Depth-Specific Hypoxic Responses to Spreading Depolarizations in Gyrencephalic Swine Cortex Unveiled by Photoacoustic Imaging.

Spreading depolarizations (SDs) are a marker of brain injury and have a causative effect on ischemic lesion progression. The hemodynamic responses elicited by SDs are contingent upon the metabolic integrity of the affected tissue, with vasoconstrictive reactions leading to pronounced hypoxia often indicating poor outcomes. The stratification of hemodynamic responses within different cortical layers remains poorly characterized. This pilot study sought to elucidate the depth-specific hemodynamic changes in response to SDs within the gray matter of the gyrencephalic swine brain. Employing a potassium chloride-induced SD model, we utilized multispectral photoacoustic imaging (PAI) to estimate regional cerebral oxygen saturation (rcSO2%) changes consequent to potassium chloride-induced SDs. Regions of interest were demarcated at three cortical depths covering up to 4 mm. Electrocorticography (ECoG) strips were placed to validate the presence of SDs. Through PAI, we detected 12 distinct rcSO2% responses, which corresponded with SDs detected in ECoG. Notably, a higher frequency of hypoxic responses was observed in the deeper cortical layers compared to superficial layers, where hyperoxic and mixed responses predominated (p < 0.001). This data provides novel insights into the differential oxygenation patterns across cortical layers in response to SDs, underlining the complexity of cerebral hemodynamics post-injury.

Cluster Analysis of Urban Acoustic Environments on Barcelona Sensor Network Data.

As cities grow in size and number of inhabitants, continuous monitoring of the environmental impact of sound sources becomes essential for the assessment of the urban acoustic environments. This requires the use of management systems that should be fed with large amounts of data captured by acoustic sensors, mostly remote nodes that belong to a wireless acoustic sensor network. These systems help city managers to conduct data-driven analysis and propose action plans in different areas of the city, for instance, to reduce citizens' exposure to noise. In this paper, unsupervised learning techniques are applied to discover different behavior patterns, both time and space, of sound pressure levels captured by acoustic sensors and to cluster them allowing the identification of various urban acoustic environments. In this approach, the categorization of urban acoustic environments is based on a clustering algorithm using yearly acoustic indexes, such as Lday, Levening, Lnight and standard deviation of Lden. Data collected over three years by a network of acoustic sensors deployed in the city of Barcelona, Spain, are used to train several clustering methods. Comparison between methods concludes that the k-means algorithm has the best performance for these data. After an analysis of several solutions, an optimal clustering of four groups of nodes is chosen. Geographical analysis of the clusters shows insights about the relation between nodes and areas of the city, detecting clusters that are close to urban roads, residential areas and leisure areas mostly. Moreover, temporal analysis of the clusters gives information about their stability. Using one-year size of the sliding window, changes in the membership of nodes in the clusters regarding tendency of the acoustic environments are discovered. In contrast, using one-month windowing, changes due to seasonality and special events, such as COVID-19 lockdown, are recognized. Finally, the sensor clusters obtained by the algorithm are compared with the areas defined in the strategic noise map, previously created by the Barcelona city council. The developed k-means model identified most of the locations found on the overcoming map and also discovered a new area.

Evaluation of bone densitometry by dual-energy x-ray absorptiometry as a fracture prediction tool in women with chronic kidney disease.

BACKGROUND: The 2017 KDIGO guidelines establish a 2B grade recommendation in favor of testing Bone Mineral Density (BMD) by DXA to assess osteoporotic fracture (OPF) risk in patients with CKD G3a-G5D. Still, controversy remains because large studies evaluating it for this particular population are lacking. AIM: To establish the clinical performance of BMD measured by DXA in the evaluation of fracture risk in women with CKD. METHODS: We conducted a 43 year retrospective cohort study with 218 women ≥18 years-old with CKD and BMD measurement by DXA of total hip and lumbar spine. Clinical (age, year of CKD onset, comorbidities, BMI, transplant status, treatment), and biochemical (PTH, corrected calcium, phosphate, vitamin D [25 (OH) D3], creatinine, and albumin), parameters were collected from hospital records. All osteoporotic fractures (as defined by the WHO) found in the clinical and radiologic files were registered. RESULTS: 218 women with a median age of 60 years (40-73 IQ range) and a CKD evolution time of 12 years (7-18 IQ range) were evaluated. Forty-eight (28.23%) presented an OPF. These women were older (57 vs 69 years, p =0.0072) and had a lower BMD. CKD stage did not influence fracture incidence. In the multivariate analysis we found that for each standard deviation decrease in hip and lumbar spine T-Score, the overall fracture risk was 2.7 and 2.04 times higher, respectively. More than 50% of fractures took place within the first ten years of follow-up, especially with GFR <30 mL/min/m2 and osteoporosis. Diabetes and hypothyroidism accelerated fracture onset, while renal transplant delayed it. In the ROC analysis, the AUC was largest with the total hip (0.7098, p = 0.000) and lumbar spine (0.6916, p = 0.000). CONCLUSIONS: BMD measured by DXA is a useful fracture prediction tool for women with CKD, having a sensibility and specificity similar to that in the general population. It seems to be appropriate for the diagnosis, treatment decisions, and follow-up of patients with renal failure.

