Automated Quantification of Total Cerebral Blood Flow from Phase-Contrast MRI and Deep Learning.

Knowledge of input blood to the brain, which is represented as total cerebral blood flow (tCBF), is important in evaluating brain health. Phase-contrast (PC) magnetic resonance imaging (MRI) enables blood velocity mapping, allowing for noninvasive measurements of tCBF. In the procedure, manual selection of brain-feeding arteries is an essential step, but is time-consuming and often subjective. Thus, the purpose of this work was to develop and validate a deep learning (DL)-based technique for automated tCBF quantifications. To enhance the DL segmentation performance on arterial blood vessels, in the preprocessing step magnitude and phase images of PC MRI were multiplied several times. Thereafter, a U-Net was trained on 218 images for three-class segmentation. Network performance was evaluated in terms of the Dice coefficient and the intersection-over-union (IoU) on 40 test images, and additionally, on externally acquired 20 datasets. Finally, tCBF was calculated from the DL-predicted vessel segmentation maps, and its accuracy was statistically assessed with the correlation of determination (R2), the intraclass correlation coefficient (ICC), paired t-tests, and Bland-Altman analysis, in comparison to manually derived values. Overall, the DL segmentation network provided accurate labeling of arterial blood vessels for both internal (Dice=0.92, IoU=0.86) and external (Dice=0.90, IoU=0.82) tests. Furthermore, statistical analyses for tCBF estimates revealed good agreement between automated versus manual quantifications in both internal (R2=0.85, ICC=0.91, p=0.52) and external (R2=0.88, ICC=0.93, p=0.88) test groups. The results suggest feasibility of a simple and automated protocol for quantifying tCBF from neck PC MRI and deep learning.

Osteochondral Repair with Autologous Cartilage Transplantation with or without Bone Grafting: A Short Pilot Study in Mini-Pigs.

OBJECTIVE: Treatment strategies for osteochondral defects, for which particulated autologous cartilage transplantation (PACT) is an emerging treatment strategy, aim to restore the structure and function of the hyaline cartilage. Herein, we compared the efficacy of PACT with control or human transforming growth factor-ß (rhTGF-ß), and clarified the necessity of bone graft (BG) with PACT to treat shallow osteochondral defects in a porcine model. DESIGN: Two skeletally mature male micropigs received 4 osteochondral defects in each knee. The 16 defects were randomized to (1) empty control, (2) PACT, (3) PACT with BG, or (4) rhTGF-ß. Animals were euthanized after 2 months and histomorphometry, immunofluorescence analysis, semiquantitative evaluation (O'Driscoll score), and magnetic resonance observation of cartilage repair tissue (MOCART) score were performed. RESULTS: Hyaline cartilages, glycosaminoglycan synthesis, and collagen type II staining were more abundant in the PACT than in the control and rhTGF-ß groups. The O'Driscoll score was significantly different between groups (P < 0.001), with both PACT groups showing superiority (P = 0.002). PACT had the highest score (P = 0.002), with improved restoration of subchondral bone compared with PACT with BG. The MOCART score showed significant differences between groups (P = 0.021); MOCART and O'Driscoll scores showed high correlation (r = 0.847, P < 0.001). CONCLUSION: Treatment of osteochondral defects with PACT improved tissue quality compared with that with control or rhTGF-ß in a porcine model. BG, in addition to PACT, may be unnecessary for shallow osteochondral defects. Clinical Relevance. BG may not be necessary while performing PACT.

Plasmonic Nanopillars-A Brief Investigation of Fabrication Techniques and Biological Applications.

Nanopillars (NPs) are submicron-sized pillars composed of dielectrics, semiconductors, or metals. They have been employed to develop advanced optical components such as solar cells, light-emitting diodes, and biophotonic devices. To integrate localized surface plasmon resonance (LSPR) with NPs, plasmonic NPs consisting of dielectric nanoscale pillars with metal capping have been developed and used for plasmonic optical sensing and imaging applications. In this study, we studied plasmonic NPs in terms of their fabrication techniques and applications in biophotonics. We briefly described three methods for fabricating NPs, namely etching, nanoimprinting, and growing NPs on a substrate. Furthermore, we explored the role of metal capping in plasmonic enhancement. Then, we presented the biophotonic applications of high-sensitivity LSPR sensors, enhanced Raman spectroscopy, and high-resolution plasmonic optical imaging. After exploring plasmonic NPs, we determined that they had sufficient potential for advanced biophotonic instruments and biomedical applications.

