Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Purpose: Cerebral microbleeds (CMBs) are small rounded lesions representing cerebral hemosiderin deposits surrounded by macrophages that results from previous microhemorrhages. The aim of this study was to review the distribution of cerebral microbleeds in patients with end-stage organ failure and their association with specific end-stage organ failure risk factors. Materials and methods: Between August 2015 and June 2017, we evaluated 15 patients, 9 males, and 6 females, (mean age 65.5 years). Patients population was subdivided into three groups according to the organ failure: (a) chronic kidney failure (n = 8), (b) restrictive cardiomyopathy undergoing heart transplantation (n = 1), and (c) end-stage liver failure undergoing liver transplantation (n = 6). The MR exams were performed on a 3T MR unit and the SWI sequence was used for the detection of CMBs. CMBs were subdivided in supratentorial lobar distributed, supratentorial non-lobar distributed, and infratentorial distributed. Results: A total of 91 microbleeds were observed in 15 patients. Fifty-nine CMBs lesions (64.8%) had supratentorial lobar distribution, 17 CMBs lesions (18.8%) had supratentorial non-lobar distribution and the remaining 15 CMBs lesions (16.4%) were infratentorial distributed. An overall predominance of supratentorial multiple lobar localizations was found in all types of end-stage organ failure. The presence of CMBs was significantly correlated with age, hypertension, and specific end-stage organ failure risk factors (p < 0.001). Conclusions: CMBs are mostly founded in supratentorial lobar localization in end-stage organ failure. The improved detection of CMBs with SWI sequences may contribute to a more accurate identification of patients with cerebral risk factors to prevent complications during or after the organ transplantation

Brain-core temperature of patients before and after orthotopic liver transplantation assessed by DWI thermometry

To assess brain-core temperature of end-stage liver disease patients undergoing orthotopic liver transplantation (OLT) using a temperature measurement technique based on the apparent diffusion coefficient of the cerebrospinal fluid in the lateral ventricles

Single Balloon Enteroscopy for Endoscopic Retrograde Cholangiography in a Patient with Hepaticojejunostomy after Liver Transplant

We report a case of a post-transplant patient with hepaticojejunostomy in whom we used a single balloon enteroscopy to access the biliary tree. This procedure seems to be safe and feasible for approaching the biliary anastomosis by means of the overtube and fixation of the small bowel by the balloon

Recanalization of occlusive transjugular intrahepatic portosystemic shunts inaccessible to the standard transvenous approach

PURPOSEThe aim of this study was to evaluate the feasibility and safety of recanalization of occlusive transjugular intrahepatic portosystemic shunts (TIPS) that are inaccessible to the standard transvenous approach in patients with occlusive bare and covered stents. MATERIALS AND METHODSFrom July 1999 to July 2011, 430 consecutive TIPS were performed at a single institution in patients with chronic liver diseases and complications of portal hypertension. During the follow-up, a TIPS occlusion was detected in 20 cases that could not be crossed using a standard transvenous technique with a hydrophilic guidewire. RESULTSFive cases had a bare stent, and 15 cases had a covered stent. In 19 cases (95%), the Colapinto needle technique was used. The Colapinto needle was advanced at the mouth of the occluded TIPS (n=2) or within the thrombus in the middle-distal shunt (n=16) to provide aid in advancing the hydrophilic guidewire into the portal vein. In one patient, after failure of the Colapinto technique, the combined transhepatic and transvenous approach was used. All of the procedures were successfully performed without complications. CONCLUSIONIn patients with occlusive TIPS, stent recanalization is feasible and safe. The Colapinto needle technique should be used as the first approach, reserving the combined transhepatic and transvenous approach only for failure of this technique

Assessment of Functional Connectome in End-Stage Organ Disease Patients After Life-Threatening Surgery

