Background: Resting-state functional magnetic resonance imaging (rs-fMRI) is commonly employed to study changes in functional brain connectivity. The recent hypothesis of a brain involvement in primary open angle Glaucoma has sprung interest for neuroimaging studies in this classically ophthalmological pathology.Object: We explored a putative reorganization of functional brain networks in Glaucomatous patients, and evaluated the potential of functional network disruption indices as biomarkers of disease severity in terms of their relationship to clinical variables as well as select retinal layer thicknesses.Methods: Nineteen Glaucoma patients and 16 healthy control subjects (age: 50–76, mean 61.0 ± 8.2 years) underwent rs-fMRI examination at 3T. After preprocessing, rs-fMRI time series were parcellated into 116 regions using the Automated Anatomical Labeling atlas and adjacency matrices were computed based on partial correlations. Graph-theoretical measures of integration, segregation and centrality as well as group-wise and subject-wise disruption index estimates (which use regression of graph-theoretical metrics across subjects to quantify overall network changes) were then generated for all subjects. All subjects also underwent Optical Coherence Tomography (OCT) and visual field index (VFI) quantification. We then examined associations between brain network measures and VFI, as well as thickness of retinal nerve fiber layer (RNFL) and macular ganglion cell layer (MaculaGCL).Results: In Glaucoma, group-wise disruption indices were negative for all graph theoretical metrics. Also, we found statistically significant group-wise differences in subject-wise disruption indexes in all local metrics. Two brain regions serving as hubs in healthy controls were not present in the Glaucoma group. Instead, three hub regions were present in Glaucoma patients but not in controls. We found significant associations between all disruption indices and VFI, RNFL as well as MaculaGCL. The disruption index based on the clustering coefficient yielded the best discriminative power for differentiating Glaucoma patients from healthy controls [Area Under the ROC curve (AUC) 0.91, sensitivity, 100%; specificity, 78.95%].Conclusions: Our findings support a possible relationship between functional brain changes and disease severity in Glaucoma, as well as alternative explanations for motor and cognitive symptoms in Glaucoma, possibly pointing toward an inclusion of this pathology in the heterogeneous group of disconnection syndromes.
Background and purpose. -To compare outcomes of minor stroke patients with intracranial vessel occlusions (IVO) underwent mechanical thrombectomy (MT) versus those treated with intravenous thrombolysis alone (IVT). Methods. -We retrospectively reviewed two large prospective stroke databases from two European centers searching for patients admitted with minor stroke (i.e. NIHSS Score ≤ 5), baseline mRS = 0 and occlusion of the M1-M2 segment of the middle cerebral artery (MCA). Groups receiving (A) IVT alone and (B) MT+/-IVT were compared. Primary outcome measures were MT safety, successful recanalization rate (mTICI 2b-3) and NIHSS shift (discharge NIHSS minus admission NIHSS); secondary outcomes included discharge rates and excellent outcome (mRS 0-1) at 3 months. Univariate and multivariate analyses were performed.Results. -Thirty-two patients were enrolled in Group B (19 MT alone; 13 MT + IVT) and 24 in Group A. Successful recanalization (mTICI 2b-3) was obtained in 100% of cases in Group B vs 38% in Group A. Symptomatic hemorrhagic transformation rate did not differ between the two groups. Multivariate analysis reported MT as the only predictor of early (< 12 h) favorable NIHSS shift and lower NIHSS at discharge. Moreover, discharge at home and excellent outcome at 3-month follow-up were statistically associated with MT. Conclusions. -MT in patients with minor strokes and intracranial vessel occlusion (IVO) is safe and can determine a rapid improvement of NIHSS Score. MT seems also associated with a higher rate of patients discharged at home after hospitalization and better clinical outcome at 3-month follow-up. Larger randomized trials are warranted to confirm these results.
Microwave thermal ablation (MTA) is an increasingly relevant cancer treatment targetting focal malignancies, in which high temperatures are induced into the target zone by way of the absorption of electromagnetic energy at microwave (MW) frequencies (typically 915 MHz or 2.45 GHz). Thermal ablation is achieved almost instantaneously when temperatures of 55-60 °C or higher are reached in the zone of treatment, which should encompass the tumour lesion plus a 5-10 mm safety margin of surrounding healthy tissue (Goldberg et al 2000, Ryan et al 2010.The main advantages of MTA, with respect to conventional surgery, are related to the limited invasiveness and cost of the treatment, which allow reducing recovery times, complication rates and hospital stays. Moreover, MTA is gaining increasing interest in clinical practice, due to its capability of treating large tissue volumes (up
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