Ultrasound evaluation of access complications: Thrombosis, aneurysms, pseudoaneurysms and infections

: Arteriovenous fistula (AVF) complications are classified based on fistula outcomes. This review aims to update colour Doppler (CD) and pulse wave Doppler (PWD) roles in managing early and late complications of the native and prosthetic AVF. Vascular access (VA) failure occurs because inflow or outflow stenosis activates Wirchow's triad inducing thrombosis. Therefore, the diagnosis of the tributary artery and outgoing vein stenosis will be the first topic considered. Post-implantation complications occur from the inability to achieve AVF maturation and dialysis suitability due to inflow/outflow stenosis. Late stenosis is usually a sequence of early defects repaired to maintain patency. Less frequently, in the mature AVF or graft, complications are acquired 'de novo'. They derive either from incorrect management of vascular access (haematoma, pseudoaneurysm, prosthesis infection) or wall pathologies (aneurysm, myxoid valve degeneration, kinking, coiling, abnormal dilation from defects of elastic structures). High-resolution transducers (10-20 MHz) allow the characterization of the wall damage, haemodynamic dysfunctions, early and late complications even if phlebography remains the gold standard for the diagnosis for its sensitivity and specificity

Post-transplant cerebral toxoplasmosis diagnosed by magnetic resonance imaging.

Cerebral toxoplasmosis is a rare late complication in allogeneic bone marrow transplanted patients. Neuroradiological findings may suggest the correct diagnosis. We report a patient in whom cerebral magnetic resonance imaging (MRI) showed a lesion characteristic of toxoplasmosis. Anti- toxoplasma treatment led to clinical and radiological improvement. MRI seems to be a valid tool for detection and follow-up of cerebral toxoplasmosis

DEFAULT MODE NETWORK AND WORKING MEMORY NETWORK DURING AN FMRI WORKING MEMORY TASK: DIFFERENCES AND CORRELATIONS WITH BEHAVIORAL PERFORMANCE

