Somatosensory Brain Function and Gray Matter Regional Volumes Differ According to Exercise History : Evidence from Monozygotic Twins

Associations between long-term physical activity and cortical function and brain structure are poorly known. Our aim was to assess whether brain functional and/or structural modulation associated with long-term physical activity is detectable using a discordant monozygotic male twin pair design. Nine monozygotic male twin pairs were carefully selected for an intrapair difference in their leisure-time physical activity of at least three years duration (mean age 34 +/- 1 years). We registered somatosensory mismatch response (SMMR) in EEG to electrical stimulation of fingers and whole brain MR images. We obtained exercise history and measured physical fitness and body composition. Equivalent electrical dipole sources of SMMR as well as gray matter (GM) voxel counts in regions of interest indicated by source analysis were evaluated. SMMR dipolar source strengths differed between active and inactive twins within twin pairs in postcentral gyrus, medial frontal gyrus and superior temporal gyrus and in anterior cingulate (AC) GM voxel counts differed similarly. Compared to active twins, their inactive twin brothers showed greater dipole strengths in short periods of the deviant-elicited SMMR and larger AC GM voxel counts. Stronger activation in early unattended cortical processing of the deviant sensory signals in inactive co-twins may imply less effective gating of somatosensory information in inactive twins compared to their active brothers. Present findings indicate that already in 30's long-term physical activity pattern is linked with specific brain indices, both in functional and structural domains.Peer reviewe

Changes in the serum metabolite profile correlate with decreased brain gray matter volume in moderate-to-heavy drinking young adults

Our aim was to analyze metabolite profile changes in serum associated with moderate-to-heavy consumption of alcohol in young adults and to evaluate whether these changes are connected to reduced brain gray matter volumes. These study population consisted of young adults with a 10-year history of moderate-to-heavy alcohol consumption (n = 35) and light-drinking controls (n = 27). We used the targeted liquid chromatography mass spectrometry method to measure concentrations of metabolites in serum, and 3.0 T magnetic resonance imaging to assess brain gray matter volumes. Alterations in amino acid and energy metabolism were observed in the moderate-to-heavy drinking young adults when compared to the controls. After correction for multiple testing, the group of moderate-to-heavy drinking young adults had increased serum concentrations of 1-methylhistamine (p = 0.001, d = 0.82) when compared to the controls. Furthermore, concentrations of 1-methylhistamine (r = 0.48, p = 0.004) and creatine (r = 0.52, p = 0.001) were negatively correlated with the brain gray matter volumes in the females. Overall, our results show association between moderate-to-heavy use of alcohol and altered metabolite profile in young adults as well as suggesting that some of these changes could be associated with the reduced brain gray matter volume. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Contemporary radiation doses in interventional cardiology: a nationwide study of patient doses in Finland

The amount of interventional procedures such as percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI), pacemaker implantation (PI) and ablations has increased within the previous decade. Simultaneously, novel fluoroscopy mainframes enable lower radiation doses for patients and operators. Therefore, there is a need to update the existing diagnostic reference levels (DRLs) and propose new ones for common or recently introduced procedures. We sought to assess patient radiation doses in interventional cardiology in a large sample from seven hospitals across Finland between 2014 and 2016. Data were used to set updated national DRLs for coronary angiographies (kerma-air product (KAP) 30 Gycm2) and PCIs (KAP 75 cm2), and novel levels for PIs (KAP 3.5 Gycm2), atrial fibrillation ablation procedures (KAP 25 Gycm2) and TAVI (KAP 90 Gycm2). Tentative KAP values were set for implantations of cardiac resynchronization therapy devices (CRT, KAP 22 Gycm2), electrophysiological treatment of atrioventricular nodal re-entry tachycardia (6 Gycm2) and atrial flutter procedures (KAP 16 Gycm2). The values for TAVI and CRT device implantation are published for the first time on national level. Dose from image acquisition (cine) constitutes the major part of the total dose in coronary and atrial fibrillation ablation procedures. For TAVI, patient weight is a good predictor of patient dose.</p

