Search

Objective: To apply a machine learning analysis to clinical and presynaptic dopaminergic imaging data of patients with rapid eye movement (REM) sleep behavior disorder (RBD) to predict the development of Parkinson disease (PD) and dementia with Lewy bodies (DLB). Method s : In this multicenter study of the International RBD study group, 173 patients (mean age 70.5 ± 6.3 years, 70.5% males) with polysomnography‐confirmed RBD who eventually phenoconverted to overt alpha‐synucleinopathy (RBD due to synucleinopathy) were enrolled, and underwent baseline presynaptic dopaminergic imaging and clinical assessment, including motor, cognitive, olfaction, and constipation evaluation. For comparison, 232 RBD non‐phenoconvertor patients (67.6 ± 7.1 years, 78.4% males) and 160 controls (68.2 ± 7.2 years, 53.1% males) were enrolled. Imaging and clinical features were analyzed by machine learning to determine predictors of phenoconversion. Results: Machine learning analysis showed that clinical data alone poorly predicted phenoconversion. Presynaptic dopaminergic imaging significantly improved the prediction, especially in combination with clinical data, with 77% sensitivity and 85% specificity in differentiating RBD due to synucleinopathy from non phenoconverted RBD patients, and 85% sensitivity and 86% specificity in discriminating PD‐converters from DLB‐converters. Quantification of presynaptic dopaminergic imaging showed that an empirical z‐score cutoff of −1.0 at the most affected hemisphere putamen characterized RBD due to synucleinopathy patients, while a cutoff of −1.0 at the most affected hemisphere putamen/caudate ratio characterized PD‐converters. Interpretation: Clinical data alone poorly predicted phenoconversion in RBD due to synucleinopathy patients. Conversely, presynaptic dopaminergic imaging allows a good prediction of forthcoming phenoconversion diagnosis. This finding may be used in designing future disease‐modifying trials. ANN NEUROL 2024;95:1178–1192 [ABSTRACT FROM AUTHOR]

Isolated REM sleep behavior disorder (iRBD) is an early stage of synucleinopathy with most patients progressing to Parkinson's disease (PD) or related conditions. Quantitative susceptibility mapping (QSM) in PD has identified pathological iron accumulation in the substantia nigra (SN) and variably also in basal ganglia and cortex. Analyzing whole‐brain QSM across iRBD, PD, and healthy controls (HC) may help to ascertain the extent of neurodegeneration in prodromal synucleinopathy. 70 de novo PD patients, 70 iRBD patients, and 60 HCs underwent 3 T MRI. T1 and susceptibility‐weighted images were acquired and processed to space standardized QSM. Voxel‐based analyses of grey matter magnetic susceptibility differences comparing all groups were performed on the whole brain and upper brainstem levels with the statistical threshold set at family‐wise error‐corrected p‐values <.05. Whole‐brain analysis showed increased susceptibility in the bilateral fronto‐parietal cortex of iRBD patients compared to both PD and HC. This was not associated with cortical thinning according to the cortical thickness analysis. Compared to iRBD, PD patients had increased susceptibility in the left amygdala and hippocampal region. Upper brainstem analysis revealed increased susceptibility within the bilateral SN for both PD and iRBD compared to HC; changes were located predominantly in nigrosome 1 in the former and nigrosome 2 in the latter group. In the iRBD group, abnormal dopamine transporter SPECT was associated with increased susceptibility in nigrosome 1. iRBD patients display greater fronto‐parietal cortex involvement than incidental early‐stage PD cohort indicating more widespread subclinical neuropathology. Dopaminergic degeneration in the substantia nigra is paralleled by susceptibility increase, mainly in nigrosome 1. [ABSTRACT FROM AUTHOR]

