Electrical Impedance Tomography of Electrolysis

The primary goal of this study is to explore the hypothesis that changes in pH during electrolysis can be detected with Electrical Impedance Tomography (EIT). The study has relevance to real time control of minimally invasive surgery with electrolytic ablation. To investigate the hypothesis, we compare EIT reconstructed images to optical images acquired using pH-sensitive dyes embedded in a physiological saline agar gel phantom treated with electrolysis. We further demonstrate the biological relevance of our work using a bacterial E.Coli model, grown on the phantom. The results demonstrate the ability of EIT to image pH changes in a physiological saline phantom and show that these changes correlate with cell death in the E.coli model. The results are promising, and invite further experimental explorations.     

电阻抗断层成像技术研究进展

电阻抗断层成像(EIT)是一种重要的医学成像方法,通过对物体表面的分布电测量来获知物体内部的电特性图像,有着良好的应用前景.本文对EIT的硬件系统和成像算法的研究进展作了全面的描述.首先对硬件部分的信号源和驱动模式进行了介绍,并对目前使用的EIT系统作了简要的分析;然后介绍了成像算法,从二维和三维成像两个方面对目前EIT的重建算法进行阐述.最后,对EIT进行了讨论和总结.     

基于径向基函数神经网络的肺部加权频差电阻抗成像方法

目的 对肺通气过程进行床旁实时连续图像监控，是机械通气患者和临床医生的迫切需求。肺部电阻抗成像（EIT）可反映呼吸引起的胸腔电特性变化分布，在肺通气监测方面具有天然的优势。本文目的在于建立基于径向基函数神经网络（RBFNN）的肺部加权频差电阻抗成像（wfd-EIT）方法，实现对肺通气的高空间分辨率成像。方法 利用肺部wfd-EIT成像方法实时描绘胸腔电导率分布状况，再通过RBFNN将目标区域可视化并精准识别其边界信息。首先通过数值分析模拟，在各个激励频率利用COMSOL与MATLAB软件建立2 028个仿真样本，分为训练样本集和测试样本集，验证所提出成像方法的可行性和有效性。其次，为了验证仿真结果，建立肺部物理模型，选用具有低电导特性的生物组织模拟肺部通气区域，对其进行成像实验，并采用图像相关系数（ICC）和肺区域比（LRR）定量数据衡量成像方法的准确性。结果 wfd-EIT方法可以在任意时刻进行图像重建，并能够准确反映出目标区域的电特性分布；利用基于RBFNN的算法能够增强目标区域的成像精度，ICC可达0.94以上，更好地凸显其边界轮廓信息。结论 通过wfd-EIT成像方法，利用多频阻抗谱同步测量实现目标区域的快速可视化，并结合RBFNN网络逼近任意非线性函数的优点，实现对目标区域电特性变化的精准识别，为下一步进行临床肺通气的EIT图像监测奠定了理论和技术基础。     

Functional Regions of Interest in Electrical Impedance Tomography: A Secondary Analysis of Two Clinical Studies

Introduction

Patients with acute respiratory distress syndrome (ARDS) typically show a high degree of ventilation inhomogeneity, which is associated with morbidity and unfavorable outcomes. Electrical impedance tomography (EIT) is able to detect ventilation inhomogeneity, but it is unclear which method for defining the region of interest (ROI) should be used for this purpose. The aim of our study was to compare the functional region of interest (fROI) method to both the lung area estimation method (LAEM) and no ROI when analysing global parameters of ventilation inhomogeneity. We assumed that a good method for ROI determination would lead to a high discriminatory power for ventilation inhomogeneity, as defined by the area under the receiver operating characteristics curve (AUC), comparing patients suffering from ARDS and control patients without pulmonary pathologies.

Methods

We retrospectively analysed EIT data from 24 ARDS patients and 12 control patients without pulmonary pathology. In all patients, a standardized low-flow-pressure volume maneuver had been performed and was used for EIT image generation. We compared the AUC for global inhomogeneity (GI) index and coefficient of variation (CV) between ARDS and control patients using all EIT image pixels, the fROI method and the LAEM for ROI determination.

Results

When analysing all EIT image pixels, we found an acceptable AUC both for the GI index (AUC = 0.76; 95% confidence interval (CI) 0.58–0.94) and the CV (AUC = 0.74; 95% CI 0.55–0.92). With the fROI method, we found a deteriorating AUC with increasing threshold criteria. With the LAEM, we found the best AUC both for the GI index (AUC = 0.89; 95% CI 0.78–1.0) and the CV (AUC = 0.89; 95% CI 0.78–1.0) using a threshold criterion of 50% of the maximum tidal impedance change.

Conclusion

In the assessment of ventilation inhomogeneity with EIT, functional regions of interest obscure the difference between patients with ARDS and control patients without pulmonary pathologies. The LAEM is preferable to the fROI method when assessing ventilation inhomogeneity.     

Analysis of parametric estimation of head tissue conductivities using Electrical Impedance Tomography

We study the theoretical performance of using Electrical Impedance Tomography (EIT) to measure the conductivity of the main tissues of the head. The governing equations are solved using the Finite Element Method for realistically shaped head models with isotropic and anisotropic electrical conductivities. We focus on the Electroencephalography (EEG) signal frequency range since EEG source localization is the assumed application. We obtain the Cramér-Rao Lower Bound (CRLB) to find the minimum conductivity estimation error expected with EIT measurements. The more convenient electrode pairs selected for current injection from a typical EEG array are determined from the CRLB. Moreover, using simulated data, the Maximum Likelihood Estimator of the conductivity parameters is shown to be close to the CRLB for a relatively low number of measurements. The results support the idea of using EIT as a low-cost and practical tool for individually measure the conductivity of the head tissues, and to use them when solving the EEG source localization. Even when the conductivity of the soft tissues of the head is available from Diffusion Tensor Imaging, EIT can complement the electrical model with the estimation of the skull and scalp conductivities.     

Assessment of Regional Ventilation Distribution: Comparison of Vibration Response Imaging (VRI) with Electrical Impedance Tomography (EIT)

Background

Vibration response imaging (VRI) is a bedside technology to monitor ventilation by detecting lung sound vibrations. It is currently unknown whether VRI is able to accurately monitor the local distribution of ventilation within the lungs. We therefore compared VRI to electrical impedance tomography (EIT), an established technique used for the assessment of regional ventilation.

Methodology/Principal Findings

Simultaneous EIT and VRI measurements were performed in the healthy and injured lungs (ALI; induced by saline lavage) at different PEEP levels (0, 5, 10, 15 mbar) in nine piglets. Vibration energy amplitude (VEA) by VRI, and amplitudes of relative impedance changes (rel.ΔZ) by EIT, were evaluated in seven regions of interest (ROIs). To assess the distribution of tidal volume (V_T) by VRI and EIT, absolute values were normalized to the V_T obtained by simultaneous spirometry measurements. Redistribution of ventilation by ALI and PEEP was detected by VRI and EIT. The linear correlation between pooled V_T by VEA and rel.ΔZ was R² = 0.96. Bland-Altman analysis showed a bias of −1.07±24.71 ml and limits of agreement of −49.05 to +47.36 ml. Within the different ROIs, correlations of V_T-distribution by EIT and VRI ranged between R² values of 0.29 and 0.96. ALI and PEEP did not alter the agreement of V_T between VRI and EIT.

Conclusions/Significance

Measurements of regional ventilation distribution by VRI are comparable to those obtained by EIT.     

体外循环血栓非侵入在线电阻抗成像方法

目的 在体外循环系统中,血栓的在线检测和可视化具有重要意义。本文提出了基于电阻抗成像（EIT）的体外循环血栓非侵入在线检测方法。方法 首先通过联合仿真研究了传感器尺寸对成像效果的影响。其次,根据仿真结果设计了直径为20 mm的16铜质电极EIT传感器,搭建了循环流动实验平台,并设计了静态和循环流动实验。使用尺寸为3～6 mm的猪血块代替血栓,将血块置于新鲜猪血样本中,采用Tikhonov正则化算法进行成像。将3 mm和5 mm的血块分别置于循环系统中,重建血块在传感器截面的大小和位置图像,并与高速相机拍摄结果进行对比。结果 仿真结果显示当目标物与传感器面积比（AR）不小于0.01时,传感器直径为20 mm和30 mm对应的图像相关系数（IC）均大于0.06,成像效果较好。静态成像结果显示,相对尺寸覆盖率误差（RCR）小于等于0.1。循环流动实验显示,血块经过传感器时,检测到归一化后的相对电导率变化值分别为80和200,结果显示该方法能够检测到循环系统中的血块。结论 该方法具有实时性和非侵入的优点,有望应用于体外血栓的检测。     

伽玛刀治疗术后顽固性脑水肿的临床分析

目的:探讨伽玛刀治疗术后顽固性脑水肿发生的临床特点和相关影响因素。方法:总结432例颅内病变经伽玛刀治疗患者,发生顽固性脑水肿87例,以年龄,性别,病灶部位,90%病灶容积的边缘剂量,病灶的平均直径,病灶与正常脑组织的关系作为影响因素,分析伽玛刀治疗术后顽固性脑水肿的相关性。结果:伽玛刀治疗术后顽固性脑水肿的总发生率20.1%,其中以脑内动静脉畸形发生率最高,达41.9%;脑水肿发生率与年龄,病灶部位,90%病灶容积的边缘剂量,病灶平均直径,病灶与正常脑组织关系等因素密切相关。结论:伽玛刀治疗术后顽固性脑水肿发生率较高,值得临床重视。     

Benefits of Continuous Glucose Monitor Use in Clinical Practice

ObjectiveTo determine the benefits of personal con- tinuous glucose monitoring (CGM) outside of a controlled clinical trial in a single ambulatory diabetes clinic.MethodsIn this retrospective study, we reviewed medical records of all patients who began CGM in our university-based clinical practice between July 2006 and October 2008. Data pertaining to 1 year before initiation of CGM through January 2009 were collected. All patient visits were performed by any 1 of 7 board-certified endo- crinologists and/or 5 certified diabetes educators. A severe hypoglycemic event was considered to have occurred if the patient reported requiring assistance or losing conscious- ness, or if there was documentation from another source (eg, an emergency department visit). Analysis of the effect of CGM on hemoglobin A_1c and occurrence of severe hypoglycemia was performed.ResultsA total of 117 patients initiated CGM between July 2006 and October 2008 and used CGM for at least 2 months (total experience on CGM, 1136 patient-months; average 9.7 months per patient). Mean age was 44.5 ± 12.8 years (range, 14.3-71.7 years), and average duration of dia- betes mellitus was 23.9 years. All patients were using insu- lin pumps before initiation of CGM, including 10 patients with type 2 diabetes. Sixty-eight patients (58%) had pre- existing hypoglycemia unawareness. Average hemoglobin A_1c level for 1 year before CGM initiation was 7.6 ± 1.1%, and with CGM use it dropped to 7.2 ± 0.8% (P <.001). Forty-two patients had severe hypoglycemic events in the year before CGM use or during CGM use. Overall, CGM use was associated with a significant decrease in the rate of severe hypoglycemic episodes (odds ratio, 0.40; 95% confidence interval, 0.24-0.65).ConclusionsPersonal CGM, in a real-world setting, improves glucose control and reduces the rate of severe hypoglycemic episodes. (Endocr Pract. 2010;16:371-375)     

Comparison of Regional Cerebral Blood Flow Responses to Hypoglycemia Using Pulsed Arterial Spin Labeling and Positron Emission Tomography

Different brain regions sense and modulate the counterregulatory responses that can occur in response to declining plasma glucose levels. The aim of this study was to determine if changes in regional cerebral blood flow (rCBF) during hypoglycemia relative to euglycemia are similar for two imaging modalities–pulsed arterial spin labeling magnetic resonance imaging (PASL-MRI) and positron emission tomography (PET). Nine healthy non-diabetic participants underwent a hyperinsulinemic euglycemic (92±3 mg/dL) – hypoglycemic (53±1 mg/dL) clamp. Counterregulatory hormone levels were collected at each of these glycemic levels and rCBF measurements within the previously described network of hypoglycemia-responsive regions (thalamus, medial prefrontal cortex and globus pallidum) were obtained using PASL-MRI and [¹⁵O] water PET. In response to hypoglycemia, rCBF was significantly increased in the thalamus, medial prefrontal cortex, and globus pallidum compared to euglycemia for both PASL-MRI and PET methodologies. Both imaging techniques found similar increases in rCBF in the thalamus, medial prefrontal cortex, and globus pallidum in response to hypoglycemia. These brain regions may be involved in the physiologic and symptom responses to hypoglycemia. Compared to PET, PASL-MRI may provide a less invasive, less expensive method for assessing changes in rCBF during hypoglycemia without radiation exposure.     

