Plan de intervención fisioterápico tras acromioplastia por artroscopia de hombro en un síndrome de pinzamiento subacromial. A propósito de un caso.

INTRODUCCIÓN: El síndrome de pinzamiento subacromial es la compresión patológica del manguito de los rotadores contra las estructuras anteriores del arco coracoacromial, el tercio anterior del acromion, el ligamento coracoacromial y la articulación acromioclavicular. La acromioplastia tiene como objetivo disminuir este conflicto mecánico y el tratamiento fisioterapéutico mejorar la funcionalidad del paciente y la realización de las actividades de la vida diaria (AVD) sin complicación alguna. OBJETIVOS: El objetivo principal de este trabajo es describir un plan de intervención fisioterapéutico en una paciente con síndrome de pinzamiento subacromial tras acromioplastia. Siendo una paciente de larga evolución ya que la intervención comienza a los 5 meses de ser intervenida quirúrgicamente. METODOLOGÍA: Estudio intrasujeto (n=1) descriptivo longitudinal, de una paciente de 30 años, intervenida quirúrgicamente por síndrome de pinzamiento subacromial. Se realiza una valoración inicial en la que las variables que se escogen para el control de la evolución tras el tratamiento son: el dolor, el balance articular y muscular, la función del miembro superior y la capacidad para las AVD. DESARROLLO: Se ha llevado a cabo un tratamiento fisioterápico durante 4 semanas, centrado en cumplir los objetivos terapéuticos propuestos. La intervención se ha basado en disminuir la sintomatología, aumentar el rango de movimiento, tratar la cicatriz, potenciar la musculatura y enseñar el tratamiento domiciliario. CONCLUSIONES: El plan de intervención de fisioterapia que se ha llevado a cabo, parece ser efectivo en el caso presentado para la readaptación funcional del miembro superior en el desempeño de las actividades de la vida diaria y laboral. <br /

Reduction of motion effects in myocardial arterial spin labeling

Purpose To evaluate the accuracy and reproducibility of myocardial blood flow measurements obtained under different breathing strategies and motion correction techniques with arterial spin labeling. Methods A prospective cardiac arterial spin labeling study was performed in 12 volunteers at 3 Tesla. Perfusion images were acquired twice under breath-hold, synchronized-breathing, and free-breathing. Motion detection based on the temporal intensity variation of a myocardial voxel, as well as image registration based on pairwise and groupwise approaches, were applied and evaluated in synthetic and in vivo data. A region of interest was drawn over the mean perfusion-weighted image for quantification. Original breath-hold datasets, analyzed with individual regions of interest for each perfusion-weighted image, were considered as reference values. Results Perfusion measurements in the reference breath-hold datasets were in line with those reported in literature. In original datasets, prior to motion correction, myocardial blood flow quantification was significantly overestimated due to contamination of the myocardial perfusion with the high intensity signal of blood pool. These effects were minimized with motion detection or registration. Synthetic data showed that accuracy of the perfusion measurements was higher with the use of registration, in particular after the pairwise approach, which probed to be more robust to motion. Conclusion Satisfactory results were obtained for the free-breathing strategy after pairwise registration, with higher accuracy and robustness (in synthetic datasets) and higher intrasession reproducibility together with lower myocardial blood flow variability across subjects (in in vivo datasets). Breath-hold and synchronized-breathing after motion correction provided similar results, but these breathing strategies can be difficult to perform by patients

Multiparametric renal magnetic resonance imaging: A reproducibility study in renal allografts with stable function

