Multiple Physiological Signals Fusion Techniques for Improving Heartbeat Detection: A Review.

This paper presents a review of the techniques found in the literature that aim to achieve a robust heartbeat detection from fusing multi-modal physiological signals (e.g., electrocardiogram (ECG), blood pressure (BP), artificial blood pressure (ABP), stroke volume (SV), photoplethysmogram (PPG), electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG), among others). Techniques typically employ ECG, BP, and ABP, of which usage has been shown to obtain the best performance under challenging conditions. SV, PPG, EMG, EEG, and EOG signals can help increase performance when included within the fusion. Filtering, signal normalization, and resampling are common preprocessing steps. Delay correction between the heartbeats obtained over some of the physiological signals must also be considered, and signal-quality assessment to retain the best signal/s must be considered as well. Fusion is usually accomplished by exploiting regularities in the RR intervals; by selecting the most promising signal for the detection at every moment; by a voting process; or by performing simultaneous detection and fusion using Bayesian techniques, hidden Markov models, or neural networks. Based on the results of the review, guidelines to facilitate future comparison of the performance of the different proposals are given and promising future lines of research are pointed out.

Positive and Negative Evidence Accumulation Clustering for Sensor Fusion: An Application to Heartbeat Clustering.

In this work, a new clustering algorithm especially geared towards merging data arising from multiple sensors is presented. The algorithm, called PN-EAC, is based on the ensemble clustering paradigm and it introduces the novel concept of negative evidence. PN-EAC combines both positive evidence, to gather information about the elements that should be grouped together in the final partition, and negative evidence, which has information about the elements that should not be grouped together. The algorithm has been validated in the electrocardiographic domain for heartbeat clustering, extracting positive evidence from the heartbeat morphology and negative evidence from the distances between heartbeats. The best result obtained on the MIT-BIH Arrhythmia database yielded an error of 1.44%. In the St. Petersburg Institute of Cardiological Technics 12-Lead Arrhythmia Database database (INCARTDB), an error of 0.601% was obtained when using two electrocardiogram (ECG) leads. When increasing the number of leads to 4, 6, 8, 10 and 12, the algorithm obtains better results (statistically significant) than with the previous number of leads, reaching an error of 0.338%. To the best of our knowledge, this is the first clustering algorithm that is able to process simultaneously any number of ECG leads. Our results support the use of PN-EAC to combine different sources of information and the value of the negative evidence.

Balancing a retroreflector to minimize rotation errors using a pendulum and quadrature interferometer.

A corner-cube retroreflector has the property that the optical path length for a reflected laser beam is insensitive to rotations about a mathematical point called its optical center (OC). This property is exploited in ballistic absolute gravity meters in which a proof mass containing a corner-cube retroreflector is dropped in a vacuum, and its position is accurately determined with a laser interferometer. In order to avoid vertical position errors when the proof mass rotates during free fall, it is important to collocate its center of mass (COM) with the OC of the retroreflector. This is commonly done using a mechanical scale-based balancing procedure, which has limited accuracy due to the difficulty in finding the exact position of the COM and the OC. This paper describes a novel way to achieve the collocation by incorporating the proof mass into a pendulum and using a quadrature interferometer to interrogate its apparent translation in its twist mode. The mismatch between the COM and OC generates a signal in a quiet part of the spectrum where no mechanical resonance exists. This allows us to tune the position of the COM relative to the OC to an accuracy of about 1 µm in all three axes. This provides a way to directly demonstrate that a rotation of the proof mass by several degrees causes an apparent translation in the direction of the laser beam of less than 1 nm. This technique allows an order of magnitude improvement over traditional methods of balancing.

Dengue virus serotype 4 and chikungunya virus coinfection in a traveller returning from Luanda, Angola, January 2014.

A concurrent dengue virus serotype 4 and chikungunya virus infection was detected in a woman in her early 50s returning to Portugal from Luanda, Angola, in January 2014. The clinical, laboratory and molecular findings, involving phylogenetic analyses of partial viral genomic sequences amplified by RT-PCR, are described. Although the circulation of both dengue and chikungunya viruses in Angola has been previously reported, to our knowledge this is the first time coinfection with both viruses has been detected there.

Probabilistic metabolite annotation using retention time prediction and meta-learned projections.

