Diseño y desarrollo de una plataforma para la predicción de fibrilación auricular a partir del procesado de señales de ECG

[ES] La fibrilación auricular es una taquiarritmia supraventricular en la que las aurículas se activan de manera descoordinada sin contracción efectiva. Su presencia supone un aumento de riesgo de ictus y tromboembolismo periférico, suponiendo graves consecuencias para la salud. La predicción del riesgo a largo plazo es una prioridad para la prevención de la fibrilación auricular. El presente trabajo fin de máster aborda el estudio de la función auricular a través de la parametrización de las ondas P mediante algoritmos de detección automática. Se pretende conseguir una delineación precisa para obtener medidas de voltaje, dispersión y duración que describan la conducción auricular. Se utilizarán electrocardiogramas de seguimiento de diferentes pacientes con el objetivo de evaluar el potencial predictor de la variabilidad de los índices de onda P en la detección temprana de la fibrilación auricular. Para este objetivo se implementará una interfaz gráfica a través del software Matlab que permitirá dirigir el proceso de delineado. Se incluirá un módulo en el cual el especialista pueda visualizar de forma fácil e intuitiva las diferentes medidas y detectar así las posibles anomalías. Adicionalmente, se incluirá un módulo que permita al especialista delinear las señales electrocardiográficas de forma manual, obteniendo así anotaciones con la posición de cada onda. Esto permitirá llevar a cabo un proceso de validación de los diferentes algoritmos de delineación automática mediante el estudio de variables como la sensibilidad o el valor predictivo positivo de cada algoritmo. El trabajo se realizará en el Centro de Investigación e Innovación en Bioingeniería (Ci2B) de la Universitat Politècnica de València, en colaboración especial con el Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III y, en concreto, con el doctor David Filgueiras Rama, jefe investigador del grupo centrado en Desarrollo Avanzado sobre Mecanismos y Terapias de las Arritmias.[CA] La fibril·lació auricular (FA) és una taquiarritmia supraventricular en la qual l'aurícula s'activa de manera descoordinada sense contracció efectiva. Es tracta d'una malaltia amb una elevada prevalença, mortalitat i morbiditat que, a més, s'esperen incrementades en els pròxims anys, concedint cada vegada més importància a la prevenció i diagnòstic precoç d'aquesta. Per tant, la FA suposa un triple repte: per als pacients, ja que suposa un important impacte clínic; en els metges, ja que es tracta d'una malaltia amb una àmplia varietat de tractaments amb variabilitat inter pacient; per als gestors, per suposar un elevat cost sanitari. Els índexs d'ona P són mesuraments electrocardiográficas que llancen informació rellevant sobre la conducció auricular. L'anàlisi d'aquests mesuradors electrocardiográficos juga un paper rellevant en la determinació prospectiva de FA. De fet, s'han desenvolupat importants estudis a nivell europeu que han analitzat l'associació entre els índexs d'ona P i el major risc de FA. El present treball fi de màster aborda l'estudi de la funció auricular a través de la parametrització de les ones P mitjançant algorismes de detecció automàtica. Per a això s'implementen dos algorismes de delineació amb diferents metodologies de detecció i base matemàtica. Aquests algorismes s'integren a través de l'elaboració d'una interfície senzilla i intuïtiva que permeta a l'expert guiar el procés de delineat de manera dinàmica i robusta. Amb tot això, es pretén donar cobertura al procés complet d'estudi de les dades contingudes en el conjunt de pacients proporcionats pel CNIC. Especialment, s'analitza la correlació i significança estadística de les diferències observades entre el control i el grup de pacients amb desenvolupament de FA, identificant paràmetres indicatius de major risc de FA. S'observen diferències de variabilitat i valor mig relatives a la duració, dispersió i voltatge de l'ona P en el subgrup de FA respecte al grup que no desenvolupa FA. No obstant això, l'única diferència estadísticament significativa és la que s'associa amb el voltatge de l'ona P (p<0.0006).[EN] Atrial fibrillation is a supraventricular tachyarrhythmia in which the atria activate uncoordinatedly without effective contraction. Its presence leads to an increased risk of stroke and peripheral thromboembolism, with serious health consequences. Predicting long-term risk is a priority for the prevention of atrial fibrillation. This master's thesis addresses the study of atrial function through the parameterization of P waves using automatic detection algorithms. It is intended to achieve an accurate delineation to obtain voltage, dispersion and duration measurements describing atrial conduction. Follow-up electrocardiograms from different patients will be used to evaluate the predictive potential of the variability of the P wave indices in early atrial fibrillation detection. For this purpose, a graphical interface will be implemented in Matlab to perform the delineation process. A module for the specialist to easily and intuitively visualize different measurements and thus, detect possible anomalies, will be included. Additionally, a module for the specialist to manually delineate the electrocardiographic signals, obtaining annotations with the position of each wave, will be also included. This will allow a validation of the different automatic delineation algorithms by studying parameters such as their sensitivity or positive predictive value. The work will be carried out at the Centro de Investigación e Innovación en Bioingeniería (Ci2B) of the Universitat Politècnica de València, in close collaboration with the Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III and, specifically, with Dr. David Filgueiras Rama, chief researcher of the group Desarrollo Avanzado sobre Mecanismos y Terapias de las Arritmias.Palomino Fernández, D. (2020). Diseño y desarrollo de una plataforma para la predicción de fibrilación auricular a partir del procesado de señales de ECG. Universitat Politècnica de València. http://hdl.handle.net/10251/160723TFG

