Relation between periodontal disease and arterial stiffness.

BACKGROUND AND OBJECTIVE: Periodontal disease has been described as playing a role in the atherosclerosis process, and its relation with intimal thickness and vascular endothelial function (EF) has been investigated. The present study sought to determine whether there are differences in parameters of arterial stiffness and EF between patients with and without severe periodontal disease (SPD). MATERIAL AND METHODS: Patients referred to the School of Dentistry University of Buenos Aires, were assessed. Demographic characteristics, atherogenic risk factors and concomitant pathologies were recorded. Patients with known cardiovascular pathology were excluded. Using carotid Doppler ultrasound an operator assessed arterial stiffness parameters: compliance, elastic modulus (EM), ß stiffness index (ßSI) and vascular EF by brachial artery flow-mediated dilatation. The patients were divided into two groups: with and without SPD. RESULTS: Forty patients were included; 60% were women; 15 were in the SPD group and 25 in the group without SPD. Respective results of the studied variables were: age 56.53 ± 17.58 vs. 51.12 ± 12.97 years (NS); probing depth 2.53 ± 1.30 (95% CI 1.81-3.25) vs. 1.25 ± 0.51 (95% CI 1.31-1.73) p = 0.02; clinical attachment level 4.80 ± 2.00 (95% CI 3.69-5.91) vs. 1.72 ± 0.93 (95% CI 1.33-2.11) p = 0.001; intimal thickness 0.10 ± 0.17 (95% CI 0.095-0.11) vs. 0.82 ± 0.18 (95% CI 0.074-0.98) (NS); EM 48.33 ± 12.53 vs. 38.86 ± 7.69 (p = 0.005); ßSI 4.21 ± 1.03 vs. 3.64 ± 1.02 (p = 0.004); EF 16.13 ± 5.02 vs. 22.76 ± 4.50 (p = 0.0003). Correlation between: EM and clinical attachment level r = 0.58 (p < 0.001), ßSI and clinical attachment level r = 0.66 (p < 0.001), EF and clinical attachment level 0.59 (p < 0.001). CONCLUSIONS: Parameters of arterial stiffness and EF were worse in patients with SPD and correlated moderately with clinical attachment level. Correlation with compliance and EF was negative.

Feasibility of iterative learning control mediated by functional electrical stimulation for reaching after stroke.

BACKGROUND: An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and functional electrical stimulation (FES) to reduce upper limb impairments, but current systems may not encourage maximal voluntary contribution from the participant because assistance is not responsive to performance. OBJECTIVE: This study aimed to investigate whether iterative learning control (ILC) mediated by FES is a feasible intervention in upper limb stroke rehabilitation. METHODS: Five hemiparetic participants with reduced upper limb function who were at least 6 months poststroke were recruited from the community. No participants withdrew. INTERVENTION: Participants undertook supported tracking tasks using 27 different trajectories augmented by responsive FES to their triceps brachii muscle, with their hand movement constrained in a 2-dimensional plane by a robot. Eighteen 1-hour treatment sessions were used with 2 participants receiving an additional 7 treatment sessions. OUTCOME MEASURES: The primary functional outcome measure was the Action Research Arm Test (ARAT). Impairment measures included the upper limb Fugl-Meyer Assessment (FMA), tests of motor control (tracking accuracy), and isometric force. RESULTS: Compliance was excellent and there were no adverse events. Statistically significant improvements were measured (P

A robotic workstation for stroke rehabilitation of the upper extremity using FES.

An experimental test facility is developed for use by stroke patients in order to improve sensory-motor function of their upper limb. Subjects are seated at the workstation and their task is to repeatedly follow reaching trajectories that are projected onto a target above their arm. To do this they use voluntary control with the addition of electrical stimulation mediated by advanced control schemes applied to muscles in their impaired shoulder and arm. Full details of the design of the workstation and its periphery systems are given, together with a description of its use during the treatment of stroke patients.

Comparison of sound fields generated by different coded excitations--experimental results.

