Exploration of the Neural Correlates of Ticklish Laughter by Functional Magnetic Resonance Imaging

The burst of laughter that is evoked by tickling is a primitive form of vocalization. It evolves during an early phase of postnatal life and appears to be independent of higher cortical circuits. Clinicopathological observations have led to suspicions that the hypothalamus is directly involved in the production of laughter. In this functional magnetic resonance imaging investigation, healthy participants were 1) tickled on the sole of the right foot with permission to laugh, 2) tickled but asked to stifle laughter, and 3) requested to laugh voluntarily. Tickling that was accompanied by involuntary laughter activated regions in the lateral hypothalamus, parietal operculum, amygdala, and right cerebellum to a consistently greater degree than did the 2 other conditions. Activation of the periaqueductal gray matter was observed during voluntary and involuntary laughter but not when laughter was inhibited. The present findings indicate that hypothalamic activity plays a crucial role in evoking ticklish laughter in healthy individuals. The hypothalamus promotes innate behavioral reactions to stimuli and sends projections to the periaqueductal gray matter, which is itself an important integrative center for the control of vocalization. A comparison of our findings with published data relating to humorous laughter revealed the involvement of a common set of subcortical center

Reproducibility of the lung anatomy under active breathing coordinator control:Dosimetric consequences for scanned proton treatments

Purpose The treatment of moving targets with scanned proton beams is challenging. For motion mitigation, an Active Breathing Coordinator (ABC) can be used to assist breath-holding. The delivery of pencil beam scanning fields often exceeds feasible breath-hold durations, requiring high breath-hold reproducibility. We evaluated the robustness of scanned proton therapy against anatomical uncertainties when treating nonsmall-cell lung cancer (NSCLC) patients during ABC controlled breath-hold. Methods Four subsequent MRIs of five healthy volunteers (3 male, 2 female, age: 25-58, BMI: 19-29) were acquired under ABC controlled breath-hold during two simulated treatment fractions, providing both intrafractional and interfractional information about breath-hold reproducibility. Deformation vector fields between these MRIs were used to deform CTs of five NSCLC patients. Per patient, four or five cases with different tumor locations were modeled, simulating a total of 23 NSCLC patients. Robustly optimized (3 and 5 mm setup uncertainty respectively and 3% density perturbation) intensity-modulated proton plans (IMPT) were created and split into subplans of 20 s duration (assumed breath-hold duration). A fully fractionated treatment was recalculated on the deformed CTs. For each treatment fraction the deformed CTs representing multiple breath-hold geometries were alternated to simulate repeated ABC breath-holding during irradiation. Also a worst-case scenario was simulated by recalculating the complete treatment plan on the deformed CT scan showing the largest deviation with the first deformed CT scan, introducing a systematic error. Both the fractionated breath-hold scenario and worst-case scenario were dosimetrically evaluated. Results Looking at the deformation vector fields between the MRIs of the volunteers, up to 8 mm median intra- and interfraction displacements (without outliers) were found for all lung segments. The dosimetric evaluation showed a median difference in D-98% between the planned and breath-hold scenarios of -0.1 Gy (range: -4.1 Gy to 2.0 Gy). D-98% target coverage was more than 57.0 Gy for 22/23 cases. The D-1 cc of the CTV increased for 21/23 simulations, with a median difference of 0.9 Gy (range: -0.3 to 4.6 Gy). For 14/23 simulations the increment was beyond the allowed maximum dose of 63.0 Gy, though remained under 66.0 Gy (110% of the prescribed dose of 60.0 Gy). Organs at risk doses differed little compared to the planned doses (difference in mean doses <0.9 Gy for the heart and lungs, <1.4% difference in V-35 [%] and V-20 [%] to the esophagus and lung). Conclusions When treating under ABC controlled breath-hold, robustly optimized IMPT plans show limited dosimetric consequences due to anatomical variations between repeated ABC breath-holds for most cases. Thus, the combination of robustly optimized IMPT plans and the delivery under ABC controlled breath-hold presents a safe approach for PBS lung treatments

Η επίδραση της αναιμίας στην θνητότητα ασθενών με ΧΑΠ που νοσηλεύονται στην Μονάδα Εντατικής Θεραπείας υπό μηχανικό αερισμό

