Cardiac Electrophysiological Experiments in Numero, Part III: Simulation of Arrhythmias and Pacing

This paper is the third and final part of a series of articles reviewing mathematical and computer models of the electrophysiological processes. This section reviews the arrhythmia simulation and discusses models of arrhythmogenic processes, fibrillation and defibrillation, and of heart-pacemaker interaction. The models of arrhythmogenesis are classified into three main sections: models of reentry and vortex reentry, models of myocardial electrotonic interactions, and models of macroreentrant supraventricular tachycardias. This final part of the review discusses the future potential of mathematical and computer models of different cardiac processes.     

A neuromuscular monitoring system based on a personal computer

We have developed a computerized neuromuscular monitoring system (NMMS) using commercially available subsystems, i.e., computer equipment, clinical nerve stimulator, force transducer, and strip-chart recorder. This NMMS was developed for acquisition and analysis of data for research and teaching purposes. Computer analysis of the muscle response to stimulation allows graphic and numeric presentation of the twitch response and calculated ratios. Since the system can store and recall data, research data can be accessed for analysis and graphic presentation. An IBM PC/AT computer is used as the central controller and data processor. The computer controls timing of the nerve stimulator output, initiates data acquisition, and adjusts the paper speed of the strip chart recorder. The data processing functions include establishing control response values (when no neuromuscular blockade is present), displaying force versus time and calculated data graphically and numerically, and storing these data for further analysis. The general purpose nature of the computer and strip chart recording equipment allow modification of the system primarily by changes in software. For example, new patterns of nerve stimulation, such as the posttetanic count, can be programmed into the computer system along with appropriate data display and analysis routines. The NMMS has functioned well in the operating room environment. We have had no episodes of electrocautery interference with the computer functions. The automated features have enhanced the utility of the NMMS. The prime advantages of this system are (1) the ability to customize its features by altering its controlling programs, (2) the ready availability of the hardware and software, (3) the general purpose nature of the system, so that it is not limited to this one application, and (4) the adaptable nature of the system.     

Improvement in quality of cryopreserved human spermatozoa by swim-up before freezing

Selecting a population of spermatozoa by the swim-up technique yields, after freezing and thawing, a population of cells that contains proportionally more spermatozoa which are morphologically normal, fewer spermatozoa with damaged tail membranes, and a greater percentage of progressively motile spermatozoa with greater velocities and amplitudes of head displacement than those obtained after freezing and thawing the same semen samples in the normal way. This pattern was found for the semen from 10 patients and five volunteers. However, the cells selected by swim-up were as susceptible to the stresses caused by freezing and thawing as unselected spermatozoa in the original semen sample, and the improvement came from the better quality of the initial sample.     

31例活动性肺结核治疗前及治愈后的CT征象分析

目的 探讨抗结核疗前及治愈后活动性肺结核CT征象的变化特点.方法 选取临床治愈的活动性肺结核31例,对比观察活动性肺结核的CT征象转归表现.结果 肺结核活动性CT征象治愈前检出率为100.0%,治疗后检出率为35.5%.活动性CT征象中毛玻璃阴影、节段分布小叶中心结节影、小叶样实变影、树芽征、支气管壁增厚、厚壁空洞和肺实变治疗前检出率分别为87.1%、80.6%、80.1%、61.3%、58.1%、48.4%和32.3%、,治愈后检出率分别为0、19.4%、0、0、12.9%、0和3.2%.治疗前活动性肺结核CT检查可检出多种活动性影像,而疗程结束后上述征象减少并多以单发为主,两者有显著差异（P＜0.01）.结论 CT检查有助于活动性肺结核治疗疗效的判定,并具有较高的敏感度,但特异度较低.     

Evaluation of computerized analysis of the propagation of human duodenojejunal contractions

Abstract Detection of peristalsis in the human small intestine has been limited in the past by both the available measurement techniques and the complexity of this activity. Recent developments in ambulant recording have provided a means of monitoring the occurrence of intestinal contractions at multiple sites in the small bowel, but the problem of complexity remains. Using digital data recorded from an intra-luminal strain-gauge transducer in the proximal gut, an algorithm was implemented to identify and classify contractile events within the small bowel. By modelling propagated activity the effect of varying transducer spacing and the number of transducers used was assessed. The question of variability of apparent velocity of peristaltic contractions was examined using successive cross-correlation calculations to extract underlying phase differences between samples of 512 minutes of manometric recording over 150 mm of human small bowel. The effective velocity was found to have a median value of 14 mm sec^-1 and an inter quartile range of 12–18 mm see^-1). It is proposed that, in dynamically tracking variations in phase difference between adjacent recording sites, cross-correlation techniques should be used to control the parameters used for the recognition of propagated contractile events and thereby improve the specificity of this process.     

Numerical comparisons of two formulations of the logistic regressive models with the mixed model in segregation analysis of discrete traits.

Segregation analysis of discrete traits can be conducted by the classical mixed model and the recently introduced regressive models. The mixed model assumes an underlying liability to the disease, to which a major gene, a multifactorial component, and random environment contribute independently. Affected persons have a liability exceeding a threshold. The regressive logistic models assume that the logarithm of the odds of being affected is a linear function of major genotype effects, the phenotypes of older relatives, and other covariates. A formulation of the regressive models, based on an underlying liability model, has been recently proposed. The regression coefficients on antecedents are expressed in terms of the relevant familial correlations and a one-to-one correspondence with the parameters of the mixed model can thus be established. Computer simulations are conducted to evaluate the fit of the two formulations of the regressive models to the mixed model on nuclear families. The two forms of the class D regressive model provide a good fit to a generated mixed model, in terms of both hypothesis testing and parameter estimation. The simpler class A regressive model, which assumes that the outcomes of children depend solely on the outcomes of parents, is not robust against a sib-sib correlation exceeding that specified by the model, emphasizing testing class A against class D. The studies reported here show that if the true state of nature is that described by the mixed model, then a regressive model will do just as well. Moreover, the regressive models, allowing for more patterns of family dependence, provide a flexible framework to understand gene-environment interactions in complex diseases.     

Virtual real-time digital processing of hemodynamic data

At present, the majority of cardiac catheterization laboratories acquire and store hemo-dynamic data in analog form. To examine the possibility of performing complex analysis of digital data during the catheterization procedure, we examined whether virtual realtime digital (fast Fourier) analysis improves the accuracy of clinical data. We compared digital filtering of fluid manometry during right heart catheterization with 10-Hz and 250-Hz analog filters. Using the simultaneously acquired micromanometry as the “gold standard,” we found that analog filtering is associated with a greater error and time delay than digital filtering. This study demonstrates that digital hemodynamic data analysis performed during cardiac catheterization can improve the quality of data obtained during right heart catheterization, with the results available within seconds. More extensive use of computers in the cardiac catheterization laboratory may be useful for both clinical and research purposes. © 1992 Wiley-Liss, Inc.     

The usefulness of detailed information to patients with contact allergy

To find out if patients with contact allergy are helped by computerized information lists, a retrospective study was carried out on 58 patients with contact allergy to lanolin, traced through our local database DALUK. All were sent a questionnaire about their usage of the information list, clearance of their eczema, their education and other details. Clearance of the patient's eczema was found to correlate with use of the information list. It was also found that the effectiveness of the information depended on factors such as education, family circumstances, ethnic background and, most of all, how and where the information list was used.