This work reports the results of measurements of spatial distributions of ultrasound fields obtained from five energizing schemes. Three different codes, namely, chirp signal and two sinusoidal sequences were investigated. The sequences were phase modulated with 13 bits Barker code and 16 bits Golay complementary codes. Moreover, two reference signals generated as two and sixteen cycle sine tone bursts were examined. Planar, 50% (fractional) bandwidth, 15 mm diameter source transducer operating at 2 MHz center frequency was used in all measurements. The experimental data were collected using computerized scanning system and recorded using wideband, PVDF membrane hydrophone (Sonora 804). The measured echoes were compressed, so the complete pressure field in the investigated location before and after compression could be compared. In addition to a priori anticipated increase in the signal to noise ratio (SNR) for the decoded pressure fields, the results indicated differences in the pressure amplitude levels, directivity patterns, and the axial distance at which the maximum pressure amplitude was recorded. It was found that the directivity patterns of non-compressed fields exhibited shapes similar to the patterns characteristic for sinusoidal excitation having relatively long time duration. In contrast, the patterns corresponding to compressed fields resembled those produced by brief, wideband pulses. This was particularly visible in the case of binary sequences. The location of the maximum pressure amplitude measured in the 2 MHz field shifted towards the source by 15 mm and 25 mm for Barker code and Golay code, respectively. The results of this work may be applicable in the development of new coded excitation schemes. They could also be helpful in optimizing the design of imaging transducers employed in ultrasound systems designed for coded excitation. Finally, they could shed additional light on the relationship between the spatial field distribution and achievable image quality and in this way facilitate optimization of the images obtained using coded systems.

Wave envelopes method for description of nonlinear acoustic wave propagation.

A novel, free from paraxial approximation and computationally efficient numerical algorithm capable of predicting 4D acoustic fields in lossy and nonlinear media from arbitrary shaped sources (relevant to probes used in medical ultrasonic imaging and therapeutic systems) is described. The new WE (wave envelopes) approach to nonlinear propagation modeling is based on the solution of the second order nonlinear differential wave equation reported in [J. Wójcik, J. Acoust. Soc. Am. 104 (1998) 2654-2663; V.P. Kuznetsov, Akust. Zh. 16 (1970) 548-553]. An incremental stepping scheme allows for forward wave propagation. The operator-splitting method accounts independently for the effects of full diffraction, absorption and nonlinear interactions of harmonics. The WE method represents the propagating pulsed acoustic wave as a superposition of wavelet-like sinusoidal pulses with carrier frequencies being the harmonics of the boundary tone burst disturbance. The model is valid for lossy media, arbitrarily shaped plane and focused sources, accounts for the effects of diffraction and can be applied to continuous as well as to pulsed waves. Depending on the source geometry, level of nonlinearity and frequency bandwidth, in comparison with the conventional approach the Time-Averaged Wave Envelopes (TAWE) method shortens computational time of the full 4D nonlinear field calculation by at least an order of magnitude; thus, predictions of nonlinear beam propagation from complex sources (such as phased arrays) can be available within 30-60 min using only a standard PC. The approximate ratio between the computational time costs obtained by using the TAWE method and the conventional approach in calculations of the nonlinear interactions is proportional to 1/N2, and in memory consumption to 1/N where N is the average bandwidth of the individual wavelets. Numerical computations comparing the spatial field distributions obtained by using both the TAWE method and the conventional approach (based on a Fourier series representation of the propagating wave) are given for circular source geometry, which represents the most challenging case from the computational time point of view. For two cases, short (2 cycle) and long (8 cycle) 2 MHz bursts, the computational times were 10 min and 15 min versus 2 h and 8 h for the TAWE method versus the conventional method, respectively.

Clinical features of ciguatera fish poisoning: a study of the disease in the US Virgin Islands.

Clinical data were obtained on 33 patients involved in 27 episodes of ciguatera fish poisoning occurring during a 14-week period on St Thomas in the US Virgin Islands. All patients had gastrointestinal tract symptoms, with 30 patients (91%) complaining of diarrhea and 23 patients (70%) complaining of vomiting; these symptoms occurred early in the disease and were of short duration. Twenty-three patients (70%) complained of malaise, and 19 patients (58%) had pain and weakness in the lower extremities. Dysesthesias were noted by 19 patients (58%); the median duration of dysesthesias was two weeks or more, with symptoms present is some cases for more than two months. Cardiovascular signs and symptoms, including both hypotension and bradycardia were noted in some acute cases. Therapy included antidiarrheal and antiemetic agents, intravenous fluids, atropine, and pralidoxime chloride. Efficacy of pralidoxime therapy could not be established on the basis of our data.

Acousto-optic, point receiver hydrophone probe for operation up to 100 MHz.

This work describes the results of initial evaluation of a wideband acousto-optic hydrophone probe designed to operate as point receiver in the frequency range up to 100 MHz. The hydrophone was implemented as a tapered fiber optic (FO) probe sensor with a tip diameter of approximately 7 microm. Such small physical dimensions of the sensor eliminate the need for spatial averaging corrections so that true pressure-time (p-t) waveforms can be faithfully recorded. The theoretical considerations that predicted the FO probe sensitivity to be equal to 4.3 mV/MPa are presented along with a brief description of the manufacturing process. The calibration results that verified the theoretically predicted sensitivity are also presented along with a brief description of the improvements being currently implemented to increase this sensitivity level by approximately 20 dB. The results of preliminary measurements indicate that the fiber optic probes will exhibit a uniform frequency response and a zero phase shift in the frequency range considered. These features might be very useful in rapid complex calibration i.e. determining both magnitude and phase response of other hydrophones by the substitution method. Also, because of their robust design and linearity, these fiber optic hydrophones could also meet the challenges posed by high intensity focused ultrasound (HIFU) and other therapeutic applications. Overall, the outcome of this work shows that when fully developed, the FO probes will be well suited for high frequency measurements of ultrasound fields and will be able to complement the data collected by the current finite aperture piezoelectric PVDF hydrophones.

The effects of prenatal ultrasound exposure on postnatal growth and acquisition of reflexes.

The examination of pregnant women using diagnostic ultrasound has increased greatly over past decades in the United States. As sonography techniques have been altered and refined, there has been renewed interest concerning possible effects on the developing fetus, since exposures in mid-gestation occur during the sensitive period of brain development. The present study is concerned with possible neonatal functional deficits due to exposure of the fetus to ultrasound. An ultrasound exposure tank was designed specifically for controlled studies of bioeffects. Thirty-six pregnant rats were anesthetized, immersed to the axilla in a water tank and exposed on the 15th, 17th and 19th days of gestation. Twelve rats were exposed to 5.0 MHz pulsed ultrasound of effective pulse duration equal to approximately 0.170 microseconds, pulse repetition rate 1 kHz, and a spatial peak, temporal peak intensity (ISPTP) of 500 W/cm2, representing a clinically relevant exposure level. The spatial peak, pulse average intensity (ISPPA), spatial peak temporal average intensity (ISPTA) and maximum intensity (Im) were determined to be 100 W/cm2, 24 mW/cm2 and 230 W/cm2, respectively. The maximum rarefaction pressure, pr, was measured as 12.5 x 10(5) Pa, and the total power was 2.5 mW. Twelve other rats were exposed to 1500 W/cm2, ISPTP (ISPPA, 350 W/cm2; ISPTA, 58 mW/cm2; Im, 600 W/cm2). Twelve additional rats were sham-exposed. Since the focal area was about 0.5 cm2, computer-controlled stepper motors moved the rats through the ultrasound field to assure uniform exposure of the abdominal/pelvic region. Total exposure time was 35 min. Additionally, a miniature thermocouple was implanted in a few rats to verify that no significant increase in body temperature took place during exposure. All neonates were subjected to five reflex tests and observed for four physiological parameters. Postnatal growth also was monitored. Analyses of the data indicate there were no significant alterations in neonatal development or postnatal growth due to exposure to 5.0 MHz ultrasound below an intensity (ISPTP) of 1500 W/cm2. Studies continue to be completed at higher exposure levels to determine the margin of safety, and the animals will continue to be monitored and evaluated through young adulthood to determine if there are long-term behavioral effects due to fetal exposure to ultrasound.

Ciguatera fish poisoning epidemiology of the disease on St. Thomas, U.S. Virgin Islands.