Clinical Usefulness of Simultaneous Electroencephalography and Functional Magnetic Resonance Imaging in Children With Focal Epilepsy.

BACKGROUND AND PURPOSE: The current study analyzed the interictal epileptiform discharge (IED)-related hemodynamic response and aimed to determine the clinical usefulness of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) in defining the epileptogenic zone (EZ) in children with focal epilepsy. METHODS: Patients with focal epilepsy showing IEDs on conventional EEG were evaluated using EEG-fMRI. Statistical analyses were performed using the times of spike as events modeled with multiple hemodynamic response functions. The area showing the most significant t-value for blood-oxygen-level-dependent (BOLD) changes was compared with the presumed EZ. Moreover, BOLD responses between -9 and +9 s around the spike times were analyzed to track the hemodynamic response patterns over time. RESULTS: Half (n=13) of 26 EEG-fMRI investigations of 19 patients were successful. Two patients showed 2 different types of spikes, resulting in 15 analyses. The maximum BOLD response was concordant with the EZ in 11 (73.3%) of the 15 analyses. In 10 (66.7%) analyses, the BOLD response localized the EZs more specifically. Focal BOLD responses in the EZs occurred before IEDs in 11 analyses and were often widespread after IEDs. Hemodynamic response patterns were consistent in the same epilepsy syndrome or when repeating the investigation in the same patients. CONCLUSIONS: EEG-fMRI can provide additional information for localizing the EZ in children with focal epilepsy, and also reveal the pathogenesis of pediatric epilepsy by evaluating the patterns in the hemodynamic response across time windows of IEDs.

The blood-brain barrier disruption after syncope: a dynamic contrast-enhanced magnetic resonance imaging study: A case report.

RATIONALE: Using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), we demonstrated blood-brain barrier (BBB) disruption following syncope. PATIENT CONCERNS: A 45-year-old man experienced syncope with a chief complaint of syncope (duration: 1 minutes), 1 day before visiting a university hospital for examination. He had no history of medical problems and was not taking any medications. This episode was the first in his lifetime. DIAGNOSES: After syncope, the patient did not have any illnesses or symptoms, such as headache, cognitive deficits, or somnolence. INTERVENTIONS: Cardiac evaluation did not reveal any abnormal findings. In addition, in conventional brain and chest computed tomography and brain MRI, no abnormal lesions were observed. OUTCOMES: DCE-MRI of the patient showed bright blue colored lines within the sulci throughout the cerebral cortex. The regions of interest, including bright blue colored lines, had significantly higher Ktrans values (6.86 times higher) than those in healthy control participants. These findings are indicative of BBB disruption of the vessels in the sulci. LESSONS: Using DCE-MRI, we demonstrated BBB disruption following syncope. DCE-MRI is a useful tool for the detection of BBB disruption following syncope.

The Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for the Evaluation of Blood-Brain Barrier Disruption in Traumatic Brain Injury: What Is the Evidence?

(1) Background: Blood brain barrier (BBB) disruption following traumatic brain injury (TBI) results in a secondary injury by facilitating the entry of neurotoxins to the brain parenchyma without filtration. In the current paper, we aimed to review previous dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies to evaluate the occurrence of BBB disruption after TBI. (2) Methods: In electronic databases (PubMed, Scopus, Embase, and the Cochrane Library), we searched for the following keywords: dynamic contrast-enhanced OR DCE AND brain injury. We included studies in which BBB disruption was evaluated in patients with TBI using DCE-MRI. (3) Results: Four articles were included in this review. To assess BBB disruption, linear fit, Tofts, extended Tofts, or Patlak models were used. KTrans and ve were increased, and the values of vp were decreased in the cerebral cortex and predilection sites for diffusion axonal injury. These findings are indicative of BBB disruption following TBI. (4) Conclusions: Our analysis supports the possibility of utilizing DCE-MRI for the detection of BBB disruption following TBI.

Development of a photochemical thrombosis investigation system to obtain a rabbit ischemic stroke model.

