brain tumors in the aged, 132 cases over 60 years of age were studied from the consecutive series of 1,793 brain tumors in the University of Tokyo Hospital (1963 - 1979). The incidence of brain tumors in the aged was 7.4% on the whole, while it showed a significant increase from 4.8% (1960's) to 11.5% (the later half of 1970's). Histologically, meningiomas were the most common tumors (26%), followed by neurinomas (17%), pituitary adenomas (16%) and metastatic tumors (15%). Malignant gliomas were found more frequently than benign ones. There were more meningiomas as age advanced. The proportion and the number of meningioma cases has obviously increased in recent years when CT scanners became available. Symptoms of intracranial hypertention were found less frequently in aged patients although they were still common in cases of glioblastomas. The duration from onset to surgery was relatively long, especially in cases of neurinomas and pituitary adenomas. Two cases of astrocytomas belonged to the category of silent gliomas. Overall operative mortality rate was 10.6%, while it showed a marked decrease to 4.7% in the 1970's. Five-year survival rates were as follows: meningiomas (58%), pituitary adenomas (70%), neurinomas (80%), glioblastomas (20%) and astrocytomas (25%). As for functional prognoses, 30% of the patients showed poor states on ADL, mostly because of residual psychic disorders. (author)

  8. Clinical values of CT and dynamic CT in brain infarction

    International Nuclear Information System (INIS)

    Lim, Soo Il; Jang, Do; Seo, Eun Joo; Sohn, Myung Hee; Choi, Ki Chul

    1985-01-01

    With the advent of faster scan time and new computer program, a scanning technique called 'dynamic computed tomography' has become possible. Dynamic computed tomography consisted of performing multiple rapid sequence scans after injection of contrast material. The authors have evaluated the clinical usefulness of computed tomography and dynamic computed tomography of 93 patients with brain infarction and/or ischemia during the period of 17 months from April 1983 to August 1984 in Department of Radiology, Chonbuk National University Hospital. The results were as follows; 1. The age distribution ranged from 18 years to 78 years. Among them the most common age group was between 50 years and 59 years (40.9%). 2. The sites of brain infarction were cerebral lobes (63 cases,68), basal ganglia (15 cases, 16.1%) and multiple sites (6 cases, 6.4%). The common affected site was middle cerebral artery territories. 3. The contrast enhancement of acute infarction was noted in 14 cases (17.5%) which occurred commonly between 3 days and 2 weeks from ictus. 4. The patterns of time-density curve in brain infarction and/or ischemia were as follow: a. Depression of slow wash-in phase was 20 cases (59%). b. Lower peak concentration was 17 cases (50%). c. Lower and delayed peak concentration was 7 cases (21%). d. No definite peak concentration was 6 cases (18%). First three patterns of time-density curve were thought as relatively characteristic curve of brain infarction and/or ischemia. 5. Two cases that showed negative findings on precontrast CT scan appeared to be positive findings as hypodensity on postcontrast CT scan and were confirmed as brain infarction by dynamic CT. 6. The diagnostic entity of dynamic CT scan were as follows; a. large artery thrombotic infarction were 23 cases (58%). b. lacnar infarction were 6 cases (15%). c. ischemia were 5 cases (13%). d. normal were 5 cases (13%). In six cases of lacunar infarction which was double hypodensity on pre-and postcontrast CT

  9. Clinical values of CT and dynamic CT in brain infarction

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Il; Jang, Do; Seo, Eun Joo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University College of Medicine, Jeonju (Korea, Republic of)

    1985-04-15

    With the advent of faster scan time and new computer program, a scanning technique called 'dynamic computed tomography' has become possible. Dynamic computed tomography consisted of performing multiple rapid sequence scans after injection of contrast material. The authors have evaluated the clinical usefulness of computed tomography and dynamic computed tomography of 93 patients with brain infarction and/or ischemia during the period of 17 months from April 1983 to August 1984 in Department of Radiology, Chonbuk National University Hospital. The results were as follows; 1. The age distribution ranged from 18 years to 78 years. Among them the most common age group was between 50 years and 59 years (40.9%). 2. The sites of brain infarction were cerebral lobes (63 cases,68), basal ganglia (15 cases, 16.1%) and multiple sites (6 cases, 6.4%). The common affected site was middle cerebral artery territories. 3. The contrast enhancement of acute infarction was noted in 14 cases (17.5%) which occurred commonly between 3 days and 2 weeks from ictus. 4. The patterns of time-density curve in brain infarction and/or ischemia were as follow: a. Depression of slow wash-in phase was 20 cases (59%). b. Lower peak concentration was 17 cases (50%). c. Lower and delayed peak concentration was 7 cases (21%). d. No definite peak concentration was 6 cases (18%). First three patterns of time-density curve were thought as relatively characteristic curve of brain infarction and/or ischemia. 5. Two cases that showed negative findings on precontrast CT scan appeared to be positive findings as hypodensity on postcontrast CT scan and were confirmed as brain infarction by dynamic CT. 6. The diagnostic entity of dynamic CT scan were as follows; a. large artery thrombotic infarction were 23 cases (58%). b. lacnar infarction were 6 cases (15%). c. ischemia were 5 cases (13%). d. normal were 5 cases (13%). In six cases of lacunar infarction which was double hypodensity on pre

  10. Clinical significance of I-123 IMP brain SPECT in children with brain diseases

    International Nuclear Information System (INIS)

    Takishima, Teruo; Machida, Kikuo; Honda, Norinari; Mamiya, Toshio; Takahashi, Taku; Kamano, Tsuyoshi; Hasegawa, Noriko

    1990-01-01

    Single photon emission computed tomography (SPECT) of the brain using N-isopropyl p-I-123-iodoamphetamine (I-123 IMP) was performed in 43 children with suspected brain diseases. Forty-three children (25 males and 18 females), with an age range of 24 days-15 years (mean: 6.6 years), were included in the study. Six patients were subsequently diagnosed as normal. Early SPECT of the brain was performed 30 minutes after intravenous administration of 74-111 MBq (2-3 mCi) I-123 IMP using a rotating gamma camera equipped with a 30-degree slant hole and medium energy collimator. Transverse images were reconstructed by Shepp-Logan filtered back projection method with attenuation correction after spatial filtering using an 8th order Butterworth-Wiener filter. Findings of I-123 IMP SPECT were compared with those of X-ray computed tomography (CT) and electroencephalography (EEG). The results showed that in I-123 IMP SPECT, abnormality was found in 30 out of 37 children with brain diseases. The incidence of abnormal findings in the 37 patients was 81% in I-123 IMP SPECT, 61% in X-ray CT, and 78% in EEG; in both cryptogenic and secondary epilepsy, the incidence of abnormality was higher in I-123 IMP SPECT than in X-ray CT. (70% and 94% vs 50% and 81% respectively), and epileptic foci detected by EEG did not correspond with defects found using I-123 IMP SPECT in 27% of the patients; and in asphyxiated infants, a high incidence of abnormality was observed on both I-123 IMP SPECT (86%) and X-ray CT (86%). In conclusion, I-123 IMP SPECT is a clinically useful examination in children with brain disease. (author)

  11. Specialized consultant in radiological safety to the Reforma peripheral clinic, PEMEX. - I. - May-June of 2003; Asesoria especializada en seguridad radiologica a la clinica periferica Reforma, PEMEX.- I.- Mayo-Junio de 2003

    Energy Technology Data Exchange (ETDEWEB)

    Torres P, A.; Garcia A, J.; Rodriguez A, F

    2003-07-15

    The Reforma peripheral clinic, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the clinic can conserve its respective sanitary license.(Author)

  12. NMO in pediatric patients: brain involvement and clinical expression

    Directory of Open Access Journals (Sweden)

    Joaquín A. Peña

    2011-02-01

    Full Text Available OBJECTIVE: To analyze the clinical, neuroimaging characteristics and positivity of the acquaporin water channel (NMO-IgG in pediatric patients with neuromyelitis optica (NMO. This disorder could have a variable clinical expression. To address such variability, the term NMO spectrum has been suggested. METHOD: We evaluated six pediatric patients, with a median age of 11 years at the time of the study, with the diagnosis of NMO by the Wingerchuck criteria. RESULTS: All the cases exhibited bilateral optic neuritis (ON. Four patients had abnormalities on brain MRI from the onset,although only three of them developed symptoms correlated to those lesions during the course of their disorder. NMO-IgG was positive in 80%. CONCLUSION: Optic neuropathy is the most impaired feature in NMO patients. Brain MRI lesions are not compatible with multiple sclerosis and positivity of the NMO-IgG are also present in NMO pediatric patients, confirming the heterogeneity in the expression of this disorder.

  13. Hospital de La Misericordia, 6 de mayo de 1906 - 6 de mayo de 1981

    Directory of Open Access Journals (Sweden)

    Liborio Sánchez Avella

    1981-07-01

    Full Text Available El 6 de mayo de 1981 cumplió el Hospital de La Misericordia 75 años de haber iniciado sus labores. La idea de crear el Hospital se venía gestando desde comienzos de 1890. Obtuvo la Personería Jurídica el 23 de julio de 1897y el 25 de julio del mismo año colocó la primera piedra el Presidente de la República Miguel Antonio Caro. José Ignacio Barberi, su fundador, dejó un escrito en el cual relataba la historia de este Hospital. El mejor homenaje que se le puede hacer al Hospital y a José Ignacio Barberi, es transcribir las palabras que él dejó inéditas en 1940.

  14. Clinical applications of proton magnetic resonance spectroscopy of the brain

    International Nuclear Information System (INIS)

    Laubenberger, J.; Bayer, S.; Thiel, T.; Hennig, J.; Langer, M.

    1998-01-01

    In spite of all the scientific advances of the past few years, proton magnetic resonance spectroscopy of the brain has not attained the status of a routine examination technique with clinically accepted indications. The method should be considered as an additional option to MR imaging for inherited and acquired encephalopathic changes as well as, in future, for localization diagnosis of epilepsies. A proton magnetic resonance spectroscopic investigation without a prior intensive clinical and imaging investigation is not useful. Above all, factors influencing metabolite distribution such as for example, serum osmolability must be known. Methodological prerequisites for the clinical application of proton resonance spectroscopy are, first of all, a high stability of the chosen technique as well as a sufficiently certain quantification of metabolites and the availability of a reference group. The use of short echo times is necessary for the quantification of glutamine and the osmolyte myo-inositol. Indications for individual cases in which clinical investigations and MR topography cannot provide sufficient certainty and spectroscopy can furnish additional information are, in addition to uses in neuropediatrics, the suspicion of Alzheimer's dementia, HIV encephalopathy in early manifestations, and unclarified depressions of consciousness accompanying liver cirrhosis. (orig.) [de

  15. Clinical application of magnetic resonance in acute traumatic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Morais, Dionei F.; Gaia, Felipe F.P. [Hospital de Base de Sao Jose do Rio Preto, SP (Brazil). Servico de Neurocirurgia]. E-mail: centro@cerebroecoluna.com.br; Spotti, Antonio R.; Tognola, Waldir A. [Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil). Dept. de Ciencias Neurologicas; Andrade, Almir F. [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Dept. de Neurocirurgia da Emergencia

    2008-07-01

    Purpose: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. Method: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. Results: Statistical significant differences (McNemar test): occurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. Conclusion: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI. (author)

  16. Clinical application of magnetic resonance in acute traumatic brain injury

    International Nuclear Information System (INIS)

    Morais, Dionei F.; Gaia, Felipe F.P.; Spotti, Antonio R.; Tognola, Waldir A.; Andrade, Almir F.

    2008-01-01

    Purpose: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. Method: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. Results: Statistical significant differences (McNemar test): occurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. Conclusion: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI. (author)

  17. Brain imaging with synthetic MR in children: clinical quality assessment

    Energy Technology Data Exchange (ETDEWEB)

    Betts, Aaron M.; Serai, Suraj [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Leach, James L.; Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); University of Cincinnati College of Medicine, Cincinnati, OH (United States); Zhang, Bin [Cincinnati Children' s Hospital Medical Center, Biostatistics and Epidemiology, Cincinnati, OH (United States)

    2016-10-15

    Synthetic magnetic resonance imaging is a quantitative imaging technique that measures inherent T1-relaxation, T2-relaxation, and proton density. These inherent tissue properties allow synthesis of various imaging sequences from a single acquisition. Clinical use of synthetic MR imaging has been described in adult populations. However, use of synthetic MR imaging has not been previously reported in children. The purpose of this study is to report our assessment of diagnostic image quality using synthetic MR imaging in children. Synthetic MR acquisition was obtained in a sample of children undergoing brain MR imaging. Image quality assessments were performed on conventional and synthetic T1-weighted, T2-weighted, and FLAIR images. Standardized linear measurements were performed on conventional and synthetic T2 images. Estimates of patient age based upon myelination patterns were also performed. Conventional and synthetic MR images were evaluated on 30 children. Using a 4-point assessment scale, conventional imaging performed better than synthetic imaging for T1-weighted, T2-weighted, and FLAIR images. When the assessment was simplified to a dichotomized scale, the conventional and synthetic T1-weighted and T2-weighted images performed similarly. However, the superiority of conventional FLAIR images persisted in the dichotomized assessment. There were no statistically significant differences between linear measurements made on T2-weighted images. Estimates of patient age based upon pattern of myelination were also similar between conventional and synthetic techniques. Synthetic MR imaging may be acceptable for clinical use in children. However, users should be aware of current limitations that could impact clinical utility in the software version used in this study. (orig.)

  18. High-resolution whole-brain DCE-MRI using constrained reconstruction: Prospective clinical evaluation in brain tumor patients

    International Nuclear Information System (INIS)

    Guo, Yi; Zhu, Yinghua; Lingala, Sajan Goud; Nayak, Krishna; Lebel, R. Marc; Shiroishi, Mark S.; Law, Meng

    2016-01-01

    Purpose: To clinically evaluate a highly accelerated T1-weighted dynamic contrast-enhanced (DCE) MRI technique that provides high spatial resolution and whole-brain coverage via undersampling and constrained reconstruction with multiple sparsity constraints. Methods: Conventional (rate-2 SENSE) and experimental DCE-MRI (rate-30) scans were performed 20 minutes apart in 15 brain tumor patients. The conventional clinical DCE-MRI had voxel dimensions 0.9 × 1.3 × 7.0 mm 3 , FOV 22 × 22 × 4.2 cm 3 , and the experimental DCE-MRI had voxel dimensions 0.9 × 0.9 × 1.9 mm 3 , and broader coverage 22 × 22 × 19 cm 3 . Temporal resolution was 5 s for both protocols. Time-resolved images and blood–brain barrier permeability maps were qualitatively evaluated by two radiologists. Results: The experimental DCE-MRI scans showed no loss of qualitative information in any of the cases, while achieving substantially higher spatial resolution and whole-brain spatial coverage. Average qualitative scores (from 0 to 3) were 2.1 for the experimental scans and 1.1 for the conventional clinical scans. Conclusions: The proposed DCE-MRI approach provides clinically superior image quality with higher spatial resolution and coverage than currently available approaches. These advantages may allow comprehensive permeability mapping in the brain, which is especially valuable in the setting of large lesions or multiple lesions spread throughout the brain.

  19. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Linnemann, Mia; Tibæk, Maiken

    2013-01-01

    To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI).......To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI)....

  20. An Academic Healthcare Twitter Account: The Mayo Clinic Experience.

    Science.gov (United States)

    Widmer, R Jay; Engler, Nicole B; Geske, Jeffrey B; Klarich, Kyle W; Timimi, Farris K

    2016-06-01

    With more than 300 million monthly active users, Twitter is a powerful social media tool in healthcare, yet the characterization of an academic healthcare Twitter account remains poor to date. We assessed basic gender and geographic data on the account's "followers," as well as categorization of each tweet based on content type. We analyzed the impressions, engagements, retweets, favorites, replies, hashtag clicks, and detail expansions using both Sprinklr and Twitter Analytics. Over a period of 12 months, the account amassed 1,235 followers, with 54 percent being male and 68 percent residing in the United States. Of the 1,635 tweets sent out over the life of the account, we report more than 382,464 impressions, 6,023 engagements, 1,255 retweets, 776 favorites, and 1,654 embedded media clicks in this period. When broken down by tweet category, publication tweets garnered the highest engagement with an estimated mean number of clicks per tweet of 8.2 ± 81.9. Original content had higher total engagement per tweet than retweeted material (2.8 ± 9.2 vs. 0.2 ± 0.9 engagements per tweet; p < 0.0001). Tweets regarding internal, national, and continuing medical education events had similar engagement. Herein is the first publication within the medical literature describing a "case series" of cardiovascular tweets over 12 months. We highlight a rapidly emerging group of interactive followers, a successful means by which to disseminate and engage in breaking topics throughout the cardiovascular field, and the importance of combining physician-led knowledge with intermittent marketing messages.

  1. Adjuvant therapy for ampullary carcinomas: The Mayo Clinic experience

    International Nuclear Information System (INIS)

    Bhatia, Sumita; Miller, Robert C.; Haddock, Michael G.; Donohue, John H.; Krishnan, Sunil

    2006-01-01

    Purpose: To determine the effects of adjuvant radiotherapy and chemotherapy for carcinoma of the ampulla of Vater. Methods and Materials: We retrospectively reviewed the records of 125 patients who underwent definitive surgery for carcinomas involving the ampulla of Vater between April 1977 and February 2005 and who survived more than 50 days after surgery. Twenty-nine of the patients also received adjuvant radiotherapy (median dose, 50.4 Gy in 28 fractions) with concurrent 5-fluorouracil chemotherapy. Adverse prognostic factors were investigated, and overall survival (OS) and local and distant failure were estimated. Results: Adverse prognostic factors for decreased OS by univariate analysis included lymph node (LN) involvement, locally advanced tumors (T3/T4), and poor histologic grade. By multivariate analysis, positive LN status (p = 0.02) alone was associated with decreased OS. The addition of adjuvant radiotherapy and chemotherapy improved OS for patients with positive LN (p = 0.01). Median survival for positive LN patients receiving adjuvant therapy was 3.4 years, vs. 1.6 years for those with surgery alone. Conclusions: The addition of adjuvant radiotherapy and 5-fluorouracil chemotherapy may improve OS in patients with LN involvement. The effect of adjuvant therapy on outcomes for patients with poor histologic grade or T3/T4 tumors without LN involvement could not be assessed

  2. Adjuvant Therapy for Gallbladder Carcinoma: The Mayo Clinic Experience

    International Nuclear Information System (INIS)

    Gold, Douglas G.; Miller, Robert C.; Haddock, Michael G.; Gunderson, Leonard L.; Quevedo, Fernando; Donohue, John H.; Bhatia, Sumita; Nagorney, David M.

    2009-01-01

    Purpose: To analyze the effect of adjuvant chemoradiotherapy on gallbladder carcinoma. Methods and Materials: We retrospectively reviewed the records from consecutive patients who underwent R0 resection of gallbladder carcinoma between January 1, 1985, and December 31, 2004. Patients had either Stage I (T1-T2N0M0) or Stage II (T3N0M0 or T1-T3N1M0) disease. Patients undergoing adjuvant therapy received 5-fluorouracil chemotherapy concurrently with radiotherapy (median dosage, 50.4 Gy in 28 fractions). Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) were evaluated. Results: A total of 73 patients were included in the analysis; of these, 25 received adjuvant chemoradiotherapy. On univariate analysis, no adverse prognostic factors for OS reached statistical significance, but trends were noted for Stage N1 vs. N0 (p = .06), Nx vs. N0 (p = .09), Stage T3 vs. T1-T2 (p = .06), and histologic findings other than adenocarcinoma (p = .13). The median OS for patients receiving adjuvant chemoradiotherapy vs. surgery alone was 4.8 years and 4.2 years, respectively (log-rank test, p = .56). However, a significantly greater percentage of patients receiving adjuvant chemoradiotherapy had Stage II disease (p <.001). In the multivariate Cox model, increasing T and N category and histologic findings other than adenocarcinoma were significant predictors of decreased OS. Additionally, adjuvant chemoradiotherapy was a significant predictor of improved OS after adjusting for these prognostic factors (hazard ratio for death, 0.3; 95% confidence interval, 0.13-0.69; p = .004). Conclusion: After adjusting for the stage parameters and histologic findings, our data suggest that adjuvant chemoradiotherapy might improve OS for patients with gallbladder cancer.

  3. Conservative management of pineal tumors - Mayo clinic experience

    International Nuclear Information System (INIS)

    Laws, E.R.; Abay, E.O.; Forbes, G.S.; Grado, G.L.; Bruckman, J.E.; Scott, M.

    1984-01-01

    The typical pineal tumor occurs in an adolescent boy with subacute increased intracranial pressure and Parinaud's syndrome. Diagnosis is confirmed by CT scanning, and long-term survival usually following shunting and radiation therapy. Direct surgical methods for successful treatment of suitable pineal tumors have evolved and may be utilized with relatively low risk in appropriate cases

  4. Clinical diagnosis and brain imaging in nuclear medicine

    International Nuclear Information System (INIS)

    Fujie, Hiroshi

    1989-01-01

    Fifty-five patients of cerebral occlusive diseases were studied using IMP and single photon emission tomograph (HEADTOME-II). Early imaging was begun after intravenous injection of IMP and delayed imaging was performed 3 hours more later. We classified the change of IMP distribution into 4 types, type 1: no uptake of the lesion in both early and delayed images, type 2: low IMP uptake of the lesion in early images but recognized redistribution of IMP is delayed images, type 3: high IMP uptake of the lesion in both early and delayed images, type 4: high IMP uptake of the lesion in early images but it decreased more rapidly in delayed images. In cases of type 3 and 4 recanalization of the occlusive arteries was found by cerebral angiography. The difference of IMP distribution has relation to the time of recanalization and the amount of collateral circulation at the lesion. Clinical prognosis shows a tendency to be better in cases of type 2 and 4 than type 1 and 3. IMP brain scans with SPECT seems useful for estimating the prognosis of patients. (author)

  5. Brain perfusion single photon emission computed tomography in major psychiatric disorders: From basics to clinical practice

    International Nuclear Information System (INIS)

    Santra, Amburanjan; Kumar, Rakesh

    2014-01-01

    Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF). It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings. Though there is ample evidence validating brain SPECT as a technique to track human behavior and correlating psychiatric disorders with dysfunction of specific brain regions, only few psychiatrists have adopted brain SPECT in routine clinical practice. It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary. In this article, we have reviewed the available studies in this regard from existing literature and tried to present the evidence for establishing the clinical role of brain SPECT in major psychiatric illnesses

  6. Advance MRI for pediatric brain tumors with emphasis on clinical benefits

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Ra, Young Shin [Asan Medical Center, University of Ulsan College of Medicine, Seoul(Korea, Republic of)

    2017-01-15

    Conventional anatomic brain MRI is often limited in evaluating pediatric brain tumors, the most common solid tumors and a leading cause of death in children. Advanced brain MRI techniques have great potential to improve diagnostic performance in children with brain tumors and overcome diagnostic pitfalls resulting from diverse tumor pathologies as well as nonspecific or overlapped imaging findings. Advanced MRI techniques used for evaluating pediatric brain tumors include diffusion-weighted imaging, diffusion tensor imaging, functional MRI, perfusion imaging, spectroscopy, susceptibility-weighted imaging, and chemical exchange saturation transfer imaging. Because pediatric brain tumors differ from adult counterparts in various aspects, MRI protocols should be designed to achieve maximal clinical benefits in pediatric brain tumors. In this study, we review advanced MRI techniques and interpretation algorithms for pediatric brain tumors.

  7. Diagnosis and prognosis of brain tumors in clinical trials

    NARCIS (Netherlands)

    T.S. Gorlia (Thierry)

    2013-01-01

    textabstractAccording to the Central Brain Registry Of The United States (CBTRUS) statistical report (February 2012) the incidence rate of all primary non malignant and malignant brain and central nervous system tumors is 19.89 cases per 100.000 (11.58 for non-malignant tumors and 7.31 for malignant

  8. Epidemiology and clinical characteristics of traumatic brain injury in Lebanon

    Science.gov (United States)

    Abou-Abbass, Hussein; Bahmad, Hisham; Ghandour, Hiba; Fares, Jawad; Wazzi-Mkahal, Rayyan; Yacoub, Basel; Darwish, Hala; Mondello, Stefania; Harati, Hayat; El Sayed, Mazen J.; Tamim, Hani; Kobeissy, Firas

    2016-01-01

    Abstract Background: Traumatic brain injury (TBI) is a debilitating medical and emerging public health problem that is affecting people worldwide due to a multitude of factors including both domestic and war-related acts. The objective of this paper is to systematically review the status of TBI in Lebanon – a Middle Eastern country with a weak health system that was chartered by several wars and intermittent outbursts of violence - in order to identify the present gaps in knowledge, direct future research initiatives and to assist policy makers in planning progressive and rehabilitative policies. Methods: OVID/Medline, PubMed, Scopus databases and Google Scholar were lastly searched on April 15th, 2016 to identify all published research studies on TBI in Lebanon. Studies published in English, Arabic or French that assessed Lebanese patients afflicted by TBI in Lebanon were warranting inclusion in this review. Case reports, reviews, biographies and abstracts were excluded. Throughout the whole review process, reviewers worked independently and in duplicate during study selection, data abstraction and methodological assessment using the Downs and Black Checklist. Results: In total, 11 studies were recognized eligible as they assessed Lebanese patients afflicted by TBI on Lebanese soils. Considerable methodological variation was found among the identified studies. All studies, except for two that evaluated domestic causes such as falls, reported TBI due to war-related injuries. Age distribution of TBI victims revealed two peaks, young adults between 18 and 40 years, and older adults aged 60 years and above, where males constituted the majority. Only three studies reported rates of mild TBI. Mortality, rehabilitation and systemic injury rates were rarely reported and so were the complications involved; infections were an exception. Conclusion: Apparently, status of TBI in Lebanon suffers from several gaps which need to be bridged through implementing more basic

  9. Occurrence and clinical features of brain metastasis after chemoradiotherapy for esophageal carcinoma

    International Nuclear Information System (INIS)

    Kanemoto, Ayae; Hashimoto, Takayuki; Harada, Hideyuki; Asakura, Hirofumi; Ogawa, Hirofumi; Furutani, Kazuhisa; Boku, Narikazu; Nakasu, Yoko; Nishimura, Tetsuo

    2011-01-01

    Brain metastasis from esophageal carcinoma has been considered rare and survival following esophageal carcinoma with distant metastasis is poor. The purpose of this report was to clarify cumulative incidence and risk factors for brain metastasis after chemoradiotherapy for esophageal carcinoma, and to consider recommended treatments for brain metastasis from esophageal carcinoma. We reviewed 391 patients treated with chemoradiotherapy. Median age was 65 years. Clinical stages were I, II, III, and IV in 32, 47, 150, and 162 patients, respectively. Brain imaging was performed usually when patients revealed neurological symptoms. The 3-year cumulative incidence of brain metastasis after chemoradiotherapy was 6.6%. There were 4 patients with single metastasis and 8 with multiple metastases. Initial clinical stages were II, III, and IV in 1, 2, and 9 patients, respectively. Histology included squamous cell carcinoma in 10 patients and others in 2 patients. Univariate analysis demonstrated M factor, distant lymph node relapse, and recurrent lung and liver metastasis as significant risk factors of brain metastasis (P<0.05). Median survival time after diagnosis of brain metastasis was 2.1 months. Brain metastasis was not directly related to cause of mortality. The causes were extracranial tumor deterioration in 8 patients and infection in 4 patients. Brain metastasis may increase in the future with improving survival from esophageal carcinoma. However, considering the poor survival after diagnosis of brain metastasis, short-term palliative therapy for brain metastasis appears preferable to vigorous long-term therapy. (author)

  10. Claremount Nursing Home, Claremount, Claremorris, Mayo.

    LENUS (Irish Health Repository)

    Reeves, Emer P

    2012-01-01

    The pathogenesis of lung disease in cystic fibrosis is characterised by decreased airway surface liquid volume and subsequent failure of normal mucociliary clearance. Mucus within the cystic fibrosis airways is enriched in negatively charged matrices composed of DNA released from colonizing bacteria or inflammatory cells, as well as F-actin and elevated concentrations of anionic glycosaminoglycans. Therapies acting against airway mucus in cystic fibrosis include aerosolized hypertonic saline. It has been shown that hypertonic saline possesses mucolytic properties and aids mucociliary clearance by restoring the liquid layer lining the airways. However, recent clinical and bench-top studies are beginning to broaden our view on the beneficial effects of hypertonic saline, which now extend to include anti-infective as well as anti-inflammatory properties. This review aims to discuss the described therapeutic benefits of hypertonic saline and specifically to identify novel models of hypertonic saline action independent of airway hydration.

  11. The clinical use of brain SPECT imaging in neuropsychiatry

    International Nuclear Information System (INIS)

    Amen, Daniel G; Wu, Joseph C; Carmichael, Blake

    2003-01-01

    This article reviews the literature on brain SPECT imaging in brain trauma, dementia, and temporal lobe epilepsy. Brain SPECT allows clinicians the ability to view cerebral areas of healthy, low, and excessive perfusion. This information can be correlated with what is known about the function or dysfunction of each area. SPECT has a number of advantages over other imaging techniques, including wider availability, lower cost, and high quality resolution with multi-headed cameras. There are a number of issues that compromise the effective use of SPECT, including low quality of some imaging cameras, and variability of image rendering and readings (Au)

  12. Diagnosis and prognosis of brain tumors in clinical trials

    OpenAIRE

    Gorlia, Thierry

    2013-01-01

    textabstractAccording to the Central Brain Registry Of The United States (CBTRUS) statistical report (February 2012) the incidence rate of all primary non malignant and malignant brain and central nervous system tumors is 19.89 cases per 100.000 (11.58 for non-malignant tumors and 7.31 for malignant tumors). Malignant brain tumors account for only 1% to 2% of all adult cancers. As a comparison, in 2012, the incidence of women breast cancer was 121.2 (per 100.000). Tumors of neuroepithelial ti...

  13. Study on Mobile Augmented Reality Adoption for Mayo Language Learning

    OpenAIRE

    Miranda Bojórquez, Erasmo; Vergara Villegas, Osslan Osiris; Cruz Sánchez, Vianey Guadalupe; García-Alcaraz, Jorge Luis; Favela Vara, Jesús

    2016-01-01

    This paper presents the results of a study applied to undergraduates in order to know how the cultural dimensions affect their perceptions of the acceptance and use of new technologies in a student-centered learning environment. A total of 85 undergraduate students from the Autonomous Indigenous University of Mexico (UAIM) participated in the study. Each student was asked to use a mobile augmented reality (MAR) application designed to learn Mayo language (language spoken in Northwestern Mexic...

  14. Remembering Joseph Mayo and His Contributions to Animal Science | Poster

    Science.gov (United States)

    By Carolynne Keenan, Guest Writer In the 1990s, when Joseph Mayo, D.V.M, ran out of gas leading coworkers home from a meeting in Bethesda, he pulled over to the side of the road on I-270 and waited for help. He didn’t have to wait long; within a few minutes a passing motorist took pity on the group of scientists and offered them a lift back to Fort Detrick.

  15. Clinical Significance of Brain SPECT in Zipeprol Abusers

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Dai Ok; Kim, Jae Phil; Kim, Deog Yoon; Yang, Hyung In; Koh, Eun Mi; Kim, Kwang Won; Choi, Young Kil [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    1993-03-15

    Drug abuse is widespread in worldwide and has been associated with neurologic complication. Zipeprol is one of drugs which been abused for psychological satisfaction in some adolescents. This agent is non-opioid antitussive agent, which is not legally considered as being capable of creating dependence or abuse liability at therapeutic serum levels. But it has been reported that acute or chronic overdose create neurologic complication such as convulsion as well as dependence. Recently we experienced six zipeprol abusers who admitted due to convulsion and variable neurologic symptoms. The aim of our study was to determine the role of Tc-99m- HMPAO brain SPECT in those patients. EEG and brain CT showed no abnormal finding, but brain SPECT showed focal or multiple perfusion abnormalities in frontal, parietal, occipital cortex, basal ganglia, thalamus and especially at temporal cortex. These results suggest that brain SPECT may be a useful diagnostic tool to evaluate the cerebral dysfunction induced by zipeprol abuse.

  16. Clinical Significance of Brain SPECT in Zipeprol Abusers

    International Nuclear Information System (INIS)

    Cho, Dai Ok; Kim, Jae Phil; Kim, Deog Yoon; Yang, Hyung In; Koh, Eun Mi; Kim, Kwang Won; Choi, Young Kil

    1993-01-01

    Drug abuse is widespread in worldwide and has been associated with neurologic complication. Zipeprol is one of drugs which been abused for psychological satisfaction in some adolescents. This agent is non-opioid antitussive agent, which is not legally considered as being capable of creating dependence or abuse liability at therapeutic serum levels. But it has been reported that acute or chronic overdose create neurologic complication such as convulsion as well as dependence. Recently we experienced six zipeprol abusers who admitted due to convulsion and variable neurologic symptoms. The aim of our study was to determine the role of Tc-99m- HMPAO brain SPECT in those patients. EEG and brain CT showed no abnormal finding, but brain SPECT showed focal or multiple perfusion abnormalities in frontal, parietal, occipital cortex, basal ganglia, thalamus and especially at temporal cortex. These results suggest that brain SPECT may be a useful diagnostic tool to evaluate the cerebral dysfunction induced by zipeprol abuse.

  17. Adolescent Brain and Cognitive Developments: Implications for Clinical Assessment in Traumatic Brain Injury

    Science.gov (United States)

    Ciccia, Angela Hein; Meulenbroek, Peter; Turkstra, Lyn S.

    2009-01-01

    Adolescence is a time of significant physical, social, and emotional developments, accompanied by changes in cognitive and language skills. Underlying these are significant developments in brain structures and functions including changes in cortical and subcortical gray matter and white matter tracts. Among the brain regions that develop during…

  18. Longitudinal Regional Brain Development and Clinical Risk Factors in Extremely Preterm Infants.

    Science.gov (United States)

    Kersbergen, Karina J; Makropoulos, Antonios; Aljabar, Paul; Groenendaal, Floris; de Vries, Linda S; Counsell, Serena J; Benders, Manon J N L

    2016-11-01

    To investigate third-trimester extrauterine brain growth and correlate this with clinical risk factors in the neonatal period, using serially acquired brain tissue volumes in a large, unselected cohort of extremely preterm born infants. Preterm infants (gestational age regions covering the entire brain. Multivariable regression analysis was used to determine the influence of clinical variables on volumes at both scans, as well as on volumetric growth. MRIs at term equivalent age were available for 210 infants and serial data were available for 131 infants. Growth over these 10 weeks was greatest for the cerebellum, with an increase of 258%. Sex, birth weight z-score, and prolonged mechanical ventilation showed global effects on brain volumes on both scans. The effect of brain injury on ventricular size was already visible at 30 weeks, whereas growth data and volumes at term-equivalent age revealed the effect of brain injury on the cerebellum. This study provides data about third-trimester extrauterine volumetric brain growth in preterm infants. Both global and local effects of several common clinical risk factors were found to influence serial volumetric measurements, highlighting the vulnerability of the human brain, especially in the presence of brain injury, during this period. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Late brain metastases from breast cancer: clinical remarks on 11 patients and review of the literature.

    Science.gov (United States)

    Piccirilli, Manolo; Sassun, Tanya Enny; Brogna, Christian; Giangaspero, Felice; Salvati, Maurizio

    2007-01-01

    Late brain metastases from breast cancer are a rare event. Only a few cases have been reported in the English literature. The authors describe the clinical and pathological remarks, together with treatment modalities, removal extent and overall survival, of 11 patients in whom brain metastases were detected more than 10 years from the primary tumor. Between January 1997 and April 2001, we hospitalized 11 patients, all females, with a histologically proven diagnosis of brain metastasis from breast invasive ductal carcinoma. We defined 'late metastasis' as those metastases that appeared at least 10 years after the breast cancer diagnosis. The median age at the moment of brain metastasis diagnosis was 59 years (range, 47-70), with a median latency time from breast cancer diagnosis of 16 years (range, 11-30). Ten patients underwent surgery followed by adjuvant radiotherapy (whole brain radiotherapy). Two of them received, after whole brain radiotherapy, stereotaxic radio surgery treatment. One patient had stereotaxic brain biopsy, performed by neuronavigator, followed by palliative corticosteroid therapy. Median survival after brain metastasis diagnosis was 28 months (range, 3 months-4 years). Although late brain metastases are a rare event, specific neurologic symptoms and neuroradiological evidence of a cerebral neoplasm should be correlated to the presence of a cerebral metastasis, in a patient with a previous history of breast cancer. The longer latency time from breast cancer to brain metastasis could be explained by the "clonal dominance" theory and by different genetic alterations of the metastatic cell, which could influence the clinical history of the disease.

  20. Neuro-ophthalmic and clinical characteristics of brain tumours in a ...

    African Journals Online (AJOL)

    Background: Anecdotally, increasing number of patients are seen at Korle Bu Teaching Hospital (KBTH) with brain tumour. Neuro-ophthalmic symptoms and signs may help in timely diagnosis and intervention. Objective: To evaluate the neuro-ophthalmic and clinical characteristics of brain tumour in patients presenting at a ...

  1. Effect of clinical information in brain CT scan interpretation : a blinded double crossover study

    International Nuclear Information System (INIS)

    Zhianpour, M.; Janghorbani, M.

    2004-01-01

    Errors and variations in interpretation can happen in clinical imaging. Few studies have examined the biased effect of clinical information on reporting of brain CT scans. In a blinded double crossover design, we studied whether three radiologists were biased by clinical information when making CT scan diagnosis of the brain. Three consultant radiologists in three rounds with at least a one month interval assessed 100 consecutive cases of brain CT scan. In the first round, clinical information was not available and 100 films without clinical information were given to radiologists. In the second round, the same 100 films were given and true clinical information was available. In the third round, the same 100 films were given and false clinical information was allocated. In 180 cases (60%) the evaluation resulted in the same diagnosis on all three occasions (95% confidence interval (CI): 54.5, 65.5), whereas 120(40%; 95% CI:34.5, 45.5) sets were evaluated differently. 48 cases (16%; 95% CI:11.9,20.1) had discordant evaluation with true and 33 (11%; 95% CI:7.5, 14.5) with false clinical information. Discordance without and with true and false clinical information was 39 (13%; 95% CI:9.2, 16.8). Correct clinical information improves the brain CT report, while the report became less accurate false clinical information was allocated. These results indicate that radiologists are biased by clinical information when reporting brian CT scans

  2. Neuromyelitis optica with clinical and histopathological involvement of the brain.

    NARCIS (Netherlands)

    Hengstman, G.J.D.; Wesseling, P.; Frenken, C.W.; Jongen, P.J.H.

    2007-01-01

    Diagnostic criteria for neuromyelitis optica (NMO) state that there should be no active disease outside the optic nerves and spinal cord. However, several cases have been described with symptomatic brain involvement. We describe an autopsy case of a patient with NMO and symptomatic involvement of

  3. Progress in clinical research and application of resting state functional brain imaging

    International Nuclear Information System (INIS)

    Long Miaomiao; Ni Hongyan

    2013-01-01

    Resting state functional brain imaging experimental design is free of stimulus task and offers various parametric maps through different data-driven post processing methods with endogenous BOLD signal changes as the source of imaging. Mechanism of resting state brain activities could be extensively studied with improved patient compliance and clinical application compared with task related functional brain imaging. Also resting state functional brain imaging can be used as a method of data acquisition, with implicit neuronal activity as a kind of experimental design, to reveal characteristic brain activities of epileptic patient. Even resting state functional brain imaging data processing method can be used to analyze task related functional MRI data, opening new horizons of task related functional MRI study. (authors)

  4. Promising approaches to circumvent the blood-brain barrier: progress, pitfalls and clinical prospects in brain cancer.

    Science.gov (United States)

    Papademetriou, Iason T; Porter, Tyrone

    2015-01-01

    Brain drug delivery is a major challenge for therapy of central nervous system (CNS) diseases. Biochemical modifications of drugs or drug nanocarriers, methods of local delivery, and blood-brain barrier (BBB) disruption with focused ultrasound and microbubbles are promising approaches which enhance transport or bypass the BBB. These approaches are discussed in the context of brain cancer as an example in CNS drug development. Targeting to receptors enabling transport across the BBB offers noninvasive delivery of small molecule and biological cancer therapeutics. Local delivery methods enable high dose delivery while avoiding systemic exposure. BBB disruption with focused ultrasound and microbubbles offers local and noninvasive treatment. Clinical trials show the prospects of these technologies and point to challenges for the future.

  5. Long-term global and regional brain volume changes following severe traumatic brain injury: A longitudinal study with clinical correlates

    DEFF Research Database (Denmark)

    Sidaros, Annette; Skimminge, Arnold Jesper Møller; Liptrot, Matthew George

    2009-01-01

    with percent brain volume change (%BVC) ranging between − 0.6% and − 9.4% (mean − 4.0%). %BVC correlated significantly with injury severity, functional status at both scans, and with 1-year outcome. Moreover, %BVC improved prediction of long-term functional status over and above what could be predicted using......Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D...... scan time point using SIENAX. Regional distribution of atrophy was evaluated using tensor-based morphometry (TBM). At the first scan time point, brain parenchymal volume was reduced by mean 8.4% in patients as compared to controls. During the scan interval, patients exhibited continued atrophy...

  6. Clinical application of brain imaging for the diagnosis of mood disorders: the current state of play.

    Science.gov (United States)

    Savitz, J B; Rauch, S L; Drevets, W C

    2013-05-01

    In response to queries about whether brain imaging technology has reached the point where it is useful for making a clinical diagnosis and for helping to guide treatment selection, the American Psychiatric Association (APA) has recently written a position paper on the Clinical Application of Brain Imaging in Psychiatry. The following perspective piece is based on our contribution to this APA position paper, which specifically emphasized the application of neuroimaging in mood disorders. We present an introductory overview of the challenges faced by researchers in developing valid and reliable biomarkers for psychiatric disorders, followed by a synopsis of the extant neuroimaging findings in mood disorders, and an evidence-based review of the current research on brain imaging biomarkers in adult mood disorders. Although there are a number of promising results, by the standards proposed below, we argue that there are currently no brain imaging biomarkers that are clinically useful for establishing diagnosis or predicting treatment outcome in mood disorders.

  7. Clinical application of brain imaging for the diagnosis of mood disorders: the current state of play

    Science.gov (United States)

    Savitz, J B; Rauch, S L; Drevets, W C

    2013-01-01

    In response to queries about whether brain imaging technology has reached the point where it is useful for making a clinical diagnosis and for helping to guide treatment selection, the American Psychiatric Association (APA) has recently written a position paper on the Clinical Application of Brain Imaging in Psychiatry. The following perspective piece is based on our contribution to this APA position paper, which specifically emphasized the application of neuroimaging in mood disorders. We present an introductory overview of the challenges faced by researchers in developing valid and reliable biomarkers for psychiatric disorders, followed by a synopsis of the extant neuroimaging findings in mood disorders, and an evidence-based review of the current research on brain imaging biomarkers in adult mood disorders. Although there are a number of promising results, by the standards proposed below, we argue that there are currently no brain imaging biomarkers that are clinically useful for establishing diagnosis or predicting treatment outcome in mood disorders. PMID:23546169

  8. Osmotic blood-brain barrier modification: clinical documentation by enhanced CT scanning and/or radionuclide brain scanning

    International Nuclear Information System (INIS)

    Neuwelt, E.A.; Specht, H.D.; Howieson, J.; Haines, J.E.; Bennett, M.J.; Hill, S.A.; Frenkel, E.P.

    1983-01-01

    Results of initial clinical trials of brain tumor chemotherapy after osmotic blood-brain barrier disruption are promising. In general, the procedure is well tolerated. The major complication has been seizures. In this report, data are presented which indicate that the etiology of these seizures is related to the use of contrast agent (meglumine iothalamate) to monitor barrier modification. A series of 19 patients underwent a total of 85 barrier modification procedures. Documentation of barrier disruption was monitored by contrast-enhanced computed tomographic (CT) scanning, radionuclide brain scanning, or a combination of both techniques. In 56 procedures (19 patients) monitored by enhanced CT, seizures occurred a total of 10 times in eight patients. Twenty-three barrier modification procedures (in nine of these 19 patients) documented by nuclear brain scans alone, however, resulted in only one focal motor seizure in each of two patients. In eight of the 19 patients who had seizures after barrier disruption and enhanced CT scan, four subsequently had repeat procedures monitored by radionuclide scan alone. In only one of these patients was further seizure activity noted; a single focal motor seizure was observed. Clearly, the radionuclide brain scan does not have the sensitivity and spatial resolution of enhanced CT, but at present it appears safer to monitor barrier modification by this method and to follow tumor growth between barrier modifications by enhanced CT. Four illustrative cases showing methods, problems, and promising results are presented

  9. Image registration in the brain: a test of clinical accuracy

    International Nuclear Information System (INIS)

    Rosenman, Julian; Miller, Elizabeth P.; Rinker, Lillian; Mukherji, Suresh; Tracton, Gregg; Cullip, Tim J.; Muller, Keith E.; DeLuca, Marla C.; Major, Stacey A.; Sailer, Scott; Varia, Mahesh

    1997-01-01

    (p=.250). Overall, the expansion required by 3D registration software was significan tly less than that required by either the CT or simulated films method. Conclusion: For multimodality imaging data to be used in treatment planning of brain tumors it must be 3D-registered with the planning CT. Hand drawing the tumor onto the planning CT or directly onto the simulation film will lead to clinically significant targeting errors

  10. Clinical application of synthesized brain surface imaging for preoperative simulation of brain biopsy under local anesthesia

    International Nuclear Information System (INIS)

    Ogura, Yuko; Katada, Kazuhiro; Imai, Fumihiro; Fujisawa, Kazuhisa; Takeshita, Gen; Kanno, Tetsuo; Koga, Sukehiko

    1994-01-01

    Surface anatomy scanning (SAS) is the technique which permits the direct visualization of brain surface structures, including cortical sulci, guri, subcortical lesions as well as skin markings for craniotomy. A synthesized brain surface image is a technique that combines MR angiography (MRA) with SAS, and it proposed by us for detecting cerebral superficial veins with these surface structures on the same image. The purpose of this report is to present the result of applying the synthesized brain surface image to the preoperative simulation of biopsy under local anesthesia in 2 cases of multiple metastatic brain tumors. The parameters for SAS were TR/TE=50/40 msec, flip angle=60deg by the fast T 2 technique using refocused FID in steady-state (STERF technique). SAS images were processed by gray scale reversal. The MRA data were acquired with two-dimensional time of flight (TOF) sequence after intravenous administration of Gd-DTPA. Before imaging, the water-filled plastic tubes were placed on the patients scalp as markings for craniotomy. Their positions were planned by the neurosurgeons. On SAS, the markings for burr-hole appeared located above the tumors. However on the synthesized brain surface images, the positions of burr-hole were considered to be inadequate, since superficial cerebral vein and sinus were also visualized in the area of the markings. From these results, the positions of burr-hole were reset to avoid the venous structures, and so as to include the lesions in operations. The biopsies were performed successfully and safely because the venous structure could be excluded from the operative field. By this technique it was easy to confirm the relationships among lesions, skin markings and venous structures. The technique described appears to be a useful method for preoperative simulation of biopsies for multiple metastatic brain tumors under local anesthesia. (author)

  11. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Battal, Bilal; Hamcan, Salih; Akgun, Veysel; Sari, Sebahattin; Tasar, Mustafa [Gulhane Military Medical School, Department of Radiology, Ankara (Turkey); Oz, Oguzhan [Gulhane Military Medical School, Department of Neurology, Ankara (Turkey); Castillo, Mauricio [University of North Carolina School of Medicine, Division of Neuroradiology, Department of Radiology, Chapel Hill, NC (United States)

    2016-06-15

    To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. (orig.)

  12. Early monitoring of PtiO2, PtiCO2, pH and brain temperat ure in patients with brain injuries and the clinical significanc e

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To explore the regulation of early br ain tissue metabolic changing after brain injuries and the clinical significance .   Methods: There were 17 patients with brain injuries. Early dire ct monitoring of PtiO2, PtiCO2, pH and brain temperature, dynami c observation of the relation between various parameters and clinics after brai n injuries were performed.   Results: Early changes of PtiO2, PtiCO2 and pH we re closely correlated with outcome. The death rate obviously increased when P tiO2 was continuously lower than 9 mm?Hg within 24 hours after injuries. Secondary brain injury prolonged and aggravated brain tissue metabolic disturban ce. When intracerebral pressure was over 30 mm?Hg PtiO2 began to de crea se. The brain temperature in brain death patients was evidently lower than axill ary temperature.   Conclusions: The direct monitoring of PtiO2, PtiC O2, pH and brain temperature is safe and accurate and can find early anoxia da mage to brain tissue and provide reliable basis for clinical therapy. It ha s an instructive significance in selecting and studying a new treatment method i n brain injuries. And it can be taken as a criterion in clinical judging brain d eaths.

  13. [Introduction of neuroethics: out of clinic, beyond academia in human brain research].

    Science.gov (United States)

    Fukushi, Tamami; Sakura, Osamu

    2008-11-01

    Higher cognitive function in human brain is one of well-developed fields of neuroscience research in the 21st century. Especially functional magnetic resonance imaging (fMRI) and near infrared recording system have brought so many non-clinical researchers whose background is such as cognitive psychology, economics, politics, pedagogy, and so on, to the human brain mapping study. Authors have introduced the ethical issues related to incidental findings during the fMRI recording for non-clinical purpose, which is a typical problem derived from such expanded human brain research under non clinical condition, that is, neuroethics. In the present article we would introduce neuroethical issues in contexts of "out of clinic" and "beyond academia".

  14. Gas-containing brain abscess: Etiology, clinical characteristics, and outcome

    Directory of Open Access Journals (Sweden)

    Tsung-Ming Su

    2014-12-01

    Full Text Available Gas-containing brain abscess remains a life-threatening disease that requires immediate diagnostic and therapeutic intervention. The aim of this study is to report on a series of gas-containing brain abscess and discuss its pathological mechanism and therapeutic consideration. This study included 11 patients with gas-containing brain abscess at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan during a 27-year period. The predisposing factors to infection included hematogenous spread in five patients, contiguous infection in one patient, and abnormal fistulous communication due to head injury in four patients. In one patient, the predisposing factor might be contiguous infection from frontal sinusitis or abnormal fistulous communication due to previous sinus surgery. Klebsiella pneumoniae was the most common causative pathogen that was isolated from the gas-containing abscess not related to skull base defect. Among these 11 patients, six underwent excision and five accepted aspiration for the surgical treatment of abscess. In the five patients who underwent aspiration, two required repeated craniotomy to excise the recurrent abscess and repair the abnormal fistulous communication through the skull base. When encountered with a gas-containing abscess in patients with an impaired host defense mechanism, K. pneumoniae infection should be suspected, and further attention should be paid to discovering if other metastatic septic abscesses exist. For patients with a history of basilar skull fracture or surgery involving the skull base, craniotomy is indicated to excise the abscess and repair the potential fistulous communication through the cranium. Aspiration may be a reasonable alternative to treat deep-seated lesions, lesions in an eloquent area, patients with severe concomitant medical disease, or patients without a history of basilar skull fracture or surgery involving the skull base. Prompt diagnosis, appropriate antibiotic use, and

  15. Optogenetically inspired deep brain stimulation: linking basic with clinical research.

    Science.gov (United States)

    Lüscher, Christian; Pollak, Pierre

    2016-01-01

    In the last decade, optogenetics has revolutionised the neurosciences. The technique, which allows for cell-type specific excitation and inhibition of neurons in the brain of freely moving rodents, has been used to tighten the links of causality between neural activity and behaviour. Optogenetics is also enabling an unprecedented characterisation of circuits and their dysfunction in a number of brain diseases, above all those conditions that are not caused by neurodegeneration. Notable progress has been made in addiction, depression and obsessive-compulsive disorders, as well as other anxiety disorders. By extension, the technique has also been used to propose blueprints for innovative rational treatment of these diseases. The goal is to design manipulations that disrupt pathological circuit function or restore normal activity. This can be achieved by targeting specific projections in order to apply specific stimulation protocols validated by ex-vivo analysis of the mechanisms underlying the dysfunction. In a number of cases, specific forms of pathological synaptic plasticity have been implicated. For example, addictive drugs via strong increase of dopamine trigger a myriad of alterations of glutamate and γ-aminobutyric acid transmission, also called drug-evoked synaptic plasticity. This opens the way to the design of optogenetic reversal protocols, which might restore normal transmission with the hope to abolish the pathological behaviour. Several proof of principle studies for this approach have recently been published. However, for many reasons, optogenetics will not be translatable to human applications in the near future. Here, we argue that an intermediate step is novel deep brain stimulation (DBS) protocols that emulate successful optogenetic approaches in animal models. We provide a roadmap for a translational path to rational, optogenetically inspired DBS protocols to refine existing approaches and expand to novel indications.

  16. Brain atrophy in multiple sclerosis: therapeutic, cognitive and clinical impact

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Rojas

    2016-03-01

    Full Text Available ABSTRACT Multiple sclerosis (MS was always considered as a white matter inflammatory disease. Today, there is an important body of evidence that supports the hypothesis that gray matter involvement and the neurodegenerative mechanism are at least partially independent from inflammation. Gray matter atrophy develops faster than white matter atrophy, and predominates in the initial stages of the disease. The neurodegenerative mechanism creates permanent damage and correlates with physical and cognitive disability. In this review we describe the current available evidence regarding brain atrophy and its consequence in MS patients.

  17. Which drug or drug delivery system can change clinical practice for brain tumor therapy?

    OpenAIRE

    Siegal, Tali

    2013-01-01

    The prognosis and treatment outcome for primary brain tumors have remained unchanged despite advances in anticancer drug discovery and development. In clinical trials, the majority of promising experimental agents for brain tumors have had limited impact on survival or time to recurrence. These disappointing results are partially explained by the inadequacy of effective drug delivery to the CNS. The impediments posed by the various specialized physiological barriers and active efflux mechanis...

  18. Challenges in clinical applications of brain computer interfaces in individuals with spinal cord injury

    OpenAIRE

    Rupp, Rüdiger

    2014-01-01

    Brain computer interfaces (BCIs) are devices that measure brain activities and translate them into control signals used for a variety of applications. Among them are systems for communication, environmental control, neuroprostheses, exoskeletons, or restorative therapies. Over the last years the technology of BCIs has reached a level of matureness allowing them to be used not only in research experiments supervised by scientists, but also in clinical routine with patients with neurological im...

  19. Brain hypothermia therapy for childhood acute encephalopathy based on clinical evidence

    OpenAIRE

    IMATAKA, GEORGE; ARISAKA, OSAMU

    2015-01-01

    Although previous studies have reported on the effectiveness of brain hypothermia therapy in childhood acute encephalopathy, additional studies in this field are necessary. In this review, we discussed brain hypothermia therapy methods for two clinical conditions for which sufficient evidences are currently available in the literature. The first condition is known as hypoxic-ischemic encephalopathy and occurs in newborns and the second condition is acute encephalopathy which occurs in adults ...

  20. Clinical peculiarities of the brain damage in the liquidators of the Chernobyl accident

    Energy Technology Data Exchange (ETDEWEB)

    Zozulya, Y A; Vinnitsky, A R; Stepanenko, I V [Institute of Neurosurgery, Academy of Medical Sciences, Kiev (Ukraine)

    1997-09-01

    Investigation into the features of the brain damage by the liquidators of the Chernobyl accident has become an urgent issue of today due to a number of circumstances. According to the classical concept dominating radiobiology until recently, the brain being composed of highly - differentiated nerve cells, present a radioresistant structure responsive to radiation injury induced by high and very high radiation doses (10000 rem and higher) only. The results of clinical examinations given to the Chernobyl accident recovery workers at Kiev Institute of Neurosurgery, Academy of Medical Sciences of Ukraine, show that even the so - called ``small - dose`` radiation, when consumed continuously, produces neurological sings of brain damage. 6 figs.

