Enhanced adaptive matched filter for automated identification and measurement of electrocardiographic alternans

Electrocardiographic alternans, consisting of P-wave alternans (PWA), QRS-complex alternans (QRSA) and Twave alternans (TWA), is an index of cardiac risk. However, only automated TWA measurement methods have been proposed so far. Here, we presented the enhanced adaptive matched filter (EAMF) method and tested its reliability in both simulated and experimental conditions. Our methodological novelty consists in the introduction of a signal enhancement procedure according to which all sections of the electrocardiogram (ECG) but the wave of interest are set to baseline, and in the extraction of the alternans area (AAr) in addition to the standard alternans amplitude (AAm). Simulated data consisted of 27 simulated ECGs representing all combinations of PWA, QRSA and TWA of low (10 mu V) and high (100 mu V) amplitude. Experimental data consisted of exercise 12-lead ECGs from 266 heart failure patients with an implanted cardioverter defibrillator for primary prevention. EAMF was able to accurately identify and measure all kinds of simulated alternans (absolute maximum error equal to 2%). Moreover, different alternans kinds were simultaneously present in the experimental data and EAMF was able to identify and measure all of them (AAr: 545 mu V x ms, 762 mu V x ms and 1382 mu V x ms; AAm: 5 mu V, 9 mu V and 7 mu V; for PWA, QRSA and TWA, respectively) and to discriminate TWA as the prevalent one (with the highest AAr). EAMF accurately identifies and measures all kinds of electrocardiographic alternans. EAMF may support determination of incremental clinical utility of PWA and QRSA with respect to TWA only.Cardiolog

Automatic diagnosis of newly emerged heart failure from serial electrocardiography by repeated structuring & learning procedure

Heart failure (HF) diagnosis, typically visually performed by serial electrocardiography, may be supported by machine-learning approaches. Repeated structuring & learning procedure (RS & LP) is a constructive algorithm able to automatically create artificial neural networks (ANN); it relies on three parameters, namely maximal number of hidden layers (MNL), initializations (MNI) and confirmations (MNC), arbitrarily set by the user. The aim of this study is to evaluate RS & LP robustness to varying values of parameters and to identify an optimized combination of parameter values for HF diagnosis. To this aim, the Leiden University Medical Center HF data-base was used. The database is constituted by 129 serial ECG pairs acquired in patients who experienced myocardial infarction; 48 patients developed HF at follow-up (cases), while 81 remained clinically stable (controls). Overall, 15 ANNs were created by considering 13 serial ECG features as inputs (extracted from each serial ECG pair), 2 classes as outputs (cases/controls), and varying values of MNL (1, 2, 3, 4 and 10), MNI (50, 250, 500, 1000 and 1500) and MNC (2, 5, 10, 20 and 50). The area under the curve (AUC) of the receiver operating characteristic did not significantly vary with varying parameter values (P >= 0.09). The optimized combination of parameter values, identified as the one showing the highest AUC, was obtained for MNL = 3, MNI = 500 and MNC = 50 (AUC = 86 %; ANN structure: 3 hidden layers of 14, 14 and 13 neurons, respectively). Thus, RS & LP is robust, and the optimized ANN represents a potentially useful clinical tool for a reliable auto-matic HF diagnosis.Cardiolog

Міські проекції в ранній ліриці Лесі Українки

У статті вивчаються особливості художнього осмислення міського простору в ранній ліриці Лесі Українки. Звертається увага на те, що в процесі свого літературного становлення поетеса використала досвід різних традицій. Сентиментально налаштована героїня її творів оцінює місто як меркантильне, нелюдяне, байдуже до природної краси. В окремих поезіях переважає романтичний погляд: міський простір розглядається як тісний і задушливий, такий, що нівелює неповторність окремої особистості. Низка творів авторки репрезентує погодження неокласичних і романтичних тенденцій. Ключові слова: сентименталізм, романтизм, неокласицизм, лірика.В предлагаемой статье исследуются особенности художественного осмысления городского пространства в ранней лирике Леси Украинки. Учитывается тот факт, что в процессе своего литературного становления поэтесса использовала опыт различных традиций. Сентиментально настроенная героиня ее произведений оценивает город как меркантильный, исполненный безразличия к естественной красоте. В отдельных поэзиях преобладает романтический взгляд: городское пространство рассматривается как тесное, нивелирующее неповторимость отдельной личности. Ряд произведений Леси Украинки представляет взаимодействие романтических и неоклассических тенденций. Ключевые слова: сентиментализм, романтизм, неоклассицизм, лирика.In the article the features of early lyric poetry of Lesya Ukrainka are explored. That is taken into account, that in the process of the literary becoming a poetess used experience of different traditions. The sentimentally adjusted heroine gives preference to natural beauty. A romantic look prevails in separate poetries: urbanism space appears as incompatible with the uniqueness of individual. Romantic and neoclassical tendencies co-operate in a number of works of Lesya Ukrainka. Keywords: sentimentalizm, romanticism, neoclassicism, lyric poetry

Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity.

Background: An illness staging model for anorexia nervosa (AN) has received increasing attention, but assessing the merits of this concept is dependent on empirically examining a model in clinical samples. Building on preliminary findings regarding the reliability and validity of the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN), the current study explores operationalising CASIAN severity scores into stages and assesses their relationship with other clinical features. Method: In women with DSM-IV-R AN and sub-threshold AN (all met AN criteria using DSM 5), receiver operating curve (ROC) analysis (n = 67) assessed the relationship between the sensitivity and specificity of each stage of the CASIAN. Thereafter chi-square and post-hoc adjusted residual analysis provided a preliminary assessment of the validity of the stages comparing the relationship between stage and treatment intensity and AN sub-types, and explored movement between stages after six months (Time 3) in a larger cohort (n = 171). Results: The CASIAN significantly distinguished between milder stages of illness (Stage 1 and 2) versus more severe stages of illness (Stages 3 and 4), and approached statistical significance in distinguishing each of the four stages from one other. CASIAN Stages were significantly associated with treatment modality and primary diagnosis, and CASIAN Stage at Time 1 was significantly associated with Stage at 6 month follow-up. Conclusions: Provisional support is provided for a staging model in AN. Larger studies with longer follow-up of cases are now needed to replicate and extend these findings and evaluate the overall utility of staging as well as optimal staging models

The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes

<p>Abstract</p> <p>Background</p> <p>In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same population.</p> <p>Methods</p> <p>This study performed as a cross-sectional study. All elite Iranian female athletes of 34 sports federation, including female athletes in national teams and medalists of Tehran were invited to participate. A total of 788 (95% response rate) returned the questionnaires and were examined. Younger athletes under the age of menarche were excluded. Each athlete completed a self-administered questionnaire, which covered the following questions about participant's demographic information, athletic history, history of injuries and menstrual pattern. In order to diagnose the causes of amenorrhea/Oligomenorrhea including polycystic ovary syndrome(PCOS), participants with amenorrhea/Oligomenorrhea underwent further investigation. They were evaluated by following Para clinic investigation, and an ultrasonographic study of ovary.</p> <p>Results</p> <p>The age ranged from 13–37 (mean = 21.1, SD = 4.5). Seventy one (9.0%) individuals had amenorrhea/oligomenorrhea, among those, 11 (15.5%) had PCOS.</p> <p>There was also a positive association between amenorrhea/oligomenorrhea and the following: age under 20 OR; 2.67, 95%CI(1.47 – 4.85), weight class sports OR; 2.09, 95%CI(1.15 – 3.82), endurance sports OR; 2.89, 95%CI(1.22 – 6.84), late onset of menarche OR; 3.32 95%CI(1.04–10.51), and use of oral contraceptive pills OR; 6.17, 95%CI(3.00 – 12.69). Intensity of training sport or BMI were not risk factors.</p> <p>Conclusion</p> <p>These findings support the previous findings in the literature that the prevalence of amenorrhea/oligomenorrhea is high in athletes. Furthermore, we provided the first report on the prevalence of PCOS in female athletes with amenorrhea/oligomenorrhea. Athletes would be greatly benefited by greater general awareness about the complications of amenorrhea/oligomenorrhea.</p> <p>To increase awareness of exercise-associated menstrual cycle irregularities, it is necessary to design complete and comprehensive education programs for female athletes, their parents, their coaches, and the relevant authorities.</p

Reduced resting-state connectivity in areas involved in processing of face-related social cues in female adolescents with atypical anorexia nervosa.

Atypical anorexia nervosa (AN) has a high incidence in adolescents and can result in significant morbidity and mortality. Neuroimaging could improve our knowledge regarding the pathogenesis of eating disorders (EDs), however research on adolescents with EDs is limited. To date no neuroimaging studies have been conducted to investigate brain functional connectivity in atypical AN. We investigated resting-state functional connectivity using 3 T MRI in 22 drug-naïve adolescent patients with atypical AN, and 24 healthy controls. Psychological traits related to the ED and depressive symptoms have been assessed using the Eating Disorders Examination Questionnaire (EDE-Q) and the Montgomery-Åsberg Depression Rating Scale self-reported (MADRS-S) respectively. Reduced connectivity was found in patients in brain areas involved in face-processing and social cognition, such as the left putamen, the left occipital fusiform gyrus, and specific cerebellar lobules. The connectivity was, on the other hand, increased in patients compared with controls from the right inferior temporal gyrus to the superior parietal lobule and superior lateral occipital cortex. These areas are involved in multimodal stimuli integration, social rejection and anxiety. Patients scored higher on the EDE-Q and MADRS-S questionnaires, and the MADRS-S correlated with connectivity from the right inferior temporal gyrus to the superior parietal lobule in patients. Our findings point toward a role for an altered development of socio-emotional skills in the pathogenesis of atypical AN. Nonetheless, longitudinal studies will be needed to assess whether these connectivity alterations might be a neural marker of the pathology

Abnormalities in autonomic function in obese boys at-risk for insulin resistance and obstructive sleep apnea.

Study objectivesCurrent evidence in adults suggests that, independent of obesity, obstructive sleep apnea (OSA) can lead to autonomic dysfunction and impaired glucose metabolism, but these relationships are less clear in children. The purpose of this study was to investigate the associations among OSA, glucose metabolism, and daytime autonomic function in obese pediatric subjects.MethodsTwenty-three obese boys participated in: overnight polysomnography; a frequently sampled intravenous glucose tolerance test; and recordings of spontaneous cardiorespiratory data in both the supine (baseline) and standing (sympathetic stimulus) postures.ResultsBaseline systolic blood pressure and reactivity of low-frequency heart rate variability to postural stress correlated with insulin resistance, increased fasting glucose, and reduced beta-cell function, but not OSA severity. Baroreflex sensitivity reactivity was reduced with sleep fragmentation, but only for subjects with low insulin sensitivity and/or low first-phase insulin response to glucose.ConclusionsThese findings suggest that vascular sympathetic activity impairment is more strongly affected by metabolic dysfunction than by OSA severity, while blunted vagal autonomic function associated with sleep fragmentation in OSA is enhanced when metabolic dysfunction is also present

Tyrosine hydroxylase activity in the endocrine pancreas: changes induced by short-term dietary manipulation

BACKGROUND: Tyrosine hydroxylase (TH) activity and its possible participation in the control of insulin secretion were studied in pancreatic islets of adult Wistar rats fed a standard commercial diet (SD) or carbohydrates alone (CHD) for one week. TH activity, norepinephrine (NE) content, and glucose-induced insulin secretion were assessed. Blood glucose and insulin levels were measured at the time of sacrifice. RESULTS: CHD rats had significantly higher blood glucose and lower insulin levels than SD rats (114.5 ± 6.7 vs 80.7 ± 7.25 mg/dl, p < 0.001; 20.25 ± 2.45 vs 42.5 ± 4.99 μU/ml, p < 0.01, respectively). Whereas TH activity was significantly higher in CHD isolated islets (600 ± 60 vs 330 ± 40 pmol/mg protein/h; p < 0.001), NE content was significantly lower (18 ± 1 vs 31 ± 5 pmol/mg protein), suggesting that TH activity would be inhibited by the end-products of catecholamines (CAs) biosynthetic pathway. A similar TH activity was found in control and solarectomized rats (330 ± 40 vs 300 ± 80 pmol/mg protein/h), suggesting an endogenous rather than a neural origin of TH activity. CHD islets released significantly less insulin in response to glucose than SD islets (7.4 ± 0.9 vs 11.4 ± 1.1 ng/islet/h; p < 0.02). CONCLUSIONS: TH activity is present in islet cells; dietary manipulation simultaneously induces an increase in this activity together with a decrease in glucose-induced insulin secretion in rat islets. TH activity – and the consequent endogenous CAs turnover – would participate in the paracrine control of insulin secretion

Ectopic Expression of E2F1 Stimulates β-Cell Proliferation and Function

OBJECTIVE-Generating functional beta-cells by inducing their proliferation may provide new perspectives for cell therapy in diabetes. Transcription factor E2F1 controls G(1)- to S-phase transition during the cycling of many cell types and is required for pancreatic beta-cell growth and function. However, the consequences of overexpression of E2F1 in beta-cells are unknown. RESEARCH DESIGN AND METHODS-The effects of E2F1 overexpression on beta-cell proliferation and function were analyzed in isolated rat beta-cells and in transgenic mice. RESULTS-Adenovirus AdE2F1-mediated overexpression of E2F1 increased the proliferation of isolated primary rat beta-cells 20-fold but also enhanced beta-cell death. Coinfection with adenovirus Ad Akt expressing a constitutively active form of Akt (protein kinase B) suppressed beta-cell death to control levels. At 48 h after infection, the total beta-cell number and insulin content were, respectively, 46 and 79% higher in AdE2F1+AdAkt-infected cultures compared with untreated. Conditional overexpression of E2F1 in mice resulted in a twofold increase of beta-cell proliferation and a 70% increase of pancreatic insulin content, but did not increase beta-cell mass. Glucose-challenged insulin release was increased, and the mice showed protection against toxin-induced diabetes. CONCLUSIONS-Overexpression of E2F1, either in vitro or in vivo, can stimulate beta-cell proliferation activity. In vivo E2F1 expression significantly increases the insulin content and function of adult beta-cells, making it a strategic target for therapeutic manipulation of beta-cell function. Diabetes 59:1435-1444, 201