Brain charts for the human lifespan.

Over the past few decades, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, no reference standards currently exist to quantify individual differences in neuroimaging metrics over time, in contrast to growth charts for anthropometric traits such as height and weight1. Here we assemble an interactive open resource to benchmark brain morphology derived from any current or future sample of MRI data ( http://www.brainchart.io/ ). With the goal of basing these reference charts on the largest and most inclusive dataset available, acknowledging limitations due to known biases of MRI studies relative to the diversity of the global population, we aggregated 123,984 MRI scans, across more than 100 primary studies, from 101,457 human participants between 115 days post-conception to 100 years of age. MRI metrics were quantified by centile scores, relative to non-linear trajectories2 of brain structural changes, and rates of change, over the lifespan. Brain charts identified previously unreported neurodevelopmental milestones3, showed high stability of individuals across longitudinal assessments, and demonstrated robustness to technical and methodological differences between primary studies. Centile scores showed increased heritability compared with non-centiled MRI phenotypes, and provided a standardized measure of atypical brain structure that revealed patterns of neuroanatomical variation across neurological and psychiatric disorders. In summary, brain charts are an essential step towards robust quantification of individual variation benchmarked to normative trajectories in multiple, commonly used neuroimaging phenotypes.

Spatio-temporal correlations from fMRI time series based on the NN-ARx model.

For the purpose of statistical characterization of the spatio-temporal correlation structure of brain functioning from high-dimensional fMRI time series, we introduce an innovation approach. This is based on whitening the data by the Nearest-Neighbors AutoRegressive model with external inputs (NN-ARx). Correlations between the resulting innovations are an extension of the usual correlations, in which mean-correction is carried out by the dynamic NN-ARx model instead of the static, standard linear model for fMRI time series. Measures of dependencies between regions are defined by summarizing correlations among innovations at several time lags over pairs of voxels. Such summarization does not involve averaging the data over each region, which prevents loss of information in case of non-homogeneous regions. Statistical tests based on these measures are elaborated, which allow for assessing the correlation structure in search of connectivity. Results of application of the NN-ARx approach to fMRI data recorded in visual stimuli experiments are shown. Finally, a number of issues related with its potential and limitations are commented.

[Video-EEG evaluation complemented by spectral and EEG source analysis in patients with medication-resistant medial temporal lobe epilepsy]. / Evaluación videoelectroencefalográfica complementada con análisis espectral y de las fuentes generadoras del electroencefalograma en pacientes con epilepsia del lóbulo temporal medial resistente a los fármacos.

AIM: To evaluate the value of prolonged video-electroencephalographic (video-EEG) monitoring complemented with spectral and EEG source analysis in identifying the epileptogenic area in patients with medial temporal lobe epilepsy who are candidates for non-lesional resective surgery. PATIENTS AND METHODS: The electrographic patterns during the onset of seizures were evaluated in over 667 seizures from 41 patients with a clinical diagnosis of medication-resistant partial epilepsy. Analyses were performed using Harmonie software and variable resolution electrical tomography (VARETA). RESULTS: Video-EEG was used to determine that 53.6% of the patients evaluated suffered complex partial seizures of a temporal origin; these were characterised by having an average frequency of 5.56 +/- 1.56 Hz, while the non-temporal seizures displayed a frequency within the range 9.17 +/- 3.32 Hz. The topographic location of the dominant ictal frequency during the period of maximum spectral energy in patients with temporal lobe epilepsy enabled us to draw a distinction between a group of patients with mesial seizures and those with non-mesial seizures that exceeded the number that was determined by visual inspection of the EEG, that is, 78.9 versus 47.3%, respectively. There was a 100% coincidence between the area where the seizures began as defined by surface EEG complemented with spectral analysis, the generator of this activity as defined by VARETA and the epileptogenic region. CONCLUSIONS: The localising information provided by video-EEG complemented with spectral and EEG source analysis allows for non-invasive location of the epileptogenic region in patients with medial temporal lobe epilepsy even when structural imaging studies show an absence or bilaterality of abnormalities.

3D statistical parametric mapping of EEG source spectra by means of variable resolution electromagnetic tomography (VARETA).

This article describes a new method for 3D QEEG tomography in the frequency domain. A variant of Statistical Parametric Mapping is presented for source log spectra. Sources are estimated by means of a Discrete Spline EEG inverse solution known as Variable Resolution Electromagnetic Tomography (VARETA). Anatomical constraints are incorporated by the use of the Montreal Neurological Institute (MNI) probabilistic brain atlas. Efficient methods are developed for frequency domain VARETA in order to estimate the source spectra for the set of 10(3)-10(5) voxels that comprise an EEG/MEG inverse solution. High resolution source Z spectra are then defined with respect to the age dependent mean and standard deviations of each voxel, which are summarized as regression equations calculated from the Cuban EEG normative database. The statistical issues involved are addressed by the use of extreme value statistics. Examples are shown that illustrate the potential clinical utility of the methods herein developed.

[Atresia of the pulmonary artery with intact interventricular septum. Apropos of 2 cases with prolonged course]. / Atrésie de l'artère pulmonaire à septum interventriculaire intact. A propos de deux observations d'évolution prolongée

The authors report two cases of atresia of the pulmonary outflow with an intact interventricular septum; they are remarkable for their slow progression. In one patient the pulmonary perfusion was furnished by systemic arteries, while in the other it was by way of a patent ductus arteriosus. This second patient died following an attempted bi-cavo-pulmonary anastomosis. Such slow progression, which is the exception, is only possible if there is a substantial vicarious pulmonary circulation.

A nurse-run business to improve health care for nursing home residents.

The costs of health care for the rapidly growing segment of our population over age 75 are staggering. EverCare is a nurse-run business that seeks to improve cost-effectiveness and quality of health care for nursing home residents enrolled in a health maintenance organization.

Care coordinator--blending roles to improve patient outcomes.

A care coordinator blends aspects of the case manager and clinical specialist roles with those of a unit-based staff developer. In this position, the nurse facilitates critical pathways; coordinates care with the patient, family, ancillary staff and community services; delivers unit-based staff-development programs; and acts as mentor, staff resource person and physician liaison. The development and utilization of this professional nursing role in a community hospital is outlined.

QEEG norms for the first year of life.

BACKGROUND: QEEG allows a more objective evaluation of cerebral electrical activity as well as the production of topographical maps for easier comprehension. Here we have developed qEEG norms for the first year of life using methods previously published for other age ranges, including for example, regression for Gausssianity before Z transformation. These norms constitute a non-invasive and low cost tool for the functional evaluation of the infant's brain. RESULTS: Developmental equations were obtained from 101 healthy infants recording at spontaneous quiet sleep stage II. Polynomial regression equations, with age as independent variable, were calculated for full Broad Band Spectral Parameters (BBSP) using the Least Squares technique. Interpolated maps of the BBSP values or their Z transformation were constructed for linked-ear reference, average reference and Laplacian montages. All montages produced similar tendency curves and Z maps of absolute and relative power, and mean frequency at all frequency bands. The norms obtained were validated against an independent group of 50 healthy infants and some pathological cases. 91-98% of cases were well classified as normal across all measures and montages. To exemplify, two pathological cases are presented of which their qEEG maps show resemblance to CT and MRI. CONCLUSIONS: These qEEG norms are highly useful as an aid to visual interpretation and for the study of pathology further evolution as well as for assessment of infants showing brain risk factors. To our knowledge this is the first normative qEEG study for the initial year of life with such large sample and validation-group.

Case report: acute pancreatitis induced by Clozapine.

