Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

BACKGROUND QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population. OBJECTIVE In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals. METHODS This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30-61 years. QRS duration and QT interval (Bazett's) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval - QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD. RESULTS During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017-1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001-1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996-1.007). CONCLUSION Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.Peer reviewe

Diabetes, glucose tolerance, and the risk of sudden cardiac death

Background: Diabetes predisposes to sudden cardiac death (SCD). However, it is uncertain whether greater proportion of cardiac deaths are sudden among diabetes patients than other subjects. It is also unclear whether the risk of SCD is pronounced already early in the course of the disease. The relationship of impaired glucose tolerance (IGT) and SCD is scarcely documented. Methods: A general population cohort of 10594 middle-aged subjects (mean age 44 years, 52.6 % male, follow-up duration 35-41 years) was divided into diabetes patients (n = 82), subjects with IGT (n = 3806, plasma glucose = 9.58 mmol/l in one-hour glucose tolerance test), and controls (n = 6706). Results: Diabetes patients had an increased risk of SCD after adjustment confounders (hazard ratio 2.62, 95 % confidence interval 1.46-4.70, p = 0.001) but risk for non-sudden cardiac death was similarly increased and the proportion of SCD of cardiac deaths was not increased. The SCD risk persisted after exclusion of subjects with baseline cardiac disease or non-fatal cardiac events during the follow-up. Subjects with IGT were at increased risk for SCD (univariate hazard ratio 1.51; 95 % confidence interval 1.31-1.74; p <0.001) and also for non-sudden cardiac deaths and non-fatal cardiac events but adjustments for other risk factors attenuated these effects. Conclusions: Diabetes was associated with increased risk of SCD but also the risk of non-sudden cardiac death was similarly increased. The proportion of cardiac deaths being sudden in subjects with diabetes was not increased. The higher SCD risk in diabetes patients was independent of known cardiac disease at baseline or occurrence of nonfatal cardiac event during the follow-up.Peer reviewe

Expression of CPPED1 in human trophoblasts is associated with timing of term birth

Understanding of timing of human parturition is incomplete. Therefore, we carried out proteomic analyses of full-term placentas from uncomplicated pregnancies to identify protein signatures associated with the onset of spontaneous delivery. We found quantitative associations of 10 proteins with spontaneous term birth, evident either in the basal or in the chorionic plates or in both. Additional 18 proteins were associated according to the location within placenta indicating local variations in protein amounts. Calcineurin-like phosphoesterase domain-containing 1 (CPPED1), a phosphatase previously suggested dephosphorylating AKT1/PKB, was one of the identified proteins. qRT-PCR revealed the mRNA level of CPPED1 was higher in elective caesarean deliveries than in spontaneous births, while immunohistochemistry showed CPPED1 in cytotrophoblasts, syncytiotrophoblasts and extravillous trophoblasts. Noteworthy, phosphorylation status of AKT1 did not differ between placentas from elective caesarean and spontaneous deliveries. Additionally, analyses of samples from infants indicated that single-nucleotide polymorphisms rs11643593 and rs8048866 of CPPED1 were associated with duration of term pregnancy. Finally, post-transcriptional silencing of CPPED1 in cultured HTR8/SVneo cells by siRNAs affected gene expression in pathways associated with inflammation and blood vessel development. We postulate that functions regulated by CPPED1 in trophoblasts at choriodecidual interphase have a role in the induction of term labour, but it may be independent of AKT1

Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

BackgroundQRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population.ObjectiveIn this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals.MethodsThis study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30–61 years. QRS duration and QT interval (Bazett’s) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval – QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD.ResultsDuring a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017–1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001–1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996–1.007).ConclusionProlonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.</p

Estimation of energy detection thresholds and error probability for amplitude-modulated short-range communication radios

