• MeSH
• Brain Mapping MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Statistika
• NML Fields
• statistika, zdravotnická statistika

Výskyt muzikálních halucinací je spojován nejčastěji s hypakuzí, psychiatrickým onemocněním (např. obsedantně kompulzivní poruchou, schizofrenií, afektivními poruchami), fokální mozkovou lézí, epilepsií a intoxikacemi. Metodika: 60letá žena hospitalizovaná v Psychiatrickém centru Praha pro 4 roky trvající muzikální halucinace a 3 roky se rozvíjející obsedantně kompulzivní poruchu (OKP) byla vyšetřena 18FDG PET a léčena repetitivní transkraniální magnetickou stimulací (rTMS). Od 15 let je léčena pro epilepsií (v 50 letech prodělala anteromesiobazální resekci pravého temporálního laloku). V 58 letech u ní byla zjištěna hypakuze. Pacientka byla léčena fluvoxaminem, sertralinem, haloperidolem, tiapridem, melperonem, lamotriginem, gabapentinem a při hospitalizaci escitalopramem a risperidonem. Tato léčba byla bez efektu na muzikální halucinace a obsedantně kompulzivní příznaky. Výsledky: U pacientky byl detekován snížený metabolizmus pravého předního mediálního temporálního laloku. Zvýšený metabolizmus byl nalezen v orbitofrontální kůře bilaterálně – BA 11, středním/dolním frontálním gyru – BA 46 bilaterálně a levém nc. putamen. Na základě PET vyšetření byla zahájena rTMS frontálně bilaterálně (1 Hz, intenzita 100 % motorického prahu, 900 pulzů na každou hemisféru, v 17 sezeních). Během léčby rTMS nedošlo k významné změně obsedantně kompulzivních příznaků (škála Y – BOCS), ale došlo k redukci muzikálních halucinací (vizuální analogová škála) o 44 %. Diskuze: Hypometabolizmus v pravém temporálním laloku odpovídá místu po částečné resekci laloku. Hypermetabolizmus prefrontálně a v bazálních gangliích je v souladu s diagnózou OKP, ale i muzikálních halucinací. Závěr: Podle našich znalostí jde o první pozorování, že rTMS aplikovaná prefrontálně může snižovat intenzitu muzikálních halucinací.

Musical hallucinations are associated with hypacusis, psychiatric disorders (obsessive – compulsive disorder, schizophrenia, mood disorders, etc.), brain focal lesion, epilepsy and intoxication. Methods: A 60 year-old woman (with a history of epilepsy since age of 15, anteromesiobasal resection of the right temporal lobe at the age of 50 and hypacusis from the age of 58) was hospitalized at the Psychiatric centre Prague with musical hallucinations which started at age of 56 and obsessive-compulsive disorder (OCD) since age 57. She was treated with fluvoxamine, sertraline, haloperidole, tiapride, melperone, lamotrigine, gabapentine and with escitalopram and risperidone during current hospitalizations. These CNS drugs had no effect on the musical hallucinations or obssessive- compulsive symptoms. She was assessed with 18FDG PET. Results: 18FDG PET detected a decreased metabolism in the right anterior temporal lobe and an increased metabolism in the orbitofrontal cortex BA 11, middle/inferior frontal gyrus BA 46 bilateraly, and left ncl. putamen. Based on the PET scan we started to administer rTMS over the prefrontal cortex bilaterally (1 Hz, 100 % motor treshold, 900 pulses under each hemispheres in 17 sessions). We did not see a clinical improvement in the specific rating scale for OCD (Y– BOCS), but rTMS led to a reduction (Visual analog scale) in musical hallucinations by 44 %. Discussion: Hypometabolism in the right temporal lobe reflects the state after anteromesiobasal resection of the right temporal lobe. Hypermetabolism in the prefrontal cortex and nc. putamen is in agreement with neuroimaging findings for OCD and musical hallucinations. Conclusion: To our knowledge, this is the first report on influencing musical hallucinations with prefrontal rTMS.

• MeSH
• Epilepsy etiology   complications   therapy   MeSH
• Research Support as Topic MeSH
• Hallucinations MeSH
• Deep Brain Stimulation trends   utilization   MeSH
• Music psychology   MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   trends   utilization   MeSH
• Hearing Loss complications   MeSH
• Obsessive-Compulsive Disorder etiology   therapy   MeSH
• Positron-Emission Tomography instrumentation   utilization   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

