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A Doppler flowmeter for use in theatre.

We have developed a Doppler flowmeter based on a 10 MHz pencil probe and mean frequency estimator which overcomes many of the limitations of existing electromagnetic and ultrasonic flowmeters. The output of the flowmeter, which is proportional to the first moment of the Doppler power spectrum and hence mean blood velocity is linear from 1.3 to over 50 cm s-1 for pulsatile flow. Variation in vessel diameter and angle of insonation, which are the common sources of error in Doppler flowmetry, are minimised by constraining the vessel in a plastic cuff which fixes the probe angle at 50 degrees. A simple gauge is used to compress the vessel flat, before the cuff is applied, to measure the wall thickness to within 0.25 mm. The vessel internal diameter and hence blood flow can then be calculated using an experimentally determined calibration factor to compensate for non-even insonation. A range of sterilizable cuffs from 3-12 mm diameter have been built and the flowmeter is now being used routinely during all arterial reconstructive surgery. The accuracy and reproducibility of the system was tested for range of different sized silastic tubes on a hydraulic model and found to be less than 12% for vessels greater than 2 mm internal diameter. Satisfactory signals were easily obtained from all prosthetic materials with the exception of PTFE. The instantaneous output was compared to an electromagnetic flowmeter using a fast Fourier transform algorithm; the moduli of the harmonics were virtually identical but the Doppler system produced a smaller phase shift with increasing harmonics.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

High-speed optical observations of contrast agent destruction.

Ultrasound contrast agents are now available since a few years and used for diagnostic purposes. Improved diagnostic decisions have been made possible with new imaging methods that are mainly based on the nonlinear properties of gas microbubbles. Since it is well known that contrast agents are destroyed by ultrasound when the acoustic pressure exceeds a threshold, extremely low acoustic pressures were applied to achieve enhanced contrast image quality. However, destruction of contrast microbubbles is not necessarily undesirable, since it is beneficial in, for example, destruction/reperfusion imaging and recently in drug delivery. We investigate in this experimental study the destruction dynamics of a contrast agent consisting of nitrogen bubbles encapsulated in a double polymer/albumin wall shell. This is accomplished using an ultrafast camera Brandaris that operates at a frame rate of 25 MHz and records 128 frames. The measurements were performed with an ultrasound sine burst of 10 cycles at 1.7 MHz. Different acoustic pressures were applied and various microsphere sizes were examined. The results show three different zones depending on the applied pressure and bubble size: these are nondestruction zone, transient zone and destruction zone. The nondestruction zone is reached for either very small microspheres or low mechanical indices (MI) (<0.3). In the destruction zone lie either large microspheres (5 microm or higher) even when irradiated at low MIs or small microspheres (<5 microm) when the MI is above 0.6. The optical observations revealed that the destruction of the microspheres is characterized by shell rupture and gas release. The release of the gas gives rise to new free microbubble that lasts for a few milliseconds and then disappears due to dissolution. In the transient zone, the microspheres are mainly compressed in the first few cycles but no expansion is induced. After intense compressions, the shell fissures and gas escapes in the last cycles of the burst or during a second burst depending on the initial size and MI. These optical recordings are important to investigate contrast bubble destruction and can help in amplifying or minimizing this process. Indeed, bubble disruption remains the basis of most current sensitive methods for detecting perfusion with contrast agents and is an essential component of perfusion quantification with microbubbles, in addition to drug delivery applications and pressure measurements.

Algorithms↗

A unified benchmark of supervised and retrieval-based methods for viral genomic sequence classification.

