Detection Of Changes In Patients Research Articles

MR volumetry in detection of brain atrophic changes in MS patients and its implication on disease prognosis: retrospective study

BackgroundMultiple sclerosis is a chronic demyelinating disease of the central nervous system. It may lead to disability and cognitive impairment. Our study aimed at evaluation of the role of MR volumetry technique in detection of brain atrophic changes in patients with multiple sclerosis and its impact on disease prognosis.ResultsThis study was carried out on thirty healthy control with mean age 26.23 years and thirty patients with remitting relapsing multiple sclerosis, with a mean age of 28.18 years. Patients with multiple sclerosis were distributed across six subgroups based on the z-score cut-off of − 1.96 for regional and whole brain atrophy. We found that 2 patients (6.6%) showed no thalamic or brain atrophy, 28 patients (93.3%) showed whole brain atrophy only and 10 patients (33.3%) showed both, thalamic and BP atrophy. No patients showed only thalamic atrohy, 4 patients showed whole brain atrophy with other structure atrophy rather than thalamus (13.3%), 10 patients with whole brain and more than one structure atrophy (33.3%). Relation between subgroups and degree of increase in the Expanded Disability Status Scale (EDSS) as well as presence of cognitive decline were assessed. No significant relation were found between RRMS patients subgroups with whole brain atrophy, subgroup with isolated thalamic atrophy or subgroup with multiple structure atrophy and increase of EDSS or cognitive decline.ConclusionWe found that MRI volumetry is a very useful technique in the assessment of the atrophic changes that occur as a consequence of multiple sclerosis affecting the whole brain, deep grey matter as well as corpus callosum. Although our study did not prove significant relation between presence of brain atrophic changes and disability or cognitive impairment, presence of atrophy warrants careful clinical evaluation of those patients to detect any possible further progression of disability or cognitive decline.

Association between microstructural white matter abnormalities and cognitive functioning in patients with type 2 diabetes mellitus: a diffusion tensor imaging study

BackgroundDiffusion tensor imaging (DTI) technique is important for exploring more sensitive imaging-based biomarkers in prevention and early treatment of cognitive dysfunction induced by type 2 diabetes mellitus (DM).ObjectivesTo predict early cognitive dysfunction and detection of microstructural white matter changes in patients with type 2 DM by diffusion tensor imaging.Patients and methodsA case-control study included thirty patients aged ≥ 18 years old of both sexes with type 2 DM and 30 controls. All subjects underwent to Montreal Cognitive Assessment (MoCA) “Arabic version”: to detect mild cognitive impairment (MCI) and diffusion tensor imaging study (DTI).ResultsMild cognitive impairment is related to type 2 DM (56.7% of diabetic group), reduced fractional anisotropy (FA) values, and elevated mean diffusivity (MD) values were related to cognitive impairment evaluated through Montreal Cognitive Assessment (MoCA) in patients with type 2 DM.ConclusionThe integrity of the white matter measured using DTI vary in MCI diabetics compared with non-MCI diabetics. Such changes have major implications on the cognitive function.

Improvement in the Clinical Global Impression of Change with Voxelotor in Patients with Sickle Cell Disease in the Phase 3 HOPE Trial

