Evaluation of full-term infants fed an evaporated milk formula

The objective of this prospective, cohort study was to compare the nutritional status of full-term infants who were fed human milk (BF, n = 29). formula (FF, n = 30) or evaporated milk formulae (EM, n = 30) for at least 3 months. Infants were seen at enrollment, 3 and 6 months, at which times a blood sample, diet record and anthropometric data were collected. Infants in the EM group received solids earlier (12 ± 5 weeks) than did FF infants (15 ± 4 weeks), and both were earlier than BF infants (19 ± 4 weeks). Only 26% of the EM fed group received iron supplements as ferrous sulphate drops. Seven BF, 12 FF and 20 EM had abnormal ferritin values (<10ngml^-1) at 6 months. Copper intake was lower in the EM infants at 3 and 6 months. However, plasma copper and erythrocyte copper zinc superoxide dismutase (ZnCuSOD) levels did not differ between groups. Selenium intake was lower in the EM group (5 ± 1 and 10 ± 5 μg d^-1; 3 and 6 months) than in the FF infants (13 ± 4 and 19 ± 7 μgd^-1; 3 and 6 months). Erythrocyte SeGHSPx levels in EM infants were lower at 6 months (EM, 33.2 ± 3.4; FF, 35.2 ± 3.9; BF, 36.1 ± S.SmUmgHb^-1). Thiamin intake (0.99 ± 0.08 and 1.24 ± 0.32; 3 and 6 months, mg 1000 kcal^-1) was higher in the FF group than in EM infants (0.38 ± 0.39 and 0.66 ± 0.38; 3 and 6 months). There were more (13%) abnormal thiamin assays in the EM group at 6 months than in the BF and FF infants (0%). In conclusion, infants fed evaporated milk formula receive adequate copper but may not receive enough thiamin or selenium. Unless supplemented from birth with medicinal iron, intakes of iron will be inadequate.     

Mixed-phase modeling in snore sound analysis

Obstructive sleep apnea (OSA) is a highly prevalent disease in which upper airways are collapsed during sleep, leading to serious consequences. The gold standard of diagnosis, called Polysomnography (PSG), requires a full-night hospital stay connected to over 15 channels of measurements requiring physical contact with sensors. PSG is expensive and unsuited for community screening. Snoring is the earliest symptom of OSA, but its potential in OSA diagnosis is not fully recognized yet. In this paper, we propose a novel model for SRS as the response of a mixed-phase system (total airways response, TAR) to a source excitation at the input. The TAR/source model is similar to the vocal tract/source model in speech synthesis, and is capable of capturing acoustical changes brought about by the collapsing upper airways in OSA. We propose an algorithm based on higher-order-spectra (HOS) to jointly estimate the source and TAR, preserving the true phase characteristics of the latter. Working on a clinical database of signals, we show that TAR is indeed a mixed-phased signal and second-order statistics cannot fully characterize it. Night-time speech sounds can corrupt snore recordings and pose a challenge to snore based OSA diagnosis. We show that the TAR could be used to detect speech segments embedded in snores, and derive features to diagnose OSA via non-contact, low-cost instrumentation holding potential for a community screening device.     

Detection and management of an implantable cardioverter defibrillator lead failure: incidence and clinical implications

OBJECTIVES: This study evaluated the long-term reliability of an implantable cardioverter defibrillator (ICD) lead to determine the incidence, clinical presentation, and management of lead failure. BACKGROUND: Despite recent advances in ICD technology, the long-term reliability of ICD leads remains a significant problem. METHODS: Concern about long-term reliability of coaxial polyurethane ICD leads caused us to systematically study all patients implanted with Medtronic (Minneapolis, Minnesota) 6936 lead at our institution. We performed follow-up of 74 patients with 76 ICD leads that were implanted from February 28, 1995 to September 8, 1997. Thirty-seven patients underwent routine clinical ICD follow-up testing and ventricular fibrillation induction to determine the status of their ICD lead after a mean follow-up of 68.6 +/- 8.2 months. RESULTS: The lead survival analysis shows a cumulative failure probability of 37% (confidence interval, 24% to 54%) at 68.6 months. Six patients demonstrated a previously undescribed mode of ICD lead failure: prolonged oversensing immediately after shock therapy. The use of short interval counters to monitor nonphysiologic R-R intervals and the measurement of ring-to-coil impedance detected early lead failures in five patients. CONCLUSIONS: This analysis shows: 1) problems with ICD leads may not become apparent until late during follow-up and may become a significant late problem, 2) a "signature" mode of lead failure for the 6936 consisting of oversensing of electrical noise following shocks, 3) early detection of lead failure with a short interval counter algorithm or measurement of ring-to-coil impedance may be clinically useful.     