Εισαγωγή: Η αναιμία είναι μια γνωστή συννοσηρότητα της Χρόνιας Αποφρακτικής Πνευμονοπάθειας (ΧΑΠ) με επιπολασμό που κυμαίνεται από 12,3 έως 23%. Η αναιμία στη ΧΑΠ σχετίζεται άμεσα με δυσμενείς κλινικές εκβάσεις, συμπεριλαμβανομένης της θνησιμότητας. Σκοπός: Σκοπός της παρούσας συστηματικής ανασκόπησης, ήταν να μελετηθεί η επίδραση της αναιμίας στην έκβαση ασθενών με ΧΑΠ που νοσηλεύονται σε Μονάδα Εντατικής Θεραπείας (ΜΕΘ) υπό μηχανικό αερισμό. Μέθοδος: Πραγματοποιήθηκε συστηματική ανασκόπηση της βιβλιογραφίας στις διεθνείς βάσεις ηλεκτρονικών δεδομένων PubMed, Cinalh και Scopus με τις ακόλουθες λέξεις κλειδιά: «Chronic Obstructive Pulmonary Disease», «anemia», « hemoglobin» OR «hematocrit» AND «Intensive Care Unit». Στην ανασκόπηση συμπεριελήφθησαν μελέτες που αφορούσαν σε ενήλικες ασθενείς με ΧΑΠ που νοσηλεύτηκαν σε ΜΕΘ υπό μηχανικό αερισμό και διερευνούσαν την επίδραση της αναιμίας στη θνησιμότητα αυτών των ασθενών. Οι μελέτες ήταν δημοσιευμένες στην αγγλική γλώσσα και μέχρι 1/6/2020. Αποτελέσματα: Στην ανασκόπηση συμπεριελήφθησαν 6 μελέτες, εκ των οποίων 3 ήταν αναδρομικές, 2 προοπτικές μελέτες και 1 μελέτη παρακολούθησης. Σύμφωνα με τις μελέτες, η αναιμία βρέθηκε να αποτελεί ανεξάρτητο παράγοντα της βραχυπρόθεσμης και της μακροπρόσθεσης (90-ημερών, 2 ετών) θνησιμότητας. Επίσης, βρέθηκε ότι η αποτυχία του μη επεμβατικού αερισμού ήταν πιο συχνή στους ασθενείς με αναιμία σε σχέση με τους ασθενείς χωρίς αναιμία. Τέλος, βρέθηκε ότι η αναιμία αποτελεί σημαντικό προγνωστικό παράγοντα για την έναρξη του επεμβατικού μηχανικού αερισμού. Συμπεράσματα: Η αναιμία αποτελεί σημαντικό παράγοντα πρόβλεψης της βραχυπρόθεσμης και μακροχρόνιας επιβίωσης, καθώς και της έναρξης επεμβατικού μηχανικού αερισμού σε ασθενείς με ΧΑΠ που νοσηλεύονται σε ΜΕΘ υπό μηχανικό αερισμό.Introduction: Anemia is a known comorbidity of Chronic Obstructive Pulmonary Disease (COPD) with a prevalence ranging from 12.3 to 23%. COPD anemia is related to adverse clinical outcomes, including mortality. Aim: The purpose of this systematic review was to study the effect of anemia on the outcome of patients with COPD, who admitted to the Intensive Care Unit (ICU) under mechanical ventilation. Method: A systematic review of the literature in the international electronic databases PubMed, Cinalh and Scopus was performed with the following keywords: &quot;Chronic Obstructive Pulmonary Disease&quot;, &quot;anemia&quot;, &quot;hemoglobin&quot;, &quot;hematocrit&quot; and &quot;Intensive Care Unit&quot;. The review included studies of adult patients with COPD who were admitted to the ICU under mechanical ventilation and investigated the effect of anemia on mortality in these patients. The studies were published in English until 1/6/2020. Results: In the review 6 studies, of which 3 were retrospective, 2 prospective studies and 1 follow-up study. According to studies, anemia has been found to be an independent factor in short-term and long-term (90-day, 2-year) mortality. It was also found that failure of non-invasive ventilation was more common in patients with anemia than in patients without anemia. Finally, anemia was found to be an important prognostic factor for the onset of invasive mechanical ventilation. Conclusion: Anemia is an important factor in predicting short-term and long-term survival, as well as the onset of invasive mechanical ventilation in COPD patients admitted to ICUs under mechanical ventilation. Keywords: anemia, outcome, mechanical ventilation, chronic obstructive pulmonary diseas

Exploration of the neural correlates of ticklish laughter by functional magnetic resonance imaging

The burst of laughter that is evoked by tickling is a primitive form of vocalization. It evolves during an early phase of postnatal life and appears to be independent of higher cortical circuits. Clinicopathological observations have led to suspicions that the hypothalamus is directly involved in the production of laughter. In this functional magnetic resonance imaging investigation, healthy participants were 1) tickled on the sole of the right foot with permission to laugh, 2) tickled but asked to stifle laughter, and 3) requested to laugh voluntarily. Tickling that was accompanied by involuntary laughter activated regions in the lateral hypothalamus, parietal operculum, amygdala, and right cerebellum to a consistently greater degree than did the 2 other conditions. Activation of the periaqueductal gray matter was observed during voluntary and involuntary laughter but not when laughter was inhibited. The present findings indicate that hypothalamic activity plays a crucial role in evoking ticklish laughter in healthy individuals. The hypothalamus promotes innate behavioral reactions to stimuli and sends projections to the periaqueductal gray matter, which is itself an important integrative center for the control of vocalization. A comparison of our findings with published data relating to humorous laughter revealed the involvement of a common set of subcortical centers

A generalized framework unifying image registration and respiratory motion models and incorporating image reconstruction, for partial image data or full images.

Surrogate-driven respiratory motion models relate the motion of the internal anatomy to easily acquired respiratory surrogate signals, such as the motion of the skin surface. They are usually built by first using image registration to determine the motion from a number of dynamic images, and then fitting a correspondence model relating the motion to the surrogate signals. In this paper we present a generalized framework that unifies the image registration and correspondence model fitting into a single optimization. This allows the use of 'partial' imaging data, such as individual slices, projections, or k-space data, where it would not be possible to determine the motion from an individual frame of data. Motion compensated image reconstruction can also be incorporated using an iterative approach, so that both the motion and a motion-free image can be estimated from the partial image data. The framework has been applied to real 4DCT, Cine CT, multi-slice CT, and multi-slice MR data, as well as simulated datasets from a computer phantom. This includes the use of a super-resolution reconstruction method for the multi-slice MR data. Good results were obtained for all datasets, including quantitative results for the 4DCT and phantom datasets where the ground truth motion was known or could be estimated