Practical constraints on estimation of source extent with MEG beamformers

We aimed to determine practical constraints on the estimation of the spatial extent of neuronal activation using MEG beamformers. Correct estimation of spatial extent is a pre-requisite for accurate models of electrical activity, allows one to estimate current density, and enables non-invasive monitoring of functional recovery following stroke. The output of an MEG beamformer is maximum when the correct source model is used, so that the spatial extent of a source can in principal be determined through evaluation of different source models with the beamformer. Here, we simulated 275-channel MEG data using sources of varying spatial extents that followed the cortical geometry. These data were subsequently used to estimate the spatial extent of generic disc elements without knowledge of the underlying surface, and we compared these results to estimates based on cortical surface geometry (with and without error in surface location). We found that disc-shaped source models are too simplistic, particularly for areas with high curvature. For areas with low curvature spatial extent was underestimated, although on average there was a linear relationship between the true and estimated extent. In contrast, cortical surface models gave accurate predictions of spatial extent. However, adding small errors (>2 mm) to the estimated location of the cortical surface abolished this relationship between true and estimated extent, implying that accurate co-registration is needed with such models. Our results show that models exploiting surface information are necessary in order to model spatial extent and in turn current density, but in order to render such models applicable in practical situations, the accuracy of the cortical surface model itself needs to improve.     

Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain

Human swallowing represents a complex highly coordinated sensorimotor function whose functional neuroanatomy remains incompletely understood. Specifically, previous studies have failed to delineate the temporo-spatial sequence of those cerebral loci active during the differing phases of swallowing. We therefore sought to define the temporal characteristics of cortical activity associated with human swallowing behaviour using a novel application of magnetoencephalography (MEG). In healthy volunteers (n = 8, aged 28-45), 151-channel whole cortex MEG was recorded during the conditions of oral water infusion, volitional wet swallowing (5 ml bolus), tongue thrust or rest. Each condition lasted for 5 s and was repeated 20 times. Synthetic aperture magnetometry (SAM) analysis was performed on each active epoch and compared to rest. Temporal sequencing of brain activations utilised time-frequency wavelet plots of regions selected using virtual electrodes. Following SAM analysis, water infusion preferentially activated the caudolateral sensorimotor cortex, whereas during volitional swallowing and tongue movement, the superior sensorimotor cortex was more strongly active. Time-frequency wavelet analysis indicated that sensory input from the tongue simultaneously activated caudolateral sensorimotor and primary gustatory cortex, which appeared to prime the superior sensory and motor cortical areas, involved in the volitional phase of swallowing. Our data support the existence of a temporal synchrony across the whole cortical swallowing network, with sensory input from the tongue being critical. Thus, the ability to non-invasively image this network, with intra-individual and high temporal resolution, provides new insights into the brain processing of human swallowing.     

Usefulness of MEG magnetometer for spike detection in patients with mesial temporal epileptic focus

The present study investigated the sensitivity of magnetoencephalography (MEG) for spikes depending on sensor type in patients with mesial temporal epileptic focus. We recorded MEG in 6 patients with mesial temporal epileptic focus using two sensor types (magnetometer and gradiometer) simultaneously. The number of spikes detected and the corresponding equivalent current dipole (ECD) parameters (distance from the coordinated head center (radius), and dipole moment) were evaluated with respect to sensor type. Among 426 MEG 'consensus spikes' determined by 3 reviewers, 378 spikes satisfied the predetermined criteria for source localization. Comparing ECD parameters, spikes detected by magnetometer alone displayed a smaller radius and larger dipole moment than those detected by gradiometer alone. Spikes estimated in the mesial temporal area were more frequently detected by magnetometer alone (38.5%) than by gradiometer alone (11.5%), whereas spikes in the lateral temporal area were detected less by magnetometer alone (3.7%) than by gradiometer alone (53.9%). The present results suggest that a magnetometer is advantageous for spike detection in patients with mesial temporal epileptic focus. This also implies the higher sensitivity of magnetometer for deep sources.     

