Tuberculosis in Mexico and the USA, Comparison of Trends Over Time 1990–2010

Eduardo Hernández-Garduño,Fabiola Mendoza-Damián,Salvador Ayón-Garibaldo,Adriana Garduño-Alanís 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.3

Background: The aim was to compare tuberculosis trends in Mexico and United States and to evaluate Mexican diagnostic methods and contact investigation. Methods: Retrospective comparative study of tuberculosis cases and incidence rates between both countries (1990–2010). Diagnostic methods and contact investigations were also evaluated for Mexico. Estimates were obtained from official websites. Results: In Mexico, no clear trend was found over time for cases. Pulmonary (PTB) and all forms of tuberculosis (AFTB) incidence decreased 2.0% annually. There was a negative correlation between the mean contacts examined per case and AFTB incidence (r2=–0.44, p=0.01) with a 33% reduction in AFTB incidence. In United States, PTB and AFTB cases have been decreasing 6.0% and 5.6% annually, respectively. The incidence decreased 7.3% and 6.8%, respectively. Conclusion: The incidence of tuberculosis in Mexico is decreasing slightly over time at 2% annually. In the United States, cases and incidence rates have been decreasing at a higher rate (5% to 7% annually). The inverse association between number of contacts examined per state and incidence rates in Mexico underscore the importance of reinforcing and improving contact investigations with the likely translation of a decrease of TB incidence at a higher rate.

Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

Víctor Manuel Anguiano-Álvarez,Alonso Hernández-Company,Nashla Hamdan-Pérez,Daniel Montante-M,Diego A. Zúñiga-Tamayo,Sergio Rodríguez-Rodríguez,Alan Pomerantz,Elena J. Tuna-Aguilar 대한혈액학회 2018 Blood Research Vol.53 No.1

BackgroundSplenic myeloid metaplasia (SMM) is a kind of extramedullary hematopoiesis, whereasits clinical significance in wAIHA remains unclear. The aim of this study is evaluating thefrequency and clinical characteristics of SMM, compared with splenic-congestion (SC). MethodsWe included patients with wAIHA treated in a Mexican tertiary hospital between January1992 and December 2015. All patients received steroids as first-line treatment and splenectomyas second-line treatment. ResultsAmong the thirty-six splenectomized patients, 15 (41.6%) and 21 (58.4%) were diagnosedas SMM and SC, respectively. No differences were found in clinical characteristicsbetween two groups. SMM patients showed lower platelet count (147×109/L vs. 240×109/L, P=0.02) and higher presence of anti-dsDNA antibodies (40% vs. 4.7%,P=0.01) than SC patients. Although the complete response (CR) rate with first-line treatmentwas lower in SMM patients (13.3% vs. 47.6%; P=0.04), post-splenectomy mediandisease-free-survival (DFS) was longer (16.2 mo vs. 5.1 mo; P=0.19). Univariate/multivariateanalysis showed that achieving CR during first-line treatment (OR 0.3, 95% CI:0.03‒0.94, P=0.03) and higher platelet count (OR 0.99, 95% CI: 0.98‒0.99, P=0.03)were protective factors for SMM; and anti-dsDNA titer higher than 9.6 IU/dL was a riskfactor for SMM (OR 2.76, 95% CI: 1.48‒5.14, P<0.001). ConclusionThe wAIHA patients with SMM have different biological profiles with those without SMM. This study is the first trial evaluating the significance of histopathological spleen findingsand their association with rheumatologic profile.

Roadmapping technique in the hybrid operating room for the microsurgical treatment of complex intracranial aneurysms

Juan Luis Gómez-Amador,Cristopher G Valencia-Ramos,Marcos Vinicius Sangrador-Deitos,Aldo Eguiluz-Melendez,Gerardo Y Guinto-Nishimura,Alan Hernández-Hernández,Samuel Romano-Feinholz,Luis Alberto Ortega 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.1

Objective: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. Methods: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. Results: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. Conclusions: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage. Keywords ‌Aneurysm, Angiography, Complex, Hybrid operating room, Microsurgery, Roadmapping

Intra-aneurysmatic thrombectomy in a distal anterior cerebral artery aneurysm

Juan Luis Gómez-Amador,Leoncio Alberto Tovar-Romero,Andrea Castillo-Matus,Ricardo Marian-Magaña,Jorge Fernando Aragón-Arreola,Marcos Vinicius Sangrador-Deitos,Alan Hernández-Hernández,Germán López-Val 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.4

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a wellformed clot was visualized through the aneurysm’s wall obstructing the left DACA flow. We proceeded to open the aneurysm’s dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA.Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient’s postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

Unilateral approach for bilateral clipping of posterior communicating artery aneurysms in a hybrid operating room: A technical note

Juan Luis Gómez-Amador,Pablo David Guerrero-Suárez,Jaime Jesús Martínez-Anda,Jorge Fernando Aragón-Arreola,Andrea Castillo-Matus,Ricardo Marian-Magaña,Marcos V Sangrador-Deitos,Alan Hernández-Hernánde 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.4

Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.

