Biomedical subjects

Rao P Gullapalli

Publications and source records attributed to Rao P Gullapalli.

12 recordsLinked to original sources

PubMed2007

Heart preservation using continuous ex vivo perfusion improves viability and functional recovery.

BACKGROUND: Cold static storage (CS) is a proven preservation method for heart transplantion, yet early postoperative graft dysfunction remains prevalent, so continuous perfusion (CP) during ex vivo transport may improve viability and function of heart grafts. METHODS AND RESULTS: Canine hearts underwent CP (n=9) or CS (n=9) for 6 h while intramyocardial pH was continuously monitored. Biopsies were assayed for ATP, caspase-3, malondialdehyde (MDA), and endothelin-1 (ET-1) levels at baseline, after preservation (t1), and after 1 h of blood reperfusion on a Langendorff model (t2). Functional recovery was determined at t2 by +dP/dt, -dP/dt, developed pressure, peak pressure and end-diastolic pressure. CP resulted in higher tissue pH and ATP stores and reduced caspase-3, MDA and ET-1 levels compared with CS at both t1 and t2. Post reperfusion recovery was significantly greater in CP vs CS for all myocardial functional parameters except end-diastolic pressure. Weight gain was significantly increased in CP vs CS at t1, but not at t2. CONCLUSIONS: Low-grade tissue acidosis and energy depletion occur during CS and are associated with oxidative injury and apoptosis during reperfusion. CP attenuates these biochemical and pathologic manifestations of tissue injury, together with improved myocardial recovery, despite mild, transient edema.

Adenosine Triphosphate↗

PubMed2006

Sex differences in the cerebral BOLD signal response to painful heat stimuli.

There are limited data addressing the question of sex differences in pain-related cerebral processing. This study examined whether pain-related blood oxygenation level-dependent (BOLD) signal change measured with functional magnetic resonance imaging (fMRI) demonstrated sex differences, under conditions of equivalent pain perception. Twenty-eight healthy volunteers (17 women, 11 men) were subject to a fMRI scan while noxious heat stimuli were applied to the dorsum of the left foot. Significant BOLD signal modulation was observed in several nociceptive processing regions of interest (ROIs) in all subjects. There were no sex differences in the spatial extent of BOLD signal change for any ROI, but the signal amplitude was lower for women in most ROIs and significantly so for the primary somatosensory cortex (S1), the midanterior cingulate cortex, and the dorsolateral prefrontal cortex (DLPFC). The BOLD signal response could be positive or negative, and frequently, both polarities were observed within a single ROI. In most ROIs, women show proportionately more voxels with negative signal change than men, and this difference was statistically significant for the S1 and the DLPFC. The time course of the negative signal change was very similar to that of the positive signal change, suggesting that the latter was not "driving" the former. The location of negative and positive clusters formed distinct patterns in several of the ROIs, and these patterns suggest something other than a local "steal" phenomenon as an explanation for the negative signal changes. Sex differences in baseline cerebral blood flow may contribute to the BOLD signal differences observed in this study.

Adult↗

PubMed2006

Diffusion-weighted magnetic resonance imaging of white matter in bipolar disorder: a pilot study.

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (MRI) has shown increased sensitivity in detecting brain white matter disease compared to traditional T2-weighted MRI. Diffusion-weighted imaging (DWI) can quantitatively assess the microstructural integrity of white matter using the average apparent diffusion coefficient (ADC(av)), a measure of the extent to which water molecules move freely within tissue. On the basis of numerous studies suggesting white matter disease in bipolar patients, particularly patients with more severe illness, this study aimed to test the utility of DWI in assessing the white matter integrity of bipolar patients with severe illness. METHODS: The existing MRI scans of eight bipolar patients and eight age-matched controls with neurological illness were examined retrospectively. ADC(av) values for pixels within white matter regions of interest (ROIs) were calculated and used to plot ADC(av) frequency histograms for each ROI. Mean ADC(av) values for the two groups were then compared by ANCOVA. RESULTS: The bipolar mean ADC(av) (0.855 +/- 0.051 x 10(-3) mm2/s) for combined white matter ROIs significantly exceeded that of controls (0.799 +/- 0.046 x 10(-3) mm2/s), while covarying for age (F = 4.47, df = 3, p = 0.025). CONCLUSIONS: This is the first report of an elevated ADC(av) in the white matter of a group of patients with bipolar disorder. In this group of patients with severe illness, increased white matter ADC(av) suggests microstructural changes consistent with decreased white matter integrity. DWI may be an additional, useful tool to assess white matter abnormalities in bipolar disorder.

