P2657Prognostic impact of skeletal muscle mass in upper and lower extremities in patients with ST-segment elevation myocardial infarction

Introduction

Sarcopenia, characterized by the loss of skeletal muscle mass and muscle strength, has been demonstrated the importance in cardiovascular diseases including ST-segment elevation myocardial infarction (STEMI). However, there is few data comparing the effects on the prognosis of skeletal muscle mass of upper and lower extremities in STEMI patients.

Purpose

Our purpose was to examine whether skeletal muscle mass of upper and lower extremities affect the prognosis after STEMI.

Methods

A total of 432 patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. Each of upper and lower extremity skeletal muscle masses was indexed by height squared (kg/m2), and divided into two groups using the first quartile value for each sex. All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization.

Results

During a median follow-up of 32 months, 68 patients experienced primary composite outcome. The event rate was significantly higher in patients with low-lower extremity skeletal muscle mass index (LESMI) than in those with high-LESMI (24.3% vs 12.9%, log-rank p<0.001), as well as in those with low-upper extremity muscle mass index than in those with high-upper extremity muscle mass index (UESMI) (19.6% vs 14.5%, log-rank p=0.047). However, after adjustment for age, gender, renal function, diabetes mellitus, infarct size, body mass index, and body fat percentage, only low-LESMI was independently and significantly associated with the primary composite outcome (adjusted hazard ratio for LESMI 2.11, 95%-confidence interval 1.06–4.14, p=0.034, adjusted hazard ratio for UESMI 1.04, 95%-confidence interval 0.52–2.08, p=0.906,).

Conclusions

Decreased muscle mass of lower extremity, rather than upper extremity, might have prognostic impact in patients with STEMI.

Voxel-based correlation of 18F-THK5351 accumulation and gray matter volume in the brain of cognitively normal older adults

Backgrounds

Although neurofibrillary tangles (NFTs) mainly accumulate in the medial temporal lobe with human aging, only a few imaging studies have investigated correlations between NFT accumulation and gray matter (GM) volume in cognitively normal older adults. Here, we investigated the correlations between ¹⁸F-THK5351 accumulation and GM volume at the voxel level.

Material and methods

We recruited 47 amyloid-negative, cognitively normal, older adults (65.0 ± 7.9 years, 26 women), who underwent structural magnetic resonance imaging, ¹¹C-Pittsburgh compound-B and ¹⁸F-THK5351 PET scans, and neuropsychological assessment. The magnetic resonance and ¹⁸F-THK5351 PET images were spatially normalized using Statistical Parametric Mapping 12. Voxel-wise correlations between ¹⁸F-THK5351 accumulation and GM volume were evaluated using the Biological Parametric Mapping toolbox.

Results

A significant negative correlation (p < 0.001) between ¹⁸F-THK5351 accumulation and GM volume was detected in the bilateral medial temporal lobes.

Conclusions

Voxel-wise correlation analysis revealed a significant negative correlation between ¹⁸F-THK5351 accumulation and GM volume in the medial temporal lobe in individuals without amyloid-β deposits. These results may contribute to a better understanding of the pathophysiology of primary age-related tauopathy in human aging.

Exploring the frequency and clinical background of the "zebra sign" in amyotrophic lateral sclerosis and multiple system atrophy

In amyotrophic lateral sclerosis (ALS), the "zebra sign" in the precentral gyrus on phase difference enhanced magnetic resonance imaging (PADRE) recently has been reported as a possible imaging biomarker for upper motor neuron (UMN) involvement. A previous study has shown that the "zebra sign" allowed us to differentiate patients with ALS from healthy subjects with excellent accuracy. We validated the usefulness of the sign for differentiating patients with ALS from healthy subjects and investigated whether the "zebra sign" can be observed other neurodegenerative disorders with UMN involvement. The "zebra sign" on PADRE was assessed in 26 patients with ALS, 26 with multiple system atrophy (MSA) and 26 healthy controls, and the sign was observed in 50%, 23%, and no subjects, respectively. ALS patients with the "zebra sign" demonstrated a higher UMN burden score than those without the sign. The "zebra sign" on PADRE is not specific to ALS, also present in MSA, but might reflect the degeneration of the UMN within the motor cortex in neurodegenerative disorders.