  1. Clinical peculiarities of the brain damage in the liquidators of the Chernobyl accident

    International Nuclear Information System (INIS)

    Zozulya, Y.A.; Vinnitsky, A.R.; Stepanenko, I.V.

    1997-01-01

    Investigation into the features of the brain damage by the liquidators of the Chernobyl accident has become an urgent issue of today due to a number of circumstances. According to the classical concept dominating radiobiology until recently, the brain being composed of highly - differentiated nerve cells, present a radioresistant structure responsive to radiation injury induced by high and very high radiation doses (10000 rem and higher) only. The results of clinical examinations given to the Chernobyl accident recovery workers at Kiev Institute of Neurosurgery, Academy of Medical Sciences of Ukraine, show that even the so - called ''small - dose'' radiation, when consumed continuously, produces neurological sings of brain damage. 6 figs

  2. Computational Analysis of Brain Images: Towards a Useful Tool in Clinical Practice

    DEFF Research Database (Denmark)

    Puonti, Oula

    scans, many of the developed methods are not readily extendible to clinical applications due to the variability of clinical MRI data and the presence of pathologies, such as tumors or lesions. Thus, clinicians are forced to manually analyze the MRI data, which is a time consuming task and introduces...... rater-dependent variability that reduces the accuracy and sensitivity of the results. The goal of this PhD-project was to enlarge the scope of the automatic tools into clinical applications. In order to tackle the variability of the data and presence of pathologies, we base our methods on Bayesian...... this framework can be extended with models of brain lesions. This results in a set of fast, robust and fully automatic tools for segmenting MRI brain scans of both healthy subjects and subjects suffering from brain disorders such as multiple sclerosis. Having access to quantitative measures of both lesions...

  3. [A clinical trial of neutron capture therapy for brain tumors

    International Nuclear Information System (INIS)

    Zamenhof, R.G.

    1990-01-01

    This document briefly describes recent advances in the author's laboratory. Topics described include neutron beam design, high- resolution autoradiography, boronated phenylalanine (BPA) distribution and survival studies in glioma bearing mice, computer- aided treatment planning, prompt gamma boron 10 analysis facility at MITI-II, non-rodent BPA toxicity studies, and preparations for clinical studies

  4. Update on Clinical Features and Brain Abnormalities in Neurogenetics Syndromes

    Science.gov (United States)

    Jackowski, Andrea Parolin; Laureano, Maura Regina; Del'Aquilla, Marco Antonio; de Moura, Luciana Monteiro; Assuncao, Idaiane; Silva, Ivaldo; Schwartzman, Jose Salomao

    2011-01-01

    Neuroimaging methods represent a critical tool in efforts to join the study of the neurobiology of genes with the neurobiology of behaviour, and to understand the neurodevelopmental pathways that give rise to cognitive and behavioural impairments. This article reviews the clinical features and highlights studies with a focus on the relevant…

  5. Location of brain lesions predicts conversion of clinically isolated syndromes to multiple sclerosis

    DEFF Research Database (Denmark)

    Giorgio, Antonio; Battaglini, Marco; Rocca, Maria Assunta

    2013-01-01

    OBJECTIVES: To assess in a large population of patients with clinically isolated syndrome (CIS) the relevance of brain lesion location and frequency in predicting 1-year conversion to multiple sclerosis (MS). METHODS: In this multicenter, retrospective study, clinical and MRI data at onset......: In CIS patients with hemispheric, multifocal, and brainstem/cerebellar onset, lesion probability map clusters were seen in clinically eloquent brain regions. Significant lesion clusters were not found in CIS patients with optic nerve and spinal cord onset. At 1 year, clinically definite MS developed...... in the converting group in projection, association, and commissural WM tracts, with larger clusters being in the corpus callosum, corona radiata, and cingulum. CONCLUSIONS: Higher frequency of lesion occurrence in clinically eloquent WM tracts can characterize CIS subjects with different types of onset...

  6. Brain lesions in neurofibromatosis: clinical and MRI findings

    International Nuclear Information System (INIS)

    Magnaldi, S.

    1990-01-01

    Neurofibromatosis is the commonest neuroectodermal disease. It is characterized by dysplasias and/or tumors of organs and tissues derived from the embryonic ectoderm, and most frequently presents with nervous system and cutaneous lesions. It can be classified as neurofibromatosis type 2 (NF-2 or bilateral acoustic neurofibromatosis). In order to assess clinical presentation of the disease and diagnostic value of Magnetic Resonance Imaging (MRI), the authors retrospectively evaluated the clinical records and the cranial MR studies of 21 patients with neurofibromatosis (18 with NF-1 and 3 with NF-2). Distinctive abnormalities between the two types were found in both clinical presentation and MR studies. Clinically, NF-1 patients presented most often with blindness, while NF-2 patients were deaf and had fewer cutaneous lesions. The evaluation of MR studies showed that NF-1 patients were more likely to be affected with intracranial gliomas, predominantly of the optic pathways. Moreover, foci of prolonged T2 relaxation were frequently observed, primarily in the globus pallidus of the basal ganglia and in the dentate nucleus of the cerebellum. Some of the foci in the globi pallidi exhibited increased signal intensity on T1-weighted images as well. NF-2 patients more frequently presented with bilateral acoustic schwannomas, meningiomas and cerebral white matter foci of prolonged T2 relaxation, but they did not have dentate and basal ganglia lesions. The authors conclude that as a rule the manifestations of NF-1 and NF-2 on cranial MRI are separate and distinct; they do not overlap. MRI is an useful clinical tool for the diagnosis and the follow-up of patients with neurofibromatosis

  7. Clinical course of brain stroke in the persons exposed to ionizing radiation under the production conditions

    International Nuclear Information System (INIS)

    Bouchmanov, A.

    2000-01-01

    The purpose was to study the risk factors and clinical course of brain strokes in professionally exposed workers being employed in plutonium production in comparison with a control group. The method and materials of study -clinical supervision and clinical database creation on 162 cases of brain stroke (128 males and 34 females) developed among professionally exposed workers. Age of patient varied from 21 to 68 years (in average -51.6 y.). The control group consisted of patients with the same diagnosis, worked on the same enterprise, but non-exposed to radiation. Data on the totally accumulated dose of external gamma radiation were received on the base of the individual dosimeters (from 0.1 cSv to 52 cSv, in average about 13 cSv); the plutonium-239 body content was estimated accordingly to the level of urine radionuclide excretion (from 0.4 kBq to 1.6 kBq, in average about 0.33 kBq). Muscle's hypertinsion and pathological great-toe reflexes in paretic legs and hands, hemianopsia, impressive and ataxic aphasia prevailed in the patients with ischemic brain strokes in system of internal carotid artery, exposed to radiation. The changes of muscle's tension, ataxia and nystagmus were marked more often in the professionals with ischemic brain strokes in system of vertebrobasilar artery. The illness proceeded more easy and with smaller frequency of frustration of consciousness and algesthesia, irrespective of a type ischemic brain strokes in the people exposed to ionizing radiation, than in patients of non-irradiated group. It was found that the arterial hypertension appeared to be the main risk factor for the brain stroke in both groups of patients (in 81.48% and 91.15% of cases). There was no marked differences in significance of risk factors and in main clinical parameters of various types of ischemic brain strokes among the patients professionally exposed to radiation in comparison with a control group. (author)

  8. Correlation of glucose metabolism in brain cells and brain morphological changes with clinical typing in children with cerebral palsy

    Institute of Scientific and Technical Information of China (English)

    Qiongxiang Zhai; Huixian Qiao; Jiqing Liu

    2006-01-01

    BACKGROUND:It is widely known that fluorino-18-fluorodeoxyglucose positron emission tomography(18F-FDG PET)is commonly used to evaluate and diagnose epilepsy;however,whether it is beneficial to understand functional metabolism of bra in cells so as to reflect injured site and degree of brain cells or not should be studied further.OBJECTIVE:To evaluate the correlation between glucose metabolism and clinical typling as well as the conelation between active function of brain cells and degree of brain injury among children with cerbral palsy with 18F-FDG PET and MRI and compare the results of them.DESIGN:Case analysis.SETTING:Department of Pediatrics,People's Hospital of Guangdong Province.PARTICIPANTS:A total of 31 children with cerebral palsy were selected from Out-patient Clinic and In-patient Department of People's Hospital of Guangdong Province from July 2001 to August 2004.Based on clinical criteria of cerebral palsy,patients were classified into spasm(n=10),gradual movement(n=4),mixed type(n =13)and ataxia(n=4).There were 18 boys and 13 girls aged from 10 months to 4 years.All of them were met the diagnostic criteria of cerebral palsy and all parents of them were told the facts.Exclusion cdteria:Patients who had cerebral palsy caused by genetic metabolism disease were excluded.METHODS:①All children accepted MRI examination after hospitalization with Philips Acs NT 15T superconductling magnetic resonance scanner.②All children were fasted for 4 hours.And then,PET image of brain was collected based on T+EID type.If obvious hypermetabolism or hypometabolism region successively occurred on two layers, the image was regarded as abnormality. ③Different correlations of various abnormal greups of MRI and vadous types of cerebral palsy with PET image were compared and analyzed with Erusal-Willas rank sum test.MAIN OUTCOME MEASURES:①Results of 18F-FDG PET;②Results of MRI examination;③Correlation of variously abnormal groups of MRI and various types of cerebral

  9. The juvenile antisocial brain : brain imaging studies in clinically antisocial youth with nascent phychopathic traits

    NARCIS (Netherlands)

    Aghajani, M.

    2018-01-01

    The work presented in this thesis provides important new clues on the neurobiology of juvenile psychopathic traits in clinically antisocial juveniles. The data specifically shows that these traits are ostensibly underpinned by highly specific corticolimbic network dysfunctions, in which

  10. Radon in dwellings the national radon survey Galway and Mayo

    International Nuclear Information System (INIS)

    McGarry, A.T.; Fennell, S.G.; Mackin, G.M.; Madden, J.S.; O'Colmain, M.

    1999-07-01

    This report presents the results of the final phase of the National Radon Survey carried out by the Radiological Protection Institute of Ireland. The counties included in this phase are Galway and Mayo. The average radon concentrations for the houses measured in these counties were 112 Bq/m 3 and 100 Bq/m 3 , respectively. The measurement data were grouped on the basis of the 10 km grid squares of the Irish National Grid System and used to predict the percentage of dwellings in each grid square which exceeds the Reference Level of 200 Bq/m 3 . Grid squares where this percentage is predicted to be 10% or higher are designated High Radon Areas. The health effects of exposure to high radon levels are discussed and recommendations are made regarding both new and existing dwellings. (author)

  11. Analysis of fractional anisotropy facilitates differentiation of glioblastoma and brain metastases in a clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Bette, Stefanie, E-mail: stefanie.bette@tum.de [Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich (Germany); Huber, Thomas; Wiestler, Benedikt; Boeckh-Behrens, Tobias [Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich (Germany); Gempt, Jens; Ringel, Florian; Meyer, Bernhard [Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich (Germany); Zimmer, Claus; Kirschke, Jan S. [Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich (Germany)

    2016-12-15

    Purpose: Differentiating glioblastoma from brain metastases is important for therapy planning. Diffusion tensor imaging (DTI) was described as a promising tool, however with conflicting results. Aim: of this study was to analyze the clinical utility of DTI for the differentiation of brain metastases and glioblastoma. Methods: 294 patients (165 glioblastoma, 129 brain metastases) with preoperative DTI were included in this retrospective study. Fractional anisotropy (FA) was measured via regions of interest (ROIs) in the contrast-enhancing tumor, the necrosis and the FLAIR-hyperintense non-enhancing peritumoral region (NEPTR). Two neuroradiologists classified patient cases as glioblastoma or brain metastases without and with knowledge of FA values. Results: Glioblastoma showed significantly higher FA{sub contrast} (median glioblastoma = 0.33, metastases = 0.23; P < 0.001) whereas no significant difference was observed for FA{sub NEPTR} (0.21 vs. 0.22; P = 0.28) and for FA{sub necrosis} (0.17 vs. 0.18, P = 0.37). FA improved diagnostic accuracy of the neuroradiologists significantly from an AUC of 0.84/0.85 (Reader1/Reader2) to 0.89/0.92. Conclusions: Glioblastoma show significantly higher FA values in the contrast enhancing tumor part than brain metastases. Implementation of a ROI-based measurement of FA values and FA color maps in clinical routine helps to differentiate between glioblastoma and brain metastases.

  12. The self-regulating brain and neurofeedback: Experimental science and clinical promise.

    Science.gov (United States)

    Thibault, Robert T; Lifshitz, Michael; Raz, Amir

    2016-01-01

    Neurofeedback, one of the primary examples of self-regulation, designates a collection of techniques that train the brain and help to improve its function. Since coming on the scene in the 1960s, electroencephalography-neurofeedback has become a treatment vehicle for a host of mental disorders; however, its clinical effectiveness remains controversial. Modern imaging technologies of the living human brain (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous research protocols that utilize such methodologies begin to shed light on the underlying mechanisms that may facilitate more effective clinical applications. In this paper we focus on recent technological advances in the field of human brain imaging and discuss how these modern methods may influence the field of neurofeedback. Toward this end, we outline the state of the evidence and sketch out future directions to further explore the potential merits of this contentious therapeutic prospect. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. neuro-ophthalmic and clinical characteristics of brain tumours in a ...

    African Journals Online (AJOL)

    2015-09-01

    Sep 1, 2015 ... Ophthalmology, Neurosurgery and Endocrine units of. KBTH, Ghana. All patients had clinical diagnosis of brain tumour with confirmation by computerized to- mography (CT) or magnetic resonance imaging (MRI). Thirteen patients had histological confirmation of di- agnosis. Outcome measures: Presenting ...

  14. Mapping causal functional contributions derived from the clinical assessment of brain damage after stroke

    Directory of Open Access Journals (Sweden)

    Melissa Zavaglia

    2015-01-01

    Full Text Available Lesion analysis reveals causal contributions of brain regions to mental functions, aiding the understanding of normal brain function as well as rehabilitation of brain-damaged patients. We applied a novel lesion inference technique based on game theory, Multi-perturbation Shapley value Analysis (MSA, to a large clinical lesion dataset. We used MSA to analyze the lesion patterns of 148 acute stroke patients together with their neurological deficits, as assessed by the National Institutes of Health Stroke Scale (NIHSS. The results revealed regional functional contributions to essential behavioral and cognitive functions as reflected in the NIHSS, particularly by subcortical structures. There were also side specific differences of functional contributions between the right and left hemispheric brain regions which may reflect the dominance of the left hemispheric syndrome aphasia in the NIHSS. Comparison of MSA to established lesion inference methods demonstrated the feasibility of the approach for analyzing clinical data and indicated its capability for objectively inferring functional contributions from multiple injured, potentially interacting sites, at the cost of having to predict the outcome of unknown lesion configurations. The analysis of regional functional contributions to neurological symptoms measured by the NIHSS contributes to the interpretation of this widely used standardized stroke scale in clinical practice as well as clinical trials and provides a first approximation of a ‘map of stroke’.

  15. Mapping causal functional contributions derived from the clinical assessment of brain damage after stroke.

    Science.gov (United States)

    Zavaglia, Melissa; Forkert, Nils D; Cheng, Bastian; Gerloff, Christian; Thomalla, Götz; Hilgetag, Claus C

    2015-01-01

    Lesion analysis reveals causal contributions of brain regions to mental functions, aiding the understanding of normal brain function as well as rehabilitation of brain-damaged patients. We applied a novel lesion inference technique based on game theory, Multi-perturbation Shapley value Analysis (MSA), to a large clinical lesion dataset. We used MSA to analyze the lesion patterns of 148 acute stroke patients together with their neurological deficits, as assessed by the National Institutes of Health Stroke Scale (NIHSS). The results revealed regional functional contributions to essential behavioral and cognitive functions as reflected in the NIHSS, particularly by subcortical structures. There were also side specific differences of functional contributions between the right and left hemispheric brain regions which may reflect the dominance of the left hemispheric syndrome aphasia in the NIHSS. Comparison of MSA to established lesion inference methods demonstrated the feasibility of the approach for analyzing clinical data and indicated its capability for objectively inferring functional contributions from multiple injured, potentially interacting sites, at the cost of having to predict the outcome of unknown lesion configurations. The analysis of regional functional contributions to neurological symptoms measured by the NIHSS contributes to the interpretation of this widely used standardized stroke scale in clinical practice as well as clinical trials and provides a first approximation of a 'map of stroke'.

  16. Mapping causal functional contributions derived from the clinical assessment of brain damage after stroke

    Science.gov (United States)

    Zavaglia, Melissa; Forkert, Nils D.; Cheng, Bastian; Gerloff, Christian; Thomalla, Götz; Hilgetag, Claus C.

    2015-01-01

    Lesion analysis reveals causal contributions of brain regions to mental functions, aiding the understanding of normal brain function as well as rehabilitation of brain-damaged patients. We applied a novel lesion inference technique based on game theory, Multi-perturbation Shapley value Analysis (MSA), to a large clinical lesion dataset. We used MSA to analyze the lesion patterns of 148 acute stroke patients together with their neurological deficits, as assessed by the National Institutes of Health Stroke Scale (NIHSS). The results revealed regional functional contributions to essential behavioral and cognitive functions as reflected in the NIHSS, particularly by subcortical structures. There were also side specific differences of functional contributions between the right and left hemispheric brain regions which may reflect the dominance of the left hemispheric syndrome aphasia in the NIHSS. Comparison of MSA to established lesion inference methods demonstrated the feasibility of the approach for analyzing clinical data and indicated its capability for objectively inferring functional contributions from multiple injured, potentially interacting sites, at the cost of having to predict the outcome of unknown lesion configurations. The analysis of regional functional contributions to neurological symptoms measured by the NIHSS contributes to the interpretation of this widely used standardized stroke scale in clinical practice as well as clinical trials and provides a first approximation of a ‘map of stroke’. PMID:26448908

  17. Motor programme activating therapy influences adaptive brain functions in multiple sclerosis: clinical and MRI study.

    Science.gov (United States)

    Rasova, Kamila; Prochazkova, Marie; Tintera, Jaroslav; Ibrahim, Ibrahim; Zimova, Denisa; Stetkarova, Ivana

    2015-03-01

    There is still little scientific evidence for the efficacy of neurofacilitation approaches and their possible influence on brain plasticity and adaptability. In this study, the outcome of a new kind of neurofacilitation approach, motor programme activating therapy (MPAT), was evaluated on the basis of a set of clinical functions and with MRI. Eighteen patients were examined four times with standardized clinical tests and diffusion tensor imaging to monitor changes without therapy, immediately after therapy and 1 month after therapy. Moreover, the strength of effective connectivity was analysed before and after therapy. Patients underwent a 1-h session of MPAT twice a week for 2 months. The data were analysed by nonparametric tests of association and were subsequently statistically evaluated. The therapy led to significant improvement in clinical functions, significant increment of fractional anisotropy and significant decrement of mean diffusivity, and decrement of effective connectivity at supplementary motor areas was observed immediately after the therapy. Changes in clinical functions and diffusion tensor images persisted 1 month after completing the programme. No statistically significant changes in clinical functions and no differences in MRI-diffusion tensor images were observed without physiotherapy. Positive immediate and long-term effects of MPAT on clinical and brain functions, as well as brain microstructure, were confirmed.

  18. Right brain, left brain in depressive disorders: Clinical and theoretical implications of behavioral, electrophysiological and neuroimaging findings.

    Science.gov (United States)

    Bruder, Gerard E; Stewart, Jonathan W; McGrath, Patrick J

    2017-07-01

    The right and left side of the brain are asymmetric in anatomy and function. We review electrophysiological (EEG and event-related potential), behavioral (dichotic and visual perceptual asymmetry), and neuroimaging (PET, MRI, NIRS) evidence of right-left asymmetry in depressive disorders. Recent electrophysiological and fMRI studies of emotional processing have provided new evidence of altered laterality in depressive disorders. EEG alpha asymmetry and neuroimaging findings at rest and during cognitive or emotional tasks are consistent with reduced left prefrontal activity in depressed patients, which may impair downregulation of amygdala response to negative emotional information. Dichotic listening and visual hemifield findings for non-verbal or emotional processing have revealed abnormal perceptual asymmetry in depressive disorders, and electrophysiological findings have shown reduced right-lateralized responsivity to emotional stimuli in occipitotemporal or parietotemporal cortex. We discuss models of neural networks underlying these alterations. Of clinical relevance, individual differences among depressed patients on measures of right-left brain function are related to diagnostic subtype of depression, comorbidity with anxiety disorders, and clinical response to antidepressants or cognitive behavioral therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. [Brain lateralization and seizure semiology: ictal clinical lateralizing signs].

    Science.gov (United States)

    Horváth, Réka; Kalmár, Zsuzsanna; Fehér, Nóra; Fogarasi, András; Gyimesi, Csilla; Janszky, József

    2008-07-30

    Clinical lateralizing signs are the phenomena which can unequivocally refer to the hemispheric onset of epileptic seizures. They can improve the localization of epileptogenic zone during presurgical evaluation, moreover, their presence can predict a success of surgical treatment. Primary sensory phenomena such as visual aura in one half of the field of vision or unilateral ictal somatosensory sensation always appear on the contralateral to the focus. Periictal unilateral headache, although it is an infrequent symptom, is usually an ipsilateral sign. Primary motor phenomena like epileptic clonic, tonic movements, the version of head ubiquitously appear contralateral to the epileptogenic zone. Very useful lateralization sign is the ictal hand-dystonia which lateralizes to the contralateral hemisphere in nearly 100%. The last clonus of the secondarily generalized tonic-clonic seizure lateralizes to the ipsilateral hemisphere in 85%. The fast component of ictal nystagmus appears in nearly 100% on the contralateral side of the epileptic focus. Vegetative symptoms during seizures arising from temporal lobe such as spitting, nausea, vomiting, urinary urge are typical for seizures originating from non-dominant (right) hemisphere. Ictal pallor and cold shivers are dominant hemispheric lateralization signs. Postictal unilateral nose wiping refers to the ipsilateral hemispheric focus compared to the wiping hand. Ictal or postictal aphasia refers to seizure arising from dominant hemisphere. Intelligable speech during complex partial seizures appears in non-dominant seizures. Automatism with preserved consciousness refers to the seizures of non-dominant temporal lobe.

  20. Challenges of proper placebo control for non-invasive brain stimulation in clinical and experimental applications.

    Science.gov (United States)

    Davis, Nick J; Gold, Edward; Pascual-Leone, Alvaro; Bracewell, R Martyn

    2013-10-01

    A range of techniques are now available for modulating the activity of the brain in healthy people and people with neurological conditions. These techniques, including transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS, which includes direct and alternating current), create magnetic or electrical fields that cross the intact skull and affect neural processing in brain areas near to the scalp location where the stimulation is delivered. TMS and tCS have proved to be valuable tools in behavioural neuroscience laboratories, where causal involvement of specific brain areas in specific tasks can be shown. In clinical neuroscience, the techniques offer the promise of correcting abnormal activity, such as when a stroke leaves a brain area underactive. As the use of brain stimulation becomes more commonplace in laboratories and clinics, we discuss the safety and ethical issues inherent in using the techniques with human participants, and we suggest how to balance scientific integrity with the safety of the participant. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  1. Microdialysis Monitoring in Clinical Traumatic Brain Injury and Its Role in Neuroprotective Drug Development.

    Science.gov (United States)

    Thelin, Eric Peter; Carpenter, Keri L H; Hutchinson, Peter J; Helmy, Adel

    2017-03-01

    Injuries to the central nervous system continue to be vast contributors to morbidity and mortality; specifically, traumatic brain injury (TBI) is the most common cause of death during the first four decades of life. Several modalities are used to monitor patients suffering from TBI in order to prevent detrimental secondary injuries. The microdialysis (MD) technique, introduced during the 1990s, presents the treating physician with a robust monitoring tool for brain chemistry in addition to conventional intracranial pressure monitoring. Nevertheless, some limitations remain, such as limited spatial resolution. Moreover, while there have been several attempts to develop new potential pharmacological therapies in TBI, there are currently no available drugs which have shown clinical efficacy that targets the underlying pathophysiology, despite various trials investigating a plethora of pharmaceuticals. Specifically in the brain, MD is able to demonstrate penetration of the drug through the blood-brain barrier into the brain extracellular space at potential site of action. In addition, the downstream effects of drug action can be monitored directly. In the future, clinical MD, together with other monitoring modalities, can identify specific pathological substrates which require tailored treatment strategies for patients suffering from TBI.

  2. Traumatic Brain Injury Severity, Neuropathophysiology, and Clinical Outcome: Insights from Multimodal Neuroimaging

    Directory of Open Access Journals (Sweden)

    Andrei Irimia

    2017-10-01

    Full Text Available BackgroundThe relationship between the acute clinical presentation of patients with traumatic brain injury (TBI, long-term changes in brain structure prompted by injury and chronic functional outcome is insufficiently understood. In this preliminary study, we investigate how acute Glasgow coma score (GCS and epileptic seizure occurrence after TBIs are statistically related to functional outcome (as quantified using the Glasgow Outcome Score and to the extent of cortical thinning observed 6 months after the traumatic event.MethodsUsing multivariate linear regression, the extent to which the acute GCS and epileptic seizure occurrence (predictor variables correlate with structural brain changes (relative cortical atrophy was examined in a group of 33 TBI patients. The statistical significance of the correlation between relative cortical atrophy and the Glasgow Outcome Score was also investigated.ResultsA statistically significant correlative relationship between cortical thinning and the predictor variables (acute GCS and seizure occurrence was identified in the study sample. Regions where the statistical model was found to have highest statistical reliability in predicting both gray matter atrophy and neurological outcome include the frontopolar, middle frontal, postcentral, paracentral, middle temporal, angular, and lingual gyri. In addition, relative atrophy and GOS were also found to be significantly correlated over large portions of the cortex.ConclusionThis study contributes to our understanding of the relationship between clinical descriptors of acute TBI, the extent of injury-related chronic brain changes and neurological outcome. This is partly because the brain areas where cortical thinning was found to be correlated with GCS and with seizure occurrence are implicated in executive control, sensory function, motor acuity, memory, and language, all of which may be affected by TBI. Thus, our quantification suggests the existence of a

  3. Leptomeningeal enhancement on preoperative brain MRI in patients with glioblastoma and its clinical impact.

    Science.gov (United States)

    Kim, Hakyoung; Lim, Do Hoon; Kim, Tae Gyu; Lee, Jung-Il; Nam, Do-Hyun; Seol, Ho Jun; Kong, Doo-Sik; Choi, Jung Won; Suh, Yeon-Lim; Kim, Sung Tae

    2018-02-23

    Leptomeningeal enhancement (LME) on preoperative brain magnetic resonance imaging (MRI) does not always indicate leptomeningeal seeding (LMS). With Stupp's regimen, authors have treated glioblastoma patients with LME on preoperative brain MRI but here we tried to find the clinical impact of LME. From 2005 to 2015, 290 patients with glioblastoma have been treated with Stupp's regimen at Samsung Medical Center. Among these, 33 patients showed LME on preoperative brain MRI. We compared the clinical outcomes between the patients with or without LME on preoperative brain MRI and analyzed the clinical results according to changes of LME at following MRI. The median survival was 23 months, and 2-year overall survival (OS) and disease-free survival (DFS) rate was 46.3% and 19.6%, respectively. Prognostic factors for OS and DFS were Karnofsky performance status, extent of resection and adjuvant chemotherapy. MGMT promoter methylation status was a significant prognostic factor for DFS. However, LME was not a significant prognostic factor for OS (P = 0.156) or DFS (P = 0.193). Among the 33 patients with LME on preoperative MRI, 21 (63.6%) showed persistent LME at the next MRI. A statistically significant difference in 2-year survival was evident between patients with and without persistent LME (OS, 17.3% and 70.1%, respectively, P = 0.044; DFS, 5.3% and 54.0%, respectively, P = 0.006). The most common pattern of failure was local recurrence. However, patients with persistent LME displayed a higher incidence of LMS than patients without LME. LME on preoperative brain MRI did not affect the clinical results in glioblastoma patients treated with the Stupp's regimen. However, persistence of LME was associated with poor survival and high possibility of LMS. For these patients, the postoperative adjuvant treatment should focus on palliative aim or more aggressive treatment scheme should be followed to overcome the disastrous results. © 2018 John Wiley & Sons Australia, Ltd.

  4. Late clinical and radiological complications of stereotactical radiosurgery of arteriovenous malformations of the brain

    Energy Technology Data Exchange (ETDEWEB)

    Parkhutik, Vera [Hospital Universitario la Fe, Department of Neurology, Valencia (Spain); Universidad Autonoma de Barcelona, PhD Program of the Department of Medicine, Barcelona (Spain); Lago, Aida; Vazquez, Juan Francisco; Tembl, Jose Ignacio [Hospital Universitario la Fe, Department of Neurology, Valencia (Spain); Aparici, Fernando; Guillen, Lourdes; Mainar, Esperanza; Vazquez, Victor [Hospital Universitario la Fe, Department of Neuroradiology, Valencia (Spain)

    2013-04-15

    Post-radiation injury of patients with brain arteriovenous malformations (AVM) include blood-brain barrier breakdown (BBBB), edema, and necrosis. Prevalence, clinical relevance, and response to treatment are poorly known. We present a series of consecutive brain AVM treated with stereotactic radiosurgery describing the appearance of radiation injury and clinical complications. Consecutive patients with annual clinical and radiological follow-up (median length 63 months). Edema and BBBB were classified in four groups (minimal, perilesional, moderate, or severe), and noted together with necrosis. Clinical symptoms of interest were intracranial hypertension, new neurological deficits, new seizures, and brain hemorrhages. One hundred two cases, median age 34 years, 52 % male. Median irradiated volume 3.8 cc, dose to the margin of the nidus 18.5 Gy. Nineteen patients underwent a second radiosurgery. Only 42.2 % patients remained free from radiation injury. Edema was found in 43.1 %, blood-brain barrier breakdown in 20.6 %, necrosis in 6.9 %. Major injury (moderate or severe edema, moderate or severe BBBB, or necrosis) was found in 20 of 102 patients (19.6 %). AVM diameter >3 cm and second radiosurgery were independent predictors. Time to the worst imaging was 60 months. Patients with major radiation injury had a hazard ratio for appearance of focal deficits of 7.042 (p = 0.04), of intracranial hypertension 2.857 (p = 0.025), hemorrhage into occluded nidus 9.009 (p = 0.079), appearance of new seizures not significant. Major radiation injury is frequent and increases the risk of neurological complications. Its late appearance implies that current follow-up protocols need to be extended in time. (orig.)

  5. Analyzing the blood-brain barrier: the benefits of medical imaging in research and clinical practice.

    Science.gov (United States)

    Chassidim, Yoash; Vazana, Udi; Prager, Ofer; Veksler, Ronel; Bar-Klein, Guy; Schoknecht, Karl; Fassler, Michael; Lublinsky, Svetlana; Shelef, Ilan

    2015-02-01

    A dysfunctional BBB is a common feature in a variety of brain disorders, a fact stressing the need for diagnostic tools designed to assess brain vessels' permeability in space and time. Biological research has benefited over the years various means to analyze BBB integrity. The use of biomarkers for improper BBB functionality is abundant. Systemic administration of BBB impermeable tracers can both visualize brain regions characterized by BBB impairment, as well as lead to its quantification. Additionally, locating molecular, physiological content in regions from which it is restricted under normal BBB functionality undoubtedly indicates brain pathology-related BBB disruption. However, in-depth research into the BBB's phenotype demands higher analytical complexity than functional vs. pathological BBB; criteria which biomarker based BBB permeability analyses do not meet. The involvement of accurate and engineering sciences in recent brain research, has led to improvements in the field, in the form of more accurate, sensitive imaging-based methods. Improvements in the spatiotemporal resolution of many imaging modalities and in image processing techniques, make up for the inadequacies of biomarker based analyses. In pre-clinical research, imaging approaches involving invasive procedures, enable microscopic evaluation of BBB integrity, and benefit high levels of sensitivity and accuracy. However, invasive techniques may alter normal physiological function, thus generating a modality-based impact on vessel's permeability, which needs to be corrected for. Non-invasive approaches do not affect proper functionality of the inspected system, but lack in spatiotemporal resolution. Nevertheless, the benefit of medical imaging, even in pre-clinical phases, outweighs its disadvantages. The innovations in pre-clinical imaging and the development of novel processing techniques, have led to their implementation in clinical use as well. Specialized analyses of vessels' permeability

  6. Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

    International Nuclear Information System (INIS)

    Lekic, Mirko; Kovac, Viljem; Triller, Nadja; Knez, Lea; Sadikov, Aleksander; Cufer, Tanja

    2012-01-01

    Small cell lung cancer (SCLC) represents approximately 13 to 18% of all lung cancers. It is the most aggressive among lung cancers, mostly presented at an advanced stage, with median survival rates of 10 to12 months in patients treated with standard chemotherapy and radiotherapy. In approximately 15-20% of patients brain metastases are present already at the time of primary diagnosis; however, it is unclear how much it influences the outcome of disease according the other metastatic localisation. The objective of this analysis was to evaluate the median survival of SCLC patients treated by specific therapy (chemotherapy and/or radiotherapy) with regard to the presence or absence of brain metastases at the time of diagnosis. All SCLC patients have been treated in a routine clinical practice and followed up at the University Clinic Golnik in Slovenia. In the retrospective study the medical files from 2002 to 2007 were review. All patients with cytological or histological confirmed disease and eligible for specific oncological treatment were included in the study. They have been treated according to the guidelines valid at the time. Chemotherapy and regular followed-up were carried out at the University Clinic Golnik and radiotherapy at the Institute of Oncology Ljubljana. We found 251 patients eligible for the study. The median age of them was 65 years, majority were male (67%), smokers or ex-smokers (98%), with performance status 0 to 1 (83%). At the time of diagnosis no metastases were found in 64 patients (25.5%) and metastases outside the brain were presented in 153 (61.0%). Brain metastases, confirmed by a CT scan, were present in 34 patients (13.5%), most of them had also metastases at other localisations. All patients received chemotherapy and all patients with confirmed brain metastases received whole brain irradiation (WBRT). The radiotherapy with radical dose at primary tumour was delivered to 27 patients with limited disease and they got 4–6 cycles of

  7. Study on Mobile Augmented Reality Adoption for Mayo Language Learning

    Directory of Open Access Journals (Sweden)

    Erasmo Miranda Bojórquez

    2016-01-01

    Full Text Available This paper presents the results of a study applied to undergraduates in order to know how the cultural dimensions affect their perceptions of the acceptance and use of new technologies in a student-centered learning environment. A total of 85 undergraduate students from the Autonomous Indigenous University of Mexico (UAIM participated in the study. Each student was asked to use a mobile augmented reality (MAR application designed to learn Mayo language (language spoken in Northwestern Mexico. Afterwards, the students responded to a survey with items concerning the use and technology acceptance and about cultural dimensions of individualism and uncertainty avoidance. Structural equation modeling (SEM was used to analyze the data collected from students. Results provide evidence that the individualism contributes positively to perceived ease of use of the MAR app, and uncertainty avoidance has no impact. The findings showed that the MAR system could be easily used if it includes a natural way to promote collaborative work. In addition, to gain the trust of students, the uncertainty avoidance needs to be reduced by enriching the help information offered for app use.

  8. Mathematical modeling of human glioma growth based on brain topological structures: study of two clinical cases.

    Directory of Open Access Journals (Sweden)

    Cecilia Suarez

    Full Text Available Gliomas are the most common primary brain tumors and yet almost incurable due mainly to their great invasion capability. This represents a challenge to present clinical oncology. Here, we introduce a mathematical model aiming to improve tumor spreading capability definition. The model consists in a time dependent reaction-diffusion equation in a three-dimensional spatial domain that distinguishes between different brain topological structures. The model uses a series of digitized images from brain slices covering the whole human brain. The Talairach atlas included in the model describes brain structures at different levels. Also, the inclusion of the Brodmann areas allows prediction of the brain functions affected during tumor evolution and the estimation of correlated symptoms. The model is solved numerically using patient-specific parametrization and finite differences. Simulations consider an initial state with cellular proliferation alone (benign tumor, and an advanced state when infiltration starts (malign tumor. Survival time is estimated on the basis of tumor size and location. The model is used to predict tumor evolution in two clinical cases. In the first case, predictions show that real infiltrative areas are underestimated by current diagnostic imaging. In the second case, tumor spreading predictions were shown to be more accurate than those derived from previous models in the literature. Our results suggest that the inclusion of differential migration in glioma growth models constitutes another step towards a better prediction of tumor infiltration at the moment of surgical or radiosurgical target definition. Also, the addition of physiological/psychological considerations to classical anatomical models will provide a better and integral understanding of the patient disease at the moment of deciding therapeutic options, taking into account not only survival but also life quality.

  9. Clinical course of brain stroke in the persons exposed to ionizing radiation under the production conditions

    Energy Technology Data Exchange (ETDEWEB)

    Bouchmanov, A. [State Research Center of Russia, Moscow (Russian Federation). Inst. of Biophysics

    2000-05-01

    The purpose was to study the risk factors and clinical course of brain strokes in professionally exposed workers being employed in plutonium production in comparison with a control group. The method and materials of study -clinical supervision and clinical database creation on 162 cases of brain stroke (128 males and 34 females) developed among professionally exposed workers. Age of patient varied from 21 to 68 years (in average -51.6 y.). The control group consisted of patients with the same diagnosis, worked on the same enterprise, but non-exposed to radiation. Data on the totally accumulated dose of external gamma radiation were received on the base of the individual dosimeters (from 0.1 cSv to 52 cSv, in average about 13 cSv); the plutonium-239 body content was estimated accordingly to the level of urine radionuclide excretion (from 0.4 kBq to 1.6 kBq, in average about 0.33 kBq). Muscle's hypertinsion and pathological great-toe reflexes in paretic legs and hands, hemianopsia, impressive and ataxic aphasia prevailed in the patients with ischemic brain strokes in system of internal carotid artery, exposed to radiation. The changes of muscle's tension, ataxia and nystagmus were marked more often in the professionals with ischemic brain strokes in system of vertebrobasilar artery. The illness proceeded more easy and with smaller frequency of frustration of consciousness and algesthesia, irrespective of a type ischemic brain strokes in the people exposed to ionizing radiation, than in patients of non-irradiated group. It was found that the arterial hypertension appeared to be the main risk factor for the brain stroke in both groups of patients (in 81.48% and 91.15% of cases). There was no marked differences in significance of risk factors and in main clinical parameters of various types of ischemic brain strokes among the patients professionally exposed to radiation in comparison with a control group. (author)

  10. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury

    DEFF Research Database (Denmark)

    Lauritzen, Martin; Dreier, Jens Peter; Fabricius, Martin

    2011-01-01

    Cortical spreading depression (CSD) and depolarization waves are associated with dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells, increased energy metabolism and changes in cerebral blood flow (CBF). There is strong clinical and experimental evidence....... The consequences of these intrinsic mechanisms are intimately linked to the composition of the brain extracellular microenvironment and to the level of brain perfusion and in consequence brain energy supply. This paper summarizes the evidence provided by novel invasive techniques, which implicates CSD...... treatment strategies, which may be used to prevent or attenuate secondary neuronal damage in acutely injured human brain cortex caused by depolarization waves....

  11. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study.

    Science.gov (United States)

    Snowdon, D A; Greiner, L H; Mortimer, J A; Riley, K P; Greiner, P A; Markesbery, W R

    1997-03-12

    To determine the relationship of brain infarction to the clinical expression of Alzheimer disease (AD). Cognitive function and the prevalence of dementia were determined for participants in the Nun Study who later died. At autopsy, lacunar and larger brain infarcts were identified, and senile plaques and neurofibrillary tangles in the neocortex were quantitated. Participants with abundant senile plaques and some neurofibrillary tangles in the neocortex were classified as having met the neuropathologic criteria for AD. Convents in the Midwestern, Eastern, and Southern United States. A total of 102 college-educated women aged 76 to 100 years. Cognitive function assessed by standard tests and dementia and AD assessed by clinical and neuropathologic criteria. Among 61 participants who met the neuropathologic criteria for AD, those with brain infarcts had poorer cognitive function and a higher prevalence of dementia than those without infarcts. Participants with lacunar infarcts in the basal ganglia, thalamus, or deep white matter had an especially high prevalence of dementia, compared with those without infarcts (the odds ratio [OR] for dementia was 20.7, 95% confidence interval [95% CI], 1.5-288.0). Fewer neuropathologic lesions of AD appeared to result in dementia in those with lacunar infarcts in the basal ganglia, thalamus, or deep white matter than in those without infarcts. In contrast, among 41 participants who did not meet the neuropathologic criteria for AD, brain infarcts were only weakly associated with poor cognitive function and dementia. Among all 102 participants, atherosclerosis of the circle of Willis was strongly associated with lacunar and large brain infarcts. These findings suggest that cerebrovascular disease may play an important role in determining the presence and severity of the clinical symptoms of AD.

  12. Brain Stroke Detection by Microwaves Using Prior Information from Clinical Databases

    Directory of Open Access Journals (Sweden)

    Natalia Irishina

    2013-01-01

    Full Text Available Microwave tomographic imaging is an inexpensive, noninvasive modality of media dielectric properties reconstruction which can be utilized as a screening method in clinical applications such as breast cancer and brain stroke detection. For breast cancer detection, the iterative algorithm of structural inversion with level sets provides well-defined boundaries and incorporates an intrinsic regularization, which permits to discover small lesions. However, in case of brain lesion, the inverse problem is much more difficult due to the skull, which causes low microwave penetration and highly noisy data. In addition, cerebral liquid has dielectric properties similar to those of blood, which makes the inversion more complicated. Nevertheless, the contrast in the conductivity and permittivity values in this situation is significant due to blood high dielectric values compared to those of surrounding grey and white matter tissues. We show that using brain MRI images as prior information about brain's configuration, along with known brain dielectric properties, and the intrinsic regularization by structural inversion, allows successful and rapid stroke detection even in difficult cases. The method has been applied to 2D slices created from a database of 3D real MRI phantom images to effectively detect lesions larger than 2.5 × 10−2 m diameter.

  13. Trace element determinations in brain tissues from normal and clinically demented individuals

    International Nuclear Information System (INIS)

    Saiki, Mitiko; Genezini, Frederico A.; Leite, Renata E.P.; Grinberg, Lea T.; Ferretti, Renata E.L.; Suemoto, Claudia; Pasqualucci, Carlos A.; Jacob-Filho, Wilson

    2013-01-01

    Studies on trace element levels in human brains under normal and pathological conditions have indicated a possible correlation between some trace element concentrations and neurodegenerative diseases. In this study, analysis of brain tissues was carried out to investigate if there are any differences in elemental concentrations between brain tissues from a normal population above 50 years of age presenting Clinical Dementia Rating (CDR) equal to zero (CDR=0) and that cognitively affected population ( CDR=3). The tissues were dissected, ground, freeze-dried and then analyzed by instrumental neutron activation analysis. Samples and elemental standards were irradiated in a neutron flux at the IEA-R1 nuclear research reactor for Br, Fe, K, Na, Rb, Se and Zn determinations. The induced gamma ray activities were measured using a hyperpure Ge detector coupled to a gamma ray spectrometer. The one-way ANOVA test (p< 0.05) was used to compare the results. All the elements determined in the hippocampus brain region presented differences between the groups presenting CDR=0 and CDR=3. In the case of frontal region only the elements Na, Rb and Zn showed differences between these two groups. These findings proved the correlation between elemental levels present in brain tissues neurodegenerative diseases. Biological standard reference materials SRM 1566b Oyster Tissue and SRM 1577b Bovine Liver analyzed for quality control indicated good accuracy and precision of the results. (author)

  14. Brain Microstructural Correlates of Cognitive Dysfunction in Clinically and Biochemically Normal Hepatitis C Virus Infection.

    Science.gov (United States)

    Kumar, Ajay; Deep, Amar; Gupta, Rakesh K; Atam, Virendra; Mohindra, Samir

    2017-09-01

    This study examined correlates of the brain's neurocognitive performance among clinically and biochemically normal adult patient with hepatitis C virus (HCV). We hypothesized that anti-HCV positive individuals would demonstrate structural brain abnormalities and neurocognitive dysfunction as well as the changes in cell component and extracellular space in the white matter regions of brain in asymptomatic HCV infection by using diffusion tensor tractrography (DTT) metrics. Anti-HCV positive patient ( n  = 40), and healthy controls ( n  = 31), fulfilling inclusion criteria (incidentally detected anti-HCV positive) and able to provide informed consent were screened and recruited for the study. All these subjects and controls underwent subjective assessment of their quality of life related symptoms, neuropsychometric tests (NPT) and magnetic resonance imaging. The patients were subjected to neuroimaging as well as psychological testing. There was no significant difference in basic laboratory parameters in these two groups. Independent t -test reveals significantly lower neuropsychological functioning as compared to healthy control. A significantly decreased FA values and myoinsitol were observed in HCV subjects on sensory, inferior longitudinal fascicules, and STR fiber bundles as compared to healthy control. Bivariate correlation analysis reveals that neuropsychological scores are significantly positive. Our result show that HCV positive individuals would demonstrate structural brain abnormalities and neurocognitive dysfunction as well as the changes in cell component and extracellular space in the white matter regions of brain in asymptomatic HCV infection by using DTT metrics.

  15. The usefulness of brain MRI and CT in the clinical practice of epilepsia

    Energy Technology Data Exchange (ETDEWEB)

    Horita, Hideki [Jikei Univ., Komae, Tokyo (Japan). Daisan Hospital; Maekawa, Kihei

    1995-09-01

    This study was conducted to clarify the usefulness of brain MRI and CT in the clinical practice of epilepsy. The subjects were 100 epileptic child patients (average age, 13.2{+-}8.2 years) who underwent brain MRI, including 93 patients who also underwent brain CT. Twenty-two abnormal findings were obtained by MRI and 25 by CT. Thirty-nine patients who had complications such as mental retardation, cerebral palsy, or the overlapping disorders showed abnormal findings in a significantly high incidence. No significant correlations existed between the presence or absence of abnormal findings and the disease course after seizures. Patients with symptomatic localization-related epilepsies or cryptogenic and symptomatic generalized epilepsies showed abnormal findings in a significantly high incidence and unfavorable disease course after seizures. In 10 of 28 patients who showed abnormal findings, the abnormal finding site on images were correlated to the focus site on electroencephalograms. In conclusion, brain MRI and CT are essential in the clinical practice of epilepsy, however, we should notice the limitation of these methods. (Y.S.).

  16. Clinically Relevant Pharmacological Strategies That Reverse MDMA-Induced Brain Hyperthermia Potentiated by Social Interaction.

    Science.gov (United States)

    Kiyatkin, Eugene A; Ren, Suelynn; Wakabayashi, Ken T; Baumann, Michael H; Shaham, Yavin

    2016-01-01

    MDMA-induced hyperthermia is highly variable, unpredictable, and greatly potentiated by the social and environmental conditions of recreational drug use. Current strategies to treat pathological MDMA-induced hyperthermia in humans are palliative and marginally effective, and there are no specific pharmacological treatments to counteract this potentially life-threatening condition. Here, we tested the efficacy of mixed adrenoceptor blockers carvedilol and labetalol, and the atypical antipsychotic clozapine, in reversing MDMA-induced brain and body hyperthermia. We injected rats with a moderate non-toxic dose of MDMA (9 mg/kg) during social interaction, and we administered potential treatment drugs after the development of robust hyperthermia (>2.5 °C), thus mimicking the clinical situation of acute MDMA intoxication. Brain temperature was our primary focus, but we also simultaneously recorded temperatures from the deep temporal muscle and skin, allowing us to determine the basic physiological mechanisms of the treatment drug action. Carvedilol was modestly effective in attenuating MDMA-induced hyperthermia by moderately inhibiting skin vasoconstriction, and labetalol was ineffective. In contrast, clozapine induced a marked and immediate reversal of MDMA-induced hyperthermia via inhibition of brain metabolic activation and blockade of skin vasoconstriction. Our findings suggest that clozapine, and related centrally acting drugs, might be highly effective for reversing MDMA-induced brain and body hyperthermia in emergency clinical situations, with possible life-saving results.

  17. The Developmental Brain Disorders Database (DBDB): a curated neurogenetics knowledge base with clinical and research applications.

    Science.gov (United States)

    Mirzaa, Ghayda M; Millen, Kathleen J; Barkovich, A James; Dobyns, William B; Paciorkowski, Alex R

    2014-06-01

    The number of single genes associated with neurodevelopmental disorders has increased dramatically over the past decade. The identification of causative genes for these disorders is important to clinical outcome as it allows for accurate assessment of prognosis, genetic counseling, delineation of natural history, inclusion in clinical trials, and in some cases determines therapy. Clinicians face the challenge of correctly identifying neurodevelopmental phenotypes, recognizing syndromes, and prioritizing the best candidate genes for testing. However, there is no central repository of definitions for many phenotypes, leading to errors of diagnosis. Additionally, there is no system of levels of evidence linking genes to phenotypes, making it difficult for clinicians to know which genes are most strongly associated with a given condition. We have developed the Developmental Brain Disorders Database (DBDB: https://www.dbdb.urmc.rochester.edu/home), a publicly available, online-curated repository of genes, phenotypes, and syndromes associated with neurodevelopmental disorders. DBDB contains the first referenced ontology of developmental brain phenotypes, and uses a novel system of levels of evidence for gene-phenotype associations. It is intended to assist clinicians in arriving at the correct diagnosis, select the most appropriate genetic test for that phenotype, and improve the care of patients with developmental brain disorders. For researchers interested in the discovery of novel genes for developmental brain disorders, DBDB provides a well-curated source of important genes against which research sequencing results can be compared. Finally, DBDB allows novel observations about the landscape of the neurogenetics knowledge base. © 2014 Wiley Periodicals, Inc.

  18. The usefulness of brain MRI and CT in the clinical practice of epilepsia

    International Nuclear Information System (INIS)

    Horita, Hideki; Maekawa, Kihei.

    1995-01-01

    This study was conducted to clarify the usefulness of brain MRI and CT in the clinical practice of epilepsy. The subjects were 100 epileptic child patients (average age, 13.2±8.2 years) who underwent brain MRI, including 93 patients who also underwent brain CT. Twenty-two abnormal findings were obtained by MRI and 25 by CT. Thirty-nine patients who had complications such as mental retardation, cerebral palsy, or the overlapping disorders showed abnormal findings in a significantly high incidence. No significant correlations existed between the presence or absence of abnormal findings and the disease course after seizures. Patients with symptomatic localization-related epilepsies or cryptogenic and symptomatic generalized epilepsies showed abnormal findings in a significantly high incidence and unfavorable disease course after seizures. In 10 of 28 patients who showed abnormal findings, the abnormal finding site on images were correlated to the focus site on electroencephalograms. In conclusion, brain MRI and CT are essential in the clinical practice of epilepsy, however, we should notice the limitation of these methods. (Y.S.)

  19. Dynamic change of serum protein S100b and its clinical significance in patients with traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    CHEN Da-qing; ZHU Lie-lie

    2005-01-01

    Objective: To analyze the dynamic change of serum protein S100b in patients with traumatic brain injury and its clinical value in assessing brain damage. Methods: According to Glasgow coma scale (GCS), 102 cases of traumatic brain injury were divided into mild brain injury group (GCS≥13, n=31, Group A), moderate brain injury group (8brain injury group (GCS≤8, n=34, Group C). Serial S100b concentrations were analyzed by enzyme-linked immunosorbent assay (ELISA) in blood samples taken on admission, 12 h, 24 h, 48 h, 72 h and 7 days after traumatic brain injury. Results: The severe brain injury group showed significantly higher concentration of serum S100b, with earlier increase and longer duration, than the mild and moderate brain injury groups. The patients with higher S100b exhibited lower GCS scores and poor clinical prognosis. The increase in S100b could emerge before clinical image evidence indicated so. Conclusions: Serum S100b can be used as a sensitive index for assessment and prediction of traumatic brain injury severity and prognosis.

  20. Mida mõtleb professor Andrew Mayo? / Anne-Mari Ernesaks

    Index Scriptorium Estoniae

    Ernesaks, Anne-Mari

    2005-01-01

    PARE koordinaator tutvustab tuntud inimkapitali ideoloogi Andrew Mayo raamatut "Ettevõtte inimväärtus". Raamatu autori hinnangul on tänapäeva organisatsioonides juhtimise olulisim ülesanne inimese juhtimine varana. Lisa: Konverents

  1. Challenges in clinical applications of brain computer interfaces in individuals with spinal cord injury

    Directory of Open Access Journals (Sweden)

    Rüdiger eRupp

    2014-09-01

    Full Text Available Brain computer interfaces (BCIs are devices that measure brain activities and translate them into control signals used for a variety of applications. Among them are systems for communication, environmental control, neuroprostheses, exoskeletons or restorative therapies. Over the last years the technology of BCIs has reached a level of matureness allowing them to be used not only in research experiments supervised by scientists, but also in clinical routine with patients with neurological impairments supervised by clinical personnel or caregivers. However, clinicians and patients face many challenges in the application of BCIs. This particularly applies to high spinal cord injured patients, in whom artificial ventilation, autonomic dysfunctions, neuropathic pain or the inability to achieve a sufficient level of control during a short-term training may limit the successful use of a BCI. Additionally, spasmolytic medication and the acute stress reaction with associated episodes of depression may have a negative influence on the modulation of brain waves and therefore the ability to concentrate over an extended period of time. Although BCIs seem to be a promising assistive technology for individuals with high spinal cord injury systematic investigations are highly needed to obtain realistic estimates of the percentage of users that for any reason may not be able to operate a BCI in a clinical setting.

  2. Alexithymia is associated with attenuated automatic brain response to facial emotion in clinical depression.

    Science.gov (United States)

    Suslow, Thomas; Kugel, Harald; Rufer, Michael; Redlich, Ronny; Dohm, Katharina; Grotegerd, Dominik; Zaremba, Dario; Dannlowski, Udo

    2016-02-04

    Alexithymia is a clinically relevant personality trait related to difficulties in recognizing and describing emotions. Previous studies examining the neural correlates of alexithymia have shown mainly decreased response of several brain areas during emotion processing in healthy samples and patients suffering from autism or post-traumatic stress disorder. In the present study, we examined the effect of alexithymia on automatic brain reactivity to negative and positive facial expressions in clinical depression. Brain activation in response to sad, happy, neutral, and no facial expression (presented for 33 ms and masked by neutral faces) was measured by functional magnetic resonance imaging at 3 T in 26 alexithymic and 26 non-alexithymic patients with major depression. Alexithymic patients manifested less activation in response to masked sad and happy (compared to neutral) faces in right frontal regions and right caudate nuclei than non-alexithymic patients. Our neuroimaging study provides evidence that the personality trait alexithymia has a modulating effect on automatic emotion processing in clinical depression. Our findings support the idea that alexithymia could be associated with functional deficits of the right hemisphere. Future research on the neural substrates of emotion processing in depression should assess and control alexithymia in their analyses.