Evaluation of Perioperative High-Sensitive Cardiac Troponin I as a Predictive Biomarker of Major Adverse Cardiovascular Events After Noncardiac Surgery.

BACKGROUND: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. OBJECTIVE: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. METHODS: In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. RESULTS: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. CONCLUSIONS: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.

EVALUATION OF PERIOPERATIVE HIGH-SENSITIVE CARDIAC TROPONIN I AS A PREDICTIVE BIOMARKER OF MAJOR ADVERSE CARDIOVASCULAR EVENTS AFTER NONCARDIAC SURGERY.

BACKGROUND: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. OBJECTIVE: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. METHODS: In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. RESULTS: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. CONCLUSIONS: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.

Association of serum vitamin D levels with chronic disease and mortality / Asociación de los niveles séricos de vitamina D con la enfermedad crónica y la mortalidad

INTRODUCTION: whether hypovitaminosis D is an overarching cause of increased mortality or a prognostic marker of poor health has not been well elucidated. OBJECTIVES: we sought to determine the association of serum 25-hydroxyvitamin D [25-(OH)-D3] levels with the clinical biochemical parameters and mortality risk in chronic diseases. METHODS: we reviewed the clinical charts and collected the clinical biochemical parameters of patients diagnosed with chronic conditions who had at least one 25-(OH)-D3 determination, with or without calcium and vitamin D supplementation, and who were selected using a cluster random sampling design (n = 1,705). The analysis was focused on metabolic disorders (type-2 diabetes mellitus [T2DM] and obesity), autoimmune disorders, and mortality. Multivariate logistic regression analyses were performed. RESULTS: low 25-(OH)-D3 levels were reported in 1,433 (84.0 %) patients, of which 774 (45.4 %) had insufficiency (20-29 ng/mL) and 659 (38.6 %) patients had deficiency (< 20 ng/mL). Lower 25-(OH)-D3 levels in T2DM patients were associated with higher glycosylated hemoglobin levels (p < 0.001). Patients with 25-(OH)-D3 levels < 12.5 ng/mL had a higher mortality risk than those with levels ≥ 12.5 ng/mL (HR: 3.339; 95 % CI: 1.342-8.308). We observed lower 25-(OH)-D3 levels in patients with grade-III obesity (p = 0.01). We found a higher risk of 25-(OH)-D3 deficiency in rheumatoid arthritis, type-1 diabetes, and systemic lupus erythematosus (p = 0.032, p = 0.002, p = 0.049, respectively). CONCLUSIONS: we found a significant relationship between 25-(OH)-D3 levels and glycemic control, body mass index, autoimmune disease, and mortality risk. Nevertheless, whether hypovitaminosis D plays a causal role or is a consequence of chronic disease remains controversial

