Pub Date : 2010-10-12DOI: 10.2174/1876388X01002010086
P. Pelosi, M. G. Abreu
In the last 20 years, the use of computed tomography (CT) to evaluate thoracic diseases has rapidly gained popularity and CT has become firmly established as an important research and diagnostic modality. In particular, CT has played an important role in improving our knowledge about the pathophysiology of the adult respiratory distress syndrome (ARDS) and in determining the morphological and functional relationships of different therapeutic options commonly used in the clinical management of this syndrome. CT scan may provide: 1) accurate measurement of the impact of mechanical ventilation on hyperaeration and reaeration/recruitment, being the most objective technique currently available to set mechanical ventilation and identifying patients for extracorporeal lung support; 2) the amount of lung edema, associated with the severity of the alveolar capillary barrier lesion and the risk of mortality; 3) clinical information in patients with a sudden and unexplained deterioration of the clinical status or the lack of expected improvement as well as to follow the evolution with time. We recommend to perform: 1) one single whole lung CT scan at end-expiration at PEEP 5 cmH2O, to evaluate the distribution of aeration and to compute the amount of lung weight; 2) only three lung CT slices, taken at the lung apex, hilum, and basis, at PEEP = 5 cmH2O and at Pplat = 45 cmH2O, to assess of lung recruitability; 3) a CT scan as early as possible after onset of ARDS (if clinical characteristics persist for more than 24 hours) and repeat it after 1 week if no clinical improvement is observed; 4) a CT scan in presence of any clinical deterioration not explained by conventional diagnostic tools. We suggest considering the measurement of extravascular lung water and end-expiratory lung volume by non radiological techniques and lung ultrasound if CT scan cannot be done.
{"title":"Lung CT Scan","authors":"P. Pelosi, M. G. Abreu","doi":"10.2174/1876388X01002010086","DOIUrl":"https://doi.org/10.2174/1876388X01002010086","url":null,"abstract":"In the last 20 years, the use of computed tomography (CT) to evaluate thoracic diseases has rapidly gained popularity and CT has become firmly established as an important research and diagnostic modality. In particular, CT has played an important role in improving our knowledge about the pathophysiology of the adult respiratory distress syndrome (ARDS) and in determining the morphological and functional relationships of different therapeutic options commonly used in the clinical management of this syndrome. CT scan may provide: 1) accurate measurement of the impact of mechanical ventilation on hyperaeration and reaeration/recruitment, being the most objective technique currently available to set mechanical ventilation and identifying patients for extracorporeal lung support; 2) the amount of lung edema, associated with the severity of the alveolar capillary barrier lesion and the risk of mortality; 3) clinical information in patients with a sudden and unexplained deterioration of the clinical status or the lack of expected improvement as well as to follow the evolution with time. We recommend to perform: 1) one single whole lung CT scan at end-expiration at PEEP 5 cmH2O, to evaluate the distribution of aeration and to compute the amount of lung weight; 2) only three lung CT slices, taken at the lung apex, hilum, and basis, at PEEP = 5 cmH2O and at Pplat = 45 cmH2O, to assess of lung recruitability; 3) a CT scan as early as possible after onset of ARDS (if clinical characteristics persist for more than 24 hours) and repeat it after 1 week if no clinical improvement is observed; 4) a CT scan in presence of any clinical deterioration not explained by conventional diagnostic tools. We suggest considering the measurement of extravascular lung water and end-expiratory lung volume by non radiological techniques and lung ultrasound if CT scan cannot be done.","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"86-98"},"PeriodicalIF":0.0,"publicationDate":"2010-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68126872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-10-12DOI: 10.2174/1876388X01002010119
V. Caillé, A. Vieillard-Baron
We illustrate the valuable information provided by echocardiography for hemodynamic monitoring and for optimizing ventilatory strategies, during ARDS. Although the transthoracic and the transesophageal routes can be used, we always prefer, in the absence of contraindications, to perform transesophageal echocardiography. ARDS includes numerous affections which brutally damage the interface between the distal airway tract and pulmonary vascular bed. Two factors combine to produce right ventricular systolic overload, the pathologic features of the syndrome per se and mechanical ventilation. Acute cor pulmonale (ACP) reflects the severity of the pulmonary disease, but may also be caused or exacerbated by an aggressive and unsuitable ventilatory strategy. With tidal volume limitation, the incidence of ACP has declined to 25%. Providing that ventilatory management is adapted to right ventricular function, ACP is no longer significantly associated with increased mortality. If not, it is demonstrated that right ventricular dysfunction is actually associated with a poor prognosis. In conclusion, whereas some have promoted a lung protective approach, echocardiography allows us to promote a right ventricular protective approach, by adapting respiratory settings to right ventricular function, which is key in the prognosis of these patients.
