Effective technologies for noninvasive remote monitoring in heart failure

Background Trials of new technologies to remotely monitor for signs and symptoms of worsening heart failure are continually emerging. The extent to which technological differences impact the effectiveness of non-invasive remote monitoring for heart failure management is unknown. Objective To examine the effect of specific technology used for non-invasive remote monitoring of people with heart failure on all-cause mortality and heart failure-related hospitalisations. Methods A sub-analysis of a large systematic review and meta-analysis was conducted. Studies were stratified according to the specific type of technology used and separate meta-analyses were performed. Four different types of non-invasive remote monitoring technologies were identified including structured telephone calls, videophone, interactive voice response devices and telemonitoring. Results Only structured telephone calls and telemonitoring were effective in reducing the risk of all-cause mortality (RR 0.87; 95% CI=0.75-1.01; p=0.06 and 0.62; 95% CI=0.50-0.77; p<0.0001) and heart failure-related hospitalisations (RR 0.77; 95% CI=0.68-0.87; p<0.001) and 0.75; 95% CI=0.63-0.91; p=0.003). More research data is required for videophone and interactive voice response technologies. Conclusions This sub-analysis identified that only two of the four specific technologies used for non-invasive remote monitoring in heart failure improved outcomes. When results of studies that involved these disparate technologies were combined in previous meta-analyses, significant improvements in outcomes were identified. As such, this study has highlighted implications for future meta-analyses of randomised controlled trials focused on evaluating the effectiveness of remote monitoring in heart failure.

Age-related factors that confound peripheral pulse timing characteristics in Caucasian children

Characteristics obtained from peripheral pulses can be used to assess the status of cardiovascular system of subjects. However, nonintrusive techniques are preferred when prolonged monitoring is required for their comfort. Pulse transit time ( PTT) measurement has showed its potentials to monitor timing changes in peripheral pulse in cardiovascular and respiratory studies. In children, the common peripheries used for these studies are fingers or toes. Presently, there is no known study conducted on children to investigate the possible physiologic parameters that can confound PTT measure at these sites. In this study, PTT values from both peripheral sites were recorded from 55 healthy Caucasian children ( 39 male) with mean age of 8.4 +/- 2.3 years ( range 5 - 12 years). Peripheries' path length, heart rate, systolic blood pressure, diastolic blood pressure ( DBP) and mean arterial pressure ( MAP) were measured to investigate their contributions to PTT measurement. The results reveal that PTT is significantly related to all parameters ( P< 0.05), except for DBP and MAP. Age is observed to be the dominant factor that affects PTT at both peripheries in a child. Regression equations for PTT were derived for measuring from a finger and toe, ( 6.09 age + 189.2) ms and ( 6.70 age + 243.0) ms, respectively.

Non-invasive VHF monitoring of low-temperature atmospheric pressure plasma

A real-time VHF swept frequency (20–300 MHz) reflectometry measurement for radio-frequency capacitive-coupled atmospheric pressure plasmas is described. The measurement is scalar, non-invasive and deployed on the main power line of the plasma chamber. The purpose of this VHF signal injection is to remotely interrogate in real-time the frequency reflection properties of plasma. The information obtained is used for remote monitoring of high-value atmospheric plasma processing. Measurements are performed under varying gas feed (helium mixed with 0–2% oxygen) and power conditions (0–40 W) on two contrasting reactors. The first is a classical parallel-plate chamber driven at 16 MHz with well-defined electrical grounding but limited optical access and the second is a cross-field plasma jet driven at 13.56 MHz with open optical access but with poor electrical shielding of the driven electrode. The electrical measurements are modelled using a lumped element electrical circuit to provide an estimate of power dissipated in the plasma as a function of gas and applied power. The performances of both reactors are evaluated against each other. The scalar measurements reveal that 0.1% oxygen admixture in helium plasma can be detected. The equivalent electrical model indicates that the current density between the parallel-plate reactor is of the order of 8–20 mA cm-2 . This value is in accord with 0.03 A cm-2 values reported by Park et al (2001 J. Appl. Phys. 89 20–8). The current density of the cross-field plasma jet electrodes is found to be 20 times higher. When the cross-field plasma jet unshielded electrode area is factored into the current density estimation, the resultant current density agrees with the parallel-plate reactor. This indicates that the unshielded reactor radiates electromagnetic energy into free space and so acts as a plasma antenna.