Abstract In this thesis, novel data and channel estimation methods are proposed and analyzed for low-complexity short-range communication (SRC) radios. Low complexity is challenging to achieve especially in very wideband or millimeter-wave SRC radios where phase recovery and energy capture from numerous multipaths easily become a bottleneck for system design. A specific type of transceiver is selected using pulse amplitude modulation (PAM) at the transmitter and energy detection (ED) at the receiver, and it is thus called an ED-PAM system. Nonnegative PAM alphabets allow using an ED structure which enables a phase-unaware detection method for avoiding complicated phase recovery at the receiver. Moreover, the ED-PAM approach results in a simple multipath energy capture, and only one real decision variable, whose dimension is independent of the symbol alphabet size, is needed. In comparison with optimal phase-aware detection, the appealing simplicity of suboptimal ED-PAM systems is achieved at the cost of the need for a higher transmitted signal energy or shorter link distance for obtaining a sufficient signal-to-noise ratio (SNR) at the receiver, as ED-PAM systems are more vulnerable to the effects of noise and interference. On the other hand, the consequences of requiring a higher SNR may not be severe in the type of SRC scenarios where a sufficient received SNR is readily available due to a short link distance. Furthermore, significant interference can be avoided by signal design. However, what has slowed down the development of ED-PAM systems is that efficient symbol decision threshold estimation and related error probability analysis in multipath fading channels have remained as unsolved problems. Based on the above observations, this thesis contributes to the state-of-the-art of the design and analysis for ED-PAM systems as follows. Firstly, a closed-form near-optimal decision threshold selection method, which adapts to a time-varying channel gain and enables an arbitrary choice of the PAM alphabet size and an integer time-bandwidth product of the receiver filters, is proposed. Secondly, two blind estimation schemes of the parameters for the threshold estimation are introduced. Thirdly, analytical error probability evaluation in frequency-selective multipath fading channels is addressed. Special attention is given to lognormal fading channels, which are typically used to model very wideband SRC multipath channels. Finally, analytical error probability evaluation with nonideal parameter estimation is presented. The results can be used in designing low-complexity transceivers for very wideband and millimeter-wave wireless SRC devices of the future.Tiivistelmä Tässä työssä esitetään ja analysoidaan uusia data- ja kanavaestimointimenetelmiä, joiden tavoitteena on yksinkertaistaa lähikommunikaatiota (short-range communication, SRC) langattomien laitteiden välillä. SRC-radioiden yksinkertainen toteutus on poikkeuksellisen haasteellista silloin, kun käytetään erittäin suurta kaistanleveyttä tai millimetriaaltoalueen tiedonsiirtoa. Tällöin vastaanottimen yksinkertaisen toteutuksen voivat estää esimerkiksi kantoaallon vaiheen estimointi ja signaalienergian kerääminen lukuisilta kanavan monitiekomponenteilta. Näistä lähtökohdista valitaan SRC-radion järjestelmämalliksi positiiviseen pulssiamplitudimodulaatioon (pulse amplitude modulation, PAM) perustuva lähetin ja energiailmaisimeen (energy detection, ED) perustuva vastaanotin. ED-PAM-järjestelmän ei tarvitse tietää vastaanotetun signaalin vaihetta ja signaalienergian kerääminen tapahtuu yksinkertaisen diversiteettiyhdistelytekniikan avulla. Lisäksi ilmaisuun tarvitaan vain yksi reaalinen päätösmuuttuja, jonka dimensio on riippumaton PAM-tasojen määrästä. ED-PAM-tekniikan yksinkertaisuutta optimaaliseen vaihetietoiseen ilmaisuun verrattuna ei saavuteta ilmaiseksi. Yhtenä rajoituksena on alioptimaalisen ED-PAM-tekniikan luontainen taipumus vahvistaa kohinan ja häiriöiden vaikutusta symbolin päätöksenteossa. Kohinan vahvistus ei välttämättä ole suuri ongelma niissä SRC-radioissa, joissa pienen linkkietäisyyden johdosta riittävä signaali-kohinasuhde vastaanottimessa voidaan kohinan vahvistuksesta huolimatta saavuttaa. Myös häiriöiden vahvistuksen vaikutusta voidaan tehokkaasti vähentää signaalisuunnittelulla. Joka tapauksessa ED-PAM-tekniikan käyttöönottoa on hidastanut tehokkaiden symbolipäätöskynnysten estimointi- ja analysointimenetelmien puuttuminen. Edellä mainitut havainnot ovat motivoineet löytämään uusia suunnittelu- ja analyysimenetelmiä ED-PAM-järjestelmille seuraavasti. Symbolipäätöskynnysten estimointiin johdetaan lähes optimaalinen suljetun muodon menetelmä, joka kykenee adaptoitumaan muuttuvassa kanavassa ja valitsemaan mielivaltaisen kokonaisluvun sekä PAM-tasojen määrälle että vastaanottimen aika-kaistanleveystulolle. Lisäksi esitetään kaksi sokeaa päätöskynnysten estimointimenetelmää, jotka eivät tarvitse redundanttista opetussignaalia. Työn toisessa osassa ED-PAM-järjestelmän symbolivirhesuhdetta analysoidaan taajuusselektiivisessä monitiekanavassa. Analyysissä keskitytään log-normaalijakauman mukaan häipyvään kanavaan. Seuraavaksi analyysia laajennetaan ottamalla mukaan epäideaalisten kynnysarvojen estimoinnin vaikutus. Saavutettuja tuloksia voidaan hyödyntää erittäin laajakaistaisten ja millimetriaaltoalueen SRC-laitteiden suunnittelussa

Multidisciplinary and historical perspectives for developing intelligent and resource-efficient systems

