Pulse Index Research Articles

Predictive value of graft patency and major adverse cardiac and cerebrovascular events (MACCEs) in coronary artery bypass grafting (CABG) based on Fourier transform (FFT).

BackgroundTransit time flow measurement (TTFM) is widely used in coronary artery bypass grafting (CABG); however, its predictive value is unclear. We aimed to identify new factors to evaluate graft quality using fast Fourier transform (FFT).MethodsIntraoperative and postoperative 2-year follow-up data of 114 patients undergoing CABG from January 2017 to December 2018 were collected. The TTFM waveform was transformed by FFT. Mean graft flow (MGF), pulse index, the amplitude of the main wave in FFT (H0), the amplitude of the first harmonic (H1), H0/H1, and the frequency of the first harmonic (P) were analyzed as predictors using logistic regression and receiver operating characteristic (ROC) curves.ResultsThe overall graft patency rate was 80.3%, and the incidence of major adverse cardiac and cerebrovascular events (MACCEs) was 14.9%. The results demonstrate that compared with the graft failure group, MGF, H0, and H1 were higher, but H1 and P were lower in the patent group. With univariate and multivariate logistic regression analyses, the decrease in H0 and H1 and the increase in P were independent risk factors for graft failure, while the decrease in MGF and the increase in H0/H1 were only statistically significant with a univariate analysis. In the cardiovascular events group, the increase in P was an independent risk factor. With a ROC curve analysis, MGF, H0, H1, H0/H1, and P predicted graft failure, while only P predicted cardiovascular events. None of the indicators showed predictive value for MACCEs.ConclusionsTTFM waveforms after FFT can be used to evaluate graft quality and cardiovascular events, but have no predictive value for MACCEs.

Classification of patients with Alzheimer\u2019s disease using the arterial pulse spectrum and a multilayer-perceptron analysis

Cerebrovascular atherosclerosis has been identified as a prominent pathological feature of Alzheimer’s disease (AD); the link between vessel pathology and AD risk may also extend to extracranial arteries. This study aimed to determine the effectiveness of using arterial pulse-wave measurements and multilayer perceptron (MLP) analysis in distinguishing between AD and control subjects. Radial blood pressure waveform (BPW) and finger photoplethysmography signals were measured noninvasively for 3 min in 87 AD patients and 74 control subjects. The 5-layer MLP algorithm employed evaluated the following 40 harmonic pulse indices: amplitude proportion and its coefficient of variation, and phase angle and its standard deviation. The BPW indices differed significantly between the AD patients (6247 pulses) and control subjects (6626 pulses). Significant intergroup differences were found between mild, moderate, and severe AD (defined by Mini-Mental-State-Examination scores). The hold-out test results indicated an accuracy of 82.86%, a specificity of 92.31%, and a 0.83 AUC of ROC curve when using the MLP-based classification between AD and Control. The identified differences can be partly attributed to AD-induced changes in vascular elastic properties. The present findings may be meaningful in facilitating the development of a noninvasive, rapid, inexpensive, and objective method for detecting and monitoring the AD status.

Pulse Index Modulation

Emerging systems such as Internet-of-things (IoT) and machine-to-machine (M2M) communications have strict requirements on the power consumption of used equipments and associated complexity in the transceiver design. To meet these requirements, we propose a novel index modulation (IM) scheme, namely pulse index modulation (PIM) for single-input single-output (SISO) schemes. The proposed model uses well-localized and orthogonal Hermite-Gaussian pulses for data transmission and provides high spectral efficiency owing to the Hermite-Gaussian pulse indices. Considering the high complexity of maximum-likelihood (ML) detector, we propose a matched filtering-based low complexity detector to implement the PIM scheme in practice. Besides, it has been shown via analytical derivations and computer simulations that the proposed PIM system has better error performance and considerable signal-to-noise ratio (SNR) gain compared to existing spatial modulation (SM), code index modulation aided spread-spectrum (CIM-SS), CIM-SM, and traditional $M$ -ary systems.

