Showing papers in "Medical & Biological Engineering & Computing in 2002"

Systematic comparison of different algorithms for apnoea detection based on electrocardiogram recordings.

Abstract: Sleep apnoea is a common disorder that is usually diagnosed through expensive studies conducted in sleep laboratories. Sleep apnoea is accompanied by a characteristic cyclic variation in heart rate or other changes in the waveform of the electrocardiogram (ECG). If sleep apnoea could be diagnosed using only the ECG, it could be possible to diagnose sleep apnoea automatically and inexpensively from ECG recordings acquired in the patient's home. This study had two parts. The first was to assess the ability of an overnight ECG recording to distinguish between patients with and without apnoea. The second was to assess whether the ECG could detect apnoea during each minute of the recording. An expert, who used additional physiological signals, assessed each of the recordings for apnoea. Research groups were invited to access data via the world-wide web and submit algorithm results to an international challenge linked to a conference. A training set of 35 recordings was made available for algorithm development, and results from a test set of 35 different recordings were made available for independent scoring. Thirteen algorithms were compared. The best algorithms made use of frequency-domain features to estimate changes in heart rate and the effect of respiration on the ECG waveform. Four of these algorithms achieved perfect scores of 100% in the first part of the study, and two achieved an accuracy of over 90% in the second part of the study.

Investigation into the origin of the noise of surface electrodes.

Abstract: In the recording of biomedical signals, a significant noise component is introduced by the electrode. The magnitude of this noise is considerably higher than the equivalent thermal noise from the electrode impedance. As the noise in surface electrodes limits the resolution of biopotential recordings, it is important to understand its origin. It was found that the noise mainly originates in the electrolyte-skin interface and that it is highly dependent on the electrode gel used and the skin properties of the test subject. Depending on skin treatment, magnitudes between 1 and 20μVrms were measured among subjects. When the metal-electrolyte interface was allowed time to stabilise, electrodes of different metals measured face to face all showed a negligibly small noise magnitude (<1μVrms). In pre-gelled electrodes, where the metal-electrolyte interface has stabilised, no difference in noise properties was found between Ag−AgCl electrodes and other metals when measured on the skin. In subjects at rest, the contribution of EMG signals to the total noise level was shown to be negligibly small compared with the noise contribution of the electrolyte-skin interface. The magnitude of the noise of electrodes appeared to be inversely proportional to the square root of the area of the electrode on the skin.

Biomechanical model to simulate tissue differentiation and bone regeneration: Application to fracture healing

Abstract: Bone regeneration is a common biological process occurring, for example, during fracture healing or osseo-integration of prostheses. Computer simulation of bone regeneration is difficult to carry out because it is a complex sequence of cell-mediated processes regulated by mechanobiological stimuli. An algorithm to predict the time-course of intramembranous and endochondral ossification has been developed. The algorithm assumes that there are precursor cells in the undifferentiated tissue and that these cells differentiate into either fibroblasts (to form fibrous connective tissue), chondrocytes (to form cartilaginous tissue) or osteoblasts (to form bone), based on a combination of biophysical stimuli derived from strain in the collagenous matrix and flow of the interstitial fluid. Both these stimuli are known to deform the precursor cells, and the authors hypothesise that this causes activation of cell differentiation pathways. The observation that precursor cells take time to spread throughout the fracture callus has been included in the algorithm. The algorithm was tested in an investigation of the fracture healing of a long bone using an axisymmetric finite element model. The spatio-temporal sequence of tissue phenotypes that appear in the course of fracture healing was successfully simulated. Furthermore, the origin of the precursor cells (either surrounding muscle, bone marrow or periosteum) was predicted to have a fundamental effect on the healing pattern and on the rate of reduction of the interfragmentary strain (IFS). The initial IFS=0.15 drops to 0.01 within seven iterations if cells originated from the surrounding soft tissue, but took more than 50% longer if cells originated in the inner cambium layer of the periosteum, and four times longer if precursor cells originated from the bone marrow only.

Progress towards automated diabetic ocular screening: a review of image analysis and intelligent systems for diabetic retinopathy

Abstract: Patients with diabetes require annual screening for effective timing of sight-saving treatment. However, the lack of screening and the shortage of ophthalmologists limit the ocular health care available. This is stimulating research into automated analysis of the reflectance images of the ocular fundus. Publications applicable to the automated screening of diabetic retinopathy are summarised. The review has been structured to mimic some of the processes that an ophthalmologist performs when examining the retina. Thus image processing tasks, such as vessel and lesion location, are reviewed before any intelligent or automated systems. Most research has been undertaken in identification of the retinal vasculature and analysis of early pathological changes. Progress has been made in the identification of the retinal vasculature and the more common pathological features, such as small aneurysms and exudates. Ancillary research into image preprocessing has also been identified. In summary, the advent of digital data sets has made image analysis more accessible, although questions regarding the assessment of individual algorithms and whole systems are only just being addressed.

