Clinical Practicability of a Newly Developed Real-time Digital Kymographic System.

BACKGROUND: A digital kymogram shows real images of vocal fold vibration. However, DKG is difficult to use in clinical practice because the recorded image cannot be seen instantaneously after examination, as considerable encoding time is required to visualize a digital kymogram. In addition, frame-by frame analysis should be implemented to evaluate high-speed videoendoscopy data, but is time- and labor-intensive. PURPOSE: The purpose of the study was to validate the clinical practicability of a real-time multislice digital kymographic system developed by the authors. We analyzed the promptness and accuracy of the examination before and after intracordal injections in patients with unilateral vocal fold paralysis. METHODS: To assess the clinical applicability of this system, six patients with unilateral vocal fold paralysis were selected. Real-time DKG was performed before and immediately after intracordal injection. We observed changes in the digital kymogram after the intracordal injection. RESULTS: Using this system, 10 scanning lines and up to five vertical pixel row could be obtained in real time, and the maximum acquisition time for the DKG image was 10 seconds. A digital kymogram of the patients could be instantaneously acquired, and whether the intracordal injection was appropriate or not. CONCLUSION: This article is the first validation study after the development of the real-time multislice digital kymographic system. Our system may be a promising tool in clinical practice for immediate assessment of the vibratory patterns of the vocal cords. More research is necessary for further clinical validation.

A radiographic criteria checklist to determine reasons for errors, resulting in sub-optimal routine shoulder projections

Background: Optimal shoulder images must adhere to specific radiographic criteria before they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase radiation exposure to the patient. Aim: The aims of this study were to determine whether images adhered to the required radiographic criteria for routine shoulder imaging and to identify possible reasons for non-adherence. Setting: The study was conducted at an imaging department at a tertiary academic hospital in Bloemfontein, South Africa. Methods: A criteria checklist compiled from literature was used to evaluate 578 routine shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y) projections. The checklist determined whether the shoulder images adhered to the criteria with regard to the anatomy included, positioning and technical factors, such as inclusion of the correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software. Results: More than 80% of the AP external rotation images included unnecessary anatomical structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided collimation was not present in more than 50% of both AP external rotation and LAT-Y images because of incorrect centring, while more than 30% of shoulder images presented with anatomical digital markers. Conclusion: The application of criteria required for shoulder imaging must be addressed at the participating imaging department to improve overall patient care. An in-service training session is recommended to enhance the radiographic technique with regard to routine shoulder projections

Measurement of clavicular length and shortening after a midshaft clavicular fracture: Spatial digitization versus planar roentgen photogrammetry.

PURPOSE: Clavicular shortening after fracture is deemed prognostic for clinical outcome and is therefore generally assessed on radiographs. It is used for clinical decision making regarding operative or non-operative treatment in the first 2weeks after trauma, although the reliability and accuracy of the measurements are unclear. This study aimed to assess the reliability of roentgen photogrammetry (2D) of clavicular length and shortening, and to compare these with 3D-spatial digitization measurements, obtained with an electromagnetic recording system (Flock of Birds). PATIENTS AND METHODS: Thirty-two participants with a consolidated non-operatively treated two or multi-fragmented dislocated midshaft clavicular fracture were analysed. Two observers measured clavicular lengths and absolute and proportional clavicular shortening on radiographs taken before and after fracture consolidation. The clavicular lengths were also measured with spatial digitization. Inter-observer agreement on the radiographic measurements was assessed using the Intraclass Correlation Coefficient (ICC). Agreement between the radiographic and spatial digitization measurements was assessed using a Bland-Altman plot. RESULTS: The inter-observer agreement on clavicular length, and absolute and proportional shortening on trauma radiographs was almost perfect (ICC>0.90), but moderate for absolute shortening after consolidation (ICC=0.45). The Bland-Altman plot compared measurements of length on AP panorama radiographs with spatial digitization and showed that planar roentgen photogrammetry resulted in up to 37mm longer and 34mm shorter measurements than spatial digitization. CONCLUSION: Measurements of clavicular length on radiographs are highly reliable between observers, but may not reflect the actual length and shortening of the clavicle when compared to length measurements with spatial digitization. We recommend to use proportional shortening when measuring clavicular length or shortening on radiographs for clinical decision making.