In a random household survey conducted on St. Thomas, U.S. Virgin Islands, the incidence of ciguatera fish poisoning was found to be 36.5 cases per 1,000 population per 5 years (95% confidence limits +/- 16.9 cases per 1,000 population per 5 years). An average of 3.6 cases per 1,000 population per year were diagnosed in the hospital emergency room on St. Thomas. Cases seen in the emergency room occurred most frequently among persons aged 30-39 years. No clear seasonality for cases could be demonstrated. In an investigation of cases occurring between 1 January and 10 April 1980, illness was caused by a variety of different fish, with carrang (Caranx ruber) the species most commonly implicated. Patients and age-matched controls ate fish with equal frequency; patients were significantly more likely to have had previous episodes of ciguatera fish poisoning than were controls.

Isolated late-onset cone-rod dystrophy revealing a familial neurogenic muscle weakness, ataxia, and retinitis pigmentosa syndrome with the T8993G mitochondrial mutation.

PURPOSE: To report a late-onset cone-rod dystrophy that revealed a familial neurogenic muscle weakness, ataxia, and retinitis pigmentosa syndrome as a consequence of the T8993G mitochondrial mutation. METHODS: Observational case series. A 42-year-old female disclosed a late-onset retinal dystrophy. The family history revealed that her three sons, one of them deceased at the age of 4, had mental and neurologic impairment of variable severity. The retinal dystrophy of the mother was classified as a cone-rod dystrophy. Retinal dystrophy was subsequently diagnosed in the two surviving sons. Screening for mutation in the mitochondrial DNA (mtDNA) was performed because of the combination of neurologic involvement and retinal dystrophy in this family. RESULTS: Molecular analysis of the mtDNA revealed the ATPase-6 gene T8993G mutation in the mother and the two sons. CONCLUSION: This family illustrates the remarkably variable expression of retinal and systemic manifestations related to the T8993G mutation ranging from an isolated late-onset cone-rod dystrophy to a severe neurodegenerative process with a dramatic outcome. Genetic counseling for retinal dystrophies requires careful evaluation of the familial medical history.

Connexin 26 gene mutations in congenitally deaf children: pitfalls for genetic counseling.

OBJECTIVE: To evaluate difficulties encountered in genetic counseling in deaf children carrying connexin 26 gene (CX26 or GJB2) mutations. DESIGN: Prospective study. SETTING: Outpatients, tertiary referral center. PATIENTS: Ninety-six unrelated deaf children in whom CX26 mutations had been detected consecutively. Children were recruited to a center for genetic counseling for deaf children, and all had congenital deafness, sporadic or familial. RESULTS: In 63 children, deafness was clearly a DFNB1 form with autosomal recessive inheritance: 47 of the 63 were homozygous for the most frequent mutation, the deletion of G at position 35 (35delG); 16 of 63 carried on both alleles of CX26 frameshift or stop mutations, or missense mutations affecting a critical region of the gene. In 33 of 96 children, genetic counseling was difficult: 21 of 33 had a single mutation detected, 11 of 33 had new missense mutations or mutations whose pathogenicity remains debated in the literature, and 1 of 33 had a genotype with both a recessive mutation (35delG) and a mutation acting as a dominant mutation. CONCLUSIONS: Interpretation of results for the molecular diagnosis of mutations in the connexin 26 gene is difficult in almost one third of cases. Close collaboration between geneticists familiar with deafness and otolaryngologists is essential to provide a high standard of genetic advice.

Thermoacoustic sensor for ultrasound power measurements and ultrasonic equipment calibration.

This paper describes a thermoacoustic sensor developed for measurements of the acoustic power and calibration of ultrasonic transducers in the medical imaging and nondestructive testing frequency range. It is shown that the equilibrium temperature produced by ultrasound absorption in an absorbing material and detected by a copper-constantan thermocouple is proportional to the square of the current applied to the acoustic source. It is also demonstrated that the simultaneous measurement of this current and the corresponding equilibrium temperature at a given frequency allow the transmitting current sensitivity of the acoustic source to be calculated. The sensor thus provides a useful and low-cost alternative to the expensive calibration methods such as those based on the reciprocity technique, the planar scanning technique and the radiation force balance. The principles of the sensor's operation are outlined and its construction and characteristics are described. Experimental data in the frequency range of 1-8 MHz are presented and the advantages and disadvantages of the sensor are discussed.

