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11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007: MEDICON 2007, 26-30 June 2007, Ljubljana, Slovenia

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EMITEL – an e-Encyclopedia for Medical Imaging Technology

Slavik Tabakov; C. A. Lewis; A. Cvetkov; M. Stoeva

The paper gives a brief explanation of a new International project EMITEL and its associated multilingual e-Dictionary. The project is developing the first web-based e-Encyclopedia in the profession. EMITEL will address the lifelong learning of a wide range of specialists and will be available free on Internet. The project advanced work-inprogress - the e-Dictionary is already functioning at www.emitdictionary.co.uk

- Invited Lectures | Pp. 1-2

Control for Therapeutic Functional Electrical Stimulation

Dejan B. Popovic; Mirjana B. Popovic

We suggest in this review paper that control of assistive systems for individuals with disability caused by injury or disease of central nervous system has to be approached with rather sophisticated methods that are capable to deal with high redundancy, nonlinearities, time variations, adaptation to the environment, and perturbations. The use of three levels that provide interaction with user, coordination of multi joint activity, and biological actuators is likely to be the solution for future electrical stimulation assistive systems. This is especially important for therapeutic assistive systems that must mimic life-like movement. The top control level needs to be discrete and secure the recognition of intended movement and possibly some kind of feedback, the middle control level needs to be discrete and provide multi joint coordination that is based on temporal and spatial synergistic model of the movement. The lowest control level needs to be model-based in order to match the specifics of the musculo-skeletal system. The hierarchical hybrid control is inherently predictive adaptive controller that, if properly designed, could results with effective generation of segment movements that lead to life like function (e.g., walking, standing, manipulation, grasping, etc.).

Palabras clave: Assistive System; Functional Electrical Stimulation; Coordination Level; Hybrid Control System; Rule Base Control.

Pp. 3-6

From Academy to Industry: Translational Research in Biophysics

Ruggero Cadossi

The translation “from bench to bedside” of a scientific discovery, proof of principle or simple idea, that originated within academia, into a successful industrial product is a complex, long and costly process. Many factors need to be accounted for and careful planning and protection of intellectual property are essential to retain the value of the idea. This analysis, based on more than twenty-five years of experience in the biomedical field at IGEA, is presented to outline the different steps involved in such an endeavour. Critical factors defining the different phases, from initial evaluation of the idea to marketing and post-marketing monitoring, are described focusing on development processes.

- Invited Lectures | Pp. 10-13

Effects of vagal blockade on the complexity of heart rate variability in rats

Mathias Baumert; E. Nalivaiko; D. Abbott

In this paper we investigate the influence of vagal blockage on heart rate variability complexity measures. Nine conscious rats are injected with methyl-scopolamine brobide (50 μg/kg s.c.). We analyze 10 minute segments of beat-to-beat intervals before and after injection by standard time and frequency domain methods, compression entropy, sample entropy, Poincaré plot, detrended fluctuation analysis and symbolic dynamics. All parameter domains show changes in heart rate variability after vagal blockade, indicating a decrease in heart rate complexity. In conclusion, vagal modulation plays an important role in the generation of heart complexity in rats or, in other words, heart rate complexity measures are sensitive to vagal heart rate modulation.

- Analysis of the ECG | Pp. 26-29

Classification Methods for Atrial Fibrillation Prediction after CABG

Siniša Sovilj; R. Magjarević; G. Rajsman

The aim of this study is to compare different methods for the classification type problems specifically in predicting Atrial Fibrillation (AF) after Coronary Artery Bypass Grafting (CABG). The prediction/classification model tends to predict a categorical dependent variable (which determines the belonging of patient to a group of patients that have or to a group of patients that have not developed AF), by one or more continuous and/or categorical predictor variables derived from the patients' history, electrocardiograms and in particular from the P wave. We have obtained the parameters from continuously recorded ECG after the surgery.

- Analysis of the ECG | Pp. 46-49

Modelling effects of Sotalol on Action Potential morphology using a novel Markov model of the HERG channel

Thomas Brennan; M. Fink; B. Rodriguez; L.T. Tarassenko

In this paper, we present a simulation study of the effects of Sotalol, a known anti-arrhythmic drug, on the rapid delayed rectifier potassium current (). The current is encoded by the (HERG), which plays a major role in repolarization in mammalian ventricles. HERG is also the target of class III anti-arrhythmic drugs, such as Sotalol. Due to its unique structure and electrophysiological qualities, non-cardiac drugs readily bind with residues inside HERG's intracellular cavity. A novel Markov model was developed to model Sotalol's interaction with HERG. The model was validated using experimental data from HERG expressed in Human Embryonic Kidney (HEK) cells and integrated into the ten Tusscher (2006) human ventricular cell model. The simulation results show that an increase in Sotalol concentration decreases the overall conductance of over time, resulting in prolongation of the action potential duration. This effect is larger in mid-myocardial than in endocardial and epicardial cells. Therefore, Sotalol-induced effects on cardiac repolarization may result in enhanced transmural dispersion of repolarization in the ventricles, and also in changes in the T wave.

- Analysis of the ECG | Pp. 50-53

FPGA-based System for ECG Beat Detection and Classification

Andrej Zemva; M. Cvikl

We present a Field Programmable Gate Arraybased system for single-lead electrocardiogram signal processing which performs beat detection and classification to normal and ventricular beats. Geometrical properties of a phase-space portrait of an ECG signal are used for QRS complex detection, while classification is done with a modified classification algorithm that is a part of the Open Source ECG Analysis Software. The chosen Field Programmable Gate Array has an embedded PowerPC processor and is very suitable for mixed hardware and software designs. Beat detection is implemented in hardware and the classification is executed on the embedded PowerPC 405 core. The algorithm was developed on the MITBIH Arrhythmia Database resampled to 250 samples per second. Sensitivity of 99.80% and positive predictivity of 99.84% was achieved for QRS complex detection and sensitivity of 92.59% and positive predictivity of 95.55% was achieved for identification of premature ventricular complexes. A comparison of processing speed between a personal computer and the embedded system shows that a personal computer running at 18-times faster clock speed processes data only six times faster.

Palabras clave: Processing Speed; Field Programmable Gate Array; Beat Detection; Beat Classification; IFMBE Proceeding.

Pp. 66-69

Feature extraction and selection algorithms in biomedical data classifiers based on time-frequency and principle component analysis.

Pawel Kostka; E.J. Tkacz

Proposed methods for feature extraction and selection stages of biomedical pattern recognition system are presented. Time-Frequency signal analysis based on adaptive wavelet transform and Principle Component Algorithm (PCA) algorithm is used for extracting and selecting from original data the input features that are most predictive for a given outcome. From the discrete fast wavelet transform coefficients optimal feature set based on energy and entropy of wavelet components is created. Then PCA is used to shrink this feature group by creating the most representative parameter subset for given problem, which is the input for last neural classifier stage. System was positively verified on the set of clinically classified ECG signals for control and atrial fibrillation (AF) disease patients taken from MITBIH data base. The measures of specificity and sensitivity computed for the set of 20 AF and 20 patients from control group divided into learning and verifying subsets were used to evaluate presented pattern recognition structure. Different types of wavelet basic function for feature extraction stage as well as supervised (Multilayer Perceptron) and unsupervised (Self Organizating Maps) neural network classification units were tested to find the best system structure.

Palabras clave: Atrial Fibrillation; Feature Extraction; Principle Component Analysis; Pattern Recognition System; Feature Extraction Stage.

Pp. 70-73

Neural Networks Based Approach to remove Baseline drift in Biomedical Signals

Jorge Mateo Sotos; C. Sanchez; J. Mateo; R. Alcaraz; C. Vaya; J.J. Rieta

Nowadays there exist different approaches to cancel out noise effect and baseline drift in biomedical signals. However, none of them can be considered as completely satisfactory. In this work an artificial neural network (ANN) based approach to cancel out baseline drift in electrocardiogram signals is presented. The system is based on a grown ANN allowing to optimize both the hidden layer number of nodes and the coefficient matrixes. These matrixes are optimized following the simultaneous perturbation algorithm, offering much lower computational cost that the traditional back propagation algorithm. The proposed methodology has been compared with traditional baseline reduction methods (FIR, Wavelet-based and Adaptive LMS filtering) making use of cross correlation, signal to interference ratio and signal to noise ratio indexes. Obtained results show that the ANN-based approach performs better, with respect to baseline drift reduction and signal distortion at filter output, than traditional methods.

- Analysis of the ECG | Pp. 90-93

An Approach to the Real-Time Surface Electromyogram Decomposition

Vojko Glaser; A. Holobar; D. Zazula

This paper studies a sequential decomposition method suitable for real-time separation of linear mixtures of finite-length signals. The signals are modelled as channel responses in a multiple-input multiple-output (MIMO) model, with positive pulse trains as channel inputs. Our decomposition method compensates the channel responses and aims to reconstruct the input pulse trains in real time. Tests on synthetic surface electromyograms (SEMG) show how well the proposed method performs, in comparison to its batch version, and how robust it is.

- Analysis of Surface EMG | Pp. 105-108

EMG Based Muscle Force Estimation using Motor Unit Twitch Model and Convolution Kernel Compensation

Rok Istenic; A. Holobar; R. Merletti; D. Zazula

In this paper we introduce a new method for muscle force estimation from multi-channel surface electromyograms. The method combines a motor unit twitch model with motor unit innervation pulse trains, which are estimated from multi-channel surface electromyograms. The motor unit twitches are then aligned to the innervation pulse trains and summed up to obtain the total muscle force. The method was tested on real surface EMG signals acquired during force ramp contractions of abductor pollicis brevis muscle in 8 male subjects. With 22 ± 5 (mean ± std. dev.) motor units identified per subject, the force estimation error of our method was 16 ± 4 % RMS. These results were compared to the method which uses the EMG amplitude processing to estimate muscle force. The results of our new concept proved to be completely comparable to those of EMG amplitude processing.

- Analysis of Surface EMG | Pp. 114-117

Uterine Electromyography in Humans – Contractions, Labor, and Delivery

R. E. Garfield; W.L. Maner

Today’s maternal/fetal monitoring lacks the capability to diagnose labor and predict delivery. The objective of this work was to demonstrate that uterine electromyography (EMG) is proven to be a viable alternative to current monitoring techniques. Uterine EMG was monitored noninvasively and trans-abdominally from pregnant patients using surface electrodes. Several aspects of the uterine EMG were investigated: contraction plotting, diagnosing labor, and predicting delivery. Contractions were seen to correspond well with tocodynamometer- (TOCO-) plotted contractions. As well, increases in electrical activity were indicative of labor and imminent delivery. Uterine EMG could be a valuable tool for obstetricians if implemented on a routine basis in the clinic.

Palabras clave: Obstet Gynecol; Power Density Spectrum; Uterine Contraction; Abdominal Surface; Myometrial Activity.

Pp. 128-130

Predictive value of EMG basal activity in the cervix at initiation of delivery in humans

Drago Rudel; G. Vidmar; B. Leskosek; I. Verdenik

We present efforts to objectively assess cervical ripeness in humans. The hypothesis was that the cervical EMG basal activity might reflect readiness of the cervix for delivery. 47 women at initiation of delivery were involved in the study. EMG parameters – amplitude ( U _ RMSA ) and frequency contents ( MF _ A ) – were related to Cumulative Bishop Score values (CBS) assessed by an obstetrician in each woman at the labor onset. The results show that the parameters are predictive of the CBS, both correlating negatively with the CBS value. Hence, EMG parameters have potentials to become objective indicators in assessment of cervical ripeness in humans. This would empower an obstetrician in his/her decisions how to further conduct the labor.

Palabras clave: Median Frequency; Power Spectrum Density; Bishop Score; Cervical Ripeness; Butterworth Band Pass Filter.

Pp. 131-134

Detection of contractions during labour using the uterine electromyogram

Alenka Macek-Lebar; D. Novak; D. Rudel; Tomaz Jarm

This paper describes two simple algorithms for detection of uterine contractions during labour using the uterine electromyogram recorded from the abdominal surface. The location of a contraction is extracted from the signal’s energy using either an amplitude- or derivative-based algorithm. For our recordings, these algorithms managed to correctly locate the majority of contractions, with an average success rate of 87.4% for the derivative-based algorithm and 85.6% for the amplitude-based algorithm.

- Analysis of Uterine EMG/EHG | Pp. 148-151

Analyzing Distributed Medical Databases on DataMiningGrid©

Vlado Stankovski; Martin Swain; Matevz Stimec; Natasa Fidler Mis

Hospitals throughout Europe hold vast amounts of data in the form of patient records. Performing on-the-fly analyses of these data and their actual transformation into information and knowledge may help improve medical procedures, treatments or prevent illnesses. Grid technology has recently emerged to address the needs for efficient and effective exploitation of heterogeneous and geographically distributed resources, such as large and distributed data, open source or proprietary programs for data analysis, massive storage devices and high-performance computers. A de facto standard framework for building grid environments is the Open Grid Service Architecture (OGSA) and the corresponding Web Service Resource Framework (WSRF). The Globus Toolkit version 4, is a fully WSRF-compliant grid middleware, which addresses the needs for secure, flexible, interoperable and seamless use of grid resources. The DataMiningGrid© (www.datamininggrid.org) system was recently built on top of existing Globus technology inter alia to address the requirements of a community of medical users and enable them to perform on-the-fly analysis of geographically distributed medical databases. DataMiningGrid© is a set of grid services and user-friendly workflow editing and managing tools, which facilitate manipulation of distributed data, registering, discovery and use of grid-enabled statistical and data mining programs, their execution in the grid environment and a provenance tracking mechanism. The software is now freely available at SourceForge.net under Apache License V2. The present work illustrates the use of the DataMiningGrid© system to perform analysis of nine regional medical databases in Slovenia.

Palabras clave: Grid Resource; Grid Environment; Urinary Iodine; Medical Database; Grid Technology.

Pp. 166-169

Separation of electroporated and non-electroporated cells by means of dielectrophoresis

Jakob Oblak; D. Krizaj; S. Amon; Alenka Macek-Lebar; D. Miklavcic

By exposing cells to high voltage electric pulses, cells’ membrane permeability increases significantly. Phenomenon is known as electroporation and is widely used in biotechnology, biology and medicine, as a way of introducing into a cell molecules which otherwise are deprived of membrane transport mechanisms. Besides cell membrane permeability, the cells’ geometrical and electrical properties change significantly due to electroporation. These changes have a huge impact on dielectrophoretic force, which could allow us to separate the electroporated and non-electroporated cells. Usually, a test whether a cell is electroporated or not is performed by exposing cells to a dye. After such test cells are most often not useful for further use. For this reason cell separation based on dielectrophoretic force could be very useful, because cells are not destroyed or changed due to dielectrophoresis. In this study we report the results of an attempt to separate the electroporated and non-electroporated cells by means of dielectrophoresis. In several experiments we managed to separate the electroporated and non-electroporated cells suspended in a medium with conductivity 0.174 S/m by exposing them to a non-uniform electric field at a frequency of 2 MHz. Because experimental results did not match theoretical predictions entirely we presume that cell membrane permittivity decreases after electroporation for at least ten times.

- Bioimpedance | Pp. 178-181

A simple DAQ-card based bioimpedance measurement system

Tomaz Zagar; D. Krizaj

A custom made DAQ-card based bioimpedance measurement system is presented. The signals are processed by the digital lock-in technique. The system was tested on an electrical model of skin with underlying tissues over a frequency range of 20 Hz to 1 MHz. The measurements performed directly with the DAQ-card are compared to the measurements with the instrumentation amplifier interface. The highest achieved accuracy without special calibration and compensation is about 0.5 % for the impedance magnitude and 0.02° for the impedance phase angle in the low frequency region, whereas in the high frequency region the respective values are approximately 1 % and 1°.

Palabras clave: Phase Angle; Stratum Corneum; High Frequency Region; Electrical Model; Underlying Tissue.

Pp. 182-185

Bioimpedance spectroscopy of human blood at low frequency using coplanar microelectrodes

NADI Mustapha; J. Prado; C. Margo; A. Rouane

Dielectric properties of biological substances are usually deduced ex vivo by the way of the impedance measurement of a cell loaded by the investigated medium. At low frequency it is well known that the bioimpedance depends on the polarization effects that occur at the electrodes interface. Measurements being affected for frequencies lower than 50 kHz for standard electrodes, black platinum was used to decrease polarization effects. In this paper, dielectric properties of blood measured at different temperatures are presented for frequencies varying between 100 Hz and 1 MHz.

Palabras clave: Dielectric Property; Microelectrode Array; Electrode Interface; Physiological Serum; Bioimpedance Measurement.

Pp. 186-189

Parameter Optimization in Voltage Pulse Plethysmography

Martina Melinscak

Measurement optimization is being studied when short voltage pulses are stimulating bio-tissue and the transient process is sampled in order to measure the tissue volume changes. The measurement sensitivity depends on the ratio of the sampling instant to the time constant of the transient process, ( T /τ) and on the ratio of the current sensing resistance to the resistance of the electrode-skin interface ( R _0/ R _ SX ). With variations of R _0/ R _ SX and T /τ the sensitivity changes from negative to positive values, while it equals zero for certain R _0/ R _ SX and T /τ ratios. The sensitivity is greater when positive while than negative but it depends on T /τ and R _0/ R _ SX . For negative sensitivity, T and R _0 can be chosen to maximize the sensitivity and minimize its variations.

Palabras clave: Voltage Pulse; Measurement Sensitivity; Transient Process; Resistance Change; Sensitivity Curve.

Pp. 198-201

Effect of Modulated 450 MHz Microwave on HumanEEG at Different Field Power Densities

Hiie Hinrikus; R. Tomson; M. Bachmann; J. Lass; V. Tuulik

The experiments on the effect of modulated microwaves on human EEG were carried out on two different groups of 14 and 7 healthy volunteers exposed to 450 MHz microwave radiation modulated at 40 and 1000 Hz frequencies. The field power densities at the scalp were 0.16 mW/cm for the first and 0.9 mW/cm for the second group. The EEG analysis performed for individuals showed that increase in the EEG rhythm energy in both groups was comparable: up to 40% at lower and up to 30% at higher level of the field power density. Microwave caused statistically significant changes in the EEG rhythms energy for 20% of subjects in the first and for 14% of subjects in the second group. Our results suggested that effect of microwave on EEG didn’t enlarged with increase of the applied power density.

- Biological Effects of Electromagnetic Radiation | Pp. 210-213

Regenerative Effects of (-)-epigallocatechin-gallate Against Hepatic Oxidative Stress Resulted by Mobile Phone Exposure

Elcin Ozgur; G. Güler; N. Seyhan

Many in vivo and in vitro studies have been performed to investigate the biological consequences and to assess health risks of RFR (Radio Frequency Radiation) generated from mobile phones. Mechanism of RFR and oxidative damage and the question if antioxidants taken as nutrition can alter the oxidative damage of mobile phone damage are popular subjects tried to investigate. In this study, it was aimed to investigate whether the antioxidative effects of green tea catechins can inhibit RFR- induced free radical releases causing oxidative damage of proteins in guinea pigs’ liver tissue. RFR generated by mobile phone with 0.81 W/kg digital SAR value operating in GSM 1800 MHz frequency. Male Guinea pigs were exposed to mobile phone radiation averaged as 11.2 V/m, measured during exposure for 20 minutes in 7 days of a week. Activities of antioxidant enzymes such as superoxide dimutase (SOD), glutathione peroxidase (GSH-Px), and level of malondialdehyde (MDA) were measured in liver guinea pigs which divided into four groups as control, EGCG-treated, mobile phone-exposed and both mobile phone-exposed and EGCG-treated. As a result, both antioxidant enzyme activities and free radical levels of the mobile phone exposed and mobile phone exposed with EGCG groups changed significantly ( p < 0.05).