Multi-Method Analysis of MRI Images in Early Diagnostics of Alzheimer's Disease

The role of structural brain magnetic resonance imaging (MRI) is becoming more and more emphasized in the early diagnostics of Alzheimer's disease (AD). This study aimed to assess the improvement in classification accuracy that can be achieved by combining features from different structural MRI analysis techniques. Automatically estimated MR features used are hippocampal volume, tensor-based morphometry, cortical thickness and a novel technique based on manifold learning. Baseline MRIs acquired from all 834 subjects (231 healthy controls (HC), 238 stable mild cognitive impairment (S-MCI), 167 MCI to AD progressors (P-MCI), 198 AD) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were used for evaluation. We compared the classification accuracy achieved with linear discriminant analysis (LDA) and support vector machines (SVM). The best results achieved with individual features are 90% sensitivity and 84% specificity (HC/AD classification), 64%/66% (S-MCI/P-MCI) and 82%/76% (HC/P-MCI) with the LDA classifier. The combination of all features improved these results to 93% sensitivity and 85% specificity (HC/AD), 67%/69% (S-MCI/P-MCI) and 86%/82% (HC/P-MCI). Compared with previously published results in the ADNI database using individual MR-based features, the presented results show that a comprehensive analysis of MRI images combining multiple features improves classification accuracy and predictive power in detecting early AD. The most stable and reliable classification was achieved when combining all available features

New Insights into Alzheimer's Disease Progression: A Combined TMS and Structural MRI Study

BACKGROUND: Combination of structural and functional data of the human brain can provide detailed information of neurodegenerative diseases and the influence of the disease on various local cortical areas. METHODOLOGY AND PRINCIPAL FINDINGS: To examine the relationship between structure and function of the brain the cortical thickness based on structural magnetic resonance images and motor cortex excitability assessed with transcranial magnetic stimulation were correlated in Alzheimer's disease (AD) and mild cognitive impairment (MCI) patients as well as in age-matched healthy controls. Motor cortex excitability correlated negatively with cortical thickness on the sensorimotor cortex, the precuneus and the cuneus but the strength of the correlation varied between the study groups. On the sensorimotor cortex the correlation was significant only in MCI subjects. On the precuneus and cuneus the correlation was significant both in AD and MCI subjects. In healthy controls the motor cortex excitability did not correlate with the cortical thickness. CONCLUSIONS: In healthy subjects the motor cortex excitability is not dependent on the cortical thickness, whereas in neurodegenerative diseases the cortical thinning is related to weaker cortical excitability, especially on the precuneus and cuneus. However, in AD subjects there seems to be a protective mechanism of hyperexcitability on the sensorimotor cortex counteracting the prominent loss of cortical volume since the motor cortex excitability did not correlate with the cortical thickness. Such protective mechanism was not found on the precuneus or cuneus nor in the MCI subjects. Therefore, our results indicate that the progression of the disease proceeds with different dynamics in the structure and function of neuronal circuits from normal conditions via MCI to AD

Potilasohjaus sydänpotilaan hoitotyössä : – Ohjekansio sydänhoitajalle Kainuun keskussairaalan sisätautien poliklinikalla

