Armed with new knowledge about how neurodegenerative diseases alter brain structures, increasing numbers of neurologists, psychiatrists and other clinicians are adopting quantitative brain imaging as a tool to measure and help manage cognitive declines in patients. These imaging findings can help spur beneficial lifestyle changes in patients to reduce risk for Alzheimer’s disease.

The concept that cognitive decline can be identified early and prevented by applying quantitative brain imaging techniques is the focus of a recent review. Author Cyrus Raji, M.D., Ph.D., of UCLA and an international team suggest a framework in which neuroradiologists work as part of a team of clinical neuroscientists (neurologists, psychiatrists, neuropsychologists, etc.) to apply quantitative neuroradiology towards prevention of cognitive decline in populations at high risk for dementia — namely those with lifestyle, genetic, and other associated risk factors.

‘I believe neuroradiology, and especially quantitative MRI technology, will have a huge impact in the future of diagnosis and treatment of Alzheimer’s disease, since there is compelling evidence for the baseline size of hippocampus as a key determinant of risk for future cognitive decline, and since many lifestyle factors can cause atrophy or expansion in the volume of this critical brain structure,’ says neurologist Majid Fotuhi, M.D., Ph.D., of Johns Hopkins University.

Such work is already happening at UCLA and other institutions that meld these approaches into novel ways to improve patient care. ‘We are working closely with neuroradiologists to redefine how we can reduce risk for Alzheimer’s with quantitative neuroimaging that helps us pinpoint symptom-relevant volume loss in the brain and subsequent targets for tracking our lifestyle-based interventions,’ says Dr. David Merrill, a geriatric psychiatrist at UCLA Medical Center.

‘Recent advances have improved the ability to characterize imaging markers along the trajectory of Alzheimers disease, starting in the pre-clinical phase. These markers, including structural, functional, and molecular imaging are being used in the AD diagnositc criteria, ‘ says Howard Aizenstein, M.D., Ph.D., a psychiatrist at University of Pittsburgh.

Fotuhi sees imaging findings as a unique motivator for patients to make positive lifestyle changes. ‘Patients seem to enjoy reviewing results of their imaging studies, more so than reading the results of their blood tests or other clinical evaluations. For example, they can see with their own eyes whether there are any strokes or atrophy in their brain. This can have a powerful impact on them and on their determination to make changes in their lifestyle in order to improve their brain health,’ he adds.

Among the lifestyle and risk factors that can be altered to potentially prevent cognitive declines are obesity, diet, sleep, hypertension, diabetes, depression, supplementation, smoking and physical activity. It is estimated that as many as 3 million cases of Alzheimer’s dementia worldwide can be prevented with as little as a 10% reduction in the burden of preventable lifestyle. EurekAlert

Paediatric surgery can be traumatic for children – and their parents. To guide families through the experience, Dr. Zeev Kain, chair of UC Irvine’s Department of Anesthesiology & Perioperative Care, is creating a unique Internet site to help parents ease children’s anxiety (and their own), properly manage postsurgical pain and, ultimately, facilitate healing.

The Web-based Tailored Intervention Preparation for Surgery (WebTIPS) site will address one of the most pressing needs in paediatric surgical care. About 60 percent of the 5 million children who undergo surgery in the U.S. each year develop extreme anxiety beforehand and suffer from unnecessary pain afterward.

When the patient showed up in the emergency department, he was hurting. He’d taken a nice long soak in a warm tub, and a few hours later his fingers swelled enough to trap his ring. Now that finger was painful and swollen. The ring needed to come off, since restricted blood flow can lead to tissue death in the finger, which is about as fun as it sounds.

Ordinarily, this wouldn’t be much of a problem. ER personnel are used to removing rings. ‘It’s not uncommon at all,’ says Dr. Bret Nicks, an emergency room physician at Wake Forest Baptist Medical Center in Winston-Salem, N.C., who says he and his colleagues see traumatic injuries from working with heavy machinery such as cars or even the odd softball misfire. A published review of the problem also names ‘infection, skin disorders, allergic reactions, bee sting, and pregnancy’ as causes for trapped rings.

Usually they can be removed using lubrication, elevating the hand or the nifty string trick. And if that fails, out comes the ring cutter. But as two physicians describe, this patient’s ring was made of titanium.

Titanium rings are growing in popularity because they’re very strong, light, hypoallergenic and less expensive than rings made of precious metals like gold or platinum. But that strength can also make them more difficult to remove. A normal ring cutter won’t necessarily work, says Dr. Andrej Salibi, a plastic surgeon at Sheffield Teaching Hospitals in the U.K. and co-author of the letter. Jewellers who work with titanium say the commercially pure grades are much softer and easier to cut than aircraft grade, an alloy that also includes aluminum and vanadium; the exact type of titanium in this patient’s ring isn’t known. And of course the degree of difficulty can be boosted by the thickness of the ring.

In this case, the ring cutter failed, and the fire department came in with its own specialized cutting gear. The ring wouldn’t budge. The patient was admitted to the hospital and spent the night with his hand elevated. The next morning one of the physicians suggested they try something else, namely bolt cutters, which are often on hand in hospitals.

It worked! But ‘the other problem is that once you cut it, you have to take it off,’ says Salibi. And that takes a lot of force. So using some large, heavy-duty paperclips, the two physicians pulled the ring apart. The man’s finger was fine. The doctors say bolt cutters are preferable to dental saws or diamond-tipped saws, which aren’t likely to be lying around the hospital and require more manpower. npr

Hydrocephalus is a nightmarish medical condition. Accumulating fluid in the skull ratchets up pressure on the brain and can cause lifelong mental disabilities. Current treatment requires physicians to cut through the skull and implant pressure-relieving shunts.
The necessary surgery is effective but invasive. For surgeries like these, science fiction authors have long dreamt of shrinking surgeons to mere millimeters to allow them to navigate interior passageways of the body instead of cutting large access holes. Arriving at problem sites, the fictional physicians might provide targeted drug delivery or surgical intervention.
Aaron T. Becker, electrical and computer engineering professor at the UH Cullen College of Engineering, is working collaboratively to deliver a robotic version of this micro-surgeon. His submission to ICRA, the flagship conference of the IEEE Robotics and Automation Society in Seattle, Wash., was nominated for best conference paper and best medical robotics paper.

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