Amyotrophic lateral sclerosis with upper motor neuron predominance: diagnostic accuracy of qualitative and quantitative susceptibility metrics in the precentral gyrus

OBJECTIVE

The study aims at comparing the diagnostic accuracy of qualitative and quantitative assessment of the susceptibility in the precentral gyrus in detecting amyotrophic lateral sclerosis (ALS) with predominance of upper motor neuron (UMN) impairment.

METHODS

We retrospectively collected clinical and 3T MRI data of 47 ALS patients, of whom 12 with UMN predominance (UMN-ALS). We further enrolled 23 healthy controls (HC) and 15 ALS Mimics (ALS-Mim). The Motor Cortex Susceptibility (MCS) score was qualitatively assessed on the susceptibility-weighted images (SWI) and automatic metrics were extracted from the quantitative susceptibility mapping (QSM) in the precentral gyrus. MCS scores and QSM-based metrics were tested for correlation, and ROC analyses.

RESULTS

The correlation of MCS score and susceptibility skewness was significant (Rho = 0.55, p < 0.001). The susceptibility SD showed an AUC of 0.809 with a specificity and positive predictive value of 100% in differentiating ALS and ALS Mim versus HC, significantly higher than MCS (Z = -3.384, p-value = 0.00071). The susceptibility skewness value of -0.017 showed specificity of 92.3% and predictive positive value of 91.7% in differentiating UMN-ALS versus ALS mimics, even if the performance was not significantly better than MCS (Z = 0.81, p = 0.21).

CONCLUSION

The MCS and susceptibility skewness of the precentral gyrus show high diagnostic accuracy in differentiating UMN-ALS from ALS-mimics subjects. The quantitative assessment might be preferred being an automatic measure unbiased by the reader.

CLINICAL RELEVANCE STATEMENT

The clinical diagnostic evaluation of ALS patients might benefit from the qualitative and/or quantitative assessment of the susceptibility in the precentral gyrus as imaging marker of upper motor neuron predominance.

KEY POINTS

• Amyotrophic lateral sclerosis diagnostic work-up lacks biomarkers able to identify upper motor neuron involvement. • Susceptibility-weighted imaging/quantitative susceptibility mapping-based measures showed good diagnostic accuracy in discriminating amyotrophic lateral sclerosis with predominant upper motor neuron impairment from patients with suspected motor neuron disorder. • Susceptibility-weighted imaging/quantitative susceptibility mapping-based assessment of the magnetic susceptibility provides a diagnostic marker for amyotrophic lateral sclerosis with upper motor neuron predominance.

P-447 Enhancing oxygen availability in the dynamic culture of bovine ovarian cortical tissue improves the yield of secondary follicles

Study question

Does enhancing oxygen availability during dynamic in vitro culture of bovine ovarian cortical tissue (BOCT) improve follicle growth and health?

Summary answer

Enhancing oxygen availability during dynamic in vitro culture of BOCT in perifusion bioreactors (PB) does improve follicle health and yield to secondary follicles

What is known already

Oxygen availability has been demonstrated to represent a key factor in follicle health and growth during in vitro culture of bovine and human ovarian cortical tissue (HOCT) under static culture conditions. Disruption of solutes gradients and application of physiological fluid mechanical stress, through in vitro dynamic culture of HOCT in a newly designed perifusion bioreactor have been shown to further enhance follicle growth and health. As it shows striking similarities with human, bovine folliculogenesis is considered a valuable model to study follicle growth in vitro

Study design, size, duration

Bovine ovaries from animals aged 8-24 months were collected at slaughterhouse. In each experiment (n = 3), BOCT strips from the same ovary were cultured for 6 days in perifusion bioreactors (PB, dynamic culture) and conventional dishes (CD, static culture). Culture outcome in static culture was analysed and compared to two bioreactor configurations in which medium oxygenation was kept low by using a standard tube reservoir (StPB) or was enhanced by using a gas-permeable dish reservoir (PB+O2).

Participants/materials, setting, methods

Slices of BOCT 0.5mm thick were cut with a tissue slicer and chopped into 1x1mm strips. In each experiment, fresh (D0) and cultured tissue (groups of ten strips) were analyzed. Follicle stages and health were assessed by histology (hematoxylin-eosin staining). Follicle viability was estimated by labelling with live-dead far-red and propidium iodide followed by clearing before analysis at the confocal laser scanning microscope.