CASSIA (cardiology software suite for image analysis): a potential new tool for the evaluation of [18F]FDG PET/CT in the setting of infective endocarditis.

Due to the high morbidity and mortality of infective endocarditis (IE), medical imaging techniques are combined to ensure a correct diagnosis. [18F]FDG PET/CT has demonstrated the ability to improve diagnostic accuracy compared with the conventional modified Duke criteria in patients with suspected IE, especially those with prosthetic valve infective endocarditis (PVIE). The aim of this study is to provide an adjunctive diagnostic tool to improve the diagnostic accuracy in cardiovascular infections, specifically PVIE. A segmentation tool to extract quantitative measures of [18F]FDG PET/CT image studies of prosthetic heart valve regions was developed and validated in 20 cases of suspected PVIE, of which 9 were confirmed. For that, Valvular Heterogeneity Index (VHI) and Ring-to-Center Ratio (RCR) were defined. Results show an overall increase in the metabolic uptake of the prosthetic valve ring in the studies with confirmed PVIE diagnosis (SUVmax from 1.70 to 3.20; SUVmean from 0.86 to 1.50). The VHI and RCR showed areas under the curve of 0.727 and 0.808 in the receiver operating characteristics curve analyses, respectively, for PVIE diagnosis. Mann-Whitney U tests showed statistically significant differences between groups for RCR (p = 0.02). Visual analyses and clinical reports were concordant with the extracted quantitative metrics. The proposed new method and presented software solution (CASSIA) provide the capability to assess quantitatively myocardial metabolism along the prosthetic valve region in routine [18F]FDG PET/CT scans for evaluating heart valve infectious processes. VHI and RCR are proposed as new potential adjunctive measures for PVIE diagnosis.The project was partially funded by Sociedad Española de Cardiología (SEC/FEC-INVBAS 21/022). Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature.S

Comparing surgically induced astigmatism calculated by means of simulated keratometry versus total corneal refractive power

Purpose: To evaluate surgically induced astigmatism as computed by means of either simulated keratometry (KSIM) or total corneal refractive power (TCRP) after temporal incisions. Methods: Prospective observational study including 36 right eyes undergoing cataract surgery. Astigmatism was measured preoperatively during the 3-month follow-up period using Pentacam. Surgically induced astigmatism was computed considering anterior corneal surface astigmatism at 3mm with KSIM and considering both corneal surfaces with TCRP from 1 to 8mm (TCRP3 for 3mm). The eyes under study were divided into two balanced groups: LOW with KSIM astigmatism <0.90D and HIGH with KSIM astigmatism ≥0.90D. Resulting surgically induced astigmatism values were compared across groups and measuring techniques by means of flattening, steepening, and torque analysis. Results: Mean surgically induced astigmatism was higher in the HIGH group (0.31D @ 102°) than in the LOW group (0.04 D @ 16°). The temporal incision resulted in a steepening in the HIGH group of 0.15 D @ 90°, as estimated with KSIM, versus 0.28 D @ 90° with TCRP3, but no significant differences were found for the steepening in the LOW group or for the torque in either group. Differences between KSIM- and TCRP3-based surgically induced astigmatism values were negligible in LOW group. Conclusion: Surgically induced astigmatism was considerably higher in the high-astigmatism group and its value was underestimated with the KSIM approach. Eyes having low astigmatism should not be included for computing the surgically induced astigmatism because steepening would be underestimated

