Untargeted metabolomics and infrared ion spectroscopy identify biomarkers for pyridoxine-dependent epilepsy

BackgroundPyridoxine-dependent epilepsy (PDE-ALDH7A1) is an inborn error of lysine catabolism that presents with refractory epilepsy in newborns. Biallelic ALDH7A1 variants lead to deficiency of α-aminoadipic semialdehyde dehydrogenase/antiquitin, resulting in accumulation of piperideine-6-carboxylate (P6C), and secondary deficiency of the important cofactor pyridoxal-5'-phosphate (PLP, active vitamin B6) through its complexation with P6C. Vitamin B6 supplementation resolves epilepsy in patients, but intellectual disability may still develop. Early diagnosis and treatment, preferably based on newborn screening, could optimize long-term clinical outcome. However, no suitable PDE-ALDH7A1 newborn screening biomarkers are currently available.MethodsWe combined the innovative analytical methods untargeted metabolomics and infrared ion spectroscopy to discover and identify biomarkers in plasma that would allow for PDE-ALDH7A1 diagnosis in newborn screening.ResultsWe identified 2S,6S-/2S,6R-oxopropylpiperidine-2-carboxylic acid (2-OPP) as a PDE-ALDH7A1 biomarker, and confirmed 6-oxopiperidine-2-carboxylic acid (6-oxoPIP) as a biomarker. The suitability of 2-OPP as a potential PDE-ALDH7A1 newborn screening biomarker in dried bloodspots was shown. Additionally, we found that 2-OPP accumulates in brain tissue of patients and Aldh7a1-knockout mice, and induced epilepsy-like behavior in a zebrafish model system.ConclusionThis study has opened the way to newborn screening for PDE-ALDH7A1. We speculate that 2-OPP may contribute to ongoing neurotoxicity, also in treated PDE-ALDH7A1 patients. As 2-OPP formation appears to increase upon ketosis, we emphasize the importance of avoiding catabolism in PDE-ALDH7A1 patients.FundingSociety for Inborn Errors of Metabolism for Netherlands and Belgium (ESN), United for Metabolic Diseases (UMD), Stofwisselkracht, Radboud University, Canadian Institutes of Health Research, Dutch Research Council (NWO), and the European Research Council (ERC).

Comparison of Droplet Size, Coverage, and Drift Potential from UAV Application Methods and Ground Application Methods on Row Crops

Worldwide, the use of uncrewed aerial vehicles (UAVs) for pesticide application has grown tremendously in the past decade. Their adoption has been slower for Midwestern row crops. This study compared droplet size, coverage, and drift potential of sprays from UAV application methods to those from ground (implement) sprayer methods on corn in the Midwest. Droplet sizes measured during UAV spray trials [geometric mean diameters of 179 and 112 μm for UAV (boom) and UAV (no boom), respectively] were substantially smaller than those deposited during implement spray trials [mean diameters of 303 and 423 μm for implement (regular) and implement (pulse)]. Droplet coverage was high and localized in the middle swath of the field for the UAV with boom (10 to 30 droplets cm-2) and with no boom (60 droplets cm-2). Droplet coverage was broader, covering the entire field width for the implement methods (10 to 40 droplets cm-2). Vertical coverage of droplets was more uniform for UAV methods than implement methods. Although the UAVs produced smaller droplets than the implement methods, we still observed greater potential for downwind pesticide drift during the implement spray trials. Because localized application may be beneficial for pest control and drift reduction, the findings indicate a strong potential for "spot" or "band" spray coverage using UAV methods. This is likely due to the smaller size, reduced spray volumes, and increased agility of UAVs as compared to more conventional methods.

Dual-hormone artificial pancreas: benefits and limitations compared with single-hormone systems

Technological advances have made the artificial pancreas a reality. This has the potential to improve the lives of individuals with Type 1 diabetes by reducing the risk of hypoglycaemia, achieving better overall glucose control, and enhancing quality of life. Both single-hormone (insulin-only) and dual-hormone (insulin and glucagon) systems have been developed; however, a focused review of the relative benefits of each artificial pancreas system is needed. We reviewed studies that directly compared single- and dual-hormone systems to evaluate the efficacy of each system for preventing hypoglycaemia and maintaining glycaemic control, as well as their utility in specific situations including during exercise, overnight and during the prandial period. We observed additional benefits with the dual-hormone artificial pancreas for reducing the risk of hypoglycaemic events overall and during exercise over the study duration. The single-hormone artificial pancreas was sufficient for maintenance of euglycaemia in the overnight period and for preventing late-onset post-exercise hypoglycaemia. Future comparative studies of longer duration are required to determine whether one system is superior for improving mean glucose control, eliminating severe hypoglycaemia, or improving quality of life.

Excess psychosocial burden in women with diabetes and premature acute coronary syndrome

AIM

Diabetes is a stronger risk factor for acute coronary syndrome for women than men. We investigate whether behavioural and psychosocial factors contribute to the disparity in acute coronary syndrome risk and outcomes among women with diabetes relative to women without diabetes and men.

METHODS

Among 939 participants in the GENESIS-PRAXY cohort study of premature acute coronary syndrome (age ≤ 55 years), we compared the prevalence of traditional and non-traditional factors by sex and Type 2 diabetes status. In a case-only analysis, we used generalized logit models to investigate the influence of traditional and non-traditional factors on the interaction of sex and diabetes.

RESULTS

In 287 women (14.3% with diabetes) and 652 men (10.4% with diabetes), women and men with diabetes showed a heavier burden of traditional cardiac risk factors compared with individuals without diabetes. Women with diabetes were more likely to be the primary earner and have more anxiety relative to women without diabetes, and reported worse perceived health compared with women without diabetes and men with diabetes. The interaction term for sex and diabetes (odds ratio (OR) 1.40, 95% confidence intervals (95% CI) 0.83-2.36) was diminished after additional adjustment for non-traditional factors (OR 1.12, 95% CI 0.54-2.32), but not traditional factors alone (OR 1.41, 95% CI 0.84-2.36).

CONCLUSIONS

We observed trends toward a more adverse psychosocial profile among women with diabetes and incident acute coronary syndrome compared with women without diabetes and men with diabetes, which may explain the increased risk of acute coronary syndrome in women with diabetes and may also contribute to worse outcomes.