Retention time information is used for metabolite annotation in metabolomic experiments. But its usefulness is hindered by the availability of experimental retention time data in metabolomic databases, and by the lack of reproducibility between different chromatographic methods. Accurate prediction of retention time for a given chromatographic method would be a valuable support for metabolite annotation. We have trained state-of-the-art machine learning regressors using the 80, 038 experimental retention times from the METLIN Small Molecule Retention Tim (SMRT) dataset. The models included deep neural networks, deep kernel learning, several gradient boosting models, and a blending approach. 5, 666 molecular descriptors and 2, 214 fingerprints (MACCS166, Extended Connectivity, and Path Fingerprints fingerprints) were generated with the alvaDesc software. The models were trained using only the descriptors, only the fingerprints, and both types of features simultaneously. Bayesian hyperparameter search was used for parameter tuning. To avoid data-leakage when reporting the performance metrics, nested cross-validation was employed. The best results were obtained by a heavily regularized deep neural network trained with cosine annealing warm restarts and stochastic weight averaging, achieving a mean and median absolute errors of [Formula: see text] and [Formula: see text], respectively. To the best of our knowledge, these are the most accurate predictions published up to date over the SMRT dataset. To project retention times between chromatographic methods, a novel Bayesian meta-learning approach that can learn from just a few molecules is proposed. By applying this projection between the deep neural network retention time predictions and a given chromatographic method, our approach can be integrated into a metabolite annotation workflow to obtain z-scores for the candidate annotations. To this end, it is enough that just as few as 10 molecules of a given experiment have been identified (probably by using pure metabolite standards). The use of z-scores permits considering the uncertainty in the projection when ranking candidates, and not only the accuracy. In this scenario, our results show that in 68% of the cases the correct molecule was among the top three candidates filtered by mass and ranked according to z-scores. This shows the usefulness of this information to support metabolite annotation. Python code is available on GitHub at https://github.com/constantino-garcia/cmmrt.

Strength of association of classical vascular risk factors in young patients with ischaemic stroke: a case-control study.

INTRODUCTION: Recent studies have reported an increasing incidence of ischaemic stroke among young adults. However, the strength of the association between traditional vascular risk factors has not been fully established. METHODS: We compared 120 patients with a first ischaemic stroke before the age of 55 years admitted to the stroke unit of our centre with 600 healthy non-stroke controls from a population-based cohort study (HERMEX), matched for sex. Risk factors assessed included: hypertension, obesity, auricular fibrillation, current smoking, estimated glomerular filtration rate (eGFR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and diabetes mellitus. We used logistic regression analysis and calculated population attributable risk. We performed an overall analysis, by sex and aetiological subgroup. RESULTS: Using logistic regression analysis, we found that overall, the significant risk factors were: hypertension (OR: 1.58; 95%CI: 1.01-2.50), atrial fibrillation (OR: 4.77; 95%CI: 1.20-19.00), low eGFR (OR: 4.74; 95%CI: 1.3-21.94) and low HDL-C (OR: 5.20; 95%CI: 3.29-8.21), as well as smoking for males (OR: 1.86; 95%CI: 1.14-3.03). LDL-C showed an inverse association with stroke. The population attributable risk for HDL-C was 37.8% and for hypertension 21.1%. In terms of aetiological subgroups, only low HDL-C was associated with stroke of undetermined aetiology. CONCLUSIONS: Hypertension, auricular fibrillation, low eGFR, and low HDL-C, plus tobacco use in men, are the main risk factors among patients under 55 years of age with a first ischaemic stroke. We believe that it would be of particular interest to further explore the management of low HDL-C levels as part of preventive strategies in young stroke patients.

Serum biochemistry of Trachemys scripta elegans and Trachemys dorbignyi (Testudines: Emydidae) bred in captivity in the Northeastern semiarid region of Brazil.

AIM: This study aimed to assess fundamental biochemical values of healthy animals and to provide useful data on comparative physiologies of Testudines, being assessed the serum biochemistry profiles, and body and tail biometry of Trachemys scripta elegans and Trachemys dorbignyi bred in interaction in the semiarid region of the São Francisco river valley. MATERIALS AND METHODS: Serum biochemistry variables (urea, creatinine, glucose, total serum protein, albumin, globulin, and albumin/globulin ratio), and biometry values of the body (mass [body mass (BM)], maximum curvilinear length [carapace length (CL)], and width [carapace width (CW)] of the carapace, maximum curvilinear length [plastron length (PL)], and width [plastron width PW] of the plastron), and the tail (total length of the tail [TLT], pre-cloacal tail length [PrCL], post-cloacal tail length [PoCL]) were measured after 24 h fasting. RESULTS: T. s. elegans displayed higher BM, CL, CW, PL, PW, AST, TP, albumin, and globulin values. T. dorbignyi displayed higher values of glucose, TLT, and PrCL. Variables aspartate aminotransferase (AST) and total protein (TP) in T. s. elegans and glucose in T. dorbignyi explained most of the variance between the species and could serve to distinguish them. CONCLUSION: We conclude that most of the differences between T. s. elegans and T. dorbignyi shall be explained by biometric variables, AST, TP, and glucose, which characterize interspecific differences. Our results point out terms of reference for these species bred in captivity in the semiarid region of Brazilian Northeastern region and serve as a model for the comparative intra- and inter-species physiology and as a base for the health assessment of these species.

