[Serum selectin E level in lead-exposed workers]

Lead is recognised as a potential atherogenic factor. One of the earliest events in the development of atherosclerosis is monicyte attachment to the endothelial surface. This is followed by recruitment of monocytes into the subendothelial space and ingestion of modified LDL by these cells. In turn, modified LDL stimulates endothelial cells to induce expression of proinflammatory adhesion molecules, such as selectins, which further promote monocyte migration. It was observed that atherosclerotic vascular damage is associated with increased level of circulating selectin E. The aim of this study was to determine the impact of the occupational exposure to lead on the serum selectin E level. The study involved 80 patients, including 37 workers of a copper foundry and 43 people not exposed to lead. The subjects were matched in pairs according to sex, age and cholesterol concentration in blood. There were 25 hipercholesterolemic pairs and 9 pairs with normal serum total cholesterol. People exposed to lead had higher (about 7 ng/ml) serum selectin E concentration than those not exposed. There was positive linear correlation between selectin E and triglycerides in the whole group (p < 0.01), and the strongest correlation was observed in the group of subjects not exposed to lead (aged 40-60, r = 0.74). In the context of the described hypertriglyceridemic action induced by lead, these results suggest that lead could potentially act as an atherogenic factor in the early, inflammatory stage of atherosclerosis.

Neuronavigation in surgery of intracranial and spinal tumors

PURPOSE

To demonstrate the new possibilities and advantages of neuronavigation in the surgery of intracranial and spinal tumors, based on patient populations treated in our hospital.

MATERIALS AND METHODS

An infrared navigation system with integrated microscope guidance was used for frameless intracranial neuronavigation. The biopsies of intracranial tumors were carried out using a frame-based stereotactic technique. Intracranial navigation was, in part, combined with the use of an intraoperative CT scanner and a three-dimensional ultrasound system for data acquisition, correction of brain shifts, and intraoperative quality control. The navigation was also supported by presurgical brain mapping with magnetic source imaging. Navigation in spinal surgery was exclusively performed using an infrared navigation system in combination with an intraoperative CT scanner.

RESULTS

The stereotactic tumor biopsies (n = 57) were carried out with an accuracy of 91.4% as compared with the histological diagnosis. The work flow of stereotactic procedures could be increased by using the intraoperative CT scanner. Fifty-seven patients with intracranial tumors were treated with the aid of neuronavigation between July 1997 and December 1999. These patients showed an improvement from 80% to 86% on the Karnofsky index 8 weeks postoperatively. The majority of intracranial cases were primary brain tumors (n = 30) and metastases (n = 13) in functionally important areas of the brain. In four patients, a significant brain shift was observed during neuronavigation, and could be corrected by an image update using either the intraoperative CT scanner (n = 2) or the three-dimensional ultrasound system (n = 2). The presurgical brain mapping with magnetoencephalography was shown to be reliable in the sensory cortex (n = 25). Eleven patients with a thoracic or lumbar tumor were treated by open surgery or stabilization, using a combination of spinal neuronavigation and the intraoperative CT scanner. Two patients with spinal tumors underwent navigated biopsies. Neither of them showed a reduction in the clinical stage, but the Karnofsky index improved from 63% up to 72% 8 weeks postoperatively.

CONCLUSION

Neuronavigation allows very precise intracranial and spinal surgery. The problem of brain shift during the navigation procedures has been solved by intraoperative image acquisition. The use of neuronavigation was shown to improve the postoperative quality of life of patients suffering from brain and spinal tumors.

Temporal properties of high frequency intra-QRS signals in myocardial infarction and healthy hearts

The prevalence of late potentials after myocardial infarction depends on the site of the infarction. This may be caused by the different activation onsets of the anterior and inferior myocardial segments. Therefore, in anterior infarcts the high frequency signals may be concealed within the QRS whereas in the inferior infarcts they last beyond the end of the QRS. We compared the timing and the spatial patterns of high frequency intra-QRS signals (IQSs) in the different infarction sites. We investigated 14 patients with anterior infarcts, 17 patients with inferior infarcts, and 10 healthy subjects. 31-lead magnetocardiograms were recorded in left precordial position and averaged. The QRS signals were smoothed with a Savitzky-Golay filter. The smoothed QRS signals were subtracted from the measured ones. The difference of the signals (frequency band of about 60-200 Hz) representing the high frequency components was quantified. The percentage of the high frequency signals was calculated for the entire QRS, for the first and for the second half, respectively. We found that in patients with anterior infarcts the high frequency components predominantly appeared in the first half of the QRS whereas in inferior infarcts these components predominantly appeared in the second half of the QRS. The different infarction sites were associated with different spatial patterns of the high frequency signals on the body surface. In healthy subjects there was not such a preferential association of time intervals and high frequency signals. Late potentials are the special case of high frequency signals appearing in the terminal QRS. It is the general property of the myocardium to generate high frequency signals associated with the depolarization of infarcted tissue. The timing of such signals and the spatial distribution patterns on the body surface may help to identify the location of the sources.