Assessment of psychological aspects during systemic provocation tests in patients with pseudoallergic drug reactions

BACKGROUND: Basic mechanisms of pseudoallergic drug reactions as well as a possible role of the psyche are currently unknown. OBJECTIVE: Examination of psychological status and reactions during diagnostic provocation tests in patients with previous pseudoallergic reactions to drugs. SUBJECTS AND METHODS: Ten inpatients, admitted for provocation tests, were studied in a double-blind, placebo-controlled setting, with inventories of anxiety and depression being measured at baseline and psychological reactions and symptoms being recorded daily by patients and the attending physician. RESULTS: Patients reported more than twice as many symptoms as the physician, independent of the type of exposure. While the basic psychological profile of the patients was normal, anxiety trait and state values were high during testing, with a significant increase depending on whether the patients thought they had received a drug or a placebo. Similarly, frequency of symptoms was dependent on the patients' perception of the type of exposure. CONCLUSION: These findings demonstrate a high level of anxiety during systemic provocation tests in patients with previous pseudoallergic drug reactions, raising serious questions as to the diagnostic validity of the routine application of this testing.     

Artificial neural networks for source localization in the human brain

Summary Source localization in the brain remains an ill-posed problem unless further constraints about the type of sources and the head model are imposed. Human head is modeled in various ways depending critically on the computing power available and/or the required level of accuracy. Sophisticated and truly representative models may yield more accurate results in general, but at the cost of prohibitively long computer times and huge memory requirements. In conventional source localization techniques, solution source parameters are taken as those which minimize an index of performance, defined relative to the model-generated and clinically measured voltages. We propose the use of a neural network in the place of commonly employed minimization algorithms such as the Simplex Method and the Marquardt algorithm, which are iterative and time consuming. With the aid of the error-backpropagation technique, a neural network is trained to compute source parameters, starting from a voltage set measured on the scalp. Here we describe the methods of training the neural network and investigate its localization accuracy. Based on the results of extensive studies, we conclude that neural networks are highly feasible as source localizers. A trained neural network's independence of localization speed from the head model, and the rapid localization ability, makes it possible to employ the most complex head model with the ease of the simplest model. No initial parameters need to be guessed in order to start the calculation, implying a possible automation of the entire localization process. One may train the network on experimental data, if available, thereby possibly doing away with head models.     

Investigation of Obstructive Sleep Apnea Using Nonlinear Mode Interactions in Nonstationary Snore Signals

Acoustic studies on snoring sounds have recently drawn attention as a potential alternative to polysomnography in the diagnosis of obstructive sleep apnea (OSA). This paper investigates the feasibility of using nonlinear coupling between frequency modes in snore signals via wavelet bicoherence (WBC) analysis for screening of OSA. Two novel markers (PF1 and PSF), which are frequency modes with high nonlinear coupling strength in their respective WBC spectrum, are proposed to differentiate between apneic and benign snores in same- or both-gender snorers. Snoring sounds were recorded from 40 subjects (30 apneic and 10 benign) by a hanging microphone, and subsequently preprocessed within a wavelet transform domain. Forty inspiratory snores (30 as training and 10 as test data) from each subject were examined. Results demonstrate that nonlinear mode interactions in apneic snores are less self-coupled and usually occupy higher and wider frequency ranges than that of benign snores. PF1 and PSF are indicative of apneic and benign snores (p < 0.0001), with optimal thresholds of PF1 = 285 Hz and PSF = 492 Hz (for both genders combined), as well as sensitivity and specificity values between 85.0 and 90.7%, respectively, outperforming the conventional diagnostic indicator (spectral peak frequency, PF = 243–275 Hz, sensitivity = 77.7–79.7%, specificity = 72.0–78.0%, p < 0.0001). Relationships between apnea-hypopnea index and the proposed markers could likely take the functional form of exponential or power. Perspectives on nonlinear dynamics analysis of snore signals are promising for further research and development of a reliable and inexpensive diagnostic tool for OSA.     

Effect of MR imaging on spleen colony formation following gamma irradiation

This article describes experiments performed to examine the possible effect of interaction between ionizing radiation and magnetic resonance (MR) on damage to normal tissue. Eight-week-old ICR male mice were irradiated (cobalt-60 radiation) with 5, 6, or 7 Gy given either alone or followed by MR imaging. Other groups received fractionated doses of 6 Gy (3 Gy + 3 Gy) or 7 Gy (3 Gy + 4 Gy) either with or without subsequent MR imaging. Ten days after exposure, spleens were assayed for endogenous spleen colonies. The number of spleen colonies was lower at higher radiation doses, and fractionation of the dose resulted in an increase in colony number compared with a comparable dose in a single exposure. No difference was seen, however, between comparable radiation groups that were or were not subjected to MR imaging. In addition to the spleen colony assay, body weights and wet weights for spleen, thymus, and testes were obtained, since these suffer weight loss in proportion to radiation dose. As with the spleen colony assay, no significant effect of MR imaging was observed. These results indicate that for the normal tissues studied, MR imaging neither increases radiation damage nor inhibits repair between fractions.