Binary classification of copy number alteration profiles in liquid biopsy with potential clinical impact in advanced NSCLC.

Liquid biopsy has recently emerged as an important tool in clinical practice particularly for lung cancer patients. We retrospectively evaluated cell-free DNA analyses performed at our Institution by next generation sequencing methodology detecting the major classes of genetic alterations. Starting from the graphical representation of chromosomal alterations provided by the analysis software, we developed a support vector machine classifier to automatically classify chromosomal profiles as stable (SCP) or unstable (UCP). High concordance was found between our binary classification and tumor fraction evaluation performed using shallow whole genome sequencing. Among clinical features, UCP patients were more likely to have ≥ 3 metastatic sites and liver metastases. Longitudinal assessment of chromosomal profiles in 33 patients with lung cancer receiving immune checkpoint inhibitors (ICIs) showed that only patients that experienced early death or hyperprogressive disease retained or acquired an UCP within 3 weeks from the beginning of ICIs. UCP was not observed following ICIs among patients that experienced progressive disease or clinical benefit. In conclusion, our binary classification, applied to whole copy number alteration profiles, could be useful for clinical risk stratification during systemic treatment for non-small cell lung cancer patients.

Maximum a posteriori detection of heartbeats from a chest-worn accelerometer.

Objective. Unobtrusive long-term monitoring of cardiac parameters is important in a wide variety of clinical applications, such as the assesment of acute illness severity and unobtrusive sleep monitoring. Here we determined the accuracy and robustness of heartbeat detection by an accelerometer worn on the chest.Approach. We performed overnight recordings in 147 individuals (69 female, 78 male) referred to two sleep centers. Two methods for heartbeat detection in the acceleration signal were compared: one previously described approach, based on local periodicity, and a novel extended method incorporating maximumaposterioriestimation and a Markov decision process to approach an optimal solution.Main results. The maximumaposterioriestimation significantly improved performance, with a mean absolute error for the estimation of inter-beat intervals of only 3.5 ms, and 95% limits of agreement of -1.7 to +1.0 beats per minute for heartrate measurement. Performance held during posture changes and was only weakly affected by the presence of sleep disorders and demographic factors.Significance. The new method may enable the use of a chest-worn accelerometer in a variety of applications such as ambulatory sleep staging and in-patient monitoring.

Estimating the Severity of Obstructive Sleep Apnea Using ECG, Respiratory Effort and Neural Networks.

OBJECTIVE: wearable sensor technology has progressed significantly in the last decade, but its clinical usability for the assessment of obstructive sleep apnea (OSA) is limited by the lack of large and representative datasets simultaneously acquired with polysomnography (PSG). The objective of this study was to explore the use of cardiorespiratory signals common in standard PSGs which can be easily measured with wearable sensors, to estimate the severity of OSA. METHODS: an artificial neural network was developed for detecting sleep disordered breathing events using electrocardiogram (ECG) and respiratory effort. The network was combined with a previously developed cardiorespiratory sleep staging algorithm and evaluated in terms of sleep staging classification performance, apnea-hypopnea index (AHI) estimation, and OSA severity estimation against PSG on a cohort of 653 participants with a wide range of OSA severity. RESULTS: four-class sleep staging achieved a κ of 0.69 versus PSG, distinguishing wake, combined N1-N2, N3 and REM. AHI estimation achieved an intraclass correlation coefficient of 0.91, and high diagnostic performance for different OSA severity thresholds. CONCLUSIONS: this study highlights the potential of using cardiorespiratory signals to estimate OSA severity, even without the need for airflow or oxygen saturation (SpO2), traditionally used for assessing OSA. SIGNIFICANCE: while further research is required to translate these findings to practical and unobtrusive sensors, this study demonstrates how existing, large datasets can serve as a foundation for wearable systems for OSA monitoring. Ultimately, this approach could enable long-term assessment of sleep disordered breathing, facilitating new avenues for clinical research in this field.