Adult↗

PubMed2005

A systematic investigation of the functional neuroanatomy of auditory and visual phonological processing.

Neuroimaging studies of auditory and visual phonological processing have revealed activation of the left inferior and middle frontal gyri. However, because of task differences in these studies (e.g., consonant discrimination versus rhyming), the extent to which this frontal activity is due to modality-specific linguistic processes or to more general task demands involved in the comparison and storage of stimuli remains unclear. An fMRI experiment investigated the functional neuroanatomical basis of phonological processing in discrimination and rhyming tasks across auditory and visual modalities. Participants made either "same/different" judgments on the final consonant or rhyme judgments on auditorily or visually presented pairs of words and pseudowords. Control tasks included "same/different" judgments on pairs of single tones or false fonts and on the final member in pairs of sequences of tones or false fonts. Although some regions produced expected modality-specific activation (i.e., left superior temporal gyrus in auditory tasks, and right lingual gyrus in visual tasks), several regions were active across modalities and tasks, including posterior inferior frontal gyrus (BA 44). Greater articulatory recoding demands for processing of pseudowords resulted in increased activation for pseudowords relative to other conditions in this frontal region. Task-specific frontal activation was observed for auditory pseudoword final consonant discrimination, likely due to increased working memory demands of selection (ventrolateral prefrontal cortex) and monitoring (mid-dorsolateral prefrontal cortex). Thus, the current study provides a systematic comparison of phonological tasks across modalities, with patterns of activation corresponding to the cognitive demands of performing phonological judgments on spoken and written stimuli.

Acoustic Stimulation↗

PubMed2005

Reliability estimation of grouped functional imaging data using penalized maximum likelihood.

We analyzed grouped fMRI data and developed a reliability analysis for such data using the method of penalized maximum likelihood (ML). Specifically, this technique was applied to a somatosensory paradigm that used a mechanical probe to provide noxious stimuli to the foot, and a paradigm consisting of four levels of graded peripheral neuromuscular electrical stimulation (NMES). In each case, reliability maps of activation were generated. Receiver operating characteristic (ROC) curves were constructed in the case of the graded NMES paradigm for each level of stimulation, which revealed an increase in the specificity of activation with increasing stimulation levels. In addition, penalized ML was used to determine whether the grouped reliability maps obtained from one stimulus level were significantly different from those obtained at other levels. The results show a significant difference (P < 0.01) in the reliability of activation from one stimulation level to the next. These results are in agreement with those obtained using generalized linear modeling (GLM). While the reliability maps generated are not directly comparable, they are qualitatively similar to those obtained by controlling the expected false discovery rate (FDR). The proposed methodology can be used to objectively compare activation maps between groups, as well as to perform reliability assessments. Furthermore, this method potentially can be used to assess the longitudinal effect of treatment therapies within a group.

Analysis of Variance↗

PubMed2004

An fMRI investigation of speech and tone segmentation.

Recent research strongly indicates that phonological tasks activate a subregion of the inferior frontal gyrus. The purpose of the present fMRI study was to investigate the extent to which activation of this region during phonological processing is due to speech processes per se such as articulatory recoding or to other cognitive task demands such as working memory. Thus, we compared activation patterns during segmentation of speech and tone sequences to a tone discrimination task. In particular, participants performed same/different judgments on pairs of words, pseudowords, and tone sequences that required segmentation of a continuous acoustic signal as well as tone pairs that did not require segmentation. Accuracy and reaction time data showed that speech and tone sequence segmentation conditions patterned more similarly to each other than to tone discrimination pairs. Analyses of group data revealed strong activation of the region at the border of the left inferior and middle frontal gyrus for all three segmentation conditions compared to tone discrimination, but no consistent differences were observed when word and pseudoword segmentation were directly contrasted. Analyses of individual subjects indicated that a large number of participants activated a small area of the middle frontal gyrus during the speech conditions compared to the sequences. These results suggest that a significant portion of active frontal areas is recruited for extracting acoustic information and maintaining it in memory for decision. However, some regions at the border of the inferior/middle frontal gyrus may be unique to speech segmentation.