Electrostatic dust collectors compared to inhalable samplers for measuring endotoxin concentrations in farm homes

Paired electrostatic dust collectors (EDCs) and daily, inhalable button samplers (BS) were used concurrently to sample endotoxin in 10 farm homes during 7-day periods in summer and winter. Winter sampling included an optical particle counter (OPC) to measure PM2.5 and PM2.5-10 . Electrostatic dust collectors and BS filters were analyzed for endotoxin using the kinetic chromogenic Limulus amebocyte lysate assay. Optical particle counter particulate matter (PM) data were divided into two PM categories. In summer, geometric mean (geometric standard deviation) endotoxin concentrations were 0.82 EU/m(3) (2.7) measured with the BS and 737 EU/m(2) (1.9) measured with the EDC. Winter values were 0.52 EU/m(3) (3.1) for BS and 538 EU/m(2) (3.0) for EDCs. Seven-day endotoxin values of EDCs were highly correlated with the 7-day BS sampling averages (r = 0.70; P < 0.001). Analysis of variance indicated a 2.4-fold increase in EDC endotoxin concentrations for each unit increase of the ratio of PM2.5 to PM2.5-10 . There was also a significant correlation between BS and EDCs endotoxin concentrations for winter (r = 0.67; P < 0.05) and summer (r = 0.75; P < 0.05). Thus, EDCs sample comparable endotoxin concentrations to BS, making EDCs a feasible, easy to use alternative to BS for endotoxin sampling.

Augmented environments for minimally invasive therapy: implementation barriers from technology to practice

Augmented environments for medical applications have been explored and developed in an effort to enhance the clinician's view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking and display technology into a common framework centered around the patient. However, few image guidance environments have been successfully translated into clinical use. Several challenges that contribute to the slow progress of integrating such environments into clinical practice are discussed here in terms of both technical and clinical limitations.

Standardisation of multilocus variable-number tandem-repeat analysis (MLVA) for subtyping of Salmonella enterica serovar Enteritidis

Salmonella enterica serovar (S.) Enteritidis is an important cause of food-borne infection in Europe and the United States. Further subtyping of isolates is necessary to support epidemiological data for the detection of outbreaks and identification of the vehicle of infection. Multilocus variable-number tandem-repeat analysis (MLVA) is reportedly more discriminatory and produces data that are easier to share via databases than other molecular subtyping methods. However, lack of standardisation of the methodology and interpretive criteria for data analysis has meant that comparison of data between laboratories can be problematic. On the basis of MLVA profiles of 298 S. Enteritidis isolates received at the Health Protection Agency’s Salmonella Reference Unit and sequence analysis of selected isolates, we propose a MLVA scheme for S. Enteritidis based on five loci (SENTR4, SENTR5, SENTR6, SENTR7 and SE-3) that have been selected from previously published S. Enteritidis MLVA schemes. A panel of reference strains has been developed that can be used by laboratories to normalise their raw fragment data to actual fragment sizes. We also provide recommendations for analysing and interpreting MLVA data. We urge laboratories to consider implementing these guidelines, thereby allowing direct comparison of data between laboratories irrespective of the platform used for fragment analysis, to facilitate international surveillance and investigation of international outbreaks.

Standardisation of multilocus variable-number tandem-repeat analysis (MLVA) for subtyping of Salmonella enterica serovar Enteritidis

Binary file ES_Abstracts_Final_ECDC.txt matches

Fusion and visualization of intraoperative cortical images with preoperative models for epilepsy surgical planning and guidance

OBJECTIVE

During epilepsy surgery it is important for the surgeon to correlate the preoperative cortical morphology (from preoperative images) with the intraoperative environment. Augmented Reality (AR) provides a solution for combining the real environment with virtual models. However, AR usually requires the use of specialized displays, and its effectiveness in the surgery still needs to be evaluated. The objective of this research was to develop an alternative approach to provide enhanced visualization by fusing a direct (photographic) view of the surgical field with the 3D patient model during image guided epilepsy surgery.

MATERIALS AND METHODS

We correlated the preoperative plan with the intraoperative surgical scene, first by a manual landmark-based registration and then by an intensity-based perspective 3D-2D registration for camera pose estimation. The 2D photographic image was then texture-mapped onto the 3D preoperative model using the solved camera pose. In the proposed method, we employ direct volume rendering to obtain a perspective view of the brain image using GPU-accelerated ray-casting. The algorithm was validated by a phantom study and also in the clinical environment with a neuronavigation system.

RESULTS

In the phantom experiment, the 3D Mean Registration Error (MRE) was 2.43 ± 0.32 mm with a success rate of 100%. In the clinical experiment, the 3D MRE was 5.15 ± 0.49 mm with 2D in-plane error of 3.30 ± 1.41 mm. A clinical application of our fusion method for enhanced and augmented visualization for integrated image and functional guidance during neurosurgery is also presented.

CONCLUSIONS

This paper presents an alternative approach to a sophisticated AR environment for assisting in epilepsy surgery, whereby a real intraoperative scene is mapped onto the surface model of the brain. In contrast to the AR approach, this method needs no specialized display equipment. Moreover, it requires minimal changes to existing systems and workflow, and is therefore well suited to the OR environment. In the phantom and in vivo clinical experiments, we demonstrate that the fusion method can achieve a level of accuracy sufficient for the requirements of epilepsy surgery.

Relationship of pulsed-field profiles with key phage types of Salmonella enterica serotype Enteritidis in Europe: results of an international multi-centre study

Salmonella is one of the most common causes of foodborne infection in Europe with Salmonella enterica serovar Enteritidis (S. Enteritidis) being the most commonly identified serovar. The predominant phage type for S. Enteritidis is phage type (PT) 4, although PT 8 has increased in incidence. Within these phage types, pulsed-field gel electrophoresis (PFGE) provides a method of further subdivision. The international project, Salm-gene, was established in 2001 to develop a database of PFGE profiles within nine European countries and to establish criteria for real-time pattern recognition. It uses DNA fingerprints of salmonellas to investigate outbreaks and to evaluate trends and emerging issues of foodborne infection within Europe. The Salm-gene database contains details of about 11 700 S. Enteritidis isolates, demonstrating more than 65 unique PFGE profiles. The clonal nature of S. Enteritidis is evidenced by the high similarity and distribution of PFGE profiles. Over 56% (6603/11 716) of the submitted isolates of several different phage types were profile SENTXB.0001, although this profile is most closely associated with PT 4. The next most common profiles, SENTXB.0002 and SENTXB.0005, were closely associated with PT 8 and PT 21 respectively. Studies to investigate the relationship of profile types with outbreaks and possible vehicles of infection suggest that the incidence of PFGE profile SENTXB.0002, and thus PT 8, in some countries may be due to importation of foods or food production animals from Eastern Europe, where PT 8 is amongst the most frequently identified phage types. Collation of subtyping data, especially in the commonly recognized phage types, is necessary in order to evaluate trends and emerging issues in salmonella infection.

3-D image guidance for minimally invasive robotic coronary artery bypass

BACKGROUND

The introduction of a robot-assisted microsurgical system has made endoscopic coronary artery bypass grafting (ECABG) possible. Despite the success of this approach, surgeons still require better visualization tools for pre-surgical planning and intra-operative image guidance. Such visualization tools could, for example, assist in the placement of thoracic ports to acquire optimum access to the target vessels. In this paper we discuss the essential steps toward image-guided completely endoscopic coronary bypass surgery with robot assistance, and we present our preliminary efforts toward the development of a three-dimensional (3-D) virtual cardiac surgical planning platform (VCSP) for ECABG.

