[Informatics and health, from digitization to information and communication technologies (TIC)]. / Informatique et santé, du numérique aux technologies de l'information et de la communication (TIC).

Integrating the progress that has been made on a daily basis since it was jointly commissioned in 2013 by the French National Academy of Medicine (Biotechnology Committee XX, Prof Emmanuel-Alain Cabanis) and the Technologies Academy (Pr Jean de Kervasdoué), this report, covering such a vast subject, can only represent one step in a long process. Summarized here in a volume compatible with the Bulletin, it makes reference to the full report (52 pages ; 22 pages of text, 4 pages of references, a 20-page glossary for physicians, plus 522 figures spanning 6 pages), which is available on the Academy's website. The six chapters first define "health" (WHO) and "informatics" and provide a brief history. The first chapter, on technologies, is divided into "bad" news (cybercrime, ecological risks) and advances relevant to health. The next four chapters describe the contribution of digitization to patient management, ranging from "fragile" individuals (from the gamete to old age and dependency) to healthy subjects trained to work in hostile situations (scuba diving to space exploration), and finally research. The last chapter proposes 7 areas for progress: expansion of the national imaging and communications platforms, stimulation of the medical robotics industry, extension of telemedicine to all medical and surgical specialties, support for drug dispensing and therapeutic education, and foundation of a European portal for m-health certification, research prioritization according to multiyear health plans, and reinforcement of mathematic education, starting in primary school (see: "La main à la pâte" ("Going hands-on").

[Virtual endoscopic navigation and body transparency based on computed tomography. A step towards in vivo imaging]. / Navigation endoscopique et transparences corporelles par scanner à RX, une étape en imagerie in vivo.

Progress in HR-CTdata processing has led to lower X-ray exposure and to better diagnostic performance. We describe 19 adult patients (among 5000) examined by HR CT with 64 detectors, acquisition and exposure protocols in mSv, spiral, 0.6-mm slices, 5To PACS. After the two usual processing steps (60 gray values, 5122 and 10242 matrices, dedicated workstations for coronaroscopy and virtual coloscopy, 2D multiplanar reformation, surfacic, 3D volumes with dissection and navigation), a third original data processing step on additional workstations was added. Variable matrix extrapolated images, flexible colored curves (different from anatomical conventions), lighting (sources) and transparencies (unavailable with traditional endoscopy) were used. The digital film is a 16-minute "journey "consisting of 19 endo-body navigations in 5 regions, from the head to the bronchi, from the heart to the coronary arteries, and from the digestive tract to the abdomen and pelvis. One possible application is post-operative verification of an aortic graft. The movie is illustrated here with ten plates. This new approach is cost-effective and beneficial for the patient, in terms of early diagnosis and therapeutic follow-up. Ethical issues are also examined.

[Health risks of long-distance air travel. Role of the general practitioner]. / Santé des voyageurs sur des vols aériens de longue durée. Rô1e du méecin traitant.

Air transport is seeing an increase in long-distance flights (12-16 hours average flight time), greater seating capacity, and a higher proportion of elderly, and hence more fragile, passengers. The French Academy of Medicine recommends that medical care be reinforced, particularly on long-distance flights, through the following measures: (i) passengers should be informed in advance of potential risks, through a Passenger's Guide, (ii) all future passengers should be encouraged to seek health advice and information from their general practitioner, (iii) flight crew members should receive training as "in-flight medical correspondents", and (iv) airlines and plane designers should reserve a "medical space" on the plane, equipped with appropriate medical materials.

[Boxing: traumatology and prevention]. / La boxe, sport de combat, de la traumatologie à la prévention.

In 1986, a surgeon who, as an amateur boxer himself was concerned with boxers' health, approached a pioneering Parisian neuroimaging unit. Thus began a study in close cooperation with the French Boxing Federation, spanning 25 years. In a first series of 52 volunteer boxers (13 amateurs and 39 professionals), during which MRI gradually replaced computed tomography, ten risk factors were identified, which notably included boxing style: only one of 40 "stylists" with a good boxing technique had cortical atrophy (4.5 %), compared to 15 % of "sloggers". Changes to the French Boxing Federation rules placed the accent on medical prevention. The second series, of 247 boxers (81 amateurs and 266 professionals), showed a clear improvement, as lesions were suspected in 14 individuals, of which only 4 (1.35 %) were probably due to boxing. The third and fourth series were part of a protocol called "Brain-Boxing-Ageing", which included 76 boxers (11 having suffered KOs) and 120 MRI scans, with reproducible CT and MRI acquisitions (9 sequences with 1.5 T then 3 T, and CT). MRI anomalies secondary to boxing were found in 11 % of amateurs and 38 % of professionals (atrophy, high vascular T2 signal areas, 2 cases of post-KO subdural bleeding). CT revealed sinus damage in 13 % of the amateurs and 19 % of the professionals. The risk of acute and chronic facial and brain damage was underline, along with detailed precautionary measures (organization of bouts, role of the referee and ringside doctor, and application of French Boxing Federation rules).

[Imaging the brain, from the cell to the organ]. / Imagerie de l'encéphale, de la cellule a l'organe.

Brain imaging has progressed over the centuries, from prehistory (surgical and sculptural empiricism), through the Middle Ages (dissection and drawings), the Renaissance (printing) and the 18th century (Spallanzani and ultrasounds), to the 19th century and the discovery of piezoelectricity by the Curie brothers and X-rays by Röntgen in 1895. The head had finally become transparent! The microscope was used by Ramon Y Cajal for histological and neuropathological brain studies. Marie Curie's discovery of radioisotopes paved the way for advances in in vivo neurophysiology. In the 20th century, technical progress accelerated with the advent of computed tomography. Injected contrast products were initially negative (air for ventriculography and pneumo-encephalography), and subsequently positive (intraventricular then intraarterial iodine, cerebral arteriography, increasingly hyperselective). Neurology and neurosurgery were followed by neuroradiology, stereotaxy, and interventional neuroradiology. G.N. Hounsfield's EMI CT scanner replaced silver salts crystals with computed pixels and voxels. Magnetic resonance imaging (MRI, 1981), which dispenses with the need for X-rays, is evolving at the same pace as computer science itself (Moore's Law) in the form of nanometric biophotonics for example. Diffusion MRI is providing precious information on neuroanatomy (axonal organization of the white matter and neuro-tractography, vascular anatomy), neurochemistry (MRS) and neurophysiology. Functional MRI of sensory activation and resting connectivity, the substrate of thought, is giving fascinating results. Functional stereotactic neurosurgery (for epilepsy, abnormal movements, etc.), stereotactic radiosurgery and endovascular interventional neuroradiology are among the latest approaches.

Neural correlates of simple unimanual discrete and continuous movements: a functional imaging study at 3 T.

INTRODUCTION: The cerebral and cerebellar network involved in unimanual continuous and discrete movements was studied in blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) at 3 T. METHODS: Seven healthy right-handed volunteers were scanned (1) while drawing a circle with the tip of the right index finger (continuous motor task), and (2) while drawing a triangle with the tip of the right index finger (discrete motor task). RESULTS: In both motor tasks, extensive activations were observed in the sensorimotor (M1/S1), parietal, prefrontal, insular, lateral occipital (LOC) and anterior cerebellar cortices. Subcortical activations within red, thalamic and lentiform nuclei were also detected. However, discrete movements were specifically followed by the recruitment of the left orbitofrontal cortex, right dentate nucleus and the second cerebellar homunculus (HVIII), and bilateral and stronger activation of the sensorimotor cortical areas, whereas continuous movements specifically activated the right prefrontal cortex and the lateral hemispherical part of the neocerebellum (crus 1). CONCLUSION: We confirm the findings of previous studies showing partly distinct neural networks involved in monitoring continuous and discrete movements, but we found new differential neural relays within the prefrontal, insular and neocerebellar cortices.

Anatomical parcellation of the brainstem and cerebellar white matter: a preliminary probabilistic tractography study at 3 T.

INTRODUCTION: The aims of this study were: (1) to test whether higher spatial resolution diffusion tensor images and a higher field strength (3 T) enable a more accurate delineation of the anatomical tract within the brainstem, and, in particular, (2) to try to distinguish the different components of the corticopontocerebellar paths in terms of their cortical origins. METHODS: The main tracts of the brainstem of four volunteers were studied at 3 T using a probabilistic diffusion tensor imaging (DTI) axonal tracking. The resulting tractograms enabled anatomical well-delineated structures to be identified on the diffusion tensor coloured images. RESULTS: We tracked corticopontine, corticospinal, central tegmental, inferior and superior cerebellopeduncular, transverse, medial lemniscal and, possibly, longitudinal medial fibres. Moreover, DTI tracking allowed a broad delineation of the corticopontocerebellar paths. CONCLUSION: Diffusion tensor coloured images allow a rapid and reliable access to the white matter broad parcellation of the brainstem and of the cerebellum, which can be completed by fibre tracking. However, a more accurate and exhaustive depiction of the anatomical connectivity within the brainstem requires the application of more sophisticated techniques and tractography algorithms, such as diffusion spectrum imaging.

Cortical projection to the human red nucleus: complementary results with probabilistic tractography at 3 T.

INTRODUCTION: In a previous study using streamlined diffusion tensor imaging (DTI) axonal tracking at 1.5 T, we found that the main afferents to the human red nucleus arise from the sensorimotor and prefrontal cortices. However, the spatial resolution of our data was low and our streamlining DTI algorithm was less powerful than the probabilistic tractography algorithm usually used to define connections between low anisotropic cortical or nuclear areas. Therefore, we reassessed and completed our previous results with trajectories computed with a probabilistic algorithm and with a high-field MRI system. METHODS: Afferents to the red nuclei of five volunteers were studied at 3 T using probabilistic DTI axonal tracking. RESULTS: Trajectories were constantly tracked between the red nucleus and the ipsilateral prefrontal, pericentral, temporal and occipital cortices, and the ipsilateral lentiform and contralateral dentate nuclei. We showed that the dentate nucleus was connected to the mammillary tubercle and, through the contralateral ventral thalamus, to the frontal and prefrontal cortices. CONCLUSION: The red nucleus receives extensive projections from the cerebral cortex and has dense subcortical connections to the striopallidal system.

The neural network involved in a bimanual tactile-tactile matching discrimination task: a functional imaging study at 3 T.

INTRODUCTION: The cerebral and cerebellar network involved in a bimanual object recognition was studied in blood oxygenation dependent level functional magnetic resonance imaging (fMRI). METHODS: Nine healthy right-handed volunteers were scanned (1) while performing bilateral finger movements (nondiscrimination motor task), and (2) while performing a bimanual tactile-tactile matching discrimination task using small chess pieces (tactile discrimination task). RESULTS: Extensive activations were specifically observed in the parietal (SII, superior lateral lobule), insular, prefrontal, cingulate and neocerebellar cortices (HVIII), with a left predominance in motor areas, during the tactile discrimination task in contrast to the findings during the nondiscrimination motor task. CONCLUSION: Bimanual tactile-tactile matching discrimination recruits multiple sensorimotor and associative cerebral and neocerebellar networks (including the cerebellar second homunculus, HVIII), comparable to the neural circuits involved in unimanual tactile object recognition.

Three-dimensional Procrustes analysis of modern human craniofacial form.

The objective of this study was to analyze modern human craniofacial form using 3D Procrustes superimposition in order to establish a reference model and validate it on computed tomography (CT). The sample consists of 136 specimens from five modern human regional groups. Thirty-three craniofacial landmark coordinates have been recorded using a Microscribe and calculated on CT scans for five crania from the sample. Procrustes superimposition has been performed to calculate the mean shape, and a discriminant analysis has also been carried out to estimate the variability of shape. The results show that the repeatability of measurements made on CT and on Microscribe is excellent (R = 0.99). There is no major distinctiveness in the craniofacial shape; however, discriminant function 1 separates out the European crania from the others, especially African and American. It includes the width and the length of the face, the flatness of the upper face, the prognathism of the maxilla, as well as the length and the inclination of the palate. The width of the maxilla and the palate do not show a great variability. This may be the common invariant feature responsible for the alignment of the teeth in all specimens. It may correspond to functional patterns related to masticatory constraints manifested by the important interproximal and occlusal dental wear in all specimens. This study confirms the high accuracy of measurements made on CT scan and the importance of geometric morphometrics, which provides an accurate characterization of the overall craniofacial shape and its variation within the entire population.

[Computed tomography and cranial paleoanthropology]. / Scanner à rayons X et paléoanthropologie crânienne.