Postoperative changes in the brain: Assessment with serial T2WI/FLAIR MR images in non-neoplastic patients

The aim of the current study was to investigate the postoperative changes of high-signal lesions at the surgical margin on serial T2WI/FLAIR images in non-neoplastic patients. Seventy-one postoperative MR images in 27 patients (17 focal cortical dysplasia and 10 hippocampal sclerosis) who underwent surgery for intractable epilepsy were evaluated. T2WI/FLAIR-high-signal lesions in size and shape were visually assessed using a 3-point grading system. Associations of postoperative seizures or electroencephalography(EEG)spikes with advancing grade were also evaluated. As a result, follow-up showed enlarged T2WI/FLAIR-high-signal lesions in 6 of 27 patients (22%). The presence of post-operative seizures or EEG spikes was significantly associated with enlargement of the T2WI/FLAIR-high-signal lesion. Enlargement of the T2WI/FLAIR-high-signal lesion was observed in some non-neoplastic patients, and this finding might be correlated with remnant epileptogenesis.

Disrupted cortico-ponto-cerebellar pathway in patients with hemimegalencephaly

OBJECTIVE

Cerebellar dysmaturation and injury is associated with a wide range of neuromotor, neurocognitive and behavioral disorders as well as with preterm birth. We used diffusion tensor MR imaging to investigate a disruption in structural cortico-ponto-cerebellar (CPC) connectivity in children with infantile-onset severe epilepsy.

METHODS

We performed CPC tract reconstructions in 24 hemimegalencephaly (HME) patients, 28 West syndrome (WS) of unknown etiology patients, and 25 pediatric disease control subjects without a history of epilepsy nor brain abnormality on MRI. To identify the CPC tract, we placed a seeding ROI separately in each right and left cerebral peduncle. We evaluated the distribution patterns of the CPC tracts to the cerebellum and their correlation with clinical findings.

RESULTS

In control and WS of unknown etiology groups, both sides' CPC tracts descended to bilateral hemispheres in 20 (80.0%) and 21 (75.0%); mixed (bilateral on one side and unilateral on the other side) in five (20.0%) and five (17.9%); and unilateral in zero (0.0%) and two (7.1%), respectively. However, in the HME, both sides' CPC tracts descended to bilateral hemispheres in four (16.7%); mixed in 13 (54.1%); and unilateral in seven (29.2%). These CPC patterns differed significantly between the HME and other groups (p < 0.001). Among HME patients, those with a unilateral cerebellar distribution on both sides had significantly earlier seizure onset (p = 0.049) and more frequent seizures (p = 0.052) at a trend level compared to those with bilateral and mixed distributions.

CONCLUSION

Disrupted CPC tracts were observed more frequently in HME patients than in WS of unknown etiology patients and controls, and they may be correlated with earlier seizure onset and more frequent seizures in HME patients. DTI is a useful and non-invasive method for speculating the pathology in the developing brain.

Radiologic and Pathologic Features of the Transmantle Sign in Focal Cortical Dysplasia: The T1 Signal Is Useful for Differentiating Subtypes

BACKGROUND AND PURPOSE

The transmantle sign is a characteristic MR imaging finding often seen in focal cortical dysplasia type IIb. The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. However, in some cases, it shows T1 high signal. We evaluated the imaging and pathologic findings to identify the causes of the T1 high signal in the transmantle sign.

MATERIALS AND METHODS

We retrospectively reviewed the preoperative imaging data of 141 consecutive patients with histologically proved focal cortical dysplasia. We selected 25 patients with focal cortical dysplasia with the transmantle sign and divided them into groups based on the pathologic focal cortical dysplasia subtype and T1 signal of the transmantle sign. We evaluated the clinical, radiologic, and pathologic findings, including the number of balloon cells and dysmorphic neurons and the severity of gliosis or calcifications and compared them among the groups.