Determination of phthalic acid esters in Chinese white spirit using dispersive liquid-liquid microextraction coupled with sweeping ß-cyclodextrin-modified micellar electrokinetic chromatography.

A simple method that consumes low organic solvent is proposed for the analysis of phthalic acid esters in Chinese white spirit using dispersive liquid-liquid microextraction coupled with sweeping-micellar electrokinetic chromatography. Tetrachloromethane and white-spirit-containing ethanol were used as the extraction and dispersing solvents, respectively. The electrophoresis separation buffer was composed of 5 mM ß-cyclodextrin, 50 mM sodium dodecyl sulfate and 25 mM borate buffer (pH 9.2) with 9% acetonitrile, enabling the baseline resolution of the analytes within 13 min. Under the optimum conditions, satisfactory linearities (5-1000 ng/mL, r ≥ 0.9909), good reproducibility (RSD ≤ 6.7% for peak area, and RSD ≤ 2.8% for migration time), low detection limits (0.4-0.8 ng/mL) and acceptable recovery rates (89.6-105.7%) were obtained. The proposed method was successfully applied to 22 Chinese white spirits, and the content of dibutyl phthalate in 55% of the samples exceeded the Specific Migration Limit of 0.3 mg/kg established by the domestic and international regulations.

Automated kymograph analysis for profiling axonal transport of secretory granules.

This paper describes an automated method to profile the velocity patterns of small organelles (BDNF granules) being transported along a selected section of axon of a cultured neuron imaged by time-lapse fluorescence microscopy. Instead of directly detecting the granules as in conventional tracking, the proposed method starts by generating a two-dimensional spatio-temporal map (kymograph) of the granule traffic along an axon segment. Temporal sharpening during the kymograph creation helps to highlight granule movements while suppressing clutter due to stationary granules. A voting algorithm defined over orientation distribution functions is used to refine the locations and velocities of the granules. The refined kymograph is analyzed using an algorithm inspired from the minimum set cover framework to generate multiple motion trajectories of granule transport paths. The proposed method is computationally efficient, robust to significant levels of noise and clutter, and can be used to capture and quantify trends in transport patterns quickly and accurately. When evaluated on a collection of image sequences, the proposed method was found to detect granule movement events with 94% recall rate and 82% precision compared to a time-consuming manual analysis. Further, we present a study to evaluate the efficacy of velocity profiling by analyzing the impact of oxidative stress on granule transport in which the fully automated analysis correctly reproduced the biological conclusion generated by manual analysis.

Arytenoid adduction for correcting vocal fold asymmetry: high-speed imaging.

OBJECTIVES: We hypothesized that high-speed digital imaging provides a quantitative method to evaluate the effect of arytenoid adduction for the correction of asymmetric and irregular vocal fold vibration in unilateral vocal fold paralysis. METHODS: Six subjects with unilateral vocal fold paralysis participated in the study (4 male, 2 female; mean [-SD] age, 52.5 +/- 21.3 years). Videokymographic and laryngotopographic methods for image analysis were performed for high-speed recordings of vocal fold vibration for visualizing the glottal vibratory patterns, and for quantifying the frequency of vibration of each vocal fold, respectively. Comparisons of the paralyzed and the normal vocal folds were made before and after arytenoid adduction. RESULTS: Analysis of the laryngotopographs revealed 2 distinct frequencies of vibration for the paralyzed and the contralateral vocal folds for all subjects before surgery. After arytenoid adduction, the vibration frequencies became identical or nearly identical in all subjects. CONCLUSIONS: Asymmetric vibration in vocal fold paralysis was exemplified by differences in vibration frequency between the vocal folds. The present data showed that after arytenoid adduction the vibration frequencies and the vibratory patterns of the contralateral vocal folds approached symmetry. This surgical procedure could improve the functional symmetry of the larynx for phonation.

