Selective stimulation of human intrinsic laryngeal muscles: Analysis in a mathematical three-dimensional space.
- 作者列表："Broniatowski M","Grundfest-Broniatowski S","Schiefer M","Ludlow DH","Broniatowski DA","Tucker HM
OBJECTIVES/HYPOTHESIS:Standard stimulating methods using square waves do not appropriately restore physiological control of individual intrinsic laryngeal muscles (ILMs). To further explore our earlier study of evoked orderly recruitment by quasitrapezoidal (QT) currents, we integrated the contribution of the cricothyroideus (CT) with attention to mutual activation in an additional patient, based on recent studies of appropriate responses via strict recurrent laryngeal nerve (RLN) stimulation. STUDY DESIGN:Basic science study. METHODS:The patient received functional electrical stimulation (FES) with QT pulses at 5 Hz, 60 to 2,000 μAmp, 100 to 500 μs pulse width, 0 to 500 μs decay. Ipsilateral electromyography (EMG) responses were calculated using the average maximum amplitude, area under the curve, and the root mean square of the rectified amplitude waveforms. The thyroarytenoideus (TA), posterior cricoarytenoideus (PCA), lateral cricothyroideus (LCA), and the CT were each interrogated via two monopolar electrodes, values were recorded in MATLAB, exported to Excel, and analyzed. Individual and mutual recruitment configurations and activation delays with stimulation were explored using multiple regression and exploration factor analyses. RESULTS:A total of 868 EMG data points based on 18 trials and up to 11 subtrials were captured from each of the four ILMs. Various combinations of pulse amplitude, pulse width, and exponential decay were found to produce significant (P ≤ .001) individual ILM responses. CT mirrored the LCA, whereas the TA and PCA exhibited separate interactions along shared trajectories in a three-dimensional space. CONCLUSIONS:FES calibrated to individual and coupled ILMs offers promise for restoring normal and pathological contraction patterns via strict RLN stimulation. LEVEL OF EVIDENCE:5 Laryngoscope, 130:967-973, 2020.
目的/假设: 使用方波的标准刺激方法不能适当地恢复个体固有喉肌 (ilm) 的生理控制。为了进一步探索我们早期通过QT电流诱发有序募集的研究，我们基于最近通过严格喉返神经 (RLN) 刺激的适当反应研究，将环甲肌 (CT) 的贡献与对额外患者相互激活的关注结合起来。 研究设计: 基础科学研究。 方法: 患者接受功能性电刺激 (FES)，QT脉冲为5Hz，60至2,000 μ amp，100至500 μ s脉冲宽度，0至500 μ s衰减。使用平均最大振幅、曲线下面积和整流振幅波形的均方根计算同侧肌电图 (EMG) 反应。通过两个单极电极分别检查甲状腺腱鞘 (TA) 、后环腱鞘 (PCA) 、外侧环腱鞘 (LCA) 和CT，在MATLAB中记录值，输出到Excel中，并进行分析。使用多元回归和探索因子分析探索了刺激的个体和相互招募配置和激活延迟。 结果: 基于18项试验和多达11项子试验，从4项ilm的每一项中总共捕获了868个EMG数据点。发现脉冲幅度、脉冲宽度和指数衰减的各种组合产生显著 (P ≤.001) 的个体ILM反应。CT反映了LCA，而TA和PCA在三维空间中沿共享轨迹表现出单独的相互作用。 结论: 针对个体和耦合ILMs校准的FES提供了通过严格RLN刺激恢复正常和病理性收缩模式的前景。 证据级别: 5喉镜，130:967-973，2020。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.