INTRODUCCIÓN: si la hipovitaminosis D constituye una causa general de mayor mortalidad o un marcador de mal pronóstico para la salud no se ha dilucidado por completo. OBJETIVOS: determinar la asociación de los niveles séricos de 25-hidroxivitamina D [25-(OH)-D3] con los parámetros clínico-bioquímicos y el riesgo de mortalidad en la enfermedad crónica. MÉTODOS: se revisaron los expedientes clínicos y recopilamos los parámetros clínico-bioquímicos de pacientes diagnosticados de enfermedades crónicas que tenían al menos una determinación de 25-(OH)-D3, con o sin suplemento de calcio y vitamina D, y que se seleccionaron mediante muestreo aleatorio por grupos (n = 1705). El análisis se centró en los trastornos metabólicos (diabetes mellitus de tipo 2 [DM2] y obesidad), los trastornos autoinmunes y la mortalidad. Se realizaron análisis multivariados de regresión logística. RESULTADOS: se encontraron niveles bajos de 25-(OH)-D3 en 1433 (84,0 %) pacientes, de los cuales 774 (45,4 %) tenían insuficiencia (20-29 ng/mL) y 659 (38,6 %) tenían deficiencia (< 20 ng/mL) de esta vitamina. Los niveles más bajos de 25-(OH)-D3 en los pacientes con DM2 se asociaron a niveles más altos de hemoglobina glucosilada (p < 0,001). Los pacientes con niveles de 25-(OH)-D3 < 12,5 ng/mL tenían mayor riesgo de mortalidad que aquellos con niveles ≥ 12,5 ng/mL (HR: 3,339; IC del 95 %: 1,342-8,308). Apreciamos niveles más bajos de 25-(OH)-D3 en los pacientes con obesidad de grado III (p = 0,01). Se encontró un mayor riesgo de deficiencia de 25-(OH)-D3 en la artritis reumatoide, la diabetes de tipo 1 y el lupus eritematoso sistémico (p = 0,032, p = 0,002, p = 0,049, respectivamente). CONCLUSIONES: apreciamos una relación significativa entre los niveles de 25-(OH)-D3 y el control glucémico, el índice de masa corporal, la enfermedad autoinmune y el riesgo de mortalidad. Sin embargo, sigue siendo controvertido si la hipovitaminosis D desempeña un papel causal o constituye una consecuencia de las enfermedades crónicas

Evaluation of perioperative high-sensitive cardiac troponin i as a predictive biomarker of major adverse cardiovascular events after noncardiac surgery

ABSTRACT Background: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. Objective: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. Methods: In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. Results: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. Conclusions: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.

Sound Levels Forecasting in an Acoustic Sensor Network Using a Deep Neural Network.

Wireless acoustic sensor networks are nowadays an essential tool for noise pollution monitoring and managing in cities. The increased computing capacity of the nodes that create the network is allowing the addition of processing algorithms and artificial intelligence that provide more information about the sound sources and environment, e.g., detect sound events or calculate loudness. Several models to predict sound pressure levels in cities are available, mainly road, railway and aerial traffic noise. However, these models are mostly based in auxiliary data, e.g., vehicles flow or street geometry, and predict equivalent levels for a temporal long-term. Therefore, forecasting of temporal short-term sound levels could be a helpful tool for urban planners and managers. In this work, a Long Short-Term Memory (LSTM) deep neural network technique is proposed to model temporal behavior of sound levels at a certain location, both sound pressure level and loudness level, in order to predict near-time future values. The proposed technique can be trained for and integrated in every node of a sensor network to provide novel functionalities, e.g., a method of early warning against noise pollution and of backup in case of node or network malfunction. To validate this approach, one-minute period equivalent sound levels, captured in a two-month measurement campaign by a node of a deployed network of acoustic sensors, have been used to train it and to obtain different forecasting models. Assessments of the developed LSTM models and Auto regressive integrated moving average models were performed to predict sound levels for several time periods, from 1 to 60 min. Comparison of the results show that the LSTM models outperform the statistics-based models. In general, the LSTM models achieve a prediction of values with a mean square error less than 4.3 dB for sound pressure level and less than 2 phons for loudness. Moreover, the goodness of fit of the LSTM models and the behavior pattern of the data in terms of prediction of sound levels are satisfactory.

A mixed boundary condition for accounting energy absorption and transmission in a diffusion equation model.

The acoustic diffusion equation model has shown to be a versatile alternative model for certain types of scenarios where the classical geometrical methods have been demonstrated to be inefficient or even inaccurate. In certain scenarios, the transmission loss plays a fundamental role for accounting, i.e., noise levels and sound propagation between rooms. This paper presents an extension of the absorption boundary conditions known as modified that unifies previously proposed boundary conditions in one equation, including transmission of energy between coupled rooms by both openings and enclosures.

Quality of life is significantly impaired in both secretory and non-functioning pituitary adenomas.