The Main Patterns of Disorders of the Visual System in Patients with Retinal Detachment in Pediatric and Adult Practice in Terms of the Level of Antioxidant Protection

The study included patients with a verified diagnosis of “Traction retinal detachment” (RD) in pediatric (50 patients, mean age 13.8 ± 1.1 years, age range from 11 to 18 years) and adults (50 patients, mean age 54, 6 ± 2.2 years, age range 19 to 72 years). The control groups included 25 children (mean age 13.1 ± 1.2 years) and 25 adults (mean age 52.8 ± 1.6 years) patients without pathology of the organ of vision. A comprehensive examination of the functional state of the visual analyzer was performed, including the assessment of clinical (maximum corrected distance visual acuity, BCVA), subjective (Quality of Life, QOL), hemodynamic (pulsation index in the central retinal artery, PI), electrophysiological (threshold of electrical sensitivity of the retina (PESR); threshold of electrical lability of the retina; critical frequency of fusion and flashing (presentation of a red object); photostress test) and biochemical (antioxidant activity in the lacrimal fluid, AOA; superoxide dismutase indicator, PS in the lacrimal fluid) indicators of the visual system. The data obtained indicate some differences in the studied parameters in patients with OS in pediatric and adult practice. In particular, a higher level of BCVA in adults was found (by 18.8 %, p < 0.001). Along with this, it was determined that RD in children is accompanied by more pronounced disorders of hemodynamic and antioxidant parameters, which is associated with a more pronounced degree of proliferative vitreoretinopathy and preservation of antioxidant defense mechanisms. The results of stepwise discriminant analysis of the statistical characteristic F, which determines the weighting coefficient of the relationship in the regression equation of the basic AOA parameter with each indicator in the general array, determined the following most informative indicators (F > 3.0) of the visual system of patients with OS associated with antioxidant protection: in an adult practice — BCVA, QOL, PI, PESR, PS; in pediatric practice — BCVA, PI, PESR, PS. The obtained similar results of statistical analysis for children and adults are actualized by research in pediatric practice aimed at increasing the clinical effectiveness of vitrectomy for RD based on antioxidant protection methods tested in adult practice.

Effect of norepinephrine challenge on cardiovascular determinants assessed using a mathematical model in septic shock: a physiological study.

The present study investigated the cardiovascular determinants of cardiac output (CO), mean systemic filling pressure analogue (Pmsa) derived by Geoffrey Parkin, efficiency of heart (Eh) and related parameters to a norepinephrine (NE) challenge [an increase of 10 mmHg mean arterial pressure (MAP) by NE] in septic shock patients using of a mathematical model. Twenty-seven septic shock patients with pulse index continuous cardiac output (PiCCO) monitoring were enrolled. These patients required NE to maintain an individualized MAP for organ perfusion after early fluid resuscitation based on their clinical condition. NE was decreased to obtain a decrease of 10 mmHg from base MAP (MAP-10mmHg), and the NE doses were adjusted to return MAP to baseline (MAPbase) and produce an increase of 10 mmHg from MAPbase (MAP+10mmHg). Two NE challenge episodes were analyzed for each patient: from MAP-10mmHg to MAPbase and from MAPbase to MAP+10mmHg. The Pmsa, pressure gradient for venous return (PGvr), and Eh (PGvr relative to Pmsa) were estimated using a mathematical model for the three MAP levels (MAP-10mmHg, MAPbase and MAP+10mmHg). A total of 54 episodes of NE challenges were obtained in 27 patients. Significant and consistent increases were observed in the central venous pressure (CVP), Pmsa, and PGvr in response during the NE titration. ΔCO negatively and significantly correlated with ΔCVP (r=-0.722, P<0.0001), ΔPmsa (r=-0.549, P<0.0001), ΔResistance of venous return (Rvr) (r=-0.597, P<0.0001), and ΔResistance of systemic vascular beds (Rsys) (r=-0.597, P<0.0001). Episodes of decreasing CO/Eh were associated with a higher ΔCVP than the CO/Eh-increasing episodes. The area under the curve (AUC) of ΔCVP to predict decreased CO by the incremental NE was 0.86, and the AUC of ΔCVP to predict decreased Eh was 0.94. A cutoff of ΔCVP >1.5 mmHg for detecting decreased CO resulted in a sensitivity of 75% and a specificity of 94.1%. A cutoff of ΔCVP >1.5 mmHg for detecting decreased Eh resulted in a sensitivity of 64.3% and a specificity of 100%. There were a highly divergent response in Eh and CO to afterload challenge episodes of an NE-induced 10mmHg increase in MAP. An increase in CVP may be an early alarm to identify the reduction in CO/Eh during an NE-induced increase of MAP.