OBJECTIVE: This study was designed to use statistical parametric mapping of interictal positron-emission tomography using [18F]Fluorodeoxyglucose (FDG-PET) to compare the brain metabolisms of patients with mesial temporal lobe epilepsy (MTLE)/hippocampal sclerosis and controls. Another aim of this study was to analyze the potential differences among patients in terms of epilepsy duration, side of hippocampal sclerosis, histopathological findings, insult in their history, and postoperative outcomes. METHODS: We analyzed FDG-PET scans from 49 patients with MTLE/hippocampal sclerosis and 24 control subjects. We analyzed the differences in regional glucose metabolism between the patients and the control group and within the patient group using multiple variables. RESULTS: We observed widespread hypometabolism in the patient group in comparison with the control group in temporal and extratemporal areas on the epileptogenic side (ES). On the nonepileptogenic side (NES), we observed the most hypometabolism in the thalamus and the anterior and middle cingulate gyrus. In the group of patients with more severe hippocampal sclerosis, we observed statistically significant hypometabolism in the insula on the ES. In patients with poor postoperative outcomes, we found statistically significant hypometabolism in the insula on the ES and the temporal pole (TP) on the NES. Patients with any insult in their history showed hypermetabolism in the TP on both sides. CONCLUSION: Our study showed that there are widespread changes in metabolism in patients with MTLE in comparison to controls, either inside or outside the temporal lobe. There are significant differences among these patients in terms of postoperative outcomes, degree of hippocampal sclerosis, and insults in their history.

• MeSH
• Adult MeSH
• Epilepsy, Temporal Lobe diagnostic imaging   drug therapy   pathology   surgery   MeSH
• Fluorodeoxyglucose F18 metabolism   MeSH
• Glucose metabolism   MeSH
• Hippocampus diagnostic imaging   metabolism   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Brain metabolism   MeSH
• Cerebral Cortex pathology   MeSH
• Postoperative Period MeSH
• Positron-Emission Tomography methods   MeSH
• Predictive Value of Tests MeSH
• Sclerosis diagnostic imaging   metabolism   pathology   MeSH
• Temporal Lobe pathology   MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• Conspectus
• Obecná genetika. Obecná cytogenetika. Evoluce
• NML Fields
• genetika, lékařská genetika

OBJECTIVE: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal-interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE). METHODS: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperative MRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization. RESULTS: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method. CONCLUSION: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.

• MeSH
• Adult MeSH
• Electroencephalography MeSH
• Epilepsy * pathology   surgery   MeSH
• Tomography, Emission-Computed, Single-Photon * MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * MeSH
• Adolescent MeSH
• Young Adult MeSH
• Brain pathology   physiopathology   MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

Cíl: Užitím inovativní metody analýzy záznamů funkční magnetické rezonance (resp. určení efektivní konektivity) objektivizovat neuroplasticitu po fyzioterapii u nemocných s roztroušenou sklerózou mozkomíšní. Soubor a metodika: Dvanáct nemocných s roztroušenou sklerózou (průměrný věk 44,3 ? 9,2 let, EDSS 3,7 ? 0,9, délky onemocnění 9,3 ? 6,0 let) podstoupilo dvouměsíční fyzioterapii – Motorické programy aktivující terapii. Na začátku a na konci facilitačního fyzioterapeutického programu (2× týdně, 1 hod) bylo provedeno klinické vyšetření zaměřené na funkci horních končetin (hodnocení třesu, diadochokinézy, taxe, kvalitativní svalové síly a spasticity) a vyšetření funkční magnetickou rezonancí během motorické úlohy prstů. Z dat funkční rezonance byly analýzou v programu Statistical parametric mapping určeny síly efektivní konektivity mezi suplementární motorickou areou a primárními motorickými oblastmi. Kontrolní skupinu tvořilo 12 zdravých dobrovolníků (průměrný věk 39,4 ? 12,2 let). Výsledky: Analýza efektivní konektivity ukázala silné spojení mezi suplementární motorickou areou a oběma primárními motorickými oblastmi (pa­cienti měli většinou silnější konektivitu než zdravé kontroly, významně mezi suplementární motorickou areou a primární motorickou oblastí vlevo; p = 0,005). Efektivní konektivita mezi levou a pravou primární motorickou oblastí byla celkově významně slabší. Po terapii došlo u nemocných ke zlepšení ve všech klinických testech (v indexu pravé ruky p < 0,001, v indexu levé ruky p < 0,001), nebyly ale prokázány signifikantní změny efektivní konektivity. Závěr: Analýza efektivní konektivity je jedna z cest k objektivizaci mozkové plasticity, a to nejenom z anatomického, ale především z funkčního hlediska. Terapie měla jednoznačný pozitivní vliv na klinické funkce, avšak signifikantní změny efektivní konektivity po terapii se neprokázaly.

