Detrended fluctuation analysis of heart rate by means of symbolic series

Detrended fluctuation analysis (DFA) has been shown to be a useful tool for diagnosis of patients with cardiac diseases. The scaling exponents obtained with DFA are an indicator of power-law correlations in signal fluctuation, independently of signal amplitude and external trends. In this work, an approach based on DFA was proposed for analyzing heart rate variability (HRV) by means of RR series. The proposal consisted on transforming consecutive RR increments to symbols, according to an adapted symbolic-quantization. Three scaling exponents were calculated, αHF, αLF and αVLF, which correspond to the well known VLF, LF and HF frequency bands in the power spectral of the HRV. This DFA approach better characterized high and low risk of cardiac mortality in ischemic cardiomyiopathy patients than DFA applied to RR time series or RR increment series.Peer ReviewedPostprint (published version

NOTCH Activation Promotes Valve Formation by Regulating the Endocardial Secretome.

The endocardium is a specialized endothelium that lines the inner surface of the heart. Functional studies in mice and zebrafish have established that the endocardium is a source of instructive signals for the development of cardiac structures, including the heart valves and chambers. Here, we characterized the NOTCH-dependent endocardial secretome by manipulating NOTCH activity in mouse embryonic endocardial cells (MEEC) followed by mass spectrometry-based proteomics. We profiled different sets of soluble factors whose secretion not only responds to NOTCH activation but also shows differential ligand specificity, suggesting that ligand-specific inputs may regulate the expression of secreted proteins involved in different cardiac development processes. NOTCH signaling activation correlates with a transforming growth factor-β2 (TGFβ2)-rich secretome and the delivery of paracrine signals involved in focal adhesion and extracellular matrix (ECM) deposition and remodeling. In contrast, NOTCH inhibition is accompanied by the up-regulation of specific semaphorins that may modulate cell migration. The secretome protein expression data showed a good correlation with gene profiling of RNA expression in embryonic endocardial cells. Additional characterization by in situ hybridization in mouse embryos revealed expression of various NOTCH candidate effector genes (Tgfβ2, Loxl2, Ptx3, Timp3, Fbln2, and Dcn) in heart valve endocardium and/or mesenchyme. Validating these results, mice with conditional Dll4 or Jag1 loss-of-function mutations showed gene expression alterations similar to those observed at the protein level in vitro These results provide the first description of the NOTCH-dependent endocardial secretome and validate MEEC as a tool for assaying the endocardial secretome response to a variety of stimuli and the potential use of this system for drug screening.We thank C. Martí Gómez-Aldaraví for help with graphic representation and critical reading of the manuscript, and S. Bartlett for English editing. RTC is supported by a Foundation La Caixa PhD fellowship (Ref LCF/BQ/ES15/10360023). LLZ is supported by a Ramón y Cajal postdoctoral contract (Ref: RYC-2016-20917). JLdlP is funded by grants SAF2016-78370-R, CB16/11/00399 (CIBER CV), and RD16/0011/0021 (TERCEL) from the Ministerio de Ciencia, Innovación y Universidades, and grants from the Fundación BBVA (Ref.: BIO14_298) and Fundación La Marató TV3 (Ref.: 20153431). JV is supported by grants BIO2015-67580-P and CB16/11/00277 (CIBER CV) from the Ministerio de Ciencia, Innovación y Universidades, and Carlos III Institute of Health-Fondo de Investigación Sanitaria (Grant ProteoRed-PRB3-IPT17/0019-ISCIII-SGEFI/ERDF), the Fundación La Marató TV3 (Ref. 122/C/2015) and “La Caixa” Banking Foundation (project code HR17-00247). The cost of this publication was supported in part with funds from the ERDF. The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).S

Straight versus Spongy -- Effect of Tortuosity on Polymer Imbibition into Nanoporous Matrices Assessed by Segmentation-Free Analysis of 3D Sample Reconstructions

We comparatively analyzed imbibition of polystyrene (PS) into two complementary pore models having pore diameters of about 380 nm and hydroxyl-terminated inorganic-oxidic pore walls, controlled porous glass (CPG) and self-ordered porous alumina (AAO), by X-ray computed tomography and EDX spectroscopy. CPG contains continuous spongy-tortuous pore systems. AAO containing arrays of isolated straight cylindrical pores is a reference pore model with a tortuosity close to 1. Comparative evaluation of the spatiotemporal imbibition front evolution yields important information on the pore morphology of a probed tortuous matrix like CPG and on the imbibition mechanism. To this end, pixel brightness dispersions in tomographic 3D reconstructions and 2D EDX maps of infiltrated AAO and CPG samples were condensed into 1D brightness dispersion profiles normal to the membrane surfaces. Their statistical analysis yielded positions and widths of the imbibition fronts without segmentation or determination of pore positions. The retardation of the imbibition front movement with respect to AAO reference samples may be used as a descriptor for the tortuosity of a tested porous matrix. The velocity of the imbibition front movements in CPG equaled two-thirds of the velocity of the imbibition front movements in AAO. Moreover, the dynamics of the imbibition front broadening discloses whether porous matrices are dominated by cylindrical neck-like pore segments or by nodes. Independent single-meniscus movements in cylindrical AAO pores result in faster imbibition front broadening than in CPG, in which a morphology dominated by nodes results in slower cooperative imbibition front movements involving several menisci