Purpose The purpose of this study was to assess the organization of intrinsic functional brain networks (functional connectome) in neurologically asymptomatic patients with end-stage organ disease who had undergone major surgery for life-threating conditions and compare it to a control group. Materials and Methods Resting-state functional magnetic resonance imaging (rest-fMRI) was performed in 10 adult, post-operative patients with end-stage organ disease. The patients (7 men, 3 women, mean age 57.9 ± 7.4 years) had undergone: n=4 coronary artery bypass graft for heart failure, n=2 orthotopic liver transplantation for non-alcoholic cirrhotic liver failure, n=3 mitral valve repair for heart failure, n=1 pancreaticoduodenectomy for pancreatic papillary tumor. Rest-fMRI was acquired within 48 hours after intensive care unit discharge. Structural brain MR imaging was acquired with T1-weighted, T2-weighted, diffusion weighted imaging, and susceptibility weighted imaging along with 3D isotropic T1-weighted MR images. MR examinations were performed on a 3T MR scanner (Discovery 750w, General Electric Healthcare, Milwaukee, WI, USA). Ten age- and sex-matched healthy controls were studied with the same protocol. Brain functional networks were analyzed by calculating the interregional correlation of low-frequency fluctuations in spontaneous brain activity. Weighted graph-based models were employed to topologically recognize reproducibly determined large-scale functional networks, including default mode, salience, dorsal attention, sensorimotor, visual and language networks using a seed-based approach with Functional Connectivity Toolbox (CONN) (https://web.conn-toolbox.org/) running under MatLab (The MathWorks Inc., Natick, MA, USA). A p-uncorrected < 0.0025 was used to threshold connectomes for voxel-wise paired statistical analysis to take in account the lateralization effect. Network comparisons were thresholded using a false discovery rate (FDR) cluster-level correction approach in patients and controls using the MatLab function “mafdr” for p-uncorrected <0.0025 obtaining the p-FDR < 0.077. Results Functional connectivity in patients and controls was successfully assessed for the default mode, salience, dorsal attention, sensorimotor, visual, and language networks of the brain. There was statistically significant (p <0.05) reduced connectivity between seeds in the default mode, salience, sensorimotor, and language networks in patients compared to controls (Fig. 1). No acute structural lesions were observed in patients at MR imaging. Conclusion Assessment of functional connectome in end-stage organ disease patients is feasible in routine clinical setting. Rest-fMRI can demonstrate reduced connectivity of several intrinsic functional networks in critically ill, post-operative patients and it may be a useful prognostic indicator of early and long-term clinical outcome. References Ma X, et al. Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease. PloS One 2015;10:e0121085. Lariviere S, et al. Disrupted functional network integrity and flexibility after stroke: Relation to motor impairments. NeuroImage. Clinical 2018;19:883–891. Cheng Y, et al. Longitudinal Intrinsic Brain Activity Changes in Cirrhotic Patients before and One Month after Liver Transplantation. Korean Journal of Radiology, 2017;18,370–377. Zhang XD, et al. Long-and short-range functional connectivity density alteration in non-alcoholic cirrhotic patients one month after liver transplantation: A resting-state fMRI study. Brain Research, 2015;1620:177–187. Whitfield-Gabrieli S, Nieto-Castanon A. Conn: a functional connectivity toolbox for correlated and anticorrelated brain networks. Brain Connect. 2012; 2:125-141. Additional Video Material: https://youtu.be/15lzif0MOO

The Italian version of the Job Crafting Scale (JCS)

Job crafting refers to actions carried out by workers in order to bring their job demands and job resources at a preferred level. Crafting behaviors are measured by the Dutch Job Crafting Scale (JCS). The Italian version of the JCS includes the following three positive factors: increasing structural job resources, social job resources and challenging job demands. To assess the factorial validity of the scale, an exploratory factor analysis (N=311) and confirmatory factor analyses (N=410) were performed. Convergent and criterion validity were investigated through correlations with other variables. Factor analyses showed a good three-factor structure, in line with the literature. Moreover, as expected, job crafting behaviors were correlated with work self-efficacy, work engagement and job performance. Results suggest that the Italian version of the JCS can be reliably used to measure job crafting

Statistical Approaches to Identify Pairwise and High-Order Brain Functional Connectivity Signatures on a Single-Subject Basis

Keeping up with the shift towards personalized neuroscience essentially requires the derivation of meaningful insights from individual brain signal recordings by analyzing the descriptive indexes of physio-pathological states through statistical methods that prioritize subject-specific differences under varying experimental conditions. Within this framework, the current study presents a methodology for assessing the value of the single-subject fingerprints of brain functional connectivity, assessed both by standard pairwise and novel high-order measures. Functional connectivity networks, which investigate the inter-relationships between pairs of brain regions, have long been a valuable tool for modeling the brain as a complex system. However, their usefulness is limited by their inability to detect high-order dependencies beyond pairwise correlations. In this study, by leveraging multivariate information theory, we confirm recent evidence suggesting that the brain contains a plethora of high-order, synergistic subsystems that would go unnoticed using a pairwise graph structure. The significance and variations across different conditions of functional pairwise and high-order interactions (HOIs) between groups of brain signals are statistically verified on an individual level through the utilization of surrogate and bootstrap data analyses. The approach is illustrated on the single-subject recordings of resting-state functional magnetic resonance imaging (rest-fMRI) signals acquired using a pediatric patient with hepatic encephalopathy associated with a portosystemic shunt and undergoing liver vascular shunt correction. Our results show that (i) the proposed single-subject analysis may have remarkable clinical relevance for subject-specific investigations and treatment planning, and (ii) the possibility of investigating brain connectivity and its post-treatment functional developments at a high-order level may be essential to fully capture the complexity and modalities of the recovery

Clinical and Molecular-Based Approach in the Evaluation of Hepatocellular Carcinoma Recurrence after Radical Liver Resection

Background: Hepatic resection remains the treatment of choice for patients with early-stage HCC with preserved liver function. Unfortunately, however, the majority of patients develop tumor recurrence. While several clinical factors were found to be associated with tumor recurrence, HCC pathogenesis is a complex process of accumulation of somatic genomic alterations, which leads to a huge molecular heterogeneity that has not been completely understood. The aim of this study is to complement potentially predictive clinical and pathological factors with next-generation sequencing genomic profiling and loss of heterozygosity analysis. Methods: 124 HCC patients, who underwent a primary hepatic resection from January 2016 to December 2019, were recruited for this study. Next-generation sequencing (NGS) analysis and allelic imbalance assessment in a case-control subgroup analysis were performed. A time-to-recurrence analysis was performed as well by means of Kaplan-Meier estimators. Results: Cumulative number of HCC recurrences were 26 (21%) and 32 (26%), respectively, one and two years after surgery. Kaplan-Meier estimates for the probability of recurrence amounted to 37% (95% C.I.: 24-47) and to 51% (95% C.I.: 35-62), after one and two years, respectively. Multivariable analysis identified as independent predictors of HCC recurrence: hepatitis C virus (HCV) infection (HR: 1.96, 95%C.I.: 0.91-4.24, p = 0.085), serum bilirubin levels (HR: 5.32, 95%C.I.: 2.07-13.69, p = 0.001), number of nodules (HR: 1.63, 95%C.I.: 1.12-2.38, p = 0.011) and size of the larger nodule (HR: 1.11, 95%C.I.: 1.03-1.18, p = 0.004). Time-to-recurrence analysis showed that loss of heterozygosity in the PTEN loci (involved in the PI3K/AKT/mTOR signaling pathway) was significantly associated with a lower risk of HCC recurrence (HR: 0.35, 95%C.I.: 0.13-0.93, p = 0.036). Conclusions: multiple alterations of cancer genes are associated with HCC progression. In particular, the evidence of a specific AI mutation presented in 20 patients seemed to have a protective effect on the risk of HCC recurrence

Translating self-efficacy in job performance over time: The role of job crafting

This investigation intends to uncover the mechanisms linking self-efficacy to job performance by analyzing the mediating role of job crafting. A two-wave study on 465 white-collar workers was conducted, matching participants’ self-report data (i.e., self-efficacy and job crafting) with supervisory performance ratings. The structural equation model showed a positive reciprocal relationship between self-efficacy and crafting behaviors. In turn, job crafting predicted performance positively over time. More importantly, results confirmed the mediating role of crafting actions, which may represent the behavioral process underlying the positive effect of self-efficacy on individual outcomes. Practical implications for organizations, such as encouraging bottom-up job design or designing job-crafting interventions, and future research directions are also offered

Imaging of hepatocellular carcinoma recurrence after liver transplantation

Liver transplantation (LT) provides the highest survival benefit to patients with unresectable hepatocellular carcinoma (HCC). The Milan criteria have been developed for the selection of LT candidates with the goal of improving survival and maintaining an acceptable risk of HCC recurrence. Despite this, recurrence of HCC after LT occurs in up to 20% of cases and represents a major concern due to the poor prognosis of these patients. Furthermore, several extended criteria for the selection of LT candidates have been proposed to account for the growing demand for organs and the resultant increase in the risk of HCC recurrence. Radiologists should be aware that HCC can recur after LT with multiple organ involvement. Knowledge of the location and radiologic appearance of recurrent HCC is necessary to ensure the choice of the most appropriate therapy. This paper aims to comprehensively summarize the spectrum of HCC recurrence after LT and to examine and discuss the imaging features of these lesions. CRITICAL RELEVANCE STATEMENT: This paper aims to share a review of imaging findings of HCC recurrence after LT and to make radiologists familiar with the spectrum of this disease