State of the art laryngeal imaging: research and clinical implications.

PURPOSE OF REVIEW: This study provides a review of the latest advances in videostroboscopy, videokymography and high-speed videoendoscopy, and outlines the development of new laryngeal imaging modalities based on optical coherence tomography, laser-depth kymography, and magnetic resonance imaging (MRI), published in the past 2 years. RECENT FINDINGS: Videostroboscopy and videokymography: Image quality has improved and several image processing and measurement techniques have been published. High-speed videoendoscopy: Significant progress has been made through increased sensitivity and frame rates of the cameras, and the development of facilitative playbacks, phonovibrography and several image segmentation and measurement methods. Clinical evidence was presented through applications in phonosurgery, comparisons with videostroboscopy, normative data, and better understanding of voice production. Optical coherence tomography: Latest developments allow the capture of dynamic high-resolution cross-sectional images of the vibrating vocal fold mucosa during phonation. Depth kymography: New laser technique allowing recording of the vertical movements of the vocal folds during phonation in calibrated spatial values. Laryngeal magnetic resonance: New methods allow high-resolution imaging of laryngeal tissue microstructure, or measuring of dynamic laryngeal structures during phonation. SUMMARY: The endoscopic laryngeal imaging techniques have made significant advances increasing their clinical value, whereas techniques providing new types of potentially clinically relevant information have emerged.

Advances in laryngeal imaging.

Imaging and image analysis became an important issue in laryngeal diagnostics. Various techniques, such as videostroboscopy, videokymography, digital kymography, or ultrasonography are available and are used in research and clinical practice. This paper reviews recent advances in imaging for laryngeal diagnostics.

Alzheimer's disease genetic mutation evokes ultrastructural alterations: correlation to an intracellular Abeta deposition and the level of GSK-3beta-P(Y216) phosphorylated form.

Herein we demonstrate that PC12 cells, which overexpress human wild-type amyloid-beta precursor protein (AbetaPPwt) or AbetaPP bearing double Swedish mutation (AbetaPPsw), reveal phenotype characteristic for Alzheimer's disease (AD). The examination of cell ultrastructure showed the presence of peptide aggregates within the cells, activation of endosomal-lysosomal system and extensive exocytosis. Furthermore, the autophagy induction was also characteristic hallmark of amyloid-beta-induced cytotoxicity. Morphological changes were positively correlated with the extent of phosphorylated glycogen synthase kinase-3beta (phospho-Tyr(216)-GSK-3beta, GSK-3beta-P(Y216)). The activity of GSK-3beta is believed to cause tau protein hyper-phosphorylation, increased amyloid-beta production and local plaque-associated microglial-mediated inflammatory responses. All of them are symptomatic for AD. In our studies, the highly significant Y216 phosphorylation and over-expression of total GSK-3beta were observed in AbetaPPsw-transfected PC12 cells. In addition, the immuocytochemical analysis showed co-localization of GSK-3beta-P(Y216) and amyloid-beta deposits. Thus, our data support a functional role of GSK-3beta in AbetaPP processing, further implicating this kinase in the amyloid-beta-dependent pathogenesis.

Niveles séricos de tetrayodotironina libre (T4L), mediante el método de electroquimioluminiscencia en caninos / Free tetraiodothyronine (FT4) serum levels by electrochemiluminescence method in canines

El presente estudio establece valores de referencia para niveles séricos de tetrayodotironina libre (T4L) en caninos mediante el método de electroquimioluminiscencia. Se utilizaron 180 caninos que fueron divididos en grupos según la edad y el sexo. Se encontraron diferencias altamente significativas (P<0,0001) relacionadas con la edad, sin encontrarse diferencias significativas con respecto al sexo para dicha hormona. Los resultados de este estudio sugieren que las concentraciones séricas de tetrayodotironina libre (ng/L) en caninos menores de 1año, de 1 a 7 años y mayores de 7 años, oscilan entre 9,90-11,74 ng/L, 8,51-11,74 ng/L y 7,48-8,64 ng/L, respectivamente. La determinación de T4L mediante electroquimioluminiscencia, puede considerarse útil como ayuda diagnóstica de posibles alteraciones tiroideas.

