Background： Electrical impedance tomography （EIT） is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution i...Background： Electrical impedance tomography （EIT） is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome （ARDS） during positive-end-expiratory pressure （PEEP） titration using EIT. Methods： Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study. After recruitment maneuvers （RMs）, decremental PEEP titration was performed from 20 cmH20 to 5 cmH20 in steps of 3 cmH20 every 5-10 min. Regional over-distension and recruitment were monitored with EIT. Results： After RMs, patient with arterial blood oxygen partial pressure （PaO2） ＋ carbon dioxide partial pressure （PaCO2） 〉400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders. Thirteen ARDS patients was diagnosed as responders whose PaO2 ＋ PaCO2, were higher than nonresponders （419 ± 44 mmHg vs. 170 ±73 mmHg, P 〈 0.0001）. In responders, PEEP mainly increased-recruited pixels in dependent regions and over-distended pixels in nondependent regions. PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume. PEEP levels without significant alveolar derecruitment and over-distension were identified individually. Conclusions： After RMs, PEEP titration significantly affected regional gas distribution in lung, which could be monitored with EIT. EIT has the potential to optimize PEEP titration.展开更多
Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training thro...Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values 展开更多
Corresponding customized software tool is usually unavailable, which increases the time and workload for evaluating the results of a clinical trial. In the present paper, we demonstrate the development process of a cu...Corresponding customized software tool is usually unavailable, which increases the time and workload for evaluating the results of a clinical trial. In the present paper, we demonstrate the development process of a customized software for one clinical trial on patients with obstructive lung disease. Over hundred patients and volunteers as controlled were included in the clinical trial. They were examined by spirometry and EIT in a seated position during spontaneous tidal breathing. Subsequently, standard vital capacity maneuver and forced full expiration maneuver were performed. In order to evaluate the offline data, a customized software was developed. The requirements of the software were defined by investigators. The software was then tested on patients’ data and refined based on feedbacks of the investigators. We finalized the customized software with analysis of various disease-specific parameters and indices. Compared to the data process with device specific programs and other commercial software, the customized software is more flexible, user-friendly and extendable. As conclusion, customized software simplifies the evaluation process distinctly and helps physicians to focus on study design and result interpretation.展开更多
Purpose: To evaluate the effects of methodological variation of biophysical therapies on wound healing outcomes, as a preliminary study to develop a composite wound healing device. Methods: A literature search was foc...Purpose: To evaluate the effects of methodological variation of biophysical therapies on wound healing outcomes, as a preliminary study to develop a composite wound healing device. Methods: A literature search was focused on the variable devices, sys-tem configurations, input parameters, and treatment durations of negative pressure wound therapy (NPWT), electrical stimulation (ES), and low-level light therapy (LLLT) from 2011 to July 2016. Results: In NPWT, lower vacuum pressures of ?50 and ?80 mmHg achieved similar tissue perfusion outcomes as earlier recommendations of ?125 mmHg, while there is no established regimen with respect to continuous, square wave, or triangular NP waveform due to inconsistent results. Use of wound filler may contribute to improved tissue granulation when compared to topical NP. An ES configuration of high-voltage pulsed current with the stimulation electrode placed in the wound bed best resembles the endogenous skin current, which guides cellular migration. However, no studies have established optimal stimulation parameters. For LLLT, laser and LED proved similarly effective. Although red light has been almost exclusively used in human pressure ulcer treatment, studies comparing blue, green, and red wavelengths more consistently show biological effects using green light. Conclu-sions: Variation in the application of mechanical, electrical, and radiant energies may be used to modulate wound healing pathways. To 2012, no studies have examined use of these biophysical modalities in combination. Further methodological studies with a systems approach would help define optimal treatment protocols for improved wound healing outcomes in clinical practice.展开更多
