A Parametric Approach to Measuring Cerebral Blood Flow Autoregulation from Spontaneous Variations in Blood Pressure

Autoregulation maintains cerebral blood flow (CBF) almost constant in the face of changes in arterial blood pressure (ABP). Tests for impairment of this process using only spontaneous fluctuations in ABP, without provoking large variations, are of great clinical interest, and a range of different approaches have previously been applied. Extending earlier work based on linear filters, we propose a simple parametric method using a first order finite impulse response filter. We evaluate the method on ABP and CBF velocity [(CBFV), from trancranial Doppler ultrasound] signals collected in 60 patients with stenosis or occlusion of the carotid arteries. Data were collected during the inspiration of ambient air, a 5% CO2/air mixture, and finally the return to ambient air. Equivalent data were collected in 15 normal subjects. The filters estimated from the data segments with constant inspiratory pCO2 showed the expected high-pass characteristic, which was reduced during hypercapnia and also in patients. Highly significant correlation between the filter parameters and cerebrovascular reactivity (percent increase in CBFV per unit change in end-tidal pCO2) gives further evidence that the filters reflect autoregulation. The method allows simple parametrization of the dynamic autoregulatory responses in CBFV, and the analysis of short (1 min) data segments. © 2001 Biomedical Engineering Society. PAC01: 8719Uv, 4762+q, 4380Qf     

Biometry of infrarenal inferior vena cava measured by cavography

Summary Placement of a transvenous vena cava filter has became a common way to control recurrent pulmonary embolism. However few studies have been reported on the diameter of the infrarenal inferior vena cava (IIVC) where the device is usually placed. This study based upon 100 cavographies has showed the calculated average diameter of IIVC was 20.9 mm (range 12–27 mm) in its middle part and 21.3 mm (range 10–31 mm) in its terminal end. The calculated average IIVC length was 96 mm (range 80.3–142 mm). There was no statistical correlation between caval size and age, sex, height, weight and corporeal area. There was a statistical difference of left renal vein location between patients presenting with lumbar arthrosis and those without. We discuss different methods to measure IIVC in particular tomodensitometry. CT scans reviewed in our department show that the largest diameter of IIVC is not in a frontal plane and that the width seen on cavography is the projection of the largest diameter on the film. Therefore, the range of the real caval diameters is greater than indicated above.

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Biométrie de la v. cave inférieure sous-rénale: mesure par cavographieApplication clinique

Résumé L'utilisation de filtre cave endoveineux pour prévenir une récidive d'embolie pulmonaire est devenue d'un usage courant. Cependant peu de travaux ont été faits sur le diamètre de la veine cave inférieure infrarénale (IIVC) où l'appareil est généralement situé. Cette étude a pour but d'étudier le diamètre transversal de la VCI sousrénale (VCISR) à partir de 100 cavographies réalisées dans des conditions techniques identiques. Le diamètre moyen de la VCISR est de 20.9 mm (extrême 12–27 mm) dans sa partie moyenne et de 21.3 mm (extrême 10–31 mm) au niveau de sa terminaison. La longueur moyenne de la VCISR est de 96 mm (extrême 80,3–142 mm). L'âge, le sexe, la taille, le poids, la surface corporelle n'influencent pas les dimensions de la VCISR. Il existe une différence statistiquement significative de l'abouchement de la v. rénale gauche entre les sujets ayant une arthrose lombaire et ceux qui en sont dépourvus.La cavographie reste un examen de base en matière d'exploration de la VCI. La connaissance des variations des dimensions de la VCISR qu'elle apporte est donc indispensable. L'intérêt de cette étude est cependant limité par le fait que l'image radiologique correspond en réalité à la projection du diamètre transversal réel. Des études complémentaires utilisant en particulier la tomodensitométrie sont donc nécessaire pour préciser une éventuelle relation entre le diamètre réel et le diamètre mesuré par cavographie.

     

Adaptive spatial filtering of multichannel surface electromyogram signals

Spatial filtering of surface electromyography (EMG) signal can be used to enhance single motor unit action potentials (MUAPs). Traditional spatial filters for surface EMG do not take into consideration that some electrodes could have poor skin contact. In contrast to the traditional a priori defined filters, this study introduces an adaptive spatial filtering method that adapts to the signal characteristics. The adaptive filter, the maximum kurtosis filter (MKF), was obtained by using the linear combination of surrounding channels that maximises kurtosis. The MKF and conventional filters were applied to simulated EMG signals and to real EMG signals recorded with an electrode grid to evaluate their performance in detecting single motor units. The MKF was compared with conventional spatial filtering methods. Simulated signals, with different levels of spatially correlated noise, were used for comparison. The influence of one electrode with poor skin contact was also investigated. The MKF was found to be considerably better at enhancing a single MUAP than conventional methods for all levels of spatial correlation of the noise. For a spatial correlation of 0.97 of the noise, the improvement in the signal-to-noise ratio, where a MUAP could be detected, was at least 6 dB. With a simulated poor skin contact for one electrode, the improvement over the other methods was at least 19 dB.     

Analysis of dynamic cerebral autoregulation using an ARX model based on arterial blood pressure and middle cerebral artery velocity simulation

The study aimed to model the cerebrovascular system, using a linear ARX model based on data simulated by a comprehensive physiological model, and to assess the range of applicability of linear parametric models. Arterial blood pressure (ABP) and middle cerebral arterial blood flow velocity (MCAV) were measured from 11 subjects non-invasively, following step changes in ABP, using the thigh cuff technique. By optimising parameters associated with autoregulation, using a non-linear optimisation technique, the physiological model showed a good performance (r=0.83±0.14) in fitting MCAV. An additional five sets of measured ABP of length 236±154 s were acquired from a subject at rest. These were normalised and rescaled to coefficients of variation (CV=SD/mean) of 2% and 10% for model comparisons. Randomly generated Gaussian noise with standard deviation (SD) from 1% to 5% was added to both ABP and physiologically simulated MCAV (SMCAV), with ‘normal’ and ‘impaired’ cerebral autoregulation, to simulate the real measurement conditions. ABP and SMCAV were fitted by ARX modelling, and cerebral autoregulation was quantified by a 5 s recovery percentage R5% of the step responses of the ARX models. The study suggests that cerebral autoregulation can be assessed by computing the R5% of the step response of an ARX model of appropriate order, even when measurement noise is considerable.     

