Artificial intelligence for heart rate variability analyzing with arrhythmias

Introduction. Existing standards of Heart Rate Variability (HRV) technology limit its use to sinus rhythm. A small number of extrasystoles is allowed, if the device used has special procedures for the detection and replacement of ectopic complexes. However, it is important to expand the indicated limits of the applicability of the HRV technology. This specially regards the cases when the HRV technology looks promising in the diagnostics, as, for example, in atrial fibrillation and atrial flutter. Materials and Methods. All ECG measurements were performed on XAI-MEDICA® equipment and software. Processing of the obtained RR Series was carried out using the software Kubios® HRV Standard. All recommended HRV characteristics for Time-Domain, Frequency-Domain and Nonlinear were calculated. The purpose of the work. The article presents an artificial intelligence (AI) procedure for detecting episodes of arrhythmias and reconstruction of core patient’s rhythm, and demonstrates the efficacy of its use for the HRV analysis in patients with varying degrees of arrhythmias. The results of the study. It was shown efficiency of developed artificial intelligence procedure for HRV analyzing of patients with different level of arrhythmias. These were demonstrated for Time-Domain, Frequency-Domain and Nonlinear methods. The direct inclusion into review of Arrhythmia Episodes and the use of the initial RR Series leads to a significant distortion of the results of the HRV analysis for the whole set of methods and for all considered options for arrhythmia. Conclusion. High efficacy of operation of the procedure AI core rhythm extraction from initial RR Series for patients with arrhythmia was reported in all cases

Stratification of THROMBOTIC RISK in patients that are undergoing to PICC implantation. The “CoRa-MaPiCC STUDY”

Background: The PICC is a central venous system inserted in the peripherally vein. The central peripheral catheter catheter system (PICC=peripherally inserted central catheters) is a widely used procedure in clinical practice by medical and nurse team. PICC has potential complications that are rare but not entirely irrelevant. It is used for continuous and discontinuous treatment and, after a correct insertion procedure, it can be used for a period of time between 1 week to 3 months. The last-generation dispositive has an high-biocompatibility due to the high quality of the materials (silicone or polyurethane), a total length of 40-60 cm and a diameter between 16 to 25 Gauge or 2 to 5 French. Aims: The aim of our study is to evaluate the trombotic risk related to the positioning of the device in relation to the individual risk factors. Therefore we have elaborated the CoRaMaPicc protocol that allows, based on the preliminary data evaluation, to reduce the trombotic risk in patients with high cardiovascular risk profile. Methods: The study has started in July 2016. We have enrolled 30 patients (18 males and 12 females with range age of 30-99 yrs and mean age of 82+13,5 yrs). Enrolled patients have Body mass Index or (BMI) with range from 16,3-26,5 Kg/mq and mean BMI value of 23,5+2,5 Kg/mq. Enrolled patients were subjected to laboratory assessment of cardiovascular risk factors like laboratory assessment of Methyl-Tetra-Hydro-Folate-Reductase or (MTHFR) and Homocysteine, Fibrinogen, D-Dimer, International Normalized Ratio (INR), Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), Platelets (PLT), trombotic risk evaluation (CHA2DS2-VASc Score), and bledding risk evaluation (HAS-BLED Score). Before the insertion procedure of the PICC, single or duble lumen (Groshong or Power PICC type), the patient were subjected to a preliminary ultrasound and echo-doppler vein evaluation to underline the presence of atipical anatomical state of the patients veins. After the procedure the patients were subjected to second ultrasound and echo-doppler vein evaluation and then to a radiographic examination to verify the correct position of the PICC. All patients were enrolled for follow- Up to evaluate trombotic complications. Statistical analysis was performed using the Survival Analysis test to evaluate the patients during the follow-up period in relation to thrombotic events. The data obtained from our study have been described taking also into account the data present in the international literature. Setting: The study was performed using a specific setting in a room of the Internal Medicine Department of the Alfredo Fiorini Hospital (Terracina, Italy), guarantee an aseptic procedure , the right comfort for the patients and the appropriate privacy. Discussion: More data in the literature underline the presence of non-eliminable risk factors like anatomic state of the patients vein that can play a variable role of procedural risk factor and can predispose to procedural or post-procedural complication after the implantation procedure. In specific cases it is difficult to asses an echo-doppler examination of heart for meteorism or ascites and radiographic exams for the presence of pleural effusion. The CoRaMaPiCC protocol use different technique to explore the post-insertion period and the follow-up time at 12 week. In case of meteorism or ascites the ultrasound examination of the heart cameras was replaced by the radiographyc evaluation while in case of pleural effusion, the evaluation of the device position was deduced using the only ultrasound approach (when the vein system is explorable). Procedural algorithm utilized in our implant protocol allows to improve the diagnostic capabilities of the conditions that can predispose to thrombotic complications. During the study period (1 year), the PICCs were removed for death (7 patients; 4 patients for irreversible heart disease, 1 patient for cardiogenic shock 1 patient for septic shock and 1 patient for Creutzfeld-Jacob disease), for spontaneously remotion (1 patient for low compliance of the patient) and for end of therapy (22 patients). The presence of cardiovascular risk factors alone is not sufficient for determining statistically significant changes in the thrombotic risk. As reported historically by the description of the wirkow triad, the presence of three clinical signs, and in particular the presence of endothelial damage (functio lesa) is a sine qua non condition for the occurrence of thrombotic episodes. Conclusion: The CoRaMaPicc protocol allows, based on the evaluation of the data, to minimize endothelial damage and therefore to reduce the incidence of the wirchof's triade related with an high trombotic risk. The data were elaborated considering the different thrombotic risk linked to the presence of the homozygous MTHR mutation responsible for the increase of homocysteine values and therefore of the further thrombotic risk. Further studies are needed to expand the number of enrolled patients and increase the follow-up period. Our data give comfortable results but further evaluation are needed to have conclusive results

Effect of insulin glargine on cardiovascular risk analysed by mean HRV

Type 2 diabetes mellitus is an insidious disease that is increasingly present in geriatric population [1]. The greatest difficulty is represented by glycaemic control in geriatric patients often not very compliant with diet therapy and drug therapy. A new insulin glargine 300 units/ml formulation seems im- prove patient compliance due to the lower volume of insulin to be injected and improved glycaemic control over 24 hours. The HRV signal, derived from digital electrocardiographic recording, is the simplest and most imme- diate analysis that consists in calculating some temporal parameters [2]. HRV is a simple statistics derived from beat-beat intervals of sinus origin expressed as units of time in milliseconds. Data in the literature indicate that a decrease in HRV, measured with time domain analysis, denotes a worse prognosis and/or an increased risk of mortality in patients with heart disease, especially in the elderly ones

Effect of Ferric Sodium EDTA administration, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine, on cardiovascular risk evaluation: exploration of the HRV frequency domain

diseases. Using the Heart Rate Variability (HRV) analysis is possible to provide an evaluation of the safety and the effectiveness of intervention. Objective: To evaluate the efficacy and safety of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) 2 tabs/day for 24 days in elderly patients with secondary anaemia, by exploring the HRV frequency domain. Methods: In 45 elderly patients with secondary anaemia and/or low-moderate kidney failure, laboratory values after administration of Ferric Sodium EDTA, 2 tabs a day, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) for 24 days (N=16 patients) or ferrous gluconate 63 mg/day added to saline solution, administered using intravenous access during the hospitalization period of 15 ± 5 days (N=29 patients) were evaluated. Also, ECG signals and bioelectrical impedance (BIA) were measured. Results: Oral iron supplementation with Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) confirmed to be effective and safe about the cardiovascular risk in old patients. This study showed the real superiority of the oral administration about the cardiovascular risk in elderly patients in comparison with intravenous administration of ferrous gluconate. Conclusion: This study confirms that Ferric Sodium EDTA combination (Ferachel forte®) can be a valid alternative to ferrous gluconate intravenous therapy (gold standard) in the treatment of secondary anaemia in elderly patients. In fact, during the treatment, efficacy results have been maintained without statistically significant variations about cardiovascular risk, evaluated by exploring the HRV frequency domain

Low dose of Rotigotine in post-stroke patients with vascular parkinsonism and obstructive sleep apnoea syndrome, effects on quality of life and rehabilitation therapy

Stroke is a frequent cause of disability in U.S.A. (200.000/ year). Aim: The aim of this study is to underline the effect of low dose of Rotigotine patches 2 mg/24 h, a complete dopamine agonist with continuous dopaminergic stimulation through the transdermal administration, in elderly with recent stroke and vascular Parkinsonism about quality of life and adherence to rehabilitation therapy. Methods: We have enrolled 6 elderly patients (3 males and 3 females, range age 60 – 95 years) with recent ischemic and vascular Parkinsonism. We have evaluated quality of life and cognitive function with UPDRS part III, MMSE, ADL, IADL and Morinsky Scale. At the same time we have evaluated the adherence to therapy and timing of rehabilitation therapy before and post-administration of Rotigotine 2 mg/24 hours. Conclusion: In conclusion, Rotigotine could be a new useful approach in the treatment of elderly patients with recent ischemic and hemorrhagic stroke correlated with vascular Parkinsonism which can lead to an akinesia with the need to start rehabilitation therapy. Our preliminary data gives comfortable results but, at this time, we have enrolled only few patients to give conclusive results

Sustained IFN signaling is associated with delayed development of SARS-CoV-2-specific immunity.

Plasma RNAemia, delayed antibody responses and inflammation predict COVID-19 outcomes, but the mechanisms underlying these immunovirological patterns are poorly understood. We profile 782 longitudinal plasma samples from 318 hospitalized patients with COVID-19. Integrated analysis using k-means reveals four patient clusters in a discovery cohort: mechanically ventilated critically-ill cases are subdivided into good prognosis and high-fatality clusters (reproduced in a validation cohort), while non-critical survivors segregate into high and low early antibody responders. Only the high-fatality cluster is enriched for transcriptomic signatures associated with COVID-19 severity, and each cluster has distinct RBD-specific antibody elicitation kinetics. Both critical and non-critical clusters with delayed antibody responses exhibit sustained IFN signatures, which negatively correlate with contemporaneous RBD-specific IgG levels and absolute SARS-CoV-2-specific B and CD4 <sup>+</sup> T cell frequencies. These data suggest that the "Interferon paradox" previously described in murine LCMV models is operative in COVID-19, with excessive IFN signaling delaying development of adaptive virus-specific immunity

Biogeochemical cycling of dissolved zinc along the GEOTRACES South Atlantic transect GA10 at 40°S

The biogeochemical cycle of zinc (Zn) in the South Atlantic, at 40°S, was investigated as part of the UK GEOTRACES program. To date there is little understanding of the supply of Zn, an essential requirement for phytoplankton growth, to this highly productive region. Vertical Zn profiles displayed nutrient-like distributions with distinct gradients associated with the watermasses present. Surface Zn concentrations are among the lowest reported for theworld’s oceans (<50 pM). A strong Zn-Si linear relationshipwas observed (Zn (nM)= 0.065 Si (μM), r2=0.97, n = 460). Our results suggest that the use of a global Zn-Si relationship would lead to an underestimation of dissolved Zn in deeper waters of the South Atlantic. By utilizing Si* and a new tracer Zn* our data indicate that the preferential removal of Zn in the Southern Ocean prevented a direct return path for dissolved Zn to the surface waters of the South Atlantic at 40°S and potentially the thermocline waters of the South Atlantic subtropical gyre. The importance of Zn for phytoplankton growth was evaluated using the Zn-soluble reactive phosphorus (SRP) relationship. We hypothesize that the low Zn concentrations in the South Atlantic may select for phytoplankton cells with a lower Zn requirement. In addition, a much deeper kink at ~ 500m in the Zn:SRP ratio was observed compared to other oceanic regions

O Antigen Allows B. parapertussis to Evade B. pertussis Vaccine–Induced Immunity by Blocking Binding and Functions of Cross-Reactive Antibodies

Although the prevalence of Bordetella parapertussis varies dramatically among studies in different populations with different vaccination regimens, there is broad agreement that whooping cough vaccines, composed only of B. pertussis antigens, provide little if any protection against B. parapertussis. In C57BL/6 mice, a B. pertussis whole-cell vaccine (wP) provided modest protection against B. parapertussis, which was dependent on IFN-γ. The wP was much more protective against an isogenic B. parapertussis strain lacking O-antigen than its wild-type counterpart. O-antigen inhibited binding of wP–induced antibodies to B. parapertussis, as well as antibody-mediated opsonophagocytosis in vitro and clearance in vivo. aP–induced antibodies also bound better in vitro to the O-antigen mutant than to wild-type B. parapertussis, but aP failed to confer protection against wild-type or O antigen–deficient B. parapertussis in mice. Interestingly, B. parapertussis–specific antibodies provided in addition to either wP or aP were sufficient to very rapidly reduce B. parapertussis numbers in mouse lungs. This study identifies a mechanism by which one pathogen escapes immunity induced by vaccination against a closely related pathogen and may explain why B. parapertussis prevalence varies substantially between populations with different vaccination strategies

Best practice methodology for 14C calibration of marine and mixed terrestrial/marine samples

There is a lack of detailed guidance in the published literature on how to calibrate 14C measurements made on marine or mixed marine/terrestrial (primarily human remains) samples. We describe what we consider to be the best approach towards achieving the most accurate calibrated age ranges, using the most appropriate ΔR and percentage marine diet estimates, and associated, realistic error terms on these values. However, this approach will increase the calibrated age range(s) by fully accounting for the variability in both the model and the material. While the discussion is based on examples from the UK and Iceland, the same fundamental arguments can be applied in any geographic location largely devoid of C4 plants as the high δ13C values from such plants can make identification of marine intake difficult to determine