Measurement of respiratory mechanics in a mechanically ventilated infant lung simulator: effects of variations in the frequency response of the flow measurement system

The frequency responses of systems used to measure flow and pressure in ventilated infants may differ, and hence affect estimates of resistance and compliance. We estimated resistance and compliance in 16 ventilated mechanical lung models using linear regression while varying the frequency response of the flow measurement system. Lung models comprised combinations of four sections of tubing and four bottles filled with steel wool. The cut-off frequencies of a filter in the flow measurement system were chosen to yield time delays of 0, ±3, ±6, and ±9 ms relative to the pressure signal. When the phase lags in the measurement systems were not equal at 10 Hz, a bias in resistance ≈(relative delay) × (elastance) ensued. The bias in the resistance estimate when resistance is 5 Pa ml⁻¹ s and compliance is 2 ml kPa⁻¹ is approximately 28% per ms of delay mismatch. Time-shifting the flow data to eliminate the phase discrepancy reduced the resistance bias by 85%. The residual resistance bias was assumed to be due to inappropriate amplitude response. Compliance measurements were affected by less than 8% and less than 2% after time correction of the flow data. Pressure and flow signals must be synchronized to within 1 ms at 10 Hz and the amplitude responses of the measurement systems must be adequate for reliable resistance measurement.     

A computerized decision support system for patient selection in dental education

A computerized decision support system is presented. The system is used to aid in the situation of patient selection for the purpose of dental education and utilizes the PERT/CPM methodology and decision tables. It runs on a microcomputer and written in Basic. The input is a list of patient's needs, and the output is a tentative treatment plan, the chair time needed to complete the treatment, its cost, and the probability that the student will finish it on time.     

Correlation between cerebral blood volume and cerebral blood flow in the cat

Summary Blood flow and blood volume were measured simultaneously in the same cerebral region in anaesthetized cats with controlled respiration. The measurements were made with the same scintillation-detector, using the freely diffusible indicator ¹³³ Xenon for flow determinations and the intra-vascular indicator RISA (¹³¹I) for volume recordings. A very high correlation was found between volume and flow changes (r = .96, p < 0.001). This finding indicates that variations of regional cerebral blood volume are accompanied by proportional blood flow changes.Attaché de recherche au C.N.R.S., Laboratoire de Neurophysiologie, Hopital Henri Rouselle, Paris, France.     

The role of adenosine in autoregulation of cerebral blood flow

We have investigated the role of adenosine, a purine nucleoside and potent vasodilator of cerebral pial vessels, during both acute (0–60 sec) and sustained (2–5 min) changes in cerebral perfusion pressure. Brain adenosine concentrations are rapidly increased within 5 sec of the onset of systemic hypotension and parallel, in a temporal fashion, the changes in pial vessel diameter and alterations in cerebral vascular resistance. During sustained hypotension, brain levels of adenosine are increased even within the autoregulatory range. These data are constant with the hypothesis that adenosine is an important metabolic factor in cerebral autoregulation.     

A four-phase model of the evolution of clinical decision support architectures

BACKGROUND: A large body of evidence over many years suggests that clinical decision support systems can be helpful in improving both clinical outcomes and adherence to evidence-based guidelines. However, to this day, clinical decision support systems are not widely used outside of a small number of sites. One reason why decision support systems are not widely used is the relative difficulty of integrating such systems into clinical workflows and computer systems. PURPOSE: To review and synthesize the history of clinical decision support systems, and to propose a model of various architectures for integrating clinical decision support systems with clinical systems. METHODS: The authors conducted an extensive review of the clinical decision support literature since 1959, sequenced the systems and developed a model. RESULTS: The model developed consists of four phases: standalone decision support systems, decision support integrated into clinical systems, standards for sharing clinical decision support content and service models for decision support. These four phases have not heretofore been identified, but they track remarkably well with the chronological history of clinical decision support, and show evolving and increasingly sophisticated attempts to ease integrating decision support systems into clinical workflows and other clinical systems. CONCLUSIONS: Each of the four evolutionary approaches to decision support architecture has unique advantages and disadvantages. A key lesson was that there were common limitations that almost all the approaches faced, and no single approach has been able to entirely surmount: (1) fixed knowledge representation systems inherently circumscribe the type of knowledge that can be represented in them, (2) there are serious terminological issues, (3) patient data may be spread across several sources with no single source having a complete view of the patient, and (4) major difficulties exist in transferring successful interventions from one site to another.     

