Heart Rate Activity Research Articles

Variational Autoencoders for Biomedical Signal Morphology Clustering and Noise Detection.

Accurate estimation of physiological biomarkers using raw waveform data from non-invasive wearable devices requires extensive data preprocessing. An automatic noise detection method in time-series data would offer significant utility for various domains. As data labeling is onerous, having a minimally supervised abnormality detection method for input data, as well as an estimation of the severity of the signal corruptness, is essential. We propose a model-free, time-series biomedical waveform noise detection framework using a Variational Autoencoder coupled with Gaussian Mixture Models, which can detect a range of waveform abnormalities without annotation, providing a confidence metric for each segment. Our technique operates on biomedical signals that exhibit periodicity of heart activities. This framework can be applied to any machine learning or deep learning model as an initial signal validator component. Moreover, the confidence score generated by the proposed framework can be incorporated into different models' optimization to construct confidence-aware modeling. We conduct experiments using dynamic time warping (DTW) distance of segments to validated cardiac cycle morphology. The result confirms that our approach removes noisy cardiac cycles and the remaining signals, classified as clean, exhibit a 59.92% reduction in the standard deviation of DTW distances. Using a dataset of bio-impedance data of 97885 cardiac cycles, we further demonstrate a significant improvement in the downstream task of cuffless blood pressure estimation, with an average reduction of 2.67 mmHg root mean square error (RMSE) of Diastolic Blood pressure and 2.13 mmHg RMSE of systolic blood pressure, with increases of average Pearson correlation of 0.28 and 0.08, with a statistically significant improvement of signal-to-noise ratio respectively in the presence of different synthetic noise sources. This enables burden-free validation of wearable sensor data for downstream biomedical applications.

ПИЩЕВОЙ ПЕПТИД ДЛЯ ПРЕДУПРЕЖДЕНИЯ ИЗБЫТОЧНОЙ МАССЫ ТЕЛА: ВИРТУАЛЬНЫЙ СКРИНИНГ ПРОГНОЗИРОВАНИЯ ТОКСИЧНОСТИ И ВЫВЕДЕНИЯ

The aim of the research is to predict the toxicity and excretion of a biopeptide that prevents obesity. A synthesized peptide with the following sequence of amino acids was used as object of research: CHAECGAACKEFCLEG, preventing overweight. The peptide has similarities to glucagon-like peptide-1 (GLP-1), which regulates energy metabolism. Peptide characterization is the following: total hydrophobic ratio is 53 %, total charge is +0.25, hydrophobicity of the peptide according to Wimley-White in whole residue is 4.63, molecular weight 1556.826 Da, molecular formula C62H97N19O20S4, protein binding potential (Boman index) is 0.93 kcal / mol, isoelectric point pH 6.77. The peptide is highly soluble in water. The study established that the studied peptide, when ingested, does not cause acute toxicity, hepatotoxicity and cytotoxicity, does not adversely affect heart activity, does not activate heat shock protein gene receptors, does not cause DNA damage and mitochondrial dysfunction. The peptide is characterized by average half-life and low plasma clearance, which makes it effective. It should be noted that predicted characteristics do not always coincide with actual values obtained in in vitro experiments. Therefore, it is possible to recommend the peptide for inclusion in composition of specialized and preventive food products, provided that its effectiveness is proven in preclinical and clinical studies.

IoT-Based Health Monitoring System: Design, Implementation, and Performance Evaluation

The Internet of Things (IoT) technology's rapid improvements have opened the door for creative solutions across a range of industries, including healthcare. An IoT-based health monitoring system that aims to revolutionise patient care and healthcare administration is described in this study along with its design, implementation, and performance evaluation. To continuously gather and send health-related data, our system makes use of a network of wearable sensors and gadgets that are seamlessly incorporated into a patient's daily life. Vital indicators like heart rate, blood pressure, temperature, and activity levels are tracked by these devices. To enable real-time analysis and storage, the data is safely sent to a centralised server. Both patients and healthcare professionals can access this information through a user-friendly smartphone application, enabling proactive healthcare decision-making. An effective and scalable architecture is used in the implementation of this system to guarantee the confidentiality, accuracy, and reliability of the data. The data is analysed using machine learning algorithms, which enables the early identification of abnormalities and trends that could portend serious health problems. The system can also produce warnings and notifications, ensuring prompt intervention when it's necessary. Our IoT-based health monitoring system's performance review indicates how well it performs in terms of enhancing healthcare outcomes. The solution gives healthcare professionals immediate access to crucial health information, allowing them to personalise treatment regimens, offer remote consultations, and make educated judgements. Continuous monitoring benefits patients by allowing for early intervention, fewer hospital stays, and an improvement in general health. Additionally, the system's scalability and versatility make it appropriate for a variety of healthcare settings, including small-scale home care and extensive hospital networks.

Implementation of Wearable IoT Devices for Continuous Physiological Monitoring and Analysis

The development of wearable devices for ongoing physiological monitoring and analysis has been made possible by the emergence of the Internet of Things (IoT), which has completely changed the healthcare industry. This study discusses the use of such wearable IoT devices and their potential to improve healthcare delivery. Our research focuses on the development, manufacture, and implementation of wearable sensors capable of real-time monitoring of vital signs like heart rate, body temperature, blood pressure, and activity levels. These devices leverage the Internet of Things to transmit data wirelessly to a cloud service for further analysis. The core components of these gadgets are miniature sensors, low-power microcontrollers, and wireless communication modules. These developments permit the invisible and continuous collection of data, which aids in the early detection of irregularities and permits urgent medical treatments. Data collected by these devices is processed by sophisticated analytics and machine learning algorithms before being transmitted securely to a cloud-based server. As a result, doctors and nurses are able to anticipate health issues, monitor their patients' physical conditions in real time, and provide individualised care. Los patients have more control over their own medical decisions since they have access to their own data. Frequent use of Internet-connected devices for monitoring and analysing physical phenomena may lead to better medical care, lower hospitalisation costs, and higher quality of life. Additionally, these devices have the potential to revolutionise clinical research by providing extensive real-world data for medical research. These wearable IoT devices have the potential to enhance the management of chronic illnesses, encourage early treatments, and raise general wellbeing. Wearable physiological monitoring technology has a lot of potential for the future of healthcare thanks to the advancements of the internet of things.

Anesthetic Management of Carcinoma Breast during Third Trimester of Pregnancy: a Case Report

Although malignancy during pregnancy is uncommon, if occurs, it adds challenge to ensure safety of both the mother and fetus. A 36-year lady was diagnosed with carcinoma breast and scheduled for modified radical mastectomy at 29 weeks of gestation. The case was conducted under general anesthesia with intraoperative pectoralis nerve block for postoperative analgesia. Care was taken to avoid hypotension, tachycardia and hypercarbia so that the placental perfusion was not hampered. The trachea was extubated and immediate postoperative obstetrician review revealed no abnormality in the fetal heart rate and activity. Postoperative course was uneventful. Pregnancy was continued till 34 weeks of gestation when elective cesarean section was done under subarachnoid block. A healthy baby was delivered without any adverse consequences. Anesthesia during last trimester of pregnancy can be safely performed, when precautions are taken with involvement of proper teamwork, and the benefit of surgery outweighs the risk of postponing it.

Prolonged mHealth-Based Arrhythmia Monitoring in Patients With Hypertrophic Cardiomyopathy (HCM-PATCH): Protocol for a Single-Center Cohort Study.

Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias and other arrhythmias. Screening for arrhythmias is mandatory to assess the individual SCD risk, but long-term electrocardiography (ECG) is rarely performed in routine clinical practice. Intensified monitoring may increase the detection rate of ventricular arrhythmias and identify more patients with an increased SCD risk who are potential candidates for the primary prophylactic implantation of an implantable cardioverter-defibrillator. To date, reliable data on the clinical benefit of prolonged arrhythmia monitoring in patients with HCM are rare. This prospective study aims to measure the prevalence of ventricular arrhythmias in patients with HCM observed by mobile health (mHealth)-based continuous rhythm monitoring over 14 days compared to standard practice (a 24- and 48-h long-term ECG). The frequency of ventricular arrhythmias in this 14-day period is compared with the frequency in the first 24 or 48 hours for the same patient (intraindividual comparison). Following the sample size calculation, 34 patients with a low or intermediate risk for SCD, assessed by the HCM Risk-SCD calculator, will need to be recruited in this single-center cohort study between June 2023 and February 2024. All patients will receive an ECG patch that records their heart activity over 14 days. In addition, cardiac magnetic resonance imaging and genetic testing data will be integrated into risk stratification. All patients will be asked to complete questionnaires about their symptoms; previous therapy; family history; and, at the end of the study, their experience with the ECG patch-based monitoring. The Hypertrophic Cardiomyopathy: Clinical Impact of a Prolonged mHealth-Based Arrhythmia Monitoring by Single-Channel ECG (HCM-PATCH) study investigates the prevalence of nonsustained ventricular tachycardia (ie, ≥3 consecutive ventricular beats at a rate of 120 beats per minute, lasting for <30 seconds) in low- to intermediate-risk patients with HCM (according to the HCM Risk-SCD calculator) with additional mHealth-based prolonged rhythm monitoring. The study was funded by third-party funding from the Department of Cardiology and Intensive Care Medicine, University Hospital Ostwestfalen-Lippe of Bielefeld University in June 2023 and approved by the institutional review board in May 2023. Data collection began in June 2023, and we plan to end the study in February 2024. Of the 34 patients, 26 have been recruited. Data analysis has not yet taken place. Publication of the results is planned for the fall of 2024. Prolonged mHealth-based rhythm monitoring could lead to differences in the prevalence of arrhythmias compared to 24- and 48-hour long-term ECGs. This may lead to improved identification of patients at high risk and trigger therapeutic interventions that may provide better protection from SCD or atrial fibrillation-related complications such as embolic stroke. Deutsches Register Klinischer Studien DRKS00032144; https://tinyurl.com/498bkrx8. DERR1-10.2196/52035.