Comparison of laser speckle and laser Doppler perfusion imaging: measurement in human skin and rabbit articular tissue.

Abstract: Laser Doppler perfusion imaging (LDI) is currently used in a variety of clinical applications, however, LDI instruments produce images of low resolution and have long scan times. A new optical perfusion imager using a laser speckle measurement technique and its use for in vivo blood flow measurements are described. Measurements of human skin and surgically exposed rabbit tissue made using this instrument were compared with a commercial laser Doppler perfusion imaging instrument. Results from blood flow measurements showed that the laser speckle imager measured an 11-67% decrease in blood flow under arterial occlusion. Under similar conditions, the laser Doppler imager measured blood flow decreases of 21-63%. In comparison with LDI, it was observed that the higher temporal resolution of the laser speckle imager was more sensitive to measuring the hyperaemic response immediately following occlusion. This in vivo study demonstrated some of the several advantages laser speckle imaging has over conventional LDI, making the new instrument more versatile in a clinical environment.

Joint symbolic dynamic analysis of beat-to-beat interactions of heart rate and systolic blood pressure in normal pregnancy.

Abstract: Pregnancy induces important changes in the autonomic control. Measures of heart rate (HR) variability and systolic blood pressure (SP) variability are sensitive to those changes. The interactions between HR and SP are complex and strongly non-linear. Therefore they cannot be completely described by linear analysis techniques. A study of joint symbolic dynamics is presented as a new short-term non-linear analysis method to investigate the interactions between HR and SP. Continuous, non-invasive 30 min blood pressure recordings (Portapres) of 25 pregnant and 14 non-pregnant women were analysed. Time series of beat-to-beat HR and SP were extracted. Using the concept of joint symbolic dynamics, HR and SP changes were transformed into a bivariate symbol vector. Subsequently, this symbol vector was transformed into a word series (words consisting of three successive symbols), and the probability of occurrence of each word type was calculated and compared between both groups. Significant differences were found in five word types between pregnant and non-pregnant women: w0,4(0.021±0.011 against 0.008±0.006; p=0.022), w4,6(0.020±0.010 against 0.007±0.003; p=0.001), w3,2(0.004±0.003 against 0.007±0.003; p=0.038), w6,5(0.009±0.007 against 0.023±0.008; p<0.001) and w3,6(0.011±0.007 against 0.023±0.008; p=0.001). Joint symbolic dynamics provides an efficient non-linear representation of HR and SP interactions that offers simple physiological interpretations.

Linear and non-linear methods for automatic seizure detection in scalp electro-encephalogram recordings

Abstract: The electro-encephalogram is a time-varying signal that measures electrical activity in the brain. A conceptually intuitive non-linear technique, multi-dimensional probability evolution (MDPE), is introduced. It is based on the time evolution of the probability density function within a multi-dimensional state space. A synthetic recording is employed to illustrate why MDPE is capable of detecting changes in the underlying dynamics that are invisible to linear statistics. If a non-linear statistic cannot outperform a simple linear statistic such as variance, then there is no reason to advocate its use. Both variance and MDPE were able to detect the seizure in each of the ten scalp EEG recordings investigated. Although MDPE produced fewer false positives, there is no firm evidence to suggest that MDPE, or any other non-linear statistic considered, outperforms variance-based methods at identifying seizures.

Changes in electrical resistivity of swine liver after occlusion and postmortem

Abstract: The resistivity of swine liver tissue was measured in vivo, during induced ischaemia and post-mortem, so that associated changes in resistivity could be quantified. Plunge electrodes, the four-terminal method and a computer-automated measurement system were used to acquire resistivities between 10Hz and 1 MHz. Liver resistivity was measured in vivo in three animals at 11 locations. At 10 Hz, resistivity was 758 +/- 170 ohm x cm. At 1 MHz, the resistivity was 250 +/- 40 ohm x cm. The resistivity time course was measured during the first 10 min after the liver blood supply in one animal had been occluded. Resistivity increased steadily during occlusion. The change in resistivity of an excised tissue sample was measured during the first 12h after excision in one animal. Resistivity increased during the first 2h by 53% at 10 Hz and by 32% at 1 MHz. After 2h, resistivity decreased, probably owing to membrane breakdown. The resistivity data were fitted to a Cole-Cole circle, from which extracellular resistance Re, intracellular resistance Ri and cell membrane capacitance Cm were estimated. Re increased during the first 2h by 95% and then decreased, suggesting an increase in extracellular volume. Cm increased during the first 4 h by 40%, possibly owing to closure of membrane channels, and then decreased, suggesting membrane breakdown. Ri stayed constant during the initial 6h and then increased.

Computational simulations of stress shielding and bone resorption around existing and computer-designed orthopaedic screws.

Abstract: Failure of an orthopaedic fixation due to stress shielding and consequent screw loosening is a major concern among surgeons: the loosened screws could not only interfere with the healing process but also endanger adjacent anatomical structures. In this study, the effect of the screw's engineering design (dimensions, profile shape and material properties) on the load sharing with adjacent bone and consequent bone resorption was tested, using a set of two-dimensional computational (finite element) models. An algorithm simulating local bone adaptation to strain energy density (SED) mechanical stimuli was developed and used to evaluate the biomechanical performances of different commercial screws. Two new designs, a ‘graded-stiffness’ composite screw, with a reduced-stiffness titanium core and outer polymeric threads, and an active-compression hollow screw that generates compressive stresses on the surrounding bone, were also evaluated. A dimensionless set of stress transfer parameters (STPs) were utilised for ranking the performances of the different screws according to the expected screw-bone load sharing and its evolution with adaptation of the surrounding tissue. The results indicated that commercial wide (6mm thread diameter) trapezoidal and rectangular screw profiles have superior biomechanical compatibility with bone (i.e. predicted to be stable after 2 years). The graded-stiffness and active-compression screws provided the best biomechanical performances: bone loading around them was predicted to decrease by no more than 15% after 3 years, compared with a decrease of 55–70% in bone loading around commercially available screws. Computer simulations of bone adaptation around orthopaedic screws are demonstrated to be effective means for objective and quantitative evaluation of the biomechanical aspects of implant-tissue compatibility.

Biomechanical analysis of fatigue-related foot injury mechanisms in athletes and recruits during intensive marching.

Abstract: An integrative analysis, comprising radiographic imaging of the foot, plantar pressure measurements, surface electromyography (EMG) and finite element (FE) modelling of the three-dimensional (3D) foot structure, was used to determine the effects of muscular fatigue induced by intensive athletic or military marching on the structural stability of the foot and on its internal stress state during the stance phase. The medial/lateral (M/L) tendency towards instability of the foot structure during marching in fatigue conditions was experimentally characterised by measuring the M/L deviations of the foot-ground centre of pressure (COP) and correlating these data with fatigue of specific lower-limb muscles, as demonstrated by the EMG spectra. The results demonstrated accelerated fatigue of the peroneus longus muscle in marching conditions (treadmill march of 2km completed by four subjects at an approximately constant velocity of 8 kmh−1). Severe fatigue of the peroneus longus is apparently the dominant cause of lack of foot stability, which was manifested by abnormal lateral deviations of the COP during the stance phase. Under these conditions, ankle sprain injuries are likely to occur. The EMG analysis intensive marching (averaged decreases of 36% and 40% in the median frequency of their EMG signal spectra, respectively). Incorporation of this information into the 3D FE model of the foot resulted in a substantial rise in the levels of calcaneal and metatarsal stress concentrations, by 50% and 36%, respectively. This may point to the mechanism by which stress fractures develop and provide the biomechanical tools for future clinical investigations.

Automatic P-wave analysis of patients prone to atrial fibrillation.

Abstract: A method is presented for automatic analysis of the P-wave, based on lead II of a 12-lead standard ECG, in resting conditions during a routine examination for the detection of patients prone to atrial fibrillation (AF), one of the most prevalent arrhythmias. First, the P-wave was delineated, and this was achieved in two steps: the detection of the QRS complexes for ECG segmentation, using a wavelet analysis method, and a hidden Markov model to represent one beat of the signal for P-wave isolation. Then, a set of parameters to detect patients prone to AF was calculated from the P-wave. The detection efficiency was validated on an ECG database of 145 patients, including a control group of 63 people and a study group of 82 patients with documented AF. A discriminant analysis was applied, and the results obtained showed a specificity and a sensitivity between 65% and 70%.

Human platelet supernatant promotes proliferation but not differentiation of articular chondrocytes.

Abstract: The objective of the study was to evaluate the growth-promoting activity of human platelet supernatant on primary chondrocytes in comparison with fetal calf serum (FCS) supplemented cell culture medium. Furthermore, the differentiation potential of platelet supernatant was determined in three-dimensional artificial cartilage tissues of bovine articular chondrocytes. Proliferation of articular and nasal septal chondrocytes was assayed by incorporation of BrdU upon stimulation with ten different batches of human platelet supernatant. On bovine articular chondrocytes, all these batches were at least as growth-promoting as FCS. On nasal septal chondrocytes, nine out of ten batches revealed increased or equivalent mitogenic stimulation compared with medium supplemented with FCS. Three-dimensional culture and subsequent histological analysis of matrix formation were used to determine the differentiation properties of platelet supernatant on articular chondrocytes. Human platelet supernatant failed to induce the deposition of typical cartilage matrix components, whereas differentiation and matrix formation were apparent upon cultivation of articular chondrocytes with FCS. Proliferation assays demonstrated that human platelet supernatant stimulates growth of articular and nasal septal chondrocytes; however, platelet supernatant failed to stimulate articular chondrocytes to redifferentiate in three-dimensional chondrocyte cultures. Therefore platelet lysate may be suitable for chondrocyte expansion, but not for maturation of tissue-engineered cartilage.

Polysomnographic pattern recognition for automated classification of sleep-waking states in infants.

Abstract: A robust, automated pattern recognition system for polysomnography data targeted to the sleep-waking state and stage identification is presented. Five patterns were searched for: slow-delta and theta wave predominance in the background electro-encephalogram (EEG) activity; presence of sleep spindles in the EEG; presence of rapid eye movements in an electro-oculogram; and presence of muscle tone in an electromyogram. The performance of the automated system was measured indirectly by evaluating sleep staging, based on the experts' accepted methodology, to relate the detected patterns in infants over four months of post-term age. The set of sleep-waking classes included wakefulness, REM sleep and non-REM sleep stages I, II, and III–IV. Several noise and artifact rejection methods were implemented, including filters, fuzzy quality indices, windows of variable sizes and detectors of limb movements and wakefulness. Eleven polysomnographic recordings of healthy infants were studied. The ages of the subjects ranged from 6 to 13 months old. Six recordings counting 2665 epochs were included in the training set. Results on a test set (2369 epochs from five recordings) show an overall agreement of 87.7% (kappa 0.840) between the automated system and the human expert. These results show significant improvements compared with previous work.

Unconstrained and non-invasive measurement of heart-beat and respiration periods using a phonocardiographic sensor

Abstract: With the rapid growth in the number of elderly people in the population, interest in health monitoring is increasing. Therefore the development of an unconstrained and non-invasive vital signs measurement system could be important for monitoring health status at home or in hospitals or nursing facilities. A simple system is proposed for measuring heart-beat and respiration periods for home healthcare. This was achieved with a phonocardiographic (PCG) sensor set on a water-mat or air-mat. The PCG sensor was an acceleration sensor that extracted the vibration of the mat caused by heart-beat and respiration. By calculating an autocorrelation function of the fully rectified sensor output or by local pattern matching between the rectified output and a reference signal (pre-memorised for each subject), the system measured the average and instantaneous periods of both heart-beat and respiration. Results showed that these periods were measured to a similar level of accuracy as for the electrocardiogram and thermistor respiration pickup. The comparative accuracies were within the following ranges: average heartbeat 0.19% to 0.67%, instantaneous heartbeat 0.53% to 1.15%, average respiration 0.51% to 2.17%, and instantaneous respiration 2.51% to 5.20%.

Cardiovascular response to dynamic aerobic exercise: a mathematical model.

Abstract: An original mathematical model of the cardiovascular response to dynamic exercise is presented. It includes the pulsating heart, the pulmonary and systemic circulation, a separate description of the vascular bed in active tissues, the local metabolic vasodilation in these tissues and the mechanical effects of muscular contractions on venous return. Moreover, the model provides a description of the ventilatory response to exercise and various neural regulatory mechanisms working on cardiovascular parameters. These mechanisms embrace the so-called central command, the arterial baroreflex and the lung inflation reflex. All parameters in the model have been given in accordance with physiological data from the literature. In this work, the model has been used to simulate the steady-state value of the main cardiorespiratory quantities at different levels of aerobic exercise and the temporal pattern in the transient phase from rest to moderate exercise. Results suggest that, with suitable parameter values the model is able accurately to simulate the cardio-respiratory response in the overall range of aerobic exercise. This response is characterised by a moderate hypertension (10–30%) and by a conspicuous increase in systemic conductance (80–130%), heart rate (64–150%) and cardiac output (100–200%). The transient pattern exhibits three distinct phases (lasting approximately 5 s, 15 s and 2 min), that reflect the temporal heterogeneity of the mechanisms involved. The model may be useful to improve understanding of exercise physiology and as an educational tool to analyse the complexity of cardiovascular and respiratory regulation.