The influence of lorazepam on somatosensory-evoked fast frequency (600 Hz) activity in MEG

The generators of high frequency bursts (600-Hz activity) detected at the parietal scalp over the primary somatosensory cortex after electrical stimulation of peripheral nerves are not yet known. We investigated the influence of benzodiazepine on the somatosensory-evoked 600-Hz activity by means of neuromagnetic measurements and source analysis. After oral administration of lorazepam, the latency of the 600-Hz burst activity was increased; specifically later peaks were delayed more than earlier peaks. In contrast, the latency of the concurrent primary cortical low frequency response (N20m) was not significantly changed. The source strengths of both N20m and 600-Hz bursts were significantly increased. Our results provide evidence for two components of the 600-Hz activity with a different generator structure.

Relations between early prespike magnetic field changes, interictal discharges, and return to basal activity in the neocortex of rabbits

To evaluate possible prespike field synchronizations, its relation to both interictal discharges and postspike return to baseline, penicillin-induced cortical interictal discharges were recorded in anaesthetized rabbits by magnetoencephalography (MEG) and electrocorticography (EcoG). Statistical parameters of spatial (global field power (GFP)) and temporal properties (Z-parameter) of field synchronization were calculated. In our previous report, three types of prespike field synchronization were found before the onset of interictal spike. We report here that the continuous and fluctuating, but not the abrupt prespike increases, were more often associated with a spike and wave pattern of interictal discharge than with a spike alone. Furthermore, the postspike return of these statistical parameters shows the same three patterns as the prespike field synchronizations, but in the inverse time sequence. More often than not pre- and postspike pattern were of the same type. The results suggest an influence of prespike field synchronization upon interictal discharge and subsequent field return dynamics.

Source localization and possible causes of interictal epileptic activity in tumor-associated epilepsy

Electrophysiological studies in gliomas have demonstrated action potentials in neoplastic cells. These "spiking tumor cells" are, however, an enigma. In attempt to find evidences for spikes within tumoral borders, 21 patients with different intracerebral tumors were preoperatively screened for the occurrence of epileptogenic discharges using multichannel MEG and EEG. A correlation between histopathology and the distance between dipole and tumor border could be found. Glioma patients showed epileptic activities closer to the border than those with mixed glioneuronal neoplasms and metastases. Four glioma patients demonstrated epileptic activity within the tumor boundary, however, not in the deep center of the tumor. Patch-clamping of cells from acute glioma slices did not yield a correlation between the presence of voltage-gated sodium channels in tumor cells and the MEG/EEG data. Our results demonstrate that the zone with the highest epileptogenic potential is different in gliomas and other brain tumors. However, our data do not strongly suggest that glioma cells are directly involved in the generation of tumor-associated epilepsy in vivo via their capability to generate action potentials.

Tonotopy of the Auditory-Evoked Field Component N100m in Patients with Schizophrenia

Abstract A number of clinical studies on the auditory neuromagnetic evoked field (AEF) component N100m have reported an altered lateralization in schizophrenic patients. This study addresses the problem of a possible functional reorganization of the temporal cortex in schizophrenia by examining the tonotopic organization of the N100m. Thirty-two patients with schizophrenia and 33 healthy controls of both sexes took part. Two tone frequencies (1000 and 5000 Hz tone) were applied for auditory stimuli, and AEF were recorded over both hemispheres successively using a 31-channel biomagnetometer. The comparison of N100m dipole location and orientation between hemispheres revealed no alterations in male or female patients. Between tone frequencies highly significant differences were found for N100m peak latency, mean global field power, dipole orientation, and dipole location in the anterior-posterior direction. Although the main effects of frequency were found to be the same in patients and controls, the balance between hemispheres was altered in patients with schizophrenia, with respect to the dependence between frequency and dipole location in the anterior-posterior direction as well as between frequency and latency. In patients, the influence of frequency on these variables was more pronounced in the right hemisphere and less pronounced in the left, compared to controls.

The influence of local tissue conductivity changes on the magnetoencephalogram and the electroencephalogram

We examined the influence of local tissue conductivity changes in the vicinity of a dipolar source on the neuromagnetic field and the electric scalp potential using a high resolution finite element method model of the human head. We found that the topology of both the electric scalp potential and the neuromagnetic field (and consequently dipole localization) is influenced significantly by conductivity changes only in voxels adjacent to the source. Conductivity changes in these voxels yield a greater change in the amplitude of the magnetic field (and consequently in the dipole strength) than in the amplitude of the electric potential.

[Effect of choice of baseline correction interval on localization of electrical heart activity]

The electric heart activity can be localised from body surface mapping data with computer algorithms. At higher heart rates the T and P waves merge. Thus, the offset can not be subtracted in the TP segment. We investigated 28 healthy volunteers with signal averaged 31-lead magnetocardiography. The offset of the baseline was determined in the TP-segment and in the PR-segment, respectively. The electrical heart activity was localised in the initial 30 ms of the QRS complex (Q), at the QRS maximum (R), and at the T wave maximum (T). The volume currents were considered by using a boundary element model with the compartments lungs and torso. The 3D positions of the dipoles, the dipole orientations, and the dipole strengths were calculated using the data preprocessed with two different offset correction intervals. The offsets of the TP and PR segments significantly differed one from another. The average deviations of the dipole localisation were within a few centimetres (Q: 20 +/- 31 mm, R: 6 +/- 13 mm, T: 14 +/- 30 mm). However, in a small number of subjects (Q: n = 5, R: n = 2, T: n = 5) we observed a deviation of more than 30 mm. These deviations were not linearly correlated to the differences in the baseline offsets. High resolution recordings continuously detect heart activity in the PR segment. The correction of the baseline in the PR segment instead of the TP segment may introduce artefacts in the source localisation and therefore should be avoided.

Habituation of the auditory evoked field component N100m in male patients with schizophrenia

The auditory evoked field (AEF) component N100m represents the most prominent and stable peak of the AEF, and its alterations in patients with schizophrenia are an extensive topic of neuropsychiatric research. In our current study, the degree of N100m habituation was investigated in 20 male schizophrenics and 19 healthy male controls. Participants were stimulated monaurally with 270 trials of 1000 Hz tones separated by an interstimulus interval between 800-1800 ms. The trial sample of the bilaterally recorded AEF was separated into three consecutive blocks of 90 trials and these blocks were compared with each other. The mean global field power (MGFP) of the N100m decreased on average 9.1% from the first to the third trial block, while the N100m latency was increasing. The analyses of the influence of habituation revealed a systematic change of dipole location in inferior-superior direction, mainly in the left hemisphere. This habituation effect was found to be the same for both groups. The groups also did not differ in the N100m latency increase and MGFP decrease, except for one parameter. The right-hemispheric MGFP decrease from the first to second block was found to be more pronounced in patients compared to controls. However, this difference was related to medication with clozapine. Overall, the habituation behaviour of the N100m seems to be undisturbed in schizophrenic patients.

QRS amplitude and shape variability in magnetocardiograms

In magnetocardiography, averaging of QRS complexes is often used to improve the signal-to-noise ratio. However, averaging of QRS complexes ignores the variation in amplitude and shape of the signals caused, for example, by respiration. This may lead to suppression of signal portions within the QRS complexes. Furthermore, for inverse source, reconstructions of dipoles and of current density distributions errors in the spacial arrangement may occur. To overcome these problems we developed a method for separating and selective averaging QRS complexes with different shapes and amplitudes. The method is based on a spline interpolation of the QRS complex averaged by a standard procedure. This spline function then is fitted to each QRS complex in the raw data by means of nonlinear regression (Levenberg-Marquardt method). Five regression parameters are applied: a linear amplitude scaling, two parameters describing the baseline drift, a time scaling parameter, and a time shift parameter. We found that both amplitude and shape of the QRS complex are influenced by respiration. The baseline shows a weaker influence of the respiration. The regression parameters of two neighboring measurement channels correlate linearly. Thus, selective averaging of a larger number of sensors can be performed simultaneously.

A 16-channel SQUID-device for biomagnetic investigations of small objects

Biomagnetic investigations in basic physiological research using animals require measurement devices different from commercial biomagnetometers used in human investigations. Two major problems have to be tackled in the design of such biomagnetometers. First, the spatial sampling needs to be much higher. Second, the distance between pick-up coils and the sources needs to be much shorter in order to compensate the worse signal-to-noise ratio (SNR) due to the smaller pick-up coils. We designed and built a 16-channel biomagnetic measurement system meeting these design criteria. The pick-up coil diameter of this new biomagnetometer is 6.7 mm, thus allowing 16 channels on an area of 3.2x3.2 cm2. The pick-up coils are located 3 mm above the dewar outer bottom, hence the closest distance to the cortical surface can be a few millimetres. We provide as an example of first measurements performed with the new biomagnetometer investigations of epileptic spikes in adult rabbits by simultaneous magnetoencephalogram (MEG) and electrocorticogram (ECoG) recordings. The high SNR of the recorded MEG and the simultaneously detected electric potentials allow investigations of the spatio-temporal pattern of neuronal processes of epileptiform spikes with signal strengths of about 3.5 pT.