Monitoring renal allograft function after transplantation is key for the early detection of allograft impairment, which in turn can contribute to preventing the loss of the allograft. Multiparametric renal MRI (mpMRI) is a promising noninvasive technique to assess and characterize renal physiopathology; however, few studies have employed mpMRI in renal allografts with stable function (maintained function over a long time period). The purposes of the current study were to evaluate the reproducibility of mpMRI in transplant patients and to characterize normal values of the measured parameters, and to estimate the labeling efficiency of Pseudo-Continuous Arterial Spin Labeling (PCASL) in the infrarenal aorta using numerical simulations considering experimental measurements of aortic blood flow profiles. The subjects were 20 transplant patients with stable kidney function, maintained over 1 year. The MRI protocol consisted of PCASL, intravoxel incoherent motion, and T1 inversion recovery. Phase contrast was used to measure aortic blood flow. Renal blood flow (RBF), diffusion coefficient (D), pseudo-diffusion coefficient (D*), flowing fraction ( f ), and T1 maps were calculated and mean values were measured in the cortex and medulla. The labeling efficiency of PCASL was estimated from simulation of Bloch equations. Reproducibility was assessed with the within-subject coefficient of variation, intraclass correlation coefficient, and Bland-Altman analysis. Correlations were evaluated using the Pearson correlation coefficient. The significance level was p less than 0.05. Cortical reproducibility was very good for T1, D, and RBF, moderate for f , and low for D*, while medullary reproducibility was good for T1 and D. Significant correlations in the cortex between RBF and f (r = 0.66), RBF and eGFR (r = 0.64), and D* and eGFR (r = -0.57) were found. Normal values of the measured parameters employing the mpMRI protocol in kidney transplant patients with stable function were characterized and the results showed good reproducibility of the techniques

Emerging risk factors and the dose-response relationship between physical activity and lone atrial fibrillation: a prospective case-control study

A history of a parts per thousand yen2000 h of vigorous endurance training, tall stature, abdominal obesity, and OSA are frequently encountered as risk factors in patients with Ln-AF. Fewer than 2000 total hours of high-intensity endurance training associates with reduced Ln-AF risk

Successful working memory processes and cerebellum in an elderly sample: A neuropsychological and fMRI study

Background Imaging studies help to understand the evolution of key cognitive processes related to aging, such as working memory (WM). This study aimed to test three hypotheses in older adults. First, that the brain activation pattern associated to WM processes in elderly during successful low load tasks is located in posterior sensory and associative areas; second, that the prefrontal and parietal cortex and basal ganglia should be more active during high-demand tasks; third, that cerebellar activations are related to high-demand cognitive tasks and have a specific lateralization depending on the condition. Methods We used a neuropsychological assessment with functional magnetic resonance imaging and a core N-back paradigm design that was maintained across the combination of four conditions of stimuli and two memory loads in a sample of twenty elderly subjects. Results During low-loads, activations were located in the visual ventral network. In high loads, there was an involvement of the basal ganglia and cerebellum in addition to the frontal and parietal cortices. Moreover, we detected an executive control role of the cerebellum in a relatively symmetric fronto-parietal network. Nevertheless, this network showed a predominantly left lateralization in parietal regions associated presumably with an overuse of verbal storage strategies. The differential activations between conditions were stimuli-dependent and were located in sensory areas. Conclusion Successful WM processes in the elderly population are accompanied by an activation pattern that involves cerebellar regions working together with a fronto-parietal network

Spatio-temporal signal processing for motion correction and identification in FLIP image sequences

Ingeniería de TelecomunicaciónTelekomunikazio Ingeniaritz

Trade-off between frequency and precision during stepping movements:Kinematic and BOLD brain activation patterns