RESULTS

Nine of the 25 patients had a T1-high-signal transmantle sign; the other 16 patients did not. All 9 patients with a T1-high-signal transmantle sign were diagnosed as type IIb (group A). Of the 16 patients with no T1-high-signal transmantle sign, 13 were diagnosed as having type IIb (group B), and the other 3 patients, as type IIa (group C). The number of balloon cells was significantly higher in group A than in the other groups, but there were no differences regarding dysmorphic neurons, the severity of gliosis, or calcifications.

CONCLUSIONS

Approximately 6% (9/141) of this patient series had a T1-high-signal transmantle sign, and all were type IIb. The signal may reflect a rich density of balloon cells. This finding could support the differentiation of subtypes, especially type IIb.

Similar and Differing Distributions Between 18F-FDG-PET and Arterial Spin Labeling Imaging in Temporal Lobe Epilepsy

Background: Despite the increasing use of arterial spin labeling (ASL) in patients with epilepsy, little is known about its brain regional distribution pattern, including diaschisis, and its correspondence with FDG-PET. Here, we investigated the regional match and mismatch between FDG-PET and ASL in temporal lobe epilepsy (TLE). Methods: We recruited 27 patients with unilateral TLE, who underwent inter-ictal ASL and FDG-PET scans. These images were spatially normalized using Statistical Parametric Mapping 12, and the regional values in both ASL and FDG-PET were calculated using PMOD software within 20 volumes of interest (VOIs), including the temporal lobe, adjacent cortices, subcortical structures, and cerebellum. ASL images of 37 healthy controls were also analyzed and compared. Results: Whereas, ASL showed significant side differences, mainly in the temporal and frontal lobes, the significant abnormalities in FDG-PET were more widespread and included the insula and supramarginal gyrus. Ipsilateral thalamic reduction was found in FDG-PET only. The detectability of the focus side compared with the contralateral side was generally higher in FDG-PET. The discriminative values in ASL compared with healthy controls were higher in temporal neocortex and amygdala VOIs. Conclusions: There are similar and differing regional distributions between FDG-PET and ASL in TLE, possibly reflecting regional match and mismatch of cerebral blood flow and metabolism. At this stage, it seems that ASL couldn't present comparable clinical usefulness with FDG-PET. These findings deepen our knowledge of ASL imaging and are potentially useful for its further application.

Reduced resilience of brain gray matter networks in idiopathic generalized epilepsy: A graph-theoretical analysis

Purpose

The pathophysiology of idiopathic generalized epilepsy (IGE) is still unclear, but graph theory may help to understand it. Here, we examined the graph-theoretical findings of the gray matter network in IGE using anatomical covariance methods.

Materials and methods

We recruited 33 patients with IGE and 35 age- and sex-matched healthy controls. Gray matter images were obtained by 3.0-T 3D T1-weighted MRI and were normalized using the voxel-based morphometry tools of Statistical Parametric Mapping 12. The normalized images were subjected to graph-theoretical group comparison using the Graph Analysis Toolbox with two different parcellation schemes. Initially, we used the Automated Anatomical Labeling template, whereas the Hammers Adult atlas was used for the second analysis.

Results

The resilience analyses revealed significantly reduced resilience of the IGE gray matter networks to both random failure and targeted attack. No significant between-group differences were found in global network measures, including the clustering coefficient and characteristic path length. The IGE group showed several changes in regional clustering, including an increase mainly in wide areas of the bilateral frontal lobes. The second analysis with another region of interest (ROI) parcellation generated the same results in resilience and global network measures, but the regional clustering results differed between the two parcellation schemes.

Conclusion

These results may reflect the potentially weak network organization in IGE. Our findings contribute to the accumulation of knowledge on IGE.

Changes of Myelin Organization in Patients with Alzheimer's Disease Shown by q-Space Myelin Map Imaging

Background

Recent studies detected the aberrant myelination of the central nervous system (CNS) in Alzheimer's disease (AD). Here, we compared the change of myelination between patients with AD and controls by a novel magnetic resonance imaging modality, “q-space myelin map (MM) imaging.”

Methods

Twenty patients with AD and 18 healthy subjects underwent MM imaging. We compared the MM metric between the 2 groups and examined the relationships between the metric and the clinical symptoms of AD.