{"title":"The Right Ventricle During the Acute Respiratory Distress Syndrome Revisited by Echocardiography","authors":"V. Caillé, A. Vieillard-Baron","doi":"10.2174/1876388X01002010119","DOIUrl":"https://doi.org/10.2174/1876388X01002010119","url":null,"abstract":"We illustrate the valuable information provided by echocardiography for hemodynamic monitoring and for optimizing ventilatory strategies, during ARDS. Although the transthoracic and the transesophageal routes can be used, we always prefer, in the absence of contraindications, to perform transesophageal echocardiography. ARDS includes numerous affections which brutally damage the interface between the distal airway tract and pulmonary vascular bed. Two factors combine to produce right ventricular systolic overload, the pathologic features of the syndrome per se and mechanical ventilation. Acute cor pulmonale (ACP) reflects the severity of the pulmonary disease, but may also be caused or exacerbated by an aggressive and unsuitable ventilatory strategy. With tidal volume limitation, the incidence of ACP has declined to 25%. Providing that ventilatory management is adapted to right ventricular function, ACP is no longer significantly associated with increased mortality. If not, it is demonstrated that right ventricular dysfunction is actually associated with a poor prognosis. In conclusion, whereas some have promoted a lung protective approach, echocardiography allows us to promote a right ventricular protective approach, by adapting respiratory settings to right ventricular function, which is key in the prognosis of these patients.","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"119-124"},"PeriodicalIF":0.0,"publicationDate":"2010-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68126376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020063
C. Babiloni, F. Vecchio, R. Lizio, G. Frisoni, R. Ferri, G. Rodriguez, P. Rossini
{"title":"Resting State Cortical Electroencephalographic Rhythms in Alzheimer`s Disease~!2009-11-16~!2010-01-17~!2010-05-06~!","authors":"C. Babiloni, F. Vecchio, R. Lizio, G. Frisoni, R. Ferri, G. Rodriguez, P. Rossini","doi":"10.2174/1876388X01002020063","DOIUrl":"https://doi.org/10.2174/1876388X01002020063","url":null,"abstract":"","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020058
P. Tiraboschi, U. Guerra
{"title":"How to Distinguish Dementia with Lewy Bodies from Alzheimer Disease?~!2009-11-08~!2010-01-17~!2010-05-06~!","authors":"P. Tiraboschi, U. Guerra","doi":"10.2174/1876388X01002020058","DOIUrl":"https://doi.org/10.2174/1876388X01002020058","url":null,"abstract":"","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020031
A. Chincarini, M. Corosu, G. Gemme, P. Calvini, Roberta Monge, M. Penco, L. Rei, S. Squarcia, P. Boccacci, G. Rodriguez
{"title":"Automatic Morphological Analysis of Medial Temporal Lobe~!2009-10-09~!2010-01-25~!2010-05-06~!","authors":"A. Chincarini, M. Corosu, G. Gemme, P. Calvini, Roberta Monge, M. Penco, L. Rei, S. Squarcia, P. Boccacci, G. Rodriguez","doi":"10.2174/1876388X01002020031","DOIUrl":"https://doi.org/10.2174/1876388X01002020031","url":null,"abstract":"","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"31-39"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020040
Klaus P. Ebmeier
Although research interest within functional imaging has moved towards applications of MRI, such as BOLD and perfusion imaging, there is a wealth of clinical experience in emission tomographic imaging techniques that make the use of these modalities relevant for the decades to come. This review touches upon the technical and practical issues that distinguish SPECT from PET, describes perfusion and metabolic changes observed in the dementias, compares the clinical utility of the two techniques, and reports data on clinical sensitivity and specificity, as well as diagnostic head-to head comparisons in dementia, and specifically Alzheimer’s disease. While few centres have a genuine choice between PET and SPECT, either appears to be good enough to help with the differential diagnosis of dementia in difficult cases.