  3. Clinical application of 1H-chemical-shift imaging (CSI) to brain diseases

    International Nuclear Information System (INIS)

    Naruse, Shoji; Furuya, Seiichi; Ide, Mariko

    1992-01-01

    An H-1 chemical shift imaging (CSI) was developed as part of the clinical MRI system, by which magnetic resonance spectra (MRS) can be obtained from multiple small voxels and metabolite distribution in the brain can be visualized. The present study was to determine the feasibility and clinical potential of using an H-1 CSI. The device used was a Magnetom H 15 apparatus. The study population was comprised of 25 healthy subjects, 20 patients with brain tumor, 4 with ischemic disease, and 6 with miscellaneous degenerative disease. The H-1 CSI was obtained by the 3-dimensional Fourier transformation. After suppressing the lipid signal by the inversion-recovery method and the water signal by the chemical-shift selective pulse with a following dephasing gradient, 2-directional 16 x 16 phase encodings were applied to the 16 x 16∼18 x 18 cm field of view, in which a 8 x 8 x 2∼10 x 10 x 2 cm area was selected by the stimulated echo or spin-echo method. The metabolite mapping and its contour mapping were created by using the curve-fitted area, with interpolation to the 256 x 256 matrix. In the healthy group, high resolution spectra for N-acetyl aspartate (NAA), creatine, choline (Cho), and glutamine/glutamate were obtained from each voxel; and metabolite mapping and contour mapping also clearly showed metabolite distribution in the brain. In the group of brain tumor, an increased Cho and lactate and loss of NAA were observed, along with heterogeneity within the tumor and changes in the surrounding tissue; and there was a good correlation between lactate peak and tumor malignancy. The group of ischemic and degenerative disease had a decreased NAA and increased lactate on both spectra and metabolite mapping, depending on disease stage. These findings indicated that H-1 CSI is helpful for detecting spectra over the whole brain, as well as for determining metabolite distribution. (N.K.)

  4. Association of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism with early-onset bipolar disorder.

    Science.gov (United States)

    Nassan, Malik; Croarkin, Paul E; Luby, Joan L; Veldic, Marin; Joshi, Paramjit T; McElroy, Susan L; Post, Robert M; Walkup, John T; Cercy, Kelly; Geske, Jennifer R; Wagner, Karen D; Cuellar-Barboza, Alfredo B; Casuto, Leah; Lavebratt, Catharina; Schalling, Martin; Jensen, Peter S; Biernacka, Joanna M; Frye, Mark A

    2015-09-01

    Brain-derived neurotrophic factor (BDNF) Val66Met (rs6265) functional polymorphism has been implicated in early-onset bipolar disorder. However, results of studies are inconsistent. We aimed to further explore this association. DNA samples from the Treatment of Early Age Mania (TEAM) and Mayo Clinic Bipolar Disorder Biobank were investigated for association of rs6265 with early-onset bipolar disorder. Bipolar cases were classified as early onset if the first manic or depressive episode occurred at age ≤19 years (versus adult-onset cases at age >19 years). After quality control, 69 TEAM early-onset bipolar disorder cases, 725 Mayo Clinic bipolar disorder cases (including 189 early-onset cases), and 764 controls were included in the analysis of association, assessed with logistic regression assuming log-additive allele effects. Comparison of TEAM cases with controls suggested association of early-onset bipolar disorder with the rs6265 minor allele [odds ratio (OR) = 1.55, p = 0.04]. Although comparison of early-onset adult bipolar disorder cases from the Mayo Clinic versus controls was not statistically significant, the OR estimate indicated the same direction of effect (OR = 1.21, p = 0.19). When the early-onset TEAM and Mayo Clinic early-onset adult groups were combined and compared with the control group, the association of the minor allele rs6265 was statistically significant (OR = 1.30, p = 0.04). These preliminary analyses of a relatively small sample with early-onset bipolar disorder are suggestive that functional variation in BDNF is implicated in bipolar disorder risk and may have a more significant role in early-onset expression of the disorder. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Radiotherapy for pediatric brain tumors: Standards of care, current clinical trials, and new directions

    International Nuclear Information System (INIS)

    Goldwein, Joel W.

    1995-01-01

    The objectives of the course are to evaluate the role of radiation therapy in the treatment of pediatric brain tumors. Areas where the role is evolving will be identified, and the results of clinical trials which been mounted to clarify radiotherapy's role will be reviewed. Brain tumors are the second most common malignancy of childhood after leukemias and lymphomas. However, they remain the most common group of childhood tumors to require radiation therapy. Therefore, a thorough understanding of these tumors, and the appropriate role of surgery, radiation and chemotherapy is critical. Issues surrounding the management of sequelae are no less important. The role of radiotherapy for the treatment of these tumors is far different from that for adults. These differences relate to the profound potential for sequelae from therapy, the higher overall cure rates, and the utility of multimodality therapies. In addition, the rarity of childhood brain tumors compared with adults' makes them more difficult to study. In this session, the following issues will be reviewed; 1. Incidence of pediatric brain tumors, 2. General issues regarding symptoms, diagnosis, diagnostic tests and evaluation, 3. Importance of a team approach, 4. General issues regarding treatment sequelae, 5. Specific tumor types/entities; a. Cerebellar Astrocytomas b. Benign and malignant Gliomas including brainstem and chiasmatic lesions c. Primitive Neuroectodermal Tumors (PNET) and Medulloblastoma d. Ependymomas e. Craniopharyngiomas f. Germ cell tumors g. Miscellaneous and rare pediatric brain tumors 6. Management of sequelae 7. New and future directions a. Treatment of infants b. The expanding role of chemotherapy c. Advances in radiotherapy. The attendees will complete the course with a better understanding of the role that radiation therapy plays in the treatment of pediatric brain tumors. They will be knowledgeable in the foundation for that role, and the changes which are likely to take place in the

  6. A system architecture for sharing de-identified, research-ready brain scans and health information across clinical imaging centers.

    Science.gov (United States)

    Chervenak, Ann L; van Erp, Theo G M; Kesselman, Carl; D'Arcy, Mike; Sobell, Janet; Keator, David; Dahm, Lisa; Murry, Jim; Law, Meng; Hasso, Anton; Ames, Joseph; Macciardi, Fabio; Potkin, Steven G

    2012-01-01

    Progress in our understanding of brain disorders increasingly relies on the costly collection of large standardized brain magnetic resonance imaging (MRI) data sets. Moreover, the clinical interpretation of brain scans benefits from compare and contrast analyses of scans from patients with similar, and sometimes rare, demographic, diagnostic, and treatment status. A solution to both needs is to acquire standardized, research-ready clinical brain scans and to build the information technology infrastructure to share such scans, along with other pertinent information, across hospitals. This paper describes the design, deployment, and operation of a federated imaging system that captures and shares standardized, de-identified clinical brain images in a federation across multiple institutions. In addition to describing innovative aspects of the system architecture and our initial testing of the deployed infrastructure, we also describe the Standardized Imaging Protocol (SIP) developed for the project and our interactions with the Institutional Review Board (IRB) regarding handling patient data in the federated environment.

  7. Incidental extracerebral findings on brain nonenhanced magnetic resonance imaging: frequency, nondetection rate, and clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ming-Liang; Wei, Xiao-Er [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Lu, Li-Yan [Nanjing Medical University, Department of Radiology, Nanjing First Hospital, Nanjing (China); Li, Wen-Bin [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Kashgar Prefecture Second People' s Hospital, Imaging Center, Kashgar (China)

    2017-03-15

    This study aims to elucidate the frequency, nondetection rate, and clinical importance of incidental extracerebral findings (IECFs) on brain nonenhanced magnetic resonance imaging (MRI). A total of 8284 brain MRIs performed between January 1, 2015 and December 31, 2015 were evaluated for the presence of IECFs and the distribution of IECFs was analyzed. IECFs were categorized as E1 (clinically unimportant, e.g., sinus mucosal thickening); E2 (likely unimportant, e.g., pharyngeal mucosal symmetrical thickening); and E3 (potentially important, e.g., pharyngeal mucosal asymmetrical thickening). The nondetection rate was determined by comparing the results of the structured approach with the initial MRI reports. The medical records were examined for patients with E3 IECFs to assess clinical importance and outcome of these lesions. A total of 5992 IECFs were found in 4469 of the 8284 patients (54.0%). E1 findings constituted 82.2% (4924/5992) of all IECFs; E2 constituted 16.6% (995/5992) and E3 constituted 1.2% (73/5992). Overall IECFs and E1 findings were significantly more common in male patients (P < 0.05). Statistically significant difference was also seen between the different age groups (P < 0.001). The nondetection rate was 56.9% (3409/5992) for overall IECFs and 32.9% (24/73) for E3 IECFs. Of the 73 patients with E3 IECFs, 34 (46.6%) received final diagnosis and appropriate treatment during the study period. IECFs are prevalent in clinical patients on brain MR images with a nondetection rate of 32.9% for potentially important (E3) findings. The reporting of IECFs according to clinical importance is helpful for patients' management. (orig.)

  8. Radiotherapy for pediatric brain tumors: Standard of care, current clinical trials, and new directions

    International Nuclear Information System (INIS)

    Kun, Larry E.

    1996-01-01

    Objectives: To review the clinical characteristics of childhood brain tumors, including neurologic signs, neuroimaging and neuropathology. To critically assess indications for therapy relevant to presenting characteristics, age, and disease status. To discuss current management strategies including neurosurgery, radiation therapy, and chemotherapy. To analyze current clinical trials and future directions of clinical research. Brain tumors account for 20% of neoplastic diseases in children. The most common tumors include astrocytoma and malignant gliomas, medulloblastoma and supratentorial PNET's, ependymoma, craniopharyngioma, and intracranial germ cell tumors. Tumor type and clinical course are often correlated with age at presentation and anatomic site. The clinical characteristics and disease extent largely determine the relative merits of available 'standard' and investigational therapeutic approaches. Treatment outcome, including disease control and functional integrity, is dependent upon age at presentation, tumor type, and disease extent. An understanding of the clinical, neuroimaging, and histologic characteristics as they relate to decisions regarding therapy is critical to the radiation oncologist. Appropriate radiation therapy is central to curative therapy for a majority of pediatric brain tumor presentations. Technical advances in neurosurgery provide greater safety for 'gross total resection' in a majority of hemispheric astrocytomas and medulloblastomas. The relative roles of 'standard' radiation therapy and evolving chemotherapy for centrally located astrocytomas (e.g., diencephalic, optic pathway) need to be analyzed in the context of initial and overall disease control, neurotoxicities, and potential modifications in the risk:benefit ratio apparent in the introduction of precision radiation techniques. Modifications in radiation delivery are fundamental to current investigations in medulloblastoma; the rationale for contemporary and projected

  9. Brain functional networks. Correlation analysis with clinical indexes in patients with diabetic retinopathy

    International Nuclear Information System (INIS)

    Dai, Hui; Zhang, Yu; Hu, Su; Wang, Ximing; Li, Yonggang; Hu, Chunhong; Lai, Lillian; Shen, Hailin

    2017-01-01

    The relationship between parameters of brain functional networks and clinical indexes is unclear so far in patients with diabetic retinopathy (DR). This paper is to investigate this. Twenty-one patients with different grades of DR and 21 age- and sex-matched healthy controls were enrolled from August 2012 to September 2014. The clinical indexes recorded included DR grade, duration of diabetes, HbA1c, diabetic foot screen, fasting plasma glucose, insulin, Homa-β, Homa-IR, insulin sensitive index (ISI), Mini-Mental State Examination (MMSE), and patient sex and age. Subjects were scanned using 3-T MR with blood-oxygen-level-dependent and 3D-FSPGR sequences. MR data was analyzed via preprocessing and functional network construction, and quantified indexes of network (clustering coefficient, characteristic path length, global efficiency, degree distribution, and small worldness) were evaluated. Statistics consisted of ANOVA and correlation. There were significant differences between patients and controls among clustering coefficient, characteristic path length, degree distribution, and small worldness parameters (P < 0.05). MMSE scores negatively correlated with characteristic path length, and Hb1Ac negatively correlated with small worldness. MMSE, duration of diabetes, diabetic foot screen, fasting plasma glucose, insulin, Homa-β, Homa-IR, ISI, DR grade, and patient age, except from Hb1Ac, correlated with degree distribution in certain brain areas. Brain functional networks are altered, specifically in the areas of visual function and cognition, and these alterations may reflect the severity of visual weakness and cognitive decline in DR patients. Moreover, the brain networks may be affected both by long-standing and instant clinical factors. (orig.)

  10. Brain functional networks. Correlation analysis with clinical indexes in patients with diabetic retinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Dai, Hui; Zhang, Yu; Hu, Su; Wang, Ximing; Li, Yonggang; Hu, Chunhong [The First Affiliated Hospital of Soochow University, Department of Radiology, Suzhou, Jiangsu (China); Lai, Lillian [LAC+USC Medical Center, Department of Neuroradiology, Los Angeles, CA (United States); Shen, Hailin [Suzhou Kowloon Hospital, Shanghai Jiao Tong University Medical School, Department of Radiology, Suzhou, Jiangsu (China)

    2017-11-15

    The relationship between parameters of brain functional networks and clinical indexes is unclear so far in patients with diabetic retinopathy (DR). This paper is to investigate this. Twenty-one patients with different grades of DR and 21 age- and sex-matched healthy controls were enrolled from August 2012 to September 2014. The clinical indexes recorded included DR grade, duration of diabetes, HbA1c, diabetic foot screen, fasting plasma glucose, insulin, Homa-β, Homa-IR, insulin sensitive index (ISI), Mini-Mental State Examination (MMSE), and patient sex and age. Subjects were scanned using 3-T MR with blood-oxygen-level-dependent and 3D-FSPGR sequences. MR data was analyzed via preprocessing and functional network construction, and quantified indexes of network (clustering coefficient, characteristic path length, global efficiency, degree distribution, and small worldness) were evaluated. Statistics consisted of ANOVA and correlation. There were significant differences between patients and controls among clustering coefficient, characteristic path length, degree distribution, and small worldness parameters (P < 0.05). MMSE scores negatively correlated with characteristic path length, and Hb1Ac negatively correlated with small worldness. MMSE, duration of diabetes, diabetic foot screen, fasting plasma glucose, insulin, Homa-β, Homa-IR, ISI, DR grade, and patient age, except from Hb1Ac, correlated with degree distribution in certain brain areas. Brain functional networks are altered, specifically in the areas of visual function and cognition, and these alterations may reflect the severity of visual weakness and cognitive decline in DR patients. Moreover, the brain networks may be affected both by long-standing and instant clinical factors. (orig.)

  11. A novel pre-clinical in vivo mouse model for malignant brain tumor growth and invasion.

    Science.gov (United States)

    Shelton, Laura M; Mukherjee, Purna; Huysentruyt, Leanne C; Urits, Ivan; Rosenberg, Joshua A; Seyfried, Thomas N

    2010-09-01

    Glioblastoma multiforme (GBM) is a rapidly progressive disease of morbidity and mortality and is the most common form of primary brain cancer in adults. Lack of appropriate in vivo models has been a major roadblock to developing effective therapies for GBM. A new highly invasive in vivo GBM model is described that was derived from a spontaneous brain tumor (VM-M3) in the VM mouse strain. Highly invasive tumor cells could be identified histologically on the hemisphere contralateral to the hemisphere implanted with tumor cells or tissue. Tumor cells were highly expressive for the chemokine receptor CXCR4 and the proliferation marker Ki-67 and could be identified invading through the pia mater, the vascular system, the ventricular system, around neurons, and over white matter tracts including the corpus callosum. In addition, the brain tumor cells were labeled with the firefly luciferase gene, allowing for non-invasive detection and quantitation through bioluminescent imaging. The VM-M3 tumor has a short incubation time with mortality occurring in 100% of the animals within approximately 15 days. The VM-M3 brain tumor model therefore can be used in a pre-clinical setting for the rapid evaluation of novel anti-invasive therapies.

  12. Vitamins and nutrients as primary treatments in experimental brain injury: Clinical implications for nutraceutical therapies.

    Science.gov (United States)

    Vonder Haar, Cole; Peterson, Todd C; Martens, Kris M; Hoane, Michael R

    2016-06-01

    With the numerous failures of pharmaceuticals to treat traumatic brain injury in humans, more researchers have become interested in combination therapies. This is largely due to the multimodal nature of damage from injury, which causes excitotoxicity, oxidative stress, edema, neuroinflammation and cell death. Polydrug treatments have the potential to target multiple aspects of the secondary injury cascade, while many previous therapies focused on one particular aspect. Of specific note are vitamins, minerals and nutrients that can be utilized to supplement other therapies. Many of these have low toxicity, are already FDA approved and have minimal interactions with other drugs, making them attractive targets for therapeutics. Over the past 20 years, interest in supplementation and supraphysiologic dosing of nutrients for brain injury has increased and indeed many vitamins and nutrients now have a considerable body of the literature backing their use. Here, we review several of the prominent therapies in the category of nutraceutical treatment for brain injury in experimental models, including vitamins (B2, B3, B6, B9, C, D, E), herbs and traditional medicines (ginseng, Gingko biloba), flavonoids, and other nutrients (magnesium, zinc, carnitine, omega-3 fatty acids). While there is still much work to be done, several of these have strong potential for clinical therapies, particularly with regard to polydrug regimens. This article is part of a Special Issue entitled SI:Brain injury and recovery. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Perioperative brain damage after cardiovascular surgery; Clinical evaluation including CT scans

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Michiyuki; Kuriyama, Yoshihiro; Sawada, Toru; Fujita, Tsuyoshi; Omae, T. (National Cardiovascular Center, Suita, Osaka (Japan))

    1989-08-01

    We examined 39 cases (1.6%) of post-operative brain damages out of 2,445 sequential cases of cardiovascular surgery in NCVC during past three years. In this study, we investigated clinical course and CT findings of each patient in details and analyzed the causes of the post operative brain damages. Of 39 cases, 23 (59%) were complicated with cerebral ischemia, 8 (21%) with subdural hematoma (SDH), 2 (5%) with intracranial hemorrhage (ICH) and 1 (2%) with subarachnoid hemorrhage (SAH), respectively. 5 cases (13%) had unclassified brain damages. In 23 cases of cerebral ischemia there were 5 cases of hypotension-induced ischemia, 4 cases of hypoxic encephalopathy, 3 cases of ischemia induced by intra-operative maneuvers, 3 cases of embolism after operation and a single case of 'microembolism'. Seven cases could not be classified into any of these categories. Duration of ECC was 169.9 {plus minus} 48.5 min on the average in patients with such brain damages as SDH, ICH, SAH and cardiogenic embolism, which were thought not to be related with ECC. On the other hand, that of the patients hypotensive ischemia or 'microembolism' gave an average value of 254.5 {plus minus} 96.8 min. And these patients were thought to have occurred during ECC. There was a statistically significant difference between these two mean values. (J.P.N.).

  14. Current Opportunities for Clinical Monitoring of Axonal Pathology in Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Parmenion P. Tsitsopoulos

    2017-11-01

    Full Text Available Traumatic brain injury (TBI is a multidimensional and highly complex disease commonly resulting in widespread injury to axons, due to rapid inertial acceleration/deceleration forces transmitted to the brain during impact. Axonal injury leads to brain network dysfunction, significantly contributing to cognitive and functional impairments frequently observed in TBI survivors. Diffuse axonal injury (DAI is a clinical entity suggested by impaired level of consciousness and coma on clinical examination and characterized by widespread injury to the hemispheric white matter tracts, the corpus callosum and the brain stem. The clinical course of DAI is commonly unpredictable and it remains a challenging entity with limited therapeutic options, to date. Although axonal integrity may be disrupted at impact, the majority of axonal pathology evolves over time, resulting from delayed activation of complex intracellular biochemical cascades. Activation of these secondary biochemical pathways may lead to axonal transection, named secondary axotomy, and be responsible for the clinical decline of DAI patients. Advances in the neurocritical care of TBI patients have been achieved by refinements in multimodality monitoring for prevention and early detection of secondary injury factors, which can be applied also to DAI. There is an emerging role for biomarkers in blood, cerebrospinal fluid, and interstitial fluid using microdialysis in the evaluation of axonal injury in TBI. These biomarker studies have assessed various axonal and neuroglial markers as well as inflammatory mediators, such as cytokines and chemokines. Moreover, modern neuroimaging can detect subtle or overt DAI/white matter changes in diffuse TBI patients across all injury severities using magnetic resonance spectroscopy, diffusion tensor imaging, and positron emission tomography. Importantly, serial neuroimaging studies provide evidence for evolving axonal injury. Since axonal injury may be a key

  15. Radiotherapy for pediatric brain tumors: Standard of care, current clinical trials and new directions

    International Nuclear Information System (INIS)

    Kun, Larry E.

    1997-01-01

    Objectives: To review the clinical characteristics of childhood brain tumors, including neurologic signs, neuroimaging and neuropathology. To critically assess indications for therapy relevant to presenting characteristics, age, and disease status. To discuss current management strategies including neurosurgery, radiation therapy, and chemotherapy. To analyze current clinical trials and future directions of clinical research. Brain tumors account for 20% of neoplastic diseases in children. The most common tumors include astrocytoma and malignant gliomas, medulloblastoma and supratentorial PNET's, ependymoma, craniopharyngioma, and intracranial germ cell tumors. The clinical characteristics and disease extent largely determine the relative merits of available 'standard' and investigational therapeutic approaches. Treatment outcome, including disease control and functional integrity, is dependent upon tumor type and site, age at presentation, and disease extent. An understanding of the clinical, neuroimaging, and histologic characteristics as they relate to decisions regarding therapy is critical to the radiation oncologist. Appropriate radiation therapy is central to curative therapy for a majority of pediatric brain tumor presentations. Technical advances in neurosurgery provide greater safety for 'gross total resection' in a majority of hemispheric astrocytomas and medulloblastomas. The relative roles of radiation therapy and chemotherapy for centrally located astrocytomas (e.g., diencephalic, optic pathway) need to be analyzed in the context of initial and overall disease control, neurotoxicities, and potential modifications in the risk:benefit ratio apparent in the introduction of 3-dimensional radiation techniques. Modifications in radiation delivery are important components of current investigations in medulloblastoma; the rationale for contemporary cooperative group trials will be presented as well as the background data re surgical, radiotherapeutic, and

  16. Exploring the uncertainties of early detection results: model-based interpretation of mayo lung project

    Directory of Open Access Journals (Sweden)

    Berman Barbara

    2011-03-01

    Full Text Available Abstract Background The Mayo Lung Project (MLP, a randomized controlled clinical trial of lung cancer screening conducted between 1971 and 1986 among male smokers aged 45 or above, demonstrated an increase in lung cancer survival since the time of diagnosis, but no reduction in lung cancer mortality. Whether this result necessarily indicates a lack of mortality benefit for screening remains controversial. A number of hypotheses have been proposed to explain the observed outcome, including over-diagnosis, screening sensitivity, and population heterogeneity (initial difference in lung cancer risks between the two trial arms. This study is intended to provide model-based testing for some of these important arguments. Method Using a micro-simulation model, the MISCAN-lung model, we explore the possible influence of screening sensitivity, systematic error, over-diagnosis and population heterogeneity. Results Calibrating screening sensitivity, systematic error, or over-diagnosis does not noticeably improve the fit of the model, whereas calibrating population heterogeneity helps the model predict lung cancer incidence better. Conclusions Our conclusion is that the hypothesized imperfection in screening sensitivity, systematic error, and over-diagnosis do not in themselves explain the observed trial results. Model fit improvement achieved by accounting for population heterogeneity suggests a higher risk of cancer incidence in the intervention group as compared with the control group.

  17. Living longer living happier: My journey from clinical neurology to complexities of brain

    Directory of Open Access Journals (Sweden)

    Ashok Panagariya

    2011-01-01

    Full Text Available The present article is a treatise on the illuminating voyage of a Neurophysician along the fascinating horizons and frontiers of neurosciences. During the career as a clinical neurologist, some very interesting and intriguing cases and issues were dealt with and documented scientifically. The working of the brain and its operational architectonics came up for critical analysis, opening up new vistas in the appreciation and management of various neurological disorders. Issues regarding the working of the mind and the guidelines for health and happiness became apparent, and some very interesting generalizations with far-reaching consequences on the general well-being and health have been formulated and put forward for a healthy and happy future for mankind. A paradigm shift is warranted for a closer and better appreciation of neural dynamics at all levels of the brain, namely microscopic, mesoscopic and macroscopic levels!

  18. Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions

    OpenAIRE

    Seo, Kwon-Duk; Suh, Sang Hyun; Kim, Yong Bae; Kim, Ji Hwa; Ahn, Sung Jun; Kim, Dong-Seok; Lee, Kyung-Yul

    2015-01-01

    Purpose Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD. Materials and Methods FLAIR images of 83 patients were reviewed. Each cerebr...

  19. The Mayo Portland Adaptability Inventory-4 outcome measure is superior to UK FIM+FAM in a British military population.

    Science.gov (United States)

    McGilloway, Emer; Mitchell, James; Dharm-Datta, Shreshth; Roberts, Andrew; Tilley, Haydn; Etherington, John

    2016-01-01

    The aim of this study was to identify the most appropriate rehabilitation outcome measure for use in a young adult population with acquired brain injury. A 2-year prospective study of patients admitted to a UK military neuro-rehabilitation unit with acquired brain injury to compare the appropriateness of the Functional Independence Measure/Functional Assessment Measure (FIM+FAM) vs the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) in assessing outcomes. Patients were assessed at admission, discharge and at 4-month follow-up using FIM+FAM and MPAI-4. The FIM+FAM total motor score showed a marked ceiling affect, 42% of patients scored the maximum on admission rising to 80% at discharge. The MPAI-4 did not show significant ceiling effects. The other sub-scales of FIM+FAM and MPAI-4 were generally comparable, no more than 17% achieved ceiling at follow-up. This is the first comparative study of FIM+FAM and MPAI-4 in a young adult military population following acquired brain injury. All patients showed improvements in both outcome measures following intensive inpatient rehabilitation. However, the MPAI-4 did not show ceiling effects in motor scores. This measure was, therefore, found to be more appropriate in the cohort.

  20. Donepezil for Irradiated Brain Tumor Survivors: A Phase III Randomized Placebo-Controlled Clinical Trial.

    Science.gov (United States)

    Rapp, Stephen R; Case, L Doug; Peiffer, Ann; Naughton, Michelle M; Chan, Michael D; Stieber, Volker W; Moore, Dennis F; Falchuk, Steven C; Piephoff, James V; Edenfield, William J; Giguere, Jeffrey K; Loghin, Monica E; Shaw, Edward G

    2015-05-20

    Neurotoxic effects of brain irradiation include cognitive impairment in 50% to 90% of patients. Prior studies have suggested that donepezil, a neurotransmitter modulator, may improve cognitive function. A total of 198 adult brain tumor survivors ≥ 6 months after partial- or whole-brain irradiation were randomly assigned to receive a single daily dose (5 mg for 6 weeks, 10 mg for 18 weeks) of donepezil or placebo. A cognitive test battery assessing memory, attention, language, visuomotor, verbal fluency, and executive functions was administered before random assignment and at 12 and 24 weeks. A cognitive composite score (primary outcome) and individual cognitive domains were evaluated. Of this mostly middle-age, married, non-Hispanic white sample, 66% had primary brain tumors, 27% had brain metastases, and 8% underwent prophylactic cranial irradiation. After 24 weeks of treatment, the composite scores did not differ significantly between groups (P = .48); however, significant differences favoring donepezil were observed for memory (recognition, P = .027; discrimination, P = .007) and motor speed and dexterity (P = .016). Significant interactions between pretreatment cognitive function and treatment were found for cognitive composite (P = .01), immediate recall (P = .05), delayed recall (P = .004), attention (P = .01), visuomotor skills (P = .02), and motor speed and dexterity (P < .001), with the benefits of donepezil greater for those who were more cognitively impaired before study treatment. Treatment with donepezil did not significantly improve the overall composite score, but it did result in modest improvements in several cognitive functions, especially among patients with greater pretreatment impairments. © 2015 by American Society of Clinical Oncology.

  1. SU-F-T-668: Irradiating Mouse Brain with a Clinical Linear Accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Torres, C [N Rancilio Purdue University, West Lafayette, IN (United States)

    2016-06-15

    Purpose: To design and construct a “mouse jig” device that would allow for irradiation of the mouse brain with a clinical Varian 6 MeV Linear Accelerator. This device must serve as a head immobilizer, gaseous anesthesia delivery, and radiation bolus concurrently. Methods: The mouse jig was machined out of nylon given that it is inexpensive, easy to machine, and has similar electron density to water. A cylindrical opening with diameter of 16 mm and 40 mm depth was drilled into a nylon block sized 56×56×50 mm (width, length, depth). Additional slots were included in the block for ear bars and a tooth bar to serve as a three-point immobilization device as well as for anesthesia delivery and scavenging. For ease of access when loading the mouse into the holder, there is a removable piece at the top of the block that is 15 mm in depth. This serves a dual purpose, as with the proper extra shielding, the mouse jig could be used with lower linear energy transfer photons with this piece removed. A baseplate was then constructed with five square slots where the mouse jig can securely be inserted plus additional slots that would allow the baseplate to be mounted on a standard lock bar in the treatment couch. This maximizes the reproducibility of placement between imaging and treatment and between treatment sessions. Results: CT imaging and radiation treatment planning was performed that showed acceptable coverage and uniformity of radiation dose in the mouse brain while sparing the throat and eyes. Conclusion: We have designed and manufactured a device that fulfills our criteria allowing us to selectively irradiate the mouse brain with a clinical linear accelerator. This setup will be used for generating mouse models of radiation-induced brain injury.

  2. Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Vincenzo Salpietro

    2014-01-01

    Full Text Available Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency has been reported with neurological and magnetic resonance imaging (MRI abnormalities (e.g., delayed myelination and brain atrophy due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH, a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric CNS seems to be particularly vulnerable to alterations induced by

  3. Promising approaches to circumvent the blood-brain barrier: progress, pitfalls and clinical prospects in brain cancer

    OpenAIRE

    Papademetriou, Iason T; Porter, Tyrone

    2015-01-01

    Brain drug delivery is a major challenge for therapy of central nervous system (CNS) diseases. Biochemical modifications of drugs or drug nanocarriers, methods of local delivery, and blood–brain barrier (BBB) disruption with focused ultrasound and microbubbles are promising approaches which enhance transport or bypass the BBB. These approaches are discussed in the context of brain cancer as an example in CNS drug development. Targeting to receptors enabling transport across the BBB offers non...

  4. Clinical implications of brain atrophy by computed tomography in patients with age-related dementia

    International Nuclear Information System (INIS)

    Imai, Yukimitsu; Honma, Akira; Ashida, Hiroshi; Hasegawa, Kazuo

    1981-01-01

    The purpose of the present study is to clarify the clinical significance of brain atrophy by computed tomography in age-related dementia. Eighty elderly patients with clinical diagnosis of presenile or senile dementia whose mental states were assessed clinically and by several psychometric test were studied by computed tomography. Patients with suspected cerebrovascular disorders and normal pressure hydrocephalus were excluded. Three tomographic sections through anterior and posterior horns and cella media of lateral ventricles and cortex with intracranial space of 60 - 80 cm 2 were evaluated. CSF spaces (%) were measured as an index of brain atrophy. The measurement of CSF spaces (%) was carried out by the computerized planimetric method to avoid visual definition of ventricular borders. In this study, CSF spaces comprised ventricular and subarachnoid spaces. Hasegawa's dementia scale, Bender-Gestalt test and Kohs' block design test were employed for the cognitive assessment of the subjects. In two sections through lateral ventricles, significant correlations were obtained between CSF spaces (%) and scores of Hasegawa's dementia scale and Kohs' block design test. Scores of Bender-Gestalt test did not correlate with CSF spaces (%) in these two sections. In the section through cortex, no correlation were found between CSF spaces (%) and scores of any psychometric test. Also, no positive correlations were obtained between age and CSF spaces (%) in the three sections. (author)

  5. An audit of clinical practice, referral patterns, and appropriateness of clinical indications for brain MRI examinations: A single-centre study in Ghana.

    Science.gov (United States)

    Piersson, A D; Nunoo, G; Gorleku, P N

    2018-05-01

    The aim of this study was to investigate current brain MRI practice, pattern of brain MRI requests, and their appropriateness using the American College of Radiology (ACR) Appropriateness Criteria. We used direct observation and questionnaires to obtain data concerning routine brain MRI practice. We then retrospectively analyzed (i) demographic characteristics, (ii) clinical history, and (iii) appropriateness of brain MRI requests against published criteria. All patients were administered the screening questionnaire; however, no reviews were undertaken directly with patients, and no signature of the radiographer was recorded. Apart from routine brain protocol, there were dedicated protocols for epilepsy and stroke. Brain MRI images from 161 patients (85 Males; 76 Females) were analyzed. The age group with most brain MRI requests were from 26 to 45 year olds. The commonest four clinical indications for imaging were brain tumour, headache, seizure, and stroke. Using the ACR Appropriateness Criteria, almost 43% of the brain MRI scans analyzed were found to be "usually appropriate", 38% were "maybe appropriate" and 19% were categorized as "usually not appropriate". There was knowledge gap with regards to MRI safety in local practice, thus there is the utmost need for MRI safety training. Data on the commonest indications for performing brain MRI in this study should be used to inform local neuroradiological practice. Dedicated stroke and epilepsy MRI protocols require additional sequences i.e. MRA and 3D T1 volume acquisition, respectively. The ACR Appropriateness Criteria is recommended for use by the referring practitioners to improve appropriateness of brain MRI requests. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  6. Clinical evidence of inflammation driving secondary brain injury: A systematic review

    Science.gov (United States)

    Hinson, Holly E.; Rowell, Susan; Schreiber, Martin

    2015-01-01

    Background Despite advances in both prevention and treatment, traumatic brain injury (TBI) remains one of the most burdensome diseases; 2% of the US population currently lives with disabilities resulting from TBI. Recent advances in the understanding of inflammation and its impact on the pathophysiology of trauma have increased the interest in inflammation as a possible mediator in TBI outcome. Objectives The goal of this systematic review is to address the question: “What is the evidence in humans that inflammation is linked to secondary brain injury?” As the experimental evidence has been well described elsewhere, this review will focus on the clinical evidence for inflammation as a mechanism of secondary brain injury. Data Sources Medline database (1996-Week 1 June 2014), Pubmed and Google Scholar databases were queried for relevant studies. Study Eligibility Criteria Studies were eligible if participants were adults and/or children who sustained moderate or severe TBI in the acute phase of injury, published in English. Studies published in the last decade (since 2004) were preferentially included. Trials could be observational or interventional in nature. Appraisal and Synthesis Methods To address the quality of the studies retrieved, we applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria to assess the limitations of the included studies. Results Trauma initiates local central nervous system as well as systemic immune activation. Numerous observational studies describe elevation of pro-inflammatory cytokines that are associated with important clinical variables including neurologic outcome and mortality. A small number of clinical trials have included immunomodulating strategies, but no intervention to date has proven effective in improving outcomes after TBI. Limitations Inclusion of studies not initially retrieved by the search terms may have biased our results. Additionally, some reports may have been

  7. Age and recovery from brain injury: legal opinions, clinical beliefs and experimental evidence.

    Science.gov (United States)

    Johnson, David A; Rose, F D; Brooks, B M; Eyers, S

    2003-01-01

    Despite considerable scientific evidence to the contrary, many medical practitioners maintain that children recover from brain injury better than adults. This belief, which is commonly referred to as the "Kennard Principle", has important ramifications for personal injury compensation claims in which the amount of financial damages claimed is partly based on medical experts' prognoses for recovery and long-term outcome. The present study investigated whether legal practitioners' beliefs are consistent with those of medical practitioners. Lawyers were asked to estimate their confidence in consultant neurologists' estimates of recovery in four clinically-based but fictitious case studies which differed only in the reported age of the patient. The lawyers showed more confidence in estimates which coincided with the Kennard Principle than those which did not. These results support previous findings in showing widespread belief that "younger is better" in recovery from brain injury. In consequence, it is likely that financial compensation for children with brain injury is currently being underestimated in litigation, thereby prejudicing the long-term outcome of the child.

  8. The clinical usefulness of Tc-99m ECD brain SPECT in acute measles encephalitis

    International Nuclear Information System (INIS)

    Lim, Seok Tae; Sohn, Myung Hee

    2003-01-01

    Since the prognosis of measles encephalitis is poor, early diagnosis and proper management are very important to improve clinical outcomes. We compared Tc-99m ECD brain SPECT (SPECT) with MR imaging (MRI) for the detection of acute measles encephalitis. Eleven patients (M : F=4 : 7, age range 18 months-14 yrs) with acute measles encephalitis were enrolled in this studies. All of them underwent both MRI and SPECT. The results of SPECT were scored from 0 (normal) to 3 (most severe defect) according to perfusion state. We compared two image modalities for the detection of brain abnormality in acute measles encephalitis. Seven of 11 patients (63.6%) revealed high signal intensity in the white matter on T2WI of MRI, on the other hand all patients (100%) showed hypoperfusion on SPECT. Severe perfusion deficits above score 2 were located with decreasing frequencies in the frontal lobe (81.8%), temporal lobe (72.7%), occipital lobe (27.3%), basal ganglia (27.3%), and parietal lobe (9.1%). We conclude that SPECT is more useful than MRI for the detection of brain involvement in patients with acute measles encephalitis

  9. Positron Emission Tomography (PET) and its application in clinical diagnosis and functional brain organization studies

    International Nuclear Information System (INIS)

    Grabowska, A.; Krolicki, L.

    1997-01-01

    Recent advances in positron emission tomography (PET) and other brain-imaging techniques have made it possible to visualize the working brain while the human subject is thinking, speaking or planning an action. PET provides researches with an opportunity to infer the neuroanatomy of a given function. Subjects either inhale or are injected with a radioactive material that binds to a physiologically active compound in the body. This serves as a tracer of blood flow and metabolic processes that reflect the activation of a given structure by emitting gamma rays which may be detected through a tomograph. PET research has produced findings that extend our knowledge on several important issues such as cerebral representation of language, perception, attention or memory. It has also proven to be an important source of information for clinical diagnosis of various neurological and psychiatric diseases. The present article provides a short review of main achievements in those fields. However, functional brain imaging is not exempt from methodological and theoretical difficulties. The main limitations of the method have been outlined. (author)

  10. The clinical usefulness of Tc-99m ECD brain SPECT in acute measles encephalitis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Sohn, Myung Hee [School of Medicine, Chonbuk National Univ., Chonju (Korea, Republic of)

    2003-08-01

    Since the prognosis of measles encephalitis is poor, early diagnosis and proper management are very important to improve clinical outcomes. We compared Tc-99m ECD brain SPECT (SPECT) with MR imaging (MRI) for the detection of acute measles encephalitis. Eleven patients (M : F=4 : 7, age range 18 months-14 yrs) with acute measles encephalitis were enrolled in this studies. All of them underwent both MRI and SPECT. The results of SPECT were scored from 0 (normal) to 3 (most severe defect) according to perfusion state. We compared two image modalities for the detection of brain abnormality in acute measles encephalitis. Seven of 11 patients (63.6%) revealed high signal intensity in the white matter on T2WI of MRI, on the other hand all patients (100%) showed hypoperfusion on SPECT. Severe perfusion deficits above score 2 were located with decreasing frequencies in the frontal lobe (81.8%), temporal lobe (72.7%), occipital lobe (27.3%), basal ganglia (27.3%), and parietal lobe (9.1%). We conclude that SPECT is more useful than MRI for the detection of brain involvement in patients with acute measles encephalitis.

  11. Clinical applications of susceptibility weighted MR imaging of the brain - a pictorial review

    International Nuclear Information System (INIS)

    Thomas, Bejoy; Somasundaram, Sivaraman; Thamburaj, Krishnamoorthy; Kesavadas, Chandrasekharan; Kumar Gupta, Arun; Bodhey, Narendra K.; Raman Kapilamoorthy, Tirur

    2008-01-01

    Susceptibility-weighted imaging (SWI) is a novel magnetic resonance (MR) technique that exploits the magnetic susceptibility differences of various tissues, such as blood, iron and calcification. This pictorial review covers many clinical conditions illustrating its usefulness. SWI consists of using both magnitude and phase images from a high-resolution, three-dimensional fully velocity-compensated gradient echo sequence. Phase mask is created from the MR phase images, and multiplying these with the magnitude images increase the conspicuity of the smaller veins and other sources of susceptibility effects, which is depicted using minimal intensity projection (minIP). The phase images are useful in differentiating between diamagnetic and paramagnetic susceptibility effects of calcium and blood, respectively. This unique MR sequence will help in detecting occult low flow vascular lesions, calcification and cerebral microbleed in various pathologic conditions and aids in characterizing tumors and degenerative diseases of the brain. This sequence also can be used to visualize normal brain structures with conspicuity. Susceptibility-weighted imaging is useful in differentiating and characterizing diverse brain pathologies. (orig.)

  12. Brain alterations and clinical symptoms of dementia in diabetes: Abeta/tau-dependent and independent mechanisms

    Directory of Open Access Journals (Sweden)

    Naoyuki eSato

    2014-09-01

    Full Text Available Emerging evidence suggests that diabetes affects cognitive function and increases the incidence of dementia. However, the mechanisms by which diabetes modifies cognitive function still remains unclear. Morphologically, diabetes is associated with neuronal loss in the frontal and temporal lobes including the hippocampus, and aberrant functional connectivity of the posterior cingulate cortex and medial frontal/temporal gyrus. Clinically, diabetic patients show decreased executive function, information processing, planning, visuospatial construction, and visual memory. Therefore, in comparison with the characteristics of AD brain structure and cognition, diabetes seems to affect cognitive function through not only simple AD pathological feature-dependent mechanisms, but also independent mechanisms. As an Abeta/tau-independent mechanism, diabetes compromises cerebrovascular function, increases subcortical infarction and might alter the blood brain barrier (BBB. Diabetes also affects glucose metabolism, insulin signaling and mitochondrial function in the brain. Diabetes also modifies metabolism of Abeta and tau and causes Abeta/tau-dependent pathological changes. Moreover, there is evidence that suggests an interaction between Abeta/tau-dependent and independent mechanisms. Therefore, diabetes modifies cognitive function through Abeta/tau-dependent and independent mechanisms. Interaction between these two mechanisms forms a vicious cycle.

  13. Clinical evaluation of BrainTree, a motor imagery hybrid BCI speller

    Science.gov (United States)

    Perdikis, S.; Leeb, R.; Williamson, J.; Ramsay, A.; Tavella, M.; Desideri, L.; Hoogerwerf, E.-J.; Al-Khodairy, A.; Murray-Smith, R.; Millán, J. d. R.

    2014-06-01

    Objective. While brain-computer interfaces (BCIs) for communication have reached considerable technical maturity, there is still a great need for state-of-the-art evaluation by the end-users outside laboratory environments. To achieve this primary objective, it is necessary to augment a BCI with a series of components that allow end-users to type text effectively. Approach. This work presents the clinical evaluation of a motor imagery (MI) BCI text-speller, called BrainTree, by six severely disabled end-users and ten able-bodied users. Additionally, we define a generic model of code-based BCI applications, which serves as an analytical tool for evaluation and design. Main results. We show that all users achieved remarkable usability and efficiency outcomes in spelling. Furthermore, our model-based analysis highlights the added value of human-computer interaction techniques and hybrid BCI error-handling mechanisms, and reveals the effects of BCI performances on usability and efficiency in code-based applications. Significance. This study demonstrates the usability potential of code-based MI spellers, with BrainTree being the first to be evaluated by a substantial number of end-users, establishing them as a viable, competitive alternative to other popular BCI spellers. Another major outcome of our model-based analysis is the derivation of a 80% minimum command accuracy requirement for successful code-based application control, revising upwards previous estimates attempted in the literature.

  14. Neuroinflammatory responses to traumatic brain injury: etiology, clinical consequences, and therapeutic opportunities

    Directory of Open Access Journals (Sweden)

    Lozano D

    2015-01-01

    Full Text Available Diego Lozano,* Gabriel S Gonzales-Portillo,* Sandra Acosta, Ike de la Pena, Naoki Tajiri, Yuji Kaneko, Cesar V Borlongan Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA *These authors contributed equally to this work Abstract: Traumatic brain injury (TBI is a serious public health problem accounting for 1.4 million emergency room visits by US citizens each year. Although TBI has been traditionally considered an acute injury, chronic symptoms reminiscent of neurodegenerative disorders have now been recognized. These progressive neurodegenerative-like symptoms manifest as impaired motor and cognitive skills, as well as stress, anxiety, and mood affective behavioral alterations. TBI, characterized by external bumps or blows to the head exceeding the brain’s protective capacity, causes physical damage to the central nervous system with accompanying neurological dysfunctions. The primary impact results in direct neural cell loss predominantly exhibiting necrotic death, which is then followed by a wave of secondary injury cascades including excitotoxicity, oxidative stress, mitochondrial dysfunction, blood–brain barrier disruption, and inflammation. All these processes exacerbate the damage, worsen the clinical outcomes, and persist as an evolving pathological hallmark of what we now describe as chronic TBI. Neuroinflammation in the acute stage of TBI mobilizes immune cells, astrocytes, cytokines, and chemokines toward the site of injury to mount an antiinflammatory response against brain damage; however, in the chronic stage, excess activation of these inflammatory elements contributes to an “inflamed” brain microenvironment that principally contributes to secondary cell death in TBI. Modulating these inflammatory cells by changing their phenotype from proinflammatory to antiinflammatory would likely promote therapeutic effects on TBI. Because neuroinflammation occurs at

  15. Clinical Management of a Patient with Chronic Recurrent Vertigo Following a Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Eric G. Johnson

    2009-01-01

    Full Text Available Vertigo, was provoked and right torsional up-beat nystagmus was observed in a 47-year-old patient when she was placed into the right Hallpike-Dix test position using infrared goggle technology. The clinical diagnosis was benign paroxysmal positional vertigo (BPPV, specifically right posterior canalithiasis, resulting from a mild traumatic brain injury (TBI suffered approximately six-months earlier. Previous medical consultations did not include vestibular system examination, and Meclizine was prescribed to suppress her chief complaint of vertigo. Ultimately, the patient was successfully managed by performing two canalith repositioning maneuvers during a single clinical session. The patient reported 100% resolution of symptoms upon reexamination the following day, and the Hallpike-Dix test was negative. Continued symptom resolution was subjectively reported 10 days postintervention via telephone consultation. This case report supports previous publications concerning the presence of BPPV following TBI and the need for inclusion of vestibular system examination during medical consultation.

  16. Clinical utility of the Wechsler Adult Intelligence Scale-Fourth Edition after traumatic brain injury.

    Science.gov (United States)

    Donders, Jacobus; Strong, Carrie-Ann H

    2015-02-01

    The performance of 100 patients with traumatic brain injury (TBI) on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) was compared with that of 100 demographically matched neurologically healthy controls. Processing Speed was the only WAIS-IV factor index that was able to discriminate between persons with moderate-severe TBI on the one hand and persons with either less severe TBI or neurologically healthy controls on the other hand. The Processing Speed index also had acceptable sensitivity and specificity when differentiating between patients with TBI who either did or did not have scores in the clinically significant range on the Trail Making Test. It is concluded that WAIS-IV Processing Speed has acceptable clinical utility in the evaluation of patients with moderate-severe TBI but that it should be supplemented with other measures to assure sufficient accuracy in the diagnostic process. © The Author(s) 2014.

  17. DIAGNOSTIC VALUE OF THE DEJA VU PHENOMENON IN THE CLINICAL PICTURE OF GLIAL BRAIN TUMORS

    Directory of Open Access Journals (Sweden)

    Pavel Nikolaevich Vlasov

    2009-01-01

    This investigation was undertaken to study the implication of the DV phenomenon in the clinical picture of glial brain tumors (GBT. One hundred and sixty-one subjects (mean age 29,2±6,4 years; males 47%, including 129 healthy individuals and 32 patients with GBT, were examined. In the clinical picture of GBT with seizures, DV is a common symptom that is encountered in the involvement of predominantly the right temporal lobe and accompanied by generalized convulsive attacks and olfactory hallucinations. DV in GBT occurs more than once daily; its duration is a few (as many as 5 minutes; DV is characterized by a negative emotional tinge and attended by fear

  18. Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

    International Nuclear Information System (INIS)

    Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W.

    1997-01-01

    The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84±17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78±10.36), mild defect ( 2 test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients

  19. Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

    Energy Technology Data Exchange (ETDEWEB)

    Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W. [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    1997-07-01

    The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84{+-}17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78{+-}10.36), mild defect (<50MQ : n=9, MQ=66.11{+-}13.87). The degree of rCBF decrease between the two groups was evaluated by {chi}{sup 2} test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients.

  20. Rebuilding the injured brain: use of MRS in clinical regenerative medicine

    Science.gov (United States)

    Zare, Alina; Weiss, Michael; Gader, Paul

    2011-03-01

    Hypoxic-Ischemic Encephalopathy (HIE) is the brain manifestation of systemic asphyxia that occurs in 20 out of 1000 births. HIE triggers an immediate neuronal and glial injury leading to necrosis secondary to cellular edema and lysis. Because of this destructive neuronal injury, up to 25% of neonates exhibit severe permanent neuropsychological handicaps in the form of cerebral palsy, with or without associated mental retardation, learning disabilities, or epilepsy. Due to the devastating consequences of HIE, much research has focused on interrupting the cascade of events triggered by HIE. To date, none of these therapies, with the exception of hypothermia, have been successful in the clinical environment. Even in the case of hypothermia, only neonates with mild to moderate HIE respond to therapy. Stem cell therapy offers an attractive potential treatment for HIE. The ability to replace necrotic cells with functional cells could limit the degree of long-term neurological deficits. The neonatal brain offers a unique milieu for stem cell therapy due to its overall plasticity and the continued division of cells in the sub-ventricular zones. New powerful imaging tools allow researchers to track stem cells in vivo post-transplant, as shown in Figure 1. However, neuroimaging still leaves numerous questions unresolved: How can we identify stem cells without using tracking agents, what cells types are destroyed in the brain post injury? What is the final phenotypic fate of transplanted cells? Are the transplanted cells still viable? Do the transplanted cells spare endogenous neuronal tissue? We hypothesize that magnetic resonance spectroscopy (MRS), a broadly used clinical technique that can be performed at the time of a standard MRI scan, can provide answers to these questions when coupled with advanced computational approaches. MRS is widely available clinically, and is a relative measure of different metabolites within the sampled area. These measures are presented as a

  1. Clinical and neuroradiological studies of eclampsia. Cerebral vasospasm and relation to the brain edema

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Yasuhiro; Niwa, Hisayoshi; Ando, Tetsuo; Yasuda, Takeshi; Yanagi, Tsutomu [Nagoya Daini Red Cross Hospital, Aichi (Japan)

    1995-04-01

    Clinical and neuroradiological studies involving cerebral angiography were conducted in four patients with eclampsia. In three cases (case 1, 2 and 4), neurological focal signs, abnormal low density areas on cranial CT and T{sub 2} high intensity areas on cranial MRI disappeared within a month. But in one case (case 3), cerebral infarction occurred and right hemiparesis and aphasia persisted. Cerebral angiography in the acute phase demonstrated vasospasm in all cases and arterial occlusion in the middle cerebral artery due to vasospasm in case 3. Angiography demonstrated several types of spasms, including diffuse, peripheral and multi local. Furthermore, in some cases, diffuse vasospasms were recognized at the siphon and extracranial portions of the internal carotid artery. In one case (Case 4), segmental vasospasms were detected in the bilateral vertebral arteries. Three to four weeks later, follow-up cerebral angiography was performed in three cases. Cerebral vasospasms had partially or completely recovered. Subarachnoid hemorrhage (SAH) was excluded by lumbar puncture and neuroradiological findings in all cases. We concluded that eclampsia itself causes cerebral vasospasm and that the mechanism of vasospasm is different from that of SAH, since cerebral vasospasm occurred in the extracranial cerebral arteries. We suspected that cerebral vasospasm in eclampsia causes cerebral ischemia, which leads to cytotoxic edema and dysfunction of the blood-brain barrier (BBB) and cerebral autoregulation. With this background, brain edema, especially vasogenic edema, may easily occur and clinical symptoms of eclampsia may appear when the blood pressure rapidly increases. (author).

  2. Clinical and neuroradiological studies of eclampsia. Cerebral vasospasm and relation to the brain edema

    International Nuclear Information System (INIS)

    Ito, Yasuhiro; Niwa, Hisayoshi; Ando, Tetsuo; Yasuda, Takeshi; Yanagi, Tsutomu

    1995-01-01

    Clinical and neuroradiological studies involving cerebral angiography were conducted in four patients with eclampsia. In three cases (case 1, 2 and 4), neurological focal signs, abnormal low density areas on cranial CT and T 2 high intensity areas on cranial MRI disappeared within a month. But in one case (case 3), cerebral infarction occurred and right hemiparesis and aphasia persisted. Cerebral angiography in the acute phase demonstrated vasospasm in all cases and arterial occlusion in the middle cerebral artery due to vasospasm in case 3. Angiography demonstrated several types of spasms, including diffuse, peripheral and multi local. Furthermore, in some cases, diffuse vasospasms were recognized at the siphon and extracranial portions of the internal carotid artery. In one case (Case 4), segmental vasospasms were detected in the bilateral vertebral arteries. Three to four weeks later, follow-up cerebral angiography was performed in three cases. Cerebral vasospasms had partially or completely recovered. Subarachnoid hemorrhage (SAH) was excluded by lumbar puncture and neuroradiological findings in all cases. We concluded that eclampsia itself causes cerebral vasospasm and that the mechanism of vasospasm is different from that of SAH, since cerebral vasospasm occurred in the extracranial cerebral arteries. We suspected that cerebral vasospasm in eclampsia causes cerebral ischemia, which leads to cytotoxic edema and dysfunction of the blood-brain barrier (BBB) and cerebral autoregulation. With this background, brain edema, especially vasogenic edema, may easily occur and clinical symptoms of eclampsia may appear when the blood pressure rapidly increases. (author)

  3. The persistence of mind-brain dualism in psychiatric reasoning about clinical scenarios.

    Science.gov (United States)

    Miresco, Marc J; Kirmayer, Laurence J

    2006-05-01

    Despite attempts in psychiatry to adopt an integrative biopsychosocial model, social scientists have observed that psychiatrists continue to operate according to a mind-brain dichotomy in ways that are often covert and unacknowledged and suggest that the same intuitive cognitive schemas that people use to make judgments of responsibility lead to dualistic reasoning among clinicians. The goal of this study was to confirm these observations. Self-report questionnaires were sent to the 270 psychiatrists and psychologists in the Department of Psychiatry at McGill University. In response to clinical vignettes, the participants rated the level of intentionality, controllability, responsibility, and blame attributable to the patients, as well as the importance of neurobiological, psychological, and social factors in explaining the patients' symptoms. A total of 136 faculty members (50.4%) responded, and 127 were included in the analysis. Factor analysis revealed a single dimension of responsibility regarding the patients' illnesses that correlated positively with ratings of psychological etiology and negatively with ratings of neurobiological etiology. Psychological and neurobiological ratings were inversely correlated. Multivariate analyses of variance supported these results. Mental health professionals continue to employ a mind-brain dichotomy when reasoning about clinical cases. The more a behavioral problem is seen as originating in "psychological" processes, the more a patient tends to be viewed as responsible and blameworthy for his or her symptoms; conversely, the more behaviors are attributed to neurobiological causes, the less likely patients are to be viewed as responsible and blameworthy.