Condition of the problem of organ transplantation in the USSR in 1970–1971 and ways to solve it (Yu.M. Lopukhin, A.G. Lapchinsky, V.P. Demikhov)

Aim. The article examines and analyzes the state of the problem of organ transplantation in the USSR in the early 1970s and ways to solve it with the participation of three prominent transplantologists of the Soviet Union – Yu.M. Lopukhin, A.G. Lapchinsky and V.P. Demikhov, as well as some world achievements in this field.Material and methods. Available printed works on the history of Russian and world transplantology in the 1970s, the analysis of which was carried out by historical-genetic and comparative-analytical methods.Results. Developed by Yu.M. Lopukhin together with leading surgeons and immunologists of the country the Program of scientific research on the problem of transplantation of organs and tissues included three main areas: clinical problems of transplantation of organs and body parts (limbs), including ensuring the viability of organs and tissues outside the body, the ways to overcome biological incompatibility, and also the moral and ethical issues of transplantation, and donation issues. It is shown that the methods of overcoming biological incompatibility in organ and tissue allotransplantations, which had been used for many years by A.G. Lapchinsky and V.P. Demikhov (exchange transfusion of blood between organisms of different species, cross circulation between individuals of the same species), no longer corresponded to the state of medical science, which was represented by Yu.M. Lopukhin. However, scientists who had world-class priorities for the duration of survival of experimental animals with a transplanted limb (A.G. Lapchinsky) and an additional heart and lung transplanted into the chest (V.P. Demikhov) could help in the implementation of some provisions of the Lopukhin’s Program. The preservation of organs and tissues before transplantation in a state of suspended animation was studied by A.G. Lapchinsky, and V.P. Demikhov worked at developing the methods for the extracorporeal connection of organs to the body of an intermediate host and using portable artificial hearts to maintain the vital activity of a cadaveric heart before transplantation.Conclusions. Pioneers of experimental transplantology in the USSR A.G. Lapchinsky and V.P. Demikhov, who began their research in the 1940s, still could have solved many issues of transplanting organs and body parts by the 1970s. But in presented in 1971 Program on the problem of organ and tissue transplantation, prepared under the guidance of Yu.M. Lopukhin, the emphasis was placed on immunological studies, while experimental surgeons played a minor role in it.

COMPLEXITY-BASED ANALYSIS OF THE CORRELATION OF BRAIN AND HEART ACTIVITY IN YOUNGER AND OLDER SUBJECTS

Studying the activity of organs during aging is a very important research area. On the other hand, simultaneous analysis of the activities of various organs is important to understand how their activities are correlated. For the first time, this research analyzes the brain-heart correlation in younger and older subjects. We analyzed the sample entropy (SampEn) and approximate entropy (ApEn) of EEG and R-R signals (as heart rate variability (HRV)) of younger and older participants while they sat comfortably in an armchair with their eyes open. The results indicated that older subjects’ EEG and R-R signals have greater values of sample and approximate entropies than younger subjects. Therefore, as subjects age, their EEG and R-R signals become more complex. This analysis can be extended to investigate the correlation between other physiological signals among different age groups.

Age-Induced Accumulation of Succinate Promotes Cardiac Fibrogenesis.