Tässä opinnäytetyössä tarkastellaan sydänhoitajan työtä ja potilasohjausta Kainuun keskussairaalassa sisätautien poliklinikalla. Opinnäytetyön tavoitteena on hyvän potilasohjauskäytännön merkityksen korostaminen sydänhoitajan työssä. Opinnäytetyön toteutusta ohjaa tuotteistettu prosessi. Opinnäytetyön lopputuloksena on konkreettinen tuote, kirjallinen ohjekansio, jonka tarkoituksena on helpottaa sydänhoitajan päivittäistä työtä poliklinikalla. Ohjekansion tarve työelämässä on todellinen. Sydänhoitajilla ei ole käytössä kirjallisia ohjeita siitä, miten heidän tulee valmistautua potilaalle tehtäviin tutkimuksiin ja toimenpiteisiin, ja mitä heidän tulee huomioida potilasohjauksessa valmistaessa potilasta tutkimuksiin. Opinnäytetyön keskeisenä käsitteenä on potilasohjaus. Alakäsitteinä ovat sydänhoitaja, sydänpotilas ja sydänpotilaan hoitotyö. Sydänhoitaja käsitteen määritteleminen oli haasteellista, koska siitä ei ollut saatavilla aikaisempaa tutkittua tietoa. Opinnäytetyössä tarkastellaan potilasohjausta sydänhoitajan työn näkökulmasta. Opinnäytetyön tutkimusongelmat ovat seuraavat: 1) Mitä sydänhoitajan työhön kuuluu Kainuun Keskussairaalan sisätautien poliklinikalla? 2) Millaisia ammatillisia valmiuksia Kainuun Keskussairaalan sisätautien poliklinikan sydänhoitajalta edellytetään? 3) Mitkä seikat korostuvat sydänpotilaan ohjauksessa? Johtopäätöksenä voidaan todeta, että sydänhoitajan toteuttaman potilasohjauksen sisällön tulee nousta potilaan yksilöllisistä tarpeista ja sairauden vaiheesta, huomioiden myös potilaan omaisten ohjauksen tarve. Sydänpotilas tarvitsee tukea ja motivaatiota selviytyäkseen jokapäiväisestä elämästä sairauden ja sen myötä tulleiden muutosten kanssa. Ohjauksen kautta hoitajalla on mahdollisuus potilaan motivoimiseen ja tukemiseen erilaisten ohjaustyyppien ja menetelmien avulla. Sydänpotilaan ohjaustilanteessa korostuu hoitajan ja potilaan välinen vuorovaikutussuhde ja luottamus.The purpose of this thesis is to examine the work activities and patient education of the cardiac nurses at the Internal Medicines Policlinic in the Kainuu Central Hospital. The objective of the study is to emphasize the importance of high-quality patient education in the work of the nursing staff. The concept of productized process is used as the method of implementation of the thesis, and the end result is a handbook which aims to facilitate the daily working activities of the nursing staff at the Cardiological Policlinic. There is a real need for these guidelines. The cardiac nurses do not currently have any written manual of how they should prepare for the examinations and treatments that are done on the patients. There are also insufficient instructions about the facts that should be taken into account when preparing patients for the examinations. The main concept of the work is patient education. The sub-concepts are cardiac nurse, heart patient and the nursing of the heart patient. It is challenging to define the concept of cardiac nurse since there is no previous scientific research about the subject. The perspective of this work is the one of the cardiac nurse. The research problems are as follows: 1) What are the tasks of a cardiac nurse at the Internal Medicines Policlinic in the Kainuu Central Hospital? 2) What kind of professional qualifications are required from the cardiac nurse? 3) Which issues are emphasized in the education of heart patient? We conclude that the counselling of the patients with cardiac diseases should be based on the individual needs and the phase of the heart disease of the patient. The counselling needs of the relatives should be taken into account as well. A heart patient needs support and motivation to be able to survive the daily life. Through the patient education the nurse has a possibility to motivate and support the heart patient with various methods. Interaction and trust are specifically important in the relationship of the nurse and the patient in the counselling situation

Dynamic probabilistic atlas of functional brain regions for transcranial magnetic stimulation

Transcranial Magnetic Stimulation (TMS) is a technique to stimulate the brain non-invasively. The applications range from accurate localization of the primary motor areas to potential treatment of disorders such as tinnitus, severe depression, and pain. Stereotactic guidance requires individual MR images of the subject's head, which is in some applications typically omitted due to financial motivations. In this paper, we introduce a method that offers improved TMS pulse targeting also to those subjects who do not have MR examinations. A probabilistic brain model was constructed by spatially normalizing the locations of the functional brain areas in a study population, and modeling the distributions and estimates of the locations of the functional brain regions using probabilistic methods. The application of the probabilistic brain model to the target subject was based on a point set determined from the scalp and facial skin of the target subject. The methods were evaluated using data from four functional brain areas from 56 healthy subjects. The accuracy of the estimates of the locations of the functional brain regions was about nine millimeters

Somatosensory Brain Function and Gray Matter Regional Volumes Differ According to Exercise History : Evidence from Monozygotic Twins

Associations between long-term physical activity and cortical function and brain structure are poorly known. Our aim was to assess whether brain functional and/or structural modulation associated with long-term physical activity is detectable using a discordant monozygotic male twin pair design. Nine monozygotic male twin pairs were carefully selected for an intrapair difference in their leisure-time physical activity of at least three years duration (mean age 34 ± 1 years). We registered somatosensory mismatch response (SMMR) in EEG to electrical stimulation of fingers and whole brain MR images. We obtained exercise history and measured physical fitness and body composition. Equivalent electrical dipole sources of SMMR as well as gray matter (GM) voxel counts in regions of interest indicated by source analysis were evaluated. SMMR dipolar source strengths differed between active and inactive twins within twin pairs in postcentral gyrus, medial frontal gyrus and superior temporal gyrus and in anterior cingulate (AC) GM voxel counts differed similarly. Compared to active twins, their inactive twin brothers showed greater dipole strengths in short periods of the deviant-elicited SMMR and larger AC GM voxel counts. Stronger activation in early unattended cortical processing of the deviant sensory signals in inactive co-twins may imply less effective gating of somatosensory information in inactive twins compared to their active brothers. Present findings indicate that already in 30′s long-term physical activity pattern is linked with specific brain indices, both in functional and structural domains.peerReviewe