- Biological Effects of Electromagnetic Radiation | Pp. 214-217

EMF Monitoring Campaign in Slovenian Communes

Blaz Valic; J. Jancar; P. Gajsek

To give the Slovenian communes and their inhabitants the possibility to obtain information about electromagnetic fields in their neighborhood, Forum EMS – an independent project aimed to inform general public about electromagnetic fields and their biological effects – started monitoring campaign in 2005. In communes expressed the interest, remote monitoring station was installed for one week. The value of electric field intensity was stored every minute 24 hours a day and. For each location all collected data were evaluated and presented to the interested public as an article in commune bulletin and on internet, where the data for all locations are available. In last two years more than 35 communes participated in this campaign. The monitoring campaign showed that typical electromagnetic field exposure due to GSM base stations in urban area is low. Maximum values reach 2 % of reference level for I. region of Slovenian legislation, which is 0.2 % of ICNIRP reference level for general public. Due to the vicinity of radio and TV broadcasting tower in one case, instead of GSM probe, wide band probe was used. In this case, measured electric field was 40 % of reference level for I. region of Slovenian legislation (4 % of ICNIRP reference level for general public).

Pp. 234-237

Expression of Smooth Muscle Cells Grown on Magnesium Alloys

Shao Kuo Lu; W.H. Lee; T.Y Tian; C.H. Chen; H.I. Yeh

In the present study, it compared the behavior of smooth muscle cells grown on various “magnesium alloys” materials. Human Smooth Muscle Cells (HSMC) were seeded (800 cells/mm^2) onto various magnesium alloy sheets, including Mg-Al-Zn alloys (AZ31, AZ91) and Mg-Al-Mn alloy (AM60). And they were cultured with SMGS (Smooth Muscle Growth Supplement) medium. Cells seeded onto tissue culture treated polystyrene dish coated with gelatin were used as controls. Forty-eight hours later, the cells were examined by immunofluorescence microscopy. In this study, it investigated three factors: vimentin, desmin, and SMC α-Actin. The results showed that the cellularity at 48 hours, all magnesium groups were much lower than controls (p<0.05), significantly. And immunoconfocal microscopy showed that vimentin, desmin, and SMC α-Actin proteins were all less in the metal groups. Therefore, it suggested that down-regulation of vimentin, desmin, and SMC α-Actin may be a common phenomenon in HSMC grown on magnesium alloys.

Palabras clave: Magnesium Alloy; Wire Electrical Discharge Machine; Growth Profile; Magnesium Alloy Sheet; Metallic Sheet.

Pp. 242-245

Coalescence of phospholipid vesicles mediated by β2GPI – experiment and modelling

Jasna Urbanija; B. Rozman; A. Iglič; T. Mareš; M. Daniel; Veronika Kralj-Iglic

Collective interactions between the giant phospholipid vesicles made of POPC, cardiolipin and cholesterol after the addition of β2GPI may cause the coalescence of membrane buds to the mother cell. Using the discrete elastic model of the vesicle membrane mechanics it was shown that the coalescence of the buds depends on the adhesion strength and rigidity of the biomembrane.

Palabras clave: Adhesion Energy; Phospholipid Vesicle; POPC Vesicle; Unilamellar Phospholipid Vesicle; IFMBE Proceeding.

- Biomaterials | Pp. 246-248

Combination of microfluidic and structure-continual studies in biorheology of blood with magnetic additions

Evgeny Taran; V.A. Gryaznova; O.O. Melnyk

Multiscale combination of microfluidic and structure-continual studies is used in order to construct the structure-phenomenological theory of stressed state in arbitrary gradient flows of dilute suspension in blood of rigid axially symmetric elongated particles possessing permanent magnetic moment. The obtained rheological equation is used to examine the revealed viscoelastic behaviour of the considered suspension, explore the possibility of control over its rheological properties with the use of an external magnetic field and investigate the dependence of the suspension effective viscosity on the hematocrit value of blood.

Palabras clave: Suspended Particle; Couple Stress; Carrier Fluid; Magnetic Carrier; Simple Shear Flow.

Pp. 257-261

Virtual Rehabilitation of Lower Extremities

Tomaž Koritnik; T. Bajd; M. Munih

The paper presents a kinematic model of a human body and a corresponding graphic representation of the human figure in virtual reality. The model was developed in order to visualize the movements of the subject in a real-time virtual environment on a large display, which represented a virtual mirror. An optical system with active markers was used to assess the movements of the subjects. We conducted an experiment with 10 healthy adults performing a stepping-inplace test in a virtual environment by tracking the motion of a reference virtual figure, which represented the virtual instructor. Both figures, the training subject and virtual instructor, were superimposed and shown from the desired angle of view. It was our aim to study the abilities of immersion and adaptation to the reference movements through the virtual mirror. The results of this preliminary investigation include basic kinematic and temporal parameters of the stepping movements, providing quantitative evaluation and comparison of the subjects’ performance.

Palabras clave: Knee Angle; Graphic Processor Unit; Posterior Superior Iliac Spine; Step Period; Stance Duration.

Pp. 262-265

Rating Stroke Patients Based on Movement Analysis

Akos Jobbagy; G. Fazekas

Impairments and activities of daily living (ADL) of patients with stroke are usually assessed by clinical scales. It is a rather subjective method. A device and a method are presented to objectively characterize movement disorders (impairment) of stroke patients. The finger-tapping and the pointing movements of 15 stroke patients were recorded and analysed with a simple, 2D, passive marker-based, clinically applicable movement analyser, PAM (Passive Marker-based Analyzer for Movements). The result of the objective assessment is compared to human ratings. Movement analysis gives valuable information also about the improvement of motor performance during rehabilitation. Based on the analysis, functional rating can be done with good resolution and accuracy; the measure of disability can also be determined. Good correlation has been found between the results of movement analysis and the Rivermead Motor Assessment. The rating scales assessing ADL functions give markedly different results.

Palabras clave: Stroke Patient; Movement Analysis; Barthel Index; Functional Independence Measure; Modify Ashworth Scale.

- Biomechanics | Pp. 266-269

Hip stress distribution may be a risk factor for avascular necrosis of femoral head

Veronika Kralj-Iglic; D. Dolinar; M. Ivanovski; I. List; M. Daniel; B. Mavcic; M. Tomsic; A. Iglic; Veronika Kralj-Iglic

Avascular necrosis of femoral head (AN) is a hip disorder with various risk factors, however, the underlying mechanisms are not yet understood. In order to elucidate the effect of the mechanical factors on AN we have compared a group of hips at risk for AN and a group of healthy hips with respect to biomechanical parameters: functional angle of the weight bearing area (ϑ), position of the stress pole (Θ), index of the gradient of the contact stress at the lateral border of the load bearing area (G) and peak contact hip stress (pmax). The test group representing hips at risk for AN consisted of 32 male hips contralateral to the necrotic hips while the control group consisted of 46 healthy male hips. The biomechanical parameters we computed with the HIPSTRESS method (based on measurements of geometrical parameters from standard anterior-posterior pelvic radiographs). The average values of parameters pertaining to both groups were compared by the unpaired two-sided Student t-test. The functional angle of the weight bearing area was on the average larger (more favorable) in the control group (112.9º±13.5º) than in the test group (105.0º±12.4º), the difference (7%) being statistically significant (p < 0.01). The position of the stress pole was more lateral (less favorable) in the test group (15.44º±7.23º) than in the control group (11.80º±7.58º), the difference (27%) being statistically significant (p = 0.037). The index of the hip stress gradient was higher (less favorable) in the test group (-17.23º±17.16º x 10m) than in the control group (26.05±16.85 x 10m), the difference (40%) being statistically significant (p = 0.028) while we found no statistically significant difference in the peak contact stress between the two groups. Our results indicate that a less favorable steep stress distribution over a smaller load-bearing area is a risk factor in AN.

- Biomechanics | Pp. 282-285

Elasticity Distribution Imaging of Sliced Liver Cirrhosis and Hepatitis using a novel Tactile Mapping System

Yoshinobu Murayama; T. Yajima; H. Sakuma; Y. Hatakeyama; C.E. Constantinou; S. Takenoshita; S. Omata

In the recent past, it has been indicated that the liver consistency can be useful to estimate functional reserve for hepatectomy however, it is still unknown how the liver gets hardened when it becomes chronic hepatitis and cirrhosis. In this study, pathological model rats of liver cirrhosis and hepatitis were developed and the elasticity distribution over their sections were measured using Tactile Mapping system that was specifically designed to measure the two-dimensional elasticity distribution of very thin sliced tissues. The elasticity distribution images were then compared with the conventional azanstaining image to identify the tissues. Young’s modulus of both soft normal and hard fibrotic components exist in the sections were statistically compared and it was indicated that there was no significant difference in the elasticity of both components but the content ratio of harder fibrotic matrix was higher in the liver cirrhosis.

Palabras clave: Chronic Hepatitis; Liver Cirrhosis; Liver Fibrosis; Tactile Sensor; Soft Part.

Pp. 286-287

Changes in Biomechanics Induced by Fatigue in Single-leg Jump and Landing

Jernej Stublar; P. Usenik; R. Kamnik; M. Munih

The purpose of this study was to determine the effects on lower extremities during muscle fatigue. The experimental trial of single-leg landing and jumping was conducted in a group of healthy male subjects. The experimental protocol included series of single-leg landings from elevated platform, single-leg jumps and fatiguing process that was kept at reasonable level, by asking each subject to make total of 60 two-legged squats. The results show that there was no significant change in overall shock attenuation prior and after the experiment. However the ankle work decreased, while the hip work increased. Even though the fatigue caused significant decrease in peak moments at the hip, knee and ankle joints, the significant increase in hip range of motion resulted in constant overall shock attenuation. The results suggest that the lower extremity is able to adapt to fatigue due to redistributing work to larger hip muscles.

Palabras clave: Ground Reaction Force; Force Plate; Joint Moment; Fatigue Process; Peak Moment.

Pp. 288-291

Musculoskeletal Modeling to Provide Muscles and Ligaments Length Changes during Movement for Orthopaedic Surgery Planning

Carlo Frigo; E.E. Pavan

The estimation of muscles and ligaments behavior can be useful in orthopaedic surgery or when a functional restoration may be reached by means of soft tissues surgery, i.e. in each case a different function is necessary to be planned for a muscle. Models of the skeletal muscle system were almost used to predict the rate of muscle-tendon lengthening during the most common tasks. In this work, a more general approach is proposed, in which individual anthropometry was considered through imaging processing, and joint kinematics captured in a movement analysis laboratory was used to animate a skeletal model, with the aim of simulating the effects of different surgical solutions on the muscle system functioning. To attain this result, the integration of different technologies, models and algorithms was required. After developing a model of the musculoskeletal and ligament system, the procedures for the pre-operative planning of both hip and knee joint replacement were simulated. A surgery planning tool based on the previously created model allowed the surgeon to plan an operation through a three-dimensional visualization of bones, by defining components’ sizes and improving their positioning by taking into account not only bone geometry but also the soft tissues spanning the articulations. Since the model is defined on a specific patient, it gives the possibility to increase model’s specificity with the aim of improving planning accuracy. The use of this planning tool can be useful both in pre-operative planning and during the surgical operation because the surgeon can develop skills in performing different operation’s steps. In this work, we considered two examples based on the model of muscles, bones and ligaments that was developed. The main steps of this procedure and the preliminary results are here presented pointing out the feasibility of the planning tool and of the model itself.

Palabras clave: Preoperative Planning; Joint Kinematic; Ligament Length; Musculoskeletal Model; Muscle Tendon.

Pp. 292-295

Numerical model of a myocyte for the evaluation of the influence of inotropic substances on the myocardial contractility

Bernardo Innocenti; Andrea Corvi

In order to increase the knowledge about heart and its physiology, a great number of experimental activities have being conducted. Part of such activities analyses single myocardial cells; usually, these processes present a lot of complications mainly concerning myocytes isolation, low reproducibility and high number of system related variables. Basing on these considerations the present work refers to the development of a numerical model of myocyte that permits to simulate its physiological contraction as well as pathological behaviours. The analysis of the single myocyte (the basic unit of cardiac tissue) is necessary to investigate heart as a single complex system in order to develop a numerical heart model able to simulate either the physiological and the pathological behaviour and thus overcome the experimental trials. The model enables the evaluation of contractility under three inotropic substances effect: angiotensin-II, endothelin-I and isoproterenol. It has been developed in three phases: an initial analysis of the behaviour of the sarcomere has been executed and a sarcomere model has been developed, such model permits to simulate both physiological activity of sarcomere and to analyze the inotropic effect of the three substances on it; finally a model of myocyte has been elaborated using both experimental data obtained from several trials previously defined and literature data; at the end the model has been validated both with literature results and with data obtained from subsequent experimental trials.

Palabras clave: Total Force; Myocardial Contractility; Sarcomere Length; Passive Force; Pathological Behaviour.

Pp. 296-299

Application of Simplified Ray Method for the Determination of the Cortical Bone Elastic Coefficients by the Ultrasonic Wave Inversion

Tomas Goldmann; H. Seiner; M. Landa

This work contributes to the methodology of an evaluation of elastic properties of cortical bones by ultrasonic wave inversion, whilst the bone is considered to be a linear elastic anisotropic continuum. Velocities of acoustic waves are used as an input data into inverse problem and they are experimentally detected by means of the ultrasonic based pulseecho immersion technique. The geometry of bone specimens is also implicated into algorithm by the model of wave propagation through curvilinear anisotropic sample based on the simplified ray method. The stability of resulting data is evaluated by the statistical method based on the Monte-Carlo simulation. The immersion method based on the wave inversion has shown to be a reliable tool for determination of some elastic constants only, the remaining coefficients need to be measured or improved by another experimental method. The ultrasonic contact pulse through transmission technique was rated as an acceptable experimental approach for this purposes. The RUS was found to be an unsuitable method for the measurement of the elastic coefficients of the cortical bone tissue.

- Biomechanics | Pp. 304-307

Model for Muscle Force Calculation Including Dynamics Behavior and Vicoelastic Properties of Tendon

Miloslav Vilimek

This paper presents a musculotendon model for muscle force calculation based on Hill type model including viscoelastic properties of tendon. For describing the viscoelastic properties the Poynting-Thomson discrete model was used. The applied Hill type muscle model observes all active and passive properties of skeletal muscle. Differential equation which expresses musculotendon dynamics including constants which can be numerable from experimentally measured tendon tension, creep and relaxation data. This Model is suitable to use in forward dynamics problems and dynamic optimization approaches.

- Biomechanics | Pp. 308-309

The Education and Training of the Medical Physicist in Europe The European Federation of Organisations for Medical Physics -EFOMP Policy Statements and Efforts

Stelios Christofides; T. Eudaldo; K.J. Olsen; J.H. Armas; R. Padovani; W. Schlegel; M. Buchgeister; A. Del Guerra; P.F. Sharp

One of the main aims of the European Federation for Organisations of Medical Physics is to propose guidelines for education, training and accreditation programmes. This is achieved through the publication of Policy Statements and the organisation of education and training course, seminars and conferences. This is a continuous effort in an attempt to harmonise the education and training of the Medical Physicist across Europe. This paper presents an overview of the past, present and future efforts of EFOMP to achieve this aim.

- Biomedical Engineering Education and E-learning | Pp. 313-318

A Web-Based E-learning Application on Electrochemotherapy

Selma Corovic; J. Bester; A. Kos; M. Papic; D. Miklavcic

In this paper we present the web-based elearning application on electrochemotherapy, an effective approach in local tumor treatment employing locally applied high-voltage electric pulses in combination with chemotherapeutic drugs. The antiumor treatment outcome is directly related to the electric field distribution in the target/tumor tissue. As the electric field distribution can not be displayed during the therapy we use numerical calculations in combination with web-based tools which allow visualizing and understanding the important parameters for effective electrochemotherapy.

- Biomedical Engineering Education and E-learning | Pp. 323-326

The value of clinical simulation-based training

Vesna Paver-Erzen; Matej Cimerman

Simulators were first used in aviation for flight training of pilots and for inter-staff communication. Regular training in the simulation centre is obligatory for all aircraft staff, whatever their rank or position. Simulation-based training has been introduced in nuclear power, space flight and petrochemical industries, particularly in the settings where there is a high probability of large-scale catastrophic events. The major advantages of learning skills on a simulator are: each procedure can be interrupted, improved and repeated until the required proficiency has been achieved, and no real harm is done when an eventual mistake –inadmissible in real clinical setting – is made on a mannequin. This learning modality is therefore less stressful for both the trainee and the teacher, and helps increase the trainee's self-confidence.

- Biomedical Engineering Education and E-learning | Pp. 327-328

Biomedical Engineering and Virtual Education

Asta Kybartaite; J. Nousiainen; K. Lindroos; J. Malmivuo

This paper briefly presents Biomedical Engineering (BME) in the virtual education. BME is a relatively new and highly multidisciplinary field of engineering. Due to its versatility and innovativeness, BME requires special learning and teaching methods. Virtual education is an emerging trend in the higher educational system. Technologies, learning theories, instructions, tutoring, and collaboration incorporated in the virtual education can lead to effective learning outcomes. European Virtual Campus for Biomedical Engineering (EVICAB) is the platform, where traditional biomedical education is transferred to the virtual.

- Biomedical Engineering Education and E-learning | Pp. 329-331

Internet Examination – A New Tool in e-Learning

Jaakko Malmivuo; K. Lindroos; J.O. Nousiainen

Internet examination is a new innovation in elearning. Internet examination extends the virtual mobility from the learning process to the examination of the students’ knowledge on the course topic. Internet examination has pedagogical benefits also in the case where the students are on the site of teaching. The paper is based on the experience we have obtained at the Ragnar Granit Institute.

- Biomedical Engineering Education and E-learning | Pp. 336-337

Development of a calibration bath for clinical thermometers

Igor Pusnik; J. Bojkovski; J. Drnovsek

Pp. 338-341

Evaluation of non-invasive blood pressure simulators

Gregor Gersak; J. Drnovsek

Non-invasive blood pressure (NIBP) simulators are electro-mechanical devices used for testing and evaluating oscillometric non-invasive blood pressure monitors. Simulators are used mainly in clinical environment to assist with routine and after-repair testing of NIBP monitors. In this paper we suggest basic procedures for evaluating a NIBP simulator; assessing its suitability and quality. Proposed evaluation procedure consists of a static calibration and a dynamic evaluation. In static calibration the simulator is calibrated as a common indicating barometer. In dynamic evaluation the output waveforms are investigated (repeatability of the output according to different static pressures and heart rates, repeatability of the output at a constant blood pressure magnitude). Proposed evaluation procedure represents a minimal set of tests to ensure the simulator can be used for testing NIBP monitors. A commercial simulator SmartArm (by Clinical Dynamics, USA) was evaluated according to it and the results are presented.

- Biomedical Instrumentation and Measurement | Pp. 342-345

Development of Implantable SAW Probe for Epilepsy Prediction

S. Kulikov; N. Gopalsami; I. Osorio; S. Buyko; A. Martynov; A.C. Raptis

An implantable surface acoustic wave (SAW) microsensor has been developed for early detection and monitoring of seizures based on local temperature changes in the brain’s epileptogenic zones that occur prior to and during an epileptic event. Three SAW sensors were designed and fabricated: a 172 MHz filter, a 434 MHz filter, and a 434 MHz delay line. Their temperature sensitivities were tested by measuring the phase change between the input and output waveforms as a function of temperature. We achieved a phase sensitivity of 144 phase degrees per °C and a minimum detectable temperature of 5 mK for the 434-MHz, 10.2-μs delay line. Based on the sensitivity tests, a prototype 434 MHz SAW sensor was fabricated to a size of 11 x 1 x 1.1 mm, which is commensurate with existing brain implantable probes. Because of possible damping of the surface waves by the surrounding tissue or fluid, a glass housing with dry air was built on the top of the SAW substrate. Test and reference sensors were used in the prototype system to minimize the effect of source instabilities and to amplify the temperature effect. The phase change between the output waveforms of the sensors was measured with phase detector electronics after they were converted to lower (10.7 MHz) frequencies by standard mixers. The complete prototype sensor was tested in a saline water bath and found to detect as low as 3 mK changes of temperature caused by the addition of hot water. Operation ability of the system in its wireless variant was demonstrated.