METHODS

Preoperative 3-D images of the thorax acquired with computed tomography and electrocardiogram-gated magnetic resonance imaging are imported into VCSP. Using VCSP, a user may interactively visualize and manipulate the simulated thoracic ports in 3-D within the reconstructed thoracic region. We have also implemented a virtual endoscope to simulate the endoscopic view observed by the surgeon during the operation. Once the port placements for optimal access to the target vessels are determined, the positions of the simulated tools can be recorded and marked on the patient to specify the positions for port incisions.

RESULTS

A static thorax phantom was used to verify the port placements obtained from VCSP simulations. The angles and the distances between the ports, the endoscope and the markers that were placed on the surface of the phantom were measured, and the results were compared with those obtained from simulation. The physical measured distances and angles agreed with the simulated results with average errors of 4 mm and 2 degrees, respectively.

CONCLUSIONS

The VCSP image-guided surgical system allows a surgeon to visualize a patient's thorax in a 3-D interactive environment for planning surgical procedures, and to determine the optimum port placement based on preoperative 3-D images. However, during an operation, the positions and orientation of the heart and the coronary arteries are changed from their corresponding locations in the preoperative images due to carbon-dioxide insufflation, lung deflation, and dynamic motions of the beating heart. One of our future goals of this project is the use of mathematical models that correct for these changes so that our system could be applied to intra-operative image guidance.

Distribution of molecular subtypes within Salmonella enterica serotype Enteritidis phage type 4 and S. Typhimurium definitive phage type 104 in nine European countries, 2000-2004: results of an international multi-centre study

This study investigates the distribution of pulsed-field gel electrophoresis (PFGE) profiles within Salmonella enterica serotype Enteritidis phage type (PT) 4 and S. Typhimurium definitive phage type (DT) 104, from cases of human infection in nine European countries from 2000 to 2004. Isolates were subtyped using standardized methods and gel images submitted by each participating country to the coordinating centre (Health Protection Agency Centre for Infections, London, UK), where they were entered into a central database, developed within BioNumerics software, and designated using an agreed nomenclature. S. Enteritidis PT4 (n=3637) was differentiated into 38 different profiles. Simpson's index of diversity (D) of profiles ranged from 0.2 to 0.4. Profile SENTXB.0001 represented at least 80% of all profiles in each country. S. Typhimurium DT104 (n=1202) was differentiated into 28 different profile types. Simpson's D was at least 0.6 in all countries except in Austria and Italy. In both these countries over 74% of S. Typhimurium DT104 profiles were STYMXB.0013. Profile STYMXB.0061, was predominant in Denmark, Spain, Finland and England and Wales where it represented between 36% and 45% of profiles. Profile STYMXB.0001 represented nearly half of all profiles in Scotland and 23% in England and Wales. PFGE is proving useful for further discrimination within S. Enteritidis PT4 and S. Typhimurium DT104. Ascertainment of international outbreaks involving common serotypes and phage types may be increased by the timely pooling of PFGE profiles within a central database readily accessible to all participating countries.

Poly(vinyl alcohol) cryogel phantoms for use in ultrasound and MR imaging

Poly(vinyl alcohol) cryogel, PVA-C, is presented as a tissue-mimicking material, suitable for application in magnetic resonance (MR) imaging and ultrasound imaging. A 10% by weight poly(vinyl alcohol) in water solution was used to form PVA-C, which is solidified through a freeze-thaw process. The number of freeze-thaw cycles affects the properties of the material. The ultrasound and MR imaging characteristics were investigated using cylindrical samples of PVA-C. The speed of sound was found to range from 1520 to 1540 m s(-1), and the attenuation coefficients were in the range of 0.075-0.28 dB (cm MHz)(-1). T1 and T2 relaxation values were found to be 718-1034 ms and 108-175 ms, respectively. We also present applications of this material in an anthropomorphic brain phantom, a multi-volume stenosed vessel phantom and breast biopsy phantoms. Some suggestions are made for how best to handle this material in the phantom design and development process.

The Salm-gene project - a European collaboration for DNA fingerprinting for food-related salmonellosis

An external quality assessment of PFGE method to discriminate between salmonella serotypes and lysotypes was carried out by the Salm-Gene project in Europe. A set of 16 strains of S. Enteritidis was sent to 9 national salmonella reference laboratories. By using a harmonised protocol, the PFGE profiles produced were comparable between each centre. In most cases, there was at least 90% similarity between isolates tested in the different European laboratories and there was usually >95% similarity. This suggests that PFGE analyses are reproducible and therefore can be used as a valuable investigation tool combined with epidemiological data.

Surveillance and clinical relevance of vacA genotypes of Helicobacter pylori infecting dyspeptic patients in mid-Essex

The Helicobacter pylori vacuolating cytotoxin is a putative pathogenicity factor encoded by vacA, a mosaic gene with a global distribution. The vacA type prevalence and diversity of H. pylori isolated from antral gastric biopsies of 360 dyspeptic patients in mid-Essex, and of 79 patients from other locations, were investigated in order to test for links with disease severity. Mid (m)-region genotyping and subtyping by vacA HaeIII RFLP (restriction fragment length polymorphism) analysis showed that the m1 and m2 alleles were diverse, with 191 different subtypes. Variation in 44% of strains was accounted for by ten subtypes of which subtype v-1 represented a conserved core (33%) of the m1 form. Prevalence rates for combined mid and signal (s)-region genotypes were 40% for s1/m1, 46% for s1/m2, and 11% for s2/m2. Overall, vacA genotyping provided high typability and discrimination, but no specific RFLP markers could reliably predict a clinically significant presentation due to an H. pylori infection.

Single-enzyme amplified fragment length polymorphism and its applicability for Salmonella epidemiology

Amplified fragment length polymorphism (AFLP) is a PCR-based DNA fingerprinting technique whereby restriction fragments may be visualized without prior knowledge of nucleotide sequences. In AFLP analysis, bacterial genomic DNA is digested with a restriction enzyme and ligated to adapter oligonucleotides. A subset of DNA fragments are then amplified using primers which contain adapter-defined sequences. Selective amplification is achieved by the use of primers containing adapter-defined sequences with one additional arbitrary nucleotide. We used four primers complementary to the adapter sequence, but each differing in the final 3' base that extended into the fragment DNA. The usefulness of these primers for fingerprinting Salmonella enterica was assessed in a hierarchical manner. Using a single-enzyme approach (SAFLP) we have used this method to fingerprint 30 strains of S. enterica, belonging to 14 different serotypes. SAFLP profiles derived from Hind III fragments differentiated between the serotypes. In addition, SAFLP profiles for each serotype differentiated between the phage types and individual strains. The technique is significantly faster to perform than other DNA-based methods and has given reproducible and discriminatory results. This hierarchical SAFLP technique may provide a valuable addition to existing methods for the DNA fingerprinting of S. enterica for epidemiological studies.