Aim: The aim was to objectify neuroplasticity after physiotherapy using an innovative method of functional magnetic resonance imaging data analysis (determination of effective connectivity) in multiple sclerosis patients. Material and methods: Twelve patients (mean: age 44.3 ? 9.2 years, EDSS 3.7 ? 0.9, disease duration 9.3 ? 6.0 years underwent Motor program activation therapy (one hour therapy, twice a week). Clinical and fMRI examination during a motoric task for fingers was carried out before and after the therapy. The clinical examination focused on the upper extremity function (evaluation of tremor, diadochokinesis, ataxia, muscle strength and spasticity). Effective connectivity between supplementary motor and right and left primary motor areas was determined using the Statistical Parametric Mapping software. A control group consisted of 12 healthy controls (mean age 39.4 ? 12.2). Results: The analysis of effective connectivity showed strong connection between the supplementary motor area and both primary motor areas (patients had stronger connection in more cases than healthy controls, significant between the supplementary motor area and the left primary motor area, p = 0.005). Effective connectivity between the right and left primary motor areas was significantly weaker. After the therapy, improvement occurred in all the clinical tests (right hand index p < 0.001, left hand index p < 0.001) but no changes were observed in effective connectivity. Conclusion: Effective connectivity represents a possible approach to objectification of brain plasticity. Facilitation physiotherapy had a significant effect on clinical function while significant changes of effective connectivity were not demonstrated. Key words: multiple sclerosis – physiotherapy techniques – functional magnetic resonance imaging – neuroplasticity The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

• Keywords
• efektivní konektivita,
• MeSH
• Adult MeSH
• Upper Extremity MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * statistics & numerical data   MeSH
• Brain Mapping MeSH
• Motor Cortex MeSH
• Statistics, Nonparametric MeSH
• Neuronal Plasticity MeSH
• Pilot Projects MeSH
• Multiple Sclerosis * physiopathology   therapy   MeSH
• Case-Control Studies MeSH
• Physical Therapy Modalities * MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Facial allotransplantation requires a detailed arterial and venous assessment for surgical planning. Target vessels are often depleted by multiple reconstructive attempts or the severe facial injury itself. The purpose of this study was to retrospectively compare the diagnostic performance of computed tomography and magnetic resonance angiography in the preoperative assessment. METHODS: Four-dimensional (three spatial planes plus time) computed tomographic and magnetic resonance images including 126 potential vessels (76 arteries and 50 veins) from five candidates were analyzed independently by two radiologists using a four-point image quality scale. Computed tomographic versus magnetic resonance image quality was compared directly, using a computed tomographic angiography consensus read as reference standard. Vessels with metal artifact on magnetic resonance imaging, computed tomography, or both underwent separate analyses to determine the impact of metal implants on image quality. RESULTS: Considering all 126 vessels, the mean computed tomographic image quality was superior to that of magnetic resonance angiography. When considering individual vessels, all except for major neck vessels were better visualized by computed tomography. Images of 26 vessels were degraded by metal artifact; magnetic resonance image quality was inferior for those vessels. Considering images of major vessels with no metal artifact, there was no significant mean image quality difference between computed tomography and magnetic resonance imaging. CONCLUSIONS: Computed tomographic angiography should be used as the first-choice modality for preoperative imaging of facial transplant patients because, when compared with magnetic resonance imaging, the visualization of small vessels is far superior and images have fewer artifacts. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

• MeSH
• Surgical Flaps blood supply   MeSH
• Four-Dimensional Computed Tomography methods   MeSH
• Adult MeSH
• Transplantation, Homologous MeSH
• Humans MeSH
• Magnetic Resonance Angiography methods   MeSH
• Statistics, Nonparametric MeSH
• Face blood supply   surgery   MeSH
• Observer Variation MeSH
• Preoperative Care methods   MeSH
• Retrospective Studies MeSH
• Sensitivity and Specificity MeSH
• Sampling Studies MeSH
• Plastic Surgery Procedures methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Evaluation Study MeSH
• Comparative Study MeSH

BACKGROUND: Individuals with osteoporosis are predisposed to hip fracture during trips, stumbles or falls, but half of all hip fractures occur in those without generalised osteoporosis. By analysing ordinary clinical CT scans using a novel cortical thickness mapping technique, we discovered patches of markedly thinner bone at fracture-prone regions in the femurs of women with acute hip fracture compared with controls. METHODS: We analysed CT scans from 75 female volunteers with acute fracture and 75 age- and sex-matched controls. We classified the fracture location as femoral neck or trochanteric before creating bone thickness maps of the outer 'cortical' shell of the intact contra-lateral hip. After registration of each bone to an average femur shape and statistical parametric mapping, we were able to visualise and quantify statistically significant foci of thinner cortical bone associated with each fracture type, assuming good symmetry of bone structure between the intact and fractured hip. The technique allowed us to pinpoint systematic differences and display the results on a 3D average femur shape model. FINDINGS: The cortex was generally thinner in femoral neck fracture cases than controls. More striking were several discrete patches of statistically significant thinner bone of up to 30%, which coincided with common sites of fracture initiation (femoral neck or trochanteric). INTERPRETATION: Femoral neck fracture patients had a thumbnail-sized patch of focal osteoporosis at the upper head-neck junction. This region coincided with a weak part of the femur, prone to both spontaneous 'tensile' fractures of the femoral neck, and as a site of crack initiation when falling sideways. Current hip fracture prevention strategies are based on case finding: they involve clinical risk factor estimation to determine the need for single-plane bone density measurement within a standard region of interest (ROI) of the femoral neck. The precise sites of focal osteoporosis that we have identified are overlooked by current 2D bone densitometry methods.