  4. The brain stem function in patients with brain bladder; Clinical evaluation using dynamic CT scan and auditory brainstem response

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Toshihiro (Yokohama City Univ. (Japan). Faculty of Medicine)

    1990-11-01

    A syndrome of detrusor-sphincter dyssynergia (DSD) is occasionally found in patients with brain bladder. To evaluate the brain stem function in cases of brain bladder, urodynamic study, dynamic CT scan of the brain stem (DCT) and auditory brainstem response (ABR) were performed. The region of interest of DCT aimed at the posterolateral portion of the pons. The results were analysed in contrast with the presense of DSD in urodynamic study. DCT studies were performed in 13 cases with various brain diseases and 5 control cases without neurological diseases. Abnormal patterns of the time-density curve consisted of low peak value, prolongation of filling time and low rapid washout ratio (low clearance ratio) of the contrast medium. Four of 6 cases with DSD showed at least one of the abnormal patterns of the time-density curve bilaterally. In 7 cases without DSD none showed bilateral abnormality of the curve and in 2 of 7 cases only unilateral abnormality was found. ABR was performed in 8 patients with brain diseases. The interpeak latency of the wave I-V (I-V IPL) was considered to be prolonged in 2 cases with DSD compared to that of 4 without DSD. In 2 cases with DSD who had normal DCT findings, measurement of the I-V IPL was impossible due to abnormal pattern of the ABR wave. Above mentioned results suggests the presence of functional disturbance at the posterolateral portion of the pons in cases of brain bladder with DSD. (author).

  5. Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities.

    NARCIS (Netherlands)

    Jacobs, B.; Beems, T.; Stulemeijer, M.; Vugt, A.B. van; Vliet, A.M. van der; Borm, G.F.; Vos, P.E.

    2010-01-01

    Mild traumatic brain injury (mTBI) is a common heterogeneous neurological disorder with a wide range of possible clinical outcomes. Accurate prediction of outcome is desirable for optimal treatment. This study aimed both to identify the demographic, clinical, and computed tomographic (CT)

  6. Clinical and Brain Magnetic Resonance Imaging Features in a Cohort of Chinese Patients with Kearns-Sayre Syndrome

    Directory of Open Access Journals (Sweden)

    Meng Yu

    2016-01-01

    Conclusions: The clinical features of KSS evolve dynamically, affecting the cardiac conduction system predominantly, highlighting the significance of ECG monitoring. Brain MRI showed changes involving both the white matter and deep gray nuclei. Clinical presentation or severity of muscle pathological changes is not related to the size of mtDNA deletions.

  7. Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline.

    Science.gov (United States)

    Ramakrishna, Naren; Temin, Sarah; Chandarlapaty, Sarat; Crews, Jennie R; Davidson, Nancy E; Esteva, Francisco J; Giordano, Sharon H; Gonzalez-Angulo, Ana M; Kirshner, Jeffrey J; Krop, Ian; Levinson, Jennifer; Modi, Shanu; Patt, Debra A; Perez, Edith A; Perlmutter, Jane; Winer, Eric P; Lin, Nancy U

    2014-07-01

    To provide formal expert consensus-based recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer. The American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic review of the literature. When that failed to yield sufficiently strong quality evidence, the Expert Panel undertook a formal expert consensus-based process to produce these recommendations. ASCO used a modified Delphi process. The panel members drafted recommendations, and a group of other experts joined them for two rounds of formal ratings of the recommendations. No studies or existing guidelines met the systematic review criteria; therefore, ASCO conducted a formal expert consensus-based process. Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. Clinicians should not perform routine magnetic resonance imaging (MRI) to screen for brain metastases, but rather should have a low threshold for MRI of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. © 2014 by American Society of Clinical Oncology.

  8. Whole Brain Radiotherapy and RRx-001: Two Partial Responses in Radioresistant Melanoma Brain Metastases from a Phase I/II Clinical Trial: A TITE-CRM Phase I/II Clinical Trial.

    Science.gov (United States)

    Kim, Michelle M; Parmar, Hemant; Cao, Yue; Pramanik, Priyanka; Schipper, Matthew; Hayman, James; Junck, Larry; Mammoser, Aaron; Heth, Jason; Carter, Corey A; Oronsky, Arnold; Knox, Susan J; Caroen, Scott; Oronsky, Bryan; Scicinski, Jan; Lawrence, Theodore S; Lao, Christopher D

    2016-04-01

    Kim et al. report two patients with melanoma metastases to the brain that responded to treatment with RRx-001 and whole brain radiotherapy (WBRT) without neurologic or systemic toxicity in the context of a phase I/II clinical trial. RRx-001 is an reactive oxygen and reactive nitrogen species (ROS/RNS)-dependent systemically nontoxic hypoxic cell radiosensitizer with vascular normalizing properties under investigation in patients with various solid tumors including those with brain metastases. Metastatic melanoma to the brain is historically associated with poor outcomes and a median survival of 4 to 5 months. WBRT is a mainstay of treatment for patients with multiple brain metastases, but no significant therapeutic advances for these patients have been described in the literature. To date, candidate radiosensitizing agents have failed to demonstrate a survival benefit in patients with brain metastases, and in particular, no agent has demonstrated improved outcome in patients with metastatic melanoma. Kim et al. report two patients with melanoma metastases to the brain that responded to treatment with novel radiosensitizing agent RRx-001 and WBRT without neurologic or systemic toxicity in the context of a phase I/II clinical trial. Published by Elsevier Inc.

  9. Computed tomographic (CT) study of the brains of 357 elderly demented patients. Clinical usefulness of CT measurements of brain atrophy and its correlation with mental assessment

    Energy Technology Data Exchange (ETDEWEB)

    Kono, Kazuhiko; Endo, Hidetoshi; Yamamoto, Takayuki; Kuzuya, Fumio

    1988-05-01

    It is well known that there is some limitation in the diagnostic effectiveness of brain computed tomography (CT) of dementia. Some investigators suggested certain correlation between brain atrophy and degree of psychological imparement in demented patients, but others did not agree with these suggestions. Authors have felt that the number of samples is very important in statistical analyses, thus they collected a great number of appropriate samples of dementia: that is, 59 of Alzheimer disease (AD), 120 of senile dementia of Alzheimer type (SDAT) and 178 of vascular dementia (VD), and compared these CT findings with those of 100 non-demented people. Firstly, we observed no relation between aging and brain atrophy in any type of dementia while there was a certain relation in non-demented people. Secondly, the female brain could easily become atrophic physiologically and was more severely atrophic in case of dementia compared with the male brain. Thirdly, it was impossible to differentiate SDAT from VD only by measuring values of dilatation of ventricles (maximum width of the third ventricle and cella media index) and sylvian fissures (''sylvian index''). Finally, it was observed that there was deep relation between the results of clinical assessments and the degree of brain atrophy in SDAT, because individual specificity in the type of atrophy was not variable in this type of dementia. Moreover all functions: that is, motor, intellectual, and emotional functions in SDAT patients, were impaired in the same degree respectively. From these results, authors could know many available characteristics of atrophy in the brains of demented patients through the following easy methods of measurement: linear measure method and ventricular-brain method, because we could analyse a sufficient number of samples.

  10. Computed tomography and clinical outcome in patients with severe traumatic brain injury.

    Science.gov (United States)

    Stenberg, Maud; Koskinen, Lars-Owe D; Jonasson, Per; Levi, Richard; Stålnacke, Britt-Marie

    2017-01-01

    To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). Initial CT (CT i ) and CT 24 hours post-trauma (CT 24 ) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated. Thirty-seven patients were included. Marshall CT i and CT 24 were significantly correlated with RLAS-R at three months. Rotterdam CT 24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year. Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.

  11. Neuro-ophthalmic and clinical characteristics of brain tumours in a tertiary hospital in Ghana

    International Nuclear Information System (INIS)

    Tagoe, N. N.; Essuman, V. A.; Fordjuor, G.; Akpalu, J.; Bankah, P.; Ndanu, T.

    2015-01-01

    Anecdotally, increasing number of patients are seen at Korle Bu Teaching Hospital (KBTH) with brain tumour. Neuro-ophthalmic symptoms and signs may help in timely diagnosis and intervention. The objective of this study is to evaluate the neuro-ophthalmic and clinical characteristics of brain tumour in patients presenting at a tertiary hospital in Ghana. The study design involved a prospective case series involving 36 consecutive patients newly diagnosed with brain tumour from November 2010 to October 2011, at the Ophthalmology, Neurosurgery and Endocrine units of KBTH, Ghana. All patients had clinical diagnosis of brain tumour with confirmation by computerized tomography (CT) or magnetic resonance imaging (MRI). Thirteen patients had histological confirmation of diagnosis. The outcome measures of the study include presenting visual acuity, colour vision, visual fields and cranial nerve deficits. Data of 36 patients were analysed. The results of the study showed that ages ranged from 3 to 69 years, mean (SD) 42.56(±16.6 years). Twenty-six (72%) were females. Tumours included pituitary adenoma (20, 55.5%), meningioma (10, 27.8%), choroid plexus tumour (1, 2.8%), medulloblastom (1, 2.8%), craniopharyngioma (1, 2.8%), haemangioblastoma (1, 2.8%), thalamic tumour (1, 2.8%) and haemangioma (1, 2.8%). Histologically confirmed tumours included pituitary adenoma (9, 69.2%), meningioma (3, 23.1%), craniopharyngioma (1, 7.7%). One patient had both a pituitary adenoma and meningioma. Blurred vision (30, 83.3%), headache (28, 77.8%) and photophobia (13, 36.1%) were predominant symptoms. Commonest neuro-ophthalmic signs were impaired colour vision (62 eyes, 88.6%), optic atrophy (26, 74.3%), unilateral or bitemporal hemianopia (15, 41.5%) and relative afferent pupillary defect (12, 34.3%). Seven (19.4%) patients were visually impaired and nine (25%) blind. Thirty-three of 72(45.8%) eyes had monocular blindness. Common neuro-ophthalmic characteristics were blurred vision

  12. Comparison of different references for brain perfusion SPECT quantification in clinical routine

    International Nuclear Information System (INIS)

    Olivera J, P.; Acton, P.; Costa, D.

    1997-01-01

    Full text: We used 40 brain perfusion SPECT studies from the INM, UCL database to investigate the performance of several references (denominators) in the calculation of perfusion ratios with single photon emission tomography (S PET) within a routine clinical service. According to clinical diagnosis and previous SPECT findings 4 groups were identified composed of: 10 controls (C, 23 to 84 y old); 10 myalgic-encephalomyelitis / chronic fatigue syndrome (ME/CFS, 22 to 61 y old); 10 major depression (MD, 24 to 68 y old); and 10 temporal lobe epilepsy (TLE, 19 to 39 y old). Routine protocols for processing were used and the analysis was blind to group classification. Brain perfusion ratios were calculated using 7 different references: hemi cerebellum with higher counts (Cer), total counts in a 4 pixel slice through the basal ganglia slice (BG), average counts per pixel in the visual cortex (VC), average counts per pixel in the white matter (WM), total acquired counts (TAC), total reconstructed counts (TRC) and maximum counts per pixel in the entire study (MAXX). Unpaired test to compare different diagnostic groups, coefficient of variation (CV) to assess the reliability to each references followed by ANOVA were the statistical test used. The lowest mean CV's were found with VC (4.8%) and TRC (5.1%), with all the others significantly higher (p<0.0001). The range of CV's for Cer was the lowest (3.7% to 5.9%). Consistent differentiation between diagnostic groups and controls was only obtained with Cer. In conclusion, it appears that for clinical routine services Cer is the most reliable reference, exception made for all diseases affecting the cerebellum. In these cases TRC or VC should be preferred. (authors)

  13. Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice.

    Science.gov (United States)

    Micoulaud-Franchi, J-A; McGonigal, A; Lopez, R; Daudet, C; Kotwas, I; Bartolomei, F

    2015-12-01

    The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by

  14. Clinical predictive score of intracranial hemorrhage in mild traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Yuksen C

    2018-02-01

    Full Text Available Chaiyaporn Yuksen,1 Yuwares Sittichanbuncha,1 Jayanton Patumanond,2 Sombat Muengtaweepongsa,3 Kittisak Sawanyawisuth4,5 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 2Clinical Epidemiology Unit and Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani, 3Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, 4Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 5Sleep Apnea Research Group, Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, and Research and Training Center for Enhancing Quality of Life of Working Age People, Khon Kaen University, Khon Kaen, Thailand Background: Mild traumatic brain injury (TBI is a common condition at the Emergency Medicine Department. Head computer tomography (CT scans in mild TBI patients must be properly justified in order to avoid unnecessary exposure to X-rays and to reduce the hospital/transfer costs. This study aimed to evaluate which clinical factors are associated with intracranial hemorrhage in Asian population and to develop a user-friendly predictive model.Methods: The study was conducted retrospectively at the Emergency Medicine Department in Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study period was between September 2013 and August 2016. The inclusion criteria were age >15 years and having received a head CT scan after presenting with mild TBI. Those patients with mild TBI and no symptoms/deterioration after 24 h of clinical observation were excluded. The predictive model and prediction score for intracranial hemorrhage was developed by multivariate logistic regression analysis.Results: During the study period, there were 708 patients who met the study criteria. Of those, 100 patients (14.12% had positive head CT scan results. There were seven independent factors that were

  15. 78 FR 14528 - Mayo Hydropower, LLC, Avalon Hydropower, LLC; Notice of Application for Transfer of License, and...

    Science.gov (United States)

    2013-03-06

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Project No. 11169-029] Mayo Hydropower, LLC, Avalon Hydropower, LLC; Notice of Application for Transfer of License, and Soliciting Comments and Motions To Intervene On November 20, 2012, Mayo Hydropower, LLC (transferor) and Avalon Hydropower...

  16. Clinical applications of brain spect with N-isopropyl-123I-p-iodoamphetamine

    International Nuclear Information System (INIS)

    Moretti, J.L.; Sergent, A.; Raynaud, C.; Baron, J.C.; Samson, Y.; Lassen, N.; Bourdoiseau, M.

    1985-01-01

    Single-photon emission computed tomography (SPECT) with N-isopropyl- 123 I-p-iodoamphetamine (IAMP-I-123) was used for 250 patients suffering from brain disorders, comprising brain tumours (36), normal-pressure hydrocephalus (NPH) (23), cerebrovascular pathologies (127) and partial epilepsy (64). Brain tumours were found to be hypoactive, whatever the grade and nature. Frontal hypoactivity was found in NPH patients, and IAMP-I-123 perfusion was improved after cerebral spinal fluid (CSF) lumbar drainage, giving a good predictive criterion of clinical outcome after CSF diversion. For cerebrovascular disorders, it was possible to obtain with IAMP-I-123 SPECT larger pictures of hypoactive areas than the pictures of hypodense lesions obtained with X-ray CT scans; other hypoactive areas that could not be observed with CT were also delineated by IAMP-I-123 SPECT. The hypoactive areas found in constituted infarctions can present two types of kinetics - those which are 'persistent' (still present on delayed scans performed 5 h after IAMP-I-123 injection) and those which disappear with time, thereby suggesting hypofunctional parenchyma without tissue impairment. IAMP-I-123 SPECT was proved to be useful in assessing ischaemia, especially in reversible ischaemia patients, by defining the affected arterial territory and guiding complementary arteriographic exploration in view of surgical procedures. IAMP-I-123 SPECT was able to accurately delineate the affected parenchymal areas. It could also be of help in the follow-up of the efficiency of drug therapy and surgery, and it can be regarded as a good predictive criterion for stroke rehabilitation. The results obtained with IAMP-I-123 indicate that the lesional and epileptogenic areas in epileptic patients are hypoactive. The localization of these territories by IAMP-I-123 SPECT correlates well with other, more accurate, neuroradiological and stereotactic techniques. (author)

  17. Influence of cerebrovascular disease on brain networks in prodromal and clinical Alzheimer's disease.

    Science.gov (United States)

    Chong, Joanna Su Xian; Liu, Siwei; Loke, Yng Miin; Hilal, Saima; Ikram, Mohammad Kamran; Xu, Xin; Tan, Boon Yeow; Venketasubramanian, Narayanaswamy; Chen, Christopher Li-Hsian; Zhou, Juan

    2017-11-01

    Network-sensitive neuroimaging methods have been used to characterize large-scale brain network degeneration in Alzheimer's disease and its prodrome. However, few studies have investigated the combined effect of Alzheimer's disease and cerebrovascular disease on brain network degeneration. Our study sought to examine the intrinsic functional connectivity and structural covariance network changes in 235 prodromal and clinical Alzheimer's disease patients with and without cerebrovascular disease. We focused particularly on two higher-order cognitive networks-the default mode network and the executive control network. We found divergent functional connectivity and structural covariance patterns in Alzheimer's disease patients with and without cerebrovascular disease. Alzheimer's disease patients without cerebrovascular disease, but not Alzheimer's disease patients with cerebrovascular disease, showed reductions in posterior default mode network functional connectivity. By comparison, while both groups exhibited parietal reductions in executive control network functional connectivity, only Alzheimer's disease patients with cerebrovascular disease showed increases in frontal executive control network connectivity. Importantly, these distinct executive control network changes were recapitulated in prodromal Alzheimer's disease patients with and without cerebrovascular disease. Across Alzheimer's disease patients with and without cerebrovascular disease, higher default mode network functional connectivity z-scores correlated with greater hippocampal volumes while higher executive control network functional connectivity z-scores correlated with greater white matter changes. In parallel, only Alzheimer's disease patients without cerebrovascular disease showed increased default mode network structural covariance, while only Alzheimer's disease patients with cerebrovascular disease showed increased executive control network structural covariance compared to controls. Our

  18. Clinical research on alterations of brain MRI and 1H-MRS in chronic hepatic disease

    International Nuclear Information System (INIS)

    Long Liling; Li Xiangrong; Hong Zhongkui

    2006-01-01

    Objective: To study the abnormal findings and metabolic alterations of the brain in chronic hepatic disease with MRI and 1 H magnetic resonance spectroscopy ( 1 H-MRS) for better understanding the clinical significance of pallidal hyperintensity and the role in the diagnosis and treatment of hepatic encephalopathy (HE). Methods: Brain MRI and 1 H-MRS examination were performed in 50 patients with chronic hepatic disease and 20 healthy volunteers. The pallidus index (PI) was calculated and the height of resonance peaks of Glx was measured. The correlation between PI and Child/Pugh classification, and the association between blood ammonia and the spectroscopic alterations were studied. Pre-and post-therapeutic comparative study was also conducted in 5 cases with chronic HE. Results: PI was gradually increased from healthy volunteers to patients with chronic hepatitis and liver cirrhosis (1.01± 0.04, 1.06±0.09, and 1.18±0.09), and the differences in PI value among them were significant (F=22.294, P 1 -weighted MRI disappeared and the abnormal metabolic alterations returned to normal range 5 to 6 months after successful liver transplantation. However, the normalization of 1 H-MRS alterations preceded the disappearance of pallidal hyperintensities. Conclusion: PI can be an index of reference for liver dysfunction. Glx is more sensitive than blood ammonia in detecting the brain dysfunction. MRI and 1 H-MRS are reliable techniques in the diagnosis and evaluation of therapy for hepatic encephalopathy. (authors)

  19. Cerebral perfusion pressure, microdialysis biochemistry and clinical outcome in patients with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Paraforou Theoniki

    2011-12-01

    Full Text Available Abstract Background Traumatic Brain Injury (TBI is a major cause of death and disability. It has been postulated that brain metabolic status, intracranial pressure (ICP and cerebral perfusion pressure (CPP are related to patients' outcome. The aim of this study was to investigate the relationship between CPP, ICP and microdialysis parameters and clinical outcome in TBIs. Results Thirty four individuals with severe brain injury hospitalized in an intensive care unit participated in this study. Microdialysis data were collected, along with ICP and CPP values. Glasgow Outcome Scale (GOS was used to evaluate patient outcome at 6 months after injury. Fifteen patients with a CPP greater than 75 mmHg, L/P ratio lower than 37 and Glycerol concentration lower than 72 mmol/l had an excellent outcome (GOS 4 or 5, as opposed to the remaining 19 patients. No patient with a favorable outcome had a CPP lower than 75 mmHg or Glycerol concentration and L/P ratio greater than 72 mmol/l and 37 respectively. Data regarding L/P ratio and Glycerol concentration were statistically significant at p = 0.05 when patients with favorable and unfavorable outcome were compared. In a logistic regression model adjusted for age, sex and Glasgow Coma Scale on admission, a CPP greater than 75 mmHg was marginally statistically significantly related to outcome at 6 months after injury. Conclusions Patients with favorable outcome had certain common features in terms of microdialysis parameters and CPP values. An individualized approach regarding CPP levels and cut -off points for Glycerol concentration and L/P ratio are proposed.

  20. Phase II clinical trial of whole-brain irradiation plus three-dimensional conformal boost with concurrent topotecan for brain metastases from lung cancer

    International Nuclear Information System (INIS)

    Ge, Xiao-hui; Liu, Miao-ling; Lin, Qiang; Ren, Xiao-cang; Liu, Yue-e; Chen, Xue-ji; Wang, Dong-ying; Wang, Yong-qiang; Cao, Bin; Li, Zhi-gang

    2013-01-01

    Patients with brain metastases from lung cancer have poor prognoses and short survival time, and they are often excluded from clinical trials. Whole-cranial irradiation is considered to be the standard treatment, but its efficacy is not satisfactory. The purpose of this phase II clinical trial was to evaluate the preliminary efficacy and safety of the treatment of whole-brain irradiation plus three-dimensional conformal boost combined with concurrent topotecan for the patients with brain metastases from lung cancer. Patients with brain metastasis from lung cancer received concurrent chemotherapy and radiotherapy: conventional fractionated whole-brain irradiation, 2 fields/time, 1 fraction/day, 2 Gy/fraction, 5 times/week, and DT 40 Gy/20 fractions; for the patients with ≤ 3 lesions with diameter ≥ 2 cm, a three-dimensional (3-D) conformal localised boost was given to increase the dosage to 56–60 Gy; and during radiotherapy, concurrent chemotherapy with topotecan was given (the chemoradiotherapy group, CRT). The patients with brain metastasis from lung cancer during the same period who received radiotherapy only were selected as the controls (the radiotherapy-alone group, RT). From March 2009 to March 2012, both 38 patients were enrolled into two groups. The median progression-free survival(PFS) time , the 1- and 2-year PFS rates of CRT group and RT group were 6 months, 42.8%, 21.6% and 3 months, 11.6%, 8.7% (χ 2 = 6.02, p = 0.014), respectively. The 1- and 2-year intracranial lesion control rates of CRT and RT were 75.9% , 65.2% and 41.6% , 31.2% (χ 2 = 3.892, p = 0.049), respectively. The 1- and 2-year overall survival rates (OS) of CRT and RT were 50.8% , 37.9% and 40.4% , 16.5% (χ 2 = 1.811, p = 0.178), respectively. The major side effects were myelosuppression and digestive toxicities, but no differences were observed between the two groups. Compared with radiotherapy alone, whole-brain irradiation plus 3-D conformal boost irradiation and concurrent

  1. A clinical perspective on the 2016 WHO brain tumor classification and routine molecular diagnostics.

    Science.gov (United States)

    van den Bent, Martin J; Weller, Michael; Wen, Patrick Y; Kros, Johan M; Aldape, Ken; Chang, Susan

    2017-05-01

    The 2007 World Health Organization (WHO) classification of brain tumors did not use molecular abnormalities as diagnostic criteria. Studies have shown that genotyping allows a better prognostic classification of diffuse glioma with improved treatment selection. This has resulted in a major revision of the WHO classification, which is now for adult diffuse glioma centered around isocitrate dehydrogenase (IDH) and 1p/19q diagnostics. This revised classification is reviewed with a focus on adult brain tumors, and includes a recommendation of genes of which routine testing is clinically useful. Apart from assessment of IDH mutational status including sequencing of R132H-immunohistochemistry negative cases and testing for 1p/19q, several other markers can be considered for routine testing, including assessment of copy number alterations of chromosome 7 and 10 and of TERT promoter, BRAF, and H3F3A mutations. For "glioblastoma, IDH mutated" the term "astrocytoma grade IV" could be considered. It should be considered to treat IDH wild-type grades II and III diffuse glioma with polysomy of chromosome 7 and loss of 10q as glioblastoma. New developments must be more quickly translated into further revised diagnostic categories. Quality control and rapid integration of molecular findings into the final diagnosis and the communication of the final diagnosis to clinicians require systematic attention. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Magnetic resonance imaging in perinatal brain injury: clinical presentation, lesions and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Rutherford, Mary; Ward, Phil; Allsop, Joanna; Counsell, Serena [Imperial College London, Hammersmith Hospital, Robert Steiner MR Unit, Imaging Sciences Department, Clinical Sciences Centre, London (United Kingdom); Srinivasan, Latha; Dyet, Leigh; Cowan, Frances [Imperial College, Hammersmith Hospital, Department of Paediatrics, Imaging Sciences Department, Clinical Sciences Centre, London (United Kingdom)

    2006-07-15

    Neonatal MR imaging is invaluable in assessing the term born neonate who presents with an encephalopathy. Successful imaging requires adaptations to both the hardware and the sequences used for adults. The perinatal and postnatal details often predict the pattern of lesions sustained and are essential for correct interpretation of the imaging findings, but additional or alternative diagnoses in infants with apparent hypoxic ischaemic encephalopathy should always be considered. Perinatally acquired lesions are usually at their most obvious between 1 and 2 weeks of age. Very early imaging (<3 days) may be useful to make management decisions in ventilated neonates, but abnormalities may be subtle at that stage. Diffusion-weighted imaging is clinically useful for the early identification of ischaemic white matter in the neonatal brain but is less reliable in detecting lesions within the basal ganglia and thalami. The pattern of lesions seen on MRI can predict neurodevelopmental outcome. Additional useful information may be obtained by advanced techniques such as MR angiography, venography and perfusion-weighted imaging. Serial imaging with quantification of both structure size and tissue damage provides invaluable insights into perinatal brain injury. (orig.)

  3. A survey of head movement during clinical brain SPECT using an optical tracking system

    International Nuclear Information System (INIS)

    Pandos, G.; Barnden, L.; Lineage, H.; Smith, T.; Unger, S.

    2002-01-01

    Full text: The aim of this study was to survey patient motion during clinical brain SPECT using a commercial motion detection system called Polaris. Polaris is an optical tracker that remotely tracks head position and orientation via a small target attached to the patient. Its accuracy for position measurement is 1mm or 1 degree (deg), 33% moved > 2mm or 2deg and 10% moved > 4mm or 4deg. 65% of subjects moved 3 or more times. Motion in the D and P groups was equally likely to be small (<3mm or <3deg) or large and equally likely to occur early or late during acquisition. Motion in the N, F and C groups was less likely to be large and for N and F more likely to occur late in the acquisition suggesting fatigue was the main cause. The most common large movements were anterior-posterior translations and axial (Z) rotations. Significant head movement is common in brain SPECT, particularly in dementia and psychiatric subjects, and accurate motion correction is desirable to maintain image quality. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  4. Timing of thyroid hormone action in the developing brain: clinical observations and experimental findings.

    Science.gov (United States)

    Zoeller, R T; Rovet, J

    2004-10-01

    Abstract The original concept of the critical period of thyroid hormone (TH) action on brain development was proposed to identify the postnatal period during which TH supplement must be provided to a child with congenital hypothyroidism to prevent mental retardation. As neuropsychological tools have become more sensitive, it has become apparent that even mild TH insufficiency in humans can produce measurable deficits in very specific neuropsychological functions, and that the specific consequences of TH deficiency depends on the precise developmental timing of the deficiency. Models of maternal hypothyroidism, hypothyroxinaemia and congenital hyperthyroidism have provided these insights. If the TH deficiency occurs early in pregnancy, the offspring display problems in visual attention, visual processing (i.e. acuity and strabismus) and gross motor skills. If it occurs later in pregnancy, children are at additional risk of subnormal visual (i.e. contrast sensitivity) and visuospatial skills, as well as slower response speeds and fine motor deficits. Finally, if TH insufficiency occurs after birth, language and memory skills are most predominantly affected. Although the experimental literature lags behind clinical studies in providing a mechanistic explanation for each of these observations, recent studies confirm that the specific action of TH on brain development depends upon developmental timing, and studies informing us about molecular mechanisms of TH action are generating hypotheses concerning possible mechanisms to account for these pleiotropic actions.

  5. [Lightning strike and lesions outside the brain: Clinical cases and a review of the literature].

    Science.gov (United States)

    Morin, A; Lesourd, A; Cabane, J

    2015-01-01

    Every year, 240,000 people are struck by lightning worldwide, causing injuries leading to significant handicaps. Most of the symptoms involve brain lesions; neuromuscular sequelae and myelopathy are less common. We describe five cases of patients struck by lightning with various clinical presentations. The first patient presented painful paresthesias in both upper limbs that disappeared 18 months later; the injury was a plexopathy. The second patient developed proximal weakness in the upper-left limb due to a myopathy. Two patients presented with various motor weaknesses in the lower limbs due to motor neuron disease and myelopathy. The last patient had a transient tetraplegy, which resolved in 5minutes; the diagnosis was keraunoparalysis. Lightning injuries can have many consequences depending on the different mechanisms involved. The clinical presentation is often due to a very focal lesion without any secondary extension. Motor neuron disease probably results from post-traumatic myelopathy. We discuss the ALS-electrocution association, frequently described in the literature. Various peripheral nerve and spinal cord lesions can be seen in lightning strike victims involving myelopathy, motor neuron, muscle and plexus. Clinical syndromes are often atypical but outcome is often favorable. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. The Influence of BMX Gene Polymorphisms on Clinical Symptoms after Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Yu-Jia Wang

    2014-01-01

    Full Text Available Mild traumatic brain injury (mTBI is one of the most common neurological disorders. Most patients diagnosed with mTBI could fully recover, but 15% of patients suffer from persistent symptoms. In recent studies, genetic factors were found to be associated with recovery and clinical outcomes after TBI. In addition, results from our previous research have demonstrated that the bone marrow tyrosine kinase gene in chromosome X (BMX, a member of the Tec family of kinases, is highly expressed in rats with TBI. Therefore, our aim in this study was to identify the association between genetic polymorphisms of BMX and clinical symptoms following mTBI. Four tagging single nucleotide polymorphisms (tSNPs of BMX with minimum allele frequency (MAF >1% were selected from the HapMap Han Chinese database. Among these polymorphisms, rs16979956 was found to be associated with the Beck anxiety inventory (BAI and dizziness handicap inventory (DHI scores within the first week after head injury. Additionally, another SNP, rs35697037, showed a significant correlation with dizziness symptoms. These findings suggested that polymorphisms of the BMX gene could be a potential predictor of clinical symptoms following mTBI.

  7. Prácticas de crianza y educación inicial en la etnia Mayo

    Directory of Open Access Journals (Sweden)

    Ángel Vera Noriega

    2010-01-01

    Full Text Available En el artículo se describen las características de las prácticas de crianza en una comunidad mayo y se realiza un análisis documental del Modelo de Educación Inicial no Escolarizada del CONAFE. Ello con la finalidad de contrastar los resultados de la práctica de crianza con las competencias esperadas de los padres y niños que asisten al programa y con base en ello, identificar la eficacia de la implementación del programa para la reproducción social en la etnia mayo. Participaron cincuenta madres y niños de la comunidad indígena mayo "El Júpare" ubicada en el municipio de Huatabampo, al sur de Sonora. Los instrumentos utilizados fueron Índice de Estrés Parental (Abidin, 1990, Interacción Padre-Hijo-Madre (Peña, 2004, Estimulación del Niño en el Hogar (Caldwell y Bradley, 1967 y Escala del Desarrollo Integral del niño (Atkin, 1987. En la evaluación del desarrollo, 54% de los niños presentan un desarrollo normal, 26% rrollo en riesgo y en 20% se detectan problemas. El programa de Educación Inicial no Escolarizado requiere de modificaciones sustantivas para responder a las prácticas de crianza que se desarrollan en la etnia mayo.

  8. Headache after traumatic brain injury: a national survey of clinical practices and treatment approaches.

    Science.gov (United States)

    Brown, Allen W; Watanabe, Thomas K; Hoffman, Jeanne M; Bell, Kathleen R; Lucas, Sylvia; Dikmen, Sureyya

    2015-01-01

    Individuals with headache after traumatic brain injury (TBI) receive care in a wide variety of clinical locations by physicians trained in multiple specialties. To understand current practice patterns and perceptions of treatment issues among clinicians managing headache after TBI. National survey of current clinical practice using a 20-item questionnaire developed by the authors. Survey respondents were members of the Central Nervous System Council list survey of the American Academy of Physical Medicine and Rehabilitation (N = 1782) and the American Headache Society membership (N = 1260). The survey was sent electronically to potential participants and was followed by 2 biweekly reminders. The survey queried the physicians' clinical setting; their use of headache classification systems, headache diaries, checklists, and diagnostic procedures; the pharmacologic and nonpharmacologic treatments prescribed; and headache chronicity and associated symptoms and disorders among their patients with TBI. Completed surveys were received from 193 respondents. The use of standardized classification systems and checklists was commonly reported. Respondents used nonpharmacologic and pharmacologic treatment approaches with similar frequency and modest perceived success rates. A high frequency of headache-associated new sleep and mood disorders was reported. When response differences occurred between practice settings, they reflected a focus on headache diagnosis, classification, and pharmacologic treatment among neurology and specialty headache clinics, whereas a nonpharmacologic approach to management among TBI specialty and general rehabilitation clinicians was more commonly reported. Management strategies for treating headache after TBI vary widely among general and specialty clinical practices. This suggests that additional research is needed that would lead to an increase in the use of established headache classification and the development of standardized management

  9. Clinical manifestations that predict abnormal brain computed tomography (CT in children with minor head injury

    Directory of Open Access Journals (Sweden)

    Nesrin Alharthy

    2015-01-01

    Full Text Available Background: Computed tomography (CT used in pediatric pediatrics brain injury (TBI to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative. Objectives: The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT. Materials and Methods: Retrospective cross-sectional study was undertaken in patients (1-14 years with blunt head injury and having a Glasgow Coma Scale (GCS of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury. Results: No statistically significant association between parameteres such as Loss of Consciousness, ′fall′ as mechanism of injury, motor vehicle accidents (MVA, more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury. Conclusion: Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.

  10. Hughlings Jackson and the "doctrine of concomitance": mind-brain theorising between metaphysics and the clinic.

    Science.gov (United States)

    Chirimuuta, M

    2017-09-11

    John Hughlings Jackson (1835-1911) is a major figure at the origins of neurology and neuroscience in Britain. Alongside his contributions to clinical medicine, he left a large corpus of writing on localisation of function in the nervous system and other theoretical topics. In this paper I focus on Jackson's "doctrine of concomitance"-his parallelist theory of the mind-brain relationship. I argue that the doctrine can be given both an ontological and a causal interpretation, and that the causal aspect of the doctrine is especially significant for Jackson and his contemporaries. I interpret Jackson's engagement with the metaphysics of mind as an instance of what I call meta-science-the deployment by scientists of metaphysical positions and arguments which help streamline empirical investigations by bracketing off unanswerable questions and focussing attention on matters amenable to the current tools of experimental research.

  11. Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma

    DEFF Research Database (Denmark)

    Blomstrand, M.; Berthelsen, Anne Kiil; Munck af Rosenschöld, Per Martin

    2012-01-01

    to the whole-brain irradiation that is part of standard management. Neurogenesis is very sensitive to radiation, and limiting the radiation dose to the hippocampus and the subventricular zone (SVZ) may preserve neurocognitive function. Radiotherapy plans were created using 4 techniques: standard opposing...... fields, intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (IMAT), and intensity-modulated proton therapy (IMPT). Mean dose to the hippocampus and SVZ (mean for both sites) could be limited to 88.3% (range, 83.6%-91.0%), 77.1% (range, 71.5%-81.3%), and 42.3% (range, 26......-modulated proton therapy, thus making this an attractive option to be tested in a prospective clinical trial....

  12. NASA/DARPA advanced communications technology satellite project for evaluation of telemedicine outreach using next-generation communications satellite technology: Mayo Foundation participation.

    Science.gov (United States)

    Gilbert, B K; Mitchell, M P; Bengali, A R; Khandheria, B K

    1999-08-01

    To describe the development of telemedicine capabilities-application of remote consultation and diagnostic techniques-and to evaluate the feasibility and practicality of such clinical outreach to rural and underserved communities with limited telecommunications infrastructures. In 1992, Mayo Foundation (Rochester, Minn, Jacksonville, Fla, and Scottsdale, Ariz), the National Aeronautics and Space Administration, and the Defense Advanced Research Projects Agency collaborated to create a complex network of fiberoptic landlines, video recording systems, satellite terminals, and specially developed data translators linking Mayo sites with other locations in the continental United States on an on-demand basis. The purpose was to transmit data via the asynchronous transfer mode (ATM) digital communications protocol over the Advanced Communications Technology Satellite. The links were intended to provide a conduit for transmission of data for patient-specific consultations between physicians, evaluation of medical imagery, and medical education for clinical staffs at remote sites. Low-data-rate (LDR) experiments went live late in 1993. Mayo Clinic Rochester successfully provided medical consultation and services to 2 small regional medical facilities. High-data-rate (HDR) experiments included studies of remote digital echocardiography, store-and-forward telemedicine, cardiac catheterization, and teleconsultation for congenital heart disease. These studies combined landline data transmission with use of the satellite. The complexity of the routing paths and network components, immaturity of available software, and inexperience with existing telecommunications caused significant study delays. These experiments demonstrated that next-generation satellite technology can provide batch and real-time imagery for telemedicine. The first-generation of the ATM and satellite network technology used in these experiments created several technical problems and inconveniences that should

  13. Clinical treatment of traumatic brain injury complicated by cranial nerve injury.

    Science.gov (United States)

    Jin, Hai; Wang, Sumin; Hou, Lijun; Pan, Chengguang; Li, Bo; Wang, Hui; Yu, Mingkun; Lu, Yicheng

    2010-09-01

    To discuss the epidemiology, diagnosis and surgical treatment of cranial nerve injury following traumatic brain injury (TBI) for the sake of raising the clinical treatment of this special category of TBI. A retrospective analysis was made of 312 patients with cranial nerve injury among 3417 TBI patients, who were admitted for treatment in this hospital. A total of 312 patients (9.1%) involving either a single nerve or multiple nerves among the 12 pairs of cranial nerves were observed. The extent of nerve injury varied and involved the olfactory nerve (66 cases), optic nerve (78 cases), oculomotor nerve (56 cases), trochlear nerve (8 cases), trigeminal nerve (4 cases), abducent nerve (12 cases), facial nerve (48 cases), acoustic nerve (10 cases), glossopharyngeal nerve (8 cases), vagus nerve (6 cases), accessory nerve (10 cases) and hypoglossal nerve (6 cases). Imaging examination revealed skull fracture in 217 cases, complicated brain contusion in 232 cases, epidural haematoma in 194 cases, subarachnoid haemorrhage in 32 cases, nasal cerebrospinal fluid (CSF) leakage in 76 cases and ear CSF leakage in 8 cases. Of the 312 patients, 46 patients died; the mortality rate associated with low cranial nerve injury was as high as 73.3%. Among the 266 surviving patients, 199 patients received conservative therapy and 67 patients received surgical therapy; the curative rates among these two groups were 61.3% (122 patients) and 86.6% (58 patients), respectively. TBI-complicated cranial nerve injury is subject to a high incidence rate, a high mortality rate and a high disability rate. Our findings suggest that the chance of recovery may be increased in cases where injuries are amenable to surgical decompression. It is necessary to study all 12 pairs of cranial nerves systematically. Clinically, it is necessary to standardise surgical indications, operation timing, surgical approaches and methods for the treatment of TBI-complicated cranial nerve injury. 2010 Elsevier Ltd. All

  14. Clinical utility of partial flip angle T2-weighted spin-echo imaging of the brain

    International Nuclear Information System (INIS)

    Chang, K.H.; Yi, J.G.; Han, M.H.; Han, M.C.; Kim, C.W.; Cho, M.H.; Cho, Z.H.

    1990-01-01

    To assess the clinical usefulness of partial flip angle (PFA) spin-echo (SE) brain imaging, a total of eighty patients were examined with both conventional double echo T2-weighted SE (2500/30, 80/90deg/one excitation) and PFA double echo SE (1200/30, 70/45deg/two excitations) on 2.0T system. Two comparative studies were performed: (1) In 65 patients PFA SE technique was compared with conventional SE without flow compensating gradients, and (2) in 15 patients the former was compared with the latter with flow compensating gradients. Imaging time was nearly identical in each sequence. In both studies we found that PFA T2-weighted SE images were almost identical to those obtained with the conventional SE technique in the contrast characteristics and the detection rate of the abnormalities (100%, 85/85 lesions), and more importantly, PFA SE revealed few flow artifacts in the brain stem, temporal lobes and basal ganglia which were frequently seen on conventional SE without flow compensating gradients. Additionally, PFA SE images demonstrated no suppression of CSF flow void in the aqueduct which was commonly seen on conventional SE with flow compensating gradients. In overall image quality, the PFA SE images, particularly the second echo images, were almost comparable with those of conventional SE with flow compensating gradients. A flip angle of 45deg seems to be close to Ernst angle, the angle at which maximum signal occurs, for a given TR of 1200 msec for CSF and most of the abnormalities containing higher water content. In conclusion, PFA SE sequence (i.e. 1200/30, 70/45deg/2) appears to be useful as a primary or an adjunctive technique in certain clinical circumstances, particularly in imaging of hydrocephalic patients for assessing aqueductal patency. (orig.)

  15. Clinical correlative evaluation of an iterative method for reconstruction of brain SPECT images

    International Nuclear Information System (INIS)

    Nobili, Flavio; Vitali, Paolo; Calvini, Piero; Bollati, Francesca; Girtler, Nicola; Delmonte, Marta; Mariani, Giuliano; Rodriguez, Guido

    2001-01-01

    Background: Brain SPECT and PET investigations have showed discrepancies in Alzheimer's disease (AD) when considering data deriving from deeply located structures, such as the mesial temporal lobe. These discrepancies could be due to a variety of factors, including substantial differences in gamma-cameras and underlying technology. Mesial temporal structures are deeply located within the brain and the commonly used Filtered Back-Projection (FBP) technique does not fully take into account either the physical parameters of gamma-cameras or geometry of collimators. In order to overcome these limitations, alternative reconstruction methods have been proposed, such as the iterative method of the Conjugate Gradients with modified matrix (CG). However, the clinical applications of these methods have so far been only anecdotal. The present study was planned to compare perfusional SPECT data as derived from the conventional FBP method and from the iterative CG method, which takes into account the geometrical and physical characteristics of the gamma-camera, by a correlative approach with neuropsychology. Methods: Correlations were compared between perfusion of the hippocampal region, as achieved by both the FBP and the CG reconstruction methods, and a short-memory test (Selective Reminding Test, SRT), specifically addressing one of its function. A brain-dedicated camera (CERASPECT) was used for SPECT studies with 99m Tc-hexamethylpropylene-amine-oxime in 23 consecutive patients (mean age: 74.2±6.5) with mild (Mini-Mental Status Examination score ≥15, mean 20.3±3), probable AD. Counts from a hippocampal region in each hemisphere were referred to the average thalamic counts. Results: Hippocampal perfusion significantly correlated with the MMSE score with similar statistical significance (p<0.01) between the two reconstruction methods. Correlation between hippocampal perfusion and the SRT score was better with the CG method (r=0.50 for both hemispheres, p<0.01) than with

  16. Clinical correlative evaluation of an iterative method for reconstruction of brain SPECT images

    Energy Technology Data Exchange (ETDEWEB)

    Nobili, Flavio E-mail: fnobili@smartino.ge.it; Vitali, Paolo; Calvini, Piero; Bollati, Francesca; Girtler, Nicola; Delmonte, Marta; Mariani, Giuliano; Rodriguez, Guido

    2001-08-01

    Background: Brain SPECT and PET investigations have showed discrepancies in Alzheimer's disease (AD) when considering data deriving from deeply located structures, such as the mesial temporal lobe. These discrepancies could be due to a variety of factors, including substantial differences in gamma-cameras and underlying technology. Mesial temporal structures are deeply located within the brain and the commonly used Filtered Back-Projection (FBP) technique does not fully take into account either the physical parameters of gamma-cameras or geometry of collimators. In order to overcome these limitations, alternative reconstruction methods have been proposed, such as the iterative method of the Conjugate Gradients with modified matrix (CG). However, the clinical applications of these methods have so far been only anecdotal. The present study was planned to compare perfusional SPECT data as derived from the conventional FBP method and from the iterative CG method, which takes into account the geometrical and physical characteristics of the gamma-camera, by a correlative approach with neuropsychology. Methods: Correlations were compared between perfusion of the hippocampal region, as achieved by both the FBP and the CG reconstruction methods, and a short-memory test (Selective Reminding Test, SRT), specifically addressing one of its function. A brain-dedicated camera (CERASPECT) was used for SPECT studies with {sup 99m}Tc-hexamethylpropylene-amine-oxime in 23 consecutive patients (mean age: 74.2{+-}6.5) with mild (Mini-Mental Status Examination score {>=}15, mean 20.3{+-}3), probable AD. Counts from a hippocampal region in each hemisphere were referred to the average thalamic counts. Results: Hippocampal perfusion significantly correlated with the MMSE score with similar statistical significance (p<0.01) between the two reconstruction methods. Correlation between hippocampal perfusion and the SRT score was better with the CG method (r=0.50 for both hemispheres, p<0

  17. Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Anjni Patel

    Full Text Available Traumatic brain injury (TBI is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC. To inform the development of a standard Clinical Practice Guideline (CPG for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours, for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007, followed by the New Zealand Guidelines Group (NZ, 2006 and the National Clinical Guideline (SIGN, 2009 both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability

  18. Graph Theory-Based Brain Connectivity for Automatic Classification of Multiple Sclerosis Clinical Courses

    Directory of Open Access Journals (Sweden)

    Gabriel Kocevar

    2016-10-01

    Full Text Available Purpose: In this work, we introduce a method to classify Multiple Sclerosis (MS patients into four clinical profiles using structural connectivity information. For the first time, we try to solve this question in a fully automated way using a computer-based method. The main goal is to show how the combination of graph-derived metrics with machine learning techniques constitutes a powerful tool for a better characterization and classification of MS clinical profiles.Materials and methods: Sixty-four MS patients (12 Clinical Isolated Syndrome (CIS, 24 Relapsing Remitting (RR, 24 Secondary Progressive (SP, and 17 Primary Progressive (PP along with 26 healthy controls (HC underwent MR examination. T1 and diffusion tensor imaging (DTI were used to obtain structural connectivity matrices for each subject. Global graph metrics, such as density and modularity, were estimated and compared between subjects’ groups. These metrics were further used to classify patients using tuned Support Vector Machine (SVM combined with Radial Basic Function (RBF kernel.Results: When comparing MS patients to HC subjects, a greater assortativity, transitivity and characteristic path length as well as a lower global efficiency were found. Using all graph metrics, the best F-Measures (91.8%, 91.8%, 75.6% and 70.6% were obtained for binary (HC-CIS, CIS-RR, RR-PP and multi-class (CIS-RR-SP classification tasks, respectively. When using only one graph metric, the best F-Measures (83.6%, 88.9% and 70.7% were achieved for modularity with previous binary classification tasks.Conclusion: Based on a simple DTI acquisition associated with structural brain connectivity analysis, this automatic method allowed an accurate classification of different MS patients’ clinical profiles.

  19. Clinical Predictors of Progressive Hemorrhagic Injury in Children with Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Guangfu Di

    2017-11-01

    Full Text Available ObjectiveTraumatic brain injury (TBI occurs commonly in children. Repeat computed tomography (CT follow up of TBI patients is often scheduled to identify progressive hemorrhagic injury (PHI. However, the utility of repeated CT scans, especially in children with mild TBI [Glasgow Coma Scale (GCS scores of 13–15], has been debated. The purposes of the present study were to identify clinical predictors of PHI in children with mild TBI and to clarify relevant clinical factors via radiological examination.MethodsFrom 2014 to 2016, we retrospectively enrolled children <15 years of age with mild TBI. We recorded age, sex, GCS scores on admission, causes of head injury, timing of initial CT, any loss of consciousness, vomiting and seizure data, and type of TBI. Based on repeat CT findings, patients were dichotomized into either a PHI group or a non-PHI group. Also, clinical data were comparatively reviewed. Multivariate logistic regression analysis was used to identify clinical predictors of PHI.ResultsOf the 175 enrolled children, 15 (8.6% experienced PHI. Univariate analysis revealed that GCS score on admission, cause of head injury, vomiting, seizure, and TBI type were associated with PHI. Multivariate logistic regression analysis showed that a GCS score of 13 and epidural hemorrhage (EDH were independently associated with PHI (hazard ratio = 0.131, P = 0.018; hazard ratio = 6.612, P = 0.027, respectively.ConclusionA GCS score of 13 and EDH were associated with PHI. These factors should be considered when deciding whether to repeat CT on children with mild TBI.

  20. Radiosurgery with flattening-filter-free techniques in the treatment of brain metastases. Plan comparison and early clinical evaluation

    International Nuclear Information System (INIS)

    Rieber, J.; Tonndorf-Martini, E.; Schramm, O.; Rhein, B.; Stefanowicz, S.; Lindel, K.; Debus, J.; Rieken, S.; Kappes, J.; Hoffmann, H.

    2016-01-01

    Radiosurgical treatment of brain metastases is well established in daily clinical routine. Utilization of flattening-filter-free beams (FFF) may allow for more rapid delivery of treatment doses and improve clinical comfort. Hence, we compared plan quality and efficiency of radiosurgery in FFF mode to FF techniques. Between November 2014 and June 2015, 21 consecutive patients with 25 brain metastases were treated with stereotactic radiosurgery (SRS) in FFF mode. Brain metastases received dose-fractionation schedules of 1 x 20 Gy or 1 x 18 Gy, delivered to the conformally enclosing 80 % isodose. Three patients with critically localized or large (>3 cm) brain metastases were treated with 6 x 5 Gy. Plan quality and efficiency were evaluated by analyzing conformity, dose gradients, dose to healthy brain tissue, treatment delivery time, and number of monitor units. FFF plans were compared to those using the FF method, and early clinical outcome and toxicity were assessed. FFF mode resulted in significant reductions in beam-on time (p [de

  1. Cranium-brain trauma in computed tomographs - diagnosis and clinical correlation

    International Nuclear Information System (INIS)

    Wrasse, K.

    1982-01-01

    For the successful treatment of intracranial complications in the case of cranium-brain trauma a quick and exact diagnosis is necessary. The goal of this work was to test and evaluate the effectivity of computed tomography for neurotraumatology. Using 565 patients, who were acutely or at one time suffering from a cranium-brain trauma, the high validity of computed tomography for these injuries was proven. The following areas in question were studied with respect to the value of computed tomography in comparison to them: angiography, X-ray diagnostic, echoencephalography, brain scintigraphy, electroencephalography and neurological-psychopathological findings from cranium-brain trauma. Statement possibilities and difficulties of computed tomography are discussed in the cases of the following neurotraumatological diseases: extracranial hematomas; acute cranium-brain traumas; traumatic arachnoidal bleeding; diffuse brain edema; transtentorial herniation and brain contusions. At the end the diagnostic and therapeutic procedures in the case of cranium-brain trauma are presented. (orig.) [de

  2. Imaging of Brain Connectivity in Dementia: Clinical Implications for Diagnosis of its Underlying Diseases

    NARCIS (Netherlands)

    R. Meijboom (Rozanna)

    2017-01-01

    markdownabstractIn this thesis we investigated the use of advanced magnetic resonance imaging (MRI) techniques in identifying subtle brain abnormalities, associating brain abnormalities with disease symptomatology, and improving early (differential) diagnosis in several diseases underlying dementia.

  3. State of the Art for Deep Brain Stimulation Therapy in Movement Disorders: A Clinical and Technological Perspective.

    Science.gov (United States)

    Wagle Shukla, Aparna; Okun, Michael S

    2016-01-01

    Deep brain stimulation (DBS) therapy is a widely used brain surgery that can be applied for many neurological and psychiatric disorders. DBS is American Food and Drug Administration approved for medication refractory Parkinson's disease, essential tremor and dystonia. Although DBS has shown consistent success in many clinical trials, the therapy has limitations and there are well-recognized complications. Thus, only carefully selected patients are ideal candidates for this surgery. Over the last two decades, there have been significant advances in clinical knowledge on DBS. In addition, the surgical techniques and technology related to DBS has been rapidly evolving. The goal of this review is to describe the current status of DBS in the context of movement disorders, outline the mechanisms of action for DBS in brief, discuss the standard surgical and imaging techniques, discuss the patient selection and clinical outcomes in each of the movement disorders, and finally, introduce the recent advancements from a clinical and technological perspective.

  4. An 'integrative neuroscience' perspective on ADHD: linking cognition, emotion, brain and genetic measures with implications for clinical support.

    Science.gov (United States)

    Williams, Leanne M; Tsang, Tracey W; Clarke, Simon; Kohn, Michael

    2010-10-01

    There remains a translational gap between research findings and their implementation in clinical practice that applies to attention-deficit/hyperactivity disorder (ADHD), as well as to other major disorders of brain health in childhood, adolescence and adulthood. Research studies have identified potential 'markers' to support diagnostic, functional assessment and treatment decisions, but there is little consensus about these markers. Of these potential markers, cognitive measures of thinking functions, such as sustaining attention and associated electrical brain activity, show promise in complementing the clinical management process. Emerging evidence highlights the relevance of emotional, as well as thinking, functions to ADHD. Here, we outline an integrative neuroscience framework for ADHD that offers one means to bring together cognitive measures of thinking functions with measures of emotion, and their brain and genetic correlates. Understanding these measures and the relationships between them is a first step towards the development of tools that will help to assess the heterogeneity of ADHD, and aid in tailoring treatment choices.

  5. Whole-brain atrophy rate and cognitive decline: longitudinal MR study of memory clinic patients

    NARCIS (Netherlands)

    Sluimer, J.D.; van der Flier, W.M.; Karas, G.B.; Fox, N.C.; Scheltens, P.; Barkhof, F.; Vrenken, H.

    2008-01-01

    Purpose: To prospectively determine whole-brain atrophy rate in mild cognitive impairment (MCI) and Alzheimer disease (AD) and its association with cognitive decline, and investigate the risk of progression to dementia in initially non-demented patients given baseline brain volume and whole-brain

  6. Distinguished Neuropsychologist Award Lecture 1999. The lesion(s) in traumatic brain injury: implications for clinical neuropsychology.

    Science.gov (United States)

    Bigler, E D

    2001-02-01

    This paper overviews the current status of neuroimaging in neuropsychological outcome in traumatic brain injury (TBI). The pathophysiology of TBI is reviewed and integrated with expected neuroimaging and neuropsychological findings. The integration of clinical and quantitative magnetic resonance (QMR) imaging is the main topic of review, but these findings are integrated with single photon emission computed tomography (SPECT) and magnetoencephalography (MEG). Various clinical caveats are offered for the clinician.

  7. Brain lateralization and self-reported symptoms of ADHD in non-clinical adults : A dimensional approach

    NARCIS (Netherlands)

    Mohamed, Saleh M. H.; Borger, Norbertus; Geuze, Reint; van der Meere, Jacob

    2015-01-01

    Many clinical studies reported a compromised Brain Lateralization (BL) in patients with Attention-Deficit/Hyperactivity Disorder (ADHD). However, the question remains whether the deficit is in the left or right hemisphere. It is well-recognized that research on patients is vulnerable to

  8. Cerebrovascular disease in newborn infants: report of three cases with clinical follow-up and brain SPECT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Moura-Ribeiro, Maria Valeriana L. de; Ciasca, Sylvia Maria; Vale-Cavalcanti, Mariza; Etchebehere, Elba C.S.C.; Camargo, Edwaldo E. [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas

    1999-07-01

    The clinical and neurological findings of three neonates with the diagnosis of cerebrovascular disease are reported. The neuropsychological evaluation disclosed impairment of fine motor function, coordination, language, perception and behavioral disturbances. Brain SPECT imaging revealed perfusional deficits in the three cases. (author)

  9. Cerebrovascular disease in newborn infants: report of three cases with clinical follow-up and brain SPECT imaging

    International Nuclear Information System (INIS)

    Moura-Ribeiro, Maria Valeriana L. de; Ciasca, Sylvia Maria; Vale-Cavalcanti, Mariza; Etchebehere, Elba C.S.C.; Camargo, Edwaldo E.