- Biomedical Instrumentation and Measurement | Pp. 346-349

Clinical implication of pulse wave analysis

Rok Accetto; K. Rener; J. Brguljan-Hitij; B. Salobir

Conventional blood pressure measurement can not explain the link between hypertension and cardiovascular diseases. The missing link is arterial stifness wich can be meassured by noninvasive applanation tonometry. Although well known fenomenon, due to techological reasons it was not clinicaly used for diagnostic purposes. With computer and other technology we are able do detect and analize periferal pulse wave and central aortic pulse wave. Central aortic pulse wave is a function of arterial stifness. The process, by wich the arterial system interacts with left ventricle and coronary arteries can be demonstrated by analysing aortic root pressure waveform. In the young it is common to see no or small augmentation in contarst to older person. Examlpes are presented.

Palabras clave: Pulse Wave; Wave Reflection; Pressure Waveform; Applanation Tonometry; Pulse Wave Analysis.

Pp. 354-356

Ambulatory blood pressure monitoring is highly sensitive for detection of early cardiovascular risk factors in young adults

Ales Zemva; Maja Benca; Primoz Dolenc

We evaluated the appropriateness of 24-h ambulatory blood pressure (BP) monitoring to detect prehypertensive conditions in apparently healthy siblings of patients with premature cardiovascular disease (CVD). We performed office blood pressure measurements and 24-hour ambulatory blood pressure monitoring in 30 young adults (mean age 26 ± 3 years), whose parents have experienced premature CVD, and 30 control subjects (mean age 26 ± 3 years) with a negative family history of CVD. Positive parental CVD history group had significantly higher mean values of 24-h systolic BP (123 ± 10 mm Hg vs. 118 ± 6 mm Hg; p = 0.044), daytime systolic (127 ± 12 mm Hg vs. 121 ± 7 mm Hg; p = 0.041) and diastolic BP (77 ± 8 mm Hg vs. 73 ± 4 mm Hg; p = 0.045) as well as 24-h heart rate (71 ± 8 beats/min vs. 67 ± 8 beats/min; p =0.05) and systolic BP load (21 ± 20% vs. 10 ± 11%; p = 0.02) compared to controls. There was no significant inter-group difference in blood pressure measurements obtained by conventional office method. In addition, the study group had a considerably higher diurnal variability of blood pressure and heart rate, which is believed to be contributing to their overall CVD risk. In conclusion, slightly higher levels of blood pressure, blood pressure variability and heart rate are early determinants of higher CVD risk, which can be detected in individuals by using 24-h ambulatory blood pressure monitoring.

- Biomedical Instrumentation and Measurement | Pp. 357-360

System Identification of Integrative Non Invasive Blood Pressure Sensor Based on ARMAX Estimator Algorithm

Noaman M. Noaman; Abbas K. Abbas

Varieties of the oscillometric non-invasive blood pressure (NIBP) measuring devices are based on recording the arterial pressure pulsation in an inflated cuff wrapped around a limb during the cuff deflation. The recorded NIBP data contain the pressure pulses in the cuff, called oscillometric pulses, superimposed on the cuff deflation. Some of NIBP devices have also implanted microphone inside the cuff, which enables measurements of Korotkoff sounds The objectives of this contribution are, first, to extract the transfer characteristics of the oscillotonometric method of NIBP deflation from the pressure pulses, and second, to extract the Parametric coefficient of the NIBP system with regression path with ARMAX algorithm.

- Biomedical Instrumentation and Measurement | Pp. 385-389

Evaluation of muscle dynamic response measured before and after treatment of spastic muscle with a BTX-A − A case study

Dejan Krizaj; K. Grabljevec; B. Simunic

Contraction properties of spastic muscle has been evaluated using tensiomyographic method before and after treatment of spastic muscles with BTX-A. Significant differences are observed in TMG responses of a spastic muscle of cerebral origin before and after treatment with BTX-A. Typically, a TMG parameter Dm increases while time related TMG parameters Tr and Ts decrease after treatment of a muscle with a BTX-A. A parameter Tr/Dm has been found the most sensitive to changes of the muscle’s contractile properties. It is expected that the method can be used for determining muscle selection and therefore more effective use of expensive medicine and to evaluate the efficiency of the treatment.

Palabras clave: Traumatic Brain Injury; Botulinum Toxin; Contraction Time; Gastrocnemius Lateralis; Spastic Muscle.

Pp. 393-396

Development of the ISO standard for clinical thermometers

Igor Pusnik

Pp. 401-404

Hardware optimization of a Real-Time Telediagnosis System

Muhammad Kamrul Hasan; Md. Nazmus Sayadat; Md. Atiqur Rahman Sarker

Integration of home and healthcare environments and the need for precise and detailed diagnosis data are the driving forces of the recent research works in the area of wireless medical devices. The aim of this paper is to make a comparative analysis on various research works done in this sector in the last couple of years and suggest some approaches for the design of a portable, power efficient, affordable and ergonomic system with the assurance of quick and reliable response. We focus on the relative-discussion on various biosignal analysis methods, circuit design, microcontrollers, wireless communication protocols on the basis of performance, reliability, size and cost regarding the design of a telediagnosis system. Though we have limited this paper on the ECG analysis only, the proposed hardware can be extended anytime for monitoring other biosignals.

- Biomedical Instrumentation and Measurement | Pp. 405-409

Application of time-gated, intensified CCD camera for imaging of absorption changes in non-homogenous medium.

Piotr Sawosz; M. Kacprzak; A. Liebert; R. Maniewski

The paper presents application of time-gated, intensified CCD camera for imaging of local changes of absorption in the non-homogenous liquid phantom. The surface of the phantom was illuminated sequentially at 25 points (forming 5×5 array) by laser beam at wavelength of 780 nm generated by picosecond, near-infrared diode laser. The spatial distribution of diffusely reflected photons was measured in reflectance geometry at null source-detector separation. For each position of the laser beam the reflectance was measured for two different time windows, distinctly delayed in respect to the laser pulse. The observation of late photons, which penetrated deeply in the optically turbid medium allowed to image the absorbing inclusion (10 mm diameter black ball) located at depth of 15 mm. For each of two time windows the single images for all scanned points were summed. Obtained final images allowed to localize the non-homogeneity in the phantom. The study shows, that the presented method based on imaging at null source-detector separation distance for late time windows may be applied in the evaluation of the tissue absorption measurements, especially in the brain oxygenation imaging.

Palabras clave: Near Infrared Spectroscopy; Diameter Black Ball; Cerebral Hemodynamic; Turbid Medium; Brain Oxygenation.

Pp. 410-412

The impact of the intubation model upon ventilation parameters

Marek Darowski; B. Stankiewicz; J. Glapinski; M. Rawicz; B. Woloszczuk-Gebicka; M. Michnikowski

The impact of various shaped endotracheal tubes on ventilation parameters has been preliminary assessed in this study. Two uncuffed pediatric tubes of different designs: a standard tube (cylindrical) and a new tube of smooth cone shape (3, 3.5 and 4 mm ID) have been examined under IPPV mode ventilation and using infant lung model. The total inspiratory flow resistance (R_i), peak inspiratory preassure (PIP) and work of breathing (WOB) have been determined under intubation with the standard and the cone shaped tube, and also for non-intubated infant lung model. The significant reduction of the Ri, PIP and WOB has been received when the standard tube had been changed with the new cone tube. The results have been confirmed in a case clinic study.

Palabras clave: Endotracheal Tube; Flow Resistance; Peak Inspiratory Pressure; Lung Model; Standard Tube.

- Biomedical Instrumentation and Measurement | Pp. 413-415

The hybrid piston model of lungs

Marek Darowski; M. Kozarski; K. Zielinski; K.J. Palko

The novel hybrid (pneumo-electrical-numerical physical) model of lungs is presented. A general procedure of creating of this type of models is also described. It consists in application of proportional transformation of an electrical impedance of a lumped parameter electrical or numerical model of lungs into a pneumatic impedance obtained in an input pneumatic terminal of the model. The standard Dubois mathematical model of lungs has been applied in model examinations. That proved the assumed concept of hybrid modeling.

- Biomedical Instrumentation and Measurement | Pp. 416-418

Analysis of foveation duration and repeatability at different gaze positions in patients affected by congenital nystagmus.

Mario Cesarelli; P. Bifulco; M. Romano; G. Pasquariello; A. Fratini; L. Loffredo; A. Magli; T. De Berardinis; D. Boccuzzi

Congenital nystagmus (CN) is a disturbance of the oculomotor centers which develops at birth or in the first months of life. Nystagmus consists essentially in involuntary, conjugated, horizontal rhythmic movements of the eye. Its pathogenesis is still unknown. Current therapies for CN aim to increase the patient’s visual acuity by means of refraction defects correction, drug delivery and ocular muscle surgery. Eye movement recording supports for accurate diagnosis, for patient follow-up and for therapy evaluation. In general, CN patients show a considerable decrease of visual acuity (image fixation on the retina is obstructed by nystagmus continuous oscillations) and severe postural alterations such as the anomalous head position, searched by patient to obtain a better fixation of the target image onto the retina. Often CN presents ‘neutral zones’ corresponding to particular gaze angles, in which nystagmus amplitude minimizes allowing a longer foveation time and a more stable repositioning of foveations, increasing visual acuity. Selected patients’ eye movements were recorded by using EOG or infrared oculography devices. Visual stimulation was delivered by means of an arched LED bar covering a visual field of –30 +30 degrees with respect to the central position. Computation of CN concise parameters allows in-dept analysis of foveations and estimation of visual acuity at different gaze angles. Preliminary results show a maximum of visual acuity at a specific gaze angle; this angle is mostly located at the patient’s right side for the analyzed group.

Palabras clave: Visual Acuity; Neutral Zone; Congenital Nystagmus; Anomalous Head Position; Infantile Nystagmus.

Pp. 426-429

Frequency characteristics of arterial catheters – an in vitro study

Ferenc Tamas Molnar; G. Halasz

Continuous blood pressure recording carries the most information on the cardiovascular state of a person. Therefore accurate instrumentation is of high importance. Nowadays the most accurate continuous blood pressure measuring method is the intra-arterial catheterization. However, the accuracy of the fluid-filled catheters raises doubts: the elastic wall of the catheter and the transmission tube each has a damping effect that could play a significant role together. Furthermore the intra-arterial part of a cardiac catheter is in a pulsatile flow, which is assumed to affect the pressure transmission within the measuring line. In this paper behavior of two different types of fluid filled catheters (femoral and cardiac) is described. For the in vitro experiments, a pulsatile arterial system model was applied. Simultaneous measurements of the intra-arterial pressure were carried out: directly with use of a pressure transmitter and through the catheter. Thus the accuracy and the frequency response of the catheters could be obtained and a comparison between the two different types could be made. A numerical model – based on the method of impedances – was developed to describe the frequency transmitting ability of the catheters. The numerical results were compared to the measurements. We found that the experimental results of the different catheters show significant similarities; the numerical and experimental results of the femoral catheter were in a good accordance whereas those of the cardiac catheter show discrepancies.

- Biomedical Signal Processing | Pp. 430-433

Signal Processing methods for PPG Module to Increase Signal Quality

Kristjan Pilt; K. Meigas; J. Lass; M. Rosmann

To estimate blood pressure with using pulse wave transit time method, the PPG and ECG signals have to be measured with high quality. This paper describes a device that improves PPG signal quality, with using different analogue and digital signal processing methods. The device is developed for the 24-hour ambulatory blood pressure monitoring system. Part of the device is designed in hardware and part of it is modelled in MATLAB. The experiments with PPG signal, noises and DC component drift included, have been carried out. As a result, the PPG signal quality has been improved with this device.

Palabras clave: Finite Impulse Response; Pulse Transit Time; Signal Processing Method; Pulse Wave Transit Time; Estimate Blood Pressure.

Pp. 434-437

Detection of the cancerous tissue sections in the breast optical biopsy dataflow using neural networks

Anton Nuzhny; Tatiana Lyubynskaya; S. Shumsky

The method of artificial neural networks was applied for analysis of the data obtained in the clinical trials of the optical biopsy system. Detection of malignant tissue sections was carried out using a multilayer perceptron. The coefficients of wavelet decomposition of optical scattering spectra were given at the perceptron input and its output gave the malignancy probability for the current spectrum. End-to-end probability calculation throughout the optical biopsy procedure dataset showed reliable detection of the cancer sections in the same place as it was specified by experts.

Palabras clave: Wavelet Coefficient; Wavelet Decomposition; Multilayer Perceptron; Learning Sample; Current Spectrum.

- Biomedical Signal Processing | Pp. 438-441

A device for quantitative kinematic analysis of children’s handwriting movements

Agostino Accardo; A. Chiap; M. Borean; L. Bravar; S. Zoia; M. Carrozzi; A. Scabar

Kinematic analysis of handwriting is a promising new frontier towards the characterization of handwriting movements, both in children and adults, with and without difficulties or pathologies that disrupt normal handwriting processes. The challenge, however, is to define and measure parameters that tap and highlight underlying mechanisms and strategies in order to comprehend such disorders, promote prevention programs and provide treatment or remedy, whenever possible. This work represents a practical application, binding neuropsychologic theory and engineering technology in the development of a device that enables on-line process analysis of handwriting, offering ample possibilities of research, both in medical and educational fields. Although employing complex mathematical procedures, the device is user friendly in its interface design and allows the rapid analysis of the parameters reported in literature, as well as some new and interesting variables that may contribute to the understanding of handwriting difficulties. The device has been successfully tested and used in a major Italian institute for childcare and research to evaluate handwriting proficiency in children. Preliminary results indicate that kinematic analysis of handwriting thus performed provides important information for the diagnosis and treatment of dysgraphia.

- Biomedical Signal Processing | Pp. 445-448

Automatic recognition of hemodynamic responses to rare stimuli using functional Near-Infrared Spectroscopy

Michele Butti; A.C. Merzagora; M. Izzetoglu; S. Bunce; A.M. Bianchi; S. Cerutti; B Onaral

Attention domain is of crucial importance for goal-directed behaviors and it has been widely studied through response analysis to rare stimuli using electroencephalography (EEG). More recent researches have explored the brain circuitry of attention by applying neuroimaging techniques, such as functional magnetic resonance. This paper investigates for the first time the feasibility of automatic recognition of responses to rare stimuli by using functional near-infrared spectroscopy (fNIRS). fNIRS is a portable brain imaging modality that optically measures the cortical hemodynamic activation and may prove useful in monitoring localized activity changes in frontal cortex related to attention processes. In this preliminary study, Fisher Linear Discriminant (FLD) is used to discriminate between average responses to rare task-relevant stimuli and responses to task-irrelevant stimuli.

- Blood Flow and Oxygenation Measurement | Pp. 473-476

Brain on a Chip: Engineering Form and Function in Cultured Neuronal Networks

B.C. Wheeler

We culture embryonic rat hippocampal neurons to learn how small networks of neurons interact and code information. We design the networks by using microlithography to control surface chemistry that in turn controls the initial position of the neurons and strongly influences subsequent growth. The lithography also permits us to guide neurons preferentially to electrodes of a microelectrode array, with a resultant increase in recordability and excitability of the cultured neurons. Geometric control also allows us to begin to investigate the question as to whether the geometric pattern of a neuronal network influences the patterns of its neuroelectric activity. Various neuronal network behaviors can be demonstrated, including propagation of both action potential and synaptically coupled activity, graded activation of networks, convergence of information flow, and elementary learning phenomena. The immediate aim of the research is the creation of a reliable, repeatable, and robust tool for understanding neuronal information processing. Long term the results will assist basic and applied neuroscience including prosthetics and cell based biosensors.

- Brain Research and Analysis of EEG | Pp. 477-477

Identification of Gripping-Force Control from Electroencephalographic Signals

Aleš Belič; B. Koritnik; V. Logar; S. Brezan; V. Rutar; R. Karba; G. Kurillo; J. Zidar

The exact mechanism of information transfer between different brain regions is still not known. The theory of binding tries to explain how different aspects of perception or motor action combine in the brain to form a unitary experience. The theory presumes that there is no specific center in the brain that would gather the information from all the other brain centers, governing senses, motion, etc., and then make the decision about the action. Instead, the centers bind together when necessary, maybe through electromagnetic (EM) waves of specific frequency. Therefore, it is reasonable to assume that the information that is transferred between the brain centers is somehow coded in the electroencephalographic (EEG) signals. The aim of this study was to explore whether it is possible to extract the information on brain activity from the EEG signals during visuomotor tracking task. In order to achieve the goal, artificial neural network (ANN) was used. The ANN was used to predict the measured gripping-force from the EEG signal measurements and thus to show the correlation between EEG signals and motor activity. The ANN was first trained with raw EEG signals of all the measured electrodes as inputs and gripping-force as the output. However, the ANN could not be trained to perform the task successfully. If we presume that brain centers transmit and receive information through EM signals, as suggested by the binding theory, a simplified model of signal transmission in brain can be proposed. We propose a computational model of a human brain where the information between centers is transmitted as phase-modulation of certain carrier frequency. Demodulated signals were then used as the inputs for the ANN and the gripping-force signal was used as the output. It was possible to train the network to efficiently calculate the gripping-force signal from the phase-demodulated EEG signals.

Palabras clave: Artificial Neural Network; Theta Rhythm; Brain Center; Binding Theory; Visuomotor Task.

Pp. 478-481

Quantitative EEG as a Diagnostic Tool in Patients with Head Injury and Posttraumatic Epilepsy

T. Bojic; B. Ljesevic; A. Dragin; S. Jovic; L. Schwirtlich; A. Stefanovic

We investigated by means of quantitative EEG (qEEG) analysis EEG traces of patients with brain trauma (with and without posttraumatic epilepsy) with respect to control group. The aim of our work was to determine if there are qEEG parameters sensible for traumatic and epileptic changes of brain tissue and how these parameters change after hyperventilation (HV), one of the routine methods for cerebral activation. On 69 patients (36 patients with posttraumatic epilepsy (PTE) and 33 without PTE) and control group of healthy patients (34 subjects), EEG registration and analysis was performed before and after HV: Fast Fourier analysis was performed on 16-s segments and amplitude mean value was calculated in ten frequency ranges in four EEG projections. HV induced significant differences in F7-C3 projection in all three groups of patients, so we analysed differences for each frequency range in F7-C3 projection for all three groups of patients. Significant differences are registered between group of healthy patients and patients with PTE in intervals of low frequencies (0-3 Hz) and high frequencies (6-11 Hz). After HV statistically significant difference is observed in all frequency ranges. Factor “epilepsy” (patients with trauma without PTE vs. patients with PTE) marks significant differences in high frequency ranges (6-11 Hz). For this factor, HV expands the group of significantly different frequency ranges towards the low frequency ranges. Consequently, the most sensitive frequency ranges for factor “epilepsy” are in high frequency range. There are no significant differences in any frequency ranges for factor “trauma” (control group of subjects vs. patients with brain trauma without PTE) before HV. After HV the significant differences appear in the range of low (0-2 Hz) and high frequencies (7-11 Hz). qEEG analysis is a diagnostic tool of potentially high selectivity in differential diagnosis of patients with brain trauma with or without PTE.

Palabras clave: Traumatic Brain Injury; Head Injury; Temporal Lobe Epilepsy; High Frequency Range; Mechanical Brain Injury.

Pp. 482-486

Assessing FSP Index Performance as an Objective MLAEP Detector during Stimulation at Several Sound Pressure Levels

Antonio Fernando Catelli Infantosi; M. Cagy; E.J.B. Zaeyen

The need for a better approach for auditory screening is due to pathologies that can affect higher auditory centers. Therefore, the Middle Latency Auditory Evoked Potential (MLAEP) was investigated by using the statistical index. The EEG of ten adults during click stimulation with different sound pressure levels was collected. With the critical value for the statistical null hypothesis (absence of response), particularly considering EEG as a colored noise and fitting the number of degrees of freedom of the index distribution, objective detection of MLAEP resulted in a better performance than the threshold of 3.1, commonly employed in the literature. This finding suggests the for detecting MLAEP response as an auxiliary tool for determining objectively the neurophysiologic acoustical threshold level.

