Diffuse myocardial fibrosis in patient with diabetes mellitus type-II assessed by Cardiac Magnetic Resonance T1 mapping technique

Purpose: Diabetic cardiomyopathy (DCM) can be cause of a progressive dysfunction of ventricular contractility with the evolution to heart failure, independently of ischaemic heart disease or hypertension. Early stages of DCM are asymptomatic and characterized by various degrees of myocardial fibrosis. Our aim is to non-invasively detect myocardial fibrotic infiltration in DM-II patients, to assess its relationship with ventricular function abnormalities and to compared our results with a group of healthy controls. Methods and Materials: 100 patients affected by DM-II (57 man, 43 women) with preserved ventricular function and no history of ischaemic disease and 20 matching controls underwent contrast cardiac MR (CMR) between September 2014 and July 2017. Imaging protocol included: modified Look-Locker sequence before and 20 minutes after a double dose of 0.1 mmol/kg gadoterate meglumine injection; T2-mapping; ventricular function module; tagged-cineMR module and late gadolinium enhanced (LGE) imaging. Native myocardial T1 (nT1) and T2 values, extracellular volume fraction (ECV), ventricular torsion angle and myocardial strain values have been calculated and correlated to glycated haemoglobin (HbA1c) and duration of disease. Pearson Correlation, Mann-Whitney test and unpaired T-test were used for statistical analysis. Results: Patient group had higher nT1 and ECV values compared to controls (1018.29±73.28 ms vs.975±38 ms, 29.2±0.07% vs. 22.8±4.3% respectively, p<0.05 for both), whereas no significant differences occurred in T2 measurements (47.61±2.7ms vs. 47.0±2.8ms respectively, p=0.23). nT1 and ECV correlated with HbA1c (nT1: r2=0.99, p<0.0001; ECV: r2=0,07; p<0.005) and disease duration (nT1: r2=0.99, p<0.0001;ECV: r2=0,70 p<0,001) in DM-II patients. nT1 and ECV correlate positively torsion (nT1: r2=0.31, p<0.001; ECV: r2=0.30;p<0.001) and negatively with strain values in tagged-cineMR analysis (nT1 with global longitudinal and circunferential strain: both r2=-0.97, p<0.0001; ECV: r2=0.63 and r2=0.76, p<0.0001). LGE with ischemic pattern was found in eight patients as marker of silent infarction. Conclusion: In DM-II patients with preserved ventricular function, HbA1c values and disease duration showed a significant correlation to myocardial nT1 and ECV increase, as reflection of diffuse fibrosis, and geometrical modification

Desenvolvimento de Sistema de Odontologia – Módulo Relatório de Sistema:Odonto Clínica ERP

trabalho descrito neste relatório é sobre desenvolvimento de sistema de informação que possui a função de informatizar uma clínica odontológica de acordo com suas principais necessidades. O sistema, Odonto Clínica ERP é um Projecto desenvolvido na empresa Ada Soluções que tem como objectivo melhorar o atendimento aos pacientes da clínica, garantindo agilidade e facilidade aos seus utilizadores na consulta e documentação de seus serviços. O Odonto Clínica ERP é um sistema simples e eficiente que garante às clínicas odontológicas o controlo e emissão de relatórios de todos os relatórios de sistema. O documento possui informações sobre o sistema, os requisitos do sistema, diagramas para a implementação dos requisitos do sistema e visualização dos conceitos de sistema de informação, descrição da base de dados que armazenará os dados do sistema e sobre a modelação do sistema. Várias abordagens teóricas foram adoptadas para a realização desse sistema, privilegiando os conhecimentos adquiridos durante a formação académica designadamente nas disciplinas de Base de Dados, Desenvolvimento de Aplicação Web, Sistema de Informação, Programação e Desenho e Guião de Conteúdos Web. Para o desenvolvimento desse sistema utilizou-se a plataforma Oracle Application Express 10g com a linguagem de programação PL/SQL, para fazer a modelação desse sistema foi usada a ferramenta Visual Paradigma for UML 6.0. Esse sistema foi dividido em sete módulos, por isso, esse relatório vai focar no módulo Relatório de Sistema

Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer

This study aims to evaluate the feasibility of a magnetic resonance (MR) automatic method for quantitative assessment of the percentage of fibrosis developed within locally advanced rectal cancers (LARC) after neoadjuvant radiochemotherapy (RCT). A total of 65 patients were enrolled in the study and MR studies were performed on 3.0 Tesla scanner; patients were followed-up for 30 months. The percentage of fibrosis was quantified on T2-weighted images, using automatic K-Means clustering algorithm. According to the percentage of fibrosis, an optimal cut-off point for separating patients into favorable and unfavorable pathologic response groups was identified by ROC analysis and tumor regression grade (MR-TRG) classes were determined and compared to histopathologic TRG. An optimal cut-off point of 81% of fibrosis was identified to differentiate between favorable and unfavorable pathologic response groups resulting in a sensitivity of 78.26% and a specificity of 97.62% for the identification of complete responders (CRs). Interobserver agreement was good (0.85). The agreement between P-TRG and MR-TRG was excellent (0.923). Significant differences in terms of overall survival (OS) and disease free survival (DFS) were found between favorable and unfavorable pathologic response groups. The automatic quantification of fibrosis determined by MR is feasible and reproducible

Quantitative assessment of diffuse myocardial fibrosis in II-type diabetes mellitus patients using T1 mapping technique: preliminary data

In diabetic cardiomyopathy (DCM), ventricular remodelling consists in a progressive impairment of myocardial contraction (evolving from diastolic to combined diastolic-systolic dysfunction) occurring regardless of ischemic heart disease, hypertension or other macrovascular complications, which ultimately leads to heart failure. Early stages of DCM are asymptomatic and characterised by initial contractile disfunction and various degree of myocardial fibrosis, that may not be recognised by traditional cardiology tests. Our purpose was to detect myocardial fibrotic infiltration in DM-II patients by using T1-mapping technique with extracellular volume fraction (ECV) measurement

Characterization of COVID-19-related lung involvement in patients undergoing magnetic resonance T1 and T2 mapping imaging: a pilot study

Tissue characterization by mapping techniques is a recent magnetic resonance imaging (MRI) tool that could aid the tissue characterization of lung parenchyma in coronavirus disease-2019 (COVID-19). The aim of the present study was to compare lung MRI findings, including T1 and T2 mapping, in a group of n = 11 patients with COVID-19 pneumonia who underwent a scheduled cardiac MRI, and a cohort of healthy controls. MRI scout images were used to identify affected and remote lung regions within the patients’ cohort and appropriate regions of interest (ROIs) were drawn accordingly. Both lung native T1 and T2 values were significantly higher in the affected areas of patients with COVID-19 as compared to the controls (1375 ms vs. 1201 ms, p = 0.016 and 70 ms vs. 30 ms, p &lt; 0.001, respectively), whereas no significant differences were detected between the remote lung parenchyma of the COVID-19 patients and the controls (both p &gt; 0.05). When a larger ROI was identified, comprising the whole lung parenchyma within the image irrespective of the affected and remote areas, the COVID-19 patients still retained higher native T1 (1278 ms vs. 1149 ms, p = 0.003) and T2 values (38 ms vs. 34 ms, p = 0.04). According to the receiver operator characteristics curves, the T2 value of the affected region retained the higher accuracy for the differentiation of the COVID-19 patients against the controls (area under the curve 0.934, 95% confidence interval 0.826–0.999). These findings, possibly driven by the ability of MRI tissue mapping to detect ongoing inflammation in the lungs of patients with COVID-19, suggest that T1 and T2 mapping of the lung is a feasible approach in this clinical scenario

