The ZOLL Arrhythmia Management System, a mobile cardiac telemetry (MCT) device from ZOLL Corporation (Chelmsford, MA, USA), records single-channel electrocardiogram (ECG) signals, heart rate, ...activity, respiratory rate, and posture. Comprehensive reporting from these multiple biometrics may provide a global evaluation of arrhythmic or other cardiovascular risks in individual patients and insights into the patient’s overall wellness and health status. The objective of the study was to evaluate the physician-perceived utility of adding biometric data to the traditional ECG-only–based assessment and subject-reported symptoms. This prospective study recruited candidates for MCT. Independent event and end-of-use (EOU) reports based on ECG and biometrics data were provided to physicians. To document whether the biometric data affected treatment plan decisions or added value over the ECG-alone data, physicians completed a questionnaire for each report. Additionally, they completed the questionnaire to understand the utility of the subject wellness information provided in the EOU report. From December 2020 to July 2021, 583 patients were enrolled by 27 physicians from 18 cardiology practices in the United States. When using biometrics data compared to the ECG alone, this study found that 96% of the physicians made changes to the treatment plan that initially was based on the ECG alone. The biometrics-based changes involved 64% of all patients (n = 535), and included modifications to medications, follow-up, and lifestyle in 18%, 19%, and 63% of the subjects, respectively. In this largest MCT study conducted to date, next-generation MCT, by providing multiple biometric parameters along with ECG data, improves physicians’ ability to make patient management decisions. This added functionality and clarity may replace traditional “ECG with diary”–based monitoring.
the questions and questionings about the work of rural teachers have turned out to be, in recent decades, a worthy object of academic reflection. ...the objective of this article aims to understand ...the school culture that is developed and deconstructed in those territories that are framed in the midst of armed conflict. For this, a qualitative research was designed and a biographical-narrative approach was used. ...semi-structured interviews and narrative workshops were designed, validated and applied to twenty teachers from rural areas of the Bajo Cauca subregion of Antioquia. Among the most significant findings are: the role of memory as a transformational element, the importance of collaborative work and the force that inhabits the resignification of the stories that emerged in the midst of the armed conflict.
The objective of this study was to develop a machine deep learning algorithm for endoleak detection and measurement of aneurysm diameter, area, and volume from computed tomography angiography (CTA).
...Digital Imaging and Communications in Medicine files representing three-phase postoperative CTA images (N = 334) of 191 unique patients undergoing endovascular aneurysm repair for infrarenal abdominal aortic aneurysm (AAA) with a variety of commercial devices were used to train a deep learning pipeline across four tasks. The RetinaNet object-detection convolutional neural network (CNN) architecture was trained to predict bounding boxes around the axial CTA slices that were then stitched together in two dimensions into a smaller region containing the aneurysm. Multiclass endoleak detection and segmentation of the AAA, endograft, and endoleak were performed on this smaller region. Segmentations on a single randomly selected contrast from each scan included 33 full and 68 partial segmentations for endograft and AAA and 99 full segmentations for endoleak. A modified version of ResNet-50 CNN was used to detect endoleak on individual axial slices. A three-dimensional U-Net CNN model was trained on the task of dense three-dimensional segmentation and used to measure diameter and volume with a specially designed loss function. We made use of fivefold cross-validation to evaluate model performance for each step, splitting training and testing data at each fold, such that multiple scans from the same patient were preserved with the same fold. Algorithm predictions for endoleak were compared with the radiology report and with a subset of CTA images independently read by two vascular specialists.
The localization portion of the network accurately predicted a region of interest containing the AAA in 99% of cases. The best model of binary endoleak detection obtained an area under the receiver operating characteristic curve of 0.94 ± 0.03 with an optimized accuracy of 0.89 ± 0.03 on a balanced data set. An introduced postprocessing algorithm for determining maximum diameter was used on both the predicted AAA segmentation and ground truth segmentation, predicting on average an absolute diameter error of 2.3 ± 2.0 mm by 1.4 ± 1.7 mm for each measurement, respectively. The algorithm measured AAA and endograft volume accurately (Dice coefficient, 0.95 ± 0.2) with an absolute volume error of 10.1 ± 9.1 mL. The algorithm measured endoleak volume less accurately, with a Dice score of 0.53 ± 0.21 and an average absolute volume error of 1.2 ± 1.9 mL.