Results

AD patients showed a significant reduction of MM metric in the hippocampus, insula, precuneus, and anterior cingulate regions. There was also a significant negative correlation between the duration of illness and the MM metric in the temporoparietal region.

Conclusion

Our findings suggest that MM imaging could be a clinically proper modality to estimate the myelination changes in AD patients.

Phase Angle Is a Useful indicator for Muscle Function in Older Adults

AIM

Phase angle (PhA) can be determined through bioelectrical impedance analysis and is a unique variable for skeletal muscle. The objective of this study was to evaluate the relationship between PhA and muscle mass/quality in older adults. In addition, we attempted to determine the cutoff value of PhA for poor muscle function.

METHODS

Community-dwelling Japanese older men (n=285, 81.1±7.1 years) and women (n=724, 80.4±6.8 years) participated in this study and were classified into four groups based on the Asian Working Group for Sarcopenia (normal, presarcopenia, dynapenia, and sarcopenia). We measured PhA using bioelectrical impedance analysis, muscle quantity and quality indicators using ultrasonography, muscle strength, and physical performance and compared them in four groups. We also tried to determine the cutoff value of PhA for poor muscle function.

RESULTS

We found a significant difference in PhA among the four groups in men (P<0.05), and the dynapenia (3.61±0.75°) and sarcopenia groups (3.40±0.74°) showed significantly lower values than the normal group (4.50±0.86°) (P<0.05), but not the presarcopenia group (4.12±0.85°). In women, a significant difference was also observed among the four groups (P<0.05), and the dynapenia (3.41±0.65°) and sarcopenia groups (3.31±0.66°) showed significantly lower measures than the normal group (4.14±0.71°) (P<0.05), but not the presarcopenia group (4.07±0.51°). The receiver-operating characteristic curve analysis indicated the best cutoff value of PhA (men: 4.05°, women: 3.55°) to discriminate sarcopenia and dynapenia from normal and presarcopenia.

CONCLUSION

These findings suggest that PhA is a useful indicator for muscle function.

Widely Impaired White Matter Integrity and Altered Structural Brain Networks in Psychogenic Non-Epileptic Seizures

OBJECTIVE

The underlying neural correlates of psychogenic non-epileptic seizures (PNES) are still unknown and their identification would be helpful for clinicians and patients. This study aimed to reveal details of white matter microstructure and alterations in brain structural networks in patients with PNES by using diffusion tensor imaging (DTI) and graph theoretical connectivity analysis.

METHODS

Seventeen patients with PNES and 26 age- and sex-matched healthy controls were enrolled. All participants underwent DTI on a 3.0-T MRI scanner, and fractional anisotropy (FA) and mean diffusivity (MD) maps were compared by tract-based spatial statistics. Additionally, the structural networks derived from DTI data were analyzed using graph theory and two different parcellation schemes.

RESULTS

Patients with PNES showed widespread decreases in FA and increases in MD, particularly in the deep white matter. In addition, graph theoretical analysis revealed impaired brain networks in PNES, including increased path length, decreased network efficiency, altered nodal topology, and reduced regional connectivity in the right posterior areas.

CONCLUSION

We found widely impaired white matter integrity and impaired brain structural networks in Japanese patients with PNES. These findings contribute to the accumulation of evidence on PNES and may improve understanding of this condition.

Terminal Ileac Ulcers Mimicked Post-transplantation Lymphoproliferative Disorder in a Heart Recipient Treated With Everolimus: A Case Report

Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized and potentially fatal complication of cardiac transplantation that commonly involves the gastrointestinal tract. Herein, we report a case of life-threatening gastrointestinal bleeding from recurrent terminal ileac ulcers mimicking PTLD in a heart recipient treated with everolimus (EVL). A 40-year-old man underwent heart transplantation for dilated cardiomyopathy 3 years prior to the current admission and was treated with tacrolimus and EVL. He was admitted to a local hospital because of fever, abdominal pain, and diarrhea. His symptoms persisted and, 3 weeks later, hematochezia occurred; thus, he was transferred to our hospital. As computed tomography and ¹⁸F-fluorodeoxyglucose positron emission tomography showed bowel-wall thickening of the terminal ileum, gastrointestinal PTLD was initially suspected. However, although colonoscopy- performed after switching EVL to mycophenolate mofetil (MMF)-showed terminal ileac ulcers, the histologic examination revealed no findings corresponding to PTLD. As EVL may delay ulcer healing, MMF was maintained for 3 months. After repeated colonoscopy showed ulcer healing, MMF was switched back to EVL for cardiac allograft vasculopathy prevention. Three weeks later, he was emergently admitted to a local hospital for life-threatening gastrointestinal bleeding from a recurrent terminal ileal ulcer, which required hemostatic forceps hemostasis. As EVL is suspected to be associated with recurrent ileal ulcers, EVL was again switched back to MMF. The ileal ulcers resolved, without recurrence in 3 months of clinical follow-up. This case demonstrates that cases of life-threatening gastrointestinal bleeding from recurrent terminal ileac ulcers can mimic PTLD in a heart recipient treated with EVL.

Changes in the blood level, efficacy, and safety of tacrolimus in pregnancy and the lactation period in patients with systemic lupus erythematosus

OBJECTIVES

We investigated the efficacy and safety of tacrolimus (TAC) by monitoring its serum concentration for mothers and infants in pregnant patients with systemic lupus erythematosus (SLE).

METHODS

We measured trough concentrations of TAC in 25 pregnant patients with SLE to assess influence of TAC on the disease activity. Additionally, we measured the concentrations of TAC in umbilical arterial blood, breast milk, and breastfed infants to investigate the safety of TAC for the mothers and infants.

RESULTS

The trough concentrations of TAC in the mothers significantly decreased in the second trimester as compared with those before pregnancy. However, the decrease in the trough concentrations of TAC did not lead to the deterioration of SLE. When examined, the doses of TAC were significantly lower in the second trimester and postpartum in the deteriorating group than those in the non-deteriorating group. There were no adverse events by TAC in mothers and fetuses. The concentrations of TAC in the umbilical cord blood were lower than those in the maternal blood. The relative infant dose in breastfed infants of TAC was < 1%. The level of TAC in infant bloods was below detectable limits.

CONCLUSION

These findings suggest that TAC is one of the most effective and safest immunosuppressive drugs for use in pregnant patients with SLE.

Investigating fetal myocardial function in heart anomalies by Doppler myocardial performance indices

Fetal myocardial performance index are used to assess aspects of systolic and diastolic function in developing fetal heart. The aim of this study was to determine normal values of fetal left ventricular (LV) Tei Index (TI) for measuring systolic performance and K-Index (KI) for diastolic performance in early (<;32 weeks), Mid (32-35 weeks) and late trimester (35-41 weeks) normal fetuses and fetuses with congenital heart diseases (CHD). Simultaneous recordings of Doppler Ultrasound Signal (DUS) of the LV outflow tracts and fetal electrocardiogram signals were obtained in 57 normal and 14 fetuses with CHD. CHDs were categorized in two types (conduction pathway abnormalities [8 cases] and structural anomalies [6 cases]). The LV isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ventricular ejection time (VET) and ventricular filling time (VFT) were measured from amplitudes and peaks of high frequency component of DUS signals by an automated model. The TI and the new index were calculated by using the formula (ICT + IRT)/VET and (ICT + IRT)/VFT respectively. The TI did not show any significant change from CHD (conduction) to CHD (structural) fetuses (0.72± 0.09 vs 0.76±0.02; NS). On the other hand, KI showed significant decline in values (0.82±0.24 vs 0.49±0.34; p<;0.05) during normal development period and CHD with structural anomalies particularly. The correlation of KI with gestational ages was found to be negative and significant (r=- 0.29; p=0.025). Both TI and KI can be easily obtained in the fetus from DUS recording without the need for precise anatomic imaging. In conclusion, KI may be a useful tool to explore the healthy development of fetal myocardial function and identify fetuses with CHD (structural). More research is needed to check if KI could recognize the compromised fetuses from normal ones in future.