    1999-01-01

    The clinical and neurological findings of three neonates with the diagnosis of cerebrovascular disease are reported. The neuropsychological evaluation disclosed impairment of fine motor function, coordination, language, perception and behavioral disturbances. Brain SPECT imaging revealed perfusional deficits in the three cases. (author)

  10. Brain SPECT analysis by 3D-SSP and clinical features of Parkinson's disease

    International Nuclear Information System (INIS)

    Mito, Yasunori; Yoshida, Kazuto; Makino, Kenichi; Yabe, Ichiro; Kikuchi, Seiji; Sasaki, Hidenao; Tashiro, Kunio

    2006-01-01

    The aim of the present study is to investigate the association of symptoms in Parkinson's disease (PD) with cerebral perfusion on single photon emission computed tomography (SPECT). The clinical features of PD were compared with SPECT images of the brain obtained by three-dimensional stereotactic surface projection (3D-SSP) analysis. Thirty-eight patients who had PD without dementia (17 men and 21 women with a mean age of 68.6±4.7 years) were enrolled in this study. Their symptoms were rated using the unified parkinson's disease rating scale (UPDRS). Within a week, all patients were examined by SPECT with I-123, and reconstructed images were analyzed with 3D-SSP using an image-analysis software, iSSP ver. 3.5. Data on brain surface perfusion extracted by 3D-SSP analysis were compared between the PD patients and the normal control group. The same comparisons were made for subgroups of PD patients with severe symptoms, such as tremor, gait disturbance, bradykinesia, and the UPDRS motor score. Cerebral perfusion was decreased at the anterior cingulate cortex and occipital lobe of the PD patients compared with the normal controls. In the subgroups with severe gait disturbance and severe bradykinesia, additional hypoperfusion was seen at the lateral frontal association and lateral temporal association and the medial frontal gyrus, and by the pixel-by-pixel comparison, perfusion was significantly decreased (p<0.05) at the medial frontal gyrus and anterior cingulate cortex compared with the normal control group. In PD patients, severe gait disturbance and bradykinesia may be correlated with hypoperfusion of the medial aspect of the frontal lobe. This suggests that functional disturbance of the supplementary motor area and other parts of the frontal lobe are involved in the development of gait disturbance and bradykinesia in PD. (author)

  11. Frequency, clinical correlates and rating of behavioural changes in primary brain tumour patients: A preliminary investigation.

    Directory of Open Access Journals (Sweden)

    Grahame K Simpson

    2015-04-01

    Full Text Available PurposeFew studies have addressed the specific behavioural changes associated with primary brain tumour (PBT. This paper will report on the frequency and demographic/clinical correlates of such behaviours, and the reliability of rating such behaviours amongst people with PBT, family informants and clinicians. The association of behavioural changes and patient functional status will also be discussed.MethodsA total of 57 patients with 37 family informants were recruited from two large Australian metropolitan hospitals. Each completed three neuro-behavioural self-report measures. Patients also completed a depression symptom measure. Functional status was defined by clinician-rated Karnofsky Performance Status.ResultsPatients were on average 52 years old, a median of four months (range 1-82 post-diagnosis, with high grade (39%, low grade (22% or benign tumours (39%. Patients reported frequency rates of 7-40% across various behavioural domains including anger, inappropriate behaviour, apathy, inertia and executive impairment. The presence of epileptic seizures was associated with significantly higher levels of behavioural changes. Notably, behaviour did not correlate with tumour grade or treatment modality. There was moderate agreement between patients and relatives on the presence or absence of behavioural changes, and substantial agreement between relative and clinician ratings. Depressed patients did not generally report more changes than non-depressed patients. Increases in the relative and clinician-rated behaviour scores were significantly correlated with decreasing functional status in the patient.ConclusionsBehavioural changes were a common sequela of both benign and malignant PBT. Larger scale studies are required to confirm these results. The results suggest the importance of including behaviour in brain cancer psychosocial assessments and the need to develop interventions to treat these patients and reduce the burden of care on families.

  12. Clinical Evaluation of Brain Perfusion SPECT with Brodmann Areas Mapping in Early Diagnosis of Alzheimer's Disease.

    Science.gov (United States)

    Valotassiou, Varvara; Papatriantafyllou, John; Sifakis, Nikolaos; Tzavara, Chara; Tsougos, Ioannis; Psimadas, Dimitrios; Fezoulidis, Ioannis; Kapsalaki, Eftychia; Hadjigeorgiou, George; Georgoulias, Panagiotis

    2015-01-01

    Early diagnosis of Alzheimer's disease (AD) based on clinical criteria alone may be problematic, while current and future treatments should be administered earlier in order to be more effective. Thus, various disease biomarkers could be used for early detection of AD. We evaluated brain perfusion with 99mTc-HMPAO single photon emission computed tomography (SPECT) and Brodmann areas (BAs) mapping in mild AD using an automated software (NeuroGam) for the semi-quantitative evaluation of perfusion in BAs and the comparison with the software's normal database. We studied 34 consecutive patients with mild AD: 9 men, 25 women, mean age 70.9 ± 8.1 years, mean Mini-Mental State Examination 22.6 ± 2.5. BAs 25L, 25R, 38L, 38R, 28L, 28R, 36L, and 36R had the lower mean perfusion values, while BAs 31L, 31R, 19R, 18L, 18R, 17L, and 17R had the higher mean values. Compared with healthy subjects of the same age, perfusion values in BAs 25L, 25R, 28R, 28L, 36L, and 36R had the greatest deviations from the healthy sample, while the lowest deviations were found in BAs 32L, 32R, 19R, 24L, 17L, 17R, 18L, and 18R. A percentage of ≥94% of patients had perfusion values more than -2SDs below the mean of healthy subjects in BAs 38R, 38L, 36L, 36R, 23L, 23R, 22L, 44L, 28L, 28R, 25L, and 25R. The corresponding proportion was less than 38% for BAs 11L, 19R, 32L, 32R, 18L, 18R, 24L, and 17R. In conclusion, brain SPECT studies with automated perfusion mapping could be useful as an ancillary tool in daily practice, revealing perfusion impairments in early AD.

  13. The Cerefy registered clinical brain atlas on CD-ROM. Based on the classic Talairach-Tournoux and Schaltenbrand-Wahren brain atlases. 2. ed.

    International Nuclear Information System (INIS)

    Nowinski, W.L.; Thirunavuukarasuu, A.

    2001-01-01

    This remarkable CD-ROM provides enhanced and extended versions of three world-famous Thieme atlases, (Schaltenbrand and Wahren's Atlas for Stereotaxy of the Human Brain, Talairach and Tournoux's Co-Planar Stereotaxis Atlas of the Human Brain and Referentially Oriented Cerebral MRI Anatomy). It contains the electronic atlases as well as an easy navigation system to facilitate searching for and displaying more than 525 anatomical structures. Revolutionizing the field of brain anatomy, the authors have segmented, labeled, and cross referenced all the information contained in the books, and created contours for all three atlases. The Cerefy registered Clinical Brain Atlas now allows you to electronically navigate these atlases simultaneously on axial, coronal, and sagittal planes, and enjoy the ability to: 1. Access 210 high-quality, fully segmented, and labeled atlas images with corresponding contours, 2. Display and manipulate spatially co-registered atlases, 3. Dynamically label images with structure names and descriptions, and then highlight selected structures in the atlas image, 4. Image zoom in five different levels, mensurate, search, set triplanar, get coordinates, save, and print, 5. Access on-line help, glossary, and supportive atlas materials. (orig.)

  14. Clinical features of brain metastases in breast cancer: an implication for hippocampal-sparing whole-brain radiation therapy

    Directory of Open Access Journals (Sweden)

    Wu S

    2016-12-01

    Full Text Available San-Gang Wu,1,* Jia-Yuan Sun,2,* Qin Tong,3 Feng-Yan Li,2 Zhen-Yu He2 1Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, 2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 3Department of Radiation Oncology, The First Affiliated Hospital of University of South China, Hengyang, People’s Republic of China *These authors contributed equally to this work Objective: The objectives of this study were to describe the distribution of brain metastases (BM in breast cancer patients and investigate the risk factors for perihippocampal metastases (PHM. Patients and methods: Retrospective analysis of the clinicopathological characteristics and patterns of BM was performed. Associations between clinicopathological characteristics and PHM (the hippocampus plus 5 mm margin were evaluated using logistic regression analyses. Results: A total of 1,356 brain metastatic lesions were identified in 192 patients. Patients with 1–3 BM, 4–9 BM, and ≥10 BM accounted for 63.0%, 18.8%, and 18.2%, respectively. There were only 7 (3.6% patients with hippocampal metastases (HM and 14 (7.3% patients with PHM. On logistic regression, the number of BM was an independent risk factor for PHM. Patients with ≥10 BM had a significantly higher risk of PHM compared with those with <10 BM. Breast cancer subtype (BCS was not associated with PHM. The number of BM was significantly correlated with various BCSs. Patients with hormone receptor (HR+/human epidermal growth factor receptor 2 (HER2+, HR-/HER2+, and HR-/HER2- subtypes had a higher probability of ≥10 BM, relative to patients with an HR+/HER2- subtype. Conclusion: Our study suggests that a low incidence of PHM may be acceptable to perform hippocampal-sparing whole-brain radiation therapy for breast cancer patients

  15. Comparison of the EZ-Cap recapper with the Mayo recapper for the prevention of needlesticks.

    Science.gov (United States)

    Dewhirst, Chad A; Hung, Joseph C

    2008-09-01

    The purpose of this project was the development of a device that improves the design of our current capping block, the Mayo recapper. The major challenges for design and improvement included creating a device that is simple to use and can be applied throughout our department. We wanted a recapper device that increased safety and minimized the potential for needlesticks. Simplicity was another important factor, along with versatility and low cost. A new recapper, called EZ-Cap, was developed, and a comparison study was conducted to evaluate the pros and cons of the EZ-Cap recapper and the Mayo recapper. Nuclear medicine technologists (n = 10) in our department used each device when administering patient injections. At the conclusion of their patient injection rotation, they recorded on a survey sheet the pros and cons of each device. The results of this survey were used to evaluate the effectiveness, comfort level during use, and safety of each recapping device. We used a 2-level scoring system to help determine which device was more favorable. The first level focused on comfort and convenience and was given a score of +1 or -1. The second level focused on safety and was given a score of +2 or -2. Because we believed that safety was a high priority for our capping blocks, this level received a higher score than the first level. The Mayo recapper was the device preferred by 9 of 10 technologists surveyed. The EZ-Cap recapper had several technical issues that made it difficult to use and that could potentially lead to safety concerns. According to our scoring system, the Mayo recapper received a score of +9 for its pros and -4 for its cons. By comparison, the EZ-Cap recapper received a score of +7 for its pros and -16 for its cons. Our results show that the Mayo recapper was the device of choice because its pros outweighed its cons. However, we will continually improve the effectiveness of the Mayo recapper to prevent needlesticks.

  16. D'Alton Community Nursing Unit, Claremorris, Mayo.

    LENUS (Irish Health Repository)

    Hurley, Deirdre A

    2009-01-01

    BACKGROUND: Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief\\/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven. METHODS AND DESIGN: This study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research

  17. Diagnosing dementia and normal aging: clinical relevance of brain ratios and cognitive performance in a Brazilian sample

    Directory of Open Access Journals (Sweden)

    Chaves M.L.F.

    1999-01-01

    Full Text Available The main objective of the present study was to evaluate the diagnostic value (clinical application of brain measures and cognitive function. Alzheimer and multiinfarct patients (N = 30 and normal subjects over the age of 50 (N = 40 were submitted to a medical, neurological and cognitive investigation. The cognitive tests applied were Mini-Mental, word span, digit span, logical memory, spatial recognition span, Boston naming test, praxis, and calculation tests. The brain ratios calculated were the ventricle-brain, bifrontal, bicaudate, third ventricle, and suprasellar cistern measures. These data were obtained from a brain computer tomography scan, and the cutoff values from receiver operating characteristic curves. We analyzed the diagnostic parameters provided by these ratios and compared them to those obtained by cognitive evaluation. The sensitivity and specificity of cognitive tests were higher than brain measures, although dementia patients presented higher ratios, showing poorer cognitive performances than normal individuals. Normal controls over the age of 70 presented higher measures than younger groups, but similar cognitive performance. We found diffuse losses of tissue from the central nervous system related to distribution of cerebrospinal fluid in dementia patients. The likelihood of case identification by functional impairment was higher than when changes of the structure of the central nervous system were used. Cognitive evaluation still seems to be the best method to screen individuals from the community, especially for developing countries, where the cost of brain imaging precludes its use for screening and initial assessment of dementia.

  18. Clinical characteristics and treatment outcomes of patients with colorectal cancer who develop brain metastasis: a single institution experience.

    Science.gov (United States)

    Fountzilas, Christos; Chang, Katherine; Hernandez, Brian; Michalek, Joel; Crownover, Richard; Floyd, John; Mahalingam, Devalingam

    2017-02-01

    The development of brain metastasis (BM) in patients with colorectal cancer (CRC) is a rare and late event. We sought to investigate the clinical characteristics, disease course and safety using biologic agents in our patients with CRC who develop brain metastases. A retrospective review of patients with CRC with brain metastases treated at our institution from 01/2005-01/2015 was performed. Survival analysis was performed using the Kaplan-Meier method. Forty patients were included in the analysis. Median age was 55.5 years, 67.5% were males, and 28% had a KRAS mutation. Twenty-four percent were treatment-naive at the time of BM diagnosis. Patients had a median of two brain lesions. Sixty-five percent of the patients were treated with radiotherapy alone, 22.5% had both surgical resection and brain radiotherapy. Median overall survival was 3.2 months after development of BM. Overall survival was longer in patients who received combined modality local therapy compared to patients treated with surgical resection or radiotherapy alone. Patients who received systemic treatment incorporating biologics following development of BM had a median overall survival of 18.6 months. Overall, the administration of biologic agents was safe and well tolerated. In summary, BM is an uncommon and late event in the natural history of metastatic CRC. The ability to deliver combined-modality local brain therapy as well as availability of more systemic therapy options appear to lead to improved outcomes.

  19. Validation of In Vitro Cell-Based Human Blood-Brain Barrier Model Using Clinical Positron Emission Tomography Radioligands To Predict In Vivo Human Brain Penetration

    International Nuclear Information System (INIS)

    Mabondzo, A.; Guyot, A.C.; Bottlaender, M.; Deverre, J.R.; Tsaouin, K.; Balimane, P.V.

    2010-01-01

    We have evaluated a novel in vitro cell-based human blood-brain barrier (BBB) model that could predict in vivo human brain penetration for compounds with different BBB permeabilities using the clinical positron emission tomography (PET) data. Comparison studies were also performed to demonstrate that the in vitro cell-based human BBB model resulted in better predictivity over the traditional permeability model in discovery organizations, Caco-2 cells. We evaluated the in vivo BBB permeability of [ 18 F] and [ 11 C]-compounds in humans by PET imaging. The in vivo plasma-brain exchange parameters used for comparison were determined in humans by PET using a kinetic analysis of the radiotracer binding. For each radiotracer, the parameters were determined by fitting the brain kinetics of the radiotracer using a two-tissue compartment model of the ligand-receptor interaction. Bidirectional transport studies with the same compounds as in in vivo studies were carried out using the in vitro cell-based human BBB model as well as Caco-2 cells. The in vitro cell-based human BBB model has important features of the BBB in vivo and is suitable for discriminating between CNS and non-CNS marketed drugs. A very good correlation (r 2 =0.90; P≤0.001) was demonstrated between in vitro BBB permeability and in vivo permeability coefficient. In contrast, a poor correlation (r 2 = 0.17) was obtained between Caco-2 data and in vivo human brain penetration. This study highlights the potential of this in vitro cell-based human BBB model in drug discovery and shows that it can be an extremely effective screening tool for CNS programs. (authors)

  20. Diffusion-weighted MR of the brain: methodology and clinical applications

    International Nuclear Information System (INIS)

    Mascalchi, Mario; Filippi, Massimo; Floris, Roberto; Fonda, Claudio; Gasparotti, Roberto; Villari, Natale

    2005-01-01

    Clinical diffusion magnetic resonance (MR) imaging in humans started in the last decade with the demonstration of the capabilities of this technique of depicting the anatomy of the white matter fibre tracts in the brain. Two main approaches in terms of reconstruction and evaluation of the images obtained with application of diffusion sensitising gradients to an echo planar imaging sequence are possible. The first approach consists of reconstruction of images in which the effect of white matter anisotropy is averaged -know as the isotropic or diffusion weighted images, which are usually evaluated subjectively for possible areas of increased or decreased signal, reflecting restricted and facilitated diffusion, respectively. The second approach implies reconstruction of image maps of the apparent diffusion coefficient (ADC), in which the T2 weighting of the echo planar diffusion sequence is cancelled out, and their objective, i.e. numerical, evaluation with regions of interest or histogram analysis. This second approach enables a quantitative and reproducible assessment of the diffusion changes mot only in areas exhibiting signal abnormality in conventional MR images, but also in areas of normal signal. A further level of image post-processing requires the acquisition of images after application of sensitive gradients along at least 6 different spatial orientations and consists of computation of the diffusion tensor and reconstruction of maps of the mean diffusivity (D) and of the white matter anisotropic properties, usually in terms of fractional anisotropy (FA). Diffusion-weighted imaging is complementary to conventional MR imaging in the evaluation of the acute ischaemic stroke. The combination of diffusion and perfusion MR imaging has the potential of providing all the information necessary for the diagnosis and management of the individual patient with acute ischaemic stroke. Diffusion-weighted MR, in particular quantitative evaluation based on the diffusion

  1. Friars Lodge Nursing Home, Convent Road, Ballinrobe, Mayo.

    LENUS (Irish Health Repository)

    Murphy, JFA

    2011-01-01

    Lack of sleep has well established effects on physiological, cognitive and behavioural functionality. Sleep deprivation can adversely affect clinical performance as severely as alcohol according to some sources. Sleep deficiency may be due to loss of one night’s sleep or repeated interruptions of sleep. Chronic sleep degrades the ability to recognise one’s ability to recognise the impairments induced by sleep loss. The problem of sleep deprivation has vexed acute medical practice for decades. Improvement has been painfully slow. The problem is that all 168 hours throughout every week of every year have to be covered and there are a finite number of doctors to shoulder the burden. There are many strongly held views about how best to provide night-time and week-end care. Constructive innovations are thin on the ground. The biggest gap is between administration and doctors with financial considerations being the limiting factor. It is, however, generally accepted on all sides that sleep loss and fatigue can have adverse effects on both patients and doctors.

  2. Analysis of angiographic findings in arteriovenous malformations(AVM) of brain according to presenting clinical manifestations

    International Nuclear Information System (INIS)

    Kim, Jun Hyoung; Kim, Jae Kyun; Suh, Dae Chul and others

    1998-01-01

    To evaluate the different angio-architectures of brain arteriovenous malformations(AVMs) according to the presence of non-hemorrhagic symptoms or intracerebral (ICH) and/or intraventricular hemorrhage (IVH). The results of complete cerebral angiography obtained in 215 patients with AVM between 1989 and 1994 were retrospectively reviewed. The M:F ratio was 136:78 and their mean age was 29 (ranged 4-66) years. On the base of clinical presentation, CT and/or MR images, they were divided into hemorrhagic and non-hemorrhagic groups. Angiograms were analyzed by two radiologists for the size and location of nidus;the number of feeding arteries and the extent of aneurysm, stenosis, dural supply, and angiomatous change;the number of draining veins and the extent of deep or superficial drainage, stenosis, ectasia, kinking, and stasis. The standard chi-square test was used for statistical analysis. Hemorrhage was noted in 140 patients (65%), and no hemorrhage in 75 (35%). Hemorrhage was more common in AVM with deep-seated and callosal locations, a nidus of less than 2cm, single feeder and single venous drainage, and deep venous drainage only (p<0.05-0.001). Non-hemorrhagic presentations were more common in AVM with cortical and subcortical location, a nidus of more than 5cm, angiomatous change, dural supply, both superficial and deep venous drainage, kinking, and stasis(p<0.05-0.001). The angio-architechture of AVM with hemorrhage correlated with clinical symptomatic presentation. Analysis of the patterns of angioarchitectures useful for prognosis and in deciding the direction of treatment. =20

  3. Multi-voxel MR spectroscopic imaging of the brain: utility in clinical setting-initial results

    International Nuclear Information System (INIS)

    Parmar, Hemant; Lim, Tchoyoson C.C.; Yin Hong; Chua, Violet; Khin, Lay-Wai; Raidy, Tom; Hui, Francis

    2005-01-01

    Background and purpose: Compared to single voxel methods, MR spectroscopic imaging (MRSI) of the brain provides metabolic information with improved anatomical coverage and spectral resolution, but may be difficult to perform in the clinical setting. We evaluate the factors influencing spectral quality in MRSI using a semi-automated method, focussing on lipid contamination, and phase correction errors related to magnetic field inhomogeneity. Methods: We retrospectively analysed MRSI studies planned by radiologists and radiographers. Two-dimensional MRSI studies using point-resolved spectroscopy (PRESS) localisation, at long echo time (135 or 144 ms) were acquired on a 1.5 T scanner. Studies that contained lipid contamination and abnormally inverted spectra were reviewed and the latter correlated with anatomic location at the base of skull, and with the area of the region of interest (ROI) studied. Results: Of 128 consecutive MRSI studies, six showed abnormal inverted spectra, of which four were acquired at the base of skull. Multivariate logistic regression analysis showed that study location at the base of skull, but not larger ROI, was a significant predictor for the risk of being affected by inverted spectra (RR for base of skull: 11.76, 95% CI: 1.86-74.18, P = 0.009. RR for area of ROI: 3.68, 95% CI: 0.57-23.67, P = 0.170). Seven studies showed lipid contamination; all were in close proximity to the overlying scalp. Conclusion: Using a semi-automated acquisition and post-processing method, MRSI can be successfully applied in the clinical setting. However, care should be taken to avoid regions of high magnetic field inhomogeneity at the base of skull, and lipid contamination in voxels prescribed near the scalp

  4. Basic and clinical study of boron neutron capture therapy for malignant brain tumor

    Energy Technology Data Exchange (ETDEWEB)

    Nose, Tadao; Matsumura, Akira; Nakai, Kei; Nakagawa, Kunio; Yoshii, Yoshihiko [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine; Shibata, Yasushi; Yamamoto, Tetsuya; Hayakawa, Yoshinori; Yamada, Takashi

    1998-01-01

    Rat malignant cells (9L glioma cell) were exposed to neutron radiation after culturing with boron compounds; BSH and STA-BX909, and cell growing ability after the exposure was determined by colony forming assay. The effects of in vivo radiation were examined by measuring neutron flux levels in rat brain and skin aiming to use neutron radiation in clinical study. STA-BX909 was found to show a dose-dependent cell toxicity, which was higher than that of BSH. The radiation induced G2/M block in 9L-glioma cells and their cell cycles recovered thereafter in low-dose radiated cells, but high-dose radiated cells became aneuploidy. Furthermore, boron neutron capture therapy (BNCT) was applied in two patients, 41-year old woman with glioma grade 3 recurred and 45-year old man with glioblastoma multiforme. The former died from systemic deterioration due to ileus, but BNCT was made only one time although conventional radiotherapy is carried out for a relatively long period. Therefore, BNCT was thought to be beneficial from an aspect of `quality of life` and the effects to repress a recurrence of cancer also seemed larger than the conventional one. (M.N.)

  5. Clinical manifestations and computed tomography of the pseudovascular form of metastatic brain tumor

    International Nuclear Information System (INIS)

    Kurimoto, Tadahisa; Mizuno, Makoto; Tani, Sadayasu; Miki, Kazuhito; Kawamura, Yasuo; Matsumura, Hiroshi

    1982-01-01

    Forty-two cases of metastatic brain tumor were subdivided into 3 groups (acute, subacute, and chronic) from their mode of the onset of symptoms and signs. The clinical symptoms and signs and the computed tomogram were all analyzed and compared with each other. The acute form was found in 14 cases (33%), of which 7% (3 cases) were seizures and 26% (11 cases) were acute neurological deficits, including hemorrhages from tumors (3 cases, 7%). There were no significant differences in their age, sex, or primary lesions. The characteristic course of the acute form, other than seizure and hemorrhage, involved acutely and progressively developing neurological symptoms, symptoms and signs of increased intracranial pressure were rare. In computed tomogram, the solitary metastasis in the parietal and occipital lesions was much more in the acute form than in other forms, and the perifocal low-density area showed a tendency to be larger than the other forms. In these cases, acute symptoms and signs appeared to occur easily when perifocal edema was joined in the above locations. The pathogenesis of acute neurological symptoms and signs other than seizure and hemorrhage is unclear. We suggest that the location of a tumor and peritumoral edema be important factors in causing acute symptoms and signs, but, in addition to that, abrupt hemodynamic changes in the peritumoral edema may also be of importance. (J.P.N.)

  6. Clinical studies of cerebral arteriosclerosis in diabetic subjects. Analysis with brain MRI study

    International Nuclear Information System (INIS)

    Ohashi, Makoto; Tanahashi, Hideo; Nomura, Makoto; Yamada, Yoshio; Abe, Hiroshi.

    1994-01-01

    In order to investigate the clinical characteristics of cerebral arteriosclerosis in diabetic subjects, brain MRI studies were conducted in diabetic patients and healthy subjects. The subjects were 93 diabetic patients without symptoms and signs of cerebral infarction (49 males and 44 females) with a mean age of 59 years and 73 healthy subjects (43 males and 30 females) with a mean age of 57 years. The MRI studies were performed on a General Electric 1.5-T signa system. The spin-echo technique (T2-weighted image) was used with a pulse repetition time (TR) of 2,500 msec and echo time (TE) of 80 msec. The quantitative evaluation of cerebral infarction was assessed using personal computer and image-scanner. By MRI, the incidence of cerebral infarction in diabetic patients was significantly higher than that in healthy subjects (30.1% vs. 13.7%, respectively, p<0.05). The mean age of the diabetic patients with cerebral infarctions was higher than that of those without cerebral infarctions. Hypertension and diabetic nephropathy were present more frequently in the subjects with cerebral infarctions. These data suggest that it is important to delay the onset and slow the progression of cerebral infarction in diabetic patients by strict blood glucose control and management of blood pressure. (author)

  7. Clinical, neuropsychological, and pre-stimulus dorsomedial thalamic nucleus electrophysiological data in deep brain stimulation patients

    Directory of Open Access Journals (Sweden)

    Catherine M. Sweeney-Reed

    2016-09-01

    Full Text Available The data presented here comprise clinical, neuropsychological, and intrathalamic electrophysiological data from 7 patients with pharmacoresistant focal epilepsy and are related to the article “Pre-stimulus thalamic theta power predicts human memory formation” C.M. Sweeney-Reed, T. Zaehle, J. Voges, F.C. Schmitt, L. Buentjen, K. Kopitzki, et al. (2016 [1]. The patients participated in a memory paradigm after receiving electrodes implanted in the DMTN due to the surgical approach taken in electrode insertion for deep brain stimulation of the anterior thalamic nucleus. Epilepsy duration and pre-operative neuropsychological tests provide an indication of the profile of patients receiving intrathalamic electrode implantation and the memory capabilities in such a patient group. The electrophysiological data were recorded from the right DMTN preceding stimulus presentation during intentional memory encoding. The patients viewed a series of photographic scenes, which they judged as indoors or outdoors. The 900 ms epochs prior to stimulus presentation were labeled as preceding successful or unsuccessful subsequent memory formation according to a subsequent memory test for the items. The difference between theta power preceding successful versus unsuccessful subsequent memory formation is shown against time for each patient individually. Keywords: Memory encoding, Dorsomedial thalamic nucleus, Pre-stimulus theta

  8. Basic and clinical study of boron neutron capture therapy for malignant brain tumor

    International Nuclear Information System (INIS)

    Nose, Tadao; Matsumura, Akira; Nakai, Kei; Nakagawa, Kunio; Yoshii, Yoshihiko; Shibata, Yasushi; Yamamoto, Tetsuya; Hayakawa, Yoshinori; Yamada, Takashi

    1998-01-01

    Rat malignant cells (9L glioma cell) were exposed to neutron radiation after culturing with boron compounds; BSH and STA-BX909, and cell growing ability after the exposure was determined by colony forming assay. The effects of in vivo radiation were examined by measuring neutron flux levels in rat brain and skin aiming to use neutron radiation in clinical study. STA-BX909 was found to show a dose-dependent cell toxicity, which was higher than that of BSH. The radiation induced G2/M block in 9L-glioma cells and their cell cycles recovered thereafter in low-dose radiated cells, but high-dose radiated cells became aneuploidy. Furthermore, boron neutron capture therapy (BNCT) was applied in two patients, 41-year old woman with glioma grade 3 recurred and 45-year old man with glioblastoma multiforme. The former died from systemic deterioration due to ileus, but BNCT was made only one time although conventional radiotherapy is carried out for a relatively long period. Therefore, BNCT was thought to be beneficial from an aspect of 'quality of life' and the effects to repress a recurrence of cancer also seemed larger than the conventional one. (M.N.)

  9. Pre-Clinical Traumatic Brain Injury Common Data Elements: Toward a Common Language Across Laboratories.

    Science.gov (United States)

    Smith, Douglas H; Hicks, Ramona R; Johnson, Victoria E; Bergstrom, Debra A; Cummings, Diana M; Noble, Linda J; Hovda, David; Whalen, Michael; Ahlers, Stephen T; LaPlaca, Michelle; Tortella, Frank C; Duhaime, Ann-Christine; Dixon, C Edward

    2015-11-15

    Traumatic brain injury (TBI) is a major public health issue exacting a substantial personal and economic burden globally. With the advent of "big data" approaches to understanding complex systems, there is the potential to greatly accelerate knowledge about mechanisms of injury and how to detect and modify them to improve patient outcomes. High quality, well-defined data are critical to the success of bioinformatics platforms, and a data dictionary of "common data elements" (CDEs), as well as "unique data elements" has been created for clinical TBI research. There is no data dictionary, however, for preclinical TBI research despite similar opportunities to accelerate knowledge. To address this gap, a committee of experts was tasked with creating a defined set of data elements to further collaboration across laboratories and enable the merging of data for meta-analysis. The CDEs were subdivided into a Core module for data elements relevant to most, if not all, studies, and Injury-Model-Specific modules for non-generalizable data elements. The purpose of this article is to provide both an overview of TBI models and the CDEs pertinent to these models to facilitate a common language for preclinical TBI research.

  10. Quality of clinical brain tumor MR spectra judged by humans and machine learning tools.

    Science.gov (United States)

    Kyathanahally, Sreenath P; Mocioiu, Victor; Pedrosa de Barros, Nuno; Slotboom, Johannes; Wright, Alan J; Julià-Sapé, Margarida; Arús, Carles; Kreis, Roland

    2018-05-01

    To investigate and compare human judgment and machine learning tools for quality assessment of clinical MR spectra of brain tumors. A very large set of 2574 single voxel spectra with short and long echo time from the eTUMOUR and INTERPRET databases were used for this analysis. Original human quality ratings from these studies as well as new human guidelines were used to train different machine learning algorithms for automatic quality control (AQC) based on various feature extraction methods and classification tools. The performance was compared with variance in human judgment. AQC built using the RUSBoost classifier that combats imbalanced training data performed best. When furnished with a large range of spectral and derived features where the most crucial ones had been selected by the TreeBagger algorithm it showed better specificity (98%) in judging spectra from an independent test-set than previously published methods. Optimal performance was reached with a virtual three-class ranking system. Our results suggest that feature space should be relatively large for the case of MR tumor spectra and that three-class labels may be beneficial for AQC. The best AQC algorithm showed a performance in rejecting spectra that was comparable to that of a panel of human expert spectroscopists. Magn Reson Med 79:2500-2510, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  11. Clinical relevance of n-isopropyl-(/sup 123/I)p-iodoamphetamine (IMP) SPECT brain imaging

    International Nuclear Information System (INIS)

    Podreka, I.; Holl, K.; Dal Bianco, P.; Goldenberg, G.; Wimberger, D.; Auff, E.; Brucke, T.

    1986-01-01

    SPECT studies of the brain were performed by means of N-isopropyl-(/sup 123/I)p-iodoamphertamine and a double head rotating scintillation camera. Energy spectra showed an increase of scattered radiation proportional to the geometrical resolution of the used Tc-collimators. This is due to the higher lead content and thin septa (septum-penetration of high energy photons of /sup 123/I, scattering in the crystal) of HRES or UHRES collimators. A LEAP collimator (14 mm FWHM resolution in the reconstructed image) is the most suitable one (sufficient resolution - relatively low scatter-fraction) for /sup 123/I labeled tracers. With a multiple window technique scatter correction was performed. The width and position of the scatter windows were estimated in phantom studies. Further steps of data processing (prereconstructional filtering, analytical attenuation compensation), leading to an improvement of the final set of cross sections, are described. Clinical cases (Alzheimers, Huntingtons, Parkinson disease, Moya Moya, stroke and partial complex seizures) and stimulation (acoustic memory tasks, visual stimulations) studies in normal volunteers are presented, and results are compared with PET-data known from recent literature

  12. Intraparenchymal hemorrhage segmentation from clinical head CT of patients with traumatic brain injury

    Science.gov (United States)

    Roy, Snehashis; Wilkes, Sean; Diaz-Arrastia, Ramon; Butman, John A.; Pham, Dzung L.

    2015-03-01

    Quantification of hemorrhages in head computed tomography (CT) images from patients with traumatic brain injury (TBI) has potential applications in monitoring disease progression and better understanding of the patho-physiology of TBI. Although manual segmentations can provide accurate measures of hemorrhages, the processing time and inter-rater variability make it infeasible for large studies. In this paper, we propose a fully automatic novel pipeline for segmenting intraparenchymal hemorrhages (IPH) from clinical head CT images. Unlike previous methods of model based segmentation or active contour techniques, we rely on relevant and matching examples from already segmented images by trained raters. The CT images are first skull-stripped. Then example patches from an "atlas" CT and its manual segmentation are used to learn a two-class sparse dictionary for hemorrhage and normal tissue. Next, for a given "subject" CT, a subject patch is modeled as a sparse convex combination of a few atlas patches from the dictionary. The same convex combination is applied to the atlas segmentation patches to generate a membership for the hemorrhages at each voxel. Hemorrhages are segmented from 25 subjects with various degrees of TBI. Results are compared with segmentations obtained from an expert rater. A median Dice coefficient of 0.85 between automated and manual segmentations is achieved. A linear fit between automated and manual volumes show a slope of 1.0047, indicating a negligible bias in volume estimation.

  13. THERMAL REGULATION OF THE BRAIN -AN ANATOMICAL AND PHYSIOLOGICAL REVIEW FOR CLINICAL NEUROSCIENTISTS

    Directory of Open Access Journals (Sweden)

    Huan (John eWang

    2016-01-01

    Full Text Available Humans, like all mammals and birds, maintain a nearly constant core body temperature (36 -37.5°C over a wide range of environmental conditions and are thus referred to as endotherms. The evolution of the brain and its supporting structures in mammals and birds coincided with this development of endothermy. Despite the recognition that a more evolved and complicated brain with all of its temperature-dependent cerebral circuitry and neuronal processes would require more sophisticated thermal control mechanisms, the current understanding of brain temperature regulation remains limited. To optimize the development and maintenance of the brain in health and to accelerate its healing and restoration in illness, focused and committed efforts are much needed to advance the fundamental understanding of brain temperature. In order to effectively study and examine brain temperature regulation, it is critical to first understand the relevant anatomical and physiological properties in the head-neck regions.

  14. Relatively High Complication and Revision Rates of the Mayo® Metaphysical Conservative Femoral Stem in Young Patients.

    Science.gov (United States)

    Rutenberg, Tal Frenkel; Warshevski, Yaniv; Gold, Aviram; Shasha, Nadav; Snir, Nimrod; Chechik, Ofir; Dolkart, Oleg; Eilig, Dynai; Herman, Amir; Rath, Ehud; Kramer, Moti; Drexler, Michael

    2018-05-08

    The Mayo metaphysical conservative femoral stem (Zimmer, Warsaw, Indiana) is a wedge-shaped implant designed to transfer loads proximally, reduce femoral destruction, and enable the preservation of bone stock in the proximal femur. Thus, it is a potentially preferred prosthesis for active, non-elderly patients who may require additional future surgeries. This retrospective case study analyzed the outcomes of consecutive patients who underwent total hip replacements with this stem between May 2001 and February 2013. All patients underwent clinical assessment, radiological evaluation for the presence and development of radiolucent lines, and functional assessment (numerical analog scale, Harris hip score, and Short Form-12 questionnaire). Ninety-five hips (79 patients) were available for analysis. The patients' mean age was 43 years (range, 18-64 years), and the mean follow-up was 97 months (range, 26.9-166 months). The postoperative clinical assessments and functional assessments revealed significant improvements. Sixteen patients (20.3%) had 18 orthopedic complications, the most common of which were an intraoperative femoral fracture and implant dislocation requiring revision surgeries in 10 hips (10.5%). Radiological analysis revealed evidence of femoral remodeling in 64 (67.4%) implants, spot welds (neocortex) in 35 (36.8%), and osteolysis in 3 (3.2%). These results suggest that the conservative hip femoral implant has an unacceptable complication rate for non-elderly patients. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2018, SLACK Incorporated.

  15. Stereoscopic Three-Dimensional Visualization Applied to Multimodal Brain Images: Clinical Applications and a Functional Connectivity Atlas.

    Directory of Open Access Journals (Sweden)

    Gonzalo M Rojas

    2014-11-01

    Full Text Available Effective visualization is central to the exploration and comprehension of brain imaging data. While MRI data are acquired in three-dimensional space, the methods for visualizing such data have rarely taken advantage of three-dimensional stereoscopic technologies. We present here results of stereoscopic visualization of clinical data, as well as an atlas of whole-brain functional connectivity. In comparison with traditional 3D rendering techniques, we demonstrate the utility of stereoscopic visualizations to provide an intuitive description of the exact location and the relative sizes of various brain landmarks, structures and lesions. In the case of resting state fMRI, stereoscopic 3D visualization facilitated comprehension of the anatomical position of complex large-scale functional connectivity patterns. Overall, stereoscopic visualization improves the intuitive visual comprehension of image contents, and brings increased dimensionality to visualization of traditional MRI data, as well as patterns of functional connectivity.

  16. Automatic quality control in clinical (1)H MRSI of brain cancer.

    Science.gov (United States)

    Pedrosa de Barros, Nuno; McKinley, Richard; Knecht, Urspeter; Wiest, Roland; Slotboom, Johannes

    2016-05-01

    MRSI grids frequently show spectra with poor quality, mainly because of the high sensitivity of MRS to field inhomogeneities. These poor quality spectra are prone to quantification and/or interpretation errors that can have a significant impact on the clinical use of spectroscopic data. Therefore, quality control of the spectra should always precede their clinical use. When performed manually, quality assessment of MRSI spectra is not only a tedious and time-consuming task, but is also affected by human subjectivity. Consequently, automatic, fast and reliable methods for spectral quality assessment are of utmost interest. In this article, we present a new random forest-based method for automatic quality assessment of (1)H MRSI brain spectra, which uses a new set of MRS signal features. The random forest classifier was trained on spectra from 40 MRSI grids that were classified as acceptable or non-acceptable by two expert spectroscopists. To account for the effects of intra-rater reliability, each spectrum was rated for quality three times by each rater. The automatic method classified these spectra with an area under the curve (AUC) of 0.976. Furthermore, in the subset of spectra containing only the cases that were classified every time in the same way by the spectroscopists, an AUC of 0.998 was obtained. Feature importance for the classification was also evaluated. Frequency domain skewness and kurtosis, as well as time domain signal-to-noise ratios (SNRs) in the ranges 50-75 ms and 75-100 ms, were the most important features. Given that the method is able to assess a whole MRSI grid faster than a spectroscopist (approximately 3 s versus approximately 3 min), and without loss of accuracy (agreement between classifier trained with just one session and any of the other labelling sessions, 89.88%; agreement between any two labelling sessions, 89.03%), the authors suggest its implementation in the clinical routine. The method presented in this article was implemented

  17. Clinical value of proton magnetic resonance spectroscopy for differentiating recurrent or residual brain tumor from delayed cerebral necrosis

    International Nuclear Information System (INIS)

    Taylor, June S.; Langston, James W.; Reddick, Wilburn E.; Kingsley, Peter B.; Ogg, Robert J.; Pui, Margaret H.; Kun, Larry E.; Jenkins, Jesse J.; Gang, Chen; Ochs, Judith J.; Sanford, Robert A.; Heideman, Richard L.

    1996-01-01

    Purpose: Delayed cerebral necrosis (DN) is a significant risk for brain tumor patients treated with high-dose irradiation. Although differentiating DN from tumor progression is an important clinical question, the distinction cannot be made reliably by conventional imaging techniques. We undertook a pilot study to assess the ability of proton magnetic resonance spectroscopy ( 1 H MRS) to differentiate prospectively between DN or recurrent/residual tumor in a series of children treated for primary brain tumors with high-dose irradiation. Methods and Materials: Twelve children (ages 3-16 years), who had clinical and MR imaging (MRI) changes that suggested a diagnosis of either DN or progressive/recurrent brain tumor, underwent localized 1 H MRS prior to planned biopsy, resection, or other confirmatory histological procedure. Prospective 1 H MRS interpretations were based on comparison of spectral peak patterns and quantitative peak area values from normalized spectra: a marked depression of the intracellular metabolite peaks from choline, creatine, and N-acetyl compounds was hypothesized to indicate DN, and median-to-high choline with easily visible creatine metabolite peaks was labeled progressive/recurrent tumor. Subsequent histological studies identified the brain lesion as DN or recurrent/residual tumor. Results: The patient series included five cases of DN and seven recurrent/residual tumor cases, based on histology. The MRS criteria prospectively identified five out of seven patients with active tumor, and four out of five patients with histologically proven DN correctly. Discriminant analysis suggested that the primary diagnostic information for differentiating DN from tumor lay in the normalized MRS peak areas for choline and creatine compounds. Conclusions: Magnetic resonance spectroscopy shows promising sensitivity and selectivity for differentiating DN from recurrent/progressive brain tumor. A novel diagnostic index based on peak areas for choline and

  18. Dysglycemia, brain volume and vascular lesions on MRI in a memory clinic population

    NARCIS (Netherlands)

    Exalto, L.G.; van der Flier, W.M.; Scheltens, P.; Vrenken, H.; Biessels, G.J.

    2014-01-01

    Objective It is unclear, if the association between abnormalities in glucose metabolism (dysglycemia) and impaired cognitive functioning is primarily driven by degenerative or vascular brain damage. We therefore examined the relation between dysglycemia and brain volume and vascular lesions on MRI

  19. Clinical Utility of '99mTc-HMPAO Brain SPECT Findings in Chronic Head Injury

    International Nuclear Information System (INIS)

    Chung, Jin ll; Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Lee, Jong Doo; Park, Chang Yoon; Kim, Young Soo

    1992-01-01

    Minima deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using 99m Tc-HMPAO Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months following head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with 99m Tc-HMPAO Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using 99m Tc-HMPAO Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

  20. Brain Malformations Associated with Knobloch Syndrome – Review of Literature, Expanding Clinical Spectrum and Identification of Novel Mutations

    Science.gov (United States)

    Caglayan, Ahmet Okay; Baranoski, Jacob F.; Aktar, Fesih; Han, Wengi; Tuysuz, Beyhan; Guzel, Aslan; Guclu, Bulent; Kaymakcalan, Hande; Aktekin, Berrin; Akgumus, Gozde Tugce; Murray, Phillip B.; Omay, E. Zeynep Erson; Caglar, Caner; Bakircioglu, Mehmet; Sakalar, Yildirim Bayezit; Guzel, Ebru; Demir, Nihat; Tuncer, Oguz; Senturk, Senem; Ekici, Baris; Minja, Frank J.; Šestan, Nenad; Yasuno, Katsuhito; Bilguvar, Kaya; Caksen, Huseyin; Gunel, Murat

    2014-01-01

    BACKGROUND Knobloch syndrome is a rare, autosomal recessive, developmental disorder characterized by stereotyped ocular abnormalities with or without occipital skull deformities (encephalocele, bone defects, cutis aplasia). Although there is clear heterogeneity in clinical presentation, central nervous system malformations, aside from the characteristic encephalocele, have not typically been considered a component of the disease phenotype. METHODS Four patients originally presented for genetic evaluation of symptomatic structural brain malformations. Whole-genome genotyping, whole-exome sequencing, and confirmatory Sanger sequencing were performed. Using immunohistochemical analysis, we investigated the protein expression pattern of COL18A1 in the mid-fetal and adult human cerebral cortex and then analyzed the spatial and temporal changes in the expression pattern of COL18A1 during human cortical development using the Human Brain Transcriptome database. RESULTS We identified two novel homozygous deleterious frame-shift mutations in the COL18A1 gene. Upon further investigation of these patients and their families, we found that many exhibited certain characteristics of Knobloch syndrome, including pronounced ocular defects. Our data strongly support an important role for COL18A1 in brain development and this report contributes to an enhanced characterization of the brain malformations that can result from deficiencies of collagen XVIII. CONCLUSIONS This case series highlights the diagnostic power and clinical utility of whole-exome sequencing technology – allowing clinicians and physician scientists to better understand the pathophysiology and presentations of rare diseases. We suggest that patients who are clinically diagnosed with Knobloch syndrome and/or found to have COL18A1 mutations via genetic screening should be investigated for potential structural brain abnormalities even in the absence of encephaloceles. PMID:25456301

  1. Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries

    Science.gov (United States)

    Lannin, Natasha A; Hoffmann, Tammy

    2018-01-01

    Objectives Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations. Design Systematic review. Interventions Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. Results From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high (>75%) across all domains of AGREE-II; highest rated domains were ‘scope and purpose’ (85.1, SD 18.3) and ‘clarity’ (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines. Conclusion Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality. PROSPERO registration number CRD42016026936. PMID:29490958

  2. Determinants of HIV-induced brain changes in three different periods of the early clinical course: A data mining analysis

    Directory of Open Access Journals (Sweden)

    Bokai Cao

    2015-01-01

    Full Text Available To inform an understanding of brain status in HIV infection, quantitative imaging measurements were derived at structural, microstructural and macromolecular levels in three different periods of early infection and then analyzed simultaneously at each stage using data mining. Support vector machine recursive feature elimination was then used for simultaneous analysis of subject characteristics, clinical and behavioral variables, and immunologic measures in plasma and CSF to rank features associated with the most discriminating brain alterations in each period. The results indicate alterations beginning in initial infection and in all periods studied. The severity of immunosuppression in the initial virus host interaction was the most highly ranked determinant of earliest brain alterations. These results shed light on the initial brain changes induced by a neurotropic virus and their subsequent evolution. The pattern of ongoing alterations occurring during and beyond the period in which virus is suppressed in the systemic circulation supports the brain as a viral reservoir that may preclude eradication in the host. Data mining capabilities that can address high dimensionality and simultaneous analysis of disparate information sources have considerable utility for identifying mechanisms underlying onset of neurological injury and for informing new therapeutic targets.

  3. Concepts and strategies for clinical management of blast-induced traumatic brain injury and posttraumatic stress disorder.

    Science.gov (United States)

    Chen, Yun; Huang, Wei; Constantini, Shlomi

    2013-01-01

    After exposure of the human body to blast, kinetic energy of the blast shock waves might be transferred into hydraulic energy in the cardiovascular system to cause a rapid physical movement or displacement of blood (a volumetric blood surge). The volumetric blood surge moves through blood vessels from the high-pressure body cavity to the low-pressure cranial cavity, causing damage to tiny cerebral blood vessels and the blood-brain barrier (BBB). Large-scale cerebrovascular insults and BBB damage that occur globally throughout the brain may be the main causes of non-impact, blast-induced brain injuries, including the spectrum of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). The volumetric blood surge may be a major contributor not only to blast-induced brain injuries resulting from physical trauma, but may also be the trigger to psychiatric disorders resulting from emotional and psychological trauma. Clinical imaging technologies, which are able to detect tiny cerebrovascular insults, changes in blood flow, and cerebral edema, may help diagnose both TBI and PTSD in the victims exposed to blasts. Potentially, prompt medical treatment aiming at prevention of secondary neuronal damage may slow down or even block the cascade of events that lead to progressive neuronal damage and subsequent long-term neurological and psychiatric impairment.

  4. Clinical evaluation of dose-volume-effect relationship in radiation injury of the brain

    International Nuclear Information System (INIS)

    Saito, Mari

    1990-01-01

    Radiation brain injury, including functional disturbances or morphological changes (brain atrophy, periventricular lucencies or ventricular dilatation), were studied by CT in patients with primary intracranial neoplasms who were followed-up for at least 5 months after receiving radiotherapy. Each of 33 patients with medulloblastoma, pinealregion tumor or malignant lymphoma received a total dose of 40-61 Gy by conventional fractionation using a whole brain irradiation field boosted by a localized field. Of these patients, 19 (58%) developed radiation brain injury. It was concluded that the volume-dose was one of the most important factors influencing the development of radiation brain injury. Age at the time of radiotherapy and time of follow-up after the treatment were also considered to be important factors. (author)

  5. Long-Term Clinical Outcome of Internal Globus Pallidus Deep Brain Stimulation for Dystonia.

    Directory of Open Access Journals (Sweden)

    Hye Ran Park

    Full Text Available GPi (Internal globus pallidus DBS (deep brain stimulation is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia.This report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital.Nine patients with a known genetic cause, 12 patients with acquired dystonia, and 15 patients with isolated dystonia without a known genetic cause were included. When categorized by phenomenology, 29 patients had generalized, 5 patients had segmental, and 2 patients had multifocal dystonia. Patients were assessed preoperatively and at defined follow-up examinations postoperatively, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS for movement and functional disability assessment. The mean follow-up duration was 47 months (range, 12-84.The mean movement scores significantly decreased from 44.88 points preoperatively to 26.45 points at 60-month follow up (N = 19, P = 0.006. The mean disability score was also decreased over time, from 11.54 points preoperatively to 8.26 points at 60-month follow up, despite no statistical significance (N = 19, P = 0.073. When analyzed the movement and disability improvement rates at 12-month follow up point, no significant difference was noted according to etiology, disease duration, age at surgery, age of onset, and phenomenology. However, the patients with DYT-1 dystonia and isolated dystonia without a known genetic cause showed marked improvement.GPi DBS is a safe and efficient therapeutic method for treatment of dystonia patients to improve both movement and disability. However, this study has some limitations caused by the retrospective design with small sample size in a single-center.

  6. Disrupted Module Efficiency of Structural and Functional Brain Connectomes in Clinically Isolated Syndrome and Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Yaou Liu

    2018-04-01

    Full Text Available Recent studies have demonstrated disrupted topological organization of brain connectome in multiple sclerosis (MS. However, whether the communication efficiency between different functional systems is affected in the early stage of MS remained largely unknown. In this study, we constructed the structural connectivity (SC and functional connectivity (FC networks in 41 patients with clinically isolated syndrome (CIS, 32 MS patients and 35 healthy controls (HC based on diffusion and resting-state functional MRI. To quantify the communication efficiency within and between different functional systems, we proposed two measures called intra- and inter-module efficiency. Based on the module parcellation of functional backbone network, the intra- and inter-module efficiency of SC and FC networks was calculated for each participant. For the SC network, CIS showed decreased inter-module efficiency between the sensory-motor network (SMN, the visual network (VN, the default-mode network (DMN and the fronto-parietal network (FPN compared with HC, while MS showed more widespread decreased module efficiency both within and between modules relative to HC and CIS. For the FC network, no differences were found between CIS and HC, and a decreased inter-module efficiency between SMN and FPN and between VN and FPN was identified in MS, compared with HC and CIS. Moreover, both intra- and inter-module efficiency of SC network were correlated with the disability and cognitive scores in MS. Therefore, our results demonstrated early SC changes between modules in CIS, and more widespread SC alterations and inter-module FC changes were observed in MS, which were further associated with cognitive impairment and physical disability.

  7. The impact of preoperative language mapping by repetitive navigated transcranial magnetic stimulation on the clinical course of brain tumor patients.

    Science.gov (United States)

    Sollmann, Nico; Ille, Sebastian; Hauck, Theresa; Maurer, Stefanie; Negwer, Chiara; Zimmer, Claus; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M

    2015-04-11

    Language mapping by repetitive navigated transcranial magnetic stimulation (rTMS) is used for resection planning in patients suffering from brain lesions within regions known to be involved in language function. Yet we also need data that show whether patients benefit clinically from preoperative rTMS for language mapping. We enrolled 25 patients with language eloquently located brain lesions undergoing preoperative rTMS language mapping (GROUP 1, 2011-2013), with the mapping results not being available for the surgeon, and we matched these patients with 25 subjects who also underwent preoperative rTMS (GROUP 2, 2013-2014), but the mapping results were taken into account during tumor resection. Additionally, cortical language maps were generated by analyzing preoperative rTMS and intraoperative direct cortical stimulation (DCS) data. Mean anterior-posterior (ap) craniotomy extents and overall craniotomy sizes were significantly smaller for the patients in GROUP 2 (Ap: p = 0.0117; overall size: p = 0.0373), and postoperative language deficits were found significantly more frequently for the patients in GROUP 1 (p = 0.0153), although the preoperative language status did not differ between groups (p = 0.7576). Additionally, there was a trend towards fewer unexpected tumor residuals, shorter surgery duration, less peri- or postoperative complications, shorter inpatient stay, and higher postoperative Karnofsky performance status scale (KPS) for the patients in GROUP 2. The present study provides a first hint that the clinical course of patients suffering from brain tumors might be improved by preoperative rTMS language mapping. However, a significant difference between both groups was only found for craniotomy extents and postoperative deficits, but not for other clinical parameters, which only showed a trend toward better results in GROUP 2. Therefore, multicenter trials with higher sample sizes are needed to further investigate the distinct impact of r

  8. Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review

    OpenAIRE

    Raji, Cyrus A.; Tarzwell, Robert; Pavel, Dan; Schneider, Howard; Uszler, Michael; Thornton, John; van Lierop, Muriel; Cohen, Phil; Amen, Daniel G.; Henderson, Theodore

    2014-01-01

    PURPOSE: This systematic review evaluated the clinical utility of single photon emission computed tomography (SPECT) in traumatic brain injury (TBI). METHODS: After defining a PICO Statement (Population, Intervention, Comparison and Outcome Statement), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were applied to identify 1600 articles. After screening, 374 articles were eligible for review. Inclusion for review was focus on SPECT in the setting of mild,...