Is 44-hour better than 24-hour ambulatory blood pressure monitoring in hemodialysis?

The aim of this study is to evaluate if hemodialysis (HD) patients with similar blood pressure (BP) in the whole inter-HD period could have different target organ lesions and survival if the behavior of BP differs from the first to the second day of the inter-HD period. The present study compares 44-hour ambulatory BP monitoring (ABPM) patterns in 45 HD patients. Three BP patterns emerged: group A (n = 15) had similar BPs throughout (138 ± 11/88 ± 12 in the first 22 h vs. 140 ± 11/87 ± 12 mm Hg in the second 22-hour period); group B (n = 15) had a significant systolic BP rise from the first to the second period (132 ± 15/80 ± 12 vs. 147 ± 12/86 ± 13 mm Hg, p < 0.05); group C (n = 15) had significantly higher BPs (p < 0.05) than the other 2 groups throughout the whole inter-HD period, with no significant change between the 2 halves (172 ± 14/108 ± 12 vs. 173 ± 18/109 ± 14 mm Hg). Ventricular mass and survival during the 30-month follow-up period were statistically significantly better in group A, intermediate in group B and worse in group C. The data suggest that a 44-hour ABPM is more accurate than a 24-hour one in evaluating organ lesion and prognosis in HD patients. Copyright © 2006 S. Karger AG.

The presence of the NOS3 gene polymorphism for intron 4 mitigates the beneficial effects of exercise training on ambulatory blood pressure monitoring in adults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prediction of hypertensive crisis based on average, variability and approximate entropy of 24-h ambulatory blood pressure monitoring

Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P<0.01), average of systolic BP (P=0.02) and average of diastolic BP (P=0.03) were significant predictors of hypertensive crisis. The incidence rate ratio of hypertensive crisis was 14.0 (95% confidence interval (CI) 1.8, 631.5; P<0.01) for high ApEn of systolic BP as compared to low values. In multivariable regression analysis, ApEn of systolic (P=0.01) and average of diastolic BP (P<0.01) were independent predictors of hypertensive crisis. A combination of these two measures had a positive predictive value of 75%, and a negative predictive value of 91%, respectively. ApEn, combined with other measures of 24-h ABPM, is a potentially powerful predictor of hypertensive crisis. If confirmed in independent samples, these findings have major clinical implications since measures predicting the risk of hypertensive crisis define patients requiring intensive follow-up and intensified therapy.

Combinação de drogas para o tratamento da Hipertensão Arterial: estratégia para um melhor controle pressórico

A taxa de controle da hipertensão arterial permanece subótima apesar dos amplos e intensos programas institucionais e o número das novas medicações. A combinação de drogas de diferentes mecanismos de ação vem se tornando uma alternativa para aumentar a redução na pressão arterial (PA) e aumentar seu controle, aumentar aderência ao tratamento e reduzir os eventos adversos. Um estudo fatorial 4X4 foi desenhado para determinar a eficácia e a segurança de telmisartana (T) mais anlodipino (A) em pacientes hipertensos estágios I e II. Pacientes hipertensos adultos (N=1461) estágios I e II (pressão arterial basal 153,212,1 ⁄101,74,3 mm Hg) foram randomizados para 1 de 16 grupos de tratamento com T 0, 20, 40, 80 mg e A 0, 2.5, 5, 10 mg por oito semanas. A maior redução na média das pressões sistólica e diastólica foram observadas com T 80 mg mais A10 mg (- 26,4 ⁄20,1 mm Hg; p<0,05 comparados com as monoterapias). A taxa de controle da PA foi também maior no grupo T 80mg mais A 10mg (76,5% [controle total] e 85,3% [controle da PA diastólica ]), e taxa de controle da PA >90% com esta combinação. O edema periférico maleolar foi o evento adverso mais frequente e ocorreu no grupo A 10mg (17,8%), porém, esta taxa foi marcadamente menor quando A foi usada associada com T: 11,4% (T20+A10), 6,2% (T40+ A10), e 11,3% (T80+A10). Um subestudo utilizando a monitorização ambulatorial da pressão arterial (MAPA) foi realizado na fase basal e após oito semanas de tratamento. A maior redução média das pressões nas 24 horas a partir do período basal foi registrada para a combinação de telmisartana 80 mg e anlodipino 10 mg e encontrou-se queda de 22,4/14,6 mmHg, de 11,9/6,9 mmHg para anlodipino 10 mg monoterapia e de 11,0/6,9 mmHg para telmisartana 80 mg (p< 0,001). Além disso, resultados relevantes foram também constatados numa análise post hoc de subgrupos incluindo idosos, obesos, diabéticos tipo 2 e hipertensão sistólica. A resposta anti-hipertensiva da combinação foi semelhante, independente de qualquer característica de cada subgrupo. Estes dados demonstram que telmisartana e anlodipino em combinação oferecem substancial redução e controle nas 24 horas superior às respectivas monoterapias em hipertensos estágios I e II.

