Classification of morphological features extracted from intracranial pressure recordings in the diagnosis of Normal Pressure Hydrocephalus (NPH).

The intracranial pressure (ICP) monitoring is a common procedure in neuro-intensive care for pathologies such traumatic brain injuries or hemorrhages, but also for chronic ones as the Normal Pressure Hydrocephalus (NPH). The only available treatment for NPH is the surgical implantation of a shunt with the aim of routing cerebrospinal fluid (CSF) away from the brain to another part of the body. In this study, using the classification software WEKA, an intensive investigation of ICP signals has been conducted. In particular we studied 14 ICP recordings of different patients who underwent an infusion test, with the aim of investigating the presence of NPH through the ICP recording. More precisely, 20 morphological features are extracted from the ICP pulsed wave, the trend have been computed and, for each one, 9 statistical functions determined. The 180 features have been selected and passed for the classification. The results obtained shows how, among the 14 patients, a number of 12 out of 14 (85.7%) have been correctly classified, looking at just 3 features. In particular 8 out of 9 not-NPH-affected patients were correctly identified (88.89%) while 4 out of 5 NPH-affected patients were correctly identified (80%).

R-point detection for noise affected ECG recording through signal segmentation.

In this work we propose a novel approach for filtering noise-affected electrocardiogram (ECG) signals. The proposed method, mainly based on signal approximation by means of linear segments, has been applied for R-peaks recognition and has been compared with both cardiologists' manual marking and the automatic Laguna's method. The obtained results show that when compared to the Laguna's method the proposed algorithm provides a smaller mean error and a better error distribution.

Novel sensing materials for breath analysis devices.

The development of new transition metal complexes (TMCs) sensing materials, based on di-rhodium (II,II) complexes with a lantern structure, is investigated. Specifically, in this work is reported a study carried out with the Rh2(form)4 complex having the formamidinate (form = N.N-p-tolylformamidinate anion) bridging ligand in the equatorial positions. Thick films of the complex have been deposited on interdigitated alumina substrate and their electrical characteristics have been evaluated. Rh2(form)4 behaves as a p-type semiconductor, showing a large decrease in forward and reverse current in presence of ammonia vapors in air. The preliminary results reported promise a practical application of the developed devices in the breath analysis for clinical diagnostics.

GIS and spatial analysis for costs and services optimization in neurological telemedicine.

Telemedicine is an integrated, biomedical and psychosocial, secondary prevention intervention, where a specialized team guides the patient and his family in the course of the disease by reducing the stress of caregivers and allowing patients to stay longer at home, reducing, consequently, costs related to go to the specialist clinic. Teleneurology is a part of Telemedicine which uses modern communication technologies to allow neurology to be practiced when the doctor and patient are not present in the same place, and possibly not at the same time. This study focuses on identifying regional spots as potential territorial stations for the telemedicine service through the GIS (Geographical Information System), a computerized systems that allows placement of data of different types and sources into one system to manage and form spatial relationships that allow the display and analysis of relationships of geographic, environmental, and population factors (Scholten & de Lepper, 1991). We analyzed the optimal location of territorial telemedicine spots in correspondence of general practitioner clinics. It could be intended as a way to involve general practitioners in the management of those patients. The aim of this study is to improve the quality of life of patients and their caregivers providing a continuity of care through this system that reduces the inconvenience of travel and related costs. We estimated, then, the reduction of costs for patients and care-givers joining the telemedicine service in terms of hours out of work.

Analysis of intracranial pressure recordings: comparison of PCA and signal averaging based filtering methods and signal period estimation.

Intracranial pressure monitoring is a common used approach for neuro-intensive care in cases of brain damages and injuries or to investigate chronic pathologies. Several types of noises and artifacts normally contaminate ICP recordings. They can be sorted in 2 classes, i.e. high-frequency noises (due to measurement and amplifier devices or electricity supply presence) and low-frequency noises (due to unwanted patient's movement, speeches, coughing during the recording and quantization noise). Thus, deep investigations on ICP components aimed to extract features from ICP signal, require a denoised signal. For this reason the authors have addressed a study upon the most common filtering techniques. On each ICP recording we have performed 4 configurations of filters, which involve the use of a FIR filter together with Signal Averaging filters or PCA based filters. Next step is period estimation for absolute minima detection. The results obtained by the algorithm for automatic ICP marking are compared to those ones obtained from manual marking (peaks are manually identified and annotated by a brain surgeon). The procedure is repeated varying the filters sliding window size to minimize the mean square error. The results show how the configurations FIR filter + Signal averaging provides smaller mean squared error (MSE=118.84[sample(2)]) than the others 3 configurations FIR filter + PCA filter based (MSE=135.29-147.15[sample(2)]).

A preliminary study for investigating idiopatic normal pressure hydrocephalus by means of statistical parameters classification of intracranial pressure recordings.

The objective of this study is to investigate Id-iopatic Normal Pressure Hydrocephalus (INPH) through a multidimensional and multiparameter analysis of statistical data obtained from accurate analysis of Intracranial Pressure (ICP) recordings. Such a study could permit to detect new factors, correlated with therapeutic response, which are able to validate a predicting significance for infusion test. The algorithm developed by the authors computes 13 ICP parameter trends on each of the recording, afterward 9 statistical information from each trend is determined. All data are transferred to the datamining software WEKA. According to the exploited feature-selection techniques, the WEKA has revealed that the most significant statistical parameter is the maximum of Single-Wave-Amplitude: setting a 27 mmHg threshold leads to over 90% of correct classification.

Growing skull fracture of the posterior cranial fossa and of the orbital roof.

BACKGROUND: Growing Skull Fractures (GSF) are rare complications of head trauma, primarily reported in infancy and early childhood. GSF are commonly located on calvaria, and rarely in other locations, including the skull base. METHOD: In this study, we report two cases of GSF occurring in unusual locations. The first, a 8-month old girl, with a GSF of the suboccipital posterior fossa region, and the second, a 4-year old boy with a GSF of the right orbital roof. Both cases underwent operative treatment of the GSF, with microsurgical dissection and excision of the protruding gliotic brain tissue, watertight duraplasty and autologous bone cranial repair. The authors conducted a Medline search of the relevant English literature from 1966 to 2002. FINDINGS: From the search, three cases of suboccipital posterior fossa region GSF and twelve series of orbital GSF, describing a total of 22 cases, have been found. INTERPRETATION: A survey of the pathogenic mechanisms underlying this entity in these locations is reported. A review of suboccipital posterior fossa and orbital roof GSF cases, of nosological, ophthalmological and neurological data, neuroradiological and operative findings, and results of different treatment strategies are described.