Two percent of acute pancreatitis are drug induced. In the present paper, we reported the case of a 39 year-old patient with chronic-hallucinatory schizophrenia who developed symptomatic pancreatitis during the clozapine dose titration performed to reach the therapeutic range. Diagnosis of pancreatitis was suggested by clinical examination and abnormal laboratory values of pancreatic enzymes and confirmed by C-T scan and ultrasonography. The causal incrimination of clozapine in this case seems likely as all other possible causes of pancreatitis were excluded, as AP developed shortly after the introduction of the drug and as the pancreatic enzymes normalized after clozapine was stopped. No rechallenge to confirm the causal relationship was however attempted. So far, only eight cases of acute pancreatitis have been reported in association with clozapine use. Clozapine is an atypical antipsychotic drug which belongs to the chemical class of dibenzodiazepines. The mechanism by which clozapine could produce acute pancreatitis remained unclear. Nevertheless, we advocate a careful biological follow-up (measuring periodically the concentrations of amylase, lipase and triglycerides) during the treatment by clozapine.

[Histological, histochemical and histophysiological changes of the exocrine pancreas and stomach fundus in Anguilla anguilla L. in the course of postlarval development]. / Einige Untersuchungen zu den histologischen, histochemischen und histophysiologischen Veränderungen des exokrinen Pankreas und des Magenfundus bei Anguilla anguilla L. im Verlauf der postlarvalen Entwicklung

During the postlarval development of eels exocrine status of pancreas and fundus was investigated. Therefore results of histomorphological, histophysiological and histochemical tests were interpreted. The conclusion is that there is no secretory activity till stage I. No relation exists between secretory activity and food-supply.

On the structure of EEG development.

Two different descriptions of EEG maturation are compared: a broad-band spectral parameters (BBSPs) model and a recently developed xi-alpha (xi alpha) model. 'Developmental equations' were obtained for both parameter sets using 1 min, eyes closed EEG sample from 165 normal children (5-12 years old). At each age, the xi alpha parameter set described the average spectrum more closely than the BBSP developmental equations. Furthermore, a more detailed picture of changes of spectral shape with age is possible with the xi alpha model. A computer simulation illustrates the possible appearance of fixed frequency bands as a byproduct of inadequate statistical models.

Intracerebral sources of human auditory-evoked potentials.

Evoked potentials to brief 1,000-Hz tones presented to either the left or the right ear were recorded from 30 electrodes arrayed over the head. These recordings were submitted to two different forms of source analysis: brain electric source analysis (BESA) and variable-resolution electromagnetic tomography (VARETA). Both analyses showed that the dominant intracerebral sources for the late auditory-evoked potentials (50-300 ms) were in the supratemporal plane and lateral temporal lobe contralateral to the ear of stimulation. The analyses also suggested the possibility of additional sources in the frontal lobes.

Invariant reversible QEEG effects of anesthetics.

Continuous recordings of brain electrical activity were obtained from a group of 176 patients throughout surgical procedures using general anesthesia. Artifact-free data from the 19 electrodes of the International 10/20 System were subjected to quantitative analysis of the electroencephalogram (QEEG). Induction was variously accomplished with etomidate, propofol or thiopental. Anesthesia was maintained throughout the procedures by isoflurane, desflurane or sevoflurane (N = 68), total intravenous anesthesia using propofol (N = 49), or nitrous oxide plus narcotics (N = 59). A set of QEEG measures were found which reversibly displayed high heterogeneity of variance between four states as follows: (1) during induction; (2) just after loss of consciousness (LOC); (3) just before return of consciousness (ROC); (4) just after ROC. Homogeneity of variance across all agents within states was found. Topographic statistical probability images were compared between states. At LOC, power increased in all frequency bands in the power spectrum with the exception of a decrease in gamma activity, and there was a marked anteriorization of power. Additionally, a significant change occurred in hemispheric relationships, with prefrontal and frontal regions of each hemisphere becoming more closely coupled, and anterior and posterior regions on each hemisphere, as well as homologous regions between the two hemispheres, uncoupling. All of these changes reversed upon ROC. Variable resolution electromagnetic tomography (VARETA) was performed to localize salient features of power anteriorization in three dimensions. A common set of neuroanatomical regions appeared to be the locus of the most probable generators of the observed EEG changes.

