EEG-EMG-coherence in SDB patients with utilization of a support vector machine-algorithm [Poster Abstract]

Background We investigated whether the EEG-EMG-coherence allows a differentiation between patients with sleep-disordered breathing (SDB) without OSA and SDB-patients with mild, moderate or severe OSA. Methods Polysomnographic recordings of 102 patients with SDB (33 female; age: 53,± 12,4 years) were analyzed with the multitaper coherence method (MTM). Recordings contained 2 EEG-channels (C3 and C4) and a chin EMG-channel for one night. Four epochs (each 30 seconds, classified manually by AASM 2007 criteria) of each sleep stage were marked (1632 epochs in total), which were included in the classification analysis. The collected data sets were supplied to the support vector machine (SVM) algorithm to classify OSA severity. Twenty patients had a mild (RDI ≥10/h and < 15/h), 30 patients had a moderate (RDI ≥15/h and < 30/h) and 27 patients had a severe OSA (RDI ≥30/h). 25 patients had a RDI < 10/h. The AUC (area under the curve) value was calculated for each receiver operator curve (ROC) curve. Results EEG-EMG coherence was able to distinguish between the SDB-patients without OSA and SDB-patients with OSA in each of the 3 severity groups using an SVM algorithm. In mild OSA, the AUC was 0.616 (p = 0.024), in moderate OSA the AUC was 0.659 (p = 0.003), and in severe OSA the AUC was 0.823 (p < 0.001). Conclusions SDB patients with OSA can be differentiated from SDB patients without OSA on the basis of EEG-EMG coherence by using the Multitaper Coherence Method (MTM) and SVM algorithm

Sleep stage classification using spectral analyses and support vector machine algorithm on C3- and C4-EEG signals [Abstract]

Introduction Sleep stage classification currently relies largely on visual classification methods. We tested a new pipeline for automated offline classification based upon power spectrum at six different frequency bands. The pipeline allowed sleep stage classification and provided whole-night visualization of sleep stages. Materials and methods 102 subjects (69 male; 53.74 ± 12.4 years) underwent full-night polysomnography. The recording system included C3- and C4-EEG channels. All signals were measured at sampling rate of 200 Hz. Four epochs (30 seconds each) of each sleep stage (N1, N2, N3, REM, awake) were marked in the visually scored recordings of each one of the 102 patients. Scoring of sleep stages was performed according to AASM 2007-criteria. In total 408 epochs for each sleep stage were included in the sleep stage classification analyses. Recordings of all these epochs were fed into the pipeline to estimate the power spectrum at six different frequency bands, namely from very low frequency (VLF, 0.1-1 Hz) to gamma frequency (30-50 Hz). The power spectrum was measured with a method called multitaper method. In this method the spectrum is estimated by multiplying the data with K windows (i.e tapers).The estimated parameters were given as input to the support vector machine (SVM) algorithm to classify the five different sleep stages based on the mean power amplitude estimated from six different frequency bands. The SVM algorithm was trained with 51 subjects and the testing was done with the other 51 subjects. In order to avoid bias of the training dataset, a 10-fold cross validation was additionally done to check the performance of the SVM algorithm Results The estimated testing accuracy of prediction of the sleep stages was 84.1% for stage N1 using the mean power amplitude from the delta frequency band. Accuracy was 67.8% for stage N2 from the delta frequency band and 74.9% for stage N3 from the VLF. Accuracy was 79.7% for REM stage from the delta frequency band and 84,8% for the wake stage from the theta frequency band. Conclusions We were able to successfully classify the sleep stages using the mean power amplitude at six different frequency bands separately and achieved up to 85% accuracy using the electrophysiological EEG signals. The delta and theta frequency bands gave the best accuracy of classification among all sleep stages

Direct stenting with the Bx VELOCITY balloon-expandable stent mounted on the Raptor rapid exchange delivery system versus predilatation in a European randomized Trial: the VELVET trial.

Abstract AIMS: This study examined the six-month angiographic results of direct coronary stenting, and compared the nine-month safety, efficacy and cost of this strategy versus stenting after balloon predilatation. METHODS: In phase I of VELVET, 122 patients (mean age = 62.3 +/- 10.1 years, 77% male, 11% with diabetes) with angina pectoris or myocardial ischemia resulting from a single de novo 51% to 95% coronary stenosis underwent direct stenting. The endpoints of phase I included angiographic findings and rates of major adverse cardiac events up to six months of follow-up. In phase II, 401 patients (mean age = 61.3 +/- 10.8 years, 79% male, 16% with diabetes) with angina pectoris or documented myocardial ischemia resulting from single or multiple, de novo or restenotic, coronary lesions were randomized between direc

Crystal structures of self-assembled nanotubes from flexible macrocycles by weak interactions