Voltage sensitivity response of ultrasonic hydrophones in the frequency range 0.25-2.5 MHz.

Frequency responses of different PVDF polymer hydrophones, including membrane and needle designs, were measured and are presented in terms of end-of-cable voltage sensitivity vs. frequency over a wide, 4.5-octave bandwidth ranging from 0.25-2.5 MHz. The experimental data indicate that the membrane PVDF hydrophones can exhibit uniform, to within +/- 0.75 dB, responses. However, a widely used bilaminar membrane hydrophone-preamplifier combination may display sensitivity variations of +/- 2 dB. Also, even well-designed needle-type hydrophones show a more distinct sensitivity variation below 1 MHz that is on the order of 3-4 dB. The overall uncertainty of the calibration technique was estimated to be better than +/- 2 dB in the frequency range considered. The technique, which uses a combination of swept frequency chirp and reciprocity so that both the relative and absolute plots of sensitivity vs. frequency can be obtained, is also briefly described. The results of this work are important to implement procedures for adequate determination of the mechanical index of ultrasound (US) imaging devices. Mechanical index is widely accepted as a predictor of potential bioeffects associated with cavitation phenomena. Also, absolute calibration data are essential in development of therapeutic procedures based on the use of high-intensity focused ultrasound (HIFU), and in characterization of conventional therapeutic US applicators operating at frequencies below 1 MHz.

Prediction of ultrasonic field propagation through layered media using the extended angular spectrum method.

The angular spectrum method is a powerful technique for modeling the propagation of acoustic fields. The technique can predict an acoustic pressure field distribution over a plane, based upon knowledge of the pressure field distribution at a parallel plane. Predictions in both the forward and backward propagation directions are possible. In addition to predicting the effects of diffraction, the model also includes the effects of attenuation, refraction, dispersion, phase distortion, and the effects of finite amplitude acoustic propagation. No other model currently exists which can predict the propagation of wideband acoustic fields produced by sources of arbitrary geometry including all of the above propagation effects. Prior investigations have focused on using backward propagation predictions to analyze the surface vibration patterns of acoustic radiators. In contrast, the current effort has placed particular emphasis on verifying the model in the forward propagation case. In this paper, both forward and backward predictions are presented which demonstrate the ability of the model to characterize a three-dimensional acoustic field based upon measurements at a single plane. Results are also presented which examine the ability of the extended model to predict acoustic propagation through media composed of stacked homogeneous layers. The model has immediate applications in the study of acoustic phenomena and in the field of acoustic transducer design. Additionally, significant progress has been made toward the ultimate goal of predicting the degradation of acoustic transducer performance due to propagation through inhomogeneous, nonlinear, tissue-like media.

Characterization of ultrasonic transducers using a fiberoptic sensor.

The PVDF (polyvinylidene fluoride) hydrophones, commonly used to measure the characteristics of ultrasonic transducers, suffer from a number of drawbacks. They disturb the field distribution to be measured and cause spatial averaging effects because of their finite aperture. In addition, they are very delicate and susceptible to damage. To overcome some of these problems, the authors previously proposed the use of an optical fiber-based probe to measure the ultrasonic fields. In this paper, this fiberoptic ultrasonic sensor is used to measure the characteristics of six transducers, focused as well as unfocused, covering a frequency range of 2.25 MHz to 20 MHz. Results obtained using the fiberoptic sensor are compared with those obtained using a calibrated PVDF needle hydrophone with an effective diameter of 0.5 mm. The temporal responses as well as the beam profiles of the transducers measured using the fiberoptic sensor show excellent agreement with the results obtained using the PVDF needle hydrophone.

Frequency response of PVDF needle-type hydrophones.

This paper examines the factors governing the frequency response of ultrasonic polyvinylidene fluoride (PVDF) polymer needle-type hydrophones, in particular the sensitivity variations in the lower frequency range of 1-6 MHz. A theoretical model was used to analyze the influence of the hydrophone's diameter, the metal electrodes, thickness, PVDF material properties, the adhesive layer acoustical characteristics and the backing material, on the frequency response of the hydrophone. The results of the theoretical modelling differ by less than +/- 0.5 dB from those obtained experimentally from the reciprocity calibration in the frequency range 1-20 MHz. It is shown that the needle hydrophone's diameter and backing material are the main reasons for the sensitivity variations observed in the frequency range below 6 MHz.