Photochemical thrombosis is a method for the induction of ischemic stroke in the cerebral cortex. It can generate localized ischemic infarcts in the desired region; therefore, it has been actively employed in establishing an ischemic stroke animal model and in vivo assays of diagnostic and therapeutic techniques for stroke. To establish a rabbit ischemic stroke model and overcome the shortcoming of previous studies that were difficult to build a standardized photothrombotic rabbit model, we developed a photochemical thrombosis induction system that can produce consistent brain damage on a specific area. To verify the generation of photothrombotic brain damage using the system, longitudinal magnetic resonance imaging, 2,3,5-triphenyltetrazolium chloride staining, and histological staining were applied. These analytical methods have a high correlation for ischemic infarction and are appropriate for analyzing photothrombotic brain damage in the rabbit brain. The results indicated that the photothrombosis induction system has a main advantage of being accurately controlled a targeted region of photothrombosis and can produce cerebral hemisphere lesions on the target region of the rabbit brain. In conjugation with brain atlas, it can induce photochemical ischemic stroke locally in the part of the brain that is responsible for a particular brain function and the system can be used to develop animal models with degraded specific functions. Also, the photochemical thrombosis induction system and a standardized rabbit ischemic stroke model that uses this system have the potential to be used for verifications of biomedical techniques for ischemic stroke at a preclinical stage in parallel with further performance improvements.

Complete Genome Sequences of Two Severe Fever with Thrombocytopenia Syndrome Virus Strains Isolated from a Human and a Dog in the Republic Of Korea.

Severe fever with thrombocytopenia syndrome virus (SFTSV) is tick-borne and causes this disease (SFTS) in humans. We determined the complete genome sequences of two SFTSV strains isolated from serum from a human with SFTS and a dog with asymptomatic infection using reverse transcription and rapid amplification of cDNA ends PCR.

The Effects of Acupuncture Stimulation for Brain Activation and Alcohol Abstinence Self-Efficacy: Functional MRI Study.

We attempted to investigate whether acupuncture stimulation at HT7 can have an effect on brain activation patterns and alcohol abstinence self-efficacy. Thirty-four right-handed healthy subjects were recruited for this study. They were randomly assigned into two groups: the HT7 (Shenmen) group and the LI5 (Yangxi) group. Acupuncture stimulation was performed using a block paradigm during fMRI scanning. Additionally, the Korean version of Alcohol Abstinence Self-Efficacy Scale (AASES) was used to determine the effect of acupuncture stimulation on self-efficacy to abstain from alcohol use. According to the result of fMRI group analysis, the activation induced by HT7 stimulation was found on the bilateral postcentral gyrus, inferior parietal lobule, inferior frontal gyrus, claustrum, insula, and anterior lobe of the cerebellum, as well as on the left posterior lobe of the cerebellum (p < 0.001, uncorrected). According to the AASES analysis, the interaction effect for gender and treatment was marginally significant (F(1, 30) = 4.152, p = 0.050). For female group, the simple main effect of treatment was significant (F(1, 11) = 8.040, p = 0.016), indicating that the mean change score was higher in the HT7 stimulation than in the LI5 stimulation. Therefore, our study has provided evidence to support that HT7 stimulation has a positive therapeutic effect on the alcohol-related diseases.

Consecutive Outbreaks of Enterotoxigenic Escherichia coli O6 in Schools in South Korea Caused by Contamination of Fermented Vegetable Kimchi.

BACKGROUND: Two outbreaks of gastroenteritis occurred in South Korea, affecting a middle school in the Jeollanam-do province in 2013 (Outbreak 1) and 10 schools in the Incheon province in 2014 (Outbreak 2). We investigated the outbreaks to identify the pathogen and mode of transmission. METHODS: A retrospective cohort study was conducted in the Outbreak 1; and case-control studies were performed for the Outbreak 2. Samples from students, environments, and preserved food items were collected and pulsed-field gel electrophoresis (PFGE) was conducted to identify strains of pathogen. RESULTS: We identified 167 and 1022 students who met the case definition (≥3 loose stools in any 24-h period) in the Outbreaks 1 and 2, respectively. The consumption of cabbage kimchi and young radish kimchi were significantly associated with the illness. Adjusted odds ratios of kimchi were 2.62-11.74. In the Outbreak 1, cabbage kimchi was made and consumed in the school restaurant and in the Outbreak 2, young radish kimchi was supplied by food company X and distributed to all the 10 schools in the Incheon province. Enterotoxigenic Escherichia coli (ETEC) O6 was isolated from fecal samples in 375 cases (33.9%) and from kimchi samples. PFGE patterns of the outbreak strains isolated from cases and food were indistinguishable in each outbreak. CONCLUSION: The suspected food vehicle in these two consecutive outbreaks was kimchi contaminated with ETEC O6. We recommend continued monitoring and stricter sanitation requirements for the food supply process in Korea, especially in relation to kimchi.

An Outbreak of Foodborne Illness Caused by Enteroaggregative Escherichia coli in a High School in South Korea.