- Brain Research and Analysis of EEG | Pp. 492-496

The Colorful Brain: Compact Visualisition of Routine EEG Recordings

M.J.A.M. van Putten

Clinical EEG recordings are typically evaluated by visual analysis of the various waveforms Besides the long learning curve, it is rather subjective and prone to human error. To assist in the visual interpretation, various quantitative techniques have been proposed. Here, we describe a triplet of features that quantify the spatial distribution of the various EEG waveforms and their coherence, represented as three time-frequency plots. The technique allows compression of 20 minutes of EEG recordings into a single picture, that captures various essential elements, including anterior-posterior differentiation, reactivity to eyes opening and closing, and photic drving. In addition, it may detect disorders, including various manifestations of epileptiform discharges.

Palabras clave: Photic Stimulation; Background Pattern; Neighbor Coherence; Photic Driving; Medisch Spectrum.

Pp. 497-500

Using ANN on EEG signals to predict working memory task response

Vito Logar; A. Belic; B. Koritnik; S. Brezan; V. Rutar; J. Zidar; R. Karba; D. Matko

Many authors have shown that performing working-memory tasks causes an elevated neuronal activity in several areas of the human brain, which suggests information exchange between them. Since the information exchanged, encoded in brain waves is measurable by electroencephalography (EEG) it is reasonable to assume that it can be extracted with an appropriate method. In this paper we present a method for extracting the information using an artificial neural network (ANN), which we consider as a stimulusresponse model. The EEG was recorded from three subjects while they performed a modified Sternberg task that required them to respond to each trial with the answer "true" or "false". The study revealed that a stimulus-response model can successfully be identified by observing phase-demodulated theta-band EEG signals 1 second prior to a subject's answer. The results showed that the model was able to predict the answers from the EEG signals with an average reliability of 75% for all three subjects. From this we concluded that stimulus-response model successfully observes the system states and consequently predicts the correct answer using the EEG signals as inputs.

Palabras clave: Artificial Neural Network; Theta Rhythm; Response Prediction; Theta Frequency Band; Sternberg Task.

- Brain Research and Analysis of EEG | Pp. 501-504

Cross-correlation based methods for estimating the functional connectivity in populations of cortical neurons

Alessandro Noriaki Ide; M. Chiappalone; L. Berdondini; V. Sanguineti; C. Martinoia

In this paper we estimate the functional connectivity in in-vitro cultured cortical neurons plated into highdensity passive microelectrodes arrays. We compare standard and partial correlation methods in order to find out the main pathways between two electrodes. In summary, while standard correlation considers just pairs of electrodes, giving a general overview of the network, partial correlation can give more details about the connectivity map due to the cancellation of indirect connections.

Palabras clave: Cortical Neuron; Functional Connectivity; Partial Correlation; Spike Train; Cortical Network.

Pp. 525-528

Extracellular ATP-Purinoceptor Signaling for the Intercellular Synchronization of Intracellular Ca2+ oscillation in Cultured Cardiac Myocytes

Koichi Kawahara; Y. Nakayama

Isolated and cultured neonatal cardiac myocytes contract spontaneously and cyclically. The contraction rhythms of two isolated cardiac myocytes, each of which beats at different frequencies at first, become synchronized after the establishment of mutual contacts, suggesting that mutual entrainment occurs due to electrical and/or mechanical interactions between two myocytes. The intracellular concentration of free Ca also changes rhythmically in association with the rhythmic contraction of myocytes (Ca oscillation), and such a Ca oscillation is also synchronized among cultured cardiac myocytes. In this study, we investigated whether intercellular communication other than via gap junctions was involved in the intercellular synchronization of intracellular Ca oscillation in spontaneously beating cultured cardiac myocytes. Treatment with either blockers of gap junction channels or an un-coupler of E-C coupling did not affect the intercellular synchronization of Ca oscillation. In contrast, treatment with a blocker of P2 purinoceptors resulted in the asynchronization of Ca oscillatory rhythms among cardiac myocytes. The present study suggested that the extracellular ATP-purinoceptor system was responsible for the intercellular synchronization of Ca oscillation among cardiac myocytes.

- Cardiovascular System | Pp. 537-540

Computer Assisted Optimization of Biventricular Pacing Assuming Ventricular Heterogeneity

Raz Miri; M. Reumann; D. Farina; B. Osswald; O. Dössel

Reduced cardiac output, dysfunction of the conduction system, atrio-ventricular block, bundle branch blocks and remodeling of the chambers are results of congestive heart failure (CHF). Biventricular pacing as Cardiac Resynchronization Therapy (CRT) is a recognized therapy for the treatment of heart failure. The present paper investigates an automated non-invasive strategy to optimize CRT with respect to electrode positioning and timing delays based on a complex threedimensional computer model of the human heart. The anatomical model chosen for this study was the segmented data set of the Visible Man and a set of patient data with dilated ventricles and left bundle branch block. The excitation propagation and intra-ventricular conduction were simulated with Ten Tusscher electrophysiological cell model and adaptive cellular automaton. The pathologies simulated were a total atrioventricular (AV) block and a left bundle branch block (LBBB) in conjunction with reduced interventricular conduction velocities. The simulated activation times of different myocytes in the healthy and diseased heart model are compared in terms of root mean square error. The outcomes of the investigation show that the positioning of the electrodes, with respect to proper timing delay influences the efficiency of the resynchronization therapy. The proposed method may assist the surgeon in therapy planning.

Pp. 541-544

Power density spectra of the velocity waveforms in Artificial heart valves

A. A. Sakhaeimanesh

To find the possible frequencies induced by the vibration of the flexible membrane of the Jellyfish valve, power density spectra of the the valvular velocity waveforms were carried out. Most of the spectral energy was contained in frequencies lower than 11 Hz and all spectra exhibited pronounced peaks which implied wave motions in the preferred frequency range. Two distinct peak frequencies, 1.2 and 2.4 Hz, were observed downstream of the Jellyfish valve which qualified as the frequencies of fundamental harmony of the waveform velocity and one of its sub harmonics. Effect of oscillation on elevating turbulent shear stresses through the jellyfish and St.Vincent valves has also been investigated. Laser Doppler Anemometry (LDA) was employed to determine the velocity and shear stress distributions at various locations downstream of the valves. Comparison between two valves revealed that at 0.5D downstream of the valves the magnitude of shear stresses in the Jellyfish valve were much higher than those of the St. Vincent valve at cardiac outputs of 4, 5.5 and 6.5 l/min. The cause of high shear stresses in close proximity to the Jellyfish valve could be attributed to the oscillation of the membrane which in turn generated a wake downstream of the valve (in the core of valve chamber) and produced a wide region of disturbance further downstream. This resulted in further pressure drag and consequently, higher pressure drops across the valve and higher shear stresses downstream of the valve.

Palabras clave: Turbulent Intensity; Power Density Spectrum; High Shear Stress; Shear Stress Distribution; Laser Doppler Anemometry.

- Cardiovascular System | Pp. 545-548

Method for Reducing Pacing Current Threshold at Transesophageal Stimulation

Andres Anier; J. Kaik; K. Meigas

In order to reduce pacing current threshold at transesophageal stimulation use of additional chest electrode was studied. The study was performed in 34 patients aged 19 to 66 years using standard transesophageal pacing equipment. Use of chest electrode lowered pacing current over standard bipolar transesophageal methods.

Palabras clave: Supraventricular Tachycardia; Atrial Pace; Sick Sinus Syndrome; Interelectrode Spacing; Pace Threshold.

Pp. 554-557

User–centered system to manage Heart Failure in a mobile environment

Elena Villalba Mora; D. Salvi; M. Ottaviano; I. Peinado; M.T. Arredondo; M. Docampo

In Western world, the prevalence of chronic diseases is highly increasing due to the increase in the life expectancy. Besides, cardiovascular diseases (CVD) are the leading source of death, causing 45% of all deaths and Heart Failure (HF), the paradigm of CVD, mainly affects people older than 65. This paper focuses on the latest advances in the design and development of the user interaction system to manage Heart Failure Management in a mobile environment, based on daily monitoring of Vital Body Signals, with wearable and information technologies, for the continuous assessment of this chronic disease.

Palabras clave: User Interaction; Mobile Environment; Research Phase; Manage Heart Failure; Heart Failure Care.

Pp. 558-561

Cell membrane fluidity at different temperatures in relation to electroporation effectiveness of cell line V79

Masa Knaduser; Marjeta Sentjurc; Damijan Miklavcic

When cell is exposed to short electric pulses with high amplitudes its membrane is transiently permeabilised. Characteristics of the cell play important role in this process. In the present study the effect of cell membrane fluidity on electroporation was investigated. To obtain significant differences in cell membrane fluidity cell suspension was exposed to different temperatures for five minutes before and during the pulse application. To exclude the effect of the temperature on cell membrane resealing only a small droplet of cell suspension was used for cell membrane permeabilization assay as it reached room temperature in few seconds after it was removed from electroporated sample. It was found that the decrease in cell membrane fluidity caused by exposure of cells to low temperature during electric pulse application significantly reduces electroporation effectiveness of the cell line V79.

Palabras clave: Electric Pulse; Spin Probe; Pulse Application; Reach Room Temperature; Cell Membrane Fluidity.

Pp. 570-573

Voltage commutator for multiple electrodes in gene electrotransfer of skin cells

Peter Kramar; M. Kranjc; M. Rebersek; D. Miklavcic

Gene electrotransfer is a promising nonviral method for transferring genes into the cells. The method is based on electroporation and it has been proven to be successful in both in vivo and in vitro conditions. This phenomenon occurs when cells are exposed to electric field established by high and low voltage pulses. The first high voltage pulse results in a high level of cell permeabilization (permeabilization pulse), while the second low voltage pulse provides a driving force for transport of DNA into cells (electrophoretic pulse). The efficiency and successfulness of gene electrotransfer significantly depends on electrical devices in use. A voltage commutator presents one of the most important electrical components in bipolar or multi electrodes devices. Its main function is commutating high and low voltage pulses, which are delivered through the microelectrodes to the skin cells. Even though gene electrotransfer is based on electroporation, our previous voltage commutator for electroporation is appropriate for gene electrotransfer because of its slow switching between voltage pulses.

Palabras clave: Output Signal; Voltage Pulse; Electric Pulse; Skin Cell; High Voltage Pulse.

- Electroporation Based Therapies | Pp. 574-577

Antitumor effectiveness of electrotransfer of p53 into murine sarcomas alone or combined with electrochemotherapy using cisplatin

Maja Cemazar; A. Grosel; S. Kranjc; G. Sersa

The aim of our study was to evaluate feasibility and therapeutic potential of electrotransfer of alone or combined with electrochemotherapy using cisplatin on two murine sarcomas with different status. Antitumor effectiveness of three consecutive electrotransfer of was more effective in wild-type LPB tumor than mutated SA-1 tumors, resulting in 21.4% of tumor cures in LPB tumor and 12.5% in SA-1 tumors. Pretreatment of tumors with electrotransfer of enhanced chemosensitivity of both tumor models treated by electrochemotherapy with cisplatin. After only one application of this treatment combination in LPB tumor model, specific tumor growth delay was prolonged in combined treatment group compared to electrotransfer of or electrochemotherapy with cisplatin alone, whereas in SA-1 tumors this treatment combination resulted in 31.6% of cured animals. Results of our study show that electrotransfer of alone or combined with electrochemotherapy is feasible and effective treatment of tumors. The combination of electrotransfer and electrochemotherapy after only one application resulted in complete regression of tumors.

- Electroporation Based Therapies | Pp. 582-585

Electrochemotherapy in veterinary medicine

Nataša Tozon; Maja Cemazar

Electrochemotherapy is a treatment that combines electroporation, i.e. application of electric pulses to the tumors, that induces under suitable conditions reversible permeabilization of cell membrane and administration of nonpermeant or poorly permeant chemotherapeutic drugs with intracellular targets, whose entry into the cells is facilitated by electroporation. In veterinary medicine, the predominant chemotherapeutic drug used in electrochemotherapy is cisplatin, followed by bleomycin. In this review, the results of the studies performed at the University of Ljubljana, Veterinary faculty are presented. Spontaneous tumors of different origin in dogs, cats and horses were treated with electrochemotherapy using either cisplatin or bleomycin. Different electroporation protocols were used and the results on antitumor effectiveness compared. The results demonstrated that electrochemotherapy is highly effective and safe local treatment regardless of tumor histology, chemotherapeutic drug or electroporation protocol used.

Palabras clave: Objective Response; Electric Pulse; Antitumor Effectiveness; Mast Cell Tumour; Veterinary Faculty.

Pp. 586-588

A numerical model of skin electroporation as a method to enhance gene transfection in skin

Natasa Pavselj; V. Preat; D. Miklavcic

Electroporation is an effective alternative to viral methods to significantly improve DNA transfection after intradermal and topical delivery. We performed a series of in vivo experiments on rat skin using external plate electrodes. The experiments showed that skin layers below stratum corneum can be permeabilized in this way. In order to study the course of skin tissue permeabilization by means of electric pulses, a numerical model was built, with COMSOL Multiphysics, using the finite element method. The model is based on the tissue-electrode geometry and electric pulses from our in vivo experiments. We took into account the layered structure of skin and changes of its bulk electric properties during electroporation, as observed in the in vivo experiments. We were using tissue conductivity values found in literature and experimentally determined electric field threshold values needed for tissue permeabilization. The results obtained with the model were then compared to the in vivo results of gene transfection in rat skin and a good agreement was obtained.

Palabras clave: Stratum Corneum; Electric Pulse; Skin Layer; Electric Field Distribution; Gene Transfection.

Pp. 597-601

Tumor blood flow modifying and vascular disrupting effect of electrochemotherapy

Sersa Gregor; G. Sersa; M. Cemazar; S. Kranjc; D. Miklavcic

The aim of this study was to determine the tumor blood flow modifying, and potential vascular disrupting effect of electrochemotherapy with bleomycin or cisplatin. Electrochemotherapy was performed by application of short intense electric pulses to the tumors after systemic administration of bleomycin or cisplatin. Evaluated were antitumor effectiveness of electrochemotherapy by tumor measurement, tumor blood flow modifying effect by Patent blue staining technique, and sensitivity of endothelial and tumor cells to the drugs and electrochemotherapy by clonogenicity assay. Electrochemotherapy was effective in treatment of SA-1 tumors in A/J mice resulting in substantial tumor growth delay and also tumor cures. Tumor blood flow reduction following electrochemotherapy correlated well with its antitumor effectiveness. Virtually complete shut down of the tumor blood flow was observed already at 24 h after electrochemotherapy with bleomycin whereas only 50% reduction was observed after electrochemotherapy with cisplatin.

Palabras clave: Electric Pulse; Tumor Growth Delay; Tumor Perfusion; Tumor Blood Flow; Human Dermal Microvascular Endothelial Cell.

Pp. 602-605

Electrochemotherapy in treatment of solid tumours in cancer patients

Sersa Gregor

Electrochemotherapy consists of chemotherapy followed by local application of electric pulses to the tumour to increase drug delivery into cells. Drug uptake can be increased by electroporation for only those drugs whose transport through the plasma membrane is impeded. Among many drugs that have been tested so far, only bleomycin and cisplatin found their way from preclinical testing to clinical trials. This local drug delivery approach is aimed at the treatment with palliative intent of cutaneous and subcutaneous tumour nodules of different histology. In clinical studies electrochemotherapy has proved to be highly effective and safe treatment approach for the treatment of cutaneous and subcutaneous tumour nodules. Treatment response for various tumours was 75% complete and 10% partial responses of the treated nodules. The main advantages of electrochemotherapy are its high effectiveness on tumours with different histology, simple application, minimal side effects and the possibility of effective repetitive treatment.

Palabras clave: Basal Cell Carcinoma; Electric Pulse; Tumour Nodule; Isolate Limb Perfusion; Anorectal Malignant Melanoma.

Pp. 614-617

An endoscopic system for gene & drug delivery directly to intraluminal tissue.

Declan Soden; M. Sadadcharam; J. Piggott; A. Morrissey; C.G. Collins; G.C. O’Sullivan

Electrochemotherapy has been established in preclinical and clinical studies as an effective therapy; however, the currently available technology for delivery of this treatment is limited to surface tumours and is reliant on macroelectrodes such as callipers and needles. Internal cancers are not currently amenable to electrochemotherapy. If it were possible to deliver permeabilising electric pulses to intraluminal gastrointestinal or urinary tract tumours endoscopically, or to intra-abdominal tumours via the laparoscopic approach, many cancers which are now deemed inoperable or which are unresponsive to conventional therapies would become accessible to electrochemotherapy. Tumour reduction or regression would be a feasible aim, facilitating the achievement of palliation of symptoms, improved quality of life, prolonged survival and ultimately cure.

- Electroporation Based Therapies | Pp. 628-628

Equine Cutaneous Tumors Treatment by Electro-chemo-immuno-geno-therapy

Youssef Tamzali; B. Couderc; M.P. Rols; M. Golzio; J. Teissie

Kishida has shown that in mice having B16 tumors, simultaneous administration of bleomycin and DNAc coding interleukin 12 (IL12) by electropermeabilization (electrochemo- immuno-geno-therapy : ECIGT) induces an immune response resulting in tumors volume decrease as well as decrease of metastatic lesions.

Palabras clave: Metastatic Lesion; Therapeutic Challenge; Simultaneous Administration; Electric Impulse; Approach Coupling.

- Electroporation Based Therapies | Pp. 630-630

The effect of afferent training on long-term neuroplastic changes in the human cerebral cortex

Raf L.J. Meesen; O. Levin; S.P. Swinnen

In the present study we explored the effect of longterm intervention protocol (3 w, 1 h/day) with sensory stimulation on neuroplastic changes in the human motor cortex. Interventions consisted of repetitive activation of afferent pathways of the right abductor policies brevis (APB) muscle with tendon vibration (TV) and transcutaneous electrical nerve stimulation (TENS). The representations of the hand (APB, ADM) and forearm (FCR, ECR) muscles were mapped using transcranial magnetic stimulation (TMS) before and after the 3 weeks of sensory intervention (TV and TENS) groups or after similar periods of daily active training of the APB or rest (control). Our observations showed a significant increase in motor cortical representation of all the four muscles (as measured by changes in the map size) for the TENS group. No such effects were observed in the tendon vibration group, active training group or the control group.

Palabras clave: Transcranial Magnetic Stimulation; Motor Evoke Potential; Transcutaneous Electrical Nerve Stimulation; Motor Evoke Potential Amplitude; Corticospinal Excitability.

Pp. 643-646

An Experimental Test of Fuzzy Controller Based on Cycle-to-Cycle Control for FES-induced Gait: Knee Joint Control with Neurologically Intact Subjects

Takashi Watanabe; A. Arifin; T. Masuko; M. Yoshizawa

Functional Electrical Stimulation (FES) can be effective in assisting or restoring paralyzed motor functions caused by the spinal cord injury or the celebrovascular disease. The purpose of this study was to develop a control method of gait induced by FES. We had proposed a fuzzy control system based on cycle-to-cycle control for controlling hip, knee and ankle joints during the swing phase of FESinduced gait and evaluated it in computer simulation studies. In this report, the fuzzy controller was tested experimentally in controlling maximum knee extension angle stimulating the vastus muscles using surface electrodes with neurologically intact subjects. The fuzzy controller worked properly in regulating stimulation burst duration time and the maximum knee extension angle was controlled well. The experimental results suggested that the fuzzy controller would be practical in clinical applications for the control of FES-induced gait. However, it was also suggested that electrical stimulation with large burst duration time or muscle fatigue caused a change in muscle response.

