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AAEM minimonograph #16: instrumentation and measurement in electrodiagnostic medicine--Part II.

A review of instrumentation and measurement in electrodiagnostic medicine is continued in this Part II which focuses on digital instrumentation principles, gain and sweep effects, noise, nerve stimulation, and conduction measurement limitations. With the adoption of microprocessor-based equipment, the neurophysiologic signal must undergo analog-to-digital conversion (ADC) before analysis and display on a video monitor. ADC resolution and sampling rates affect accuracy and measurement precision. Following waveform display, the visual assessment of latency and duration may be influenced by sweep and gain settings, often overlooked sources of error. Undesired signal or noise typically originates from power-line interference, electronic amplifier noise, background muscle activity, or nerve stimulation artifact. Noise often interferes with clinical studies but techniques exist to reduce noise to acceptable levels in virtually all situations. An awareness and understanding of these technical issues will lead to an appreciation of the limitations of electrodiagnostic testing and improve interpretation and clinical decision-making.

Action Potentials↗

Real time micro-fiberoptic monitoring of endogenous fluorescence in the rat conceptus during hypoxia.

A micro-fiberoptic methodology has been developed for non-invasive, real time measurement of endogenous pyridine nucleotide fluorescence from the surface of the visceral yolk sac (VYS) in intact, viable rat conceptuses. Gestational day (GD) 10-12 conceptuses are maintained in a customized perifusion system, which allows for control of oxygenation, as well as the continuous measurement of pH and oxygen concentration in the effluent perifusate. Miniaturized light guides were constructed by drawing 250 microns ESKA acrylic optical fibers through a stainless steel sheath with a high strength epoxy polymer. A single fiber supplied the excitation signal from a mercury arc lamp at a wavelength of 366 nm. The emission signal was returned via three additional fibers, electronically amplified, processed, and recorded, using a dual channel lamp-compensated fluorometer, optimized for detection of reduced pyridine nucleotides at 455 nm. Endogenous fluorescence in the conceptus was monitored by placing the polished tip of the sensor directly on the surface of the VYS. Oxygen-equilibrated conceptuses, exposed to 100% nitrogen, produced a reproducible biphasic surface fluorescence peak, which returned to baseline levels upon reoxygenation of the perifusate. This biphasic response consisted of an initial rapid rise in fluorescence (phase I), followed by an attenuated rate in fluorescence signal increase (phase II). The hypoxia produced age-dependent rates of fluorescence change during phase I, while phase II remained relatively unchanged throughout GD 10-12. These results demonstrate the ability to monitor endogenous fluorescence, non-invasively and in real time, during the period of organogenesis in the intact rat conceptus and will provide valuable information in studies of embryonic metabolism and response to chemical embryotoxicants.

Animals↗

[The effects of acoustic overstimulation].

Basic aspects of acoustic trauma are presented. Exposure to loud noise leads to an acoustic traumatization with a temporary threshold shift initially and, with increasing exposure, intensity and duration, a permanent hearing loss. Impulse sound such as hammer blows on metal, gun shots and other detonations reaching peak levels of 160 to 180 dB is particularly hazardous to the inner ear. Playing loud musical instruments such as trumpets or percussion may also lead to hearing damage. Less dangerous than often believed is listening to electronically amplified music with walkmen, at discos or rock concerts. The reason is that, while the sound level is quite high, the particularly dangerous sound peaks are absent, as loudspeakers usually have an output limit of 110-120 dB. Traffic noise (cars, trains, air planes) is usually not threatening to the ear, but it may represent a considerable subjective annoyance and a stress factor leading to psychosomatic disturbances (neurovegetative symptoms, sleeping disorders). An effective treatment for the acoustic trauma is still missing. The systematic and consequent prophylaxis either with individual ear protectors (plugs or ear muffs) or by reducing the noise level at the source by means of isolation, encapsulation, or by using motors that are less noisy remains very important. Increasing awareness of acoustic pollution and preventive means have led to a reduction in the incidence of the acoustic trauma in the last decades.

