COMBINED DELAY AND GRAPH EMBEDDING OF EPILEPTIC DISCHARGES IN EEG REVEALS COMPLEX AND RECURRENT NONLINEAR DYNAMICS.

The dynamical structure of the brain's electrical signals contains valuable information about its physiology. Here we combine techniques for nonlinear dynamical analysis and manifold identification to reveal complex and recurrent dynamics in interictal epileptiform discharges (IEDs). Our results suggest that recurrent IEDs exhibit some consistent dynamics, which may only last briefly, and so individual IED dynamics may need to be considered in order to understand their genesis. This could potentially serve to constrain the dynamics of the inverse source localization problem.

Case report. Fractionated Helical Tomotherapy as an alternative to radiosurgery in patients unwilling to undergo additional radiosurgery for recurrent brain metastases.

Our clinic routinely treats brain metastases with stereotactic radiosurgery using a 6 megavoltage (MV) linear accelerator, cones, and a surgically attached head frame. Four patients declined repeat radiosurgery for new lesions due to their previous discomfort and a fifth patient could not complete radiosurgery because of uncontrolled nausea. Instead patients were treated with Helical Tomotherapy (HT). This report discusses the spatial dose distribution of HT as measured in a head phantom and the clinical course of these five patients. The planning target volume (PTV) was a 3 mm geometric expansion of the gross tumour volume (GTV). The prescribed dose to the PTV was 27 Gy in five daily fractions with the distribution optimised to deliver 30 Gy to the GTV. Patients were immobilised with a mask and the lesions were targeted by MV computerised tomography, an inherent feature of the system. One patient died six weeks later from systemic disease; the remaining patients survived eight to 16 months. No patient experienced an exacerbation of neurological symptoms following Helical Tomotherapy. These results suggest that fractionated Helical Tomotherapy for brain metastases may be a viable alternative to radiosurgery in patients unable or unwilling to undergo that procedure.

Effects of immersion water temperature on whole-body fluid distribution in humans.

AIM: In this study, we quantified acute changes in the intracellular and extracellular fluid compartments during upright neutral- and cold-water immersion. We hypothesized that, during short-term cold immersion, fluid shifts would be wholly restricted to the extracellular space. METHODS: Seven males were immersed 30 days apart: control (33.3 degrees SD 0.6 degrees C); and cold (18.1 degrees SD 0.3 degrees C). Posture was controlled for 4 h prior to a 60-min seated immersion. RESULTS: Significant reductions in terminal oesophageal (36.9 degrees +/- 0.1 degrees -36.3 degrees +/- 0.1 degrees C) and mean skin temperatures (30.3 degrees +/- 0.3 degrees -23.0 degrees +/- 0.3 degrees C) were observed during the cold, but not the control immersion. Both immersions elicited a reduction in intracellular fluid [20.17 +/- 6.02 mL kg(-1) (control) vs. 22.72 +/- 9.90 mL kg(-1)], while total body water (TBW) remained stable. However, significant plasma volume (PV) divergence was apparent between the trials at 60 min [12.5 +/- 1.0% (control) vs. 6.1 +/- 3.1%; P < 0.05], along with a significant haemodilution in the control state (P < 0.05). Plasma atrial natriuretic peptide concentration increased from 18.0 +/- 1.6 to 58.7 +/- 15.1 ng L(-1) (P < 0.05) during cold immersion, consistent with its role in PV regulation. We observed that, regardless of the direction of the PV change, both upright immersions elicited reductions in intracellular fluid. CONCLUSION: These observations have two implications. First, one cannot assume that PV changes reflect those of the entire extracellular compartment. Second, since immersion also increases interstitial fluid pressure, fluid leaving the interstitium must have been rapidly replaced by intracellular water.

Cold-water acclimation does not modify whole-body fluid regulation during subsequent cold-water immersion.