Palabras clave: Joint Angle; Muscle Fatigue; Fuzzy Controller; Swing Phase; Functional Electrical Stimulation.

- Functional Electrical and Magnetic Stimulation | Pp. 647-650

Troubleshooting for DBS patients by a non-invasive method with subsequent examination of the implantable device

Hermann Lanmüller; J. Wernisch; F. Alesch

Multichannel devices are used for deep brain stimulation in patients suffering from Parkinson’s disease. A non invasive method to inspect each single output of these devices was applied in 12 patients. The clinician programmer indicates an electrode impedances beyond standard values in these patients or a non explainable loss of the therapeutic effect was given. A small device was developed to measure and display the stimulation impulse via surface electrodes. The results from the measurement pointed at an incorrect measurement by the programmer in 9 cases, broken electrode leads in 2 patients and an IPG failure in 1 patient. Leads and IPG was exchanged and inspected by light or electron microscopy. Each failure prognosis was confirmed by these examinations. The non invasive measurement of the stimulation pulse via surface electrodes turned out as an easy and accurate method for the detection of incomplete IPG malfunctions.

- Functional Electrical and Magnetic Stimulation | Pp. 651-653

Treating drop-foot in hemiplegics: the role of matrix electrode

Christine Azevedo-Coste; G. Bijelic; L. Schwirtlich; D.B. Popovic

We present advantages of the “intelligent matrix electrode” for providing selective correction of drop-foot in hemiplegic individuals. The matrix electrode which integrates stimulating and sensing parts could allow the emulation of the appropriate electrode shape and size; thereby, provision of selective stimulation that leads to functional movement and online adaptation of the electrode during the application. The need for selective stimulation follows recent findings about therapeutic effects of electrical stimulation in neurorehabilitation. The matrix electrode comprises small fields that can be made conductive and a controller that allows computerized selection of the fields being conductive. Here we present results from a study in nine hemiplegics. The matrix electrode was positioned over the peroneal nerve and primary dorsiflexor muscles and we estimated the movement of the foot by measuring the ankle joint angle. We found that the branched tree type shape and size of the electrode vary substantially when stimulating over the dorsiflexor muscles individuals in the study. We confirmed very high sensitivity to the position of small electrode when stimulating over the nerve.

Palabras clave: Peroneal Nerve; Ankle Joint Movement; Ankle Joint Angle; Selective Stimulation; Conductive Field.

Pp. 654-657

Magnetic Coils Design for Localized Stimulation

Laura CRET; M. Plesa; D. Stet; R.V. Ciupa

The technique of magnetic stimulation of nerve fibres represents a new direction of research in modern medicine. This study starts from a major limitation of the coils used for magnetic stimulation: their inability to specifically stimulate the target tissue, without activating the surrounding areas. The first goal of this study was to determine the optimal configuration of coils for some specific applications and evaluate the distribution of the electric field induced. Once the coil configuration established, we address other issues that need to be solved: achieving smaller coils, reducing power consumption (the low efficiency of power transfer from the coil to the tissue is a major drawback) and reducing coil heating.

- Functional Electrical and Magnetic Stimulation | Pp. 665-668

Vertical unloading produced by electrically evoked withdrawal reflexes during gait: preliminary results

Jonas Emborg; E. Spaich; O.K. Andersen

The objective of this study was to investigate the capability of Force Sensitive Resistors (FSR) to characterize perturbations of gait produced by electrically evoked withdrawal reflexes. Reflexes were evoked by cutaneous electrical stimulation at 4 locations on the sole of the left foot and delivered at 3 different phases in early swing. Force changes were measured by 4 FSR's attached to each foot. The vertical ground reaction force was estimated by summing the force signals for each foot separately. Response measures were mean peak force and peak slope evaluated in 5 gait sub-phases immediately after the stimulus: 1^st double support, 1^st right single support, 2^nd double support, 1^st left single support and 3^rd double support. The results showed that perturbation of gait could be detected by the selected features and that stimulation led to a weight shift from the ipsilateral to contralateral leg starting with a more rapid unloading of the ipsilatteral leg, supported by a rapid loading of the contralateral leg in the 1st double support.

Palabras clave: Peak Force; Gait Cycle; Stimulation Site; Weight Shift; Double Support.

Pp. 669-672

Two-level control of bipedal walking model

Andrej Olenšek; Z. Matjacic

This paper presents a two-level control strategy for bipedal walking model that accounts for implicit control of push-off and power absorption on the between-step control level and tracking of imposed holonomic constraints on kinematic variables via feedback control on within-step control level. The proposed control strategy was tested in a biologically inspired model with minimal set of segments that allows evolution of human-like push-off and power absorption. We evaluated the performance of the biped walking model in terms of how variations in torso position and gait velocity relate to push-off and power absorption. The results show that the proposed control strategy can accommodate to various trunk inclinations and gait velocities in a similar way as seen in humans.

Palabras clave: Gait Cycle; Support Phase; Propose Control Strategy; Power Absorption; Gait Velocity.

- Gait and Motion Analysis | Pp. 673-676

Kinematic and kinetic patterns of walking in spinal muscular atrophy, type III

Zlatko Matjacic; A. Praznikar; A. Olensek; I. Krajnik; I. Tomsic; M. Gorisek-Humar; A. Klemen; A. Zupan

Our knowledge on altered neurocontrol of walking due to weakness of various muscle groups of lower extremities is still limited. The aim of this study was to assess kinematic and kinetic walking patterns in a functionally similar group of seven subjects with spinal muscular athrophy, type III (SMA group) and compare them with normal data obtained in nine healthy subjects (CONTROL group) in order to identify characteristic compensatory changes. Kinematic and kinetic patterns were assessed during free walking of a SMA and CONTROL groups. The results showed characteristic changes in ankle plantarflexion moment and associated control of centre of pressure during loading response and midstance that facilitated minimization of external flexion moment acting on the knee and hip in SMA group. Additionally, we identified distinct and consistent changes also in the control of hip rotators and abductors that act in a way to rapidly bring hip in the extension early in the stance phase and delay weight shift onto the leg entering the stance phase, respectively.

- Gait and Motion Analysis | Pp. 681-684

The Gait E-Book – Development of Effective Participatory Learning using Simulation and Active Electronic Books

Anders Sandholm; P. Fritzson; V. Arora; Scott Delp; G. Petersson; J. Rose

In this paper we outline an interactive electronic book that teaches high school students about human locomotion. Today the most common teaching methods are lectures or reading a static textbook where the student’s participation is passive and they do not engage in the learning process. When learning about human gait, students not only learn anatomy and kinesiology but also have the opportunity to grasp theoretical subjects such as mathematics, physics, biomechanics as well as concepts of modeling and simulation to carry out experiments. In this paper we outline an interactive electronic book where the student becomes engaged in the learning processes, they can add/remove text, images, video, create models and perform simulation in one environment. The Gait E-book combines the theoretical lecture with the interactive learning process of modeling and simulation. Two different simulation platforms will be supported in the E-book, OpenModelica and OpenSim. Modelica is a powerful modern equation based simulation language where students can focus on learning mathematical and physical behavior.

Palabras clave: Gait Cycle; Human Gait; Human Locomotion; Open Source Software Project; Electronic Book.

Pp. 685-688

A Study on Sensing System of Lower Limb Condition with Piezoelectric Gyroscopes: Measurements of Joint Angles and Gait Phases

Norio Furuse; Takashi Watanabe

Functional electrical stimulation (FES) training of paralyzed muscles is effective for incomplete spinal cord injured patients in the early period of the rehabilitation process. Information of lower limb joint angles and gait phases are very important to assist walking and to restore motor function with FES. It is considered that a small and inexpensive gyroscope is useful to construct a practical sensor system in clinical. In this paper, we examined the simultaneous measurement method of the lower limb joint angles and the gait phases by using the gyroscopes. From the result of the walking analysis with normal subjects, it was indicated that the sensor system could measure the joint angles with sufficient accuracy and could detect practicably the swing phase and the stance phase without mistake. Therefore, the sensing system of lower limb condition with appropriate accuracy that could be used in clinical would be constructed compactly at inexpensive by using the gyroscopes.

Palabras clave: Root Mean Square; Joint Angle; Stance Phase; Swing Phase; Functional Electrical Stimulation.

- Gait and Motion Analysis | Pp. 689-692

A standard tool to interconnect clinical, genomic and proteomic data for personalization of cardiac disease treatment

Mauro Giacomini; F. Lorandi; C. Ruggiero

Within the post genomic era a new type of medicine was born: “personalized medicine”. It makes it possible to study how to synthesize new drugs for the treatment of different kind of diseases at the individual level. It is necessary to handle a large amount of data coming from genomics and proteomics analysis. For this purpose we propose a way to make data available in a standardized format, using the international standard HL7. Another important topic is the link between clinical and genomics/proteomics data to have a general view in order to facilitate their analysis.

- Health Care and Medical Informatics | Pp. 693-695

Informational Internet-systems in Ukrainian healthcare – problems and perspectives.

Artur Lendyak

Today can be noticed the rash development of medicine and pharmacy. Nowadays appears the necessity of modernizations in systems of medical and pharmaceutical information of the post-USSR countries because of the wide range of diseases, methodic of treatment and quantity of available drugs on the markets. Existing systems in modern circumstances, in conditions of limited labor and financial resources, and large implantation of evidence-base medicine, often can’t effectively satisfy the requirements of population and health professionals in medical and pharmaceutical information. The work was based on the study of Ukrainian project Doctor.UA. Introducing of Doctor.UA is scheduled in several stages. First of all in January, 2003 was opened fouryears test project, which was the part of corporative site of the company (http://apteka-doctor.com). It was named Pre- Doctor.UA and it in simplified form modeled Doctor.UA. During first decade of January, 2007 the results of activity of Pre- Doctor.UA were drew up. For deciding given tasks was analyzed following information: statistics systems, usabilitytesting, interviewing the visitors.

- Health Care and Medical Informatics | Pp. 700-703

Reducing time in emergency medical service by improving information exchange among information systems

Matic Stern; A. Jelovsek

There are many organized units involved to perform an emergency rescue mission: dispatch center, mobile rescue units and emergency departments (ED) in hospitals. Communication among them is often not fully automated, and then personnel need to cope with unnecessary work. That of course takes time in cases of urgent interventions, while time is one of the most important factors for patient survival. There are several processes in which better performance could be established. Improvement can be made by reducing communication obstacles between actors in processes and among three different information systems involved: hospital information system (HIS) in emergency department, computer aided dispatch (CAD) and records management system (RMS) used by mobile units.

- Health Care and Medical Informatics | Pp. 704-707

Data Presentation Methods for Monitoring a Public Health-Care System

Aleksander Pur; Marko Bohanec; Nada Lavrač; Bojan Cestnik

This paper present methods of data presentations that enable performance and activity monitoring of a health care system. The methods enable visual discovery of typical and atypical patterns, anomalies and outliers in the data. The methods were successfully implemented in a monitoring system developed for monitoring the primary healthcare system of Slovenia, to be used by the national Ministry of Health.

- Health Care and Medical Informatics | Pp. 708-711

Simulation in Medicine and Nursing – First Experiences in Simulation centre at Faculty of Health Sciences University of Maribor

Dusanka Micetic-Turk; M. Krizmaric; H. Blazun; N. Krcevski-Skvarc; A. Kozelj; P. Kokol; Š. Grmec; Z. Turk

Medical and nursing simulations at the Faculty of Health Sciences University of Maribor provide the skills to nursing and medical students that will improve clinical practice. Simulations is thus becoming an essential tool in improving quality of patient care and safety. Simulations enable teaching, learning, evaluation and clinical research.

Palabras clave: Simulation Technology; Simulation Centre; SimMan Simulator; Simulation Education; Critical Thinking Ability.

- Health Care and Medical Informatics | Pp. 716-718

The Open Three Consortium: an open-source, full-service-based world-wide e-health initiative

Paolo Inchingolo; M. Beltrame; P. Bosazzi; D. Dinevski; G. Faustini; S. Mininel; A. Poli; F. Vatta

The Higher Education in Clinical Engineering (HECE) of the University of Trieste constituted in 2005 the Open Three Consortium (O3), an innovative open-source project dealing with the multi-centric integration of hospitals, RHIOs and citizen (care at home and on the move, and ambient assisted living), based on the about 60 HECE bilateral cooperation Agreements with Hospitals, Medical Research Centers, Healthcare Enterprises, Industrial Enterprises and Governmental Agencies and on the International Networks ABIC-BME (Adriatic Balcanic Ionian Cooperation on Biomedical Engineering) and ALADIN (Alpe Adria Initiative Universities’ Network). Some months ago, the collaboration with multiple open-source solutions has been extended, starting an international cooperation with the open-source based company Sequence Managers Software, Raleigh, NC, United States. The O3 Consortium proposes e-inclusive citizen-centric solutions to cover the above reported three main aspects of the future of e-health in Europe with open-source strategies joined to full-service maintenance and management models.

- Health Care and Medical Informatics | Pp. 723-726

O3-RWS: a Java-based, IHE-compliant open-source radiology workstation

Giorgio Faustini; P. Inchingolo

Within the Open Three Consortium (O3) an open source radiological reporting workstation, called O3- RWS, has been studied, developed and experimented in the routine of European and US hospitals. The O3 Consortium is an international open-source project constituted in 2005 by Higher Education in Clinical Engineering (HECE) of the University of Trieste; it deals with the multi-centric integration of hospitals, RHIOs and citizen (care at home and on the move, and ambient assisted living). O3-RWS has been studied and developed with the goal to give a solution for the needs of the physician, who wants to have an easy-to-use, light and complete solution for the radiology reporting and report creation. O3-RWS, a very versatile platform-independent radiology workstation, providing user authentication and being easy to use also for private users, is able to retrieve, visualize and manage medical images; in an universal version, it is going to be able to deal with vital signs like ECG, hemodynamical and pneumological data.

Palabras clave: Private User; Ambient Assisted Living; Teaching File; Healthcare Enterprise; Medical Image Resource Centre.

Pp. 727-731

Reshaping Clinical Trial Data Collection Process to Use the Advantages of the Web-Based Electronic Data Collection

Ivan Pavlovic; I. Lazarevic

In this paper some results of modeling web-based clinical trial electronic data collection process are presented. Clinical trial data collection is usually a paper-based process. Here we propose a new process of electronic data collection adjusted for the utilization of the web-based technology. Two models that we present here are the basis for the development of the electronic data collection software to support clinical trials. The first one defines use cases of the actors using the system. The second one is a model of the structure of the electronic Case Report Form (eCRF) document. Descriptions of these two models at a high level of abstraction are presented using the standard UML (Unified Modeling Language) version 2.0.

Palabras clave: Case Report Form; Data Collection Process; Data Verification; Erroneous Data; Case Diagram.

- Health Care and Medical Informatics | Pp. 741-744

E-learning for Laurea in Biomedical laboratory Technicians: a feasibility study

Daniele Giansanti; L. Castrichella; M.R. Giovagnoli

With the development of e-learning and its ability to provide rich animated content rapidly to a wide audience, new methods for teaching have evolved. E-learning tools allow building of learner-focused structured courses. The authors affords in this paper the feasibility study of a Webbased e-learning course in the academic degree of Laurea for Biomedical Laboratory Technicians (LBLT). Topic and basic aspects and essential requirements have been identified covering (1) the simplicity of the needed methodology to exchange didactic material and (2) the need of a simple and fast architecture for digital tele-pathology to exchange pathologic and /or cytological data. The last is a core aspect for the amount of data to be exchanged and the complexity of the applications even higher that other tele-imaging methodologies such as tele-radiology and tele-echocardiography. For these reasons a course of LBLT could represent thus an interesting bench test for the e-learning.

Palabras clave: Medical Engineer; Academic Degree; Cytological Data; Didactic Material; Minimal Transmission Rate.

Pp. 749-751

A hospital structural and technological performance indicators set

Ernesto Iadanza; F. Dori; G. Biffi Gentili; G. Calani; E. Marini; E. Sladoievich; A. Surace

Management is one of the most complex subjects in the field of of health care systems. Indeed, the performance of an hospital is affected by plenty of factors, related to technology, organization and estate. Health centres have often been monitoring their operations by analyzing financial and operational reports provided, but organizational and technological aspects are sometimes pushed to the background. This paper describes a decision support system designed for hospital administrators to increase their analysis and management effectiveness.. Taking as a starting point recent researches, this study proposes a set of performance indicators, balancing organizational, structural and technological aspects, to be used together with widely adopted clinical indicators.

- Health Care Technology Assessment and Management | Pp. 752-755

Technology Assessment for evaluating integration of Ambulatory Follow-up and Home Monitoring

Marcello Bracale; L. Bisaccia; P. Melillo; L. Argenziano; M. Bracale

The introduction of new services into a complex system, as it is the Health System, is not an easy challenge. Health Technology Assessment could support decision makers and drive decision making regarding the introduction of new health services. This paper describes an analysis to evaluate those clinical and patient’s needs that could be satisfied by integration of Ambulatory Follow-up and Home Monitoring. Then a cost-analysis on the ambulatory follow-up and a preliminary cost-estimation on Web Service are performed in order to assess the economical impact of these services on the follow-up.

- Health Care Technology Assessment and Management | Pp. 758-761

A Multi Scale Methodology for Technology Assessment. A case study on Spine Surgery

Marcello Bracale; L. Pecchia; F. Acampora; S. Acampora

This article describes a multi-scale methodology for Health Technology Assessment. Multi-scale means that this method focuses the attention on the needs to be satisfied taken as a whole, by categories and one by one. For this reason a graphic representation has been used to identify the strengths of every technology to be compared. Than an objective function has been established in order to individuate the technology that better fill the needs as whole and by category. In order to establish a scale of satisfaction, it was necessary to define an algorithm that could distinguish parameters in objectivequantitative and subjective-qualitative. These last items have been quantified by auditing an un-polarized sample of experts trough questionnaires. Finally the chosen method was applied to neurosurgery, especially to spine surgery. Two different surgical techniques have been evaluated for different pathologies, each method applying different biocompatible elements: the traditional treatment, which employs rigid fixers (Cage and Titanium bars) and a new procedure, which employs elastic fixers with shape memory (Somafix and Nitinol bars).

Palabras clave: Shape Memory; Spine Surgery; Technology Assessment; Health Technology Assessment; Satisfaction Rate.

Pp. 762-765

Complexity Analysis of Heart Rate Control Using Symbolic Dynamics in Young Diabetic Patients

Michal Javorka; Z. Trunkvalterova; I. Tonhajzerova; J. Javorkova; K. Javorka

Cardiovascular dysregulation and autonomic neuropathy are common complications of diabetes mellitus (DM). Although autonomic neuropathy is considered as one of the late complications of DM, there are some sensitive methods, that can detect autonomic nervous system dysregulation even in early phases of DM. There is ongoing effort to apply methods based on nonlinear dynamics to improve the description and classification of different cardiac states. The aim of this study was to find out which of the heart rate variability parameters of symbolic dynamics are different in young patients with DM compared to control group. Several parameters based on 4 symbols encoding were used for quantification of heart rate variability and complexity. Our results suggest slightly reduced complexity (expressed by marginally nonsignificantly reduced number of “forbidden words”) even in young diabetic patients pointing out to another aspect of heart rate dysregulation in this group. In addition we have found qualitative difference in distribution of symbolic words expressed by parameter “wpsum02”.

