Identification of the sensorimotor cortex with functional MRI: frequency and actual contribution in a neurosurgical context.

BACKGROUND AND PURPOSE: We assessed the actual frequency of motor functional MRI (fMRI) in a neurosurgical environment and estimated the extent to which it aided surgeons' identifications of the sensorimotor cortex. METHODS: During five consecutive years, an fMRI protocol aimed at generating a selective activation of the hand cortical area was prescribed to 147 patients showing a centrally located space-occupying lesion, which represents 6.7% of all assisted surgical candidates showing an intracranial mass. Three senior neurosurgeons indicated the position of the sensorimotor cortex on two different anatomical displays, reporting confidence ratings for each decision. RESULTS: The sensorimotor cortex could not be identified in 16.5% of cases using conventional anatomical MRI, and in 15% of cases using 3-dimensional reconstructions. In an additional 12.5% of cases, the neurosurgeons were not confident when they correctly identified the sensorimotor cortex. The tumor distorting effect on central region anatomy significantly contributed to sensorimotor cortex misidentification. fMRI, by contrast, showed a selective activation indicating the position of the sensorimotor cortex in all but 4% of cases. CONCLUSIONS: In our neurosurgical environment, fMRI was prescribed to a selected group of surgical candidates showing a centrally located brain lesion. Compared to conventional anatomical imaging, fMRI does appear to improve the identification of sensorimotor cortex.     

Beneficial effect of donepezil on sensorimotor function after stroke

Pharmacotherapy of poststroke sensorimotor deficits is currently used alone or combined with physiotherapy to promote recovery of mobility problems. This case study examined the effectiveness of donepezil hydrochloride (HCl) administered to a stroke patient with chronic, dense, left sensorimotor deficit. The patient received donepezil HCl (5 mg daily for 4 wk, followed by 10 mg daily for 12 wk) but no physiotherapy. Baseline and posttreatment evaluations were performed with the Fugl-Meyer scale and the Rivermead Mobility Index. One month after starting donepezil HCl (10 mg/day), sensorimotor function improved dramatically in the hemiplegic lower limb and shoulder. It was concluded that donepezil HCl may be an effective treatment for improving sensorimotor function in chronic stroke patients. Randomized controlled trials are required to support these preliminary findings.     

The relationship between fibre post geometry and flexural properties: an assessment through a modified three-point bending test

The aim of this study was to investigate the flexural properties of five types of fiber-reinforced dowels using a modified three-point bending test. Fiber-reinforced resin dowels were tested by a modified three-point bending test associated with models for cylindrical and conical simple-supported beams. The fracture load ranged from 86 to 246 N and the flexural strength from 423 to 1192 MPa. FRC Postec had significantly higher flexural strength and fracture loads values. Thus, the present study demonstrated higher flexural strength values for the FRC Postec fibre posts, suggesting that this system would present a better response to the forces of mastication.     

Human cytomegalovirus glycoprotein B genotypes in Brazilian mothers and their congenitally infected infants

A case-control study design was used in order to compare the distribution of human cytomegalovirus (HCMV) glycoprotein B (gB) genotypes in 48 mothers of 49 congenitally infected infants with that observed in 144 mothers of 146 uninfected infants to study genetic variation of HCMV strains and maternal-fetal transmission. Congenital infection with HCMV was characterized by DNA detection and virus isolation from two urine or saliva samples collected prior to the third week of life. Genotyping of HCMV was carried out by a polymerase chain reaction-restriction fragment length polymorphism analysis of the variable region of the gB gene, testing for four genotypes. Genotype frequency was similar among the 28 non-transmitting mothers who were shedding virus (gB1: 25%; gB2: 28.6%; gB3: 42.8%; gB4: 0%), the 37 transmitting mothers (gB1: 21.6%; gB2: 46%; gB3: 27%; gB4: 0%), and the 49 infected infants (gB1: 39%; gB2: 37%; gB3: 24%; gB4: 0%). The same genotype was detected at different body sites (urine, saliva, and blood) of each infected newborn and in the respective mother (breast milk, urine, and saliva). Co-infection with multiple genotypes was observed in the immediate postpartum period in two mothers of infected infants (5.4%) and one non-transmitting mother (3.6%). The gB genotype was not correlated with intrauterine HCMV transmission. The genotype distribution found reflects the overall frequency of wild strains circulating in this geographic region. A single genotype is responsible for congenital HCMV infection. Co-infection with more than one strain, as characterized by gB genotype, was infrequent in women who were presumably immunocompetent.