Effects of increasing arterial pressure on cerebral blood flow in the baboon: Influence of the sympathetic nervous system

The influence of stimulation of the cervical sympathetic chain on the response of cerebral blood flow to hypertension induced by the intravenous infusion of angiotensin was studied in anaesthetised baboons. Cerebral blood flow was measured by the intracarotid¹³³Xenon injection technique. Possible lesions of the blood-brain barrier were studied by injecting Evans blue towards the end of the experiment and ischaemic brain damage was assessed following perfusion fixation.In a control group of five baboons blood flow increased by 53±9% (mean ±S.E.) from the base line values in the arterial pressure range 130–159 mm Hg.In four baboons subjected to unilateral sympathetic stimulation flow increased by 16±4% in the same pressure range.In three babbons subjected to bilateral sympathetic stimulation there were not significant increases in flow until the arterial pressure had increased above 159 mm Hg.Disruption of the blood-brain barrier in the parietooccipital regions was only seen in the control animals but not in the stimulated baboons. Ischaemic brain damage was not observed with the exception of one small lesion in a single stimulated baboon.These findings provide strong support for the observations of Bill and Linder (1976) that activation of the cervical sympathetic can modify the level at which breakthrough of cerebral blood flow occurs in association with systemic hypertension.These investigations were supported by the Medical Research Council and Tenovus (Scotland)     

Optimising the methodology of calculating the cerebral blood flow of newborn infants from near infra-red spectrophotometry data

Cerebral blood flow can be measured in neonates by near infra-red spectrophotometry. The tracer is oxyhaemoglobin. The purpose of the study is to compare the test-retest variability of two previously proposed methods (UCH and COP) of analysis, and to investigate the influence of sampling rates, smoothing and integration periods. Under clinical conditions good measurements are often difficult to obtain. Therefore, a second goal is to find ways of determining the quality of individual measurements. 380 cerebral blood flow measurements from 69 infants are analysed. The data set is optimised statistically for the lowest test-retest variability and the following results are obtained. The test-retest variability of measurements at 2 s sampling time data is considerably worse than at 0·5 s sampling time. Smoothing does not change the test retest variability. A 6 s integration period gives higher values and higher test-retest variability than an 8 s integration period. By applying the suggested criteria, a test-retest variability of 17% is achieved, if 50% of the measurements are rejected. The mean cerebral blood flow is 12·2 ml(100 g)⁻¹ min⁻¹ for the UCH method and 97·7 ml(100 g)⁻¹ min⁻¹ for the COP method. The test-retest variability of both methods is comparable for 0·5 s sampling time. For 2 s sampling time the method proposed by Skov et al. is significantly better. These test retest variabilities represent maximum values, part of the observed variability may be due to physiological changes of unknown magnitude.     

Deficient adjustment of cerebral blood flow to cognitive activity due to chronically low blood pressure

The present study aimed to investigate aberrances in the adjustment of cerebral blood flow to cognitive activity due to chronically low blood pressure. By means of transcranial Doppler sonography blood flow velocities in both middle cerebral arteries (MCA) were recorded during the execution of a serial subtraction task in 40 subjects with constitutional hypotension and 40 normotensive control persons. Additionally, blood pressure was continuously monitored. As a main result significant correlations between the task-induced changes in blood pressure and those in MCA blood flow velocities were found in hypotensives, but not in control subjects. The dependence of the regulation of cerebral blood flow on blood pressure points towards deficits in cerebral autoregulation in hypotension. Over the total sample the extent of the task-induced MCA flow velocity increase was positively related to cognitive performance. This underlines the importance of the adjustment of cerebral blood flow to current demands for optimal cognitive functioning.     