Anatomically informed interpolation of fMRI data on the cortical surface

Analyzing functional magnetic resonance imaging (fMRI) data restricted to the cortical surface is of particular interest for two reasons: (1) to increase detection sensitivity using anatomical constraints and (2) to compare or use fMRI results in the context of source localization from magneto/electro-encephalography (MEEG) data, which requires data to be projected on the same spatial support. Designing an optimal scheme to interpolate fMRI raw data or resulting activation maps on the cortical surface relies on a trade-off between choosing large enough interpolation kernels, because of the distributed nature of the hemodynamic response, and avoiding mixing data issued from different anatomical structures. We propose an original method that automatically adjusts the level of such a trade-off, by defining interpolation kernels around each vertex of the cortical surface using a geodesic Vorono? diagram. This Vorono?-based interpolation method was evaluated using simulated fMRI activation maps, manually generated on an anatomical MRI, and compared with a more standard approach where interpolation kernels were defined as local spheres of radius r=3 or 5 mm. Several validation parameters were considered: the spatial resolution of the simulated activation map, the spatial resolution of the cortical mesh, the level of anatomical/functional data misregistration and the location of the vertices within the gray matter ribbon. Using an activation map at the spatial resolution of standard fMRI data, robustness to misregistration errors was observed for both methods, whereas only the Vorono?-based approach was insensitive to the position of the vertices within the gray matter ribbon.     

Dynamic causal modelling of evoked responses in EEG/MEG with lead field parameterization

Dynamical causal modeling (DCM) of evoked responses is a new approach to making inferences about connectivity changes in hierarchical networks measured with electro- and magnetoencephalography (EEG and MEG). In a previous paper, we illustrated this concept using a lead field that was specified with infinite prior precision. With this prior, the spatial expression of each source area, in the sensors, is fixed. In this paper, we show that using lead field parameters with finite precision enables the data to inform the network's spatial configuration and its expression at the sensors. This means that lead field and coupling parameters can be estimated simultaneously. Alternatively, one can also view DCM for evoked responses as a source reconstruction approach with temporal, physiologically informed constraints. We will illustrate this idea using, for each area, a 4-shell equivalent current dipole (ECD) model with three location and three orientation parameters. Using synthetic and real data, we show that this approach furnishes accurate and robust conditional estimates of coupling among sources and their orientations.     

股骨近端解剖型钢板治疗股骨转子间骨折

目的探讨股骨近端解剖型钢板治疗股骨转子间骨折的临床价值。方法回顾分析38例股骨转子间骨折应用股骨近端解剖型钢板手术治疗临床资料,根据术前术后X线片及术后髋关节功能、站立及行走等恢复情况评价内固定效果。结果38例随访时间6个月至2年,根据黄公怡评定标准,优23例,良12例,差3例。结论股骨近端解剖型钢板是治疗股骨转子间骨折的一个很好的方法。     

MEG localization of rolandic spikes with respect to SI and SII cortices in benign rolandic epilepsy

The purpose of this study was to study the relationship between interictal spike sources and somatosensory cortices in benign rolandic epilepsy of childhood (BREC) using a whole-scalp neuromagnetometer. We recorded spontaneous magnetoencephalography (MEG) and EEG signals and cortical somatosensory-evoked magnetic fields (SEFs) to electric stimulation of the median nerve in 9 children with BREC. Interictal rolandic discharges (RDs) and SEFs were analyzed by equivalent current dipole (ECD) modeling. Based on the orientation and locations of corresponding ECDs, we compared generators of RDs with primary (SI) and second somatosensory cortices (SII). Our results showed that RDs and SII responses had similar ECD orientation on the magnetic field maps. The ECDs of RDs were localized 15.3 +/- 1.9 and 12.2 +/- 2.8 mm anterior to SI and SII, respectively. The spatial distance on average from the location of RDs to SII (21.9 +/- 1.6 mm) cortex was significantly shorter than to SI cortex (29.7 +/- 1.7 mm) (P<0.01, Wilcoxon signed-rank test). In conclusion, the cortical generators for RDs in patients with BREC are localized in the precentral motor cortex, closer to hand SII than to SI cortex.     

