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A practical and reliable method of measuring blood pressure in the neonate by pulse oximetry.

OBJECTIVE: We investigated the reliability of the plethysmographic waveform of the pulse oximeter to measure systolic blood pressure in sick neonates. METHODS: Fifty infants admitted to the neonatal intensive care unit, with indwelling arterial catheters placed for their ongoing care, were enrolled. Median gestational age was 31 weeks (range, 24 to 40 weeks), and the mean birth weight was 1711 gm (range, 546 to 3856 gm). Blood pressure was recorded by an oscillometric method as well as from a transducer connected to an arterial catheter. Additionally, pulse oximeter blood pressures were obtained by gradually inflating an appropriately sized blood pressure cuff in increments of 2 to 5 mm Hg, on the same extremity as the oximeter probe, until the waveform just disappeared. The cuff was then rapidly inflated another 20 mm Hg and then gradually deflated in increments of 2 to 5 mm Hg until the waveform reappeared on the oximeter screen display. The pulse oximeter blood pressures were calculated both as the blood pressure noted at disappearance of the pulse oximeter waveform and as the blood pressure noted by the average pulse oximeter blood pressure at the disappearance and reappearance of the waveform. The mean intraarterial systolic blood pressure was 54 mm Hg (range, 36 to 82 mm Hg). RESULTS: Blood pressures obtained by pulse oximetry showed a significantly better correlation with intraarterial measurements in comparison with those obtained by oscillometric instruments. Additionally, the limits of agreement (mean difference +/- 2 SD) between blood pressures obtained by intraarterial measurements and those obtained by pulse oximetry were within a clinically acceptable range as opposed to those obtained by the comparison of intraarterial and oscillometric methods. CONCLUSION: Measurements of blood pressure in the neonate by means of pulse oximetry waveform analysis are easily obtainable and more accurate than those obtained by the oscillometric method.

Blood Pressure Determination↗

Elimination of free-living amoebae in fresh water with pulsed electric fields.

This study investigates the effects of pulsed electric fields on the inactivation of trophozoite form of Naegleria lovaniensis Ar9M-1 in batch and flow processes, systematically examining the lethal effect of field strength, pulse duration, number of pulses, and pulse frequency. Our results show that amoebae eradication is modulated by pulse parameters, composition of the pulsing medium, and physiological state of the cells. Cell survival is not related to the energy delivered to the cell suspension during the electrical treatment. For a given energy a strong field applied for a short cumulative pulse duration affects viability more than a weak field with a long cumulative pulsation. We also determine the optimal electrical conditions to obtain an inactivation rate higher than 95% while using the least energy. Flow processes allow to treat large-scale volumes. Our results show that the most efficient flow process for amoeba eradication requires a field parallel to the flow. Pulsed electric fields are a new and attractive method for inactivating amoebae in large volumes of fresh water.

Animals↗

Effect of pulse frequency and interval on the toxicity of chlorpyrifos to Daphnia magna.

Due to the episodic nature in which organisms are exposed to non-point source pollutants, it is necessary to understand how they are affected by pulsed concentrations of contaminants. This is essential, as standard toxicity tests may not adequately simulate exposure scenarios for short-lived hydrophobic compounds, such as chlorpyrifos (CPF), a broad-spectrum organophosphate insecticide. Studies were conducted with 7-day old Daphnia magna for 7 days to evaluate the effect of pulse frequency and interval among multiple CPF exposures. Daphnids were exposed to a total exposure of either 12 h at 0.5 microg/l or 6 h at 1.0 microg/l nominal CPF, respectively, in all studies. For interval studies, D. magna were exposed to two pulses of CPF at each concentration, with 0-96-h intervals between pulses. For frequency studies, D. magna were exposed to each CPF concentration altering the pulse scheme by decreasing the exposure duration but increasing the number of pulses, keeping the total exposure time the same. The pulse interval between multiple pulses in these experiments was 24 h. Our results suggest that D. magna can withstand an acutely lethal CPF exposure provided that there is adequate time for recovery between exposures.

Animals↗

A review of MRI pulse sequences and techniques in neuroimaging.

