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Calculation of pulse-wave velocity using cross correlation--effects of reflexes in the arterial tree.

The need to investigate the elastic properties of arterial vessels in situ for the early recognition of degenerative disorders in arteries has long been apparent. Pulse-wave diagnostics has been used in traditional medicine, but only in a qualitative way. By measuring the vessel diameter change, simultaneously at two levels along an artery, it should be possible to calculate the pulse-wave velocity (PWV). A newly developed ultrasonic instrument, DIAMOVE, was designed to provide a two-dimensional, real time, B-mode image for display of the exact position of two measurement sites; a computer-controlled digital phased-locked loop detector for the measurement of diameter changes; and a personal computer for the display of the momentary displacement of the artery walls. The cross-correlation technique was used on the information from the vessel wall movements to calculate the resulting PWV. Early measurements on healthy patients showed some unexpected artifacts, which were found to be due to reflected waves, affecting the shape of the pulse-wave at the sites of measurement. A modified PWV estimation algorithm, where only the foot of the pulse-wave in every beat is utilized, seems to have solved this problem and now makes the method suitable for clinical use.

Algorithms

Evaluation of lung dose correction methods for photon irradiations of thorax phantoms.

Radiation absorbed dose in lung is measured and calculated using several algorithms available on commercial treatment planning systems. Phantoms resembling the human thorax are used and irradiated with small and large photon beams of 60Co, 4, 6, and 10 MV X ray energies. The applicability and usefulness of the different calculation methods in clinical situations is discussed.

Lung

Neural networks to identify glaucoma with structural and functional measurements.

PURPOSE: Neural networks can recognize patterns and classify complex variables. We assessed the ability of neural networks to discriminate between normal and glaucomatous eyes by using structural and functional measurements. METHODS: Several neural network algorithms were tested with a database of 185 eyes of patients with early glaucomatous visual field loss (average mean defect, 4.5 dB) and 54 eyes of age-matched normal control subjects. The information used included automated visual field indices (mean defect, corrected loss variance, and short-term fluctuation) and structural data (cup/disk ratio, rim area, cup volume, and nerve fiber layer height) from computerized image analysis. RESULTS: A back propagation network with two intermediate layers assigned an estimated probability of being glaucomatous to each eye and correctly identified 88% of all eyes with 90% sensitivity and 84% specificity. The same neural network trained with only structural data correctly identified 80% of the eyes with 87% sensitivity and 56% specificity, and when trained with functional data only, it correctly identified 84% of the eyes with 84% sensitivity and 86% specificity. CONCLUSION: Analysis of several optic nerve and visual field variables by neural networks can help identify early glaucomatous damage and assign an estimated probability that early damage is present in individual patients.

Algorithms

Effects of cognitive training on primary mental ability structure.

We report results of the first empirical test, as far as we know, of the assumption of structural invariance of latent constructs from pretest to posttest in cognitive training research on the elderly. In all, 401 participants in the Seattle Longitudinal Study, over 62 years old, received a 5-hr test battery at pre- and posttest that included 16 ability tests, marking the five primary abilities of Spatial Orientation, Inductive Reasoning, Numerical Ability, Verbal Ability, and Perceptual Speed. A total of 229 of our subjects received 5 hr of individual training on either Spatial Orientation or Inductive Reasoning. Restricted factor analysis with the LISREL algorithm tested the hypothesis of measurement equivalence across test occasions, separately for the control subjects and for each of the training groups. When ability-specific cognitive training intervenes, no structural change is observed for abilities not subject to intervention. However, slight shifts occurred in the optimal regression weights for the different markers for the training target abilities.

Aged

Detecting periodic patterns in biological sequences.