The present study establishes references values for free Tetraiodotironine (FT4) in canines using eletrochemiluminescence method. Blood samples from 180 canines divided in six groups of age (males and females), 30 animals for each group were used. Significant differences (P<0.0001) was found between age groups but not between sex groups. The canine average values for FT4 using this technique were as follow: younger than 1 year of age , 9.9 - 11.7 ng/L; from 1 to 7 years of age, 8.1 - 11.7 ng/L; older than 7 years of age 7.4- 8.6 ng/L. The electrochemiluminiscence method for measuring FT4 is valuable diagnostic tool in canine medicine.

Animal model of the short-term cardiorespiratory effects of intermittent vagus nerve stimulation.

PURPOSE: To develop an animal model of the effects of vagus nerve stimulation (VNS) on heart rate and respiration in studies of seizure treatment. METHODS: Nine rats implanted with ECG, EMG, and VNS electrodes and pulse generator were stimulated with 81 different sets of parameters while they slept in a plethysmographic box. RESULT: From cardiorespiratory effects of VNS, an index (alpha) was found to distinguish between weak and strong VNS doses. Weak VNS dose induced an increase in respiratory frequency and no significant change in heart rate. The effect of VNS on respiration, similar to that observed in children, can be divided into 3 phases. Strong VNS dose induced a decrease in respiratory frequency concomitant with a decrease in heart rate. Increasing the intensity of the VNS induced a proportional increase in the maximal inspiratory strength. CONCLUSION: Various VNS parameter settings induce different and concomitant cardiorespiratory variations in conscious sleeping rats. These effects correlate with the intensity of the VNS parameters. Understanding the effects of the intensity of VNS parameters may allow for further optimization of VNS parameters in patients receiving VNS.

Three registers in an untrained female singer analyzed by videokymography, strobolaryngoscopy and sound spectrography.

There has been a lack of objective data on the singing voice registers, particularly on the so called "whistle" register, occurring in the top part of the female pitch range, which is accessible only to some singers. This study offers unique strobolaryngoscopic and high-speed (7812.5 imagess) videokymographic data on the vocal fold behavior of an untrained female singer capable of producing three distinct voice qualities, i.e., the chest, head and whistle registers. The sound was documented spectrographically. The transition from chest to head register, accompanied by pitch jumps, occurred around tones B4-C#5 (500-550 Hz) and was found to be associated with a slight decrease in arytenoids adduction, resulting in decrease of the closed quotient. The register shifts from head to whistle, also accompanied by pitch jumps, occurred around tones E5-B5 (670-1000 Hz) without any noticeable changes in arytenoids adduction. Some evidence was found for the vocal tract influence on this transition. The mechanism of the vocal fold vibration in whistle register was found principally similar to that at lower registers: vibrations along the whole glottal length and vertical phase differences (indicated by sharp lateral peaks in videokymography) were seen on the vocal folds up to the highest tone G6 (1590 Hz).

Validation of a raw data-based synchronization signal (kymogram) for phase-correlated cardiac image reconstruction.

Phase-correlated reconstruction is commonly used in computed tomography (CT)-based cardiac imaging. Alternatively to the commonly used ECG, the raw data-based kymogram function can be used as a synchronization signal. We used raw data of 100 consecutive patient exams to compare the performance of kymogram function to the ECG signal. For objective validation the correlation of the ECG and the kymogram was assessed. Additionally, we performed a double-blinded comparison of ECG-based and kymogram-based phase-correlated images. The two synchronization signals showed good correlation indicated by a mean difference in the detected heart rate of negligible 0.2 bpm. The mean image quality score was 2.0 points for kymogram-correlated images and 2.3 points for ECG-correlated images, respectively (3: best; 0: worst). The kymogram and the ECG provided images adequate for diagnosis for 93 and 97 patients, respectively. For 50% of the datasets the kymogram provided an equivalent or even higher image quality compared with the ECG signal. We conclude that an acceptable image quality can be assured in most cases by the kymogram. Improvements of image quality by the kymogram function were observed in a noticeable number of cases. The kymogram can serve as a backup solution when an ECG is not available or lacking in quality.

