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  • 1.
    Abbott, Rebecca
    et al.
    Northwestern Univ, IL 60611 USA.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    West, Janne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Tekniska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Elliott, James M.
    Northwestern Univ, IL 60611 USA; Univ Queensland, Australia; Zurich Univ Appl Sci, Switzerland.
    Åslund, Ulrika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Karlsson, Anette
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Dahlqvist Leinhard, Olof
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging2018Ingår i: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, nr 5, s. 717-725Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND CONTEXT: The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE: The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING: This is a cross-sectional study. PATIENT SAMPLE: Thirty-one subjects with WAD and 31 age-and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES: The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS: The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS: Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (pamp;lt;.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS: These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice. (C) 2017 Elsevier Inc. All rights reserved.

  • 2.
    Abrahamsson, Annelie
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Rzepecka, Anna
    Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Romu, Thobias
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Borga, Magnus
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Dahlqvist Leinhard, Olof
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Lundberg, Peter
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Kihlberg, Johan
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Dabrosin, Charlotta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment in vivo2016Ingår i: Oncoimmunology, ISSN 2162-4011, E-ISSN 2162-402X, Vol. 5, nr 10, artikel-id e1229723Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Inflammation is one of the hallmarks of carcinogenesis. High mammographic density has been associated with increased risk of breast cancer but the mechanisms behind are poorly understood. We evaluated whether breasts with different mammographic densities exhibited differences in the inflammatory microenvironment.Postmenopausal women attending the mammography-screening program were assessed having extreme dense, n = 20, or entirely fatty breasts (nondense), n = 19, on their regular mammograms. Thereafter, the women were invited for magnetic resonance imaging (MRI), microdialysis for the collection of extracellular molecules in situ and a core tissue biopsy for research purposes. On the MRI, lean tissue fraction (LTF) was calculated for a continuous measurement of breast density. LTF confirmed the selection from the mammograms and gave a continuous measurement of breast density. Microdialysis revealed significantly increased extracellular in vivo levels of IL-6, IL-8, vascular endothelial growth factor, and CCL5 in dense breast tissue as compared with nondense breasts. Moreover, the ratio IL-1Ra/IL-1 was decreased in dense breasts. No differences were found in levels of IL-1, IL-1Ra, CCL2, leptin, adiponectin, or leptin:adiponectin ratio between the two breast tissue types. Significant positive correlations between LTF and the pro-inflammatory cytokines as well as between the cytokines were detected. Stainings of the core biopsies exhibited increased levels of immune cells in dense breast tissue.Our data show that dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment and, if confirmed in a larger cohort, suggests novel targets for prevention therapies for women with dense breast tissue.

  • 3.
    Adelöf, Anna
    et al.
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Lindberg, Christina
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Barlow, Lotti
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Gerdin, Ulla
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Bränd Persson, Kristina
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Ericsson, Erika
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Testi, Stefano
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Nyström, Mikael
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
    Förvaltning av SNOMED CT som en del i det nationella fackspråket för vård och omsorg2011Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Förvaltningsrapporten fokuserar på Snomed CT, eftersom det redan i dag finns rutiner för förvaltningar av termbanken och nationella hälsorelaterade klassifikationer. Ett särskilt utvecklingsarbete kommer att krävas för dessa delar.

    Rapporten tar upp syfte och mål med förvaltningen. Utöver det redogör rapporten för vilka konkreta ansvarsområden som ingår i förvaltningen av Snomed CT. Målet för förvaltningen är att Socialstyrelsen regelbundet ska kunna tillhandahålla en kontrollerad och uppdaterad release av Snomed CT. Det skulle möjliggöra användning inom vård och omsorg. Rapporten tar även upp behovet av kompetens, utbildning och finansiella resurser.

  • 4.
    Adolfsson, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
    Visual Evaluation of 3D Image Enhancement2006Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats
    Abstract [en]

    Technologies in image acquisition have developed and often provide image volumes in more than two dimensions. Computer tomography and magnet resonance imaging provide image volumes in three spatial dimensions. The image enhancement methods have developed as well and in this thesis work 3D image enhancement with filter networks is evaluated.

    The aims of this work are; to find a method which makes the initial parameter settings in the 3D image enhancement processing easier, to compare 2D and 3D processed image volumes visualized with different visualization techniques and to give an illustration of the benefits with 3D image enhancement processing visualized using these techniques.

    The results of this work are;

    1. a parameter setting tool that makes the initial parameter setting much easier and

    2. an evaluation of 3D image enhancement with filter networks that shows a significant enhanced image quality in 3D processed image volumes with a high noise level compared to the 2D processed volumes. These results are shown in slices, MIP and volume rendering. The differences are even more pronounced if the volume is presented in a different projection than the volume is 2D processed in.

  • 5.
    Agebratt, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Ström, Edvin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Romu, Thobias
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Dahlqvist Leinhard, Olof
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Borga, Magnus
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Leandersson, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Arbets- och miljömedicin.
    Nyström, Fredrik H.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Endokrinmedicinska kliniken.
    A Randomized Study of the Effects of Additional Fruit and Nuts Consumption on Hepatic Fat Content, Cardiovascular Risk Factors and Basal Metabolic Rate2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 1, s. e0147149-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Fruit has since long been advocated as a healthy source of many nutrients, however, the high content of sugars in fruit might be a concern.

    Objectives

    To study effects of an increased fruit intake compared with similar amount of extra calories from nuts in humans.

    Methods

    Thirty healthy non-obese participants were randomized to either supplement the diet with fruits or nuts, each at +7 kcal/kg bodyweight/day for two months. Major endpoints were change of hepatic fat content (HFC, by magnetic resonance imaging, MRI), basal metabolic rate (BMR, with indirect calorimetry) and cardiovascular risk markers.

    Results

    Weight gain was numerically similar in both groups although only statistically significant in the group randomized to nuts (fruit: from 22.15±1.61 kg/m2 to 22.30±1.7 kg/m2, p = 0.24 nuts: from 22.54±2.26 kg/m2 to 22.73±2.28 kg/m2, p = 0.045). On the other hand BMR increased in the nut group only (p = 0.028). Only the nut group reported a net increase of calories (from 2519±721 kcal/day to 2763±595 kcal/day, p = 0.035) according to 3-day food registrations. Despite an almost three-fold reported increased fructose-intake in the fruit group (from 9.1±6.0 gram/day to 25.6±9.6 gram/day, p<0.0001, nuts: from 12.4±5.7 gram/day to 6.5±5.3 gram/day, p = 0.007) there was no change of HFC. The numerical increase in fasting insulin was statistical significant only in the fruit group (from 7.73±3.1 pmol/l to 8.81±2.9 pmol/l, p = 0.018, nuts: from 7.29±2.9 pmol/l to 8.62±3.0 pmol/l, p = 0.14). Levels of vitamin C increased in both groups while α-tocopherol/cholesterol-ratio increased only in the fruit group.

    Conclusions

    Although BMR increased in the nut-group only this was not linked with differences in weight gain between groups which potentially could be explained by the lack of reported net caloric increase in the fruit group. In healthy non-obese individuals an increased fruit intake seems safe from cardiovascular risk perspective, including measurement of HFC by MRI.

  • 6.
    Ahlström, Christer
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    Nonlinear phonocardiographic Signal Processing2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this thesis work has been to develop signal analysis methods for a computerized cardiac auscultation system, the intelligent stethoscope. In particular, the work focuses on classification and interpretation of features derived from the phonocardiographic (PCG) signal by using advanced signal processing techniques.

    The PCG signal is traditionally analyzed and characterized by morphological properties in the time domain, by spectral properties in the frequency domain or by nonstationary properties in a joint time-frequency domain. The main contribution of this thesis has been to introduce nonlinear analysis techniques based on dynamical systems theory to extract more information from the PCG signal. Especially, Takens' delay embedding theorem has been used to reconstruct the underlying system's state space based on the measured PCG signal. This processing step provides a geometrical interpretation of the dynamics of the signal, whose structure can be utilized for both system characterization and classification as well as for signal processing tasks such as detection and prediction. In this thesis, the PCG signal's structure in state space has been exploited in several applications. Change detection based on recurrence time statistics was used in combination with nonlinear prediction to remove obscuring heart sounds from lung sound recordings in healthy test subjects. Sample entropy and mutual information were used to assess the severity of aortic stenosis (AS) as well as mitral insufficiency (MI) in dogs. A large number of, partly nonlinear, features was extracted and used for distinguishing innocent murmurs from murmurs caused by AS or MI in patients with probable valve disease. Finally, novel work related to very accurate localization of the first heart sound by means of ECG-gated ensemble averaging was conducted. In general, the presented nonlinear processing techniques have shown considerably improved results in comparison with other PCG based techniques.

    In modern health care, auscultation has found its main role in primary or in home health care, when deciding if special care and more extensive examinations are required. Making a decision based on auscultation is however difficult, why a simple tool able to screen and assess murmurs would be both time- and cost-saving while relieving many patients from needless anxiety. In the emerging field of telemedicine and home care, an intelligent stethoscope with decision support abilities would be of great value.