Background: Impairments of olfactory and speech function are likely early prodromal symptoms of α‐synucleinopathy. Objective: The aim of this study is to assess whether dysprosody is present in isolated rapid eye movement sleep behavior disorder (iRBD) with hyposmia/anosmia and a normal nigrostriatal system. Methods: Pitch variability during speech was investigated in 17 iRBD subjects with normal olfactory function (iRBD‐NOF), 30 iRBD subjects with abnormal olfactory function (iRBD‐AOF), and 50 healthy controls. iRBD subjects were evaluated using the University of Pennsylvania Smell Identification Test and [123I]‐2ß‐carbomethoxy‐3ß‐(4‐iodophenyl)‐N‐(3‐fluoropropyl)‐nortropane dopamine transporter single‐photon emission computed tomography (DAT‐SPECT). All iRBD subjects completed the 24‐month follow‐up with DAT‐SPECT, speech, and olfactory testing. Results: At baseline, only iRBD‐AOF showed monopitch when compared to iRBD‐NOF (P = 0.04) and controls (P = 0.03), with no difference between iRBD‐NOF and controls (P = 1). At follow‐up, dysprosody progressed only in iRBD‐AOF with abnormal DAT‐SPECT (P = 0.03). Conclusion: Prosody is impaired in hyposmic but not in normosmic iRBD subjects before the nigrostriatal dopaminergic transmission is affected (Braak stage 2). © 2021 International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background: The mechanisms underlying speech abnormalities in Parkinson's disease (PD) remain poorly understood, with most of the available evidence based on male patients. This study aimed to estimate the occurrence and characteristics of speech disorder in early, drug‐naive PD patients with relation to gender and dopamine transporter imaging. Methods: Speech samples from 60 male and 40 female de novo PD patients as well as 60 male and 40 female age‐matched healthy controls were analyzed. Quantitative acoustic vocal assessment of 10 distinct speech dimensions related to phonation, articulation, prosody, and speech timing was performed. All patients were evaluated using [123]I‐2b‐carbomethoxy‐3b‐(4‐iodophenyl)‐N‐(3‐fluoropropyl) nortropane single‐photon emission computed tomography and Montreal Cognitive Assessment. Results: The prevalence of speech abnormalities in the de novo PD cohort was 56% for male and 65% for female patients, mainly manifested with monopitch, monoloudness, and articulatory decay. Automated speech analysis enabled discrimination between PD and controls with an area under the curve of 0.86 in men and 0.93 in women. No gender‐specific speech dysfunction in de novo PD was found. Regardless of disease status, females generally showed better performance in voice quality, consonant articulation, and pauses production than males, who were better only in loudness variability. The extent of monopitch was correlated to nigro‐putaminal dopaminergic loss in men (r = 0.39, p = 0.003) and the severity of imprecise consonants was related to cognitive deficits in women (r = −0.44, p = 0.005). Conclusions: Speech abnormalities represent a frequent and early marker of motor abnormalities in PD. Despite some gender differences, our findings demonstrate that speech difficulties are associated with nigro‐putaminal dopaminergic deficits. [ABSTRACT FROM AUTHOR]

Hyperparatyreóza (HPT) je poměrně časté endokrinní onemocnění, nejčastěji se vyskytuje jako primární (PHPT), která zaujímá třetí místo podle výskytu endokrinních chorob. Hlavním projevem choroby je nadměrná tvorba parathormonu (PTH) se současně se zvětšujícími příštítnými tělísky (PT). Vyskytuje se v několika formách, a to při patologických stavech majících příčinu v samotných PT, či sekundárně při poruchách kalciového metabolismu. V určování diagnózy jsou kromě anamnestických dat prioritní výsledky biochemických hodnot. K nejdůležitějším patří hladiny imunoreaktivního PTH (iPTH) v plazmě a hodnoty Ca a P v séru, dále základní biochemické hodnoty funkce ledvin, pankreatu, event. kostního metabolismu. Diagnóza se rovněž opírá o nálezy zobrazovacích technik, k základním vyšetřením se řadí sonografie a scintigrafie. Na základě shrnutí laboratorních výsledků a nálezů zobrazovacích technik je indikována chirurgická nebo konzervativní terapie. V posledních letech se výrazně zlepšila péče o pacienty s HPT. Jistě k tomu přispěly i možnosti přesnější lokalizace hyperprodukující tkáně PT pomocí zobrazovacích metod, které jsou vodítkem k výběru nejefektivnějšího a nejšetrnějšího operačního řešení. Tento souhrnný článek s potřebnými informacemi týkajícími se hyperparatyreózy, je určen především pro kolegy v předatestační přípravě. [ABSTRACT FROM AUTHOR]