Tradução para o espanhol, adaptação transcultural e validação da escala ADTC (Atopic Dermatitis Control Tool)

The ADCT questionnaire (Atopic Dermatitis Control Tool) allows for a brief and self-administered objectification of the impact of atopic dermatitis (AD) on the daily life of those who suffer from it. Objectives: Obtain a version to validate it in a population of adults with AD. Materials and methods: 1) Translation into Spanish and cross-cultural adaptation of the questionnaire from the original version in English, through a seven-step process. 2) Evaluation of the unidimensionality of the resulting scale by means of an exploratory factor analysis (EFA), of its reliability by means of Cronbach\u27s alpha coefficient, and of its validity by evaluating the correlation of its score with those of the POEM and DLQI questionnaires. (external reference criteria). Results: The version resulting from the translation and cross-cultural adaptation process was well understood by the target population. The AFE of the 66 questionnaires documented the unidimensionality of the scale based on compliance with all the criteria used for its verification. Its reliability was excellent (Cronbach\u27s Alpha: 0.917) and its score had a very high correlation with the external reference criteria (POEM: Spearman\u27s Rho 0.85; p < 0.0001; DLQI Spearman\u27s Rho = 0.81; p < 0 .0001). Conclusions: The version translated into Spanish and adapted for transculturation of the ADCT questionnaire has appropriate psychometric characteristics, which will contribute to optimizing the care processes of Spanish-speaking patients.El cuestionario ADCT (Atopic Dermatitis Control Tool) permite objetivar en forma breve y autoadministrada la repercusión de la dermatitis atópica (DA) sobre la vida cotidiana de quien la padece. OBJETIVOS: Obtener una versión validarla en una población de adultos con DA. METODOLOGIA: 1) Traducción al español y adaptación transcultural del cuestionario a partir de la versión original en inglés, a través de un proceso de siete pasos. 2) Evaluación de la unidimensionalidad de la escala resultante mediante un análisis factorial exploratorio (AFE), de su confiabilidad mediante el coeficiente alfa de Cronbach, y de su validez mediante la evaluación de la correlación de su puntaje con los de los cuestionarios POEM y DLQI (criterios externos de referencia). RESULTADOS: La versión resultante del proceso de traducción y adaptación transcultural fue bien comprendida por la población blanco. El AFE de los 66 cuestionarios documentó la unidimensionalidad de la escala a partir del cumplimiento de todos los criterios utilizados para su verificación. Su confiabilidad fue excelente (Alfa de Cronbach: 0,917) y su puntaje tuvo muy alta correlación con los criterios de referencia externos (POEM: Spearman’s Rho 0,85; p < 0,0001; DLQI Spearman’s Rho = 0,81; p < 0,0001). CONCLUSION: La versión traducida al español y adaptada transculturación del cuestionario ADCT tiene características psicométricas apropiadas, lo que contribuirá a optimizar los procesos de cuidado de pacientes de habla hispana.O questionário ADCT (Atopic Dermatitis Control Tool) permite uma objetivação breve e autoaplicável do impacto da dermatite atópica (DA) na vida diária de quem a padece. Objetivos: Obter uma versão para validá-lo em uma população de adultos com DA Materiais e métodos: 1) Tradução para o espanhol e adaptação transcultural do questionário a partir da versão original em inglês, por meio de um processo de sete etapas. 2) Avaliação da unidimensionalidade da escala resultante por meio de uma análise fatorial exploratória (EFA), de sua confiabilidade por meio do coeficiente alfa de Cronbach e de sua validade avaliando a correlação de sua pontuação com os questionários POEM e DLQI .(critérios de referência externa). Resultados: A versão resultante do processo de tradução e adaptação transcultural foi bem compreendida pela população-alvo. A AFE dos 66 questionários documentou a unidimensionalidade da escala com base no cumprimento de todos os critérios utilizados para a sua verificação. Sua confiabilidade foi excelente (Cronbach\u27s Alpha: 0,917) e seu escore teve uma correlação muito alta com os critérios externos de referência (POEM: Spearman\u27s Rho 0,85; p < 0,0001; DLQI Spearman\u27s Rho = 0,81; p < 0,0001). Conclusões: A versão traduzida para o espanhol e adaptada para transculturação do questionário ADCT possui características psicométricas adequadas, o que contribuirá para otimizar os processos de atendimento de pacientes de língua española