Temperature dosimetry using MR relaxation characteristics of poly(vinyl alcohol) cryogel (PVA-C)

Hyperthermic therapy is being used for a variety of medical treatments, such as tumor ablation and the enhancement of radiation therapy. Research in this area requires a tool to record the temperature distribution created by a heat source, similar to the dosimetry gels used in radiation therapy to record dose distribution. Poly(vinyl alcohol) cryogel (PVA-C) is presented as a material capable of recording temperature distributions between 45 and 70 degrees C, with less than a 1 degrees C error. An approximately linear, positive relationship between MR relaxation times and applied temperature is demonstrated, with a maximum of 16.3 ms/ degrees C change in T(1) and 10.2 ms/ degrees C in T(2) for a typical PVA-C gel. Applied heat reduces the amount of cross-linking in PVA-C, which is responsible for a predictable change in T(1) and T(2) times. Temperature distributions in PVA-C volumes may be determined by matching MR relaxation times across the volumes to calibration values produced in samples subjected to known temperatures. Factors such as thermotolerance, perfusion effects, and thermal conductivity of PVA-C are addressed for potentially extending this method to modeling thermal doses in tissue.

Image-guided surgery: from X-rays to virtual reality

Since the discovery of X-rays, medical imaging has played a major role in the guidance of surgical procedures. While medical imaging began with simple X-ray plates to indicate the presence of foreign objects within the human body, the advent of the computer has been a major factor in the recent development of this field. Imaging techniques have grown greatly in their sophistication and can now provide the surgeon with high quality three-dimensional images depicting not only the normal anatomy and pathology, but also vascularity and function. One key factor in the advances in Image-Guided Surgery (IGS) is the ability not only to register images derived from the various imaging modalities amongst themselves, but also to register them to the patient. The other crucial aspect of IGS is the ability to track instruments in real time during the procedure, and to portray them as part of a realistic model of the operative volume. Stereoscopic and virtual-reality techniques can usefully enhance the visualization process. IGS nevertheless relies heavily on the assumption that the images acquired prior to surgery, and upon which the surgical guidance is based, accurately represent the morphology of the tissue during the surgical procedure. In many instances this assumption is invalid, and intra-operative real-time imaging, using interventional MRI, Ultrasound, and electrophysiological recordings are often employed to overcome this limitation. Although now in extensive clinical use, IGS is often currently perceived as an intrusion into the operating room. It must evolve towards becoming a routine surgical tool, but this will only happen if natural and intuitive human interfaces are developed for these systems.

Genetic diversity in the Helicobacter pylori cag pathogenicity island and effect on expression of anti-CagA serum antibody in UK patients with dyspepsia

AIMS

To investigate variation within the cag pathogenicity island (PAI) of Helicobacter pylori isolated from patients with dyspepsia in mid-Essex, and to evaluate the effect on expression of anti-CagA antibody.

METHODS

Sixty two isolates of H pylori cultured from gastric biopsies were screened by specific PCR assays for the presence of cagA and other gene markers (cagD and cagE, and virD4) in the cag PAI. An enzyme linked immunosorbent assay (ELISA) kit (Viva Diagnostica helicobacter p120) was used to test for anti-CagA IgG antibody in matching sera. Isolates were also genotyped by vacuolating cytotoxin polymerase chain reaction (PCR) analysis, and tested for absence of the complete cag PAI (empty site PCR assay).

RESULTS

Forty one of the H pylori isolates had a cag PAI containing cagA. One strain had no cagA but other cag PAI loci were present, whereas the remaining 20 strains had no detectable cag PAI markers. Anti-CagA IgG antibody was detected in 34 sera by the ELISA assay, and when compared with the cag PAI genotype of the infecting strain, accuracy, sensitivity, and specificity were 92%, 87%, and 100%, respectively. The seven discrepant or borderline strains in the ELISA were all vacA s1 but differed in other genotypic markers.

CONCLUSIONS

The cag PAI was widely distributed in H pylori from patients with dyspepsia in mid-Essex who had different gastric pathologies. Infection with a strain having an uninterrupted cag PAI was associated with the presence of anti-CagA antibody in most patients. Discrepant ELISA results, mostly for elderly patients with duodenal ulcers, were attributed to cagA associated variation, particularly to the presence of mixed cagA+/cagA- cell variants in the infecting strain population. Tests for anti-CagA serum antibody were unreliable for predicting severity of clinical disease associated with H pylori infection in this series of patients.

Molecular epidemiology of Helicobacter pylori in England: prevalence of cag pathogenicity island markers and IS605 presence in relation to patient age and severity of gastric disease

The cagA gene is a key marker for the Helicobacter pylori cag pathogenicity island (PAI), which may vary in composition in different strains with insertion sequence mediated interruptions and deletions of genes. While presence of cagA has been associated with increased risk for peptic ulcer disease and gastric cancer, the precise link with virulence is controversial. We investigated H. pylori from dyspeptics in one location in England (mid-Essex) with reference to the prevalence and distribution by age cohort of different cag PAI forms to determine if presence of the insertion element IS605 had a modifying effect on the severity of associated disease. H. pylori isolated from gastric biopsies over a 4-year period were screened by specific PCR assays for the presence of cagA, cagD, cagE and virD4 genes in the cag PAI, and for the presence of IS605 in the PAI and elsewhere in the genome. Most (68%) of the 166 isolates of H. pylori contained a PAI based on detection of cagA whereas 29% had no detectable PAI using multiple loci. The cagA+ genotype frequencies were similar in the peptic ulcer and non-ulcer dyspepsia-gastritis groups (79% vs. 74%) whereas frequencies in the NUD-oesophagitis and normal mucosa groups were lower (58%) but not significantly different (P>0.41). Genomic IS605 inserts were present at an overall frequency of 32% and were widely distributed with respect to patient age and disease severity. The combined cagA+/IS- strain genotype was common but not significantly associated with PUD compared to endoscopically normal mucosa (P> or =0.807). We concluded that presence of the IS605 element, whether in cagA+ or cagA- strains of H. pylori, did not systematically modify the severity of associated disease in the study population.

An algorithmic overview of surface registration techniques for medical imaging

This paper presents a literature survey of automatic 3D surface registration techniques emphasizing the mathematical and algorithmic underpinnings of the subject. The relevance of surface registration to medical imaging is that there is much useful anatomical information in the form of collected surface points which originate from complimentary modalities and which must be reconciled. Surface registration can be roughly partitioned into three issues: choice of transformation, elaboration of surface representation and similarity criterion, and matching and global optimization. The first issue concerns the assumptions made about the nature of relationships between the two modalities, e.g. whether a rigid-body assumption applies, and if not, what type and how general a relation optimally maps one modality onto the other. The second issue determines what type of information we extract from the 3D surfaces, which typically characterizes their local or global shape, and how we organize this information into a representation of the surface which will lead to improved efficiency and robustness in the last stage. The last issue pertains to how we exploit this information to estimate the transformation which best aligns local primitives in a globally consistent manner or which maximizes a measure of the similarity in global shape of two surfaces. Within this framework, this paper discusses in detail each surface registration issue and reviews the state-of-the-art among existing techniques.