Pp. 766-768

Recurrence Quantification Analysis of Heart Rate Dynamics in Young Patients with Diabetes Mellitus

Zuzana Trunkvalterova; M. Javorka; I. Tonhajzerova; J. Javorkova; K. Javorka

There is an ongoing effort to apply methods based on nonlinear dynamics to improve the description and classification of different states and diseases. Relatively few studies were focused on autonomic neuropathy in young adults with diabetes mellitus (DM) type 1. The aim of this study was to find out which of the heart rate variability parameters derived from recurrence plot (recurrence quantification analysis parameters) are different in young patients with DM compared to control group. We have quantified various recurrence plot measures. From RQA measures based on diagonal lines in recurrence plots, we have found higher percentage of recurrence and of determinism and increased maximal length of diagonal line in DM group. Parameter Trapping Time was higher in DM group compared to control subjects. These results suggests reduced complexity and increased predictability of heart rate dynamics even in young patients with DM. RQA parameters should be used together with other HRV parameters for better description of heart rate dysregulation in various patients groups.

Palabras clave: Heart Rate Variability; Diagonal Line; Autonomic Neuropathy; Recurrence Plot; Heart Rate Variability Parameter.

Pp. 769-772

Joint Symbolic Dynamic of Cardiovascular Time Series of Rats

Tatjana Loncar-Turukalo; D. Varga; D. Bajic; S. Milutinovic; N. Japundzic-Zigon

Insight in complex heart rate and blood pressure interactions reveals the most important aspects of autonomic control. Our main interest was in baroreceptor reflex (BRR), the most important autonomic cardiovascular reflex. We evaluated the joint symbolic dynamics of heart rate and blood pressure variations in assessing the BRR by opening the BRR loop at different levels using pharmacological blockade of β- adrenergic, α-adrenergic and M-cholinergic receptors. Experiments were done in conscious telemetred Wistar out bred male rats. The observed changes between experimental groups are promising for use of symbolic dynamic method in assessment of impaired autonomic control of the cardiovascular system.

- Heart Rate Analysis | Pp. 773-776

2CTG2: A new system for the antepartum analysis of fetal heart rate

Giovanni Magenes; M.G. Signorini; M. Ferrario; F. Lunghi

The cardiotocography (CTG) has been introduced in in the early ‘70ies as a clinical test for checking fetal well-being during pregnancy and at the moment of delivery. The traditional approach was based on the detection of several time domain parameters of Fetal Heart Rate (FHR) signal starting from the identification of a signal baseline. With the certainty that FHR really contains important indications about potentially dangerous fetal conditions, a prototype system has been setup based on new algorithms and indices which can enhance the differences among normal and pathological fetal conditions. The basic characteristics of this system are: FHR sampled and recorded at 2 Hz; on-line traditional analysis by incremental Mantel algorithm; extraction of accelerations, decelerations, FHR variability and related parameters; extraction of power spectral components related to different physiological control mechanisms; computation of FHR signal regularity indices through the Approximate Entropy algorithm.

- Heart Rate Analysis | Pp. 781-784

Speeding up the Computation of Approximate Entropy

George Manis; S. Nikolopoulos

Approximate entropy is a measure of regularity which finds application in many problems in biomedical engineering. One drawback of the method is its high complexity which results in large execution times. The purpose of this paper is to alleviate this problem by examining three algorithms, two of which have never been suggested before for approximate entropy computation. In our experiments heart rate signals were analyzed using the three algorithms. The speedup achieved was significant.

Palabras clave: Correlation Dimension; Approximate Entropy; Phase Space Reconstruction; Similar Vector; Heart Rate Signal.

Pp. 785-788

Cardiac arrhythmias and artifacts in fetal heart rate signals: detection and correction

Mario Cesarelli; M. Romano; P. Bifulco; A. Fratini

Cardiotocography is the most commonly used noninvasive diagnostic technique that provides physicians information about fetal development (in particular about development of autonomous nervous system - ANS) and wellbeing. It allows the simultaneous recording of Fetal Heart Rate (FHR), by means of a Doppler probe, and Uterine Contractions (UC), by means of an indirect pressure transducer. Currently, in cardiotocographic devices, Doppler methodology involves autocorrelation techniques to recognize heart beats, so evaluation of inter-beats time-interval is very improved. However, recorded FHR signals may contain artifacts, because of the possible degradation, or even less, of the Doppler signal due to relative motion between probe and fetal heart, maternal movements, muscle contractions and other causes. Moreover, fetal cardiac arrhythmias can have an effect on FHR signals. These arrhythmias do not represent an expression of the physiological behavior of the ANS. Both, artifacts and cardiac arrhythmias represent outliers of the FHR signals, so they affect both time domain and time frequency signal analysis.

- Heart Rate Analysis | Pp. 789-792

Using Heuristics for the Lung Fields Segmentation in Chest Radiographs

D. Gados; G. Horvath

The cancerous attaches, mainly the lung cancers, make a serious medical problem all over the world. The early diagnoses based on chest radiographs could notably lower its mortality. The efficiency of the computers gives the possibility to facilitate the work of the radiologists by a CADsystem. But first the region of the interest, i.e. the lung fields should be determined. The lung segmentation in our sense differs from the trends accounted in literature (where the area hidden by the heart is ignored), because the left border of the left lung is located beneath the heart. In this paper we describe a method based mainly on heuristics and rules which can be used to find the contours of the lung. The algorithm is divided to five main steps: (1) finding some parameters of the lungs without long processing, (2) determining the usual lung contours, (3) finding the mediastinum, (4) finding the lower border of the left lung and (5) applying a model to achieve better results, to make some refinement.

Palabras clave: Chest Radiograph; Left Lung; Lung Field; Left Border; Degree Angle.

Pp. 802-805

Measuring Red Blood Cell Velocity with a Keyhole Tracking Algorithm

Constantino Carlos Reyes-Aldasoro; S. Akerman; G.M. Tozer

A tracking algorithm is proposed to measure the velocity of red blood cells traveling through microvessels of tumors growing in skin flaps implanted on mice. The tracking is based on a keyhole model that describes the probable movement of a segmented cell between contiguous frames in a video sequence. When a history of movements exists, past, present and a predicted landing position define two regions of probability with a keyhole shape. This keyhole is used to determine if cells in contiguous frames should be linked to form tracks. Preprocessing segments cells from background and post-processing joins tracks and discards links that could have been formed due to noise or uncertainty. The algorithm presents several advantages over traditional methods such as kymographs or particle image velocimetry: manual intervention is restricted to the thresholding, several vessels can be analyzed simultaneously, algorithm is robust to noise and a wealth of statistical measures can be obtained. Two tumors with different geometries were analyzed; average velocities were 211±136 [μm/s] (mean±std) with a range 15.9-797 [μm/s], and 89±62 [μm/s] with a range 5.5-300 [μm/s] respectively, which are consistent with previous results in the literature.

Palabras clave: Particle Image Velocimetry; Tracking Algorithm; Intravital Microscopy; Wide Vessel; Royal Hallamshire Hospital.

- Medical Imaging | Pp. 810-813

Web-based Visualization Interface for Knee Cartilage

Richard I. Kitney; C.-L. Poh; R.B.K. Shrestha

Osteoarthritis (OA) of the knee can be described as the degradation and loss of articular cartilage. Adequate visualization of cartilage is paramount in allowing accurate and clinically meaningful assessment of cartilage surface morphology and thickness. In this paper we present a web-based user interface that allows the visualization of quantitative results (i.e., cartilage thickness) derived from MR knee images. The use of web-based technology has allowed greater access to the interface and clinically useful interactive functions for the viewing of data (i.e., cartilage thickness WearMap and MR images).

Palabras clave: Cartilage Thickness; Clinical Information System; Knee Cartilage; Scalable Vector Graphic; Magnetic Resonance Knee Image.

Pp. 814-817

Markov Chain Based Edge Detection Algorithm for Evaluation of Capillary Microscopic Images

Gabor Hamar; G. Horvath; Zs. Tarjan; T. Virag

Nailfold capillaroscopy is a non invasive, simple examination, which provides exact information on the assessment of the microcirculation. The peripheral blood circulation is very sensible for certain illnesses e.g.: autoimmune diseases, diabetes. In many cases there exists a pattern specific for certain illnesses, therefore this test is capable of differentiate between them. Our aim is to develop a computer aided evaluation system for capillary microscopic images. The fist step of the evaluation is the detection of capillaries, which is done by edge detection. Classical edge detectors resulted in unsatisfactory output, therefore we tried a different approach, which is able to take into account not only the local properties of the image, but also the relations of pixels. During the test of the algorithm we obtained that with a suitable post processing procedure the capillaries shown in the picture can be detected robustfully, hence our procedure is applicable as the first step of the evaluation of these images.

- Medical Imaging | Pp. 818-821

Evaluation of Tomographic Reconstruction for Small Animals using micro Digital Tomosynthesis (microDTS)

Delia Soimu; Z. Kamarianakis; N. Pallikarakis

Significant advances in the development of transgenic and knockout animal models of human disease have made whole-animal imaging an important new application for micro CT. In many studies of genetically altered animals, investigators require a non-destructive, 3D technique to characterize the phenotype of the animal. However, a fundamental limitation which should be considered, especially in experiments involving imaging the same animal over time, is the inherent use of ionizing radiations which may approach the lethal dose for small rodents. Digital Tomosynthesis (DTS) is a fast, low-dose 3D imaging approach which yields image with excellent in-plane resolution, though low plane-to-plane resolution. A stack of DTS slices can be reconstructed from a singlelimited arc scan, with typical scan angles ranging from 10°-60° and acquisition time of less than 10 seconds. This study evaluates the reconstructed tomograms for small animal imaging system using µCT and µDTS, for three different DTS scan angles (20°, 40°, and 60°). Resulting DTS slice show soft tissue contrast approaching that of full cone-beam CT.

Palabras clave: Small Animal; Small Rodent; Soft Tissue Contrast; Small Animal Imaging; Voxel Spacing.

- Medical Imaging | Pp. 826-829

Methods for Automatic Honeycombing Detection in HRCT images of the Lung

Tatjana Zrimec; J. Wong

Honeycombing in High-Resolution CT (HRCT) indicates the presence of a number of diseases involving fibrosis of the lung. Honeycombing is difficult to detect due to its textural and structural appearance, which changes with the progression of the diseases. Structure-based and texture-based methods, developed for detecting the honeycombing pattern, are presented and compared. Machine learning is used to generate rules for honeycomb detection using examples of its appearance in HRCT images, provided by radiologists. The effectiveness of each method was evaluated using cross validation on 16692 examples of regions with and without honeycombing from 42 images of 8 patients.

Palabras clave: Idiopathic Pulmonary Fibrosis; Tenfold Cross Validation; HRCT Image; Inverse Difference Moment; Honeycomb Region.

Pp. 830-833

Estimation method for brain activities are influenced by blood pulsation effect

W.H. Lee; H.R. Lee; K.W. Han; J.S. Park; J.J. Kim; I.Y. Kim; S.I. Kim; Jeonghun Ku

BOLD T2*-weighted MR images reflects cortical blood flow and oxygenation alterations. fMRI study relies on the detection of localized changes in BOLD signal intensity. Since fMRI measures the very small modulations in BOLD signal intensity that occur during changes in brain activity, it is also very sensitive to small signal intensity variations caused by physiologic noise during the scan. Due to the complexity of movement of various organs associated with heart beat, it is important to reduce cardiac related noise rather than other physiological noise which could be required with relatively simple method. Therefore, a number of methods have been developed for the estimation and reduction of cardiac noise in fMRI study. But, each method has limitation. In this study, we proposed a new estimation method for brain activities influenced by blood pulsation effect using regression analysis with blood pulsation signal and the correspond slice of fMRI. We could find out that the right anterior cingulate cortex and right olfactory cortex and left olfactory cortex were largely influenced by blood pulsation effect for new method.

Palabras clave: Functional Connectivity; Anterior Cingulate Cortex; Blood Oxygenation Level Dependent; Blood Oxygenation Level Dependent Signal; fMRI Signal.

Pp. 839-842

Classification of Prostatic Tissues using Feature Selection Methods

S. Bouatmane; B. Nekhoul; A. Bouridane; C. Tanougast

This paper proposes the use of sequential feature selection for classification of prostatic tissues. The technique aims to classify microscopic samples taken by needle biopsy for the purpose of prostate Cancer diagnosis. Four major classes (representing different grades of abnormality from normal to cancer respectively: Stroma, BPH, PIN, PCa) have to be discriminated. To achieve that, the same feature vector, based on texture measurements, was derived for each class. Haralick features have been used to describe textures. Sequential forward selection (SFS) and sequential backward selection (SBS) has been used to reduce the dimensionality of the generated feature vector into a manageable size. Tests have been carried out using k nearest neighbor (kNN) method and have shown that the use of feature selection algorithms SFS and SBS can significantly improve the classification performance.

Palabras clave: Feature Selection; Prostatic Tissue; Mahalanobis Distance; Feature Subset; Feature Selection Method.

Pp. 843-846

Automatic cell detection in phase-contrast images for evaluation of electroporation efficiency in vitro

Marko Usaj; Drago Torkar; Damijan Miklavcic

In the research of electroporation, we often need to know the percent of electroporated cells under different experimental conditions. Manual counting of the cells in digital images is time-consuming and subjective, especially on phase contrast images. In this paper, we present an automatic cell counting method based on optimization of ITCN (Image-based Tool for Counting Nuclei) algorithm’s parameters to fit training data that is based on counts from user or expert. In comparing the results of automatic cell counting and user manual counting 94,21 % average agreement was achieved what is good.

Palabras clave: Training Data; Average Relative Error; Manual Counting; Gene Electrotransfer; Adaptive Histogram Equalization.

Pp. 851-855

Scattered radiation spectrum analysis for the breast cancer diagnostics

G.G. Kochemasov; S.A. Belkov; N.V. Maslov; S.V. Bondarenko; N.M. Shakhova; I.Yu. Pavlycheva; A. Rubenchik; U. Kasthuri; L.B. Da Silva

Data analysis of the optical scattering spectra obtained in the clinical trials of the optical biopsy system is presented. The major types of spectra were revealed characterizing malignant and benign tumors.

Palabras clave: Benign Tumor; Scattered Radiation; Current Spectrum; Russian Federal Nuclear; Optical Biopsy.

- Medical Physics | Pp. 856-858

Modulation of the beam intensity with wax filter compensators

Dasa Grabec; P. Strojan

In order to achieve homogenous dose distribution in target volume several approaches are possible. We are discussing the possibility of field intensity modulation with wax filter compensators and comparing the technique with other techniques. The case report of the head and neck region radiotherapy with the use of 2D wax filter compensator is presented. The 3D wax filter compensators technique is further discussed as a substitute to the step and shoot IMRT or to the sliding window IMRT technique. The advantages and disadvantages of the wax filter compensators are put side by side. The case of meduloblastoma treatment is outlined as the case where whit applying 3D wax filter compensators the benefit would be the greatest.

Palabras clave: Dose Distribution; Multileaf Collimator; Leaf Movement; Homogenous Dose Distribution; Filter Compensator.

Pp. 867-870

A Model of Flow Mechanical Properties of the Lung and Airways

Bozena Kuraszkiewicz; T. Podsiadly-Marczykowska; M. Darowski

The paper describes a lung model, which illustrates the pressure - volume - flow relationships in the lungs. The model includes three airway segments in series; the resistance of one of them is a function of transmural pressure and a constant related to airway compressibility. The model can be used to obtain IVPF curves and flow-volume curves, and various assumptions concerning the distribution of airway resistance, the magnitude of lung elastic recoil; and other factors can be tested with it.

Palabras clave: Lung Volume; Transmural Pressure; Driving Pressure; Airway Conductance; Airway Narrowing.

Pp. 871-874

Verification of planned relative dose distribution for irradiation treatment technique using half-beams in the area of field abutment

Rihard Hudej

The aim of the study was to assure a proper treatment by using pairs of opposed abutting half-beams. Different beam arrangements were studied with the treatment planning system. The delivered dose in the region of beam abutment was measured with the film dosimetry and compared to the planned dose. A noticeable dose difference was found in the area of few millimetres around the abutment of the half-beams. The dose difference, resulting from inaccurate positioning of Y jaws, was up to 22%. The displacement of the jaws was evaluated and the correction of the position of the jaw was made.

Palabras clave: Dose Distribution; Beam Arrangement; Film Dosimetry; Plan Dose Distribution; Isocentric Plane.

- Medical Physics | Pp. 883-886

Experimental verification of the calculated dose for Stereotactic Radiosurgery with specially designed white polystyrene phantom

Bozidar Casar; A. Sarvari

Accuracy in the dose delivery in the Stereotactic Radiosurgery is one of the most important components in this sophisticated radiotherapy treatment of benign and malignant intracranial diseases. In the present study, we carried out the measurements with small volume cylindrical ionization chamber PTW 31006 (PinPoint), together with specially designed and elaborated bullet-shaped white polystyrene phantom in order to verify the dose calculation by the commercially available 3D treatment planning system BrainScan from BrainLab company. Comparison of the doses was done in four simulated simple treatments, applying non-coplanar circular arc technique with tertiary conical collimators on linear accelerator Varian Clinac 2100 C/D with high energy photon beams of 6 MV. We found systematic differences in all four cases. The differences were found to range from 2.4% to 3.9% - the measured doses were always higher than the calculated ones. Although the results of our study could confirm the accuracy of the treatment planning dose calculations, as the differences lie within the recommended 5% value of the International Commission on Radiation Units and Measurements (ICRU), it is advisable to investigate further the origin of these, most probably systematic errors.

- Medical Physics | Pp. 887-890

In vivo dosimetry with diodes in radiotherapy patients treated with four field box technique

Andrej Strojnik

Two diodes have been calibrated as in vivo dosimeters for entrance and exit dose measurements in radiotherapy with 15 MV photon beams. Their response dependencies on dose, dose rate, focus skin distance, field size, gantry angle and patient thickness have been investigated. 1243 routine measurements have been performed in 302 rectal and prostate cancer patients irradiated with four field box technique. Measurement statistics is presented.

- Medical Physics | Pp. 891-894

The Cavitational Potential of a Single-leaflet Virtual MHV: A Multi-Physics and Multiscale Modelling Approach

Dan Rafiroiu; V. Díaz-Zuccarini; D.R. Hose; P.V. Lawford; A.J. Narracott; R.V. Ciupa

A newly developed lumped parameter model of the left ventricle contraction and a computational fluid dynamics (CFD) representation of the fluid structure interaction (FSI) of a single leaflet mechanical heart valve are coupled to investigate the cavitation potential of a single leaflet prosthetic heart valve. The left ventricle model gives a “more-realistic” representation of the cardiac muscle contraction, from the level of the contractile proteins, up to the hemodynamics of the whole ventricle. A commercial finite volume CFD code (ANSYS-CFX) is coupled to the lumped parameter ventricle model through the inlet and outlet boundary conditions. Cavitation potential is evaluated from the negative pressure gradients occurring on the surface of the occluder and vortex formations adjacent to its atrial aspect.

Palabras clave: Computational Fluid Dynamic; Fluid Structure Interaction; Computational Fluid Dynamic Model; Valve Closure; Mechanical Heart Valve.

- Medical Physics | Pp. 895-898

Wavelet-based quantitative evaluation of a digital density equalization technique in mammography

Antonis P. Stefanoyiannis; I. Gerogiannis; E. Efstathopoulos; S. Christofides; P.A. Kaplanis; A. Gouliamos

In this study, quantitative evaluation of a proposed digital density equalization technique in mammography was carried out. The evaluation was performed on a set of 90 mammograms, based on wavelet-generated measurable parameters of image quality, such as contrast, noise and contrastto- noise ratio (CNR). These parameters were estimated for dense mammary gland and breast periphery, for both initial and corresponding corrected mammograms. The equalization character of the technique was also examined. A statistically significant (p<0.05) or highly significant increase (p<0.0005) was observed in breast periphery and mammary gland contrast, noise and CNR values. The proposed technique was found to result in density equalization, since the decrease in equalization index is statistically highly significant (p<0.0005).

Palabras clave: Mammary Gland; Dense Breast; Digital Mammography; Equalization Index; Mammographic Image.