Background: Patients with sickle cell disease (SCD) experience varied salient symptoms that impact their health-related quality of life, which incorporates illness severity, their level of distress and other aspects of impairment, and the impact of the illness on functional status. SCD symptoms may begin at an early age, and their severity varies over time and between patients. Although detection of changes in patients' self-assessed symptoms may be obfuscated by their lifelong symptoms, treating physicians with SCD expertise may be able to detect changes in a patient's status given their experience in treating the diverse symptoms across multiple patients. We evaluated the longitudinal impact of voxelotor (Oxbryta®) in the HOPE study using the single-item Clinical Global Impression of Change (CGI-C), a validated clinician-reported outcome analogous to the commonly used Patient Global Impression of Change (PGI-C), which provides expert clinical impressions that transcend symptom checklists. Methods: In the randomized, placebo-controlled, double-blinded HOPE study, participants with SCD aged 12 to 65 years were randomized to receive voxelotor (1500 mg or 900 mg dose administered orally, once daily) or placebo. Study participants had a hemoglobin (Hb) level 5.5 to 10.5 g/dL at enrollment and 1 to 10 vaso-occlusive crises in the past 12 months at screening. Clinicians were blinded to treatment assignment and to all central laboratory measures (eg, hematological parameters) throughout the 72-week study period. Clinicians rated the CGI-C at 24 and 72 weeks from baseline. CGI-C ratings used a 7-point scale ("very much improved," "moderately improved," "minimally improved," "no change," "minimally worse," "moderately worse," and "very much worse"). CGI-C outcomes were stratified by baseline Hb levels and baseline markers of hemolysis to identify measures predictive of assessment outcomes. Results: Trends of improvement from baseline in overall clinical status with voxelotor 1500 mg, as assessed by CGI-C scores, were observed as early as week 24. At week 72, patients receiving voxelotor 1500 mg were more often rated by the clinician as "very much improved" or "moderately improved" (74%; 39 of 53) compared with those who received placebo (47%; 24 of 51) (P<0.01, Figure 1). CGI-C score improvement was consistently greater in participants treated with voxelotor compared with placebo regardless of baseline Hb. Greater proportions of participants were rated "very much improved" or "moderately improved" with voxelotor 1500 mg than placebo regardless of baseline hemolysis markers (indirect bilirubin, percentage reticulocytes, absolute reticulocyte count). Conclusions: Treatment with voxelotor 1500 mg resulted in improved clinician-reported patient outcomes, as assessed using the CGI-C. Greater proportions of participants were rated "very much improved" or "moderately improved" regardless of baseline Hb levels and baseline markers of hemolysis. The CGI provides an overall clinician-determined summary measure that takes all available information into account, including the patient's history, psychosocial circumstances, symptoms, and behavior, as well as the impact of symptoms on the patient's ability to function. Therefore, a tool that provides a holistic assessment of a patient's well-being may be complementary in capturing changes in a patient's status, considering the substantial interpatient and intrapatient variability in SCD symptomatology. CGI-C assessments are being included in ongoing studies of voxelotor. Disclosures Smith: Emmaeus Pharmaceuticals, Inc.: Consultancy; Novartis, Inc.: Consultancy, Other: Investigator, Research Funding; Global Blood Therapeutics, Inc.: Consultancy, Research Funding; Shire, Inc.: Other: Investigator, Research Funding; NHLBI: Research Funding; Patient-Centered Outcomes Research Institute: Other: Investigator, Research Funding; Health Resources and Services Administration: Other: Investigator, Research Funding; Incyte: Other: Investigator; Pfizer: Consultancy; Ironwood: Consultancy; Novo Nordisk: Consultancy; Imara: Research Funding; Shire: Research Funding; GlycoMimetics, Inc.: Consultancy. Hankins:American Society of Pediatric Hematology/Oncology: Honoraria; UptoDate: Consultancy; Novartis: Research Funding; MJH Life Sciences: Consultancy, Patents & Royalties; LINKS Incorporate Foundation: Research Funding; National Heart, Lung, and Blood Institute: Honoraria, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding. Abboud:Novartis: Consultancy, Honoraria, Research Funding; Global Blood Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding; Crispr Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Travel support; Eli Lilly: Research Funding; Modus Pharmaceuticals: Research Funding. Cong:Global Blood Therapeutics: Current Employment, Current equity holder in publicly-traded company. Sorof:Global Blood Therapeutics: Current Employment, Current equity holder in publicly-traded company. Gray:Global Blood Therapeutics: Current Employment, Current equity holder in publicly-traded company. Hoppe:Global Blood Therapeutics: Current Employment, Current equity holder in publicly-traded company. Telfer:Global Blood Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Terumo: Honoraria; Pfizer: Membership on an entity's Board of Directors or advisory committees; Bluebird Bio: Honoraria, Research Funding; ApoPharma: Membership on an entity's Board of Directors or advisory committees.

