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Optimized performance of the Abiomed BVS 5000: adjustment of the pump height based on Doppler control of the flow pattern.

The Abiomed BVS 5000 is an automatic volume-driven paracorporeal pulsatile assist device providing left, right or biventricular support. The paracorporeal position allows optical adjustment of filling volumes of the device, which determines the output of the system. A procedure to adjust for maximal stable flow has not yet been established. In vitro measurements have been performed to assess the flow and pressure characteristics of the Abiomed BVS 5000 by raising the preload in 5 mmHg steps before running the system. Doppler probes were placed at the inflow and outflow lines of the pump. After setting the afterload at 80 mmHg the assist device was started. Two measurements were performed to find optimal flow (based on Doppler control and optical adjustment). (1) By Doppler control a stable flow pattern was found at a preload of 25 mmHg with a mean atrial pressure of 5 mmHg and a mean flow of 5.3 +/- 0.7 l/min (mean +/- standard deviation) at the inflow and outflow sites (the console flow was 4.8 +/- 0.4 l/min with a frequency of 61.8 +/- 2.0 l/min). (2) Optical adjustment of the pump height gave rise to a preload of 35 mmHg where we recorded a maximal atrial pressure of 107 +/- 5.8 mmHg, a maximal retrograde flow of -4.3 +/- 1.2 l/min at the inflow and -1.2 +/- 0.4 l/min at the outflow site. The mean flow at the inflow and outflow sites was 5.1 +/- 0.5 l/min (the console flow was 4.6 +/- 0.3 l/min with a frequency of 59.6 +/- 2.6 Hz). At an initial afterload of 60 and 40 mmHg the system showed the same qualitative behaviour, but the results were less accurate. Optical adjustment of the pump height may result in an atrioventricular valve insufficiency with undetected retrograde flow and high atrial pressures. We conclude that a Doppler flow probe must be placed at the inflow site to guarantee maximal stable flow.

Equipment Design↗

Clinical evaluation of a commercial photorefractor.

The Visiscreen 100 is a system designed to detect ocular anomalies photographically. Photorefractions obtained in 63 consecutive 3-month-old to 8-year-old patients were compared in a masked fashion with results obtained by conventional techniques, including cycloplegic refraction. In 87% of the 57 patients with analyzable photographs, photorefractive and examination results correlated for the detection of constant tropias. The photorefractor detected all ocular media opacities. In 77% of the cases, its refraction was within 2.5 diopters or 33% of the cycloplegic spherical equivalent. In detecting abnormal ocular status, the Visiscreen had a 91% sensitivity and a 74% specificity. The overall agreement rate in distinguishing abnormal from normal status was 84%. Most errors were related to inaccuracies in fixation and positioning, rather than the optical principles utilized. This device offers a rapid technique for the detection of factors predisposing preverbal children to amblyopia.

Child↗

Childhood multiple sclerosis: clinical features and demonstration of changes in T cell subsets with disease activity.

Using monoclonal antibodies that identify T cell subsets in human beings (T4 = inducer cell; T5 = suppressor/cytotoxic cell), we have previously shown that most patients with multiple sclerosis (MS) have decreased T5 cells and an elevated T4:T5 ratio during periods of disease activity. We have recently studied three children with MS beginning at 4 years 11 months, 101/2 years, and 2 years 11 months of age. Clinical symptoms included a relapsing brainstem syndrome in the first, Devic syndrome and recurrent optic neuritis in the second, and multiple attacks with accumulating neurological deficits in the third. Two of these children represent the youngest cases of MS yet reported. In each child, circulating T5 cells were reduced or absent during an acute exacerbation of disease; following stabilization, T5 cells returned and the T4:T5 ratio became normal. No changes in T cell subsets were seen in a group of age-matched healthy children or in children suffering from other neurological diseases. Our finding that young children with active MS have a pattern of T cell abnormalities identical to that of adult MS patients suggests that the same pathophysiological process which causes MS in adults occurs in young children as well.

Antibodies, Monoclonal↗

Videomicroscopy, image processing, and analysis of whole histologic sections of the human brain.

Serial histologic sections of a whole human brain may have extensions of up to 130 x 130 mm within the coronal plane around the temporal lobe. To date, however, technology has not provided a bright field microscope that is able to shift the object holder continuously in the x- and y-direction over such distances and still possess the same optical capabilities as comparable devices. We developed a new light microscope to continuously quantify such sections. We also developed the computing environment for controlling the device and for analyzing the data produced. In principle, we are now able to quantify each neuron of a human brain. The data ultimately will provide the most detailed structural information about the human brain ascertained thus far. Such detailed information of the spatial distribution of neurons is essential to develop realistic models for simulation of large-scale neuronal networks and to investigate the significance of neuronal arrangements with respect to neuronal signal processing in the CNS. After preprocessing of the data produced by the new microscope, we are able to detect lamination patterns in the spatial distribution of gravity centers of cells. Furthermore, morphological features like size of the projection area and mean staining intensity are visualized as a particle process. The particle process presents the sizes and staining intensity of perikaryons and allows a distinction of gray matter and white matter. These results provide evidence that the system works correctly and can be applied to a systematic analysis of a larger sequence of serial histologic sections. The objective of this study is to introduce the very large section analyzing microscope (VLSAM) and to present the initial data produced by the system. Moreover, we will discuss workload and future developments of the parallel image analysis system that are associated with the microscope.

Aged↗

A study on the development of a filing system for funduscopic images with a personal computer for Twin AMHTS.

A filing system for ocular funduscopic image data was developed by using a personal computer for the Twin AMHTS. The development of the system was tried as one of the data transfer system including image data between two similar AMHTSs named the Twin AMHTS through the information network system. The filing system is capable of storing 26782 data of ophthalmoscopic pictures with a data compression mode by using a magneto-optical disk (MOD) whose storage capacity of both sides is 616 MB. It takes no long time for retrieval and display of the image data in the filing system. Good quality of compression and decompression obtained and reproducibility of the ocular fundus picture is favorable regardless of normal or abnormal cases. As a result, it is suggested that the developed system has practical utility although it requires more improvement.

Computer Communication Networks↗

Automatic analysis of cortical signals recorded with voltage-sensitive dyes using a forward-backward non-linear filtering technique and deconvolution.

A method for automatically analyzing cortical signals recorded with voltage-sensitive dyes and a photodiode array is described. First, a forward-backward non-linear filtering technique is used to eliminate the background noise and preserve the fast transients of the signals. Then the filtered signals are deconvoluted from their maximal values by using a gaussian function. The different components of the signals can be identified and characterized by their respective latencies, amplitudes, plateau durations, and slopes. These parameters can be used for subsequent statistical analysis. This automated method is much faster than a manual analysis because of the large number of responses that are optically recorded. Moreover, it can be easily applied to different experimental protocols and to other signals such as field potentials.

Animals↗

Present status and performance of PACS at Kyoto University Hospital.

A pilot PACS project, named KIDS, has been running in Kyoto University Hospital. The purpose of the system is to establish a small PACS that includes all digital imaging modalities and to evaluate it. The project has been continued from the first phase (KIDS-1) to the second phase (KIDS-2). In the first phase, a small-scale PACS was developed. In the second phase, the expansion of coverage of modalities and completion of the image database was intended. At present, the database contains image data of 16264 patients amounting to 150 Gbytes. Simulation of the retrieval process to the database shows that 154.3 s per patient is required for retrieving his/her entire image data. This calculated value is close to the actual time.

Computer Communication Networks↗

Computed radiography and image workstation from the radiologist's point of view.