The rapid growth of genomic sequencing demands fast, accurate, and scalable analysis methods. In viral genomic classification, expanding labeled reference collections can make supervised models costly to update and dependent on fixed label sets, motivating retrieval-based genomic classification as a simpler, more flexible alternative. We present a unified benchmark of supervised and retrieval-based methods for viral genomic sequence classification across three viral classification tasks: hepatitis C virus (HCV) genotyping, COVID-19 discrimination, and human papillomavirus (HPV) genotyping. We compare standard sequence encodings (one-hot, k-mers, FCGR) with dense embeddings (dna2vec, DNABERT). For each representation, we evaluate supervised classifiers (Random Forest, Decision Tree, XGBoost) and retrieval-based classification, where sequence vectors are indexed with FAISS and labels are assigned via similarity-weighted k-NN. Furthermore, we benchmark multiple FAISS index types (Flat, IVF, HNSW, IVFPQ, OPQ) to characterize accuracy-speed-memory trade-offs at scale. The results show that XGBoost and retrieval using Flat or IVF indexes achieve strong classification performance under different computational profiles. Compressed indexes such as IVFPQ and OPQ substantially reduce memory usage, although their accuracy loss depends on the dataset and representation. Overall, supervised XGBoost provides a favorable accuracy-size trade-off, while retrieval-based classification remains competitive and allows labeled reference sequences to be incorporated without retraining a global classifier. This benchmark provides practical guidance for selecting sequence representations, classifiers, and vector-search indexes under different accuracy, memory, and update requirements.

Genome, Viral↗

Directional bonding in compacted microcrystalline cellulose.

The mechanical properties of compacts of microcrystalline cellulose (MCC) and silicified microcrystalline cellulose (SMCC) were evaluated by tensile testing, diametric compression testing, and compression testing. For tensile and compression testing, cubic specimens were carefully machined from MCC and SMCC compacts, and the tensile and compression strengths were evaluated both normal and parallel to the compaction direction. The cubic tensile strengths were compared to values obtained from the diametric compression test. The results obtained using the diametric compression test suggested compacts of SMCC exhibit greater strength than those of MCC. In addition, the cubes machined from compacts of MCC and SMCC exhibited directional strength; the direction normal to the compaction direction display ed the greater tensile strength, and the parallel direction had greater compression strength. The diametric compression test afforded strength values with reduced spread compared to the values collected from the cubic tensile test, suggesting that the errors involved in collecting diametric compression test data of compacts are less than those for the cubic tensile test. Analysis of the cubes using X-ray diffraction (XRD) suggested that they display directional structural anisotropy, with the direction normal to the compaction direction being more crystalline than the parallel direction. However, it is not clear whether the difference in the directional strength is solely a consequence of the increased crystallinity or a culmination of crystallographic and mechanical keying effects.

Algorithms↗

The use of artificial neural networks for the selection of the most appropriate formulation and processing variables in order to predict the in vitro dissolution of sustained release minitablets.

The objective of this work was to apply artificial neural networks (ANNs) to examine the relative importance of various factors, both formulation and process, governing the in-vitro dissolution from enteric-coated sustained release (SR) minitablets. Input feature selection (IFS) algorithms were used in order to give an estimate of the relative importance of the various formulation and processing variables in determining minitablet dissolution rate. Both forward and backward stepwise algorithms were used as well as genetic algorithms. Networks were subsequently trained using the back propagation algorithm in order to check whether or not the IFS process had correctly located any unimportant inputs. IFS gave consistent rankings for the importance of the various formulation and processing variables in determining the release of drug from minitablets. Consistent ranking was achieved for both indices of the release process; ie, the time taken for release to commence through the enteric coat (T(lag)) and that for the drug to diffuse through the SR matrix of the minitablet into the dissolution medium (T9(0-10)). In the case of the T(lag) phase, the main coating parameters, along with the original batch blend size and the blend time with lubricant, were found to have most influence. By contrast, with the T(90-10 phase), the amounts of matrix forming polymer and direct compression filler were most important. In the subsequent training of the ANNs, removal of inputs regarded as less important led to improved network performance. ANNs were capable of ranking the relative importance of the various formulations and processing variables that influenced the release rate of the drug from minitablets. This could be done for all main stages of the release process. Subsequent training of the ANN verified that removal of less relevant inputs from the training process led to an improved performance from the ANN.

Artificial Intelligence↗

[Metastatic bone disease. Strategies for imaging].