Development of Prolonged Focal Cerebral Edema and Regional Cation Changes Following Experimental Brain Injury in the Rat

The present study examined the formation of regional cerebral edema in adult rats subjected to lateral (parasagittal) experimental fluid-percussion brain injury. Animals receiving fluid-percussion brain injury of moderate severity over the left parietal cortex were assayed for brain water content at 6 h, 24 h, and 2, 3, 5, and 7 days post injury. Regional sodium and potassium concentrations were measured in a separate group of animals at 10 min, 1 h, 6 h, and 24 h following fluid-percussion injury. Injured parietal cortex demonstrated significant edema, beginning at 6 h post injury (p less than 0.05) and persisting up to 5 days post injury. In the hippocampus ipsilateral to the site of cortical injury, significant edema occurred as early as 1 h post injury (p less than 0.05), with resolution of water accumulation beginning at 3 days. Sodium concentrations significantly increased in both injured cortex (1 h post injury, p less than 0.05) and injured hippocampus (10 min post injury, p less than 0.05). Potassium concentrations fell significantly 1 h post injury within the injured cortex (p less than 0.05), whereas significant decreases were not observed until 24 h post injury within the injured hippocampus. Cation alterations persisted throughout the 24-h post injury period. These results demonstrate that regional brain edema and cation deregulation occur in rats subjected to lateral fluid-percussion brain injury and that these changes may persist for a prolonged period after brain injury.     

Alterations of Regional Cerebral Blood Flow in Tinnitus Patients as Assessed Using Single-Photon Emission Computed Tomography

Tinnitus is the perception of phantom sound without an external auditory stimulus. Using neuroimaging techniques, such as positron emission tomography, electroencephalography, magnetoencephalography, and functional magnetic resonance imaging (fMRI), many studies have demonstrated that abnormal functions of the central nervous system are closely associated with tinnitus. In our previous research, we reported using resting-state fMRI that several brain regions, including the rectus gyrus, cingulate gyrus, thalamus, hippocampus, caudate, inferior temporal gyrus, cerebellar hemisphere, and medial superior frontal gyrus, were associated with tinnitus distress and loudness. To reconfirm these results and probe target regions for repetitive transcranial magnetic stimulation (rTMS), we investigated the regional cerebral blood flow (rCBF) between younger tinnitus patients (<60 years old) and the age-matched controls using single-photon emission computed tomography and easy Z-score imaging system. Compared with that of controls, the rCBF of tinnitus patients was significantly lower in the bilateral medial superior frontal gyri, left middle occipital gyrus and significantly higher in the bilateral cerebellar hemispheres and vermis, bilateral middle temporal gyri, right fusiform gyrus. No clear differences were observed between tinnitus patients with normal and impaired hearing. Regardless of the assessment modality, similar brain regions were identified as characteristic in tinnitus patients. These regions are potentially involved in the pathophysiology of chronic subjective tinnitus.     

Demonstrating the Use of High-Volume Electronic Medical Claims Data to Monitor Local and Regional Influenza Activity in the US

Introduction

Fine-grained influenza surveillance data are lacking in the US, hampering our ability to monitor disease spread at a local scale. Here we evaluate the performances of high-volume electronic medical claims data to assess local and regional influenza activity.

Material and Methods

We used electronic medical claims data compiled by IMS Health in 480 US locations to create weekly regional influenza-like-illness (ILI) time series during 2003–2010. IMS Health captured 62% of US outpatient visits in 2009. We studied the performances of IMS-ILI indicators against reference influenza surveillance datasets, including CDC-ILI outpatient and laboratory-confirmed influenza data. We estimated correlation in weekly incidences, peak timing and seasonal intensity across datasets, stratified by 10 regions and four age groups (<5, 5–29, 30–59, and 60+ years). To test IMS-Health performances at the city level, we compared IMS-ILI indicators to syndromic surveillance data for New York City. We also used control data on laboratory-confirmed Respiratory Syncytial Virus (RSV) activity to test the specificity of IMS-ILI for influenza surveillance.

Results

Regional IMS-ILI indicators were highly synchronous with CDC''s reference influenza surveillance data (Pearson correlation coefficients rho≥0.89; range across regions, 0.80–0.97, P<0.001). Seasonal intensity estimates were weakly correlated across datasets in all age data (rho≤0.52), moderately correlated among adults (rho≥0.64) and uncorrelated among school-age children. IMS-ILI indicators were more correlated with reference influenza data than control RSV indicators (rho = 0.93 with influenza v. rho = 0.33 with RSV, P<0.05). City-level IMS-ILI indicators were highly consistent with reference syndromic data (rho≥0.86).

Conclusion

Medical claims-based ILI indicators accurately capture weekly fluctuations in influenza activity in all US regions during inter-pandemic and pandemic seasons, and can be broken down by age groups and fine geographical areas. Medical claims data provide more reliable and fine-grained indicators of influenza activity than other high-volume electronic algorithms and should be used to augment existing influenza surveillance systems.     