  9. Randomized Clinical Trial of Online Parent Training for Behavior Problems After Early Brain Injury.

    Science.gov (United States)

    Wade, Shari L; Cassedy, Amy E; Shultz, Emily L; Zang, Huaiyu; Zhang, Nanhua; Kirkwood, Michael W; Stancin, Terry; Yeates, Keith O; Taylor, H Gerry

    2017-11-01

    To evaluate the effectiveness of Internet-based Interacting Together Everyday: Recovery After Childhood TBI (I-InTERACT) versus abbreviated parent training (Express) or access to online resources (internet resources comparison [IRC]) in improving parenting skills and decreasing behavior problems after early traumatic brain injury (TBI). In this randomized, controlled, clinical trial, 113 children 3 to 9 years old previously hospitalized for moderate to severe TBI were randomly assigned to receive Express (n = 36), I-InTERACT (n = 39), or IRC (n = 38). Express included 7 online parent skills sessions, and I-InTERACT delivered 10 to 14 sessions addressing parenting skills, TBI education, stress, and anger management. The 2 interventions coupled online modules with therapist coaching through a Health Insurance Portability and Accountability Act-compliant Skype link. The IRC group received access to online TBI and parent skills resources. Co-primary outcomes were blinded ratings of parenting skills and parent report of behavior problems and problem intensity on the Eyberg Child Behavior Inventory (ECBI). Outcomes were assessed before treatment and 3 and 6 months after treatment, with the latter constituting the primary endpoint. The Express and I-InTERACT groups displayed higher levels of positive parenting at follow-up. Only the I-InTERACT group had lower levels of negative parenting at 6 months. The Express group had lower ECBI intensity scores than the IRC group. Baseline symptom levels moderated improvements; children in the Express and I-InTERACT groups with higher baseline symptoms demonstrated greater improvements than those in the IRC group. Changes in parenting skills mediated improvements in behavior in those with higher baseline symptoms. Brief online parent skills training can effectively decrease behavior problems after early TBI in children with existing behavioral symptoms. Clinical trial registration information-Internet-based Interacting Together

  10. Clinical and pathological analysis of benign brain tumors resected after Gamma Knife surgery.

    Science.gov (United States)

    Liu, Ali; Wang, Jun-Mei; Li, Gui-Lin; Sun, Yi-Lin; Sun, Shi-Bin; Luo, Bin; Wang, Mei-Hua

    2014-12-01

    The goal of this study was to assess the clinical and pathological features of benign brain tumors that had been treated with Gamma Knife surgery (GKS) followed by resection. In this retrospective chart review, the authors identified 61 patients with intracranial benign tumors who had undergone neurosurgical intervention after GKS. Of these 61 patients, 27 were male and 34 were female; mean age was 49.1 years (range 19-73 years). There were 24 meningiomas, 18 schwannomas, 14 pituitary adenomas, 3 hemangioblastomas, and 2 craniopharyngiomas. The interval between GKS and craniotomy was 2-168 months, with a median of 24 months; for 7 patients, the interval was 10 years or longer. For 21 patients, a craniotomy was performed before and after GKS; in 9 patients, pathological specimens were obtained before and after GKS. A total of 29 patients underwent GKS at the Beijing Tiantan Hospital. All specimens obtained by surgical intervention underwent histopathological examination. Most patients underwent craniotomy because of tumor recurrence and/or exacerbation of clinical signs and symptoms. Neuroimaging analyses indicated tumor growth in 42 patients, hydrocephalus in 10 patients with vestibular schwannoma, cystic formation with mass effect in 7 patients, and tumor hemorrhage in 13 patients, of whom 10 had pituitary adenoma. Pathological examination demonstrated that, regardless of the type of tumor, GKS mainly induced coagulative necrosis of tumor parenchyma and stroma with some apoptosis and, ultimately, scar formation. In addition, irradiation induced vasculature stenosis and occlusion and tumor degeneration as a result of reduced blood supply. GKS-induced vasculature reaction was rarely observed in patients with pituitary adenoma. Pathological analysis of tumor specimens obtained before and after GKS did not indicate increased tumor proliferation after GKS. Radiosurgery is effective for intracranial benign tumors of small size and deep location and for tumor recurrence

  11. Relationships between brain and body temperature, clinical and imaging outcomes after ischemic stroke

    Science.gov (United States)

    Karaszewski, Bartosz; Carpenter, Trevor K; Thomas, Ralph G R; Armitage, Paul A; Lymer, Georgina Katherine S; Marshall, Ian; Dennis, Martin S; Wardlaw, Joanna M

    2013-01-01

    Pyrexia soon after stroke is associated with severe stroke and poor functional outcome. Few studies have assessed brain temperature after stroke in patients, so little is known of its associations with body temperature, stroke severity, or outcome. We measured temperatures in ischemic and normal-appearing brain using 1H-magnetic resonance spectroscopy and its correlations with body (tympanic) temperature measured four-hourly, infarct growth by 5 days, early neurologic (National Institute of Health Stroke Scale, NIHSS) and late functional outcome (death or dependency). Among 40 patients (mean age 73 years, median NIHSS 7, imaged at median 17 hours), temperature in ischemic brain was higher than in normal-appearing brain on admission (38.6°C-core, 37.9°C-contralateral hemisphere, P=0.03) but both were equally elevated by 5 days; both were higher than tympanic temperature. Ischemic lesion temperature was not associated with NIHSS or 3-month functional outcome; in contrast, higher contralateral normal-appearing brain temperature was associated with worse NIHSS, infarct expansion and poor functional outcome, similar to associations for tympanic temperature. We conclude that brain temperature is higher than body temperature; that elevated temperature in ischemic brain reflects a local tissue response to ischemia, whereas pyrexia reflects the systemic response to stroke, occurs later, and is associated with adverse outcomes. PMID:23571281

  12. Brain Iron Homeostasis: From Molecular Mechanisms To Clinical Significance and Therapeutic Opportunities

    Science.gov (United States)

    Haldar, Swati; Tripathi, Ajai K.; Horback, Katharine; Wong, Joseph; Sharma, Deepak; Beserra, Amber; Suda, Srinivas; Anbalagan, Charumathi; Dev, Som; Mukhopadhyay, Chinmay K.; Singh, Ajay

    2014-01-01

    Abstract Iron has emerged as a significant cause of neurotoxicity in several neurodegenerative conditions, including Alzheimer's disease (AD), Parkinson's disease (PD), sporadic Creutzfeldt-Jakob disease (sCJD), and others. In some cases, the underlying cause of iron mis-metabolism is known, while in others, our understanding is, at best, incomplete. Recent evidence implicating key proteins involved in the pathogenesis of AD, PD, and sCJD in cellular iron metabolism suggests that imbalance of brain iron homeostasis associated with these disorders is a direct consequence of disease pathogenesis. A complete understanding of the molecular events leading to this phenotype is lacking partly because of the complex regulation of iron homeostasis within the brain. Since systemic organs and the brain share several iron regulatory mechanisms and iron-modulating proteins, dysfunction of a specific pathway or selective absence of iron-modulating protein(s) in systemic organs has provided important insights into the maintenance of iron homeostasis within the brain. Here, we review recent information on the regulation of iron uptake and utilization in systemic organs and within the complex environment of the brain, with particular emphasis on the underlying mechanisms leading to brain iron mis-metabolism in specific neurodegenerative conditions. Mouse models that have been instrumental in understanding systemic and brain disorders associated with iron mis-metabolism are also described, followed by current therapeutic strategies which are aimed at restoring brain iron homeostasis in different neurodegenerative conditions. We conclude by highlighting important gaps in our understanding of brain iron metabolism and mis-metabolism, particularly in the context of neurodegenerative disorders. Antioxid. Redox Signal. 20, 1324–1363. PMID:23815406

  13. Central pontine myelinolysis in a chronic alcoholic: A clinical and brain magnetic resonance imaging follow-up

    Directory of Open Access Journals (Sweden)

    Dujmović Irena

    2013-01-01

    Full Text Available Introduction. Central pontine myelinolysis (CPM is a noninflammatory, demyelinating lesion usually localised in the basis pontis. Chronic alcoholism is frequently associated with this condition which may have a variable clinical outcome. Until now, brain magnetic resonance imaging (MRI follow-up in alcoholic CPM cases after alcohol withdrawal has been rarely described. Case report. We reported a 30- year-old male with a 12-year history of alcohol abuse, who presented with inability to stand and walk, nausea, vomiting and somnolence. Neurological examination revealed: impared fixation on lateral gaze, dysarthria, mild spastic quadriparesis, truncal and extremity ataxia, sock-like hypesthesia and moderate decrease in vibration sense in legs. Brain MRI showed a trident-shaped non-enhancing pontine lesion highly suggestive of CPM. After an eight-month alcoholfree follow-up period, the patient’s clinical status significantly improved, while the extent of MRI pontine lesion was merely slightly reduced. Conclusion. The presented case demonstrates that CPM in chronic alcoholics may have a benign clinical course after alcohol withdrawal, which is not necessarily associated with the reduction of lesions on brain MRI. [Projekat Ministarstva nauke Republike Srbije, br. 175031

  14. Diagnostic and prognostic value of asphyxia, Sarnat's clinical classification, and CT-scan in perinatal brain damage

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Toshihide; Wakita, Yoshiharu; Kubonishi, Sakae; Yoshikawa, Seishi (Kochi Prefectural Central Hospital (Japan)); Ito, Toshiyuki; Okada, Yasusuke

    1990-11-01

    A retrospective review was made of 145 babies, excluding those with congenital heart disease or chromosome aberration, admitted for CT scanning. The study was done to determine the diagnostic and prognostic value of CT findings, as well as the presence of asphyxia and the clinical stage based on the Sarnat's classification, in perinatal brain damage. The patients had a minimum follow up of 2 years for the evaluation of neurologic manifestations, such as cerebral palsy, epilepsy and mental retardation. Among babies weighing 2,000 g or more at birth, neonatal asphyxia was significantly correlated with neurologic prognosis. In addition, both clinical stages and CT findings were significantly correlated with neurologic prognosis, irrespective of birth weight. The correlation between clinical stages and CT findings was significant, irrespective of body weight, however, a significant correlation between clinical stages and neonatal asphyxia was restricted to those weighing 2,000 g or more. These findings suggest that the presence of asphyxia, clinical stages and CT findings are complementary in the diagnosis and prognosis evaluation of perinatal brain damage. (N.K.).

  15. Finding language in the matter of the brain: origins of the clinical aphasia examination.

    Science.gov (United States)

    Roth, Heidi L

    2002-12-01

    The origins of the aphasia examination can be traced back to the 19th century when physicians and scientists began to understand how higher mental functions such as language could be localized in the brain. Paul Broca, Carl Wernicke, and Hughlings Jackson developed different models of brain function, and each contributed important insights to the study of aphasia. Broca's contributions were influenced by the fundamental question of whether higher mental function could be localized in the brain at all; Wernicke's contributions were influenced by an attempt to unite more mechanistic and physiological principles to a model of higher brain functions; and Jackson's contributions were influenced by British association psychology. In addition to reviewing the origins of the aphasia examination, this article reviews the historical context in which these contributors worked, the factors that affected the reception of their views, and the manner in which their views have affected the aphasia examination and understanding of aphasia today.

  16. Current status and future role of brain PET/MRI in clinical and research settings

    Energy Technology Data Exchange (ETDEWEB)

    Werner, P.; Barthel, H.; Sabri, O. [University Hospital Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Drzezga, A. [University Hospital Cologne, Department of Nuclear Medicine, Koeln (Germany)

    2015-01-09

    Hybrid PET/MRI systematically offers a complementary combination of two modalities that has often proven itself superior to the single modality approach in the diagnostic work-up of many neurological and psychiatric diseases. Emerging PET tracers, technical advances in multiparametric MRI and obvious workflow advantages may lead to a significant improvement in the diagnosis of dementia disorders, neurooncological diseases, epilepsy and neurovascular diseases using PET/MRI. Moreover, simultaneous PET/MRI is well suited to complex studies of brain function in which fast fluctuations of brain signals (e.g. related to task processing or in response to pharmacological interventions) need to be monitored on multiple levels. Initial simultaneous studies have already demonstrated that these complementary measures of brain function can provide new insights into the functional and structural organization of the brain. (orig.)

  17. Explorative investigation of biomarkers of brain damage and coagulation system activation in clinical stroke differentiation

    DEFF Research Database (Denmark)

    Undén, Johan; Strandberg, Karin; Malm, Jan

    2009-01-01

    INTRODUCTION: A simple and accurate method of differentiating ischemic stroke and intracerebral hemorrhage (ICH) is potentially useful to facilitate acute therapeutic management. Blood measurements of biomarkers of brain damage and activation of the coagulation system may potentially serve as nov...

  18. Current status and future role of brain PET/MRI in clinical and research settings

    International Nuclear Information System (INIS)

    Werner, P.; Barthel, H.; Sabri, O.; Drzezga, A.

    2015-01-01

    Hybrid PET/MRI systematically offers a complementary combination of two modalities that has often proven itself superior to the single modality approach in the diagnostic work-up of many neurological and psychiatric diseases. Emerging PET tracers, technical advances in multiparametric MRI and obvious workflow advantages may lead to a significant improvement in the diagnosis of dementia disorders, neurooncological diseases, epilepsy and neurovascular diseases using PET/MRI. Moreover, simultaneous PET/MRI is well suited to complex studies of brain function in which fast fluctuations of brain signals (e.g. related to task processing or in response to pharmacological interventions) need to be monitored on multiple levels. Initial simultaneous studies have already demonstrated that these complementary measures of brain function can provide new insights into the functional and structural organization of the brain. (orig.)

  19. PROFOUND AND SEXUALLY DIMORPHIC EFFECTS OF CLINICALLY-RELEVANT LOW DOSE SCATTER IRRADIATION ON THE BRAIN AND BEHAVIOR

    Directory of Open Access Journals (Sweden)

    Anna eKovalchuk

    2016-06-01

    Full Text Available Irradiated cells can signal damage and distress to both close and distant neighbors that have not been directly exposed to the radiation (naïve bystanders. While studies have shown that such bystander effects occur in the shielded brain of animals upon body irradiation, their mechanism remains unexplored. Observed effects may be caused by some blood-borne factors; however they may also be explained, at least in part, by very small direct doses received by the brain that result from scatter or leakage. In order to establish the roles of low doses of scatter irradiation in the brain response, we developed a new model for scatter irradiation analysis whereby one rat was irradiated directly at the liver and the second rat was placed adjacent to the first and received a scatter dose to its body and brain. This work focuses specifically on the response of the latter rat brain to the low scatter irradiation dose. Here, we provide the first experimental evidence that very low, clinically relevant doses of scatter irradiation alter gene expression, induce changes in dendritic morphology, and lead to behavioral deficits in exposed animals. The results showed that exposure to radiation doses as low as 0.115 cGy caused changes in gene expression and reduced spine density, dendritic complexity, and dendritic length in the prefrontal cortex tissues of females, but not males. In the hippocampus, radiation altered neuroanatomical organization in males, but not in females. Moreover, low dose radiation caused behavioral deficits in the exposed animals. This is the first study to show that low dose scatter irradiation influences the brain and behavior in a sex-specific way.

  20. Anesthesia Practice in Pediatric Radiation Oncology: Mayo Clinic Arizona's Experience 2014-2016.

    Science.gov (United States)

    Khurmi, Narjeet; Patel, Perene; Koushik, Sarang; Daniels, Thomas; Kraus, Molly

    2018-02-01

    Understanding the goals of targeted radiation therapy in pediatrics is critical to developing high quality and safe anesthetic plans in this patient population. An ideal anesthetic plan includes allaying anxiety and achieving optimal immobilization, while ensuring rapid and efficient recovery. We conducted a retrospective chart review of children receiving anesthesia for radiation oncology procedures from 1/1/2014 to 7/31/2016. No anesthetics were excluded from the analysis. The electronic anesthesia records were analyzed for perianesthetic complications along with efficiency data. To compare our results to past and current data, we identified relevant medical literature covering a period from 1984-2017. A total of 997 anesthetic procedures were delivered in 58 unique patients. The vast majority of anesthetics were single-agent anesthesia with propofol. The average duration of radiation treatment was 13.24 min. The average duration of anesthesia was 37.81 min, and the average duration to meet discharge criteria in the recovery room was 29.50 min. There were seven instances of perianesthetic complications (0.7%) and no complications noted for the 80 CT simulations. Two of the seven complications occurred in patients receiving total body irradiation. The 5-year survival rate for pediatric cancers has improved greatly in part due to more effective and targeted radiation therapy. Providing an anesthetic with minimal complications is critical for successful daily radiation treatment. The results of our data analysis corroborate other contemporary studies showing minimal risk to patients undergoing radiation therapy under general anesthesia with propofol. Our data reveal that single-agent anesthesia with propofol administered by a dedicated anesthesia team is safe and efficient and should be considered for patients requiring multiple radiation treatments under anesthesia.

  1. Comparative analysis of fracture characteristics of the developing mandible: the Mayo Clinic experience.

    Science.gov (United States)

    Siwani, Rizwan; Tombers, Nicole M; Rieck, Kevin L; Cofer, Shelagh A

    2014-07-01

    To review and compare the epidemiology and treatment of mandibular fractures in subgroups of a pediatric population. We conducted a retrospective review of pediatric patients (age, ≤18 years) with mandibular fractures treated at our institution from January 1996 through November 2011. We identified 122 patients (93 [76%] male) with 216 mandibular fractures. The prevalent mechanisms of injury were motor vehicle accidents (n=52 [43%]), sports injuries (n=24 [20%]), and assault (n=13 [11%]). The most common fracture sites were subcondylar, parasymphyseal, angle, and body. Two patients (2%) were treated conservatively by observation only, 67 (55%) underwent maxillomandibular fixation alone, 41 (34%) underwent maxillomandibular fixation with plate fixation, and 7 (5.7%) underwent plate fixation only. The average duration of maxillomandibular fixation was 26 days (range, 7-49 days). Complications occurred in 11 patients (9.0%) over a mean follow-up of 92 days (range, 21-702 days). Fifty patients (41.0%) had comorbid conditions or a history of mental illness at the time of injury, including attention deficit hyperactivity disorder (n=11 [9%]), mental disorders other than attention deficit hyperactivity disorder (n=23 [19%]), and asthma (n=17 [14%]). Twenty-six patients (21%) had a history of substance use, the most common being tobacco (n=18 [15%]), alcohol (n=13 [11%]), and marijuana (n=11 [9%]). Treatment approach and outcomes were affected by age and fracture characteristics. In addition, a marked proportion of this cohort had preexisting mental disorders and history of substance use, which may have implications on treatment approach. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Catheter-based intervention for pulmonary vein stenosis due to fibrosing mediastinitis: The Mayo Clinic experience

    Directory of Open Access Journals (Sweden)

    Shiva P. Ponamgi

    2015-09-01

    Conclusions: We describe the largest reported case series of catheter-based intervention for PV stenosis in FM. Although catheter-based therapy improved hemodynamics, short-term vascular patency, and patient symptoms, the rate of life-threatening complications, restenosis, and mortality associated with these interventions was found to be high. Despite these associated risks, catheter-based intervention is the only palliative option available to improve quality of life in severely symptomatic patients with PV stenosis and FM. Patients with PV stenosis and FM (especially those with bilateral disease have an overall poor prognosis in spite of undergoing these interventions due to the progressive and recalcitrant nature of the disease. This underscores the need for further innovative approaches to manage this disease.

  3. Radiotherapy for malignancy in patients with scleroderma: The Mayo Clinic experience

    International Nuclear Information System (INIS)

    Gold, Douglas G.; Miller, Robert C.; Petersen, Ivy A.; Osborn, Thomas G.

    2007-01-01

    Purpose: To determine the frequency of acute and chronic adverse effects in patients with scleroderma who receive radiotherapy for treatment of cancer. Methods and Materials: Records were reviewed of 20 patients with scleroderma who received radiotherapy. Acute and chronic toxic effects attributable to radiotherapy were analyzed, and freedom from radiation-related toxicity was calculated. Results: Of the 20 patients, 15 had acute toxic effects, with Grade 3 or higher toxicity for 3 patients. Seven patients had self-limited Grade 1 or 2 radiation dermatitis, and no patient had Grade 3 or higher radiation dermatitis. Thirteen patients had chronic toxic effects, with Grade 3 or higher chronic toxicity for 3 patients. The median estimated time to any grade chronic toxicity was 0.4 years, and the median estimated time to Grade 3 or higher chronic toxicity has not been reached. Conclusions: The results suggest that although some patients with scleroderma treated with radiation experience considerable toxic effects, the occurrence of Grade 3 or higher toxicity may be less than previously anticipated

  4. The U.S. Role in Global Security: The Mayo Clinic, Not the Emergency Room

    National Research Council Canada - National Science Library

    Hillen, John

    1998-01-01

    While many different proposals have been put forward outlining a post-Cold War security identity for the United States, most do not characterize an American role in terms of either excessive activism...

  5. Stress Induced Cardiomyopathy Triggered by Acute Myocardial Infarction: A Case Series Challenging the Mayo Clinic Definition.

    Science.gov (United States)

    Christodoulidis, Georgios; Kundoor, Vishwa; Kaluski, Edo

    2017-08-28

    BACKGROUND Various physical and emotional factors have been previously described as triggers for stress induced cardiomyopathy. However, acute myocardial infarction as a trigger has never been reported. CASE REPORT We describe four patients who presented with an acute myocardial infarction, in whom the initial echocardiography revealed wall motion abnormalities extending beyond the coronary distribution of the infarct artery. Of the four patients identified, the mean age was 59 years; three patients were women and two patients had underlying psychiatric history. Electrocardiogram revealed ST elevation in the anterior leads in three patients; QTc was prolonged in all cases. All patients had ≤ moderately elevated troponin. Single culprit lesion was found uniformly in the proximal or mid left anterior descending artery. Initial echocardiography revealed severely reduced ejection fraction with relative sparing of the basal segments, whereas early repeat echocardiography revealed significant improvement in the left ventricular function in all patients. CONCLUSIONS This is the first case series demonstrating that acute myocardial infarction can trigger stress induced cardiomyopathy. Extensive reversible wall motion abnormalities, beyond the ones expected from angiography, accompanied by modest elevation in troponin and marked QTc prolongation, suggest superimposed stress induced cardiomyopathy.

  6. The state of the science of whole blood: lessons learned at Mayo Clinic.

    Science.gov (United States)

    Stubbs, James R; Zielinski, Martin D; Jenkins, Donald

    2016-04-01

    AABB Standards specify that ABO group-specific whole blood is the only acceptable choice for whole blood transfusions. Although universal donor group O stored whole blood (SWB) was used extensively by the military during the wars of the mid-twentieth century, its use has fallen out of favor and has never been used to great extent in the civilian trauma population. Interest in the use of whole blood has been renewed, particularly in light of its potential value in far-forward military and other austere environments. Evidence of preserved platelet function in SWB has heightened enthusiasm for a "one stop shop" resuscitation product providing volume, oxygen carrying capacity, and hemostatic effects. Experience with universal donor group O SWB is required to ascertain whether its use will be an advance in trauma care. Described here is the process of establishing a universal donor group O SWB at a civilian trauma center in the United States. © 2016 AABB.

  7. Systemic Lupus Erythematosus, Radiotherapy, and the Risk of Acute and Chronic Toxicity: The Mayo Clinic Experience

    International Nuclear Information System (INIS)

    Pinn, Melva E.; Gold, Douglas G. M.; Petersen, Ivy A.; Osborn, Thomas G.; Brown, Paul D.; Miller, Robert C.

    2008-01-01

    Purpose: To determine the acute and chronic toxic effects of radiotherapy in patients with systemic lupus erythematosus (SLE). Methods and Materials: Medical records of 21 consecutive patients with SLE, who had received 34 courses of external beam radiotherapy and one low-dose-rate prostate implant, were retrospectively reviewed. Patients with discoid lupus erythematosus were excluded. Results: Median survival was 2.3 years and median follow-up 5.6 years. Eight (42%) of 19 patients evaluable for acute toxicity during radiotherapy experienced acute toxicity of Grade 1 or greater, and 4 (21%) had acute toxicity of Grade 3 or greater. The 5- and 10-year incidence of chronic toxicity of Grade 1 or greater was 45% (95% confidence interval [CI], 22-72%) and 56% (95% CI, 28-81%), respectively. The 5- and 10-year incidence of chronic toxicity of Grade 3 or greater was 28% (95% CI, 18-60%) and 40% (95% CI, 16-72%), respectively. Univariate analysis showed that chronic toxicity of Grade 1 or greater correlated with SLE renal involvement (p < 0.006) and possibly with the presence of five or more American Rheumatism Association criteria (p < 0.053). Chronic toxicity of Grade 3 or greater correlated with an absence of photosensitivity (p < 0.02), absence of arthritis (p < 0.03), and presence of a malar rash (p < 0.04). Conclusions: The risk of acute and chronic toxicity in patients with SLE who received radiotherapy was moderate but was not prohibitive of the use of radiotherapy. Patients with more advanced SLE may be at increased risk for chronic toxicity

  8. Animal-assisted therapy at Mayo Clinic: The time is now.

    Science.gov (United States)

    Creagan, Edward T; Bauer, Brent A; Thomley, Barbara S; Borg, Jessica M

    2015-05-01

    The animal-human bond refers to an emotional, almost existential, relationship between animals and people. From the time of antiquity, domestic animals were an important source of economic vitality, but with the changing cultural landscape, the companion animal has become a faithful friend. Overwhelming anecdotal evidence supports the healing power of this relationship. We summarize the emerging literature on the neurobiochemical and cardiovascular benefits of companion pet ownership. We address the peer-reviewed data from myriad journal articles assessing the impact of the companion animal on the quality and often the length of life of select patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study.

    Science.gov (United States)

    Välimäki, Maritta; Mishina, Kaisa; Kaakinen, Johanna K; Holm, Suvi K; Vahlo, Jukka; Kirjonen, Markus; Pekurinen, Virve; Tenovuo, Olli; Korkeila, Jyrki; Hämäläinen, Heikki; Sarajuuri, Jaana; Rantanen, Pekka; Orenius, Tage; Koponen, Aki

    2018-03-19

    Traumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation. The aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI. A total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered. The effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points

  10. A proteomic network approach across the ALS-FTD disease spectrum resolves clinical phenotypes and genetic vulnerability in human brain.

    Science.gov (United States)

    Umoh, Mfon E; Dammer, Eric B; Dai, Jingting; Duong, Duc M; Lah, James J; Levey, Allan I; Gearing, Marla; Glass, Jonathan D; Seyfried, Nicholas T

    2018-01-01

    Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are neurodegenerative diseases with overlap in clinical presentation, neuropathology, and genetic underpinnings. The molecular basis for the overlap of these disorders is not well established. We performed a comparative unbiased mass spectrometry-based proteomic analysis of frontal cortical tissues from postmortem cases clinically defined as ALS, FTD, ALS and FTD (ALS/FTD), and controls. We also included a subset of patients with the C9orf72 expansion mutation, the most common genetic cause of both ALS and FTD Our systems-level analysis of the brain proteome integrated both differential expression and co-expression approaches to assess the relationship of these differences to clinical and pathological phenotypes. Weighted co-expression network analysis revealed 15 modules of co-expressed proteins, eight of which were significantly different across the ALS-FTD disease spectrum. These included modules associated with RNA binding proteins, synaptic transmission, and inflammation with cell-type specificity that showed correlation with TDP-43 pathology and cognitive dysfunction. Modules were also examined for their overlap with TDP-43 protein-protein interactions, revealing one module enriched with RNA-binding proteins and other causal ALS genes that increased in FTD/ALS and FTD cases. A module enriched with astrocyte and microglia proteins was significantly increased in ALS cases carrying the C9orf72 mutation compared to sporadic ALS cases, suggesting that the genetic expansion is associated with inflammation in the brain even without clinical evidence of dementia. Together, these findings highlight the utility of integrative systems-level proteomic approaches to resolve clinical phenotypes and genetic mechanisms underlying the ALS-FTD disease spectrum in human brain. © 2017 The Authors. Published under the terms of the CC BY 4.0 license.

  11. A combined solenoid-surface RF coil for high-resolution whole-brain rat imaging on a 3.0 Tesla clinical MR scanner.

    Science.gov (United States)

    Underhill, Hunter R; Yuan, Chun; Hayes, Cecil E

    2010-09-01

    Rat brain models effectively simulate a multitude of human neurological disorders. Improvements in coil design have facilitated the wider utilization of rat brain models by enabling the utilization of clinical MR scanners for image acquisition. In this study, a novel coil design, subsequently referred to as the rat brain coil, is described that exploits and combines the strengths of both solenoids and surface coils into a simple, multichannel, receive-only coil dedicated to whole-brain rat imaging on a 3.0 T clinical MR scanner. Compared with a multiturn solenoid mouse body coil, a 3-cm surface coil, a modified Helmholtz coil, and a phased-array surface coil, the rat brain coil improved signal-to-noise ratio by approximately 72, 61, 78, and 242%, respectively. Effects of the rat brain coil on amplitudes of static field and radiofrequency field uniformity were similar to each of the other coils. In vivo, whole-brain images of an adult male rat were acquired with a T(2)-weighted spin-echo sequence using an isotropic acquisition resolution of 0.25 x 0.25 x 0.25 mm(3) in 60.6 min. Multiplanar images of the in vivo rat brain with identification of anatomic structures are presented. Improvement in signal-to-noise ratio afforded by the rat brain coil may broaden experiments that utilize clinical MR scanners for in vivo image acquisition. 2010 Wiley-Liss, Inc.

  12. ROC [Receiver Operating Characteristics] study of maximum likelihood estimator human brain image reconstructions in PET [Positron Emission Tomography] clinical practice

    International Nuclear Information System (INIS)

    Llacer, J.; Veklerov, E.; Nolan, D.; Grafton, S.T.; Mazziotta, J.C.; Hawkins, R.A.; Hoh, C.K.; Hoffman, E.J.

    1990-10-01

    This paper will report on the progress to date in carrying out Receiver Operating Characteristics (ROC) studies comparing Maximum Likelihood Estimator (MLE) and Filtered Backprojection (FBP) reconstructions of normal and abnormal human brain PET data in a clinical setting. A previous statistical study of reconstructions of the Hoffman brain phantom with real data indicated that the pixel-to-pixel standard deviation in feasible MLE images is approximately proportional to the square root of the number of counts in a region, as opposed to a standard deviation which is high and largely independent of the number of counts in FBP. A preliminary ROC study carried out with 10 non-medical observers performing a relatively simple detectability task indicates that, for the majority of observers, lower standard deviation translates itself into a statistically significant detectability advantage in MLE reconstructions. The initial results of ongoing tests with four experienced neurologists/nuclear medicine physicians are presented. Normal cases of 18 F -- fluorodeoxyglucose (FDG) cerebral metabolism studies and abnormal cases in which a variety of lesions have been introduced into normal data sets have been evaluated. We report on the results of reading the reconstructions of 90 data sets, each corresponding to a single brain slice. It has become apparent that the design of the study based on reading single brain slices is too insensitive and we propose a variation based on reading three consecutive slices at a time, rating only the center slice. 9 refs., 2 figs., 1 tab

  13. Salida de campo a Etang de Fournelet (Francia) el 1 de mayo de 1954

    OpenAIRE

    Valverde Gómez, José Antonio, 1926-2003

    2008-01-01

    Salida de campo a Etang de Fournelet, seguramente cerca a la reserva natural de La Camarga, en el delta del río Ródano (Provenza), el 1 de mayo de 1954, de la que se anotaron observaciones sobre las siguientes aves: Actitis hypoleucos (Andarríos chico, llamado Actynioides hypoleucus por el autor), Circus aeruginosus (Aguilucho lagunero occidental), Himantopus himantopus (Cigüeñuela común), Motacilla flava (Lavandera boyera), Saxicola rubetra (Tarabilla norteña), Sylvia conspicillata (Curruca ...

  14. Antimycobacterial activity of medicinal plants used by the Mayo people of Sonora, Mexico.

    Science.gov (United States)

    Coronado-Aceves, Enrique Wenceslao; Sánchez-Escalante, José Jesús; López-Cervantes, Jaime; Robles-Zepeda, Ramón Enrique; Velázquez, Carlos; Sánchez-Machado, Dalia Isabel; Garibay-Escobar, Adriana

    2016-08-22

    Tuberculosis (TB) is an infectious disease mainly caused by Mycobacterium tuberculosis (Mtb), which generates 9 million new cases worldwide each year. The Mayo ethnicity of southern Sonora, Mexico is more than 2000 years old, and the Mayos possess extensive knowledge of traditional medicine. To evaluate the antimycobacterial activity levels of extracts of medicinal plants used by the Mayos against Mtb and Mycobacterium smegmatis (Msm) in the treatment of TB, respiratory diseases and related symptoms. A total of 34 plant species were collected, and 191 extracts were created with n-hexane, dichloromethane, ethyl acetate (EtOAc), methanol and water. Their minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) were determined against Mtb H37Rv using the microplate alamar blue assay (MABA) and against Msm using the resazurin microplate assay (REMA) at 6 and 2 days of exposure, respectively, and at concentrations of 250-1.9µg/mL (n-hexane extracts) and 1000-7.81µg/mL (extracts obtained with dichloromethane, EtOAc, methanol and water). Rhynchosia precatoria (Willd.) DC. (n-hexane root extract), Euphorbia albomarginata Torr. and A. Gray. (EtOAc shoot extract) and Helianthus annuus L. (n-hexane stem extract) were the most active plants against Mtb H37Rv, with MICs of 15.6, 250, 250µg/mL and MBCs of 31.25, 250, 250µg/mL, respectively. R. precatoria (root) was the only active plant against Msm, with MIC and MBC values of ≥250µg/mL. None of the aqueous extracts were active. This study validates the medicinal use of certain plants used by the Mayo people in the treatment of TB and related symptoms. R. precatoria, E. albomarginata and H. annuus are promising plant sources of active compounds that act against Mtb H37Rv. To our knowledge, this is the first time that their antimycobacterial activity has been reported. Crude extracts obtained with n-hexane, EtOAc and dichloromethane were the most active against Mtb H37Rv. Copyright © 2016

  15. 8 de Mayo ... día internacional de la mujer

    OpenAIRE

    Gutiérrez González, Acela Elena

    1987-01-01

    Al movimiento feminista lo podemos dividir en dos etapas. La primera corresponde a su lucha por la igualdad de derechos civiles que concluye en los países europeos y Norteamérica con la finalización de la segunda guerra mundial. La segunda etapa es política. En Latinoamérica surge con el nacimiento de la revolución cubana. En los países europeos, como consecuencia de la Primavera de Praga, el Mayo Francés y la oposición de los jóvenes norteamericanos a intervenir militarmente en la autodeterm...

  16. Circulating and brain BDNF levels in stroke rats. Relevance to clinical studies.

    Directory of Open Access Journals (Sweden)

    Yannick Béjot

    Full Text Available BACKGROUND: Whereas brain-derived neurotrophic factor (BDNF levels are measured in the brain in animal models of stroke, neurotrophin levels in stroke patients are measured in plasma or serum samples. The present study was designed to investigate the meaning of circulating BDNF levels in stroke patients. METHODS AND RESULTS: Unilateral ischemic stroke was induced in rats by the injection of various numbers of microspheres into the carotid circulation in order to mimic the different degrees of stroke severity observed in stroke patients. Blood was serially collected from the jugular vein before and after (4 h, 24 h and 8 d embolization and the whole brains were collected at 4, 24 h and 8 d post-embolization. Rats were then selected from their degree of embolization, so that the distribution of stroke severity in the rats at the different time points was large but similar. Using ELISA tests, BDNF levels were measured in plasma, serum and brain of selected rats. Whereas plasma and serum BDNF levels were not changed by stroke, stroke induced an increase in brain BDNF levels at 4 h and 24 h post-embolization, which was not correlated with stroke severity. Individual plasma BDNF levels did not correlate with brain levels at any time point after stroke but a positive correlation (r = 0.67 was observed between individual plasma BDNF levels and stroke severity at 4 h post-embolization. CONCLUSION: Circulating BDNF levels do not mirror brain BDNF levels after stroke, and severe stroke is associated with high plasma BDNF in the very acute stage.

  17. The degree of certainty in brain death: probability in clinical and Islamic legal discourse.

    Science.gov (United States)

    Qazi, Faisal; Ewell, Joshua C; Munawar, Ayla; Asrar, Usman; Khan, Nadir

    2013-04-01

    The University of Michigan conference "Where Religion, Policy, and Bioethics Meet: An Interdisciplinary Conference on Islamic Bioethics and End-of-Life Care" in April 2011 addressed the issue of brain death as the prototype for a discourse that would reflect the emergence of Islamic bioethics as a formal field of study. In considering the issue of brain death, various Muslim legal experts have raised concerns over the lack of certainty in the scientific criteria as applied to the definition and diagnosis of brain death by the medical community. In contrast, the medical community at large has not required absolute certainty in its process, but has sought to eliminate doubt through cumulative diagnostic modalities and supportive scientific evidence. This has recently become a principal model, with increased interest in data analysis and evidence-based medicine with the intent to analyze and ultimately improve outcomes. Islamic law has also long employed a systematic methodology with the goal of eliminating doubt from rulings regarding the question of certainty. While ample criticism of the scientific criteria of brain death (Harvard criteria) by traditional legal sources now exists, an analysis of the legal process in assessing brain death, geared toward informing the clinician's perspective on the issue, is lacking. In this article, we explore the role of certainty in the diagnostic modalities used to establish diagnoses of brain death in current medical practice. We further examine the Islamic jurisprudential approach vis-à-vis the concept of certainty (yaqīn). Finally, we contrast the two at times divergent philosophies and consider what each perspective may contribute to the global discourse on brain death, understanding that the interdependence that exists between the theological, juridical, ethical, and medical/scientific fields necessitates an open discussion and active collaboration between all parties. We hope that this article serves to continue the

  18. Pre-clinical and Clinical Development of Low Dose Methamphetamine for the Treatment of Traumatic Brain Injury

    Science.gov (United States)

    2014-12-01

    Aim 3: Secure FDA approval of a phase I/II clinical trial plan and obtain an amended IND in preparation for initiating human clinical testing in TBI...Neurology 6:193–201. Raineri M, Gonzalez B, Goitia B, Garcia-Rill E, Krasnova IN, Cadet JL, Urbano FJ, Bisagno V. 2012. Modafinil abrogates

  19. Assessing emotional status following acquired brain injury: the clinical potential of the depression, anxiety and stress scales.

    Science.gov (United States)

    Ownsworth, Tamara; Little, Trudi; Turner, Ben; Hawkes, Anna; Shum, David

    2008-10-01

    To investigate the clinical potential of the Depression, Anxiety and Stress Scales (DASS 42) and its shorter version (DASS 21) for assessing emotional status following acquired brain injury. Participants included 23 individuals with traumatic brain injury (TBI), 25 individuals with brain tumour and 29 non-clinical controls. Investigations of internal consistency, test-re-test reliability, theory-consistent differences, sensitivity to change and concurrent validity were conducted. Internal consistency of the DASS was generally acceptable (r > 0.70), with the exception of the anxiety scale for the TBI sample. Test-re-test reliability (1-3 weeks) was sound for the depression scale (r > 0.75) and significant but comparatively lower for other scales (r = 0.60-0.73, p scale (p DASS in the context of hospital discharge was demonstrated for depression and stress (p 0.05). Concurrent validity with the Hospital Anxiety and Depression Scale was significant for all scales of the DASS (p DASS following ABI, further research examining the factor structure of existing and modified versions of the DASS is recommended.

  20. High-cervical spinal cord electrical stimulation in brain low perfusion syndromes: experimental basis and preliminary clinical report.

    Science.gov (United States)

    Broseta, J; García-March, G; Sánchez-Ledesma, M J; Gonçalves, J; Silva, I; Barcia, J A; Llácer, J L; Barcia-Salorio, J L

    1994-01-01

    Previous studies of our group showed that C1-C2 spinal cord stimulation increases carotid and brain blood flow in normal conditions in the goat and dog and it has a beneficial vasomotor effect in a model of vasospasm in the rat. For further clinical application it seemed rational to investigate the possible vascular changes mediated by this technique in experimental brain infarction. To this aim, 45 New Zealand rabbits were used. Brain infarction was produced by bilateral carotid ligation in 15, unilateral microcoagulation of the middle cerebral artery in 15 and by microcoagulation of the vertebral artery at the craniocervical junction in the other 15. One week later, following daily clinical scoring and cortical and posterior fossa blood flow readings by laser Doppler, a period of 120 min of right C1-C2 spinal cord electric stimulation was performed. A mean of 27% increase in previous blood flow recordings was obtained at the right hemisphere and a mean of 32% in the posterior fossa. This procedure was used in 10 patients presenting with various cerebral low perfusion syndromes. Though not constant, an increase in alertness, retention, speech, emotional lability and performance in skilled acts was achieved. No MR changes were observed, though SPECT readings showed an increase in blood flow in the penumbral perilesional area.

  1. Whole brain irradiation in case of brain metastases in from 2005 to 2011 in the clinic for nuclear medicine of the university hospital Freiburg

    International Nuclear Information System (INIS)

    Hintz, Mandy

    2017-01-01

    Brain metastases are the largest group of brain tumors. Their occurrence influences the overall survival and the quality of life. The retrospective study deals with the overall survival, the local tumor control and the prognostic factors of patients treated with whole brain irradiation. The data were evaluated using multivariate analysis. Whole brain irradiation has shown to be an efficient therapy option for patients with brain metastases and has the possibility to improve the overall progress-free survival and the symptom control.

  2. Clinical study on eating disorders. Brain atrophy revealed by cranial computed tomography scans

    Energy Technology Data Exchange (ETDEWEB)

    Nishiwaki, Shinichi

    1988-06-01

    Cranial computed tomography (CT) scans were reviewed in 34 patients with anorexia nervosa (Group I) and 22 with bulimia (Group II) to elucidate the cause and pathological significance of morphological brain alterations. The findings were compared with those from 47 normal women. The incidence of brain atrophy was significantly higher in Group I (17/34, 50%) and Group II (11/22, 50%) than the control group (3/47, 6%). In Group I, there was a significant increase in the left septum-caudate distance, the maximum width of interhemispheric fissure, the width of the both-side Sylvian fissures adjacent to the skull, and the maximum width of the third ventricle. A significant increase in the maximum width of interhemispheric fissure and the width of the left-side Sylvian fissure adjacent to the skull were noted as well in Group II. Ventricular brain ratios were significantly higher in Groups I and II than the control group (6.76 and 7.29 vs 4.55). Brain atrophy did not correlate with age, body weight, malnutrition, eating behavior, depression, thyroid function, EEG findings, or intelligence scale. In Group I, serum cortisol levels after the administration of dexamethasone were correlated with ventricular brain ratio. (Namekawa, K) 51 refs.

  3. Clinical and neuroimaging profile of congenital brain malformations in children with spastic cerebral palsy

    International Nuclear Information System (INIS)

    Kulak, W.; Okurowska-Zawada, B.; Sobaniec, W.; Goscik, M.; Olenski, J.

    2008-01-01

    Purpose: Analysis of the incidence of congenital brain malformations in children with spastic cerebral palsy (CP) in a hospital based study. Material and Methods: The present study included 74 boys and 56 girls with spastic tetraplegia, diplegia, and hemiplegia CP. Magnetic resonance imaging MRI findings were analyzed in children with CP. Results: Significant abnormalities relevant to the CP were evident on MRI in 124 (95.3%) subjects. Periventicular leukomalacia (PVL) was detected more frequently in children with spastic diplegia than in patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 15 (10.7%) children with spastic CP. Brain malformations included: schizencephaly (5), agenesis corpus callosum (4), polymicrogyria (2), holoprosencephaly (2) and lissencephaly (2). Intractable epilepsy and mental retardation were observed more often in children with brain anomalies. Twelve patients with congenital brain malformations were born at term and three born at preterm. Conclusions: Neuroimaging results in children with CP may help determine the etiology and make better prognosis of CP. (authors)

  4. Serum levels of brain-derived neurotrophic factor in major depressive disorder: state-trait issues, clinical features and pharmacological treatment

    NARCIS (Netherlands)

    Molendijk, M.L.; Bus, B.A.A.; Spinhoven, P.; Penninx, B.W.J.H.; Kenis, G.; Prickaerts, J.; Voshaar, R.C.O.; Elzinga, B.M.

    2011-01-01

    Recent evidence supports 'the neurotrophin hypothesis of depression' in its prediction that brain-derived neurotrophic factor (BDNF) is involved in depression. However, some key questions remain unanswered, including whether abnormalities in BDNF persist beyond the clinical state of depression,

  5. Nose-to-brain drug delivery: An update on clinical challenges and progress towards approval of anti-Alzheimer drugs.

    Science.gov (United States)

    Agrawal, Mukta; Saraf, Swarnlata; Saraf, Shailendra; Antimisiaris, Sophia G; Chougule, Mahavir Bhupal; Shoyele, Sunday A; Alexander, Amit

    2018-05-23

    According to the Alzheimer Association Report (2017), Alzheimer's disease (AD) is the 6th primary cause of death in the USA, which affects nearly 5.5 million people. In the year 2017 itself, the cost of AD treatment in the USA has been reported to rise to $259 billion. This statistic shows the severity of the disease in the USA which is very much similar across the globe. On the other hand, the treatment remains limited to a few conventional oral medications (approved by FDA). These are mainly acting superficially from mild to the moderate AD. The therapeutic efficacy of the drug is not only affected by its reduced concentration in the brain owing to the existence of blood-brain-barrier (BBB) but also due to its low brain permeability. In this context, the intranasal (IN) route of drug administration has emerged as an alternative route over the systemic (oral and parenteral) drug delivery to the brain. The delivery of the drug via an IN route offers various advantages over systemic drug delivery system, as it directly delivers the drug into the brain via olfactory route. Presence of drug in the olfactory bulb, in turn, increases the drug bioavailability in the brain and reduces the drug degradation as well as wastage of the drug through` systemic clearance. However, there is also some limitation associated with IN like poor drug permeation through the nasal mucosa and mucociliary clearance. The delivery system various through novel strategies (nano drug carrier system, colloidal carriers, mucoadhesive devices, controlled delivery system, pro-drug, etc.) are adapted to overcome the above-stated limitations. Although, after all, such successful research claims, very few of the nose-to-brain drug delivery of anti-AD drugs have gained market approval due to lack of sufficient clinical evidence. Onzetra Xsail® is one such marketed preparations approved for IN delivery used for the treatment of a brain disorder; migraine. In the field of patents also, no work is found

  6. Clinical applications of brain perfusion imaging with 99mTc-HM-PAO

    International Nuclear Information System (INIS)

    Lin Xiangtong

    1989-01-01

    200 patients with central nervous system diseases were studied with 99m Tc-HM-PAO and SPECT, including Parkinson's disease (PD) 47, Vascular headache 69, CVD 34, Epilepsy 26, Head truma 10, Brain tumor 5 and other 9 cases. Part of them have been compared with the results of MRI, X-CT and EEG. The positivity of SPECT in PD is 61.7% with decrease perfusion in local area of cerebram and basal ganglia and only 4 cases had lower perfusion in cerebellum; in headache is 46.4%, showing variable perfusion patterns; in CVD is 79.4% with decrease perfusion, luxury perfusion and the phenomenon of 'diaschsis'. In epilepsy, the abnormal foci mostly localize in temporal lobe and have close relation to the results of EEG. In brain tumor it also denotes decreased uptake of tracer. The clinicl singnificance of brain perfusion imaging with 99m Tc-HM-PAO was discussed

  7. Clinical applications of brain perfusion imaging with sup 99m Tc-HM-PAO

    Energy Technology Data Exchange (ETDEWEB)

    Xiangtong, Lin [Shanghai Medical Univ. (China). Huashan Hospital; and others

    1989-11-01

    200 patients with central nervous system diseases were studied with {sup 99m}Tc-HM-PAO and SPECT, including Parkinson's disease (PD) 47, Vascular headache 69, CVD 34, Epilepsy 26, Head truma 10, Brain tumor 5 and other 9 cases. Part of them have been compared with the results of MRI, X-CT and EEG. The positivity of SPECT in PD is 61.7% with decrease perfusion in local area of cerebram and basal ganglia and only 4 cases had lower perfusion in cerebellum; in headache is 46.4%, showing variable perfusion patterns; in CVD is 79.4% with decrease perfusion, luxury perfusion and the phenomenon of 'diaschsis'. In epilepsy, the abnormal foci mostly localize in temporal lobe and have close relation to the results of EEG. In brain tumor it also denotes decreased uptake of tracer. The clinicl singnificance of brain perfusion imaging with {sup 99m}Tc-HM-PAO was discussed.

  8. Radionuclide determination of brain blood flow time and its clinical significance

    International Nuclear Information System (INIS)

    Vlakhov, N.; Vylkanov, P.; Kirkov, M.

    1986-01-01

    Brain blood flow time in the two cerebral hemispheres was measured by the method of radioisotope circulography. The radiopharmaceutical used was 131 I-hypuran with activity 3,7 μBq in volume 0,3 ml. Registrations were made with two-channel radiograph GAMMA (Hungary) with external diameter of the colimator 50 mm. Tape speed was 160 mm/min at time costant 10. Patients with neurological and neurosurgical symptoms, as well as a group of normal subjects, were examined. Brain blood flow time varied within the range 5,5-7,5 s for either sex. It was increased in patients with concussion of the brain, epilepsy, atherosclerosis and tumors and shortened in patients with arterio-venous aneurysm. Conclusion is made that the diagnosis value of the method is high, it is practicable with no radiation load and furnisches reliable information on the effectiveness of surgical or drug treatment

  9. Swift Acetate Glial Assay (SAGA): an accelerated human ¹³C MRS brain exam for clinical diagnostic use.

    Science.gov (United States)

    Sailasuta, Napapon; Tran, Thao T; Harris, Kent C; Ross, B D

    2010-12-01

    We demonstrate a robust procedure for the quantitative characterization of glial metabolism in human brain. In the past, the slope of the uptake and production of enriched label at steady state were used to determine metabolic rates, requiring the patient to be in the magnet for 120-160 min. In the present method, (13)C cerebral metabolite profiles were acquired at steady state alone on a routine clinical MR scanner in 25.6 min. Results obtained from the new short method (SAGA) were comparable to those achieved in a conventional, long method and effective for determination of glial metabolic rate in posterior-parietal and frontal brain regions. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: A longitudinal study

    DEFF Research Database (Denmark)

    Sidaros, A.; Engberg, A.W.; Sidaros, K.

    2008-01-01

    of longitudinal studies on TBI that follow DTI changes over time and correlate findings with long-term clinical outcome. We performed a prospective longitudinal study of 30 adult patients admitted for subacute rehabilitation following severe traumatic brain injury. DTI and conventional MRI were acquired at mean 8......Diffusion tensor imaging (DTI) has been proposed as a sensitive biomarker of traumatic white matter injury, which could potentially serve as a tool for prognostic assessment and for studying microstructural changes during recovery from traumatic brain injury (TBI). However, there is a lack...... weeks (5-11 weeks), and repeated in 23 of the patients at mean 12 months (9-15 months) post-trauma. Using a region-of-interest-based approach, DTI parameters were compared to those of healthy matched controls, scanned during the same time period and rescanned with a similar interval as that of patients...

  11. Radiosurgery with flattening-filter-free techniques in the treatment of brain metastases. Plan comparison and early clinical evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Rieber, J.; Tonndorf-Martini, E.; Schramm, O.; Rhein, B.; Stefanowicz, S.; Lindel, K.; Debus, J.; Rieken, S. [University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Heidelberg Institute of Radiation Oncology, Heidelberg (Germany); Kappes, J. [Heidelberg University, Translational Research Unit, Thoraxklinik, Heidelberg (Germany); Heidelberg University, Department of Pneumology, Thoraxklinik, Heidelberg (Germany); Member of the German Centre for Lung Research (DZL), Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (Germany); Hoffmann, H. [Heidelberg University, Translational Research Unit, Thoraxklinik, Heidelberg (Germany); Heidelberg University, Department of Thoracic Surgery, Thoraxklinik, Heidelberg (Germany); Member of the German Centre for Lung Research (DZL), Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg (Germany)

    2016-11-15

    Radiosurgical treatment of brain metastases is well established in daily clinical routine. Utilization of flattening-filter-free beams (FFF) may allow for more rapid delivery of treatment doses and improve clinical comfort. Hence, we compared plan quality and efficiency of radiosurgery in FFF mode to FF techniques. Between November 2014 and June 2015, 21 consecutive patients with 25 brain metastases were treated with stereotactic radiosurgery (SRS) in FFF mode. Brain metastases received dose-fractionation schedules of 1 x 20 Gy or 1 x 18 Gy, delivered to the conformally enclosing 80 % isodose. Three patients with critically localized or large (>3 cm) brain metastases were treated with 6 x 5 Gy. Plan quality and efficiency were evaluated by analyzing conformity, dose gradients, dose to healthy brain tissue, treatment delivery time, and number of monitor units. FFF plans were compared to those using the FF method, and early clinical outcome and toxicity were assessed. FFF mode resulted in significant reductions in beam-on time (p < 0.001) and mean brain dose (p = 0.001) relative to FF-mode comparison plans. Furthermore, significant improvements in dose gradients and sharper dose falloffs were found for SRS in FFF mode (-1.1 %, -29.6 %; p ≤ 0.003), but conformity was slightly superior in SRS in FF mode (-1.3 %; p = 0.001). With a median follow-up time of 5.1 months, 6-month overall survival was 63.3 %. Local control was observed in 24 of 25 brain metastases (96 %). SRS in FFF mode is time efficient and provides similar plan quality with the opportunity of slightly reduced dose exposure to healthy brain tissue when compared to SRS in FF mode. Clinical outcomes appear promising and show only modest treatment-related toxicity. (orig.) [German] Die radiochirurgische Behandlung (SRS) von Hirnmetastasen wird vielfach in der klinischen Routine durchgefuehrt. Die zusaetzliche Anwendung von ausgleichsfilterfreien Bestrahlungstechniken (FFF) kann die Bestrahlungszeit

  12. Clinical studies of brain functional images by motor activation using single photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kawaguchi, Masahiro [Gifu Univ. (Japan). School of Medicine

    1998-09-01

    Thirty participants (10 normal controls; group A, 5 patients with brain tumors located near central sulcus without hemiparesis; group B, 10 patients with brain tumors located near central sulcus with hemiparesis; group C, and 5 patients with brain tumors besides the central regions with hemiparesis; group D) were enrolled. The images were performed by means of split-dose method with {sup 99m}Tc-ECD at rest condition (SPECT 1) and during hand grasping (SPECT 2). The activation SPECT were obtained by subtracting SPECT 1 from SPECT 2, and the functional mapping was made by the strict registration of the activation SPECT with 3D MRI. To evaluate the changes of CBF (%{Delta}CBF) of the sensorimotor and supplementary motor areas on the functional mapping, ratio of the average counts of SPECT 1 and SPECT 2 was calculated and statistically compared. The functional activation paradigms caused a significant increase of CBF in the sensorimotor area contra-lateral to the stimulated hand, although the sensorimotor area and the central sulcus in groups B and C were dislocated, compared with hemisphere of non-tumor side. The sensorimotor area ipsi-lateral to the stimulated hand could be detected in almost of all subjects. The supplementary motor area could be detected in all subjects. In group A, the average %{Delta}CBF were up 24.1{+-}4.3% in the contra-lateral sensorimotor area, and 22.3{+-}3.6% in the supplementary motor area, respectively. The average %{Delta}CBF in the contra-lateral sensorimotor area of group D was significantly higher than that of group A. The brain functional mapping by motor activation using SPECT could localize the area of cortical motor function in normal volunteers and patients with brain tumors. The changes of regional CBF by activation SPECT precisely assess the cortical motor function even in patients with brain tumors located near central sulcus. (K.H.)