Using pentoxifylline, arginine hydrochloride, levocarnitine and rheosorbilact solutions for correction of fetoplacental dysfunction in pregnant women with preeclampsia

Annotation. As of today, there is no effective method for treating the fetoplacental dysfunction (FPD) in pregnant women with preeclampsia. The aim of research was the study of the method proposed by the authors for restoring the functional activity of the fetoplacental complex in pregnant women with FPD on the background of treatment of preeclampsia. А randomized controlled study of the effect proposed treatment (intravenous solution of pentoxifylline; solution containing arginine hydrochloride and levocarnitine; rheosorbilact) of 37 pregnant women at 35-40 weeks of gestation with FPD on the background of moderate preeclampsia, was performed. Such ultrasound doppler measurements have been studied: systolic-diastolic ratio, resistance index, pulsation index in the umbilical arteries, right and left uterine arteries, fetal middle cerebral artery, fetal internal carotid artery and fetal aorta before and after the performed treatment. Statistics were processed using LibreOffice Calc (Mozilla Public License v 2.0), adapted for medical and biological research. We used nonparametric Wilcoxon criteria, Mann-Whitney criteria at a significance level of p &lt;0.05. After the performed treatment, stabilization of the fetoplacental blood circulation in women of the main group was observed, which manifested by decrease in S/D in umbilical artery in 1.3 times, in the left uterine artery in 1.4 times and in the fetal aorta in 1,1 times, and decrease in RI indices in the umbilical artery in 1.1 times, in the right uterine artery in 1.3 times, and increase in the middle cerebral artery in 1.4 times. So, in the course of the proposed treatment, the restoration of the blood flow velocity and the stabilization of vascular resistance in uterine arteries and the umbilical artery were observed in the women of the main group. The research of the possibility of using the above methodology in earlier gestational age and in the risk group for the prevention of preeclampsia is prospective and requires further attention.

Hemodynamics in renal transplant in children with various morphological changes in the long-term post-transplant period

Introduction. Ultrasound scanning is one of the main methods of instrumental examination of patients after allogenic transplantation of kidney. The main reasons of dysfunction of the kidney transplant in long post-transplantation term are acute or chronic rejection, as well as acute and chronic nephrotoxicity of calcineurin inhibitors.Objective. Assessment of dopplerographic indicators of the blood flow throughout the transplanted kidney vessels in patients with preserved nitrogen excretion function under various morphological changes.Materials and methods. The study includes an analysis of the medical history of 98 children with end-stage chronic renal failure who underwent 98 allogeneic kidney transplants from a posthumous donor. There were analyzed the results of 185 percutaneous puncture biopsies and ultrasound studies of renal transplants. The analyzed data of morphological studies are divided into 4 groups. 1st group – there are no morphological changes affecting graft function. 2nd group – morphological signs of calcineurin toxicity. 3rd group – borderline damage of the graft. 4th group – acute and chronic graft rejection.Results and discussion. Indices of resistance and pulsation measured at the level of the renal artery and interlobular arteries tended to decrease in the kidneys with immunological influence and remained stable in other morphological groups. This means that, the higher the degree of hyalinosis of the arteries, the lower the indices of resistance and pulsation indices measured at the level of the common renal artery and interlobular arteries.Conclusions. The revealed tendency of a decrease in the values of the resistance index and the pulsation index at the level of the common renal artery of the interlobular arteries can be considered as one of the initial ultrasound signs that allow to speak of a decrease in the elasticity of the vascular wall. Normal indices of renal hemodynamics do not exclude the presence of pathological processes leading to graft dysfunction.

Effect of Radiation in Patients with HeartMate 3 LVAD Therapy

Introduction Radiation therapy in patients with axial flow left ventricular assist devices (LVAD) has not been associated with significant device malfunction. However, the effects of radiation on the fully magnetically levitated HeartMate 3 (Abbott, Abbott Park, IL) LVAD are not well known. We report two cases of stereotactic bone radiation therapy (SBRT) in patients with a HeartMate 3 LVAD implantation. Case Report Patient 1 71-year-old woman with history of chronic systolic heart failure status post HeartMate 3 LVAD and history of left upper lobe non-small cell lung cancer status post lobectomy was found to have an incidental left lateral thorax wall mass on CT imaging with subsequent biopsy consistent for recurrent oligometastatic lung adenocarcinoma. She consequently underwent 5 fractions of 600 cGy SBRT to her left lateral chest wall over a period of 10 days. Mild fatigue was reported following radiation, however LVAD log files sent subsequent to each fraction were unremarkable. On follow up, no cardiac symptoms were reported and LVAD parameters were normal with flow 4.6 L/min, speed 5600 rpm, pulse index 2.8 and power 4.4 watts. Device malfunction has not been witnessed during 1 year follow up. Patient 2 70-year-old man with history of advanced systolic heart failure status post HeartMate 3 LVAD implantation was found to have a right upper lobe nodule and mediastinal lymphadenopathy on CT imaging. Ensuing biopsy diagnosed squamous cell lung cancer without metastatic disease. SBRT was initiated and 5 treatments of 1000 cGy were delivered to the right upper lobe lesion within 10 days. No LVAD complications or symptoms of heart failure were witnessed during treatment. On follow up, patient denied any symptoms and LVAD function remained normal with observed with flow 4.3 L/min, speed 5200 rpm, pulse index 4.8 and power 3.8 watts. Device malfunction has not been witnessed during 1 year follow up. Summary Our 2 cases suggests that SBRT in patients with HeartMate 3 LVAD implantation may be safe and likely not associated with device malfunction. Larger studies are required to better evaluate this relationship and to determine long term safety profile.

Arterial Stiffness Index and Exercise Tolerance in Patients Undergoing Cardiac Rehabilitation.

Arterial stiffness contributes to the development of cardiovascular disease (CVD). However, the relationship between the arterial stiffness and exercise tolerance in CVD patients with preserved ejection fraction (pEF) and those with reduced EF (rEF) is unclear. We enrolled 358 patients who participated in cardiac rehabilitation and underwent cardiopulmonary exercise testing at Juntendo University Hospital. After excluding 195 patients who had undergone open heart surgery and 20 patients with mid-range EF, the patients were divided into pEF (n = 99) and rEF (n = 44) groups. Arterial stiffness was assessed using arterial velocity pulse index (AVI) and arterial pressure volume index (API) at rest. The patients in the pEF group were significantly older and had a higher prevalence of coronary artery disease than the rEF group. The pEF group had significantly lower AVI levels and higher API levels than the rEF group. In the pEF group, the peak oxygen uptake (peak VO2) and the anaerobic threshold was significantly higher than those in the rEF group. The peak VO2 was significantly and negatively correlated with AVI and API in the pEF group (All, P < 0.05), but not in the rEF group. Multivariate linear regression analyses demonstrated that AVI was independently associated with peak VO2 (β = -0.34, P < 0.05) in the pEF group. In conclusion, AVI may be a useful factor for assessing exercise tolerance, particularly in CVD patients with pEF.

Оптимизация диагностики доклинической дисфункции почек при артериальной гипертензии и ее сочетании с сахарным диабетом 2 типа

In order to optimize the diagnosis of early renal dysfunction in patients with arterial hypertension and its combination with type 2 diabetes mellitus, we examined 100 patients aged 35 to 58 years (mean age 46.8 ± 0.68). The first group included 50 patients with AH of the 1st and 2nd degrees, the 2nd group consisted of 50 patients with a combination of AH and type 2 diabetes. In all patients, the concentration of creatinine, cystatin C, uric acid was determined, and the glomerular filtration rate was calculated using the formulas of KokroftGault, MDRD, CKD EPI, Hoek. Along with this, the degree of albuminuria was determined, ultrasound and the dopplerography of the renal vessels was performed to determine the biometric parameters of the kidneys. Both in patients with AH and in its combination with type 2 diabetes, an increase in the level of cystatin C and uric acid in the blood was detected. The calculation of GFR by various formulas more often revealed an insignificant decrease in renal function when using the formula based on cystatin as opposed to the calculation based on creatinine.When the degree of albuminuria was detected in 9% of patients with AH of 1st degree and in 21% of patients with AH of 2nd degree, albuminuria of A2 grading was revealed. In the 2nd group, albuminuria of A2 gradation was detected in 36%, and in 4% — gradation A3. Ultrasound revealed a significant increase in renal volume (224.6 ± 3.17 cm3, p &lt;0.001) in patients of group 2. Doppler sonography in both groups revealed a decrease in speed indicators and an increase in resistance and pulsation indices. Thus, a set of methods, including the determination of the level of cystatin C and uric acid in the blood, the calculation of GFR for cystatin C, the identification of the degree of albuminuria and ultrasound of the kidneys is important for the diagnosis of preclinical kidney damage in patients with hypertension and hypertension with an adjacent course with type 2 diabetes.

ОЦЕНКА СОСТОЯНИЯ ПЛОДА И ОСОБЕННОСТИ ТЕЧЕНИЯ НЕОНАТАЛЬНОГО ПЕРИОДА У ДЕТЕЙ, РОЖДЕННЫХ ОТ ЖЕНЩИН ПОЗДНЕГО РЕПРОДУКТИВНОГО ВОЗРАСТА, ПРОЖИВАЮЩИХ В ЧЕЧЕНСКОЙ РЕСПУБЛИКЕ

Objective of the research: conduct a Doppler ultrasound (DUS) assessment of utero-placentalfetal blood flow and the condition of newborns in the early neonatal period from women of the late reproductive period (LRP), depending on the parity of delivery, using the example of women in the Chechen Republic. Material and methods: retrospective multicenter study. DUS assessment of the state of utero-placental-fetal blood flow and the state of newborns in the early neonatal period was performed in 95 pregnant women, including: group 1–35 primiparous of LRP and their 35 newborns, group 2 – 35 multi-pregnant (MP) of LRP and their 35 newborns. The 3 control group included 25 healthy pregnant women aged 18 to 25 years and their 25 newborns. DUS was performed on Aloka SD SSD 3500 device (Japan), and a transvaginal sensor was used if necessary. Newborns were assessed on the APGAR score at 1 and 5 minutes after birth. Of the instrumental methods for examining newborns, brain ultrasound examination (neurosonography) was used. Results: analyzing the DUS results of LRP pregnant, depending on the labor parity, it was found that in the 1st group there was an increase in resistance in both uterine arteries (61%), an increase in the resistance index and pulsation index, a decrease in diastolic blood flow, characteristic of arteries with high resistance. Hemodynamic parameters in the mid-brain artery (MBA) of the fetus remained normal in all pregnant women. LRP women often born children in a state of asphyxia, with neurological disorders, and these children often has more complex postnatal adaptation and concomitant pathology. Among LRP women, primiparous has significantly more severe disorders. Conclusion: the data of uteroplacental fetal blood flow of the 1st group correspond to blood flow disorders of the IA degree, which indirectly indicates a compensatory reaction of the vascular system of uteroplacental fetal blood flow, as well as the absence of a tendency to an increase in the severity of fetoplacental insufficiency. It is possible that high incidence of neurological disorders in children born to LRP women is associated with age-related changes in their germ cells, use of assisted reproductive technologies, intake of hormonal drugs at an early stage of pregnancy and environmental factors associated with iodine deficiency in the region which includes the North Caucasus.

Effects of 150- and 450-mL Acute Blood Losses on Maximal Oxygen Uptake and Exercise Capacity.

This study investigated whether maximal oxygen uptake (V˙O2max) and exercise capacity are affected by small acute blood loss (150 mL) and elucidated compensatory mechanisms. Thirteen male subjects (V˙O2max, 63 ± 9 mL·kg-1·min-1; mean ± SD) performed incremental exercise to exhaustion on a cycle ergometer in three experimental conditions: in euvolemia (control; blood volume [BV], 6.0 ± 0.7 L) and immediately after acute BV reductions of 150 mL (BVR150mL) and 450 mL (BVR450mL). Changes in plasma volume (PV) and BV during exercise were calculated from hematocrit, hemoglobin concentration, and hemoglobin mass (carbon monoxide rebreathing). The reduction in V˙O2max per milliliter of BVR was 2.5-fold larger after BVR450mL compared with BVR150mL (-0.7 ± 0.3 vs -0.3 ± 0.6 mL·min-1·mL-1, P = 0.029). V˙O2max was not significantly changed after BVR150mL (-1% ± 2%, P = 0.124) but reduced by 7% ± 3% after BVR450mL (P < 0.001) compared with control. Peak power output only decreased after BVR450mL (P < 0.001). At maximal exercise, BV was restored after BVR150mL compared with control (-50 ± 185 mL, P = 0.375) attributed to PV restoration, which was, however, insufficient in restoring BV after BVR450mL (-281 ± 184 mL, P < 0.001). The peak heart rate tended to increase (3 ± 5 bpm, P = 0.062), whereas the O2 pulse (-2 ± 1 mL per beat, P < 0.001) and vastus lateralis tissue oxygenation index (-4% ± 8% points, P = 0.080) were reduced after BVR450mL, suggesting decreased stroke volume and increased leg O2 extraction. The deteriorations of V˙O2max and of maximal exercise capacity accelerate with the magnitude of acute blood loss, likely because of a rapid PV restoration sufficient to establish euvolemia after a small but not after a moderate blood loss.

The parameters of regional hemodynamics in patients with chronic pelvic pain syndrome against the background of magnetic stimulation and peloid therapy

The study of Doppler parameters of hemodynamics of internal genital organs was carried out in 102 patients with chronic pelvic pain syndrome, 54 men and 48 women. It was found that against the background of extracorporeal magnetic stimulation of the neuromuscular apparatus of the pelvic floor and peloid therapy in patients of the main group, there is an improvement in the Doppler parameters of the hemodynamics of the internal genital organs in the form of a decrease in angle-independent indices: systolic-diastolic ratio, resistance and pulsation index, an increase in blood flow velocity on average by 36,2% in men and 42,1% in women from the initial values with the results being preserved for 6 months. In patients of the control group, Doppler measurements of the arteries of the prostate and ovaries showed no significant dynamics of vascular indices and blood flow velocities in the presence of a tendency to unidirectional shifts in parameters with the main group.

Adoption of Color Doppler Ultrasound in the Measurement of Fetal Hypoxia in Late Pregnancy

Objective: In order to improve the detection rate of fetal hypoxia in the third trimester and reduce the probability of adverse pregnancy outcome, color doppler ultrasound (CDU), and contractions were used to assess the severity of fetal hypoxia. Methods: The 61 pregnant women diagnosed with intrauterine hypoxia in South District of The Affiliated Hospital of Chengde Medical College from October 2017 to September 2019 were classified as the sick group. Meanwhile, the 61 normal pregnant women were selected as the control group. CDU was used to detect the relevant indexes of umbilical artery (UA) and middle cerebral artery (MCA) in the two groups, including pulse index (PI), resistance index (RI), systolic peak blood flow velocity (S) and diastolic peak blood flow velocity (D). The Apgar scale was used to score neonatal status. According to the score results, newborns were divided into Apgar ≤ 7 group and Apgar &gt; 7 group. The indexes of UA and MCA were compared between the two groups. The amniotic fluid status of pregnant women was assessed using the contractile stimulation test (CST). The rate of amniotic fluid pollution in pregnant women and the incidence of neonatal asphyxia were calculated. Pregnant women were grouped according to the CST score. The correlation between CST score and amniotic fluid pollution and neonatal asphyxia in pregnant women was analyzed. Results: First, the index of fetal UA was obviously higher than that of the control group, while the index of MCA was obviously lower than that of the control group (P &lt; 0.05). Second, the indexes of fetal UA in Apgar ≤ 7 group were obviously higher than those in Apgar &gt; 7 group, while those in MCA were obviously lower than those in Apgar &gt; 7 group (P &lt; 0.05). Third, the incidence of amniotic fluid pollution and neonatal asphyxia in low and middle groups of pregnant women was obviously higher than that in high groups (P &lt; 0.01). Conclusion: This indicates that the CDU technology combined with uterine contraction stimulation experiment can assess the degree of intrauterine hypoxia in the late stage of pregnancy, which provides a feasible scheme for clinical detection of intrauterine hypoxia.

Physical Features and Vital Signs Predict Serum Albumin and Globulin Concentrations Using Machine Learning.

Objective:Serum protein concentrations are diagnostically and prognostically valuable in cancer and other diseases, but their measurement via blood test is uncomfortable, inconvenient, and costly. This study investigates the possibility of predicting albumin, globulin, and albumin-globulin ratio from easily accessible physical characteristics (height, weight, Body Mass Index, age, gender) and vital signs (systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, pulse) using advanced machine learning techniques. Methods:We obtained albumin concentration, globulin concentration, albumin-globulin ratio and predictor information (physical characteristics, vital signs) from physical exam records of 46,951 healthy adult participants in Hangzhou, China. We trained a computational model to predict each serum protein concentration from the predictors and then evaluated the predictive accuracy of each model on an independent portion of the dataset that was not used in model training. We also determined the relative importance of each feature within the model. Results:Prediction accuracies were r=0.540 (95% CI: 0.539-0.540; Pearson r) for albumin, r=0.250 (95% CI: 0.249-0.251) for globulin, and r=0.373 (95% CI: 0.372-0.374) for albumin-globulin ratio. The most important predictive features were age (100% ± 0.0%; mean ± 95% CI of normalized importance), gender (34.4% ± 0.7%), pulse (25.6% ± 1.3%) and Body Mass Index (24.4% ± 2.3%) for albumin, pulse (83.7% ± 3.8%) for globulin, and age (99.2% ± 1.0%), gender (59.2% ± 1.7%), Body Mass Index (46.1% ± 4.2%) and height (40.0% ± 3.8%) for albumin-globulin ratio. Conclusions:Our models predicted serum protein concentrations with appreciable accuracy showing the promise of this approach. Such models could serve to augment existing tools for identifying “at-risk” individuals for follow-up with a blood test.

Features of cerebral blood flow in patients with chronic obstructive pulmonary disease associated with hypertension

Objective. The aim of the work was to study the features of cerebral blood flow in patients with chronic obstructive pulmonary disease (COPD) associated with hypertension (HTN). Design and methods. A crosssectional study was conducted, which included 90 males 40–60 years old. Of these, 30 patients with chronic COPD associated with HTN (COPD + HTN) were included in the study group, 30 individuals with isolated COPD were in the comparison group, 30 healthy volunteers were included in the control group. All participants underwent physical examination, spirography, 24-hour blood pressure monitoring and ultrasound examination of cerebral vessels. Results. Patients with COPD + HTN in comparison with the control showed an increase in the diameter (p = 0,018) and complex of the intima-media of the common carotid artery (p = 0,003) while the velocities, resistance index (RI) and pulsation index (PI) did not change. In the basin of the internal carotid artery an increase in RI values was noted (p = 0,018). At the intracranial level there was a decrease in the end-diastolic velocity (p = 0,03) and the time-averaged average blood flow velocity (TAV) (p = 0,033) without due changes RI and PI. At the same time no changes in speed indicators and indices were noted in the vertebral artery basin. Among the indicators of cerebral perfusion in patients with COPD + HTN, hydrodynamic resistance (p = 0,0015), intracranial pressure (ICP) (p = 0,0048) significantly increased, and the cerebral blood flow index was comparable with the control. Assessment of venous cerebral blood flow showed an increase in the diameter of the internal jugular vein (p = 0,021) with unchanged TAV together with an increase in ICP indicating the formation of venous dysfunction. It was shown that the body mass index, forced expiratory volume at the first second, systolic and diastolic blood pressure together determine the peak systolic blood flow velocity from the midbrain artery. Conclusions. The cerebral blood flow in patients with COPD + HTN is characterized by a change in arterial blood flow at the level of both intra- and extracranial vessels, while maintaining a normal cerebral blood flow index, as well as the formation of arteriovenous dyshemia against the background of remodeling of the cerebral vascular bed.

Adoption of Ultrasonic Imaging Diagnosis Under Machine Learning Algorithm in Treatment of Pregnancy-Induced Hypertension and Nursing

In order to study the application of doppler ultrasound in monitoring the changes of important vascular hemodynamic indexes in pregnant women with Pregnancy-induced Hypertension (PIH) during pregnancy under the Omaha systematic nursing intervention (NI), in this study, 83 PIH pregnant women were taken as the study object. First, 60 normal pregnant women were taken as the control group (CG). Ultrasonic images of the uterine artery (UA) and middle cerebral artery (MCA) were collected. The machine learning (ML) algorithm was used to detect the edge of the target vessel in the UA image. The hemodynamic indexes of UA and MCA were compared between the two groups. Then, according to the routine NI and the NI method based on the Omaha system, 83 PIH pregnant women were divided into the routine group (RG) (n = 35) and the observation group (OG) (n = 48). The differences in UA hemodynamic parameters and quality of life (QOL) scores were compared between the two groups at 6 d after surgery. The results showed that pre-pregnancy BMI, mean artery pressure (MAP), and uric acid content in the CG were significantly lower than those in the PIH group (P &lt; 0.05); the content of serum albumin in the CG was significantly higher than that in the PIH group (P &lt; 0.05); compared with Sobel operator, edge detection (ED) based on ML algorithm was more coherent; in the CG, the systolic peak velocity (PSV), acceleration index (AI), pulse index (PI), and resistance index (RI) were significantly lower than those in the PIH group (P &lt; 0.05); the values of PI and RI in MCA of CG were significantly higher than those in PIH group (P &lt; 0.05); after NI, PSV, PI, RI, and AI values in the OG were significantly lower than those in the RG (P &lt; 0.05); the health status, trunk pain, social function, emotional function, vitality, mental health, and total score of the OG were significantly higher than that of the RG (P &lt; 0.05), which indicated that ultrasonic detection based on ML algorithm can be used in monitoring the changes of hemodynamic indexes of PIH pregnant women during NI, and the NI based on the Omaha system can effectively improve the QOL of PIH pregnant women.

The impact of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis: a clinical study

Background: Previous studies had shown that major uterine wall resection and reconstruction of the uterus (MURU) was safe and effective in the treatment of adenomyosis. However, MURU results in loss of a significant amount of myometrial and some endometrial tissues, which may have an impact on uterine hemodynamics and ovarian function. Therefore, it is necessary to study the changes of uterine hemodynamics and ovarian function in patients after MURU, in order to provide an evidence-base for its clinical application. Objective: To explore the effects of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis. Study design: The maximum thickness of unilateral uterine muscle wall or the maximum diameters of adenomyosis focus were measured by ultrasonography. Patients with adenomyosis were divided into three groups: mild, moderate or severe. Fifty cases of adenomyosis without fertility requirement were treated with MURU (observation group), and levonorgestrel-releasing system (LNG-IUS) was placed in uterine cavity during the operation. Fifty patients with intramural myoma of the uterus were selected for hysteromyomectomy (control group). The changes of arterial pulsation index (PI) and resistance index (RI) of uterine artery, as well as antral follicle count (AFC) and serum antimullerian hormone (AMH) were observed before operation and 1 month, 3 months, 6 months, 12 months and 18 months post-operation. Results: No complications were observed in both groups, no significant difference in uterine hemodynamics and ovarian function were found between the two groups (P &gt; 0.05). During intragroup comparison, there were no significant changes in PI and RI before and after operation in the two groups, and no significant changes in AFC and AMH were detected in both groups before and after operation (P &gt; 0.05). Conclusions: MURU did not significantly affect the uterine hemodynamics and ovarian function in patients with adenomyosis, but the long-term effects need to be further investigated.

Assessment of hemodynamics in the vertebral arteries with instability of the cervical vertebrae and uncovertebral arthrosis with functional tests

Instability of the cervical vertebrae and uncovertebral arthrosis are often the cause of hemodynamic disorders in the vertebral arteries. The aim of the investigation was to perform Doppler analysis of the parameters of blood flow in the vertebral arteries in patients with instability of the cervical spine (CS) and uncovertebral arthrosis with functional tests. Materials and methods. We examined 43 patients aged 18 to 44 years with CS instability, in 34 cases in combination with uncovertebral arthrosis (UVA). Determined Vs, Vd, RI, PI, MFV at the level in the second segment of the VA in the neutral position of the head and functional tests. Instability and uncovertebral arthrosis were diagnosed by radiography of the neck in frontal and lateral projections. Doppler sonography was performed on a Philips HD 11XE device using linear and microconvection sensors in the frequency range of 5-10 MHz Results. In patients with antilisthesis, the Vs value in the extension position was 32.1 ± 3.4 cm / s, RI - 0.71 ± 0.03, CCV - 84 ± 7 ml / min, significantly (P &lt;0.05) lower than in the case of retrolisthesis and in comparison group (CG). With head flexion, the lowest Vs value was found in the group with retrolisthesis and was 31.5 ± 3.1 cm / s, RI – 0.72 ± 0.03, CCV – 87 ± 8 ml / min, significantly (P&lt;0.05) lower than with antelisthesis and in CG. In the case of left localization of UVA, the lowest Vs value was recorded in the left VA during ipsilateral head rotation and amounted to 31.2 ± 2.9 cm / s, RI index - 0.72 ± 0.03, PI - 1.03 ± 0.06, and MFV - 85 ± 9 ml / min, reliably (P&lt;0,05) are lower than the indices of the right VA with right-sided localization of UVA. In right-sided uncovertebral arthrosis, Vs in the right VA had the smallest value and amounted to 30.4 ± 3.2 cm / s, RI index - 0.73 ± 0.03, PI - 1.04 ± 0.06, MFV - 81 ± 8 ml / min, respectively. These indices significantly (P &lt;0.05) differed from the indices of the left VA in the case of left-sided localization of UVA. Conclusions. With antelisthesis, the deterioration of blood flow parameters in the form of a decrease in systolic peak velocity and minute blood volume, as well as an increase in resistance and pulsation indices, occurs during extension, and in retrolisthesis, on the contrary, with bending of the head. With uncovertebral arthrosis, the deterioration of hemodynamic parameters is better manifested with rotational head movements. A decrease in the systolic velocity and minute volume of blood flow, an increase in the indices of resistance and pulsation occur during impsilateral rotation of the head on the side of arthrosis. Key words: instability of the cervical vertebrae, uncovertebral arthrosis, duplex scanning, vertebral arteries, functional tests.

Decoupled control of quasi-Z source inverter for decentralised renewable energy application

Decentralised renewable energy (DRE) systems are acclaimed worldwide as it serves as an alternate to the grid extension to remote areas having no access to electricity. The impedance source inverter (ZSI) has overcome the limitations of conventional voltage source inverter (VSI), have buck/boost capabilities. This paper presents an alternative approach of obtaining shoot-through pulses in a quasi-Z source inverter (qZSI) along with decoupled control by keeping dc link voltage constant instead of capacitor voltage. Dynamics of the system are investigated by deriving small signal model, the proposed control methodology uses separate controllers to handle dc and ac side dynamics to get desired shoot-through pulse and modulation index without any overlap, performance of the control methodology is verified under normal condition and under disturbances. Results are obtained using PSIM which verifies the control methodology and depicts the ability of disturbance rejection and effective reference tracking without compromising stability issues.