Characterisation of electrocardiogram signals based on blind source separation.

Abstract: Blind source separation assumes that the acquired signal is composed of a weighted sum of a number of basic components corresponding to a number of limited sources. This work poses the problem of ECG signal diagnosis in the form of a blind source separation problem. In particular, a large number of ECG signals undergo two of the most commonly used blind source separation techniques, namely, principal component analysis (PCA) and independent component analysis (ICA), so that the basic components underlying this complex signal can be identified. Given that such techniques are sensitive to signal shift, a simple transformation is used that computes the magnitude of the Fourier transformation of ECG signals. This allows the phase components corresponding to such shifts to be removed. Using the magnitude of the projection of a given ECG signal onto these basic components as features, it was shown that accurate arrhythmia detection and classification were possible. The proposed strategies were applied to a large number of independent 3s intervals of ECG signals consisting of 320 training samples and 160 test samples from the MIT-BIH database. The samples equally represent five different ECG signal types, including normal, ventricular couplet, ventricular tachycardia, ventricular bigeminy and ventricular fibrillation. The intervals analysed were windowed using either a rectangular or a Hamming window. The methods demonstrated a detection rate of sensitivity 98% at specificity of 100% using nearest neighbour classification of features from ICA and a rectangular window. Lower classification rates were obtained using the same classifier with features from either PCA or ICA and a rectangular window. The results demonstrate the potential of the new method for clinical use.

Ambulatory measurement of upper limb usage and mobility-related activities during normal daily life with an upper limb-activity monitor: a feasibility study.

Abstract: The aim of this research was to assess the ability of an upper limb-activity monitor (ULAM) to discriminate between upper limb usage and non-usage in healthy and disabled subjects during normal daily life. The ULAM was based on ambulatory accelerometry and consisted of several acceleration sensors connected to a small recorder worn around the waist. While wearing this ULAM, four healthy and four disabled subjects performed an activity protocol representing normal daily life upper limb usage or non-usage. The motility feature (derived from the raw acceleration signals) was used as a measure of the extent of upper limb usage. Agreement scores between ULAM output and videotape recordings (reference method) were calculated. ULAM data that were of special interest for rehabilitation were detected satisfactorily (overall agreement 83.9%). There were no systematic differences in the agreement percentages between healthy and disabled subjects for mobility-related activities (p=0.345) and the different forms of upper limb usage or non-usage (p=0.715). The ULAM can be used in future studies in subjects with upper limb disorders to discriminate between upper limb usage and non-usage during performance of mobility-related activities to determine activity limitations.

Wavelet transform analysis of heart rate variability during myocardial ischaemia.

Abstract: Analysis of heart rate variability (HRV) is a valuable, non-invasive method for quantifying autonomic cardiac control in humans. Frequency-domain analysis of HRV involving myocardial ischaemic episodes should take into account its non-stationary behaviour. The wavelet transform is an alternative tool for the analysis of non-stationary signals. Fourteen patients have been analysed, ranging from 40 to 64 years old and selected from the European Electrocardiographic ST-T Database (ESDB). These records contain 33 ST episodes, according to the notation of the ESDB, with durations of between 40s and 12min. A method for analysing HRV signals using the wavelet transform was applied to obtain a time-scale representation for very low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands using the orthogonal multiresolution pyramidal algorithm. The design and implementation using fast algorithms included a specially adapted decomposition quadrature mirror filter bank for the frequency bands of interest. Comparing a normality zone against the ischaemic episode in the same record, increases in LF (0.0112±0.0101 against 0.0175±0.0208s2Hz−1; p<0.1) and HF (0.0011±0.0008 against 0.0017±0.0020s2Hz−1; p<0.05) were obtained. The possibility of using these indexes to develop an ischaemic-episode classifier was also tested. Results suggest that wavelet analysis provides useful information for the assessment of dynamic changes and patterns of HRV during myocardial ischaemia.

Coherence between one random and one periodic signal for measuring the strength of responses in the electro-encephalogram during sensory stimulation.

Abstract: Coherence between a pulse train representing periodic stimuli and the EEG has been used in the objective detection of steady-state evoked potentials. This work aimed to quantify the strength of the stimulus responses based on the statistics of coherence estimate between one random and one periodic signal, focusing on the confidence limits and power of significance tests in detecting responses. To detect the responses in 95% of cases, a signal-to-noise ratio of about −7.9 dB was required when using 48 windows (M) in the coherence estimation. The ratio, however, increased to −1.2 dB when M was 12. The results were tested in Monte Carlo simulations and applied to EEGs obtained from 14 subjects during visual stimulation. The method showed differences in the strength of responses at the stimulus frequency and its harmonics, as well as variations between individuals and over cortical regions. In contrast to those from the parietal and temporal regions, results for the occipital region gave confidence limits (with M=12) that were above zero for all subjects, indicating statistically significant responses. The proposed technique extends the usefulness of coherence as a measure of stimulus responses and allows statistical analysis that could also be applied usefully in a range of other biological signals.