8 páginas, 7 figuras, 2 tablas, 2 esquemas.Herein we report the crystal structures of tubular self-assemblies of flexible macrooligolides. The assembly is driven by the propensity of the macrocycles to create nearly flat structures displaying a void space within them and the cooperativity of weak directional interactions such as dipole–dipole interactions and CH***Ohydrogen bonds and non-directional interactions such as van der Waals contacts. The significance of the stereochemistry and the size of the cavity in the formation of the nanotubes are also studied.This research was supported by the Spanish MICINN-FEDER (CTQ2008-03334/BQU, CTQ2008-06806-C02-01/BQU and CTQ2008-06754-C04-01/PPQ), the MSC (RTICC RD06/0020/ 1046) and the Canary Islands FUNCIS (PI 01/06).Peer reviewe

EEG-EMG-Kohärenz bei Rhonchopathie-Patienten unter Verwendung eines Support Vector Machine-Algorithmus [Abstract]

Einleitung: Untersucht wurde, ob die EEG-EMG-Kohärenz die Differenzierung zwischen Rhonchopathie-Patienten ohne obstruktive Schlafapnoe (OSA) und Patienten mit OSA eines gering-, mäßig- oder schwergradigen Ausmaßes erlaubt. Methoden: Polysomnographische Aufzeichnungen von 102 Rhonchopathie-Patienten (33 weiblich Alter: 53,74 ± 12,4 Jahre) wurden mit der Multitaper-Kohärenz-Methodik (MTM) analysiert. Die Aufnahmen umfassten u.a. die C3- und C4-EEG-Kanäle und einen Kinn-EMG-Kanal. Vier Epochen (30 Sekunden, manuell nach AASM 2007-Kriterien klassifiziert) jedes Schlafstadiums wurden markiert (insgesamt 1632 Epochen), die in die Klassifikation-Analysen aufgenommen wurden. Die erhobenen Datensätze wurden als Input für den support vector machine (SVM) – Algorithmus eingegeben, um die 4 verschiedenen OSA-Schweregrade zu klassifizieren. Zwanzig Patienten hatten an einer milden (RDI ≥10/h und < 15/h), 30 Patienten an einer mäßigen (RDI ≥15/h und < 30/h) und 27 Patienten an einer schweren OSA (RDI ≥30/h) gelitten. 25 Patienten hatten ein RDI < 10/h. Der AUC (area under the curve)-Wert wurde bei jeder ROC (receiver operator curve)-Kurve errechnet. Ergebnisse: Mithilfe der EEG-EMG-Kohärenz konnte unter Verwendung eines SVM-Algorithmus zwischen den Rhonchopathie-Patienten ohne OSA und den OSA-Patienten der jeweiligen 3 Schweregrad-Gruppen unterschieden werden. Bei milder OSA lag der AUC-Wert bei 0.616 (p = 0.024), bei mäßiger OSA lag der AUC-Wert bei 0.659 (p = 0.003) und bei schwerer OSA lag der AUC-Wert bei 0.823 (p < 0.001). Schlussfolgerung: Rhonchopathie-Patienten mit OSA lassen sich von Rhonchopathie-Patienten ohne OSA allein durch die EEG-EMG-Kohärenz der Polysomnografie mithilfe der Multitaper-Kohärenz -Methodik (MTM) unter Verwendung eines SVM-Algorithmus unterscheiden

Delayed intracardial shunting and hypoxemia after massive pulmonary embolism in a patient with a biventricular assist device

We describe the interdisciplinary management of a 34-year-old woman with dilated cardiomyopathy three months postpartum on a cardiac biventricular assist device (BVAD) as bridge to heart transplantation with delayed onset of intracardial shunting and subsequent hypoxemia due to massive pulmonary embolism. After emergency surgical embolectomy pulmonary function was highly compromised (PaO2/FiO2 54) requiring bifemoral veno-venous extracorporeal membrane oxygenation. Transesophageal echocardiography detected atrial level hypoxemic right-to-left shunting through a patent foramen ovale (PFO). Percutaneous closure of the PFO was achieved with a PFO occluder device. After placing the PFO occluder device oxygenation increased significantly (Δ paO2 119 Torr). The patient received heart transplantation 20 weeks after BVAD implantation and was discharged from ICU 3 weeks after transplantation

Cell Therapy for Cardiovascular Disease: A Comparison of Methods of Delivery

The field of myocardial regeneration utilizing novel cell-based therapies, gene transfer, and growth factors may prove to play an important role in the future management of ischemic heart disease and cardiomyopathy. Phases I and II clinical trials have been published for a variety of biologics utilizing four methods of delivery: systemic infusion, intracoronary infusion, transvenous coronary sinus, and intramyocardial. This review discusses the advantages and disadvantages of the delivery approaches above

Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957