Diagnostic value of N-terminal ProB-Type Natriuretic Peptide in Emergency Department: Analysis by subgroups

Objectives. Our aim was to evaluate the diagnostic impact of N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement in patients presenting with acute dyspnea in Emergency Department (ED), taking into account clinical and chest x-ray results routinely obtained. Methods. This was a prospective observational study. Four hundred eighty-eight consecutive subjects evaluated for dyspnea in a metropolitan 600 beds hospital ED, entered into the final data analysis. According to a clinical and radiological score, the patients enrolled were divided in three groups: low (A-group), intermediate (B-group), and high (C-group) probability of heart failure. Results. NT-proBNP median value was 2445 ng/L (Inter Quartile Range 631-5847 ng/L), and the area under the receiver-operating characteristic curves (AUC) was 0.854 for NT-proBNP, 0.921 for clinical/radiological score and 0.936 for the two in combination (logistic model). In the B-group (intermediate) NT-proBNP test added correct diagnostic information in 126 subjects with HF and in 53 subjects without a final diagnosis of HF. In A- and C-group NT-proBNP test added correct diagnostic information in 1 patient. Conclusions. NT-proBNP did not substantially enhance diagnostic accuracy in all patients with shortness of breath in ED. However, in patients with not conclusive clinical and radiological results NT-proBNP determinations improved the percentage of correct diagnosis

A new shape for an old function: lasting effect of a physiologic surgical restoration of the left ventricle

BACKGROUND: Long-term morphofunctional outcome may vary widely in surgical anterior left ventricular wall restoration, suggesting variability in post-surgical remodeling similar to that observed following acute myocardial infarction. The aim of this pilot study was to demonstrate that surgical restoration obtained with a particular shape of endoventricular patch leads to steady morphofunctional ventricular improvement when geometry, volume and residual akinesia can be restored as normal as possible. METHODS: This study involved 12 consecutive patients with previous anterior myocardial infarction, dilated cardiomyopathy and no mitral procedures, who underwent left ventricular reconstruction and coronary revascularization between May 2002 and May 2003 using a small, narrow, oval patch aiming at a volume ≤ 45 mL/m(2 )with elliptical shape. Eleven geometric parameters were examined preoperatively and at least 3, 12 and 24 months after the operation by serial echocardiographic studies and evaluated by paired t test taking the time of surgery as a starting point for remodeling. RESULTS: All patients were in NYHA class 1 at follow-up. Patch geometry obtained a conical shape of the ventricle with new apex, physiologic rearrangement of functioning myocardial wall and small residual akinesia. Ventricular changes at the four time-points showed that all parameters improved significantly compared to preoperative values (end-diastolic volume = 184.2 ± 23.9 vs 139.9 ± 22.0, p = 0.001; vs 151.0 ± 33.8, p = 0.06; vs 144.9 ± 34.0, p = 0.38; end-systolic volume = 125.7 ± 20.6 vs 75.2 ± 14.1, p = 0.001; vs 82.1 ± 23.9, p = 0,18; vs 77.1 ± 19.4, p = 0.41) without further changes during follow-up except for wall motion score index (2.0 ± 0.2 to 1.7 ± 0.2, to 1.4 ± 0.2, to 1.3 ± 0.2) and percentage of akinesia (30.4 ± 7.5 to 29.3 ± 4.2, to 19.8 ± 11.6, to 14.5 ± 7.2) which slowly and significantly improved suggesting a positive post-surgery remodeling. CONCLUSION: Ventricular reconstruction caring of physiological shape, volume, revascularization and residual akinesia obtained a steady geometry. Positive remodeling and equalization of geometrical outcome may persistently prevent long-term redilation

Is "option B+" also being adopted in pregnant women in high-income countries? Temporal trends from a national study in Italy

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Differential diagnosis of neurodegenerative dementias with the explainable MRI based machine learning algorithm MUQUBIA

Biomarker-based differential diagnosis of the most common forms of dementia is becoming increasingly important. Machine learning (ML) may be able to address this challenge. The aim of this study was to develop and interpret a ML algorithm capable of differentiating Alzheimer’s dementia, frontotemporal dementia, dementia with Lewy bodies and cognitively normal control subjects based on sociodemographic, clinical, and magnetic resonance imaging (MRI) variables. 506 subjects from 5 databases were included. MRI images were processed with FreeSurfer, LPA, and TRACULA to obtain brain volumes and thicknesses, white matter lesions and diffusion metrics. MRI metrics were used in conjunction with clinical and demographic data to perform differential diagnosis based on a Support Vector Machine model called MUQUBIA (Multimodal Quantification of Brain whIte matter biomArkers). Age, gender, Clinical Dementia Rating (CDR) Dementia Staging Instrument, and 19 imaging features formed the best set of discriminative features. The predictive model performed with an overall Area Under the Curve of 98%, high overall precision (88%), recall (88%), and F1 scores (88%) in the test group, and good Label Ranking Average Precision score (0.95) in a subset of neuropathologically assessed patients. The results of MUQUBIA were explained by the SHapley Additive exPlanations (SHAP) method. The MUQUBIA algorithm successfully classified various dementias with good performance using cost-effective clinical and MRI information, and with independent validation, has the potential to assist physicians in their clinical diagnosis