External validation of the A2SD2 and ISAN scales for predicting infectious respiratory complications of ischaemic stroke. / Validación externa de las escalas A2DS2 e ISAN para predecir la infección respiratoria asociada al ictus isquémico.

BACKGROUND AND PURPOSE: Pneumonia as a complication of stroke is associated with poor outcomes. The A2DS2 and ISAN scales were developed by German and English researchers, respectively, to predict in-hospital stroke-associated pneumonia. We conducted an external validation study of these scales in a series of consecutive patients admitted to our hospital due to ischaemic stroke. METHOD: These predictive models were applied to a sample of 340 consecutive patients admitted to hospital in 2015 due to stroke. Discrimination was assessed by calculating the area under the ROC curve for diagnostic efficacy. Calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and graphing the corresponding curve. Logistic regression analysis was performed to determine the independent predictors of respiratory infection secondary to stroke. RESULTS: We included 285 patients, of whom 45 (15.8%) had respiratory infection after stroke according to the study criteria. Mean age was 71.01±12.62 years; men accounted for 177 of the patients (62.1%). Seventy-two patients (25.3%) had signs or symptoms of dysphagia, 42 (14.7%) had atrial fibrillation, and 14 (4.9%) were functionally dependent before stroke; the median NIHSS score was 4 points. Mean scores on A2DS2 and ISAN were 3.25±2.54 and 6.49±3.64, respectively. Our analysis showed that higher A2DS2 scores were associated with an increased risk of infection (OR=1.576; 95% CI: 1.363-1.821); the same was true for ISAN scores (OR=1.350; 95% CI: 1.214-1.501). CONCLUSION: High scores on A2DS2 and ISAN were found to be a strong predictor of respiratory infection associated with acute stroke in a cohort of consecutive patients with stroke. These easy-to-use scales are promising tools for predicting this complication in routine clinical practice.

A standard addition method to assay the concentration of biologically interesting polyphenols in grape berries by reversed-phase HPLC.

A reversed-phase HPLC method which allows the simultaneous assay of (+)- catechin, (-)-epicatechin, trans-resveratrol, quercetin and quercetin glycosides in grape berries is described. Kromasil 100 served as stationary phase and a gradient of acetic acid, water and methanol was used. The analytical run requires 42 min for complete sample elution. Satisfactory peak resolution was achieved following a novel extraction process and direct injection of a 20 microL sample. The method was used for the analyses of eighteen samples. Linearities were in the range of 0.98 to 0.999 regression coefficient, for all phenolics, while detection limits ranged from 30 microg mL(-1) for trans-resveratrol to 1.5 mg mL(-1) for (+)-catechin. Recoveries ranged from 95.1 to 98.7% while the method provided good precision, with standard deviations between 3.5 and 6.1%, n=5.

Nitrogen Sources Screening for Ethanol Production Using Carob Industrial Wastes.

Nowadays, bioethanol production is one of the most important technologies by the necessity to identify alternative energy resources, principally when based on inexpensive renewable resources. However, the costs of 2nd-generation bioethanol production using current biotechnologies are still high compared to fossil fuels. The feasibility of bioethanol production, by obtaining high yields and concentrations of ethanol, using low-cost medium, is the primary goal, leading the research done today. Batch Saccharomyces cerevisiae fermentation of high-density sugar from carob residues with different organic (yeast extract, peptone, urea) and inorganic nitrogen sources (ammonium sulfate, ammonium nitrate) was performed for evaluating a cost-effective ethanol production, with high ethanol yield and productivity. In STR batch fermentation, urea has proved to be a very promising nitrogen source in large-scale production of bioethanol, reaching an ethanol yield of 44 % (w/w), close to theoretical maximum yield value and an ethanol production of 115 g/l. Urea at 3 g/l as nitrogen source could be an economical alternative with a great advantage in the sustainability of ethanol production from carbohydrates extracted from carob. Simulation studies, with experimental data using SuperPro Design software, have shown that the bioethanol production biorefinery from carob wastes could be a very promising way to the valorization of an endogenous resource, with a competitive cost.