An inverse problem approach to the correction of distortion in EPI images

Magnetic resonance imaging using the echo planar imaging (EPI) technique is particularly sensitive to main (B0) field inhomogeneities. The primary effect is geometrical distortion in the phase encoding direction. In this paper, we present a method based on the conjugate gradient algorithm to correct for this geometrical distortion, by solving the EPI imaging equation. Two versions are presented: one that attempts to solve the full four-dimensional (4-D) imaging equation, and one that independently solves for each profile along the blip encoding direction. Results are presented for both phantom and in vivo brain EPI images and compared with other proposed correction methods.

Intraoperative ultrasound for guidance and tissue shift correction in image-guided neurosurgery

We present a surgical guidance system that incorporates pre-operative image information (e.g., MRI) with intraoperative ultrasound (US) imaging to detect and correct for brain tissue deformation during image-guided neurosurgery (IGNS). Many interactive IGNS implementations employ pre-operative images as a guide to the surgeons throughout the procedure. However, when a craniotomy is involved, tissue movement during a procedure can be a significant source of error in these systems. By incorporating intraoperative US imaging, the target volume can be scanned at any time, and two-dimensional US images may be compared directly to the corresponding slice from the pre-operative image. Homologous points may be mapped from the intraoperative to the pre-operative image space with an accuracy of better than 2 mm, enabling the surgeon to use this information to assess the accuracy of the guidance system along with the progress of the procedure (e.g., extent of lesion removal) at any time during the operation. Anatomical features may be identified on both the pre-operative and intraoperative images and used to generate a deformation map, which can be used to warp the pre-operative image to match the intraoperative US image. System validation is achieved using a deformable multi-modality imaging phantom, and preliminary clinical results are presented.

Potential for aging female Aedes aegypti (Diptera: Culicidae) by gas chromatographic analysis of cuticular hydrocarbons, including a field evaluation

Gas chromatography with flame-ionization detection was used to measure the time-associated, quantitative changes in the cuticular hydrocarbons of female Aedes aegypti (L.). Cohorts of unstressed Ae. aegypti, Rockefeller strain, were reared and held at 3 constant temperatures (24, 28, and 30 degrees C). Five females from each cohort were taken at 33 degree-day (DD) intervals from 0 to 231 DD (using 17 degrees C as the threshold temperature). Quantitative changes over time of cuticular hydrocarbons associated with gas chromatographic peaks 1 and 5 were identified as having promise for age grading. The relative abundance of peak 1 (pentacosane) decreased linearly from 0 to 132 DD, whereas peak 5 (nonacosane) increased linearly over the same period. Suboptimal larval conditions (crowded and starved), which resulted in physiological stress (decreased size), had negligible effect on the relative abundance of pentacosane and nonacosane. Additionally, the rate of change in the relative abundance of pentacosane and nonacosane were the same for both a recently colonized Chachoengsao (Thailand) strain of Ae. aegypti compared with the long-colonized Rockefeller (Caribbean) strain over a 0-99 DD interval. Two linear regression models, one based on the relative abundance of pentacosane and the other on the logit transformation of these values, were developed for aging female Ae. aegypti. A blind study using laboratory-reared mosquitoes and a mark-release-recapture experiment using field mosquitoes validated these age-grading models and produced promising results for aging females up to 132 DD (19, 12, and 10 calendar days at 24, 28 and 30 degrees C, respectively). Therefore the regression models, based on the relative abundance of these 2 cuticular hydrocarbons, appeared to be a useful approach for age-grading Ae. aegypti up to at least 12 d of age regardless of environmental conditions (temperature and stress) and population history (origin and colonization time).

Localization of somatosensory function by using positron emission tomography scanning: a comparison with intraoperative cortical stimulation

OBJECT

To investigate the utility of [15O]H2O positron emission tomography (PET) activation studies in the presurgical mapping of primary somatosensory cortex, the authors compared the magnitude and location of activation foci obtained using PET scanning with the results of intraoperative cortical stimulation (ICS).

METHODS

The authors used PET scanning and vibrotactile stimulation (of the face, hand, or foot) to localize the primary somatosensory cortex before surgical resection of mass lesions or epileptogenic foci affecting the central area in 20 patients. With the aid of image-guided surgical systems, the locations of significant activation foci on PET scanning were compared with those of positive ICS performed at craniotomy after the patient had received a local anesthetic agent. In addition, the relationship between the magnitude and statistical significance of blood flow changes and the presence of positive ICS was examined. In 22 (95.6%) of 23 statistically significant (p < 0.05) PET activation foci, spatially concordant sites on ICS were also observed. Intraoperative cortical stimulation was positive in 40% of the PET activation studies that did not result in statistically significant activation. In the patients showing these results, there was a clearly identifiable t-statistic peak that was spatially concordant with the site of positive ICS in the sensorimotor area. All PET activation foci with a t statistic greater than 4.75 were associated with spatially concordant sites of positive ICS. All PET activation foci with a t statistic less than 3.2 were associated with negative ICS.

CONCLUSIONS

Positron emission tomography is an accurate method for mapping the primary somatosensory cortex before surgery. The need for ICS, which requires local anesthesia, may be eliminated when PET foci with high (> 4.75) or low (< 3.20) t-statistic peaks are elicited by vibrotactile stimulation.

Development of a scheme for genotyping Helicobacter pylori based on allelic variation in urease subunit genes

Helicobacter pylori urease subunit genes in 383 isolates from 10 countries were investigated by PCR-restriction fragment length polymorphism (HaeIII) analysis. Eighty-two different ureAB profiles were documented by reference to known sequences. Variation among 51% of strains was accounted for by 10 predominant patterns, which provided a unique framework for categorizing isolates with geographically diverse origins.

Automated atlas integration and interactive three-dimensional visualization tools for planning and guidance in functional neurosurgery

Many critical functionally distinct subcortical structures are not distinguishable on anatomical magnetic resonance imaging (MRI) scans. In order to provide the neurosurgeon with this missing information, a deformable volumetric atlas of the basal ganglia and thalamus has been created from the Schaltenbrand and Wahren atlas of cryogenic slices. The volumetric atlas can be automatically deformed to an individual patient's MRI. To facilitate the clinical use of the atlas, a visualization platform has been developed for preoperative and intraoperative use which permits manipulation of the merged atlas and MRI data sets in two- and three-dimensional views. The platform includes graphical tools which allow the visualization of projections of a leukotome and other surgical tools with respect to the atlas data, as well as preregistered images from any other imaging modality. In addition, a graphical interface has been designed to create custom virtual lesions using computer models of neurosurgical tools for intraoperative planning. To date this system has been employed as an adjunct to over 30 functional neurosurgical cases including surgery for movement disorders.