解剖定位模式在NICU新生儿中长期静脉留置中的应用

目的:探讨解剖定位模式在NICU新生儿中长期静脉留置中的应用效果及护理方法。方法:将180例拟行中长期静脉留置的NICU新生儿随机分为对照组和观察组各90例。对照组按常规方式进行置管操作和护理。观察组按解剖定位模式进行置管操作,并给予针对性护理。对两组静脉穿刺时间、留置时间、置管成功率及并发症情况进行比较。结果:两组静脉穿刺时间、留置时间、置管成功率及并发症发生率等比较差异有统计学意义(P<0.01,P<0.05)。结论:解剖定位模式可缩短NICU静脉置管新生儿的穿刺时间,延长留置时间,减少并发症发生,精心护理是置管成功的重要保证。     

Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability

BACKGROUNDRecently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIMTo evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODSTwenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTSA total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.CONCLUSIONAll-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.     

The use of cognitive behavioural therapy with people with schizophrenia

• ? The role of cognition as one aspect of the stress-vulnerability model of schizophrenia is discussed, and the use of cognitive therapy reviewed.
• ? A holistic approach to the development of schizophrenia is explored.
• ? The stress vulnerability model is explained and the way in which individuals suffering from schizophrenia are vulnerable to attentional, perceptual and cognitive difficulties, are discussed.
• ? Using case examples, it is demonstrated that the use of cognitive behavioural techniques can be used by nurses to effectively reduce client problems associated with schizophrenia.

     

The use of analgesics in patients with acute abdominal pain

Analgesics in patients with acute abdominal pain are often withheld for fear that they may change physical examination findings and thus may be unsafe. We conducted a randomized, prospective, placebo-controlled trial to investigate changes in physical examination following the administration of placebo, 5 mg, or 10 mg of morphine to 49 patients with acute abdominal pain. One patient was withdrawn secondary to inadequate documentation. Of the 48 patients who completed the trial, a statistically significant change in physical examination was noted in both groups receiving analgesics, but not in the placebo group. No adverse events or delays in diagnosis were attributed to the administration of analgesics. We conclude that physical examination does change after the administration of analgesics in patients with acute abdominal pain and that a larger study is needed to evaluate analgesic safety in this subpopulation of emergency department patients.     

皮层电刺激联合康复治疗对脑缺血大鼠躯体运动功能的影响及机制

目的探讨皮层电刺激联合康复治疗对脑缺血大鼠躯体运动功能的影响及可能机制。 方法采用随机数字表法将60只成年雄性SD大鼠分为假手术组、脑缺血组、脑缺血＋单纯运动治疗(跑台训练)组、脑缺血＋运动(跑台训练)＋皮层电刺激组,每组15只。制备大脑中动脉栓塞模型,筛选成功模型大鼠为实验对象。在患侧肢体相对应的皮层脑区外埋置刺激电极,术后第3天开始皮层电刺激,治疗持续至第13天。第14天时进行Bederson评分、疲劳转棒实验,之后取材进行免疫组织化学染色或免疫蛋白印记(Western Blot),检测缺血侧脑组织酪蛋白激酶Ⅱ α亚基(CK2α)和钙调素依赖蛋白激酶Ⅱ(CaMK Ⅱ)表达水平,研究皮层电刺激联合康复治疗可能的作用机制。 结果皮层电刺激联合康复治疗组大鼠存活率改善,Bederson评分为(0.38±0.15)分、疲劳转棒停留时间为(155.37±42.44)s,较脑缺血组有明显好转(t＝7.58,8.95;均P<0.01),且结果优于单纯运动治疗组(t＝3.80,5.58;均P<0.05)。免疫组织化学染色结果可见脑缺血组CK2α及CaMK Ⅱ阳性率明显降低,与假手术组相比差异有统计学意义(t＝15.99,12.39;均P<0.01)。皮层电刺激联合康复治疗组CK2α、CaMK Ⅱ阳性比例分别为(24.75±4.55)%、(33.48±3.23)%,较脑缺血组明显升高,差异有统计学意义(t＝6.05,7.99;均P<0.01),且阳性比例高于单纯运动治疗组(16.40±2.59)%、(22.53±6.44)%(t＝4.52,4.62;均P<0.05)。Western Blot结果显示,脑缺血组CK2α及CaMK Ⅱ表达水平显著下降,分别为假手术组的(0.31±0.12)、(0.39±0.12)倍,皮层电刺激联合康复治疗组CK2α及CaMK Ⅱ表达量明显升高,分别升高至假手术组的(0.81±0.08)、(0.76±0.19)倍,与脑缺血组相比差异有统计学意义(t＝10.68,4.73;均P<0.05)。 结论皮层电刺激联合康复治疗可显著促进脑缺血大鼠运动功能恢复,其机制可能与上调运动皮层区CK2α及CaMK Ⅱ表达有关。     