The coronavirus genome

En enero de 2020 se reportaría oficialmente el agente causal de una nueva y misteriosa neumonía, una variante de coronavirus: SARS-CoV-2. En pocas semanas e incluso días luego de la aparición del virus, originado en la ciudad China de Wuhan, comenzaron a manifestarse ininterrumpidamente brotes en diferentes lugares de mundo. Casi a la par que esto sucedía, fueron obtenidas las secuencias genómicas de decenas de miles de aislamientos clínicos de los cinco continentes. El hecho de que las secuencias del genoma se obtengan sincrónicamente con el desarrollo de la pandemia permite estudiar el proceso evolutivo de manera simultánea al desarrollo de la misma. Esto representa un evento sin precedentes para la historia científica de la humanidad. En este artículo exploramos la importancia de contar con esta información y cómo nos ayuda a entender el desarrollo de esta pandemia.Palabras claves: SARS-CoV-2, genómica, filogenia.In January 2020, the causal agent of a mysterious new pneumonia, a variant of coronavirus (SARS-CoV-2), was officially reported. After the first appearance of the virus in Wuhan (China), different outbreaks started throughout the world. Almost simultaneously, viral genomes of thousands of clinical isolates were globally sequenced. These genome sequences are being obtained simultaneously with the pandemic allowing us to study the pandemic evolution at the same time of its development. This represents an unprecedented event for human scientific history. In this article we explore the importance of these data and how it can help us to understand the development of SARS-CoV-2 pandemic.Fil: Pardo, Agustin Maria. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Schuster, Claudio David. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; ArgentinaFil: Palomino, Maria Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; ArgentinaFil: Turjanski, Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; ArgentinaFil: Fernández Do Porto, Darío Augusto. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Prevalence, clinical characteristics and outcome of severe primary HIV-1 infection: a prospective cohort study

Background: Severe cases of primary HIV infection have been described in patients presenting with neurological involvement, AIDS defining events or other life-threatening events. These severe forms have not been fully studied. Objectives: To determine the prevalence and characteristics of severe PHI in a hospital-based cohort of primary HIV infection, and the response to the early initiation of antiretroviral therapy (ART) at 12 months. Methods: Every patient with PHI attending Hospital Clínic of Barcelona (1997-2015) was evaluated. Severe PHI was defined using clinical, analytical and immunological criteria. Chi-squared test was used for categorical variables and Student's t-test for quantitative variables. Results: 33% of 224 PHI patients (95% CI: 26.84%-39.16%) had a severe PHI. These patients had more symptoms, abnormal analytical parameters and hospital admissions. The severe PHI group had a significantly higher viral load although no differences were observed at 12 months in terms of viral suppression or CD4 count recovery. None died during PHI. Conclusions: Up to one third of patients in our cohort presented with a severe PHI, which was associated with higher hospitalization rates and higher plasma HIV RNA viral load. However, severe forms were not associated to a worse clinical, immunological or virological outcome at 12 months

Seafloor Morphology and Processes in the Alboran Sea

The seafloor of the Alboran Sea reflects its complex tectonic, sedimentary, and oceanography dynamics as a consequence of the geological context, involving interaction between the Eurasian and African plates, and oceanographic context, as it is where the Atlantic and Mediterranean waters meet. Their physiography has a semi-enclosed configuration characterized by two margins (the Spanish Iberian and North Africa—mostly Moroccan margins) enclosing deep basins. Tectonic activity is mainly attested by folds and faults that predominantly affect the central and eastern seafloor sectors, as well as numerous seamounts and fluid-flow features (pockmarks, mud volcanoes, and diapirs) that dot the seafloor. The sedimentary and oceanographic processes allow us to distinctly define two principal environments in the Alboran Sea: the shallow proximal margin (continental shelf); and the deep distal margin (continental slope and base of the slope) with the adjacent sub-basins. The shelf mostly comprises prodeltaic and infralittoral prograding wedges, with local bedform fields, submarine valleys, and wave-cut terraces. Coastal and fluvio-marine sedimentary processes, acting since the last glacial period, are responsible for these features. The deep marine environment is characterised by the ubiquity of contourites, whose continuity is interrupted by turbidite systems, canyons, and landslides. The alongslope action of the Mediterranean waters and their interfaces with the Atlantic water has been the main process governing transport, seafloor reworking, and sedimentation of contourites. Mass-movement processes are responsible for the formation of: (1) turbidite systems—turbidity flows and mass flows were dominant during the last glacial sea-level lowstand, evolving to dilute gravity flows during present interglacial high stand; and (2) landslides—the main triggering factors comprising over-steepening, seismicity, under consolidation due to overpressure by interstitial fluids, stratigraphy, and high sedimentation rates. Locally, still-undetermined biological activity in the Spanish and coral activity in the Moroccan margin generated fields of mounded bioconstructions. The seafloor morphology of the Alboran Sea offers interesting clues for assessing the main potential geological hazards, with tectonic seismicity and landslides (as well as their related tsunamis) being some of the most important potential hazards affecting coastal populations. In addition, the seafloor morphology in combination with assemblages of habitat-forming species enables habitat identification and mapping.En prens