Analytical problems associated with the noninvasive measurements of cerebral blood flow in cerebrovascular diseases

The validity of atraumatic measurements of regional cerebral blood flow (r.c.b.f) by intravenous injection of Xenon 133 has been studied in 17 patients with cerebrovascular diseases. The results were directly compared with those obtained in the same subjects using the intracarotid-injection method. Clearance curves obtained by the intravenous method were analysed by means of a bicompartmental model of blood circulation corrected for recirculation of the tracer. Use of different modes of intravenous injection and systematic analysis of the portion of the clearance curve usable for estimation of regional cerebral blood flow enabled the authors to define the optimal conditions for measurement of r.c.b.f. in subjects with cerebrovascular disorders. A predominant source of error was found to be the difficulty in defining the exact instant when clearance begins. As a result, the best conditions were as follows: slow injection (1 min) of tracer and analysis of the portion of clearance curve between 3 and 11 min after the beginning of the clearance. Under these conditions this atraumatic method is as precise in subjects with cerebrovascular disease as in those with normal cerebral circulation.     

Cognitive performance and cerebral blood flow in essential hypotension

In the present study cerebral blood flow was assessed in 40 subjects with chronically low blood pressure and 40 normotensive controls at resting conditions and during the execution of a cued reaction time task. Blood flow velocities were recorded by means of transcranial Doppler sonography in both middle cerebral arteries. In hypotensives flow velocity at rest was reduced bilaterally. During the anticipation of the stimuli, which the subjects had to respond to, a predominantly right hemispheric increase of flow velocity was observed in both groups. This increase was significantly less pronounced in the hypotensive group. Hypotensives showed longer reaction times, and there was a negative correlation between the extent of the flow velocity increase and the reaction times. This study is the first to demonstrate a reduced cerebral perfusion and maladaption of blood flow to cognitive demands due to essential hypotension.     

Microcomputer evaluation of cerebral blood flow velocity studies in the neonate

A semi-automated system for evaluation of Doppler cerebral blood flow studies obtained from newborn infants is described. A low cost digitizer is used to convert the graphic data from the flow tracing to digital data. A small business computer is used to analyze the data and produce a chartable report. The reliability of the digitizer is also evaluated.     

A mouse model of cerebral oligemia: relation to brain histopathology, cerebral blood flow, and energy state

An animal model involving stepwise occlusion of the common carotid arteries (sCCAO) in DBA/2 mice is presented in which the right and left carotid arteries were permanently ligated within a time interval of four weeks. Thereafter, cerebral functional and structural parameters were determined at acute (15 min) and subchronic (1 day; 3, 7, and 14 days) time points after sCCAO. Quantitative changes in regional cerebral blood flow (rCBF) as determined by the [14C]iodoantipyrine method, energy state (ATP, phosphocreatine, ADP, AMP, adenosine) as shown by HPLC, brain histopathology, and neuronal densities were measured in both hemispheres. Acute sCCAO was accompanied by a drastic reduction in cerebral energy-rich phosphate concentrations, ATP and phosphocreatine, and in rCBF of more than 50%. In contrast, cortical adenosine increased around five-fold. Subchronic sCCAO, however, was associated with normalization in brain energy metabolites and near-complete restoration of rCBF, except in the caudate nucleus (–40%). No marked signs of necrotic or apoptotic cell destruction were detected. Thus, during the subchronic period, compensatory mechanisms are induced to counteract the drastic changes seen after acute vessel occlusion. In conclusion, this sCCAO mouse model may be useful for long-lasting investigations of stepwise deterioration contributing to chronic cerebrovascular disorders.     

Effect of electrode size on the contributions of intracranial and extracranial blood flow to the cerebral electrical impedance plethysmogram

The contribution of scalp blood flow to pulses obtained by cerebral electrical impedance plethysmography (rheoencephalography) has been investigated using a four-electrode (quadripolar) montage with brass disc electrodes 1 cm, 2 cm and 4 cm in diameter. Three states of scalp perfusion were produced by the application of a tourniquet around the occipto-frontal circumference of the head, and blood flow in the scalp was monitored by means of reflection photoplethysmography and an electrical impedance technique. When scalp perfusion was occluded, cerebral impedance pulse amplitude was reduced to 80% of that obtained during normal scalp flow; in the presence of maximal scalp flow as a result of the reactive hyperaemia induced by release of the tourniquet, cerebral impedance pulse amplitude was 30% greater than during normal scalp flow. Altering electrode diameter did not affect the contribution of scalp flow to cerebral impedance pulse size. The effect of changes in scalp flow did, however, increase when a bipolar electrode montage was used instead of a quadripolar montage.     