    Delarbeten
    1. A method for accurate localization of the first heart sound and possible applications
    Öppna denna publikation i ny flik eller fönster >>A method for accurate localization of the first heart sound and possible applications
    2008 (Engelska)Ingår i: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 29, nr 3, s. 417-428Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    We have previously developed a method for localization of the first heart sound (S1) using wavelet denoising and ECG-gated peak-picking. In this study, an additional enhancement step based on cross-correlation and ECG-gated ensemble averaging (EA) is presented. The main objective of the improved method was to localize S1 with very high temporal accuracy in (pseudo-) real time. The performance of S1 detection and localization, with and without EA enhancement, was evaluated on simulated as well as experimental data. The simulation study showed that EA enhancement reduced the localization error considerably and that S1 could be accurately localized at much lower signal-to-noise ratios. The experimental data were taken from ten healthy subjects at rest and during invoked hyper- and hypotension. For this material, the number of correct S1 detections increased from 91% to 98% when using EA enhancement. Improved performance was also demonstrated when EA enhancement was used for continuous tracking of blood pressure changes and for respiration monitoring via the electromechanical activation time. These are two typical applications where accurate localization of S1 is essential for the results.

    Ort, förlag, år, upplaga, sidor
    Institutionen för medicinsk teknik, 2008
    Nyckelord
    ensemble averaging, detection, localization, heart sound, bioacoustics
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-11856 (URN)10.1088/0967-3334/29/3/011 (DOI)
    Anmärkning
    Original publication: C Ahlstrom, T Länne, P Ask and A Johansson, A method for accurate localization of the first heart sound and possible applications, 2008, Physiological Measurement, (29), 3, 417-428. http://dx.doi.org/10.1088/0967-3334/29/3/011. Copyright: Institute of Physics and IOP Publishing Limited, http://www.iop.org/EJ/journal/PMTillgänglig från: 2008-05-20 Skapad: 2008-05-20 Senast uppdaterad: 2017-12-13
    2. Assessing Aortic Stenosis using Sample Entropy of the Phonocardiographic Signal in Dogs
    Öppna denna publikation i ny flik eller fönster >>Assessing Aortic Stenosis using Sample Entropy of the Phonocardiographic Signal in Dogs
    Visa övriga...
    2008 (Engelska)Ingår i: IEEE Transactions on Biomedical Engineering, ISSN 0018-9294, E-ISSN 1558-2531, Vol. 55, nr 8, s. 2107-2109Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    In aortic valve stenosis (AS), heart murmurs arise as an effect of turbulent blood flow distal to the obstructed valves. With increasing AS severity, the flow becomes more unstable, and the ensuing murmur becomes more complex. We hypothesize that these hemodynamic flow changes can be quantified based on the complexity of the phonocardiographic (PCG) signal. In this study, sample entropy (SampEn) was investigated as a measure of complexity using a dog model. Twenty-seven boxer dogs with various degrees of AS were examined with Doppler echocardiography, and the peak aortic flow velocity (Vmax) was used as a reference of AS severity. SampEn correlated to Vmax with R = 0.70 using logarithmic regression. In a separate analysis, significant differences were found between physiologic murmurs and murmurs caused by AS (p < 0.05), and the area under a receiver operating characteristic curve was calculated to 0.96. Comparison with previously presented PCG measures for AS assessment showed improved performance when using SampEn, especially for differentiation between physiological murmurs and murmurs caused by mild AS. Studies in patients will be needed to properly assess the technique in humans.

    Nyckelord
    Aortic stenosis (AS), bioacoustics, heart sound, murmur, sample entropy (SampEn)
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13042 (URN)10.1109/TBME.2008.923767 (DOI)
    Tillgänglig från: 2008-03-20 Skapad: 2008-03-20 Senast uppdaterad: 2017-12-13
    3. Assessing mitral regurgitation attributable to myxomatous mitral valve disease in dogs using signal analysis of heart sounds and murmurs
    Öppna denna publikation i ny flik eller fönster >>Assessing mitral regurgitation attributable to myxomatous mitral valve disease in dogs using signal analysis of heart sounds and murmurs
    Visa övriga...
    2008 (Engelska)Artikel i tidskrift (Refereegranskat) Submitted
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13043 (URN)
    Tillgänglig från: 2008-03-20 Skapad: 2008-03-20 Senast uppdaterad: 2009-03-26
    4. Feature Extraction for Systolic Heart Murmur Classification
    Öppna denna publikation i ny flik eller fönster >>Feature Extraction for Systolic Heart Murmur Classification
    Visa övriga...
    2006 (Engelska)Ingår i: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 34, nr 11, s. 1666-1677Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an “intelligent stethoscope” with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil’s sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.

    Nyckelord
    Auscultation, Bioacoustics, Feature selection, Heart sounds, Valvular disease
    Nationell ämneskategori
    Teknik och teknologier
    Identifikatorer
    urn:nbn:se:liu:diva-13044 (URN)10.1007/s10439-006-9187-4 (DOI)
    Tillgänglig från: 2008-03-20 Skapad: 2008-03-20 Senast uppdaterad: 2017-12-13
    5. Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction
    Öppna denna publikation i ny flik eller fönster >>Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction
    2005 (Engelska)Ingår i: IEEE Signal Processing Letters, ISSN 1070-9908, E-ISSN 1558-2361, Vol. 12, nr 12, s. 812-815Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Heart sounds (HS) obscure the interpretation of lung sounds (LS). This letter presents a new method to detect and remove this undesired disturbance. The HS detection algorithm is based on a recurrence time statistic that is sensitive to changes in a reconstructed state space. Signal segments that are found to contain HS are removed, and the arising missing parts are replaced with predicted LS using a nonlinear prediction scheme. The prediction operates in the reconstructed state space and uses an iterated integrated nearest trajectory algorithm. The HS detection algorithm detects HS with an error rate of 4% false positives and 8% false negatives. The spectral difference between the reconstructed LS signal and an LS signal with removed HS was 0.34/spl plusmn/0.25, 0.50/spl plusmn/0.33, 0.46/spl plusmn/0.35, and 0.94/spl plusmn/0.64 dB/Hz in the frequency bands 20-40, 40-70, 70-150, and 150-300 Hz, respectively. The cross-correlation index was found to be 99.7%, indicating excellent similarity between actual LS and predicted LS. Listening tests performed by a skilled physician showed high-quality auditory results.

    Ort, förlag, år, upplaga, sidor
    Institutionen för medicinsk teknik, 2005
    Nyckelord
    Bioacoustics, heart sound (HS), lung sound (LS), nonlinear prediction, recurrence time statistics
    Nationell ämneskategori
    Teknik och teknologier
    Identifikatorer
    urn:nbn:se:liu:diva-11857 (URN)10.1109/LSP.2005.859528 (DOI)
    Anmärkning
    Original publication: Ahlstrom, C., Liljefeldt, O., Hult, P. and Ask, P., Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction, 2005, IEEE Signal Processing Letters, (12), 12, 812-815. http://dx.doi.org/10.1109/LSP.2005.859528. Copyright: IEEE, http://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=97Tillgänglig från: 2008-05-20 Skapad: 2008-05-20 Senast uppdaterad: 2017-12-13
  • 7.
    Ahlström, Christer
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Processing of the Phonocardiographic Signal: methods for the intelligent stethoscope2006Licentiatavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Phonocardiographic signals contain bioacoustic information reflecting the operation of the heart. Normally there are two heart sounds, and additional sounds indicate disease. If a third heart sound is present it could be a sign of heart failure whereas a murmur indicates defective valves or an orifice in the septal wall. The primary aim of this thesis is to use signal processing tools to improve the diagnostic value of this information. More specifically, three different methods have been developed:

    • A nonlinear change detection method has been applied to automatically detect heart sounds. The first and the second heart sounds can be found using recurrence times of the first kind while the third heart sound can be found using recurrence times of the second kind. Most third heart sound occurrences were detected (98 %), but the amount of false extra detections was rather high (7 % of the heart cycles).

    • Heart sounds obscure the interpretation of lung sounds. A new method based on nonlinear prediction has been developed to remove this undesired disturbance. High similarity was obtained when comparing actual lung sounds with lung sounds after removal of heart sounds.

    • Analysis methods such as Shannon energy, wavelets and recurrence quantification analysis were used to extract information from the phonocardiographic signal. The most prominent features, determined by a feature selection method, were used to create a new feature set for heart murmur classification. The classification result was 86 % when separating patients with aortic stenosis, mitral insufficiency and physiological murmurs.

    The derived methods give reasonable results, and they all provide a step forward in the quest for an intelligent stethoscope, a universal phonocardiography tool able to enhance auscultation by improving sound quality, emphasizing abnormal events in the heart cycle and distinguishing different heart murmurs.