Nonparametric estimation of stochastic differential equations with sparse Gaussian processes.

The application of stochastic differential equations (SDEs) to the analysis of temporal data has attracted increasing attention, due to their ability to describe complex dynamics with physically interpretable equations. In this paper, we introduce a nonparametric method for estimating the drift and diffusion terms of SDEs from a densely observed discrete time series. The use of Gaussian processes as priors permits working directly in a function-space view and thus the inference takes place directly in this space. To cope with the computational complexity that requires the use of Gaussian processes, a sparse Gaussian process approximation is provided. This approximation permits the efficient computation of predictions for the drift and diffusion terms by using a distribution over a small subset of pseudosamples. The proposed method has been validated using both simulated data and real data from economy and paleoclimatology. The application of the method to real data demonstrates its ability to capture the behavior of complex systems.

Growth kinetics and physiological behavior of co-cultures of Saccharomyces cerevisiae and Kluyveromyces lactis, fermenting carob sugars extracted with whey.

Alcoholic fermentation of carob waste sugars (sucrose, glucose and fructose) extracted with cheese whey, by co-cultures of Saccharomyces cerevisiae and Kluyveromyces lactis has been analyzed. Growth and fermentation of S. cerevisiae in the carob-whey medium showed an inhibition of about 30% in comparison with water-extracted carob. The inhibition of K. lactis on carob-whey was greater (70%) when compared with the whey medium alone, due to osmolarity problems. Oxygen availability was a very important factor for K. lactis, influencing its fermentation performance. When K. lactis was grown alone on carob-whey medium, lactose was always consumed first, and glucose and fructose were consumed afterwards, only at high aeration conditions. In co-culture with S. cerevisiae, K. lactis was completely inhibited and, at low aeration, died after 3 days; at high aeration this culture could survive but growth and lactose fermentation were only recovered after S. cerevisiae became stationary. To overcome the osmolarity and K. lactis' oxygen problems, the medium had to be diluted and a sequential fermentative process was designed in a STR-3l reactor. K. lactis was inoculated first and, with low aeration (0.13vvm), consumed all the lactose in 48h. Then S. cerevisiae was inoculated, consuming the total of the carob sugars, and producing ethanol in a fed-batch regime. The established co-culture with K. lactis increased S. cerevisiae ethanol tolerance. This fermentation process produced ethanol with good efficiency (80g/l final concentration and a conversion factor of 0.4g ethanol/g sugar), eliminating all the sugars of the mixed waste. These efficient fermentative results pointed to a new joint treatment of agro-industrial wastes which may be implemented successfully, with economic and environmental sustainability for a bioethanol industrial proposal.

The delta opioid receptor 1 is expressed by proliferating bile ductules in rats with cholestasis: implications for the study of liver regeneration and malignant transformation of biliary epithelium.

In sharp contrast with the normal adult liver, the fetal human and rat livers and the liver of rats with cholestasis secondary to bile duct resection express the preproenkephalin mRNA, which codes for the endogenous opioid peptide Met-enkephalin. Furthermore, Met-enkephalin immunoreactivity is detected in hepatocytes and in proliferating bile ductules in the cholestatic rat liver. These data suggest that in cholestasis endogenous opioids may have a local effect in the cholestatic liver. As endogenous opioids exert their effect by binding to opioid receptors, the presence of opioid receptors in the cholestatic livers would support the hypothesis that Met-enkephalin plays a role in situ. Preliminary data presented in this manuscript reveals the expression of the delta opioid receptor in the liver of rats with cholestasis. This finding suggests that there is a scenario in which Met-enkephalin can bind to opioid receptors in the liver in cholestasis to exert a local effect. In vivo studies in this model of cholestasis with the use of opioid agonist and antagonist will shed light on the possible role of opioidergic regulation of liver regeneration. Studies on the effect of opiate antagonists on the evolution of cholestasis in this animal model may provide insight into the mechanisms of liver regeneration. In addition, as some conditions associated with cholestasis and bile ductular proliferation can be complicated by malignancy, the expression of the delta opioid receptor in malignant tumors of the biliary tree merits research.