Pp. 899-902

Interaction between charged membrane surfaces mediated by charged nanoparticles

Janez Pavlič; A. Iglic; V. Kralj-Iglic; K. Bohinc

The interaction between charged membrane surfaces, separated by a solution containing charged nanoparticles was studied experimentally and theoretically. The nonlocal theory for the nanoparticles was developed where finite size of nanoparticles and spatial distribution of charge within a particle were taken into account. It was shown that for large enough membrane surface charge densities and large enough dimensions of nanoparticles, the force between equally charged membranes may be attractive due to spatially distributed charges within the nanoparticles.

- Medical Physics | Pp. 903-906

Optical biopsy system for breast cancer diagnostics

S.A. Belkov; G.G. Kochemasov; S.M. Kulikov; V.N. Novikov; U. Kasthuri; L.B. Da Silva

An optical biopsy system for early breast cancer diagnostics is reported. Its specific features and calibration and data preprocessing method are described.

- Medical Physics | Pp. 907-910

Implantable brain microcooler for the closed-loop system of epileptic seizure prevention

Tatiana Lyubynskaya; I. Osorio; G. Kochemasov; V. Baranov; V. Eroshenko; N. Gopalsami

A method of thermal suppression of abnormal brain activity observed in epileptic patients during preictal stage was considered for seizure blockage. The development of an implantable brain microcooler as a part of a closed-loop epileptic seizure prevention system is reported. An array of 7 needle-like probes of the diameter ~1 mm and length ~2 cm provides cooling of 1 cubic inch of brain tissue from ~37°C to ~16°C in ~30 sec. Convective method of heat exchange with tube in a tube design was adopted. Two coaxial steel tubes formed channels for the direct and reverse flows of precooled water. Theoretical studies and numerical modeling based on Pennes' equation were performed to investigate the process of brain tissue cooling. Experimental tests demonstrated good agreement with calculations. A closed cycle cooling system with a peristaltic pump and thermoelectric cooling device is being prepared for animal tests. As an additional option a single-probe microcooler of the probe length ~5 cm was developed, fabricated, and tested for cooling of deep brain areas such as hippocampus.

Palabras clave: Probe Length; Seizure Detection; Brain Cool; Seizure Prediction; Arterial Blood Temperature.

- Medical Physics | Pp. 911-914

Time-Frequency behaviour of the a-wave of the human electroretinogram

Leonardo Bellomonte; R. Barraco; M. Brai

The electroretinogram is the record of the electrical response of the retina to a light stimulus. The two main components are the a-wave and the b-wave, the former is related to the early photoreceptoral activity. Aim of this paper is to acquire useful information about the time-frequency features of the human a-wave, by means of the wavelet analysis. This represents a proper approach in dealing with nonstationary signals. We have used the Mexican Hat as mother wavelet. The analysis, carried out for four representative values of the luminance, comprehends the frequency dependence of the variance and the skeleton. The results indicate a predominance of low frequency components, their time distribution depends on the luminance whereas that of the high frequency components is little affected by the luminance.

- Medical Physics | Pp. 919-922

Electrically Elicited Stapedius Muscle Reflex in Cochlear Implant System fitting

Arkadiusz Wasowski; T. Palko; A. Lorens; A. Walkowiak; A. Obrycka; H. Skarzynski

The aim of this study was to assess the possibility of using electrically elicited stapedius muscle reflex (ESR) for estimation of most comfortable loudness level (MCL), one of the most important electrical stimulation parameter in cochlear implant system fitting. The material of this study consisted of 48 adult patients, sampled from the group of MedEl Combi 40+ and MedEl Pulsar users, implanted in the Institute of Physiology and Pathology of Hearing. Their cochlear implant system was fitted according to the results of psychophysical tests: loudness scaling and electrical amplitude growth function. ESR measurement was performed, and ESR thresholds and MCL values were compared. Good correlation after 12 months of using cochlear implant system was observed. Results indicate that ESR can be included in cochlear implant system fitting procedure as objective measurement for prediction of optimal MCL values.

- Rehabilitation Engineering | Pp. 940-942

Use of rapid prototyping technology in comprehensive rehabilitation of a patient with congenital facial deformity or partial finger or hand amputation

Tomaz Maver; H. Burger; N. Ihan Hren; A. Zuzek; L. Butolin; J. Weingartner

Our experiences show that patients wish to replace the lost part of their body with a prosthesis – epithesis that is a mirror image of the relevant healthy part of the body. Four years ago we linked up with other institutions, companies and the University of Ljubljana in order to search for new more advanced technological possibilities to bring the form of epitheses closer to the form of a healthy hand or part of a face. A healthy and impaired part of the body were scanned. A digital virtual model was made by using a computer programme. 3D printing technology, DMLS (Direct Metal Laser Sintering) and SLS (Select Laser Sintering) technology were used to build up the first model or mould for manufacturing a silicone epithesis. Through our development project we have found the way for the high-resolution digitising of body parts and technology to produce a prototype model and mould allowing the fine recognition of skin details. By using CAD-CAM high resolution technology, the highest-quality prosthetic design can be achieved even when the prosthetist lacks artistic skills.

Palabras clave: Select Laser Sinter; Prototype Model; Artistic Skill; Rapid Prototype Technology; Direct Metal Laser Sinter.

Pp. 943-946

Using computer vision in a rehabilitation method of a human hand

Jaka Katrasnik; Mitja Veber; P. Peer

We developed this program for the purpose of a rehabilitation method that requires a patient to move an object around with his hand. Using a black and white firewire camera the program determines the position and orientation of a black rectangle on a white plane. The user must enter the length and width of the rectangle before the start. With this information the position is determined even if a part of the rectangle is obscured by a user’s hand. The program works in real-time (15 to 20 frames per second).

- Rehabilitation Engineering | Pp. 947-949

New Experimental Results in Assessing and Rehabilitating the Upper Limb Function by Means of the Grip Force Tracking Method

Marian Poboroniuc; R. Kamnik; S. Ciprian; Gh. Livint; D. Lucache; T. Bajd

The aim of the paper is to present new experimental results while using a tracking system for the assessment and training of grip force control in patients with neuromuscular diseases. In conjunction with the Jebsen-Taylor hand test the Grip Force Tracking System proved to be a valuable tool to assess hand dexterity and to quantify the hand rehabilitation process in stroke patients.

Palabras clave: Grip Force; Stroke Survivor; Functional Electrical Stimulation; Tracking Task; Relative Root Mean Square Error.

- Rehabilitation Engineering | Pp. 954-957

The “IRIS Home”

Anton Zupan; R. Cugelj; F. Hocevar

The article presents the IRIS Home. IRIS is an acronym for Independent Residing enabled by Intelligent Solutions. It is planned as a demonstration apartment located at the Institute for rehabilitation in Ljubljana. It will be fitted with the latest equipment, technical aids and rehabilitation technology. The aim of the IRIS home is demonstration, testing and application of contemporary technological solutions that compensate for the most diverse kinds of disabilities and thereby improve the quality of life of persons with disabilities and assure their optimal occupational, educational and social integration in society.

Palabras clave: Home Environment; Smart Home; Rehabilitation Technology; Retirement Home; Living Quarter.

Pp. 958-960

Evaluation of biofeedback of abdominal muscles during exercise in COPD

Martin Tomsic

Biofeedback method to alter breathing pattern in patients with COPD during physical activity was evaluated. Respiratory muscles EMG was reliably detected during exercise. The relaxation of abdominal muscles in expiratory phase was tested. There was no significant difference between different abdominal muscles activation. In conclusion, the present study showed that the EMG technique is reproducible and sensitive enough to assess changes in respiratory abdominal muscle activity and breathing patterns in patients with COPD.

- Rehabilitation Engineering | Pp. 961-964

Can haptic interface be used for evaluating upper limb prosthesis in children and adults

Helena Burger; D. Brezovar; S. Kotnik; A. Bardorfer; M. Munih

There is a lack of objective measurement methods for assessing upper limb prosthetic use in adults and children. The aim of the present study was to find out whether haptic interface could be used for that purpose. Fifty-five adults and twenty-three children were included into the study. All were tested by UNB observational test and haptic interface, and they filled in one or two questionnaires. Haptic interface showed differences between hands and prostheses, the results depended on the age of a child or adult and correlated with the amputation level and the stump length. Correlations were also found among the results of haptic interface, UNB test and questionnaires. It was not demonstrated that the results of haptic interface depended on the time from amputation to fitting with the first prosthesis, or amputation of the dominant hand. It was not possible to test subjects after shoulder disarticulation or very high trans-humeral amputation. Haptic interface seems a promising tool for assessing upper limb prosthetic use in adults and children after trans-radial amputation.

Palabras clave: Limb Amputation; Haptic Interface; Limb Prosthesis; Myoelectric Prosthesis; Functional Status Questionnaire.

- Robotics and Haptics | Pp. 965-968

FreeForm modeling of spinal implants

Massimo Martorelli; M. Lo Sapio; R.I. Campbell

To design a customized prosthesis that is tailored to the size and the shape of a unique anatomy provides better medical treatments and outcomes along with improved comfort and quality of life for patients. In this paper an innovative approach to spine implant design is proposed which relies on freeform modeling software and a haptic interface. The system mimics working on a physical replica of the patient’s spine and allows the user to model a prosthesis which might represent a promising concept to fix a curved vertebral column.

Palabras clave: Vertebral Body; Shape Memory Alloy; Adolescent Idiopathic Scoliosis; Shape Memory Alloy Wire; Coil Spring.

Pp. 969-972

Grip force response in graphical and haptic virtual environment

J. Podobnik

Current state of the art in virtual environment development allows different levels of immersion, from graphical environments, where only visual information is conveyed to the user, to haptic environments, where whole set of visual and kinesthetic information is conveyed to the user. This paper presents results of two experimental sets conducted one in a haptic virtual environment (HVE) and second in a graphical virtual experiment (GVE). The grip force response to a haptic or visual cue is investigated and compared. Although the underlying neural control mechanism triggered by haptic or visual cue are different, both responses are well pronounced, have similar shape and can thus be compared. Response triggered by the haptic cue has shorter delay, is stronger and shorter in duration in comparison to the response triggered by the visual cue.

- Robotics and Haptics | Pp. 973-976

Assessment of hand kinematics and its control in dexterous manipulation

Mitja Veber; T. Bajd; M. Munih

The aim of our work was to design a method for assessment and training of human hand dexterity while manipulating an object. A virtual environment was used to display a target object in various poses. The target poses were first recorded for a single person – a virtual trainer. The poses of a real object, held by the subjects included in the investigation, were assessed by a motion tracking device and displayed within the virtual environment. The subjects were asked to align the 3D images of real object and the target object. The target poses were normalized with respect to the different sizes of arms and hands. In this way all subjects were able to reach the desired target postures. Satisfactory repeatability of hand movements was observed in a single subject and across a group of twelve unimpaired subjects.

Palabras clave: Virtual Environment; Target Object; Real Object; Dorsal Aspect; Forearm Rotation.

Pp. 982-985

A model arm for testing motor control theories on corrective movements during reaching

Stefano Ramat; D. Curone; F. Lunghi; G. Magenes

Based on a simple robotic toolkit, we have developed a robotic arm control system to be used as a humanoid benchmark for testing trajectory planning models and control hypotheses for both reaching and corrective movements during reaching. The developed system integrates visual sensory feedback of the end-effector of the arm allowing controlling its movement online. The system may operate in 1) open-loop configuration providing the servos at the joints of the robot one point of an initially planned trajectory every 20 ms; 2) correction closed loop configuration using visual feedback only for planning the corrective movement trajectory or 3) continuous closed loop configuration using initial conditions derived from visual feedback information and computing the next trajectory point at every time step. Although the planning and control of reaching movements has been extensively investigated, not much is know on the planning of corrective movements. The research tool we developed will be used to implement and test different trajectory planning and movement control models.

Pp. 986-989

The Influence of Reduced Breathing During Incremental Bicycle Exercise on Some Ventilatory and Gas Exchange Parameters

Jernej Kapus; A. Usaj; V. Kapus; B. Strumbelj

The purpose of this study was to examine the ventilatory, gas exchange, oxygen saturation and heart rate response to reduced breathing frequency during an incremental bicycle exercise. Eight healthy male subjects performed an incremental bicycle exercise test on an electromagnetically braked cycle ergometer twice: first with continuous breathing (CB), and second with reduced breathing frequency (B10), which was defined as 10 breaths per minute. As work rates increased, significantly higher VE, Vco and R were measured during the exercise with SB than during the exercise with B10. Consequently, PETco and PETo2 were higher and lower, respectively, during the exercise with B10 than during the exercise with SB at 150 W. In addition, HR was greater during the exercise with SB than during the exercise with B10; significant differences were achieved at 90, 120 and 150W. However, Vo showed no significant difference between the exercises in two different breathing conditions. In summary, reduced breathing frequency during the incremental bicycle exercise decreased V and consequently decreased So and increased PETco. However, it seemed that this degree of breathing reduction did not influence on aerobic metabolism due to unchanged Vo.

- Sports Sessions | Pp. 994-997

Change of mean frequency of EMG signal during 100 meter maximal free style swimming

Igor Stirn; T. Vizintin; V. Kapus; T. Jarm; V. Strojnik

Changes in EMG signal spectral parameters of some arm muscles were monitored during 100 m maximum front crawl swimming. MNF linearly decreased at approximately the same extent in all observed muscles during swimming and no plateau of stabilized MNF values was observed at the end of swim. Yet, when normalized with respect to the endurance level MNF value obtained with the 90-second maximal voluntary isometric contraction after swimming, some differences between the analyzed muscles were shown.

Palabras clave: Isometric Contraction; Latissimus Dorsi; Maximal Voluntary Isometric Contraction; Blood Lactate Concentration; Triceps Brachii.

- Sports Sessions | Pp. 1002-1005

Obtaining completely stable cellular neural network templates for ultrasound image segmentation

Mitja Lenic; D. Zazula; B. Cigale

Cellular neural networks (CNNs) have been successfully applied to image segmentation problem. Nevertheless, the main difficulty remains in the process of creating appropriate templates to solve a segmentation problem. In this paper we present machine learning approach to obtain completely stable CNN templates and compare the obtained results to unconstrained machine learning approach. Despite introduced constraints of templates stability the results are comparable to unobstructed ones.

Palabras clave: Support Vector Machine; Ultrasound Image; True Positive Rate; Learning Problem; Cellular Neural Network.

- Ultrasound Image Processing | Pp. 1013-1016

Segmentation of 3D Ovarian Ultrasound Volumes using Continuous Wavelet Transform

Boris Cigale; D. Zazula

A novel algorithm for the segmentation of 3D ultrasound images of ovary is presented in this paper. The algorithm is based on continuous wavelet transform (CWT) and consists of two consecutive steps. In the first step, the centers of follicles are determined by tracing the local maxima from higher to lower scale in the wavelet transform of input images. The center of follicle appears as local maximum near value 0 when the size of the follicle corresponds to the scale of CWT. In the second step, the shape of the follicle is outlined. This is done by casting the rays in different directions from the center of the follicle in order to find its border. The position of border is connected with the wavelet scale and the position of the first local minimum on each ray. The method was tested on a small set of real 3D ultrasound images. The results were evaluated visually, since we do not have manually annotated images.

Palabras clave: Ultrasound Image; Wavelet Coefficient; Ovarian Follicle; Continuous Wavelet Transform; Lower Scale.

Pp. 1017-1020

Selected Applications of Dynamic Radiation Force of Ultrasound in Biomedicine

Azra Alizad ; J.F. Greenleaf; M. Fatemi

Ultrasound imaging has been used for decades for medical and industrial imaging. Ultrasound in the range of 1-10 MHz has also been used for evaluating tissue properties characterization for many years. Recently, use of low frequency (audio range) vibration for medical diagnosis and evaluation of tissue properties has attracted increased attention. It has been shown that such vibration can reveal important information about tissue mechanical properties that are related to tissue pathology. We use the radiation force of ultrasound to vibrate tissue at low (kHz) frequency range, and record the resulting acoustic response to produce images that are related to the stiffness of the tissue. This method is tested on human breast, liver, heart valve, and arteries. Results show that small microcalcifications can be detected in human breast, calcium buildups can be seen in arteries, and mass lesions can be detected in liver tissues. In these tests, the vibration frequency ranged from 5 to 50 kHz. Another application of the radiation force method is studying solid structures through modal analysis.

- Ultrasound Image Processing | Pp. 1021-1024

Development of Alcohol craving induction and measurement system using virtual reality: Craving characteristics to social situation

Jeonghun H. Ku; S.W. Cho; J.S. Park; K.W. Han; Y.K. Choi; K. NamKoong; Y.C. Jung; J.J. Kim; I.Y. Kim; S.I. Kim

Alcoholism is a disease that affects some part of brain that control emotion, decisions, and behavior. Sometimes, people experience situation that have to drink alcohol in their social life. Alcoholic needs cognitive behavior therapy to develop restraint on alcohol craving. Alcohol craving could be triggered when exposure to object, environment, or social pressure situation which is related with alcohol. But cognitive behavior therapy have defect in which does not provide social pressure situation properly. Virtual reality (VR) is humancomputer interface that computer expressed an immersive and interactive three-dimensional virtual environments like real space in world. In this study, we developed alcohol craving induction system using virtual reality to provide social situations in which avatar asks to drink together. Nine males and one female (age from 21 to 27 years) who do not have any history of alcohol related disease were recruited for this experiment. In the results, in situation without social pressure, more alcohol craving was induced in situation with alcohol than that of a situation without alcohol. That means our alcohol craving induction system shows same result as conventional study shows

Palabras clave: Cognitive Behavior Therapy; Virtual Reality; Social Pressure; Alcohol Craving; Alcohol Related Disease.

Pp. 1034-1037

Patient safety - a challenge for clinical engineering

Joachim H. Nagel; M. Nagel

Every tenth patient in US and European hospitals suffers from preventable harm and adverse effects related to his or her care. As adverse events also carry a high financial cost, patient safety remains a major global priority. Often forgotten in discussions on the necessary actions to improve patient safety, clinical engineering is one of the major pillars for safe health care. Realizing the huge potential of contributing to the world-wide efforts to provide safer care, the clinical engineering community has accepted the challenge to take a lead in providing a safer environment for patients.

- Clinical Engineering and Patient Safety | Pp. 1043-1046

MIDS-project – a National Approach to Increase Patient Safety through Improved Use of Medical Information Data Systems

Heikki Terio

MIDS, Medical Information Data Systems is proposed as a term for systems consisting of medical devices and IT-systems. MIDS are used for collection of physiological data from patients and transferring this data through a computer network to serves and databases. The project showed that the manufacturers of IT-systems for health care and the users of them do not take their full responsibility for the development and implementation of the information safety and functionality. For example there is no clear routines how to secure the accuracy of the information that is transferred between different IT-systems. It is also a problem that the borderline between medical devices and IT-systems is unclear, which makes it difficult to decide what directives or legislation should be applied. This makes it also unclear who should support the systems and the project proposes guidelines to improve the situation. The project also showed that there is need for continuing education of the staff handling MIDS.

Palabras clave: Medical Device; Electronic Health Record; County Council; Patient Data Management System; Laboratory Information System.

- Clinical Engineering and Patient Safety | Pp. 1047-1050

Improving Patient Safety Through Clinical Alarms Management

Yadin David; J. Tobey Clark; J. Ott; T. Bauld; B. Patail; I. Gieras; M. Shepherd; S. Miodownik; J. Heyman; O. Keil; A. Lipschultz; B. Hyndman; W. Hyman; J. Keller; M. Baretich; W. Morse; D. Dickey

Clinical alarms warn caregivers of immediate or potential adverse patient conditions. Alarms must be accurate, intuitive, and provide alerts which are readily interpreted and acted on by clinicians appropriately alarms and their shortcomings have been the topic of numerous studies and analysis. The (JCAHO) established a National Patient Safety (NPS) goal in 2002 to improve the effectiveness of clinical alarms. Despite the technological and healthcare improvements related to efforts to meet the NPS goal, adverse patient events continue to occur related to alarm system design and performance, care management and the complexity of the patient care environment. In 2004, the American College of Clinical Engineering Healthcare Technology Foundation started an initiative to improve clinical alarms. The HTF task force reviews the literature related to clinical alarm factors and analyzes adverse event databases. Forums, meetings and a survey of 1,327 clinicians, engineers, technical staff and managers provided feedback regarding alarm issues. Of particular value is the response from nursing who represented the majority of the respondents.

