Development of a tele-stethoscope and its application in pediatric cardiology

Over the years, many attempts have been made to develop special stethoscopes for the teaching of auscultation. The objective of this article is to report on the experience with the development and implementation of an electronic stethoscope and a virtual library of cardiac sounds. There were four stages to this project: (1) the building of the prototype to acquire, filter and amplify the cardiac sounds, (2) the development of a software program to record, reproduce and visualize them, (3) the testing of the prototype in a clinical scenario, and (4) the development of an internet site, to store and display the sounds collected. The first two stages are now complete. The prototype underwent an initial evaluation in a clinical scenario within the Unit and during virtual out-patient clinical sessions. One hundred auscultations were recorded during these tests. They were reviewed and discussed on-line by a panel of experience cardiologists during the sessions. Although the sounds were considered "satisfactory" for diagnostic purposes by the cardiology team, they identified some qualitative differences in the electronic recorded auscultations, such as a higher pitch of the recorded sounds. Prospective clinical studies are now being conducted to further evaluate the interference of the electronic device in the physicians' capability to diagnose different cardiac conditions. An internet site (www.caduceusvirtual.com.br/ auscultaped) was developed to host these cardiac auscultations. It is set as a library of cardiac sounds, catalogued by pathologies and already contains examples from auscultations of the majority of common congenital heart lesions, such as septal defects and valvar lesions.     

A System for Heart Sounds Classification

The future of quick and efficient disease diagnosis lays in the development of reliable non-invasive methods. As for the cardiac diseases – one of the major causes of death around the globe – a concept of an electronic stethoscope equipped with an automatic heart tone identification system appears to be the best solution. Thanks to the advancement in technology, the quality of phonocardiography signals is no longer an issue. However, appropriate algorithms for auto-diagnosis systems of heart diseases that could be capable of distinguishing most of known pathological states have not been yet developed. The main issue is non-stationary character of phonocardiography signals as well as a wide range of distinguishable pathological heart sounds. In this paper a new heart sound classification technique, which might find use in medical diagnostic systems, is presented. It is shown that by combining Linear Predictive Coding coefficients, used for future extraction, with a classifier built upon combining Support Vector Machine and Modified Cuckoo Search algorithm, an improvement in performance of the diagnostic system, in terms of accuracy, complexity and range of distinguishable heart sounds, can be made. The developed system achieved accuracy above 93% for all considered cases including simultaneous identification of twelve different heart sound classes. The respective system is compared with four different major classification methods, proving its reliability.     

Low frequency sounds from sustained contraction of human skeletal muscle.

Low frequency audible vibrations are produced by human skeletal muscles undergoing sustained contraction. The effect is easily demonstrable with an electronic stethoscope which amplifies sound below 50 Hz. Autocorrelation analysis of the signal shows that it is periodic with a frequency 25 +/- 2.5 Hz. The quality of the sound is the same for all the skeletal muscles tested and is unaffected by changes in tension, ambient temperature, and blood flow. Electrically-stimulated contraction produces a sound which is indistinguishable from voluntary contraction. The amplitude of the sound increases linearly with tension. The sound signals are uncorrelated both in frequency and phase with electromyographic signals obtained simultaneously while the muscle is contacted. Arguments are presented to show that the sounds may be an intrinsic property of muscle contraction.     

An open real-time tele-stethoscopy system

ABSTRACT: BACKGROUND: Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient's body. METHODS: A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, pleural friction rub) sounds. RESULTS: The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge. CONCLUSIONS: It has been shown that real-time tele-stethoscopy, together with a videoconference system that allows a remote specialist to oversee the auscultation, may be a very helpful tool in rural areas of developing countries.     

Effects of phorbol myristate acetate and sivelestat on the lung injury caused by fat embolism in isolated lungs

Background  

Fat embolism syndrome (FES) associated with acute lung injury (ALI) is a clinical condition following long bone fracture. We have reported 14 victims due to ALI with FES. Our laboratory has developed an animal model that produced fat emboli (FE). The major purpose of this study was to test whether neutrophil activation with phorbol myristate acetate (PMA) and inhibition with sivelestat (SVT) exert protection on the lung.     