MOTIVATION: The search for repeated patterns in DNA and protein sequences is important in sequence analysis. The rapid increase in available sequences, in particular from large-scale genome sequencing projects, makes it relevant to develop sensitive automatic methods for the identification of repeats. RESULTS: A new method for finding periodic patterns in biological sequences is presented. The method is based on evolutionary distance and 'phase shifts' corresponding to insertions and deletions. A given sequence is aligned to itself in a certain sense, trying to minimize a distance to periodicity. Relationships between different such periodicity measures are discussed. An iterative algorithm is used, and the running time is nearly proportional to the sequence length. The alignment produces a periodic consensus pattern. A 'phase score' is used to indicate a statistical significance of the periodicity. Three examples using both DNA and protein sequences illustrate how the method can be used to find patterns. AVAILABILITY: On request from the authors. CONTACT: evindc@mat nu.no; finn.drablos@unimed.sintef.no

Algorithms

Limitations of a structured psychiatric diagnostic instrument in assessing somatization among Latino patients in primary care.

BACKGROUND: The Composite International Diagnostic Interview (CIDI) has been developed as a state-of-the-art, structured diagnostic instrument, designed to diagnose psychiatric disorders across cultures and languages. Partly because it has been validated in a number of countries and cultural settings, the CIDI has become widely accepted as a diagnostic instrument in epidemiologic and clinical research. OBJECTIVES: As part of a larger study of psychiatric disorders in a multi-ethnic, primary care setting, we tried to clarify the limitations of the CIDI in diagnosing somatoform symptoms among Latino patients. DESIGN: Relevant sections of the CIDI were administered in English or Spanish to new patients seeking primary care services at an inner-city, university-affiliated community clinic. Interviews were tape recorded and pertinent passages were transcribed for qualitative analysis. SUBJECTS: One thousand, four hundred and fifty six new patients, comprising 4 ethnic groups: Central American; Mexican; Chicano; and non-Latino White. MEASURES: The CIDI's diagnostic algorithms for somatization were examined in relation to the transcriptions of interviews for Latino patients whom the CIDI diagnosed as somatizers. RESULTS: The CIDI led to the inaccurate identification of somatoform symptoms resulting from such issues as financial barriers to healthcare access, cultural syndromes that were not recognized by Western medicine, and language differences between patients and physicians. Like other structured instruments, the CIDI also forced a range of complex experience into a fixed-choice interview format. CONCLUSIONS: Despite the advantages of such structured instruments as the CIDI, their capacity to reach accurate psychiatric diagnoses in some cultural groups and clinical settings requires clarification. These findings also call into question the relatively high rates of somatization among Latino patients reported in previous studies that have used structured psychiatric diagnostic instruments.

Algorithms

Electrical impedance tomography of complex conductivity distributions with noncircular boundary.

Electrical impedance tomography (EIT) uses low-frequency current and voltage measurements made on the boundary of a body to compute the conductivity distribution within the body. Since the permittivity distribution inside the body also contributes significantly to the measured voltages, the present reconstruction algorithm images complex conductivity distributions. A finite element model (FEM) is used to solve the forward problem, using a 6017-node mesh for a piecewise-linear potential distribution. The finite element solution using this mesh is compared with the analytical solution for a homogeneous field and a maximum error of 0.05% is observed in the voltage distribution. The boundary element method (BEM) is also used to generate the voltage data for inhomogeneous conductivity distributions inside regions with noncircular boundaries. An iterative reconstruction algorithm is described for approximating both the conductivity and permittivity distributions from this data. The results for an off-centered inhomogeneity showed a 35% improvement in contrast from that seen with only one iteration, for both the conductivity and the permittivity values. It is also shown that a significant improvement in images results from accurately modeling a noncircular boundary. Both static and difference images are distorted by assuming a circular boundary and the amount of distortion increases significantly as the boundary shape becomes more elliptical. For a homogeneous field in an elliptical body with axis ratio of 0.73, an image reconstructed assuming the boundary to be circular has an artifact at the center of the image with an error of 20%. This error increased to 37% when the axis ratio was 0.64. A reconstruction algorithm which used a mesh with the same axis ratio as the elliptical boundary reduced the error in the conductivity values to within 0.5% of the actual values.

Algorithms

Autotransfusion after open heart surgery: the oxygen delivery capacity of shed mediastinal blood is maintained.