Adolescent↗

Communication with a chaotic traveling wave tube microwave generator.

Traveling wave tubes (TWTs) are vacuum electronic amplifiers (see Beck, Gittins, and Pierce) that are commonly used for communication in the centimeter wavelength range. Increasing demand for high data flow in wireless communication systems (satellite communication systems are a good example) raises needs for making TWT's more compact and efficient. Motivated by this we suggest a scheme in which a TWT with feedback is operated in a highly nonlinear regime where the device behaves chaotically. The chaos is controlled using small controls. Then, at the receiving end a receiving TWT synchronizes to the chaotic transmitter and amplifies the received signal with nearly no distortion. Results on numerical simulations of the proposed scheme are reported and used to evaluate its effectiveness.

Communication↗

Intraoperative localization of retained metallic fragments in missile wounds.

OBJECTIVE: Patients with missile wounds often retain fragments of different materials within their bodies. They are usually of no clinical consequence, but sometimes they can cause complications. Furthermore, the presence of metallic objects is a contraindication for magnetic resonance imaging. Therefore, the fragments should be removed whenever possible. A new metal detector designed for intraoperative use and a method that allows exact localization and removal of conductive fragments is presented. METHODS: Practical experience shows that the volume of missile fragments varies by a factor of 1,000. Different materials can be detected and located at distances usually not greater than 50 mm. An adaptive electronic amplifier was used in this instrument to locate missile fragments of different sizes and magnetic properties at different distances. Environmental disturbances such as electrical wires and external magnetic fields, and the limited dynamics of human perception, were compensated for by the spatial selectivity and adaptive sensitivity of the instrument. The source of the alternating magnetic field was placed in a hand-held probe connected to the instrument, with which small changes in the magnetic field were detected and exploited for the location of metallic fragments. RESULTS: The boundaries of detectability and localizability by the device have been determined for different missile fragments to demonstrate the diagnostic feasibility and limitations of the method. CONCLUSION: The successful use of the method, in cases where other imaging procedures are either not available or ineffective, is demonstrated by two cases of patients with gunshot wounds.

Adult↗

Multiple Purkinje Cell Recording in Rodent Cerebellar Cortex.

The spatial and temporal organization of climbing fibre activation of Purkinje cells, the so-called complex spikes, were studied in the rat cerebellar Crus II folium utilizing a multiple microeletrode recording technique. As many as 32 Purkinje cells could be simultaneously recorded by using a custom-built electronic amplifier system and a special data storage device. Analysis of the auto-correlation activity of complex spikes in any given group of Purkinje cells indicated that activation occurs with a particular rhythmicity having a base firing of 10 Hz. Cross-correlation of spontaneous complex spikes demonstrated, in addition to a particular rhythmicity, an extraordinarily high degree of synchronicity within a particular spatial distribution of Purkinje cells. Thus, Purkinje cells organized in rostro-caudal rows tend to fire within 1 ms of each other for distances as far as 800 microm (the width of a folium) from the 'master' neuron. By contrast, Purkinje cells located medial or lateral to the master neuron showed almost no cross-correlation. Administration of harmaline to the animal increased the degree of auto- and cross-correlation but did not change the spatial order of the distribution of the cross-correlation. The results indicate that the olivo-cerebellar system is organized in such a way that climbing fibre afferents may be activated in a close-to-synchronous and rhythmic fashion. The spatial distribution of these afferents over the cortex is such as to activate rostro-caudal bands of Purkinje cells which tend to fire in a close-to-synchronous manner.

Journal Article↗

Ear damage caused by leisure noise.

Noise is a health risk. Recent findings suggest that leisure noise is a substantial danger especially to children, teenagers and young adults. Epidemiological studies of teenagers with no occupational noise exposure show an increasing number with a substantial and measurable irreversible inner ear damage. This is basically due to the wide spread exposition to very loud toys (pistols and squibs), crackers and exposure to electronically amplified music, e.g. from personal cassette players (PCP), at discos or concerts etc. Protection against irreversible ear damage by leisure noise has an important impact in preventive medical care. Therefore the general public must be informed that loud leisure activities may cause damage to the ear. In order to protect children, young people and adults, the legislature ought to set limits for sound levels in discos, concert halls and for music equipment and toys by establishing the necessary standards and regulations.