An on-line advisory control system for the lactic acid fermentation process

A fuzzy expert system was developed for online diagnosing and controlling of bioprocesses. The system was constructed in object-oriented Smalltalk/V for diagnosing and controlling of bioprocesses. Lactic acid fermentation with an industrial strain ofLactobacillus casei was chosen as the model system. The performance of the fuzzy expert system and the knowledge base utilizing experts' knowledge and several facts obtained from the experiments were successfully validated with on-line fermentations. The fuzzy expert system could diagnose a fault on-line and give reasonable advice to the process operator. In order to achieve the diagnosing faculty, a database, a knowledge base, and both backward and forward chaining procedures were implemented employing the object-oriented programming environment. A defuzzifier was implemented in the system to achieve on-line control. In order to realize a decision-making system with a human operator and a fuzzy expert system, a new control strategy namedAdvice was also introduced. Several cultivations were carried out in order to collect knowledge on the effects concerned with inoculum properties to the process and to construct a database including standard time-course profiles. The performance of the fuzzy expert control system was successfully tested with on-line experiments.Visiting scientist from HUT at RIKEN     

Stabilization of human standing posture using functional neuromuscular stimulation

Functional neuromuscular stimulation (FNS)/functional electrical stimulation (FES) is a potential way to restore some functionality to the limbs of patients with spinal cord injury through direct/indirect stimulation of the motoneuron. One of the constraints for wider use of FNS on paraplegic patients is the lack of efficient control algorithm. Most of the published works on FNS/FES control are based on oversimplified models of human body dynamics. An innovative control strategy for stabilizing the standing posture of paraplegic patients is proposed here which is a combination of a proportional-plus-derivative controller for motions of the skeletal system and a control action prediction mechanism to produce musculotendon activation. The goal is to produce musculotendon torque which can approximate those demanded by the controller for the skeletal system. In computer simulations, using a detailed skeletal–musculotendon–muscle activation dynamics model of human body, this FNS/FES control approach can stabilize a paraplegic patient's standing posture with the minimum number of musculotendon groups. Also, it is found that this control strategy can maintain stability even in the presence of reasonable variations in the controller's musculotendon parameters.     

Modeling biological motor control for human locomotion with functional electrical stimulation

This paper develops a novel control system for functional electrical stimulation (FES) locomotion, which aims to generate normal locomotion for paraplegics via FES. It explores the possibility of applying ideas from biology to engineering. The neural control mechanism of the biological motor system, the central pattern generator, has been adopted in the control system design. Some artificial control techniques such as neural network control, fuzzy logic, control and impedance control are incorporated to refine the control performance. Several types of sensory feedback are integrated to endow this control system with an adaptive ability. A musculoskeletal model with 7 segments and 18 muscles is constructed for the simulation study. Satisfactory simulation results are achieved under this FES control system, which indicates a promising technique for the potential application of FES locomotion in future.     

Chimpanzee vocal signaling points to a multimodal origin of human language

The evolutionary origin of human language and its neurobiological foundations has long been the object of intense scientific debate. Although a number of theories have been proposed, one particularly contentious model suggests that human language evolved from a manual gestural communication system in a common ape-human ancestor. Consistent with a gestural origins theory are data indicating that chimpanzees intentionally and referentially communicate via manual gestures, and the production of manual gestures, in conjunction with vocalizations, activates the chimpanzee Broca's area homologue--a region in the human brain that is critical for the planning and execution of language. However, it is not known if this activity observed in the chimpanzee Broca's area is the result of the chimpanzees producing manual communicative gestures, communicative sounds, or both. This information is critical for evaluating the theory that human language evolved from a strictly manual gestural system. To this end, we used positron emission tomography (PET) to examine the neural metabolic activity in the chimpanzee brain. We collected PET data in 4 subjects, all of whom produced manual communicative gestures. However, 2 of these subjects also produced so-called attention-getting vocalizations directed towards a human experimenter. Interestingly, only the two subjects that produced these attention-getting sounds showed greater mean metabolic activity in the Broca's area homologue as compared to a baseline scan. The two subjects that did not produce attention-getting sounds did not. These data contradict an exclusive "gestural origins" theory for they suggest that it is vocal signaling that selectively activates the Broca's area homologue in chimpanzees. In other words, the activity observed in the Broca's area homologue reflects the production of vocal signals by the chimpanzees, suggesting that this critical human language region was involved in vocal signaling in the common ancestor of both modern humans and chimpanzees.     

Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise

Recent brain imaging studies using functional magnetic resonance imaging (fMRI) have implicated insula and anterior cingulate cortices in the empathic response to another's pain. However, virtually nothing is known about the impact of the voluntary generation of compassion on this network. To investigate these questions we assessed brain activity using fMRI while novice and expert meditation practitioners generated a loving-kindness-compassion meditation state. To probe affective reactivity, we presented emotional and neutral sounds during the meditation and comparison periods. Our main hypothesis was that the concern for others cultivated during this form of meditation enhances affective processing, in particular in response to sounds of distress, and that this response to emotional sounds is modulated by the degree of meditation training. The presentation of the emotional sounds was associated with increased pupil diameter and activation of limbic regions (insula and cingulate cortices) during meditation (versus rest). During meditation, activation in insula was greater during presentation of negative sounds than positive or neutral sounds in expert than it was in novice meditators. The strength of activation in insula was also associated with self-reported intensity of the meditation for both groups. These results support the role of the limbic circuitry in emotion sharing. The comparison between meditation vs. rest states between experts and novices also showed increased activation in amygdala, right temporo-parietal junction (TPJ), and right posterior superior temporal sulcus (pSTS) in response to all sounds, suggesting, greater detection of the emotional sounds, and enhanced mentation in response to emotional human vocalizations for experts than novices during meditation. Together these data indicate that the mental expertise to cultivate positive emotion alters the activation of circuitries previously linked to empathy and theory of mind in response to emotional stimuli.     

Computer-aided design and manufacture of an above-knee amputee socket

This paper describes the initial test results obtained from a newly developed computer-aided socket design (CASD) and manufacturing (CASM) process for above-knee amputees. Anthropometric measures taken from an amputee provided input information to a CASD system. Using these measurements, data from a reference shape library stored in the computer were selected and modified to create a unique socket shape reflecting the particular characteristics of the amputation stump. The resultant shape was produced as a ‘primitive’ test socket by a CASM process. Numerical shape data were then transferred to a CNC milling machine to construct a negative cast, from which the primitive socket was produced by a vacuum-forming procedure. The resultant primitive socket shape was fitted and the amputee was able to load the socket without discomfort. Some shape discrepancies were identified and the shape data were modified interactively by the CASD system to create a final socket shape. The final socket shape was manufactured and worn by the amputee during a 35 min walking trial. Subjective evaluation was that the socket provided comfort and control comparable with that of the conventional socket, and proved to be acceptable to the amputee. This was followed by a 2-month home trial which was also successful. The CASD socket shapes were compared numerically in area, shape and volume with data taken from the original socket worn by the amputee, a new socket made by conventional methods and a topographic model of the amputation stump. The final CASD socket shape compared favourably with that of a socket manufactured by conventional methods. Results indicated that by the use of the CASD/CASM process, it was possible to produce an above-knee prosthetic socket which provided comfort and control for the amputee.     

Stridulatory Sound-Production and Its Function in Females of the Cicada Subpsaltria yangi

Acoustic behavior plays a crucial role in many aspects of cicada biology, such as reproduction and intrasexual competition. Although female sound production has been reported in some cicada species, acoustic behavior of female cicadas has received little attention. In cicada Subpsaltria yangi, the females possess a pair of unusually well-developed stridulatory organs. Here, sound production and its function in females of this remarkable cicada species were investigated. We revealed that the females could produce sounds by stridulatory mechanism during pair formation, and the sounds were able to elicit both acoustic and phonotactic responses from males. In addition, the forewings would strike the body during performing stridulatory sound-producing movements, which generated impact sounds. Acoustic playback experiments indicated that the impact sounds played no role in the behavioral context of pair formation. This study provides the first experimental evidence that females of a cicada species can generate sounds by stridulatory mechanism. We anticipate that our results will promote acoustic studies on females of other cicada species which also possess stridulatory system.     

