Segmentation and classification of capnograms: application in respiratory variability analysis.

Variability analysis of respiratory waveforms has been shown to provide key insights into respiratory physiology and has been used successfully to predict clinical outcomes. The current standard for quality assessment of the capnogram signal relies on a visual analysis performed by an expert in order to identify waveform artifacts. Automated processing of capnograms is desirable in order to extract clinically useful features over extended periods of time in a patient monitoring environment. However, the proper interpretation of capnogram derived features depends upon the quality of the underlying waveform. In addition, the comparison of capnogram datasets across studies requires a more practical approach than a visual analysis and selection of high-quality breath data. This paper describes a system that automatically extracts breath-by-breath features from capnograms and estimates the quality of individual breaths derived from them. Segmented capnogram breaths were presented to expert annotators, who labeled the individual physiological breaths into normal and multiple abnormal breath types. All abnormal breath types were aggregated into the abnormal class for the purpose of this manuscript, with respiratory variability analysis as the end-application. A database of 11,526 breaths from over 300 patients was created, comprising around 35% abnormal breaths. Several simple classifiers were trained through a stratified repeated ten-fold cross-validation and tested on an unseen portion of the labeled breath database, using a subset of 15 features derived from each breath curve. Decision Tree, K-Nearest Neighbors (KNN) and Naive Bayes classifiers were close in terms of performance (AUC of 90%, 89% and 88% respectively), while using 7, 4 and 5 breath features, respectively. When compared to airflow derived timings, the 95% confidence interval on the mean difference in interbreath intervals was ± 0.18 s. This breath classification system provides a fast and robust pre-processing of continuous respiratory waveforms, thereby ensuring reliable variability analysis of breath-by-breath parameter time series.

Extracorporeal blood oxygenation and ozonation (EBOO) in man. preliminary report.

Autohemotherapy with ozone has been used for four decades with encouraging results but, owing to the lack of clinical studies, it has never been adopted by orthodox medicine. Confident of the valid principles of ozone therapy, we have endeavoured to increase its therapeutic efficacy. Over a ten-year period we have developed an apparatus that makes it possible to treat large quantities of blood with ozone in extracorporeal circulation (extracorporeal blood oxygenation and ozonation EBOO). One of us volunteered to test the system and after six treatments noted the disappearance of two lipomas. This prompted us to treat a patient with Madelung disease and several patients with atherosclerotic vasculopathy. Besides showing therapeutic effects, the preliminary results indicate that EBOO is clinically valid, without side-effects and worthy of testing in various diseases.

Intracoronary serotonin release after high-pressure coronary stenting.

It is known that platelet-derived serotonin at the site of coronary angioplasty induces an increase in coronary tone and plays a role in vasoconstriction after balloon angioplasty. The goal of the present investigation was to compare local release of serotonin with changes in coronary tone after coronary stenting and coronary angioplasty. Twenty patients with significant stenosis (> or =50% diameter narrowing) of the left anterior descending coronary artery were referred to traditional coronary angioplasty (10 patients; group 1) or high-pressure coronary stenting (10 patients; group 2). An additional 16 patients with similar angiographic characteristics were referred to the coronary angioplasty group (8 patients; group 1a) or stenting group (8 patients; group 2a) after pretreatment with ketanserin. Serotonin plasma levels in coronary sinus and coronary cross-sectional area distal to the site of dilatation were measured before and after bath revascularization procedures. In groups 1 and 1a, plasma serotonin levels in coronary sinus increased from basal values of 3.2+/-0.8 and 3.2+/-0.5 ng/ml to 29.5+/-13 and 25.6+/-9 ng/ml after ballooning (p <0.001 vs baseline). In groups 2 and 2a, plasma serotonin levels in coronary sinus increased from basal values of 3.5+/-0.3 and 3.5+/-0.7 ng/ml to 114.6+/-34 and 113+/-29 ng/ml after stenting (p <0.001 vs baseline and vs postangioplasty values in groups 1 and 1a). Coronary cross-sectional area distal to the site of dilatation significantly decreased after angioplasty in group 1 (from 4.33+/-0.4 to 3.32+/-0.3 mm2; p <0.001), and after stenting in group 2 (from 4.27+/-0.3 to 2.86+/-0.2 mm2; p <0.001 vs baseline, and p <0.02 vs values after coronary angioplasty in group 1). Pretreatment with ketanserin significantly reduced distal coronary vasoconstriction after angioplasty and stenting. It is concluded that the higher local serotonin release after coronary stenting may explain the more marked coronary constriction observed after prosthesis deployment with respect to traditional coronary angioplasty. Ketanserin is able to significantly attenuate the increase in distal coronary tone induced by both revascularization procedures.

Chlamydia pneumoniae antibodies and angiographically demonstrated coronary artery disease in a sample population from Italy.