Journal Article↗

[Effect of various technical parameters on potential danger of an electric injury in the bathtub].

In contrast to common beliefs there is not strict necessity for lethal danger during electric shock in a bathtub. Measurements of the electric field demonstrates the ground conditions and water temperature are of vital importance as are a variety of other parameters. With an electronic amplifier especially designed for this problem measurement of the electric parameters in the water was made possible.

Baths↗

[Hysterosalpingography in sterility].

From 1967 to 1975 the authors performed 500 hysterosalpingographies in 851 women examined for sterility. Hysterosalpingography was carried out under the diascopic control of an electronic amplifier and a tele-monitor. As a contrast medium only the water-soluble Joduron U-S (Cilag) was used. In 286 women (57%) primary sterility and 214 (43%) secondary sterility were established. Radiographic analysis revealed 209 anomalies of the uterus, 114 of which related to hypoplastic uterus. In 286 women with primary sterility there was occlusion of one or both tubes in 62 cases (21.67%) and the sactosalpinx of one or both tubes in 48 cases (16.78%). In 214 women with secondary sterility, there was occlusion of one or both tubes in 66 cases (31.30%) and the sactosalpinx of one or both tubes in 48 cases (22.42%). In 500 hysterosalpingographies the intravasation of the contrast medium into the venous system occurred in 23 cases (4.60%) but there was not a single case of unatoward side-effects. Sixty-six women became gravid 1--6 months after hysterosalpingography, without the use any other kind of therapy.

Adult↗

Electron tomography of amplified nanogold immunolabelling: Improvement of quality based on alignment of projections with sinograms and use of post-reconstruction deconvolution.

Electron tomography of immunolabelled proteins identified with amplified nanogold particles imaged by Scanning and Transmission Electron Microscopy within thick sections is a powerful method to investigate the three-dimensional organization of complex cellular machineries. In order to increase the overall quality of the reconstructed cube, we have developed two methods that improve the tomographic reconstruction process. We first performed a very precise alignment of the projections before reconstruction with a technique using sinograms. After reconstruction, we propose to compute image restoration by calculating the Point Spread Function of the projection/back-projection system and to use it to deblur the reconstructed cubes. Improvement in the quality of the reconstructed cubes is demonstrated on images of nucleolar proteins tagged with EGFP and immunolabelled with nanogold particles.

Gold↗

Time-resolved phase measurement of a self-amplified free-electron laser.

We report on the first time-resolved phase measurement on self-amplified spontaneous emission (SASE) free-electron laser (FEL) pulses. We observed that the spikes in the output of such free-electron laser pulses have an intrinsic positive chirp. We also observed that the energy chirp in the electron bunch mapped directly into the FEL output. Under certain conditions, the two chirps cancel each other. The experimental result was compared with simulations and interpreted with SASE theory.

Journal Article↗

Characterization of a chaotic optical field using a high-gain, self-amplified free-electron laser.

We report on a characterization of the chaotic optical field from a high-gain, self-amplified spontaneous-emission (SASE) free-electron laser. The temporal structure of the amplitude and phase are measured in a single-shot mode, with a resolution well below the coherence length, and the statistics over multiple pulses is determined. The measurement is in excellent quantitative agreement with the prediction based on analysis of random noise, and further verifies the chaotic nature of the SASE optical field.

Journal Article↗

An inexpensive electronic switch for preventing amplifier overload in neurophysiological recording.

A circuit for an electronic switch is described that suppresses large unwanted signals that might overload physiological amplifiers during recording of weak neural signals. The circuit, made from inexpensive and easily available integrated circuits, can be operated from any timer that produces at least a +5 volt output pulse. It operates by connecting a low gain preamplifier to a high gain amplifier only during the signal of interest.