A computed radiography system (Digiscan, Siemens) connected to an image workstation (Siemens) has been used for 1 1/2 years in our department. The image quality is good and it has been possible to reduce radiation dose by about 30% without any appreciable loss of image quality. The image workstation has been used in cases where image postprocessing is considered to be useful. For routine reporting of X-ray images the workstation is too slow although the image quality is comparable to that of the computed radiography film.

Computer Systems↗

Oral diagnostic reporting and synchronized image filing using magneto-optical disks.

An experimental radiologic reporting system has been developed and tested. The rewritable and compact magneto-optical disk (MOD) is applied to storing medical images with oral diagnostic reports of these radiologic images. The disk is 5.25 inches in diameter, has 600 MB memory capacity, is erasable, light and compact. Advantages are simultaneous recording of radiologic images and their oral reports by radiologists, and application to circulation of media inside the hospital as well as to filing of medical images. The MOD has a multimedia function of communication and filing. When medical images are taken and stored, oral interpretation by radiologists can be simultaneously added. Physicians can get information of the images and their reports by oral speech at the same time in front of computer workstation. Furthermore, integration of a voice recognition capability is now being undertaken.

Image Processing, Computer-Assisted↗

IS & C system and file protection mechanism.

This paper reports a new extension of IS & C (Image Save And Carry) project. Because IS & C is an off-line system and requires full compatibility so as to enable medical data interchange with ease among hospitals and clinics, specifications that are indispensable for compatibility have been standardized by the IS & C committee. The IS & C system is supposed to be used in medicine, so the file protection mechanism for the security of the recorded files has been also developed. The characteristics of IS & C volume and file structure and the second national project being carried out in National Cancer Center Hospital are briefly explained as well.

Computer Communication Networks↗

IS & C implementation of an image workstation.

The Image Save & Carry (IS & C) 5-inch magneto-optical disk system was introduced to a PACS image workstation so as to exchange digital image data between two independent PACS modules. The results showed that it was possible to connect two different PACS modules by off-line data transmission. Also, the IS & C standard software proved to be of high speed read/write performance for several data files on an image workstation. However, when the IS & C is implemented to the high resolution real-time digital radiography system, an image compression standard will be required to expand its capacity.

Animals↗

Development and evaluation of oral reporting system for PACS.

Experimental workstations for oral reporting and synchronized image filing have been developed and evaluated by radiologists and referring physicians. The file media is a 5.25-inch rewritable magneto-optical disk of 600-Mb capacity whose file format is in accordance with the IS&C specification. The results of evaluation tell that this system is superior to other existing methods of the same kind such as transcribing, dictating, handwriting, typewriting and key selections. The most significant advantage of the system is that images and their interpretation are never separated. The first practical application to the teaching file and the teaching conference is contemplated in the Osaka University Hospital. This system is a complete digital system in terms of images, voices and demographic data, so that on-line transmission, off-line communication or filing to any database will be easily realized in a PACS environment. We are developing an integrated system of a speech recognizer connected to this digitized oral system.

Education, Medical↗

Multiphase electrodes for microbead control applications: integration of DEP and electrokinetics for bio-particle positioning.

Advances in microfabrication have introduced new possibilities for automated, high-throughput biomedical investigations and analysis. Physical effects such as dielectrophoresis (DEP) and AC electrokinetics can be used to manipulate particles in solution to coordinate a sequence of bioanalytical processing steps. DEP is accomplished with non-uniform electric fields that can polarize particles (microbeads, cells, viruses, DNA, proteins, etc.) in suspension causing translational or rotational movement. AC electrokinetics is another phenomena involved with movement of particles in suspension with electric fields and is comprised of both electro-thermal and electro-osmotic effects. This paper investigates single layer electrodes that are effective for particle localization and clustering based on DEP and AC electrokinetic effects. We demonstrate a novel multi-electrode setup capable of clustering particles into an array of discrete bands using activated and electrically floating electrodes. These bands shift to adjacent regions on the electrode surface by altering the electrode activation scheme. The predictability of particle placement to specific locations provides new opportunities for integration and coordination with raster scanning lasers or a charge coupled device (CCD) for advanced biomedical diagnostic devices, and more sophisticated optical interrogation techniques.

