Noninvasive markers of functional nausea in children

项目摘要 胃电慢波介导胃肠合胞体中的神经肌肉相互作用， 确定消化和消化的功能状态。数以百万计的病人向胃肠病学家 与胃慢波节律障碍相关的功能性胃肠道疾病。然而，在这方面， 用于定量评估这种活性的非侵入性方法仍然是难以捉摸的。结构成像由 当功能障碍与解剖结构变化相关时，CT和超声可能有用，但 胃疾病的发生常常没有伴随的结构异常。功能性恶心（FN）是一种GI 一种影响数百万美国人，特别是青少年的疾病，但诊断在很大程度上仍然是排除性的 依靠病理学和其他正常的诊断检查。FN在青少年中的研究很重要 因为它是普遍存在的，慢性的，跟踪到成年期，并对患者的生活质量产生不利影响， 了解病理生理学可能允许在治疗可塑性的时候进行干预。的能力 研究FN由于缺乏客观的临床试验来表征或测量恶心或预测其 对治疗或加重因素的反应。胃电图（EGG）是一种可能的方法，但信号 腹部容积传导的质量和局限性以前限制了它在 时间动态的特征。我们的初步数据表明，盲源分离适用于 多通道胃电图（EGG）可以表征胃慢波的传播， 胃磁图（MGG），其测量来自胃的磁场的时空特性， 慢波，也允许表征胃慢波的传播，除了评价 频率和功率分布。此外，这些时空特征在 高血糖症和功能性疾病如胃轻瘫。我们建议研究功能性恶心是如何在 青少年可以通过使用多通道EGG和MGG记录来非侵入性地表征。我们 该建议的主要目的是开发FN的数学模型，将缓慢生长的FN中的功能差异 使用建模和实验方法对FN患者的恶心波进行研究，并描述 使用EGG/MGG的FN的生物物理、临床和心理社会表型。我们将研究差异 在标准四通道EGG和多通道EGG/MGG之间，评估慢波节律的变化， FN患者中EGG和MGG的传播模式，检查EGG和MGG之间的差异。 FN患者中严重恶心的MGG特征，并将确定MGG/EGG慢波节律和 模式异常与心理功能和药物干预有关。分析 慢波活动代表了第一种生理学上可量化的非侵入性评估方法， 与青少年功能性恶心相关的病理过程。

Project Summary The gastric electrical slow wave mediates neuromuscular interactions in the gastrointestinal syncytium that determine the functional status of peristalsis and digestion. Millions of patients present to gastroenterologists each year with functional GI disorders which are associated with gastric slow wave dysrhythmia. However, noninvasive methods for assessing this activity quantitatively remain elusive. Structural imaging provided by CT and ultrasound can be useful when functional disorders are associated with anatomical changes, but frequently, gastric disorders occur with no concomitant structural abnormality. Functional nausea (FN) is a GI disorder that affects millions of Americans, particularly adolescents, but diagnoses remain largely exclusionary relying on symptomology with an otherwise normal diagnostic workup. FN is important to study in adolescents because it is ubiquitous, chronic, tracks into adulthood and adversely affects the quality of life in patients, yet understanding the pathophysiology might allow interventions at a time of therapeutic plasticity. The ability to study FN is limited by the lack of an objective clinical test to characterize or measure nausea or to predict its response to treatment or exacerbating factors. Electrogastrography (EGG) is as a possible approach, but signal quality and limitations of volume conduction in the abdomen have previously limited its utility to the characterization of temporal dynamics. Our preliminary data show that blind source separation applied to the multichannel electrogastrogram (EGG) can characterize propagation of the gastric slow wave, and that the magnetogastrogram (MGG), which measures spatiotemporal properties of magnetic fields from the gastric slow wave, also allows characterization of the propagation of the gastric slow wave in addition to evaluation of its frequency and power distribution. Furthermore, these spatiotemporal characteristics change during hyperglycemia and functional disorders like gastroparesis. We propose to study how functional nausea in adolescents may be characterized noninvasively by the use of multichannel EGG and MGG recordings. Our main aims in this proposal are to develop a mathematical model of FN, correlate functional differences in slow waves with nausea in patients with FN using modeling and experimental approaches, and to characterize biophysical, clinical and psychosocial phenotypes of FN using EGG/MGG. We will investigate differences between standard four-channel EGG and multichannel EGG/MGG, assess changes in slow wave rhythm and propagation pattern from EGG and MGG with disease in FN patients, examine differences between EGG and MGG signatures of severe nausea in FN patients, and will determine how MGG/EGG slow wave rhythm and pattern abnormalities relate to psychological functioning and pharmacological intervention. The analysis of slow wave activity represents the first physiologically-quantifiable noninvasive assessment method for pathological processes associated with functional nausea in adolescents.