表面肌电在脑卒中患者肢体功能障碍评价中的意义

摘要 目的：探讨表面肌电图评定脑卒中偏瘫患者肢体功能障碍的临床应用价值。 方法：计算机检索中国生物医学文献数据库、万方、维普等中文期刊,MEDLINE、EMBASE等英文期刊,利用纳入、排除标准对所收集文献进行筛选。采用RevMan 5.0软件进行Meta分析。 结果：8篇文献纳入研究。综合效应量：协同收缩率（CR）WMD=17.31,95%CI 5.78—28.84,P＜0.01;力矩WMD=-10.95,95%CI -13.40—-8.51,P＜0.00001。 结论：表面肌电图客观定量评价脑卒中偏瘫患者肢体功能状况,指导其临床康复。     

The use of advance directives among patients with implantable cardioverter defibrillators

Background: We aimed to determine the prevalence of advance directives (ADs) among patients with implantable cardioverter defibrillators (ICDs) and of ADs that addressed ICD management at the end of life. Methods: The medical records of all patients who underwent ICD implantation during 2007 at a single institution were reviewed retrospectively to determine the number of patients with an AD and the number of ADs mentioning the ICD specifically (i.e. ICD management at end of life). Results: During 2007, 420 patients (males, 71%) underwent ICD implantation at our institution (mean age [range] at implantation, 63 [1–90] years). Primary prevention was the most common indication for device therapy (254 patients [61%]). Overall, 127 patients (30%) had an AD, with 83 ADs (65%) completed more than 12 months before ICD implantation and 10 (8%) completed after it. Several life‐sustaining treatments were mentioned in the ADs: tube feeding, 46 (37%); cardiopulmonary resuscitation, 25 (20%); mechanical ventilation, 22 (17%); and hemodialysis, nine (7%). Pain control was mentioned in 58 ADs (46%) and comfort measures in 38 (30%). However, only two ADs (2%) mentioned the ICD or its deactivation at end of life. Conclusions: About one‐third of patients with ICDs had an AD, but only a couple ADs mentioned the ICD. These results suggest that clinicians should not only encourage patients with ICDs to complete an AD, but also encourage them to address ICD management specifically. Not addressing ICD management in an AD may result in ethical dilemmas during end‐of‐life care. (PACE 2012; xx; 1–7)     