INTRODUCTION Previous neuroimaging studies have shown that working memory load has marked effects on regional neural activation[1-5]. However, the mechanism through which working memory load modulates brain connectivity is still unclear. During a working memory task, two of the most involved networks are the default mode network (DMN) and the working memory network (WMN)[6-7]: the selective focus on these networks can be useful in better understanding the load effects. Spatial independent component analysis (ICA)[8] has becomes a reliable technique to investigate the networks involved during an fMRI task, as it extracts spatiotemporal patterns of neural activity maximizing spatial independence. A specific study, conducted with ICA, investigating on how the load and phase of a working memory task are related with the activation and response time, is nowadays lacking. The aim of this work is to use the time course of DMN and WMN, selected by means of ICA, for studying: a) how these networks are involved with the complexity of the task and the phase; b) how, in these networks, complexity and phase are correlated with reaction times. METHODS MR Data Acquisition and preprocessing Fifteen young adult healthy and right-handed were involved. The MR protocol consisted of one anatomical sequence 3D T1-weighted MP-RAGE (Voxel size: 1 x 1 x 1 mm) and three functional acquisitions of 15 minutes each performed with a T2*-weighted EPI sequence (TR/TE: 1500/30, In- plane resolution: 3.5x3.5 mm, Thickness: 3.5 mm, Nr of slices: 24, Field of view: 64 x 64 mm). All the images were collected with a Siemens Allegra 3T MR scanner (Siemens, Erlangen, Germany) and a standard head coil. During the fMRI acquisition the subjects performed a delayed spatial working memory paradigm presented with three levels of difficulty. The memory set consisted of one, three or five circles presented randomly in different locations and to the subjects were asked to judge whether or not a given target stimulus had been part of a previous memory stimulus set. Every experiment consisted of 90 working memory trials, 30 per load, divided in three runs. Data were analyzed with Brain Voyager QX. 2.4 (Brain Innovation, Maastricht, The Netherlands). FMRI preprocessing included: 3D head-motion correction, slice-scan time correction, spatial smoothing, temporal high pass filter and linear trend removal. Anatomic 3D data set was inhomogeneities corrected, filtered and transformed into Talairach coordinates and coregistered with the functional information. Independent Component Analysis This analysis was conducted using Brainvoyager QX 2.4. ICA analysis was performed on each subject\u2019s three functional acquisitions. A subsequent total ICA group analysis[9-10] was achieved by an inter- subject ICA group analysis of all the intra-subject ICA group analysis. From the obtained maps were selected two Independent Components (ICs) containing the WMN[1,2]: WMN1 defined by SPL and Precuneus, and WMN2 with DLPFC and IPS (Fig. 1b-c). Also one IC describing the DMN was considered, with PCC, IPL and MPFC (Fig. 1a)[11]. For each run of all the subjects the ICs time course was considered: three time windows of 3TR (4.5s) for each working memory task phase (encode, maintenance and retrieval) were selected taking into account the haemodynamic response by delaying the window of 5 volumes events from the start of every trial. The window time course was corrected for a baseline value. Mean values of the ICs where examined and a subsequent correlation between the mean values and the response time in every trial was estimated. A 3x3 two-way ANOVA on Fisher transformed correlation was conducted to test the variation of loads (load1=less complex, load3=more complex), phases and runs. Figure 1: Networks selected from ICA analysis (transversal view): (a) DMN, (b) WMN1 (c) WMN2. RESULTS Figure 2 exhibits window mean activities and correlations divided for phase and load. DMN mean activity is negative while WMN1-2 mean activities have opposite behaviors regarding the phase, but similar concerning with the complexity (Fig. 2a-c). DMN shows a reduction of the correlation from encode to retrieval, instead of WM1-2 where it grows (Fig. 2d-f). The ANOVA showed significant variation for the phases over all the subjects in WMN1-2, an interaction of the variation of phases and runs in WMN2 and a interaction of phases, runs and loads in DMN. DISCUSSION These findings suggest that working memory networks (WMNs), as isolated by means of IC A, display substantially opposed mean values related to a different areas specialization. WMN1 seems to be more involved in the first part of the mnemonic phase and the amount of this involvement is associated to the trial: the more complicated the task, the higher the activation with respect to baseline. On the other hand, WMN2 increases from the first to the last part of the trial and is probably more involved in the operation of retrieval. In Figure 2e-f it is also shown that in the retrieval there is a stronger correlation between WMN1-2 mean values and the response time probably because this phase is the more complex. DMN exhibits, over all the phases, smaller than zero mean values (due to the task inducted deactivation). In contrast, its correlation has a different trend and increases above zero during the maintenance, probably due to the free thought of this phase. The different behavior of load 3 is probably due to the fact that this type of complexity is totally different from the other two. In conclusion, this study shows that, by means of ICA, it is possible to isolate networks of connected regions and relate their time courses to task phases and behavioral performance. This is a promising approach to advance the understanding of connectivity modulations in several brain networks, including WMNs and DMN

Long-Term Fluoride Release from Dental Resins Affects STRO-1+ Cell Behavior.

Fluoride-releasing restorative dental materials can be beneficial to remineralize dentin and help prevent secondary caries. However, the effects of fluoride release from dental materials on the activity of dental pulp stem cells are not known. Here we investigate whether different fluoride release kinetics from dental resins supplemented with modified hydrotalcite (RK-F10) or fluoride-glass filler (RK-FG10) could influence the behavior of a human dental pulp stem cell subpopulation (STRO-1(+) cells) known for its ability to differentiate toward an odontoblast-like phenotype. The 2 resins, characterized by similar physicochemical properties and fluoride content, exhibited different long-term fluoride release kinetics. Our data demonstrate that long-term exposure of STRO-1(+) cells to a continuous release of a low amount of fluoride by RK-F10 increases their migratory response to transforming growth factor β1 (TGF-β1) and stromal cell-derived factor 1 (SDF-1), both important promoters of pulp stem cell recruitment. Moreover, the expression patterns of dentin sialoprotein (dspp), dentin matrix protein 1 (dmp1), osteocalcin (ocn), and matrix extracellular phosphoglycoprotein (mepe) indicate a complete odontoblast-like cell differentiation only when STRO-1(+) cells were cultured on RK-F10. On the contrary, RK-FG10, characterized by an initial fluoride release burst and reduced lifetime of the delivery, did not elicit any significant effect on both STRO-1(+) cell migration and differentiation. Taken together, our results highlight the importance of taking into account fluoride release kinetics in addition to fluoride concentration when designing new fluoride-restorative materials