Skeletal metastases represent the most common malignant bone tumor. They occur mainly in adults and even more frequently in the elderly. The most common metastases in men are from prostate cancer (60%) and in women from breast cancer (70%). Other primitive tumors responsible for bone metastases are: lung, kidney, thyroid, alimentary tract, bladder, and skin. The spine and pelvis are the most common metastatic sites, due to the presence of red (haematopoietic active) bone marrow in a high amount. As a general rule, the radiographic pattern was lytic type; other aspects were osteosclerotic, mixed, lytic vs mixed and osteosclerotic vs lytic patterns. The main symptom is pain, although many bone metastases are asymptomatic. The most severe consequences are pathologic fractures and cord compression. Clinical evaluation of patients with skeletal metastases needs multimodal diagnostic imaging, able to detect lesions, to assess their extension and localization, and eventually drive the biopsy (for histo-morphological diagnosis). These techniques give different performances in terms of sensitivity and specificity; but none of the modalities alone seems to be adequate to yield a reliable diagnostic outcome. Therefore multidisciplinary cooperation is required to optimize the screening, clinical management and follow-up of the patients. In other terms, what is the efficacy of these new diagnostic tests compared to the "older" diagnostic tests? Frequently the new procedures do not replace the older one, but it is added to the diagnostic workup, thereby increasing costs without impacting the "patient's condition". The aim of the present work is to propose an "algorithm" for the detection and diagnosis of skeletal metastases, which may be applied differently in symptomatic and asymptomatic oncologic patients. Bone scintigraphy remains the first choice technique in the evaluation of asymptomatic patients, in whom skeletal metastases are supposed. Although it has a high sensitivity, scintigraphy is unspecific. So that a negative scan response has to be re-evaluated with other methods: if clinical status remains "negative", the diagnostic route can stop. On the contrary, in patients with "positive" scan or with local symptoms and pain, the screening of metastatic lesions must be accomplished by a combination of radiography and CT: the result may be negative (for low sensitivity of conventional radiology), not conclusive (in this case bone biopsy is necessary) or symptoms are not due to metastatic lesions (i.e., osteoarthritis). CT represents an excellent mean of defining the extent of any metastatic lesions, especially those located at sites difficult to evaluate (vertebral column and pelvis). Before bone biopsy is carried out, MRI must be performed, because it is the only technique that makes it possible to distinguish between bone marrow components. It has been used most extensively in the evaluation of spine metastases. The limitation of MRI is the unspecificity of its findings, which may lead to an equivocal diagnosis, and because only part of the skeleton can be studied.

Aged↗

Evaluation of novel one-step dry-coated tablets as a platform for delayed-release tablets.

Using a novel one-step dry-coated tablets (OSDRC) manufacturing method, which we have recently invented, we evaluated the possibility of its application to delayed-release tablets. The manufacturing method for OSDRC is different from conventional methods in that dry-coated tablets can be made with only one process. One of the major advantages of OSDRC is that we can expect to produce tablets, which always contain the core exactly in the center of the whole tablet. This characteristic means that the thickness of outer layer is constantly uniform, which is difficult to achieve with the conventional dry-coated tablets. The effects of different outer layer thicknesses and various compression pressures were examined using HPMC to evaluate OSDRC applicability to delayed-release tablets. We proved that the lag-time can be adjusted only by changing the thickness of the outer layer without any arrangement of its ingredients, which is quite different from the conventional approach. Further, the lag-time of each OSDRC prepared in the 100-200 MPa compression pressure range was almost the same, indicating the lag-time of OSDRC under these compression pressures does not vary. The release rate of the drug (acetaminophen) from the OSDRC with 0.5 and 1.0 mm outer layer thicknesses was almost constant independent of compression pressure. On the other hand, the release rate of the OSDRC with a 2.0 mm outer layer thickness was delayed compared to that of other thicknesses. That is, in the tablets with 2.0 mm outer layer thickness, the release rate declined since its outer layer thickness was sufficient to form a gel-layer. In conclusion, OSDRC could be a platform for delayed-release tablets, which do not utilize the conventional method used for dry-coated tablets.

Acetaminophen↗

The role of lasers and light sources in the treatment of leg veins.

Telangiectasia of the legs occurs in 29% to 41% of women in the United States. The variation in size, flow, depth, and type preclude the possibility of a single effective treatment modality. When a systematic approach is used where feeder vessels are first surgically removed and sclerotherapy proceeds from largest to smallest vessels, 80-90% of vessels respond to a single sclerotherapy treatment. Because of the relatively modest results demonstrated with lasers and light sources and the high rate of success and the relatively low cost of ambulatory phlebectomy, compression sclerotherapy and superficial sclerotherapy, we generally recommend using lasers and light sources only for vessels that remain after this treatment approach. Lasers and light sources should be considered prior to sclerotherapy in patients who are fearful of needles, who do not tolerate sclerotherapy, who fail to respond to sclerotherapy, or who are prone to telangiectatic matting. Carefully monitored, controlled studies are essential to better define the role of the available laser and light sources in the treatment of leg veins.