Abstract As communication and computation systems become more complex and target at higher performance, the fundamental limits of nature can be expected to constrain their development and optimization. This calls for intelligent use of basic resources, that is, materials, energy, information, time, frequency, and space. We present a multidisciplinary and historical review on the body of knowledge that can be applied in researching such intelligent and resource-efficient systems. We review general system theory, decision theory, control theory, computer science, and communication theory. While multidisciplinarity has been recognized important, there are no earlier reviews covering all these five disciplines. Based on the review, we build a chronology of intelligent systems and identify connections between the disciplines. Optimization, decision-making, open- and closed-loop control, hierarchy, and degree of centralization turn out as recurring themes in these disciplines, which have converged to similar solutions that are based on remote control, automation, autonomy, and self-organization. We use future wireless networks as an example to illustrate the open questions and how they can be addressed by applying multidisciplinary knowledge. This paper can help researchers to use knowledge outside their own field and avoid repeating the work done already. The resulting consolidated view can speed up research and is especially important when the fundamental limits of nature are approached and new insights are required to overcome the challenges. The general, long-standing problem to be tackled is multiobjective optimization with autonomous and distributed decision-making in an uncertain, dynamic, and nonlinear environment where the objectives are mutually conflicting

Validation of Questionnaires in Screening for Restorative Treatment Need among 15-, 21-, and 40-year olds

Publisher Copyright: © 2022 Dental Hypotheses.Introduction: This cross-sectional study aims to investigate the association between three age-specific questionnaires in three age groups and restorative dental treatment need. Materials and methods: Three separate questionnaires were designed on etiology of dental caries in different age groups. Randomly selected 15- (n = 36), 21- (n = 21), and 40-year-old (n = 45) subjects answered these questionnaires. Responses were compared to restorative treatment need (DT) according to the clinical oral examination, which calibrated examiner performed. Results: Responses to questionnaires were only indicative in prediction of restorative treatment need at individual level. Kappa values for 15-, 21-, and 40-year olds, between responses and restorative treatment need were 0.01, 0.44, and 0.33, respectively. Conclusion: The need for restorative care could plausible be screened with a questionnaire among the 21- and 40-year olds, but not among 15-year olds in a country with low caries prevalence. Further development of questionnaires and studies are needed.Peer reviewe

Anticholinergic burden, oral hygiene practices, and oral hygiene status:cross-sectional findings from the Northern Finland Birth Cohort 1966

Abstract Objectives: To study the association between anticholinergic burden and oral hygiene practices and oral hygiene status among 46-year-old people. Materials and methods: The study included 1945 participants from the Northern Finland Birth Cohort 1966 (NFBC1966), who had a complete dental status. The participants underwent clinical medical and dental examinations, and their medication data were gathered by combining self-reported drug use with information from the National Prescription Register. Anticholinergic burden was measured using nine previously published anticholinergic scales. Oral hygiene practices were assessed with toothbrushing frequency and oral hygiene status with the presence of visible dental plaque. Poisson regression with robust variance estimation and negative binomial regression models were used to estimate relative risks (RR). Results: Thirty percent of the participants reported brushing their teeth twice a day and about 25% of their teeth had dental plaque on them. Fifteen percent of the participants used at least one anticholinergic drug or had an anticholinergic burden according to the nine anticholinergic scales. After adjustments for confounding factors, the RRs of anticholinergic burden varied between 0.95 and 1.11 for toothbrushing frequency. Anticholinergic burden (according to Anticholinergic Activity Scale, Anticholinergic Cognitive Burden, Chew’s scale) was associated statistically significantly with the number of teeth with dental plaque. For the three scales, RRs varied from 1.24 to 1.50. Conclusions: Anticholinergic burden associated with poor oral hygiene. Clinical relevance: The findings stress the importance of providing oral hygiene instructions and prophylactic measures to patients taking anticholinergic drugs

Acceptability of a mobile application in children’s oral health promotion:a pilot study

Abstract The aim of this pilot study was to investigate the acceptability of an oral health-related mobile application developed for young children based on the feedback given by the children and their parents. Another aim was to evaluate the self-reported change in children’s oral health behaviors during a short test period. The application—a virtual pet integrated into a child’s daily routines—aimed to promote oral hygiene and dietary behaviors in children. A total of 36 4–12-year-old voluntary children were given a mobile phone with the installed application. After the 5-week testing period, the feasibility of the application and possible changes in the children’s oral health behaviors were asked using an electronic questionnaire. Most of the children considered the application clear (n = 34), amusing (n = 31), and useful (n = 29). The children’s tooth brushing manners improved both qualitatively and quantitatively: the time used for tooth brushing increased and the children learned how to brush different tooth surfaces. Mobile applications can be fun and useful in oral health promotion; while playing, children can learn good oral health-related behaviors. Mobile applications integrate oral health promotion into children’s daily environment and routines