Citations

Loss of sensation and increased sensory phenomena are major expressions of varieties of diabetic polyneuropathies needing improved assessments for clinical and research purposes. We provide a neurobiological explanation for the apparent paradox between decreased sensation and increased sensory phenomena. Strongly endorsed is the use of the 10-g monofilaments for screening of feet to detect sensation loss, with the goal of improving diabetic management and prevention of foot ulcers and neurogenic arthropathy. We describe improved methods to assess for the kind, severity, and distribution of both large- and small-fiber sensory loss and which approaches and techniques may be useful for conducting therapeutic trials. The abnormality of attributes of nerve conduction may be used to validate the dysfunction of large sensory fibers. The abnormality of epidermal nerve fibers/1 mm may be used as a surrogate measure of small-fiber sensory loss but appear not to correlate closely with severity of pain. Increased sensory phenomena are recognized by the characteristic words patients use to describe them and by the severity and persistence of these symptoms. Tests of tactile and thermal hyperalgesia are additional markers of neural hyperactivity that are useful for diagnosis and disease management.

Vibro-acoustography is a method that uses the dynamic radiation force (stress) of ultrasound to locally excite an object at low frequency [Fatemi and Greenleaf, Science 280, 82]. A multifrequency vibro-acoustography method is proposed that uses a multifrequency radiation stress produced by an array transducer driven with N ultrasound frequencies. A multifrequency image at the different N(N−1)/2 frequencies is produced with one scan of the region of interest, increasing the information yield by a factor of N(N−1)/2. Image formation theory is presented for multifrequency vibro-acoustography using an annular array transducer. Simulations of the stress field were performed for a 20-element, 3.5-MHz annular array transducer. Four ultrasound frequencies produce six unique low-frequency components in the point spread function. Computer phantoms with small spheres are used to demonstrate the usefulness of multifrequency vibro-acoustography for microcalcification detection in breast imaging. The lateral and axial width of the main lobe at −6 dB is 0.68 and 6.47 mm, respectively. The lateral and axial sidelobe levels are −27.8 and −16.8 dB, respectively. The proposed method holds the potential for large gains of information with good spatial resolution and no increase in scanning time. [Work supported by Grant EB00535-03 from NIH.]

Vibro-acoustography is an imaging modality that uses ultrasound as the source of energy to explore objects at two ends of the spectrum. Employing two ultrasound beams at slightly different frequencies, this technique produces a highly localized radiation stress field that vibrates the object at the difference frequency. In response, the object produces a secondary acoustic field. This sound, which contains information about the dynamics of the object at the low difference frequency as well as objects characteristics at the ultrasound range, is used to produce an image of the object. This combination makes vibro-acoustography a unique tool to study biological tissues at low and high frequencies simultaneously. Utility of this method has already been demonstrated for a wide range of applications in vitro. In vivo applications of vibro-acoustography have been demonstrated in a recent study on human breast. It has been shown that this technique can produce high quality in vivo images at ultrasound intensities within the recommended FDA limits. Vibro-acoustography may also be used for imaging solids, such as metallic implants. This paper describes recent achievements in vibro-acoustography as well as possible future role of this technology in medicine. [This abstract includes materials patented by MF and JFG.]

We have proposed generating a bending wave in the arterial wall using ultrasound radiation force and measuring the wave velocity along the arterial wall [Zhang et al., IEEE Trans. Ultrason. Ferroelectr. Freq. Control 52, 642–652 (2005)]. Here, we report the results of in vivo studies on pigs. The pig was anesthetized, and a micromanometer tip catheter was inserted into the femoral artery to measure luminal pressure. A water bath was created on the animal’s groin to allow unimpeded access of the ultrasound beams to the femoral artery. The femoral artery was first located using a 13-MHz linear-array transducer. Then, a vibro-acoustography image was obtained to ensure precise positioning of the excitation force relative to the artery. The artery was excited by the force transducer and the resulting vibration of the arterial wall was measured by a sensing Doppler transceiver. Measured wave velocity was 3.1 m/s at 300 Hz. With this new method wave velocity over a distance of 5 mm, and therefore stiffness of arteries, can be measured locally and non-invasively. Measurement time is short in a few tens of milliseconds, which allows pressure dependence and pharmacological effect on the wall properties to be measured at different cardiac times.

The head-gimbal assembly suspension is a cantilever-like structure that holds the heads on a hard drive. We will discuss a noncontact method for modal testing, of suspensions in air, that utilizes the radiation force at the difference frequency generated by two intersecting ultrasound beams. The resulting low-frequency excitations were measured using a scanning vibrometer. This excitation technique has been demonstrated for MEMS and other small devices. There are several unique advantages of the ultrasound radiation force relative to mechanical shakers. Since the ultrasound radiation force is noncontact, a specialized test fixture was not needed; the technique was relatively insensitive to distracting resonances of fixtures and support structures. Another advantage is broadband excitation; a 550-kHz confocal ultrasound transducer excited suspension resonance frequencies from under 1 kHz to over 50 kHz. Other advantages include the ability to selectively excite different modes. For example, the amplitude of the suspension’s 2.28-kHz transverse mode was suppressed by an order of magnitude by shifting the modulation phase between the two ultrasound beams by 90. In another test, the amplitude of the 6.01-kHz torsional mode was doubled by moving the ultrasound focus point from near the center to near the edge of the suspension.

An internal assessment was undertaken to understand the flow of patients to ensure comfort and privacy during their health care experience at Mayo Clinic. A number of different prototypes, work flows, and methodologies were utilized and assessed to determine the ‘‘best experience for our patients.’’ A number of prototypes ranging from self-check in to personal pagers were assessed along with creating environments that introduced ‘‘passive distractions’’ for acoustical and noise management, which can range from fireplaces, to coffee shops to playgrounds to ‘‘tech corridors.’’ While a number of these designs are currently being piloted, the over-reaching goal is to make the patient experience ‘‘like no other’’ when receiving their care at Mayo Clinic.

Clonal eosinophilic disorders are rare among hematological malignancies. Most eosinophilia tends to be due to secondary causes such as infections, hypersensitivity conditions, drug reactions, and connective tissue disorders. The presence of a primary clonal eosinophilic disorder such as chronic eosinophilic leukemia—not otherwise specified (NOS) in the presence of a synchronous large cell lymphoma—is rare making the diagnosis challenging. We present a case of a 51-year-old female with the aforementioned presentation and demonstrate the extensive workup performed to identify the diagnosis.