Age-related cardiac fibrosis is a risk factor for heart failure and a marker for heart aging. However, the mechanisms underlying age-related cardiac fibrosis remain unclear. Ischemia and hypoxia are inevitable events in the aging process, which are direct causes of mitochondrial dysfunction and metabolic alterations. In this study, we identified metabolic changes and determined the mechanisms by which succinate (a tricarboxylic acid cycle intermediate) accumulation promotes fibroblast activation and apoptosis resistance in the aging heart. We also assessed its significance in relation to cardiac fibrosis and diastolic dysfunction. We first investigated how aging promotes persistent cardiac fibrosis. Following this, the metabolic alterations of the aging heart were identified by untargeted metabolomics, and the succinate level was verified via quantitative analysis. Furthermore, the correlations between succinate and fibrosis or diastolic dysfunction in older mice/people were assessed. We also described the role of succinate and its receptor SUCNR1/GPR91 in establishing a fibrosis network during diastolic dysfunction with age using SUCNR1-/- mouse model and an AAV9-based approach. We further identified the specific mechanisms involved in PKM2 dimerization, which regulate fibroblast activation and apoptosis resistance. We demonstrated that aging promotes fibrogenesis and diastolic dysfunction, which are linked to fibroblast activation and apoptosis resistance in the heart. Succinate levels were correlated with diastolic dysfunction and cardiac fibrosis in older mice and people. Functionally, succinate promoted fibroblast activation and apoptosis resistance, which aggravate cardiac fibrosis formation in both young and old mice. This was attributed to the ability of succinate to stimulate PKM2 dimerization via succinate receptor SUCNR1. Furthermore, dimeric PKM2 translocated to the nucleus and mitochondria, where it promoted fibroblast activation and apoptosis resistance, respectively. Accumulated PKM2 in the nucleus interacted with HIF-1α, increasing the DNA binding of HIF-1α and the expression of fibrogenic genes, resulting in fibroblast activation. In the mitochondria, accumulated PKM2 phosphorylated VDAC1 at T93 and increased VDAC1 degradation by promoting SYVN1-based E3 ligase binding to VDAC1, which is associated with increased apoptosis resistance and fibrosis persistence. We found that targeting succinate accumulation by metformin can inhibit fibroblast activation and apoptosis resistance in mice, which is a potential strategy to control age-related cardiac fibrosis and diastolic dysfunction. Our findings indicate that targeting metabolic dysregulation has significant implications for the treatment of age-related cardiac fibrosis and diastolic dysfunction. We further demonstrate a novel mechanism by which succinate induces fibroblast activation and apoptosis resistance by promoting PKM2 dimerization. Hence, inhibiting succinate generation or blocking its downstream effects is potentially a promising new strategy for slowing the heart aging.

Non-Invasive Electroanatomical Mapping: A State-Space Approach for Myocardial Current Density Estimation.

Electroanatomical mapping is a method for creating a model of the electrophysiology of the human heart. Medical professionals routinely locate and ablate the site of origin of cardiac arrhythmias with invasive catheterization. Non-invasive localization takes the form of electrocardiographic (ECG) or magnetocardiographic (MCG) imaging, where the goal is to reconstruct the electrical activity of the human heart. Non-invasive alternatives to catheter electroanatomical mapping would reduce patients' risks and open new venues for treatment planning and prevention. This work introduces a new system state-based method for estimating the electrical activity of the human heart from MCG measurements. Our model enables arbitrary propagation paths and velocities. A Kalman filter optimally estimates the current densities under the given measurements and model parameters. In an outer optimization loop, these model parameters are then optimized via gradient descent. This paper aims to establish the foundation for future research by providing a detailed mathematical explanation of the algorithm. We demonstrate the feasibility of our method through a simplified one-layer simulation. Our results show that the algorithm can learn the propagation paths from the magnetic measurements. A threshold-based segmentation into healthy and pathological tissue yields a DICE score of 0.84, a recall of 0.77, and a precision of 0.93.

