Musculoskeletal MRI at 7 T: do we need more or is it more than enough?

Ultra-high field magnetic resonance imaging (UHF-MRI) provides important diagnostic improvements in musculoskeletal imaging. The higher signal-to-noise ratio leads to higher spatial and temporal resolution which results in improved anatomic detail and higher diagnostic confidence. Several methods, such as T2, T2*, T1rho mapping, delayed gadolinium-enhanced, diffusion, chemical exchange saturation transfer, and magnetisation transfer techniques, permit a better tissue characterisation. Furthermore, UHF-MRI enables in vivo measurements by low-γ nuclei (23Na, 31P, 13C, and 39K) and the evaluation of different tissue metabolic pathways. European Union and Food and Drug Administration approvals for clinical imaging at UHF have been the first step towards a more routinely use of this technology, but some drawbacks are still present limiting its widespread clinical application. This review aims to provide a clinically oriented overview about the application of UHF-MRI in the different anatomical districts and tissues of musculoskeletal system and its pros and cons. Further studies are needed to consolidate the added value of the use of UHF-MRI in the routine clinical practice and promising efforts in technology development are already in progress

Remote monitoring and telemedicine in heart failure: implementation and benefits

Purpose of review: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of heart failure (HF) patients. Aim of this article is to critically review recent findings on RM, highlighting potential benefits and barriers to its implementation. Recent findings: Device-based RM is useful in the early detection of CIEDs technical issues and cardiac arrhythmias. Moreover, RM allows the continuous monitoring of several patients' clinical parameters associated with impending HF decompensation, but there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations. Summary: Implementation of RM strategies, together with a proactive physicians' attitude towards clinical actions in response to RM data reception, will make RM a more valuable tool, potentially leading to better outcomes

Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy

BACKGROUND: Rehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP.METHODS/DESIGN: The trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training) in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment), T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively). A further assessment will be performed at T3 (24 weeks after T1), to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2.DISCUSSION: The paper aims to describe the methodology of a RCT for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with hemiplegia. This study will be the first to test this new type of treatment in childhood. The paper presents the theoretical background, study hypotheses, outcome measures and trial methodology

Modeling brain connectivity dynamics in functional Magnetic Resonance Imaging via Particle Filtering

Interest in the studying of functional connections in the brain has grown considerably in the last decades, as many studies have pointed out that alterations in the interaction among brain areas can play a role as markers of neurological diseases. Most studies in this field treat the brain network as a system of connections stationary in time, but dynamic features of brain connectivity can provide useful information, both on physiology and pathological conditions of the brain. In this paper, we propose the application of a computational methodology, named Particle Filter (PF), to study non-stationarities in brain connectivity in functional Magnetic Resonance Imaging (fMRI). The PF algorithm estimates time-varying hidden parameters of a first-order linear time-varying Vector Autoregressive model (VAR) through a Sequential Monte Carlo strategy. On simulated time series, the PF approach effectively detected and enabled to follow time-varying hidden parameters and it captured causal relationships among signals. The method was also applied to real fMRI data, acquired in presence of periodic tactile or visual stimulations, in different sessions. On these data, the PF estimates were consistent with current knowledge on brain functioning. Most importantly, the approach enabled to detect statistically significant modulations in the cause-effect relationship between brain areas, which correlated with the underlying visual stimulation pattern presented during the acquisition

A predation assay using amoebae to screen for virulence factors unearthed the first W. chondrophila inclusion membrane protein.

Waddlia chondrophila is an intracellular bacterium phylogenetically related to the well-studied human and animal pathogens of the Chlamydiaceae family. In the last decade, W. chondrophila was convincingly demonstrated to be associated with adverse pregnancy outcomes in humans and abortions in animals. All members of the phylum Chlamydiae possess a Type Three Secretion System that they use for delivering virulence proteins into the host cell cytosol to modulate their environment and create optimal conditions to complete their life cycle. To identify W. chondrophila virulence proteins, we used an original screening approach that combines a cosmid library with an assay monitoring resistance to predation by phagocytic amoebae. This technique combined with bioinformatic data allowed the identification of 28 candidate virulence proteins, including Wimp1, the first identified inclusion membrane protein of W. chondrophila

Muscle MRI in <i>TRPV4-</i> related congenital distal SMA

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Double-Tuned Birdcage Radio Frequency Coil for 7 T MRI: Optimization, Construction and Workbench Validation

The aim of the present study is the optimization, construction, and workbench validation of a double-tuned 1H- 23Na volume radio frequency (RF) coil suitable for human head imaging at 7 T, based on the birdcage geometry. The birdcage-like design which is considered is the four-ring model, in which two standard birdcage-like structures with the same diameters are nested along the longitudinal axis. Simulations based on Maxwell’s equations are performed to evaluate the RF magnetic field homogeneity and the RF coil efficiency varying the coil geometrical parameters. The RF magnetic field homogeneity is evaluated both on the transverse (z = 0) and longitudinal (y = 0) planes without performing the impedance matching procedure, so that the RF coil symmetry is not perturbed by the matching network. The RF coil efficiency is instead dependent on the effective coil input RF power, and it is evaluated after matching the coil, so that the reflected power is minimized, assuming that the stimulation power is totally delivered to the RF coil. Considering the simulation results and the target application, the useful RF coil geometrical parameters are fixed. The four-ring model, which showed the best performances, has been built and tested on a workbench, using a cylindrical phantom filled with a 0.05 M saline solution as load. This provides the first example of a four-ring realization intended 1H- 23Na for human head imaging at 7 T

252. Prediction of subject-specific SAR distribution in MSK MR exam at 7 T

Purpose we predict SAR during MRI exam using a 7 T 1H 298 MHz eight-channel degenerate birdcage coil1 combining SAR simulations with subject-specific measured (RF) maps. Materials and Methods We simulated the coil1 in CST MW Suite, loaded by a model of human knee (Fig. 1, top). was calculated in an axial slice crossing the patella. The maximum local SAR for an Axial “Zero” Time-of-Echo (ZTE) sequence “SILENT”2 was calculated. We acquired maps of an adult (female) knee with a Bloch-Siegert sequence on 7 axial slices, centered on the same slice of the simulation, on a GE MR950 7T human system. For each slice a coefficient C, proportional to avg, was used to scale the SAR simulated3. Results Fig. 1 shows: bottom left, simulated magnitude; bottom center, local SAR for an input of 1 W per channel; bottom right, simulated magnitude for a FA = 90° (length = 3.2 ms) sinc-pulse in the slice previously chosen. Fig. 2 shows the subject-specific measured for a FA = 90° sinc-pulse. The predicted SAR obtained with scaled maps are 0.50 W/kg (global) and 3.68 W/kg (maximum). Conclusions we obtained a good agreement between simulated and measured in vivo maps, and we were able to calculate the distribution of SAR exposure, a safety MRI parameter not available in current exams, where only global SAR is provided, combining simulations and subject-specific measurements. Limits on global and local SAR (20 W/kg) were met for this sequence [1], [2], [3]

Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T

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