Methods to Quantify Nanomaterial Association with, and Distribution across, the Blood-Brain Barrier in Vivo

The role and functional anatomy of the blood-brain barrier (BBB) is summarized to enable the investigator to appropriately address evaluation of nanomaterial interaction with, and distribution across, it into brain tissue (parenchyma). Transport mechanisms across the BBB are presented, in relation to nanomaterial physicochemical properties. Measures and test substances to assess BBB integrity/disruption/permeation are introduced, along with how they are used to interpret the results obtained with the presented methods. Experimental pitfalls and misinterpretation of results of studies of brain nanomaterial uptake are briefly summarized, that can be avoided with the methods presented in this chapter. Two methods are presented. The in situ brain perfusion technique is used to determine rate and extent of nanomaterial distribution into the brain. The capillary depletion method separates brain parenchymal tissue from the endothelial cells that contribute to the BBB. It is used to verify nanomaterial brain tissue entry. These methods are best used together, the latter refining the results obtained with the former. Details of the materials and equipment needed to conduct these methods, and description of the procedures and data interpretation, are provided

Self-selected speed gait training in Parkinson's disease: robot-assisted gait training with virtual reality versus gait training on the ground

Background: Parkinson's disease (PD) is a neurodegenerative disorder causing progressive gait disability. Although robot-assisted gait training (RAGT) using the Lokomat device has been demonstrated to improve gait in PD, it is not clear what the best training settings are, in particular if a self-selected treadmill speed can give better results. Aim: The aims of this study were: 1) to evaluate if self-selected speed training using Lokomat plus virtual reality (VR) can give better results compared to self-selected speed overground training; 2) to assess the possible influence of VR on patients' gait speed in the Lokomat group. Design: Retrospective analysis. Population: Patients with idiopathic PD (N.=20), aged 18-90 years, Hoehn & Yahr 2-3, Mini Mental State Examination (MMSE) ≥24, unchanged therapy, and without freezing episodes, dyskinesia, and neurological, orthopedic, cardiac, respiratory or severe visual impairments, who underwent four weeks of gait training (five 30-minute sessions/week): ten with Lokomat (Group 1) and ten without (Group 2). Setting: Rehabilitation hospital; inpatients. Methods: Group 1: Lokomat parameters: body weight support fixed at 30%, guidance force set at 80% bilaterally. Treadmill speed was self-selected by each patient, and subsequently modified on patient request. VR scenery was applied. Group 2: self-selected speed gait training on the ground. Both groups were assessed pre- and post-training with the Unified Parkinson's Disease Rating Scale (UPDRS), Functional Independence Measure (FIM) scale, and the 10-metre walking test (10-MWT). For group 1, a VR score was evaluated. Results: All patients showed significant post-training improvement in UPDRS and FIM scores, with a significantly better improvement in Group 1 for total UPDRS (P=0.037). Velocity at 10-MWT significantly improved after rehabilitation in Group 2 (P=0.002). Lokomat treadmill speed and VR score both improved significantly after rehabilitation, but without any association (P=0.48), while a significant inverse relationship (P=0.014) was observed between the changes in 10-MWT and in treadmill speed. Conclusions: Self-selected speed Lokomat training in PD patients can provide clinical enhancements but is not superior to self-selected speed overground gait training; the influence of VR on motor performance seems to be related to non-motor aspects. Clinical rehabilitation impact: Regarding self-selected speed gait training, there seems to be no difference between RAGT and conventional overground gait training. Other parameter settings for RAGT need to be carefully investigated for a tailored use of RAGT in PD

Diagnostic value of N-terminal ProB-Type Natriuretic Peptide in Emergency Department: Analysis by subgroups

Objectives. Our aim was to evaluate the diagnostic impact of N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement in patients presenting with acute dyspnea in Emergency Department (ED), taking into account clinical and chest x-ray results routinely obtained. Methods. This was a prospective observational study. Four hundred eighty-eight consecutive subjects evaluated for dyspnea in a metropolitan 600 beds hospital ED, entered into the final data analysis. According to a clinical and radiological score, the patients enrolled were divided in three groups: low (A-group), intermediate (B-group), and high (C-group) probability of heart failure. Results. NT-proBNP median value was 2445 ng/L (Inter Quartile Range 631-5847 ng/L), and the area under the receiver-operating characteristic curves (AUC) was 0.854 for NT-proBNP, 0.921 for clinical/radiological score and 0.936 for the two in combination (logistic model). In the B-group (intermediate) NT-proBNP test added correct diagnostic information in 126 subjects with HF and in 53 subjects without a final diagnosis of HF. In A- and C-group NT-proBNP test added correct diagnostic information in 1 patient. Conclusions. NT-proBNP did not substantially enhance diagnostic accuracy in all patients with shortness of breath in ED. However, in patients with not conclusive clinical and radiological results NT-proBNP determinations improved the percentage of correct diagnosis