Efficient parameterization of MUAP signal for identification of MU and volume conductor characteristics using neural networks.

The motor unit action potential (MUAPs) shapes depend on the anatomy and the physiology of the contracted muscle. The aim of this work is the identification of some characteristics of the motor unit (MU) and the volume conductor, namely the MU depth, the innervation zone width and the thickness of fat and skin layers based on MUAP signal parameters. The relationship between these characteristics and MUAP parameters are non-linear and complex. Thus, the use of the neural networks approach becomes an efficient tool to put in evidence this relationship. We have used the similarity and the homogeneity of the parameter criterions to choose which parameters are appropriate for the extraction. Two identification systems are presented and compared, a global system and a separate one. In order to evaluate the performance of each system, we have tested them using several simulated MUAP signals corrupted with additive Gaussian noise at different signal to noise ratios (SNR). A new test is introduced in which the electrode radius, the bar electrode dimensions and inclination angles for the detection system, fixed during the training process, are changed.

Lingual angioedema after perindopril use.

We report a case of severe lingual edema and airway compromise associated with angiotensin-converting enzyme inhibitor use. Although angiotensin-converting enzyme inhibitors are generally considered as safe drugs, angioedema may induce severe respiratory distress and death.

Value of C-reactive protein in the detection of bacterial contamination at the time of presentation in drug-induced aspiration pneumonia.

STUDY OBJECTIVES: To compare the plasma concentration of C-reactive protein (CRP) with traditional markers for diagnosis of bacterial pneumonia in patients with suspected aspiration. DESIGN: Prospective, nonrandomized, controlled study of consecutive hospital admissions. SETTING: Toxicology ICU in a university hospital. PATIENTS OR PARTICIPANTS: Acutely poisoned comatose patients admitted to the hospital with suspicion of aspiration pneumonia. INTERVENTIONS: Distal protected catheter sampling per fiberoptic bronchoscopy and bacteriologic culture were employed as a standard to detect the bacterial component of suspected aspiration pneumonia. Plasma CRP concentrations, temperature, and WBC count were measured on hospital day 1. MEASUREMENTS AND RESULTS: Sixty-six patients were evaluated. Thirty-two had bacterial contamination by positive culture (> or =10(3) cfu/mL). Multiple receiver-operating characteristic (ROC) curves were used to compare each parameter for detection of infection secondary to aspiration. The ROC curve of CRP concentrations showed that a CRP >75 mg/L is associated with bacterial contamination with a sensitivity of 87%, specificity of 76%, positive predictive value of 78%, and negative predictive value of 87%. ROC curves of temperature and WBC count demonstrated poor diagnostic value of these markers in indicating the bacterial component of suspected aspiration pneumonia. CONCLUSIONS: Early measurement of CRP is useful for the diagnosis of aerobic bacterial content of aspiration pneumonia and perhaps in determining the need for invasive bacteriologic sampling. Temperature and WBC count are poor indicators of bacterial infection of aspiration pneumonia in poisoned patients.

The use of a neural network system in the identification of motor unit characteristics from surface detected action potentials: a simulation study.

The surface detected motor unit action potential (MUAP) morphology depends on many physiological and anatomical characteristics of the contracting muscle that are not directly accessible to measurement. In this paper, a neural network based approach is proposed to estimate the motor unit (MU) parameters from a simulated single surface MUAP. We have developed an estimation system that is composed of the following stages: conduction velocity estimation, signal dimension reduction, MU parameters estimation, and number of MU fibres estimation. The parameter estimation stage employs four multilayer neural networks trained on simulated MUAPs corresponding to various ranges of MU parameters. In the estimation mode, this module produces four MU parameters sets. The selected set of the five muscle characteristics is that which minimises an error criterion on a signal reconstructed from the estimated parameters. The proposed system is tested with several simulated MUAPs signals with additive white noise in order to evaluate its performance. It is shown that the technique performs well when the signal to noise ratio is greater than 20 dB.

Treatment of methanol and isopropanol poisoning with intravenous fomepizole.

CASE REPORT: We report a case of mixed methanol and isopropanol poisoning in a patient who refused dialysis but agreed to treatment with intravenous fomepizole. The patient was asymptomatic on arrival, with initial blood methanol and isopropanol concentrations of 146 mg/dL and 39 mg/dL, respectively. Blood ethanol was undetectable. The patient was treated with fomepizole twice daily intravenously until blood methanol was undetectable. No side effects of therapy, other than transient eosinophilia, were observed. The evolution was uneventful and no metabolites of either alcohol were detected at any time during the hospitalization. The decay of plasma methanol and isopropanol under fomepizole treatment were well described by first-order kinetics. The plasma elimination half-lives of methanol and isopropanol were 47.6 hours and 27.7 hours, respectively. Fomepizole appears to have been effective in blocking the toxic metabolism of both methanol and isopropanol and was associated with a favorable outcome.