We investigated the impact of cold-water acclimation on whole-body fluid regulation using tracer-dilution methods to differentiate between the intracellular and extracellular fluid compartments. Seven euhydrated males [age 24.7 (8.7) years, mass 74.4 (6.4) kg, height 176.8 (7.8) cm, sum of eight skinfolds 107.4 (20.4) mm; mean (SD)] participated in a 14-day cold-water acclimation protocol, with 60-min resting cold-water stress tests [CWST; 18.1 (0.1) degrees C] on days 1, 8 and 15, and 90-min resting cold-water immersions [18.4 (0.4) degrees C] on intervening days. Subjects were immersed to the 4th intercostal space. Intracellular and extracellular fluid compartments, and plasma protein, electrolyte and hormone concentrations were investigated. During the first CWST, the intracellular fluid (5.5%) and plasma volumes were reduced (6.1%), while the interstitial fluid volume was simultaneously expanded (5.4%). This pattern was replicated on days 8 and 15, but did not differ significantly among test days. Acclimation did not produce significant changes in the pre-immersion distribution of total body water, or changes in plasma osmolality, total protein, electrolyte, atrial natriuretic peptide or aldosterone concentrations. Furthermore, a 14-day cold-water acclimation regimen did not elicit significant changes in body-fluid distribution, urine production, or the concentrations of plasma protein, electrolytes or the fluid-regulatory hormones. While acclimation trends were not evident, we have confirmed that fluid from extravascular cells is displaced into the interstitium during acute cold-water immersion, both before and after cold acclimation.

A diffusion theory model of spatially resolved fluorescence from depth-dependent fluorophore concentrations.

A photon diffusion model has been developed to calculate the steady-state spatially resolved fluorescence from pencil beam excitation in layered tissue. The model allows the calculation of both the excitation reflectance and the fluorescence escape for an arbitrary continuous depth distribution of tissue optical properties and fluorophore concentration. The validity of this model was verified by comparison with Monte Carlo simulations and experimental measurements using phantoms with tissue-like optical properties. The potential usefulness of the spatially resolved fluorescence was explored using the model and simulations of realistic drug distributions. It was shown that using this technique it may be possible to quantify the diffusion of a topically administered drug into the skin, or the photobleaching of a sensitizer during photodynamic therapy.

Metabolic habituation following repeated resting cold-water immersion is not apparent during low-intensity cold-water exercise.

This project examined the effects of repeated, resting cold-water immersion on metabolic heat production and core temperature defence during subsequent rest and exercising immersions. Seven males undertook 15 days of cold-water adaptation, immersed to the fourth intercostal space, with cold-water stress tests (CWST) on days 1, 8 and 15 (18.1 SD 0.1 degree C: 60 min seated, followed by 30 min cycling (1 W.kg-1)), and 90-min resting immersions (18.4 SD 0.4 degree C) on each of the intervening days. Adaptation elicited an habituated thermogenic response during the rest phase of CWST3 beyond 20 min, compared to CWST1 (P < 0.05), with oxygen consumption averaging 11.15 (+/- 0.25) ml.kg-1.min-1 and 8.61 (+/- 0.90) ml.kg-1.min-1 by 50 min, for CWST1 and CWST3, respectively. During exercise, this metabolic blunting was only apparent over the first 10-min period (60-70 min). No significant differences were observed during either the rest or exercise phases of the CWSTs for oesophageal temperature (Tes). While repeated cold-water exposures produced an habituated-thermogenic response, for an equivalent drop in Tes during rest, neither this response, nor an elevated thermogenesis, were apparent during subsequent cold-water exercise.

Enhanced aggregability of human red blood cells by diving.

