Cardiovascular Disease in Systemic Lupus Erythematosus: The Role of Traditional and Lupus Related Risk Factors

Atherosclerosis is a chronic inflammatory disorder characterized by immune cell activation, inflammation driven plaque formation and subsequent destabilization. In other disorders of an inflammatory nature, the chronic inflammatory state per se has been linked to acceleration of the atherosclerotic process which is underlined by an increased incidence of cardiovascular disease (CVD) in disorders such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphopholipid (Hughes) syndrome (APS). SLE is an autoimmune disease that may affect any organ. Premature coronary heart disease has emerged as a major cause of morbidity and mortality in SLE. In addition to mortality, cardiovascular morbidity is also markedly increased in these patients, compared with the general population. The increased cardiovascular risk can be explained only partially by an increased prevalence of classical risk factors for cardiovascular disease; it also appears to be related to inflammation. Inflammation is increasingly being considered central to the pathogenesis of atherosclerosis and an important risk factor for vascular disease. Recent epidemiologic and pathogenesis studies have suggested a great deal in common between the pathogenesis of prototypic autoimmune disease such as SLE and that of atherosclerosis

Biological Therapy in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a prototypic inflammatory autoimmune disorder characterized by multisystem involvement and fluctuating disease activity. Symptoms range from rather mild manifestations such as rash or arthritis to life-threatening end-organ manifestations. Despite new and improved therapy having positively impacted the prognosis of SLE, a subgroup of patients do not respond to conventional therapy. Moreover, the risk of fatal outcomes and the damaging side effects of immunosuppressive therapies in SLE call for an improvement in the current therapeutic management. New therapeutic approaches are focused on B-cell targets, T-cell downregulation and costimulatory blockade, cytokine inhibition, and the modulation of complement. Several biological agents have been developed, but this encouraging news is associated with several disappointments in trials and provide a timely moment to reflect on biologic therapy in SLE

Seizures in Primary Antiphospholipid Syndrome: The Relevance of Smoking to Stroke

Objectives. To evaluate the frequency of seizures in primary antiphospholipid syndrome (PAPS) and their possible clinical and laboratory associations. Methods. Eighty-eight PAPS patients (Sydney's criteria) were analyzed by a standard interview, physical examination and review of medical charts. Risk factors for seizures, clinical manifestations, associated comorbidities, and antiphospholipid antibodies were evaluated. Results. Nine (10.2%) patients with seizures were identified, 77.8% had convulsions onset after PAPS diagnosis. Mean age, gender, and race were comparable in groups with or without seizures. Interestingly, a higher frequency of current smoking (44.4 versus 10.1%, P = 0.019) was observed in the first group. Stroke, Sneddon's syndrome, and livedo reticularis were more frequent in PAPS patients with seizures than those without seizures, although not statistically significant (P > 0.05). Comparison between patients with seizures onset after PAPS diagnosis (n = 7) and those without convulsions (n = 79) demonstrated a higher frequency of current smoking (42.9 versus 10%, P = 0.042) and stroke in the first group (71.4 versus 30.4%, P = 0.041). Regression analysis confirmed that smoking (P = 0.030) and stroke (P = 0.042) were independently associated to seizures. Conclusion. About 10.2% of PAPS patients had convulsions, predominantly after PAPS diagnosis, and seizures were associated to current smoking and stroke

Seizures in Primary Antiphospholipid Syndrome: The Relevance of Smoking to Stroke

Objectives. To evaluate the frequency of seizures in primary antiphospholipid syndrome (PAPS) and their possible clinical and laboratory associations. Methods. Eighty-eight PAPS patients (Sydney's criteria) were analyzed by a standard interview, physical examination and review of medical charts. Risk factors for seizures, clinical manifestations, associated comorbidities, and antiphospholipid antibodies were evaluated. Results. Nine (10.2%) patients with seizures were identified, 77.8% had convulsions onset after PAPS diagnosis. Mean age, gender, and race were comparable in groups with or without seizures. Interestingly, a higher frequency of current smoking (44.4 versus 10.1%, P = 0.019) was observed in the first group. Stroke, Sneddon's syndrome, and livedo reticularis were more frequent in PAPS patients with seizures than those without seizures, although not statistically significant (P > 0.05). Comparison between patients with seizures onset after PAPS diagnosis (n = 7) and those without convulsions (n = 79) demonstrated a higher frequency of current smoking (42.9 versus 10%, P = 0.042) and stroke in the first group (71.4 versus 30.4%, P = 0.041). Regression analysis confirmed that smoking (P = 0.030) and stroke (P = 0.042) were independently associated to seizures. Conclusion. About 10.2% of PAPS patients had convulsions, predominantly after PAPS diagnosis, and seizures were associated to current smoking and stroke