Detection of uterine artery hemodynamic changes in patients with gestational hypertension based on Doppler ultrasonography

Detection of uterine artery hemodynamic changes in patients with gestational hypertension based on Doppler ultrasonography

Effect of thyroid dysfunction on left ventricular performance using different echo-Doppler modalities

Background Thyroid dysfunction (Thy.D) is one of the commonest endocrinological disorders that increase cardiovascular morbidity and mortality. Echocardiography is a useful, noninvasive, easily accessible, and affordable tool for detection of early cardiovascular changes in patients with thyroid disorders. Aim To assess the effect of Thy.D on left ventricular (LV) performance using different echo-Doppler modalities. Patients and methods This study included 60 individuals, divided into three groups: GI: 20 patients (hypothyroidism), GII: 20 patients (hyperthyroidism), and 20 healthy individuals as controls (GIII). All participants underwent history taking, clinical examination, thyroid profile (free triiodothyronine, free tetraiodothyronine, and thyroid-stimulating hormone), conventional echocardiography, tissue Doppler imaging (TDI) velocities averaged from four annular sites (Av-Sa, Av-Ea, and Av-Aa), TDI-derived strain, and two-dimensional-global longitudinal strain (2D-GLS). Results Despite LV systolic function being preserved in all studied groups, there was a statistically significant reduction in GI and GII compared with GIII (CL), with more reduction in GI (P Conclusion Thyroid disorders have a significant effect on LV systolic and diastolic functions. TDI (velocities and strain) and 2D-GLS are useful indices for detection of LV functions in patients with Thy.D.

P190Is acoustocerebrography a new noninvasive method for early detection of the brain changes in patients with hypertension?

P190Is acoustocerebrography a new noninvasive method for early detection of the brain changes in patients with hypertension?

Effects of self and familiarity on change detection in patients with schizophrenia

In schizophrenia, processing of self-related stimuli has been shown to be altered. It is unclear whether altered self-processing in schizophrenia is confined to cognitive functions such as self-recognition, or whether it pertains to automatic lower-level perceptual processes. Visual face processing was tested in patients with schizophrenia (n=36) and healthy controls (n=33). Using a change detection paradigm (self, famous, unknown faces), we tested whether self-related stimuli gain access to awareness preferentially. The task was unrelated to face category, thus probing implicit processing of the face identity information. Furthermore we explored hemifield differences, the association of preferential self-processing with disease insight and with schizophrenic symptom severity. Change detection was overall enhanced for one’s own face and familiar faces compared to unknown faces. There were no group differences regarding perception of self-related or familiar stimuli. The enhancing effect of self and familiarity on change detection was smaller in patients with more severe symptoms. We found no association between implicit visual self-perception and insight in schizophrenia. The privileged access of self-related visual information is not impaired in patients with schizophrenia. The reduced overall left-hemifield advantage for face-change detection points to an altered lateralization of face processing in patients with schizophrenia.

Abstract WP41: Peri-Procedural Arterial Spin Labeling and Dynamic Susceptibility contrast Perfusion in Detection of Cerebral Blood Flow in Patients with Acute Ischemic Syndrome

Purpose: To investigate the potential clinical value and diagnostic performance of arterial spin-labeled (ASL) and dynamic susceptibility contrast (DSC) perfusion in detection of cerebral blood flow (CBF) changes before and after endovascular recanalization in patients with acute ischemic syndrome (AIS). Methods: This retrospective study was performed using MR examinations between 2010-2012. Inclusion criteria were: patients with AIS who underwent endovascular recanalization and acquisition of both ASL and DSC before and after revascularization. ASL CBF and multiparametric DSC perfusion maps were qualitatively evaluated for image quality, presence of hypo or hyperperfusion and location of perfusion abnormality. Lesion segmentation for infarct core (ADCb >550) and hypoperfused area (TMax > 4 sec) was performed on DSC. rCBF was calculated using a regions-of-interest (ROI) method in the infarction core and hypoperfused areas using coregistered ASL and DSC images. Core and hypoperfused rCBF ROI’s were used for paired pre- and post-treatment intermodality comparisons. Interobserver and intermodality agreement was evaluated by Kappa test. T-test and Spearman correlation coefficients were calculated for ASL and DSC rCBF values. Results: Twenty-five patients were met our inclusion criteria. Five studies were rated non-diagnostic, resulting in a total of 45 pair of DSC-ASL for comparison. ASL and DSC agreed on type of perfusion abnormality in 32 of 45 cases (71%) and location of the perfusion abnormality in 36 of 45 cases (80%). The image quality of ASL was lower than DSC, resulting in interobserver variability for the type (k =0.45) and location (k=0.56) of perfusion abnormality. ASL was unable to show any type of perfusion abnormality in 11% of patients. In patients with successful recanalization, hyperperfusion (rCBF> 1) was detected in 100% on DSC and 47% on ASL. ASL showed prolonged arterial transit effects in 58% of successfully recanalized patients. Conclusion: ASL is moderately consistent with DSC for detection of cerebral blood flow changes in patients with AIS. Qualitative and quantitative differences exist between two modalities, in particular in respect to detection of hyperperfusion in successfully recanalized patients.

