Spatial variability and directional shifts in postural control in Parkinson's disease.

Individuals with Parkinson's disease exhibit tremors, rigidity, and bradykinesia, disrupting normal movement variability and resulting in postural instability. This comprehensive study aimed to investigate the link between the temporal structure of postural sway variability and Parkinsonism by analyzing multiple datasets from young and older adults, including individuals with Parkinson's disease, across various task conditions. We used the Oriented Fractal Scaling Component Analysis (OFSCA), which identifies minimal and maximal long-range correlations within the center of pressure time series, allowing for detecting directional changes in postural sway variability. The objective was to uncover the primary directions along which individuals exerted control during the posture. The results, as anticipated, revealed that healthy adults predominantly exerted control along two orthogonal directions, closely aligned with the anteroposterior (AP) and mediolateral (ML) axes. In stark contrast, older adults and individuals with Parkinson's disease exhibited control along suborthogonal directions that notably diverged from the AP and ML axes. While older adults and those with Parkinson's disease demonstrated a similar reduction in the angle between these two control directions compared to healthy older adults, their reliance on this suborthogonal angle concerning endogenous fractal correlations exhibited significant differences from the healthy aging cohort. Importantly, individuals with Parkinson's disease did not manifest the sensitivity to destabilizing task settings observed in their healthy counterparts, affirming the distinction between Parkinson's disease and healthy aging.

Postural control in gymnasts: anisotropic fractal scaling reveals proprioceptive reintegration in vestibular perturbation.

Dexterous postural control subtly complements movement variability with sensory correlations at many scales. The expressive poise of gymnasts exemplifies this lyrical punctuation of release with constraint, from coarse grain to fine scales. Dexterous postural control upon a 2D support surface might collapse the variation of center of pressure (CoP) to a relatively 1D orientation-a direction often oriented towards the focal point of a visual task. Sensory corrections in dexterous postural control might manifest in temporal correlations, specifically as fractional Brownian motions whose differences are more and less correlated with fractional Gaussian noises (fGns) with progressively larger and smaller Hurst exponent H. Traditional empirical work examines this arrangement of lower-dimensional compression of CoP along two orthogonal axes, anteroposterior (AP) and mediolateral (ML). Eyes-open and face-forward orientations cultivate greater variability along AP than ML axes, and the orthogonal distribution of spatial variability has so far gone hand in hand with an orthogonal distribution of H, for example, larger in AP and lower in ML. However, perturbing the orientation of task focus might destabilize the postural synergy away from its 1D distribution and homogenize the temporal correlations across the 2D support surface, resulting in narrower angles between the directions of the largest and smallest H. We used oriented fractal scaling component analysis (OFSCA) to investigate whether sensory corrections in postural control might thus become suborthogonal. OFSCA models raw 2D CoP trajectory by decomposing it in all directions along the 2D support surface and fits the directions with the largest and smallest H. We studied a sample of gymnasts in eyes-open and face-forward quiet posture, and results from OFSCA confirm that such posture exhibits the classic orthogonal distribution of temporal correlations. Head-turning resulted in a simultaneous decrease in this angle Δθ, which promptly reversed once gymnasts reoriented their heads forward. However, when vision was absent, there was only a discernible negative trend in Δθ, indicating a shift in the angle's direction but not a statistically significant one. Thus, the narrowing of Δθ may signify an adaptive strategy in postural control. The swift recovery of Δθ upon returning to a forward-facing posture suggests that the temporary reduction is specific to head-turning and does not impose a lasting burden on postural control. Turning the head reduced the angle between these two orientations, facilitating the release of postural degrees of freedom towards a more uniform spread of the CoP across both dimensions of the support surface. The innovative aspect of this work is that it shows how fractality might serve as a control parameter of adaptive mechanisms of dexterous postural control.

Age- and height-dependent bias of underweight and overweight assessment standards for children and adolescents.