Fuzzy rules to predict degree of malignancy in brain glioma

Abstract: The current pre-operative assessment of the degree of malignancy in brain glioma is based on magnetic resonance imaging (MRI) findings and clinical data. 280 cases were studied, of which 111 were high-grade malignancies and 169 were low-grade, so that regular and interpretable patterns of the relationships between glioma MRI features and the degree of malignancy could be acquired. However, as uncertainties in the data and missing values existed, a fuzzy rule extraction algorithm based on a fuzzy min-max neural network (FMMNN) was used. The performance of a multi-layer perceptron network (MLP) trained with the error back-propagation algorithm (BP), the decision tree algorithm ID3, nearest neighbour and the original fuzzy min-max neural network were also evaluated. The results showed that two fuzzy decision rules on only six features achieved an accuracy of 84.6% (89.9% for low-grade and 76.6% for high-grade cases). Investigations with the proposed algorithm revealed that age, mass effect, oedema, post-contrast enhancement, blood supply, calcification, haemorrhage and the signal intensity of the T1-weighted image were important diagnostic factors.

Pneumothorax detection using computerised analysis of breath sounds.

Abstract: The primary objective of the study was to investigate the effects of pneumothorax (PTX) on breath sounds and to evaluate their use for PTX diagnosis. The underlying hypothesis is that there are diagnostic breath sound changes with PTX. An animal model was created in which breath sounds of eight mongrel dogs were acquired and analysed for both normal and PTX states. The results suggested that pneumothorax was associated with a reduction in sound amplitude, a preferential decrease in high-frequency acoustic components and a reduction in sound amplitude variation during the respiration cycle (p<0.01 for each, using the Wilcoxson signed-rank test). Although the use of diminished sound amplitude for PTX diagnosis assumes availability of baseline measurements, this appears unnecessary for high-frequency reduction or sound amplitude changes over the respiratory cycle. Further studies are warranted to test the clinical feasibility of the method in humans.

Theoretical study of the effect of local flow disturbances on the concentration of low-density lipoproteins at the luminal surface of end-to-end anastomosed vessels.

Abstract: To elucidate the mechanisms of localisation of intimal hyperplasia in anastomosed arteries, the effects of flow disturbances on the transport of low-density lipoproteins (LDLs) from the flowing blood to the wall of end-to-end anastomosed arteries, with and without a moderate stenosis, were studied theoretically by means of a computer simulation under the condition of steady flow. In an artery with moderate stenosis at the anastomotic junction and intimal thickening distal to it, we found that, owing to the water-permeable nature of the arterial wall, the surface concentration of LDL was elevated up to 20% higher than that of the bulk flow distal to the stenosis, where a recirculation zone was formed and wall shear stresses were low. In contrast to this, no significant elevation of surface concentration of LDLs occurred in another anastomosed vessel in which no stenosis was formed and no intimal thickening was observed. These results suggest that flow-dependent concentration polarisation of LDLs plays a causative role in the localisation of anastomotic intimal hyperplasia in the human arterial system by locally elevating the surface concentration of LDLs, thus augmenting their uptake by endothelial cells.

Neonatal lungs--can absolute lung resistivity be determined non-invasively?

Abstract: The electrical resistivity of lung tissue can be related to the structure and composition of the tissue and also to the air content. Conditions such as pulmonary oedema and emphysema have been shown to change lung resistivity. However, direct access to the lungs to enable resistivity to be measured is very difficult. We have developed a new method of using electrical impedance tomographic (EIT) measurements on a group of 142 normal neonates to determine the absolute resistivity of lung tissue. The methodology involves comparing the measured EIT data with that from a finite difference model of the thorax in which lung tissue resistivity can be changed. A mean value of 5.7 ± 1.7Ωm was found over the frequency range 4kHz to 813kHz. This value is lower than that usually given for adult lung tissue but consistent with the literature on the composition of the neonatal lung and with structural modelling.

Pneumothorax detection using pulmonary acoustic transmission measurements.

