Brain atrophy and lesion load in a large population of patients with multiple sclerosis

OBJECTIVE: To measure white matter (WM) and gray matter (GM) atrophy and lesion load in a large population of patients with multiple sclerosis (MS) using a fully automated, operator-independent, multiparametric segmentation method. METHODS: The study population consisted of 597 patients with MS and 104 control subjects. The MRI parameters were abnormal WM fraction (AWM-f), global WM-f (gWM-f), and GM fraction (GM-f). RESULTS: Significant differences between patients with MS and control subjects included higher AWM-f and reduced gWM-f and GM-f. MRI data showed significant differences between patients with relapsing-remitting and secondary progressive forms of MS. Significant correlations between MRI parameters and between MRI and clinical data were found. CONCLUSIONS: Patients with multiple sclerosis have significant atrophy of both white matter (WM) and gray matter (GM); secondary progressive patients have significantly more atrophy of both WM and GM than do relapsing-remitting patients and a significantly higher lesion load (abnormal WM fraction); lesion load is related to both WM and even more to GM atrophy; lesion load and WM and GM atrophy are significantly related to Expanded Disability Status Scale score and age at onset (suggesting that the younger the age at disease onset, the worse the lesion load and brain atrophy); and GM atrophy is the most significant MRI variable in determining the final disabilit

Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review

This review focuses on ablative techniques for small renal masses (SRMs), including radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and irreversible electroporation (IRE), and discusses recurrence management. Through an extensive literature review, we outline the procedures, outcomes, and follow-up strategies associated with each ablative method. The review provides a detailed examination of these techniques—RFA, CA, MWA, and IRE—elucidating their respective outcomes. Recurrence rates vary among them, with RFA and CA showing comparable rates, MWA demonstrating favorable short-term results, and IRE exhibiting promise in experimental stages. For managing recurrences, various strategies are considered, including active surveillance, re-ablation, or salvage surgery. Surveillance is preferred post-RFA and post-CA, due to slow SRM growth, while re-ablation, particularly with RFA and CA, is deemed feasible without additional complications. Salvage surgery emerges as a viable option for larger or resistant tumors. While ablative techniques offer short-term results comparable to surgery, further research is essential to understand their long-term effects fully. Decisions concerning recurrence management should consider individual and tumor-specific factors. Imaging, notably contrast-enhanced ultrasounds, plays a pivotal role in assessing treatment success, emphasizing the necessity of a multidisciplinary approach for optimal outcomes. The lack of randomized trials highlights the need for further research

Songlines for Parkinson’s: The Process of Co-Developing a New Music-and-Movement Group-Based Intervention to Improve Mood and Movement for Parkinson’s

Data availability statement: Due to issues of anonymity (e.g., with the video recordings) we are only able to make parts of the data available, which we will do on request.Supplementary Material is available online at: https://journals.sagepub.com/doi/10.1177/16094069251335453#supplementary-materials .Participatory research promotes inclusive practice and enables stakeholder expertise to be recognized as a valuable contribution throughout the research cycle. However, there is little guidance regarding how to disseminate these qualitative processes, and the methodological insights gained. Based on preliminary research, we had developed a session framework for a new intervention using music to improve motor and non-motor symptoms for people with Parkinson’s. Our next step was to work in a trans- and interdisciplinary way to further explore concepts (e.g., imagery) and to co-develop content (e.g., musical exercises). Through a synthesis of materials including video footage, worksheets, field notes, transcriptions of interviews and feedback forms derived though workshops and interviews with people with Parkinson’s, a range of practitioners and healthcare professionals, and researchers in the UK (in English) and in Switzerland (in German and Italian), we developed a draft protocol for a 12-week course. This was then optimized through a final round of feedback with the stakeholders. We gained direct methodological insights throughout these processes, including some that led to changes in protocol (addition of two new sections), and the revision (rhythmic exercises) and removal (e.g., singing and syncopation) of some planned content. We also changed our use of language. Indirect insights included the need for cultural and contextual sensitivity, and a new understanding of the bidirectional nature of impact. A new group-based music and movement course, Songlines for Parkinson’s, has been co-developed for and with people with Parkinson’s. The methodological insights gained have not only shaped the protocol but also provided lessons that could be useful for planning and guidance in future participatory projects involving the Parkinson’s community and extended to other groups.In addition to the resources provided by the institutions, individuals and companies as described in the affiliations, this project was made possible by grants awarded to the first author from Parkinson Schweiz and the Swiss National Science Foundation (Project Grant 100001C_204/290)

Problem in diagnostic radiology

A 58-year-old woman presented with acute onset of aphasia and transient left hemiparesis involving the face, and the upper and lower limbs. We carried out cerebral computerized tomography (CT) (Fig. 1). It was negative for an acute vascular event, but can you see any abnormalities? The answers are to be found below. We then carried out cerebral magnetic resonance imaging (MRI) (Fig. 2) and spiral CT (Fig. 3). Can you see any abnormalities? Again the answers are below