Forecasting the unresponsiveness to verbal command on the basis of EEG frequency progression during anesthetic induction with propofol

The objective of this study is to model the association between the electroencephalogram (EEG) spectral features and the novel r scale representing the sedative effects of the propofol anesthetic drug. On the basis of the r scale, the unresponsiveness to the verbal command (LVC) is forecasted. EEG recordings are taken from a 16-patient study population undergoing propofol anesthetic induction. EEG was filtered into consecutive 4-Hz passbands up to 28 Hz. Of these time-series, the amplitude envelopes were extracted and used as input features to the first and the second-order polynomial multiple linear regression models. The values r epsilon [0.4, 1] were predicted with the R2 value of 0.775 with a cross validation. The LVC times were forecasted with the median error of 5%-7% or equivalently 10-13 s. In contrast, using the median of the measured LVC times of the training population as a forecast, the corresponding error was 12% or 26 s. The results suggest an acceptable correlation between the r scale and the EEG spectrum in the studied range. Moreover, the r values of an individual can be predicted using a population model. The suggested framework enables forecasting the LVC, which may open new possibilities for steering the drug administration.     

A fast modelling tool for plate heat exchangers based on depth-averaged equations

In this study, the depth-averaged flow and energy equations for plate heat exchangers are presented. The equations are derived by integrating the original 3D flow and energy equations over the height of the gap between the bottom and top plates. This approach reduces the equations from 3D to 2D but still takes into account the frictions on the surfaces and heat transfer through the plates. The depth-averaging reduces the elapsed time of CFD simulations from hours to minutes. Thus, it is very practicable modelling method in real time design work. 2D CFD simulations with depth-averaged equations are compared with full 3D models for five different corrugation angles and corrugation lengths. The simulation results show that the 2D model predicts with relatively good accuracy the profile of the pressure drop and the temperature change as a function of the corrugation angle and the function of the corrugation length. In order to get more extensive information about the significance of the different geometry parameters on the efficiency of the heat exchanger, we simulated 30 different geometries with the fast 2D model. The results suggest that the temperature change is not as sensitive for the geometrical modifications as the pressure drop.     

Views of hospital staff on the management of hypertension

A questionnaire concerning the detection and management of hypertension was presented to 265 hospital doctors, 114 medical students and 59 student nurses. Of these 75% were completed. Although only 76% thought that routine measurement was necessary in outpatients, 92% of respondents thought that blood pressure (BP) should be measured routinely in all in-patients. A total of 17% of all doctors and 11% of physicians indicated that they would not use drug treatment until the diastolic BP exceeded 105 mmHg. Thirty-four per cent of respondents still use diastolic phase IV and 84% felt that BP should be measured 2-4 times before deciding on treatment but the posture of the patient (lying, sitting or standing) during recording was inconsistent. Seventy-seven per cent of respondents indicated that they recorded BP to the nearest 5 mmHg and 4% to the nearest 10 mmHg. Despite the literature on the subject, there are still widely differing opinions amongst medical staff on how to record BP and at what level it should be treated.     

Participation of AT1 and AT2 receptor subtypes in the tonic inhibitory modulation of baroreceptor reflex response by endogenous angiotensins at the nucleus tractus solitarii in the rat

Although myelin basic protein (MBP)-recognizing T cells are not readily obtained after immunization of BALB/c mice with MBP (reflecting the BALB/c resistance to actively induced experimental autoimmune encephalomyelitis (EAE)), they can be expanded and cloned after several rounds of in vitro culture. The majority of BALB/c-derived clones recognize an epitope defined by MBP peptide 59-76. When transferred to naive BALB/c recipients, these clones cause classical EAE, with characteristic inflammation and demyelination of the central nervous system (CNS). We previously showed that two related clones recognizing a minor epitope, defined by MBP peptide 151-168, cause inflammation and demyelination preferentially of the peripheral nervous system (PNS). Because MBP has alternatively spliced isoforms, residues 151-168 are not present contiguously in all MBP isoforms. In order to determine whether induction of PNS disease is idiosyncratic to these sister clones, or related to their properties of epitope recognition, an independent T-cell line with similar recognition properties was studied. Clone 116F, derived from a BALB/c shiverer mouse, expresses a different T-cell receptor (TCR), with distinct TCR contact residues, but like the previously described T cells, this clone requires residues from both exons 6 and 7 for optimal stimulation. When adoptively transferred to BALB/c recipients, this clone preferentially induces disease of the PNS. A control BALB/c shiverer-derived MBP 59-76-recognizing clone, in contrast, induces CNS disease. These data strongly suggest that the site of disease initiation may correlate with epitope recognition, particularly when alternative isoforms are involved.     

Effects of preliminary muscular exercise on body temperature, water loss and physical performance

We investigated the effects of preliminary exercise (muscular warm-up) on body temperature, water loss and physical performance during consecutive sustained exercise. Thirty-one untrained men aged 21 to 30 years old (mean 25.12 +/- 2.92) were subjected to two physical trial tests at 75% Pma. One trial. (T - PE) was performed without preliminary exercise (PE) and the other (T + PE) was preceded by 15 minutes of preliminary exercise performed at 50% Pma. The trials involved pedaling an ergocycle until exhaustion, followed by a 30 minutes period of inactive recovery. The rate of increase of body temperature during the work consecutive to preliminary exercise (T + PE) was lower than that of the work without preliminary exercise (T - PE). The energy output and water loss during T + PE were significantly (P < 0.01) greater than during T - PE. However, the body temperatures at the end of the two tests were identical. The rate of decrease of body temperature, measured after 30 minutes of recovery, was higher for T + PE than T - PE. The duration of work was increased by PE for 25 (80.65%) subjects and decreased for 6 (19.35%). We conclude that preliminary exercise allows better adjustment of thermohydric regulation by moderating the rise in body temperature and increasing water loss during physical work. For most subjects, these adjustments allow improved endurance.     

Methodology of serial ECG classification using an adaptation of the NOVACODE for Q wave myocardial infarction in the Bypass Angioplasty Revascularization Investigation (BARI)

Serial electrocardiographic (ECG) changes are a critical component of the diagnostic algorithm for classification of myocardial ischemic events in large-scale clinical trials. This study describes a computerized serial ECG classification program developed at the St. Louis University Core ECG Laboratory for use in the Bypass Angioplasty Revascularization Investigation (BARI) trial, in which patients with multivessel coronary artery disease were randomized to receive either coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. The St. Louis University program detects and codes serial changes in Q, ST, and T wave items according to Minnesota code (MC) criteria using a modified NOVACODE hierarchical classification system. Measurements using a seven-power calibrated coding loupe are used to generate the MC from a customized software program. Significant minor or major changes are detected by the serial comparison program and referred to a physician coder for verification. Serial comparison coding rules are used to adjust for weaknesses in the standard MC classification system resulting from instability at decision boundaries. Of 4,244 BARI randomized and registry study participants with follow-up ECGs received at the Core ECG Laboratory as of March 1995, a grade 2 MC Q wave progression was noted in 568 participants (13.4%) using MC criteria alone, as compared with 367 (8.6%) after the St. Louis University coding rules were applied. The incidence of grade 1 MC Q wave progressions was 16.4% (697/4,244) versus 6.1% (259/4,244) when the St. Louis University program was applied. Intraobserver variability for grade 2 Q wave progression codes determined from a sample of 812 serial.