Algorithms↗

Analysis of a hybrid spectral strain estimation technique in elastography.

Conventional spectral elastographic techniques estimate strain using cross-correlation methods. Despite promising results, decorrelation effects compromise the accuracy of these techniques and, subsequently, the tissue strain estimates. Since tissue compression in the time-domain corresponds to upscaling in the frequency-domain, decorrelation effects become more pronounced as tissue strains increase and are a fundamental concern in spectral cross-correlation elastography. In this paper, a two-stage hybrid spectral elastographic technique is introduced. For the first stage, an approximated spectral scaling factor (i.e. initial strain estimate) is employed to compensate for bandwidth broadening (due to tissue compression) between pre- and post-compression power spectra pairs. The second stage then estimates any residual strain information using spectral cross-correlation methods due to improper scaling factor selection in the first stage. This novel hybrid spectral elastographic technique was compared to both conventional spectral and adaptive temporal elastographic methods in simulation and experimentation. In addition to demonstrating enhancement in performance over the conventional spectral elastographic technique, the hybrid spectral-based method introduced in this paper is shown to outperform the adaptive temporal-based elastographic approach.

Algorithms↗

Indentation analysis of biphasic articular cartilage: nonlinear phenomena under finite deformation.

The nonlinear indentation response of hydrated articular cartilage at physiologically relevant rates of mechanical loading is studied using a two-phase continuum model of the tissue based on the theory of mixtures under finite deformation. The matrix equations corresponding to the governing mixture equations for this nonlinear problem are derived using a total Lagrangian penalty finite element method, and solved using a predictor-corrector iteration within a modified Newton-Raphson scheme. The stress relaxation indentation problem is examined using either a porous (free draining) indenter or solid (impermeable) indenter under fast and slow compression rates. The creep indentation problem is studied using a porous indenter. We examine the finite deformation response and compare with the response obtained using the linear infinitesimal response. Differences between the finite deformation response and the linear response are shown to be significant when the compression rate is fast or when the indenter is impermeable. The finite deformation model has a larger ratio of peak-to-equilibrium reaction force, and higher relaxation rate than the linear model during the early relaxation period, but a similar relaxation time. The finite deformation model predicts a slower creep rate than the linear model, as well as a smaller equilibrium creep displacement. The pressure distribution below the indenter, particularly near the loaded surface is also larger with the finite deformation model.

Adhesiveness↗

[Magnetic resonance myelography with a fast-spin-echo sequence].

A major application of Magnetic Resonance Imaging (MRI) consists in the "myelographic effect", characterized by high signal intensity of the CSF, which permits to visualize spinal subarachnoid spaces and nerve root sheaths. Such new ultrafast pulse sequences as fast spin echo (FSE) further enhance CSF high signal intensity. In addition, suppressing background with the fat suppression technique and with maximum intensity projection (MIP), a particular algorithm already used in MR angiography, FSE sequences yield 3D myelography-like images. Our study was aimed at assessing the clinical role and the reliability of this technique. Our preliminary experience is based on 21 patients with pain in the lower back and legs and on 5 healthy volunteers; all the myelography-like images were obtained with a 1.5-T MR system (Signa, General Electric). The parameters for FSE myelography-like images included: TR = 6000, TE = 200, ETL = 32, thickness = 3 mm, matrix = 256 x 224, Nex = 4, FOV = 20 cm, fat presaturation, no phase wrap, acquisition time = 2 min 58 s. MR myelography sequences were acquired after a standard FSE T1/T2-weighted exam. MR-myelography results confirmed the diagnosis of disk herniation made on conventional T1/T2-weighted images, especially in thecal sac compression and/or amputation of nerve root sheaths. MR myelography appeared to be especially useful in migrated disk herniation or in abnormal origin of nerve roots. Moreover, it allowed full and panoramic visualization of the subarachnoid spaces and excellent definition of the thecal sac, nerve roots and nerve root sheaths. In one patient only movement artifacts affected image quality. To conclude, even though it fails to yield any functional information, MR myelography appears to be an easy, rapid and noninvasive support to conventional MRI of the lumbar spine, to replace conventional myelography.