Adult↗

PubMed2004

Whole-brain apparent diffusion coefficient in traumatic brain injury: correlation with Glasgow Coma Scale score.

BACKGROUND AND PURPOSE: Patients with traumatic brain injury (TBI) and low Glasgow coma scale (GCS) scores may have severe injury associated with cellular disruption that can be studied with whole-brain apparent diffusion coefficient (ADC) histograms. We retrospectively studied this hypothesis and correlated ADC with GCS. METHODS: Twenty-one patients (37.81 +/- 41.3 years) with TBI were enrolled: Group A had normal MR imaging findings but low GCS scores (n = 6). Group B had brain stem injury with low GCS scores (n = 6). Group C had cortical lesions with normal GCS scores (n = 5), and group D had cortical lesions with low GCS scores (n = 4). Eleven control subjects were enrolled (32.7 +/- 19.2 years). Whole-brain ADC maps and histograms were generated and normalized for each subject. Mean and peak ADCs were determined. A one-sided t test was performed for each parameter. Average GCS scores and corresponding peak and mean ADCs were correlated. RESULTS: Peak histogram values significantly differed between controls and groups A, B, and D (P <.0019, P <.00129, and P <.0148, respectively). In groups A and D, values were significantly skewed compared with control values. Mean ADC was significantly different between the control ADC and group A (P <.013) but not group C. In each group, peak ADC and GCS score were strongly correlated (R(2) = 0.67). CONCLUSION: Whole-brain peak ADCs and GCS scores are significantly correlated in patients with TBI. Although conventional MR images were normal, ADC independently indicated TBI and better represents the degree of neurologic dysfunction.

Adolescent↗

PubMed2003

Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects.

Although empirical evidence supports the use of neuromuscular electrical stimulation (NMES) to treat physical impairments associated with stroke, the mechanisms underlying the efficacy of this modality are poorly understood. Recent studies have employed functional imaging to investigations of brain responses to median nerve stimulation. These studies suggest a dose-response relationship may exist between selected stimulation parameters and hemodynamic responses in sensorimotor regions. However, substantial gaps exist in this literature. The present study was designed to address these deficiencies. Ten healthy subjects participated. In phase one, four stimulus intensity levels were established: (1). sensory threshold [Th], (2). (MM-Th)x0.333+Th [low-intermediate level, LI], (3). (MM-Th)x0.666+Th [high-intermediate level, HI], and (4). maximal motor (MM). In phase two, subjects were scanned using a spiral-echoplanar imaging technique at each stimulus level. Image sets were analyzed to determine hemodynamic responses at the highest Pearson correlation level ( r) ascertained for each of five areas of interest (AOI): (1). primary sensory, (2). primary motor, (3). cingulate gyrus, (4). thalamus, and (5). cerebellum. ANOVA demonstrated significant main effects for BOLD signal amplitude ( p<0.05) changes in all AOI. Similarly, ANOVA showed significant differences in the volume of activation ( p<0.05) with increasing stimulus intensity in four AOI. Secondary analyses of pooled data showed increasing probabilities of activation at higher stimulus intensities within each AOI. Collectively, these data indicate a dose-response relationship exists between lower extremity NMES and brain activation in specific neural regions. The current results, while limited in their generalizability, are foundational for future studies of interventions using NMES.

Adult↗

PubMed2002

Magnetic resonance spectroscopic imaging-guided brachytherapy for localized prostate cancer.