Copyright of Urologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Investigate whether 123I-ioflupane SPECT (DaT SPECT) has the potential as a marker of basal ganglia damage in acute methanol poisoning. Prospective, single-centre, cohort study of patients with confirmed methanol poisoning was conducted. DaT SPECT was performed twice with semi-quantification using DaTQUANTTM and MRI-based volumetry was calculated. Specific binding ratios (SBR) of striatum, caudate nucleus, and putamen were correlated with laboratory parameters of outcome, volumetric data, and retinal nerve fibres layer (RNFL) thickness measurements. Forty-two patients (mean age 46.3 ± 4.2 years; 8 females), including 15 with MRI-detected putamen lesions (group I) and 27 patients with intact putamen (group II), underwent DaT SPECT. Volumetry was calculated in 35 of the patients assessed. SBR values for the left putamen correlated with putamen volume (r = 0.665; p < 0.001). Decreased bilateral SBR values were determined for the striatum and the putamen, but not for the nucleus caudate, in group I (p < 0.05). Significant correlation was observed between the SBR of the posterior putamen and arterial blood pH (r = 0.574; p < 0.001) and other toxicological parameters of severity of poisoning/outcome including serum lactate, glucose, and creatinine concentrations (p < 0.05). The SBR of the posterior putamen positively correlated with the global RNFL thickness (p < 0.05). ROC analysis demonstrated a significant discriminatory ability of SBR of the posterior putamen with AUC = 0.753 (95%CI 0.604–0.902; p = 0.007). The multivariate regression model demonstrated that arterial blood pH, age, and gender were the most significant factors associated with SBR of the posterior putamen. DaT SPECT demonstrates significant potential for the diagnosis of methanol-induced basal ganglia damage. [ABSTRACT FROM AUTHOR]

Copyright of Czech Urology / Ceska Urologie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The positron emission tomography combined with computed tomography (PET/CT) is a well established imaging modality in the oncological practice. The most frequently used radiopharmaceutical is 2-deoxy-2-(18F)fluoro-D-glucose (FDG). Due to the unspecific nature of its biodistribution it can also be used in the diagnosis of other clinical entities with increased metabolic turnover, especially in the inflammation and infection. Thromboembolic disease represents a relatively frequent and serious medical issue. Inflammatory and other hypermetabolic processes have substantial impact on its development. FDG PET/CT is not routinely used for its diagnosis, however direct or indirect signs of thromboembolic disease can be frequently encountered in the routine practice of PET/CT interpretation. This is a literature review analysing the role of FDG PET/CT in the primary diagnosis of thromboembolic disease, in the pulmonary hypertension evaluation, in the detection of the cause of unprovoked thromboembolic events and in the differentiation of tumor thrombus. [ABSTRACT FROM AUTHOR]

Context: The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known. Objective: The objective of this is to study the impact of burden of co-morbidities, complications, and methanol-induced brain lesions on hospital, follow-up, and total mortality. Methods: All patients hospitalized with methanol poisoning during a mass poisoning outbreak were followed in a prospective cohort study until death or final follow-up after 6 years. The age-adjusted Charlson co-morbidity index (ACCI) score was calculated for each patient. A multivariate Cox regression model was used to calculate the adjusted hazards ratio (HR) for death. The survival was modeled using the Kaplan–Meier method. Results: Of 108 patients (mean age with SD 50.9 ± 2.6 years), 24 (54.4 ± 5.9 years) died during hospitalization (mean survival with SD 8 ± 4 days) and 84 (49.9 ± 3.0 years; p =.159) were discharged, including 27 with methanol-induced brain lesions. Of the discharged patients, 15 (56.3 ± 6.8 years) died during the follow-up (mean survival 37 ± 11 months) and 69 (48.5 ± 3.3 years; p =.044) survived. The hospital mortality was 22%, the follow-up mortality was 18%; the total mortality was 36%. Cardiac/respiratory arrest, acute respiratory failure, multiorgan failure syndrome, and arterial hypotension increased the HR for hospital and total (but not follow-up) mortality after adjustment for age, sex, and arterial pH (all p <.05). All patients who died in the hospital had at least one complication. A higher ACCI score was associated with greater total mortality (HR 1.22; 1.00–1.48 95% CI; p =.046). Of those who died, 35 (90%) had a moderate-to-high ACCI. The Kaplan–Meier curve demonstrated that patients with a high ACCI had greater follow-up mortality compared to ones with low (p =.027) or moderate (p =.020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths. Conclusions: The character and number of complications affected hospital but not follow-up mortality, while the burden of co-morbidities affected follow-up mortality. Methanol-induced brain lesions did not affect follow-up mortality. Relatively high cancer mortality rate may be associated with acute exposure to metabolic formaldehyde produced by methanol oxidation. [ABSTRACT FROM AUTHOR]

We present a case of a female patient with early prosthetic valve endocarditis of bioprosthetic aortic valve, where positron emission tomography with 18F-fluorodeoxyglucose (PET) had substantial impact on its diagnostics and indication of subsequent reoperation. We discuss current role of PET in the management of infective endocarditis. [ABSTRACT FROM AUTHOR]