Abstract: Pneumothorax is a common clinical condition that can be life threatening. The current standard of diagnosis includes radiographic procedures that can be costly and may not always be readily available or reliable. The objective of this study was to investigate the hypothesis that pneumothorax causes detectable pathognomonic changes in pulmonary acoustic transmission. An animal model was developed whereby 15 mongrel dogs were anaesthetised, intubated and mechanically ventilated. A thoracoscopic trocar was placed into the pleural space for the introduction of air and confirmation of a ∼30% pneumothorax by direct visualisation. Broadband acoustic signals were introduced into the endotracheal tube, while transmitted waves were measured at the chest surface. Pneumothorax was found consistently to lower the pulmonary acoustic transmission in the 200–1200 Hz frequency band, whereas smaller transmission changes occurred at lower frequencies (p<0.0001, sign test). The ratio of acoustic energy between low-(<220 Hz) and high-(550–770 Hz) frequency bands was significantly different in the control and pneumothorax states (p<0.0001, sign test). This implies that pneumothoraces can be reliably detected using pulmonary acoustic transmission measurements in the current animal model. Further studies are needed to investigate the feasibility of using this technique in humans.

Comparison of heart rate variability analysis methods in patients with Parkinson's disease

Abstract: The aim of the present study was to evaluate different analysis methods for revealing heart rate variability (HRV) differences between untreated patients with Parkinson's disease and healthy controls. HRV in standard cardiovascular reflex tests and during a 10 min rest period were measured by time-and frequency-domain and geometrical and non-linear analysis methods. Both frequency-and time-domain measures revealed abnormal HRV in the patients, whereas non-linear and geometrical measures did not. The absolute high-frequency spectral power of HRV was the strongest independent predictor to separate the patients from the controls (p=0.001), when the main time-domain and absolute frequency-domain measures were compared with each other. When the corresponding normalised spectral units, instead of the absolute units, were used in the comparison, the two best single measures for separating the groups were the 30/15 ratio of the tilting test (p=0.003) and the max/min ratio during deep breathing (p=0.024). When the correlations between the different measures were estimated, the time-domain measures, fractal dimension and absolute spectral powers correlated with each other. The frequencyand time-domain analysis techniques of stationary short-term HRV recordings revealed significant differences in cardiovascular regulation between untreated patients with Parkinson's disease and the controls. This confirms cardiovascular regulation failure before treatment in the early stages of Parkinson's disease. The HRV spectral powers, in absolute units, were the most effective single parameters in segregating the two groups, emphasising the role of spectral analysis in the evaluation of HRV in Parkinson's disease.

New criteria for estimating baroreflex sensitivity using the transfer function method

Abstract: Computer simulations were carried out to appraise three new criteria for the estimation of baroreflex sensitivity (BRS) using the tranfer function method. The major goal was to identify a computation procedure able to overcome the intrinsic limitations of the classical coherence criterion. Four representative shapes of the gain function and three different average agains (2, 5 and 8 ms(mmHg)−1) in the lowfrequency (LF) band (0.04–0.15 Hz) were considered. The signal-to-noise ratio was made to vary so that the peak coherence in the LF band changed from 0.15 to 0.9 All simulation parameters were derived from previous observations in healthy subjects and heart disease patients. The error of the estimated gain function was obtained from its confidence interval. BRS was computed as average gain in the LF band: (a) including in the average only those points having error≤ threshold (criterion 1, C1); (b) calculating the mean error in the band and accepting BRS measurements only when this error was ≤ threshold (criterion 2, C2); (c) including in the average all points, regardless of the error (criterion 3, C3). The three criteria were compared in terms of measurability (percentage of measured BRS) and accuracy (bias and SD of BRS). Using C1 and C2, measureability dropped to 10% when the peak cohrence in the LF band decreased, respectively, to 0.18–0.41 and to 0.26–0.53, depending on the shape and strength of the gain. In this condition (lower bound of measureability), worst bias and SD (average gain: 8 ms(mmHg)−1) were, respectively, 0.8 ms(mmHg)−1 and 3.3 ms(mmHg)−1 (C1), and 0.1 ms(mmHg)−1 and 1.0 ms(mmHg)−1 (C2), C3, by definition, always ensured 100% measurability and showed bias and SD comparable with, or even lower than, C1 and C2, within the common range of measurable BRS. In the extreme condition of 0.15 coherence, bias and SD were, respectively, 1.7 ms(mmHg)−1 and 2.3 ms(mmHg)−1 (average gain: 8 ms(mmHg)−1). Hence, error checking (C1 and C2) dramatically reduced measurability and did not improve accuracy of BRS measurements compared with performing no error check (C3). In conditions of low signal-to-noise ratio and/or impaired baroreflex gain, leading to markedly reduced coherence, the simple average of the gain function in the LF band allows BRS to be estimated with accuracy adequate for clinical purposes.