Female↗

Internet2-based 3D PET image reconstruction using a PC cluster.

We describe an approach to fast iterative reconstruction from fully three-dimensional (3D) PET data using a network of PentiumIII PCs configured as a Beowulf cluster. To facilitate the use of this system, we have developed a browser-based interface using Java. The system compresses PET data on the user's machine, sends these data over a network, and instructs the PC cluster to reconstruct the image. The cluster implements a parallelized version of our preconditioned conjugate gradient method for fully 3D MAP image reconstruction. We report on the speed-up factors using the Beowulf approach and the impacts of communication latencies in the local cluster network and the network connection between the user's machine and our PC cluster.

Algorithms↗

In-vivo imaging of skin under stress: potential of high-frequency (20 MHz) static 2-D elastography.

The aim of this study was to evaluate the potential of high-frequency static two-dimensional (2-D) elastography for in vivo exploration of the mechanical behavior of skin. Our device was based on the combination of a 20 MHz sonographer and a patented extensiometer device able to apply calibrated uniaxial stretching of the skin. We used a new algorithm to compute elastograms that improve elastographic signal-to-noise ratio (SNRe) without sacrificing resolution. Mechanical behavior was described according to the axial strain and lateral displacements induced in the tissue. The efficacy of the strain anpolyvinyl alcohol first evaluated in polyvinyl alcohol (PVA)-cryogel phantoms. Several in vivo experiments then were conducted, mainly with the multistretching averaging method, and demonstrated the potential of this technique in the evaluation of mechanical behavior of the dermis and the hypodermis under stress.

Compressive Strength↗

Low HRV entropy is strongly associated with myocardial infarction.

Heart rate variability (HRV) is a marker of autonomous activity in the heart. An important application of HRV measures is the stratification of mortality risk after myocardial infarction. Our hypothesis is that the information entropy of HRV, a non-linear approach, is a suitable measure for this assessment. As a first step, to evaluate the effect of myocardial infarction on the entropy, we compared the entropy to standard HRV parameters. The entropy was estimated by compressing the tachogram with Bzip2. For univariate comparison, statistical tests were used. Multivariate analysis was carried out using automatically generated decision trees. The classification rate and the simplicity of the decision trees were the two evaluation criteria. The findings support our hypothesis. The meanNN-normalized entropy is reduced in patients with myocardial infarction with very high significance. One entropy parameter alone exceeds the discrimination strength of multivariate standards-based trees.

Algorithms↗

Pneumothorax as a complication of recompression therapy for cerebral arterial gas embolism.

The danger from pneumothorax in patients who undergo compression chamber treatment for cerebral arterial gas embolism (CAGE) following pulmonary barotrauma is frequently emphasized. Two cases of CAGE treated by recompression after submarine escape tank training (SETT) accidents are described. Both were complicated by bilateral pneumothoraces but the first case, treated on an air table, required thoracentesis in the chamber, whereas the second case, treated on an oxygen table, escaped the need for in-chamber thoracentesis despite large pneumothoraces. Review of similar Royal Navy and United States Navy SETT accidents suggests that the danger from pneumothorax during recompression treatment of CAGE victims may be overstated. Modern management on oxygen-based therapeutic recompression tables may significantly reduce the risk. Thoracentesis while under pressure should be reserved for cases developing symptoms or signs of tension pneumothorax. Treatment options for these cases are discussed and a decision algorithm is proposed.

Atmosphere Exposure Chambers↗

Thermal residual stresses near the interface between plasma-sprayed hydroxyapatite coating and titanium substrate: finite element analysis and synchrotron radiation measurements.