BACKGROUND: The unmatched soft tissue contrast provided by magnetic resonance imaging (MRI) has made it the modality of choice for many neuroimaging examinations. The fact that signal intensity in MRI depends on many parameters, including spin-lattice and spin-spin relaxation times, proton density, and velocity, makes it possible to highlight various pathologies by appropriate choice of pulse sequences and pulse sequence parameters. It is somewhat overwhelming however, to filter through various pulse sequences and parameters in order to understand how their selection affects image contrast. This brief review is intended to highlight common pulse sequences and parameters as well as introduce new techniques currently being released for clinical use. MATERIALS: Basic pulse sequences are described and the influence of the acquisition parameters on image contrast are illustrated. Such basic sequences include the ubiquitous spin echo, fast spin echo, and gradient echo sequences. Specialized techniques for fat suppression and magnetic resonance angiography are also presented. Currently approved contrast agents for use in MRI are briefly reviewed, and various advanced pulse sequences, such as those for diffusion and magnetization transfer contrast imaging, are briefly outlined. RESULTS: The utility of basic and advanced pulse sequences are demonstrated by clinical examples and images of normal brain and spine. New sequences and techniques are briefly outlined with regard to their potential for improving neuroimaging examinations. CONCLUSIONS: This brief review outlines how the choice of pulse sequence and acquisition parameters influences the resulting image contrast for a variety of basic and advanced imaging techniques.

Humans↗

Electroactivation of rabbit oocytes in an hypotonic pulsing medium and parthenogenetic in vitro development without cytochalasin B-diploidizing pretreatment.

We investigated the electroactivation frequencies, type of activation and in vitro development of rabbit oocytes. In Experiment 1, activation (8 pulses, 12 min apart, 60 microsec, 0.6 kVcm(-1)) was performed by altering osmolarity (190 vs. 320 mOsm kg(-1)) and Ca++ concentration (10, 60 or 100 microM) in mannitol pulsing media. More oocytes were activated in hypotonic pulsing medium, regardless of Ca++ concentration (96 to 100%). Both haploid and diploid parthenogenetic embryos developed to compacted morulae (57 to 92% and 63 to 100%, respectively) regardless of the activation treatment; however, the blastocyst rates were more variable (0 to 74% and 0 to 73%, respectively). In Experiment 2, the effects of pulse duration (30 or 60 microsec) and number of applied pulses (4, 8 or 12) under hypotonic conditions were studied. Activation frequencies were the lowest after four 30 microsec-pulses (58 vs. 88 to 100%, respectively). A lower haploid frequency was obtained when more than four 30 or 60 microsec-pulses were applied (from 67 to 25% and 83 to 0%, respectively). Increasing the number of 60-microsec pulses improved the compacted morula rate of haploid and diploid oocytes (47 to 83% and 57 to 96%, respectively). Overall, haploid development to morulae and blastocysts was lower than diploid development to these stages (69 and 25% vs. 74 and 44%, respectively).

Animals↗

Combinations of pulsed white light and UV-C or mild heat treatment to inactivate conidia of Botrytis cinerea and Monilia fructigena.

The use of pulses of intense white light to inactivate conidia of the fungi Botrytis cinerea and Monilia fructigena, responsible for important economical losses during postharvest storage and transport of strawberries and sweet cherries, was investigated in this study. In the first stage, a light treatment applying pulses of 30 micros at a frequency of 15 Hz was investigated, resulting in a treatment duration varying from 1 to 250 s. The conidia of both fungi showed similar behaviour to pulsed light, with a maximal inactivation of 3 and 4 log units for B. cinerea and M. fructigena, respectively. The inactivation of the conidia increased with increasing treatment intensity, but no complete inactivation was achieved. The sigmoidal inactivation pattern obtained by the pulsed light treatment was described using a modification of the model of Geeraerd et al. [Int. J. Food Microbiol. 59 (2000) 185]. Hereto, the shoulder length was incorporated explicitly and relative values for the microbial populations were used. In the second stage, combinations of light pulses and ultraviolet-C or heat were applied. The UV light used in the experiments is the short-wave band or UV-C, running from 180 to 280 nm with a peak at 254 nm (UV-B runs from 280 to 320 nm and UV-A from 320 to 380 nm). The UV-C doses were 0.025, 0.05 and 0.10 J/cm(2), and the temperatures for the thermal treatment ranged from 35 to 45 degrees C during 3-15 min. When combining UV-C and light pulses, there was an increase in inactivation for both B. cinerea and M. fructigena, and synergism was observed. There was no effect of the order of the treatments. For the heat-light pulses combination, there was a difference between both fungi. The order of the treatments was highly significant for B. cinerea, but not for M. fructigena. Combining heat and light treatments improved the inactivation, and synergism between both methods was again observed. Complete inactivation of M. fructigena conidia was obtained after, e.g., a 40-s pulsed light treatment and 15 min at 41 degrees C, or after an 80-s light treatment and 10 min at 41 degrees C.