In June 2013, a diarrheal outbreak occurred among high school students in Incheon, South Korea. We investigated the outbreak to identify the pathogen and mode of transmission. A case-control study using a self-administered questionnaire was conducted by local authorities and the Korean Centers for Disease Control and Prevention. Bacterial cultures of stool samples, environmental samples, and samples of preserved food items were prepared. PCR, serotyping, and pulsed-field gel electrophoresis (PFGE) were used to identify and characterize the outbreak-related pathogen. We identified 54 cases of gastroenteritis, with symptoms including diarrhea, abdominal pain, and nausea. None of the food items served in the high school cafeteria were significantly associated with illness, although the odds ratio for kippered trotters mixed with vegetables was relatively high (odds ratio: 2.92, 95% confidence interval: 0.62-13.69). Enteroaggregative Escherichia coli (EAEC) was isolated from this item and the stool samples from 22 symptomatic students and 4 asymptomatic food handlers. The PFGE patterns of EAEC isolated from these sources were indistinguishable. This outbreak was caused by EAEC, and kippered trotters mixed with vegetables, perhaps contaminated by asymptomatic food handlers, were linked to the outbreak. This case-control study highlights the importance of safe food preparation.

Diarrheal outbreak caused by atypical enteropathogenic Escherichia coli O157:H45 in South Korea.

UNLABELLED: Background: In May 2013, an outbreak of gastroenteritis occurred in a high school in Incheon, South Korea. We investigated the outbreak in order to identify the pathogen and mode of transmission. MATERIALS AND METHODS: A case-control study was performed using standardized questionnaires with a case definition of illness with diarrhea. Stool samples, environmental samples, and samples from preserved food items were collected to test pathogens. Pulsed-field gel electrophoresis (PFGE) was performed on the outbreak-related Escherichia coli strains. RESULTS: Thirty-three people (attack rate: 2.5%) met the case definition, and the pattern of the epidemic curve suggested a point-source outbreak. The common symptoms of cases were diarrhea (100.0%), abdominal pain (75.8%), chills (45.5%), and nausea (39.4%). Cases were found to be 8.26 times more likely to have eaten spicy fish soup with cod (95% confidence interval: 1.05-65.01). Consumption of egg soup with spring onions or braised eggs with razor clam flesh was significantly associated with illness. Atypical enteropathogenic E. coli O157:H45 was isolated from samples of 9 cases (27.3%) and tuna bibimbap. PFGE patterns of all tested isolates of O157 serotype were indistinguishable. CONCLUSIONS: This outbreak was caused by atypical enteropathogenic E. coli O157:H45 and the food vehicle was suspected to be tuna bibimbap. The statistical analysis was not in concordance with the microbiologic tests, probably owing to low pathogenicity of atypical enteropathogenic E. coli O157. This is the first report of an outbreak caused by atypical enteropathogenic E. coli O157.

A pulse artifact removal method considering artifact variations in the simultaneous recording of EEG and fMRI.

A simultaneous recording of electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) can provide high spatiotemporal information of brain activity. However, a proper analysis of the EEG signals is often hindered by various artifacts. In particular, pulse artifact (PA) induced from the heartbeat of a subject interferes with reliable measurements of the EEG signal. A new PA removal method that takes into account the delay variation between the heartbeat and PA and the window size variation in PA is presented in order to improve the detection and suppression of PA in EEG signals. A PA is classified into either a normal PA or a deformed PA. Only normal PAs are averaged to generate a PA template that is used to remove PAs from the measured EEG signals. The performance of the proposed method was evaluated by simulated data and real EEG measurements from epilepsy patients. The results are compared with those from conventional methods.

Improved susceptibility weighted imaging method using multi-echo acquisition.

PURPOSE: To introduce novel acquisition and postprocessing approaches for susceptibility weighted imaging (SWI) to remove background field inhomogeneity artifacts in both magnitude and phase data. METHODS: The proposed method acquires three echoes in a three-dimensional gradient echo (GRE) sequence, with a field compensation gradient (z-shim gradient) applied to the third echo. The artifacts in the magnitude data are compensated by signal estimation from all three echoes. The artifacts in phase signals are removed by modeling the background phase distortions using Gaussians. The method was applied in vivo and compared with conventional SWI. RESULTS: The method successfully compensates for background field inhomogeneity artifacts in magnitude and phase images, and demonstrated improved SWI images. In particular, vessels in frontal lobe, which were not observed in conventional SWI, were identified in the proposed method. CONCLUSION: The new method improves image quality in SWI by restoring signal in the frontal and temporal regions.

The effects of orthodontic bonding steps on biofilm formation of Streptococcus mutans in the presence of saliva.

