Talairach-Based Parcellation of Neonatal Brain Magnetic Resonance Imaging Data: Validation of a New Approach

BACKGROUND AND PURPOSE: Talairach-based parcellation (TP) of human brain magnetic resonance imaging (MRI) data has been used increasingly in clinical research to make regional measurements of brain structures in vivo. Recently, TP has been applied to pediatric research to elucidate the changes in regional brain volumes related to several neurological disorders. However, all freely available tools have been designed to parcellate adult brain MRI data. Parcellation of neonatal MRI data is very challenging owing to the lack of strong signal contrast, variability in signal intensity within tissues, and the small size and thus difficulty in identifying small structures used as landmarks for TP. Hence the authors designed and validated a new interactive tool to parcellate brain MRI data from newborns and young infants. METHODS: The authors' tool was developed as part of a postprocessing pipeline, which includes registration of multichannel MR images, segmentation, and parcellation of the segmented data. The tool employs user-friendly interactive software to visualize and assign the anatomic landmarks required for parcellation, after which the planes and parcels are generated automatically by the algorithm. The authors then performed 3 sets of validation experiments to test the precision and reliability of their tool. RESULTS: Validation experiments of intra-and interrater reliability on data obtained from newborn and 1-year-old children showed a very high sensitivity of >95% and specificity >99.9%. The authors also showed that rotating and reformatting the original MRI data results in a statistically significant difference in parcel volumes, demonstrating the importance of using a tool such as theirs that does not require realignment of the data prior to parcellation. CONCLUSIONS: To the authors' knowledge, the presented approach is the first TP method that has been developed and validated specifically for neonatal brain MRI data. Their approach would also be valuable for the analysis of brain MRI data from older children and adults.     

Chocolate is a migraine-provoking agent

Patients with migraine who believed that chocolate could provoke their attacks were challenged with either chocolate or a closely matching placebo. In a double-blind parallel group study, chocolate ingestion was followed by a typical migraine episode in 5 out of 12 patients, while none of the 8 patients challenged with placebo had an attack (p = 0.051). The median time to the onset of the attack was 22 h. This brief study provides some objective evidence that chocolate is able to provoke a migraine attack in certain patients who believe themselves sensitive to it.     

Assessing diagnosis in heart failure: which features are any use?

We assessed the value of symptoms, past history, medications and signs in the evaluation of patients who might have heart failure secondary to left ventricular systolic dysfunction. An open-access echocardiography service was set up to help identify patients with left ventricular systolic dysfunction who might benefit from treatment with an angiotensin-converting-enzyme inhibitor. History and examination were recorded for each of these patients. The patients were divided into groups according to whether left ventricular systolic function was preserved or not and whether various clinical features were present or not. Of 259 consecutive patients studied, 41 had impairment of left ventricular systolic function as assessed by echocardiography. Past history of myocardial infarction and displaced apex beat were the best single predictors of left ventricular systolic dysfunction as assessed by echocardiography. The combination of past history of myocardial infarction and displaced apex had the best positive predictive value of all. Patients with such clinical features or combinations of clinical features may not need echocardiography, and where access to this resource is limited, it could be reserved for patients without such diagnostic features.      

超声引导消融治疗子宫肌瘤导航系统的设计

目的:如何将消融装置精确的放置到预期的位置,是射频消融治疗子宫肌瘤中的难点,因此研究应用于超声引导下消融治疗子宫肌瘤的导航系统。方法:①设计超声引导下消融治疗子宫肌瘤的导航系统,该系统的关键是同时跟踪超声探头和射频消融针的空间位置,从而准确的将射频消融针放到准确的位置,并缩短手术时间及使手术的创伤更小。②系统主要由三维超声导航和空间定位装置组成。使用以下设备:B型超声仪(ULTRAMARK-9,ATL公司,美国);磁跟踪器(pciBirds,model6DFOB,Ascension Technology公司,美国);射频电极;图形工作站,用于采集超声图像、记录磁跟踪器提供的位置信息、导航图像显示等。利用磁定位器实时跟踪超声探头和穿刺针,构建三维超声,穿刺操作中实时显示二维超声图像平面在三维超声中的位置及与穿刺针的空间位置关系。③为了测试系统的精度和稳定性,设计了水槽模型。以30g/L的琼脂糖经水浴加热后,注入模具中,冷却凝固后取出,制成球形穿刺目标,将球体圆心和射频电极针尖到达的实际位置之间的差值作为系统误差进行对该系统进行评价。结果:利用水槽模型进行了30次实验,最大穿刺角度为60°,实验中采集的数字图像均为768*576像素的8位灰度图像。所有实验均顺利完成穿刺操作,实验的系统误差范围在3mm内。结论:利用超声引导下消融治疗子宫肌瘤导航系统可以实现三维空间的准确定位,实现灵活准确的穿刺操作。     

Development of the Capacity Necessary to Perform and Promote Knowledge Translation Research in Emergency Medicine

Knowledge translation (KT) research in emergency medicine (EM) is in its infancy, and few EM investigators have the skills needed to perform KT research. Furthermore, the capacity to perform such KT research is underdeveloped in the field of EM. This consensus group used an iterative process to set forth initial recommendations and suggest methods for the development of EM KT research capacity. We have emphasized the need to form sustainable linkages, particularly between EM researchers and KT scientists, and to educate EM researchers in KT research methods to help create and sustain a culture of KT in our field. EM KT researchers must also engage local and national organizations and stakeholders to fund and promote KT research. Finally, we see the need to further develop and support EM research networks, as these networks will be both the clinical laboratories in which to perform the KT research and the incubators for the development of EM KT research experts.     

