Real time signal processing in the clinical setting

We routinely use a variety of real time signal acquisition, enhancement, and display techniques in the operating room to provide the surgeon with functional information. This enables reduction of surgical morbidity in cases which present a significant risk to the nervous system. Here we present regression based signal processing algorithms which produce considerable signal-to-noise-ratio enhancement with corresponding reduction in the time required to obtain an interpretable neurophysiological signal. We also present the approach we have applied to fault tolerance and distributed data display for our workstation cluster environment.     

Nocturnal evolution of respiratory effort in obstructive sleep apnoea syndrome: influence on arousal threshold

It has been recently described that the overnight increase in maximal end-apnoeic oesophageal pressure (P(oes,max)), considered as an index of the arousal threshold to occlusion, mostly contributes to apnoea lengthening during the night. However, the rise in apnoea duration could also be caused by changes in hypoxaemia, chemosensitivity and upper airway resistance. To better define the relative contributions of each of these factors, we examined the recordings of nine patients. Before apnoea, the mean pulmonary resistance at peak inspiratory flow (RPIF) was computed. During apnoea, all swings in oesophageal pressure (P(oes)) were measured to define the P(oes,max), the increase from the minimum to the maximum (deltaP(oes)), the rate of increase in P(oes) (RP(oes)) and the P(oes) at the first occluded breath (P(oes,1)). A gradual and significant increase in apnoea duration (p=0.02), P(oes,max) (p=0.02) and deltaP(oes) (p=0.006) was present across the night without any changes in oxygen saturation, RPIF, and P(oes,1). The slope of increase in P(oes,max), apnoea duration and deltaP(oes) was correlated with the apnoea/hypopnoea index. We conclude that in obstructive sleep apnoea, the nocturnal rise in apnoea duration is attributable more to an increase in the arousal threshold related to apnoea recurrence than to changes in chemosensitivity and upper airway resistance.     

The other side of scavenger receptors: pattern recognition for host defense

Scavenger receptors bind modified lipoproteins and may play an important role both in normal and in pathological lipid metabolism. A number of different classes of scavenger receptors have been identified and several of these are multiligand receptors. Studies, both in vitro and in vivo, have indicated that at least some of these scavenger receptors may serve as pattern recognition receptors because they are able to bind a wide variety of pathogens. As a consequence, they may play key roles in innate immunity and host defense.     

NeuroNet: collaborative intraoperative guidance and control

Neurophysiological monitoring assesses CNS structure function relationships during surgery. NeuroNet supports remote performance of this task through real time multimodal data processing and multimedia network communication. The system is fully integrated, transparently combining the collection, processing, and presentation of real time data sources, including all physiological monitoring functions, with non real time functions and extensive online database information. Workstations are mounted in instrumentation racks and configured with appropriate electronics to support various data acquisition tasks including electroencephalograms (EEGs), electromyograms (EMGs), and multimodality evoked potentials. Multiple racks can be used in parallel on the same case if the number of variables to be monitored exceeds the capacity of a single tack. The data acquired on these systems is transparently accessible, in real time, across the network for both review and analysis     

Moderately doped NMOS (M-LDD)-hot electron and current driveoptimization

Short-channel NMOS transistors with moderately doped drain (10¹⁴ cm^-2), and variable sidewall oxide spacer thickness were fabricated and studied. The sensitivities of hot carrier degradation, current drive capability, and other device parameters to the sidewall spacer thickness were measured and evaluated. The results clearly indicate that a moderately doped drain (M-LDD) provides a stable and well-optimized device, compared to a conventional LDD transistor with substantially lower implant dose. A simple model, explaining the observations, is proposed and discussed     

High-dose chemotherapy with autologous peripheral blood stem cell transplantation for metastatic gastric leiomyosarcoma

We report a case of metastatic gastrointestinal leiomyosarcoma treated with high-dose combination chemotherapy and autologous peripheral blood stem cell transplantation. After incomplete surgical resection, enteral, peritoneal and hepatic involvement remained. Postoperatively, standard-dose chemotherapy with etoposide, ifosfamide, cisplatin and epirubicine, and high-dose chemotherapy with the same agents (carboplatin replacing cisplatin) was given. Treatment was well tolerated and the patient remains in complete remission at 36+ months. We conclude that high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation may be of use as treatment for inoperable residual disease after resection of the primary lesion in gastrointestinal and other soft tissue sarcomas.     

Short-duration nocturnal hypoxemia and persistent pulmonary hypertension

Can daily short-duration hypoxemia (4-8 hours) induce pulmonary hypertension and right ventricular hypertrophy? A clinical model of this type of hypoxemia does exist: isolated nocturnal hypoxemia in patients with obstructive sleep apnea syndrome (OSAS) or chronic obstructive pulmonary disease (COPD). By investigating the pulmonary hemodynamics of these patients, it should be possible to determine whether nocturnal hypoxemia alone can induce pulmonary hypertension. Although nocturnal hypoxemia (in OSAS as well as in COPD) can induce acute episodes of pulmonary hypertension, it would not appear that nocturnal hypoxemia alone would be sufficient to provoke permanent diurnal pulmonary hypertension. This is the conclusion of recent studies concerning diurnal pulmonary hemodynamics in OSAS and COPD patients exhibiting minimal hypoxemia during the day but significant nocturnal desaturation. The therapeutic consequences of these data, particularly in COPD are important: current evidence is insufficient to treat with nocturnal oxygen therapy COPD patients who have minimal diurnal hypoxemia but significant nocturnal desaturation.