FMRI investigation of visual change detection in adults with autism

People with autism spectrum disorders (ASD) may show unusual reactions to unexpected changes that appear in their environment. Although several studies have highlighted atypical auditory change processing in ASD, little is known in this disorder about the brain processes involved in visual automatic change detection. The present fMRI study was designed to localize brain activity elicited by unexpected visual changing stimuli in adults with ASD compared to controls. Twelve patients with ASD and 17 healthy adults participated in the experiment in which subjects were presented with a visual oddball sequence while performing a concurrent target detection task. Combined results across participants highlight the involvement of both occipital (BA 18/19) and frontal (BA 6/8) regions during visual change detection. However, adults with ASD display greater activity in the bilateral occipital cortex and in the anterior cingulate cortex (ACC) associated with smaller activation in the superior and middle frontal gyri than controls. A psychophysiological interaction (PPI) analysis was performed with ACC as the seed region and revealed greater functionally connectivity to sensory regions in ASD than in controls, but less connectivity to prefrontal and orbito-frontal cortices. Thus, compared to controls, larger sensory activation associated with reduced frontal activation was seen in ASD during automatic visual change detection. Atypical psychophysiological interactions between frontal and occipital regions were also found, congruent with the idea of atypical connectivity between these regions in ASD. The atypical involvement of the ACC in visual change detection can be related to abnormalities previously observed in the auditory modality, thus supporting the hypothesis of an altered general mechanism of change detection in patients with ASD that would underlie their unusual reaction to change.

Diffusionsgewichtete Magnetresonanztomographie des Abdomens

Diffusion-weighted magnetic resonance imaging (DW-MRI) provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. Since DW-MRI can be performed without ionizing radiation exposure and contrast media application, DW-MRI is a particularly attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Recent technical developments have made DW-MRI a robust and feasible technique for abdominal imaging. DW-MRI provides information on the detection and characterization of focal liver lesions and can also visualize treatment effects and early changes in chronic liver disease. In addition DW-MRI is a promising tool for the detection of inflammatory changes in patients with Crohn's disease.

Letter by Varma and Stambler Regarding Article, “Big Brother is Watching You: What Do Patients Think About ICD Home Monitoring?”