Analysis of oscillatory processes in the cardiovascular system in response to local heating in patients with type 2 diabetes mellitus

A comprehensive spectral analysis was used to assess heart rate variability and skin perfusion pattern of limbs in patients with type 2 diabetes mellitus in response to local heating and to identify significant predictors of physiological and pathological changes in the cardiovascular system. An electrocardiogram and skin perfusion on the forearm and foot were measured using Laser Doppler flowmetry at rest and during local heating in both healthy volunteers and patients with type 2 diabetes. The wavelet analysis was applied to Laser Doppler signals and heart rate variability (based on electrocardiogram signals). ROC analysis was used to evaluate significant predictors. The analysis results of patients with type 2 diabetes were compared with healthy controls. The following changes were observed in patients 1) impairment of skin blood flow reserve on the foot during heating, 2) lower amplitude oscillations in heart rate at rest and during heating, 3) an increase in amplitude of oscillations in the skin blood flow from the forearm in intervals related to respiration and heart activity at rest and during heating, 4) a decrease in amplitude of oscillations in the skin blood flow on the foot in the interval related to myogenic activity at rest and in cardiointerval during heating. The parameters of cardiovascular system (energies of heart rate variability at low-frequencies recorded by laser Doppler flowmetry on forearm in intervals related to respiration activity) with high discriminative power were revealed to distinguish patients from healthy subjects in response to local heating; these parameters can be used as markers for early diagnosis of microvascular disorders.

Influence of static and dynamic changes in body positions on functional changes of the cardiovascular system

The autonomic nervous system (ANS) plays an important role in the regulation of heart activity, breathing and blood pressure. Through changes in sympathetic and parasympathetic activity, it participates in the regulation, coordination and integration of internal organ function. The method of spectral analysis of heart rate variability (SAHRV) is used to examine the functional status of autonomic regulation of heart activity. During the examination, clino-ortho-clinostasis is used, which makes it possible to assess the reactivity of functional changes in the sympathetic and parasympathetic systems.We were therefore interested in what functional changes in the autonomic regulation of heart activity will occur during static and dynamic changes in the position of the body head down and up at angles of ± 45°.For the research, we used the method of spectral analysis of heart rate variability, supplemented by blood pressure measurement during the experiment. The experimental group included 24 healthy women aged 20-30. Before and after the experiment, a standard examination of the functional state of the autonomic nervous system was performed in the clino-ortho-clinostatic position.&#x0D; During the experimental sequence, changes in sympathetic, vagus, heart rate and blood pressure reactivity were monitored in the following positions:&#x0D; &#x0D; in an inclined position of the body with the head up – angle +45°&#x0D; in an inclined position of the body with the head down – angle -45°&#x0D; during dynamic changes in oblique body positions +-45°&#x0D; &#x0D; An auto-traction reclining couch was used for the investigation of oblique positions.&#x0D; The resultsDuring the application of oblique positions of the body, there are significant changes in the activity of the autonomic regulation of heart activity.In the head down position, there is an increased activation of the parasympathetic, a decrease in heart rate and an increase in systolic and diastolic pressure.During dynamic changes in body positions +- 45°, there is significant alternating activation of baroreflexes, modulated by sympathetic and vagal aktivity.&#x0D; ConclusionThe research study draws attention to the existence to multiple interconnections of regulatory mechanisms between the autonomic nervous system, cardiovascular and cardiorespiratory systems.

Blunt Trauma and R on T Phenomenon Causing Cardiac Arrest

An injury inflicted by a blunt object, such as a car, a fist, or a bat, is referred to as blunt trauma. Usually, it causes tissue damage and discomfort. It also has the tendency to fracture bones. Blunt trauma can happen to the chest, head, abdomen, limbs, and other regions of the body. Lacerations (cuts), concussions (brain injuries), contusions (bruises), fractures (broken bones), and internal injuries are examples of blunt trauma injuries. The location of the trauma, the impact's force, and the victim's general health all got affected according to the severity of the damage. Blunt trauma to the chest can result in cardiac arrest or the abrupt blockage of the heart's pumping activity. Because the heart is a muscular organ, it needs oxygen to beat continuously. Blunt chest trauma can stop the heart from beating because of a lack of oxygen or blood supply, or because the heart muscle has been physically harmed. Pulmonary contusions (bruising of the lung tissue), rib fractures, injury to the heart or blood vessels, and other injuries caused by blunt trauma can result in cardiac arrest.

Acute and chronic effects of triclosan on the behavior, physiology, and multigenerational characteristics of the water flea Moina macrocopa

Triclosan, a chlorinated biphenyl ether is widely used in industrial products and cosmetics due to its antibiotic activity. Although relatively levels of triclosan have been detected in aquatic ecosystems, limited information is available regarding the acute and chronic impacts of triclosan on aquatic invertebrates, especially planktonic crustaceans. In this study, we analyzed the acute (24 h) and chronic (14 days exposure across three generations) effects of different concentrations of triclosan [1/10 of the no observed effect concentration (NOEC), the NOEC, and 1/10 of the LC50] calculated from the 24 h acute toxicity value, on the water flea Moina macrocopa. In the acute exposure experiment, the 1/10 LC50 value of triclosan significantly reduced survival, feeding rate, thoracic limb activity, heart activity, and acetylcholinesterase activity. In response to the 1/10 LC50 value, intracellular reactive oxygen species increased along with elevated levels of malondialdehyde and glutathione. Enzymatic activities of catalase, superoxide dismutase, glutathione peroxidase, and glutathione reductase were significantly increased by the 1/10 LC50 value, suggesting active protection of the antioxidant defense system against oxidative stress. Chronic exposure to the 1/10 NOEC and NOEC values revealed multigenerational adverse impacts of triclosan. The second generation was found to be the most sensitive to triclosan, as the NOEC value significantly reduced the survival rate, body length, and the number of neonates per brood, along with a delayed hatching period. Taken together, these results indicate that even sublethal levels of triclosan can have detrimental effects on the water flea population's maintenance through intergenerational toxicity.

Application of virtual navigation in the treatment of macro-re-entrant atrial tachyarrhythmias

Macro-re-entrant atrial tachyarrhythmias occupy the leading positions in the structure of tachyarrhythmias, and one of the most common in this group is atrial flutter. These abnormal rhythms lead to a significant decrease in the quality of patients’ life, and sometimes, indirectly due to complications, can lead to disability and fatal consequences. Medical treatment for this group of arrhythmias has limited effectiveness, and the surgical method of treatment – catheter ablation – comes to the first place. Ablation of atrial flutter is traditionally performed under the guidance of fluoroscopy without the use of a navigation system, but this is associated with increased radiation exposure to patients and staff. Advances in modern arrhythmology make it possible to create anatomical models of heart chambers and activation models of the excitation spreading along anatomical models, reducing the radiation load, but requiring additional equipment and skills. Aim: to compare the procedure duration and radiation load during radiofrequency catheter ablation of the cavo-tricuspid isthmus using 3D navigation with traditional methods. Materials and methods. The work was based on the analysis of treatment results in 84 patients at National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. Depending on the imaging method, patients were divided into 2 groups. Group I included 31 patients who underwent radiofrequency cavo-tricuspid isthmus (CTI) ablation according to the traditional method under fluoroscopic control without using a navigation system. Group II comprised 27 patients in whom an anatomical model of the right atrium was created. Results. Success criteria were achieved in all groups, bidirectional block line was created at the level of the CTI. In group I, the average time from the first application to the restoration of sinus rhythm was 325 ± 25 s with an average number of applications of 7.4 ± 0.6 (from 5 to 10). The average procedure time was 43.0 ± 3.3 min, with an average X-ray time of 572 ± 44 s and an average dose area product (DAP) was 62.0 ± 5.0 Gy.cm2. In group II, the total duration of the first stage of the intervention was 312 ± 26 s. The average time to stopping tachycardia and restoring sinus rhythm was 230 ± 19 s. The average time from sinus rhythm restoration to confirmation of bidirectional CTI block was 71 ± 6 s with an average number of applications of 3.2 ± 3.0 per the procedure. The average procedure time was 41.5 ± 3.5 min, the average X-ray time was 120 ± 10 s, the average DAP was 15.0 ± 1.3 Gy.cm2. Conclusions. The usage of the anatomical model of the right atrium reduces X-ray exposure by 75.8 %, in comparison to the traditional technique, during radiofrequency catheter ablation of the cavo-tricuspid isthmus with similar procedure time. The anatomical model can be recommended for ablation of the cavo-tricuspid isthmus.

The Reliability of the Apple Watch's Electrocardiogram.