Hippocampal morphology and cognitive functions in community-dwelling older people: the Lothian Birth Cohort 1936

Valdé,s Herná,ndez, Maria del Carmen,Cox, Simon R.,Kim, Jaeil,Royle, Natalie A.,Muñ,oz Maniega, Susana,Gow, Alan J.,Anblagan, Devasuda,Bastin, Mark E.,Park, Jinah,Starr, John M.,Ward Elsevier 2017 NEUROBIOLOGY OF AGING Vol.52 No.-

<P>Structural measures of the hippocampus have been linked to a variety of memory processes and also to broader cognitive abilities. Gross volumetry has been widely used, yet the hippocampus has a complex formation, comprising distinct subfields which may be differentially sensitive to the deleterious effects of age, and to different aspects of cognitive performance. However, a comprehensive analysis of multidomain cognitive associations with hippocampal deformations among a large group of cognitively normal older adults is currently lacking. In 654 participants of the Lothian Birth Cohort 1936 (mean age = 72.5, SD = 0.71 years), we examined associations between the morphology of the hippocampus and a variety of memory tests (spatial span, letter-number sequencing, verbal recall, and digit backwards), as well as broader cognitive domains (latent measures of speed, fluid intelligence, and memory). Following correction for age, sex, and vascular risk factors, analysis of memory subtests revealed that only right hippocampal associations in relation to spatial memory survived type 1 error correction in subiculum and in CA1 at the head (<I>β</I> = 0.201, <I>p</I> = 5.843 × 10<SUP>−4</SUP>, outward), and in the ventral tail section of CA1 (<I>β</I> = −0.272, <I>p</I> = 1.347 × 10<SUP>−5</SUP>, inward). With respect to latent measures of cognitive domains, only deformations associated with processing speed survived type 1 error correction in bilateral subiculum (<I>β</I><SUB><I>absolute</I></SUB> ≤ 0.247, <I>p</I> < 1.369 × 10<SUP>−4</SUP>, outward), bilaterally in the ventral tail section of CA1 (<I>β</I><SUB><I>absolute</I></SUB> ≤ 0.242, <I>p</I> < 3.451 × 10<SUP>−6</SUP>, inward), and a cluster at the left anterior-to-dorsal region of the head (<I>β</I> = 0.199, <I>p</I> = 5.220 × 10<SUP>−6</SUP>, outward). Overall, our results indicate that a complex pattern of both inward and outward hippocampal deformations are associated with better processing speed and spatial memory in older age, suggesting that complex shape-based hippocampal analyses may provide valuable information beyond gross volumetry.</P>

3D shape analysis of the brain's third ventricle using a midplane encoded symmetric template model

Kim, Jaeil,Valdé,s Herná,ndez, Maria del C.,Royle, Natalie A.,Maniega, Susana Muñ,oz,Aribisala, Benjamin S.,Gow, Alan J.,Bastin, Mark E.,Deary, Ian J.,Wardlaw, Joanna M.,Park, Jinah Elsevier Scientific Publishers 2016 COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE Vol.129 No.-

<▼1><P><B>Highlights</B></P><P>•<P>Present a model-based approach to investigate the morphology of the third ventricle.</P>•<P>Assess the regional deformations in relation to the atrophy of surrounding structures.</P>•<P>Use a symmetric template model with the midplane definition for unbiased analysis.</P>•<P>Achieve a robust surface modeling using a progressive surface deformation.</P>•<P>Validate the method on a healthy aging sample with different clinical variables.</P></P></▼1><▼2><P><B>Background</B></P><P>Structural changes of the brain's third ventricle have been acknowledged as an indicative measure of the brain atrophy progression in neurodegenerative and endocrinal diseases. To investigate the ventricular enlargement in relation to the atrophy of the surrounding structures, shape analysis is a promising approach. However, there are hurdles in modeling the third ventricle shape. First, it has topological variations across individuals due to the inter-thalamic adhesion. In addition, as an interhemispheric structure, it needs to be aligned to the midsagittal plane to assess its asymmetric and regional deformation.</P><P><B>Method</B></P><P>To address these issues, we propose a model-based shape assessment. Our template model of the third ventricle consists of a midplane and a symmetric mesh of generic shape. By mapping the template's midplane to the individuals’ brain midsagittal plane, we align the symmetric mesh on the midline of the brain before quantifying the third ventricle shape. To build the vertex-wise correspondence between the individual third ventricle and the template mesh, we employ a minimal-distortion surface deformation framework. In addition, to account for topological variations, we implement geometric constraints guiding the template mesh to have zero width where the inter-thalamic adhesion passes through, preventing vertices crossing between left and right walls of the third ventricle. The individual shapes are compared using a vertex-wise deformity from the symmetric template.</P><P><B>Results</B></P><P>Experiments on imaging and demographic data from a study of aging showed that our model was sensitive in assessing morphological differences between individuals in relation to brain volume (i.e. proxy for general brain atrophy), gender and the fluid intelligence at age 72. It also revealed that the proposed method can detect the regional and asymmetrical deformation unlike the conventional measures: volume (median 1.95 ml, IQR 0.96 ml) and width of the third ventricle. Similarity measures between binary masks and the shape model showed that the latter reconstructed shape details with high accuracy (Dice coefficient ≥0.9, mean distance 0.5 mm and Hausdorff distance 2.7 mm).</P><P><B>Conclusions</B></P><P>We have demonstrated that our approach is suitable to morphometrical analyses of the third ventricle, providing high accuracy and inter-subject consistency in the shape quantification. This shape modeling method with geometric constraints based on anatomical landmarks could be extended to other brain structures which require a consistent measurement basis in the morphometry.</P></▼2>