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Cyclic mechanical property degradation during fatigue loading of cortical bone.

Fatigue damage accumulation has been demonstrated in living bone and postulated as a stimulus to the bone modeling and remodeling response. Mechanical property degradation is one manifestation of fatigue damage accumulation. This study examines changes in secant modulus and cyclic energy dissipation behavior during axial load-controlled fatigue loading of cortical bone specimens. The findings suggest that secant modulus degradation and cyclic energy dissipation are greatly increased at loading levels above critical damage strain thresholds of 2500 and 4000 mu epsilon in tensile and compressive fatigue, respectively. Tensile and compressive fatigue loading also caused different forms of modulus degradation at loading levels above these thresholds. Bone behaves as a linear viscoelastic material below these thresholds, even after prior property degradation at higher loading levels. Cyclic energy dissipation was proportional to the 2.1 power of the applied effective strain range for all loadings below 2500 mu epsilon. Above 2500 mu epsilon, tensile fatigue loading caused cyclic energy dissipation proportional to the 5.8 power of the applied effective strain range. Compressive fatigue loading dissipated cyclic energy proportional to the 4.9 power of applied effective strain range over 4000 mu epsilon. Lifetime energy dissipation over all fatigue tests to fracture at a single loading level was well fitted by the same power law in the number of cycles to failure raised to the 0.6 power. Loading levels of 2500 mu epsilon in tension and 4000 mu epsilon in compression are within the ranges observed in living animals, and thus these phenomena may play a role in initiating the remodeling response in live bone tissue.

Adolescent↗

Telemammography: implementation issues.

Telemammography has the potential to improve access to centralized expertise for the interpretation of breast imaging studies. Digital mammography has more demanding spatial resolution requirements than other forms of medical imaging because of the need to detect microcalcifications, the fine details of lesion margins, and subtle architectural distortion. The resolution requirements for mammography have important implications for image acquisition and display technologies. The large size of the resulting image data sets places significant demands on local and wide area networks as well as storage media. Image data compression will be particularly important for telemammography to help make systems practical and affordable. This article describes how existing technologies can be adapted to implement telemammography systems in the near future.

Algorithms↗

Imaging system for morphometric assessment of absorption or fluorescence in stained cells.

An image acquisition and processing system has been developed for quantitative microscopy of absorption or fluorescence in stained cells. Three different light transducers are used in the system to exploit the best characteristics of these sensors for different biological measurements. A digital scanner, in the form of a linear array charge-coupled device (CCD), acquires data with high spatial and photometric resolution. A color (RGB) camera is employed when spectral information is required for the segmentation of cellular subcomponents. An image-intensified charged-injection device (CID) camera provides for very low light intensity measurements, primarily for fluorescence-labeled cells. Properties of these transducers, such as contrast transfer function, linearity, and photo-response nonuniformity, have been measured. Two dedicated image processing units were incorporated into the system. The front-end processor, based on a digital signal processor, provides functions such as object detection, raw image calibration, compression, artifact removal, and filtering. The second image processor is associated with the frame memory and includes a histogram processor, a dedicated arithmetic logic unit for image processing functions, and a graphics module for one-bit overlay functions. An interactive program was developed to acquire cell images and to experiment with a range of segmentation algorithms, feature extractions, and other image processing functions. The results of any image operation are displayed on the video monitor. Once a desired processing sequence is determined, the sequence may be stored to become part of a command library and can be executed thereafter as a single instruction.

Algorithms↗

Enhancing ultrasound images by morphology filter and eliminating ringing effect.

Various medical image compression techniques have been proposed for accelerating image propagation in many applications. JPEG2000 is a new generation technique that can encode near lossless ultrasound images at medium bit-rate with diagnostically acceptable quality. Because the coder of JPEG2000 is based on wavelet transform, the reconstructed image will contain some ringing artifacts. Some de-ringing algorithm must be applied to enhance image quality. This study presents quad-tree decomposition and a set of morphological filters for reducing the ringing artifacts of ultrasound images. Specifically, the presented morphological filters use eight predefined morphological operations, including four structuring elements (SE) that include both dilation and erosion. The proposed voting strategy can be used to select the morphological filter for each block to optimize decoded image quality. Image quality can be enhanced by applying the appropriate morphological filter to each block. Experimental results demonstrate that the proposed technique enhances reconstructed ultrasound image quality compared to JPEG2000 at the same bit-rate in terms of both PSNR and the perceptual results.