Palabras clave: False Alarm; Improve Patient Safety; Alarm System; Medical Device Industry; Nuisance Alarm.

Pp. 1051-1054

A Clinical Engineering Initiative within the Irish Healthcare System toward a Safer Patient Environment

P. J. C. Pentony; J. Mahady; R. Kinsella

Clinical Engineering within Ireland has developed significantly in recent years. This Engineering discipline has proven an essential component of the modern healthcare environment. Nationally, Clinical Engineers participate as key members within multidisciplinary teams of every Clinical specialty. The Clinical Engineering membership has developed to include participants from the areas of Healthcare institutions, community medicine, academia and the medical device industry. A national voluntary registration scheme is now established and will further contribute to the professional development of Clinical Engineering.

- Clinical Engineering and Patient Safety | Pp. 1055-1057

System for Tracing of blood transfusions and RFID

Leonardo Bocchi; P. Di Giacomo

In a medical center for blood transfusions, the blood haversacks are prepared and identified by a bar code label which identifies, for type and destination, the blood material according to the required standards. The traditional information systems use rigorous methodologies to verify and to watch the haversacks until they are delivered to the nurses. Nevertheless, at this stage, the tracing of the blood material is no more rigorous with particular regard to the mode and timing to give it to the generic patient. This is because we have not automatic systems to verify modes and timing for administering to the patient. This paper describes an automatic system for tracking the delivery process from the transfusion center to the patient transfusion. The proposed tracking system is based on RFID tags in order to offer a basic subset of functionalities also in absence of network collection.

Palabras clave: Hospital Information System; Transfusion Center; Blood Unit; Transfusion Practice; Basic Subset.

Pp. 1062-1065

Clinical Engineering Training Program in Emerging Countries Example from Albania

Heikki Terio

Emerging countries developing their health care systems with support and donations from the industrialized countries need also support to develop the know-how for management of the equipment they get. The lack of knowledge and competence can be over bridged by well-planned education and training programs based on established programs and routines from the supporting countries where clinical engineering is an established profession. The education and training must have both short-term and long-term goals. It is essential that the country get a good base to develop own educational and managerial systems for health care support. The Albanian project shows an example how this can be realized.

- Clinical Engineering and Patient Safety | Pp. 1074-1076

BME Education at the University of Trieste: the Higher Education in Clinical Engineering

Federica Vatta; P. Inchingolo

This paper presents the Higher Education in Clinical Engineering (HECE) program of the University of Trieste – Italy. HECE has been established since Academic Year 2003-04, following the long tradition and experience of the former post-graduate School in Clinical Engineering, started in 1991, with the cooperation of many Italian and foreign universities, hospitals, health ministries and biomedical industries. The paper focuses on the conceptual design and the educational structure which has been given to HECE’s extensive educational program in Clinical Engineering, specifically conceived to provide to the prospective Clinical Engineering professionals the appropriate education level and the related skill sets necessary to make them prepared for the future role of Clinical Engineers profession, according to the current and future developments of modern healthcare systems.

Palabras clave: Healthcare Industry; Healthcare Technology; Assisted Living Facility; Clinical Engineer; Biomedical Industry.

- Clinical Engineering and Patient Safety | Pp. 1077-1080

Certification of Biomedical Engineering Technicians and Clinical Engineers: Important or Not

James O. Wea

The clinical engineering staff including engineers and technicians is an important element in the use of medical technology in health care facilities. The clinical engineer is a member of the technology management team, which is involved in the selection of new technology and the design of facilities for the use of the technology. What is the impact on healthcare delivery as a result of certified Clinical Engineers and Biomedical Engineering Technicians (BMETs)? Can a certified clinical engineering staff improve accreditation of hospitals? Certification of staff is one measure of quality control for medical technology. However, no country requires that the BMETs and Clinical Engineers be certified in order to perform any functions with medical technology. The history of certification will be presented including how it differs in different countries. The recognition of certification of BMETs and Clinical Engineers by the healthcare community will be discussed. The first certification programs were initiated in 1972 in the United States. A clinical engineer may be called a biomedical engineer or medical engineer and different terminology is also used for the BMETs.

- Clinical Engineering and Patient Safety | Pp. 1081-1084

Findings of the Worldwide Clinical Engineering Survey conducted by the Clinical Engineering Division of the International Federation for Medicine and Biological Engineering

Saide Jorge Calil ; L.N. Nascimento; F.R. Painter

Despite the clinical engineering profession already exists in most parts of the world, one cannot say that its activities and profile are the same in each country. However, just a number of few countries have already conducted a survey to identify the characteristics of its clinical engineers. This survey, developed by the International Federation for Medicine and Biological Engineering, is the first attempt to identify the clinical engineer, the clinical engineering activities and the kind of employer worldwide. The results have shown significant differences according to the analyzed region.

- Clinical Engineering and Patient Safety | Pp. 1085-1088

Clinical Engineering in Malaysia – A Case Study

Azman Hamid

Clinical engineering in Malaysia has received renewed interest as an engineering discipline. Growing interest about patient safety and the decision by the Malaysian government to privatize support services at all government hospitals beginning January 01, 1997 have pushed clinical engineering to the limelight and have opened up opportunities for local biomedical engineering graduates seeking jobs as clinical engineers. Clinical engineering flourishes as new approaches to healthcare technology are introduced to enhance the quality of services provided to the hospitals.

Palabras clave: Equipment User; Engineering Discipline; Clinical Engineering; Joint Commission International; Clinical Engineer.

- Clinical Engineering and Patient Safety | Pp. 1089-1091

Health Technology Assessment in Croatian Healthcare System

Petar Milicic

The healthcare system in Croatia is in transition. HTA can improve quality and increase its efficiency. In our feasibility study we analyzed the efficiency of Croatian healthcare system, and as a result we found out that the system is expensive and of low efficiency. Health technology assessment is a systematic evaluation of properties and effects of health care technology. It may involve the investigation of one or more of the following attributes of technologies: Performance characteristics that include sensitivity and specificity of diagnostic tests, and conformity with specifications of design, manufacturing, reliability, ease of use and maintenance. Safety, a judgment of risk acceptability (possibility of adverse health outcome and its severity) associated with using technology in a particular situation. Efficiency refers to the benefit of using technology in order to address a particular problem under ideal conditions (e.g., within the protocol of a carefully managed randomized controlled trial, involving patients meeting narrowly defined criteria, or conducted at a “center of excellence”). Effectiveness refers to the benefit of using technology for a particular problem under general or routine conditions (e.g., by a physician in a community hospital treating a variety of patient types).

Palabras clave: Health Technology Assessment; Medical Equipment; Special Hospital; Adverse Health Outcome; Clinical Engineering.

Pp. 1100-1101

A QFD-based approach to quality measurement in health care

Fabrizio Dori; E. Iadanza; D. Bottacci; S. Mattei

The general problem of process control requires a big committment in terms of technologies and specific capacities about plenty of aspects that must be controlled, according to trial complexity and particularity of the health structure. This demand drove us to plan and define a methodological tool able to be applied to a general process in a health structure. Requirements for this kind of tools are related to the possibility to produce numerical, synthetic, and objective indexes, according to the idea that a numerical index has the intrinsic property to give a synthetic and comparable kind of information, especially when it’s linked to a qualitative definition. Hence, we propose a methodological tool based on QFD (Quality Function Deployment) approach and characterized by a “semi-quantitative” and at the same time objective approach to quality measurement in health care structures. Such an instrument may be applied to several processes of the health care area or, given a “target process”, more times to the same process in distinct moments (for example before and after particular changes on critical aspects), to assess the contribution supplied by this improvements on process performances.

Pp. 1102-1106

The E-HECE e-Learning Experience in BME Education

Paolo Inchingolo; F. Londero; F. Vatta

This paper focuses on the e-learning experience in BME education of E-HECE (E-Higher Education in Clinical Engineering), an integrated distance learning system for education in Clinical Engineering at the University of Trieste (Italy). E-HECE is oriented toward providing to remote students many of the valuable aspects of the live classroom experience that are essential for learning. E-HECE has proven its successfulness in providing convenience to students who can actively participate in a class, whether they attend in person (physically, by videoconference or by video-streaming), and in making also available to the students recordings on-demand of classes synchronized with the lecture’s didactic material on the E-HECE e-learning platform. The E-HECE system made its debut in its current final version in September 2005, and since then it has been extensively used by the 340 E-HECE registered users for all the 150 courses in the Clinical Engineering program which have been delivered up to now. Its use has grown beyond Clinical Engineering including also courses in the health management and medical fields. The expansion of E-HECE’s capabilities continues to extend its utility and power as a distance education system.

Palabras clave: Clinical Engineering; Valuable Aspect; Clinical Engineer; Live Classis; Classroom Lecture.

Pp. 1107-1110

Web-based Supporting Material for Biomedical Engineering Education

Kari Lindroos; J. Malmivuo; J. Nousiainen

European Commission funded virtual campus project EVICAB (European Virtual campus for Biomedical Engineering) was launched in January 2006. The idea is to develop a virtual environment for students to study biomedical engineering by means of e-courses. The transfer from contact teaching to e-courses gave rise to a need for web-based learning material. In order to face the challenge a new project was launched in Ragnar Granit Institute to produce video lectures and other supporting material to the Internet. The produced material has been evaluated and implemented as a part of ecourses in EVICAB.

Palabras clave: Virtual Environment; Biomedical Engineering; Study Process; Learn Management System; Screen Capture.

- EVICAB - European Virtual Campus for Biomedical Engineering | Pp. 1111-1114

European Virtual Campus for Biomedical Engineering EVICAB

Jaakko Malmivuo; J.O. Nousiainen

A Curriculum on Biomedical Engineering is established to the Internet for European universities under the project EVICAB. The curriculum will be free access and available free of charge. Therefore it will be available worldwide. EVICAB will make high quality education available for everyone and facilitate the development of the discipline of Biomedical Engineering.

- EVICAB - European Virtual Campus for Biomedical Engineering | Pp. 1115-1117

BIOMEDEA

Joachim H. Nagel

There is widespread recognition of the need for high quality Biomedical Engineering education, training, accreditation and certification throughout Europe. Many schemes are being developed or are awaiting implementation, but there has been little harmonization. The continuing national differences in the educational systems are a serious problem that can hinder and limit trans-national education, training, employment and cooperation. The BIOMEDEA project aims at changing this situation by establishing Europewide consensus on guidelines for the harmonization, not standardization, of high quality MBES programs, their accreditation and for the training, continuing education and certification or even registration of professionals working in the health care systems. Adherence to these guidelines, which ultimately should be recognized in all 45 Bologna signatory countries, will insure mobility in education and employment as well as proper management of health care technologies, an important aspect with regard to the necessary safety for patients. Targets for the dissemination of results will be the European universities, political decision makers at European and national levels, the European Accreditation Council as well as the accreditation councils of all European countries, European quality assurance and accreditation agencies, health care providers and students.

- EVICAB - European Virtual Campus for Biomedical Engineering | Pp. 1118-1121

Biomedical Engineering Education, Virtual Campuses and the Bologna Process

E. Göran Salerud; Michail Ilias

Higher education in Europe can be divided into before and after the Bologna Declaration, the most revolutionary process in modern education. Biomedical engineering, an emerging “subject” during the last 40 years, strongly interdisciplinary, fragmented and lacking of international coordination, may benefit from this harmonization process. An early initiative such as BIOMEDEA has made a contribution through proposing biomedical engineering foundations for building a common curriculum among higher education institutions. A common curriculum would presumably contribute to student and teacher mobility, certification and accreditation and as a consequence promote increased international employability. The virtual campus action extends or adds values to already existing educational exchange networks such as Erasmus, important in student mobility and educational harmonization and recognition. A virtual education dimension is added to European co-operation, encouraged through the development of new organisational models for European institutions, promoting virtual mobility and recognition. Virtual campuses may have a possibility to bridge the gaps in national BME curricula all with respect to the action towards a consensus on European guidelines for the harmonization. The evaluation of the e-curricula is conformant with the roadmap of BME courses as defined by BIOMEDEA. Most courses are classified as second cycle courses on a Master level, supporting that studies in BME could be a continuation from cycle one. Learning environment and the students learning outcome, points towards a strong teacher-centred approach to learning. The transparency at all levels are low, a factor that might influence recruiting potential students to a programme, especially those students with working experience and an international background. To fulfil the Bologna Declaration and other steering documents for the higher education in an expanding European future there are still tasks to be solved regarding recognition, legalisation, pedagogical issues and employability looking for a harmonized solution.

Palabras clave: Biomedical Engineering; Student Mobility; European High Education Area; Bologna Process; Bologna Declaration.

Pp. 1122-1125

Learning Managements System as a Basis for Virtual Campus Project

Kari Lindroos; M. Rajalakso; T. Väliharju

Learning management system has an important role in web-based education. Mediamaisteri Group is an expert company in web-based solutions for e-learning and provides the platform for EVICAB (European Virtual Campus for Biomedical Engineering) project. In the project the openness and free availability has been the fundamental ideas since the beginning. Moodle learning management system supports the idea. Moodle is an open source platform. Leaning management system has been modified for providing the needed tools for virtual campus project.

- EVICAB - European Virtual Campus for Biomedical Engineering | Pp. 1130-1131

Computer Aided Surgery in The 21 Century

Takeyoshi Dohi; K. Matsumiya; K. Masamune

Realization of new surgical treatment in the 21st century, it is necessary to use various advanced technologies; surgical robots, three-dimensional medical images, computer graphics, computer simulation technology and others. Three-dimensional medical image for surgical operation provides surgeons with advanced vision. A surgical robot provides surgeons with advanced hand, but it is not a machine to do the same action of a surgeon using scissors or a scalpel. The advanced vision and hands available to surgeons are creating new surgical fields, which are minimally invasive surgery, noninvasive surgery, virtual reality microsurgery, tele-surgery, fetus surgery, neuro-informatics surgery and others in the 21st century.

Palabras clave: Surgical Field; Motion Parallax; Surgical Robot; Surgical Navigation; Fetus Surgery.

- Future of Medical and Biological Engineering | Pp. 1132-1133

Multi-dimensional fluorescence imaging

Paul M. W. French

Fluorescence offers many opportunities for optical molecular imaging and can provide information beyond simply the localisation of fluorescent labels. At Imperial we are developing technology to analyse and image fluorescence radiation with respect to wavelength, polarisation and, particularly, fluorescence lifetime, in order to maximise the information content. This talk will review our recent progress applying fluorescence lifetime imaging (FLIM) and multidimensional fluorescence imaging (MDFI) to tissue imaging and in vitro cell microscopy. Applying FLIM to autofluorescence of biological tissue can provide label-free contrast for non-invasive diagnostic imaging, as we have demonstrated in various tissues including atherosclerotic plaques, cartilage, pancreas and cervical tissue. FLIM and MDFI are also applicable to image intracellular structure and function for cell biology and drug discovery: hyperspectral imaging and FLIM can provide (quantitative) information concerning the local fluorophore environment and facilitate robust fluorescence resonant energy transfer (FRET) experiments while information concerning structure and rotational mobility may be obtained by applying polarisation resolution. Our most recent work includes high-speed and optically-sectioned FLIM for automated imaging and live cell studies, hyperspectral FLIM for acquiring excitation-emission –lifetime matrices to distinguish different fluorophores and microenvironments and imaging of rotational correlation time, particularly applied to microfluidic devices. Excitation sources are a particular challenge for confocal microscopy and other FLIM modalities including endoscopy, owing to the complexity and limited spectral coverage of available technology. Increasingly we are exploiting ultrafast fibre lasers and continuously tunable ultrafast sources based on continuum generation in photonic crystal fibres for wide-field and confocal FLIM applications.

- Future of Medical and Biological Engineering | Pp. 1134-1134

Nanomedicine: Developing Nanotechnology for Applications in Medicine

Gang Bao

In this presentation I will discuss the recent development of nanomedicine as an emerging field in the United States. In particular, I will give a brief summary of the US National Institute of Health (NIH) nanotechnology / nanomedicine centers established over the last few years, and present the bionanotechnologies being developed at the NIH nanomedicine centers at Georgia Tech and Emory University. The opportunities and challenges in developing nanomedince will be discussed.

- Future of Medical and Biological Engineering | Pp. 1135-1136

The Physiome Project: A View of Integrative Biological Function

C. Forbes Dewey

The Physiome Project comprises a worldwide effort to provide a computational framework for understanding human and other eukaryotic physiology. The aim is to develop integrative models at all levels of biological organization from genes to the whole organism. This is achieved via gene regulatory networks, protein pathways, integrative cell function, and tissue and whole organ structure/function relations. A key hallmark of the Physiome is that it covers many physical scales of description, from molecule-molecule interactions to whole cell behaviour to whole organ descriptions. This talk will stress the computational and semantic layers of the Physiome, the mathematical and logical “glue” that allows the various physiological scales to communicate and work with one another. The first knowledge domain is Ontologies. Ontology is a specific expression of known facts about the real world. Work on ontologies is being undertaken in order to organize biological data and knowledge at the different levels of the biological continuum. An additional and important component of this work is to facilitate easy and effective access to a range of databases, and to facilitate automated reasoning that can simultaneously extract information from many databases.

- Future of Medical and Biological Engineering | Pp. 1137-1137

Synthetic Biology – Engineering Biologically-based Devices and Systems

Richard I. Kitney

Synthetic Biology is an emerging field that aims to design and manufacture biologically-based devices and systems that do not already exist in the natural world, including the re-design and fabrication of existing biological systems. The foundations of Synthetic Biology are based on the increasing availability of complete genetic information for many organisms, including humans, and the ability to manipulate this information in living organisms to produce novel outcomes. More specifically, engineering principles, including systems and signal theory, are used to define biological systems in terms of functional modules - creating an inventory of ‘bioparts’ whose function is expressed in terms of accurate input/output characteristics. These ‘bioparts’ can then be reassembled into novel devices - acting as components for new systems in future applications. Systems Biology aims to study natural biological systems as a whole, often with a biomedical focus, and uses simulation and modeling tools in comparisons with experimental information.

- Future of Medical and Biological Engineering | Pp. 1138-1139

Biomedical Engineering Clinical Innovations: Is the Past Prologue to the Future?

Paul Citron

The medical device industry, defined here as implanted therapeutic or restorative technologies, is roughly 50 years old. The first commercially available cardiac pacemaker to treat complete heart block was implanted in 1958 in Sweden followed by the first ball and cage prosthetic heart valve in 1960. From these tentative beginnings, medical device industry sales by U.S. companies were estimated to be $77 billion in 2003. Significant technology sectors now include mechanical and tissue prosthetic heart valves, cardiac pacemakers, implanted cardioverter-defibrillators to convert chaotic heart rhythms, cardiac re-synchronization devices to manage heart failure, vascular stents to treat occluded coronary and peripheral arteries, neurostimulation devices for certain central nervous system disorders, artificial joints and spinal implants for degenerative conditions, intraocular implants for cataracts, to cite representative examples. While financial metrics provide an indication of the direct economic impact of medical devices, a more relevant measure is the effect medical technologies have on reduction in patient morbidity and mortality, improved well-being, and increased quality of life.

Palabras clave: Bare Metal Stents; Cardiac Pacemaker; Prosthetic Heart Valve; Central Nervous System Disorder; Complete Heart Block.

- Future of Medical and Biological Engineering | Pp. 1140-1141

Información

Tipo: libros

ISBN impreso

978-3-540-73043-9

ISBN electrónico

978-3-540-73044-6

Editor responsable

Springer Nature

País de edición

Reino Unido

Fecha de publicación

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