Caracterización de las alteraciones en la función renal, la presión arterial y las malformaciones anatómicas renales- urinarias y cardiovasculares en pacientes con Sindrome de Turner en la Fundación Cardioinfantil entre 1999 y 2009

Se caracterizan las malformaciones renales y urinarias (MRU), y cardiovasculares (CV), así como la función renal (FR) y la presión arterial (PA) en pacientes con Sindrome de Turner (ST) mediante un estudio retrospectivo entre 1999 y 2009 en Bogotá. Se encontró 10 pacientes con algún grado de insuficiencia renal crónica (IRC). Además 4 pacientes presentaron prehipertensión arterial, y 5 (HTA); en ellos se encontró hidronefrosis y riñón poliquístico. Las MRU más frecuentes fueron únicas; en ellas las mayores alteraciones cromosómicas son la monosomía y el mosaicismo. La mayor malformación CV fué la válvula aórtica bicúspide. El ST amerita seguimiento de FR y PA para prevenir complicaciones a largo plazo por IRC e HTA.

Patient engagement strategies used for hypertension and their influence on self-management attributes

Background. Several effective methods to facilitate patient self-management of hypertension are available in primary care. These include direct support from community pharmacists and general practice, and the use of home blood pressure (BP) monitoring. The aim of this study is to establish the prevalence of use of key strategies and to determine their independent relationship with patient self-management attributes.

Methods. A survey of patients with treated hypertension was undertaken in 27 community pharmacies. This established recent use of BP monitoring and advice from health professionals. Patient awareness of BP and targets, appropriateness of BP targets and adherence to anti-hypertensive medications were assessed as indicative self-management outcomes. Predictors of outcomes were determined using binary logistic regression.

Results. Overall, 215 surveys were returned. Two-thirds of patients were aged >65 years, and 45% had conditions warranting tighter BP control (<130/80 mmHg). Almost all patients reported monitoring of their BP in the previous year and 63% could report their most recent BP reading. Just 36% reported knowing a target BP, and 78% of reported targets were within guidelines recommendations. One-fifth (22%) monitored their own BP, and 15% reported non-adherence to medication. Doctors provided the large majority of professional advice. Self-monitoring or documentation of BP readings was independently associated with increased likelihood of BP and target BP being known.

Conclusions. Regular monitoring of BP does not automatically translate to professional advice. Increased uptake of patient self-monitoring should be promoted as a means of enabling self-management.

Analysis of circadian rhythms from online communities of individuals with affective disorders

The circadian system regulates 24 hour rhythms in biological creatures. It impacts mood regulation. The disruptions of circadian rhythms cause destabilization in individuals with affective disorders, such as depression and bipolar disorders. Previous work has examined the role of the circadian system on effects of light interactions on mood-related systems, the effects of light manipulation on brain, the impact of chronic stress on rhythms. However, such studies have been conducted in small, preselected populations. The deluge of data is now changing the landscape of research practice. The unprecedented growth of social media data allows one to study individual behavior across large and diverse populations. In particular, individuals with affective disorders from online communities have not been examined rigorously. In this paper, we aim to use social media as a sensor to identify circadian patterns for individuals with affective disorders in online communities.We use a large scale study cohort of data collecting from online affective disorder communities. We analyze changes in hourly, daily, weekly and seasonal affect of these clinical groups in contrast with control groups of general communities. By comparing the behaviors between the clinical groups and the control groups, our findings show that individuals with affective disorders show a significant distinction in their circadian rhythms across the online activity. The results shed light on the potential of using social media for identifying diurnal individual variation in affective state, providing key indicators and risk factors for noninvasive wellbeing monitoring and prediction.

