Noninvasive markers of functional nausea in children

项目摘要 胃电慢波介导胃肠合体的神经肌肉相互作用 测定肠蠕动和消化的功能状态。数以百万计的患者出现在胃肠病专家面前 每年都有功能性胃肠功能障碍，这与胃慢波节律紊乱有关。然而， 定量评估这一活动的非侵入性方法仍然难以捉摸。由提供的结构成像 当功能障碍与解剖变化相关时，CT和超声波可能会很有用，但 通常情况下，胃病发生时没有伴随的结构异常。功能性恶心(FN)是胃肠道疾病 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他性的 依靠症状学和其他正常的诊断检查。FN对青少年的学习很重要 因为它是无处不在的，慢性的，可以追溯到成年期，并对患者的生活质量产生不利影响，但 了解病理生理学可能会在治疗可塑性的时候进行干预。有能力 由于缺乏客观的临床测试来表征或测量恶心或预测恶心，FN的研究受到限制。 对治疗或加重因素的反应。胃电(EGG)是一种可能的方法，但信号 腹部容量传导的质量和局限性以前将其应用限制在 时间动力学的表征。我们的初步数据表明，盲源分离适用于 多导胃电(EGG)可以表征胃慢波的传播，而胃电 胃磁图(MGG)，测量来自胃的磁场的时空特性 慢波，除了评估胃慢波的传播外，还可以表征胃慢波的传播 它的频率和功率分布。此外，这些时空特征在 高血糖和胃瘫等功能障碍。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。我们的 该方案的主要目的是建立FN的数学模型，将慢速中的功能差异关联起来 利用模拟和实验方法对FN患者出现恶心的波进行研究，并对其特征进行分析 应用EGG/MGG研究FN的生物物理、临床和心理社会表型。我们将调查分歧 在标准四通道EGG和多通道EGG/MGG之间，评估慢波节律和 FN患者EGG和MGG的繁殖模式，比较两者的差异 FN患者严重恶心的MGG征象，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。分析了几个问题 慢波活动代表了第一种生理上可量化的无创评估方法 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.