Background Diffusion-tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that depicts the integrity of white matter (WM) tracts. This study was conducted to assess the utility of DTI tractography as an imaging technique in assessment of brain gliomas and planning of the surgical corridor. Results Twenty adult patients with brain gliomas were included. Neurological examination and conventional MRI and DTI scans were performed before and after surgery. Low-grade and high-grade tumors were found in 30% and 70% of patients, respectively. Preoperative DTI demonstrated five patterns of WM tract involvement: non-affected (10%), displaced (75%), edematous (55%), infiltrated (60%), and disrupted (20%). The obtained DTI scans were used for preoperative planning of the surgical corridor and extent of resection to achieve the maximum resection while preserving the WM tracts. Total resection was achieved in 40%, while 60% underwent subtotal resection. Postoperative neurological examination showed deterioration of cognitive function, motor power, and vision in 15%, 10%, and 5% of patients, respectively. Headache persisted in 15%, while motor power improved in 35% of patients. High-grade tumors were significantly associated with higher percentage of subtotal resection (p=0.018) and pattern IV (p=0.018). There was a significant association between the preoperative pattern of WM tract involvement and the postoperative DTI changes (p<0.001). Conclusion DTI enables assessment of displaced and infiltrated WM tracts in the vicinity of brain tumors. Preoperative planning of tumor resection and surgical corridor should include DTI scan to achieve the balance between maximum resection of tumor and maximal preservation of function.
Adiponectin (ADPN) is an endogenous insulin sensitizing and anti-inflammatory hormone, released by the adipose tissue. We investigated the clinical and biochemical correlates of plasma ADPN levels and the predictive value of ADPN with respect to survival rates and cardiovascular (CV) events was tested prospectively in a cohort of hemodialysis (HD) patients. We measured baseline ADPN in 110 HD patients, in addition to, 34 healthy subjects to serve as reference group. ADPN levels, were related to different clinical and biochemical cardiovascular risk factors such as increased body mass index (BMI), serum triglycerides (TG), duration of HD, smoking, mean arterial blood pressure (MBP), heart rate (HR), high density (HDL) cholesterol, low density (LDL) cholesterol, serum glucose, hemoglobulin and C-reactive protein (CRP) levels in HD patients. Plasma ADPN levels were higher (P = 0.000) among HD patients (15.06 ± 3.54 μg/mL) than among reference subjects (6.52 ± 1.07 μg/mL), were independent of age, and higher among women (16.13 ± 3.09 μg/mL) than among men (13.94 ± 3.65 μg/mL). Plasma ADPN levels were inversely related to BMI, TG, CRP and glucose levels. Furthermore, plasma ADPN levels were directly related to HDL-cholesterol and Kt/V. Plasma ADPN levels were lower (P = 0.000) among patients who experienced new CV events (11.13 ± 2.15 μg/mL) than among event-free patients (16.82 ± 2.45 μg/mL), and seem to predict cardiovascular outcomes. The inverse relationships between ADPN and several cardiovascular risk factors indicate that ADPN may have a protective role in the prevention of CV events.
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