New Method for Beat-to-Beat Fetal Heart Rate Measurement Using Doppler Ultrasound Signal.

The most commonly used method of fetal monitoring is based on heart activity analysis. Computer-aided fetal monitoring system enables extraction of clinically important information hidden for visual interpretation-the instantaneous fetal heart rate (FHR) variability. Today's fetal monitors are based on monitoring of mechanical activity of the fetal heart by means of Doppler ultrasound technique. The FHR is determined using autocorrelation methods, and thus it has a form of evenly spaced-every 250 ms-instantaneous measurements, where some of which are incorrect or duplicate. The parameters describing a beat-to-beat FHR variability calculated from such a signal show significant errors. The aim of our research was to develop new analysis methods that will both improve an accuracy of the FHR determination and provide FHR representation as time series of events. The study was carried out on simultaneously recorded (during labor) Doppler ultrasound signal and the reference direct fetal electrocardiogram Two subranges of Doppler bandwidths were separated to describe heart wall movements and valve motions. After reduction of signal complexity by determining the Doppler ultrasound envelope, the signal was analyzed to determine the FHR. The autocorrelation method supported by a trapezoidal prediction function was used. In the final stage, two different methods were developed to provide signal representation as time series of events: the first using correction of duplicate measurements and the second based on segmentation of instantaneous periodicity measurements. Thus, it ensured the mean heart interval measurement error of only 1.35 ms. In a case of beat-to-beat variability assessment the errors ranged from -1.9% to -10.1%. Comparing the obtained values to other published results clearly confirms that the new methods provides a higher accuracy of an interval measurement and a better reliability of the FHR variability estimation.

Fetal electrocardiograms, direct and abdominal with reference heartbeat annotations.

Monitoring fetal heart rate (FHR) variability plays a fundamental role in fetal state assessment. Reliable FHR signal can be obtained from an invasive direct fetal electrocardiogram (FECG), but this is limited to labour. Alternative abdominal (indirect) FECG signals can be recorded during pregnancy and labour. Quality, however, is much lower and the maternal heart and uterine contractions provide sources of interference. Here, we present ten twenty-minute pregnancy signals and 12 five-minute labour signals. Abdominal FECG and reference direct FECG were recorded simultaneously during labour. Reference pregnancy signal data came from an automated detector and were corrected by clinical experts. The resulting dataset exhibits a large variety of interferences and clinically significant FHR patterns. We thus provide the scientific community with access to bioelectrical fetal heart activity signals that may enable the development of new methods for FECG signals analysis, and may ultimately advance the use and accuracy of abdominal electrocardiography methods.

Detection of Atrial Fibrillation Episodes in Long-Term Heart Rhythm Signals Using a Support Vector Machine.

Atrial fibrillation (AF) is a serious heart arrhythmia leading to a significant increase of the risk for occurrence of ischemic stroke. Clinically, the AF episode is recognized in an electrocardiogram. However, detection of asymptomatic AF, which requires a long-term monitoring, is more efficient when based on irregularity of beat-to-beat intervals estimated by the heart rate (HR) features. Automated classification of heartbeats into AF and non-AF by means of the Lagrangian Support Vector Machine has been proposed. The classifier input vector consisted of sixteen features, including four coefficients very sensitive to beat-to-beat heart changes, taken from the fetal heart rate analysis in perinatal medicine. Effectiveness of the proposed classifier has been verified on the MIT-BIH Atrial Fibrillation Database. Designing of the LSVM classifier using very large number of feature vectors requires extreme computational efforts. Therefore, an original approach has been proposed to determine a training set of the smallest possible size that still would guarantee a high quality of AF detection. It enables to obtain satisfactory results using only 1.39% of all heartbeats as the training data. Post-processing stage based on aggregation of classified heartbeats into AF episodes has been applied to provide more reliable information on patient risk. Results obtained during the testing phase showed the sensitivity of 98.94%, positive predictive value of 98.39%, and classification accuracy of 98.86%.

Impact of modification with cetylpyridinium chloride - a potential cariogenic microbiota inhibitor, on selected physical-mechanical properties of the water-activated glass-ionomer.

PURPOSE: Teeth caries is one of predominant civilization diseases. Dental fillings with antimicrobial addition might allow prevention of secondary caries. The purpose of this study was to evaluate hardness and tensile strength of cetylpyridinium chloride modified water activated glass-ionomer cement. METHODS: Samples with diameter of 6 mm and height of 3 mm made of water-activated glass-ionomer cement were control group (0.0%). Test groups were series of samples of the same dimensions, with addition of cetylpyridinium chloride antimicrobial in concentrations of 0.5, 1.0, 1.5 and 2.0%. Two subgroups were prepared in each group to determine Vickers Hardness and Diametral Tensile Strength after 1 and 24 hours of sample storage in distilled water. RESULTS: During hardness studies, no strong effect of antimicrobial concentration on hardness of samples was observed. Higher hardness values after 24 hours were demonstrated for all groups, compared to the samples tested after 1 hour. The exception was the group with the addition of 1% cetylpyridinium chloride, in which no statistically significant differences were observed. Diametral Tensile Strength values for samples tested after 1 hour decreased with increasing antibacterial concentration. A similar relationship was noticed for samples tested after 24 hours. No statistically signifi- cant differences were found between test samples after 1 or 24 hours. CONCLUSIONS: There was no significant effect of cetylpyridinium chloride concentration on the hardness of the samples that significantly increased during the study. With the increase in antimicrobial concentration a decrease in diametral tensile strength value was observed, but these values did not change over time.

Is Abdominal Fetal Electrocardiography an Alternative to Doppler Ultrasound for FHR Variability Evaluation?

Great expectations are connected with application of indirect fetal electrocardiography (FECG), especially for home telemonitoring of pregnancy. Evaluation of fetal heart rate (FHR) variability, when determined from FECG, uses the same criteria as for FHR signal acquired classically-through ultrasound Doppler method (US). Therefore, the equivalence of those two methods has to be confirmed, both in terms of recognizing classical FHR patterns: baseline, accelerations/decelerations (A/D), long-term variability (LTV), as well as evaluating the FHR variability with beat-to-beat accuracy-short-term variability (STV). The research material consisted of recordings collected from 60 patients in physiological and complicated pregnancy. The FHR signals of at least 30 min duration were acquired dually, using two systems for fetal and maternal monitoring, based on US and FECG methods. Recordings were retrospectively divided into normal (41) and abnormal (19) fetal outcome. The complex process of data synchronization and validation was performed. Obtained low level of the signal loss (4.5% for US and 1.8% for FECG method) enabled to perform both direct comparison of FHR signals, as well as indirect one-by using clinically relevant parameters. Direct comparison showed that there is no measurement bias between the acquisition methods, whereas the mean absolute difference, important for both visual and computer-aided signal analysis, was equal to 1.2 bpm. Such low differences do not affect the visual assessment of the FHR signal. However, in the indirect comparison the inconsistencies of several percent were noted. This mainly affects the acceleration (7.8%) and particularly deceleration (54%) patterns. In the signals acquired using the electrocardiography the obtained STV and LTV indices have shown significant overestimation by 10 and 50% respectively. It also turned out, that ability of clinical parameters to distinguish between normal and abnormal groups do not depend on the acquisition method. The obtained results prove that the abdominal FECG, considered as an alternative to the ultrasound approach, does not change the interpretation of the FHR signal, which was confirmed during both visual assessment and automated analysis.

Determination of fetal heart rate from abdominal signals: evaluation of beat-to-beat accuracy in relation to the direct fetal electrocardiogram.

The main aim of our work was to assess the reliability of indirect abdominal electrocardiography as an alternative to the commonly used Doppler ultrasound monitoring technique. As a reference method, we used direct fetal electrocardiography. Direct and abdominal signals were acquired simultaneously, using dedicated instrumentation. The developed method of maternal signal suppression as well as fetal QRS complexes detection was presented. Recordings were collected during established labors, each consisted of four signals from the maternal abdomen and the reference signal acquired directly from the fetal head. After assessing the performance of the QRS detector, the accuracy of fetal heart rate measurement was evaluated. Additionally, to reduce the influence of inaccurately detected R-waves, some validation rules were proposed. The obtained results revealed that the indirect method is able to provide an accuracy sufficient for a reliable assessment of fetal heart rate variability. However, the method is very sensitive to recording conditions, influencing the quality of signals. Our investigations confirmed that abdominal electrocardiography, even in its current stage of development, offers an accuracy equal to or higher than an ultrasound method, at the same time providing some additional features.

Extraction of fetal heart-rate signal as the time event series from evenly sampled data acquired using Doppler ultrasound technique.

Analysis of variability of fetal heart rate (FHR) is very important in prediction of the fetal wellbeing. The beat-to-beat variability is described quantitatively by the indices originated from invasive fetal electrocardiography which provides the FHR signal in a form of time event series. Today, monitoring instrumentation is based on Doppler ultrasound technology. We used two bedside fetal monitors with different processing methods for heartbeat detection and FHR signal determination: the autocorrelation and cross-correlation techniques. Both monitors provide the output signal in a form of evenly spaced samples. The goal of this paper is to present a new method for the FHR signal processing, which enables extraction of series of consecutive heartbeat intervals from the sampled signal. The proposed correction algorithms allow recognition and removal of the FHR signal distortions typical for fetal monitors--invalid and duplicated samples. The correction efficiency has been verified based on the FHR variability indices calculated for the sampled signal and the corresponding event series. For both monitors, considerable influence of the signal representation on indices values was noted. Concluding, we recommended implementing these algorithms in fetal surveillance system as a preprocessing stage for the determination of FHR variability indices.

Detection of low amplitude fetal QRS complexes.

The significance of the most important operations performed by the noninvasive systems for fetal heart rate determination is investigated. The method of template subtraction for maternal ECG suppression is compared to the method based on independent component analysis. The QRS detector based on the classical slope-responsive preprocessing competes with the one that employs normalized matched filtering for QRS enhancement. A small database containing the four-channel abdominal ECG signals with the marked positions of the fetal QRS complexes is prepared to enable the investigations. The performed experiments show the factors that have the greatest impact on the results of the fetal QRS detection, and an effective approach to cope the problem is proposed.

New approach to quantitative description of deceleration of fetal heart rate for the patterns classification.

The most common method of biophysical fetal monitoring is recording and analyzing the cardiotocographic signals. In analysis of the fetal heart rate signal special emphasis is paid to the deceleration patterns and their correlation to the uterine contractions. According to deceleration classification the most important is the distinguishing between the periodic and the episodic types. In visual analysis, this classification is based on fuzzy description of deceleration onset being "abrupt" or "gradual". Application of commonly used interpretation of these imprecise terms in computer aided monitoring systems very often leads to erroneous classifications. Therefore, the redefinition of the deceleration nadir phase, as a group of samples around the lowest point, is required. It ensures that the onset phase, which is very important in deceleration classification, will consist of only appropriate samples. For determination of nadir the new method based on three stage-analysis of samples frequency distribution was developed. To evaluate the proposed method we compared the results with reference data obtained from clinical experts.

Experimental dental bio-adhesives for direct restorations: the influence of PMnEDM homologs structure on bond strength.

OBJECTIVES: The purpose of this study was to evaluate the effect of PMnEDM dental monomer homologs chemical structure on shear bond strength between polymer-based composite and alloy. METHODS: Four light-cured experimental universal dental bio-adhesives (group codes: A (PMDM), B (PM2EDM), C (PM3EDM), D (PM4EDM)) were preliminarily evaluated with respect to sensitivity to ambient light, curing time, depth of cure, and uncured film thickness according to standardized procedures. Appropriate tests were performed to measure shear bond strength (SBS) of polymer-based composite to cobalt-based alloy with the use of the adhesives investigated. Variability of results was evaluated by use of the coefficient of variation (CV). Results were estimated with the aid of one-way analysis of variance (ANOVA), performed on the logarithmic values, with alpha=0.05 significance level. RESULTS: All materials passed the requirements according to physicochemical properties. Except for formulation D, all results estimating SBS were positive with respect to standardized requirements. The uppermost mean SBS was achieved for the A adhesive (11.45 MPa) and appeared to be significantly different compared to D one (5.07 MPa) (p=0.0495). Also the B adhesive, having slightly lower mean SBS value (10.50 MPa) exhibited a significant difference in respect to D one (p=0.0455). The means for other trial pairs did not differ statistically. SIGNIFICANCE: The materials here studied might be considered to have a practical use in dental clinics, especially the formulations B and C.

The influence of coincidence of fetal and maternal QRS complexes on fetal heart rate reliability.

Bioelectrical fetal heart activity being recorded from maternal abdominal surface contains more information than mechanical heart activity measurement based on the Doppler ultrasound signals. However, it requires extraction of fetal electrocardiogram from abdominal signals where the maternal electrocardiogram is dominant. The simplest technique for maternal component suppression is a blanking procedure, which relies upon the replacement of maternal QRS complexes by isoline values. Although, in case of coincidence of fetal and maternal QRS complexes, it causes a loss of information on fetal heart activity. Its influence on determination of fetal heart rate and the variability analysis depends on the sensitivity of the heart-beat detector used. The sensitivity is defined as an ability to detect the incomplete fetal QRS complex. The aim of this work was to evaluate the influence of the maternal electrocardiogram suppression method used on the reliability of FHR signal being calculated.

3D MR imaging of dental cavities-an in vitro study.

A 3D spin-echo (3D SE) pulse sequence was used on a 4.7 T research MRI system to produce images of extracted human first molar tooth placed in CuSO4 water solution. The maximal resolution achieved was 35 x 63 x 300 microm3 in read and two phase directions, respectively. The high-intensity signal from water in solution together with the lack of signal from mineralized tooth tissue produce very good contrast allowing to visualize topography of outer and inner surfaces of the tooth. The 3D MR data were median filtered, binarized and then divided into separate segments corresponding to the inner tooth cavities and the hard tooth tissue. The topography of the root canals was visualized and the canals volume was calculated. The presented technique may be used for quantitative analysis of the root canal cavities shape and volume. The results of such an analysis may be applied for estimation of the quality of the impressional mapping methods in restorative dentistry or as an alternative non-impressional 3D mapping method.