Submarine canyons and related features in the Alboran Sea: continental margins and major isolated reliefs

The analysis of a data set of multibeam bathymetry plus high resolution seismic and parametric profiles allow us to characterize the geomorphologic units on the Alboran Sea-floor as well as the evolution of morpho-sedimentary systems along the Pliocene and Quaternary, later than the main erosive Messinian event. Since the opening of the Gibraltar Straits, the sedimentary evolution of this basin has been controlled by the interchange of water masses between the Atlantic Ocean and the Mediterranean Sea. Basin physiography is also a consequence of the Pliocene-Quaternary compression which has progressively uplifted the sourrounding reliefs and deforms the interior and the margins of the basin. On this scenario, several submarine canyons and gullies have been developed in this basin which traverse especially the northern margin and the flanks of the Northern Alboran Ridge, without affecting the African margins. This fact must be related to the action of bottom contour currents which constitute the main morpho-sedimentary process. The influence of water masses distributed the sedimentary input carried by rivers and coming from the erosion of surrounding ranges. In the southern margin of this basin this influence is stronger and inhibits the development of transversal submarine canyons

The Strait of Gibraltar: submarine morphology, oceanogra- phic connections and evolution

32 pages, 10 figures[EN] The Strait of Gibraltar is a first-order physiographic feature between southern Iberia and northern Africa. It has been excavated over the Arc of Gibraltar in favor of a conjugated ENE-WSW and WNW-ESE fault system that have acted as weakness structures. The Strait was generated by erosive processes of the water masses coming from the Atlantic Ocean in the lower Pliocene, due to the rude and rapid flooding of the Alboran Sea basin. Once the flood stabilized the exchange and interaction of the Atlantic and Mediterranean water masses began as we know it today; the Atlantic water that circulates on the surface of the Strait towards the Alborán Sea, and the Mediterranean water masses that circulate in depth towards the Atlantic Ocean. The acceleration of the Atlantic and Mediterranean water masses in the Strait corridor has favored the development of erosive processes.These processeshave allowed the outcrops of the rocky substratum, the development of sedimentary instabilities and the generation of paleochannels, carbonate crusts and cold-water coral formations during the Pliocene and Quaternary. Likewise, the acceleration of the Mediterranean water masses on their way in and out of the Strait and their interaction with the sea floor have controlled sedimentation both in the Alborán Sea basin and in the Gulf of Cádiz, forming contouritic depositional systems[ES] El estrecho de Gibraltar es un rasgo fisiográfico de primer orden entre el sur de Iberia y el norte de África. Ha sido excavado sobre el Arco de Gibraltar a favor de un sistema de fallas conjugadas de direcciones ENE-OSO y ONO-ESE que han actuado como estructuras de debilidad. El Estrecho fue generado por procesos erosivos de las masas de agua procedentes del océano Atlántico en el Plioceno inferior, al producirse de forma brusca y rápida la inundación de la cuenca del mar de Alborán. Una vez estabilizada la inundación comenzó el intercambio y la interacción de las masas de agua atlántica y mediterránea tal y como hoy la conocemos: el agua atlántica que circula en la superficie del Estrecho hacia el mar de Alborán, y las masas de agua mediterráneas que transitan en profundidad hacia el océano Atlántico. La aceleración de las masas de agua atlántica y mediterránea en el corredor del Estrecho ha favorecido el desarrollo de procesos erosivos. Estos procesos han permitido los afloramientos del substrato rocoso, el desarrollo de inestabilidades sedimentarias, generación de paleocanales, costras carbonatas y formaciones coralígenas de aguas frías durante el Plioceno y el Cuaternario.Asimismo, la aceleración de las masas de agua mediterráneas en su camino de entrada y salida del Estrecho y su interacción con el suelo marino han controlado la sedimentación tanto en la cuenca del mar de Alborán como en el golfo de Cádiz, formando sistemas deposicionales contorníticosWith the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)Peer reviewe

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation