Evaluation of EEG-based depth of anaesthesia monitoring

In 2001 a University of Bristol team patented a novel data reduction method of the EEG for characterising categorical changes in consciousness. After pre-whitening the EEG signal with Gaussian white noise a parametric spectral estimation technique was applied. Two frequency domain indices were then proposed: the relative power found between 8Hz to 12Hz and 0.5Hz to 32Hz termed the 'alpha index', and the relative power between 0.5Hz to 4Hz and 0.5Hz to 32Hz termed the 'delta index'. The research and development of a precision EEG monitoring device designed to embody the novel algorithm is described in this thesis. The efficacy of the technique was evaluated using simulated and real EEG data recorded during Propofol anaesthesia. The simulated data showed improvements could be made to the patented method. Real EEG data collected whilst patients were wakeful and data from patients unresponsive to noxious stimuli were cleaned of obvious artefacts and analysed using the proposed algorithm. A Bayesian diagnostic test showed the alpha index had 65% sensitivity and selectivity to patient state. The delta index showed 72% sensitivity and selectivity. Taking a pragmatic approach, the literature is reviewed in this thesis to evaluate the use of EEG in depth of anaesthesia monitoring. Pertinent aspects of the sciences are profiled to identify physiological links to the characteristics of the EEG signal. Methods of data reduction are also reviewed to identify useful features and possible sources of error. In conclusion it is shown that the proposed indices do not provide a robust measure of depth of anaesthesia. An approach for further research is proposed based on the review work.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Sickle cell disease classification using deep learning

This paper presents a transfer and deep learning based approach to the classification of Sickle Cell Disease (SCD). Five transfer learning models such as ResNet-50, AlexNet, MobileNet, VGG-16 and VGG-19, and a sequential convolutional neural network (CNN) have been implemented for SCD classification. ErythrocytesIDB dataset has been used for training and testing the models. In order to make up for the data insufficiency of the erythrocytesIDB dataset, advanced image augmentation techniques are employed to ensure the robustness of the dataset, enhance dataset diversity and improve the accuracy of the models. An ablation experiment using Random Forest and Support Vector Machine (SVM) classifiers along with various hyperparameter tweaking was carried out to determine the contribution of different model elements on their predicted accuracy. A rigorous statistical analysis was carried out for evaluation and to further evaluate the model's robustness, an adversarial attack test was conducted. The experimental results demonstrate compelling performance across all models. After performing the statistical tests, it was observed that MobileNet showed a significant improvement (p = 0.0229), while other models (ResNet-50, AlexNet, VGG-16, VGG-19) did not (p > 0.05). Notably, the ResNet-50 model achieves remarkable precision, recall, and F1-score values of 100 % for circular, elongated, and other cell shapes when experimented with a smaller dataset. The AlexNet model achieves a balanced precision (98 %) and recall (99 %) for circular and elongated shapes. Meanwhile, the other models showcase competitive performance. [Abstract copyright: © 2023 The Authors. Published by Elsevier Ltd.