The use of nasal CPAP in newborns with respiratory distress syndrome

The efficiency of applying continuous positive airway pressure (CPAP) by the nasal route was retrospectively analyzed in 32 newborns with RDS (23 uncomplicated HMD, 2 HMD with additional cardiac or pulmonary complications and 7 RDS of non-hyaline membrane etiology) who underwent nasal CPAP treatment at the Kinderspital Zurich from 1972–1974. 16 of the 23 infants with uncomplicated HMD were successfully treated with CPAP. They showed a significant rise in Pa0₂ as well as a significant drop in respiratory frequency during nasal CPAP application, the PaC0₂ did not change significantly. The remaining 7 infants in this group ( ₂₃ ⁷ ) had to be intubated and mechanically ventilated owing to a persistent high FI0₂ (4 infants), technical difficulties (1) or nasal hypersecretion (2). Two of these 23 infants died, one of meningitis, one of cerebral hemorrhage. The two infants with HMD and additional cardiac or pulmonary complications and 3 of 7 infants with RDS of non-hyaline membrane etiology had to be intubated and mechanically ventilated after failure of nasal CPAP. All 9 infants in these two groups survived.The nasal CPAP system as described is a simple, inexpensive and effective method of applying CPTPP in newborns with uncomplicated HMD, except radiological stage IV. In HMD with additional cardiac or pulmonary complications and in RDS of non-hyaline membrane etiology the results of nasal CPAP treatment were not convincing.Abbreviations CPTPP continuous positive transpulmonary pressure - CPAP continuous positive airway pressure - CNP continuous negative chest wall pressure - CPPV continuons positive pressure ventilation - RDS respiratory distress syndrome - HMD hyaline membrane disease - FIO2 inspired oxygen concentration - PaO₂ arterial oxygen pressure - PaCO₂ arterial carbon dioxide pressure - PDA patent ductus arteriosus - PEEP positive endexpiratory pressure - IPPV intermittent positive pressure ventilationM Presented at the fourth Symposion of Pediatric Intensive Care Medicine, Mainz, Germany, October 9–11, 1975     

The use of life story work with people with dementia to enhance person-centred care

mckeown j., clarke a., ingleton c., ryan t. & repper j. (2010) The use of life story work with people with dementia to enhance person-centred care. International Journal of Older People Nursing 5 , 148–158 Background. Person-centred care has been linked with quality of care but difficulties remain in person-centred care being implemented in care practice. This study explores the use of life story work to enhance person-centred care with people with dementia. Aims and objectives. The study investigates how life story work is: understood and developed in practice; experienced by all participants and affects the delivery and outcomes of care. Design and methods. The experience of older people with dementia, family carers and care staff in using life story work was explored within an NHS Health and Social Care Trust. A multiple case study design was adopted within a constructivist approach. Semi-structured interviews, observation, conversations were employed. Findings. Life story work has the potential to: enable care staff to see the person behind the patient; allow family carers to uphold their relatives’ personhood; enable the voice of the person with dementia to be heard, verbally and non-verbally; be enjoyable for all concerned and enable the person with dementia to feel proud about themselves and their lives. Conclusion and implications for practice. Life story work has the potential to enhance person-centred care for older people with dementia and their families. Taking a practice development approach ensures that life story work can be implemented sensitively and is sustained in practice.     

PTBD治疗肝内胆管微扩张型梗阻性黄疸

目的探讨超声实时引导结合X线透视下,经皮肝胆管穿刺置管引流术（PTBD）治疗肝内胆管微扩张型梗阻性黄疸的操作技术及其临床应用价值。方法回顾性分析9例肝内胆管微扩张型梗阻性黄疸患者的临床资料,6例行右肝胆管PTBD,3例行左肝胆管PTBD。结果胆管穿刺置管成功率100％,术后短暂性发热1例、一过性血性胆汁1例,未出现腹腔出血及胆汁性腹膜炎等严重并发症,术后一周胆红素平均下降（75．4±29．6）μmol／L。引流时间10d～5个月。结论超声引导结合X线透视下PTBD治疗肝内胆管微扩张型梗阻性黄疸是安全可行的。     

某高校乙型肝炎表面抗原阳性大学生健康教育及评估

目的了解乙型肝炎表面抗原（HBsAg）阳性大学生的心理健康状况,健康教育对学生心理健康的影响,为学校健康教育和心理咨询工作提供依据。方法2007年10月,采用心理测量工具对我校部分HBsAg阳性学生健康教育前后进行心理测量。结果HmAg阳性大学生健康教育前强迫、人际敏感、抑郁、焦虑、恐怖、精神病性六项因子分高于全国常模（P〈0．05,P〈0．01）;健康教育后人际敏感、抑郁、焦虑三项因子分高于全国常模（P〈0．05,P〈0．01）;教育前后比较强迫和精神病性因子分有显著性差异（P〈0．05,P〈0．01）;不同性别教育前精神病性、焦虑因子分有显著性差异（P〈0．05）。结论HBsAg阳性大学生存在较多的心理健康问题,通过有效的健康教育方法可以改善心理状况。