Background High positive end-expiratory pressure （PEEP） and low tidal volume （VT） ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible alveoli du...Background High positive end-expiratory pressure （PEEP） and low tidal volume （VT） ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible alveoli during expiration contributes to lung protection. However, this hypothesis came from analysis of indirect indices like the analysis of the pressure-volume curve of the lung. The purpose of this study was to investigate isolated healthy and injured rat lungs by means of alveolar microscopy, in which combination of PEEP and VT is beneficial with respect to alveolar stability （I-E%）. Methods Alveolar stability was investigated in isolated, non-perfused mechanically ventilated rat lungs. Injured lungs were compared with normal lungs. For both groups three PEEP settings （5, 10, 20 cmH20） were combined with three VT settings （6, 10, 15 ml/kg） resulting in nine PEEP-VT combinations per group. Analysis was performed by alveolar microscopy. Results In normal lungs alveolar stability persisted in all PEEP-VT combinations （I-E% （3.2±11.0）%）. There was no significant difference using different settings （P 〉0.01）. In contrast, alveoli in injured lungs were extremely instable at PEEP levels of 5 cmH20 （mean I-E% 100%） and 10 cmH2O （mean I-E% （30.7±16.8）%）; only at a PEEP of 20 cmH20 were alveoli stabilized （mean I-E% of （0.2±9.3）%）. Conclusions In isolated healthy lungs alveolar stability is almost unaffected by different settings of PEEP and VT. In isolated injured lungs only a high PEEP level of 20 cmH2O resulted in stabilized alveoli whereas lower PEEP levels are associated with alveolar instability.展开更多
A tactile system to support severe visually-impaired or blind people in the world for their orientation and navigation had been developed. To optimize the design, some parameters of tactile display device were evaluat...A tactile system to support severe visually-impaired or blind people in the world for their orientation and navigation had been developed. To optimize the design, some parameters of tactile display device were evaluated. In the present paper,we focused on the reaction time to tactile stimuli. In the test, the stimuli were produced through a vibration belt that was worn around the participants’ waist. In the choice reaction time task, the participants had to click corresponding arrow keys according to the location of a tactile signal. The findings of this study provided a reference of the reaction time range, so as to design a more effective and safe tactile navigation system.展开更多
Acute Respiratory Distress Syndrome (ARDS) is a major cause of morbidity and has a high rate of mortality. ARDS patients in the intensive care unit (ICU) require mechan-ical ventilation (MV) for breathing support, but...Acute Respiratory Distress Syndrome (ARDS) is a major cause of morbidity and has a high rate of mortality. ARDS patients in the intensive care unit (ICU) require mechan-ical ventilation (MV) for breathing support, but inappropriate settings of MV can lead to ventilator induced lung injury (VILI). Those complications may be avoided by carefully optimizing ventilation parameters through model-based approaches. In this study we introduced a new model of lung mechanics (mNARX) which is a variation of the NARX model by Langdon et al. A multivariate process was undertaken to deter-mine the optimal parameters of the mNARX model and hence, the final structure of the model fit 25 patient data sets and successfully described all parts of the breathing cycle. The model was highly successful in predicting missing data and showed minimal error. Thus, this model can be used by the clinicians to find the optimal patient specific ventilator settings.展开更多
Single-pass honing is an important machining method for finish machining of holes,which can meet the requirement for high efficiency and consistency of holes.Characterization and life prediction of single-pass honing ...Single-pass honing is an important machining method for finish machining of holes,which can meet the requirement for high efficiency and consistency of holes.Characterization and life prediction of single-pass honing tool are necessary to improve the machining accuracy of holes honed,especially dimension accuracy.Single-pass honing tool is a single layer abrasive tool with fixed dimension,which still remains problematic for characterization and life prediction.For fuel injection nozzles with bore diameter under 1 mm,the stiffness of the single-pass honing tool is poor.This article presents a novel analytical model that predicts life of the tool with poor stiffness.Firstly,according to the bore diameter and dimension tolerance,the single-pass honing tool is designed and manufactured.Based on the prepared single-pass honing tool,the measurement and characterization methods are established.Furthermore,the tool wear tests are carried out,and the tool contour evolution model is established to predict the tool life.展开更多
A 78-year-old asymptomatic woman was referred to our clinic for a second opinion regarding indication for mitral valve surgery. An echocardiogram showed a moderate mitral stenosis with a concomitant severe regurgitati...A 78-year-old asymptomatic woman was referred to our clinic for a second opinion regarding indication for mitral valve surgery. An echocardiogram showed a moderate mitral stenosis with a concomitant severe regurgitation. The most striking feature, however, was a giant left atrium with a parasternal anteroposterior diameter of 79 mm and a left atrial volume index of 364 m L/m2. There are various echocardiographic definitions of a giant left atrium, which are mainly based on measurements of the anteroposterior diameter of the left atrium using M-mode in the parasternal long axis view. Since the commonly accepted method for echocardiographic evaluation of left atrial size is left atrial volume index, we propose a cut-off value of 140 m L/m2 for the definition of a "giant left atrium".展开更多