Studies on the assessment of the adequacy of anesthesia

Several hypnosis monitoring systems based on the processed electroencephalogram (EEG) have been developed for use during general anesthesia. The assessment of the analgesic component (antinociception) of general anesthesia is an emerging field of research. This study investigated the interaction of hypnosis and antinociception, the association of several physiological variables with the degree of intraoperative nociception, and aspects of EEG Bispectral Index Scale (BIS) monitoring during general anesthesia. In addition, EEG features and heart rate (HR) responses during desflurane and sevoflurane anesthesia were compared. A propofol bolus of 0.7 mg/kg was more effective than an alfentanil bolus of 0.5 mg in preventing the recurrence of movement responses during uterine dilatation and curettage (D C) after a propofol-alfentanil induction, combined with nitrous oxide (N2O). HR and several HR variability-, frontal electromyography (fEMG)-, pulse plethysmography (PPG)-, and EEG-derived variables were associated with surgery-induced movement responses. Movers were discriminated from non-movers mostly by the post-stimulus values per se or normalized with respect to the pre-stimulus values. In logistic regression analysis, the best classification performance was achieved with the combination of normalized fEMG power and HR during D C (overall accuracy 81%, sensitivity 53%, specificity 95%), and with the combination of normalized fEMG-related response entropy, electrocardiography (ECG) R-to-R interval (RRI), and PPG dicrotic notch amplitude during sevoflurane anesthesia (overall accuracy 96%, sensitivity 90%, specificity 100%). ECG electrode impedances after alcohol swab skin pretreatment alone were higher than impedances of designated EEG electrodes. The BIS values registered with ECG electrodes were higher than those registered simultaneously with EEG electrodes. No significant difference in the time to home-readiness after isoflurane-N2O or sevoflurane-N2O anesthesia was found, when the administration of the volatile agent was guided by BIS monitoring. All other early and intermediate recovery parameters were also similar. Transient epileptiform EEG activity was detected in eight of 15 sevoflurane patients during a rapid increase in the inspired volatile concentration, and in none of the 16 desflurane patients. The observed transient EEG changes did not adversely affect the recovery of the patients. Following the rapid increase in the inhaled desflurane concentration, HR increased transiently, reaching its maximum in two minutes. In the sevoflurane group, the increase was slower and more subtle. In conclusion, desflurane may be a safer volatile agent than sevoflurane in patients with a lowered seizure threshold. The tachycardia induced by a rapid increase in the inspired desflurane concentration may present a risk for patients with heart disease. Designated EEG electrodes may be superior to ECG electrodes in EEG BIS monitoring. When the administration of isoflurane or sevoflurane is adjusted to maintain BIS values at 50-60 in healthy ambulatory surgery patients, the speed and quality of recovery are similar after both isoflurane-N2O and sevoflurane-N2O anesthesia. When anesthesia is maintained by the inhalation of N2O and bolus doses of propofol and alfentanil in healthy unparalyzed patients, movement responses may be best avoided by ensuring a relatively deep hypnotic level with propofol. HR/RRI, fEMG, and PPG dicrotic notch amplitude are potential indicators of nociception during anesthesia, but their performance needs to be validated in future studies. Combining information from different sources may improve the discrimination of the level of nociception.Useita aivosähkökäyrään (EEG) perustuvia unen syvyyden valvontamenetelmiä on kehitetty yleisanestesian aikana käytettäväksi. Kudosvaurion aiheuttamia ärsykkeitä vaimentavan yleisanestesian osan arviointimenetelmien tutkimus on alkamassa. Tässä väitöskirjatyössä tutkittiin unen syvyyden ja kudosvaurion aiheuttamien ärsykkeiden vaimennuksen vuorovaikutusta, useiden elimistön toimintaa kuvaavien muuttujien ja kudosvaurion aiheuttaman ärsytyksen suhdetta sekä EEG:n bispektraali-indeksin (BIS) käyttöä yleisanestesian valvonnassa. Lisäksi verrattiin desfluraani- ja sevofluraanianestesiaan liittyviä EEG-muutoksia ja sykevasteita. Kun anestesia oli aloitettu propofolilla, alfentaniililla ja typpioksiduulilla (N2O), propofoliannos 0.7 mg/kg esti liikevasteiden toistumista kohdun kaavinnan aikana tehokkaammin kuin alfentaniiliannos 0.5 mg. Sydämen syke ja useat sykevaihtelusta, otsalihastoiminnasta, pulssiaallon mittauksesta ja EEG:sta johdetut muuttujat olivat yhteydessä leikkauksen aiheuttamiin liikevasteisiin. Pääsääntöisesti ärsykkeen jälkeen mitatut arvot sellaisenaan tai suhteutettuna ärsykettä edeltäviin arvoihin (normalisoituna) erottelivat liikkuvat potilaat liikkumattomista potilaista. Paras luokittelu saavutettiin kohdun kaavinnan aikana yhdistämällä tieto normalisoidusta otsalihastoiminnasta ja sykkeestä (herkkyys 53%, tarkkuus 95%), ja sevofluraanianestesian aikana yhdistämällä tieto normalisoidusta (otsalihastoimintaan liittyvästä) vaste-entropiasta, sykkeestä ja pulssiaallon muodosta (herkkyys 90%, tarkkuus 100%). Kun iho valmisteltiin vain pyyhkäisemällä alkoholilla, sydänsähkökäyrän (EKG) mittaukseen tarkoitettujen elektrodien sähköinen vastus oli suurempi kuin EEG:n mittaukseen tarkoitettujen elektrodien. EKG-elektrodeilla mitatut BIS-arvot olivat korkeampia kuin samanaikaisesti EEG-elektrodeilla mitatut BIS-arvot. Kun höyrystyviä anestesia-aineita annosteltiin BIS-arvojen mukaan, toipuminen oli yhtä nopeaa isofluraani-N2O-anestesian jälkeen kuin sevofluraani-N2O-anestesian jälkeen. Kun höyrystyvän anestesia-aineen pitoisuutta nostettiin nopeasti viiden minuutin ajaksi, ohimenevää epileptistä aivosähkötoimintaa havaittiin kahdeksalla viidestätoista sevofluraanipotilaasta, mutta ei yhdelläkään kuudestatoista desfluraanipotilaasta. Havaitut ohimenevät EEG-muutokset eivät vaikuttaneet haitallisesti potilaiden toipumiseen. Desfluraanipitoisuuden nopean noston jälkeen syke kiihtyi ohimenevästi ja saavutti huippunsa kahdessa minuutissa. Sevofluraaniryhmässä sykenousu oli hitaampi ja lievempi. Tulosten perusteella voidaan todeta, että desfluraani saattaa olla sevofluraania turvallisempi anestesia-aine potilailla joiden kouristuskynnys on alentunut. Nopeaan desfluraanipitoisuuden nostoon liittyvä sykenousu voi olla haitallinen sydänsairaille potilaille. EEG-elektrodit ovat BIS-mittauksessa parempia kuin halvemmat EKG-elektrodit. Kun höyrystyvä anestesia-aine annostellaan siten että BIS-arvo pysyy välillä 50-60, toipuminen on samankaltainen sekä isofluraani-N2O- että sevofluraani-N2O-anestesian jälkeen terveillä päiväkirurgisilla potilailla. Kun anestesiaa ylläpidetään N2O:lla sekä propofoli- ja alfentaniiliannoksilla terveillä potilailla, joiden lihastoimintaa ei ole lamattu, liikevasteita estetään mahdollisesti parhaiten pitämällä uni verrattain syvänä propofolin avulla. Sydämen syke, otsalihastoiminta ja pulssiaallon muoto saattavat soveltua kudosvaurion aiheut-taman ärsytyksen valvontaan anestesian aikana, mutta lisätutkimuksia aiheesta tarvitaan. Kudosvaurion aiheuttaman ärsytyksen arviointia voidaan mahdollisesti tarkentaa yhdistämällä tietoa useista elimistön toimintaa kuvaavista muuttujista

Image Analysis for the Life Sciences - Computer-assisted Tumor Diagnostics and Digital Embryomics

Current research in the life sciences involves the analysis of such a huge amount of image data that automatization is required. This thesis presents several ways how pattern recognition techniques may contribute to improved tumor diagnostics and to the elucidation of vertebrate embryonic development. Chapter 1 studies an approach for exploiting spatial context for the improved estimation of metabolite concentrations from magnetic resonance spectroscopy imaging (MRSI) data with the aim of more robust tumor detection, and compares against a novel alternative. Chapter 2 describes a software library for training, testing and validating classification algorithms that estimate tumor probability based on MRSI. It allows flexible adaptation towards changed experimental conditions, classifier comparison and quality control without need for expertise in pattern recognition. Chapter 3 studies several models for learning tumor classifiers that allow for the common unreliability of human segmentations. For the first time, models are used for this task that additionally employ the objective image information. Chapter 4 encompasses two contributions to an image analysis pipeline for automatically reconstructing zebrafish embryonic development based on time-resolved microscopy: Two approaches for nucleus segmentation are experimentally compared, and a procedure for tracking nuclei over time is presented and evaluated