A global view of protein expression in human cells,tissues, and organs

Defining the protein profiles of tissues and organs is critical to understanding the unique characteristics of the various cell types in the human body. In this study, we report on an anatomically comprehensive analysis of 4842 protein profiles in 48 human tissues and 45 human cell lines. A detailed analysis of over 2 million manually annotated, high‐resolution, immunohistochemistry‐based images showed a high fraction (>65%) of expressed proteins in most cells and tissues, with very few proteins (<2%) detected in any single cell type. Similarly, confocal microscopy in three human cell lines detected expression of more than 70% of the analyzed proteins. Despite this ubiquitous expression, hierarchical clustering analysis, based on global protein expression patterns, shows that the analyzed cells can be still subdivided into groups according to the current concepts of histology and cellular differentiation. This study suggests that tissue specificity is achieved by precise regulation of protein levels in space and time, and that different tissues in the body acquire their unique characteristics by controlling not which proteins are expressed but how much of each is produced.     

Analysis of the Stridulation in Solifuges (Arachnida: Solifugae)

Stridulation in solifuges has not been investigated yet. We performed a comparative analysis of the stridulatory organs and sounds produced by juveniles of various developmental stages and adults (both sexes) of Galeodes caspius subfuscus Birula. The stridulatory organ is of similar morphology in all developmental stages. The sound that they produced was a broad frequency hissing, composed of one or two chirps with maximum at 2.4 kHz. The intensity of the sound was found to increase with body size. Otherwise, no differences were observed between stridulation in juvenile, male and female individuals. Therefore, we suggest that the stridulation in solifuges has primarily a defensive role. As solifuges are neither venomous nor unpalatable, they might imitate an accoustically aposematic organism that shares the same habitat and has similar circadian activity, e.g. vipers. It may also have an intraspecific function in reduction of cannibalistic tendencies.     

F-IND: A framework to design fuzzy indices of environmental conditions

Multivariable indices of environmental conditions summarize the information provided by several biotic or abiotic variables into a single value of immediate interpretability. Thus they are important instruments for monitoring. Developing new indices that combine different variables is not a trivial task: variables may be qualitative, or measured in different units, and the relationship between primitive components and quality may be ambiguous. Fuzzy logic has been repeatedly proposed as an effective technique to cope with such problems; however, the variety of choices that exist at each stage of the development of fuzzy models may present a problem for the index designer. In this paper we present F-IND, a framework to create fuzzy indices by means of a simplified and intuitive procedure. It allows to capture the expert knowledge of the system under study (air, soil, water) to easily generate a multivariable index of environmental conditions. F-IND is implemented in Java, to achieve an optimal portability on any operating system.     

Comparative transcriptomics of the bacteriome and the spermalege of the bedbug Cimex lectularius (Hemiptera: Cimicidae)

The bedbug Cimex lectularius is notorious as a blood-feeding exoparasite of human and other warm-blooded animals. In addition to its medical and hygienic importance, C. lectularius is known for its unique biological traits, including obligate nutritional mutualism with a vitamin-provisioning Wolbachia endosymbiont and a peculiar mating habit called traumatic insemination wherein male sperm is injected into the female body cavity, migrates to the ovary, and fertilizes eggs therein. For these unique traits, novel insect organs, the bacteriome for endosymbiosis and the spermalege for traumatic insemination, have evolved in the lineage of bedbugs. We constructed cDNA libraries of the bacteriome and the spermalege of C. lectularius, and performed expressed sequence tag (EST) analyses of these peculiar insect organs. In total 4480 ESTs were compiled, which were assembled into 2989 unique sequences (USs). The following ESTs and USs were identified from the different organs: 1151 ESTs and 901 USs from the female whole body; 1098 ESTs and 879 USs from the female bacteriome; 1145 ESTs and 783 USs from the male bacteriome; and 1086 ESTs and 920 USs from the female spermalege. These EST data will provide a valuable genetic resource for understanding the developmental and evolutionary aspects of these novel insect organs.     

An intelligent control method based on fuzzy logic for a robotic testing system for the human spine

In previous biomechanical studies of the human spine, we implemented a hybrid controller to investigate load-displacement characteristics. We found that measurement errors in both position and force caused the controller to be less accurate than predicted. As an alternative to hybrid control, a fuzzy logic controller (FLC) has been developed and implemented in a robotic testing system for the human spine. An FLC is a real-time expert system that can emulate part of a human operator's knowledge by using a set of action rules. The FLC provides simple but robust solutions that cover a wide range of system parameters and can cope with significant disturbances. It can be viewed as a heuristic and modular way of defining a nonlinear, table-based control system. In this study, an FLC is developed which uses the force difference and the change in force difference as the input parameters, and the displacement as the output parameter. A rule-table based on these parameters is designed for the controller Experiments on a physical model composed of springs demonstrate the improved performance of the proposed method.     

基于专家数据库的人体信息诊疗仪的研制

本文介绍了我们研制的一种基于电脑专家数据库的人体信息诊疗仪。融合了先进的激光技术、电子技术、计算机技术和人体信息诊疗学于一体。该仪器由两部分组成：（1）可自动诊断的电脑专家数据库;（2）半导体激光针灸部分。     

Detection of bronchial breathing caused by pneumonia.

The classic auscultation with stethoscope is the established clinical method for the detection of lung diseases. The interpretation of the sounds depends on the experience of the investigating physician. Therefore, a new computer-based method has been developed to classify breath sounds from digital lung sound recordings. Lung sounds of 11 patients with one-sided pneumonia and bronchial breathing were recorded on both the pneumonia side and on contralateral healthy side simultaneously using two microphones. The spectral power for the 300-600 Hz frequency band was computed for four respiratory cycles and normalized. For each breath, the ratio R between the time-segments (duration = 0.1 s) with the highest inspiratory and highest expiratory flow was calculated and averaged. We found significant differences in R between the pneumonia side (R = 1.4 +/- 1.3) and the healthy side (R = 0.5 +/- 0.5; p = 0.003 Wilcoxon-test) of lung. In 218 healthy volunteers we found R = 0.3 +/- 0.2 as a reference-value. The differences of ratio R (delta R) between the pneumonia side and the healthy side (delta R = 1.0 +/- 0.9) were significantly higher compared to follow-up studies after recovery (delta R = 0.0 +/- 0.1, p = 0.005 Wilcoxon-test). The computer based detection of bronchial breathing can be considered useful as part of a quantitative monitoring of patients at risk to develop pneumonia.     

A distributed three-channel wireless Functional Electrical Stimulation system for automated triggering of stimulation to enable coordinated task execution by patients with neurological disease

Functional Electrical Stimulation (FES) is a technique used to improve mobility and function for patients suffering some neurological related diseases such us Multiple Sclerosis (MS) and stroke. Some patients might require FES applied in more than one location depending on the extent of the neurological condition. Currently, this can be achieved using multi-channel FES systems. However, these systems can be bulky and impractical in daily usage. This research investigates using a wireless distributed FES system to overcome some of the limitations of the current multi-channel systems. A prototype of a three-channel FES system was built and tested. The prototype is used for drop foot stimulation and reciprocal arm swing stimulation while the user is walking, and for elbow extension and wrist/fingers opening stimulation if triggered while standing or sitting. A pilot study was designed to evaluate the reliability and repeatability of the system with 11 healthy volunteers without applying stimulation. This was followed by a case study with a hemiplegic person. The results indicate that the system can successfully detect and generate output responses appropriate to the input signals from the body sensors.