Rising Sound Intensity: An Intrinsic Warning Cue Activating the Amygdala

Human subjects overestimate the change of rising intensity sounds compared with falling intensity sounds. Rising sound intensity has therefore been proposed to be an intrinsic warning cue. In order to test this hypothesis, we presented rising, falling, and constant intensity sounds to healthy humans and gathered psychophysiological and behavioral responses. Brain activity was measured using event-related functional magnetic resonance imaging. We found that rising compared with falling sound intensity facilitates autonomic orienting reflex and phasic alertness to auditory targets. Rising intensity sounds produced neural activity in the amygdala, which was accompanied by activity in intraparietal sulcus, superior temporal sulcus, and temporal plane. Our results indicate that rising sound intensity is an elementary warning cue eliciting adaptive responses by recruiting attentional and physiological resources. Regions involved in cross-modal integration were activated by rising sound intensity, while the right-hemisphere phasic alertness network could not be supported by this stud

Degeneration and Plasticity of the Optic Pathway in Alström Syndrome.

BACKGROUND AND PURPOSE: Alstrom syndrome is a rare inherited ciliopathy in which early progressive cone-rod dystrophy leads to childhood blindness. We investigated functional and structural changes of the optic pathway in Alstrom syndrome by using MR imaging to provide insight into the underlying pathogenic mechanisms. MATERIALS AND METHODS: Eleven patients with genetically proved Alstrom syndrome (mean age, 23 years; range, 6–45 years; 5 females) and 19 age- and sex-matched controls underwent brain MR imaging. The study protocol included conventional sequences, resting-state functional MR imaging, and diffusion tensor imaging. RESULTS: In patients with Alstrom syndrome, the evaluation of the occipital regions showed the following: 1) diffuse white matter volume decrease while gray matter volume decrease spared the occipital poles (voxel-based morphometry), 2) diffuse fractional anisotropy decrease and radial diffusivity increase while mean and axial diffusivities were normal (tract-based spatial statistics), and 3) reduced connectivity in the medial visual network strikingly sparing the occipital poles (independent component analysis). After we placed seeds in both occipital poles, the seed-based analysis revealed significantly increased connectivity in patients with Alstrom syndrome toward the left frontal operculum, inferior and middle frontal gyri, and the medial portion of both thalami (left seed) and toward the anterior portion of the left insula (right and left seeds). CONCLUSIONS: The protean occipital brain changes in patients with Alstrom syndrome likely reflect the coexistence of diffuse primary myelin derangement, anterograde trans-synaptic degeneration, and complex cortical reorganization affecting the anterior and posterior visual cortex to different degrees

Brain Changes in Kallmann Syndrome

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Defective germline reprogramming rewires the spermatogonial transcriptome.

Defective germline reprogramming in Piwil4 (Miwi2)- and Dnmt3l-deficient mice results in the failure to reestablish transposon silencing, meiotic arrest and progressive loss of spermatogonia. Here we sought to understand the molecular basis for this spermatogonial dysfunction. Through a combination of imaging, conditional genetics and transcriptome analysis, we demonstrate that germ cell elimination in the respective mutants arises as a result of defective de novo genome methylation during reprogramming rather than because of a function for the respective factors within spermatogonia. In both Miwi2-/- and Dnmt3l-/- spermatogonia, the intracisternal-A particle (IAP) family of endogenous retroviruses is derepressed, but, in contrast to meiotic cells, DNA damage is not observed. Instead, we find that unmethylated IAP promoters rewire the spermatogonial transcriptome by driving expression of neighboring genes. Finally, spermatogonial numbers, proliferation and differentiation are altered in Miwi2-/- and Dnmt3l-/- mice. In summary, defective reprogramming deregulates the spermatogonial transcriptome and may underlie spermatogonial dysfunction