Since its invention in 1972, computed tomography (C.T.) has significantly evolved. With the advent of multi-slice detectors (500 times more sensitive than conventional radiography) and high-powered computer programs, medical applications have also improved. CT is now contributing to paleoanthropological research. Its non-destructive nature is the biggest advantage for studying fossil skulls. The second advantage is the possibility of image analysis, storage, and transmission. Potential disadvantages include the possible loss of files and the need to keep up with rapid technological advances. Our experience since the late 1970s, and a recent PhD thesis, led us to describe routine applications of this method. The main contributions of CT to cranial paleoanthropology are five-fold: --Numerical anatomy with rapid acquisition and high spatial resolution (helicoidal and multidetector CT) offering digital storage and stereolithography (3D printing). --Numerical biometry (2D and 3D) can be used to create "normograms" such as the 3D craniofacial reference model used in maxillofacial surgery. --Numerical analysis offers thorough characterization of the specimen and its state of conservation and/or restoration. --From "surrealism" to virtual imaging, anatomical structures can be reconstructed, providing access to hidden or dangerous zones. --The time dimension (4D imaging) confers movement and the possibility for endoscopic simulation and internal navigation (see Iconography). New technical developments will focus on data processing and networking. It remains our duty to deal respectfully with human fossils.

[Personal identification with biometric and genetic methods]. / Identification des personnes par des analyses biométriques et génétiques.

The need for personal identification is growing in many avenues of society. To "identify" a person is to establish a link between his or her observed characteristics and those previously stored in a database. To "authenticate" is to decide whether or not someone is the person he or she claims to be. These two objectives can now be achieved by analysing biometric data and genetic prints. All biometric techniques proceed in several stages: acquisition of an image or physical parameters, encoding them with a mathematical model, comparing the results of this model with those contained in the database, and calculating the error risk. These techniques must be usable worldwide and must examine specific and permanent personal data. The most widely used are facial recognition, digital prints (flexion folds and dermatoglyphs, that offer the advantage of leaving marks), and the surface and texture of the iris. Other biometric techniques analyse behaviours such as walking, signing, typing, or speaking. Implanted radio-transmitters are another means of identification. All these systems are evaluated on the basis of the same parameters, namely the false rejection rate, the false acceptance rate, and the failure-to-enrol rate. The uses of biometrics are increasing and diversifying, and now include national and international identification systems, control of access to protected sites, criminal and victim identification, and transaction security. Genetic methods can identify individuals almost infallibly, based on short tandem repeats of 2-5 nucleotides, or microsatellites. The most recent kits analyze 11-16 independent autosomal markers. Mitochondrial DNA and Y chromosome DNA can also be analyzed. These genetic tests are currently used to identify suspected criminals or their victims from biological samples, and to establish paternity. Personal identification raises many ethical questions, however, such as when to create and how to use a database while preserving personal freedom? How to control access to genetic data? Do genetic polymorphisms delineate different human races? To what extent should different databases be interconnected? and What limits should be placed on individual files available on the web and on radiofrequency identification by implanted chips? A balance must be struck between the need to ensure the security of persons and transactions and the need to protect individual freedom and privacy.

Cortical projections to the human red nucleus: a diffusion tensor tractography study with a 1.5-T MRI machine.

INTRODUCTION: Previous studies in apes and monkeys have shown that the red nucleus receives projections from the sensorimotor and premotor cortices, whereas other experiments carried out with injured human brains have found corticorubral projections issuing from associative areas. Therefore, we reassessed in vivo the human anatomical projections from the cerebral cortex to the red nucleus using diffusion tensor imaging (DTI) axonal tracking. METHODS: The connectivity between the cerebral cortex and the red nuclei of seven volunteers was studied at 1.5 T using streamlined DTI axonal tracking. RESULTS: Trajectories were constantly tracked between the red nuclei and the ipsilateral pericentral and prefrontal cortices, as well as the temporal cortex and the striatum in two subjects. Within the cerebral trunk, trajectories also include the superior cerebellar peduncle and the central tegmental tract. CONCLUSION: The human red nucleus receives its main afferences from the sensorimotor and prefrontal cortices.

Resolution of homonymous visual field loss documented with functional magnetic resonance and diffusion tensor imaging.