    Delarbeten
    1. Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction
    Öppna denna publikation i ny flik eller fönster >>Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction
    2005 (Engelska)Ingår i: IEEE Signal Processing Letters, ISSN 1070-9908, E-ISSN 1558-2361, Vol. 12, nr 12, s. 812-815Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Heart sounds (HS) obscure the interpretation of lung sounds (LS). This letter presents a new method to detect and remove this undesired disturbance. The HS detection algorithm is based on a recurrence time statistic that is sensitive to changes in a reconstructed state space. Signal segments that are found to contain HS are removed, and the arising missing parts are replaced with predicted LS using a nonlinear prediction scheme. The prediction operates in the reconstructed state space and uses an iterated integrated nearest trajectory algorithm. The HS detection algorithm detects HS with an error rate of 4% false positives and 8% false negatives. The spectral difference between the reconstructed LS signal and an LS signal with removed HS was 0.34/spl plusmn/0.25, 0.50/spl plusmn/0.33, 0.46/spl plusmn/0.35, and 0.94/spl plusmn/0.64 dB/Hz in the frequency bands 20-40, 40-70, 70-150, and 150-300 Hz, respectively. The cross-correlation index was found to be 99.7%, indicating excellent similarity between actual LS and predicted LS. Listening tests performed by a skilled physician showed high-quality auditory results.

    Ort, förlag, år, upplaga, sidor
    Institutionen för medicinsk teknik, 2005
    Nyckelord
    Bioacoustics, heart sound (HS), lung sound (LS), nonlinear prediction, recurrence time statistics
    Nationell ämneskategori
    Teknik och teknologier
    Identifikatorer
    urn:nbn:se:liu:diva-11857 (URN)10.1109/LSP.2005.859528 (DOI)
    Anmärkning
    Original publication: Ahlstrom, C., Liljefeldt, O., Hult, P. and Ask, P., Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction, 2005, IEEE Signal Processing Letters, (12), 12, 812-815. http://dx.doi.org/10.1109/LSP.2005.859528. Copyright: IEEE, http://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=97Tillgänglig från: 2008-05-20 Skapad: 2008-05-20 Senast uppdaterad: 2017-12-13
    2. Detection of the 3rd Heart Sound using Recurrence Time Statistics
    Öppna denna publikation i ny flik eller fönster >>Detection of the 3rd Heart Sound using Recurrence Time Statistics
    2006 (Engelska)Ingår i: Proc. 31st IEEE Int. Conf. on Acoustics, Speech and Signal Processing, Toulouse, France, 2006, 2006, s. 1040-1043Konferensbidrag, Publicerat paper (Övrigt vetenskapligt)
    Abstract [en]

    The 3rd heart sound (S3) is normally heard during auscultation of younger individuals, but it is also common in many patients with heart failure. Compared to the 1st and 2nd heart sounds, S3 has low amplitude and low frequency content, making it hard to detect (both manually for the physician and automatically by a detection algorithm). We present an algorithm based on a recurrence time statistic which is sensitive to changes in a reconstructed state space, particularly for detection of transitions with very low energy. Heart sound signals from ten children were used in this study. Most S3 occurrences were detected (98 %), but the amount of false extra detections was rather high (7% of the heart cycles). In conclusion, the method seems capable of detecting S3 with high accuracy and robustness.

    Serie
    IEEE International Conference on Acoustics, Speech and Signal Processing. Proceedings, ISSN 1520-6149
    Nyckelord
    acoustic, signal detection, bioacoustics, signal reconstruction, statistics, heart sound, auscultation, heart failure, reconstructed state space, recurrence time statistics
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-14058 (URN)
    Tillgänglig från: 2006-10-09 Skapad: 2006-10-09 Senast uppdaterad: 2009-04-21
    3. Feature Extraction for Systolic Heart Murmur Classification
    Öppna denna publikation i ny flik eller fönster >>Feature Extraction for Systolic Heart Murmur Classification
    Visa övriga...
    2006 (Engelska)Ingår i: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 34, nr 11, s. 1666-1677Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an “intelligent stethoscope” with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil’s sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.

    Nyckelord
    Auscultation, Bioacoustics, Feature selection, Heart sounds, Valvular disease
    Nationell ämneskategori
    Teknik och teknologier
    Identifikatorer
    urn:nbn:se:liu:diva-13044 (URN)10.1007/s10439-006-9187-4 (DOI)
    Tillgänglig från: 2008-03-20 Skapad: 2008-03-20 Senast uppdaterad: 2017-12-13
  • 8.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Rask, Peter
    University Hospital, Örebro, Sweden .
    Karlsson, Jan-Erik
    County Hospital Ryhov, Jönköping, Sweden.
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Assessment of Suspected Aortic Stenosis by Auto Mutual Information Analysis of Murmurs2007Ingår i: Engineering in Medicine and Biology Society, 2007. EMBS 2007, 2007, s. 1945-1948Konferensbidrag (Refereegranskat)
    Abstract [en]

    Mild sclerotic thickening of the aortic valve affects 25% of the population, and the condition causes aortic valve stenosis (AS) in 2% of adults above 65 years. Echocardiography is today the clinical standard for assessing AS. However, a cost effective and uncomplicated technique that can be used for decision support in the primary health care would be of great value. In this study, recorded phonocardiographic signals were analyzed using the first local minimum of the auto mutual information (AMI) function. The AMI method measures the complexity in the sound signal, which is related to the amount of turbulence in the blood flow and thus to the severity of the stenosis. Two previously developed phonocardiographic methods for assessing AS severity were used for comparison, the murmur energy ratio and the sound spectral averaging technique. Twenty-nine patients with suspected AS were examined with Doppler echocardiography. The aortic jet velocity was used as a reference of AS severity, and it was found to correlate with the AMI method, the murmur energy ratio and the sound spectral averaging technique with the correlation coefficient R = 0.82, R = 0.73 and R = 0.76, respectively.

  • 9.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Filosofiska fakulteten.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Detection of the 3(rd) heart sound using recurrence time statistics2006Ingår i: 2006 IEEE International Conference on Acoustics, Speech and Signal Processing, Vols 1-13, 2006, Vol. 1-13, s. 2288-2291Konferensbidrag (Refereegranskat)
    Abstract [en]

    The 3(rd) heart sound (S3) is normally heard during auscultation of younger individuals, but it is also common in many patients with heart failure. Compared to the 1(st) and 2(nd) heart sounds, S3 has low amplitude and low frequency content, making it hard to detect (both manually for the physician and automatically by a detection algorithm). We present an algorithm based on a recurrence time statistic which is sensitive to changes in a reconstructed state space, particularly for detection of transitions with very low energy. Heart sound signals from ten children were used in this study. Most S3 occurrences were detected (98%), but the amount of false extra detections was rather high (7% of the heart cycles). In conclusion, the method seems capable of detecting S3 with high accuracy and robustness.

  • 10.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Detection of the 3rd Heart Sound using Recurrence Time Statistics2006Ingår i: Proc. 31st IEEE Int. Conf. on Acoustics, Speech and Signal Processing, Toulouse, France, 2006, 2006, s. 1040-1043Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    The 3rd heart sound (S3) is normally heard during auscultation of younger individuals, but it is also common in many patients with heart failure. Compared to the 1st and 2nd heart sounds, S3 has low amplitude and low frequency content, making it hard to detect (both manually for the physician and automatically by a detection algorithm). We present an algorithm based on a recurrence time statistic which is sensitive to changes in a reconstructed state space, particularly for detection of transitions with very low energy. Heart sound signals from ten children were used in this study. Most S3 occurrences were detected (98 %), but the amount of false extra detections was rather high (7% of the heart cycles). In conclusion, the method seems capable of detecting S3 with high accuracy and robustness.

  • 11.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Thresholding distance plots using true recurrence points2006Ingår i: Acoustics, Speech and Signal Processing, 2006. ICASSP 2006, IEEE , 2006, s. 688-691Konferensbidrag (Refereegranskat)
    Abstract [en]

    Recurrence plots (RP) visualize multi-dimensional state spaces and represent the recurrence of states of a system. Recurrence points can be divided into true recurrence points and false recurrence points (also called sojourn points). We introduce the true recurrence point recurrence plot, TRP, a variant of the traditional RP excluding the sojourn points. This is a cleaned up RP free from recurrence points originating from tangential motion, and hence a more robust representation of unstable periodic orbits. The method is demonstrated with three simple systems, a periodic sine wave, a quasi-periodic torus and the x-component of the chaotic Lorenz system

  • 12.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Hult, Peter
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Wheeze analysis and detection with non-linear phase-space embedding2005Ingår i: Nordic Baltic Conference Biomedical Engineering and Medical Physics,2005, Umeå: IFMBE , 2005, s. 305-Konferensbidrag (Refereegranskat)
  • 13.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Hult, Peter
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Rask, P
    Karlsson, J-E
    Nylander, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Dahlström, Ulf
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Using the intelligent stethoscope for extraction of features for systolic heart murmur classification2006Ingår i: World Congress on Medical Physics and Biomedical Engineering WC2006,2006, 2006Konferensbidrag (Övrigt vetenskapligt)
  • 14.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Rask, Peter
    Örebro university.
    Karlsson, Jan-Erik
    Nylander, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Feature Extraction for Systolic Heart Murmur Classification2006Ingår i: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 34, nr 11, s. 1666-1677Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an “intelligent stethoscope” with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil’s sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.