This machine learning algorithm shows promise in augmenting a human's ability to interpret postoperative CTA images and may help improve surveillance after endovascular aneurysm repair. External validation on larger data sets and prospective study are required before the algorithm can be clinically applicable.
This manuscript describing the application of machine learning for endoleak has clinical relevance to endovascular abdominal aortic aneurysm follow-up. The techniques described herein may be more broadly applied to the diagnosis of aortic disease. In the future, vascular surgeons will benefit from integrating such artificial intelligence algorithms into their practice.
Peripheral arterial disease (PAD) affects more than 150 million people worldwide and is associated with high rates of lower extremity amputation, myocardial infarction, stroke and death. Fatty acid ...binding protein 3 (FABP3) is released into circulation in patients with skeletal muscle injury. In this pilot study, we investigated a possible association between PAD and blood levels of FABP3.
Blood samples were collected from patients with clinical symptoms and diagnostic findings indicative of PAD (PAD group; ankle-brachial index ABI <0.9; n = 75) and in those without clinical or diagnostic features of PAD (non-PAD group; ABI >0.9; n = 75) presenting to vascular surgery ambulatory clinics at St. Michael's Hospital. Plasma samples were analyzed by protein multiplex to quantify FABP3 levels.
PAD patients were found to have higher blood levels of FABP3 compared to patients without PAD (mean 3.90 ± 1.69 vs 2.03 ± 0.78; P < .001). A subgroup analysis demonstrated that the FABP3 levels were increased by almost two-fold in patients with PAD, independent of coronary artery disease (P < .001) or diabetes mellitus status (P < .001). Moreover, a significant negative correlation between FABP3 and the ABI was observed in PAD and patients without PAD matched groups (r = –0.51; P = .001). Last, immunohistochemistry demonstrated elevated expressions of FABP3 within skeletal muscle obtained from patients with the most severe form of PAD, chronic limb-threatening ischemia, when compared with patients without PAD.
Patients with PAD have elevated plasma levels of FABP3. An increasing severity of PAD is associated with higher FABP3 levels.
There is a pressing need for a simple, readily accessible, blood-based biomarker for PAD. In this study, we found elevated levels of FABP3 in patients with PAD. This increase in FABP3 was irrespective of history of coronary artery disease or diabetes. Furthermore, our data suggest that an increasing severity of PAD is associated with higher FABP3 levels. Subsequently, FABP3 may be a potential diagnostic biomarker for PAD. However, further studies are needed to confirm the capability of FABP3 to serve as a valid and reliable biomarker for PAD.
Peripheral artery disease (PAD) is a chronic condition characterized by inflammation. Emerging literature suggests that circulating exosomes and their microRNA (miRNA) contents may influence ...atherosclerosis and vascular remodeling. We hypothesize that circulating exosomes in patients with PAD directly modulate vascular cell phenotype and contain proinflammatory miRNAs.
Exosomes (particle size, 30-150 nm) were isolated from plasma of healthy individuals (n = 6), patients with mild PAD (mPAD; median Rutherford class, 2.5; n = 6), and patients with severe PAD (sPAD; median Rutherford class, 4; n = 5). Exosome identity, size, and concentration were determined by Western blot and nanoparticle tracking analysis. Human vascular smooth muscle cell (VSMC) and endothelial cell (EC) migration was assessed by a standard wound closure assay after exposure to exosome preparations. Monocyte-derived macrophages isolated from healthy volunteers were exposed to exosome preparations, and targeted gene expression was analyzed using quantitative polymerase chain reaction. Exosome miRNA cargos were isolated, and a panel of defined, vascular-active miRNAs was assessed by quantitative polymerase chain reaction.