Evaluación videoelectroencefalográfica complementada con análisis espectral y de las fuentes generadoras del electroencefalograma en pacientes con epilepsia del lóbulo temporal medial resistente a los fármacos / Video-EEG evaluation complemented by spectral and EEG source analysis in patients with medication-resistant medial temporal lobe epilepsy

Objetivo. Evaluar la contribución de la monitorización prolongada videoelectroencefalográfica (video EEG) complementada con análisis espectral y de las fuentes generadoras del electroencefalograma (EEG) en la identificación de la zona epileptogénica de pacientes con epilepsia del lóbulo temporal medial candidatos a cirugía resectiva no lesional. Pacientesy métodos. Se evaluaron los patrones electrográficos del inicio ictal en más de 667 crisis correspondientes a 41 pacientes con diagnóstico clínico de epilepsia parcial resistente a fármacos. Para el análisis se utilizaron el software Harmonie y la tomografía eléctrica de resolución variable (VARETA). Resultados. Mediante video-EEG se determinó que el 53,6por ciento de lospacientes evaluados presentaba crisis parciales complejas de origen temporal; éstas se caracterizaron por una frecuencia media de 5,56 ± 1,56 Hz, mientras que las no temporales presentaron una frecuencia en el rango de 9,17 ± 3,32 Hz. La localizacióntopográfica de la frecuencia ictal dominante durante el período de energía espectral máxima en los pacientes conepilepsia del lóbulo temporal permitió distinguir a un grupo de pacientes con crisis mesiales y otros no mesiales que superaron el número determinado por la inspección visual del EEG: un 78,9 frente a un 47,3por ciento, respectivamente. Se evidenció unacoincidencia del 100por ciento entre la zona de inicio ictal definida por EEG de superficie complementada con análisis espectral, el generador de esta actividad definido por VARETA y la zona epileptogénica. Conclusiones. La información localizadora aportadapor el video-EEG complementada con el análisis espectral y de las fuentes del EEG permite localizar de forma no invasiva la zona epileptogénica en pacientes con epilepsia del lóbulo temporal medial aun cuando los estudios imaginológicos estructurales evidencian ausencia o bilateralidad de anomalías(AU)

Summary. Aim. To evaluate the value of prolonged video electroencephalographic (video-EEG) monitoring complemented with spectral and EEG source analysis in identifying the epileptogenic area in patients with medial temporal lobe epilepsy who are candidates for non-lesional resective surgery. Patients and methods. The electrographic patterns during the onset of seizures were evaluated in over 667 seizures from 41 patients with a clinical diagnosis of medication-resistant partial epilepsy. Analyses were performed using Harmonie software and variable resolution electrical tomography (VARETA). Results. Video- EEG was used to determine that 53.6percent of the patients evaluated suffered complex partial seizures of a temporal origin; these were characterised by having an average frequency of 5.56 ± 1.56 Hz, while the non-temporal seizures displayed a frequency within the range 9.17 ± 3.32 Hz. The topographic location of the dominant ictal frequency during the period of maximum spectral energy in patients with temporal lobe epilepsy enabled us to draw a distinction between a group of patients withmesial seizures and those with non-mesial seizures that exceeded the number that was determined by visual inspection of the EEG, that is, 78.9 versus 47.3percent, respectively. There was a 100percent coincidence between the area where the seizures began asdefined by surface EEG complemented with spectral analysis, the generator of this activity as defined by VARETA and the epileptogenic region. Conclusions. The localising information provided by video-EEG complemented with spectral and EEG source analysis allows for non-invasive location of the epileptogenic region in patients with medial temporal lobe epilepsy even when structural imaging studies show an absence or bilaterality of abnormalities(AU)