Biopolymers↗

Optical storage and surface-relief gratings in azobenzene-containing nanostructured films.

This paper brings an overview of photoisomerization-derived properties in azobenzene-containing nanostructured films produced with the Langmuir-Blodgett (LB) and layer-by-layer (LbL) methods. Emphasis was placed on the optical storage and formation of surface-relief gratings (SRGs), where the distinctive properties of the nanostructured films were highlighted. For optical storage, in particular, a discussion was made of the higher birefringence induced in LB films from azopolymers due to their organized nature, and of the strong effects from ionic interactions on the photoisomerization of azochromophores in LbL films. The molecular-level control of film properties in the LbL films is described as being responsible for the varied behavior observed in the photoinscription of SRGs, which may involve considerable level of photodegradation depending on the film fabrication conditions and materials used.

Azo Compounds↗

A low-cost digital filing system for echocardiography data with MPEG4 compression and its application to remote diagnosis.

The high cost of digital echocardiographs and the large size of data files hinder the adoption of remote diagnosis of digitized echocardiography data. We have developed a low-cost digital filing system for echocardiography data. In this system, data from a conventional analog echocardiograph are captured using a personal computer (PC) equipped with an analog-to-digital converter board. Motion picture data are promptly compressed using a moving pictures expert group (MPEG) 4 codec. The digitized data with preliminary reports obtained in a rural hospital are then sent to cardiologists at distant urban general hospitals via the internet. The cardiologists can evaluate the data using widely available movie-viewing software (Windows Media Player). The diagnostic accuracy of this double-check system was confirmed by comparison with ordinary super-VHS videotapes. We have demonstrated that digitization of echocardiography data from a conventional analog echocardiograph and MPEG 4 compression can be performed using an ordinary PC-based system, and that this system enables highly efficient digital storage and remote diagnosis at low cost.

Analog-Digital Conversion↗

Essure: a new device for hysteroscopic tubal sterilization in an outpatient setting.

OBJECTIVE: To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting. DESIGN: Prospective, observational study. SETTING: Private university hospital. PATIENT(S): Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003. INTERVENTION(S): Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting. MAIN OUTCOME MEASURE(S): Procedure feasibility without anesthesia, success rate of device implantation, patient satisfaction, and confirmation of correct placement. RESULT(S): Successful placement was achieved in 81 patients (95%). Mean time elapsed between the start of hysteroscopy, placement of devices, and removal of optics was 9 minutes (range, 1-35 minutes). No intraoperative or postoperative complications were detected. Of 81 patients, 75 (93%) had abdominal x-ray performed at the third month; bilateral correct placement was confirmed in all of them. CONCLUSION(S): Essure is a safe, effective, and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization. It seems to be a good alternative to laparoscopic tubal sterilization.

Adult↗

Comatic aberration as a cause of monocular diplopia.

Three patients (5 eyes) presented with complaints of monocular diplopia and no history of ocular trauma or surgery. The patients had comprehensive neuroophthalmic evaluation including manifest refraction, anterior segment and dilated fundus examination, and corneal topography. All patients also had wavefront analysis using the LADARWave system (Alcon). Two patients (4 eyes) also had hard contact lens overrefraction. The patients had a normal initial examination including corneal topography. One patient (2 eyes) did not experience resolution of diplopia with pinhole. No eye improved with manifest refraction or hard contact lens overrefraction. However, each patient had a significant amount of coma on wavefront analysis. Moreover, eyes with horizontal diplopia had horizontal coma and eyes with vertical diplopia had vertical coma as measured with the wavefront device. Higher-order optical aberrations such as coma may be associated with monocular diplopia. Wavefront technology may be useful in the workup of monocular diplopia.

Corneal Topography↗