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Exploring brain function with magnetic resonance imaging.

Since its invention in the early 1990s, functional magnetic resonance imaging (fMRI) has rapidly assumed a leading role among the techniques used to localize brain activity. The spatial and temporal resolution provided by state-of-the-art MR technology and its non-invasive character, which allows multiple studies of the same subject, are some of the main advantages of fMRI over the other functional neuroimaging modalities that are based on changes in blood flow and cortical metabolism. This paper describes the basic principles and methodology of fMRI and some aspects of its application to functional activation studies. Attention is focused on the physiology of the blood oxygenation level-dependent (BOLD) contrast mechanism and on the acquisition of functional time-series with echo planar imaging (EPI). We also provide an introduction to the current strategies for the correction of signal artefacts and other image processing techniques. In order to convey an idea of the numerous applications of fMRI, we will review some of the recent results in the fields of cognitive and sensorimotor psychology and physiology.

Artifacts↗

Basic concepts of artificial neural network (ANN) modeling and its application in pharmaceutical research.

Artificial neural networks (ANNs) are biologically inspired computer programs designed to simulate the way in which the human brain processes information. ANNs gather their knowledge by detecting the patterns and relationships in data and learn (or are trained) through experience, not from programming. An ANN is formed from hundreds of single units, artificial neurons or processing elements (PE), connected with coefficients (weights), which constitute the neural structure and are organised in layers. The power of neural computations comes from connecting neurons in a network. Each PE has weighted inputs, transfer function and one output. The behavior of a neural network is determined by the transfer functions of its neurons, by the learning rule, and by the architecture itself. The weights are the adjustable parameters and, in that sense, a neural network is a parameterized system. The weighed sum of the inputs constitutes the activation of the neuron. The activation signal is passed through transfer function to produce a single output of the neuron. Transfer function introduces non-linearity to the network. During training, the inter-unit connections are optimized until the error in predictions is minimized and the network reaches the specified level of accuracy. Once the network is trained and tested it can be given new input information to predict the output. Many types of neural networks have been designed already and new ones are invented every week but all can be described by the transfer functions of their neurons, by the learning rule, and by the connection formula. ANN represents a promising modeling technique, especially for data sets having non-linear relationships which are frequently encountered in pharmaceutical processes. In terms of model specification, artificial neural networks require no knowledge of the data source but, since they often contain many weights that must be estimated, they require large training sets. In addition, ANNs can combine and incorporate both literature-based and experimental data to solve problems. The various applications of ANNs can be summarised into classification or pattern recognition, prediction and modeling. Supervised 'associating networks can be applied in pharmaceutical fields as an alternative to conventional response surface methodology. Unsupervised feature-extracting networks represent an alternative to principal component analysis. Non-adaptive unsupervised networks are able to reconstruct their patterns when presented with noisy samples and can be used for image recognition. The potential applications of ANN methodology in the pharmaceutical sciences range from interpretation of analytical data, drug and dosage form design through biopharmacy to clinical pharmacy.

Algorithms↗

Scanning force microscopy in the applied biological sciences.

Fifteen years after its invention, the scanning force microscope (SFM) is rooted deep in the biological sciences. Here we discuss the use of SFM in biotechnology and biomedical research. The spectrum of applications reviewed includes imaging, force spectroscopy and mapping, as well as sensor applications. It is our hope that this review will be useful for researchers considering the use of SFM in their studies but are uncertain about its scope of capabilities. For the benefit of readers unfamiliar with SFM technology, the fundamentals of SFM imaging and force measurement are also briefly introduced.

Journal Article↗

The medium and the message.

Communication between doctor and patient is examined in relation to ways of describing the institution of medicine, the rules of engagement between doctor and patient, and the language they employ. Medicine and its institutions are presented in metaphorical terms; a theatrical taxonomy of consultations between patient and doctor is suggested; and patient-doctor communication is considered in the light of the pervasiveness of mistranslation. Because it is possible to invent a wide range of alternative metaphors for medical institutions, to envisage many different sorts of dramatic possibilities in the patient-doctor encounter, and to develop a respect for the particularity of all language, optimism is expressed about the future of research, teaching and practice in doctor-patient communication.