HomeCirculationVol. 123, No. 7Letter by Varma and Stambler Regarding Article, “Big Brother is Watching You: What Do Patients Think About ICD Home Monitoring?” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Varma and Stambler Regarding Article, “Big Brother is Watching You: What Do Patients Think About ICD Home Monitoring?” Niraj Varma Bruce S. Stambler Niraj VarmaNiraj Varma Cardiac Pacing and Electrophysiology Cleveland Clinic Cleveland, OH (Varma) Search for more papers by this author Bruce S. StamblerBruce S. Stambler University Hospitals Case Medical Center Case Western Reserve University Cleveland, OH (Stambler) Search for more papers by this author Originally published22 Feb 2011https://doi.org/10.1161/CIRCULATIONAHA.110.983148Circulation. 2011;123:e247To the Editor:We thank Dr Matlock for recognizing the Lumos-T Safely RedUceS RouTine Office Device Follow-up (TRUST) trial's quality.1 Some points raised merit further comment.We acknowledge the importance of patient perspective. TRUST was initiated in 2005, preceding the call from the Heart Rhythm Society to develop remote technologies, and coincided with well-publicized recalls which heightened patients' awareness for monitoring. The remote technology used in TRUST Home Monitoring (HM) has demonstrated excellent levels (>95%) of patient acceptance and satisfaction.2 It is likely then that patients' motivation propelled TRUST to rapid enrollment and early completion. No TRUST patients assigned to HM crossed over during the study, and 98% elected to retain this follow-up mode on trial conclusion, representing the outcome of the shared decision. In contrast, conventional care was characterized by follow up attrition, indicating how onerous patients find scheduled clinic visits.It is possible that patient notification of detection of asymptomatic problems (eg, a broken lead) or nonsustained events is anxiety-provoking. However, inaction is more hazardous. Monitoring hardware performance is a physician responsibility embodied in recent Heart Rhythm Society position statements and often demanded by post-2005 patients.3 Conventional monitoring significantly underreports these events compared to HM.4 Nonsustained arrhythmia notifications which may also be triggered by, for example, lead noise/T wave oversensing, may cause battery depletion and presage shock delivery causing patient morbidity. Shock burden reduction, especially if inappropriate, is a major current concern. HM's early detection of such asymptomatic problems provides an opportunity for early preventative action.4Adjudication of actionability of patient data is the cornerstone of clinical management. HM may facilitate this decision making process for system function as well as patient condition. Automatic longitudinal databasing generates baseline trends with automatic notification of parameter deviation. This lays a foundation for future clinical outcomes studies (not in TRUST's purview) especially for heart failure for which a variety of implantable sensors are under development. The success of these depends on continuous monitoring, accessibility of collected data, and notification of asymptomatic deviation from individually established trends, to permit preemptive clinical intervention. The threat that such event notifications needlessly increase unscheduled visits was tested in TRUST. Notifications occurred infrequently (median <2 per patient per year) yet were valuable since face-to-face encounters triggered were highly actionable (>50%).5 Problem discovery and clinical response (ie, the aims of monitoring) are therefore improved by utilizing this exception-based care model with HM. Importantly, TRUST supported continued face-to-face to follow up with heart failure physicians.We question the validity of Dr Matlock's comparison to prostate-specific antigen screening. HM purpose is to provide near-continuous surveillance for early detection of changes in patients with already declared disease, considered at high risk for subsequent problems, and to monitor a therapy with established efficacy (ie, implantable device performance). TRUST illustrates a mechanism for improved execution of this necessary responsibility.3 This philosophy is separate to population screening for disease in which value will be determined by disease prevalence, the test's predictive value, and the efficacy of treatment available.TRUST illustrates how the rich diagnostic resources of implantable devices may be accessed in an efficient and timely manner to enhance patient care.Niraj Varma, MA, DM, FRCP Cardiac Pacing and Electrophysiology Cleveland Clinic Cleveland, OHBruce S. Stambler, MD University Hospitals Case Medical Center Case Western Reserve University Cleveland, OHDisclosuresDr Varma has received research grants and honoraria from Biotronik. Dr Stambler has received honoraria from Biotronik.

Psychometric evaluation of the functional assessment of HIV Infection (FAHI) questionnaire and its usefulness in clinical trials

To evaluate psychometric properties of the Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) questionnaire, a 47-item disease-specific instrument evaluating Health-Related Quality of Life (HRQL) in human immunodeficiency virus (HIV)-infected patients. Treatment-experienced HIV-infected patients from two clinical programmes (N = 565; N = 1,096) completed the FAHI at Baseline and after 24 weeks of treatment. Psychometric properties of the FAHI were assessed in both trial populations, including minimal important differences (MIDs) calculations. Links between HRQL assessed by FAHI Total score, and biological endpoints were explored by regression analysis and mean score comparisons. Cronbach's alphas ranged from 0.72 to 0.94. Most items met convergent and discriminant validity criteria. Better FAHI scores were seen for patients in earlier HIV stages. Responsiveness was demonstrated with changes in FAHI scores significantly linked to change in EQ-5D score. Depending on methods used, MIDs ranged from 3.2 to 14 for FAHI Total score. Small association was found between FAHI Total score and CD4 count and viral load (r-square < 3%). Mean changes in FAHI scores were not statistically related to viral response. The FAHI demonstrated acceptable psychometric properties in two independent populations. HRQL assessment enabled detection of changes in patients' health status not revealed by traditional efficacy endpoints.

Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

Quantitative ultrasonic detection of liver changes in patients undergoing interleukin-2 therapy

Quantitative ultrasonic detection of liver changes in patients undergoing interleukin-2 therapy