Wearable bioimpedance measurement for respiratory monitoring during inspiratory loading

Bioimpedance is an unobtrusive noninvasive technique to measure respiration and has a linear relation with volume during normal breathing. The objective of this paper was to assess this linear relation during inspiratory loading protocol and determine the best electrode configuration for bioimpedance measurement. The inspiratory load is a way to estimate inspiratory muscle function and has been widely used in studies of respiratory mechanics. Therefore, this protocol permitted us to evaluate bioimpedance performance under breathing pattern changes. We measured four electrode configurations of bioimpedance and airflow simultaneously in ten healthy subjects using a wearable device and a standard wired laboratory acquisition system, respectively. The subjects were asked to perform an incremental inspiratory threshold loading protocol during the measurements. The load values were selected to increase progressively until the 60% of the subject's maximal inspiratory pressure. The linear relation of the signals was assessed by Pearson correlation (r) and the waveform agreement by the mean absolute percentage error (MAPE), both computed cycle by cycle. The results showed a median greater than 0.965 in r coefficients and lower than 11 % in the MAPE values for the entire population in all loads and configurations. Thus, a strong linear relation was found during all loaded breathing and configurations. However, one out of the four electrode configurations showed robust results in terms of agreement with volume during the highest load. In conclusion, bioimpedance measurement using a wearable device is a noninvasive and a comfortable alternative to classical methods for monitoring respiratory diseases in normal and restrictive breathing.Postprint (published version

Analysis of time delay between bioimpedance and respiratory volume signals under inspiratory loaded breathing

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting /republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksBioimpedance is known for its linear relation with volume during normal breathing. For that reason, bioimpedance can be used as a noninvasive and comfortable technique for measuring respiration. The goal of this study is to analyze the temporal behavior of bioimpedance measured in four different electrode configurations during inspiratory loaded breathing. We measured four bioimpedance channels and airflow simultaneously in 10 healthy subjects while incremental inspiratory loads were imposed. Inspiratory loading threshold protocols are associated with breathing pattern changes and were used in respiratory mechanics studies. Consequently, this respiratory protocol allowed us to induce breathing pattern changes and evaluate the temporal relationship of bioimpedance with volume. We estimated the temporal delay between bioimpedance and volume respiratory cycles to evaluate the differences in their temporal behavior. The delays were computed as the lag which maximize the cross-correlation of the signals cycle by cycle. Six of the ten subjects showed delays in at least two different inspiratory loads. The delays were dependent on electrode configuration, hence the appearance of the delays between bioimpedance and volume were conditioned to the location and geometry of the electrode configuration. In conclusion, the delays between these signals could provide information about breathing pattern when breathing conditions change.Peer ReviewedPostprint (author's final draft

Breathing pattern estimation using wearable bioimpedance for assessing COPD severity

Breathing pattern has been shown to be different in chronic obstructive pulmonary disease (COPD) patients compared to healthy controls during rest and walking. In this study we evaluated respiratory parameters and the breathing variability of COPD patients as a function of their severity. Thoracic bioimpedance was acquired on 66 COPD patients during the performance of the six-minute walk test (6MWT), as well as 5 minutes before and after the test while the patients were seated, i.e. resting and recovery phases. The patients were classified by their level of airflow limitation into moderate and severe groups. We characterized the breathing patterns by evaluating common respiratory parameters using only wearable bioimpedance. Specifically, we computed the median and the coefficient of variation of the parameters during the three phases of the protocol, and evaluated the statistical differences between the two COPD severity groups. We observed significant differences between the COPD severity groups only during the sitting phases, whereas the behavior during the 6MWT was similar. Particularly, we observed an inverse relationship between breathing pattern variability and COPD severity, which may indicate that the most severely diseased patients had a more restricted breathing compared to the moderate patients.This work was supported in part by the Universities and Research Secretariat from the Ministry of Business and Knowledge/Generalitat de Catalunya under the Grant GRC 2017 SGR 01770, in part by the Agencia Estatal de Investigacion from the Spanish Ministry of Science ánd Innovation and the European Regional Development Fund, under the Grants RTI2018 098472-B-I00 and PID2021-126455OB-I00, and in part by the CERCA Programme/Generalitat de Catalunya.Peer ReviewedPostprint (author's final draft

A 36 µW 1.1 mm2 reconfigurable analog front-end for cardiovascular and respiratory signals recording

© 2018 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting /republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksThis paper presents a 1.2 V 36 µW reconfigurable analog front-end (R-AFE) as a general-purpose low-cost IC for multiple-mode biomedical signals acquisition. The R-AFE efficiently reuses a reconfigurable preamplifier, a current generator (CG), and a mixed signal processing unit, having an area of 1.1 mm2 per R-AFE while supporting five acquisition modes to record different forms of cardiovascular and respiratory signals. The R-AFE can interface with voltage-, current-, impedance-, and light-sensors and hence can measure electrocardiography (ECG), bio-impedance (BioZ), photoplethysmogram (PPG), galvanic skin response (GSR), and general-purpose analog signals. Thanks to the chopper preamplifier and the low-noise CG utilizing dynamic element matching, the R-AFE mitigates 1/f noise from both the preamplifier and the CG for improved measurement sensitivity. The IC achieves competitive performance compared to the state-of-the-art dedicated readout ICs of ECG, BioZ, GSR, and PPG, but with approximately 1.4×-5.3× smaller chip area per channel.Peer ReviewedPostprint (author's final draft

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Study of time-frequency characteristics of single snores: extracting new information for sleep apnea diagnosis

Obs tructive sleep apnea (OSA) is a highly prevalent chronic disease, especially in elderly and obese population . Despite constitut ing a huge health and economic problem, most patients remain undiagnosed due to limitations in current strategies. Therefore, it is essential to find cost - effective diagnostic alternatives. One of these novel approaches is the analysis of acoustic snoring signals. Snoring is an early symptom of OSA which carr ies pathophysiological information of high diagnostic value. For this reason, the main objective of this work is to study the characteristics of single snores of different types, from healthy and OSA subjects. To do that, we analyzed snoring signals from p revious databases and developed an experimental protocol to record simulated OSA - related sounds and characterize the response of two commercial tracheal microphones. Automatic programs for filtering, downsampling, event detection and time - frequency analysi s were built in MATLAB. We found that time - frequency maps and spectral parameters (central, mean and peak frequency and energy in the 100 - 500 Hz band) allow distinguishing regular snores of healthy subjects from non - regular snores and snores of OSA subject s. Regarding the two commercial microphones, we f ound that one of them was a suitable snoring sensor, while the other had a too restricted frequency response. Future work shall include a higher number of episode s and subjects , but our study has contributed to show how important the differences between regular and non - regular snores can be for OSA diagnosis, and how much clinically relevant information can be extracted from time - frequency maps and spectral parameters of single snoresPeer Reviewe

Relationship Between Heart Rate Recovery and Disease Severity in Chronic Obstructive Pulmonary Disease Patients

Chronic obstructive pulmonary disease (COPD) patients exhibit impaired autonomic control which can be assessed by heart rate variability analysis. The study aims to evaluate the cardiac autonomic responses of COPD patients after completing a conventional six-minute walk test (6MWT). Fifty COPD patients were included in the study, for which an ECG signal (lead II) was acquired by a wearable device, before, during, and after the test. We used the heart rate (HR) time-series to assess the heart rate dynamic during recovery. The heart rate recovery (HRR) marker was evaluated every 5 s after the 6MWT and showed different dynamic trends among severity groups. We compared the HRR among patient groups classified according to the GOLD standard. Significantly larger normalized HRR values (nHRR) were found in mild COPD patients (n=23, GOLD={1,2}; nHRR1=14.8±7.5 %, nHRR2=18.6±8.1 %) compared to those with more disease severity (n=23, GOLD={3,4}; nHRR1=9.3±5.8 %, p=0.002; and nHRR2= 13.7±6.7 %, p=0.041). The largest differences were observed around the first 30 s of the recovery phase (nHRR=10.8±6.6 % vs. nHRR=5.6±4 % p=0.001). Our results showed a slower recovery for the severest patients, suggesting that cardiac parameters like the ones we propose here, may provide valuable information for a better characterization of COPD severity.Peer ReviewedPostprint (published version

Combining bioimpedance and myographic signals for the assessment of COPD during loaded breathing

© 2020 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting /republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksChronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic conditions. The current assessment of COPD requires a maximal maneuver during a spirometry test to quantify airflow limitations of patients. Other less invasive measurements such as thoracic bioimpedance and myographic signals have been studied as an alternative to classical methods as they provide information about respiration. Particularly, strong correlations have been shown between thoracic bioimpedance and respiratory volume. The main objective of this study is to investigate bioimpedance and its combination with myographic parameters in COPD patients to assess the applicability in respiratory disease monitoring. We measured bioimpedance, surface electromyography and surface mechanomyography in forty-three COPD patients during an incremental inspiratory threshold loading protocol. We introduced two novel features that can be used to assess COPD condition derived from the variation of bioimpedance and the electrical and mechanical activity during each respiratory cycle. These features demonstrate significant differences between mild and severe patients, indicating a lower inspiratory contribution of the inspiratory muscles to global respiratory ventilation in the severest COPD patients. In conclusion, the combination of bioimpedance and myographic signals provides useful indices to noninvasively assess the breathing of COPD patients.Peer ReviewedPostprint (updated version

Polypeptides immunogènes et leurs utilisations

[EN] The present invention relates to new polypeptides, more specifically to immunogenic polypeptides derived from protein Spike of SARS-CoV-2. It also relates to the use of the said polypeptides in eliciting an immune response, preventing or treating a disease caused by the infection by SARS-CoV-2 and detecting the presence of neutralizing antibodies against SARS-CoV-2.[FR] La présente invention concerne de nouveaux polypeptides, plus spécifiquement des polypeptides immunogènes dérivés de protéine de spicule du SARS-CoV-2. L'invention concerne également l'utilisation desdits polypeptides pour déclencher une réponse immunitaire, la prévention ou le traitement d'une maladie provoquée par l'infection par le SARS-CoV-2 et la détection de la présence d'anticorps neutralisants contre le SARS-CoV-2.NoConsejo Superior de Investigaciones CientíficasA1 Solicitud de patente con informe sobre el estado de la técnic