Background An electrocardiogram (ECG) is a standard tool used to detectvarious cardiovascular abnormalities. Detection sensitivity for atrial fibrillation (AF) was recently shown to be greatly increased by using short, intermittent ECG recordings.Modern mobile ECG recording devices that can monitor patients' heart activities around the clock have made this a reality.The Apple Watch is one of these portable ECG devices that can detect heart rhythms and is approved by the American FDA for screening and detecting AF. Objectives We compared the results of the Apple Watch I lead ECG with conventional ECG results to assess the sensitivity and specificity of the Apple Watch I lead ECG. We then determined the abnormalities that can be detected by the Apple Watch I lead ECG. Methods This study was conducted on outpatient cardiac clinics at King Abdullah bin Abdulaziz University Hospital (KAAUH), and Prince Sultan Cardiac Center (PSCC),from May to October 2021. A standard 12-lead ECG was recorded and compared with the Apple Watch I lead ECG. A total of 469 ECG comparisons were included in this study and evaluated by two investigators. The data on patient demographics, medical and medication history, and ECG data were reviewed and analyzed using IBMSPSSStatistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results No significant differences were seen between the Apple Watch and the 12-lead ECG in terms of the studied ECG characteristics. A significant and strong positive correlation between the heart rate measurements in the 12-lead ECG and Apple Watch ECG was documented. The most commonly found abnormalities in the Apple Watch ECG wereAF in 37 (7.9%), followed by first-degree atrioventricular (AV) block in 32 (6.8%). The sensitivity of Apple Watch's automated interpretation to detect an AF was 99.54%, while the manual interpretation yielded a sensitivity of 100%. Conclusion The results of this study demonstrated a robust relationship between the 12-lead ECG and Apple Watch ECG in the diagnosis of arrhythmias. Consequently, cardiac patients may consider the Apple Watch ECG a trustworthy remote monitoring technique.

Developing a system for measuring stress in the care for nursing home residents with dementia

Background:Measuring and monitoring stress has potential benefits for the care and self-management of stressors for people with dementia. Early identification of stressors may help to cope with challenging behaviours (CB), occurring in up to 80% of nursing home residents with dementia. The identification of stressors causing CB is difficult (as often residents cannot themselves indicate what is experienced as stressful or relaxing), hampering the psychosocial approach. Several studies have found that skin conductance and heart activity can be used as a proxy for stress. Measuring these physiological parameters using wearable sensors, might be helpful to identify (de)stressors and consequently, a psychosocial treatment approach. Therefore, wearables are promising as a supportive technology in the care of people with dementia and CB. However, stakeholders (i.e., (in)formal caregivers of people with dementia) indicate that current available (wearable) systems to measure stress are not fit for purpose within the everyday care of people with dementia. In addition, due to legislation, not all systems are allowed. The purpose of the current research is to develop a system prototype together with different stakeholders.Method:A prototype of a system measuring stress suitable in the care for people with dementia will be developed during different iterations between September 2022-July 2024. A community of stakeholders will be built, in which the needs, requirements and evaluations of people with dementia, (in)formal caregivers, legal- and IT-experts, will be collected through literature studies, focus groups, interviews and co-design sessions. The system will be developed and adjusted appropriately, taking social, technical and legal requirements into account.Results and discussion:Preliminary results will be presented regarding identified requirements for initial system prototypes as well as lessons learned from first iterations with conceptual and working prototypes. Implications for the care and self-management of people with dementia will be discussed.

Developing Climate Change and Health Impact Monitoring with eHealth at the South East Asia Community Observatory and Health and Demographic Surveillance Site, Malaysia (CHIMES).

Malaysia is projected to experience an increase in heat, rainfall, rainfall variability, dry spells, thunderstorms, and high winds due to climate change. This may lead to a rise in heat-related mortality, reduced nutritional security, and potential migration due to uninhabitable land. Currently, there is limited data regarding the health implications of climate change on the Malaysian populace, which hinders informed decision-making and interventions. This study aims to assess the feasibility and reliability of using sensor-based devices to enhance climate change and health research within the SEACO health and demographic surveillance site (HDSS) in Malaysia. We will particularly focus on the effects of climate-sensitive diseases, emphasizing lung conditions like chronic obstructive pulmonary disease (COPD) and asthma. In our mixed-methods approach, 120 participants (>18 years) from the SEACO HDSS in Segamat, Malaysia, will be engaged over three cycles, each lasting 3 weeks. Participants will use wearables to monitor heart rate, activity, and sleep. Indoor sensors will measure temperature in indoor living spaces, while 3D-printed weather stations will track indoor temperature and humidity. In each cycle, a minimum of 10 participants at high risk for COPD or asthma will be identified. Through interviews and questionnaires, we will evaluate the devices' reliability, the prevalence of climate-sensitive lung diseases, and their correlation with environmental factors, like heat and humidity. We anticipate that the sensor-based measurements will offer a comprehensive understanding of the interplay between climate-sensitive diseases and weather variables. The data is expected to reveal correlations between health impacts and weather exposures like heat. Participant feedback will offer perspectives on the usability and feasibility of these digital tools. Our study within the SEACO HDSS in Malaysia will evaluate the potential of sensor-based digital technologies in monitoring the interplay between climate change and health, particularly for climate-sensitive diseases like COPD and asthma. The data generated will likely provide details on health profiles in relation to weather exposures. Feedback will indicate the acceptability of these tools for broader health surveillance. As climate change continues to impact global health, evaluating the potential of such digital technologies is crucial to understand its potential to inform policy and intervention strategies in vulnerable regions.