  13. Clinical studies of brain functional images by motor activation using single photon emission computed tomography

    International Nuclear Information System (INIS)

    Kawaguchi, Masahiro

    1998-01-01

    Thirty participants (10 normal controls; group A, 5 patients with brain tumors located near central sulcus without hemiparesis; group B, 10 patients with brain tumors located near central sulcus with hemiparesis; group C, and 5 patients with brain tumors besides the central regions with hemiparesis; group D) were enrolled. The images were performed by means of split-dose method with 99m Tc-ECD at rest condition (SPECT 1) and during hand grasping (SPECT 2). The activation SPECT were obtained by subtracting SPECT 1 from SPECT 2, and the functional mapping was made by the strict registration of the activation SPECT with 3D MRI. To evaluate the changes of CBF (%ΔCBF) of the sensorimotor and supplementary motor areas on the functional mapping, ratio of the average counts of SPECT 1 and SPECT 2 was calculated and statistically compared. The functional activation paradigms caused a significant increase of CBF in the sensorimotor area contra-lateral to the stimulated hand, although the sensorimotor area and the central sulcus in groups B and C were dislocated, compared with hemisphere of non-tumor side. The sensorimotor area ipsi-lateral to the stimulated hand could be detected in almost of all subjects. The supplementary motor area could be detected in all subjects. In group A, the average %ΔCBF were up 24.1±4.3% in the contra-lateral sensorimotor area, and 22.3±3.6% in the supplementary motor area, respectively. The average %ΔCBF in the contra-lateral sensorimotor area of group D was significantly higher than that of group A. The brain functional mapping by motor activation using SPECT could localize the area of cortical motor function in normal volunteers and patients with brain tumors. The changes of regional CBF by activation SPECT precisely assess the cortical motor function even in patients with brain tumors located near central sulcus. (K.H.)

  14. Clinical usefulness of scatter and attenuation correction for brain single photon emission computed tomography (SPECT) in pediatrics

    International Nuclear Information System (INIS)

    Adachi, Itaru; Doi, Kenji; Komori, Tsuyoshi; Hou, Nobuyoshi; Tabuchi, Koujirou; Matsui, Ritsuo; Sueyoshi, Kouzou; Utsunomiya, Keita; Narabayashi, Isamu

    1998-01-01

    This investigation was undertaken to study clinical usefulness of scatter and attenuation correction (SAC) of brain SPECT in infants to compare the standard reconstruction (STD). The brain SPECT was performed in 31 patients with 19 epilepsy, 5 cerebro-vascular disease, 2 brain tumor, 3 meningitis, 1 hydrocephalus and psychosis (mean age 5.0±4.9 years old). Many patients was necessary to be injected sedatives for restraining body motion after Technetium-99m hexamethylpropylene amine oxime ( 99m Tc-HMPAO) was injected at the convulsion or rest. Brain SPECT data were acquired with triple detector gamma camera (GCA-9300 Toshiba Japan). These data were reconstructed by filtered backprojection after the raw data were corrected by triple energy windows method of scatter correction and Chang filtered method of attenuation correction. The same data was reconstructed by filtered backprojection without these corrections. Both SAC and STD SPECT images were analyzed by the visual interpretation. The uptake ratio of cerebral basal nuclei was calculated by the counts of the thalamus or lenticular nuclei divided by the cortex. All images of SAC method were excellent than that of STD method. The thalamic uptake ratio in SAC method was higher than that of STD method (1.22±0.09>0.87±0.22 p 1.02±0.16 p<0.01). Transmission scan is the most suitable method of absorption correction. But the transmission scan is not adequate for examination of children, because this scan needs a lot of time and the infants are exposed by the line source radioisotope. It was concluded that these scatter and absorption corrections were most suitable method for brain SPECT in pediatrics. (author)

  15. A cross-sectional MRI study of brain regional atrophy and clinical characteristics of temporal lobe epilepsy with hippocampal sclerosis.

    LENUS (Irish Health Repository)

    2012-02-01

    PURPOSE: Applying a cross-sectional design, we set out to further characterize the significance of extrahippocampal brain atrophy in a large sample of \\'sporadic\\' mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE+HS). By evaluating the influence of epilepsy chronicity on structural atrophy, this work represents an important step towards the characterization of MRI-based volumetric measurements as genetic endophenotypes for this condition. METHODS: Using an automated brain segmentation technique, MRI-based volume measurements of several brain regions were compared between 75 patients with \\'sporadic\\' MTLE+HS and 50 healthy controls. Applying linear regression models, we examined the relationship between structural atrophy and important clinical features of MTLE+HS, including disease duration, lifetime number of partial and generalized seizures, and history of initial precipitating insults (IPIs). RESULTS: Significant volume loss was detected in ipsilateral hippocampus, amygdala, thalamus, and cerebral white matter (WM). In addition, contralateral hippocampal and bilateral cerebellar grey matter (GM) volume loss was observed in left MTLE+HS patients. Hippocampal, amygdalar, and cerebral WM volume loss correlated with duration of epilepsy. This correlation was stronger in patients with prior IPIs history. Further, cerebral WM, cerebellar GM, and contralateral hippocampal volume loss correlated with lifetime number of generalized seizures. CONCLUSION: Our findings confirm that multiple brain regions beyond the hippocampus are involved in the pathogenesis of MTLE+HS. IPIs are an important factor influencing the rate of regional atrophy but our results also support a role for processes related to epilepsy chronicity. The consequence of epilepsy chronicity on candidate brain regions has important implications on their application as genetic endophenotypes.

  16. Clinical usefulness of scatter and attenuation correction for brain single photon emission computed tomography (SPECT) in pediatrics

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Itaru; Doi, Kenji; Komori, Tsuyoshi; Hou, Nobuyoshi; Tabuchi, Koujirou; Matsui, Ritsuo; Sueyoshi, Kouzou; Utsunomiya, Keita; Narabayashi, Isamu [Osaka Medical Coll., Takatsuki (Japan)

    1998-01-01

    This investigation was undertaken to study clinical usefulness of scatter and attenuation correction (SAC) of brain SPECT in infants to compare the standard reconstruction (STD). The brain SPECT was performed in 31 patients with 19 epilepsy, 5 cerebro-vascular disease, 2 brain tumor, 3 meningitis, 1 hydrocephalus and psychosis (mean age 5.0{+-}4.9 years old). Many patients was necessary to be injected sedatives for restraining body motion after Technetium-99m hexamethylpropylene amine oxime ({sup 99m}Tc-HMPAO) was injected at the convulsion or rest. Brain SPECT data were acquired with triple detector gamma camera (GCA-9300 Toshiba Japan). These data were reconstructed by filtered backprojection after the raw data were corrected by triple energy windows method of scatter correction and Chang filtered method of attenuation correction. The same data was reconstructed by filtered backprojection without these corrections. Both SAC and STD SPECT images were analyzed by the visual interpretation. The uptake ratio of cerebral basal nuclei was calculated by the counts of the thalamus or lenticular nuclei divided by the cortex. All images of SAC method were excellent than that of STD method. The thalamic uptake ratio in SAC method was higher than that of STD method (1.22{+-}0.09>0.87{+-}0.22 p<0.01). The lenticular nuclear uptake ratio in SAC method was higher than that of STD method (1.26{+-}0.15>1.02{+-}0.16 p<0.01). Transmission scan is the most suitable method of absorption correction. But the transmission scan is not adequate for examination of children, because this scan needs a lot of time and the infants are exposed by the line source radioisotope. It was concluded that these scatter and absorption corrections were most suitable method for brain SPECT in pediatrics. (author)

  17. Clinically-Important Brain Injury and CT Findings in Pediatric Mild Traumatic Brain Injuries: A Prospective Study in a Chinese Reference Hospital

    Directory of Open Access Journals (Sweden)

    Huiping Zhu

    2014-03-01

    Full Text Available This study investigated injury patterns and the use of computed tomography (CT among Chinese children with mild traumatic brain injury (MTBI. We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%, and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8. Falls were the leading cause of MTBI (61.5%, followed by blows (18.9% and traffic collisions (14.1% for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China.

  18. Smoking trends amongst young doctors of a tertiary care hospital - Mayo Hospital, Lahore - Pakistan

    International Nuclear Information System (INIS)

    Chudhary, M.K.; Younis, M.; Bukhari, M.H.

    2011-01-01

    The World Health Organization cites tobacco use as one of the biggest public health threats the world has ever faced. Tobacco is the number one preventable cause of disability and death. Tobacco has many negative health effects which many of the smokers know them well. In Pakistan tobacco use is common in general public and the health professionals don't lack behind this habit. To study the smoking trends amongst young doctors of Mayo Hospital. Questionnaire based descriptive study. This study was conducted at the Institute of Chest Medicine, Mayo Hospital - A tertiary care hospital affiliated with King Edward Medical University, Lahore. Out of 250 doctors, 180 (72%) were males and 70 (28%) were female. Amongst 180 male doctors 97 (53.88%) were smokers and 83 (46.21%) were non smokers. Amongst 70 female doctors 8 (11.43%) were smokers and 62 (88.57%) were non smokers. Smoking is common among male young doctors but it is less common in female doctors. (author)

  19. Systematic review of the clinical course, natural history, and prognosis for pediatric mild traumatic brain injury

    DEFF Research Database (Denmark)

    Hung, Ryan; Carroll, Linda J; Cancelliere, Carol

    2014-01-01

    OBJECTIVE: To synthesize the best available evidence on prognosis after pediatric mild traumatic brain injury (MTBI). DATA SOURCES: We searched MEDLINE, Embase, PsycINFO, CINAHL, and SPORTDiscus (2001-2012), as well as reference lists of eligible articles, and relevant systematic reviews and meta...

  20. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV : deep brain stimulation

    NARCIS (Netherlands)

    Mueller-Vahl, Kirsten R.; Cath, Danielle C.; Cavanna, Andrea E.; Dehning, Sandra; Porta, Mauro; Robertson, Mary M.; Visser-Vandewalle, Veerle

    Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette

  1. Amphetamines and pH-shift agents for brain imaging: Basic research and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Biersack, H.J.; Winkler, C.

    1986-01-01

    This book contains 18 selections. Some of the titles are: Labelling of amphetamines with /sup 123/I: Receptors for amphetamines; New amphetamine derivatives; Potential new approaches for the development of brain imaging agents for single-photon applications; and IM SPECT with the pinhole collimator.

  2. Repair of neonatal brain injury : bringing stem cell-based therapy into clinical practice

    NARCIS (Netherlands)

    Wagenaar, Nienke; Nijboer, Cora H.; van Bel, Frank

    2017-01-01

    Hypoxic-ischaemic brain injury is one of most important causes of neonatal mortality and long-term neurological morbidity in infants born at term. At present, only hypothermia in infants with perinatal hypoxic-ischaemic encephalopathy has shown benefit as a neuroprotective strategy. Otherwise,

  3. The structure of brain glycogen phosphorylase-from allosteric regulation mechanisms to clinical perspectives.

    Science.gov (United States)

    Mathieu, Cécile; Dupret, Jean-Marie; Rodrigues Lima, Fernando

    2017-02-01

    Glycogen phosphorylase (GP) is the key enzyme that regulates glycogen mobilization in cells. GP is a complex allosteric enzyme that comprises a family of three isozymes: muscle GP (mGP), liver GP (lGP), and brain GP (bGP). Although the three isozymes display high similarity and catalyze the same reaction, they differ in their sensitivity to the allosteric activator adenosine monophosphate (AMP). Moreover, inactivating mutations in mGP and lGP have been known to be associated with glycogen storage diseases (McArdle and Hers disease, respectively). The determination, decades ago, of the structure of mGP and lGP have allowed to better understand the allosteric regulation of these two isoforms and the development of specific inhibitors. Despite its important role in brain glycogen metabolism, the structure of the brain GP had remained elusive. Here, we provide an overview of the human brain GP structure and its relationship with the two other members of this key family of the metabolic enzymes. We also summarize how this structure provides valuable information to understand the regulation of bGP and to design specific ligands of potential pharmacological interest. © 2016 Federation of European Biochemical Societies.

  4. Metabolomic approach to human brain spectroscopy identifies associations between clinical features and the frontal lobe metabolome in multiple sclerosis

    Science.gov (United States)

    Vingara, Lisa K.; Yu, Hui Jing; Wagshul, Mark E.; Serafin, Dana; Christodoulou, Christopher; Pelczer, István; Krupp, Lauren B.; Maletić-Savatić, Mirjana

    2013-01-01

    Proton magnetic resonance spectroscopy (1H-MRS) is capable of noninvasively detecting metabolic changes that occur in the brain tissue in vivo. Its clinical utility has been limited so far, however, by analytic methods that focus on independently evaluated metabolites and require prior knowledge about which metabolites to examine. Here, we applied advanced computational methodologies from the field of metabolomics, specifically partial least squares discriminant analysis and orthogonal partial least squares, to in vivo 1H-MRS from frontal lobe white matter of 27 patients with relapsing–remitting multiple sclerosis (RRMS) and 14 healthy controls. We chose RRMS, a chronic demyelinating disorder of the central nervous system, because its complex pathology and variable disease course make the need for reliable biomarkers of disease progression more pressing. We show that in vivo MRS data, when analyzed by multivariate statistical methods, can provide reliable, distinct profiles of MRS-detectable metabolites in different patient populations. Specifically, we find that brain tissue in RRMS patients deviates significantly in its metabolic profile from that of healthy controls, even though it appears normal by standard MRI techniques. We also identify, using statistical means, the metabolic signatures of certain clinical features common in RRMS, such as disability score, cognitive impairments, and response to stress. This approach to human in vivo MRS data should promote understanding of the specific metabolic changes accompanying disease pathogenesis, and could provide biomarkers of disease progression that would be useful in clinical trials. PMID:23751863

  5. Sex differences in the clinical characteristics and brain gray matter volume alterations in unmedicated patients with major depressive disorder.

    Science.gov (United States)

    Yang, Xiao; Peng, Zugui; Ma, Xiaojuan; Meng, Yajing; Li, Mingli; Zhang, Jian; Song, Xiuliu; Liu, Ye; Fan, Huanhuan; Zhao, Liansheng; Deng, Wei; Li, Tao; Ma, Xiaohong

    2017-05-30

    This study was to explore the sex differences in clinical characteristics and brain gray matter volume (GMV) alterations in 29 male patients with major depressive disorder (MDDm), 53 female patients with MDD (MDDf), and in 29 male and 53 female matched healthy controls. Maps of GMV were constructed using magnetic resonance imaging data and compared between groups. We evaluated clinical symptoms using the Hamilton Rating Scale for Depression and obtained a total score and five syndrome scores. A two-factor ANCOVA model was specified using SPM8, with sex and diagnosis as the between-subject factors. We found that: (1) significant GMV increase in the left cerebellum and GMV reduction in the bilateral middle temporal gyrus and left ventral medial prefrontal gyrus occurred selectively in male patients, while the GMV reduction in the left lingual gyrus and dorsal medial prefrontal gyrus occurred selectively in female patients; (2) MDDf may have experienced more severe sleep disturbance than MDDm; and (3) the severity of sleep symptom could be predicted by the sex specific brain structural alterations in depressions. These findings suggest that sex specific anatomical alterations existed in MDD, and these alterations were associated with the clinical symptoms.

  6. A meta-analysis of changes in brain activity in clinical depression

    Directory of Open Access Journals (Sweden)

    Susan Mary Palmer

    2015-01-01

    Full Text Available Insights into neurobiological mechanisms of depression are increasingly being sought via brain imaging studies. Our aim was to quantitatively summarize overlap and divergence in regions of altered brain activation associated with depression under emotionally-valenced compared to cognitively-demanding task conditions, with reference to intrinsic functional connectivity. We hypothesized differences reflective of task demands. A coordinate-based meta-analysis technique, Activation Likelihood Estimation (ALE, was used to analyze relevant imaging literature. These studies compared brain activity in depressed adults relative to healthy controls during three conditions: (i emotionally-valenced (cognitively easy tasks (n=29; (ii cognitively-demanding tasks (n=15; and (iii resting conditions (n=21.The meta-analyses identified 5, 8 and 7 significant clusters of altered brain activity under emotion, cognition and resting conditions respectively in depressed individuals compared to healthy controls. Regions of overlap and divergence between pairs of the three separate meta-analyses were quantified. There were no significant regions of overlap between emotion and cognition meta-analyses, but several divergent clusters were found. Cognitively-demanding conditions were associated with greater activation of right medial frontal and insula regions while bilateral amygdala was more significantly altered during emotion (cognitively-undemanding conditions; consistent with task demands.Overlap was present in left amygdala and right subcallosal cingulate between emotion and resting meta-analyses, with no significant divergence.Our meta-analyses highlight alteration of common brain regions, during cognitively-undemanding emotional tasks and resting conditions but divergence of regions between emotional and cognitively-demanding tasks. Regions altered reflect current biological and system-level models of depression and highlight the relationship with task condition and

  7. Visual and SPM Analysis of Brain Perfusion SPECT in Patients of Dementia with Lewy Bodies with Clinical Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Do Young; Park, Kyung Won; Kim, Jae Woo [College of Medicine, Univ. of Donga, Busan (Korea, Republic of)

    2003-07-01

    Dementia with Lewy bodies (DLB) is widely recognized as the second commonest form of degenerative dementia. Its core clinical features include persistent visual hallucinosis, fluctuating cognitive impairment and parkinsonism. We evaluated the brain perfusion of dementia with Lewy bodies by SPM analysis and correlated the findings with clinical symptom. Twelve DLB patients (mean age ; 68.88.3 yrs, K-MMSE ; 17.36) and 30 control subjects (mean age ; 60.17.7 yrs) were included. Control subjects were selected by 28 items of exclusion criteria and checked by brain CT or MRI except 3 subjects. Tc-99m HMPAO brain perfusion SPECT was performed and the image data were analyzed by visual interpretation and SPM99 as routine protocol. In visual analysis, 7 patients showed hypoperfusion in both frontal, temporal, parietal and occipital lobe, 2 patients in both frontal, temporal and parietal lobe, 2 patients in both temporal, parietal and occipital lobe, 1 patients in left temporal, parietal and occipital lobe. In SPM analysis (uncorrected p<0.01), significant hypoperfusion was shown in Lt inf. frontal gyrus (B no.47), both inf. parietal lobule (Rt B no.40), Rt parietal lobe (precuneus), both sup. temporal gyrus (Rt B no.42), Rt mid temporal gyrus, Lt transverse temporal gyrus (B no.41), both para hippocampal gyrus, Rt thalamus (pulvinar), both cingulate gyrus (Lt B no.24, Lt B no.25, Rt B no.23, Rt B no.24, Rt B no.33), Rt caudate body, both occipital lobe (cuneus, Lt B no.17, Rt B no.18). All patients had fluctuating cognition and parkinsonism, and 9 patients had visual hallucination. The result of SPM analysis was well correlated with visual interpretation and may be helpful to specify location to correlate with clinical symptom. Significant perfusion deficits in occipital region including visual cortex and visual association area are characteristic findings in DLB. Abnormalities in these areas may be important in understanding symptoms of visual hallucination and

  8. Visual and SPM Analysis of Brain Perfusion SPECT in Patients of Dementia with Lewy Bodies with Clinical Correlation

    International Nuclear Information System (INIS)

    Kang, Do Young; Park, Kyung Won; Kim, Jae Woo

    2003-01-01

    Dementia with Lewy bodies (DLB) is widely recognized as the second commonest form of degenerative dementia. Its core clinical features include persistent visual hallucinosis, fluctuating cognitive impairment and parkinsonism. We evaluated the brain perfusion of dementia with Lewy bodies by SPM analysis and correlated the findings with clinical symptom. Twelve DLB patients (mean age ; 68.88.3 yrs, K-MMSE ; 17.36) and 30 control subjects (mean age ; 60.17.7 yrs) were included. Control subjects were selected by 28 items of exclusion criteria and checked by brain CT or MRI except 3 subjects. Tc-99m HMPAO brain perfusion SPECT was performed and the image data were analyzed by visual interpretation and SPM99 as routine protocol. In visual analysis, 7 patients showed hypoperfusion in both frontal, temporal, parietal and occipital lobe, 2 patients in both frontal, temporal and parietal lobe, 2 patients in both temporal, parietal and occipital lobe, 1 patients in left temporal, parietal and occipital lobe. In SPM analysis (uncorrected p<0.01), significant hypoperfusion was shown in Lt inf. frontal gyrus (B no.47), both inf. parietal lobule (Rt B no.40), Rt parietal lobe (precuneus), both sup. temporal gyrus (Rt B no.42), Rt mid temporal gyrus, Lt transverse temporal gyrus (B no.41), both para hippocampal gyrus, Rt thalamus (pulvinar), both cingulate gyrus (Lt B no.24, Lt B no.25, Rt B no.23, Rt B no.24, Rt B no.33), Rt caudate body, both occipital lobe (cuneus, Lt B no.17, Rt B no.18). All patients had fluctuating cognition and parkinsonism, and 9 patients had visual hallucination. The result of SPM analysis was well correlated with visual interpretation and may be helpful to specify location to correlate with clinical symptom. Significant perfusion deficits in occipital region including visual cortex and visual association area are characteristic findings in DLB. Abnormalities in these areas may be important in understanding symptoms of visual hallucination and

  9. Correlative study of the brain CT and clinical features of patients with Down's syndrome in three clinical stages of Alzheimer type dementia

    International Nuclear Information System (INIS)

    Maruyama, Keiko; Ikeda, Shu-ichi; Yanagisawa, Nobuo.

    1995-01-01

    Patients with Down's syndrome often develop Alzheimer type neuropathological changes as well as dementia of the Alzheimer type after the age of 40. We studied brain CT findings in relation to three clinical stages of Alzheimer type dementia in 11 patients with Down's syndrome aged from 17 to 55 years. In addition, 123 I-IMP-SPECT was studied in 4 of these patients. Dementia of the Alzheimer type was present in 9 patients; 5 patients were in the early stage, 2 were in the progressive stage, and the other 2 were in the end stage. The earliest CT finding was enlargement of the suprasellar cistern, which indicated atrophy of the medial temporal lobe including the hippocampus and amygdala. This finding was not present in non-demented individuals with Down's syndrome. Moreover, CT scans showed that brain atrophy progressed to the temporal, frontal lobe, and then generalized cerebral cortices, which correlated clinically with the severity of dementia. Studies of 123 I-IMP-SPECT in two patients with mild dementia revealed abnormally decreased isotope uptake in the temporal and posterior parietal regions. We suggest to measure the size of the suprasellar cistern in CT and SPECT scans for early detection and diagnosis of mild dementia of the Alzheimer type in patients with Down's syndrome. (author)

  10. Application of machine learning classification for structural brain MRI in mood disorders: Critical review from a clinical perspective.

    Science.gov (United States)

    Kim, Yong-Ku; Na, Kyoung-Sae

    2018-01-03

    Mood disorders are a highly prevalent group of mental disorders causing substantial socioeconomic burden. There are various methodological approaches for identifying the underlying mechanisms of the etiology, symptomatology, and therapeutics of mood disorders; however, neuroimaging studies have provided the most direct evidence for mood disorder neural substrates by visualizing the brains of living individuals. The prefrontal cortex, hippocampus, amygdala, thalamus, ventral striatum, and corpus callosum are associated with depression and bipolar disorder. Identifying the distinct and common contributions of these anatomical regions to depression and bipolar disorder have broadened and deepened our understanding of mood disorders. However, the extent to which neuroimaging research findings contribute to clinical practice in the real-world setting is unclear. As traditional or non-machine learning MRI studies have analyzed group-level differences, it is not possible to directly translate findings from research to clinical practice; the knowledge gained pertains to the disorder, but not to individuals. On the other hand, a machine learning approach makes it possible to provide individual-level classifications. For the past two decades, many studies have reported on the classification accuracy of machine learning-based neuroimaging studies from the perspective of diagnosis and treatment response. However, for the application of a machine learning-based brain MRI approach in real world clinical settings, several major issues should be considered. Secondary changes due to illness duration and medication, clinical subtypes and heterogeneity, comorbidities, and cost-effectiveness restrict the generalization of the current machine learning findings. Sophisticated classification of clinical and diagnostic subtypes is needed. Additionally, as the approach is inevitably limited by sample size, multi-site participation and data-sharing are needed in the future. Copyright

  11. Complex treatment of primary brain neuroblastoma with four local recurrences for period of 5 years -clinical case from our practice

    International Nuclear Information System (INIS)

    Marinova, L.; Georgiev, R.; Mihaylova, I.; Belcheva, M.

    2017-01-01

    We present a clinical case of 17 years old girl with primary brain neuroblastoma (supratentorial primitive neuro-ectodermal tumor - PNET in right temporo-parietal brain region). Complex treatment has been applied, including subtotal operation, standard fractioned cranio-spinal external beam radiotherapy with boost up to 56 Gy in the locus of the tumor remnant and 6 courses of adjuvant chemotherapy with Carboplatin and Etoposide. Despite the applied local treatment methods (radical surgery, standard fractioned cranio-spinal external beam radiotherapy and radio-surgery with single total dose of 14 Gy), four recurrences have appeared for period of 5 years in the locus of the primary tumor. The risk of appearance of local recurrences, necessitating re-operations, chemotherapy, bone marrow transplantation of stem cells and radio-surgery was discussed. We are also discussing the radio sensitivity of the PNET and the possibilities for overcoming it with implementation of hyper fractioned cranio-spinal external beam radiotherapy in combination with chemotherapy, followed by bone marrow transplantation of stem cells. Key words: Primary Brain Neuroblastoma. Radio Sensitivity. Cranio-Spinal External Beam Radiotherapy. Adjuvant Chemotherapy [bg

  12. Clinical use of gold-195m in evaluation of brain perfusion

    International Nuclear Information System (INIS)

    Bourgeois, P.; Erbsmann, F.; Hebbelinck, D.; De Maertelaere, P.; Fruehling, J.

    1985-01-01

    With a Byk-Mallinckrodt /sup 195m/Au generator, brain-perfusion studies in multiple incidences or in tomoscintigraphic mode were visualized in 22 patients. Of these, 17 were referred for investigation of cerebrovascular diseases and four for search for brain metastasis. One patient was normal. All these investigations were completed by a dynamic and static classic tomoscintigraphic study by using /sup 99m/Tc glucoheptonate or DTPA. Data obtained have been compared to other investigation methods, such as X-ray arteriography, Doppler echography, and X-ray computed tomography. Dynamic, as well as morphological, data concerning arteries appeared to be equivalent to those furnished by the /sup 99m/Tc classical studies. The main contribution of these /sup 195m/Au investigations, however, which appeared at the tomoscintigraphic level was the clear delineation of the main vessels involving not only the carotids but also the vertebral and, to a lesser extent, the intracerebral arteries

  13. Axial CT of the brain compared with other clinical methods of examination in neuropaediatry

    International Nuclear Information System (INIS)

    Miller, E.

    1979-01-01

    CT of the neurocranium and EEC were carried out in 53 children aged 10 weeks to 15.5 years. In most of the children, also plain-film X-rays of the skull, echoencephalography, scintiscans of the brain, cerebral angiography and, in a few cases, pneumoencephalography were carried out. The methods of examination were comparatively evaluated for neoplastic, inflammatory, congenital and degenerative diseases and cerebral attacks. (APR) [de

  14. Functional diffusion map: A noninvasive MRI biomarker for early stratification of clinical brain tumor response

    OpenAIRE

    Moffat, Bradford A.; Chenevert, Thomas L.; Lawrence, Theodore S.; Meyer, Charles R.; Johnson, Timothy D.; Dong, Qian; Tsien, Christina; Mukherji, Suresh; Quint, Douglas J.; Gebarski, Stephen S.; Robertson, Patricia L.; Junck, Larry R.; Rehemtulla, Alnawaz; Ross, Brian D.

    2005-01-01

    Assessment of radiation and chemotherapy efficacy for brain cancer patients is traditionally accomplished by measuring changes in tumor size several months after therapy has been administered. The ability to use noninvasive imaging during the early stages of fractionated therapy to determine whether a particular treatment will be effective would provide an opportunity to optimize individual patient management and avoid unnecessary systemic toxicity, expense, and treatment delays. We investiga...

  15. Neuronavigation in brain tumor surgery:clinical beta-phase of the Oulu Neuronavigator System

    OpenAIRE

    Schiffbauer, H. (Hagen)

    1999-01-01

    Abstract Interactive image-guided neurosurgery for the resection of brain tumors was developed within the last 10 years at different neurosurgical centers around the world to improve the safety of the surgery and the functional outcome of the patients. Since 1987, the Oulu Neuronavigator System, consisting mainly of a mechanical arm, visualization software, an ultrasound transducer and a computer, was developed at the Neurosurgical Research Unit, University of Oulu, Finland. It was the fir...

  16. Clinical application of fiber tracking technique for neuronavigation in brain tumor surgery

    International Nuclear Information System (INIS)

    Kamada, Kyousuke; Aoki, Shigeki; Masutani, Yoshitaka; Ino, Kenji; Todo, Tomoki; Kawai, Kensuke; Ota, Takahiro; Saito, Nobuhito

    2007-01-01

    Preserving brain functions while maximizing tumor resection is the basic strategy to prolong survival of patients with brain tumors while maintaining their quality of life. In order for better preoperative planning and direct application to intraoperative procedures, we achieved accurate co-registration of diffusion tensor imaging (DTI) -based tractography and anatomical MRI, and imported the combined images to a neuronavigation system (functional neuronavigation). Forty patients with brain lesions adjacent to the corticospinal tract (CST; n=32) and optic radiation (OR; n=8) were studied. During surgery, direct fiber stimulation was used to evoke the motor responses to confirm the accuracy of CST depicted on the functional neuronavigation. Cortical visual evoked potentials (VEPs) with flash stimulation were continuously monitored. In 25 patients, stimulation of the supposed CST led to elicitation of expected motor-evoked potentials. In the seven, stimulation at resection borders more than 1.5 cm apart from the supposed CST showed no motor responses. When the resection reached the OR on the functional neuronavigation, the cortical VEP suddenly diminished in two of 8 patients. Integration of DTI-based tractography information into a traditional neuronavigation system allowed demonstration of spatial relationships between lesions and the CST, leading to avoidance of tract injury during lesion resection. (author)

  17. Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design.

    Science.gov (United States)

    Lipsman, Nir; Giacobbe, Peter; Bernstein, Mark; Lozano, Andres M

    2012-02-01

    Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatric context, with its use currently limited to clinical trials and investigative studies. The combination of a patient population at the limits of conventional therapy and a novel technology in a new indication poses interesting challenges to the informed consent process as it relates to clinical trial enrollment. These challenges can be divided into those that relate to the patient, their disease and the technology, with each illustrating how traditional conceptualisations of research consent may be inadequate in the surgical psychiatry context. With specific reference to risk analysis, patient autonomy, voluntariness and the duty of the clinician-researcher, this paper will discuss the unique challenges that clinical trials of surgery for refractory psychiatric disease present to the consent process. Recommendations are also made for an ethical approach to clinical trial consent acquisition in this unique patient population.

  18. Amide proton transfer imaging in clinics: Basic concepts and current and future use in brain tumors and stoke

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Eun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Jahng, Geon Ho [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Jeong, Ha Kyu [Philips Korea, Seoul (Korea, Republic of)

    2016-12-15

    Amide proton transfer (APT) imaging is gaining attention as a relatively new in vivo molecular imaging technique that has higher sensitivity and spatial resolution than magnetic resonance spectroscopy imaging. APT imaging is a subset of the chemical exchange saturation transfer mechanism, which can offer unique image contrast by selectively saturating protons in target molecules that get exchanged with protons in bulk water. In this review, we describe the basic concepts of APT imaging, particularly with regard to the benefit in clinics from the current literature. Clinical applications of APT imaging are described from two perspectives: in the diagnosis and monitoring of the treatment response in brain glioma by reflecting endogenous mobile proteins and peptides, and in the potential for stroke imaging with respect to tissue acidity.

  19. Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms

    Directory of Open Access Journals (Sweden)

    Lisa eBrenner

    2012-03-01

    Full Text Available Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic, behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI and/or post traumatic stress disorder (PTSD. Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast TBI can be used to facilitate the development of clinically relevant blast models.

  20. Severity of clinical presentation in youth with type 1 diabetes is associated with differences in brain structure.

    Science.gov (United States)

    Siller, Alejandro F; Lugar, Heather; Rutlin, Jerrel; Koller, Jonathan M; Semenkovich, Katherine; White, Neil H; Arbelaez, Ana Maria; Shimony, Joshua; Hershey, Tamara

    2017-12-01

    Differences in cognition and brain structure have been found in youth with type 1 diabetes compared with controls, even after relatively short disease duration. To determine whether severity of clinical presentation contributes to these differences, we obtained structural magnetic resonance imaging (MRI) scans in youth ages 7-17 who were either newly diagnosed with type 1 diabetes (presentation was measured by the presence of diabetic ketoacidosis (DKA) and degree of hyperglycemia exposure [hemoglobin A1c (HbA1c)] at diagnosis. MRI were obtained using T1-weighted, T2-weighted, and diffusion-weighted sequences. Within the group with type 1 diabetes, 12 subjects presented in DKA and 34 did not. After controlling for age, sex, and multiple comparisons, the type 1 diabetes group had lower volume in the left temporal-parietal-occipital cortex compared with controls. Within the type 1 diabetes group, DKA at presentation was associated with lower radial, axial, and mean diffusivity (MD) throughout major white matter tracts and higher HbA1c was associated with lower hippocampal, thalamic, and cerebellar white matter volumes, lower right posterior parietal cortical thickness, and greater right occipital cortical thickness. These data suggest that severity of clinical presentation is an important factor in predicting brain structural differences in youth with type 1 diabetes approximately 3 months after diagnosis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Tumor DNA in cerebral spinal fluid reflects clinical course in a patient with melanoma leptomeningeal brain metastases

    Science.gov (United States)

    Li, Yingmei; Pan, Wenying; Connolly, Ian D.; Reddy, Sunil; Nagpal, Seema

    2017-01-01

    Cerebral spinal fluid (CSF) from brain tumor patients contains tumor cellular and cell-free DNA (cfDNA), which provides a less-invasive and routinely accessible method to obtain tumor genomic information. In this report, we used droplet digital PCR to test mutant tumor DNA in CSF of a patient to monitor the treatment response of metastatic melanoma leptomeningeal disease (LMD). The primary melanoma was known to have a BRAFV600E mutation, and the patient was treated with whole brain radiotherapy and BRAF inhibitors. We collected 9 CSF samples over 6 months. The mutant cfDNA fraction gradually decreased from 53 % (time of diagnosis) to 0 (time of symptom alleviation) over the first 6 time points. Three months after clinical improvement, the patient returned with severe symptoms and the mutant cfDNA was again detected in CSF at high levels. The mutant DNA fraction corresponded well with the patient’s clinical response. We used whole exome sequencing to examine the mutation profiles of the LMD tumor DNA in CSF before therapeutic response and after disease relapse, and discovered a canonical cancer mutation PTENR130* at both time points. The cellular and cfDNA revealed similar mutation profiles, suggesting cfDNA is representative of LMD cells. This study demonstrates the potential of using cellular or cfDNA in CSF to monitor treatment response for LMD. PMID:26961773

  2. Traumatic brain injury produced by exposure to blasts, a critical problem in current wars: biomarkers, clinical studies, and animal models

    Science.gov (United States)

    Dixon, C. Edward

    2011-06-01

    Traumatic brain injury (TBI) resulting from exposure to blast energy released by Improvised Explosive Devices (IEDs) has been recognized as the "signature injury" of Operation Iraqi Freedom and Operation Enduring Freedom. Repeated exposure to mild blasts may produce subtle deficits that are difficult to detect and quantify. Several techniques have been used to detect subtle brain dysfunction including neuropsychological assessments, computerized function testing and neuroimaging. Another approach is based on measurement of biologic substances (e.g. proteins) that are released into the body after a TBI. Recent studies measuring biomarkers in CSF and serum from patients with severe TBI have demonstrated the diagnostic, prognostic, and monitoring potential. Advancement of the field will require 1) biochemical mining for new biomarker candidates, 2) clinical validation of utility, 3) technical advances for more sensitive, portable detectors, 4) novel statistical approach to evaluate multiple biomarkers, and 5) commercialization. Animal models have been developed to simulate elements of blast-relevant TBI including gas-driven shock tubes to generate pressure waves similar to those produced by explosives. These models can reproduce hallmark clinical neuropathological responses such as neuronal degeneration and inflammation, as well as behavioral impairments. An important application of these models is to screen novel therapies and conduct proteomic, genomic, and lipodomic studies to mine for new biomarker candidates specific to blast relevant TBI.

  3. Functional brain imaging - baric and clinical questions; Funktionelle Bildgebung in der Psychiatrie - Fragestellungen der Klinik und der Forschung

    Energy Technology Data Exchange (ETDEWEB)

    Mager, T. [Psychiatrische Klinik und Poliklinik, Klinikum Innenstadt, Muenchen Univ. (Germany); Moeller, H.J. [Psychiatrische Klinik und Poliklinik, Klinikum Innenstadt, Muenchen Univ. (Germany)

    1997-06-01

    The advancing biological knowledge of disease processes plays a central part in the progress of modern psychiatry. An essential contribution comes from the functional and structural brain imaging techniques (CT, MRI, SPECT, PET). Their application is important for biological oriented research in psychiatry and there is also a growing relevance in clinical aspects. This development is taken into account by recent diagnostic classification systems in psychiatry. The capabilities and limitations of functional brain imaging in the context of research and clinic will be presented and discussed by examples and own investigations. (orig.) [Deutsch] Der Fortschritt in der Psychiatrie der letzten Jahre ist eng verknuepft mit neuen biologischen Erkenntnissen ueber Krankheitsprozesse. Einen wesentlichen Beitrag hierzu leistet die moderne funktionelle und strukturelle Bildgebung, deren Anwendung ein wichtiger Bestandteil biologischer Forschung ist und zunehmend auch an klinischer Bedeutung gewinnt. In den neuen Klassifikationssystemen der Psychiatrie wird diese Entwicklung beruecksichtigt. Moeglichkeiten und Grenzen funktioneller Bildgebung fuer die Psychiatrie werden mit Blick auf die Klinik und wissenschaftliche Fragestellungen im folgenden anhand von Beispielen und eigenen Untersuchungen skizziert und diskutiert. (orig.)

  4. Prediction of clinical depression scores and detection of changes in whole-brain using resting-state functional MRI data with partial least squares regression.

    Directory of Open Access Journals (Sweden)

    Kosuke Yoshida

    Full Text Available In diagnostic applications of statistical machine learning methods to brain imaging data, common problems include data high-dimensionality and co-linearity, which often cause over-fitting and instability. To overcome these problems, we applied partial least squares (PLS regression to resting-state functional magnetic resonance imaging (rs-fMRI data, creating a low-dimensional representation that relates symptoms to brain activity and that predicts clinical measures. Our experimental results, based upon data from clinically depressed patients and healthy controls, demonstrated that PLS and its kernel variants provided significantly better prediction of clinical measures than ordinary linear regression. Subsequent classification using predicted clinical scores distinguished depressed patients from healthy controls with 80% accuracy. Moreover, loading vectors for latent variables enabled us to identify brain regions relevant to depression, including the default mode network, the right superior frontal gyrus, and the superior motor area.

  5. Mary as Mother in the Flores de Mayo in Poblacion, Oslob

    Directory of Open Access Journals (Sweden)

    Patricia Marion Y. Lopez

    2016-06-01

    Full Text Available The paper reflects on the meanings of the Flores de Mayo ritual as performed in a town on the southeastern coast of Cebu through the examination of Mary as a “semantically open” symbol. The essay illustrates how ideas about Mary are constructed through the discourse of the Church and are in turn, reinforced through a Church-instituted and regulated ritual. An analysis of selected elements of the ritual however, reveals that the symbol of Mary has the potential to hold “other” kinds of meanings that slip in between “official” and “unofficial” discourses, highlighting how Mary continues to be a negotiated field between church authorities and the popular faithful.

  6. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials

    NARCIS (Netherlands)

    B.M. Ellingson (Benjamin M.); M. Bendszus (Martin); J. Boxerman (Jerrold); D. Barboriak (Daniel); B.J. Erickson (Bradley J.); M. Smits (Marion); S.J. Nelson (Sarah J.); E. Gerstner (Elizabeth); B. Alexander (Brian); G. Goldmacher (Gregory); W. Wick (Wolfgang); M.A. Vogelbaum (Michael); M. Weller (Michael); E. Galanis (Evanthia); J. Kalpathy-Cramer (Jayashree); L. Shankar; P. Jacobs (Paula); W.B. Pope (Whitney B.); D. Yang (Dewen); C. Chung (Caroline); R.H. Knopp; S. Cha (Soonme); M.J. van den Bent (Martin); S.M. Chang (Susan); W.K. Al Yung; T.F. Cloughesy (Timothy F.); P.Y. Wen (Patrick Y.); M.R. Gilbert (Mark R.); A. Whitney (Andrew); D. Sandak (David); A. Musella (Al); C. Haynes (Chas); M. Wallace (Max); D.F. Arons (David F.); A. Kingston (Ann)

    2015-01-01

    textabstractA recent joint meeting was held on January 30, 2014, with the US Food and Drug Administration (FDA), National Cancer Institute (NCI), clinical scientists, imaging experts, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocate groups to discuss

  7. Preclinical and Clinical Development of Low Dose Methamphetamine for the Treatment of Traumatic Brain Injury

    Science.gov (United States)

    2014-04-01

    complex and allows Bcl-xl to promote cell survival (Jeong et al., 2008; Koh et al., 2008; Uchiyama et al., 2004). pAKT also activates inhibitors of...forebrain ischemia in the Mongolian gerbil. Neurosci. Lett. 342, 25e28. Koh , P.O., Cho, J.H., Won, C.K., Lee, H.J., Sung, J.H., Kim, M.O., 2008. Estradiol...model of focal embolic cerebral ischemia. Brain Res. 766, 83e92. Zhang, Z., Zhang, R.L., Jiang, Q., Raman , S.B., Cantwell, L., Chopp, M., 1997b. A new

  8. Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis. A long-term historical cohort study

    NARCIS (Netherlands)

    van Dam, GM; Gips, CH; Reisman, Y; Maas, KW; Purmer, IM; Huizenga, [No Value; Verbaan, BW

    1999-01-01

    BACKGROUND/AIMS: One of the prognostic methods for survival in primary biliary cirrhosis (PBC) is the Mayo model, with a time-scale limited to 7 years. The aim of our study was to assess how major clinical events, signs, several severity assessment methods and Mayo survival probabilities fit in with

  9. The US Supreme Court in Mayo v. Prometheus - Taking the fire from or to biotechnology and personalized medicine?

    DEFF Research Database (Denmark)

    Minssen, Timo; Nilsson, David

    2012-01-01

    On 20 March 2012, the US Supreme Court handed down its much awaited patent eligibility- ruling in the dispute between Prometheus Laboratories Inc (“Prometheus”), acting as plaintiffs, and Mayo Medical Laboratories (“Mayo”), as alleged infringers of Prometheus’ licensed patents. This case review w...

  10. Durable Clinical Benefit of Pertuzumab in a Young Patient with BRCA2 Mutation and HER2-Overexpressing Breast Cancer Involving the Brain

    Directory of Open Access Journals (Sweden)

    Anna Koumarianou

    2016-01-01

    Full Text Available Patients with HER2-positive breast cancer and brain metastases have limited treatment options, and, as a result of their poor performance status and worse prognosis, they are underrepresented in clinical trials. Not surprisingly, these patients may not be fit enough to receive any active treatment and are offered supportive therapy. BRCA2 mutations are reported to be rarely associated with HER2-overexpressing advanced breast cancer and even more rarely with brain metastases at diagnosis. We report on a BRCA2-positive breast cancer patient with metastatic disease in multiple sites, including the brain, and poor performance status who exhibited an extraordinary clinical and imaging response to the novel anti-HER2 therapy pertuzumab after multiple lines of therapy including anti-HER2 targeting. To our knowledge, the clinicopathologic and therapeutic characteristics of this patient point to a unique case and an urgent need for further investigation of pertuzumab in patients with brain metastases.

  11. Recommendations for clinical practice and research in severe brain injury in intensive rehabilitation: the Italian Consensus Conference.

    Science.gov (United States)

    De Tanti, A; Zampolini, M; Pregno, S

    2015-02-01

    The paper reports the final statements of the jury of a National Consensus Conference organized in November 2010 at Salsomaggiore (Parma) to draw up recommendations on the rehabilitation programs for acquired brain injury (sABI) patients in the intensive hospital phase. Because of the few clinical studies of good quality found by means of the literature research we choose a mixed approach: a systematic review of the published studies and a consensus conference in order to obtain recommendations that come from the clinical evidence and the expert opinion. The final recommendations of the jury, based on the best available evidence combined with clinical expertise and the experience of persons with disabilities and other stakeholders, cover 13 topics: 1) Management of paroxysmal manifestations (sympathetic storms); 2) management of neuroendocrine problems; 3) nutrition; 4) swallowing; 5) ventilation/respiration, 6) clinical and instrument diagnosis and prognosis of vegetative state (VS) and minimally conscious state (MCS), 7) rehabilitative and pharmacological facilitation of renewed contact with surroundings; 8) neurosurgical complications and hydrocephalus; 9) sensorimotor impairment and disability; 10) rehabilitation methods; 11) assessment and treatment of cognitive-behavioural impairment and disability; 12) methodology and organization of care; 13) involving family and caregivers in rehabilitation.

  12. Imaging of perivascular spaces of the brain. MR-clinical correlation

    International Nuclear Information System (INIS)

    Okudera, Toshio; Tamura, Hajime; Uemura, Kazuo

    2000-01-01

    We evaluated the perivascular spaces (PVS) of the intraparenchymal arteries of the brain obtained from MRI, and compared them with the microangiograms of the injected autopsied brains of normal adults. The three dimensional microangiograms revealed 3 types of intraparenchymal arteries: intracortical, subcortical (including arteries of arcuate fibers) and medullary arteries. PVS of those arteries had punctated or small linear-shaped appearances according to the dimension and level of MR slices. Basic MR findings of normal PVS showed smooth and well-defined round or elliptical configurations up to 3 mm in diameter without a halo in the surrounding tissue, located along the intraparenchymal arteries, and isointense with cerebro-spinal fluid. PVS around the medullary arteries was dilated with age. Definite PVS was found in the lower portion of the basal ganglia in almost all healthy children and relatively young adults, however, it was less frequent in the subcortical white matter of frontal and parietal lobes. In adults over 60 years of age, dilatation of PVS along the medullary arteries was quite common and progressed into the frontal and parietal lobes. Dilatation of PVS around the medullary arteries was prominent and increased with the number of lacunar infarcts. The sclerotic change of medullary arteries was more accelerated in subjects with hypertension. (author)

  13. Noonan syndrome, PTPN11 mutations, and brain tumors. A clinical report and review of the literature.

    Science.gov (United States)

    Siegfried, Aurore; Cances, Claude; Denuelle, Marie; Loukh, Najat; Tauber, Maïté; Cavé, Hélène; Delisle, Marie-Bernadette

    2017-04-01

    Noonan syndrome (NS), an autosomal dominant disorder, is characterized by short stature, congenital heart defects, developmental delay, and facial dysmorphism. PTPN11 mutations are the most common cause of NS. PTPN11 encodes a non-receptor protein tyrosine phosphatase, SHP2. Hematopoietic malignancies and solid tumors are associated with NS. Among solid tumors, brain tumors have been described in children and young adults but remain rather rare. We report a 16-year-old boy with PTPN11-related NS who, at the age of 12, was incidentally found to have a left temporal lobe brain tumor and a cystic lesion in the right thalamus. He developed epilepsy 2 years later. The temporal tumor was surgically resected because of increasing crises and worsening radiological signs. Microscopy showed nodules with specific glioneuronal elements or glial nodules, leading to the diagnosis of dysembryoplastic neuroepithelial tumor (DNT). Immunohistochemistry revealed positive nuclear staining with Olig2 and pERK in small cells. SHP2 plays a key role in RAS/MAPK pathway signaling which controls several developmental cell processes and oncogenesis. An amino-acid substitution in the N-terminal SHP2 domain disrupts the self-locking conformation and leads to ERK activation. Glioneuronal tumors including DNTs and pilocytic astrocytomas have been described in NS. This report provides further support for the relation of DNTs with RASopathies and for the implication of RAS/MAPK pathways in sporadic low-grade glial tumors including DNTs. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  14. Clinical Evaluation of a Fully-automatic Segmentation Method for Longitudinal Brain Tumor Volumetry

    Science.gov (United States)

    Meier, Raphael; Knecht, Urspeter; Loosli, Tina; Bauer, Stefan; Slotboom, Johannes; Wiest, Roland; Reyes, Mauricio

    2016-03-01

    Information about the size of a tumor and its temporal evolution is needed for diagnosis as well as treatment of brain tumor patients. The aim of the study was to investigate the potential of a fully-automatic segmentation method, called BraTumIA, for longitudinal brain tumor volumetry by comparing the automatically estimated volumes with ground truth data acquired via manual segmentation. Longitudinal Magnetic Resonance (MR) Imaging data of 14 patients with newly diagnosed glioblastoma encompassing 64 MR acquisitions, ranging from preoperative up to 12 month follow-up images, was analysed. Manual segmentation was performed by two human raters. Strong correlations (R = 0.83-0.96, p < 0.001) were observed between volumetric estimates of BraTumIA and of each of the human raters for the contrast-enhancing (CET) and non-enhancing T2-hyperintense tumor compartments (NCE-T2). A quantitative analysis of the inter-rater disagreement showed that the disagreement between BraTumIA and each of the human raters was comparable to the disagreement between the human raters. In summary, BraTumIA generated volumetric trend curves of contrast-enhancing and non-enhancing T2-hyperintense tumor compartments comparable to estimates of human raters. These findings suggest the potential of automated longitudinal tumor segmentation to substitute manual volumetric follow-up of contrast-enhancing and non-enhancing T2-hyperintense tumor compartments.

  15. Mild Traumatic Brain Injury: Lessons Learned from Clinical, Sports, and Combat Concussions

    Directory of Open Access Journals (Sweden)

    Judy C. Kelly

    2012-01-01

    Full Text Available Over the past forty years, a tremendous amount of information has been gained on the mechanisms and consequences of mild traumatic brain injuries. Using sports as a laboratory to study this phenomenon, a natural recovery curve emerged, along with standards for managing concussions and returning athletes back to play. Although advances have been made in this area, investigation into recovery and return to play continues. With the increase in combat-related traumatic brain injuries in the military setting, lessons learned from sports concussion research are being applied by the Department of Defense to the assessment of blast concussions and return to duty decision making. Concussion management and treatment for military personnel can be complicated by additional combat related stressors not present in the civilian environment. Cognitive behavioral therapy is one of the interventions that has been successful in treating symptoms of postconcussion syndrome. While we are beginning to have an understanding of the impact of multiple concussions and subconcussive blows in the sports world, much is still unknown about the impact of multiple blast injuries.

  16. The protons of space and brain tumors: I. Clinical and dosimetric considerations

    International Nuclear Information System (INIS)

    Dalrymple, G.V.; Nagle, W.A.; Moss, A.J.; Cavin, L.A.; Broadwater, J.R.; McGuire, E.L.; Eason, C.S.

    1989-01-01

    Almost 25 years ago a large group of Rhesus monkeys were irradiated with protons (32--2300 MeV). The experiments were designed: (1) To estimate the RBE of protons, per se, and (2) To provide some estimate of the hazards of the radiation environment of space. The initial results showed the RBE to be about 1.0 for acute radiation effects (mortality, hematologic changes, etc). The colony has been maintained at Brooks AFB, TX since irradiation. The survivors of 55 MeV proton irradiation have developed a very high incidence of Glioblastoma multiforme, a highly malignant primary brain tumor. These tumors appeared 1--20 yrs after surface doses of 400--800 rads. Reconstruction of the dosimetry suggests that some areas within the brain may have received doses of 1500--2500 rads. More than 30 radiation induced Glioblastomas have been reported in human patients who had received therapeutic head irradiation. The radiation doses required to induce Glioblastoma were of the same order of magnitude as required to induce Glioblastoma in the Rhesus monkey

  17. Exogenous stem cells pioneer a biobridge to the advantage of host brain cells following stroke: New insights for clinical applications

    Directory of Open Access Journals (Sweden)

    Marci G Crowley

    2017-01-01

    Full Text Available Stroke continues to maintain its status as one of the top causes of mortality within the United States. Currently, the only Food and Drug Administration (FDA-approved drug in place for stroke patients, tissue plasminogen activator (tPA, has a rigid therapeutic window, closing at approximately 4.5 h after stroke onset. Due to this short time frame and other restrictions, such as any condition that increases a patient's risk for hemorrhaging, it has been predicted that <5% of ischemic stroke patients benefit from tPA. Given that rehabilitation therapy remains the only other option for stroke victims, there is a clear unmet clinical need for treatment available for the remaining 95%. While still considered an experimental treatment, the utilization of stem cell therapies for stroke holds consistent promise. Copious preclinical studies report the capacity for transplanted stem cells to rescue the brain parenchyma surrounding the stroke-induced infarct core. At present, the exact mechanisms in which stem cells contribute a robust therapeutic benefit remains unclear. Following stem cell administration, researchers have observed cell replacement, an increase in growth factors, and a reduction in inflammation. With a deeper understanding of the precise mechanism of stem cells, these therapies can be optimized in the clinic to afford the greatest therapeutic benefit. Recent studies have depicted a unique method of endogenous stem cell activation as a result of stem cell therapy. In both traumatic brain injury and stroke models, transplanted mesenchymal stromal cells (MSCs facilitated a pathway between the neurogenic niches of the brain and the damaged area through extracellular matrix remodeling. The biobridge pioneered by the MSCs was utilized by the endogenous stem cells, and these cells were able to travel to the damaged areas distal to the neurogenic niches, a feat unachievable without prior remodeling. These studies broaden our understanding of stem

  18. Clinical significance of determination of serum NSE and plasma ET, IGF-II, CNP levels in patients with acute brain injury

    International Nuclear Information System (INIS)

    Chen Bo

    2010-01-01

    Objective: To investigate the clinical significance of changes of plasma ET, IGF-II, CNP and serum NSE contents in patients with acute brain injury. Methods: Serum contents of neuron specific enolase (NSE) were measured with chemiluminescence immunoassay and plasma endothelin (ET), insulin-like growth factor-II (IGF-II) and C-type natriuretic peptide (CNP) were measured with radioimmunoassay in 30 patients with acute brain injury and 35 controls. Results: Serum contents of NSE and plasma IGF-II, CNP were not much different in patients with mild brain injury from those in controls (P >0.05), but plasma contents of ET were already significantly higher in patients with mild brain injury than those in controls(P < 0.01). The serum NSE and plasma ET levels in patients with moderate and severe brain injury were significantly higher than those in patients with mild brain injury and controls (P < 0.01). Decrease of plasma levels of IGF-II and CNP was not significant in patients with mild brain injury (vs controls). However, the plasma levels of IGF-II and CNP were significantly lower in patients with moderate and severe brain injury than those in patients with mild brain injury and controls (P <0.01). As a whole, the magnitude of changes of these parameters was proportional to the severity of the injury. Conclusion: Changes of serum NSE and plasma IGF-II, ET and CNP levels were closely related to the pathological process of brain injury. Determination of these parameters was of clinical importance for evaluation of the severity of injury and outcome prediction. (authors)

  19. Clinical presentation and epidemiology of brain tumors firstly diagnosed in adults in the Emergency Department: a 10-year, single center retrospective study.