Peripheral nerve catheterization in the management of terminal cancer pain

BACKGROUND AND OBJECTIVES

Peripheral nerve catheterization techniques were used in two patients with severe pain associated with the terminal stages of metastatic cancer. The first patient had severe upper limb pain and lymphedema secondary to breast carcinoma, and the second patient had an acutely ischemic leg secondary to pelvic obstruction from an ovarian tumor. The goal of treatment was to relieve the pain, which was resistant to opioid drugs, and to optimize the quality of life that remained, estimated to be only a few weeks.

METHODS

The first patient received a continuous brachial plexus block via an epidural catheter, introduced by means of a Tuohy needle and a peripheral nerve stimulator to locate the plexus accurately. The second patient required catheterization of both the sciatic and femoral nerves, again with a peripheral nerve stimulator used to locate the nerves prior to inserting the catheters.

RESULTS

Analgesia was established with a bolus of local anesthetic and maintained with a continuous infusion of local anesthetic in the first patient. For the second patient, fentanyl was added to the local anesthetic, as it had been shown to improve analgesia in the lower limb in previous work. In the first patient, the analgesia allowed active treatment of the lymphedema and mobilization of the limb, and she remained pain free until her death 2 weeks later. In the second patient, the infusions controlled the pain both before and after surgical amputation of the limb, until the stump was well healed.

CONCLUSIONS

Peripheral nerve catheterization proved beneficial in two patients who presented with difficult pain management problems and should be more widely considered for the relief of severe cancer-related pain in both the upper and lower limbs.

Three-dimensional reconstruction of vascular trees: experimental evaluation

This paper is the second of two that together present a novel approach to the problem of reconstructing vascular trees from a small number of projections. Previously, we described the reconstruction algorithm and how it effectively circumvents the matching or "correspondence problem" found in most photogrammetric or computer-vision-based approaches. The algorithm is fully automatic and assumes that the imaging geometry is known, the vascular tree is a connected structure, and that its center-lines have been identified in three or more images. It employs consistency and connectivity constraints and comprises three steps: The first generates a connected structure representing the multiplicity of solutions that are consistent with the first two views; the second assigns a measure of agreement to each branch in this structure based on one or more additional projections; and the third step employs this measure to distinguish between those branches comprising the vasculature and the accompanying artifacts. This paper addresses the issue of validation via simulations and experiments. In addition to a clinical case, we examine the performance of the algorithm when applied to simulated projections of two 3-D vascular models, both representative of the complexity faced in coronary and cerebral angiography. The results in each instance are impressive and demonstrate that adequate reconstructions may be obtained with as few as three distinct views.

Image-guided surgery of epilepsy

Interactive image-guided techniques used in conjunction with three-dimensional images allow accurate planning and performance of a variety of neurosurgical procedures. The authors have used the frameless stereotactic Allegro Viewing Wand System to provide real-time correlation of the operating field and computerized images in over 200 neurosurgical operations carried out for intractable epilepsy. The authors experience shows that the viewing wand system is most helpful as an adjunctive navigational device in the microsurgical treatment of epilepsy.

Three-dimensional reconstruction of vascular trees. Theory and methodology

In this paper we examine the few-view reconstruction problem as it applies to imaging vascular trees. A fully automated reconstruction algorithm is described that circumvents the traditional "correspondence problem," using only notions of consistency and connectivity. It is assumed that the vascular tree is a connected structure and that its centerlines have been identified in three or more images. The first of three steps in the procedure involves generating a connected structure that represents the multiplicity of solutions that are consistent with any two (different) projections. The second step assigns to each branch in this structure a measure of agreement based on its relationship with one or more additional views of the vasculature. The problem then becomes one of propagating this information, via connectivity relationships and consistency checks, throughout the above structure to distinguish between the branches comprising the imaged structure and the accompanying artifacts. In this paper we present the theory and methodology of the technique, while in a companion paper we address the issue of validation via simulations and experiments. Together, these papers shed some light on why ambiguities arise and often lead to errors in the few-view reconstruction problem. Strategies to handle these errors are described and results are presented that demonstrate the ability to obtain adequate reconstructions with as few as three distinct views.

Age-dependent penetrance of disease in a transgenic mouse model of familial amyotrophic lateral sclerosis

The mutation gly93-->ala of Cu,Zn superoxide dismutase (SOD) is found in patients with familial amyotrophic lateral sclerosis and causes motor neuron disease when expressed in transgenic mice. The progression of clinical and pathological disease was studied in a line of mice designated G1H. Clinical disease started at 91 +/- 14 days of age with fine shaking of the limbs, followed by paralysis and death by 136 +/- 7 days of age. Pathological changes begin by 37 days of age with vacuoles derived from swollen mitochondria accumulating in motor neurons. At the onset of clinical disease (90 days), significant death of somatic motor neurons innervating limb muscles has occurred; mice at end-stage disease (136 days) show up to 50% loss of cervical and lumbar motor neurons. However, neither thoracic nor cranial motor neurons show appreciable loss despite vacuolar changes. Autonomic motor neurons also are not affected. Mice that express wild-type human Cu,Zn SOD remain free of disease, indicating that mutations cause neuron loss by a gain-of-function. Thus, the age-dependent penetrance of motor neuron disease in this transgenic model is due to the gradual accumulation of pathological damage in select populations of cholinergic neurons.

Integration of stereoscopic DSA and 3D MRI for image-guided neurosurgery

We demonstrate the feasibility and utility of using anatomical/vascular correlation in image-guided surgery, by interfacing a PC-based stereoscopic Digital Subtraction Angiography (DSA) analysis system to a three-dimensional (3D) image based surgical workstation that has been modified to allow presentation of stereoscopic images. Numerical values representing the position and angulation of a hand-held probe are transmitted to both systems simultaneously, enabling the probe to be visualized stereoscopically in both anatomical and vascular images during the surgical procedure. The integration of the patient's vascular and anatomical data in this way provides the surgeon with a complete overview of brain structures through which he is passing the electrode-guiding cannulas, enabling him to avoid critical vessels en route to the targets.