In vitro studies have shown that mild pressure increases red blood cell (RBC) aggregation. Enhanced RBC aggregation in pathologic states can drive the circulation into stasis. This investigation examined the effects of pressure on RBC aggregation in human volunteers. The hypothesis tested is that RBC aggregation is increased during hyperbaric exposure. Eleven subjects participated in dives to 300 feet of seawater (fsw) in a man-rated chamber complex. Blood samples were taken at the surface, at 66 fsw, and at 300 fsw. Data were analyzed with a repeated measures one-way analysis of variance for a complete randomized design. Statistical significance was achieved at P < 0.05. Data are expressed as mean +/- SEM. The median aggregate size (number of RBC/aggregate) of RBCs was significantly increased at depth. At a shear stress of 0.1 dyne/cm2, median aggregate size was 12.0 +/- 2.1, 33.0 +/- 7.3, and 48.8 +/- 10.8 at the surface, at 66 fsw, and at 300 fsw, respectively. These results show that mild pressure increases RBC aggregation in the human circulation.

Physiologic and perceptual responses to hypercarbia during warm- and cold-water immersion.

Thermoregulatory, respiratory, and perceptual responses to acute CO2 exposure during light exercise (75 W) were assessed in 12 U.S. Navy divers clad only in swim trunks while immersed to the neck in water at 18 degrees and 34 degrees C. The CO2 exposures consisted of a linear 10-min ramp increase in the inspired fraction of CO2 (FICO2) from 0 to 6% followed by 5 min of breathing 6% CO2. The ability to detect and rate the severity of hypercarbia, as well as subjective changes in thermal comfort, were assessed by comparing subjective ratings given during the CO2 exposures with those given during immersion trials where the FICO2 was maintained at 0%. Hypercarbia was recognized earlier and, at a given PETCO2, was perceived to be greater during cold- than during warm-water immersions (P < 0.01). The CO2 exposures did not affect the thermal balance of divers as assessed by changes in heat flux and rectal temperature. However, increased feelings of warmth were reported during both the cold and warm immersions when breathing raised concentrations of CO2 (P < 0.01). During the cold immersions, acute exposure to 6% CO2 significantly decreased forearm blood flow (P < 0.05), but did not affect finger blood flow. It is concluded that PETCO2 levels can reach unacceptably high concentrations (> 60 mmHg) before hypercarbia can be reliably detected by working divers. Furthermore, the ability to detect hypercarbia is poorer when immersed in warm water than when in cold water.

The relationship between the U.S. Navy fleet diver physical screening test and job task performance.

The development of job-related selection and training methods will improve safety and lead to substantial cost savings to the U.S. Navy through enhanced screening and productivity. The present investigation determined the extent to which the current U.S. Navy fleet diver physical screening test predicted performance of five representative physically demanding job tasks. Subjects were 146 male diver candidates (age 25.1 +/- 4.3 years, X +/- SD, range 18-37 years) undergoing training at the Naval Diving and Salvage Training Center, Panama City, FL. Results indicate the current U.S. Navy fleet diver physical screening test provides a poor estimate of representative job task performance for the population of diver candidates tested. A finding of particular operational significance was that a substantial number of diver candidates who passed current physical screening test standards were unable to complete (i.e., failed) the tool-bag swim (18.5%) and fin-kick (25.7%) tasks. Results suggest the current screening test has limited utility for physical selection purposes and underscore the need for developing a requirements-based selection battery to ensure that diver physical capabilities are aligned to the job.

Physiological evaluation of liquid-barrier, vapor-permeable protective clothing ensembles for work in hot environments.

Work clothes using fabrics with vapor-transmitting characteristics are in limited use in various industrial applications, and there is a growing interest in their purported ability to help reduce heat stress. This study was performed to compare two vapor-transmitting ensembles with other clothing ensembles previously tested. The evaluation was based on an established experimental protocol that determines the critical values of air temperature and water-vapor pressure so that an individual maintains thermal balance, while controlling other factors that contribute to worker heat stress (e.g., air motion and metabolism). There were no differences between the two vapor-transmitting garments in their effects on worker heat stress. When compared to the results of other studies, the two vapor-transmitting garments had critical environmental characteristics similar to two layers of cotton coveralls and they performed better from a heat stress standpoint than a disposable vapor-barrier suit worn over cloth coveralls.

Age and hypohydration independently influence the peripheral vascular response to heat stress.

Seven young (Y, 22-28 yr) and seven middle-aged (MA, 49-60 yr) normotensive men of similar body size, fatness, and maximal oxygen uptake (VO2max) were exposed to a heat challenge in an environmental chamber (48 degrees C, 15% relative humidity). Tests were performed in two hydration states: hydrated (H, 25 ml water/kg body wt 1 h before the test, 2.5 h before exercise) and hypohydrated (Hypo, after 18-20 h of water deprivation). Each test began with a 90-min rest period during which the transiently increased plasma volume and decreased osmolality after drinking in the H condition returned to base line. This period was followed by 30 min of cycle exercise at a mean intensity of 43% VO2max and a 60-min resting recovery period with water ad libitum. Although prior drinking caused no sustained changes in plasma osmolality, Hypo increased plasma osmolality by 7-10 mosmol/kg in both groups. There were no significant age differences in water intake, urine output or osmolality, overall change in body weight, or sweating rate. In the H state, the percent change in plasma volume was less (P less than 0.01) during exercise for the Y group (-5.9 +/- 0.7%) than for the MA group (-9.4 +/- 0.6%). Esophageal temperature (Tes) was higher in the Hypo condition for both groups with no age-related differences. Throughout the 3-h period, mean skin temperature was higher in the Y group and significantly so (P less than 0.05) in the Hypo condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychrometric limits to prolonged work in protective clothing ensembles.

When work is performed by workers in protective clothing, sweat evaporation is limited and body temperature rises. In an attempt to quantify the limits such ensembles place on safe work, 6 acclimated men and women walked at 30% VO2max (150-200 W/m2) in 2 protocols involving environmental transients. In one, ambient water vapor pressure (Pw) was fixed at 10 torr, and after rectal temperature (Tre) plateaued, ambient dry-bulb temperature (Tdb) was raised 2 degrees C every 10 min. In the second, Tdb was constant and Pw was increased 2 torr every 10 min. Critical temperature (Tcrit) and pressure (Pcrit) were defined as the Tdb or Pw at which thermal balance could no longer be maintained and Tre rose sharply. Each test was performed in various clothing ensembles ranging from light cotton work clothes to "impermeable" suits. Lines connecting mean Tcrit and mean Pcrit define a limit for safe prolonged exposure/exercise for approximately 50% of the population in each ensemble. Similar lines, drawn to represent values 2 standard deviations below the mean, should provide critical environmental limits for 95% of the population.

Physiologically derived critical evaporative coefficients for protective clothing ensembles.

When work is performed in heavy clothing, evaporation of sweat from the skin to the environment is limited by layers of wet clothing and air. The magnitude of decrement in evaporative cooling is a function of the clothing's resistance to permeation of water vapor. A physiological approach has been used to derive effective evaporative coefficients (he) which define this ability to evaporate sweat. We refined this approach by correcting the critical effective evaporative coefficient (K for sweating efficiency (Ke,eta') since only a portion of the sweat produced under such conditions is evaporated through the clothing. Six acclimated men and women walked at 30% maximal O2 consumption (150-200 W.m-2) at a constant dry bulb temperature as ambient water vapor pressure was systematically increased 1 Torr every 10 min. Critical pressure was defined as the partial pressure of water vapor (Pw) at which thermal balance could no longer be maintained and rectal temperature rose sharply. Each test was performed in various clothing ensembles ranging from cotton shirt and pants to "impermeable" suits. This approach was used to derive he by solving the general heat balance equation, M - W +/- (R + C) = w.he.(Psk - Pw), where M is metabolic heat production, W is external work, R is radiant heat exchange, C is convective heat transfer, w is skin wettedness, and Psk is water vapor pressure of fully wet skin.(ABSTRACT TRUNCATED AT 250 WORDS)