Algorithms↗

Investigating the effect of remodelling signal type on the finite element based predictions of bone remodelling around the thrust plate prosthesis: a patient-specific comparison.

The resorption of bone in the human femur following total hip arthroplasty is recognized to be related to the loading in the bone surrounding the prosthesis. However, the precise nature of the mechanical signal that influences the biological remodelling activity of the bone is not completely understood. In this study, a validated finite element modelling methodology was combined with a numerical algorithm to simulate the biological changes over time. This was used to produce bone remodelling predictions for an implanted thrust plate prosthesis (Centerpulse Orthopedics Limited) in a patient specific bone model. The analysis was then repeated using different mechanical signals to drive the remodelling algorithm. The results of these simulations were then compared to the patient-specific clinical data, to distinguish which of the candidate signals produced predictions consistent with the clinical evidence. Good agreement was found for a range of strain energy based signals and also deviatoric remodelling signals. The results, however, did not support the use of compressive dilatational strain as a candidate remodelling signal.

Bone Plates↗

C- and D-weighted ultrasonic imaging using the translating apertures algorithm.

Conventional ultrasonic imaging systems depict tissue backscatter, that is, the ultrasonic energy reflected directly back toward the transmitter. Although diagnostically useful, these systems fail to exploit the information available in components of the sound field scattered in other directions. This paper describes a new method of imaging this angular scatter. First, the translating apertures algorithm (TAA) is used to acquire data at two scattering angles. Then, these data are processed to yield an image of the common scattering with angle and the differential scattering with angle. This paper explores the potential of these common-weighted (c-weighted) and difference-weighted (d-weighted) images using theory and simulations. In addition, it describes and analyzes the performance of the TAA when it is applied using multiple receive elements. Analysis is presented that shows that, in Rayleigh scattering environments, c- and d-weighted images depict compressibility and density variations, respectively. A simulated image and accompanying analysis are presented that show the potential of these techniques to improve soft tissue contrast and to increase the detectability of microcalcifications. A comparison with previous angular scatter measurement techniques shows that use of the TAA significantly reduces statistical variability in measured angular scatter profiles. Spatially localized, statistically reliable angular scatter measurements will enable a broad range of angular scatter imaging techniques. C- and d-weighted imaging may ultimately be applied clinically to identify calcification in atherosclerotic plaques and breast tumors.

Algorithms↗

Optimization of sparse synthetic transmit aperture imaging with coded excitation and frequency division.

An effective aperture approach is used for optimization of a sparse synthetic transmit aperture (STA) imaging system with coded excitation and frequency division. A new two-stage algorithm is proposed for optimization of both the positions of the transmit elements and the weights of the receive elements. In order to increase the signal-to-noise ratio in a synthetic aperture system, temporal encoding of the excitation signals is employed. When comparing the excitation by linear frequency modulation (LFM) signals and phase shift key modulation (PSKM) signals, the analysis shows that chirps are better for excitation, since at the output of a compression filter the sidelobes generated are much smaller than those produced by the binary PSKM signals. Here, an implementation of a fast STA imaging is studied by spatial encoding with frequency division of the LFM signals. The proposed system employs a 64-element array with only four active elements used during transmit. The two-dimensional point spread function (PSF) produced by such a sparse STA system is compared to the PSF produced by an equivalent phased array system, using the Field II simulation program. The analysis demonstrates the superiority of the new sparse STA imaging system while using coded excitation and frequency division. Compared to a conventional phased array imaging system, this system acquires images of equivalent quality 60 times faster, when the transmit elements are fired in pairs consecutively and the power level used during transmit is very low. The fastest acquisition time is achieved when all transmit elements are fired simultaneously, which improves detectability, but at the cost of a slight degradation of the axial resolution. In real-time implementation, however, it must be borne in mind that the frame rate of a STA imaging system depends not only on the acquisition time of the data but also on the processing time needed for image reconstruction. Comparing to phased array imaging, a significant increase in the frame rate of a STA imaging system is possible if and only if an equivalent time efficient algorithm is used for image reconstruction.