Main results and the role of chance

Overall, 2417 follicles were analyzed (histology, 1476; viability, 941). At day 0 most follicles were primordial (primordial, 88.7%; primary, 10.6%; secondary, 0.7%), and had good quality (grade 1-2, 92.2%; grade 3, 7.8%), and high viability (91.8%). At day 6, follicle growth and health in StPB was superior than in CD (StPB vs CD - staging: primordial, 6.8 vs 16.3, P &lt; 0.01; primary, 70.7 vs 74.1, NS; secondary, 22.5 vs 9.6%, P &lt; 0.01; grading: grade 1 + 2, 71.4 vs 44.8, P &lt; 0.01; grade 3, 28.6 vs 55.2%, P &lt; 0.01). Dynamic culture in StPB better-preserved follicle viability compared to static culture in CD (StPB vs CD: 77.75 vs 64.9%, P &lt; 0.01). Enhancing oxygen availability during dynamic culture increased follicle progression and viability (PB+O2 vs StPB - staging: primordial, 5.1 vs 6.8, NS; primary, 65.4 vs 70.7, NS; secondary, 29.5 vs 22.5%, P &lt; 0.05; viability - 92 vs 77.75, P &lt; 0.01). Overall, the obtained results demonstrate that i) disruption of stagnant layers of medium and application of shear stress to BOCT through dynamic culture improves follicle activation, growth and health; ii) enhancing oxygen availability by means of a gas-permeable medium reservoir further increases follicle progression and viability.

Limitations, reasons for caution

Although the bovine is considered a reliable model for human folliculogenesis, the study should be validated on human ovarian tissue.

Wider implications of the findings

A limiting step in the in vitro production of mature oocytes starting from primordial follicles is the low yield of secondary follicles after organ culture. The adoption of a newly designed dynamic bioreactor and modulation of oxygen availability could represent a valuable tool for multistep in vitro folliculogenesis.

Trial registration number

none

P-446 Influence of strip thickness and FSH supplementation on follicle growth in the in vitro culture of strips of bovine ovarian cortical tissue in gas-permeable dishes

Study question

Do tissue thickness and FSH supplementation affect follicle growth and health in the vitro culture of bovine ovarian cortical strips (BOCS) in gas-permeable dishes?

Summary answer

Culture of 0.5mm thin BOCS with 5ng/ml FSH does improve follicle health and yield to secondary follicles compared with 1mm thick BOCS

What is known already

Oxygen availability inside tissue has been demonstrated to represent a key factor in follicle health and growth during in vitro culture of bovine and human ovarian cortical strips (HOCS). Although, strip thickness can limit nutrients and gases diffusion in and out of the innermost tissue zone, the presence of the outer medulla in thick strips could positively affect follicle growth. The role of FSH on the progression of primordial to secondary follicles in ovarian organ culture is still debated.

Study design, size, duration

Bovine ovaries from animals aged 8-24 months were collected at a slaughterhouse. In each experiment (n = 3), BOCS of varying thickness collected from the same ovary were cultured with or without FSH in gas-permeable dishes for 10 and 15 days.

Participants/materials, setting, methods

Slices either 0.5mm or 1mm thick were cut with a tissue-slicer and were chopped into 1x1mm2 strips. BOCS were cultured for 10 or 15 days at the same tissue/medium volume ratio (groups of either five 1mm strips or ten 0.5mm strips in 5ml medium) with 0, 1, or 5ng/ml FSH. Follicle stages were assessed by histology. Follicle viability was estimated by labeling with live-dead far red and propidium iodide at the confocal laser scanning microscope.

Main results and the role of chance

Overall, 2314 follicles were analyzed (histology, 998; viability, 1316). At day 0 most follicles were primordial (primordial, 89.4%; primary, 8.7%; secondary, 1.9%), and had a high viability (94.69%). The best follicle growth and viability was observed in 0.5mm thin BOCS cultured with 5ng/ml FSH. In particular, when compared to 1mm thick BOCS cultured with 5ng/ml FSH, 0.5mm thin BOCS cultured with 5ng/ml FSH showed a higher and significant proportion of secondary follicles at day 10 (0.5 vs 1mm, % secondary follicles: 26.5 vs 10, P &lt; 0.05) and a significantly higher proportion of viable follicles at day 15 (0.5 vs 1mm, % viable follicles: 89.4 vs 60.7, P &lt; 0.01).

These results demonstrate that smaller BOCS thickness and 5ng/ml FSH supplementation significantly improve the growth and health of secondary follicles.

