The reasons why fractional flow reserve and instantaneous wave-free ratio are similar using wave separation analysis.

BACKGROUND AND OBJECTIVES: Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are the two most commonly used coronary indices of physiological stenosis severity based on pressure. To minimize the effect of wedge pressure (Pwedge), FFR is measured during hyperemia conditions, and iFR is calculated as the ratio of distal and aortic pressures (Pd/Pa) in the wave-free period. The goal of this study was to predict Pwedge using the backward wave (Pback) through wave separation analysis (WSA) and to reflect the effect of Pwedge on FFR and iFR to identify the relationship between the two indices. METHODS: An in vitro circulation system was constructed to calculate Pwedge. The measurements were performed in cases with stenosis percentages of 48, 71, and 88% and with hydrostatic pressures of 10 and 30 mmHg. Then, the correlation between Pback by WSA and Pwedge was calculated. In vivo coronary flow and pressure were simultaneously measured for 11 vessels in all patients. The FFR and iFR values were reconstructed as the ratios of forward wave at distal and proximal sites during hyperemia and at rest, respectively. RESULTS: Based on the in vitro results, the correlation between Pback and Pwedge was high (r = 0.990, p < 0.0001). In vivo results showed high correlations between FFR and reconstructed FFR (r = 0.992, p < 0.001) and between iFR and reconstructed iFR (r = 0.930, p < 0.001). CONCLUSIONS: Reconstructed FFR and iFR were in good agreement with conventional FFR and iFR. FFR and iFR can be expressed as the variation of trans-stenotic forward pressure, indicating that the two values are inferred from the same formula under different conditions.

Attenuation of the human skull at broadband frequencies by using a carbon nanotube composite photoacoustic transducer.

The shockwave generated from a focused carbon nanotube (CNT) composite photoacoustic transducer has a wide frequency band that reaches several MHz in a single pulse. The objective of this study was to measure the transmission characteristics of a shockwave generated by a CNT composite photoacoustic transducer through Asian skulls and compare the results with numerical simulation ones. Three Korean cadaver skulls were used, and five sites were measured for each skull. The average densities and sound speeds of the three skulls were calculated from computed tomography images. The sound pressure after skull penetration was about 11% of the one before skull penetration. High-frequency energy was mostly attenuated. The average attenuation coefficients measured at the five sites of the three skulls were 3.59 ± 0.29, 5.99 ± 1.07, and 3.90 ± 0.86 np/cm/MHz. These values were higher than those previously measured at 270, 836, and 1402 kHz from other groups. The attenuation coefficients simulated by Sim4life were slightly smaller than the experimental values, with similar trends at most sites. The attenuation coefficients varied with measurement sites, skull shape, and thickness. These results may provide important data for future applications of shockwaves in noninvasive neurological treatments.

Mobility of Amphidinium carterae Hulburt measured by high-frequency ultrasound.

The over-growth of phytoplankton causes harmful algal blooms (HABs) in marine ecological environments. Mobility measurement is important in understanding the action of HABs. In this study, the mobility of Amphidinium carterae Hulburt (A. carterae) was investigated using high-frequency ultrasound in the laboratory. Mobility in response to light was illustrated with M-mode images reconstructed from echoed signals. This study suggests that mobility of the swimming speed of A. carterae in response to light can be measured and calculated with M-mode images through high-frequency ultrasound. This finding may be helpful in understanding the fundamental behavior of HABs.

Low-salinity-induced surface sound channel in the western sea of Jeju Island during summer.

Surface salinity in the western sea of Jeju Island in Korea becomes low due to the inflow of the Chinese coastal waters during summer. One of the characteristics of low salinity water is the formation of a surface sound channel (SSC) due to the decrease in sound speed by salinity. However, a quantitative analysis between low salinity water and SSC has not been fully investigated yet. In this paper, a temperature-salinity (T-S) gradient diagram is introduced in order to assess SSC formation and its acoustic characteristics are also investigated through a case study of low salinity waters. Maximum angles of limiting rays were less than 4.6° and low frequency cutoffs were higher than 2.0 kHz for the SSCs formed in low salinity water. When the salinity gradients were large (>0.5 psu/m), a SSC was formed more efficiently than other cases whose salinity gradients were small. On the other hand, a SSC was not formed in spite of highly positive salinity gradients when the amount of temperature gradients was negatively high enough (<-0.5 °C/m). However, the acoustic energy transfer in the surface ducts was dependent on frequency and position of source.