Models, Theoretical↗

["Topless" cardiopulmonary resuscitation. Fashion or science?].

A decade after the onset of a discussion whether ventilation could be omitted from bystander basic life support (BLS) algorithms, the state of the evidence is reevaluated. Initial animal studies and a prospective randomized patient trial had suggested that omission of ventilation during the first minutes of lay cardiopulmonary resuscitation (CPR) did not impair patient outcomes. More recent studies demonstrate, however, that this may hold true only in very specific scenarios, and that the chest compression-only technique was never superior to standard BLS. Instead of calling basics of BLS training and practice into question, more and better training of lay persons and professionals appears mandatory, and targeted use of dispatcher-guided telephone CPR should be evaluated and, if it improves outcome, it should be encouraged. Future studies should focus much less on the omission but on the optimization of ventilation under the specific conditions of CPR.

Cardiopulmonary Resuscitation↗

Experimental determination of the linear biphasic constitutive coefficients of human fetal proximal femoral chondroepiphysis.

The mechanical properties of the cartilaginous regions of the proximal femoral epiphysis are an important factor in load transmission through the hip joint of young children. Cylindrical test specimens excised from the chondroepiphysis of human stillborn femoral heads were subjected to uniaxial loading in peripherally-unconfined compression, using a ramp/plateau input strain history. The corresponding load vs time curves were analyzed in terms of a recent analytical solution for a linear biphasic material (the well-known KLM model), allowing calculation of that model's three fundamental constitutive coefficients (permeability, equilibrium modulus and solid-phase Poisson ratio) for this material. The numerical algorithm developed to evaluate the biphasic solution yielded very precise replication of previously published KLM parametric plots. When fitted to experimental load histories, however, the model provided only a rather loose approximation of specimen behavior, due apparently to a substantial underestimation of the transient response component associated with interstitial fluid transport. Averaged over the series, the best-fit values for permeability (2.51 X 10(-15) m4 Ns-1) and equilibrium modulus (0.699 MPa) were in the range of values accepted for human adult articular cartilage. A consequence of the coarseness of the analytical curve fits was that a solid-phase Poisson ratio of 0.0 was inferred for all specimens. The permeability vs equilibrium modulus exhibited a nearly linear (r = 0.74) inverse relationship similar to that reported for adult articular cartilage.

Femur↗

Feasibility of mitral flow assessment by echo-contrast ultrasound, part II: experimental study on a mechanical model of the left heart.

The feasibility of assessing mitral flow by means of ultrasonic monitoring of backscattered power from an echo-contrast agent in the left atrium and left ventricle was studied. A mechanical model of the left heart was built in which two thin rubber balloons connected to each other in a feedback loop via two artificial heart valves mimicked the left atrium and left ventricle. The model was driven by compressed air. Its input and output flows were measured as the functions of a pacing rate, driving pressure and artificially introduced mitral regurgitation. These were compared with the corresponding data derived from the ultrasonic measurements that are based on the correlation between echo-contrast agent concentration in the volume of interest and the flow through it. Algorithms for quantitative estimations of forward stroke volume (cardiac output) and mitral regurgitation are given. This study shows, for the first time, both analytically and experimentally, that the pulsating modulation of contrast agent concentration vs. time curves in the ventricle and atrium volumes is closely related to the pulsating nature of the flow in the system. It also shows that the amplitude of the atrium concentration modulation is directly proportional to the maximum value of the incoming (to atrium) flow.

Albumins↗

Efficient computation of the Hutchinson metric between digitized images.