Chronotropic, inotropic and lusitropic effects of capsaicin on isolated rat Atria

This work includes results on chronotropic, inotropic and lusitropic changes induced by capsaicin on isolated rat atria. As regards spontaneous frequency, it was stimulated from 10(-9) M up to 7 x 10(-7) M of capsaicin. A simultaneous depression in developed force (F) showed a signigicant correlation with this positive chronotropic effect up to 7 X 10(-8) M of capsaicin, which is the result of the negative staircase phenomenon in the rat heart. The correlation was lost at 2 and 7 x 10(-7) M of capsaicin since in spite of the sustained increase in atrial rate the decrease in F was reversed and then depressed again at 2 and 7x 10(-6) M of capsaicin without changes in frequency. A concentration of capsaicin that overcome the negative staircase phenomenon, 5 x 10(-7) M, was tested as unique dose resulting in stimulation of the chronotropic, inotropic and lusitropic states of the atria. Percentual differences with respect to control values were maximal after 1-3 minutes for frequency (10+3 per cent), F (29+4 per cent), maximal velocity of force development (+F=50+12 per cent) (in all cases +F and -F,bold indicates +F and -F, respectively) and maximal velocity of relaxation (-F=64+13 per cent); a positive lusitropic effect was significant after 8-10 minutes (+F/-F=-17+7 per cent). Capsaicin did not affect the rat atria in the presence of 10(-6) M of ruthenium red, a blocker of capsaicin activation of sensory nerves, indicating that the stimulatory effects were entirely mediated by the release of neurotransmitters and that this concentration of capsaicin was not deleterous "per se". Capsaicin elicited similar inotropic responses in electrically driven isolated atria (+F=41+9 per cent) but the positive lusitropic effect was lost suggesting that capsaicin-induced increases in -F are limited at a frequency higher than the spontaneous frequency (11+6 vs. 32+4 per cent, respectively). 10(-6) M of CGRP8(-37), an antagonist of CGRP1 receptors, suppress the stimulatory effects of capsaicin on atrial contraction. In summary, atrial rate as compared to atrial contraction is more sensitive to the neurotransmitter released by capsaicin, which results in mechanical effects expressing the negative staircase phenomenon in the rat at low concentrations of capsaicin. The positive chronotropic, inotropic and lusitropic responses elicited by capsaicin are mediated by the reelease of neurotransmitters from sensory fibbers and no deletereous effects...

Insulina, reatividad valcular me hipertension arterial / Insulin, vascular reactiviry and hypertension

Varios estudios epidemiológicos indican que hay una relación entre hiper-insulinemia, resistencia insulínica e hipertensión arterial. La insulina estimula el sistema nervioso simpático, produce retención renal de Na+ y modifica en forma directa mecanismos vasculares (contrayentes y relajantes); estos efectos pueden justificar que la insulina aumente o disminuya la presión arterial. la ausencia de los efectos vasodilatadores debido a resistencia insulínica y/o la mayor manifestación de los efectos hipertensores en caso de hiperinsulinemia podrían ser el nexo entre la insulina y la hipertensión arterial.

Efectos de la insulina sobre la respuesta contractil y la captacion de calcio en aorta de rata / Effect of insulin on contractile response and calcium captation in rat aorta

La insulina afecta mecanismos fisiológicos generales que regulan la presión arterial, y a nivel celular modifica las funciones del endotelio y del mosculo liso vascular, que son determinantes de la resistencia periférica. Describimos los efectos de la preincubación con insulina (40 muU/ml, durante 1-2 hs) sobre la reactividad contráctil de anillos intactos de aorta de rata y sobre la captaci>n de 45Ca2+ en segmentos de aorta de rata hipermeabilizados por tratamiento con EGTA. La preincubación con insulina no afectó las contracciones inducids por 1 muM de NA, ni la relajación de las mismas inducida por 10 mM de cafeína. La respuesta contractil a 1 muM de Ang-II (que en la aorta de rata es independiente de endotelio) fue estimulada por la preincubación con insulina en la fuerza máxima desarrollada y en la velocidad de relajación espontánea de la contracción. La diferencia en la captación de 45Ca2+ en RS entre los segmentos de aorta tratados y no tratados con insulina fue mayor a los 5 minutos con respecto a la medida a los 30 minutos. Se concluye que la preincubación con insulina afecta en forma directa la respuesta mecánica del mosculo liso aórtico estimulado con Ang-II y se propone a la modificación de la actividad del RS como uno de los mecanismos mediante el cual la insulina participa en la regulación del Ca2+ citosólico.