Coronary Artery Disease Detected by Low Frequency Heart Sounds.

OBJECTIVES: Previous studies have observed an increase in low frequency diastolic heart sounds in patients with coronary artery disease (CAD). The aim was to develop and validate a diagnostic, computerized acoustic CAD-score based on heart sounds for the non-invasive detection of CAD. METHODS: Prospective study enrolling 463 patients referred for elective coronary angiography. Pre-procedure non-invasive recordings of heart sounds were obtained using a novel acoustic sensor. A CAD-score was defined as the power ratio between the 10-90 Hz frequency spectrum and the 90-300 Hz frequency spectrum of the mid-diastolic heart sound. Quantitative coronary angiography analysis was performed by a blinded core laboratory and patients grouped according to the results: obstructive CAD defined by the presence of at least one ≥ 50% stenosis, non-obstructive CAD as patients with a maximal stenosis in the 25-50% interval and non-CAD as no coronary lesions exceeding 25%. We excluded patients with potential confounders or incomplete data (n = 245). To avoid over-fitting the final cohort of 218 patients was randomly divided into to a training group for development (n = 127) and a validation group (n = 91). RESULTS: In both the training and the validation group the CAD-score was significantly increased in CAD patients compared to non-CAD patients (p < 0.0001). In the validation group the area under the receiver-operating curve was 77% (95% CI 63-91%). Sensitivity was 71% (95% CI 59-82%) and specificity 64% (95% CI 45-83%). CONCLUSION: The acoustic CAD-score is a new, inexpensive, non-invasive method to detect CAD, which may supplement clinical risk stratification and reduce the need for subsequent non-invasive and invasive testing.

Concept and application of a linearized ring multipass optics configuration.

A multipass optics (MPO) system is used to increase the optical path length in a limited volume. Well-known concepts such as the White-type cell and the Herriott-type cell are used in many applications. The optical path in these cells leaves a large portion of the cell volume unused. In contrast, MPO systems with astigmatic mirrors have significantly more beam passes per volume, but because of their reduced symmetry along the beam axis they are much more sensitive to misalignment. Our goal is to develop MPO systems that have both: the high beam densities of astigmatic MPO systems and the optical robustness of Herriott-type optics. We show that linearized optical ring resonators, which can be constructed by means of simple 2×2 optical ABCD-matrices, lead to suitable solutions. The concept is demonstrated using a MPO system with a base length of 150 mm and a total beam path length of 19.2 m, optimized for laser beams of 10 µm wavelength. The volume of the cell is 295cm3 with a beam density that is four times higher compared to a standard Herriott-type cell.

Transcutaneous Electrical Nerve Stimulation As A Pain-Relieving Approach in Labor Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive electrophysical pain-relieving modality that also can be used in labor pain. Compared to other methods, TENS is not commonly practiced in intrapartum care due to a lack of knowledge about its clinical efficacy. Hence, a comprehensive overview of all types of randomized controlled trials (RCTs) on TENS can provide a better insight into this method and its efficacy in labor pain. OBJECTIVES: To perform a systematic review to assess the efficacy of TENS for labor pain control compared to other treatments. SEARCH STRATEGY: PubMed, Cochrane Library, Embase, and Web of Science databases were searched for studies using keywords "TENS" combined with "labor pain" and "labor." SELECTION CRITERIA: Eligible criteria included RCTs, full-text studies, English, and Danish literature, whereas exclusion criteria included animal studies and abstracts. DATA EXTRACTION AND ANALYSIS: The selection of eligible items and assessment of methodological quality were performed independently by two researchers (KT and PG). A meta-analysis was performed to analyze the treatment effects on pain intensity reduction, additional analgesia, and satisfaction of TENS. MAIN RESULTS: Twenty-six RCTs were included in this review involving a total of 3348 parturients. TENS showed significant efficacy in the reduction of pain intensity (pooled RR 1.52, 95% CI [1.35; 1.70]). Most of the studies had a high risk of bias, and the average grade of the studies indicated low quality. CONCLUSIONS: The forest plot showed a small, but statistically significant efficacy of TENS on the reduction of pain intensity. However, it is not clear if the results were affected by the poor quality of the studies. This systematic review is the first that shows the application of TENS has significant efficacy in lowering labor pain. Findings from this review encourage the application of qualified methods for future and prospective studies with TENS applied in labor pain.

A New Quantum Cascade IR-Laser Online Detector: Chemical-Sensitive Size-Exclusion Chromatography Measurement at Unprecedented Low Levels.

Online chemically sensitive detectors for size exclusion chromatography (SEC) through coupled setups based on infrared (IR) (or NMR) spectrometers present new possibilities through unprecedented levels of polymer detail with respect to molecular weight and chemical composition. Herein, a new external cavity quantum cascade laser (EC-QCL) mid-IR spectrometer as a chemically sensitive online detector for SEC is custom-designed, built, and tested. This unique spectrometer features multiple broadly tunable EC-QCL sources, which can be operated in continuous wave and pulsed mode, accompanied with balanced liquid nitrogen cooled mercury cadmium telluride (MCT) detectors and a new custom-built transmission flow cell. Automated data analysis is done with a self-written MATLAB code. The limit of detection (LOD) is measured online, coupled with SEC chromatography, where on average, one carbonyl functionality in 530 000 g mol-1 at chromatographic conditions for SEC could be detected. It is possible to detect 0.46 µg (LOD) PMMA, which is approximately a factor of 30 lower than that reported for SEC-Fourier transform infrared.

RES-Q-Trace: A Mobile CEAS-Based Demonstrator for Multi-Component Trace Gas Detection in the MIR.

Sensitive trace gas detection plays an important role in current challenges occurring in areas such as industrial process control and environmental monitoring. In particular, for medical breath analysis and for the detection of illegal substances, e.g., drugs and explosives, a selective and sensitive detection of trace gases in real-time is required. We report on a compact and transportable multi-component system (RES-Q-Trace) for molecular trace gas detection based on cavity-enhanced techniques in the mid-infrared (MIR). The RES-Q-Trace system can operate four independent continuous wave quantum or interband cascade lasers each combined with an optical cavity. Twice the method of off-axis cavity-enhanced absorption spectroscopy (OA-CEAS) was used, twice the method of optical feedback cavity-enhanced absorption spectroscopy (OF-CEAS), respectively. Multi-functional software has been implemented (i) for the general system control; (ii) to drive the four different laser sources and (iii) to analyze the detector signals for concentration determination of several molecular species. For the validation of the versatility and the performance of the RES-Q-Trace instrument the species NO, N2O, CH4, C2H4 and C3H6O, with relevance in the fields of breath gas analysis and the detection of explosives have been monitored in the MIR with detection limits at atmospheric pressure in the ppb and ppt range.

Separation and characterization of maternal cardiac and vascular sounds in the third trimester of pregnancy.

OBJECTIVE: To characterize the vascular sounds of the uteroplacental blood flow obtained by microphones. METHODS: The present retrospective study took place in an anechoic chamber facility at Aalborg University, Aalborg, Denmark, in 2012, and included pregnant participants aged 18-40 years with a singleton pregnancy at 32-36 weeks and a parity of 0-2. Abdominal Doppler ultrasonography was performed bilaterally on the uterine arteries. Subsequently, in the same positions, sound recordings were performed with microphones. The derived raw sound signal was separated into two frequency ranges, and characterized accordingly. RESULTS: The mean pregnancy length among 25 participants was 33.6 ± 2.0 weeks. The pulsatility index of the uterine artery was 0.67 ± 0.24. All 50 recordings displayed the first and second maternal heart sounds (frequency 25-100 Hz), and in 17 of 50 recordings, maternal vascular murmurs (frequency 200-800 Hz) were present. The average pulse wave velocity between the maternal aortic valve and the uterine artery was estimated to be 6.6 ± 1.5 m/s. CONCLUSION: Maternal vascular murmurs in the frequency range of 200-800 Hz were identified as a possible marker of abnormal uteroplacental blood flow, and provide a means to measure the arterial pulse wave velocity.

Digital auscultation of the uterine artery: a measure of uteroplacental perfusion.

This observational study investigated digital auscultation for the purpose of assessing the clinical feasibility of monitoring vascular sounds in pregnancy. The study was performed at the Regional Hospital Viborg, Denmark, and included 29 pregnant women, 10 non-pregnant women and 10 male participants. Digital auscultation was performed with an electronic stethoscope bilaterally near the uterine arteries and correlated to the clinical diagnosis of preeclampsia (PE), intrauterine growth restriction (IUGR) or normal pregnancy in the group of pregnant participants. In the group of non-pregnant participants, digital auscultation was performed as control measurements in the same anatomical positions. The auscultations displayed pulse waveforms comprising systolic and diastolic periods in 20 of the 29 pregnant participants. However, in the non-pregnant and male participants, the pulse waveforms were absent. The pulsatile patterns are thus likely to originate from the arteries in relation to the pregnant uterus. In the participants displaying pulse waveforms, the presence of a dicrotic notch appeared with a sensitivity of 89% and a specificity of 100% in the discrimination of normal pregnancies (n = 11) from pregnancies with PE or IUGR (n = 9), (p < 0.001). This preliminary study shows the potential of identifying vascular complications during pregnancy such as preeclampsia and intrauterine growth restriction. The morphology of the derived pulse contour should be investigated and could be further developed to identify pathophysiology.