ER vesicles and mitochondria move and communicate at synapses.

Endoplasmic reticulum (ER) and mitochondria are multifunctional cell organelles and their involvement in Ca2+ handling is important in various neural activities. In the respiratory neurons, we observed ER as continuous reticulum in the soma and as isolated vesicles in dendrites. The vesicles moved bidirectionally with intermittent stops and decreased their velocity near exocytotic sites. ER vesicles and mitochondria that resided in these regions changed lumenal Ca2+ and mitochondrial potential in concert with synaptic activity. Ca2+ release from ER or mitochondria evoked exocytosis. ER vesicles and mitochondria bidirectionally exchanged Ca2+, the efficacy of which depended on the distance between organelles. Depolarisation-evoked exocytosis had different kinetics, depending on whether functional ER vesicles and mitochondria were present in perisynaptic regions and able to exchange Ca2+ or only one organelle type was available. Transfer of Ca2+ from ER to mitochondria produced long-lasting elevations of residual Ca2+ that increased the duration of exocytosis. In slice preparations, synaptic currents in inspiratory neurons were suppressed after disengagement of ER vesicles and mitochondria, and the activity was potentiated after stimulation of Ca2+ exchange between the organelles. We propose that communication between perisynaptic ER vesicles and mitochondria can shape intracellular Ca2+ signals and modulate synaptic and integrative neural activities.

A comparison of different methods to measure the EGG contact quotient.

The results from six published electroglottographic (EGG-based) methods for calculating the EGG contact quotient (CQEGG) were compared to closed quotients derived from simultaneous videokymographic imaging (CQKYM). Two trained male singers phonated in falsetto and in chest register, with two degrees of adduction in both registers. The maximum difference between methods in the CQEGG was 0.3 (out of 1.0). The CQEGG was generally lower than the CQKYM. Within subjects, the CQEGG co-varied with the CQkym, but with changing offsets depending on method. The CQEGG cannot be calculated for falsetto phonation with little adduction, since there is no complete glottal closure. Basic criterion-level methods with thresholds of 0.2 or 0.25 gave the best match to the CQKYM data. The results suggest that contacting and de-contacting in the EGG might not refer to the same physical events as do the beginning and cessation of airflow.

High-speed digital imaging and electroglottography of tracheoesophageal phonation by Amatsu's method.

BACKGROUND: Our previous findings have indicated that the thyropharyngeal muscles form a retropharyngeal prominence during alaryngeal phonation via the TE fistula. This prominence forms a so-called 'neoglottis', which is thought to function as the vibratory source. To better understand the mechanism of TE phonation, we analyzed the vibration of the neoglottis using electroglottography (EGG) and a high-speed digital imaging system. PATIENTS AND METHODS: Two volunteers who use TE phonation for their daily speech communication were subjected to this study. The vibrations of the neoglottis were recorded simultaneously as EGG and high-speed imaging with acoustic signals. RESULTS: The vibrations of the neoglottis, recorded by means of high-speed digital imaging, were exactly synchronized with the waveforms of the acoustic signals and EGG. CONCLUSIONS: These results further confirm the neoglottis as the source of vibration during tracheoesophageal (TE) phonation.

What have we learned about laryngeal physiology from high-speed digital videoendoscopy?

PURPOSE OF REVIEW: The purpose of this review is to describe recent developments in high-speed videoendoscopy. The applications of this technique are highlighted and important findings regarding vocal fold physiology and voice pathology are discussed. RECENT FINDINGS: The number of applications for digital high-speed imaging has increased during recent years because of the development of camera image sensor systems with increased image resolution of video and television quality. Other improvements are related to computer processing speed and storage capacity and the development of automatic algorithms for quantification and measurements both in time and room dimensions. This is enhanced by combining high-speed videoendoscopy with laser-based measurement systems, acoustic analyses or other glottographic methods, such as flow glottography or electroglottography. High-speed videoendoscopy is currently used in studies of voice mechanisms of phonation (e.g., the voice source can be examined with a high sampling rate, from 1000 to over 8000 frames per second), and in phonation onset or offset. High-speed imaging is also useful in linguistic studies and in the examination of different artistic singing styles, such as extremely high-pitched singing, throat singing, or different pop and rock styles. High-speed videoendoscopy is also used in the examination of patients with voice disorders, particularly with irregular vocal fold vibrations, ventricular phonation, or the phonation of individuals who have had a laryngectomy. SUMMARY: Findings from studies of normal voice physiology and of voice disorders using high-speed imaging are presented and their relevance is discussed.

[Computer cardiokymography. On its way to long-term noninvasive monitoring of cardiac performance in daly life]. / Komp'iuternaia kardiokimografiia na puti k dlitel'nomu neinvazivnomu nabliudeniiu za sokratil'noi deiatel'nost'iu serdtsa cheloveka.

A functioning heart generates low-frequency and low-amplitude movements (up to 40 (mrn) of soft tissues in the percardial area. Since the 1950-s of the XX-th century cardiologists have studied these movements to employ them in the diagnostics of ischemic heart disease (IHD). Indeed, changes of the movements have found their diagnostic application in this field. If blood supply to a certain area of ventricular myocardium is insufficient the contractions in this area diminish and even ceases. After systolic increase in ventricular pressure this area dilates and forces intercostal tissues out, causing a "bulge" wave on the record. For recording the patient must be in supine position and hold the breath. High frequency electromagnetic field generator was used in an attempt to examine the heart movements. It was found that such instrument measures the thickness of the air-gap that serves as a dielectric or a "capacitor" which forms between the skin and approaching it flat inductive coil. Nevertheless, such an instrument (cardiokymograph, CKG) can reveal changes in contractions of ischemic myocardium and markedly increases the sensitivity of the exercise ECG test. However, CKG can be recorded only after termination of the test. This principal disadvantage has been overcome by software that allowed the recording of CKG during the test. A low-frequency capacitance transducer developed recently by Chinese researchers has provided a simultaneous recording of several CKG. After modifying the transducer, we have established that 1) the shape of CKGs is the same as that CKGs recorded by all our predecessors, 2) CKGs are reproducible even within a 3-month interval, 3) the enormous mechanical interference caused by respiratory movements and, to a greater extent, by the vigorous movements of the legs and trunk during veloergometry can be eliminated by digital processing of the transducer signals, and 4) pathological changes appear in CKG of patients with IHD, which enables one to stop veloergometry at lower loads, thus increasing the safety of the test. Since for large medical insurance companies very simple and inexpensive cardiokymograph are quite unprofitable, their commercially production in USA and in Germany has been stopped. However, the goal of cardiokymography: a real-time, beat-to-beat, long-term monitoring of cardiac function in daily life, remains the major factor determining the future of the method.

[Instrumental diagnostics of pulmonary hypertension in patients with chronic pulmonary heart]. / Instrumental'na diahnostyka lehenevoï hipertenziï u khvorykh z khronichnym lehenevym sertsem.

64 patients aged 30-49 with chronic cor pulmonale underwent the following diagnostic evaluation: electromyography of the heart and vessels, electrocardiography, lung rheography to diagnose the presence of pulmonary hypertension. Electromyography was shown to play a key role in diagnosing pulmonary hypertension. Attention should be paid to electrocardiography (with the help of L. Burstin's nomogram) and electrocardiography (after S. A. Dushanin) methods of quantitative evaluation of pulmonary hypertension. Electrocardiography (after R. Bernar and al) was noted to have a low sensitivity, especially at early stages of the development of chronic cor pulmonale. It was established that lung rheography suggested by A. M. Novikov is to be used for diagnosing pulmonary hypertension even though it doesn't allow estimating exactly an absolute value of mean blood pressure in pulmonary arteries.