PURPOSE: Prostate brachytherapy (PB) entails the placement of radioactive sources throughout the entire prostate gland to treat localized cancer. Typically, the target volume in PB encompasses the entire prostate gland because of the inability to localize the cancer and the multifocal nature of this malignancy. However, because of the unique biochemical nature of the prostate gland, recent advances in magnetic resonance spectroscopic imaging (MRSI) of the prostate have allowed precise delineation of the cancer location within the prostate gland. This report reveals our initial experience of MRSI-guided PB. METHODS: A MRSI study was obtained in 15 localized prostate cancer patients before their scheduled PB. The results of this study were used to internally map 7 x 7 x 9-mm volumes of prostate tissue to assign cancerous areas a higher dose of radiation. Such tumor-bearing areas had a low citrate/(choline+creatine) ratio consistent with cancer. On the basis of the anatomic MRI and MRSI correlation, three-dimensional coordinates were assigned to the locations of MRSI-defined cancer. The entire target volume was treated to a standard prescription dose using I-125 or Pd-103. Abnormal citrate regions, termed the biologic tumor volume, were prescribed a dose of 130% of the target volume dose to dose escalate in the abnormal citrate regions while respecting the normal radiation tolerances of the surrounding areas. Three-dimensional treatment planning was used to perform the implant. RESULTS: Of the 15 prostate cancer patients evaluated, all had successful three-dimensional MRSI acquisition before their scheduled PB procedure. In 14 of the 15 patients planned with MRSI, the data were successfully incorporated into their treatment planning and were used to increase the radiation dose prescription to 130% in the MRSI-defined volumes. In 1 patient, MRSI revealed significant background artifact that made a focal boost impractical. Postimplant dosimetry confirmed a median V100 of 95% (range 72%-100%) in the 15 evaluated patients for the prescription dose. Furthermore, the median BTV100 for the abnormal citrate region was 90% (range 80-100%) as determined by postimplant dosimetry. Urethral and rectal dose-volume histograms were within normal limits. Morbidity was comparable with that for conventionally treated patients. CONCLUSION: MRSI offers a promising new approach for the delivery of ionizing radiation in PB. Although this series was small and with a short follow-up, MRSI-guided implants are feasible and warrant further investigation as a means of improving the therapeutic ratio in PB [corrected].

Aged↗

PubMed2002

Test-retest reliability estimation of functional MRI data.

Functional magnetic resonance imaging (fMRI) data are commonly used to construct activation maps for the human brain. It is important to quantify the reliability of such maps. We have developed statistical models to provide precise estimates for reliability from several runs of the same paradigm over time. Specifically, our method extends the premise of maximum likelihood (ML) developed by Genovese et al. (Magn Reson Med 1997;38:497-507) by incorporating spatial context into the estimation process. Experiments indicate that our methodology provides more conservative estimates of true positives compared to those obtained by Genovese et al. The reliability estimates can be used to obtain voxel-specific reliability measures for activated as well as inactivated regions in future experiments. We derive statistical methodology to determine optimal thresholds for region- and context-specific activations. Empirical guidelines are also provided on the number of repeat scans to acquire in order to arrive at accurate reliability estimates. We report the results from experiments involving a motor paradigm performed on a single subject several times over a period of 2 months.

Brain↗

PubMed2002

Functional lateralization of the human premotor cortex during sequential movements.

A neurological truism is that each side of the brain controls movements on the opposite side of the body. Yet some left hemisphere brain lesions cause bilateral impairment of complex motor function and/or ideomotor apraxia. We report that the left dorsal premotor cortex of normal right-handed people plays a fundamental role in sequential movement of both right and left hands. Subjects performed sequential finger movements during functional magnetic resonance imaging of the motor cortices. In right-handed subjects, the volume of activated dorsal premotor cortex showed a left hemispheric predominance during hand movements. We suggest that the observed left premotor dominance contributes to the lateralization found in lesion studies.

Adult↗

PubMedDate not supplied

AAPM/RSNA physics tutorial for residents: MR artifacts, safety, and quality control.

Artifacts in magnetic resonance (MR) imaging result from the complex interaction of contemporary imager subsystems, including the main magnet, gradient coils, radiofrequency (RF) transmitter and receiver, and reconstruction algorithm used. An understanding of the sources of artifacts enables optimization of the MR imaging system performance. The increasing clinical use of very high magnetic field strengths, high-performance gradients, and multiple RF channels also mandates renewed attention to the biologic effects and physical safety of MR imaging. Radiologists should be aware of the potential physiologic effects of prolonged exposure to magnetic fields, acoustic noise, and RF energy during MR imaging and should use all the available methods for avoiding accidents and adverse effects. Imaging equipment should be regularly tested and monitored to ensure its stability and the uniformity of its functioning. Newly installed or upgraded MR systems should be tested by a physicist or qualified engineer before use. In addition, the authors recommend participation in the MR imaging accreditation program of the American College of Radiology to establish the initial framework for an adequate quality assurance program, which then can be further developed to fulfill local institutional needs.

Artifacts↗