New algorithmic-based digital filter processing system for real-time continuous blood pressure measurement and analysis in conscious rats

A new algorithmic-based digital filter processing system for real-time continuous blood pressure (BP) measurement and analysis in freely-moving conscious rats has been developed. Real-time recognition of BP waveforms, real-time noise rejection and determination of representative waveform indexes (WIs) at indicated time points using digital filters and Smirnov's rejection test were realized with this system. Digital filters were applied for two different purposes: waveform segmentation and smoothing the calculations of representative WIs. Smirnov's rejection test was used for real-time noise rejection and yielded an accurate rejection rate of 99.99%. The result was that the digital filter processing and Smirnov's rejection test realized accurate real-time BP measurement and analysis in freely-moving conscious rats using a personal computer.     

用自回归白化滤波器提取脑-机接口信号VEP

利用脑-计算机接口这种新颖的人-机交互模式构建一种脑控拼写装置,其主要问题是实时、准确地从头皮电极记录到的脑电背景信号中提取视觉诱发电位,以决定用户选择按键。由于在一个短时程内可以认为自发脑电是平稳的,利用靶刺激出现前记录到的非靶刺激信号计算自回归模型参数,构造一个白化滤波器,再将实时信号通过白化滤波器滤波,使自发脑电得以白化,然后采用小波分析方法滤除白噪信号。结果表明靶刺激信号更加突出,提高了后续模式分类的正确率。采用模拟自然阅读诱发模式使短时信号的平稳性得到了保障,利用白化滤波器去除自发脑电是可行的。     

Time adaptive denoising of single trial event-related potentials in the wavelet domain

We present a new wavelet-based method for single trial analysis of transient and time variant event-related potentials (ERPs). Expecting more accurate filter settings than achieved by other techniques (low-pass filter, a posteriori Wiener filter, time invariant wavelet filter), ERPs were initially balanced in time. By simulation, better filter performance could be established for test signals contaminated with either white noise or isospectral noise. To provide an example of real application, the method was applied to limbic P300 potentials (MTL-P300). As a result, variance of single trial MTL-P300s decreased, without restricting the corresponding mean. The proposed method can be regarded as an alternative for single-trial ERP analysis.     

Simulation Studies of Latency Measures of Components of the Event-Related Brain Potential

We compared the accuracy of P300 latency estimates obtained with different procedures under several simulated signal and noise conditions. Both preparatory and signal detection techniques were used. Preparatory techniques included frequency filters and spatial filters (single electrode selection and Vector filter). Signal detection techniques included peak-picking, cross-correlation, and Woody filter. Accuracy in the latency estimation increased exponentially as a function of the signal-to-noise ratio. Both Woody filter and cross-correlation provided better estimates than peak-picking, although this advantage was reduced by frequency filtering. For all signal detection techniques, Vector filter provided better estimates than single electrode selection. Large component overlap impaired the accuracy of the estimates obtained with both single electrode selection and Vector filter, but with Vector filter impairment occurred only when the overlapping component had a scalp distribution that was similar to the scalp distribution of the signal component. The effects of varying noise characteristics, P300 duration and latency, and the parameters of Vector filter were also investigated.     

Human cerebral potentials evoked by CO2 laser stimuli causing pain

Summary Brief radiant heat pulses, generated by a CO₂ laser, were used to activate slowly conducting afferents in the hairy skin in man. In order to isolate C-fibre responses a preferential A-fibre block was applied by pressure to the radial nerve at the wrist. Stimulus estimation and evoked cerebral potentials (EP), as well as reaction times, motor and sudomotor activity were recorded in response to each stimulus. With intact nerve, the single supra-threshold stimulus induced a double pain sensation: A first sharp and stinging component (mean reaction time 480 ms) was followed by a second burning component lasting for seconds (mean reaction time 1350 ms). Under A-fibre block only one sensation remained with characteristics and latencies of second pain. The heat pulse evoked potential consisted of a late vertex negativity at 240 ms (N240) followed by a prominent late positive peak at 370 ms (P370). Later activity was not reliably present. Under A-fibre block this late EP was replaced by an ultralate EP beyond 1000 ms, which in the conventional average looked like a slow halfwave of 800 ms duration. This potential was distinct from eye movements, skin potentials or muscle artefacts. With cross-correlation methods waveforms similar to the N240/P370 were detected in the latency range from 900 to 1500 ms during A-fibre block, indicating a much greater latency jitter of the ultralate EP. Latency corrected averaging with a modified Woody filter yielded a grand mean ultralate EP (N1050/P1250), the shape of which was surprisingly similar to the late EP (N240/P370). The similarity of these components indicates that both EPs may be secondary responses to afferent input into neural centers, onto which myelinated and unmyelinated fibres converge. Such convergence may also explain through the known mechanisms of short term habituation and selective attention, why ultralate EPs are not reliably present without peripheral nerve block.     

TB prevention cascade at a district hospital in rural Eastern Cape,South Africa

SETTING:Rural Eastern Cape, South Africa.OBJECTIVE:To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program.DESIGN:This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts.RESULTS:A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1–16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed.CONCLUSION:Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.