人类项韧带的精细解剖结构

目的:观察人类项韧带的精细解剖结构及形态。方法:实验于2004-09/2005-04在大连医科大学解剖教研室及大连医大生物塑化有限公司科研部完成。观察对象为4具成人尸体的颈部,均有完整的颈部(椎)全段,包括颅骨后枕外隆突。其中1具尸体进行肉眼大体解剖;3具尸体取寰椎到C7水平,制作成P45(聚酯树脂)生物塑化薄片。所有标本及材料均由大连医大生物塑化有限公司及大连医科大学解剖教研室提供。观察大体标本及P45断层塑化薄片标本,记录各种新发现。最后将两部分的观察及影像结果合并,利用断层解剖知识,标注项韧带组织名称并进行分析。结果:在颈椎的不同平面,项韧带的浅层、背侧部和腹侧部分别由斜方肌、头夹肌、小(大)菱形肌和上后锯肌的腱膜纤维组成的一个整体,且绝大部分纤维走向为横行。结论:①项韧带的结缔组织纤维不是全部纵向走行的,是以横向走行为主的肌腱腱膜组织纤维。②P45生物塑化薄片技术的应用使项韧带精细解剖结构的全貌更直观。     

贫困县小学生睡眠状况调查

目的:了解贫困地区小学生睡眠状况,探讨提高农村儿童睡眠质量的有效措施。方法:于2005-10在吉林省的国家级贫困县应用澳大利亚悉尼大学儿童睡眠中心临床问卷的中国修订版(内容涉及儿童个人情况、睡眠状况、家庭居住环境,父母睡眠状况、吸烟状况,以及父母职业及受教育程度、家庭成员之间的关系等),采用二阶段整群随机抽样法,对750名小学生的睡眠状况进行调查分析,统计分析近1年内儿童在未患重大疾病时的睡眠状况,包括全天睡眠时间分布状况、睡眠障碍发病率及其相关影响因素,根据美国精神障碍诊断统计手册中儿童睡眠障碍的诊断标准,将每周出现1～3次单一或几种睡眠障碍相关症状,定为存在睡眠问题。结果:共发放问卷750份,回收有效问卷691份,回收率为92.1%。6岁和13岁组人数较少予以去除,实际纳入分析者669名。其中男生300名,女生369名;汉族361名,朝鲜族288名,其他民族20名;7岁组96名,8岁组93名,9岁组94名,10岁组122名,11岁组128名,12岁组136名。①贫困县小学生全天睡眠时间均值为(9.62±1.12)h,汉族小学生全天平均睡眠时间比朝鲜族学生长[(9.75±1.23),(9.48±0.90)h,P<0.01]。各年龄组学生全天睡眠时间差异无统计学意义(F=0.169,P>0.05)。②睡眠障碍总时点发病率为27.40%。低年级组小学生(一～四年级)睡眠障碍发病率高于高年级组(五～六年级)(31.80%,24.15%,P<0.05),男生睡眠障碍发病率高于女生(35.35%,20.95%,P<0.01)。③睡眠障碍症状发病率前5位依次为:睡眠不安(8.4%),睡眠姿势异常(8.3%)、张口呼吸(6.1%),梦呓(5.2%);打鼾(4.3%)。④调查结果经单因素相关分析及多重逐步回归分析显示抚养人睡眠习惯、儿童睡眠姿势异常、母亲管教孩子态度和父亲学历等是影响睡眠时间的主要因素。⑤Logistic回归分析显示,孩子患呼吸系统疾病、父母教育孩子方法、母亲有无睡眠障碍、父母之间关系、儿童体弱多病等是睡眠障碍的主要危险因素。结论:贫困地区儿童睡眠障碍是多因素共同作用的结果;孩子的抚养人应改掉不良的睡眠习惯,为儿童提供良好的生活、睡眠环境;增强儿童身体素质,积极防治呼吸系统疾病,应作为近期降低贫困县小学生睡眠障碍的有效措施。     

The dysregulated brain: consequences of spatial and temporal brain complexity for bipolar disorder pathophysiology and diagnosis

Increasingly, evidence has been accumulating emphasizing the importance of looking at bipolar disorder (BD) from a neurodevelopmental and transdimensional perspective to better understand its origins and its course. In this overview article, the problems facing pathophysiological psychiatric research in BD are addressed and interpreted in the light of brain complexity. Brain complexity can be split into spatial complexity, which constitutes the physiological levels of the central nervous system (i.e., the genetic, molecular, cellular, neuronal circuit and phenomenological levels), and temporal complexity, that is, neurodevelopment. The consequences of this consideration are discussed and suggestions for clinical practice and pathophysiological psychiatric research are made.