? 2016 Wiley Periodicals, Inc.The central nervous system has the ability to adapt our locomotor pattern to produce a wide range of gait modalities and velocities. In reacting to external pacing stimuli, deviations from an individual preferred cadence provoke a concurrent decrease in accuracy that suggests the existence of a trade-off between frequency and precision; a compromise that could result from the specialization within the control centers of locomotion to ensure a stable transition and optimal adaptation to changing environment. Here, we explore the neural correlates of such adaptive mechanisms by visually guiding a group of healthy subjects to follow three comfortable stepping frequencies while simultaneously recording their BOLD responses and lower limb kinematics with the use of a custom-built treadmill device. In following the visual stimuli, subjects adopt a common pattern of symmetric and anti-phase movements across pace conditions. However, when increasing the stimulus frequency, an improvement in motor performance (precision and stability) was found, which suggests a change in the control mode from reactive to predictive schemes. Brain activity patterns showed similar BOLD responses across pace conditions though significant differences were observed in parietal and cerebellar regions. Neural correlates of stepping precision were found in the insula, cerebellum, dorsolateral pons and inferior olivary nucleus, whereas neural correlates of stepping stability were found in a distributed network, suggesting a transition in the control strategy across the stimulated range of frequencies: from unstable/reactive at lower paces (i.e., stepping stability managed by subcortical regions) to stable/predictive at higher paces (i.e., stability managed by cortical regions). Hum Brain Mapp 37:1722-1737, 2016. ? 2016 Wiley Periodicals, Inc.Peer reviewe

Reduction of motion effects in myocardial arterial spin labeling

Purpose: To evaluate the accuracy and reproducibility of myocardial blood flow measurements obtained under different breathing strategies and motion correction techniques with arterial spin labeling. Methods: A prospective cardiac arterial spin labeling study was performed in 12 volunteers at 3 Tesla. Perfusion images were acquired twice under breath-hold, synchronized-breathing, and free-breathing. Motion detection based on the temporal intensity variation of a myocardial voxel, as well as image registration based on pairwise and groupwise approaches, were applied and evaluated in synthetic and in vivo data. A region of interest was drawn over the mean perfusion-weighted image for quantification. Original breath-hold datasets, analyzed with individual regions of interest for each perfusion-weighted image, were considered as reference values. Results: Perfusion measurements in the reference breath-hold datasets were in line with those reported in literature. In original datasets, prior to motion correction, myocardial blood flow quantification was significantly overestimated due to contamination of the myocardial perfusion with the high intensity signal of blood pool. These effects were minimized with motion detection or registration. Synthetic data showed that accuracy of the perfusion measurements was higher with the use of registration, in particular after the pairwise approach, which probed to be more robust to motion. Conclusion: Satisfactory results were obtained for the free-breathing strategy after pairwise registration, with higher accuracy and robustness (in synthetic datasets) and higher intrasession reproducibility together with lower myocardial blood flow variability across subjects (in in vivo datasets). Breath-hold and synchronized-breathing after motion correction provided similar results, but these breathing strategies can be difficult to perform by patients.Verónica Aramendía-Vidaurreta received PhD grant support from Asociación de Amigos de la Universidad de Navarra and Banco Santande

Cortical hypoperfusion in Parkinson's disease assessed using arterial spin labeled perfusion MRI

Copyright ? 2011 Elsevier Inc. All rights reserved.Alterations in cerebral perfusion and metabolism in Parkinson's disease have been assessed in several studies, using nuclear imaging techniques and more recently magnetic resonance imaging. However, to date there is no consensus in the literature regarding the extent and the magnitude of these alterations. In this work, arterial spin labeled perfusion MRI was employed to quantify absolute cerebral blood flow in a group of early-to-moderate Parkinson's disease patients and age-matched healthy controls. Perfusion comparisons between the two groups showed that Parkinson's disease is characterized by wide-spread cortical hypoperfusion. Subcortically, hypoperfusion was also found in the caudate nucleus. This pattern of hypoperfusion could be related to cognitive dysfunctions that have been previously observed even at the disease early stages. The present results were obtained by means of whole brain voxel-wise comparisons of absolute perfusion values, using statistical parametric mapping, thus avoiding the potentially biased global mean normalization procedure. In addition, this work demonstrates that between-group comparison of relative perfusion values after global mean normalization, introduced artifactual relative perfusion increases, where absolute perfusion was in fact preserved. This has implications for perfusion studies of other brain disorders.Peer reviewe