Objectives Transcranial Doppler sonography allows for the estimation of blood flow velocity, whose maximum value, especially at systole, is often of clinical interest. Given that observed values of flow velocity are subject to noise, a useful notion of “maximum” requires a criterion for separating the signal from the noise. All commonly used criteria produce a point estimate (ie, a single value) of maximum flow velocity at any time and therefore convey no information on the distribution or uncertainty of flow velocity. This limitation has clinical consequences especially for patients in vasospasm, whose largest flow velocities can be difficult to measure. Therefore, a method for estimating flow velocity and its uncertainty is desirable. Methods A gaussian mixture model is used to separate the noise from the signal distribution. The time series of a given percentile of the latter, then, provides a flow velocity envelope. This means of estimating the flow velocity envelope naturally allows for displaying several percentiles (eg, 95th and 99th), thereby conveying uncertainty in the highest flow velocity. Results Such envelopes were computed for 59 patients and were shown to provide reasonable and useful estimates of the largest flow velocities compared to a standard algorithm. Moreover, we found that the commonly used envelope was generally consistent with the 90th percentile of the signal distribution derived via the gaussian mixture model. Conclusions Separating the observed distribution of flow velocity into a noise component and a signal component, using a double‐gaussian mixture model, allows for the percentiles of the latter to provide meaningful measures of the largest flow velocities and their uncertainty.

Quantifying pain through assay of a human’s or animal’s response to a known stimulus as a function of time of day is a critical means of advancing chronotherapeutic pain management. Current methods for quantifying pain, even in the context of etiologies involving deep tissue, generally involve stimulation by quantifiable means of either cutaneous (heat-lamp tests, electrical stimuli) or both cutaneous and subcutaneous tissue (von Frey hairs, tourniquets, etc.) or study of proxies for pain (such as stress, via assay of cortisol levels). In this study, we evaluate the usefulness of intense Focused Ultrasound (iFU), already shown to generate sensations and other biological effects deep to the skin, as a means of quantifying deep diurnal pain using a standard animal model of inflammation. Beginning five days after injection of Complete Freund’s Adjuvant into the plantar surface of the rat’s right hind paw to induce inflammation, the rats were divided into two groups, the light-phase test group (09:00h–18:00h) and the dark-phase test group (23:00h–06:00h), both of which underwent iFU application deep to the skin. We used two classes of iFU protocol, motivated by the extant literature. One consisted of a single pulse (SP) lasting 0.375 seconds. The other, a multiple pulse (MP) protocol, consisted of multiple iFU pulses each of length 0.075s spaced 0.075s apart. We found the night group’s threshold for reliable paw withdrawal to be significantly higher than that of the day group as assayed by each iFU protocol. These results are consistent with the observation that the response to mechanical stimuli by humans and rodents display diurnal variations, as well as the ability of iFU to generate sensations via mechanical stimulation. Since iFU can provide a consistent method to quantify pain from deep, inflamed tissue, it may represent a useful adjunct to those studying diurnal pain associated with deep tissue as well as chronotherapeutics targeting that pain.

Background It has been hypothesized that critical closing pressure of cerebral circulation, or zero-flow pressure (ZFP), can estimate intracranial pressure (ICP). One ZFP estimation method employs extrapolation of arterial blood pressure versus blood-flow velocity. The aim of this study is to improve ICP predictions. Methods Two revisions are considered: 1) The linear model employed for extrapolation is extended to a nonlinear equation, and 2) the parameters of the model are estimated by an alternative criterion (not least-squares). The method is applied to data on transcranial Doppler measurements of blood-flow velocity, arterial blood pressure, and ICP, from 104 patients suffering from closed traumatic brain injury, sampled across the United States and England. Results The revisions lead to qualitative (e.g., precluding negative ICP) and quantitative improvements in ICP prediction. In going from the original to the revised method, the ±2 standard deviation of error is reduced from 33 to 24 mm Hg; the root-mean-squared error (RMSE) is reduced from 11 to 8.2 mm Hg. The distribution of RMSE is tighter as well; for the revised method the 25th and 75th percentiles are 4.1 and 13.7 mm Hg, respectively, as compared to 5.1 and 18.8 mm Hg for the original method. Conclusions Proposed alterations to a procedure for estimating ZFP lead to more accurate and more precise estimates of ICP, thereby offering improved means of estimating it noninvasively. The quality of the estimates is inadequate for many applications, but further work is proposed which may lead to clinically useful results.

Previous studies have observed that individual pulses of intense focused ultrasound (iFU) applied to inflamed and normal tissue can generate sensations, where inflamed tissue responds at a lower intensity than normal tissue. It was hypothesized that successively applied iFU pulses will generate sensation in inflamed tissue at a lower intensity and dose than application of a single iFU pulse. This hypothesis was tested using an animal model of chronic inflammatory pain, created by injecting an irritant into the rat hind paw. Ultrasound pulses were applied in rapid succession or individually to rats' rear paws beginning at low peak intensities and progressing to higher peak intensities, until the rats withdrew their paws immediately after iFU application. Focused ultrasound protocols consisting of successively and rapidly applied pulses elicited inflamed paw withdrawal at lower intensity and estimated tissue displacement values than single pulse protocols. However, both successively applied pulses and single pulses produced comparable threshold acoustic dose values and estimates of temperature increases. This raises the possibility that temperature increase contributed to paw withdrawal after rapid iFU stimulation. While iFU-induction of temporal summation may also play a role, electrophysiological studies are necessary to tease out these potential contributors to iFU stimulation.

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