    Science.gov (United States)

    Comelli, Ivan; Lippi, Giuseppe; Campana, Valentina; Servadei, Franco; Cervellin, Gianfranco

    2017-07-01

    Several patients with new onset brain tumors present to the Emergency Department (ED) complaining for new symptoms. Although information exists on symptom prevalence in the entire population of patients with brain tumors, little is known about the clinical presentation in ED. This retrospective study was planned to investigate clinical presentation and epidemiology of brain tumors firstly diagnosed in a large urban ED throughout a 10-year period. All medical records of patients aged ≥18 years, discharged from our ED with a diagnosis of brain tumor were retrieved from the electronic hospital database during a 10-year period (2006 to 2015). The records were reassessed for selecting only brain tumors firstly diagnosed in the ED. The symptoms at presentation were divided in six categories: (I) headache; (II) seizures; (III) focal signs; (IV) altered mental status; (V) nausea/vomiting/dizziness; (VI) trauma. For all cases, the hospital record was retrieved, to obtain histologic classification of tumors. Patients with inflammatory neoformations were excluded from the study. Overall, 205 patients with firstly diagnosed brain tumor were identified among 870,135 ED visits (i.e., presentation signs/symptoms. First presentation of brain tumor in the ED is not a rare occurrence, so that the emergency physicians should be aware of this possibility.

  20. Clinical significance of changes of serum IL-6 and TNF-α levels in rat models of hypoxic-ischemia brain injury

    International Nuclear Information System (INIS)

    Niu Tingxian; Shi Zhiyong; Luo Jianjun

    2009-01-01

    Objective: To explore the clinical significance of changes of serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) levels in rat models of hypoxic-ischemia (HI) brain injury. Methods: Seventy five rat HI brain injury nodels were prepared with bilateral occlusion of common carotid artery for 24rs followed 2hrs later by hypoxia (breathing 8% oxygen) for 2hrs. One fifth of the animals were sacrificed at 4h, 8h, 12h, 24h and 48h later respectively, the serum and brain homogenate concentrations of IL-6 and TNF-α were determined with RIA and brain tissues were pathologically examined. Results: The concentrations of IL-6 and TNF-α were dynamically changed within 48h in serum and brain homogenate. Peak values occurred at 24h with serum and at 12h with brain homogenate. Meanwhile, levels of both cytokines were significantly higher in the models than those in controls (P<0.01 or P<0.05). Conclusion: The concentrations of IL-6 and TNF-α were dynamically(sham operation only, 15 animals) changed and might be regarded as the clinical markers of degree of HI brain injury. (authors)

  1. PET/MR brain imaging: evaluation of clinical UTE-based attenuation correction

    International Nuclear Information System (INIS)

    Aasheim, Lars Birger; Karlberg, Anna; Goa, Paal Erik; Haaberg, Asta; Soerhaug, Sveinung; Fagerli, Unn-Merete; Eikenes, Live

    2015-01-01

    One of the greatest challenges in PET/MR imaging is that of accurate MR-based attenuation correction (AC) of the acquired PET data, which must be solved if the PET/MR modality is to reach its full potential. The aim of this study was to investigate the performance of Siemens' most recent version (VB20P) of MR-based AC of head PET data, by comparing it to CT-based AC. Methods: 18 F-FDG PET data from seven lymphoma and twelve lung cancer patients examined with a Biograph mMR PET/MR system were reconstructed with both CT-based and MR-based AC, avoiding sources of error arising when comparing PET data from different systems. The resulting images were compared quantitatively by measuring changes in mean SUV in ten different brain regions in both hemispheres, as well as the brainstem. In addition, the attenuation maps (μ maps) were compared regarding volume and localization of cranial bone. The UTE μ maps clearly overestimate the amount of bone in the neck, while slightly underestimating the amount of bone in the cranium, and the localization of bone in the cranial region also differ from the CT μ maps. In air/tissue interfaces in the sinuses and ears, the MRAC method struggles to correctly classify the different tissues. The misclassification of tissue is most likely caused by a combination of artefacts and the insufficiency of the UTE method to accurately separate bone. Quantitatively, this results in a combination of overestimation (0.5-3.6 %) and underestimation (2.7-5.2 %) of PET activity throughout the brain, depending on the proximity to the inaccurate regions. Our results indicate that the performance of the UTE method as implemented in VB20P is close to the theoretical maximum of such an MRAC method in the brain, while it does not perform satisfactorily in the neck or face/nasal area. Further improvement of the UTE MRAC or other available methods for more accurate segmentation of bone should be incorporated. (orig.)

  2. Managing brain metastases patients with and without radiotherapy: initial lessonsfrom a team-based consult service through a multidisciplinary integrated palliative oncology clinic.

    Science.gov (United States)

    Jung, Hellen; Sinnarajah, Aynharan; Enns, Bert; Voroney, Jon-Paul; Murray, Alison; Pelletier, Guy; Wu, Jackson Sai-Yiu

    2013-12-01

    A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development. Between January 2011 and May 2012, 100 consecutive brain metastases patients referred and assessed through a multidisciplinary clinic were evaluated for baseline characteristics, radiotherapy use, and supportive care decisions. Overall survival was examined by known prognostic groups. Proportion of patients receiving end-of-life radiotherapy (death within 30 and 14 days of brain radiotherapy) was used as a quality metric. The median age was 65 years, with non-small cell lung cancer (n = 38) and breast cancer (n = 23) being the most common primary cancers. At least 57 patients were engaged in advance care planning discussions at first consult visit. In total, 75 patients eventually underwent brain radiotherapy, whereas 25 did not. The most common reasons for nonradiotherapy management were patient preference and rapid clinical deterioration. Overall survival for prognostic subgroups was consistent with literature reports. End-of-life brain radiotherapy was observed in 9 % (death within 30 days) and 1 % (within 14 days) of treated patients. By integrating palliative care expertise to address the complex needs of patients with newly diagnosed brain metastases, end-of-life radiotherapy use appears acceptable and improved over historical rates at our institution. An appreciable proportion of patients are not suitable for palliative brain radiotherapy or opt against this treatment option, but the team approach involving nurses, palliative care experts, allied health, and clinical oncologists facilitates

  3. SU-F-303-12: Implementation of MR-Only Simulation for Brain Cancer: A Virtual Clinical Trial

    International Nuclear Information System (INIS)

    Glide-Hurst, C; Zheng, W; Kim, J; Wen, N; Chetty, I J

    2015-01-01

    Purpose: To perform a retrospective virtual clinical trial using an MR-only workflow for a variety of brain cancer cases by incorporating novel imaging sequences, tissue segmentation using phase images, and an innovative synthetic CT (synCT) solution. Methods: Ten patients (16 lesions) were evaluated using a 1.0T MR-SIM including UTE-DIXON imaging (TE = 0.144/3.4/6.9ms). Bone-enhanced images were generated from DIXON-water/fat and inverted UTE. Automated air segmentation was performed using unwrapped UTE phase maps. Segmentation accuracy was assessed by calculating intersection and Dice similarity coefficients (DSC) using CT-SIM as ground truth. SynCTs were generated using voxel-based weighted summation incorporating T2, FLAIR, UTE1, and bone-enhanced images. Mean absolute error (MAE) characterized HU differences between synCT and CT-SIM. Dose was recalculated on synCTs; differences were quantified using planar gamma analysis (2%/2 mm dose difference/distance to agreement) at isocenter. Digitally reconstructed radiographs (DRRs) were compared. Results: On average, air maps intersected 80.8 ±5.5% (range: 71.8–88.8%) between MR-SIM and CT-SIM yielding DSCs of 0.78 ± 0.04 (range: 0.70–0.83). Whole-brain MAE between synCT and CT-SIM was 160.7±8.8 HU, with the largest uncertainty arising from bone (MAE = 423.3±33.2 HU). Gamma analysis revealed pass rates of 99.4 ± 0.04% between synCT and CT-SIM for the cohort. Dose volume histogram analysis revealed that synCT tended to yield slightly higher doses. Organs at risk such as the chiasm and optic nerves were most sensitive due to their proximities to air/bone interfaces. DRRs generated via synCT and CT-SIM were within clinical tolerances. Conclusion: Our approach for MR-only simulation for brain cancer treatment planning yielded clinically acceptable results relative to the CT-based benchmark. While slight dose differences were observed, reoptimization of treatment plans and improved image registration can address

  4. Radiotherapy for asymptomatic brain metastasis in epidermal growth factor receptor mutant non-small cell lung cancer without prior tyrosine kinase inhibitors treatment: a retrospective clinical study

    International Nuclear Information System (INIS)

    Liu, SongRan; Qiu, Bo; Chen, LiKun; Wang, Fang; Liang, Ying; Cai, PeiQiang; Zhang, Li; Chen, ZhaoLin; Liu, ShiLiang; Liu, MengZhong; Liu, Hui

    2015-01-01

    Non-small cell lung cancer (NSCLC) with brain metastasis (BM) harboring an epidermal growth factor receptor (EGFR) mutation shows good response to tyrosine kinase inhibitors (TKIs). This study is to assess the appropriate timing of brain radiotherapy (RT) for asymptomatic BM in EGFR mutant NSCLC patients. There were 628 patients diagnosed with EGFR mutant NSCLC between October 2005 and December 2011. Treatment outcomes had been retrospectively evaluated in 96 patients with asymptomatic BM without prior TKI treatment. 39 patients received first-line brain RT, 23 patients received delayed brain RT, and 34 patients did not receive brain RT. With a median follow-up of 26 months, the 2-year OS was 40.6 %. Univariate analyses revealed that ECOG performance status (p = 0.006), other distant metastases (p = 0.002) and first line systemic treatment (p = 0.032) were significantly associated with overall survival (OS). Multivariate analyses revealed that other sites of distant metastases (p = 0.030) were prognostic factor. The timing of brain RT was not significantly related to OS (p = 0.246). The 2-year BM progression-free survival (PFS) was 26.9 %. Brain RT as first-line therapy failed to demonstrate a significant association with BM PFS (p = 0.643). First-line brain RT failed to improve long-term survival in TKI-naïve EGFR mutant NSCLC patients with asymptomatic BM. Prospective studies are needed to validate these clinical findings

  5. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation

    DEFF Research Database (Denmark)

    Müller-Vahl, Kirsten R; Cath, Danielle C; Cavanna, Andrea E

    2011-01-01

    Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette......, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-related (e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function......) may occur. At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general...

  6. Proton MR Spectroscopy—Detectable Major Neurotransmitters of the Brain: Biology and Possible Clinical Applications

    Science.gov (United States)

    Agarwal, N.; Renshaw, P.F.

    2015-01-01

    SUMMARY Neurotransmitters are chemical substances that, by definition, allow communication between neurons and permit most neuronal-glial interactions in the CNS. Approximately 80% of all neurons use glutamate, and almost all interneurons use GABA. A third neurotransmitter, NAAG, modulates glutamatergic neurotransmission. Concentration changes in these molecules due to defective synthetic machinery, receptor expression, or errors in their degradation and metabolism are accepted causes of several neurologic disorders. Knowledge of changes in neurotransmitter concentrations in the brain can add useful information in making a diagnosis, helping to pick the right drug of treatment, and monitoring patient response to drugs in a more objective manner. Recent advances in 1H-MR spectroscopy hold promise in providing a more reliable in vivo detection of these neurotransmitters. In this article, we summarize the essential biology of 3 major neurotransmitters: glutamate, GABA, and NAAG. Finally we illustrate possible applications of 1H-MR spectroscopy in neuroscience research. PMID:22207303

  7. The brain in hereditary hemorrhagic telangiectasia with pulmonary AVM: The clinical importance of paradoxical embolism

    International Nuclear Information System (INIS)

    Kim, W.S.; Kinnison, M.L.; Charnas, L.; Rosenbaum, A.E.; White, R.I. Jr.

    1986-01-01

    Despite the literature's emphasis on the presence of intracerebral vascular malformations in hereditary hemorrhagic telangiectasia (HHT), few cases have been documented. The authors prospectively evaluated brain CT scans in 29 consecutive patients with pulmonary arteriovenous malformations (AVMs) and known HHT. Fifty-five percent of the CT scans revealed the signs of embolic phenomena: infarctions (n=11) and intracerebral abscesses (n=5). In only one patient was a small enhancing vascular lesion seen. They conclude that embolic phenomena rather than vascular malformations cause the majority of abnormal CT findings in patients with HHT and pulmonary AVMs. Infarctions and intracerebral abscesses probably result from paradoxical embolization through the AVMs in the lungs. The therapeutic implications seem clear, since 55% of these patients are potentially treatable by balloon occlusion of the pulmonary AVMs

  8. Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome.

    Science.gov (United States)

    Einarsen, Cathrine Elisabeth; van der Naalt, Joukje; Jacobs, Bram; Follestad, Turid; Moen, Kent Gøran; Vik, Anne; Håberg, Asta Kristine; Skandsen, Toril

    2018-03-31

    Patients with moderate traumatic brain injury (TBI) often are studied together with patients with severe TBI, even though the expected outcome of the former is better. Therefore, we aimed to describe patient characteristics and 12-month outcomes, and to develop a prognostic model based on admission data, specifically for patients with moderate TBI. Patients with Glasgow Coma Scale scores of 9-13 and age ≥16 years were prospectively enrolled in 2 level I trauma centers in Europe. Glasgow Outcome Scale Extended (GOSE) score was assessed at 12 months. A prognostic model predicting moderate disability or worse (GOSE score ≤6), as opposed to a good recovery, was fitted by penalized regression. Model performance was evaluated by area under the curve of the receiver operating characteristics curves. Of the 395 enrolled patients, 81% had intracranial lesions on head computed tomography, and 71% were admitted to an intensive care unit. At 12 months, 44% were moderately disabled or worse (GOSE score ≤6), whereas 8% were severely disabled and 6% died (GOSE score ≤4). Older age, lower Glasgow Coma Scale score, no day-of-injury alcohol intoxication, presence of a subdural hematoma, occurrence of hypoxia and/or hypotension, and preinjury disability were significant predictors of GOSE score ≤6 (area under the curve = 0.80). Patients with moderate TBI exhibit characteristics of significant brain injury. Although few patients died or experienced severe disability, 44% did not experience good recovery, indicating that follow-up is needed. The model is a first step in development of prognostic models for moderate TBI that are valid across centers. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

  9. Clinical outcomes from maximum-safe resection of primary and metastatic brain tumors using awake craniotomy.

    Science.gov (United States)

    Groshev, Anastasia; Padalia, Devang; Patel, Sephalie; Garcia-Getting, Rosemarie; Sahebjam, Solmaz; Forsyth, Peter A; Vrionis, Frank D; Etame, Arnold B

    2017-06-01

    To retrospectively analyze outcomes in patients undergoing awake craniotomies for tumor resection at our institution in terms of extent of resection, functional preservation and length of hospital stay. All cases of adults undergoing awake-craniotomy from September 2012-February 2015 were retrospectively reviewed based on an IRB approved protocol. Information regarding patient age, sex, cancer type, procedure type, location, hospital stay, extent of resection, and postoperative complications was extracted. 76 patient charts were analyzed. Resected cancer types included metastasis to the brain (41%), glioblastoma (34%), WHO grade III anaplastic astrocytoma (18%), WHO grade II glioma (4%), WHO grade I glioma (1%), and meningioma (1%). Over a half of procedures were performed in the frontal lobes, followed by temporal, and occipital locations. The most common indication was for motor cortex and primary somatosensory area lesions followed by speech. Extent of resection was gross total for 59% patients, near-gross total for 34%, and subtotal for 7%. Average hospital stay for the cohort was 1.7days with 75% of patients staying at the hospital for only 24h or less post surgery. In the postoperative period, 67% of patients experienced improvement in neurological status, 21% of patients experienced no change, 7% experienced transient neurological deficits, which resolved within two months post op, 1% experienced transient speech deficit, and 3% experienced permanent weakness. In a consecutive series of 76 patients undergoing maximum-safe resection for primary and metastatic brain tumors, awake-craniotomy was associated with a short hospital stay and low postoperative complications rate. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Clinical Observation on Insomnia Treated by Wei-Defensive Qi-Regulating and Brain-Strengthening Needling Technique

    Institute of Scientific and Technical Information of China (English)

    GAO Xi-yan; LI Xing-rui; MA Qiao-lin; ZHAO Xin-ji; SHAO Su-ju; WEI Yu-long; SUN Wei-xia; HANG Guo-qi

    2007-01-01

    In order to make a report on 90 cases of insomnia treated by the Wei-defensive qi-regulating and brain-strengthening needling technique,as a clinical subject of the multiple center,for assessing the preliminary standardized indications and operating methods and making an initial summary for writing the draft of the technique operation.Methods:By ratio of 1:1,the patients in conformity with the criteria were randomly divided into the experimental group and control group.In the experimental group,45 cases were treated with the Wei-defensive qi-regulating and brain-strengthening needling technique on Baihui (GV 20),Dazhui(GV 14),Shenmai(BL 62),Zhaohai(KI 6),plus ear points.In the control group,45 cases were treated with routine acupuncture on Sishencong(Ex-HN 1),Shenmen (HT 7),Sanyinjiao(SP 6),etc.The therapeutic effects in the two groups were observed and assessed in comparison.Results:The results showed cure in 15 cases.remarkable effect in 27 cases,effect in 42 cases,failure in 6 cases,and the total eriective rate in 94.4% in 90 cases of insomnia.In the three centers,the statistic management was performed based upon PSQI integral and showed significant difference(P<0.01),and no significant difference among various groups(P>0.01).Conclusion:The therapeutic effect in the treatment of insomnia by Wei-defensive qi-regulating and brain-strengthening needling technique is better than the control group and the therapeutic effect and methods in various centers are stable.without any deviation.

  11. Unique roles of SPET brain imaging in clinical and research studies

    International Nuclear Information System (INIS)

    Seibyl, J.; Jennings, D.; Tabamo, R.; Marek, K.

    2005-01-01

    The increasing availability of PET imaging in Nuclear medicine expands the armamentarium of clinical and research tools for improving diagnosis and treatment of neuropsychiatric disorders. Nonetheless, the role of SPEC imaging remains critical to both research and clinical practice. The development of rational strategies for guiding the selection of imaging modalities flows from primarily the nature of the clinical or research question and the availability of appropriate radiopharmaceuticals. There has been extensive SPECT and PET work in Parkinson's disease (PD) which highlights the value of both these scintigraphic modalities. Three main areas of interest in PD include imaging for improving diagnostic accuracy, for monitoring the progression of disease, and for assessing the therapeutic efficacy of drugs with neoroprotective potential. The demands of the clinical or research question posed to imaging dictates the selection of radiotracer and imaging modality. Diagnosis of PD represents the easiest challenge with many imaging bio markers showing high sensitivity for detecting abnormal reduction of dopaminergic function based on qualitative review of images. On the other hand, using imaging to evaluate treatments which purportedly slow the rate of disease progression, indicated by the reduction of the rate of loss in a quantitative imaging signal in patients studied over time, represents the most rigorous requirement of the imaging measure. In each of these applications presynaptic markers of dopaminergic function using SPECT and PET have been extremely valuable. Review of neuroimaging studies of PD provides a useful example of optimized approaches to clinical and research studies in neuropsychiatric disorders

  12. Baseline brain activity changes in patients with clinically isolated syndrome revealed by resting-state functional MRI

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yaou; Duan, Yunyun; Liang, Peipeng; Jia, Xiuqin; Yu, Chunshui [Dept. of Radiology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Ye, Jing [Dept. of Neurology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Butzkueven, Helmut [Dept. of Medicine, Univ. of Melbourne, Melbourne (Australia); Dong, Huiqing [Dept. of Neurology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Li, Kuncheng [Dept. of Radiology, Xuanwu Hospital, Capital Medical Univ., Beijing (China); Beijing Key Laboratory of MRI and Brain Informatics, Beijing (China)], E-mail: likuncheng1955@yahoo.com.cn

    2012-11-15

    Background A clinically isolated syndrome (CIS) is the first manifestation of multiple sclerosis (MS). Previous task-related functional MRI studies demonstrate functional reorganization in patients with CIS. Purpose To assess baseline brain activity changes in patients with CIS by using the technique of regional amplitude of low frequency fluctuation (ALFF) as an index in resting-state fMRI. Material and Methods Resting-state fMRIs data acquired from 37 patients with CIS and 37 age- and sex-matched normal controls were compared to investigate ALFF differences. The relationships between ALFF in regions with significant group differences and the EDSS (Expanded Disability Status Scale), disease duration, and T2 lesion volume (T2LV) were further explored. Results Patients with CIS had significantly decreased ALFF in the right anterior cingulate cortex, right caudate, right lingual gyrus, and right cuneus (P < 0.05 corrected for multiple comparisons using Monte Carlo simulation) compared to normal controls, while no significantly increased ALFF were observed in CIS. No significant correlation was found between the EDSS, disease duration, T2LV, and ALFF in regions with significant group differences. Conclusion In patients with CIS, resting-state fMRI demonstrates decreased activity in several brain regions. These results are in contrast to patients with established MS, in whom ALFF demonstrates several regions of increased activity. It is possible that this shift from decreased activity in CIS to increased activity in MS could reflect the dynamics of cortical reorganization.

  13. Imaging and clinical characteristics of children with multiple foci of microsusceptibility changes in the brain on susceptibility-weighted MRI

    Energy Technology Data Exchange (ETDEWEB)

    Niwa, Tetsu [Kanagawa Children' s Medical Center, Department of Radiology, Yokohama (Japan); University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, PO Box 85500, Utrecht (Netherlands); Aida, Noriko; Fujita, Kazutoshi; Shishikura, Ayako [Kanagawa Children' s Medical Center, Department of Radiology, Yokohama (Japan); Takahara, Taro; Kwee, Thomas C. [University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, PO Box 85500, Utrecht (Netherlands); Miyata, Daiki [Kanagawa Children' s Medical Center, Department of Circulation Medicine, Yokohama (Japan); Inoue, Tomio [Yokohama City University, Graduate School of Medicine, Department of Radiology, Yokohama (Japan)

    2010-10-15

    Microsusceptibility changes in the brain are well known to correspond with microbleeds or micrometal fragments in adults, but this phenomenon has not been explored well in children. To assess imaging and clinical characteristics of children with multiple foci of microsusceptibility changes using susceptibility-weighted imaging (SWI). Between 2006 and 2008, 12 children with multiple foci of microsusceptibility on SWI without corresponding abnormal signal on conventional MRI were identified and were retrospectively assessed. The locations of foci of microsusceptibility included the cerebral white matter, basal ganglia, brainstem and cerebellar white matter, without any clear systematic anatomic distribution. CT (n = 5) showed no calcification at the locations corresponding to the microsusceptibility on SWI. Conventional MR imaging showed white matter volume loss (n = 5), delayed myelination (n = 2), acute infarction (n = 1), chronic infarction (n = 1), meningitis (n = 1), slight signal abnormality in the white matter (n = 1) and no abnormal findings (n = 1). Follow-up SWI (n = 3) showed no change of the microsusceptibility foci. Interestingly, all children had a history of heart surgery under extracorporeal circulation for congenital heart disease. Multiple foci of microsusceptibility can be seen in the brain on SWI in children with congenital heart disease who underwent heart surgery with extracorporeal circulation. (orig.)

  14. The effectiveness of non-invasive brain stimulation in improving clinical signs of hyperkinetic movement disorders

    Directory of Open Access Journals (Sweden)

    Ignacio eObeso

    2016-01-01

    Full Text Available Repetitive transcranial magnetic stimulation (rTMS is a safe and non-invasive method for stimulating cortical neurons. In neurological realm, rTMS has prevalently been applied to understand pathophysiological mechanisms underlying movement disorders. However, this tool has also the potential to be translated into a clinically applicable therapeutic use. Several available studies supported this hypothesis, but differences in protocols, clinical enrollment and variability of rTMS effects across individuals complicate better understanding of efficient clinical protocols.The aim of this present review is to discuss to what extent the evidence provided by the therapeutic use of rTMS may be generalized. In particular, we attempted to define optimal cortical regions and stimulation protocols that have been demonstrated to maximize the effectiveness seen in the actual literature for the three most prevalent hyperkinetic movement disorders: Parkinson´s disease with levodopa-induced dyskinesias, essential tremor and dystonia. A total of 28 rTMS studies met our search criteria. Despite clinical and methodological differences, overall these studies demonstrated that therapeutic applications of rTMS to normalize pathologically decreased or increased levels of cortical activity have given moderate progress in patient´s quality of life. Moreover, the present literature suggests that altered pathophysiology in hyperkinetic movement disorders establishes motor, premotor or cerebellar structures as candidate regions to reset cortico-subcortical pathways back to normal. Although rTMS has the potential to become a powerful tool for ameliorating the clinical outcome of hyperkinetic neurological patients, until now there is not a clear consensus on optimal protocols for these motor disorders. Well-controlled multicenter randomized clinical trials with high numbers of patients are urgently required.

  15. Resolution improvement of brain PET images using prior information from MRI: clinical application on refractory epilepsy

    International Nuclear Information System (INIS)

    Silva-Rodríguez, Jesus; Tsoumpas, Charalampos; Aguiar, Pablo; Cortes, Julia; Urdaneta, Jesus Lopez

    2015-01-01

    An important counterpart of clinical Positron Emission Tomography (PET) for early diagnosis of neurological diseases is its low resolution. This is particularly important when evaluating diseases related to small hypometabolisms such as epilepsy. The last years, new hybrid systems combining PET with Magnetic Resonance (MR) has been increasingly used for several different clinical applications. One of the advantages of MR is the production of high spatial resolution images and a potential application of PET-MR imaging is the improvement of PET resolution using MR information. A potential advantage of resolution recovery of PET images is the enhancement of contrast delivering at the same time better detectability of small lesions or hypometabolic areas and more accurate quantification over these areas. Recently, Shidahara et al (2009) proposed a new method using wavelet transforms in order to produce PET images with higher resolution. We optimised Shidahara’s method (SFS-RR) to take into account possible shortcomings on the particular clinical datasets, and applied it to a group of patients diagnosed with refractory epilepsy. FDG-PET and MRI images were acquired sequentially and then co-registered using software tools. A complete evaluation of the PET/MR images was performed before and after the correction, including different parameters related with PET quantification, such as atlas-based metabolism asymmetry coefficients and Statistical Parametric Mapping results comparing to a database of 87 healthy subjects. Furthermore, an experienced physician analyzed the results of non-corrected and corrected images in order to evaluate improvements of detectability on a visual inspection. Clinical outcome was used as a gold standard. SFS-RR demonstrated to have a positive impact on clinical diagnosis of small hypometabolisms. New lesions were detected providing additional clinically relevant information on the visual inspection. SPM sensitivity for the detection of small

  16. Resolution improvement of brain PET images using prior information from MRI: clinical application on refractory epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Silva-Rodríguez, Jesus [Instituto de Investigaciones Sanitarias (IDIS), Santiago de Compostela (Spain); Tsoumpas, Charalampos [University of Leeds, Leeds (United Kingdom); Aguiar, Pablo; Cortes, Julia [Nuclear Medicine Department, University Hospital (CHUS), Santiago de Compostela (Spain); Urdaneta, Jesus Lopez [Instituto de Investigaciones Sanitarias (IDIS), Santiago de Compostela (Spain)

    2015-05-18

    An important counterpart of clinical Positron Emission Tomography (PET) for early diagnosis of neurological diseases is its low resolution. This is particularly important when evaluating diseases related to small hypometabolisms such as epilepsy. The last years, new hybrid systems combining PET with Magnetic Resonance (MR) has been increasingly used for several different clinical applications. One of the advantages of MR is the production of high spatial resolution images and a potential application of PET-MR imaging is the improvement of PET resolution using MR information. A potential advantage of resolution recovery of PET images is the enhancement of contrast delivering at the same time better detectability of small lesions or hypometabolic areas and more accurate quantification over these areas. Recently, Shidahara et al (2009) proposed a new method using wavelet transforms in order to produce PET images with higher resolution. We optimised Shidahara’s method (SFS-RR) to take into account possible shortcomings on the particular clinical datasets, and applied it to a group of patients diagnosed with refractory epilepsy. FDG-PET and MRI images were acquired sequentially and then co-registered using software tools. A complete evaluation of the PET/MR images was performed before and after the correction, including different parameters related with PET quantification, such as atlas-based metabolism asymmetry coefficients and Statistical Parametric Mapping results comparing to a database of 87 healthy subjects. Furthermore, an experienced physician analyzed the results of non-corrected and corrected images in order to evaluate improvements of detectability on a visual inspection. Clinical outcome was used as a gold standard. SFS-RR demonstrated to have a positive impact on clinical diagnosis of small hypometabolisms. New lesions were detected providing additional clinically relevant information on the visual inspection. SPM sensitivity for the detection of small

  17. Clinical reliability and validity of elbow functional assessment in rheumatoid arthritis.

    NARCIS (Netherlands)

    Boer, Y.A. de; Ende, C.H.M. van den; Eygendaal, D.; Jolie, I.M.M.; Hazes, J.M.W.; Rozing, P.M.

    1999-01-01

    OBJECTIVES: (1) To investigate the measurement characteristics of the Hospital for Special Surgery (HSS) and Mayo Clinic elbow assessment instruments, utilizing methodological criteria including feasibility, reliability, validity, and discriminative ability; and (2) to develop an efficient and

  18. Old wine in new bottles: validating the clinical utility of SPECT in predicting cognitive performance in mild traumatic brain injury.

    Science.gov (United States)

    Romero, Kristoffer; Lobaugh, Nancy J; Black, Sandra E; Ehrlich, Lisa; Feinstein, Anthony

    2015-01-30

    The neural underpinnings of cognitive dysfunction in mild traumatic brain injury (TBI) are not fully understood. Consequently, patient prognosis using existing clinical imaging is somewhat imprecise. Single photon emission computed tomography (SPECT) is a frequently employed investigation in this population, notwithstanding uncertainty over the clinical utility of the data obtained. In this study, subjects with mild TBI underwent (99m)Tc-ECD SPECT scanning, and were administered a brief battery of cognitive tests and self-report symptom scales of concussion and emotional distress. Testing took place 2 weeks (n=84) and 1 year (n=49) post-injury. Multivariate analysis (i.e., partial least squares analysis) revealed that frontal perfusion in right superior frontal and middle frontal gyri predicted poorer performance on the Stroop test, an index of executive function, both at initial and follow-up testing. Conversely, SPECT scans categorized as normal or abnormal by radiologists did not differentiate cognitively impaired from intact subjects. These results demonstrate the clinical utility of SPECT in mild TBI, but only when data are subjected to blood flow quantification analysis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Clinical trial of neutron capture therapy for brain tumors at New England Medical Center and the Massachusetts Institute of Technology

    International Nuclear Information System (INIS)

    Zamenhof, R.G.A.; Madoc-Jones, H.; Harling, O.K.; Bernard, J.A.

    1986-01-01

    A proposal is submitted that is based on the conclusions of a NCT expert panel recently convened at BNL by the Department of Energy to evaluate the status of NCT and to recommend what preclinical tasks should be accomplished prior to a clinical study being undertaken. The proposal is for two years of preclinical research and preparations, followed in the third year by a pilot clinical trial of ten patients with grade-IV astrocytoma brain tumors, for whom the prognosis with existing treatment modalities is less than a 5% three-year survival rate. Preclinical tasks would include modifying the MIT Nuclear Reactor medical facility to produce an epithermal as well as the existing and highly thermalized neutron treatment beam; characterizing the transport behavior of these beams in both physical and mathematical models of the human head, and developing a treatment planning scheme for NCT; further development of the neutron-induced alpha-autoradiography track-etch method for measuring macro- and micro-distributions of B-10 uptake in tissues and blood; investigations into the B-10 cellular uptake pattern of human tumors; and examination of the nature of endothelial cell vascular damage in B-10-containing animals undergoing irradiation with neutrons. With the successful completion of the above preclinical tasks we feel we will be in a position to embark in the third year on a pilot clinical evaluation

  20. Clinical characteristics and outcome of brain abscess Systematic review and meta-analysis

    NARCIS (Netherlands)

    Brouwer, Matthijs C.; Coutinho, Jonathan M.; van de Beek, Diederik

    2014-01-01

    Objective: To establish cerebral metabolic features associated with the A3243G mitochondrial DNA mutation with proton magnetic resonance spectroscopic imaging (H-1 MRSI) and to assess their potential as prognostic biomarkers. Methods: In this prospective cohort study, we investigated 135 clinically

  1. Effects of scatter and attenuation corrections on phantom and clinical brain SPECT

    International Nuclear Information System (INIS)

    Prando, S.; Robilotta, C.C.R.; Oliveira, M.A.; Alves, T.C.; Busatto Filho, G.

    2002-01-01

    Aim: The present work evaluated the effects of combinations of scatter and attenuation corrections on the analysis of brain SPECT. Materials and Methods: We studied images of the 3D Hoffman brain phantom and from a group of 20 depressive patients with confirmed cardiac insufficiency (CI) and 14 matched healthy controls (HC). Data were acquired with a Sophy-DST/SMV-GE dual-head camera after venous injection of 1110MBq 99m Tc-HMPAO. Two energy windows, 15% on 140keV and 30% centered on 108keV of the Compton distribution, were used to obtain corresponding sets of 128x128x128 projections. Tomograms were reconstructed using OSEM (2 iterations, 8 sub-sets) and Metz filter (order 8, 4 pixels FWHM psf) and FBP with Butterworth filter (order 10, frequency 0.7 Nyquist). Ten combinations of Jaszczak correction (factors 0.3, 0.4 and 0.5) and the 1st order Chang correction (u=0.12cm -1 and 0.159cm -1 ) were applied on the phantom data. In all the phantom images, contrast and signal-noise ratio between 3 ROIs (ventricle, occipital and thalamus) and cerebellum, as well as the ratio between activities in gray and white matters, were calculated and compared with the expected values. The patients images were corrected with k=0.5 and u=0.159cm -1 and reconstructed with OSEM and Metz filter. The images were inspected visually and blood flow comparisons between the CI and the HC groups were performed using Statistical Parametric Mapping (SPM). Results: The best results in the analysis of the contrast and activities ratio were obtained with k=0.5 and u=0.159cm -1 . The results of the activities ratio obtained with OSEM e Metz filter are similar to those published by Laere et al.[J.Nucl.Med 2000;41:2051-2062]. The method of correction using effective attenuation coefficient produced results visually acceptable, but inadequate for the quantitative evaluation. The results of signal-noise ratio are better with OSEM than FBP reconstruction method. The corrections in the CI patients studies

  2. The evaluation of behavioural changes in brain-injured patients: SOFMER recommendations for clinical practice.

    Science.gov (United States)

    Prouteau, A; Stéfan, A; Wiart, L; Mazaux, J M

    2016-02-01

    Behavioural changes are the main cause of difficulties in interpersonal relationships and social integration among traumatic brain injury (TBI) patients. The Société française de médecine physique et réadaptation (SOFMER) decided to develop recommendations for the treatment and care provision for these problem under the auspices of the French health authority, the Haute Autorité de la santé (HAS). Assessment of behaviour is essential to describe, understand and define situations, assess any change and suggest lines for intervention. The relationship of these behavioural changes with the brain lesion is likewise of crucial importance in legal and forensic expertise. Using a literature review and expert opinions, the aim was to define the optimal conditions for the collection of data on behavioural changes in individuals having sustained brain trauma, to identify the situations in which they arise, to review the instruments available, and to suggest lines of intervention. A literature search identified 981 articles, among which 122 on the target subject were selected and analysed in detail and confronted with the experience of professionals and user representatives. A first draft of the recommendations was produced by the working group, and then submitted to a review group for opinions and complements. The literature on this subject is heterogeneous, and presents low levels of evidence. No article enabled the development of recommendations above the "expert opinion" level. After prior clarification of the aims of the evaluation, it is recommended first to carefully describe the changes in behaviour, from patient and third-person narratives, and where possible from direct observations. The information enabling the description of the phenomena occurring should be collected by different individuals (multi-source evaluation): the patient, his or her close circle, and professionals with different training backgrounds (multidisciplinary evaluation). The analysis of

  3. Clinical impact of {sup 11}C-methionine PET on expected management of patients with brain neoplasm

    Energy Technology Data Exchange (ETDEWEB)

    Yamane, Tomohiko; Senda, Michio [Institution of Biomedical Research and Innovation, Division of Molecular imaging, Kobe (Japan); Sakamoto, Setsu [Kobe University Graduate School of Medicine, Department of Radiology, Kobe (Japan)

    2010-04-15

    We retrospectively examined the clinical efficacy of {sup 11}C-methionine positron emission tomography ({sup 11}C-MET PET) in patients with brain neoplasm, especially whether the {sup 11}C-MET PET changed the clinical management and whether the change was beneficial or detrimental. This study reviewed 89 {sup 11}C-MET PET scans for 80 patients (20 scans for initial diagnosis of brain tumor and 69 scans for differentiating tumor recurrence from radiation necrosis). Final diagnosis and the effect on the intended management were obtained from the questionnaire to the referring physicians or directly from the medical records. The diagnostic sensitivity, specificity, and accuracy for the {sup 11}C-MET PET were evaluated. Regarding the management impact, the rate of scans that caused changes in intended management was also evaluated. Moreover, the occurrence of scans having detrimental diagnostic impact (DDI) and beneficial diagnostic impact (BDI) were evaluated. Sensitivity, specificity, and accuracy of {sup 11}C-MET PET was 87.8, 80.0, and 85.9%. The intended management was changed in 50.0% of the scans. DDI and BDI were observed in 4.3 and 36.2% of the total relevant scans, respectively. {sup 11}C-MET PET can provide useful information in initial diagnosis and differentiating tumor recurrence from radiation necrosis. The intended management was changed in half of the scans. Since a few cases did not receive the requisite treatment due to false-negative results of {sup 11}C-MET PET, management decision should be made carefully, especially in the case of a negative scan. (orig.)

  4. Serum N-terminal-pro-brain natriuretic peptide level and its clinical implications in patients with atrial fibrillation.

    Science.gov (United States)

    Bai, Mei; Yang, Jiefu; Li, Yingying

    2009-12-01

    Brain natriuretic peptide (BNP) is increasingly being used for screening and monitoring of congestive heart failure. However, the role of BNP in patients with atrial fibrillation (AF) and normal left ventricular function has not been determined. This study investigates serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level and its clinical implications in patients with AF. Serum NT-proBNP levels were measured by enzyme-linked immunosorbent assay (ELISA) and transthoracic echocardiography was performed in 136 subjects (90 cases with AF and 46 cases with sinus rhythm [SR]). Subjects were excluded if they had a history of myocardial infarction, cardiomyopathy, rheumatic heart disease, or hyperthyroidism that preceded the onset of AF. Controls (n = 30) were from a healthy outpatient primary care population. Potential determinants of serum NT-proBNP levels were identified by univariate and multivariate analyses. Individuals with AF had higher serum NT-proBNP levels (689.56 +/- 251.87 fmol/ml) than those with SR (456.11 +/- 148.14 fmol/ml, P NT-proBNP levels (P > 0.05). The regression model of serum NT-proBNP levels and clinical predictors showed that presence of AF, older age, and larger right atrial diameter were independently predictive of higher serum NT-proBNP values. Patients with AF were associated with increased serum NT-proBNP levels. Examining the change of serum NT-proBNP levels is helpful to evaluate the cardiac function in patients with AF. Copyright 2009 Wiley Periodicals, Inc.

  5. Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions.

    Science.gov (United States)

    Seo, Kwon-Duk; Suh, Sang Hyun; Kim, Yong Bae; Kim, Ji Hwa; Ahn, Sung Jun; Kim, Dong-Seok; Lee, Kyung-Yul

    2015-09-01

    Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD. FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke. TIS was significantly different as follows: 4.86±2.55 in patients with nonspecific symptoms, 5.89±3.10 in patients with single TIA, 9.60±3.98 in patients with recurrent TIA and 8.37±3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35±4.22 vs. 7.49±3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001). Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.

  6. [Clinical experience of the use of agomelatine in the treatment of patients with depression and chronic brain ischemia].

    Science.gov (United States)

    Antonen, E G; Nikitina, M V; Kruchek, M M

    2015-01-01

    To study the efficacy and tolerability of agomelatine (valdoxan) in treatment of mild depressive states in patients with chronic brain ischemia (CBI). The study comprised 33 patients (23 women, 10 men, average age 54.5 years), including 12 people (36.4%) with CBI, stage I, and 21 (63.6%) with CBI, stage II. All patients had a single depressive episode of mild severity. Diagnosis of affective and cognitive impairment was carried out using clinical and neuropsychological methods (the Hamilton Depression Rating Scale (HDRS-17), the Hospital Anxiety and Depression Scale (HADS), the night sleep questionnaire developed by A.M. Vein, the Mini-mental state examination (MMSE), the modified Mini-Cog method, the Montreal Cognitive Assessment Scale (MoCA), the Clinical Global Impression scale (CGI-S, CGI-I) to assess the degree and dynamics of the disease, the Patient Global Impression (PGI) scale. The survey had been performed after 2,4 and 8 weeks of treatment. Agomelatine (valdoxan) was used 1 time per day in the evening in a dose of 25 mg (1 tablet). Agomelatine improved sleep from the second week of treatment, reduced anxiety symptoms after six weeks and depressive symptoms after eight weeks. The improvement of cognitive functions was noted as well. No side-effects was observed. The results revealed the high antidepressive activity of the drug in treatment of mild depressive states in patients with chronic brain ischemia, the balanced spectrum of effects on anxiety, depression, insomnia, the positive effect on cognitive functions that allows to recommend agomelatine in treatment of patients with CBI.

  7. Clinical Course Score (CCS): a new clinical score to evaluate efficacy of neurotrauma treatment in traumatic brain injury and subarachnoid hemorrhage.

    Science.gov (United States)

    Brandner, Sebastian; Kellermann, Isabel; Hore, Nirjhar; Bozhkov, Yavor; Buchfelder, Michael

    2015-01-01

    Neurotrauma continues to represent a challenging public health issue requiring continual improvement in therapeutic approaches. As no such current system exists, we present in this study the Clinical Course Score (CCS) as a new clinical score to evaluate the efficacy of neurotrauma treatment. The CCS was calculated in neurotrauma patients to be the difference between the grade of the Glasgow Outcome Scale 6 months after discharge from our department and the grade of a 1 to 5 point reduced Glasgow Coma Scale on admission. We assessed the CCS in a total of 248 patients (196 traumatic brain injury [TBI] patients and 52 subarachnoid hemorrhage [SAH] patients) who were treated in our Department of Neurosurgery between January 2011 and December 2012. We found negative CCS grades both in mild TBI and in mild SAH patients. In patients with severe TBI or SAH, we found positive CCS grades. In SAH patients, we found higher CCS scores in younger patients compared with elderly subjects in both mild and severe cases. The CCS can be useful in evaluating different therapeutic approaches during neurotrauma therapy. This new score might improve assessment of beneficial effects of therapeutic procedures.

  8. Tumors and tumor - like lesions of the oro - facial region at Mayo hospital, Lahore - a five year study

    International Nuclear Information System (INIS)

    Riaz, N.; Warriach, R.A.

    2011-01-01

    The oro-facial region including the oral cavity, the maxilla and mandible and related tissues can be the site of a multitude of neoplastic conditions. These tumours have a predilection for the entire facial region; however, odontogenic tumours tend to affect the mandible more than the maxilla. We report results from a retrospective study spanning five years on the frequency, clinical presentation, sites and character of orofacial tumors seen in the main referral hospital of Pakistan. Patients and Methods: Records of consecutive patients of all age and sex seen by the author's team at the Department of Oral and Maxillofacial Surgery, Mayo Hospital with tumours affecting the oro-facial region from January 2005 to December 2009 were retrieved, coded and entered into a database. The data were then analyzed by age, sex, presenting signs and symptoms, site of lesion, and their histology. Results: A total of 237 patients with oro-facial swellings were retrieved from the registry. The complete data set was obtained for 189 patients, comprising 108 (57.9%) males and 81 (42%) females. The most common clinical presenting features were mandibular facial swelling (63%), intra-oral swelling (55%), and ulceration (29%). The tumors were found in the mandible 67 (35%), buccal mucosa 33 (17%), floor of the mouth 22 (11%) and tongue 29 (15%). The remainder making up almost 20% was found in the palate, submandibular region, pre auricular region and lips. Ninety three (49.2%) of the patients presented with lesions that were classified as malignant of which 64 (69%) were diagnosed as squamous cell carcinoma (SCC). seventy (37.0%) had benign odontogenic tumors and twenty six (13.7%) had non-odontogenic tumor - like lesions. Sixty - four (69%) of malignant tumors were squamous cell carcinoma; sixty four (86.4%) of the benign odontogenic tumors were classified as ameloblastoma. The mean age at presentation of all lesions was 40.4 years with over 50% of benign lesions in patients aged

  9. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation.

    Science.gov (United States)

    Müller-Vahl, Kirsten R; Cath, Danielle C; Cavanna, Andrea E; Dehning, Sandra; Porta, Mauro; Robertson, Mary M; Visser-Vandewalle, Veerle

    2011-04-01

    Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). For a narrative review a systematic literature search was conducted and expert opinions of the guidelines group contributed also to the suggestions. Of 63 patients reported so far in the literature 59 had a beneficial outcome following DBS with moderate to marked tic improvement. However, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-related (e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function) may occur. At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general agreement that, at present time, DBS should only be used in adult, treatment resistant, and severely affected patients. It is highly recommended to perform DBS in the context of controlled trials.

  10. Clinical studies of functional imaging of dynamic CT for chronic brain-damaged patients

    International Nuclear Information System (INIS)

    Inada, Haruo; Miyano, Satoshi

    1995-01-01

    The 311 brain-damaged patients, mostly of cerebrovascular disease (CVD) were examined by functional imaging to dynamic CT (FIDCT) at Tokyo Metropolitan Rehabilitation Hospital. The abnormal patterns of FIDCT were classified according to two categories, i.e. focal area where plain CT showed low density area (LDA), and extra-focal area where plain CT showed no abnormal findings. These patterns were diagnosed by using the two parameters, i.e. Corrected First Moment (CM) and Time to Peak (TP). Over 50% of the focal abnormal FIDCT revealed tha same area with LDA on plain CT. The extra-focal FIDCT showed various abnormal patterns, and only 11% of all the findings had no abnormalities. The correlation of the specific patterns of extra-focal FIDCT with the multiple CVD episodes was investigated, and the findings that had significant correlation were (a) delayed CM of bilateral white matter, (b) diffusely delayed TP of the affected hemisphere, and the patient group that showed no extra-focal abnormal FIDCT had significant low incidence of multiple CVD episodes. From these results, it is concluded that the high-risk group of stroke recurrence can be predicted by extra-focal findings of FIDCT. (author)

  11. Potential clinical relevance of the 'little brain' on the mammalian heart.

    Science.gov (United States)

    Armour, J A

    2008-02-01

    It is hypothesized that the heart possesses a nervous system intrinsic to it that represents the final relay station for the co-ordination of regional cardiac indices. This 'little brain' on the heart is comprised of spatially distributed sensory (afferent), interconnecting (local circuit) and motor (adrenergic and cholinergic efferent) neurones that communicate with others in intrathoracic extracardiac ganglia, all under the tonic influence of central neuronal command and circulating catecholamines. Neurones residing from the level of the heart to the insular cortex form temporally dependent reflexes that control overlapping, spatially determined cardiac indices. The emergent properties that most of its components display depend primarily on sensory transduction of the cardiovascular milieu. It is further hypothesized that the stochastic nature of such neuronal interactions represents a stabilizing feature that matches cardiac output to normal corporal blood flow demands. Thus, with regard to cardiac disease states, one must consider not only cardiac myocyte dysfunction but also the fact that components within this neuroaxis may interact abnormally to alter myocyte function. This review emphasizes the stochastic behaviour displayed by most peripheral cardiac neurones, which appears to be a consequence of their predominant cardiac chemosensory inputs, as well as their complex functional interconnectivity. Despite our limited understanding of the whole, current data indicate that the emergent properties displayed by most neurones comprising the cardiac neuroaxis will have to be taken into consideration when contemplating the targeting of its individual components if predictable, long-term therapeutic benefits are to accrue.

  12. Clinical studies of functional imaging of dynamic CT for chronic brain-damaged patients

    Energy Technology Data Exchange (ETDEWEB)

    Inada, Haruo; Miyano, Satoshi [Jikei Univ., Tokyo (Japan). School of Medicine

    1995-03-01

    The 311 brain-damaged patients, mostly of cerebrovascular disease (CVD) were examined by functional imaging to dynamic CT (FIDCT) at Tokyo Metropolitan Rehabilitation Hospital. The abnormal patterns of FIDCT were classified according to two categories, i.e. focal area where plain CT showed low density area (LDA), and extra-focal area where plain CT showed no abnormal findings. These patterns were diagnosed by using the two parameters, i.e. Corrected First Moment (CM) and Time to Peak (TP). Over 50% of the focal abnormal FIDCT revealed tha same area with LDA on plain CT. The extra-focal FIDCT showed various abnormal patterns, and only 11% of all the findings had no abnormalities. The correlation of the specific patterns of extra-focal FIDCT with the multiple CVD episodes was investigated, and the findings that had significant correlation were (a) delayed CM of bilateral white matter, (b) diffusely delayed TP of the affected hemisphere, and the patient group that showed no extra-focal abnormal FIDCT had significant low incidence of multiple CVD episodes. From these results, it is concluded that the high-risk group of stroke recurrence can be predicted by extra-focal findings of FIDCT. (author).

  13. The clinical significance of brain microbleeds in patients with Alzheimer′s disease: Preliminary study

    Directory of Open Access Journals (Sweden)

    Jae-Hyeok Heo

    2016-01-01

    Full Text Available Background: Microbleeds (MBs are observed frequently in Alzheimer′s disease (AD and suggested to play a crucial role in the pathophysiology, but their clinical significance remains unclear. Materials and Methods: The study recruited 100 patients with AD who were diagnosed at the memory clinic in Seoul Medical Center in 2014. For each patient, baseline characteristics, neuropsychological tests, cerebrovascular risk factors, medial temporal lobe atrophy (MTLA, and severity of small vessel disease (SVD according to the existence of MBs were evaluated. Results: The prevalence of MBs in patients with AD was 33%. The percentage of male gender, the severity of SVD and MTLA were significantly increased in MB(+ group. The MB(+ group showed more severe MTLA and SVD than MB(− group. Conclusions: These results suggested that MBs might reflect the burden of amyloid and ischemic vascular pathology.

  14. Mind-Body Practices and the Adolescent Brain: Clinical Neuroimaging Studies.

    Science.gov (United States)

    Sharma, Anup; Newberg, Andrew B

    Mind-Body practices constitute a large and diverse group of practices that can substantially affect neurophysiology in both healthy individuals and those with various psychiatric disorders. In spite of the growing literature on the clinical and physiological effects of mind-body practices, very little is known about their impact on central nervous system (CNS) structure and function in adolescents with psychiatric disorders. This overview highlights findings in a select group of mind-body practices including yoga postures, yoga breathing techniques and meditation practices. Mind-body practices offer novel therapeutic approaches for adolescents with psychiatric disorders. Findings from these studies provide insights into the design and implementation of neuroimaging studies for adolescents with psychiatric disorders. Clinical neuroimaging studies will be critical in understanding how different practices affect disease pathogenesis and symptomatology in adolescents. Neuroimaging of mind-body practices on adolescents with psychiatric disorders will certainly be an open and exciting area of investigation.

  15. Morbidity and mortality pattern of hospitalized children with measles at mayo hospital, lahore (epidemic 2013)

    International Nuclear Information System (INIS)

    Javed, T.; Bibi, A.

    2014-01-01

    Major outbreak of measles took place in Punjab recently (2013), leading on to increase in hospitalized cases of measles in children wards, with unacceptably high morbidity and mortality. The aim of this study was to find out morbidity and mortality pattern of hospitalized cases of measles and associated factors. Design: Prospective case series conducted at Pediatric Department Mayo Hospital, Lahore for 7 months, i.e. from 1st Jan to 31st Jul 2013 Methods:A total of 628 cases of measles were admitted in the children ward, Unit II, Mayo Hospital, Lahore from Jan-Jul 2013. The diagnosis was assigned using WHO criteria. Cases were admitted through emergency on 24 hour basis and managed in HDU and Measles isolation section. Chest X-Ray and blood complete examination was done in all cases. Complications were noted and managed along with eye consultations where necessary. Data was recorded in a predesigned proforma and entered in computer. Results: 628 admitted cases were enrolled, with comparable sex distribution, having mean age 30.8+-26.25 months and mean weight 9.69+-4.14 Kg. Eighty three percent cases were below 6 years of age (33% <1 year), 71% cases were under weight and 68% were wasted (WHO classification). Sixty six percent cases had not received measles vaccination, 144 (23%) cases had received a single dose and 71 cases (12.2%) had received two doses before admission. Majority of cases belonged to Lahore city and its peri-urban areas (83%). Pneumonia (80%), diarrhea (37%), and encephalitis (7.7%) were common complications. Eye complications (corneal ulcers, keratitis, perforation and blindness) were seen in 7.3% cases. Being under weight, H/O improper measles immunization, presence of anemia, pneumonia and encephalitis were statistically significant risk factors for mortality. The case fatality rate was 8.76%. Conclusion:Recent Measles outbreak further highlights the importance of strengthening the need for routine and mass vaccination for all children. In a

  16. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

    Science.gov (United States)

    Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David

    2015-10-01

    The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p < 0.003), with no significant change in the DBS + ODT group. DBS + ODT in early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Clinical use of 'ROTOP-NEUROSPECT' in several brain diseases. Die klinische Anwendung von 'ROTOP-NEUROSPECT' bei verschiedenen hirnorganischen Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Wuensche, A.; Kaempfer, I.; Loessner, J.; Wagner, A.; Dietrich, J.; Strauss, I.; Neumann, G.; Otto, L.; Koegler, A.; Schenk, S.; Schneider, G. (Leipzig Univ., Klinik fuer Radiologie, Abt. Nuklearmedizin (Germany) Leipzig Univ. (Germany). Klinik fuer Neurologie Leipzig Univ. (Germany). Klinik fuer Neurochirurgie Bezirkskrankenhaus fuer Psychiatrie, Leipzig-Doesen (Germany))

    1990-01-01

    We proofed the suitibility of ROTOP-NEUROSPECT (R*) (HMPAO) from Rossendorf for consideration of disturbed brain circulation in 42 patients. Results we compared with morphological methods (X-ray computing tomography, angiography) and with clinical and neurological findings. We found often a disturbed brain circulation in emission computing tomography (SPECT) before morphological changes in X-ray computing tomography (CT). ROTOP-NEUROSPECT (R*) from Rossendorf is very well for consideration of disturbed brain circulation, we did not see quality differences between ROTOP-NEUROSPECT and CERETEC from Amersham. Activity accumulations in the liver and gall of both radiopharmaceuticals did not influence the test, because of the big distance to the brain. (orig.).

  18. Clinical and Biochemical Outcomes Following EEG Neurofeedback Training in Traumatic Brain Injury in the Context of Spontaneous Recovery.

    Science.gov (United States)

    Bennett, Cathlyn N; Gupta, Rajnish K; Prabhakar, Puttachandra; Christopher, Rita; Sampath, Somanna; Thennarasu, K; Rajeswaran, Jamuna

    2017-12-01

    It has been found that reduction of posttraumatic stress symptoms is positively associated with the reduction of postconcussive symptoms. Cortisol is commonly used as a biomarker of stress. Understanding the role of posttraumatic stress and cortisol in symptom reduction has implication for neuropsychological rehabilitation particularly in the context of spontaneous recovery. The aim of the research was to study the effectiveness of EEG neurofeedback training on clinical symptoms, perceived stress, and cortisol in traumatic brain injury (TBI) patients in the context of spontaneous recovery. The design was an experimental longitudinal design with the pre-post comparison. The sample comprised 60