Patients with acute respiratory distress syndrome (ARDS) are currently treated with a lung protective ventilation strategy and the application of positive end-expiratory pressure (PEEP), sometimes in combination with ...Patients with acute respiratory distress syndrome (ARDS) are currently treated with a lung protective ventilation strategy and the application of positive end-expiratory pressure (PEEP), sometimes in combination with recruitment maneuvers. In this study, the respiratory system elastance and airway resistance of each breath before, during and after a specific recruitment maneuver (PEEP wave maneuver) were analyzed in two patient groups, ARDS and control group. A reduction of elastance after the maneuver was observed in ARDS patients. In addition, only healthy lungs exhibited a reduction of the elastance during the course of the maneuver, while the lungs of ARDS patients didn’t show that reduction of elastance. The capability of PEEP wave maneuvers to improve lung ventilation was shown and the dynamic behavior of the elastance after the maneuver was illustrated. Healthy lungs adapt faster to changes in mechanical ventilation than the lungs of ARDS patients.展开更多
Individualized models of respiratory mechanics help to reduce potential harmful effects of mechanical ventilation by supporting the evaluation of patient-specific lung protective ventilation strategies. Assessing vent...Individualized models of respiratory mechanics help to reduce potential harmful effects of mechanical ventilation by supporting the evaluation of patient-specific lung protective ventilation strategies. Assessing ventilation inhomogeneities might be an important aspect in optimizing ventilator settings. The aim of this studyis to capture and analyze ventilation inhomogeneity by a mathematical model using clinical data. The results show that the lung physiology of mechanically ventilated patients without lung condition can be described by an inhomogeneity model revealing two alveolar compartments with median time constants of 0.4 and 3.9 s. Thus, the IHM in combination with specific ventilation maneuver might be suitable to capture lung physiology for model-based optimization of ventilator settings but requires additional image-based investigations to further support the validity of the model.展开更多
Electrical Impedance Tomography (EIT) is a medical imaging technique which can be used to monitor the regional ventilation in patients utilizing voltage measurements made at the thorax. Several reconstruction algorith...Electrical Impedance Tomography (EIT) is a medical imaging technique which can be used to monitor the regional ventilation in patients utilizing voltage measurements made at the thorax. Several reconstruction algorithms have been developed during the last few years. In this manuscript we compare a well-established algorithm and a re-cently developed method for image reconstruction regarding EIT indices derived from the differently reconstructed images.展开更多
Electrical Impedance Tomography is an imaging method which attempts to reveal the conductivity distribution of a domain based on the electrical boundary condition. For time difference EIT, the voltage difference at tw...Electrical Impedance Tomography is an imaging method which attempts to reveal the conductivity distribution of a domain based on the electrical boundary condition. For time difference EIT, the voltage difference at two time steps is employed for reconstruction. This is an ill-posed inverse problem, especially, it is non-linear. The currently available EIT devices are all based on linearized reconstruction algorithms. The linearized reconstruction employs a reconstruction matrix which is essentially a regularized pseudo inverse of the Jacobian matrix. This reconstruction matrix multiplying the voltage differences will provide a distribution of conductivity changes. However, the linearized reconstruction contains modelling error. In this paper, we study the modelling error caused by linearization based on the shunt model through simulations. Specifying a current injection pattern in simulation, at each time step a simulated voltage measurement can be calculated from Maxwell’s equations. The voltage difference between two time steps can be obtained. On the other hand, according to the assumption of linearized reconstruction, the voltage difference is assumed to be the Jacobian matrix multiplying the conductivity distribution changes. The discrepancy between these two voltage differences will be studied.展开更多
Advanced biophysical wound healing therapies can apply mechanical, electrical, or light energy to re-stimulate healing processes in chronic wounds. Despite the growing evidence of the clinical efficacy of these therap...Advanced biophysical wound healing therapies can apply mechanical, electrical, or light energy to re-stimulate healing processes in chronic wounds. Despite the growing evidence of the clinical efficacy of these therapies, the optimal treatment stimulation parameters remain unknown and there are no standard treatment protocols. We introduce a closed-loop control design as an experimental system to study the dose-response of wound healing therapy treatment within a prescribed multidimensional and multimodal stimulation parameter space. Systems engineering approaches are applied to the control problem for estimation of a transfer function and model equations derived for use in optimal model-based control. The experimental control system design consisted of simultaneous application of biophysical energies inputted into a wound system. A study design set up including the use of negative pressure wound therapy, electrical stimulation therapy, and photobiomodulation device systems was described. Treatment stimulation parameters were selected from experimental ranges used in the scientific literature. Classical control methods and model-based control were suggested for model selection and evaluation and design of the overall control system. An experimental design for multimodal biophysical wound healing therapy control system is introduced to establish the dose-response interactions for development of therapeutic applications and device design.展开更多
The use of mathematical models can aid in optimizing therapy settings in ventilated patients to achieve certain therapy goals. Especially when multiple goals have to be met, the use of individualized models can be of ...The use of mathematical models can aid in optimizing therapy settings in ventilated patients to achieve certain therapy goals. Especially when multiple goals have to be met, the use of individualized models can be of great help. The presented work shows the potential of using models of respiratory mechanics and gas exchange to optimize minute ventilation and oxygen supply to achieve a defined oxygenation and carbon dioxide removal in a patient while guaranteeing lung protective ventilation. The venti-lator settings are optimized using respiratory mechanics models to compute a respira-tion rate and tidal volume that keeps the maximum airway pressure below the critical limit of 30 cm H2O while ensuring a sufficient expiration. A three-parameter gas ex-change model is then used to optimize both minute ventilation and oxygen supply to achieve defined arterial partial pressures of oxygen and carbon dioxide in the patient. The presented approach was tested using a JAVA based patient simulator that uses various model combinations to compute patient reactions to changes in the ventilator settings. The simulated patient reaction to the optimized ventilator settings showed good agreement with the desired goals.展开更多
Electrical impedance tomography (EIT) is a radiation-free imaging method. Canoni-cally, in lung EIT, 16 electrodes are placed horizontally on the thorax skin. By inject-ing currents through electrodes attached to the ...Electrical impedance tomography (EIT) is a radiation-free imaging method. Canoni-cally, in lung EIT, 16 electrodes are placed horizontally on the thorax skin. By inject-ing currents through electrodes attached to the skin, a set of induced voltage measure-ments can be collected. The conductivity distribution on the chest plane can be ob-tained from these electrical boundary conditions. It has been reported that the adjacent current injection pattern is sub-optimal for EIT reconstruction. However, this adjacent current injection pattern is commonly used in commercially available EIT devices. In this study, we modify the boundary conditions according to the superposition principle of the electrical field. As a result, boundary conditions of the adjacent current pattern will be transformed to those corresponding to “skip-3” current injection pattern. Simulation results indicated that reconstruction benefits from the modified boundary conditions.展开更多
This paper describes a prototype of an automatic system for the detection and evalua-tion of airways of Cystic Fibrosis (CF) patients from Computed Tomography (CT) Scans. The aim of the study is to present a prototype...This paper describes a prototype of an automatic system for the detection and evalua-tion of airways of Cystic Fibrosis (CF) patients from Computed Tomography (CT) Scans. The aim of the study is to present a prototype of an automatic system which could serve as a decision support for radiologists. The area percentages of airway in lung regions have been calculated in CT slices to represent Bronchiectasis stages of CF patients. The proposed automatic system has been tested on a dataset comprising of four CF patients belonging to different stages of Bronchiectasis.展开更多
文摘Background： Electrical impedance tomography （EIT） is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome （ARDS） during positive-end-expiratory pressure （PEEP） titration using EIT. Methods： Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study. After recruitment maneuvers （RMs）, decremental PEEP titration was performed from 20 cmH20 to 5 cmH20 in steps of 3 cmH20 every 5-10 min. Regional over-distension and recruitment were monitored with EIT. Results： After RMs, patient with arterial blood oxygen partial pressure （PaO2） ＋ carbon dioxide partial pressure （PaCO2） 〉400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders. Thirteen ARDS patients was diagnosed as responders whose PaO2 ＋ PaCO2, were higher than nonresponders （419 ± 44 mmHg vs. 170 ±73 mmHg, P 〈 0.0001）. In responders, PEEP mainly increased-recruited pixels in dependent regions and over-distended pixels in nondependent regions. PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume. PEEP levels without significant alveolar derecruitment and over-distension were identified individually. Conclusions： After RMs, PEEP titration significantly affected regional gas distribution in lung, which could be monitored with EIT. EIT has the potential to optimize PEEP titration.