Botrytis↗

Inactivation of Listeria innocua in liquid whole egg by pulsed electric fields and nisin.

Consumer demand for fresh-like products with little or no degradation of nutritional and organoleptic properties has led to the study of new technologies in food preservation. Pulsed electric fields (PEF) is a nonthermal preservation method used to inactivate microorganisms mainly in liquid foods. Microorganisms in the presence of PEF suffer cell membrane damage. Nisin is a natural antimicrobial known to disrupt cell membrane integrity. Thus the combination of PEF and nisin represents a hurdle for the survival of Listeria innocua in liquid whole egg (LWE). L. innocua suspended in LWE was subjected to two different treatments: PEF and PEF followed by exposure to nisin. The selected frequency and pulse duration for PEF was 3.5 Hz and 2 micros, respectively. Electric field intensities of 30, 40 and 50 kV/cm were used. The number of pulses applied to the LWE was 10.6, 21.3 and 32. The highest extent of microbial inactivation with PEF was 3.5 log cycles (U) for an electric field intensity of 50 kV/cm and 32 pulses. Treatment of LWE by PEF was conducted at low temperatures, 36 degrees C being the highest. Exposure of L. innocua to nisin following the PEF treatment exhibited an additive effect on the inactivation of the microorganism. Moreover, a synergistic effect was observed as the electric field intensity, number of pulses and nisin concentration increased. L. innocua exposed to 10 IU nisin/ml after PEF exhibited a decrease in population of 4.1 U for an electric field intensity of 50 kV/cm and 32 pulses. Exposure of L. innocua to 100 IU nisin/ml following PEF resulted in 5.5 U for an electric field intensity of 50 kV/cm and 32 pulses. The model developed for the inactivation of L. innocua by PEF and followed by exposure to nisin proved to be accurate (p = 0.05) when used to model the inactivation of the microorganism by PEF in LWE with 1.2 or 37 IU nisin/ml. The presence of 37 IU nisin/ml in LWE during the PEF treatment for an electric field intensity of 50 kV/cm and 32 pulses resulted in a decrease in the population of L. innocua of 4.4 U.

Anti-Bacterial Agents↗

Acoustic activation of drug delivery from polymeric micelles: effect of pulsed ultrasound.

The effect of a continuous wave (CW) and pulsed 20-kHz ultrasound on the Doxorubicin (DOX) uptake by HL-60 cells from the phosphate buffered saline solution (PBS) and Pluronic micellar solutions was studied. Both CW and pulsed ultrasound enhanced DOX uptake from PBS and Pluronic micelles. The main factor that effected drug uptake was ultrasound power density; however, with increasing power, the enhanced drug uptake was accompanied by the extensive cell sonolysis. For PBS, no significant effect of duration of the ultrasound pulse or inter-pulse interval on the drug uptake was observed. For Pluronic micelles, the uptake increased with increasing pulse duration in the range 0.1-2 s, overall sonication time being the same. For 2-s pulses, the uptake was close to that under CW ultrasound. There was no significant effect of the duration of the inter-pulse interval on the drug uptake from Pluronic micelles. The data on the effect of pulse duration on drug uptake suggest that the characteristic times of drug release from micelles and drug uptake by the cells are comparable. The results point to two independent mechanisms controlling acoustic activation of drug uptake from Pluronic micelles. Both mechanisms work in concert. The first one is related to the acoustically-triggered drug release from micelles that results in higher concentration of the free drug in the incubation medium. The second mechanism is based on the perturbation of cell membranes that results in the increased uptake of the micellar-encapsulated drug. The intracellular uptake of Pluronic micelles was confirmed by fluorescence microscopy.

Antibiotics, Antineoplastic↗

Evaluation of a pulse oximeter in the prehospital setting.

Paramedics field-tested a portable, battery-powered pulse oximeter to determine its applicability and usefulness as an adjunct to prehospital care. The pulse oximeter was attached to 62 consecutive patients who met local criteria for mandatory advanced life support base hospital contact. Arterial hemoglobin saturation (SaO2) levels and changes over time were documented by the pulse oximeter's integral printer and prehospital care reports prepared by paramedics. The pulse oximeter performed reliably in 60 patients (96.7%) by providing continuous SaO2 levels. Fifteen patients (24.2%) had saturations below 91%, and the pulse oximeter detected two (3.2%) otherwise undetected saturations below 80%. In each case, field intervention improved saturation. Pulse oximetry quantifies SaO2 changes correlated with many prehospital interventions: medications, suctioning, precarious gurney transport, oxygen therapy, and ventilatory assistance. The pulse oximeter performs reliably in the field and can be invaluable as an adjunct to patient care. Further prehospital studies are needed to evaluate specific field treatments and techniques, to assess the pulse oximeter's effect on morbidity and mortality, and to analyze the determination of severe hypoxemia in the field.

Adult↗

The effect of Nd:YAG pulse duration on dentine crater depth.

OBJECTIVES: The effect of alteration of laser parameters on laser-dentine interaction, in particular the effect of pulse duration, has not been well documented. The aim of this in vitro study was to determine the effect on dentine crater depth of Nd:YAG laser pulse duration, and total delivered energy, dentine site and the presence or absence of dye. METHODS: Ninety-six sound third molars were extracted and sectioned transversely to provide 192 upper and lower cut surfaces. The upper surfaces were painted with a layer of dye (IR5) suitable for absorption at 1064 nm. The specimens were divided into 16 sub-groups and exposed to two Nd:YAG lasers; one of pulse duration 7 ms and the second of pulse duration 35 ps. Both lasers operated in a non-contact mode (spot diameter 165 microm) with repetition rates of 10.5 and 10 Hz, respectively. Four total energies (2.28, 2.64, 3.6, 4.2 J) were delivered to eight dyed and eight undyed sub-groups. Eight outer and five inner sites were irradiated on each specimen. Dentine crater depth was measured five times using a Reflex Microscope and a three-dimensional centre of gravity derived. An upper and lower specimen were taken from each sub-group and viewed under a SEM. RESULTS: ANOVA and multiple regression analysis were applied and the following factors were found to have a statistically significant effect on crater depth (p<0.0001): total delivered energy, pulse duration and inner/outer location. CONCLUSIONS: Increasing energy and pulse duration produced deeper craters. Similarly inner dentine sites produced deeper crater depths. Only craters produced at the ms pulse duration were carbonised. It would appear that laser-dentine interaction has a non-thermal component at picosecond pulse duration.

Analysis of Variance↗

Dual-pulse lithotripter accelerates stone fragmentation and reduces cell lysis in vitro.

Lithotripsy is a common effective treatment for kidney stones. However, focal volumes are often larger than stones, and surrounding tissue is often injured. Our goal was to test in vitro a new lithotripter consisting of two opposing, confocal and simultaneously triggered electrohydraulic sources. The pulses superimpose at the common focus, resulting in pressure doubling and enhanced cavitation growth in a localized, approximately 1-cm wide volume. Model gypsum stones and human erythrocytes were exposed to dual pulses or single pulses. At the focus, model stones treated with 100 dual pulses at a charging voltage of 15 kV broke into 8 times the number of fragments as stones treated with 200 single pulses at 18 kV. At axial positions 2 and 4 cm away from the focus, lysis of erythrocytes was reduced or equivalent for dual pulses vs. single pulses. Hence, in half the time, dual pulses increased comminution at the focus without increasing injury in surrounding regions.

Erythrocytes↗

Biophysical effects of high-energy pulsed ultrasound on human cells.

Human benign and malignant cells of different human origin (pancreas, liver, kidney, pharynx, tongue, lip) were exposed to high-energy pulsed ultrasound (HEPUS) in vitro to evaluate the effects of various physical parameters and sonication conditions on cell viability. This included the number of pulses, focal pressure, pulse repetition rate, pulse shape, cell suspension volume, water level of the basin and cell density. Cell viability was found to depend significantly on the number of pulses (exponential), the focal pressure (linear) and the pulse repetition rate (minimum at 1 Hz). Other parameters showed no marked influence. Furthermore, electron microscopy revealed intracellular damage, and proliferation rates of cells surviving sonication were normal after HEPUS exposure. The experimental piezoelectric ultrasound transducer used in the experiments generated oscillating bipolar pulses with high negative pressure amplitudes. Measurements were made of the pulse shape and ultrasonic field of the experimental device and of a conventional lithotripter for comparison.

Biopsy↗

Differential paired-pulse effects of gabazine and bicuculline in rat hippocampal CA3 area.

Field potentials were evoked in hippocampal area CA3 of anaesthetised rats by commissural stimulation, in order to study the effect of the prototypic gamma-aminobutyric acid (GABA)A antagonists gabazine (SR-95531; GBZ) and bicuculline methiodide (BMI) on paired-pulse interaction. Prominent paired-pulse inhibition of the orthodromic population spike (PS2) was observed when the interpulse interval (IPI) was < or = 40 ms, while facilitation occurred at IPIs >100 ms. Paired-pulse facilitation was lost at 500 ms. The antidromic population spike (PS1) presented paired-pulse facilitation at low-IPI, which decayed exponentially at increasing IPI. When the recording micropipettes contained millimolar concentrations of either GBZ, or BMI, single stimuli evoked repetitive (epileptiform) orthodromic PS2, of higher amplitude, while the antidromic PS1 was only weakly influenced. BMI reduced, but GBZ enhanced the low-IPI paired-pulse inhibition of the orthodromic PS2. Furthermore, BMI blunted paired-pulse facilitation of the antidromic PS1 at low-IPI, while GBZ caused strong paired-pulse inhibition of PS1 at IPI < or = 60 ms. The differential effects of GBZ and BMI on paired-pulse interaction might reflect different mechanisms of action of these compounds.

Animals↗

Correction of errors caused by imperfect inversion pulses in MR imaging measurement of T1 relaxation times.

Spin-lattice (T1) relaxation times were measured by an inversion-recovery magnetic resonance imaging method with a slice-selective inversion pulse (SIP), a non-selective rectangular inversion pulse (RIP), or a B1-insensitive adiabatic inversion pulse (AIP). Data analysis either assumed perfect inversion (two-parameter fit) or allowed for imperfect inversion (three-parameter fit). Imperfect inversion pulses caused low T1 values in phantoms with a two-parameter fit, while three-parameter T1 estimates were accurate over the range 430-2670 ms. A difference of approximately 10% between two-parameter and three-parameter T1 values in normal human brain tissue was attributed to B1 inhomogeneity with the slice-selective inversion pulse and rectangular inversion pulse, to the slice profile with the slice-selective inversion pulse, and to T2 effects for the adiabatic inversion pulse. Any T1 method that relies on accurate flip angles may have a significant systematic error in vivo. Phantom accuracy does not ensure accuracy in vivo, because phantoms may have a more homogeneous B1 field and a longer T2 than do biological samples.

Adult↗

Evaluation of pulse oximetry in sickle cell anemia patients presenting to the emergency department in acute vasoocclusive crisis.

This prospective study was done to evaluate the accuracy of pulse oximetry as an indicator of hypoxemia in sickle cell anemia patients presenting to the ED in acute vasoocclusive crisis. Thirteen patients (age older than 18 years) presenting in crisis, with pulse oximetry readings less than 95% had arterial blood gas (ABG) analysis performed. The mean pulse oximetry reading was 91.4% +/- 3.2% (SD); the mean ABG oxygen saturation (ABG O2 sat) was 95.3% +/- 1.4% (SD). The mean O2 sat difference (ABG O2 sat minus pulse oximetry) was 4.5% (P < .001 versus a control group of ED patients receiving ABG and pulse oximetry). Pulse oximetry correlated with ABG O2 sat (r = 0.889, P < .001) and O2 sat difference (r = -0.927, P < .001). No correlation existed between complete blood count, reticulocyte count, historical and physical examination findings, and O2 sat or O2 sat difference. By linear regression, ABG O2 sat = 0.44 (pulse oximetry) + 55.6. This study suggests that pulse oximetry underestimates oxygenation in sickle cell anemia patients presenting in painful crisis.

Acute Disease↗

The relationship between body mass index and pulse pressure in older adults with isolated systolic hypertension.

BACKGROUND: Many longitudinal studies have reported excess cardiovascular mortality among lean hypertensive subjects, suggesting that obesity may mitigate the cardiovascular risk of hypertension. Available evidence also suggests that in middle-aged and older hypertensive subjects, pulse pressure may be a better predictor of cardiovascular complications. However, there are limited data on the relationship between body mass index (BMI) and pulse pressure. METHODS: Using data from the Third National Health and Nutrition Examination Survey we assessed the convergence validity of pulse pressure as a predictor of cardiovascular complications and examined the relationship between BMI and pulse pressure in 1192 older adults with isolated systolic hypertension who were not receiving blood pressure medicine. RESULTS: There was a good concordance between high pulse pressure and most of the selected cardiovascular risk factors examined in this study. Pulse pressure is higher in the lean (BMI < 25) than in the overweight (BMI > or = 25; 79 mm Hg vs 74 mm Hg, P < .001) and decreases significantly from 82 mm Hg in the first BMI quintile to 76 mm Hg in the fifth BMI quintile. Pulse pressure continues to decrease with increasing BMI until the index exceeds 30.1. This negative correlation persists in a multivariate model with statistical adjustment for age, sex, diabetes mellitus, and hypercholesterolemia. CONCLUSION: The inverse relation between BMI and pulse pressure observed here may help to explain previous reports of increased cardiovascular risk among lean versus obese subjects with isolated systolic hypertension.

Aged↗

Pulse-spray thrombolysis with reteplase: optimization and comparison with tPA in a rabbit model.

PURPOSE: To critically evaluate and optimize methodology for pulse-spray thrombolysis with reteplase in a rabbit inferior vena cava (IVC) thrombosis model and to compare results with optimized parameters for the use of tissue plasminogen activator (tPA). MATERIALS AND METHODS: Occlusive IVC thrombus was produced in 102 rabbits and treated 2 days later for 1 hour with pulse-spray thrombolysis using reteplase. Methodologic variables included pulse frequency, concentration and amount of reteplase, infusion versus pulse therapy, and admixture of heparin. After the rabbits were killed, residual thrombus was weighed and percent lysis was estimated on the basis of previous control values. Results were compared with those achieved with tPA in 18 additional rabbits and also with previous tPA results. RESULTS: As in earlier tPA studies, pulse-spray methods were far more effective than constant infusion. Pulses at 30-second intervals produced better results than pulses at 2-minute intervals. At the optimal concentration of 0.02 U/mL (molarity 90 x 10(-8) ), reteplase produced 79% lysis. At two-fold higher or lower concentrations, lysis was reduced by approximately 25%, and at eight-fold higher or six-fold lower concentrations, lysis was reduced by approximately 50%. Optimal concentration of tPA was 0.02 mg/mL, yielding 78% lysis. Admixture of reteplase with heparin suggested improvement, but differences were statistically insignificant. CONCLUSION: When used with pulse-spray methodology, reteplase demonstrated a steep bell-shaped response-concentration curve similar in pitch and amplitude to that of tPA. The optimal molar concentration of reteplase was approximately three times that of tPA. However, at their respective optimal concentrations, reteplase and tPA were equally effective.

Animals↗

High-resolution separation and accurate size determination in pulsed-field gel electrophoresis of DNA. 4. Influence of DNA topology.

Pulsed-field gel electrophoresis is a powerful technique for the fractionation of linear DNA molecules with sizes above 50 kilobase pairs (kb). Here it is demonstrated that this technique is also effective for separating smaller DNAs including linear, circular, and supercoiled species. The mobilities of linear DNAs larger than 8 kb can be modulated by pulse times between 0.1 and 100 s. The mobility of supercoiled DNA molecules up to 16 kb is generally unaffected by these pulse times except that 10-s pulse times cause a small but distinct increase in the mobility. The general insensitivity of small supercoiled DNAs to pulse time presumably occurs because these species reorient so rapidly that they spend most of their time undergoing conventional electrophoresis. However, the mobilities of larger supercoiled DNAs are affected by pulse times of less than 1 s, and at 0.1 s the molecules are better resolved by pulsed electrophoresis than by ordinary electrophoresis. The mobility of 3-19 kb nicked and relaxed circular DNA molecules is also affected by pulse time but in a complex way.

Bacteriocin Plasmids↗