呼吸机无创通气治疗急性心源性肺水肿临床研究

目的探讨大型多功能呼吸机及双相气道正压通气呼吸机治疗急性心源性肺水肿的临床价值。方法将48例急性心源性肺水肿患者分为无创通气治疗组（24例）和对照组（24例）,观察治疗前、后1h两组的血气分析及相关的症状、体征及病情缓解分值并进行统计学配对比较处理。结果治疗前各匹配组分析P〉0.05,说明两组基础病情具有可比性;治疗后1 h动脉血氧饱和度、血氧分压、呼吸频率、心率及缓解积分各组比较P〈0.01。结论表明治疗组较对照组的心肺功能改善更明显,由此表明该方法有极高的临床应用价值。     

Electrical Impedance Myography to Detect the Effects of Electrical Muscle Stimulation in Wild Type and Mdx Mice

Objective

Tools to better evaluate the impact of therapy on nerve and muscle disease are needed. Electrical impedance myography (EIM) is sensitive to neuromuscular disease progression as well as to therapeutic interventions including myostatin inhibition and antisense oligonucleotide-based treatments. Whether the technique identifies the impact of electrical muscle stimulation (EMS) is unknown.

Methods

Ten wild-type (wt) C57B6 mice and 10 dystrophin-deficient (mdx) mice underwent 2 weeks of 20 min/day EMS on left gastrocnemius and sham stimulation on the right gastrocnemius. Multifrequency EIM data and limb girth were obtained before and at the conclusion of the protocol. Muscle weight, in situ force measurements, and muscle fiber histology were also assessed at the conclusion of the study.

Results

At the time of sacrifice, muscle weight was greater on the EMS-treated side than on the sham-stimulated side (p = 0.018 for wt and p = 0.007 for mdx). Similarly, in wt animals, EIM parameters changed significantly compared to baseline (resistance (p = 0.009), reactance (p = 0.0003) and phase (p = 0.002); these changes were due in part to reductions in the EIM values on the EMS-treated side and elevations on the sham-simulated side. Mdx animals showed analogous but non-significant changes (p = 0.083, p = 0.064, and p = 0.57 for resistance, reactance and phase, respectively). Maximal isometric force trended higher on the stimulated side in wt animals only (p = 0.06). Myofiber sizes in wt animals were also larger on the stimulated side than on the sham-stimulated side (p = 0.034); no significant difference was found in the mdx mice (p = 0.79).

Conclusion

EIM is sensitive to stimulation-induced muscle alterations in wt animals; similar trends are also present in mdx mice. The mechanisms by which these EIM changes develop, however, remains uncertain. Possible explanations include longer-term trophic effects and shorter-term osmotic effects.     

脑海绵状血管瘤的MRI与临床特征及其治疗(附二例报告)

目的:探讨脑海绵状血管瘤的临床特征。方法:回顾分析29例脑海绵状血管瘤的临床资料,对其临床表现、诊断和治疗进行总结。结果:主要临床表现为头痛和癫痫发作,MRI有助于明确诊断。结论:MRI是诊断脑海绵状血管瘤最敏感的方法,对有症状者施行积极的显微外科治疗能收到良好效果     

蕲蛇酶治疗脑梗死临床分析

我科从 2 0 0 0年至 2 0 0 1年用蕲蛇酶治疗 1 85例各期脑梗死患者 ,并与用灯盏花素治疗的 70例脑梗死患者比较 ,现报告如下。1　临床资料1 .1　一般资料　蕲蛇酶组 1 85例 ,男 94例 ,女 91例 ,年龄 3 8～ 70岁。急性期 88例 ,病程在 1个月内 ;恢复期 6 8例 ,病程 1个月至 1年 ;后遗症期 2 9例 ,病程在 1年以上。灯盏花素组 70例 ,男 46例 ,女 2 4例 ,年龄 42～ 6 8岁。急性期 3 2例 ,病程在1个月内 ;恢复期 2 1例 ,病程 1个月至 1年 ;后遗症期 1 7例 ,病程在 1年以上。全部患者按 1 986年中华医学会第二次全国脑血管病学术会议修订的诊断标…     

龙津降纤酶治疗急性缺血性卒中临床疗效观察

目的 观察龙津降纤酶对急性缺血性情卒中的治疗效果。方法 选择诊断明确的急性因性卒中病人８０例,随机分为２组,对照组４０例,５％葡萄糖液５００ｍｌ加血塞通小射液０．４ｇ静脉滴注,连用１４天,降纤酶组４０例,入院后第１～３天分别给降酶１０ｕ加入生理盐水１００ｍｌ,静脉主１ｈ以上,按临床神经功能缺失程度评分标准于治疗前及治疗在进行疗效评定。结果 降纤酶组总有效率达９２．５％,显效率为７２．５％,明显优于