Autotransfusion of mediastinal shed blood after open heart surgery has become a common and accepted procedure in reducing the need for homologous transfusion during the last 15 years. The objectives of the present study were to investigate the oxygen delivery capacity of autotransfused shed mediastinal blood, compared to patient-blood, during cardiopulmonary bypass and in the postoperative period. Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration. Autotransfusion volume ranged from 450-1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood. The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion.

2,3-Diphosphoglycerate

Autotransfusion after open heart surgery: quality of shed mediastinal blood compared to banked blood.

The need to conserve a patient's own blood and avoid homologous transfusion is now well recognized. Therefore, techniques designed to reduce requirements for homologous blood transfusions have been developed. One of the methods is autotransfusion of shed mediastinal blood after open-heart surgery. The objectives of the present study were to investigate osmotic fragility and oxygen transport capacity of shed mediastinal blood compared to patient blood and stored packed red blood cells (SAGM). Shed mediastinal blood from ten consecutive patients undergoing elective cardiac surgery (coronary bypass grafting) was studied and compared to patient blood, 10 units of 3 weeks old and 10 units of 5 weeks old stored packed red blood cells (SAGM). Oxygen transport capacity was investigated by calculation of p50 for oxygen by use of the oxygen status algorithm (OSA 2.0) programme and measurement of 2,3-diphosphoglycerate (2,3-DPG) concentrations. The osmotic fragility was determined using increasing concentrations of saline. 2,3-DPG concentrations in shed mediastinal blood (5.3 mikromol/ml erythrocyte) were within the range measured in patient blood, but significantly higher than SAGM blood (P < 0.001). P50 for oxygen (3.5 kPa) in shed mediastinal blood was not significantly different compared to patient blood, but significantly higher (P < 0.01) compared with stored SAGM blood. The osmotic fragility in shed mediastinal blood was not significantly different compared to patient blood, but significantly lower (P < 0.001) than the osmotic fragility in stored SAGM blood. This suggests that red cells saved from shed mediastinal blood have better oxygen transport capacity and may have longer survival compared to stored blood.

Aged

Model-based estimation of vascular parameters: evaluation of robustness and suitability of models.

Left ventricular performance depends not only on myocardial state, but also on the properties of the systemic arterial tree. These properties can be assessed from recordings of aortic root pressure and flow by the use of appropriate vascular models. Noninvasive estimates of aortic root pressure and flow can be obtained by the combined use of calibrated external subclavian artery pulse tracing and Doppler echocardiography. With recent advances in computer technology, estimation of model parameters are thus accessible in the clinical setting. We discuss the suitability of different parametric vascular models together with methods for adapting these models to the measured aortic root pressure. We compared the results obtained with simple vascular models (three-component modified Windkessel models) with those of five-component models. The simpler models gave less accurate approximation of the measured pressure waveform, but for a representative set of aortic root pressure and flow data, the simpler models provided adequate estimates of the peripheral arterial resistance, the total arterial compliance, and the proximal aortic area compliance. Furthermore, the simpler models are robust for measurement noise with simple estimation algorithms. Distal arterial pressure and flow waveforms are more oscillatory, and for these the five-component model has more robust estimation schemes with more accurate estimated parameters. Hence, we conclude that for clinical noninvasive assessment of aortic vascular properties, the simpler three-component models provide adequate information. For assessment of the peripheral arteries with large oscillations in the flow, the three-component models can give more than 10% error in the compliance estimate and more complex models can be appropriate.

Aorta

Monte Carlo evaluation of Compton scatter subtraction in single photon emission computed tomography.

In single photon emission computed tomography (SPECT), Compton scattering produces a background that degrades the image quality and contributes erroneously to quantitative measurements. A clinically implementable compensation algorithm has previously been reported that subtracts a Compton scatter image, acquired in an energy window set below the energy of the photopeak, from the primary image acquired in the photopeak window. We present an evaluation and justification of the assumptions made in the previous empirical development of the subtraction algorithm. A Monte Carlo model of the SPECT system in which the Compton scattered vents may be followed independently of the nonscattered events was used to evaluate this subtraction technique. Simulation shows that the assumptions made in the experimental application of this algorithm were valid. Specifically (1) the "scatter" energy window used in the experiment (91-125 keV for imaging Tc-99m) contains only scattered events, (2) the shape of the line spread function (LSF) for the events in the scatter window is a reasonable approximation to the shape of the scatter in the photopeak window, and (3) the ratio of the number of scattered events in the photopeak window to the number of events in the scatter window is 0.57, close to the value of 0.5 derived heuristically. Thus, Monte Carlo simulation validates the basic assumptions underlying the empirical implementation of the scatter subtraction algorithm.