Background: Precision in evaluating underweight and overweight status among children and adolescents is paramount for averting health and developmental issues. Existing standards for these assessments have faced scrutiny regarding their validity. This study investigates the age and height dependencies within the international standards set by the International Obesity Task Force (IOTF), relying on body mass index (BMI), and contrasts them with Japanese standards utilizing the percentage of overweight (POW). Method: We scrutinized a comprehensive database comprising 7,863,520 children aged 5-17 years, sourced from the School Health Statistics Research initiative conducted by Japan's Ministry of Education, Culture, Sports, Science, and Technology. Employing the quantile regression method, we dissected the structure of weight-for-height distributions across different ages and sexes, quantifying the potentially biased assessments of underweight and overweight status by conventional criteria. Results: Applying IOFT criteria for underweight assessment revealed pronounced height dependence in males aged 11-13 and females aged 10-11. Notably, a discernible bias emerged, wherein children in the lower 25th percentile were classified as underweight five times more frequently than those in the upper 25th percentile. Similarly, the overweight assessment displayed robust height dependence in males aged 8-11 and females aged 7-10, with children in the lower 25th percentile for height deemed obese four or five times more frequently than their counterparts in the upper 25th percentile. Furthermore, using the Japanese POW criteria for assessment revealed significant age dependence in addition to considerably underestimating the percentage of underweight and overweight cases under the age of seven. However, the height dependence for the POW criterion was smaller than the BMI criterion, and the difference between height classes was less than 3-fold. Conclusion: Our findings underscore the intricacies of age-dependent changes in body composition during the growth process in children, emphasizing the absence of gold standards for assessing underweight and overweight. Careful judgment is crucial in cases of short or tall stature at the same age, surpassing sole reliance on conventional criteria results.

Individually optimized estimation of energy expenditure in rescue workers using a tri-axial accelerometer and heart rate monitor.

Objectives: This study aimed to provide an improved energy expenditure estimation for heavy-load physical labor using accelerometer data and heart rate (HR) measured by wearables and to support food preparation and supply management for disaster relief and rescue operations as an expedition team. Methods: To achieve an individually optimized estimation for energy expenditure, a model equation parameter was determined based on the measurements of physical activity and HR during simulated rescue operations. The metabolic equivalent of task (MET), which was measured by using a tri-axial accelerometer and individual HR, was used, where two (minimum and maximum) or three (minimum, intermediate, and maximum) representative reference points were selected for each individual model fitting. In demonstrating the applicability of our approach in a realistic situation, accelerometer-based METs and HR of 30 males were measured using the tri-axial accelerometer and wearable HR during simulated rescue operations over 2 days. Results: Data sets of 27 rescue operations (age:34.2 ± 7.5 years; body mass index (BMI):22.9 ± 1.5 kg/m2) were used for the energy expenditure estimation after excluding three rescue workers due to their activity type and insufficient HR measurement. Using the combined approach with a tri-axial accelerometer and HR, the total energy expenditure increased by 143% for two points and 133% for three points, compared with the estimated total energy expenditure using only the accelerometer-based method. Conclusion: The use of wearables provided a reasonable estimation of energy expenditure for physical workers with heavy equipment. The application of our approach to disaster relief and rescue operations can provide important insights into nutrition and healthcare management.

Older adults and individuals with Parkinson's disease control posture along suborthogonal directions that deviate from the traditional anteroposterior and mediolateral directions.

A rich and complex temporal structure of variability in postural sway characterizes healthy and adaptable postural control. However, neurodegenerative disorders such as Parkinson's disease, which often manifest as tremors, rigidity, and bradykinesia, disrupt this healthy variability. This study examined postural sway in young and older adults, including individuals with Parkinson's disease, under different upright standing conditions to investigate the potential connection between the temporal structure of variability in postural sway and Parkinsonism. A novel and innovative method called oriented fractal scaling component analysis was employed. This method involves decomposing the two-dimensional center of pressure (CoP) planar trajectories to pinpoint the directions associated with minimal and maximal temporal correlations in postural sway. As a result, it facilitates a comprehensive assessment of the directional characteristics within the temporal structure of sway variability. The results demonstrated that healthy young adults control posture along two orthogonal directions closely aligned with the traditional anatomical anteroposterior (AP) and mediolateral (ML) axes. In contrast, older adults and individuals with Parkinson's disease controlled posture along suborthogonal directions that significantly deviate from the AP and ML axes. These findings suggest that the altered temporal structure of sway variability is evident in individuals with Parkinson's disease and underlies postural deficits, surpassing what can be explained solely by the natural aging process.

Multifractal foundations of biomarker discovery for heart disease and stroke.