Communication↗

[Smoking cessation counseling center in a French hospital: Effectiveness at one year and predictors of outcome].

OBJECTIVE: To assess the effectiveness at 1 year of a hospital clinic providing individual management of persons seeking to stop smoking and the factors predictive of failure. METHODS: This prospective descriptive study included smokers seeking assistance at this hospital clinic over a 1-year period. This analysis excludes persons with schizophrenia and those who came only to a first consultation. Treatment methods were those recommended by the 1998 consensus conference: nicotine substitutes or slow-release bupropion, depending on the level of nicotine dependence, cognitive-behavioral therapy appropriate for smoking in all cases, and the prescription before cessation of a selective serotonin re-uptake inhibitor (SSRI) for patients with anxiety or depressive disorders. Assessment was based on patients' self-report at 3 months, 6 months and 1 year. RESULTS: Of 99 smokers who came for at least one consultation, 38 were excluded and 61 were considered in the analysis. At one year, 18 patients (29.5%) were still not smoking. Of the 43 patients who resumed smoking, 27 (63%) did so during the first three months after cessation. According to the multivariate analysis, only female sex (p = 0.0173) and early end to follow-up (p = 0.0023) were significantly associated with the risk of relapse at 1 year. CONCLUSION: The study confirmed the usefulness of specialized medical support over a one-year period and highlighted the difficulties of smoking cessation for women, who appear to need a new not yet invented approach. The other standard factors predictive of failure were not observed, possibly because of either the broad prescription of SSRIs in cases of anxiety- or depression-related comorbidity or the statistical limitations associated with the population size.

Adult↗

Re-engineering: a prescription for hospitals.

Previously applied mostly in large, private sector corporations, "re-engineering" is fast becoming a tool that hospitals can use to break away from the old to find a new and better way of doing things. Re-engineering, however, first requires strong leadership which is committed to employee involvement and re-inventing the process design to meet the needs of the customers. Once the transition has been completed, the processes and the organization must continue to be managed differently. This article reviews the processes involved in re-engineering, and discusses the implementation of the initiative at the Sunnybrook Health Science Centre in Toronto.

Hospital Restructuring↗

[Transbronchial needle aspiration].

Transbronchial needle aspiration was initially invented in 1949 by Schieppati. After its adaptation to the flexible bronchoscope in 1983 by Wang this technique has gain firm indications in the diagnosis and staging of lung cancer, in peripheral pulmonary nodules and masses; in the evaluation of endobronchial masses; in the disease of submucosal, in benign diseases, i.e. sarcoidoses and mediastinal cysts and abscesses. The yield of this technique published in the literature makes it more than useful. The material available has different indications and usefulness in different clinical settings. Despite the almost absence of complications this procedure is yet underutilized, in spite of its twenty years of results which may be due to the established routines and the lack of training.

Biopsy, Needle↗

Reflections on my involvement in orthodontic research.

Some years ago, Professor Takihashi, who was then the greatest living professor of orthodontics in Japan, called on us in Ann Arbor just before his retirement. I asked Dr. Takihashi who would replace him? and he replied, "There's a young man who will do better than I because he will be able to take Japanese orthodontics to the world and bring the world's orthodontics to Japan." That young man was Fujio Miura. Fujio Miura has, in the years since Takihashi spoke to me, written one of the most amazing records in the history of our specialty. His research is as far ranging as anyone's. For example, in biology he has written well on the ethnology of Japanese craniofacial morphology and that of the aborigines in Japan. He has written on developmental biology and on the tissue reaction of tooth movements. In metallurgy he has contrived alloys that have revolutionized our appliances, for he was a pioneer in the use of nickel-titanium wires. Fujio Miura invented direct bonding. Professor Miura has fulfilled Professor Takihashi's predictions well for he has become the most famous orthodontic professor in Japan's history. It is interesting to see that his students occupy most of the chairs of orthodontics in Japan and many elsewhere. Miura is an accomplished artist who has exhibited his work. This personable scholar probably attends more meetings of the American Association of Orthodontists Society than most American members, and he is equally at home in the European society, and many other orthodontic groups in the world.

Dental Alloys↗

Preoperative assessment: pulmonary.

Understanding the risk factors for the development of PPCs allows targeted interventions aimed at reducing the frequency and severity of PPCs. The broad categories of what increases the likelihood of developing a PPC are understood but specific understanding of how individual risk factors act to cause PPCs is lacking,and there is little information regarding the interaction or synergy between risk factors. Further research is needed to define the nature of risk factors and develop better predictive models of patients at risk for developing PPCs. It is clear that anesthetic agents produce significant changes in the respiratory system but further information is needed to define how such changes contribute, if at all, to the subsequent development of PPCs. The ongoing controversy regarding the value of regional analgesia or anesthetic techniques, especially epidural analgesia and anesthesia, in reducing or preventing PPCs requires well-done randomized clinical trials. Further research is also needed in the area of postoperative care such as interventions in patients with OSA or the use of inventive spirometric techniques.

Anesthesia↗

A dentist's experience with change of hand dominance.

Ten years ago as a young dentist, the author found himself completely unable to engage in his practice as a result of a serious nerve injury permanently affecting his dominant right hand and forearm. Some unique opportunities and chance encounters have enabled him to overcome the permanence of the injury and to advance into a dental specialty field considered very demanding bimanually. Chronicled below are the process by which this occurred and, in particular, the author's assessment of what led to the necessary change of hand dominance. Also described is an interesting process that was required by the admissions committee of the postgraduate specialty training program as part of their assessment of the author's ability to adequately perform clinical procedures prior to his admission into the program. Descriptions of certain office design changes as well as changes in instrumentarium and techniques and the inventions to support those changes are described.

Adult↗

Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68.

In this study, the Sickness Impact Profile (SIP) and the SIP68 are studied for their ability to detect changes in health-related behavioral status. Methodological approaches toward responsiveness are invented and discussed. Next, literature findings on the responsiveness of the SIP are presented and judged for their validity. The SIP appeared to be able to demonstrate changes in the expected direction and in accordance with changes detected by other instruments. Using data from seven different longitudinal projects in populations with different diagnoses, the responsiveness of both the SIP136 and the SIP68 are subsequently studied and compared. In all populations, changes in functional status were indicated by both instruments. In terms of effect sizes, the SIP136 and the SIP68 do not differ significantly in their responsiveness. Moreover, changes detected by both SIPs appear to be valid representations of changes in health-related functional status.

Activities of Daily Living↗

A celebration of the new head and an evaluation of the new mouth.

Twenty years ago now, Carl Gans and Glen Northcutt proposed that the main invention of vertebrates was a new head, with its full array of sensory organs involved in an active predatory lifestyle. Tracing back the embryological origin of these structures, they showed how all are primarily derived from the neural crest and the placodes, two transient ectodermal cell populations in the embryo. These cell types were then used for further innovations, such as a new mouth in jawed vertebrates. The interplay between patterning and plasticity of the neural crest is largely responsible for the endless variation of vertebrate craniofacial features in evolution.

Animals↗

Ethnicity and recruitment rates in clinical research studies.

The concept of a majority population in America is rapidly giving way to a collection of minority populations. To ensure representative study sample populations, nurse researchers must gain the ability to access many culturally and ethnically diverse groups. By examining common challenges to recruitment, many of the pitfalls of minority recruitment may be avoided. In looking at past clinical research studies and evaluating their successes and failures, nurse researchers can gain insight into how to design clinical research studies with sample populations representative of the increasingly diverse American population. Through careful planning, gaining knowledge of target populations, and inventive recruitment methods, the changing face of the American population can be represented in nursing research.

Clinical Nursing Research↗

Hypertrophic olivary degeneration following surgical excision of brainstem cavernous hemangioma: a case report.

Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubo-olivary pathway. It is distinguished from other types of neuronal degeneration in that hypertrophy, rather than atrophy, takes place in the neurons in the inferior olivary nucleus. Prior to the invention of Magnetic Resonance Imaging (MRI), HOD was difficult to be detected, and a firm diagnosis could only be made at autopsy. We present a case of bilateral HOD following surgical excision of a cavernous hemangioma in the brainstem. The literature and imaging findings of this uncommon condition are reviewed.

Adult↗

Transcervical embryo collection in Boer goats.

Two experiments were conducted, aimed at improving the practicability of the method for transcervical embryo collection in Boer goats described by Pereira et al. [Pereira, R.J.T.A., Sohnrey, B., Holtz, W., 1998. J. Anim. Sci. 76, 360-363]. Invention of a hammock-like restraining device, use of a wider-bore flushing catheter and a modified flushing mode contributed toward this end. The importance of a luteolytic prostaglandin F(2alpha)-treatment [Pereira et al., 1998] was confirmed. In Experiment 1, administration of PGF(2alpha) 8h before does are flushed, increased the recovery rate from 43 to 79% (P<0.05). Advancing the PG F(2alpha)-treatment to 24h before flushing was instrumental in further enhancing embryo recovery rate. The amount of time required for flushing was reduced by about 20min (P<0.05) and the number of embryos recovered from the first 10 out of 30 flushes amounted to more than 80%, compared to 50% (P<0.05) when treating 8h before flushing. Administration of 1IU of oxytocin at the onset of flushing did not have any significant effect. When applying the findings of this investigation, the time required for flushing may be reduced from about 4h [Pereira et al., 1998] to less than 45min per doe and the required number of person involved decreased from four to two persons.

Journal Article↗

The tripartite tricarboxylate transporter (TTT) family.

Extracytoplasmic solute binding receptors are constituents of primary and secondary active transport systems. Previous studies have shown that the constituents of two such families (ABC and TRAP-T) occur in bacteria and archaea and have undergone minimal shuffling of constituents between systems during evolutionary history. We here show that a third family of binding receptor-dependent transporters, the tripartite tricarboxylate transporter (TTT) family, the prototype of which is the TctABC system of Salmonella typhimurium, occurs in many bacteria but not in archaea or eukaryotes. Phylogenetic analyses suggest that these systems have evolved from a primordial tripartite system with only two out of 39 possible examples of shuffling of constituents between systems. The occurrence of TctA homologues in many bacteria and archaea that apparently lack corresponding TctB and TctC homologues suggests that the appearance of tripartite systems was a relatively recent evolutionary invention that occurred after the divergence of archaea and eukaryotes from bacteria.

Amino Acid Sequence↗

Molecular mechanisms of action of bacterial exotoxins.

Toxins are one of the inventive strategies that bacteria have developed in order to survive. As virulence factors, they play a major role in the pathogenesis of infectious diseases. Recent discoveries have once more highlighted the effectiveness of these precisely adjusted bacterial weapons. Furthermore, toxins have become an invaluable tool in the investigation of fundamental cell processes, including regulation of cellular functions by various G proteins, cytoskeletal dynamics and neural transmission. In this review, the bacterial toxins are presented in a rational classification based on the molecular mechanisms of action.

Animals↗

A contribution to the history of renal structure knowledge (from Galen to Malpighi).

This work documents the progressive gain in knowledge on renal anatomy acquired by anatomists from Galen to Malpighi. Galen, with albeit his rather imaginative explanations, was the first anatomist to recognize the urine producing function of the kidney. His influence was felt up to the Middle Ages; his followers imagined the presence of two cavities within the kidney that were separated by a porous membrane that they called the "colatorium" which was capable of filtering the urine from the blood. It was only later that Berengario da Carpi, divorcing himself from Galenic dogmatism, finally dismissed the presence of the colatorium. He described the renal papillae and gave the first elementary model of renal vascularization. Further important progress was due to the studies of Falloppius and Eustachius who brought contemporary understanding of renal structure to the limit of what could be seen with the unaided eye. They distinguished the difference between the unilobar canine kidney and the human multilobar organ, they also described the minor and major calyces and, furthermore, guessed at the canalicular structure of its parenchyma. Highmore was then responsible for the description of the archiform vessels which he hypothesized as an arterio-venous anastomotic net between the renal cortex and medulla. With the invention of the microscope, new doors opened for the study of renal structure. Bellini proved the canalicular organization of the parenchyma and, moreover, described the interlobular vessels. Malpighi then described the glomerulus and its relation to the intrarenal excretory ducts. The basis had now been laid for the beginning of modern nephrology.

Anatomy↗