OBJECTIVE: To investigate the effects of various orthodontic bonding steps on biofilm formation of Streptococcus mutans in the presence of saliva. MATERIALS AND METHODS: Hydroxyapatite (HA) and orthodontic adhesive (AD) disks were prepared to a uniform size. HA disks were etched with 37% phosphoric acid gel in the etched group (HE). In the primed group (HP), Transbond XT primer was applied to the etched HA surface and light-cured. For biofilm formation, Streptococcus mutans was grown on each specimen in a biofilm medium with either glucose or sucrose in the presence of fluid-phase UWS (F-UWS) or surface adsorbed saliva (S-UWS). The adherent bacteria were quantified by enumeration of the total viable counts of bacteria. Biofilms formed on each surface were examined by scanning electron microscopy. RESULTS: When glucose was used, both F-UWS and S-UWS suppressed biofilm formation of S. mutans. Compared to HA and HE, biofilm formation was significantly inhibited on HP and AD in the presence of glucose. Biofilm-forming patterns that were inhibited by saliva were restored in a sucrose-containing medium. F-UWS promoted biofilm formation on HA and HE, while S-UWS significantly promoted biofilm formation on HP. S. mutans developed biofilm better on HA and HE than on AD when sucrose was used as the sole carbohydrate source. CONCLUSIONS: This study suggests that the biofilm development by S. mutans is significantly influenced by the orthodontic bonding procedure. Biofilm formation of S. mutans was inhibited on AD more than other surfaces, irrespective of the presence of saliva or a carbohydrate source.

High-resolution fMRI with higher-order generalized series imaging and parallel imaging techniques (HGS-parallel).

PURPOSE: To develop a novel approach for high-resolution functional MRI (fMRI) using the conventional gradient-echo sequence. MATERIALS AND METHODS: Echo-planar imaging (EPI) techniques have generally been used for fMRI studies due to their fast imaging time. However, it is difficult for studying brain function at the submillimeter level using this sequence. In addition, EPI techniques have some drawbacks, such as Nyquist ghosts and geometric distortions in the reconstructed images, and subsequently require additional postprocessing to reduce these artifacts. One way of solving these problems is to acquire fMRI data by means of a conventional gradient-echo imaging sequence instead of EPI. To provide a fast imaging time, the proposed method combines higher-order generalized series (HGS) imaging with a parallel imaging technique which is called the HGS-parallel technique. RESULTS: The proposed HGS-parallel technique achieves a 12.8-fold acceleration in imaging time without the cost of spatial resolution. The proposed method was verified through the application of fMRI studies on normal subjects. CONCLUSION: This study suggests that the proposed method can be used for high-resolution fMRI studies without the geometric distortion and the Nyquist ghost artifacts compared to EPI.

An accurate heart beat detection method in the EKG recorded in fMRI system.

The simultaneous recording of functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG) provides an efficient signal for the high spatiotemporal brain mapping because each modality provides complementary information. The peak detection in the EEG signal measured in the MR scanner is necessary for removal of the ballistocardiac artifact. Especially, it would be affected by the quality of the EKG signal and the variation of the heart beat rate. Therefore, we propose the peak detection method using a K-teager energy operator (K-TEO) as well as further refinement processes in order to detect precise peaks. We applied this technique to the analysis of simulation waves with random noise and abrupt heat beat changes.

Brain activation related to affective dimension during thermal stimulation in humans: a functional magnetic resonance imaging study.

The aim of this study was to identify the activated brain region that is involved with the affective dimension of thermal stimulation (not pain, but innocuous warming) using functional MR imaging. Twelve healthy, right-handed male subjects participated in the study. Thermal stimulation with two different temperatures of 41 degrees C and 34 degrees C was applied to the subjects using a fomentation pack, wrapped around the right lower leg of each subject. On the basis of the subjects' responses after the scanning sessions, the authors were able to observe that the subjects felt "warm" and "slightly pleasant and comfortable" under the 41 degrees C condition. The experimental results indicated that warm stimulation produced a significant increase of activation compared to thermal neutral stimulation in various regions such as contralateral insular, ipsilateral cerebellum, ipsilateral putamen, contralateral middle frontal gyrus, ipsilateral inferior frontal gyrus, contralateral postcentral gyrus, and contralateral paracentral lobule. The activated regions are known to be related to thermal sensory, affective/emotional awareness, cognitive functions, sensory-discrimination, and emotion/affective processing, and so on. These results suggest that an appropriate thermal stimulation can produce a positive emotion and activate emotion/affect related regions of the brain.