Factors affecting the choice of preamplification for ultrasonic hydrophone probes.

This paper gives a systematic analysis of the effects of including an integrated (built-in) preamplifier into the ultrasonic piezoelectric probes (hydrophones) that are finding increasing use in biomedical applications. The design parameters considered include the end-of-cable sensitivity, gain, dynamic range, power supply requirements, construction intricacy, and cost. The rationale behind the inclusion of a preamplifier is given, and it is shown that the additional complexity introduced with the preamplifier into the measurement chain may not be warranted in all applications. Both the drawbacks and advantages of hydrophone preamplification are demonstrated, especially for the case of high pressure amplitude ultrasonic field measurements. Guidelines are developed for the potential user to identify the need for preamplification and the factors that influence the selection of the appropriate circuitry.

The influence of spatial polarization distribution on spot poled PVDF membrane hydrophone performance.

The influence of spatial polarization distribution on spot poled PVDF membrane hydrophone performance was calculated and then experimentally verified using a one-dimensional model based on acoustic wave propagation through a layered medium. It is shown that the sensitivity of the hydrophone is markedly dependent on the spatial polarization distribution. It is also shown that there can be a significant difference between the voltage sensitivities measured in the same hydrophone probe depending on which electrode is actually facing the acoustic source. The measurements carried out in the frequency range 1-20 MHz indicate that this difference, while negligible below 2 MHz, may exceed 1.6 dB at higher frequencies. The model developed can also be used to determine the "effective" piezoelectric constant d33 of the PVDF material as a continuous function of frequency. Moreover, the model predicts the existence of a negative slope in the frequency response of the spot poled membrane hydrophone. The experimental confirmation of this prediction underscores the importance of using swept frequency methods during calibration measurements.

A comparison of two calibration methods for ultrasonic hydrophones.

Although miniature ultrasonic hydrophones are frequently used to measure the acoustic pressure distributions from diagnostic ultrasound sources, relatively little attention has been devoted to the methods for absolute calibration of these hydrophones. In this study a polyvinylidene (PVDF) hydrophone was used to compare two calibration methods currently in use. One is based on a reciprocity technique and the second involves the planar scanning of a source transducer having a known radiated ultrasonic power. The reciprocity method revealed that the hydrophone response did not vary by more than +/- 1.6 dB from -262.8 dB re IV/microPa over the frequency range of 1-10 MHz. For the planar scanning technique seven ultrasound sources between 1-10 MHz were used, and all calibration points were within +/- 0.5 dB of the corresponding points found by the method of reciprocity.

A novel method to control P+/P- ratio of the shock wave pulses used in the extracorporeal piezoelectric lithotripsy (EPL).

There is growing evidence that acoustic cavitation plays an important role in stone fragmentation during extracorporeal shock wave lithotripsy (ESL) treatment. In addition, side effects of the treatment, such as the hemorrhage and destruction of the tissue in the vicinity of the stone are also ascribed to cavitation phenomenon. Since cavitation is associated with the maximum negative pressure in the shock pulse, it would thus appear that possibility of controlling this pressure would be desirable in ESL applications. This paper describes a novel technique developed to control the ratio of compressional peak (P+) to rarefactional peak pressure (P-) of the shock wave for use in lithotripsy treatment. The procedure is based on the finite amplitude wave generation by focused piezoelectric transducers and subsequent interaction of the shocked waves in the common focal region. The highly asymmetrical shock wave is produced in the focal region by providing an appropriate time delay to each of the high voltage electrical excitation signals which drive the transducers. The degree of relative reduction of negative halfcycles and the corresponding positive halfcycles amplification increases with the number of the acoustic sources used. The practical implementation of the shock wave generator was obtained by using 5 cm diameter, focused 1 MHz transmitter, and additional transducers of identical construction having frequencies corresponding to the harmonics and subharmonics of the 1 MHz frequency. The importance of the results for the future development of lithotripters, and stone treatment efficiency is pointed out.