{"title":"Is there Still a Place for Perfusion SPECT in the Diagnosis of Dementia?~!2009-10-15~!2010-01-22~!2010-05-06~!","authors":"Klaus P. Ebmeier","doi":"10.2174/1876388X01002020040","DOIUrl":"https://doi.org/10.2174/1876388X01002020040","url":null,"abstract":"Although research interest within functional imaging has moved towards applications of MRI, such as BOLD and perfusion imaging, there is a wealth of clinical experience in emission tomographic imaging techniques that make the use of these modalities relevant for the decades to come. This review touches upon the technical and practical issues that distinguish SPECT from PET, describes perfusion and metabolic changes observed in the dementias, compares the clinical utility of the two techniques, and reports data on clinical sensitivity and specificity, as well as diagnostic head-to head comparisons in dementia, and specifically Alzheimer’s disease. While few centres have a genuine choice between PET and SPECT, either appears to be good enough to help with the differential diagnosis of dementia in difficult cases.","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"40-45"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020012
P. Momeni, R. Ferrari
Alzheimer’s disease (AD) is the most prevalent form of dementia. AD is highly heritable, with a complex pattern. Although clinical diagnosis is based on accurate and well defined diagnostic criteria (NINCDS-ADRDA), the definite diagnosis relies on the postmortem pathological findings. The need for measures for the early detection of AD, as well as the need to distinguish between AD and other forms of dementia, has put great emphasis on the discovery of biomarkers for Alzheimer’s disease. In clinical practice, there is need for non-invasive, accurate methods for the early detection and differential diagnosis of AD. The successful identification and development of the biomarkers, depends completely on the understanding of pathology, genetic and molecular mechanisms involved in the disease. As blood is a circulating dynamic tissue and transcription reflects the ongoing changes in the system, it makes the transcriptional profiling of the blood cells, potentially, the most sensitive source for transcriptional biomarkers. A systematic comparison of the genetic and proteomic blood biomarkers in patients and healthy controls can reveal additional potential candidates for AD. In the first part of this review, we would like to discuss the most recent genetic findings and their possible involvement in the pathogenesis of AD. In the second part, we review the blood biomarkers which can be derived from peripheral blood mononuclear cells (PBMC), serum, and plasma. We discus three main category of bio-molecules, namely DNA, RNA (miRNA and mRNA), and protein as well as their possible role in the hypothetical mechanisms involved in pathogenesis of AD. A dynamic interaction between the genetic findings through the whole genome association studies and biomarkers discovery can advance our knowledge of AD pathogenesis beyond the scope of each field independently.
{"title":"Genetic and Blood Biomarkers of Alzheimer`s Disease~!2009-11-10~!2010-01-21~!2010-05-06~!","authors":"P. Momeni, R. Ferrari","doi":"10.2174/1876388X01002020012","DOIUrl":"https://doi.org/10.2174/1876388X01002020012","url":null,"abstract":"Alzheimer’s disease (AD) is the most prevalent form of dementia. AD is highly heritable, with a complex pattern. Although clinical diagnosis is based on accurate and well defined diagnostic criteria (NINCDS-ADRDA), the definite diagnosis relies on the postmortem pathological findings. The need for measures for the early detection of AD, as well as the need to distinguish between AD and other forms of dementia, has put great emphasis on the discovery of biomarkers for Alzheimer’s disease. In clinical practice, there is need for non-invasive, accurate methods for the early detection and differential diagnosis of AD. The successful identification and development of the biomarkers, depends completely on the understanding of pathology, genetic and molecular mechanisms involved in the disease. As blood is a circulating dynamic tissue and transcription reflects the ongoing changes in the system, it makes the transcriptional profiling of the blood cells, potentially, the most sensitive source for transcriptional biomarkers. A systematic comparison of the genetic and proteomic blood biomarkers in patients and healthy controls can reveal additional potential candidates for AD. In the first part of this review, we would like to discuss the most recent genetic findings and their possible involvement in the pathogenesis of AD. In the second part, we review the blood biomarkers which can be derived from peripheral blood mononuclear cells (PBMC), serum, and plasma. We discus three main category of bio-molecules, namely DNA, RNA (miRNA and mRNA), and protein as well as their possible role in the hypothetical mechanisms involved in pathogenesis of AD. A dynamic interaction between the genetic findings through the whole genome association studies and biomarkers discovery can advance our knowledge of AD pathogenesis beyond the scope of each field independently.","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"12-24"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020046
