Detection of Atrial Fibrillation Driver Locations Using CNN and Body Surface Potentials

[EN] Atrial fibrillation (AF) is characterized by complex and irregular propagation patterns, and AF onset locations and drivers responsible for its perpetuation are main targets for ablation procedures. Several Deep Learningbased methods have proposed to detect AF, but the estimation of the atrial area where the drivers are found is a topic where further research is needed. In this work, we propose to estimate the zone where AF drivers are found from body surface potentials (BSPs) and Convolutional Neural Networks (CNN), modeling a supervised classification problem. Accuracy in the test set was 0.89 when using noisy BSPs (SNR=20dB), while the Cohen¿s Kappa was 0.85. Therefore, the proposed method could help to identify target regions for ablation using a non-invasive procedure, and avoiding the use of ECG Imaging (ECGI).This work has been partially supported by: Ministerio de Ciencia e Innovacion (PID2019-105032GB-I00), Instituto de Salud Carlos III, and Ministerio de Ciencia, Innovacion y Universidades (supported by FEDER Fondo Europeo de Desarrollo Regional PI17/01106 and RYC2018-024346B-750), Consejeria de Ciencia, Universidades e Innovacion of the Comunidad de Madrid through the program RIS3 (S-2020/L2-622), EIT Health (Activity code 19600, EIT Health is supported by EIT, a body of the European Union) and the European Union's Horizon 2020 research and innovation program under the Marie Skodowska-Curie grant agreement No. 860974.Cámara-Vázquez, MÁ.; Hernández-Romero, I.; Morgado-Reyes, E.; Guillem Sánchez, MS.; Climent, AM.; Barquero-Pérez, Ó. (2021). Detection of Atrial Fibrillation Driver Locations Using CNN and Body Surface Potentials. 1-4. https://doi.org/10.22489/CinC.2021.2561

Non-invasive Estimation of Atrial Fibrillation Driver Position With Convolutional Neural Networks and Body Surface Potentials

[EN] Atrial fibrillation (AF) is characterized by complex and irregular propagation patterns, and AF onset locations and drivers responsible for its perpetuation are the main targets for ablation procedures. ECG imaging (ECGI) has been demonstrated as a promising tool to identify AF drivers and guide ablation procedures, being able to reconstruct the electrophysiological activity on the heart surface by using a non-invasive recording of body surface potentials (BSP). However, the inverse problem of ECGI is ill-posed, and it requires accurate mathematical modeling of both atria and torso, mainly from CT or MR images. Several deep learning-based methods have been proposed to detect AF, but most of the AF-based studies do not include the estimation of ablation targets. In this study, we propose to model the location of AF drivers from BSP as a supervised classification problem using convolutional neural networks (CNN). Accuracy in the test set ranged between 0.75 (SNR = 5 dB) and 0.93 (SNR = 20 dB upward) when assuming time independence, but it worsened to 0.52 or lower when dividing AF models into blocks. Therefore, CNN could be a robust method that could help to non-invasively identify target regions for ablation in AF by using body surface potential mapping, avoiding the use of ECGI.This work has been partially supported by: Ministerio de Ciencia e Innovacion (PID2019-105032GB-I00), Instituto de Salud Carlos III, and Ministerio de Ciencia, Innovacion y Universidades (supported by FEDER Fondo Europeo de Desarrollo Regional PI17/01106 and RYC2018-024346B-750), Consejeria de Ciencia, Universidades e Innovacion of the Comunidad de Madrid through the program RIS3 (S-2020/L2-622), EIT Health (Activity code 19600, EIT Health is supported by EIT, a body of the European Union) and the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 860974.Cámara-Vázquez, MÁ.; Hernández-Romero, I.; Morgado-Reyes, E.; Guillem Sánchez, MS.; Climent, AM.; Barquero-Pérez, O. (2021). Non-invasive Estimation of Atrial Fibrillation Driver Position With Convolutional Neural Networks and Body Surface Potentials. Frontiers in Physiology. 12:1-11. https://doi.org/10.3389/fphys.2021.733449S1111

In vivo antitumoural activity and composition of an oil extract of Brazilian propolis

AbstractThe present study aimed to evaluate in vivo and in vitro the antitumoural activity of a propolis extract obtained with edible vegetable oil and its fractions and also to investigate its chemical composition by LC–MS and LC–MS/MS. To evaluate the toxicological aspects related to the propolis extract treatment, hematological, biochemical, histopathological and morphological analyses of treated animals were performed. All propolis extracts showed an in vivo antitumour activity in the experimental model with a moderate toxicity effect at experimental exposure levels. The oil extract was as effective as the ethanolic extract at inhibiting tumour growth. In vitro assays showed that the whole oil extract produced better inhibition of tumour cells than its fractions. LC–MS and LC–MS/MS identified four phenolic acids and three flavonoids. The anticancer potential of the oil extract of propolis has been demonstrated and the edible vegetable oil was shown as an attractive alternative solvent to extract bioactive natural propolis components

Habituation of auditory steady state responses evoked by amplitudemodulated acoustic signals in rats

Generation of the auditory steady state responses (ASSR) is commonly explained by the linear combination of random background noise activity and the stationary response. Based on this model, the decrease of amplitude that occurs over the sequential averaging of epochs of the raw data has been exclusively linked to the cancelation of noise. Nevertheless, this behavior might also reflect the non-stationary response of the ASSR generators. We tested this hypothesis by characterizing the ASSR time course in rats with different auditory maturational stages. ASSR were evoked by 8-kHz tones of different supra-threshold intensities, modulated in amplitude at 115 Hz. Results show that the ASSR amplitude habituated to the sustained stimulation and that dishabituation occurred when deviant stimuli were presented. ASSR habituation increased as animals became adults, suggesting that the ability to filter acoustic stimuli with no-relevant temporal information increased with age. Results are discussed in terms of the current model of the ASSR generation and analysis procedures. They might have implications for audiometric tests designed to assess hearing in subjects who cannot provide reliable results in the psychophysical trials

Electrocardiographic imaging including intracardiac information to achieve accurate global mapping during atrial fibrillation

[EN] Atrial fibrillation (AF) is characterized by complex and irregular propagation patterns. Noninvasive electrocardiographic imaging (ECGI) has been tested during AF conditions with promising results. However, current regularization methods face important challenges in this type of unstable electrical activity scenarios. Combination of intracardiac and non-invasive simultaneous recordings could improve ECGI performance and allow real-time global mapping of complex AF patterns. In this work, we propose an ECGI method that incorporates intracardiac measurements as a constraint in a reformulation of the classical Tikhonov method. We used realistic mathematical models of atria and torso that simulates a wide number of epicardial electrical activity patterns. Body surface potentials were obtained from simulated electrograms (EGMs) by using Boundary Element Method and corrupted with Gaussian noise. Epicardial potentials were estimated using inverse problem with Tikhonov regularization, including intracavitary information as a second constraint. Results showed that first-order Constrained Tikhonov formulation provided more reliable reconstructions than the classical Tikhonov approach in AF conditions using at least 32 uniformly distributed endocardial EGMs (CC between 0.87 and 0.28, depending on the AF complexity). Constrained Tikhonov provided more accurate spatial mass functions (SMF) of PS locations (CC smF between 0.24 and 0.86). This methodology was tested on real patient data, obtaining a mean DF RMSE of 0.85 Hz, outperforming the classical Tikhonov approach. Limitations of this study include the fact that the model considered endocardium and epicardium as a single layer. Further research will include endocardium-epicardium bilayer model approximations and validation using more real patient data.This work has been partially supported by projects TEC2016-75361R and PID2019-105032GB-I00 from the Spanish Ministry of Economy and Spanish Ministry of Science and Innovation, respectively, projects IJCI-2014-22178, PI16-01123, DTS16/00160, PI17/0159, PI17/01106 from the Spanish Ministry of Economy through the Carlos III Health Institute with FEDER founds, grant GVA APOSTD/2017/068 and projects AICO/2018/267, GV/2018/103 from the Education, Research, Culture and Sports department of Generalitat Valenciana, Spain.Cámara-Vázquez, MÁ.; Hernández-Romero, I.; Rodrigo, M.; Alonso-Atienza, F.; Figuera, C.; Morgado-Reyes, E.; Atienza, F.... (2021). Electrocardiographic imaging including intracardiac information to achieve accurate global mapping during atrial fibrillation. Biomedical Signal Processing and Control. 64:1-11. https://doi.org/10.1016/j.bspc.2020.102354S1116

Composição química e atividade biológica de extrato oleoso de própolis: uma alternativa ao extrato etanólico Chemical composition and biological activity of oil propolis extract: an alternative to ethanolic extract

<abstract language="eng">Propolis is mostly used as hydroalcoholic extract. Recently there has been a growing number of patents dealing with new solvents for preparing propolis extracts. This study aimed to prepare edible oil propolis extracts and compare their chemical composition and biological activity with ethanolic propolis extracts. ESI-MS and spectrophotometric methods were used for qualitative and quantitative analyses, respectively. Antibacterial activity was evaluated by diffusion in agar. Cytotoxicity was tested by MTT assay using tumor cell lines. The oil is able to extract bioactive compounds from propolis. Further studies are needed to improve extraction efficiency and to characterize the active components

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research