Any reliable biomarker has to be specific, generalizable, and reproducible across individuals and contexts. The exact values of such a biomarker must represent similar health states in different individuals and at different times within the same individual to result in the minimum possible false-positive and false-negative rates. The application of standard cut-off points and risk scores across populations hinges upon the assumption of such generalizability. Such generalizability, in turn, hinges upon this condition that the phenomenon investigated by current statistical methods is ergodic, i.e., its statistical measures converge over individuals and time within the finite limit of observations. However, emerging evidence indicates that biological processes abound with nonergodicity, threatening this generalizability. Here, we present a solution for how to make generalizable inferences by deriving ergodic descriptions of nonergodic phenomena. For this aim, we proposed capturing the origin of ergodicity-breaking in many biological processes: cascade dynamics. To assess our hypotheses, we embraced the challenge of identifying reliable biomarkers for heart disease and stroke, which, despite being the leading cause of death worldwide and decades of research, lacks reliable biomarkers and risk stratification tools. We showed that raw R-R interval data and its common descriptors based on mean and variance are nonergodic and non-specific. On the other hand, the cascade-dynamical descriptors, the Hurst exponent encoding linear temporal correlations, and multifractal nonlinearity encoding nonlinear interactions across scales described the nonergodic heart rate variability more ergodically and were specific. This study inaugurates applying the critical concept of ergodicity in discovering and applying digital biomarkers of health and disease.

Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome-TWIST study.

BACKGROUND: We aimed to investigate the association between ventricular repolarization instability and sustained ventricular tachycardia and ventricular fibrillation (VT/VF) occurring within 48 h (acute-phase VT/VF) after the onset of acute coronary syndrome (ACS) and the prognostic role of repolarization instability and heart rate variability (HRV) after discharge from the hospital. METHODS: We studied 572 ACS patients with a left ventricular ejection fraction >35%. The ventricular repolarization instability was assessed by the beat-to-beat T-wave amplitude variability (TAV) using high-resolution 24-h Holter ECGs recorded at a median of 11 days from the date of admission. We calculated the HRV parameters including the deceleration capacity (DC) and non-Gaussian index calculated on a 25 s timescale (λ25s). The DC and λ25s were dichotomized based on previous studies' thresholds. RESULTS: Acute-phase VT/VF developed in 43 (7.5%) patients. In-hospital mortality was significantly higher among VT/VF patients (4.7% vs. 0.9%, p = .03). An adjusted logistic model showed that the maximum TAV (odds ratio 1.02, 95% confidence interval [CI] 1.00-1.29, p = .04) was associated with acute-phase VT/VF. During a median follow-up period of 2.1 years, 19 (3.3%) patients had cardiac deaths or resuscitated cardiac arrest. Acute-phase VT/VF (p = .12) and TAV (p = .72) were not significant predictors of survival. An age and sex-adjusted Cox model showed that the DC (p < .01), λ25s (p < .01), and emergency coronary intervention (p < .01) were independent predictors. CONCLUSION: T-wave amplitude variability was associated with acute-phase VT/VF, but the TAV was not predictive of survival post-discharge. The DC, λ25s, and emergency coronary intervention were independent predictors of survival.

Running exercise and food restriction affect bone chemical properties in young female rats.

PURPOSE: To investigate the effects of a combination of running and food restriction on the chemical properties of the bone in young female rats using Raman spectroscopy. Furthermore, we investigated whether the chemical property parameters correlated with the bone-breaking strength. METHODS: Female Sprague-Dawley rats (7 weeks old) were randomly divided into four groups: sedentary and ad libitum feeding (SED, n = 8), voluntary running exercise and ad libitum feeding (EX, n = 8), sedentary and 30% food-restricted (SED-FR, n = 8), and voluntary running exercise and 30% food-restricted (EXFR, n = 8). The experiment was conducted for a period of 12 weeks. Four parameters measured by Raman spectroscopy were used to evaluate the bone chemical quality. RESULTS: Exercise and restriction had significant interactions on the mineral to matrix ratio. The mineral- to-matrix ratio in the SED-FR group was significantly higher than that in the SED group and significantly lower in the EX-FR group than that in the SED-FR group. Running exercise had significant effects on increasing the crystallinity and carbonate-to-phosphate ratio. In the ad libitum intake condition, there were significant positive correlations between breaking energy and crystallinity (r = 0.593) and between breaking energy and carbonate-to-phosphate ratio (r = 0.854). CONCLUSION: Our findings show that running exercise and food restriction, alone or in combination, affect the chemical properties of bone. Furthermore, under ad libitum intake conditions, positive correlations were found between the breaking energy and crystallinity, or carbonate-to-phosphate ratio.