Effects of pulmonary fibrosis on the distribution of edema. Computed tomographic scanning and morphology

The pulmonary interstitium acts as an important safety factor against alveolar flooding. To test the hypothesis that in advanced fibrosis, edema is redistributed away from a less compliant interstitium to flood alveoli, we induced severe left lung fibrosis in six dogs with radiation and intratracheal bleomycin. Twenty-four months later, edema was induced by infusing 20% body weight lactated Ringer's solution over 30 min, preceded and followed by computed tomography (CT) scanning. Lower lobes were frozen, and samples were taken for extravascular lung water measurements (Qwl/dQl), regional blood volume, and light microscopic grading of interstitial and alveolar edema. The total volumes of the control and fibrotic lungs were 800 +/- 63 and 45 +/- 10 ml (SE), respectively, indicative of severe fibrosis. Before edema, the fibrotic carinal and basal slices had CT densities 3.5 and 2.2 times greater than respective control slices. After edema, the densities of all control lung slices rose 2.5 times and that of fibrotic carinal and basal slices rose 1.5 times. Edema significantly accentuated the small gravity-dependent gradient in CT density of control lungs, but it had minimal effect on this gradient in fibrotic lungs. The Qwl/dQl for control and fibrotic lower lobes were 8.7 +/- 0.8 and 6.8 +/- 0.7 g H2O/g dry lung, respectively, but the amounts of water per lung volume were similar, and there was no gravity-dependent gradient in Qwl/dQl or in regional blood contents. By light microscopy, we found significantly less interstitial and more alveolar edema in the fibrotic lobes. We conclude that in severe pulmonary fibrosis, similar amounts of water accumulate per lung volume as in controls, and that there is predominant alveolar flooding over interstitial edema. We also conclude that the gravity-dependent gradients in CT densities postedema in the control lungs are not accounted for by edema fluid or congestion, but probably by atelectasis.

Automatic 3D intersubject registration of MR volumetric data in standardized Talairach space

OBJECTIVE

In both diagnostic and research applications, the interpretation of MR images of the human brain is facilitated when different data sets can be compared by visual inspection of equivalent anatomical planes. Quantitative analysis with predefined atlas templates often requires the initial alignment of atlas and image planes. Unfortunately, the axial planes acquired during separate scanning sessions are often different in their relative position and orientation, and these slices are not coplanar with those in the atlas. We have developed a completely automatic method to register a given volumetric data set with Talairach stereotaxic coordinate system.

MATERIALS AND METHODS

The registration method is based on multi-scale, three-dimensional (3D) cross-correlation with an average (n > 300) MR brain image volume aligned with the Talariach stereotaxic space. Once the data set is re-sampled by the transformation recovered by the algorithm, atlas slices can be directly superimposed on the corresponding slices of the re-sampled volume. the use of such a standardized space also allows the direct comparison, voxel to voxel, of two or more data sets brought into stereotaxic space.

RESULTS

With use of a two-tailed Student t test for paired samples, there was no significant difference in the transformation parameters recovered by the automatic algorithm when compared with two manual landmark-based methods (p > 0.1 for all parameters except y-scale, where p > 0.05). Using root-mean-square difference between normalized voxel intensities as an unbiased measure of registration, we show that when estimated and averaged over 60 volumetric MR images in standard space, this measure was 30% lower for the automatic technique than the manual method, indicating better registrations. Likewise, the automatic method showed a 57% reduction in standard deviation, implying a more stable technique. The algorithm is able to recover the transformation even when data are missing from the top or bottom of the volume.

CONCLUSION

We present a fully automatic registration method to map volumetric data into stereotaxic space that yields results comparable with those of manually based techniques. The method requires no manual identification of points or contours and therefore does not suffer the drawbacks involved in user intervention such as reproducibility and interobserver variability.

Analysis of projection geometry for few-view reconstruction of sparse objects

In this paper certain projections are examined as to why they are better than others when used to reconstruct sparse objects from a small number of projections. At the heart of this discussion is the notion of "consistency," which is defined as the agreement between the object's 3-D structure and its appearance in each image. It is hypothesized that after two or more projections have been obtained, it is possible to predict how well as subsequent view will perform in terms of resolving ambiguities in the object reconstructed from only the first few views. The prediction is based on a step where views of the partial reconstruction are simulated and the use of consistency to estimate the effectiveness of a given projection is exploited. Here some freedom is presumed to acquire arbitrary as opposed to predetermined views of the object. The principles underlying this approach are outlined, and experiments are performed to illustrate its use in reconstructing a realistic 3-D model. Reflecting an interest in reconstructing cerebral vasculature from angiographic projections, the experiments employ simulations based on a 3-D wireframe model derived from an internal carotid arteriogram. It is found that for such an object, the predictions can be improved significantly by introducing a correction to account for the degree to which the object possesses some symmetry in shape. For objects sufficiently sparse, this correction is less important. It is concluded that when the number of projections is limited, it may be possible to favorably affect the reconstruction process in this manner.

Bilateral thalamic glioma: review of eight cases with personality change and mental deterioration

PURPOSE

To describe the clinical, radiographic, and neuropathologic features of bilateral thalamic glioma.

METHODS

We searched our hospital records (1963 to present) to identify patients diagnosed as having the disease.

RESULTS

Our search revealed eight patients, ranging in age from 8-63 years, with bithalamic tumor diagnosed by angiography, CT, and/or MR. All patients displayed personality changes and/or mental deterioration, including memory loss, inattention, confusion, hallucination, hyperphagia, or slow mentation. Unilateral motor weakness was also noted in six cases. The tumor always involved the medial aspect of the left and right thalami, but was often more extensive. The pathology was determined to be grades I-IV astrocytoma, confirmed by stereotactic biopsy or autopsy in six. Mild to moderate hydrocephaly occurred in some cases and was considered to be a contributing factor to mental deterioration. No correlation was found between age and type of tumor.

CONCLUSIONS

Bilateral glioma of the dorsomedial and intralaminar nuclei of the thalamus can be a primary cause of dementia that has not been well-recognized in the past. CT and particularly MR should be considered for patients presenting with personality change or dementia, because of the possible presence of this unusual but devastating disease.

From radio-astronomy to medical imaging

A common thread in much of the medical imaging that has developed over the past 20 years has been the Fourier transform. It was Richard Bates' interest in radio-interferometry, as well as his fascination with problems of medical imaging that prompted an initial interest in applying Fourier techniques to medical imaging in general and to Computed Tomography in particular. This resulted 20 years ago in one of the earliest technical papers advocating Fourier techniques for reconstructing cross-sections from radiographic projections (Bates and Peters, NZ J Science 14:883-896, 1971). Since those early days, medical imaging has explored into a multi-billion dollar industry. The CT scanner has become the workhorse imaging modality in the radiology department, while its more recent relative, the MR scanner, is rapidly gaining ground as a technique of even greater importance. Richard Bates, with his team of "Medical Imagers" was a very significant force in the development of the field of Medical Imaging as we know it today. This paper attempts to chronicle the genesis of this process from the personal perspective of the author.

Multimodality image integration for stereotactic surgical planning

A method is presented for integrating stereotactic projection and tomographic image data to give composite 3-D images (stereo pairs) of cerebral anatomy and vasculature. The technique serves to combine complementary information from each modality and allows the imaged volume to be viewed directly. The procedure is largely automated and requires no additional apparatus or information beyond that which is ordinarily employed during stereotactic surgical planning. The two types of data are combined by superimposing the projection angiogram (DSA) onto a translucent volume rendered CT or MR image. Since the rendering algorithm employs an orthographic projection technique, the tomographic volume must first be reshaped and oriented to yield a perspective view that matches the DSA projection. During this process, the data undergo various interpolations which consequently affect the accuracy of target identification based on the resulting images. The integrity of the matching procedure was assessed using simulated data sets. Also, calculations were performed to estimate the resolution of measurements made from digitized stereoscopic images. The resulting sub-pixel accuracy of the matched images suggests that the technique has potential for stereotactic applications. Preliminary results are presented illustrating combined CT-DSA and MR-DSA data sets.