Dynamic simulation of the natural and replaced human ankle joint.

Abstract: Disappointing results for total ankle replacement have been explained by poor knowledge of the mechanics of the intact and replaced joints. Dynamic simulation tools have the capacity to simulate dynamic conditions that occur in human joints. The Working Model 2D tool was used to simulate the mechanics of the intact and replaced ankle joints, based on previously validated mathematical models. Elementary objects were used to model ligaments, articular surfaces, retinacula and muscle-tendon units. The performance of several pairs of prosthetic articular surfaces was also analysed. According to the results of these simulations, rolling as well as sliding motion occurs in the natural ankle, governed by a ligamentous linkage. Elongation of the tibiocalcaneal and calcaneofibular ligaments was found to be 1.5% and 4.8%, respectively. A 13% change in lever arm length occurred for both the tibialis anterior and gastrocnemius muscles during ankle flexion. Unlike the currently available three-component designs, the newly proposed convex-tibial ligament-compatible prosthesis was found to be able to restore the original mobility and physiological function of the ligaments. This prosthesis combines freedom from restraint with congruity of the components throughout the range of flexion.

Control of a hand grasp neuroprosthesis using an electroencephalogram-triggered switch: Demonstration of improvements in performance using wavepacket analysis

Abstract: Volitionally modulated electroencephalographic (EEG) waves were monitored for the purpose of controlling a hand neuroprosthesis in people with tetraplegia. The region of the EEG signal spectrum monitored was the occipital alpha wave (8–13 Hz), and volitional modulation was achieved with the opening and closing of the eyes. In a set of 13 trials evaluated, a subject with tetraplegia successfully completed ten trials undertaking stimulated grasp and release using the EEG-triggered switch. EEG signal data recorded during the 13 trials were also post-processed off-line using wavepacket analysis. Following this signal processing, the speed and reliability of the EEG-triggered switch, when operated by the subject with tetraplegia, was significantly improved (p<0.002). Such improvements provide system performance that is likely to be acceptable to a neuroprosthesis user during activities of daily life.

Biomechanical evaluation of Cheneau-Toulouse-Munster brace in the treatment of scoliosis using optimisation approach and finite element method

Abstract: The aim of the study was to investigate the mechanisms of the Cheneau-Toulouse-Munster (CTM) brace in the correction of scoliotic curves, at night in the supine position. Magnetic resonance imaging (MRI) and Computer tomography (CT) acquisitions were performed in vivo on eight girls having an idiopathic scoliosis and being treated for the first time using a personalised CTM brace. Personalised 3D finite element models of the spine were developed for each patient, and an optimisation approach was used to quantify the forces generated by each brace on each scoliotic spine. A sensitivity study was undertaken to test the assumptions about intervertebral behaviour and load transmission from the brace to the spine. The computed CTM brace forces were 9-216N in the coronal plane and 2-72N in the sagittal plane. Personalised spinal stiffness properties should be included in spine models because, in this study, partial correction resulted from the application of higher estimated forces than for total correction. Partially reduced spines should be stiffer than totally reduced spines. The sensitivity study showed that the computed brace forces were proportional to the intervertebral Young's modulus and should be analysed as estimated data. Better knowledge of brace forces should be helpful in brace design to achieve the best correction of first scoliotic deformities.

Effects of high-rate electrical stimulation upon firing in modelled and real neurons.

Abstract: Many medical devices use high-rate, low-amplitude currents to affect neural function. This study examined the effect of stimulation rate upon action potential threshold and sustained firing rate for two model neurons, the rabbit myelinated fibre and the unmyelinated leech touch sensory cell. These model neurons were constructed with the NEURON simulator from electrophysiological data. Alternating-phase current pulses (0-1250 Hz), of fixed phase duration (0.2 ms), were used to stimulate the neurons, and propagation success or failure was measured. One effect of the high pulse rates was to cause a net depolarisation, and this was verified by the relief of action potential conduction block by 500 Hz extracellular stimulation in leech neurons. The models also predicted that the neurons would maintain maximum sustained firing at a number of different stimulation rates. For example, at twice threshold, the myelinated model followed the stimulus up to 500 Hz stimulation, half the stimulus rate up to 850 Hz stimulation, and it did not fire at 1250 Hz stimulation. By contrast, the unmyelinated neuron model had a lower maximum firing rate of 190 Hz, and this rate was obtained at a number of stimulation rates, up to 1250 Hz. The myelinated model also predicted sustained firing with 1240 Hz stimulation at threshold current, but no firing when the current level was doubled. Most of these effects are explained by the interaction of stimulus pulses with the cell's refractory period.