  • 15.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Hult, Peter
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Schmekel, Birgitta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Automatisk detektering av ronki med icke-linjära metoder2004Ingår i: Svenska Läkaresällskapets riksstämma,2004, 2004, s. 66-66Konferensbidrag (Övrigt vetenskapligt)
  • 16.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Hult, Peter
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Schmekel, Birgitta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Wheeze detection with nonlinear statespace embedding2004Ingår i: International Lung Sound Association,2004, 2004, s. 38-39Konferensbidrag (Övrigt vetenskapligt)
  • 17.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    Höglund, Katja
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    Häggström, Jens
    Kvart, Clarence
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    Assessing Aortic Stenosis using Sample Entropy of the Phonocardiographic Signal in Dogs2008Ingår i: IEEE Transactions on Biomedical Engineering, ISSN 0018-9294, E-ISSN 1558-2531, Vol. 55, nr 8, s. 2107-2109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In aortic valve stenosis (AS), heart murmurs arise as an effect of turbulent blood flow distal to the obstructed valves. With increasing AS severity, the flow becomes more unstable, and the ensuing murmur becomes more complex. We hypothesize that these hemodynamic flow changes can be quantified based on the complexity of the phonocardiographic (PCG) signal. In this study, sample entropy (SampEn) was investigated as a measure of complexity using a dog model. Twenty-seven boxer dogs with various degrees of AS were examined with Doppler echocardiography, and the peak aortic flow velocity (Vmax) was used as a reference of AS severity. SampEn correlated to Vmax with R = 0.70 using logarithmic regression. In a separate analysis, significant differences were found between physiologic murmurs and murmurs caused by AS (p < 0.05), and the area under a receiver operating characteristic curve was calculated to 0.96. Comparison with previously presented PCG measures for AS assessment showed improved performance when using SampEn, especially for differentiation between physiological murmurs and murmurs caused by mild AS. Studies in patients will be needed to properly assess the technique in humans.

  • 18.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Höglund, Katja
    Dept. of Anatomy and Physiology, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Häggström, Jens
    Dept. of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Kvart, Clarence
    Dept. of Anatomy and Physiology, Faculty of Veterinary Medicine and Animal Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Distinguishing Innocent Murmurs from Murmurs caused by Aortic Stenosis by Recurrence Quantification Analysis2006Ingår i: ROCEEDINGS OF WORLD ACADEMY OF SCIENCE, ENGINEERING AND TECHNOLOGY, VOL 18, Canakkale, Turkey: World Academy of Science, Engineering and Technology (W A S E T) , 2006, s. 40-45Konferensbidrag (Refereegranskat)
    Abstract [en]

    It is sometimes difficult to differentiate between innocent murmurs and pathological murmurs during auscultation. In these difficult cases, an intelligent stethoscope with decision support abilities would be of great value. In this study, using a dog model, phonocardiographic recordings were obtained from 27 boxer dogs with various degrees of aortic stenosis (AS) severity. As a reference for severity assessment, continuous wave Doppler was used. The data were analyzed with recurrence quantification analysis (RQA) with the aim to find features able to distinguish innocent murmurs from murmurs caused by AS. Four out of eight investigated RQA features showed significant differences between innocent murmurs and pathological murmurs. Using a plain linear discriminant analysis classifier, the best pair of features (recurrence rate and entropy) resulted in a sensitivity of 90% and a specificity of 88%. In conclusion, RQA provide valid features which can be used for differentiation between innocent murmurs and murmurs caused by AS.

  • 19.
    Ahlström, Christer
    et al.
    Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Jansson, Sabina
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Anund, Anna
    Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken. Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Local changes in the wake electroencephalogram precedes lane departures2017Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, nr 6, s. 816-819Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this exploratory study is to investigate if lane departures are associated with local sleep, measured via source-localized electroencephalography (EEG) theta power in the 5-9 Hz frequency range. Thirty participants drove in an advanced driving simulator, resulting in 135 lane departures at high levels of self-reported sleepiness. These lane departures were compared to matching non-departures at the same sleepiness level within the same individual. There was no correspondence between lane departures and global theta activity. However, at the local level an increased risk for lane departures was associated with increased theta content in brain regions related to motor function.

  • 20.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Hult, Peter
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Chaotic dynamics of respiratory sounds2006Ingår i: Chaos, Solitons & Fractals, ISSN 0960-0779, E-ISSN 1873-2887, Vol. 29, nr 5, s. 1054-1062Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a growing interest in nonlinear analysis of respiratory sounds (RS), but little has been done to justify the use of nonlinear tools on such data. The aim of this paper is to investigate the stationarity, linearity and chaotic dynamics of recorded RS. Two independent data sets from 8 + 8 healthy subjects were recorded and investigated. The first set consisted of lung sounds (LS) recorded with an electronic stethoscope and the other of tracheal sounds (TS) recorded with a contact accelerometer. Recurrence plot analysis revealed that both LS and TS are quasistationary, with the parts corresponding to inspiratory and expiratory flow plateaus being stationary. Surrogate data tests could not provide statistically sufficient evidence regarding the nonlinearity of the data. The null hypothesis could not be rejected in 4 out of 32 LS cases and in 15 out of 32 TS cases. However, the Lyapunov spectra, the correlation dimension (D2) and the Kaplan-Yorke dimension (DKY) all indicate chaotic behavior. The Lyapunov analysis showed that the sum of the exponents was negative in all cases and that the largest exponent was found to be positive. The results are partly ambiguous, but provide some evidence of chaotic dynamics of RS, both concerning LS and TS. The results motivate continuous use of nonlinear tools for analysing RS data. © 2005 Elsevier Ltd. All rights reserved.

  • 21.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Länne, Toste
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    A respiration monitor based on electrocardiographic and photoplethysmographic sensor fusion2004Ingår i: IEEE Engineering in Medical and Biological Society,2004, Piscataway, N.J. USA: IEEEEMBS , 2004, s. 2311-Konferensbidrag (Refereegranskat)
  • 22.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Länne, Toste
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Monitorering av andning and blodtrycksförändringar baserat på EKG och hjärtljud2007Ingår i: Medicinteknik dagarna,2007, 2007Konferensbidrag (Övrigt vetenskapligt)
  • 23.
    Ahlström, Christer
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Johansson, Anders
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Uhlin, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Njurmedicin.
    Länne, Toste
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Ask, Per
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik.
    Noninvasive investigation of blood pressure changes using the pulse wave transit time: A novel approach in the monitoring of hemodialysis patients2005Ingår i: Journal of Artificial Organs, ISSN 1434-7229, E-ISSN 1619-0904, Vol. 8, nr 3, s. 192-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Severe blood pressure changes are well known in hemodialysis. Detection and prediction of these are important for the well-being of the patient and for optimizing treatment. New noninvasive methods for this purpose are required. The pulse wave transit time technique is an indirect estimation of blood pressure, and our intention is to investigate whether this technique is applicable for hemodialysis treatment. A measurement setup utilizing lower body negative pressure and isometric contraction was used to simulate dialysis-related blood pressure changes in normal test subjects. Systolic blood pressure levels were compared to different pulse wave transit times, including and excluding the cardiac preejection period. Based on the results of these investigations, a pulse wave transit time technique adapted for dialysis treatment was developed and tried out on patients. To determine systolic blood pressure in the normal group, the total pulse wave transit time was found most suitable (including the cardiac preejection period). Correlation coefficients were r = 0.80 ± 0.06 (mean ± SD) overall and r = 0.81 ± 0.16 and r = 0.09 ± 0.62 for the hypotension and hypertension phases, respectively. When applying the adapted technique in dialysis patients, large blood pressure variations could easily be detected when present. Pulse wave transit time is correlated to systolic blood pressure within the acceptable range for a trend-indicating system. The method's applicability for dialysis treatment requires further studies. The results indicate that large sudden pressure drops, like those seen in sudden hypovolemia, can be detected. © The Japanese Society for Artificial Organs 2005.

  • 24.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik.
    Liljefeldt, Olle
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik.
    Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction.2005Ingår i: Medicinteknikdagarna, 2005, Vol. 12, s. 812-815Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Heart sounds (HS) obscure the interpretation of lung sounds (LS). This letter presents a new method to detect and remove this undesired disturbance. The HS detection algorithm is based on a recurrence time statistic that is sensitive to changes in a reconstructed state space. Signal segments that are found to contain HS are removed, and the arising missing parts are replaced with predicted LS using a nonlinear prediction scheme. The prediction operates in the reconstructed state space and uses an iterated integrated nearest trajectory algorithm. The HS detection algorithm detects HS with an error rate of 4% false positives and 8% false negatives. The spectral difference between the reconstructed LS signal and an LS signal with removed HS was 0 34 0 25, 0 50 0 33, 0 46 0 35, and 0 94 0 64 dB/Hz in the frequency bands 20–40, 40–70, 70–150, and 150–300 Hz, respectively. The cross-correlation index was found to be 99.7%, indicating excellent similarity between actual LS and predicted LS. Listening tests performed by a skilled physician showed high-quality auditory results.