文摘Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values
文摘Corresponding customized software tool is usually unavailable, which increases the time and workload for evaluating the results of a clinical trial. In the present paper, we demonstrate the development process of a customized software for one clinical trial on patients with obstructive lung disease. Over hundred patients and volunteers as controlled were included in the clinical trial. They were examined by spirometry and EIT in a seated position during spontaneous tidal breathing. Subsequently, standard vital capacity maneuver and forced full expiration maneuver were performed. In order to evaluate the offline data, a customized software was developed. The requirements of the software were defined by investigators. The software was then tested on patients’ data and refined based on feedbacks of the investigators. We finalized the customized software with analysis of various disease-specific parameters and indices. Compared to the data process with device specific programs and other commercial software, the customized software is more flexible, user-friendly and extendable. As conclusion, customized software simplifies the evaluation process distinctly and helps physicians to focus on study design and result interpretation.
文摘Purpose: To evaluate the effects of methodological variation of biophysical therapies on wound healing outcomes, as a preliminary study to develop a composite wound healing device. Methods: A literature search was focused on the variable devices, sys-tem configurations, input parameters, and treatment durations of negative pressure wound therapy (NPWT), electrical stimulation (ES), and low-level light therapy (LLLT) from 2011 to July 2016. Results: In NPWT, lower vacuum pressures of ?50 and ?80 mmHg achieved similar tissue perfusion outcomes as earlier recommendations of ?125 mmHg, while there is no established regimen with respect to continuous, square wave, or triangular NP waveform due to inconsistent results. Use of wound filler may contribute to improved tissue granulation when compared to topical NP. An ES configuration of high-voltage pulsed current with the stimulation electrode placed in the wound bed best resembles the endogenous skin current, which guides cellular migration. However, no studies have established optimal stimulation parameters. For LLLT, laser and LED proved similarly effective. Although red light has been almost exclusively used in human pressure ulcer treatment, studies comparing blue, green, and red wavelengths more consistently show biological effects using green light. Conclu-sions: Variation in the application of mechanical, electrical, and radiant energies may be used to modulate wound healing pathways. To 2012, no studies have examined use of these biophysical modalities in combination. Further methodological studies with a systems approach would help define optimal treatment protocols for improved wound healing outcomes in clinical practice.
文摘Background High positive end-expiratory pressure （PEEP） and low tidal volume （VT） ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible alveoli during expiration contributes to lung protection. However, this hypothesis came from analysis of indirect indices like the analysis of the pressure-volume curve of the lung. The purpose of this study was to investigate isolated healthy and injured rat lungs by means of alveolar microscopy, in which combination of PEEP and VT is beneficial with respect to alveolar stability （I-E%）. Methods Alveolar stability was investigated in isolated, non-perfused mechanically ventilated rat lungs. Injured lungs were compared with normal lungs. For both groups three PEEP settings （5, 10, 20 cmH20） were combined with three VT settings （6, 10, 15 ml/kg） resulting in nine PEEP-VT combinations per group. Analysis was performed by alveolar microscopy. Results In normal lungs alveolar stability persisted in all PEEP-VT combinations （I-E% （3.2±11.0）%）. There was no significant difference using different settings （P 〉0.01）. In contrast, alveoli in injured lungs were extremely instable at PEEP levels of 5 cmH20 （mean I-E% 100%） and 10 cmH2O （mean I-E% （30.7±16.8）%）; only at a PEEP of 20 cmH20 were alveoli stabilized （mean I-E% of （0.2±9.3）%）. Conclusions In isolated healthy lungs alveolar stability is almost unaffected by different settings of PEEP and VT. In isolated injured lungs only a high PEEP level of 20 cmH2O resulted in stabilized alveoli whereas lower PEEP levels are associated with alveolar instability.
文摘A tactile system to support severe visually-impaired or blind people in the world for their orientation and navigation had been developed. To optimize the design, some parameters of tactile display device were evaluated. In the present paper,we focused on the reaction time to tactile stimuli. In the test, the stimuli were produced through a vibration belt that was worn around the participants’ waist. In the choice reaction time task, the participants had to click corresponding arrow keys according to the location of a tactile signal. The findings of this study provided a reference of the reaction time range, so as to design a more effective and safe tactile navigation system.