Spontaneous echo-contrast in the internal jugular veins of patients with ischemic stroke.

PURPOSE: Spontaneous echo-contrast (SEC) appears on B-mode images as moving curls of smoke in the lumen of veins. The aims of this study were to investigate the prevalence and characteristics of internal jugular vein SEC among patients with stroke, in comparison with control subjects. METHODS: We enrolled 97 Korean patients with acute ischemic stroke and 50 controls. Both internal jugular veins were examined for the presence and severity of SEC and measurement of flow velocity. Venous samples were obtained for laboratory evaluation of hematologic factors. RESULTS: In 294 internal jugular veins, the prevalence of SEC was 81% in stroke patients and 68% in controls (odds ratio, 2.0; 95% confidence interval, 1.1-3.6; p = 0.013). Stroke patients were more likely to have SEC on the left (p = 0.025) than on the right (p = 0.184) internal jugular vein. Overall, the association between stroke and SEC remained significant after adjustment for other variables (odds ratio, 4.3; 95% confidence interval, 1.7-10.8; p = 0.002). CONCLUSIONS: Internal jugular vein SEC was found more frequently in stroke patients than in controls. However, local as well as systemic factors must be considered in the interpretation of this finding.

Implementation of a rotational ultrasound biomicroscopy system equipped with a high-frequency angled needle transducer--ex vivo ultrasound imaging of porcine ocular posterior tissues.

The mechanical scanning of a single element transducer has been mostly utilized for high-frequency ultrasound imaging. However, it requires space for the mechanical motion of the transducer. In this paper, a rotational scanning ultrasound biomicroscopy (UBM) system equipped with a high-frequency angled needle transducer is designed and implemented in order to minimize the space required. It was applied to ex vivo ultrasound imaging of porcine posterior ocular tissues through a minimal incision hole of 1 mm in diameter. The retina and sclera for the one eye were visualized in the relative rotating angle range of 270°~330° and at a distance range of 6~7 mm, whereas the tissues of the other eye were observed in relative angle range of 160°~220° and at a distance range of 7.5~9 mm. The layer between retina and sclera seemed to be bent because the distance between the transducer tip and the layer was varied while the transducer was rotated. Certin features of the rotation system such as the optimal scanning angle, step angle and data length need to be improved for ensure higher accuracy and precision. Moreover, the focal length should be considered for the image quality. This implementation represents the first report of a rotational scanning UBM system.

Diel variation in high-frequency acoustic backscatter from Cochlodinium polykrikoides.

The integrated backscatter power (IBP) from Cochlodinium polykrikoides was measured every 15 min by a 5-MHz acoustic system during a 5-day cultivation with an irradiation cycle. IBP increased by 0.6 dB in 5 days, but varied by 0.83 dB during the irradiation cycle. The daily increase and diel variation in IBP were postulated to be affected by an increase in cell numbers and a diel variation in cell biovolume or density via photosynthesis, respectively. Cell division/separation might also affect a total variation in IBP. This study suggests that high-frequency acoustics may be a potential tool for investigating phytoplankton cell functions.

In vivo Sonothrombolysis of Ear Marginal Vein of Rabbits Monitored with High-frequency Ultrasound Needle Transducer.

Ultrasound (US) is known to enhance thrombolysis when thrombolytic agents and/or microbubbles are injected into the targeted vessels. In this research, high-intensity US (1 MHz, 7 W/cm2, 30 % duty cycle) was applied in vivo to the ear marginal vein of three rabbits which was occluded by either laser photothrombosis or thrombin, right after the injection of 0.3~0.6 cc of microbubbles (13 × 108 bubbles/ml of concentration) through the other ear vein without using any thrombolytic agent. To determine the effect of the sonothrombolysis, the blood flow velocity near the occlusion site in the vein was measured by a custom-made 40-MHz US needle transducer and its corresponding Doppler US system. The Doppler spectra show that the blood flow velocity recovered from total occlusion after three 10-minute high-intensity US treatments. Fluorescein angiography was employed to confirm the opening of the vessel occlusion. A control study of three rabbits with only the microbubble injection showed no recovery on the occlusion in 3 hours. The results show that the sonothrombolysis in the rabbit ear marginal vein can be achieved with microbubbles only. The results of cavitation measurements indicate that the mechanism of sonothrombolysis is probably due to the cavitation induced by the microbubbles. Without the need of applying any thrombolytic agent, high-intensity US has high potential for therapies targeting on small blood vessels.

Electroencephalographic Response of Brain Stimulation by Shock Waves From Laser Generated Carbon Nanotube Transducer.

Neuromodulation is used to treat neurological disorders. Focused ultrasound can deliver acoustic energy to local regions of the brain, including deep brain structures. In addition, it is possible to induce the activation or inhibition of nerves through parameter adjustments of focused ultrasound. Laser-generated focused ultrasound (LGFUS) has demonstrated a potential use in precise therapeutic ultrasound applications owing to the ability to produce high-pressure, broadband frequency of shock waves with a tight focal spot, resulting in confined acoustic exposure of a small area. However, there have been few studies of neurostimulation using shock waves with pulse durations of several nanoseconds. The purpose of this study is to investigate the possibility of neurostimulation by shock waves generated from a focused Carbon Nanotube (fCNT) transducer. We measured electroencephalographic (EEG) signals in three rat brains before and after shock wave stimulation and compared them in the time and frequency domains. In the time domain, the number of peaks of EEG signals was measured significantly higher after shock wave stimulation than before stimulation in all three rats. The three rats showed differences in three frequency bands: theta(4-7 Hz), alpha(8-12), and 1-30 Hz, before and after shock wave stimulation (p < 0.001). These differences in EEG signals after shock wave stimulation of three rats were confirmed mainly because of shock waves. The stimulation of a rat brain was feasible using shock waves generated by the fCNT transducer. This study provides a basis for the applications of shock waves to brain stimulation for precise targeting.

Improving Sonication Efficiency in Transcranial MR-Guided Focused Ultrasound Treatment: A Patient-Data Simulation Study.

The potential improvement in sonication efficiency achieved by tilting the focused ultrasound (FUS) transducer of the transcranial MR-guided FUS system is presented. A total of 56 cases of patient treatment data were used. The relative position of the clinical FUS transducer to the patient's head was reconstructed, and region-specific skull density and porosity were calculated based on the patient's CT volume image. The total transmission coefficient of acoustic waves emitted from each channel was calculated. Then, the total energy penetrating the human skull-which represents the sonication efficiency-was estimated. As a result, improved sonication efficiency was by titling the FUS transducer to a more appropriate angle achieved in all 56 treatment cases. This simulation result suggests the potential improvement in transcranial-focused ultrasound treatment by simply adjusting the transducer angle.

Axial shear rate: A hemorheological factor for erythrocyte aggregation under Womersley flow in an elastic vessel based on numerical simulation.

Erythrocyte aggregation (EA) is a highly dynamic, vital phenomenon to interpreting human hemorheology, which would be helpful for the diagnosis and prediction of circulatory anomalies. Previous studies of EA on erythrocyte migration and the Fåhraeus Effect are based on the microvasculature. They have not considered the natural pulsatility of the blood flow or large vessels and mainly focused on shear rate along radial direction under steady flow to comprehend the dynamic properties of EA. To our knowledge, the rheological characteristics of non-Newtonian fluids under Womersley flow have not reflected the spatiotemporal behaviors of EA or the distribution of erythrocyte dynamics (ED). Hence, it needs to interpret the ED affected by temporal and spatial flow variation to understand the effect of EA under Womersley flow. Here, we demonstrated the numerically simulated ED to decipher EA's rheological role in axial shear rate under Womersley flow. In the present study, the temporal and spatial variations of the local EA were found to mainly depend on the axial shear rate under Womersley flow in an elastic vessel, while mean EA decreased with radial shear rate. The localized distribution of parabolic or M-shape clustered EA was found in a range of the axial shear rate profile (-15 to 15s-1) at low radial shear rates during a pulsatile cycle. However, the linear formation of rouleaux was realized without local clusters in a rigid wall where the axial shear rate is zero. In vivo, the axial shear rate is usually considered insignificant, especially in straight arteries, but it has a great impact on the disturbed blood flow due to the geometrical properties, such as bifurcations, stenosis, aneurysm, and the cyclic variation of pressure. Our findings regarding axial shear rate provide new insight into the local dynamic distribution of EA, which is a critical player in blood viscosity. These will provide a basis for the computer-aided diagnosis of hemodynamic-based cardiovascular diseases by decreasing the uncertainty in the pulsatile flow calculation.

Reply to Marino et al. Choroidal Thickness Measurements in the Case of Diabetic Macular Edema. Comment on "Amjad et al. Choroidal Thickness in Different Patterns of Diabetic Macular Edema. J. Clin. Med. 2022, 11, 6169".

We are pleased to see that Marino et al. have written a Comment: "Choroidal Thickness Measurements in the Case of Diabetic Macular Edema" [...].

Choroidal Thickness in Different Patterns of Diabetic Macular Edema.

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient's medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+).

Production enhancement of human adipose-derived mesenchymal stem cells by low-intensity ultrasound stimulation.

Low-intensity ultrasound (LIUS) enhances the proliferation rate of various mammalian stem cells through mechanical stimulation. This study quantitively finds suitable LIUS stimulation parameters for increasing the proliferation rate of human adipose-derived mesenchymal stem cells (hAdMSCs) for mass production. Various stimulation conditions of LIUS were assessed based on the beam pattern of the ultrasonic transducer and the attenuation of the sound waves. Using optimal LIUS stimulation parameters for enhancing proliferation of hAdMSCs taken from bromodeoxyuridine (BrdU) incorporation assay, long-term culture of hAdMSCs was performed for 16 days. The resultant hAdMSCs were characterized for various biomarkers such as CD34-, CD45-, CD73+, CD95+, CD105+ and cytological staining and a cytokine array assay. LIUS stimulation parameters found for enhancing the hAdMSCs proliferation were the frequency of 5 MHz, an intensity of 300 mWcm-2, a duration of 10 min per day, and continuous waves with a 100% duty cycle. The LIUS stimulated hAdMSCs group showed a 3.25-fold increase in the cell number compared to the control group after 16 days of culture. By confirming the effects of quantitatively measured LIUS stimulation on the enhancement of hAdMSCs proliferation, this study may be a foundation for the applications of LIUS stimulation in the industrial-scale production of hAdMSCs.

Numerical simulation of spatiotemporal red blood cell aggregation under sinusoidal pulsatile flow.

Previous studies on red blood cell (RBC) aggregation have elucidated the inverse relationship between shear rate and RBC aggregation under Poiseuille flow. However, the local parabolic rouleaux pattern in the arterial flow observed in ultrasonic imaging cannot be explained by shear rate alone. A quantitative approach is required to analyze the spatiotemporal variation in arterial pulsatile flow and the resulting RBC aggregation. In this work, a 2D RBC model was used to simulate RBC motion driven by interactional and hydrodynamic forces based on the depletion theory of the RBC mechanism. We focused on the interaction between the spatial distribution of shear rate and the dynamic motion of RBC aggregation under sinusoidal pulsatile flow. We introduced two components of shear rate, namely, the radial and axial shear rates, to understand the effect of sinusoidal pulsatile flow on RBC aggregation. The simulation results demonstrated that specific ranges of the axial shear rate and its ratio with radial shear rate strongly affected local RBC aggregation and parabolic rouleaux formation. These findings are important, as they indicate that the spatiotemporal variation in shear rate has a crucial role in the aggregate formation and local parabolic rouleaux under pulsatile flow.

Ultrasonic Doppler measurements of blood flow velocity of rabbit retinal vessels using a 45-MHz needle transducer.

BACKGROUND: The purpose of this study is to measure blood flow velocity of rabbit retinal vessels using a 45-MHz ultrasonic Doppler system with a needle transducer. METHODS: A high-frequency pulsed Doppler system that utilizes a 45-MHz PMN-PT needle transducer was developed to measure retinal blood flow velocity in situ. The pulsed Doppler allowed the differentiation of retinal from choroidal blood flow velocity. The needle transducer was inserted into the vitreous cavity through a 20-gauge incision port to access the retinal vessels. The first phase of the experiment evaluated the reproducibility of the measurements. The second phase measured velocities at four positions from the optic disc edge to the distal part of each vessel in nine eyes for the temporal and six eyes for the nasal portions. The angle between the transducer and the retinal vessel at each site was measured in enucleated rabbit eyes to estimate and compensate for measurement errors. RESULTS: In the first phase, the average measurement error was 5.97 +/- 1.34%. There was no significant difference comparing all eyes. In the second phase, the velocities gradually slowed from the disc edge to the distal part, and temporal velocities were faster than nasal velocities at all measurement sites. CONCLUSION: This study demonstrated the feasibility of reliably measuring retinal blood flow velocity using a 45-MHz ultrasonic Doppler system with a needle transducer.

Optimizing Computer-Brain Interface Parameters for Non-invasive Brain-to-Brain Interface.