Energy Expenditure of Disaster Relief Operations Estimated Using a Tri-Axial Accelerometer and a Wearable Heart Rate Monitor.

The management of nutrition, food, and health for disaster relief personnel is one of the crucial aspects for carrying out effective rescue activities during large-scale natural disasters, such as a big earthquake, flooding, and landslide following heavy rainfall or man-made disasters, such as widespread fire in industrial areas. Rescue workers, such as fire fighters and rescue teams who work on the disaster relief operations, have to work long, hard, and irregular hours that require energy (both intake and expenditure), with especially altered eating patterns. Reliable estimates of the energy expenditure (TEE) for such disaster relief operations have not been fully established. Here, we propose to clarify the energy expenditure for each type of large-scale disaster activity conducted by fire fighters. Thirty fire fighters (survey participants in this research) who participated in the simulation training of large-scale disaster activities wore tri-axial accelerometers and heart rate monitors during training; and, post-training, 28 fire fighters submitted complete activity record tables. An estimation formula combining tri-axial accelerometer and heart rate monitor data was used. Additionally, energy expenditure per hour (excluding resting energy expenditure: REE) (per average body weight of participants) was calculated for 10 types of large-scale disaster response activities. We propose utilization of these data as a reference value for examining the TEE of firefighting and rescue operations in future large-scale disasters.

Reproducible biomarkers: Leveraging nonlinear descriptors in the face of non-ergodicity.

Any reliable biomarker has to be specific, generalizable, and reproducible across individuals and contexts. The exact values of such a biomarker must represent similar health states in different individuals and at different times within the same individual to result in the minimum possible false-positive and false-negative rates. The application of standard cut-off points and risk scores across populations hinges upon the assumption of such generalizability. Such generalizability, in turn, hinges upon this condition that the phenomenon investigated by current statistical methods is ergodic, i.e., its statistical measures converge over individuals and time within the finite limit of observations. However, emerging evidence indicates that biological processes abound with non-ergodicity, threatening this generalizability. Here, we present a solution for how to make generalizable inferences by deriving ergodic descriptions of non-ergodic phenomena. For this aim, we proposed capturing the origin of ergodicity-breaking in many biological processes: cascade dynamics. To assess our hypotheses, we embraced the challenge of identifying reliable biomarkers for heart disease and stroke, which, despite being the leading cause of death worldwide and decades of research, lacks reliable biomarkers and risk stratification tools. We showed that raw R-R interval data and its common descriptors based on mean and variance are non-ergodic and non-specific. On the other hand, the cascade-dynamical descriptors, the Hurst exponent encoding linear temporal correlations, and multifractal nonlinearity encoding nonlinear interactions across scales described the non-ergodic heart rate variability ergodically and were specific. This study inaugurates applying the critical concept of ergodicity in discovering and applying digital biomarkers of health and disease.

Effect of Seat Angle when Sleeping in a Car on Quality of Sleep and Its Impact on Calculation Performance the Following Day.

The number of occasions to stay in a car overnight is increasing during disasters; however, the effects on sleep and the impact on daytime functioning are not well understood. We investigated the effect of seat angle when sleeping in a car and its impact on calculation performance the following day. Fifteen healthy males participated in three trials (sleeping in a car with the front seat angled at 45° and 60° in a laboratory and sleeping at home); sleep and calculation performance the following day were compared. Increased wake after sleep onset and decreased slow-wave sleep were observed in the 60° trial, that is, near-vertical, compared with the others. Subjective sleep quality and calculation performance in the 45° and 60° trials were poorer than those in the home trial. The effect of seat angle on sleep was confirmed objectively, but not subjectively, suggesting that a large seat angle might cause sleep impairment.

Physician eye contact in telemedicine video consultations: A cross-cultural experiment.