[Late fields in magnetcardiography and late potentials in electrocardiography after acute myocardial infarction]

A high specificity and a high positive prediction has been reached in risk stratification for a sudden cardiac death after acute myocardial infarction (AMI) by combining multiple methods. But sensitivity and negative prediction are still not satisfying. There are the same physiological processes underlying magnetocardiography (MCG) and electrocardiography (ECG). Nevertheless, the signals in each method contain different information.

METHODS

We studied the cardiac magnetic fields in 50 patients after AMI and in 32 probands and calculated the magnetic late field (LF), according to Simsons late potential (LP) analysis. We defined normal values, according to the 95% confidence interval of the probands (QRS < =97 ms, RMS > = 0. 6, LAS < 25 ms).

RESULTS

We compared the results of LF and LP analysis regarding pathologic-nonpathologic and found 76% of the patients with the same results in both methods. Four patients had magnetic signals with low amplitude in the ST segment in contrast to the ECG result, while 6 patients with a "LP positive" diagnosis based on RMS and LAS only, did not show LF. In addition, we have found the magnetic QRS complex to be shorter than the electrical one.

DISCUSSION

In general, the results of LF measurement are similar to the ones of LP measurement. Presumably, there are intracardial currents, which are not detectable by ECG. Further studies are needed to evaluate the prognostic value in patients at high risk for cardiac arrhythmias.

Source localization in an inhomogeneous physical thorax phantom

The influence of lung inhomogeneities on focal source localizations in electrocardiography (ECG) and magnetocardiography (MCG) is investigated. A realistically shaped physical thorax phantom with cylindrical lung inhomogeneities is used for electric and magnetic measurements. The lungs are modelled with a special ionic exchange membrane which allows different conductivity compartments without influencing the free ionic current flow. The dipolar current sources are composed of platinum wire and located at different depths and directions between the lung inhomogeneities. We localized the current dipoles with different boundary element method (BEM) models, based on electrical data and simultaneous electrical and magnetic data. Our results indicate the possibility of superadditive information gain by combining electrical and magnetic data for source reconstructions. We found a significant influence of the inhomogeneities on both the calculated source location and the calculated source strength. Mislocalizations of up to 16 mm and wrong dipole strengths of up to 52% were obtained when the lung inhomogeneities were not taken into account for source localization. Dipoles parallel to the lungs showed a larger localization error in depth than dipoles perpendicular to the lungs. We conclude that the incorporation of lung inhomogeneities will improve source localization accuracy in ECG and MCG.

The influence of conductivity changes in boundary element compartments on the forward and inverse problem in electroencephalography and magnetoencephalography

Source localization based on magnetoencephalographic and electroencephalographic data requires knowledge of the conductivity values of the head. The aim of this paper is to examine the influence of compartment conductivity changes on the neuromagnetic field and the electric scalp potential for the widely used three compartment boundary element models. Both the analysis of measurement data and the simulations with dipoles distributed in the brain produced two significant results. First, we found the electric potentials to be approximately one order of magnitude more sensitive to conductivity changes than the magnetic fields. This was valid for the field and potential topology (and hence dipole localization), and for the amplitude (and hence dipole strength). Second, changes in brain compartment conductivity yield the lowest change in the electric potentials topology (and hence dipole localization), but a very strong change in the amplitude (and hence in the dipole strength). We conclude that for the magnetic fields the influence of compartment conductivity changes is not important in terms of dipole localization and strength estimation. For the electric potentials however, both dipole localization and strength estimation are significantly influenced by the compartment conductivity.

The sensitivity of instantaneous coherence for considering elementary comparison processing. Part II: Similarities and differences between EEG and MEG coherences

The EEG (electroencephalogram) coherence depends on EEG deviation type. A high level of sensitivity of instantaneous coherence for investigating elementary cognitive tasks could be shown in the case of unipolar reference (ear lobe reference). In order to validate of this result the same investigations were performed for MEG (magnetoencephalogram) coherence, where EEG and MEG were measured simultaneously. A strong correlation between time intervals with high EEG and MEG coherence could be shown. The equivalence of the sensitivity of EEG and MEG coherence for the description of the dynamic behaviour of information processing and the distinction between different elementary cognitive tasks is proven statistically.