There was no difference in overall exosome particle concentration or size between the three groups (one-way analysis of variance ANOVA, P > .05). Compared with exosomes from healthy individuals, exosomes from mPAD and sPAD patients increased VSMC migration (1.0 ± 0.09-fold vs 1.5 ± 0.09-fold vs 2.0 ± 0.12-fold wound closure; ANOVA, P < .0001) and inhibited EC migration (1.8 ± 0.07-fold vs 1.5 ± 0.04-fold vs 1.3 ± 0.02-fold wound closure; ANOVA, P < .01) in a stepwise fashion. Exosomes also induced changes in monocyte-derived macrophage gene expression that did not appear PAD specific. Hierarchical analysis of exosome miRNA revealed distinct clustering of vascular-active miRNAs between the three groups. Several miRNAs that promote inflammatory pathways in vascular cells were expressed at higher levels in exosomes from sPAD patients.
Circulating exosomes from individuals with PAD exert in vitro functional effects on VSMCs and ECs that may promote adverse vessel remodeling. Exosomes from healthy individuals, mPAD patients, and sPAD patients contain distinct signatures of immune-regulatory miRNA. Together these data suggest that the proinflammatory cargo of circulating exosomes correlates with atherosclerosis severity in PAD patients and could influence vascular injury and repair.
Exosomes and their cargo have been implicated in several vascular remodeling processes including atherosclerosis, angiogenesis, and neointimal hyperplasia. In this study, we demonstrate that circulating exosomes from individuals with peripheral artery disease exert in vitro effects on vascular cells that may adversely affect vessel remodeling. Moreover, these exosomes contain elevated levels of vascular-active microRNA. Our results suggest that exosomes may serve as both biomarkers and effectors of vascular disease in patients with peripheral artery disease and motivate further investigation into the role of exosomes and their contents in aberrant remodeling in vascular diseases.
Background
Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes ...management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown.
Objective
This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes.
Design
This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia.
Participants
People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor.
Intervention
The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service.
Main Measure
The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy.
Results
A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, − 0.05%; 95% CI − 0.10 to 0.00%) and at follow-up (week 52, − 0.03%; − 0.07 to 0.02%,
p
= 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life.
Conclusion
This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed.
Trial Registration
ClinicalTrials.gov
identifier:
NCT02466880
Somatic mosaicism of KRAS gene is currently recognized as the only established molecular basis of arteriovenous malformations (AVM). However, given the limitations of the current technologies, KRAS ...somatic mutations are detected only in a limited proportion of AVMs and tissue biopsy remains an invasive high risky, sometimes life-threatening, diagnostic procedure. Next-generation sequencing liquid biopsy using cell-free DNA (cfDNA) has emerged as an innovative noninvasive approach for early detection and monitoring of cancer. This approach overcomes the space-time profile constraint of tissue biopsies opens a new scenario for vascular malformations owing to somatic mosaicism. Here, we propose a new approach as a fast noninvasive reliable tool in order to investigate the cfDNA coming from the AVMs.
A group of five patients suffering from AVM were selected. Blood samples from peripheral vein and efferent vein from vascular malformation were collected and cfDNA was extracted. The cfDNA libraries were performed using Oncomine Pan-Cancer Cell-Free Assay. We used Ion Proton for sequencing and Ion Reporter Software for analysis (Life Technologies, Carlsbad, Calif).
In all cases, either G12D or G12V mutations in KRAS were identified. The mutational load was higher in the efferent vein than in peripheral blood, confirming the causative role of the identified mutation at a somatic level.
We demonstrate that cfDNA next-generation sequencing liquid biopsy is able to identify the KRAS mutation detected in affected tissues. Moreover, we have shown that blood sample withdrawal at the lesion site increases variant allele frequency with an order of magnitude above the limit of detection (usually 0.05%), decreasing the risk of a false negative. Finally, the noninvasiveness of the method avoids any risk of bleeding, being easily performed also in children. We propose this technique as the method of choice to better investigate AVMs and consequently to identify the therapy tailored to the genetic defect.