文摘Acute Respiratory Distress Syndrome (ARDS) is a major cause of morbidity and has a high rate of mortality. ARDS patients in the intensive care unit (ICU) require mechan-ical ventilation (MV) for breathing support, but inappropriate settings of MV can lead to ventilator induced lung injury (VILI). Those complications may be avoided by carefully optimizing ventilation parameters through model-based approaches. In this study we introduced a new model of lung mechanics (mNARX) which is a variation of the NARX model by Langdon et al. A multivariate process was undertaken to deter-mine the optimal parameters of the mNARX model and hence, the final structure of the model fit 25 patient data sets and successfully described all parts of the breathing cycle. The model was highly successful in predicting missing data and showed minimal error. Thus, this model can be used by the clinicians to find the optimal patient specific ventilator settings.
基金the National Science and Technology Major Project of China(2017-Ⅶ-0015-0111)。
文摘Single-pass honing is an important machining method for finish machining of holes,which can meet the requirement for high efficiency and consistency of holes.Characterization and life prediction of single-pass honing tool are necessary to improve the machining accuracy of holes honed,especially dimension accuracy.Single-pass honing tool is a single layer abrasive tool with fixed dimension,which still remains problematic for characterization and life prediction.For fuel injection nozzles with bore diameter under 1 mm,the stiffness of the single-pass honing tool is poor.This article presents a novel analytical model that predicts life of the tool with poor stiffness.Firstly,according to the bore diameter and dimension tolerance,the single-pass honing tool is designed and manufactured.Based on the prepared single-pass honing tool,the measurement and characterization methods are established.Furthermore,the tool wear tests are carried out,and the tool contour evolution model is established to predict the tool life.
文摘A 78-year-old asymptomatic woman was referred to our clinic for a second opinion regarding indication for mitral valve surgery. An echocardiogram showed a moderate mitral stenosis with a concomitant severe regurgitation. The most striking feature, however, was a giant left atrium with a parasternal anteroposterior diameter of 79 mm and a left atrial volume index of 364 m L/m2. There are various echocardiographic definitions of a giant left atrium, which are mainly based on measurements of the anteroposterior diameter of the left atrium using M-mode in the parasternal long axis view. Since the commonly accepted method for echocardiographic evaluation of left atrial size is left atrial volume index, we propose a cut-off value of 140 m L/m2 for the definition of a "giant left atrium".
基金Partial support by the EU-Project-“eTime”-ID:“FP7-PEOPLE-2012-IRSES”is gratefully acknowledged.
文摘Patients with acute respiratory distress syndrome (ARDS) are currently treated with a lung protective ventilation strategy and the application of positive end-expiratory pressure (PEEP), sometimes in combination with recruitment maneuvers. In this study, the respiratory system elastance and airway resistance of each breath before, during and after a specific recruitment maneuver (PEEP wave maneuver) were analyzed in two patient groups, ARDS and control group. A reduction of elastance after the maneuver was observed in ARDS patients. In addition, only healthy lungs exhibited a reduction of the elastance during the course of the maneuver, while the lungs of ARDS patients didn’t show that reduction of elastance. The capability of PEEP wave maneuvers to improve lung ventilation was shown and the dynamic behavior of the elastance after the maneuver was illustrated. Healthy lungs adapt faster to changes in mechanical ventilation than the lungs of ARDS patients.
基金The German Federal Ministry of Education and Research (WiM-Vent, Grants01IB10002D, PulMODS Grant 01DR12095) EU FP7 PIRSES--GA-2012-318943 eTime
文摘Individualized models of respiratory mechanics help to reduce potential harmful effects of mechanical ventilation by supporting the evaluation of patient-specific lung protective ventilation strategies. Assessing ventilation inhomogeneities might be an important aspect in optimizing ventilator settings. The aim of this studyis to capture and analyze ventilation inhomogeneity by a mathematical model using clinical data. The results show that the lung physiology of mechanically ventilated patients without lung condition can be described by an inhomogeneity model revealing two alveolar compartments with median time constants of 0.4 and 3.9 s. Thus, the IHM in combination with specific ventilation maneuver might be suitable to capture lung physiology for model-based optimization of ventilator settings but requires additional image-based investigations to further support the validity of the model.
文摘Electrical Impedance Tomography (EIT) is a medical imaging technique which can be used to monitor the regional ventilation in patients utilizing voltage measurements made at the thorax. Several reconstruction algorithms have been developed during the last few years. In this manuscript we compare a well-established algorithm and a re-cently developed method for image reconstruction regarding EIT indices derived from the differently reconstructed images.
文摘Electrical Impedance Tomography is an imaging method which attempts to reveal the conductivity distribution of a domain based on the electrical boundary condition. For time difference EIT, the voltage difference at two time steps is employed for reconstruction. This is an ill-posed inverse problem, especially, it is non-linear. The currently available EIT devices are all based on linearized reconstruction algorithms. The linearized reconstruction employs a reconstruction matrix which is essentially a regularized pseudo inverse of the Jacobian matrix. This reconstruction matrix multiplying the voltage differences will provide a distribution of conductivity changes. However, the linearized reconstruction contains modelling error. In this paper, we study the modelling error caused by linearization based on the shunt model through simulations. Specifying a current injection pattern in simulation, at each time step a simulated voltage measurement can be calculated from Maxwell’s equations. The voltage difference between two time steps can be obtained. On the other hand, according to the assumption of linearized reconstruction, the voltage difference is assumed to be the Jacobian matrix multiplying the conductivity distribution changes. The discrepancy between these two voltage differences will be studied.
文摘Advanced biophysical wound healing therapies can apply mechanical, electrical, or light energy to re-stimulate healing processes in chronic wounds. Despite the growing evidence of the clinical efficacy of these therapies, the optimal treatment stimulation parameters remain unknown and there are no standard treatment protocols. We introduce a closed-loop control design as an experimental system to study the dose-response of wound healing therapy treatment within a prescribed multidimensional and multimodal stimulation parameter space. Systems engineering approaches are applied to the control problem for estimation of a transfer function and model equations derived for use in optimal model-based control. The experimental control system design consisted of simultaneous application of biophysical energies inputted into a wound system. A study design set up including the use of negative pressure wound therapy, electrical stimulation therapy, and photobiomodulation device systems was described. Treatment stimulation parameters were selected from experimental ranges used in the scientific literature. Classical control methods and model-based control were suggested for model selection and evaluation and design of the overall control system. An experimental design for multimodal biophysical wound healing therapy control system is introduced to establish the dose-response interactions for development of therapeutic applications and device design.
文摘The use of mathematical models can aid in optimizing therapy settings in ventilated patients to achieve certain therapy goals. Especially when multiple goals have to be met, the use of individualized models can be of great help. The presented work shows the potential of using models of respiratory mechanics and gas exchange to optimize minute ventilation and oxygen supply to achieve a defined oxygenation and carbon dioxide removal in a patient while guaranteeing lung protective ventilation. The venti-lator settings are optimized using respiratory mechanics models to compute a respira-tion rate and tidal volume that keeps the maximum airway pressure below the critical limit of 30 cm H2O while ensuring a sufficient expiration. A three-parameter gas ex-change model is then used to optimize both minute ventilation and oxygen supply to achieve defined arterial partial pressures of oxygen and carbon dioxide in the patient. The presented approach was tested using a JAVA based patient simulator that uses various model combinations to compute patient reactions to changes in the ventilator settings. The simulated patient reaction to the optimized ventilator settings showed good agreement with the desired goals.
文摘Electrical impedance tomography (EIT) is a radiation-free imaging method. Canoni-cally, in lung EIT, 16 electrodes are placed horizontally on the thorax skin. By inject-ing currents through electrodes attached to the skin, a set of induced voltage measure-ments can be collected. The conductivity distribution on the chest plane can be ob-tained from these electrical boundary conditions. It has been reported that the adjacent current injection pattern is sub-optimal for EIT reconstruction. However, this adjacent current injection pattern is commonly used in commercially available EIT devices. In this study, we modify the boundary conditions according to the superposition principle of the electrical field. As a result, boundary conditions of the adjacent current pattern will be transformed to those corresponding to “skip-3” current injection pattern. Simulation results indicated that reconstruction benefits from the modified boundary conditions.
文摘This paper describes a prototype of an automatic system for the detection and evalua-tion of airways of Cystic Fibrosis (CF) patients from Computed Tomography (CT) Scans. The aim of the study is to present a prototype of an automatic system which could serve as a decision support for radiologists. The area percentages of airway in lung regions have been calculated in CT slices to represent Bronchiectasis stages of CF patients. The proposed automatic system has been tested on a dataset comprising of four CF patients belonging to different stages of Bronchiectasis.