Three-dimensional display of cortical anatomy and vasculature: magnetic resonance angiography versus multimodality integration

We present two methods for acquiring and viewing integrated three-dimensional (3D) images of cerebral vasculature and cortical anatomy. The aim of each technique is to provide the neurosurgeon or radiologist with a 3D image containing information which cannot ordinarily be obtained from a single imaging modality. The first approach employs recent developments in MR which is now capable of imaging flowing blood as well as static tissue. Here, true 3D data are acquired and displayed using volume or surface rendering techniques. The second approach is based on the integration of x-ray projection angiograms and tomographic image data, allowing a composite image of anatomy and vasculature to be viewed in 3D. This is accomplished by superimposing an angiographic stereo-pair onto volume rendered images of either CT or MR data created with matched viewing geometries. The two approaches are outlined and compared. Results are presented for each technique and potential clinical applications discussed.

Clinical applications of integrated 3-D stereoscopic imaging in neurosurgery

Stereotactic neurosurgery planning, an intrinsically three-dimensional procedure, is generally performed on the basis of two-dimensional tomographic or projection images. We present extensions to these conventional approaches that use stereoscopic digital subtraction angiography, three-dimensional volume rendered computed tomography or magnetic resonance images, or a combination of these modalities. The stereoscopic DSA images are analysed interactively on a 3-D workstation. This system employs a liquid-crystal polarizing shutter to display alternate left- and right-eye views to a user wearing polarized glasses. Quantitative planning operations may be performed on the basis of the angiograms alone, or in conjunction with tomographic images of the anatomy. We also describe the procedures used to produce volume-rendered three-dimensional images from MR and CT data-sets, as well as the methodology for combining the stereoscopic angiograms with the volumetric anatomical images.

Within-herd variation in energy utilization for maintenance and gain in beef cows

Fourteen mature, nonpregnant, nonlactating Angus cows (498 kg) were individually fed through two consecutive phases (maintenance [M], 80 d and ad libitum [A], 70 to 79 d) to estimate within-herd variation in individual cow ME requirements for maintenance (MEm) and to identify factors contributing to this variation. Body composition was determined at initiation of phase M, at termination of phase M (also initiation of phase A) and at the end of phase A by a two-pool D2O dilution technique. Daily MEm averaged 156.7 kcal/kg BW.75 (SD = 18.4 kcal/kg BW.75) and efficiency of ME use for tissue gain or loss averaged 76% (SD = 30%). Estimates of ME intake to maintain 1 kg of protein or 1 kg of fat were 192.9 (SE = 24.8) or 20.7 (SE = 21.5) kcal. These data indicate that among cows of similar fat masses, those with larger protein masses had higher energy requirements for maintenance. Daily MEm was positively correlated (P less than .16) with liver weight (r = .40) and relative proportions of liver (r = .44; P less than .16) and heart (r = .48; P less than .10) in the empty body. Also, daily MEm was correlated negatively (P less than .05) with weight (r = -.71) and relative proportion of omental and mesenteric fat (r = -.78). Estimates of ME required for deposition of 1 kcal of protein or fat were 5.56 (SE = 1.01) or 1.26 (SE = .09) kcal. Weight of liver and the sum of liver, spleen, kidney and heart weights increased 1.58 (R2 = .47) and 1.95 kg (R2 = .52) per kilogram of daily weight gain during phase A. These results indicate that increased performance caused increased organ mass (liver).

Dose distributions in radiosurgery

A PC-based, three-dimensional treatment planning system, which may be used for planning of radiosurgical treatments with the Gamma unit or with any of the radiosurgical techniques based on isocentric linear accelerators (linacs), is described and used to calculate isodose distributions for various linac-based radiosurgical techniques ranging from the single plane rotation to a 4-pi geometry. The latter gives an isotropic dose falloff outside the target volume but cannot be used for practical radiosurgery, while the single plane rotation is simple to use but gives unacceptably shallow dose falloffs in the transverse plane. Dose falloffs for several other techniques of varying degrees of complexity are shown and discussed. Also discussed is the effect of beam energy and beam profiles on radiosurgical dose distributions.

Three-dimensional isodose distributions in stereotactic radiosurgery

A personal computer based three-dimensional treatment planning system, which may be used for planning any linear accelerator (Linac) based radiosurgical technique, is presented. The system is used to calculate dose distributions for most of the Linac-based techniques currently in use as well as the theoretically optimum 4 pi geometry. The maximum and minimum dose falloffs are used to compare the various Linac-based radiosurgical techniques. The dynamic rotation technique developed at McGill University is shown to produce distributions with dose falloffs similar to the multiple converging arc techniques used elsewhere and those obtained for the Gamma Unit. Also considered are the effects of beam energy, in the range of 4-25 MV, and beam profiles on the dose distribution.

Integration of stereoscopic DSA with three-dimensional image reconstruction for stereotactic planning

Following 4 years of experience using a microcomputer-based system for the planning of stereotactic neurosurgery, we have now developed a workstation with the capability of displaying and analyzing three-dimensional images for this purpose. In addition to viewing volumetrically rendered three-dimensional computer tomograms and magnetic resonance images, we may directly view and analyze stereoscopic digital angiograms. In addition to each set of images being viewed in isolation, we may also combine the three-dimensional anatomical images with the stereoscopic angiograms. This new system is based on a computer equipped with a light polarization switched screen capable of displaying stereoscopic images directly to the observer, thus permitting him to interact with the three-dimensional volume directly, determining coordinates and positioning probe trajectories.

Stereotactic neurosurgery planning on a personal-computer-based work station

Stereotactic surgery requires knowledge of cerebral structures derived from more than one image source. We have developed a PC-AT-based workstation that accepts patient images, made with the stereotactic frame in place, from CT, MRI, and DSA modalities. Reference markers on the frame are identified in the images to establish the coordinate geometry for each modality. Target points may be identified on each image type and trajectories of probe paths to these points defined. Targets identified on one set of images may be transferred automatically to other images of the same patient in order to guarantee a vessel-free path of approach to a target point deep within the brain. To date several hundred patients have had stereotactic surgery performed on the basis of plans using this system. Procedures included biopsy and aspiration of lesions, implantation of electrodes for the recording of deep EEG signals, and radiosurgical techniques. We present clinical examples of the use of this system in typical stereotactic neurosurgery procedures, address stereoscopic applications, and discuss the results of intermodality tests to establish the accuracy of the technique.