This article highlights the importance of using liquid biopsy as a new method to investigate the molecular profile of AVMs. In view of the frequent inaccessibility of vascular tissues owing to the invasiveness of solid biopsy and the relative high incidence of biopsies with low diagnostic power, here we evaluated the efficacy of detecting cfDNA fragments released into the bloodstream from the affected tissue cells. Through a simple blood draw from the efferent vein at the vascular malformation site, the liquid biopsy allowed us to identify KRAS pathogenic mutations piloting a personalized therapeutic approach and opening a new scenario for new therapeutic strategies.
The Y chromosome plays key roles in male fertility and reflects the evolutionary history of paternal lineages. Here, we present a de novo genome assembly of the Hu sheep with the first draft assembly ...of ovine Y chromosome (oMSY), using nanopore sequencing and Hi-C technologies. The oMSY that we generated spans 10.6 Mb from which 775 Y-SNPs were identified by applying a large panel of whole genome sequences from worldwide sheep and wild Iranian mouflons. Three major paternal lineages (HY1a, HY1b and HY2) were defined across domestic sheep, of which HY2 was newly detected. Surprisingly, HY2 forms a monophyletic clade with the Iranian mouflons and is highly divergent from both HY1a and HY1b. Demographic analysis of Y chromosomes, mitochondrial and nuclear genomes confirmed that HY2 and the maternal counterpart of lineage C represented a distinct wild mouflon population in Iran that diverge from the direct ancestor of domestic sheep, the wild mouflons in Southeastern Anatolia. Our results suggest that wild Iranian mouflons had introgressed into domestic sheep and thereby introduced this Iranian mouflon specific lineage carrying HY2 to both East Asian and Africa sheep populations.
Droughts are one of the climate extremes that occur frequently in drylands, constraining the terrestrial carbon uptake and water cycle processes. Studies about the long-term changes in the effect of ...drought stress on dryland ecosystems under global warming are still insufficient so far. Here we comprehensively investigate long-term changes in droughts and the effect of drought stresses on ecosystems across global drylands for 1982–2015, and further reveal changes in the configurations of the key meteorological and ecological factors of droughts, by using observation and reanalysis datasets. Climatically, the spatial patterns of intensity, occurrence, duration and severity of all drought categories across global drylands are highly consistent with each other. Associated with severe droughts, drylands witness insufficient precipitation (−12.4 mm mon
−1
area-averaged over global drylands), warmer temperature (0.6°C), water deficit (−19.0 mm mon
−1
), higher atmospheric aridity (0.06 kPa), lower soil moisture (−0.03 m
3
m
−3
), suppressed vegetation growth and declined carbon uptake (−0.13 g C m
−2
d
−1
). The affected area, occurrence, duration and severity for mild to severe droughts in drylands and the anomalies of meteorological and ecological factors for all drought categories have increased significantly during 1982–2015. Specifically, when droughts occur, the precipitation deficit is weakened at a rate of 3.7–9.6 mm mon
−1
(30 yr)
−1
, the higher temperature (atmospheric aridity) is further intensified at 0.71–0.87°C (30 yr)(39–47 Pa (30 yr)
−1
), the water (soil moisture) deficit is relieved at 1.7–5.1 mm mon
−1
(30 yr)
−1
(4.1×10
−3
–7.4×10
−3
m
3
m
−3
(30 yr)
−1
), and the suppressed vegetation growth is generally alleviated at 0.98×10
−2–
1.2×10
−2
(30 yr)
−1
. Since the 2000s, the increasing trend in the suppressed vegetation growth during droughts tends to stagnate over about 50% of the dryland area. By checking the probability density function, the configurations of the key meteorological and ecological factors of droughts show significant differences between the periods before and after 2000. The probability of drought stress caused by precipitation and soil moisture deficit has decreased by 20% and 10%, respectively, while that caused by higher temperature and atmospheric aridity has been doubled, and increased by 26% and 15%, respectively. Thus, the impact of drought stress on dryland ecosystems caused by atmospheric aridity are increasing under global warming.
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