Humans

Localization of cortical areas activated by thinking.

These experiments were undertaken to demonstrate that pure mental activity, thinking, increases the cerebral blood flow and that different types of thinking increase the regional cerebral blood flow (rCBF) in different cortical areas. As a first approach, thinking was defined as brain work in the form of operations on internal information, done by an awake subject. The rCBF was measured in 254 cortical regions in 11 subjects with the intracarotid 133Xe injection technique. In normal man, changes in the regional cortical metabolic rate of O2 leads to proportional changes in rCBF. One control study was taken with the subjects at rest. Then the rCBF was measured during three different simple algorithm tasks, each consisting of retrieval of a specific memory followed by a simple operation on the retrieved information. Once started, the information processing went on in the brain without any communication with the outside world. In 50-3 thinking, the subjects started with 50 and then, in their minds only, continuously subtracted 3 from the result. In jingle thinking the subjects internally jumped every second word in a nine-word circular jingle. In route-finding thinking the subjects imagined that they started at their front door and then walked alternatively to the left or the right each time they reached a corner. The rCBF increased only in homotypical cortical areas during thinking. The areas in the superior prefrontal cortex increased their rCBF equivalently during the three types of thinking. In the remaining parts of the prefrontal cortex there were multifocal increases of rCBF. The localizations and intensities of these rCBF increases depended on the type of internal operation occurring. The rCBF increased bilaterally in the angular cortex during 50-3 thinking. The rCBF increased in the right midtemporal cortex exclusively during jingle thinking. The intermediate and remote visual association areas, the superior occipital, posterior inferior temporal, and posterior superior parietal cortex, increased their rCBF exclusively during route-finding thinking. We observed no decreases in rCBF. All rCBF increases extended over a few square centimeters of the cortex. The activation of the superior prefrontal cortex was attributed to the organization of thinking. The activation of the angular cortex in 50-3 thinking was attributed to the retrieval of the numerical memory and memory for subtractions. The activation of the right midtemporal cortex was attributed to the retrieval of the nonverbal auditory memory.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain Mapping

Sex differences in circulating human leptin pulse amplitude: clinical implications.

Leptin, a product of fat cells, provides a signal of nutritional status to the central nervous system. Leptin concentrations have ultradian and diurnal fluctuations. We conducted this study to assess sex differences in the levels of organization of frequently sampled leptin concentrations in healthy, normal weight women and men. Leptin levels were sampled every 7 min for 24 h in 14 healthy, normal weight individuals (6 women and 8 men). The 14 leptin time series containing a total of 2898 leptin measurements were assessed by 1) algorithms that characterize statistically significant pulsatility, 2) Spectral (Fourier) analysis, 3) analysis of time intervals and variability, and 4) approximate entropy. We found that frequently sampled plasma leptin concentrations have a 24-h profile that is numerically more than twice as high in women as in men, and leptin pulse amplitude is likewise more than twice as high in women. However, healthy men and women have nearly identical concentration-independent and frequency-related 24-h and ultradian patterns. Leptin concentrations have nonrandom fluctuations over 24 h, independent of their absolute value and underlying 24-h periodicity, that are similar in men and women. Ultradian periodicities detected by Fourier time series have similar values in men and women. The strongest distinction between the sexes in the level of organization of leptin concentration is not at the level of pulse organization or oscillation frequency, but, rather, in the mass or amount of leptin released (or removed) per unit time, indicating that women might be more resistant to the effects of leptin than men. Because leptin is clinically relevant to the regulation of body weight, future studies should examine whether the relative leptin resistance exhibited by women might contribute to their increased susceptibility to disorders whose pathophysiology involves dysregulation of food intake and body weight.

Adult

Monitoring alcoholic liver injury.

Evidence for the economic, social, and health benefits of a more aggressive policy towards alcoholism is beginning to overcome nihilistic attitudes. Psychological, clinical, and laboratory measures are integrated in an algorithm for management.

Humans

Breast cancer detection utilizing biostereometric analysis.

Twelve female patients participated in a study designed to employ computer-assisted biostereometric analysis for the detection of breast masses. All breast masses were previously documented by physical examination and followed by xeromammography, stereophotography, and histopathologic confirmation of tumor type. "Contour mammograms" were produced from the biostereometric photographs. These data were analyzed first for tumor detection and location by visual inspection. A second analysis employed a computed algorithm designed to locate and measure surface aberrations that suggest the possibility of underlying breast tumor. Visual analysis yielded the exact location of breast tumors in eight of the ten malignancies; computer analysis exactly located nine of the ten malignancies. In the computer analysis, one malignancy not exactly located by quadrant was, nevertheless, located in the correct breast. The results of the study suggest that the biostereometric process may have future use in screening or prescreening procedures for breast cancer detection. It is noninvasive, applicable to large numbers of women and with suitable refinements, and capable of being fully automated.

Aged

[An ALGOL computer program for extensive automatic data processing and evaluation of karyometric studies].

A short survey is given upon ALGOL-computer programs which are ready for use also for a biomathematical treatment of morphometrical findings. Thereafter, the numerical and the nonnumerical steps are described following the caryometrical measurements. These steps are formulated algorithmically, constituting the main parts of a computer program for data transforming and evaluation of caryometrical studies by a data processing system.

Cell Nucleus

Fusion of immunoscintigraphy single photon emission computed tomography (SPECT) with CT of the chest in patients with non-small cell lung cancer.

In non-small cell lung cancer (NSCLC), accurate staging is critical in deciding between potentially curative surgery and palliative treatment. Image registration, or fusion, combines the unique functional information provided by SPECT imaging with the excellent anatomic detail offered by computed tomography (CT) or magnetic resonance imaging to better characterize the information provided by each separate modality. In this study, we explored the role of fusion of immunoscintigraphy SPECT with CT in the staging of NSCLC. We fused chest CT with 99mTc-labeled IMMU-4 anti-carcinoembryonic antigen Fab' antibody fragment SPECT in 14 patients with NSCLC using a landmark-based algorithm. The algorithm's accuracy was a measure from the center-to-center distance and the percentage overlap of two regions of interest: one drawn on CT and warped onto SPECT, the other drawn directly on the SPECT. We found that the average center-to-center distance was 1.3 +/- 0.8 pixels. Average overlap was 46 +/- 20%. CT-SPECT fusion helped differentiate tumor from normal blood pool, necrotic areas within viable tumor, tumor recurrence from scar, and malignant lymphadenopathy from hyperplasia. We conclude that fusion of CT and SPECT augments the information provided by each separate modality. Future clinical applications of fusion in NSCLC staging using immunoscintigraphy appear promising.

Adult

Influence of optical density on the automated segmentation of rat kidney lysosomes.

After staining for acid phosphatase, video-images were acquired from 0.5-micron sections of rat kidney. Lysosomes in proximal tubules were automatically segmented, using a VICOM digital image processor and measured for area, number and optical density (OD). The purpose of this study is to objectively evaluate the performance of the automated segmentation algorithm at different staining intensities (a) by measuring area after staining with different incubation times, reduced substrate concentration or by adding an inhibitor and (b) by 'simulating' a decrease in OD (reducing grey-values at each point of a digitized image). The results of the experiments showed that: (1) the algorithm will underestimate the size of lysosomes (a) when the OD in close to the local background and (b) when an area is larger than or close to the area of the lowpass square filter; (2) accuracy of the segmentation can be improved by comparing the results of feature extraction after segmentation of the same image at different relative OD levels; (3) lysosomes with very low OD, compared to background are delineated with a large error or not delineated at all and this cannot be corrected. Incorrectly delineated lysosomes can be identified and excluded from further calculations, or their measured area replaced by an estimate of the true area.

Acid Phosphatase