F. Nobili, S. Morbelli
{"title":"[18F]FDG-PET as a Biomarker for Early Alzheimer`s Disease~!2009-10-01~!2010-01-07~!2010-05-06~!","authors":"F. Nobili, S. Morbelli","doi":"10.2174/1876388X01002020046","DOIUrl":"https://doi.org/10.2174/1876388X01002020046","url":null,"abstract":"","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"46-52"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-20DOI: 10.2174/1876388X01002020025
A. Piccini
{"title":"CSF Biomarkers~!2009-10-10~!2010-01-21~!2010-05-06~!","authors":"A. Piccini","doi":"10.2174/1876388X01002020025","DOIUrl":"https://doi.org/10.2174/1876388X01002020025","url":null,"abstract":"","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"25-30"},"PeriodicalIF":0.0,"publicationDate":"2010-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68127595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-06DOI: 10.2174/1876388X01002010063
C. Babiloni, F. Vecchio, R. Lizio, G. Frisoni, R. Ferri, G. Rodriguez, P. Rossini
Physiological brain aging is characterized by a loss of synaptic contacts and neuronal apoptosis that provoke age-dependent decline of cognitive functions. Neural/synaptic redundancy and plastic remodelling of brain networking, also secondary to mental and physical training, promotes maintenance of brain activity in healthy elderly for everyday life and fully productive affective and intellectual capabilities. However, age is the main risk factor for neurodegenerative disorders such as Alzheimer's disease (AD) that impact on cognition. Oscillatory electromagnetic brain activity is a hallmark of neuronal network function in various brain regions. Modern neurophysiological techniques including electroencephalography (EEG) can index normal and abnormal brain aging to facilitate non-invasive analysis of cortico- cortical connectivity and neuronal synchronization of firing, and coherence of rhythmic oscillations at various frequencies. The present review provides a perspective of these issues. It is concluded that discrimination between physiological and pathological brain aging clearly emerges at the group level, with applications at the individual level also suggested. Integrated approaches utilizing neurophysiological techniques together with biological markers and structural and functional imaging are promising for large-scale, low-cost and non-invasive evaluation of at-risk populations.
{"title":"Resting State Cortical Electroencephalographic Rhythms in Alzheimer's Disease","authors":"C. Babiloni, F. Vecchio, R. Lizio, G. Frisoni, R. Ferri, G. Rodriguez, P. Rossini","doi":"10.2174/1876388X01002010063","DOIUrl":"https://doi.org/10.2174/1876388X01002010063","url":null,"abstract":"Physiological brain aging is characterized by a loss of synaptic contacts and neuronal apoptosis that provoke age-dependent decline of cognitive functions. Neural/synaptic redundancy and plastic remodelling of brain networking, also secondary to mental and physical training, promotes maintenance of brain activity in healthy elderly for everyday life and fully productive affective and intellectual capabilities. However, age is the main risk factor for neurodegenerative disorders such as Alzheimer's disease (AD) that impact on cognition. Oscillatory electromagnetic brain activity is a hallmark of neuronal network function in various brain regions. Modern neurophysiological techniques including electroencephalography (EEG) can index normal and abnormal brain aging to facilitate non-invasive analysis of cortico- cortical connectivity and neuronal synchronization of firing, and coherence of rhythmic oscillations at various frequencies. The present review provides a perspective of these issues. It is concluded that discrimination between physiological and pathological brain aging clearly emerges at the group level, with applications at the individual level also suggested. Integrated approaches utilizing neurophysiological techniques together with biological markers and structural and functional imaging are promising for large-scale, low-cost and non-invasive evaluation of at-risk populations.","PeriodicalId":88754,"journal":{"name":"The open nuclear medicine journal","volume":"2 1","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2010-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68126745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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