A non-invasive, brain-to-brain interface (BBI) requires precision neuromodulation and high temporal resolution as well as portability to increase accessibility. A BBI is a combination of the brain-computer interface (BCI) and the computer-brain interface (CBI). The optimization of BCI parameters has been extensively researched, but CBI has not. Parameters taken from the BCI and CBI literature were used to simulate a two-class medical monitoring BBI system under a wide range of conditions. BBI function was assessed using the information transfer rate (ITR), measured in bits per trial and bits per minute. The BBI ITR was a function of classifier accuracy, window update rate, system latency, stimulation failure rate (SFR), and timeout threshold. The BCI parameters, including window length, update rate, and classifier accuracy, were kept constant to investigate the effects of varying the CBI parameters, including system latency, SFR, and timeout threshold. Based on passively monitoring BCI parameters, a base ITR of 1 bit/trial was used. The optimal latency was found to be 100 ms or less, with a threshold no more than twice its value. With the optimal latency and timeout parameters, the system was able to maintain near-maximum efficiency, even with a 25% SFR. When the CBI and BCI parameters are compared, the CBI's system latency and timeout threshold should be reflected in the BCI's update rate. This would maximize the number of trials, even at a high SFR. These findings suggested that a higher number of trials per minute optimizes the ITR of a non-invasive BBI. The delays innate to each BCI protocol and CBI stimulation method must also be accounted for. The high latencies in each are the primary constraints of non-invasive BBI for the foreseeable future.

A Systemic Review of Available Low-Cost EEG Headsets Used for Drowsiness Detection.

Drowsiness is a leading cause of traffic and industrial accidents, costing lives and productivity. Electroencephalography (EEG) signals can reflect awareness and attentiveness, and low-cost consumer EEG headsets are available on the market. The use of these devices as drowsiness detectors could increase the accessibility of safety and productivity-enhancing devices for small businesses and developing countries. We conducted a systemic review of currently available, low-cost, consumer EEG-based drowsiness detection systems. We sought to determine whether consumer EEG headsets could be reliably utilized as rudimentary drowsiness detection systems. We included documented cases describing successful drowsiness detection using consumer EEG-based devices, including the Neurosky MindWave, InteraXon Muse, Emotiv Epoc, Emotiv Insight, and OpenBCI. Of 46 relevant studies, ~27 reported an accuracy score. The lowest of these was the Neurosky Mindwave, with a minimum of 31%. The second lowest accuracy reported was 79.4% with an OpenBCI study. In many cases, algorithmic optimization remains necessary. Different methods for accuracy calculation, system calibration, and different definitions of drowsiness made direct comparisons problematic. However, even basic features, such as the power spectra of EEG bands, were able to consistently detect drowsiness. Each specific device has its own capabilities, tradeoffs, and limitations. Widely used spectral features can achieve successful drowsiness detection, even with low-cost consumer devices; however, reliability issues must still be addressed in an occupational context.

An open-source phase correction toolkit for transcranial focused ultrasound.

BACKGROUND: The phase correction on transcranial focused ultrasound is essential to regulate unwanted focal point shift caused by skull bone aberration. The aim of the current study was to design and investigate the feasibility of a ray-based phase correction toolkit for transcranial focused ultrasound. RESULTS: The peak pressure at focal area was improved by 140.5 ± 7.0% on target I and 134.8 ± 19.1% on target II using proposed phase correction toolkit, respectively. A total computation time of 402.1 ± 24.5 milliseconds was achieved for each sonication. CONCLUSION: The designed ray-based phase correction software can be used as a lightweight toolkit to compensate aberrated phase within clinical environment.

Ultrasonic observation of blood disturbance in a stenosed tube: effects of flow acceleration and turbulence downstream.

Red blood cell (RBC) aggregation is known to be highly dependent on hemodynamic parameters such as shear rate, flow turbulence and flow acceleration under pulsatile flow. The effects of all three hemodynamic parameters on RBC aggregation and echogenicity of porcine whole blood were investigated downstream of an eccentric stenosis in a mock flow loop using B-mode images with Doppler spectrograms of a commercial ultrasonic system. A hyperechoic parabolic profile appeared downstream during flow acceleration, yielding another piece of evidence suggesting that the enhancement of rouleaux formation may be caused by flow acceleration. It was also found that echogenicity increased locally at a distance of three tube diameters downstream from the stenosis. The local increase of echogenicity is thought to be mainly due to flow turbulence. The hypoechoic "black hole" was also seen at the center of the tube downstream of the stenosis where blood flow was disturbed, and this may be caused by the compound effect of flow turbulence and shear rate.