OBJECTIVE: To evaluate the quality of life (QoL) in patients with pituitary adenomas in comparison with healthy Mexican population QoL scores. DESIGN & MEASUREMENTS: Cross-sectional study using the short form 36 questionnaire (SF-36) in 175 patients with pituitary adenomas grouped by adenoma subtype and disease activity, and compared them with the healthy Mexican population normative QoL scores. PATIENTS: A total of 44 patients with non-functioning pituitary adenomas (NFPA), 48 with acromegaly, 53 with prolactinomas and 30 with Cushing disease (CD) were enrolled in this study. RESULTS: Mental and physical components scores (MCS & PCS) of SF-36 questionnaire were lower in patients with active disease in all adenoma subtypes (P < 0.03). A significant negative relationship between prolactin levels and MCS (r = -0.30, P < 0.01) and PCS (r = -0.41, P < 0.01) were found in prolactinomas. Patients with CD showed 24 hours urine-free cortisol levels negatively correlated with MCS (r = -0.43, P < 0.01) but not with PCS. No significant correlation was found between IGF-1 ULN and QoL scores in acromegaly. NFPA patients had lower QoL scores than patients with controlled CD, acromegaly or prolactinoma (P < 0.02). Active CD and prolactinoma have lower QoL scores in comparison of NFPA (P < 0.05). Having an adenoma, secretory or non-functioning, decrease QoL scores in comparison of results in the healthy Mexican population register. Using an adjusted-multivariate model, we confirmed that disease activity in all secretory adenomas is an independent risk factor, reducing SF-36 scores significantly. CONCLUSION: Activity in all secretory pituitary adenomas' patients decrease mental and physical QoL. However, independently of disease activity, secretory and NFPA significantly decrease QoL in comparison with healthy Mexican population QoL register.

Calculated Versus Measured Urine Osmolarity: Accuracy of Estimated Urine Density.

BACKGROUND: Urine osmolarity (OsmU) is the gold standard for the evaluation of the kidney's urine concentration capacity; nevertheless, urinary density (UD) is often used as a surrogate for its estimation. OBJECTIVE: The objective of this study was to analyze the accuracy of UD in estimating OsmU. MATERIALS AND METHODS: A transversal study including patients with simultaneous determination of UD measured with refractometry and OsmU measured by osmometer (OsmUm). We multiplied the last two digits of the UD by 35, 30, 32, 33.5, and 40 to estimate OsmU; the estimates were considered precise if the value was ± 30 mOsm/kg from the OsmUm. A Bland-Altman analysis was conducted. RESULTS: Among 205 patients, there was no difference between OsmUm and the estimated form when using a factor of 33.5 (p = 0.578). When analyzing by the absence or presence of proteinuria and/or glycosuria, there were no differences when using the factors 35 (p = 0.844) and 32 with adjusted UD (p = 0.898). In the linear correlation analysis, values for Pearson's r = 0.788 and r2 = 0.621 were obtained (p < 0.001). The areas under the curve obtained by the receiver operating characteristics curves to estimate urine osmolarity values < 100 and > 600 mOsm/kg were > 0.90. CONCLUSION: The estimation of the OsmU from UD showed adequate performance. If an osmometer is unavailable, we recommend using the factor 35 for clean samples and 32 with adjusted UD for samples with proteinuria and/or glycosuria.

Investigation on the effect of aperture sizes and receiver positions in coupled rooms.

Some recent concert hall designs have incorporated coupled reverberation chambers to the main hall that have stimulated a range of research activities in architectural acoustics. The coupling apertures between two or more coupled-volume systems are of central importance for sound propagation and sound energy decays throughout the coupled-volume systems. In addition, positions of sound sources and receivers relative to the aperture also have a profound influence on the sound energy distributions and decays. This work investigates the effect of aperture size on the behavior of coupled-volume systems using both acoustic scale-models and diffusion equation models. In these physical and numerical models, the sound source and receiver positions relative to the aperture are also investigated. Through systematic comparisons between results achieved from both physical scale models and numerical models, this work reveals valid ranges and limitations of the diffusion equation model for room-acoustic modeling.

Influence of the scattering and absorption coefficients on homogeneous room simulations that use a diffusion equation model.

The diffusion equation model was used for room acoustic simulations to predict the sound pressure level and the reverberation time. The technical literature states that the diffusion equation method accurately models the late portion of the room impulse response if the energy is sufficiently scattered. This work provides conclusions on the validity of the diffusion equation model for rooms with homogeneous dimensions in relation to the scattering coefficients of the boundaries. A systematic evaluation was conducted out to determine the ranges of the absorption and scattering coefficient values that result in low noticeable differences between the predictions from a geometrical acoustic model and those from the diffusion equation model.

On the limitation of a diffusion equation model for acoustic predictions of rooms with homogeneous dimensions.

In recent years a model for predicting sound fields in enclosures has been proposed, based on the mathematical theory of diffusion. This model is held to be valid for predicting the late reverberation component of the impulse response, on the basis that sufficient reflection events must occur [Valeau et al., J. Acoust. Soc. Am. 119, 1504-1513 (2006)]. The present work determines numerically the extent of reflections necessary for the solution of the diffusion equation model to be accurate in quasi-cubic rooms. Some preliminary numerical experiments have been carried out to determine after how many mean-free times of the impulse response, which is obtained by a geometrical-acoustic approach, gives a similar result to the solution obtained from a diffusion equation model.