INTRODUCTION: Eye contact is generally considered a beneficial non-verbal behavior in patient-physician communication. Physicians are advised to simulate eye contact during video consultations by gazing at the camera, although we lack evidence that doing so is beneficial. This work is a cross-cultural experiment that aims to answer: "Are physicians who gaze at the camera during video consultations perceived as making eye contact, and are their communication skills rated higher?" METHODS: 43 Japanese and 61 Lebanese participants watched videos of physicians providing the same video consultations while gazing at the camera and screen. After watching each video, they rated the physicians' communication skills using six items from the GCRS and the MAAS-G scales. They also picked and justified their preferred physician gaze direction. RESULTS: When physicians gazed at the camera, they were perceived as making more eye contact and received higher communication and interpersonal skills ratings, both in Japan and Lebanon. The effect of gazing at the camera was consistently positive but varied by country and consultation content. In Japan, simulating eye contact improved the ratings of the attentive and caring physician, whereas in Lebanon, it improved the ratings of the tired and inattentive physician. When asked to choose their preferred gaze direction, 88.4% of Japanese and 90.2% of Lebanese participants chose camera gaze over screen gaze due to its positive effect on patient feelings and physician perception. Participants who chose screen gaze noted the unnaturalness of gazing at the camera and its potential negative impact on care quality. CONCLUSION: Physicians providing video consultations can simulate eye contact by gazing at the camera. Doing so improves their communication and interpersonal skills ratings and could potentially enhance their communication with their patients. Mainstream video conferencing platforms could implement gaze correction methods to simulate eye contact without affecting the physicians' experience and capacity to provide quality care.

A simple proteinuria-based risk score predicts contrast-associated acute kidney injury after percutaneous coronary intervention.

Contrast-associated acute kidney injury (CA-AKI) is a complication of percutaneous coronary intervention (PCI). Because proteinuria is a sentinel marker of renal dysfunction, we assessed its role in predicting CA-AKI in patients undergoing PCI. A total of 1,254 patients undergoing PCI were randomly assigned to a derivation (n = 840) and validation (n = 414) dataset. We identified the independent predictors of CA-AKI where CA-AKI was defined by the new criteria issued in 2020, by a multivariate logistic regression in the derivation dataset. We created a risk score from the remaining predictors. The discrimination and calibration of the risk score in the validation dataset were assessed by the area under the receiver-operating characteristic curves (AUC) and Hosmer-Lemeshow test, respectively. A total of 64 (5.1%) patients developed CA-AKI. The 3 variables of the risk score were emergency procedures, serum creatinine, and proteinuria, which were assigned 1 point each based on the correlation coefficient. The risk score demonstrated a good discriminative power (AUC 0.789, 95% CI 0.766-0.912) and significant calibration. It was strongly associated with the onset of CA-AKI (Cochran-Armitage test, p < 0.0001). Our risk score that included proteinuria was simple to obtain and calculate, and may be useful in assessing the CA-AKI risk before PCI.

Insulin signaling shapes fractal scaling of C. elegans behavior.

Fractal scaling in animal behavioral activity, where similar temporal patterns appear repeatedly over a series of magnifications among time scales, governs the complex behavior of various animal species and, in humans, can be altered by neurodegenerative diseases and aging. However, the mechanism underlying fractal scaling remains unknown. Here, we cultured C. elegans in a microfluidic device for 3 days and analyzed temporal patterns of C. elegans activity by fractal analyses. The residence-time distribution of C. elegans behaviors shared a common feature with those of human and mice. Specifically, the residence-time power-law distribution of the active state changed to an exponential-like decline at a longer time scale, whereas the inactive state followed a power-law distribution. An exponential-like decline appeared with nutrient supply in wild-type animals, whereas this decline disappeared in insulin-signaling-defective daf-2 and daf-16 mutants. The absolute value of the power-law exponent of the inactive state distribution increased with nutrient supply in wild-type animals, whereas the value decreased in daf-2 and daf-16 mutants. We conclude that insulin signaling differentially affects mechanisms that determine the residence time in active and inactive states in C. elegans behavior. In humans, diabetes mellitus, which is caused by defects in insulin signaling, is associated with mood disorders that affect daily behavioral activities. We hypothesize that comorbid behavioral defects in patients with diabetes may be attributed to altered fractal scaling of human behavior.

Safety and feasibility of a telemonitoring-guided exercise program in patients receiving cardiac resynchronization therapy.

BACKGROUND: Telerehabilitation is an alternative clinic-based rehabilitation. A remote monitoring (RM) system attached to a cardiac rhythm device can collect physiological data and the device function. This study aimed to evaluate the safety and feasibility of telerehabilitation supervised by an RM in patients receiving cardiac resynchronization therapy (CRT). METHODS: A single group pre-post exercise program was implemented for 3 months in 18 CRT recipients. The exercise regimen consisted of walking a prescribed number of steps based on a 6-min walk distance (6MWD) achieved at baseline. The patients were asked to exercise 3 to 5 times per week for up to 30 min per session, wearing an accelerometer to document the number of steps taken. The safety was assessed by the heart failure hospitalizations and all-cause death. The feasibility was measured by the improvement in the quality of life (QOL) using the EuroQol 5 dimensions, and daily active time measured by the CRT, 6MWD, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction (LVEF). RESULTS: No patients had heart failure hospitalizations or died. No patients had any ventricular tachyarrhythmias. One patient needed to suspend the exercise due to signs of exacerbated heart failure by the RM. Compared to baseline, there were significant improvements in the QOL (-0.037, p < .05), active time (1.12%/day, p < .05), and 6MWD (11 m, p < .001), but not the BNP (-32.4 pg/ml, p = .07) or LVEF (0.28%, p = .55). CONCLUSIONS: Three months of RM-guided walking exercise in patients with CRT significantly increased the QOL, active time, and exercise capacity without any adverse effects.

Clinical phenotypes of patients with non-valvular atrial fibrillation as defined by a cluster analysis: A report from the J-RHYTHM registry.

BACKGROUND: Atrial fibrillation (AF) is a heterogeneous condition caused by various underlying disorders and comorbidities. A cluster analysis is a statistical technique that attempts to group populations by shared traits. Applied to AF, it could be useful in classifying the variables and complex presentations of AF into phenotypes of coherent, more tractable subpopulations. OBJECTIVES: This study aimed to characterize the clinical phenotypes of AF using a national AF patient registry using a cluster analysis. METHODS: We used data of an observational cohort that included 7406 patients with non-valvular AF enrolled from 158 sites participating in a nationwide AF registry (J-RHYTHM). The endpoints analyzed were all-cause mortality, thromboembolisms, and major bleeding. RESULTS: The optimal number of clusters was found to be 4 based on 40 characteristics. They were those with (1) a younger age and low rate of comorbidities (n = 1876), (2) a high rate of hypertension (n = 4579), (3) high bleeding risk (n = 302), and (4) prior coronary artery disease and other atherosclerotic comorbidities (n = 649). The patients in the younger/low comorbidity cluster demonstrated the lowest risk for all 3 endpoints. The atherosclerotic comorbidity cluster had significantly higher adjusted risks of total mortality (odds ratio [OR], 3.70; 95% confidence interval [CI], 2.37-5.80) and major bleeding (OR, 5.19; 95% CI, 2.58-10.9) than the younger/low comorbidity cluster. CONCLUSIONS: A cluster analysis identified 4 distinct groups of non-valvular AF patients with different clinical characteristics and outcomes. Awareness of these groupings may lead to a differentiated patient management for AF.

Assessment of long-range cross-correlations in cardiorespiratory and cardiovascular interactions.

We propose higher-order detrending moving-average cross-correlation analysis (DMCA) to assess the long-range cross-correlations in cardiorespiratory and cardiovascular interactions. Although the original (zeroth-order) DMCA employs a simple moving-average detrending filter to remove non-stationary trends embedded in the observed time series, our approach incorporates a Savitzky-Golay filter as a higher-order detrending method. Because the non-stationary trends can adversely affect the long-range correlation assessment, the higher-order detrending serves to improve accuracy. To achieve a more reliable characterization of the long-range cross-correlations, we demonstrate the importance of the following steps: correcting the time scale, confirming the consistency of different order DMCAs, and estimating the time lag between time series. We applied this methodological framework to cardiorespiratory and cardiovascular time series analysis. In the cardiorespiratory interaction, respiratory and heart rate variability (HRV) showed long-range auto-correlations; however, no factor was shared between them. In the cardiovascular interaction, beat-to-beat systolic blood pressure and HRV showed long-range auto-correlations and shared a common long-range, cross-correlated factor. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.

Cross-correlated fractal components of H-wave amplitude fluctuations in medial gastrocnemius and soleus muscles.

The time series of the H-wave amplitude in soleus muscle (SOL) shows fractal (long-range) correlation, which is attributed to input from supraspinal centers. However, whether such long-range power-law correlated input also contributes to the synergistic muscles remains unclear. The purpose of this study was therefore to examine the correlation in the fractal components of H-wave amplitude fluctuations between the synergistic muscles used for plantar flexion, i.e., the medial head of the gastrocnemius muscle (MG) and SOL. In eight young male participants, consecutive H-reflexes were recorded almost simultaneously from the MG and SOL at a stimulation frequency of 0.5 Hz for 30 min. We performed detrending moving-average cross-correlation analysis (DMCA) for each of the H- and M-wave amplitude time series between MG and SOL to assess the existence of a common noise input contributing to these long-range correlations. The cross-correlation coefficient ρDMCA (-1 to 1) was calculated to quantify the strength of the correlation between two different time series. The results indicated a significant long-range power-law correlation between H-wave amplitudes in MG and SOL (ρDMCA: 0.50 (0.22) and 0.22 (0.17), mean (standard deviation) for the original and randomly shuffled surrogate data, respectively, P < 0.05). This was not the case for M-wave amplitudes (ρDMCA: 0.29 (0.23) and 0.20 (0.15), P > 0.05). We conclude that there is a common noise input governing these synergistic muscles, possibly due to supraspinal origin, causing long-range power-law correlations in monosynaptic reflexes.

Ischemic Stroke Risk Assessment by Multiscale Entropy Analysis of Heart Rate Variability in Patients with Persistent Atrial Fibrillation.

It has been recognized that heart rate variability (HRV), defined as the fluctuation of ventricular response intervals in atrial fibrillation (AFib) patients, is not completely random, and its nonlinear characteristics, such as multiscale entropy (MSE), contain clinically significant information. We investigated the relationship between ischemic stroke risk and HRV with a large number of stroke-naïve AFib patients (628 patients), focusing on those who had never developed an ischemic/hemorrhagic stroke before the heart rate measurement. The CHA2DS2-VASc score was calculated from the baseline clinical characteristics, while the HRV analysis was made from the recording of morning, afternoon, and evening. Subsequently, we performed Kaplan-Meier method and cumulative incidence function with mortality as a competing risk to estimate the survival time function. We found that patients with sample entropy (SE(s)) ≥ 0.68 at 210 s had a significantly higher risk of an ischemic stroke occurrence in the morning recording. Meanwhile, the afternoon recording showed that those with SE(s) ≥ 0.76 at 240 s and SE(s) ≥ 0.78 at 270 s had a significantly lower risk of ischemic stroke occurrence. Therefore, SE(s) at 210 s (morning) and 240 s ≤ s ≤ 270 s (afternoon) demonstrated a statistically significant predictive value for ischemic stroke in stroke-naïve AFib patients.

Comparison among random forest, logistic regression, and existing clinical risk scores for predicting outcomes in patients with atrial fibrillation: A report from the J-RHYTHM registry.

BACKGROUND: Machine learning (ML) has emerged as a promising tool for risk stratification. However, few studies have applied ML to risk assessment of patients with atrial fibrillation (AF). HYPOTHESIS: We aimed to compare the performance of random forest (RF), logistic regression (LR), and conventional risk schemes in predicting the outcomes of AF. METHODS: We analyzed data from 7406 nonvalvular AF patients (median age 71 years, female 29.2%) enrolled in a nationwide AF registry (J-RHYTHM Registry) and who were followed for 2 years. The endpoints were thromboembolisms, major bleeding, and all-cause mortality. Models were generated from potential predictors using an RF model, stepwise LR model, and the thromboembolism (CHADS2 and CHA2 DS2 -VASc) and major bleeding (HAS-BLED, ORBIT, and ATRIA) scores. RESULTS: For thromboembolisms, the C-statistic of the RF model was significantly higher than that of the LR model (0.66 vs. 0.59, p = .03) or CHA2 DS2 -VASc score (0.61, p < .01). For major bleeding, the C-statistic of RF was comparable to the LR (0.69 vs. 0.66, p = .07) and outperformed the HAS-BLED (0.61, p < .01) and ATRIA (0.62, p < .01) but not the ORBIT (0.67, p = .07). The C-statistic of RF for all-cause mortality was comparable to the LR (0.78 vs. 0.79, p = .21). The calibration plot for the RF model was more aligned with the observed events for major bleeding and all-cause mortality. CONCLUSIONS: The RF model performed as well as or better than the LR model or existing clinical risk scores for predicting clinical outcomes of AF.