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

Uremic cardiomyopathy (UC) is the cardiac remodelling that occurs in patients with chronic kidney disease (CKD). It is characterised by a left ventricular (LV) hypertrophy phenotype, diastolic dysfunction and generally preserved LV ejection fraction. UC has a major role mediating the increased rate of cardiovascular events, especially heart failure related, observed in patients with CKD. Recently, the use of T1 and T2 mapping techniques on cardiac MRI has expanded the ability to characterise cardiac involvement in CKD. Native T1 mapping effectively tracks the progression of interstitial fibrosis in UC, whereas T2 mapping analysis suggests the contribution of myocardial oedema, at least in a subgroup of patients. Both T1 and T2 increased values were related to worsening clinical status, myocardial injury and B-type natriuretic peptide release. Studies investigating the prognostic relevance and histology validation of mapping techniques in CKD are awaited

Magnetic resonance of rectal cancer response to therapy: an Image quality comparison between 3.0 and 1.5 Tesla

Purpose. To evaluate signal intensity (SI) differences between 3.0 T and 1.5 T on T2-weighted (T2w), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) in rectal cancer pre-, during, and postneoadjuvant chemoradiotherapy (CRT). Materials and Methods. 22 patients with locally advanced rectal cancer were prospectively enrolled. All patients underwent T2w, DWI, and ADC pre-, during, and post-CRT on both 3.0 T MRI and 1.5 T MRI. A radiologist drew regions of interest (ROIs) of the tumor and obturator internus muscle on the selected slice to evaluate SI and relative SI (rSI). Additionally, a subanalysis evaluating the SI before and after-CRT (ΔSI pre-post) in complete responder patients (CR) and nonresponder patients (NR) on T2w, DWI, and ADC was performed. Results. Significant differences were observed for T2w and DWI on 3.0 T MRI compared to 1.5 T MRI pre-, during, and post-CRT (all P&lt;0.001), whereas no significant differences were reported for ADC among all controls (all P&gt;0.05). rSI showed no significant differences in all the examinations for all sequences (all P&gt;0.05). ΔSI showed significant differences between 3.0 T and 1.5 T MRI for DWI-ΔSI in CR and NR (188.39±166.90 vs. 30.45±21.73 and 169.70±121.87 vs. 22.00±31.29, respectively, all P 0.02) and ADC-ΔSI for CR (-0.58±0.27 vs. -0.21±0.24P value 0.02), while no significant differences were observed for ADC-ΔSI in NR and both CR and NR for T2w-ΔSI. Conclusion. T2w-SI and DWI-SI showed significant differences for 3.0 T compared to 1.5 T in all three controls, while ADCSI showed no significant differences in all three controls on both field strengths. rSI was comparable for 3.0 T and 1.5 T MRI in rectal cancer patients; therefore, rectal cancer patients can be assessed both at 3.0 T MRI and 1.5 T MRI. However, a significant DWI-ΔSI and ADC-ΔSI on 3.0 T in CR might be interpreted as a better visual assessment in discriminating response to therapy compared to 1.5 T. Further investigations should be performed to confirm future possible clinical application

Characterization of Ku702–NLS as Bipartite Nuclear Localization Sequence for Non-Viral Gene Delivery

Several barriers have to be overcome in order to achieve gene expression in target cells, e.g. cellular uptake, endosomal release and translocation to the nucleus. Nuclear localization sequences (NLS) enhance gene delivery by increasing the uptake of plasmid DNA (pDNA) to the nucleus. So far, only monopartite NLS were analysed for non-viral gene delivery. In this study, we examined the characteristics of a novel bipartite NLS like construct, namely NLS Ku70. We synthesized a dimeric structure of a modified NLS from the Ku70 protein (Ku702-NLS), a nuclear transport active mutant of Ku702-NLS (s1Ku702-NLS) and a nuclear transport deficient mutant of Ku702-NLS (s2Ku702). We examined the transfection efficiency of binary Ku702-NLS/DNA and ternary Ku702-NLS/PEI/DNA gene vector complexes in vitro by using standard transfection protocols as well as the magnetofection method. The application of Ku702-NLS and s1Ku702-NLS increased gene transfer efficiency in vitro and in vivo. This study shows for the first time that the use of bipartite NLS compounds alone or in combination with cationic polymers is a promising strategy to enhance the efficiency of non-viral gene transfer