Effect of Frailty on the Long-Term Prognosis of Elderly Patients with Acute Myocardial Infarction.

To investigate the effect of frailty on the long-term prognosis of elderly patients with acute myocardial infarction (AMI). The data of 238 AMI patients (aged ≥75 years) were retrospectively reviewed. They were divided into two groups according to the Modified Frailty Index (mFI): frailty group (mFI≥0.27, n=143) and non-frailty group (mFI<0.27, n=95). The major adverse cardiovascular and cerebrovascular events (MACEs) and Kaplan-Meier survival curves of the two groups were compared. Multivariate Cox regression analysis was used to identify the risk factors for MACEs. The frailty group showed a significantly older age as well as a higher N-terminal proB-type natriuretic peptide level, Global Registry of Acute Coronary Events score, and CRUSADE bleeding score compared with the non-frailty group (P<0.05). A significantly greater proportion of patients with combined heart failure, atrial fibrillation, comorbidity, and activities of daily living score of <60 was also observed in the frailty group compared with the non-frailty group (P<0.05). At 36 months after AMI, the frailty group vs the non-frailty group showed a significantly poorer survival (log-rank P=0.005), higher incidence of MACEs (50.35 vs 29.47, P=0.001), higher overall mortality rate (20.98% vs 7.37%, P=0.006), higher 30-day mortality rate (13.99% vs 5.26%, P=0.033), higher major bleeding rate (14.69% vs 5.26, P=0.018), and lower repeat revascularization rate (2.10% vs 8.42%, P=0.03). Frailty, type 2 diabetes, and N-terminal proB-type natriuretic peptide ≥1800 pg/mL were independent risk factors for MACEs. Frailty is an independent risk factor affecting the long-term prognosis of elderly patients with AMI.

КЛИНИЧЕСКИЙ СЛУЧАЙ ДИАГНОСТИКИ КОАРКТАЦИИ АОРТЫ В ПОЖИЛОМ ВОЗРАСТЕ

Abstract. Introduction. Aortic coarctation is a congenital narrowing or complete rupture of aorta in the region of its arch, isthmus, lower thoracic part, or abdominal region. Predominantly (in over 90% of cases), the coarctation occurs in a “typical” place, i.e., around the aortic isthmus. This defect is often combined with other defects, such as bicuspid aortic valve, aortic stenosis, patent ductus arteriosus, and ventricular septal defect. Aim: To actualize knowledge about aortic coarctation and its potential clinical manifestations. Materials and Methods. Female patient N., 65 years old, was admitted in the Department of Cardiology of City Clinical Hospital 7, Kazan in an urgent manner, complaining of fatigue, chest burning that could not be reversed by taking nitroglycerin, mixed dyspnea at the minimum exercise load, heart activity disorders, and rapid uneven heartbeat for a long time. The patient was examined using general clinical, laboratory and instrumental methods. In writing this article, the authors used source medical records (history of the present disease). Results and Discussion. The defect manifested in the patient clinically at her age of 25 as her systemic hypertension was first detected, accompanied by headache, dizziness, seeing dark spots in her vision, and later rapid heartbeat and short of breath on exertion. According to literature, in about 10% of cases, early development of aortic atherosclerosis is observed especially at the site of narrowing, as well as atherosclerosis of the coronary arteries, which caused unstable angina pectoris and the development of atrial fibrillation in our patient. In view of clinical manifestations of acute coronary syndrome, the patient was prescribed coronary angiography, during which aortic coarctation was suspected. Echocardiography detected congenital heart disease that often accompanies aortic coarctation (up to 60% of cases according to official sources), namely bicuspid aortic valve, as well as atrial septal aneurysm, reduction of descending aorta, and moderate aortic stenosis with aortic insufficiency. Further, to verify the diagnosis, X-ray computed tomography of the aorta was performed, which is the gold standard in detecting aortic coarctation. This method allowed us to identify the extent of the lesion, the diameter of the narrowing of the aorta, pre- and post-stenotic areas, and the presence and condition of collaterals. Conclusions. These findings are necessary for practicing physicians when choosing a treatment strategy for patients with aortic coarctation.