Limitations, reasons for caution

Although the bovine is considered a reliable model for human folliculogenesis, the study should be validated on human ovarian tissue.

Wider implications of the findings

A limiting step in the production of mature oocytes starting from primordial follicles is the low yield to secondary follicles at the end of organ culture. Given the similarities between bovine and human folliculogenesis, the best culture conditions herein identified could contribute to the refinement of human in vitro folliculogenesis.

Trial registration number

Not applicable

Preliminary results on the design of a tool for inserting of transverse intrafascicular multichannel electrodes (TIME) into the peripheral nervous system

Transverse intrafascicular multichannel electrodes (TIMEs) are polyimide-based microelectrodes, which are potentially very interesting to restore sensorimotor functions in disabled people. By means of microstimulation of the nerve stump of an amputee, it can be possible to manipulate the phantom limb sensation, to provide sensory feedback to upper limb amputees, and to investigate methods of treatment of phantom limb pain. The current insertion procedure of TIMEs is completely done by hand. This makes the task difficult. This paper presents the preliminary results related to the development of a robotic tool to increase the accuracy in electrode placement and reduced size of the working area. The possibility to manage insertion parameters such as force, velocity, and positioning, could decrease the risk of damaging the nervous tissue, improving the coordination, and making placements repeatable. With the aim of solving the issues avbove, we developed a first prototype of a 4DoF multi-axis device. Additional strategies concerning system components and control are discussed. We performed characterization of implantation mechanics to derive mechanical design specifications for the robotic device. Force caracterization of the pig peripheral nerve during penetration of the needle at three velocities (1, 30, 40mm/sec) was executed. Results shown inverse relationship between maximal force and velocities values. The force values extracted varied between 0.081-0.174 N.

[Occupational accidents, work performance and obstructive sleep apnea syndrome (OSAS)]

Although many patients with obstructive sleep apnea syndrome (OSAS) form part of the work force, the impact of OSAS on occupational accidents and on work performance is unclear. To address this issue, we investigated 100 referents workers without OSAS (50 blue-collar and 50 white-collar) and 331 workers affected by OSAS (144 blue-collar and 187 white-collar). Workers affected by OSAS had been involved in occupational accidents more often than referents (27.2% vs. 20%). The mean number of accidents/year was slightly higher in blue-collar workers with OSAS and significantly higher (p=0.013) in white-collar workers with OSAS than referents. Furthermore, workers with OSAS referred more impairments in work performance as difficulties in memory (p=0.000), vigilance (p=0.000), concentration (p=0.000), performing monotonous tasks (p=0.000), responsiveness (p=0.000), learning new tasks (0.006) and manual ability (p=0.023), with the mean number of impairments being higher (p=0.000) in workers with a more severe OSAS (referents = 0.32; mild OSAS = 1.11; severe OSAS = 1.70). These results suggest OSAS increases the risk of occupational accidents and impaired work performance. Given the impact of OSAS on fitness for duty assessment, occupational physicians should be aware of it and could play a strategic role in its diagnosis, in monitoring treatment, and in providing appropriate information.

Risk factors in relation to postoperative complications and mortality after total gastrectomy in aged patients

To clarify the risk factors contributing to postoperative complications in elderly patients undergoing total gastrectomy, 84 patients with primary gastric cancer were evaluated. Twenty-seven patients were older than 65 years of age; they had much more preoperative cardiac (P = 0.00003), respiratory (P = 0.0008), and multiorgan impairment (P = 0.009) than did the control group (age less than 65 yrs). Although overall morbidities (44.4% vs. 19.2%; P = 0.01) and overall septic complication rates (33.3% vs. 12.2%; P = 0.02) were higher in aged patients, no significant differences between the two groups were found in the incidence of major surgical complications (18.5% in aged patients vs. 10.5% in control groups; P = NS), serious septic (sepsis score greater than 10) complications (18.5% vs. 7.0%; P = NS) and hospital mortalities (11.1% vs. 3.5%; P = NS). In older patients the occurrence of multiorgan impairment and malnutrition was significantly related to postoperative complication rates. These results suggest that the degree of organ impairment rather than age is predictive of postoperative difficulty and should be used in assessing preoperative risk.

[Diverticula of the cecum. Our experience]

On the basis of their experience in right colonic emergencies, the Authors report two cases of diverticular disease presenting with acute abdomen. Pointing out the difficulty of a correct pre- and intraoperative diagnosis, different surgical procedures are analysed.