Regional decline of cerebral blood flow with age in cognitively intact subjects

Cerebral blood flow was measured by the 133Xenon washout method in 44 cognitively intact subjects. Regression analysis of cerebral blood flow with age was performed on data from 33 subjects without arteriosclerotic cardiovascular disease, hypertension, or chronic obstructive pulmonary disease, factors which have been previously shown to lower cerebral blood flow. Changes with normal aging were significant in the left and right hemispheres with bilateral changes in temporal, parietal, and occipital regions. An additional group of 11 cognitively intact subjects with arteriosclerotic cardiovascular disease but no accompanying dementing disease had lower mean flow values at each detector position than did age- and sex-matched controls, although the differences did not always reach statistical significance. Decreased flows in temporal regions seem to be a concomitant of normal aging, and are not related to the presence of vascular disease.     

A decision support system based on support vector machines for diagnosis of the heart valve diseases

In this paper, a decision support system that classifies the Doppler signals of the heart valve to two classes (normal and abnormal) is presented to support the cardiologist. The paper uses our previous paper where ANN is used as a classifier, as feature extractor from measured Doppler signal. To make this, it uses wavelet transforms and short time Fourier transform methods. Before it classifies these features, it applies Wavelet entropy to them. In this paper, our aim is to develop our previous work by using least-squares support vector machine (LS-SVM) classifier instead of ANN. We use LS-SVM and backpropagation artificial neural network (BP-ANN) to classify the extracted features. In addition, we use receiver operator characteristic (ROC) curves to compare sensitivities and specificities of these classifiers and compute the area under the curves. Finally, we evaluate two classifiers in all aspects.     

Regional blood flow in response to exercise in conscious dogs

Summary Regional blood flow was measured with the microsphere method in conscious dogs under resting conditions and during moderate exercise on the treadmill.With respect to total organ blood flow, exercise induced a marked increase in blood flow to the calf muscles and to the myocardium, and a significant decrease in the arterial blood supply to the liver. Slight changes in blood flow to the other organs under study (various skeletal muscles, skin, brain, kidneys, intestine) were not significant.Study of the blood flow distribution within the myocardium showed a slight decrease of the ratio of subendocardial to subepicardial blood flow in the left ventricular free wall in response to exercise, and within the brain there was a relative increase in the blood flow to the cerebellum.     

Aging-related differences in cerebral capillary blood flow in anesthetized rats

Age-related decreases in baseline cerebral blood flow have been measured with various imaging modalities, however, the contribution of capillary flow to this phenomenon remain to elucidate. This study used 2-photon laser scanning fluorescence microscopy to measure capillary diameter, red blood cell speed, and flux in individual capillaries in the sensory-motor cortex of 12 adult (3-month-old) and 12 old (24-month-old) male Long-Evans rats under isoflurane anesthesia. The average (± standard deviation) diameter and speed over 921 capillaries were 6.4 ± 1.4 μm and 1.3 ± 1.1 mm/s, respectively. Red blood cell speed and flux were significantly higher, by 48% and 15%, respectively, in old compared with young animals (p < 5%). The diameter also showed a similar tendency (7% higher, p = 5.7%). Furthermore, capillary hematocrit and density were significantly lower in the older group (p < 5%), by 32% and 20%, respectively.     

LSCI检测不同缺血期对大鼠缺血再灌注过程脑血流的影响

目的　考察不同缺血期对大鼠缺血再灌注过程脑血流的影响。 方法　通过激光散斑成像技术（LSCI）检测大鼠大脑中动脉不同栓塞时间后,对再灌注过程中脑血流的影响,并对再灌注过程中的低灌注状态、无复流现象、血流流速及管径变化进行研究分析。 结果　2 h的栓塞后,大鼠脑部血流量趋向低灌注状态,约为栓塞前血流基值的(35±10)%;栓塞时间越长,无复流现象越多;在再灌注期间,缺血2 h组的血流比0.5 h组的低灌注水平低10%。 结论　长时间的脑缺血期再灌注过程可能是造成脑损伤程度加重的主要原因之一。LSCI可应用于脑部血流实时监测,操作简便,成像灵敏、稳定,结果可靠。