The Hutchinson metric is a natural measure of the discrepancy between two images for use in fractal image processing. An efficient solution to the problem of computing the Hutchinson metric between two arbitrary digitized images is considered. The technique proposed here, based on the shape of the objects as projected on the digitized screen, can be used as an effective way to establish the error between the original and the, possibly compressed, decoded image. To test the performance of our method, we apply it to compare pairs of fractal objects, as well as to compare real-world images with the corresponding reconstructed ones.

Algorithms↗

Using difference intervals for time-varying isosurface visualization.

We present a novel approach to out-of-core time-varying isosurface visualization. We attempt to interactively visualize time-varying datasets which are too large to fit into main memory using a technique which is dramatically different from existing algorithms. Inspired by video encoding techniques, we examine the data differences between time steps to extract isosurface information. We exploit span space extraction techniques to retrieve operations necessary to update isosurface geometry from neighboring time steps. Because only the changes between time steps need to be retrieved from disk, I/O bandwidth requirements are minimized. We apply temporal compression to further reduce disk access and employ a point-based previewing technique that is refined in idle interaction cycles. Our experiments on computational simulation data indicate that this method is an extremely viable solution to large time-varying isosurface visualization. Our work advances the state-of-the-art by enabling all isosurfaces to be represented by a compact set of operations.

Journal Article↗

[Aortocaval compression syndrome].

Aortocaval compression syndrome (supine hypotensive syndrome) represents a common complication mainly of late pregnancy, although the syndrome has been described to occur as early as 16 weeks of gestation. The nature and severity of symptoms range from unspecific complaints to severe maternal hypotension, loss of consciousness, cardiovascular collapse, and consecutive fetal depression. Predominantly, the syndrome is provoked by placing the parturient supine. Since supine positioning is required for diverse diagnostic and therapeutic procedures in obstetrics, these involve increased risk of aortocaval compression. For the anesthetist, cesarean section is most relevant, because of the coincidence of several risk factors. The following article begins by reviewing the pathophysiology of the syndrome, known risk factors and anesthesiological procedures that predispose to the syndrome. The second part is concerned with prophylactic measures and therapeutic options, together with the discussion of a clinically practicable algorithm.

Adult↗

Management of hepatic hemangiomas: a 14-year experience.

Hemangioma is the most common primary tumor of the liver and its diagnosis has become increasingly prevalent. Most of these lesions are asymptomatic and are managed conservatively. Large hemangiomas are often symptomatic and reports of surgical intervention are becoming increasingly frequent. We present our experience, over the last 14 years, with diagnosis and management of 249 liver hemangiomas, with special attention to a conservative strategy. Clinical presentation, diagnosis, treatment, and long-term outcome are analyzed. Of 249 patients, 77 (30.9%) were symptomatic, usually with right abdominal upper quadrant pain. Diagnosis was based on a radiologic algorithm according to the size and characteristics of the tumor; diagnosis by this method was not possible in only one case (0.4 %). Giant hemangiomas (>4 cm) were found in 68 patients (27.3%) and in 16 were larger than 10 cm. Eight patients (3.2%) underwent surgical treatment; indications were incapacitating pain in 6, diagnostic doubt in 1, and stomach compression in 1. No postoperative complications or mortality were observed in this series. Patients who did not undergo surgery (n = 241) did not present any complication related to the hemangioma during long-term follow-up (mean = 78 months). Hemangioma is a benign course disease with easy diagnosis and management. We propose a conservative approach for these lesions. Resection, which can be safely performed, should be reserved for the rare situations such as untreatable pain, diagnostic uncertainty, or compression of adjacent organs.

Adult↗

Ambulatory management of thermal injuries.

The majority of thermal injuries that occur in this country can be adequately treated on an ambulatory-care basis. The determination regarding ambulatory care can be arrived at using the simple algorithm. The primary concern in outpatient burn care is the management of the burn wound. Aggressive wound cleansing, frequent dressing changes, and appropriate antimicrobials should permit rapid re-epithelialization and prevention of bacterial infection. A nonhealing burn wound should be grafted if it takes more than two to three weeks to heal. Aftercare with splints and elastic compression may be required to obtain maximal functional and cosmetic results.