[Acoustically evoked brain magnetic activity in normal and growth retarded fetuses during the third trimester of pregnancy]

The fetal magnetoencephalogram with a 31 chanal biomagnetometer made by Philips was measured in a fetal 1F-phase in 20 normotroph unimpaired and in 14 growth retarded fetuses with a birth weight < 5 percentile after completed 36th gestational week. Trough defined acoustic stimulations, which were applied over the maternal abdominal wall, it was possible to measure acoustic evoked cerebromagnetic field changes using a special computer programs. The registrated evoked cerebromagnetic field changes had a latence time of 112.8 +/- 18.4 ms in normotroph fetuses and 130.9 +/- 18.5 ms in hypotroph fetuses. The difference was significant (p < 0.01). The presented results lead to the conclusions that the fetal magnetoencephalography makes a differentiation between normal and disturbed fetal cerebral integrity possible.

[High-resolution magnetoencephalography--studies with a small-volume phantom]

To investigate the spatiotemporal organisation of neuronal processes in an animal model using magnetoencephalography (MEG), a high temporal resolution (ms) and an appropriate spatial resolution of about 1 mm is necessary. With the aim of determining the localization error and the resolution power of high-resolution MEG systems, we developed a phantom capable of simulating the characteristics of animal models. The phantom enables us to variably position at least two magnetic field sources to within 0.1 mm. For source localization on the basis of the magnetic field data, a spatial filtering algorithm was used. The investigation of a 16-channel micro SQUID-MEG system with a current dipole orientated tangentially to the phantom surface produced the following localization data (min ... max, x, y--horizontal plane, z--depth); systematic localization error e(x) = 1.16 ... 1.67 mm, e(y) = -1.01 ... -1.28 mm, e(z) = -5.22 ... -7.64 mm, standard deviation of the individual measurements perpendicular to the dipole axis s(perp) = 0.05 ... 0.22 mm, along this axis s(long) = 0.20 ... 1.73 mm, in the depths sz = 0.17 ... 3.17 mm. The "goodness of fit" was > 95%. Separation of two dipoles was still possible for parallel dipoles at a distance apart of d(parallel) = 0.03 mm and for those oriented perpendicularly to each other at a distance apart of d(perp) = 0.10 mm. On the basis of these results we conclude that the MEG system can achieve a resolution sufficient to permit the investigation of neuronal microstructures. The spatial errors detected were related to sensor position in the cryostatic vessel as well as to external low-frequency noise.

Application of high-order boundary elements to the electrocardiographic inverse problem

Eight-noded quadrilateral boundary elements are applied to the electrocardiographic inverse problem as an example for high-order boundary elements. It is shown that the choice of the shape functions used for approximation of the potentials has a remarkable influence on the solution obtained if the number of electrodes is smaller than the number of primary source points (under-determined equation system). Three different formulations are investigated considering a concentric spheres problem where an analytic solution is available: (a) the isoparametric formulation; (b) the quasi-first-order formulation; and (c) the pseudo-subparametric formulation as a new method. In a second step the pseudo-subparametric formulation (which provided the best results in the test problem) is applied to real word data. The transmembrane potential pattern of a 40 years old female suffering from severe heart failure and ventricular tachycardia after large anterior wall myocardial infarction is reconstructed for one time instant. Furthermore, an algorithm for the calculation of the transfer matrix is presented which avoids restrictions to the boundary element mesh caused by the placement of the electrodes.

Impaired sensory processing in male patients with schizophrenia: a magnetoencephalographic study of auditory mismatch detection

The generation of mismatch negativity (MMN) as a component of auditory evoked event-related brain potentials has been reported previously to be severely disturbed in patients with schizophrenia. In the present study, we extended these findings to magnetoencephalography and investigated the neuromagnetic mismatch field (MMNm) in 15 male schizophrenic inpatients as compared to 16 healthy male volunteers. A standard tone of 1000 Hz and three different types of mismatch (1050-Hz tone, 5000-Hz tone, tone omission) were employed within the same paradigm, each mismatch occurring with a 10% pseudorandom probability. After correction for eye artifacts, the mean global field power of the mismatch reaction was calculated. Mismatch generation in patients with schizophrenia proved to be significantly impaired for all three conditions. This result confirms the theory of impaired auditory information processing in patients with schizophrenia at the level of the primary auditory cortex. Deficient generation of MMNm probably represents an impaired generation and/or faster decay of the sensory memory trace on the basis of disturbed sensory processing in male patients with schizophrenia.