Plasma-sprayed hydroxyapatite (HA) coatings on titanium alloy are often used in prosthetic implants. The metallic substrate gives the implant good mechanical strength which is combined with good biocompatibility and osteointegration of the ceramic coating. However, the interface between the HA coating and titanium alloy substrate is an area of critical weakness when compared with the interlamellar cohesive strength of the HA coating structure. Knowledge of the stresses in materials near the interface seems to be an important step in understanding why failure occurs. Synchrotron radiation, using Beamline BM16 at the European Synchrotron Radiation Facility (Grenoble, France), has been used to determine local stresses near the interface, down to 10 microm in resolution, between a plasma-sprayed HA coating and a titanium alloy substrate. This experimental determination of residual stresses is compared with the results found by a finite element analysis modeling the thermal effects of the plasma-spraying process. Residual stresses have been found in deposited ceramic near the interface due to a thermal properties mismatch of the materials. If the plane stress state is assumed, meaning the perpendicular component of residual stress is ignored (sigma(z) = 0), then the synchrotron residual stress measurements should be interpreted as mainly compressive in the ceramic coating. This is in contradiction with the coefficient of thermal expansion mismatch; therefore, the simplified plane stresses assumption seems to be inappropriate for the deposited morphology characterized by pores and a network of microcracks. The detailed finite element analysis model, taking into account the real morphology of the coating and the real three-dimensional stress field distribution, allowed the estimation of sigma(z), leading to a more accurate interpretation of synchrotron measurements, which is validated by the experimental results.

Algorithms↗

The Pennsylvania Plan II: an algorithm for the management of lumbar degenerative disc disease.

We have thus presented a series of decision-making processes that are easy to follow, clearly defined, and cost effective. We have found that with the use of this decision-making algorithm our patients receive the therapeutic measures most helpful at the optimal time and are neither denied helpful surgery nor submitted to operations that are useless surgical exercises. With the use of this protocol, we believe that our efficiency as surgeons, physicians, and advisors will increase and the specter of fear found in the general population regarding low back pain will diminish.

Adult↗

Loading conditions and cortical bone construction of an artiodactyl calcaneus.

Customary nonuniform distributions of physiological bone strains are thought to evoke heterogeneous material adaptation in diaphyseal cortices of some limb bones. Recent studies of artiodactyl calcanei have suggested that the regional prevalence of specific mechanical strain features such as mode and magnitude correlate with specific variations in cortical bone ultrastructure, microstructure and mineralization. These data are also consistent with predictions of current algorithms of mechanically induced bone adaptation. However, detailed characterization of the customary functional strain environment of these bones is needed to understand better the mechanisms of these adaptations. An in vitro loading method and rosette strain gauges were used to record principal strains, maximum shear strains and principal strain angles at multiple locations on ten calcanei of adult male mule deer (Odocoileus hemionus hemionus). Each hind limb was fixed in an apparatus to mimic the mid-support phase of the gait and loaded via the Achilles tendon over a broad range of functional loads (0 to 2943 N). Strains were recorded on the craniolateral, craniomedial, caudal, medial and lateral cortices at mid-diaphysis. Loading variations included the progressive elimination of the ligament and tendon along the caudal calcaneus. The results showed that the cranial cortex experiences longitudinal compressive strains that are nearly equal to the principal minimum strains and that the caudal cortex receives longitudinal tensile strains that are nearly equal to the principal maximum strains. With a 981 N load, the mean principal compressive strain on the cranial cortex was -636+/-344 micro(&egr;) (mean +/- s.d., N=9) and the mean principal tensile strain on the caudal cortex was 1112+/-68 micro;(&egr;)x (N=9). In contrast to the cranial and caudal cortices, principal strains in the medial and lateral cortices displayed relatively large deviations from the longitudinal axis (medial, 24 degrees cranial; lateral, 27 degrees caudal). Although shear strains predominated at all gauge sites, variations in maximum shear strains showed no apparent regional pattern or consistent regional predominance. The plantar ligament and tendon of the superficial digital flexor muscle were shown to have important load-sharing functions. These results demonstrate that the functionally loaded artiodactyl calcaneus generally behaves like a cantilevered beam with longitudinal compression and tension strains predominating in opposing cranial and caudal cortices, respectively. Differences in osteon remodeling rates, osteon morphology and mineral content reported previously between the cranial and caudal cortices correlate, in part, with the magnitudes of the principal compressive and tensile strains, respectively. However, material differences that distinguish the medial and lateral cortices from the cranial and caudal cortices could not be primarily attributed to locally increased shear strains as previously suggested. Variations in osteon and/or collagen fiber orientation may correlate more strongly with principal strain direction.

Animals↗