Plasma Molecular Signatures in Hypertensive Patients With Renin-Angiotensin System Suppression: New Predictors of Renal Damage and De Novo Albuminuria Indicators

Albuminuria is a risk factor strongly associated with cardiovascular disease, the first cause of death in the general population. It is well established that renin-angiotensin system suppressors prevent the development of new-onset albuminuria in naïf hypertensive patients and diminish its excretion, but we cannot forget the percentage of hypertensive patients who develop de novo albuminuria. Here, we applied multiple proteomic strategy with the purpose to elucidate specific molecular pathways involved in the pathogenesis and provide predictors and chronic organ damage indicators. Briefly, 1143 patients were followed up for a minimum period of 3 years. One hundred and twenty-nine hypertensive patients chronically renin-angiotensin system suppressed were recruited, classified in 3 different groups depending on their albuminuria levels (normoalbuminuria, de novo albuminuria, and sustained albuminuria), and investigated by multiple proteomic strategies. Our strategy allowed us to perform one of the deepest plasma proteomic analysis to date, which has shown 2 proteomic signatures: (1) with predictive value of de novo albuminuria and (2) sustained albuminuria indicator proteins. These proteins are involved in inflammation, immune as well as in the proteasome activation occurring in situations of endoplasmic reticulum stress. Furthermore, these results open the possibility of a future strategy based on anti-immune therapy to treat hypertension which could help to prevent the development of albuminuria and, hence, the progression of kidney damage.N

Tradução para o espanhol, adaptação transcultural e validação da escala ADTC (Atopic Dermatitis Control Tool)

Introducción: El cuestionario ADCT (Atopic Dermatitis Control Tool) permite objetivar en forma breve y autoadministrada la repercusión de la dermatitis atópica (DA) sobre la vida cotidiana de quien la padece. OBJETIVOS: Obtener una versión validarla en una población de adultos con DA. METODOLOGIA: 1) Traducción al español y adaptación transcultural del cuestionario a partir de la versión original en inglés, a través de un proceso de siete pasos. 2) Evaluación de la unidimensionalidad de la escala resultante mediante un análisis factorial exploratorio (AFE), de su confiabilidad mediante el coeficiente alfa de Cronbach, y de su validez mediante la evaluación de la correlación de su puntaje con los de los cuestionarios POEM y DLQI (criterios externos de referencia). RESULTADOS: La versión resultante del proceso de traducción y adaptación transcultural fue bien comprendida por la población blanco. El AFE de los 66 cuestionarios documentó la unidimensionalidad de la escala a partir del cumplimiento de todos los criterios utilizados para su verificación. Su confiabilidad fue excelente (Alfa de Cronbach: 0,917) y su puntaje tuvo muy alta correlación con los criterios de referencia externos (POEM: Spearman’s Rho 0,85; p < 0,0001; DLQI Spearman’s Rho = 0,81; p < 0,0001). CONCLUSION: La versión traducida al español y adaptada transculturación del cuestionario ADCT tiene características psicométricas apropiadas, lo que contribuirá a optimizar los procesos de cuidado de pacientes de habla hispana.The ADCT questionnaire (Atopic Dermatitis Control Tool) allows for a brief and self-administered objectification of the impact of atopic dermatitis (AD) on the daily life of those who suffer from it. Objectives: Obtain a version to validate it in a population of adults with AD. Materials and methods: 1) Translation into Spanish and cross-cultural adaptation of the questionnaire from the original version in English, through a seven-step process. 2) Evaluation of the unidimensionality of the resulting scale by means of an exploratory factor analysis (EFA), of its reliability by means of Cronbach's alpha coefficient, and of its validity by evaluating the correlation of its score with those of the POEM and DLQI questionnaires. (external reference criteria). Results: The version resulting from the translation and cross-cultural adaptation process was well understood by the target population. The AFE of the 66 questionnaires documented the unidimensionality of the scale based on compliance with all the criteria used for its verification. Its reliability was excellent (Cronbach's Alpha: 0.917) and its score had a very high correlation with the external reference criteria (POEM: Spearman's Rho 0.85; p < 0.0001; DLQI Spearman's Rho = 0.81; p < 0 .0001). Conclusions: The version translated into Spanish and adapted for transculturation of the ADCT questionnaire has appropriate psychometric characteristics, which will contribute to optimizing the care processes of Spanish-speaking patients.Introdução: O questionário ADCT (Atopic Dermatitis Control Tool) permite uma objetivação breve e autoaplicável do impacto da dermatite atópica (DA) na vida diária de quem a padece. Objetivos: Obter uma versão para validá-lo em uma população de adultos com DA Materiais e métodos: 1) Tradução para o espanhol e adaptação transcultural do questionário a partir da versão original em inglês, por meio de um processo de sete etapas. 2) Avaliação da unidimensionalidade da escala resultante por meio de uma análise fatorial exploratória (EFA), de sua confiabilidade por meio do coeficiente alfa de Cronbach e de sua validade avaliando a correlação de sua pontuação com os questionários POEM e DLQI .(critérios de referência externa). Resultados: A versão resultante do processo de tradução e adaptação transcultural foi bem compreendida pela população-alvo. A AFE dos 66 questionários documentou a unidimensionalidade da escala com base no cumprimento de todos os critérios utilizados para a sua verificação. Sua confiabilidade foi excelente (Cronbach's Alpha: 0,917) e seu escore teve uma correlação muito alta com os critérios externos de referência (POEM: Spearman's Rho 0,85; p < 0,0001; DLQI Spearman's Rho = 0,81; p < 0,0001). Conclusões: A versão traduzida para o espanhol e adaptada para transculturação do questionário ADCT possui características psicométricas adequadas, o que contribuirá para otimizar os processos de atendimento de pacientes de língua espanhola.Fil: Caviedes, Mariana Paula. Hospital Italiano; ArgentinaFil: Angles, María Valeria. Hospital Italiano; ArgentinaFil: Luna, Paula Carolina. Hospital Aleman; ArgentinaFil: Terrasa, Sergio Adrian. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Vazquez Peña, Fernando. Hospital Italiano; ArgentinaFil: Echeverria, Cristina. Gobierno de la Ciudad de Buenos Aires; ArgentinaFil: Larralde, Margarita. Hospital Aleman; ArgentinaFil: Mazzuoccolo, Luis Daniel. Hospital Italiano; Argentin

Αντιστροφή φύλου του διακοσμητικού ψαριού μονομάχος (Betta splendens, Regan 1910)

<p>C2 phage bound to amyloid aggregates in 50 µm-thick brain tissue sections of temporal cortex from AD patients (A–D) and from cognitively normally aging (NA) elderly subjects (E). Each panel shows, from the left: the reactivity of phage (green); the reactivity of BAM 90.1, an anti-Aβ1–42 monoclonal antibody (red); the merge between red and green channels. A, C and E: scale bar represents 150 µm; B and D: scale bar represents 10 µm.</p

Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]

BACKGROUND: Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). METHODS/DESIGN: Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. DISCUSSION: The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Statistical Evaluation of the Imbibition of Polymers into Porous Materials

Frozen transient imbibition states into two complementary pore models having pore diameters of ~380 nm and hydroxyl-terminated inorganic-oxidic pore walls, controlled porous glass (CPG) and self-ordered porous alumina (AAO), were imaged by phase-contrast X-ray computed tomography (X-ray CT), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy mapping (EDX). The deployment of phase-contrast X-ray CT bring together the advantages of macroscopic averaging methods and microscopy by allowing the algorithmic evaluation of three-dimensional reconstructions of imbibition morphologies to study characteristic features with characteristic length scales in the range from a few tens of μm down to the sub-μm scale, not possible with averaging methods, and with high validity, unattainable with microscopy. CPG contains continuous spongy-tortuous pore systems. AAO containing arrays of isolated straight cylindrical pores is a reference pore model with a tortuosity close to 1. Comparative evaluation of the spatiotemporal imbibition front evolution yields important information on the pore morphology of a probed tortuous matrix like CPG and on the imbibition mechanism. Image analysis methods based on the evaluation of pixel brightness fluctuations were developed to determine imbibition front positions and widths by descriptive statistics. The retardation of the imbibition front movement with respect to AAO reference samples may be used as a descriptor for the geometric tortuosity of a tested porous matrix. The velocity of the imbibition front movements in CPG equaled two-thirds of the velocity of the imbibition front movements in AAO. Moreover, the dynamics of the imbibition front broadening discloses whether porous matrices are dominated by cylindrical neck-like pore segments or by nodes. Independent single-meniscus movements in cylindrical AAO pores result in faster imbibition front broadening than in CPG, in which a morphology dominated by nodes results in slower cooperative imbibition front movements involving several menisci. The results presented here may be relevant to a broad variety of applications including printing, adhesive bonding, oil recovery, water filtration, as well as the optimization of production and properties of engineering, construction and hybrid materials