  • 25.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Liljefeldt, Olle
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    Hult, Peter
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Tekniska högskolan.
    Heart sound cancellation from lung sound recordings using recurrence time statistics and nonlinear prediction2005Ingår i: IEEE Signal Processing Letters, ISSN 1070-9908, E-ISSN 1558-2361, Vol. 12, nr 12, s. 812-815Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Heart sounds (HS) obscure the interpretation of lung sounds (LS). This letter presents a new method to detect and remove this undesired disturbance. The HS detection algorithm is based on a recurrence time statistic that is sensitive to changes in a reconstructed state space. Signal segments that are found to contain HS are removed, and the arising missing parts are replaced with predicted LS using a nonlinear prediction scheme. The prediction operates in the reconstructed state space and uses an iterated integrated nearest trajectory algorithm. The HS detection algorithm detects HS with an error rate of 4% false positives and 8% false negatives. The spectral difference between the reconstructed LS signal and an LS signal with removed HS was 0.34/spl plusmn/0.25, 0.50/spl plusmn/0.33, 0.46/spl plusmn/0.35, and 0.94/spl plusmn/0.64 dB/Hz in the frequency bands 20-40, 40-70, 70-150, and 150-300 Hz, respectively. The cross-correlation index was found to be 99.7%, indicating excellent similarity between actual LS and predicted LS. Listening tests performed by a skilled physician showed high-quality auditory results.

  • 26.
    Ahlström, Christer
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Ask, Per
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    Johansson, Anders
    Linköpings universitet, Institutionen för medicinsk teknik, Fysiologisk mätteknik. Linköpings universitet, Hälsouniversitetet.
    A method for accurate localization of the first heart sound and possible applications2008Ingår i: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 29, nr 3, s. 417-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We have previously developed a method for localization of the first heart sound (S1) using wavelet denoising and ECG-gated peak-picking. In this study, an additional enhancement step based on cross-correlation and ECG-gated ensemble averaging (EA) is presented. The main objective of the improved method was to localize S1 with very high temporal accuracy in (pseudo-) real time. The performance of S1 detection and localization, with and without EA enhancement, was evaluated on simulated as well as experimental data. The simulation study showed that EA enhancement reduced the localization error considerably and that S1 could be accurately localized at much lower signal-to-noise ratios. The experimental data were taken from ten healthy subjects at rest and during invoked hyper- and hypotension. For this material, the number of correct S1 detections increased from 91% to 98% when using EA enhancement. Improved performance was also demonstrated when EA enhancement was used for continuous tracking of blood pressure changes and for respiration monitoring via the electromechanical activation time. These are two typical applications where accurate localization of S1 is essential for the results.

  • 27.
    Ahn, Henrik Casimir
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Jodal, M.
    Lindhagen, J
    Lundgren, O.
    Nilsson, Gert
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Salerud, Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Bestämning av tunntarmsblodflödet med laser Doppler teknik1984Ingår i: Läkarsällskapets Riksstämma,1984, 1984Konferensbidrag (Övrigt vetenskapligt)
  • 28.
    Ahn, Henrik Casimir
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Johansson, K.
    Lindhagen, J.
    Nilsson, Gert
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Salerud, Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Förändringar av blodflödet i ventrikeln i samband med mätt med laser Dopplerteknik1984Ingår i: Läkarsällskapets Riksstämma,1984, 1984Konferensbidrag (Övrigt vetenskapligt)
  • 29.
    Ahn, Henrik Casimir
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Johansson, K.
    Lindhagen, J.
    Salerud, Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Laser Doppler flowmetry in the assessment of gastric blood flow1984Ingår i: man. Scand J of Gastroenterology,1984, 1984, s. 98:33-98:33Konferensbidrag (Övrigt vetenskapligt)
  • 30.
    Ahn, Henrik Casimir
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Lindhagen, J.
    Nilsson, Gert
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Salerud, Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Jodal, M.
    Lundgren, O.
    Evaluation of Laser Doppler Flowmetry in the assessment of blood flow in the small intestine1984Ingår i: Third World Congress of Microcirculation,1984, 1984Konferensbidrag (Övrigt vetenskapligt)
  • 31.
    Ahn, Henrik Casimir
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Thoraxkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Lindhagen, J
    Nilsson, Gert
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Salerud, Göran
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Jodal, M
    Lundgren, O
    Evaluation of Laser Doppler Flowmetry in the assessment of intestinal blood flow1985Ingår i: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 4, nr 88, s. 951-957Artikel i tidskrift (Refereegranskat)
    Abstract [en]

      

  • 32.
    Akbarian-Tefaghi, Ladan
    et al.
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Akram, Harith
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Johansson, Johannes
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Zrinzo, Ludvic
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Kefalopoulou, Zinovia
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Limousin, Patricia
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Joyce, Eileen
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Hariz, Marwan
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Foltynie, Tom
    Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
    Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome2017Ingår i: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 95, nr 4, s. 251-258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated.

    OBJECTIVES: This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood.

    METHODS: Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (17-82 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement.

    RESULTS: A region within the ventral limbic GPi, specifically on the medial medullary lamina in the pallidum at the level of the AC-PC, was significantly associated with improved tics but not mood or OCB outcome.

    CONCLUSIONS: This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required.

  • 33.
    Ali, Zaheer
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Islam, Anik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Sherrell, Peter
    Imperial Coll London, England.
    Le-Moine, Mark
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Lolas, Georgios
    Univ Athens, Greece.
    Syrigos, Konstantinos
    Univ Athens, Greece.
    Rafat, Mehrdad
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Jensen, Lasse
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Adjustable delivery of pro-angiogenic FGF-2 by alginate: collagen microspheres2018Ingår i: BIOLOGY OPEN, ISSN 2046-6390, Vol. 7, nr 3, artikel-id UNSP bio027060Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Therapeutic induction of blood vessel growth (angiogenesis) in ischemic tissues holds great potential for treatment of myocardial infarction and stroke. Achieving sustained angiogenesis and vascular maturation has, however, been highly challenging. Here, we demonstrate that alginate: collagen hydrogels containing therapeutic, pro-angiogenic FGF-2, and formulated as microspheres, is a promising and clinically relevant vehicle for therapeutic angiogenesis. By titrating the amount of readily dissolvable and degradable collagen with more slowly degradable alginate in the hydrogel mixture, the degradation rates of the biomaterial controlling the release kinetics of embedded proangiogenic FGF-2 can be adjusted. Furthermore, we elaborate a microsphere synthesis protocol allowing accurate control over sphere size, also a critical determinant of degradation/release rate. As expected, alginate: collagen microspheres were completely biocompatible and did not cause any adverse reactions when injected in mice. Importantly, the amount of pro-angiogenic FGF-2 released from such microspheres led to robust induction of angiogenesis in zebrafish embryos similar to that achieved by injecting FGF-2-releasing cells. These findings highlight the use of microspheres constructed from alginate: collagen hydrogels as a promising and clinically relevant delivery system for pro-angiogenic therapy.

  • 34.
    Almeida, Eduardo Carlos Venancio de
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska högskolan.
    Development of a wearable sensor system for real-time control of knee prostheses2012Självständigt arbete på avancerad nivå (masterexamen), 80 poäng / 120 hpStudentuppsats (Examensarbete)
    Abstract [en]

    It was demonstrated in recent studies that Complementary Limb Motion Estimation (CLME) is robust approach for controlling active knee prostheses. A wearable sensor system is then needed to provide inputs to the controller in a real-time platform. In the present work, a wearable sensor system based on magnetic and inertial measurement units (MIMU) together with a simple calibration procedure were proposed. This sensor system was intended to substitute and extend the capabilities of a previous device based on potentiometers and gyroscopes. The proposed sensor system and calibration were validated with an Optical Tracking System (OTS) in a standard gait lab and first results showed that the proposed solution had a performance comparable to similar studies in the literature.

  • 35.
    Almeida, Rosimary
    Linköpings universitet, Institutionen för medicinsk teknik, Centrum för medicinsk bildvetenskap och visualisering. Linköpings universitet, Tekniska högskolan.
    Severity of illness versus severity of disease: definitions and applications1996Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Outcome assessment should consist of two basic steps - "selection of a meaningful outcome" and "determination of what caused the outcome". The latter step requires comparisons, and therefore information about the initial status of the patients. Severity ratings attempt to group patients with similar initial status so that outcome comparisons are meaningful. They are consequently an essential ingredient in outcome assessment.

    This thesis aims at expanding the knowledge about outcome measurement focusing on the severity of a case with regard to definitions and applications of severity measures. Further, theoretical knowledge is integrated with practical needs for outcome assessment and methodology is developed for modelling the use of resources and interpreting the association between different severity measures.

    As with illness and disease, severity of illness and severity of disease are interchangeable terms in medical literature. Based on a holistic theory of health, these terms were differentiated. Severity of a case was described by two basic components - severity of disease and severity of illness. Essentially, severity of illness concerns suffering and disability, and severity of disease concerns risk of death, risk of suffering and risk of disability. These definitions were the core of a set of criteria for classifying severity measures or outcome measures.

    The role of a disease severity score in explaining resources use (e.g., intensity of technology utilization and length of hospital stay) in a neonatal intensive care unit was investigated. A disease severity score based on the death risk of the initial diagnosis was found to be an indicator of intensity of therapeutic technology together with gestational age and Apgar score. However, it does not show statistical significance to explain length of stay, which was explained by intensity of diagnostic technology and birthweight.

    The demand for patient classification systems (standard systems to describe a patient's condition) on a national and local level was investigated. There is little experience in the use of these systems, but at the same time there is a demand from the nurse managers for standard measures of a patient's need for care.

    There is still little knowledge about the association between severity of illness and severity of disease. This association was studied for patients with ulcerative colitis using data analysis techniques for dimension reduction such as cluster analysis, homogeneity analysis and non linear principal components analysis. A non linear relationship between illness and disease severity measures was found. The overall clinical judgement of disease activity was more related to illness patterns than symptoms or endoscopy and laboratory findings. In addition, the two measures of illness severity (Sickness Impact Profile and Rating Form for Inflammatory Bowel Disease Patient Concerns) were found to represent complementary information about a patient's illness experience. This illustrates the importance of conceptual knowledge in the selection process of an illness measure for outcome evaluations. These findings also reinforce the need for the development of systems to support interpretation of these kinds of complex associations, as traditional statistics have been shown to be of limited value under these circumstances.

  • 36.
    Almqvist, Ulf
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    Sjörs, Anna
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    Validation of MobileMe: a psychophysiological recording system – from a motion sickness perspective2006Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats
    Abstract [en]

    MobileMe is a recently developed system for monitoring and recording physiological variables. It is wireless, and can therefore be suitable for field research, for example when measuring motion sickness symptoms.

    The aim of this thesis was to conclude whether the MobileMe recording system was valid for research studies. A validation study, consisting of two parts and including 10 subjects, was performed. The first part was a laboratory study, where data from MobileMe and a reference equipment were compared. A field study was also performed, onboard a combat boat, to determine the equipment’s validity in uncontrolled environments. Furthermore, the field study included an investigation of motion sickness symptoms, and provided data for evaluation of motion sickness rating scales.

    Statistical results from the laboratory study, and results from evaluation of data from the field study, showed that MobileMe was valid in both controlled and uncontrolled environments.

  • 37.
    Alonso, Fabiola
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska högskolan.
    Modeling and simulation of DBS – comparison between leads and stimulation modes2014Konferensbidrag (Övrigt vetenskapligt)
  • 38.
    Alonso, Fabiola
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Deep brain stimulation (DBS) is an established surgical therapy for movement disorders such as Parkinson’s disease (PD) and essential tremor (ET). A thin electrode is implanted in a predefined area of the brain with the use of stereotactic neurosurgery. In the last few years new DBS electrodes and systems have been developed with possibilities for using more parameters for control of the stimulation volume.

    In this thesis, simulations using the finite element method (FEM) have been developed and used for investigation of the electric field (EF) extension around different types of DBS lead designs (symmetric, steering) and stimulation modes (voltage, current). The electrode surrounding was represented either with a homogeneous model or a patient-specific model based on individual preoperative magnetic resonance imaging (MRI). The EF was visualized and compared for different lead designs and operating modes.

    In Paper I, the EF was quantitatively investigated around two lead designs (3389 and 6148) simulated to operate in voltage and current mode under acute and chronic time points following implantation.Simulations showed a major impact on the EF extension between postoperative time points which may explain the clinical decisions to change the stimulation amplitude weeks after implantation. In Paper II, the simulations were expanded to include two leads having steering function (6180, Surestim1) and patient-specific FEM simulations in the zona incerta. It was found that both the heterogeneity of the tissue and the operating mode, influence the EF distribution and that equivalent contact configurations of the leads result in similar EF. The steering mode presented larger volumes in current mode when using equivalent amplitudes. Simulations comparing DBS and intraoperative stimulation test using a microelectrode recording (MER) system (Paper III), showed that several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution and that the DBS EF volume can cover, but also extend to, other anatomical areas.

    Paper IV introduces a method for an objective exploitation of intraoperative stimulation test data in order to identify the optimal implant position in the thalamus of the chronic DBS lead. Patient-specific EF simulations were related to the anatomy with the help of brain atlases and the clinical effects which were quantified by accelerometers. The first results indicate that the good clinical effect in ET is due to several structures around the ventral intermediate nucleus of the thalamus.

    Delarbeten
    1. Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study
    Öppna denna publikation i ny flik eller fönster >>Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study
    2015 (Engelska)Ingår i: Brain Disorders and Therapy, ISSN 2168-975X, Vol. 4, nr 3, artikel-id 1000169Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available. To switch between DBS-systems remains complicated as clinicians may lose their reference for programming. Simulations can help increase the understanding.

    Objective: To quantitatively investigate the electric field (EF) around two lead designs simulated to operate in voltage and current mode under two time points following implantation.

    Methods: The finite element method was used to model Lead 3389 (Medtronic) and 6148 (St Jude) with homogenous surrounding grey matter and a peri-electrode space (PES) of 250 μm. The PES-impedance mimicked the acute (extracellular fluid) and chronic (fibrous tissue) time-point. Simulations at different amplitudes of voltage and current (n=236) were performed using two different contacts. Equivalent current amplitudes were extracted by matching the shape and maximum EF of the 0.2 V/mm isolevel.

    Results: The maximum EF extension at 0.2 V/mm varied between 2-5 mm with a small difference between the leads. In voltage mode EF increased about 1 mm at acute compared to the chronic PES. Current mode presented the opposite relationship. Equivalent EFs for lead 3389 at 3 V were found for 7 mA (acute) and 2.2 mA (chronic).

    Conclusions: Simulations showed a major impact on the electric field extension between postoperative time points. This may explain the clinical decisions to reprogram the amplitude weeks after implantation. Neither the EF extension nor intensity is considerably influenced by the lead design.

    Ort, förlag, år, upplaga, sidor
    Los Angeles, CA, USA: Omics Publishing Group, 2015
    Nyckelord
    deep brain stimulation (DBS), voltage and current stimulation, finite element method
    Nationell ämneskategori
    Annan elektroteknik och elektronik
    Identifikatorer
    urn:nbn:se:liu:diva-120680 (URN)10.4172/2168-975X.1000169 (DOI)
    Forskningsfinansiär
    Vetenskapsrådet, 621-2013-6078
    Tillgänglig från: 2015-08-21 Skapad: 2015-08-20 Senast uppdaterad: 2018-09-10Bibliografiskt granskad
    2. Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study
    Öppna denna publikation i ny flik eller fönster >>Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study
    Visa övriga...
    2016 (Engelska)Ingår i: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 6, nr 3, s. 1-16Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    New deep brain stimulation (DBS) electrode designs offer operation in voltage and current mode and capability to steer the electric field (EF). The aim of the study was to compare the EF distributions of four DBS leads at equivalent amplitudes (3 V and 3.4 mA). Finite element method (FEM) simulations (n = 38) around cylindrical contacts (leads 3389, 6148) or equivalent contact configurations (leads 6180, SureStim1) were performed using homogeneous and patient-specific (heterogeneous) brain tissue models. Steering effects of 6180 and SureStim1 were compared with symmetric stimulation fields. To make relative comparisons between simulations, an EF isolevel of 0.2 V/mm was chosen based on neuron model simulations (n = 832) applied before EF visualization and comparisons. The simulations show that the EF distribution is largely influenced by the heterogeneity of the tissue, and the operating mode. Equivalent contact configurations result in similar EF distributions. In steering configurations, larger EF volumes were achieved in current mode using equivalent amplitudes. The methodology was demonstrated in a patient-specific simulation around the zona incerta and a “virtual” ventral intermediate nucleus target. In conclusion, lead design differences are enhanced when using patient-specific tissue models and current stimulation mode.

    Ort, förlag, år, upplaga, sidor
    MDPI, 2016
    Nyckelord
    deep brain stimulation (DBS), steering, patient-specific, electric field, finite element method, neuron model, brain model, zona incerta (ZI), electrode design
    Nationell ämneskategori
    Medicinteknik
    Identifikatorer
    urn:nbn:se:liu:diva-131863 (URN)10.3390/brainsci6030039 (DOI)27618109 (PubMedID)
    Tillgänglig från: 2016-10-11 Skapad: 2016-10-11 Senast uppdaterad: 2018-09-10Bibliografiskt granskad
    3. Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems: A Simulation Study
    Öppna denna publikation i ny flik eller fönster >>Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems: A Simulation Study
    Visa övriga...
    2018 (Engelska)Ingår i: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 8, nr 2Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome. Finite element models of a MER system and a chronic DBS lead were developed. Simulations of the EF were performed for homogenous and patient-specific brain models to evaluate the influence of grounding (guide tube vs. stimulator case), parallel MER leads, and non-active DBS contacts. Results showed that the EF is deformed depending on the distance between the guide tube and stimulating contact. Several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution. The DBS EF volume can cover the intraoperatively produced EF, but can also extend to other anatomical areas. In conclusion, EF deformations between stimulation tests and DBS should be taken into consideration as they can alter the clinical outcome

    Ort, förlag, år, upplaga, sidor
    MDPI, 2018
    Nyckelord
    microelectrode recording (MER); finite element method (FEM); deep brain stimulation (DBS); brain model; Dice coefficient; patient-specific
    Nationell ämneskategori
    Medicinteknik
    Identifikatorer
    urn:nbn:se:liu:diva-145112 (URN)10.3390/brainsci8020028 (DOI)
    Tillgänglig från: 2018-02-12 Skapad: 2018-02-12 Senast uppdaterad: 2018-09-10
    4. Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus
    Öppna denna publikation i ny flik eller fönster >>Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus
    Visa övriga...
    2016 (Engelska)Ingår i: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 10, s. 1-14, artikel-id 577Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Despite an increasing use of deep brain stimulation (DBS) the fundamental mechanisms of action remain largely unknown. Simulation of electric entities has previously been proposed for chronic DBS combined with subjective symptom evaluations, but not for intraoperative stimulation tests. The present paper introduces a method for an objective exploitation of intraoperative stimulation test data to identify the optimal implant position of the chronic DBS lead by relating the electric field (EF) simulations to the patient-specific anatomy and the clinical effects quantified by accelerometry. To illustrate the feasibility of this approach, it was applied to five patients with essential tremor bilaterally implanted in the ventral intermediate nucleus (VIM). The VIM and its neighborhood structures were preoperatively outlined in 3D on white matter attenuated inversion recovery MR images. Quantitative intraoperative clinical assessments were performed using accelerometry. EF simulations (n = 272) for intraoperative stimulation test data performed along two trajectories per side were set-up using the finite element method for 143 stimulation test positions. The resulting EF isosurface of 0.2 V/mm was superimposed to the outlined anatomical structures. The percentage of volume of each structure’s overlap was calculated and related to the corresponding clinical improvement. The proposed concept has been successfully applied to the five patients. For higher clinical improvements, not only the VIM but as well other neighboring structures were covered by the EF isosurfaces. The percentage of the volumes of the VIM, of the nucleus intermediate lateral of the thalamus and the prelemniscal radiations within the prerubral field of Forel increased for clinical improvements higher than 50% compared to improvements lower than 50%. The presented new concept allows a detailed and objective analysis of a high amount of intraoperative data to identify the optimal stimulation target. First results indicate agreement with published data hypothesizing that the stimulation of other structures than the VIM might be responsible for good clinical effects in essential tremor. (Clinical trial reference number: Ref: 2011-A00774-37/AU905)

    Ort, förlag, år, upplaga, sidor
    Frontiers Research Foundation, 2016
    Nyckelord
    deep brain stimulation (DBS), intraoperative stimulation tests, essential tremor, acceleration measurements, finite element method (FEM) simulations, ventral intermediate nucleus (VIM), patient-specific brain maps
    Nationell ämneskategori
    Medicinteknik
    Identifikatorer
    urn:nbn:se:liu:diva-132790 (URN)10.3389/fnhum.2016.00577 (DOI)000388426400001 ()
    Tillgänglig från: 2016-11-25 Skapad: 2016-11-25 Senast uppdaterad: 2018-09-10Bibliografiskt granskad
  • 39.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Hemm-Ode, Simone
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska högskolan. University of Applied Sciences and Arts Northwestern Switzerland.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes – A Simulation Study2015Ingår i: Brain Disorders and Therapy, ISSN 2168-975X, Vol. 4, nr 3, artikel-id 1000169Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available. To switch between DBS-systems remains complicated as clinicians may lose their reference for programming. Simulations can help increase the understanding.

    Objective: To quantitatively investigate the electric field (EF) around two lead designs simulated to operate in voltage and current mode under two time points following implantation.

    Methods: The finite element method was used to model Lead 3389 (Medtronic) and 6148 (St Jude) with homogenous surrounding grey matter and a peri-electrode space (PES) of 250 μm. The PES-impedance mimicked the acute (extracellular fluid) and chronic (fibrous tissue) time-point. Simulations at different amplitudes of voltage and current (n=236) were performed using two different contacts. Equivalent current amplitudes were extracted by matching the shape and maximum EF of the 0.2 V/mm isolevel.

    Results: The maximum EF extension at 0.2 V/mm varied between 2-5 mm with a small difference between the leads. In voltage mode EF increased about 1 mm at acute compared to the chronic PES. Current mode presented the opposite relationship. Equivalent EFs for lead 3389 at 3 V were found for 7 mA (acute) and 2.2 mA (chronic).

    Conclusions: Simulations showed a major impact on the electric field extension between postoperative time points. This may explain the clinical decisions to reprogram the amplitude weeks after implantation. Neither the EF extension nor intensity is considerably influenced by the lead design.

  • 40.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Latorre, Malcolm
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Göransson, Nathanael
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US.
    Zsigmond, Peter
    Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Wårdell, karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Investigation into Deep Brain Stimulation Lead Designs: A Patient-Specific Simulation Study2016Ingår i: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 6, nr 3, s. 1-16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    New deep brain stimulation (DBS) electrode designs offer operation in voltage and current mode and capability to steer the electric field (EF). The aim of the study was to compare the EF distributions of four DBS leads at equivalent amplitudes (3 V and 3.4 mA). Finite element method (FEM) simulations (n = 38) around cylindrical contacts (leads 3389, 6148) or equivalent contact configurations (leads 6180, SureStim1) were performed using homogeneous and patient-specific (heterogeneous) brain tissue models. Steering effects of 6180 and SureStim1 were compared with symmetric stimulation fields. To make relative comparisons between simulations, an EF isolevel of 0.2 V/mm was chosen based on neuron model simulations (n = 832) applied before EF visualization and comparisons. The simulations show that the EF distribution is largely influenced by the heterogeneity of the tissue, and the operating mode. Equivalent contact configurations result in similar EF distributions. In steering configurations, larger EF volumes were achieved in current mode using equivalent amplitudes. The methodology was demonstrated in a patient-specific simulation around the zona incerta and a “virtual” ventral intermediate nucleus target. In conclusion, lead design differences are enhanced when using patient-specific tissue models and current stimulation mode.

  • 41.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik.
    Latorre, Malcolm
    Linköpings universitet, Institutionen för medicinsk teknik.
    Zsigmond, Peter
    Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik.
    Brain Stimulation Steering of the Electric Field: A Patient-Specific Simulation Study2016Konferensbidrag (Refereegranskat)
  • 42.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Vogel, Dorian
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. University of Applied Sciences and Arts Northwestern Switzerland FHNW, 4132 Muttenz, Switzerland.
    Johansson, Johannes
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Hemm, Simone
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. rthwestern Switzerland FHNW, 4132 Muttenz, Switzerland.
    Electric Field Comparison between Microelectrode Recording and Deep Brain Stimulation Systems: A Simulation Study2018Ingår i: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 8, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome. Finite element models of a MER system and a chronic DBS lead were developed. Simulations of the EF were performed for homogenous and patient-specific brain models to evaluate the influence of grounding (guide tube vs. stimulator case), parallel MER leads, and non-active DBS contacts. Results showed that the EF is deformed depending on the distance between the guide tube and stimulating contact. Several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution. The DBS EF volume can cover the intraoperatively produced EF, but can also extend to other anatomical areas. In conclusion, EF deformations between stimulation tests and DBS should be taken into consideration as they can alter the clinical outcome

  • 43.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Vogel, Dorian
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Hemm-Ode, Simone
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten. Institute for Medical and Analytical Technologies and Department of Biomedical Engineering, University of Applied Sciences and Art Northwestern Switzerland.
    Comparison between intraoperative and chronic and deep brain stimulation2017Konferensbidrag (Refereegranskat)
    Abstract [en]

    INTRODUCTION

    The success of the deep brain stimulation (DBS) therapy relies primarily in the localization of the implanted electrode, implying the need of utmost accuracy in the targeting process. Intraoperative microelectrode recording and stimulation tests are a common procedure before implanting the permanent DBS lead to determine the optimal position with a large therapeutic window where side effects are avoided and the best improvement of the symptoms is achieved. Differences in dimensions and operating modes exist between the exploration and the permanent DBS electrode which might lead to different stimulation fields, even when ideal placement is achieved. The aim of this investigation is to compare the electric field (EF) distribution around the intraoperative and the chronic electrode, assuming that both have exactly the same position.

    METHODS

    3D models of the intraoperative exploration electrode and the chronically implanted DBS lead 3389 (Medtronic Inc., USA) were developed using COMSOL 5.2 (COMSOL AB, Sweden). Patient-specific MR images were used to determine the conductive medium around the electrode. The exploration electrode and the first DBS contact were set to current and voltage respectively (0.2mA(V) - 3 mA(V) in 0.1 mA(V) steps). The intraoperative model included the grounded guide tube used to introduce the exploration electrode; for the chronic DBS model, the outer boundaries were grounded and the inactive contacts were set to floating potential considering a monopolar configuration. The localization of the exploration and the chronic electrode was set according to the planned trajectory. The EF was visualized and compared in terms of volume and extension using a fixed isocontour of 0.2 V/mm.

    RESULTS

    The EF distribution simulated for the exploration electrode showed the influence of the parallel trajectory and the grounded guide tube. For an amplitude of e.g. 2 mA/2 V, the EF extension of the intraoperative was 0.6 mm larger than the chronic electrode at the target level; the corresponding difference in volume was 76.1 mm3.

    CONCLUSION

    Differences in the EF shape between the exploration and the chronic DBS electrode have been observed using patient-specific models. The larger EF extension obtained for the exploration electrode responds to its higher impedance and the use of current controlled stimulation. The presence of EF around the guide tube and the influence of the parallel trajectory require further experimental and clinical evaluation.

  • 44.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska högskolan.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska högskolan.
    Comparison of deep brain stimulation systems2014Ingår i: Poster Presentations, 2014, Vol. 29, s. 1173-1173, artikel-id Suppl 1Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To quantitatively compare the electric field generated by voltage and current controlled deep brain stimulation systems.

    Background: Traditionally deep brain stimulation (DBS) systems have used voltage control however more recently, current controlled systems have been approved to treat Parkinson's disease and related movement disorders. In the endeavor of understanding the behavior of DBS systems a common approach is the use of computer models suitable to simulate the electric field, current density and other related electric parameters.

    Methods: 2D finite element models based on commercially available DBS systems have been built for each system: I. Model 3389, Medtronic Inc., USA for voltage control; and II. Model 6142, St Jude Medical Inc. USA for current control. The brain tissue has been simplified to homogeneous and isotropic medium. The electric settings correspond to a monopolar configuration, using one of the four contacts available as the active electrode and the outer boundary of the tissue as the reference. Three simulations were performed to mimic different stages of the leads implantation: a) an original stage where the brain tissue is considered as pure gray matter, b) an acute stage that simulates the leakage of cerebral spinal fluid immediately after the electrodes' insertion; and c) a chronic stage mimicking fibrous tissue created around the electrodes some weeks after implantation. Both systems were submitted to the same conditions using as active electrode the third contact from the tip of the lead. The comparison is based on the maximal distance reached by the isopotential of 0.2 V/mm.

    Results: The simulations showed that voltage controlled stimulation systems are more susceptible to changes in the electrical conductivity of the medium i.e. change over time of the tissue around the electrode. This agrees with the adjustment of the stimulation amplitude often necessary a few weeks postoperatively. Current controlled stimulation in turn, presented a linear behavior of the distance reached at different stimulation amplitudes at all stages.

    Conclusions: Current controlled stimulation might be a good option due to its linear behavior over time, nevertheless more studies including a more realistic brain model, different designs of DBS electrodes and different electric parameter, are needed to encourage the use of this type of systems.

  • 45.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Tekniska fakulteten. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Electric Field Comparison of Deep Brain Stimulation Lead Designs - a Stimulation Study2016Konferensbidrag (Refereegranskat)
  • 46.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Latorre, Malcolm
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Comparison of Three Deep Brain Stimulation Lead Designs under Voltage and Current Modes2015Ingår i: WORLD CONGRESS ON MEDICAL PHYSICS AND BIOMEDICAL ENGINEERING, 2015, VOLS 1 AND 2 / [ed] David A. Jaffray, Springer, 2015, Vol. 51, s. 1196-1199Konferensbidrag (Refereegranskat)
    Abstract [en]

    Since the introduction of deep brain stimulation (DBS) the technique has been dominated by Medtronic sys-tems. In recent years, new DBS systems have become available for patients, and some are in clinical trials. The present study aims to evaluate three DBS leads operated in either voltage or current mode. 3D finite element method (FEM) models were built in combination with a neuron model for this purpose. The axon diameter was set to D = 5 μm and simulations performed in both voltage (0.5-5 V) and current (0.5-5 mA) mode. The evaluation was achieved based on the distance from the lead for neural activation and the electric field (EF) extension at 0.1 V/mm. The results showed that the neural activation distance agrees well between the leads with an activation distance dif-ference less than 0.5 mm. The shape of the field at the 0.1 V/mm isopotential surface in 3D is mostly spherical in shape around the activated section of the steering lead.

  • 47.
    Alonso, Fabiola
    et al.
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Latorre, Malcolm
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska fakulteten.
    Neural Activation Compared to Electric Field Extension of Three DBS Lead Designs2015Konferensbidrag (Refereegranskat)
    Abstract [en]

    SINCE the introduction of deep brain stimulation (DBS) about 20 years ago, the stimulation technique has been dominated by Medtronic DBS-system setup. In recent years, new DBS systems have become available, of which some are in clinical trials or available to patients [1]. In the present study three different lead designs are investigated via computer simulation:

    Medtronic 3389, St. Jude 6148 and Sapiens SureStim. The aim was to compare the neural activation distance and the electric field (EF) maximum spatial extension for each lead.

    A 3D finite element method model was built using COMSOL Multiphysics 4.4a (COMSOL AB, Stockholm, Sweden) to simulate the electric potential around the DBS lead. Brain tissue was modelled as a homogeneous volume of grey matter (electric conductivity of 0.09 S/m). The electrode-tissue interface was modelled with a 250μm thick peri-electrode space mimicking the fibrous tissue which covers the lead at the chronic stimulation stage (σ = 0.06S/m, equivalent to white matter electric conductivity). The stimulation amplitude was set to 1V in monopolar configuration using C1 electrode or equivalent in all cases. Each simulated electric potential distribution was exported to MatLab (The MathWorks, USA) and used as input to a cable neuron simulation.

    An axon cable model with 21 nodes based on the concept by Åström et al., [2] was set up in MatLab and combined with the exported field distributions. The model considered a 5 μm thick neuron, a pulse width of 60 μs and a drive potential ranging from 0.5 V to 5 V in 0.5 V steps.

    The SureStim lead results showed a shorter neural activation distance and EF extension. The distance to the isolevel of 0.2 V/mm is close to the neural activation distance at each stimulation amplitude, and we conclude that the electric field is a suitable predictor to visualize the stimulated regions.

  • 48.
    Alonso Orozco, Fabiola
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    Finite Element Method Modelling and Simulations for Comparisonbetween Deep Brain Stimulation Electrodes2012Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [en]

    The Deep Brain Stimulation (DBS) is an invasive therapy that alleviates the symptoms of several neurological disorders by electrically stimulating specific regions of the brain, generally within the basal ganglia. Until now Medtronic DBS system is the only approved by the Food and Drug Administration, nevertheless European and Australian countries  have recently approved St. Jude DBS systems to treat Parkinson’s disease and related movement disorders.

         Traditionally, voltage-controlled stimulation (the type of systems provided by Medtronic) has been used and clinicians are familiar with its settings; however the knowledge about systems based in current-controlled stimulation (St. Jude systems) is rather scarce. One of the key factors for a successful therapy is the optimal selection of the electrical parameters for stimulation. Due to the critical zone where the surgery is performed, modeling and simulations of DBS systems have been extensively used to observe how the electric field is distributed in the brain tissue and ultimately to help the clinicians to select the best parameters.

         In this thesis two finite element models of the DBS systems mentioned above have been developed; five examinations were designed, based on the physical and electrical differences between the systems, to observe and quantitatively compare the electric field distribution.

        The aim of this thesis was to investigate the differences between two representative models of each company but moreover to contribute with information regarding current-controlled stimulation.

    The results obtained are expected to be useful for further investigations where the magnitude and distribution of the electric field generated by this type of electrodes are needed.

  • 49.
    Andersen, Per Øivin
    et al.
    University of Bergen, Norway.
    Babic, Ankica
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan. University of Bergen, Norway.
    Mobile-supported life charting for bipolar patients - user requirements study2013Ingår i: MEDINFO 2013: proceedings of the 14th World Congress on Medical and Health Informatics / [ed] Christoph Ulrich Lehmann, Elske Ammenwerth, Christian Nøhr, IOS Press, 2013, s. 1111-Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    It is assumed that bipolar disorder patients can benefit from monitoring their mood, sleep, medicine intake and behavior which could be both done by patients themselves and in cooperation with health care professionals. This study aims at understanding what is required from a computerized system, as seen from the view of therapists and the patients, and how the newer mobile technologies (smart phones and tablets) can be utilized to support development of such a system. The study focuses on several existing solutions available either freely or on the market. Then these solutions are evaluated by both patients and medical professionals as a part of the system requirements study to be used in a new system development that will utilize mobile technologies to support the performance and patient outcomes.

  • 50. Anderson, C.
    et al.
    Andersson, T.
    Wårdell, Karin
    Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk instrumentteknik. Linköpings universitet, Tekniska högskolan.
    Changes in skin circulation after microdialysis probe insertion visualized by laser Doppler perfusion imaging1994Ingår i: Journal of Investigative Dermatology, ISSN 0022-202X, E-ISSN 1523-1747, Vol. 102, nr 5, s. 807-811Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Microdialysis makes possible in vivo estimation of endogenous and exogenous substances in the dermal extracellular space. Insertion of the microdialysis probe and its subsequent presence in the skin may affect both the reactivity of the skin test site and the measurement of target substances. Laser Doppler flowmetry is a non-invasive method for estimating cutaneous blood flow. A further development of this technique, laser Doppler perfusion imaging, has been used to study the time course of the circulatory changes caused in the area of microdialysis probe insertion. Laser Doppler perfusion imaging was performed prior to, during, and after microdialysis probe insertion in the skin of the ventral forearm in three subjects. Probe insertion caused an increase in skin blood perfusion in the whole test area. About 15 min after probe insertion, the flare, which is presumed to be of chiefly axon reflex origin, began to subside and the circulatory response could be seen to center around the site of insertion and the tip of the probe. Skin perfusion levels had returned to near normal levels within 60 min. Local anesthesia of the point of guide insertion inhibited the flare, but did not affect circulatory reactivity in the skin nearby. Both microdialysis and laser Doppler perfusion imaging seem to be promising new methods in dermatologic research.

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