Data-driven corpus callosum parcellation method through diffusion tensor imaging

The corpus callosum (CC) is a set of neural fibers in the cerebral cortex, responsible for facilitating inter-hemispheric communication. The CC structural characteristics appear as an essential element for studying healthy subjects and patients diagnosed with neurodegenerative diseases. Due to its size, the CC is usually divided into smaller regions, also known as parcellation. Since there are no visible landmarks inside the structure indicating its division, CC parcellation is a challenging task and methods proposed in the literature are geometric or atlas-based. This paper proposed an automatic data-driven CC parcellation method, based on diffusion data extracted from diffusion tensor imaging that uses the Watershed transform. Experiments compared parcellation results of the proposed method with results of three other parcellation methods on a data set containing 150 images. Quantitative comparison using the Dice coefficient showed that the CC parcels given by the proposed method has a mean overlap higher than 0,9 for some parcels and lower than 0,6 for other parcels. Poor overlap results were confirmed by the statistically significant differences obtained for diffusion metrics values in each parcel, when using different parcellation methods. The proposed method was also validated by using the CC tractography and was the only study that proposed a non-geometric approach for the CC parcellation, based only on the diffusion data of each subject analyzed59Advanced signal processing methods in medical imaging2242122432COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2013/07559-

Automatic DTI-based parcellation of the corpus callosum through the watershed transform

Parcellation of the corpus callosum (CC) in the midsagittal cross-section of the brain is of utmost importance for the study of diffusion properties within this structure. The complexity of this operation comes from the absence of macroscopic anatomical landmarks to help in dividing the CC into different callosal areas. In this paper we propose a completely automatic method for CC parcellation using diffusion tensor imaging (DTI). A dataset of 15 diffusion MRI volumes from normal subjects was used. For each subject, the midsagital slice was automatically detected based on the Fractional Anisotropy (FA) map. Then, segmentation of the CC in the midsgital slice was performed using the hierarchical watershed transform over a weighted FA-map. Finally, parcellation of the CC was obtained through the application of the watershed transform from chosen markers. Parcellation results obtained were consistent for fourteen of the fifteen subjects tested. Results were similar to the ones obtained from tractography-based methods. Tractography confirmed that the cortical regions associated with each obtained CC region were consistent with the literature. A completely automatic DTI-based parcellation method for the CC was designed and presented. It is not based on tractography, which makes it fast and computationally inexpensive. While most of the existing methods for parcellation of the CC determine an average behavior for the subjects based on population studies, the proposed method reflects the diffusion properties specific for each subject. Parcellation boundaries are found based on the diffusion properties within each individual CC, which makes it more reliable and less affected by differences in size and shape among subjects302132143CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão temnão temnão te

Relações entre o nível de atividade física, autoestima e resiliência em pacientes com epilepsia

A epilepsia é uma condição neurológica grave, caracterizada por crises recorrentes e espontâneas no cérebro. Devido à imprevisibilidade das crises e do preconceito existente na sociedade, alguns pacientes se isolam, prejudicando seu bem-estar físico, social e emocional. Métodos alternativos de tratamento, complementares aos medicamentosos são pesquisados com o objetivo de proporcionar uma melhor qualidade de vida a estes pacientes. Assim, pesquisas com exercício físico e atividade física mostram que a sua prática, pode proporcionar diversos benefícios na aptidão física e na saúde de pessoas saudáveis e também com diferentes tipos de doenças. Este estudo transversal tem como objetivo avaliar o nível de atividade física praticado pelos pacientes com epilepsia e comparar se os pacientes mais ativos possuem índices melhores de autoestima e resiliência. Foram entrevistados 80 pacientes com epilepsia de lobo temporal e utilizados os instrumentos: International Physical Activity Questionnaire (IPAQ), Escala de Autoestima de Rosenberg e Escala de Resiliência. Os resultados mostraram que 76,2% dos pacientes foram considerados ativos apresentando assim, melhores índices de autoestima (p = 0,001) e resiliência (p = 0,003), em comparação com grupo não ativo. Observamos uma relação significativa entre o número de crises e os níveis de autoestima e resiliência, com melhores níveis de autoestima (p = 0,046) e resiliência (p = 0,032) em pacientes considerados ativos com crises semanais, em relação ao grupo não ativo. A prática de atividade física pode contribuir como um importante método terapêutico complementar ao tratamento medicamentoso na epilepsia, romovendo a melhora da autoestima e resiliência nos pacientes, proporcionando deste modo uma melhor qualidade de vida

Etiology-based classification of brain white matter hyperintensity on magnetic resonance imaging

Brain white matter lesions found upon magnetic resonance imaging are often observed in psychiatric or neurological patients. Individuals with these lesions present a more significant cognitive impairment when compared with individuals without them. We propose a computerized method to distinguish tissue containing white matter lesions of different etiologies (e.g., demyelinating or ischemic) using texture-based classifiers. Texture attributes were extracted from manually selected regions of interest and used to train and test supervised classifiers. Experiments were conducted to evaluate texture attribute discrimination and classifiers' performances. The most discriminating texture attributes were obtained from the gray-level histogram and from the co-occurrence matrix. The best classifier was the support vector machine, which achieved an accuracy of 87.9% in distinguishing lesions with different etiologies and an accuracy of 99.29% in distinguishing normal white matter from white matter lesions. (c) 2015 Society of Photo-Optical Instrumentation Engineers (SPIE)21COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2012/21826-1; 2013/07559-

Primary Sjögren's syndrome in children: Is a family approach indicated?

[No abstract available