Seasonal changes in fecal testosterone concentrations and their relationship to the reproductive behavior, antler cycle and grouping patterns in free-ranging male Pampas deer (Ozotoceros bezoarticus bezoarticus)

The purpose of this study was to validate noninvasive endocrine monitoring techniques for Pampas deer and to evaluate seasonal changes in testicular steroidogenic activity and their correlation to reproductive behavior, antler cycle and group size. Thus, fecal samples, behavioral data and observations of antler status were collected at monthly intervals during 1 year from free-ranging Pampas deer stags (three radio-collared individuals and 15 random individuals) living in Emas National Park, Brazil (18 degrees S latitude). Fecal steroids were extracted using 80% methanol and steroid concentrations were quantified by a commercial enzyme immunoassay (EIA). Fecal testosterone concentrations peaked in December-January (summer), March (early autumn) and in August-September (winter-spring), with minimal values from April-July. Reproductive behavior had two peaks, the first in December-January, characterized by predominately anogenital sniffing, flehmen, urine sniffing, chasing and mounting behavior, and the second peak in July-September (behavior primarily related to gland marking). There were significant correlations between fecal testosterone and reproductive behavior (r = 0.490), and between fecal testosterone and antler phases (r = 0.239). Antler casting and regrowth occurred under low testosterone concentrations, whereas velvet shedding was associated with high concentrations of testosterone. We inferred that Pampas deer stags exhibited a seasonal cycle that modulated sexual behavior and the antler cycle, and we concluded that fecal steroid analysis was a practical and reliable non-invasive method for the evaluation of the endocrine status of free-ranging Pampas deer. (c) 2004 Elsevier B.V. All rights reserved.

Fecal progestins during pregnancy and postpartum periods of captive red brocket deer (Mazama americana)

This study aimed to validate the enzyme immunoassay (EIA) for fecal progestin quantification of the species Mazama americana, define its excretion profile during periods of gestation and postpartum and determine the gestation period and resumption of postpartum ovarian activity in this species in captivity Fecal samples were collected twice a week during gestation and every day in the postpartum period, and analyzed using EIA The mean concentrations (±SEM) of fecal progestins during gestation were 2180.0 ± 299.1 ng/g in early pregnancy (week 1-11), 3271.4 ± 406.9 ng/g in middle pregnancy (week 12-22) and 5592.0 ± 1125.8 ng/g in late pregnancy (week 23-32) The gestation period determined for the species was 220.9 ± 1.2 days The concentration of progestins reached its peak prior to parturition and returned to baseline levels in 4 ± 0.31 days after parturition In the postpartum period, the mean concentrations of fecal progestins were 1564.2 ± 182.6 ng/g in the interval between parturition and resumption of ovarian activity, 469.8 ± 24.5 ng/g in the inter-luteal phase and 2401.7 ± 318.5 ng/g during the luteal phase, such that the postpartum period and the luteal phase differed from the inter-luteal phase Fecal progestin profiling permitted the detection of ovulation 26.9 ± 3.4 days after parturition in all the hinds studied and estimation of the mean duration of the estrous cycle, 21.3 ± 1.1 days Analysis established that concentrations of progestins above 3038.76 ng/g diagnosed pregnancy, a value determined from the week 12 of gestation Moreover, the quantification of fecal progestins by EIA proved to be an important tool for noninvasive endocrine monitoring and to obtain reproductive data on the species M americana in captivity © 2013 Elsevier B.V.

Perfil de progestinas fecais durante a gestação de veado-campeiro (Ozotoceros bezoarticus) no Pantanal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência do gênero e treinamento físico aeróbio sobre a modulação autonômica cardíaca, pressão arterial e biomarcadores de estado redox em mulheres na perimenopausa e homens

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)