Kinetic and Energetic Parameters of Carob Wastes Fermentation by Saccharomyces cerevisiae: Crabtree Effect, Ethanol Toxicity, and Invertase Repression.

Carob waste is a useful raw material for the second-generation ethanol because 50% of its dry weight is sucrose, glucose, and fructose. To optimize the process, we have studied the influence of the initial concentration of sugars on the fermentation performance of Saccharomyces cerevisiae. With initial sugar concentrations (S0) of 20 g/l, the yeasts were derepressed and the ethanol produced during the exponential phase was consumed in a diauxic phase. The rate of ethanol consumption decreased with increasing S0 and disappeared at 250 g/l when the Crabtree effect was complete and almost all the sugar consumed was transformed into ethanol with a yield factor of 0.42 g/g. Sucrose hydrolysis was delayed at high S0 because of glucose repression of invertase synthesis, which was triggered at concentrations above 40 g/l. At S0 higher than 250 g/l, even when glucose had been exhausted, sucrose was hydrolyzed very slowly, probably due to an inhibition at this low water activity. Although with lower metabolic rates and longer times of fermentation, 250 g/l is considered the optimal initial concentration because it avoids the diauxic consumption of ethanol and maintains enough invertase activity to consume all the sucrose, and also avoids the inhibitions due to lower water activities at higher S0.

Comparison between immunofixation and crossed immunoelectrophoresis for the detection of C3 activation products.

C3 breakdown products were measured in 51 fresh and stored sera and/or EDTA plasma samples from 18 healthy subjects, 8 patients affected by essential mixed cryoglobulinaemia, and 15 patients with miscellaneous glomerulonephritis, by simultaneous crossed immunoelectrophoresis and immunofixation. C3 splitting products, as determined by both methods compared well, and showed a highly significant correlation. The advantages and reliability of these two methods are discussed. Immunofixation seems to be the most suitable for routine use in clinical practice, being less expensive and more rapid to perform.

Numerical study of the Langevin theory for fixed-energy sandpiles.

The recently proposed Langevin equation, aimed to capture the relevant critical features of stochastic sandpiles and other self-organizing systems, is studied numerically. The equation is similar to the Reggeon field theory, describing generic systems with absorbing states, but it is coupled linearly to a second conserved and static (nondiffusive) field. It has been claimed to represent a different universality class, including different discrete models: the Manna as well as other sandpiles, reaction-diffusion systems, etc. In order to integrate the equation, and surpass the difficulties associated with its singular noise, we follow a numerical technique introduced by Dickman. Our results coincide remarkably well with those of discrete models claimed to belong to this universality class, in one, two, and three dimensions. This provides a strong backing for the Langevin theory of stochastic sandpiles, and to the very existence of this meagerly understood universality class.

Parkinson's disease.

In this case study, we describe the symptoms, neurological examination, test results, and brain pathology of a man with Parkinson's disease (PD). PD commonly presents with tremor or changes in one's ability to walk or move. Other major difficulties caused by this disease include rigidity of the body, slowness of movement, and postural imbalance. The disease symptoms principally result from the degeneration of a specific population of neuronal cells in the brain stem, in a region called the pars compacta of the substantia nigra. Pathology shows the loss of these cells and the appearance of characteristic neuronal cytoplasmic inclusions called Lewy bodies, which are composed principally of aggregated alpha-synuclein protein.

Primary cardiac lymphoma in a patient with acquired immune deficiency syndrome.

A 34-year-old male prisoner with a history of intravenous drug abuse presented with fever, lymphadenopathy, weight loss, and recent onset of congestive heart failure. Serologic testing was positive for antibodies to human immune deficiency virus. There was intense myocardial uptake of gallium. Autopsy showed a primary immunoblastic lymphoma involving only the myocardium. While primary cardiac lymphoma is an extremely rare condition, the incidence may be higher in patients with acquired immune deficiency syndrome (AIDS) and should be suspected in cases with atypical cardiomyopathy.

Evaluation of the pull test technique in assessing postural instability in Parkinson's disease.

Variability in pull test (PT) performance can lead to inadequate evaluation of postural instability in patients with Parkinson's disease (PD). Assessing 66 PTs by 25 examiners, at least two of four raters agreed that specific items were performed incorrectly for stance in 27.3%, for strength and briskness of the pull in 84.9%, for examiner's response in 36.4%, and for technique issues in 9.1%. Examiners were consistent in their errors, and only 9% of examinations were error-free.