Age Factors↗

Crisis management during anaesthesia: cardiac arrest.

BACKGROUND: Cardiac arrest attributable to anaesthesia occurs at the rate of between 0.5 and 1 case per 10 000 cases, tends to have a different profile to that of cardiac arrest occurring elsewhere, and has an in-hospital mortality of 20%. However, as individual practitioners encounter cardiac arrest rarely, the rapidity with which the diagnosis is made and the consistency of appropriate management varies considerably. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a sub-algorithm for cardiac arrest, in the management of cardiac arrest occurring in association with anaesthesia. METHODS: The potential performance of this structured approach for each the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: There were 129 reports of cardiac arrest associated with anaesthesia among the first 4000 AIMS incident reports. Identified aetiological factors were grouped into five categories: (1) anaesthetic technique (11 cases with this category alone; 32 with this and one or more of the other categories, representing 25% of all 129 cardiac arrests); (2) drug related (16; 32, 25%); (3) associated with surgical procedure (9; 29, 22%); (4) associated with pre-existing medical or surgical disease (30; 82, 64%); (5) unknown (8; 14, 11%). The "real life" presentation and management of cardiac arrest in association with anaesthesia differs substantially from that detailed in general published guidelines. Cardiac rhythms at the time were sinus bradycardia (23%); asystole (22%); tachycardia/ventricular tachycardia/ventricular fibrillation (14%); and normal (7%), with a further third unknown. Details of treatment were recorded in 110 reports; modalities employed included cardiac compression (72%); adrenaline (61%); 100% oxygen (58%); atropine (38%); intravenous fluids (25%), and electrical defibrillation (17%). There were no deaths or permanent morbidity in the 11 cases due solely to anaesthetic technique. 24 of the 25 deaths occurred in patients with significant pre-existing medical or surgical disease. CONCLUSION: Because there are often multiple contributing factors to a cardiac arrest under anaesthesia, a complete systematic assessment of the patient, equipment, and drugs should be completed. The "COVER ABCD-A SWIFT CHECK" algorithm was judged to be a satisfactory process in this context and should be carried out even if the cause of the cardiac arrest is already thought to have been found. The diagnosis and management of cardiac arrest in association with anaesthesia differs considerably from that encountered elsewhere. The outcome is generally good, with most patients leaving hospital alive and apparently well.

Algorithms↗

SEQ-ED: an interactive computer program for editing, analysis and storage of long DNA sequences.

The rapidly growing body of sequenced DNA demands efficient computer programs for its analysis and storage. The program described in this paper, SEQ-ED, has been designed to handle a large number of DNA sequences up to 200 kilobases [kb] long stored in a sequence library. In order to minimize the required storage space, the sequences are stored in a compressed format using three binary digits per base. In the development of this program, special care has been given to make it easy to use for molecular biologists without any previous computer experience.

Algorithms↗

The effect of irreversible image compression on diagnostic accuracy in thoracic imaging.

RATIONALE AND OBJECTIVES: Digital image compression reduces the storage requirements and network traffic on picture archiving and communications systems. Full-frame bit-allocation (FFBA) is an irreversible image-compression method based on the discrete cosine transform that provides for high compression ratios with a high degree of image fidelity. METHODS: One hundred twenty-two posteroanterior chest radiographs were obtained on patients in an ambulatory patient setting, including 30 cases of interstitial lung disease, 45 images containing combinations of lung nodules (N = 37) or mediastinal masses (N = 39), and 47 normal images containing none of the pathology for which we were testing. The images were digitized (nominal 2 K x 2 K x 12-bit resolution), printed on a 35 x 35-cm hard copy format, and compressed at an approximate compression ratio of 20:1. Observer performance tests were conducted with five radiologists using receiver operating characteristics analysis on digitized uncompressed and compressed hard copy images. RESULTS: There were no significant differences between the two display conditions for the detectability of any of the thoracic abnormalities. CONCLUSIONS: Our preliminary results suggest that irreversible image compression at ratios of 20:1 may be acceptable for use in digital thoracic imaging.

Algorithms↗