Recent reports suggest an association between Chlamydia pneumoniae and chronic coronary heart disease. This case-control study investigates the relationship between the presence of immunoglobin G (IgG) and immunoglobin A (IgA) when measured by means of microimmunofluorescence (MIF) and angiographically diagnosed coronary disease. Cases (n = 150) were angiography patients with at least one coronary artery lesion occupying at least 50% of the luminal diameter. Controls (n = 49) were angiography patients with no detectable signs of coronary artery disease and patients (n = 56) without signs or symptoms of coronary disease and with normal ECG results. No significant differences were revealed between the seroprevalence of IgG and IaA and geometric mean titers (GMT) as measured in cases and controls. When cases were compared with controls whose angiographic results were normal, after adjusting for established risk factors (cholesterol, smoking, hypertension, diabetes, age, gender and family history), the estimated risk of coronary artery disease was 0.79 (95% confidence interval (C.I.), 0.31-1.99) for the presence of IgG and was 0.94 (95 C.I., 0.37-2.39) for IgA. When cases were compared with controls with normal ECG results, the adjusted odds ratio (O.R.) for coronary artery disease was 1.17 (95%, C.I., 0.52-2.62) for the presence of IgG and 0.82 195% C.I., 0.36-1.86) for the presence of IgA. These results do not support an association between C. pneumoniae infection and coronary disease.

Emergency stent placement in left main coronary artery subocclusion following diagnostic angiography.

We report a case of acute left main coronary artery subocclusion treated by stenting. The patient had a severe ostial left main coronary artery stenosis and after diagnostic coronary angiography developed subocclusion of the left main coronary artery, with TIMI 1 flow and life-threatening hemodynamic consequences. After two balloon dilatations had failed, a half Palmaz-Schatz stent (7 mm) was successfully deployed at the site of the lesion with immediate improvement of the angiographic and clinical picture. We claim that the placement of a half Palmaz-Schatz stent, hand-crimped on a high-pressure and non-compliance balloon, could provide a means for restoring adequate blood flow in patients who develop an important ischemia after diagnostic coronary angiography of a short, calcified left main coronary artery with severe ostial stenosis. Despite the satisfactory angiographic and clinical findings in these patients, the risk of restenosis and the presence of other multivessel diseases press us towards a more definitive surgical treatment.

A rare anatomic variation of the anomalous origin of all three major coronary arteries from the right sinus of Valsalva.

We describe the case of a patient with angiographic evidence in the right sinus of Valsalva of anomalous origin of LCx and common origin of LAD and RCA. This anomaly, which has not been reported previously, represents a further anatomic variation of the rare anomalous origins of all coronary arteries from right sinus of Valsalva. The symptoms in our patients were related exclusively to the atherosclerotic lesions in LCx and RCA and not to the anatomic anomalies. The patient underwent a bypass graft to LCx and RCA.

The giant of Oxytricha bifaria: A peculiar cell differentiation triggered and controlled by cell to cell contacts.

The heteromorphic life cycle of the freshwater hypotrich Oxytricha bifaria comprehends at least 3 phases: conjugating pairs, resting cysts and carnivorous giants. The gigantic forms represent unique adaptive devices which enable the species to survive in a certain environment when the normal bacterial food is exhausted. In this report several results are described which deal with the nature of the mechanisms underlying giant formation: (a) only cell to cell contacts (not species-specific) occurring among living specimens trigger this differentiation; (b) the higher the number of cells per ml, the shorter the "induction period", namely the time lag between the onset of the inducing conditions and the formation of the first giant; (c) it is now possible to separate and to distinguish experimentally, within the "induction period", two successive steps, namely "activation" and "predation"; (d) also the already-differentiated-giants (the so-called steadystate-giants) need cell to cell contacts to maintain their cell differentiation. The "Labile Memory Counter" hypothesis is proposed and discussed.

The formation of giants in Oxytricha bifaria: A peculiar multi-step cell differentiation.

The induction period of Oxytricha bifaria, namely the time lag elapsing between the beginning of the inducing (= overcrowded) conditions and the formation of the first giant was studied. It was found that this period consists of at least three successive steps: (a) the "early activation window", roughly corresponding to the first third of the induction period, during which the cell to cell contacts triggering the differentiation must occur; (b) the "late activation window", which corresponds to the central part of the induction period and during which a specific protein synthesis occurs. These two steps end in the "activation" of Oxytricha, which is now ready for the third phase, (c) "prédation" which occurs during the last third of the induction period, when the activated, potential giants actually engulf their preys.

Small vessel disease (SVD) in patients with unexplained ventricular arrhythmia and dilated congestive cardiomyopathy.

Small vessel coronary disease is not commonly found in endomyocardial biopsies (EMB) of nondiabetic patients with clinical evidence of ischemic heart disease, congestive heart failure, or ventricular arrhythmia (VA). In 166 patients studied by heart catheterization and multiple right ventricle EMB, we identified 4 patients with histologic evidence of small vessel disease and normal coronary arteriograms. Two patients were suffering from VA without an obvious cardiac cause. Of the other two, one initially showed frequent ventricular tachycardia attacks followed by congestive heart failure alone. In both patients, the cardiac chambers were dilated and the left ventricular function seriously impaired. In all four patients, the histologic examination of right EMB revealed a wall thickening of the precapillary arterioles and capillary vessels. At ultrastructural examination, an increased thickening (four or five times normal) of the subendothelial lamina and of the basement membrane of capillary pericytes was found. Degenerative changes of cardiac myocells were found in all cases.

[The kissing balloon in angioplasty of coronary stenosis involving the bifurcation of a major branch]. / II "kissing balloon" nella angioplastica delle stenosi coronariche interessanti la biforcazione di un ramo principale.

A case of severe effort angina treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) is described. The critical coronary lesion involved the left anterior descending coronary artery and the origin of a first diagonal branch. The "kissing balloon" technique was used. After a year, the immediate positive angiographic results remained unchanged.