• MeSH
• Densitometry methods   MeSH
• Femoral Neck Fractures diagnostic imaging   etiology   MeSH
• Bone Density physiology   MeSH
• Femur Neck diagnostic imaging   MeSH
• Humans MeSH
• Osteoporosis complications   diagnosis   MeSH
• Tomography, X-Ray Computed methods   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Case-Control Studies MeSH
• Check Tag
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: No universal solution, based on an approved pedagogical approach, exists to parametrically describe, effectively manage, and clearly visualize a higher education institution's curriculum, including tools for unveiling relationships inside curricular datasets. OBJECTIVE: We aim to solve the issue of medical curriculum mapping to improve understanding of the complex structure and content of medical education programs. Our effort is based on the long-term development and implementation of an original web-based platform, which supports an outcomes-based approach to medical and healthcare education and is suitable for repeated updates and adoption to curriculum innovations. METHODS: We adopted data exploration and visualization approaches in the context of medical curriculum innovations in higher education institutions domain. We have developed a robust platform, covering detailed formal metadata specifications down to the level of learning units, interconnections, and learning outcomes, in accordance with Bloom's taxonomy and direct links to a particular biomedical nomenclature. Furthermore, we used selected modeling techniques and data mining methods to generate academic analytics reports from medical curriculum mapping datasets. RESULTS: We present a solution that allows users to effectively optimize a curriculum structure that is described with appropriate metadata, such as course attributes, learning units and outcomes, a standardized vocabulary nomenclature, and a tree structure of essential terms. We present a case study implementation that includes effective support for curriculum reengineering efforts of academics through a comprehensive overview of the General Medicine study program. Moreover, we introduce deep content analysis of a dataset that was captured with the use of the curriculum mapping platform; this may assist in detecting any potentially problematic areas, and hence it may help to construct a comprehensive overview for the subsequent global in-depth medical curriculum inspection. CONCLUSIONS: We have proposed, developed, and implemented an original framework for medical and healthcare curriculum innovations and harmonization, including: planning model, mapping model, and selected academic analytics extracted with the use of data mining.

• MeSH
• Curriculum * MeSH
• Humans MeSH
• Models, Statistical * MeSH
• Education, Medical * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Duchenne muscular dystrophy (DMD) patients are monitored periodically for cardiac involvement, including cardiac MRI with gadolinium-based contrast agents (GBCA). Texture analysis (TA) offers an alternative approach to assess late gadolinium enhancement (LGE) without relying on GBCA administration, impacting DMD patients' care. The study aimed to evaluate the prognostic value of selected TA features in the LGE assessment of DMD patients. RESULTS: We developed a pipeline to extract TA features of native T1 parametric mapping and evaluated their prognostic value in assessing LGE in DMD patients. For this evaluation, five independent TA features were selected using Boruta to identify relevant features based on their importance, least absolute shrinkage and selection operator (LASSO) to reduce the number of features, and hierarchical clustering to target multicollinearity and identify independent features. Afterward, logistic regression was used to determine the features with better discrimination ability. The independent feature inverse difference moment normalized (IDMN), which measures the pixel values homogeneity in the myocardium, achieved the highest accuracy in classifying LGE (0.857 (0.572-0.982)) and also was significantly associated with changes in the likelihood of LGE in a subgroup of patients with three yearly examinations (estimate: 23.35 (8.7), p-value = 0.008). Data are presented as mean (SD) or median (IQR) for normally and non-normally distributed continuous variables and numbers (percentages) for categorical ones. Variables were compared with the Welch t-test, Wilcoxon rank-sum, and Chi-square tests. A P-value < 0.05 was considered statistically significant. CONCLUSION: IDMN leverages the information native T1 parametric mapping provides, as it can detect changes in the pixel values of LGE images of DMD patients that may reflect myocardial alterations, serving as a supporting tool to reduce GBCA use in their cardiac MRI examinations.

• MeSH
• Child MeSH
• Muscular Dystrophy, Duchenne * diagnostic imaging   pathology   MeSH
• Gadolinium MeSH
• Contrast Media MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Adolescent MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH