Hidden Markov models based on symbolic dynamics for statistical modeling of cardiovascular control in hypertensive pregnancy disorders

Copyright © 2006 IEEEDiscrete hidden Markov models (HMMs) were applied to classify pregnancy disorders. The observation sequence was generated by transforming RR and systolic blood pressure time series using symbolic dynamics. Time series were recorded from 15 women with pregnancy-induced hypertension, 34 with preeclampsia and 41 controls beyond 30th gestational week. HMMs with five to ten hidden states were found to be sufficient to characterize different blood pressure variability, whereas significant classification in RR-based HMMs was found using fifteen hidden states. Pregnancy disorders preeclampsia and pregnancy induced hypertension revealed different patho-physiological autonomous regulation supposing different etiology of both disorders.V. Baier, M. Baumert, P. Caminal, M. Vallverdú, R. Faber, and A. Vos

Inhomogeneous molecular ring around the B[e] supergiant LHA 120-S 73

We aim to improve our knowledge on the structure and dynamics of the circumstellar disk of the LMC B[e] supergiant LHA 120-S 73. High-resolution optical and near-IR spectroscopic data were obtained over a period of 16 and 7 years, respectively. The spectra cover the diagnostic emission lines from [CaII] and [OI], as well as the CO bands. These features trace the disk at different distances from the star. We analyzed the kinematics of the individual emission regions by modeling their emission profiles. A low-resolution mid-infrared spectrum was obtained as well, which provides information on the composition of the dusty disk. All diagnostic emission features display double-peaked line profiles, which we interpret as due to Keplerian rotation. We find that LHA 120-S 73 is surrounded by at least four individual rings of material with alternating densities (or by a disk with strongly non-monotonic radial density distribution). Moreover, we find that the molecular ring must have gaps or at least strong density inhomogeneities, or in other words, a clumpy structure. The mid-infrared spectrum displays features of oxygen- and carbon-rich grain species, which indicates a long-lived, stable dusty disk. We cannot confirm the previously reported high value for the stellar rotation velocity. The line profile of HeI 5876 A is strongly variable in both width and shape and resembles of those seen in non-radially pulsating stars. A proper determination of the real underlying stellar rotation velocity is hence not possible. The existence of multiple stable and clumpy rings of alternating density recalls ring structures around planets. Although there is currently insufficient observational evidence, it is tempting to propose a scenario with one (or more) minor bodies or planets revolving around LHA 120-S 73 and stabilizing the ring system, in analogy to the shepherd moons in planetary systems.Comment: 14 pages, 13 figure, accepted for pulication in A&

Human emotion characterization by heart rate variability analysis guided by respiration

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting /republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other worksDeveloping a tool which identifies emotions based on their effect on cardiac activity may have a potential impact on clinical practice, since it may help in the diagnosing of psycho-neural illnesses. In this study, a method based on the analysis of heart rate variability (HRV) guided by respiration is proposed. The method was based on redefining the high frequency (HF) band, not only to be centered at the respiratory frequency, but also to have a bandwidth dependent on the respiratory spectrum. The method was first tested using simulated HRV signals, yielding the minimum estimation errors as compared to classical and respiratory frequency centered at HF band based definitions, independently of the values of the sympathovagal ratio. Then, the proposed method was applied to discriminate emotions in a database of video-induced elicitation. Five emotional states, relax, joy, fear, sadness and anger, were considered. The maximum correlation between HRV and respiration spectra discriminated joy vs. relax, joy vs. each negative valence emotion, and fear vs. sadness with p-value = 0.05 and AUC = 0.70. Based on these results, human emotion characterization may be improved by adding respiratory information to HRV analysis.Peer ReviewedPostprint (author's final draft

Human emotion characterization by heart rate variability analysis guided by respiration

Developing a tool which identifies emotions based on their effect on cardiac activity may have a potential impact on clinical practice, since it may help in the diagnosing of psycho-neural illnesses. In this study, a method based on the analysis of heart rate variability (HRV) guided by respiration is proposed. The method was based on redefining the high frequency (HF) band, not only to be centered at the respiratory frequency, but also to have a bandwidth dependent on the respiratory spectrum. The method was first tested using simulated HRV signals, yielding the minimum estimation errors as compared to classical and respiratory frequency centered at HF band based definitions, independently of the values of the sympathovagal ratio. Then, the proposed method was applied to discriminate emotions in a database of video-induced elicitation. Five emotional states, relax, joy, fear, sadness and anger, were considered. The maximum correlation between HRV and respiration spectra discriminated joy vs. relax, joy vs. each negative valence emotion, and fear vs. sadness with p-value ≤ 0.05 and AUC ≥ 0.70. Based on these results, human emotion characterization may be improved by adding respiratory information to HRV analysis

Discerning the Ambiguous Role of Missense TTN Variants in Inherited Arrhythmogenic Syndromes

The titin gene (TTN) is associated with several diseases, including inherited arrhythmias. Most of these diagnoses are attributed to rare TTN variants encoding truncated forms, but missense variants represent a diagnostic challenge for clinical genetics. The proper interpretation of genetic data is critical for translation into the clinical setting. Notably, many TTN variants were classified before 2015, when the American College of Medical Genetics and Genomics (ACMG) published recommendations to accurately classify genetic variants. Our aim was to perform an exhaustive reanalysis of rare missense TTN variants that were classified before 2015, and that have ambiguous roles in inherited arrhythmogenic syndromes. Rare missense TTN variants classified before 2015 were updated following the ACMG recommendations and according to all the currently available data. Our cohort included 193 individuals definitively diagnosed with an inherited arrhythmogenic syndrome before 2015. Our analysis resulted in the reclassification of 36.8% of the missense variants from unknown to benign/likely benign. Of all the remaining variants, currently classified as of unknown significance, 38.3% showed a potential, but not confirmed, deleterious role. Most of these rare missense TTN variants with a suspected deleterious role were identified in patients diagnosed with hypertrophic cardiomyopathy. More than 35% of the rare missense TTN variants previously classified as ambiguous were reclassified as not deleterious, mainly because of improved population frequencies. Despite being inconclusive, almost 40% of the variants showed a potentially deleterious role in inherited arrhythmogenic syndromes. Our results highlight the importance of the periodical reclassification of rare missense TTN variants to improve genetic diagnoses and help increase the accuracy of personalized medicine

Characterization, high-resolution mapping and differential expression of three homologous PAL genes in Coffea canephora Pierre (Rubiaceae)

Phenylalanine ammonia lyase (PAL) is the first entry enzyme of the phenylpropanoid pathway producing phenolics, widespread constituents of plant foods and beverages, including chlorogenic acids, polyphenols found at remarkably high levels in the coffee bean and long recognized as powerful antioxidants. To date, whereas PAL is generally encoded by a small gene family, only one gene has been characterized in Coffea canephora (CcPAL1), an economically important species of cultivated coffee. In this study, a molecular- and bioinformatic-based search for CcPAL1 paralogues resulted successfully in identifying two additional genes, CcPAL2 and CcPAL3, presenting similar genomic structures and encoding proteins with close sequences. Genetic mapping helped position each gene in three different coffee linkage groups, CcPAL2 in particular, located in a coffee genome linkage group (F) which is syntenic to a region of Tomato Chromosome 9 containing a PAL gene. These results, combined with a phylogenetic study, strongly suggest that CcPAL2 may be the ancestral gene of C. canephora. A quantitative gene expression analysis was also conducted in coffee tissues, showing that all genes are transcriptionally active, but they present distinct expression levels and patterns. We discovered that CcPAL2 transcripts appeared predominantly in flower, fruit pericarp and vegetative/lignifying tissues like roots and branches, whereas CcPAL1 and CcPAL3 were highly expressed in immature fruit. This is the first comprehensive study dedicated to PAL gene family characterization in coffee, allowing us to advance functional studies which are indispensable to learning to decipher what role this family plays in channeling the metabolism of coffee phenylpropanoids

Identifying unmet needs and challenges in the definition of a plaque in mycosis fungoides: an EORTC-CLTG/ISCL survey

Background Consensus about the definition and classification of 'plaque' in mycosis fungoides is lacking. ObjectivesTo delineate a comprehensive view on how the 'plaque' entity is defined and managed in clinical practice; to evaluate whether the current positioning of plaques in the TNMB classification is adequate. MethodsA 12-item survey was circulated within a selected panel of 22 experts (pathologists, dermatologists, haematologists and oncologists), members of the EORTC and International Society for Cutaneous Lymphoma. The questionnaire discussed clinical and histopathological definitions of plaques and its relationship with staging and treatment. Results Total consensus and very high agreement rates were reached in 33.3% of questions, as all panellists regularly check for the presence of plaques, agree to evaluate the presence of plaques as a potential separate T class, and concur on the important distinction between plaque and patch for the management of early-stage MF. High agreement was reached in 41.7% of questions, since more than 50% of the responders use Olsen's definition of plaque, recommend the distinction between thin/thick plaques, and agree on performing a biopsy on the most infiltrated/indurated lesion. High divergence rates (25%) were reported regarding the possibility of a clinically based distinction between thin and thick plaques and the role of histopathology to plaque definition. ConclusionsThe definition of 'plaque' is commonly perceived as a clinical entity and its integration with histopathological features is generally reserved to specific cases. To date, no consensus is achieved as for the exact definition of thin and thick plaques and current positioning of plaques within the TNMB system is considered clinically inadequate. Prospective studies evaluating the role of histopathological parameters and other biomarkers, as well as promising diagnostic tools, such as US/RM imaging and high-throughput blood sequencing, are much needed to fully integrate current clinical definitions with more objective parameters.Dermatology-oncolog

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe