A Comparison of Three QRS Detection Algorithms Over a Public Database

AbstractWe have compared three of the best QRS detection algorithms, regarding their results, to check the performance and to elucidate which get better accuracy. In the literature these algorithms were published in a theoretical way, without offering their code, so it is difficult to check its real behaviour over different collections of ECG records. This work brings the community our source code of each algorithm and results of its validation over a public database. In addition, this software was developed as a framework in order to permit the inclusion of new QRS detection algorithms and also its testing over different databases

Understanding patterns of protest against Cuba's medical internationalism

The presence of Cuban healthcare professionals in countries like Brazil, Bolivia, and Haiti has followed a clear path from protest to acceptance, but the case Venezuela shows the vital importance of political neutrality, write Emily J. Kirk (Dalhousie University), Chris Walker (St Mary's University), and Arturo Méndez (University of Camagüey)

Heart of Darkness: Heart Rate Variability on Patients with Risk of Suicide

Heart Rate Variability (HRV) is an emerging research field in the study of diverse pathologies, as long as it allows considering another measurement for detecting possible aggravations. The aim of this work is to study the applicability of the analysis of HRV in order to establish if a person is at risk of suffering from suicidal ideation. This work includes the development and testing of a heart rate acquisition and automatic analysis system, with friendly software for clinicians, customized to the necessities of an emergency unit. Furthermore, it includes the analysis of the obtained data with the purpose of assessing possible correlations between HRV parameters and personality impulsive traits. 20 patients and 10 normal cases were selected to develop this pilot study. Results show significant statistical difference (p<0.05) among patients and normal cases for pNN50, IRRR, MADRR, total HRV power, Approximate Entropy and Fractal Dimension

Sustained Release Of Calcium Hydroxide From Poly(DL-lactide-co-glycolide) Acid Microspheres For Apexification

Calcium hydroxide (Ca(OH)2) loaded poly(DL-lactide-co-glycolide) acid (PLGA) microspheres (MS) might be employed for apexification requiring a sustained release of Ca++. The aim of this study was to formulate and characterize Ca(OH)2-PLGA-MS. The Ca(OH)2-loaded MS were prepared by either oil-in-water (O/W) or water-in-oil/in-water (W/O/W) emulsion solvent evaporation technique. MS produced by the O/W technique exhibited a larger diameter (18.63 ± 7.23 μm) than the MS produced by the W/O/W technique (15.25 ± 7.37 μm) (Mann Whitney U test P \u3c 0.001). The Ca(OH)2 encapsulation efficiency and Ca++ release were calculated from data obtained by absorption techniques. Ca++ release profile was evaluated for 30 days. The percentage of encapsulation efficiency of the O/W-produced MS was higher (24%) than the corresponding percentage of the W/O/W-produced MS (11%). O/W- and W/O/W-produced MS released slower and lower Ca++ than a control Ca(OH)2 paste with polyethylene glycol 400 (ANOVA 1 way, Tukey HSD P \u3c 0.01). O/W-produced MS released higher Ca++ than W/O/W-produced MS (statistically significant differences with t-Student test). We concluded that Ca(OH)2-PLGA-MS were successfully formulated; the technique of formulation influenced on the size, encapsulation efficiency and release profile. The MS were better sustained release system than the Ca(OH)2 paste

El género, un factor determinante en el riesgo de somnolencia

Los trastornos del sue˜no constituyen un grupo numeroso y heterogéneo de procesos. A nivel mundial se estima que la prevalencia de trastornos del sue˜no oscila entre 35 y 45% de la población adulta mayor de 18 a˜nos. Estudios previos realizados en la Cd de México han demostrado una somnolencia excesiva diurna en el 18%, de los cuales 19% fueron mujeres y 17% hombres por lo que el objetivo de este proyecto es detectar en una población adulta del valle de Toluca, el riesgo de somnolencia. Métodos: Se empleó un instrumento validado: escala de somnolencia de Epworth que tiene por objeto evaluar la magnitud de la somnolencia diurna frente a ocho situaciones de la vida diaria. Resultados: De los 227 sujetos analizados, se encontró que 76 de ellos (33.4%): 44 hombres (19.4% del total) y 27 mujeres (11.9% del total) tenían somnolencia excesiva. Se dividió a la población en dos grupos: mayores o iguales a 50 a˜nos de edad y 49 a˜nos o menos. Al comparar el riesgo Hombre-Mujer se encontró un valor de O.R. de 4.1 en los hombres de 50 a˜nos o más, mientras que en el género femenino fue de 1.0. Al establecer una separación con los sujetos que tenían entre 9 y 11 puntos de la escala de Epworth, se demostró que el riesgo seguía siendo elevado en OR = 4.0 Conclusiones: En la población estudiada el género masculino tiene un riesgo cuatro veces mayor que la mujer de presentar somnolencia excesiva diurna. © 2014 Universidad Autónoma del Estado de México. Publicado por Masson Doyma México S.A. Todos los derechos reservados

Aortic disease in Marfan syndrome is caused by overactivation of sGC-PRKG signaling by NO

AbstractThoracic aortic aneurysm, as occurs in Marfan syndrome, is generally asymptomatic until dissection or rupture, requiring surgical intervention as the only available treatment. Here, we show that nitric oxide (NO) signaling dysregulates actin cytoskeleton dynamics in Marfan Syndrome smooth muscle cells and that NO-donors induce Marfan-like aortopathy in wild-type mice, indicating that a marked increase in NO suffices to induce aortopathy. Levels of nitrated proteins are higher in plasma from Marfan patients and mice and in aortic tissue from Marfan mice than in control samples, indicating elevated circulating and tissue NO. Soluble guanylate cyclase and cGMP-dependent protein kinase are both activated in Marfan patients and mice and in wild-type mice treated with NO-donors, as shown by increased plasma cGMP and pVASP-S239 staining in aortic tissue. Marfan aortopathy in mice is reverted by pharmacological inhibition of soluble guanylate cyclase and cGMP-dependent protein kinase and lentiviral-mediated Prkg1 silencing. These findings identify potential biomarkers for monitoring Marfan Syndrome in patients and urge evaluation of cGMP-dependent protein kinase and soluble guanylate cyclase as therapeutic targets.</jats:p

Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome

Objectives: A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) at ARDS onset. Since the proposal did not mandate PaO2/FiO2 calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO2/FiO2 would not provide accurate assessment of lung injury severity. Design: A prospective, multicentre, observational study. Setting: A network of teaching hospitals. Participants: 478 patients with eligible criteria for moderate (100300). Primary and secondary outcomes Group severity and hospital mortality. Results: At ARDS onset, 173 patients had a PaO2/FiO2≤100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO2/FiO2 category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO2/FiO2 and non-standardised PaO2/FiO2 at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). Conclusions: Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. Trial registration numbers NCT00435110 and NCT00736892

Serum Lipopolysaccharide Binding Protein Levels Predict Severity of Lung Injury and Mortality in Patients with Severe Sepsis

Background: There is a need for biomarkers insuring identification of septic patients at high-risk for death. We performed a prospective, multicenter, observational study to investigate the time-course of lipopolysaccharide binding protein (LBP) serum levels in patients with severe sepsis and examined whether serial serum levels of LBP could be used as a marker of outcome. Methodology/Principal Findings: LBP serum levels at study entry, at 48 hours and at day-7 were measured in 180 patients with severe sepsis. Data regarding the nature of infections, disease severity, development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), and intensive care unit (ICU) outcome were recorded. LBP serum levels were similar in survivors and non-survivors at study entry (117.4±75.7 µg/mL vs. 129.8±71.3 µg/mL, P = 0.249) but there were significant differences at 48 hours (77.2±57.0 vs. 121.2±73.4 µg/mL, P<0.0001) and at day-7 (64.7±45.8 vs. 89.7±61.1 µg/ml, p = 0.017). At 48 hours, LBP levels were significantly higher in ARDS patients than in ALI patients (112.5±71.8 µg/ml vs. 76.6±55.9 µg/ml, P = 0.0001). An increase of LBP levels at 48 hours was associated with higher mortality (odds ratio 3.97; 95%CI: 1.84–8.56; P<0.001). Conclusions/Significance: Serial LBP serum measurements may offer a clinically useful biomarker for identification of patients with severe sepsis having the worst outcomes and the highest probability of developing sepsis-induced ARDS