While there is now evidence for thalamic abnormality in established secondary progressive and relapsing-remitting multiple sclerosis (MS), it remains unclear when such abnormality begins. This study investigated the emergence of thalamic abnormality in relapsing-remitting MS by assessing the thalamic magnetization transfer ratio (MTR) in a cohort with clinically early disease. Twenty-three patients with early relapsing-remitting MS (mean age 37; mean disease duration 1.9 years; Expanded Disability Status Scale (EDSS) range 0-3) and 19 healthy controls (mean age 34) were imaged yearly with a magnetization transfer imaging sequence. Twenty-two MS patients and 14 controls completed two-year follow-up. Regions of interest were placed in both thalami and mean thalamic MTR calculated. At baseline, significant differences between patient and control thalamic MTR were not observed. However, at years one and two, the thalamic MTR in patients was significantly lower than control MTR. Although baseline lesion volume did not correlate with baseline thalamic MTR, at year one, an association between baseline lesion volume and year one thalamic MTR emerged. There was also a significant inverse correlation between EDSS and thalamic MTR (r = -0.47, P = 0.02). The study suggests that thalamic involvement occurs within the first five years of MS onset, when most patients are still minimally disabled.
"The paired thalamic nuclei on both sides of the third ventricle play major roles in cortical activation, relaying sensory and motor information to the higher cortical centers that influence cognition (Herrero et al., 2002). Thalamic involvement occurs within the first 5 years of MS onset, when most patients are still minimally disabled (Davies et al., 2005; Henry et al., 2008). Thalamus volumes are inversely correlated with lesion load in MS (Shiee et al., 2012) and thalamus atrophy (TA) is associated with a wide range of clinical manifestations including cognitive decline, motor deficits, disability, fatigue, painful syndromes, and ocular motility disturbances in patients with MS (Hulst and Geurts, 2011; Batista et al., 2012; Shiee et al., 2012; Minagar et al., 2013). "
[Show abstract][Hide abstract] ABSTRACT: Despite a strong correlation to outcome, the measurement of gray matter (GM) atrophy is not being used in daily clinical practice as a prognostic factor and monitor the effect of treatments in Multiple Sclerosis (MS). This is mainly because the volumetric methods available to date are sophisticated and difficult to implement for routine use in most hospitals. In addition, the meaning of raw results from volumetric studies on regions of interest are not always easy to understand. Thus, there is a huge need of a methodology suitable to be applied in daily clinical practice in order to estimate GM atrophy in a convenient and comprehensive way. Given the thalamus is the brain structure found to be more consistently implied in MS both in terms of extent of atrophy and in terms of prognostic value, we propose a solution based in this structure. In particular, we propose to compare the extent of thalamus atrophy (TA) with the extent of unspecific, global brain atrophy, represented by ventricular enlargement. We name this ratio the “yearly rate of Relative Thalamic Atrophy” (yrRTA). In this report we aim to describe the concept of yrRTA and the guidelines for computing it under 2D and 3D approaches and explain the rationale behind this method. We have also conducted a very short crossectional retrospective study to proof the concept of yrRTA. However, we do not seek to describe here the validity of this parameter since these researches are being conducted currently and results will be addressed in future publications.
"A reduction of N-acetylaspartate (NAA) in the thalamus was found with MRS and is thought to reflect neuro-axonal loss [42,100,102]. MTI showed a reduced magnetization transfer ratio (MTR) in the thalamus, an abnormality which was already found within the first five years of the disease [101,104]. And also changes in thalamic DTI measures were partly associated with disability, brain volume, and lesion load . "
[Show abstract][Hide abstract] ABSTRACT: At the early onset of the 20th century, several studies already reported that the gray matter was implicated in the histopathology of multiple sclerosis (MS). However, as white matter pathology long received predominant attention in this disease, and histological staining techniques for detecting myelin in the gray matter were suboptimal, it was not until the beginning of the 21st century that the true extent and importance of gray matter pathology in MS was finally recognized. Gray matter damage was shown to be frequent and extensive, and more pronounced in the progressive disease phases. Several studies subsequently demonstrated that the histopathology of gray matter lesions differs from that of white matter lesions. Unfortunately, imaging of pathology in gray matter structures proved to be difficult, especially when using conventional magnetic resonance imaging (MRI) techniques. However, with the recent introduction of several more advanced MRI techniques, the detection of cortical and subcortical damage in MS has considerably improved. This has important consequences for studying the clinical correlates of gray matter damage. In this review, we provide an overview of what has been learned about imaging of gray matter damage in MS, and offer a brief perspective with regards to future developments in this field.
[Show abstract][Hide abstract] ABSTRACT: Preventive maintenance is essential for every chemical production site, as it can prevent equipment failure and accidents. In order to minimize the production loss caused by maintenance, the maintenance has to be carefully scheduled. To obtain an optimal maintenance strategy for a whole production site, the maintenance schedules of the production and utility plant have to be tackled simultaneously considering site-wide utility and material balances. However, the interconnections between production and utility system make the scheduling problem become very complex and difficult. In this paper, a multi-period mixed integer linear programming model, Site Model, is proposed as an aid to optimize short-term site-wide maintenance schedule. A special formulation is adopted to handle pre-set utility and material demand profiles during the shutdown, maintenance and start-up periods of plants.
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