Amplifiers, Electronic↗

Exponential gain and saturation of a self-amplified spontaneous emission free-electron laser.

Self-amplified spontaneous emission in a free-electron laser has been proposed for the generation of very high brightness coherent x-rays. This process involves passing a high-energy, high-charge, short-pulse, low-energy-spread, and low-emittance electron beam through the periodic magnetic field of a long series of high-quality undulator magnets. The radiation produced grows exponentially in intensity until it reaches a saturation point. We report on the demonstration of self-amplified spontaneous emission gain, exponential growth, and saturation at visible (530 nanometers) and ultraviolet (385 nanometers) wavelengths. Good agreement between theory and simulation indicates that scaling to much shorter wavelengths may be possible. These results confirm the physics behind the self-amplified spontaneous emission process and forward the development of an operational x-ray free-electron laser.

Journal Article↗

Audible circuit noise in hearing aid amplifiers.

Audible electronic circuit noise generated within a hearing aid is distracting to a listener in quiet situations and, if the noise level is high enough, may cause listener irritation and rejection of the hearing aid. Thus for hearing aid specification and fitting purposes, it is useful to know the acoustic levels at which this internal noise may become audible and also at which it may become objectionable. For hearing aid amplifier circuit specification and design purposes, it is useful to know the same levels in electrical terms. This paper reports on a study that used an amplifier with no acoustic input and a hearing aid receiver output to simulate internally generated hearing aid circuit noise. Results are reported for testing eight subjects with high-frequency hearing loss for the perceived acoustic and electrical levels at which internal circuit noise became both audible and objectionable.

Amplifiers, Electronic↗

Electron microscopy of amplified DNA forms in antifolate-resistant Leishmania.

Three independently derived antifolate-resistant Leishmania major cell lines overproduce the bifunctional protein thymidylate synthase-dihydrofolate reductase (TS-DHFR) by amplification of a region of DNA (R-region DNA) that contains the gene for TS-DHFR. On orthogonal-field-alteration gel electrophoresis (OFAGE), the extrachromosomal R-region DNAs are circular molecules, and different forms of R-region DNA within these cell lines are resolved. The R-region DNAs migrate aberrantly on OFAGE with respect to linear DNA and supercoiled plasmid standards. We describe a method for the isolation of these R-region DNA forms from OFAGE. By electron microscopy, we show that the extrachromosomal elements are single supercoiled circular DNA molecules, and are predominantly circular monomers and dimers of the original R-region DNA amplification unit. Using OFAGE, an analysis of cloned isolates shows that individual cells may contain multiple forms of R-region DNA. Furthermore, within a given cell line, certain distinguishable forms appear to have the same size and restriction map, suggesting they may be topoisomers. The multiple forms of R-region DNA are in a dynamic state in the antifolate-resistant populations, and the relative amount of DNA in each form as well as the number of forms within each cell line change through time. As currently understood, the generation of amplified R-region DNA in L. major is summarized.

Animals↗

[Oxidation of anthracycline antibiotics].

The quantum-chemical estimation of the highest occupied molecular orbital energy for the aglycons of carminomycin, rubomycin, adriamycin and aclacinomycin A in the neutral and ionized states was performed with a semiempirical method. It was shown that the aglycon ionization amplified the electron donor properties of the antibiotics. On the basis of the difference in the absorption spectra of the neutral and ionized chromophores their ionization constants were determined spectrophotometrically. For comparison of the electron donor properties of the anthracyclines at the physiological pH value the reaction of their oxidation with potassium ferricyanide accompanied by decoloration of the solutions was studied. On the basis of the quantum-chemical and experimental data it was concluded that the electron donor properties amplified as follows: aclacinomycin A less than adriamycin-rubomycin less than carminomycin. At the same time their acute toxicity increased (a decrease in the LD50). Therefore, the toxicity of the anthracycline antibiotics could be also due to formation of the radicals with high reactivity on the monoelectronic oxidation.

Antibiotics, Antineoplastic↗