A 68-year-old man developed right homonymous hemianopic paracentral scotomas from acute infarction of the left extrastriate area. He was studied over the ensuing 12 months with visual fields, conventional MRI, functional MRI (fMRI), and diffusion tensor imaging (DTI). As the visual field defect became smaller, fMRI demonstrated progressively larger areas of cortical activation. DTI initially showed that the lesioned posterior optic radiations were completely interrupted. This interruption lessened in time and had disappeared by one year after onset. fMRI and DTI are innovative measures to follow functional and structural recovery in the central nervous system. This is the first reported application of these imaging techniques to acute cerebral visual field disorders.

Cortical areas functionally linked with the cerebellar second homunculus during out-of-phase bimanual movements.

We used functional magnetic resonance imagery (fMRI) to study cortical activation during index finger-thumb opposition of both hands using in-phase and out-of-phase modes. In-phase movements activated the sensorimotor cortex. During out-of-phase movements, activations were also observed in the supplementary motor area (SMA), in the cingulate motor area (CMA) and, less frequently, in the anterior cingulate cortex (ACC). As we have previously shown and confirmed in the present study, the same out-of-phase bimanual movements specifically activate the cerebellar second homunculus, leading us to postulate that the cerebellar second homunculus and medial wall motor areas participate in a circuit specifically involved in timing complex movements.

Eruption of third molars: relationship to inclination of adjacent molars.

The purpose of this study was to determine the relationship between the sagittal inclination of the first and second maxillary molars and the eruption of the third molars. The sample consisted of 2 groups. The subjects in the first group (n = 28) had complete normal dentitions including third molars; those in the second group (n = 32) had impacted right and left third molars. The sagittal inclinations to the palatal plane of the first and second maxillary molars were measured on computed tomography sagittal images obtained with multiplanar reconstructions. The Mann-Whitney U test was used to compare mean angular values between the 2 groups. Spearman correlation coefficients were calculated to assess the relationship with age. A multivariate analysis was used to evaluate the relationship between the eruption of the third molars and the sagittal inclination of the first molar, the second molar, sex, and age. Maxillary first and second molars were more mesially inclined in the first group, particularly in the younger subjects (16-25 years). This inclination increased with age. The logistic regression showed that the sagittal inclination of the first molar is a predictor of the eruption of the third molar. This finding suggests that a more mesially inclined maxillary dentition is likely to be associated with third molar eruption. The absence of data on space requirements in the maxillary arch and interarch relationships warrants further exploration in an orthodontic population.

[The visual pathways, from anatomical MRI to physiological with (f)MRI and tractography with diffusion tensor MRI (DTMRI)]. / Les voies de la vision, de l'IRM anatomique à la physiologie (IRM(f)) et IRM en tenseur de diffusion (IRMTD) ou tractographie.

Advances in MRI technology have led to a better knowledge of visual pathways (1984-2004), with a new descriptive anatomy and functional model. The authors first describe the technical development of MRI over the last thirty years, then describe and illustrate the new descriptive anatomy. Cephalic MRI reveals brain structures that were previously invisible, on different encephalic planes, in the optic pathways, horizontally from the cornea to the calcarin fissure (neuro-ocular plane (NOP), oblique trans-hemispheric neuro-ocular (OTNOP) and neuro-opto-tractal planes (NOTP)), in their orthogonal orientation upon the oculomotor pathways: head and axonal optic nerve pack (visual deutoneurons in their meninges), optic tracts, lateral geniculate bodies, optic radiations and the calcarian fissure. Comparative anatomy with the rhesus macaque is mentioned. Functional neuroanatomy (physiology) benefits from cine-MRI for ocular motricity (OD MRI), growth by the observation of myelinization in children, blood and CSF circulation by MR angiography, local blood volumes by perfusion imaging, neuronal quantification with inflammation or myelin regeneration by spectroscopy (MRS), brain mapping by functional MR ((f)MRI) measuring local CBF enhancement by paradigmatic stimulations. The recent functional imaging method, tractography (or diffusion tensor MRI (DTMRI)), using diffusion MRI techniques, natural vector calculations with diffusion tensor and software power for morphological and statistical directional results, represents the direction of projection, association and commissural white matter tracts. Normal examples are shown and some common clinical consequences are discussed.