Innovative telemonitoring system for cardiology: from science to routine operation.

OBJECTIVE: Results of the Austrian MOBITEL (MOBIle phone based TELemonitoring for heart failure patients) trial indicate that home-based telemonitoring improves outcome of chronic heart failure (CHF) patients and reduces both frequency and duration of hospitalizations. Based on lessons learned, we assessed the weak points to clear the way for routine operations. METHODS: We analyzed the system with respect to recommendations of the ESC Guidelines and experiences gained throughout the trial to identify potential improvements. The following components have been identified: a patient terminal with highest usability, integrated way to document drug-intake and well-being, and automated event detection for worsening of CHF. As a consequence the system was extended by Near Field Communication (NFC) technology and by an event management tool. RESULTS: Usability evaluation with 30 adults (14f, median 51y. IQR[45-65]) showed that 21 (8f) were able to immediately operate the system after reading a step-by-step manual. Eight (6f) needed one time demonstration and one man (80y) failed to operate the blood pressure meter. Routine operation of the revised system started in March 2009. Within 9 months, 15 patients (4f, median 74y. IQR[71-83], all NYHA-III) transmitted 17,149 items. 43 events were detected because of body weight gain of more then 2kg within 2 days. 49 therapy adjustments were documented. Three patients stopped using the system, two (1f) because of non-compliance and one (m, 82y) because of death. Overall, the rate of adherence to daily data transfer was 78%. CONCLUSION: First results confirm the applicability of the revised telemonitoring system in routine operation.

Degradation of PAHs by ligninolytic enzymes of Irpex lacteus.

The ligninolytic fungus Irpex lacteus was shown as an efficient degrader of oligocyclic aromatic hydrocarbons (PAHs; 'polycyclic aromatic hydrocarbons') possessing 3-6 aromatic rings in complex liquid media. The strain produced mainly Mn-dependent peroxidase in media without pollutants. Activity of ligninolytic enzymes was higher in a N-limited medium. However, after contamination with PAHs (especially pyrene) the values increased and significant activity of Mn-independent peroxidase appeared in the complex medium. Other factors (such as the increase in nitrogen concentration or the presence of solvent(s) for dissolution of PAHs) had no effect. Cytochrome P-450 was detected in the microsomal fraction of biomass grown in the complex medium. The rate of PAH degradation was also affected by the presence of various combinations of PAHs. However, independently of the enzyme activities, anthracene was shown to have a positive influence on degradation of pyrene and fluoranthene.

Análisis comparativo de la toxicidad del extracto acuoso en cocimiento de la harina de maca (Lepidium meyenii, Walp) en tres especies de animales modelos: Artemia franciscana (Crustácea, Anostraca), pez Guppy (Poecilia Reticulata) y ratón (Mus musculus) / Comparative analisis of toxicity of aqueous boiled extracts of maca flour (Lepidium meyenii, Walp) in Artemia franciscana (Crustacea anostraca), guppy (Poecilia reticulate) and mouse (Mus musculus)

Se evalúa la toxicidad del extracto acuoso en cocimiento de la harina de maca en dos organismos acuáticos, un invertebrado la Artemia franciscana y un vertebrado el pez Guppy (Poecilia reticulata). Así mismo, se evalúa la toxicidad aguda por vía intraperitoneal en el ratón (Mus musculus) que es el modelo animal comúnmente utilizado para ensayos preclínicos a nivel de laboratorios. Se comprobó que existe toxicidad del Lepidium meyenii para estos tres animales que dependen de la dosis y el tiempo de exposición.

Toxicity of aqueous boiled extracts of maca flour was evaluated in two aquatic organisms: Artemia franciscana (invertebrate) and guppy (Poecilia reticulata), a vertebrate fish. Also, acute toxicity of this extract was evaluated by intraperitoneal administration in mouse (Mus musculus), a common animal model used in laboratories for preclinical tests. Results show toxic effects of Lepidium meyenii on all three animal species, depending on dose and exposure time.

Mobile phone-based surveillance of cardiac patients at home.

We tested the reliability, acceptability and feasibility of a home-monitoring system for cardiac patients. Each participant was equipped with a mobile phone, an automatic blood pressure device and a digital weight scale. In total, 20 patients (14 patients with chronic heart failure, six patients with hypertension; mean age 50 years, standard deviation [SD] 14) were monitored for 90 days each. They were asked to measure their blood pressure, pulse and body weight every day, and to transfer the data together with the dosage of medication to the telemonitoring server using wireless Internet technology in the mobile phone. The physician in charge received email alerts when reported data fell outside pre-defined limits. The patients' compliance with the system was high. During a cumulative monitoring period of 1,735 days, there were 2,040 data transfer sessions, a mean of 102 per patient (SD 43). The mean percentage of successful data transfers was 83% (SD 22). The stability of the telemonitoring system was 98%, meaning that patient data transfer was almost always possible. The accessibility of the secure web server for physicians was above 99%. The web-based home-monitoring system was reliable and easy to handle for both patients and health care professionals. It may be a useful tool for patients with heart failure as well as hypertensive patients.

Initial experiences with a telemedicine framework for remote pacemaker follow-up.

According to international guidelines implanted cardiac pacemakers (PM) have to be checked periodically to ensure that they are working correctly. To spare a significant number of patients the burden of traveling to specialized PM clinics a telemedicine framework has been developed prototypically. A mobile, personal digital assistant (PDA) based PM follow-up unit provides the caregiver at the point-of-care with the necessary infrastructure to perform a basic PM follow-up examination remotely. In case of detected malfunction of the PM the patient is ordered to the hospital for further examination. The system has been evaluated in a clinical pilot trial on 44 patients with a total of 23 different PM models from 8 different manufacturers. The initial results indicate the potential of the concept to work as an efficient, manufacturer independent screening method with the ultimate goal to increase the safety, quality and efficiency of PM therapy.

Automated and manufacturer independent assessment of the battery status of implanted cardiac pacemakers by electrocardiogram analysis.

According to international standards, cardiac pacemakers have to indicate the status of their batteries upon magnet application by specific stimulation patterns. The purpose of this study has been to assess whether this concept can be used as a basis for automated and manufacturer independent examination of the depletion level of pacemakers in the framework of a collaborative telemedical pacemaker follow-up system. A prototype of such a system was developed and tested in a real clinical environment. Electrocardiograms (ECGs) were recorded during magnet application and automatically processed to extract the specific stimulation patterns. The results were used to assign each signal a corresponding pacemaker status: "ok," "replace" or "undefined," based on the expected behavior of the devices as specified by the manufacturer. The outcome of this procedure was compared to the result of an expert examination, resulting in a positive predictive value of 100% for the detection of ECGs indicating pacemaker status "ok." The method can, therefore, be utilized to quickly, safely and manufacturer neutrally classify cases into the categories "ok" and "needs further checking," which - in a telemedical setting - may be used to increase the efficiency of pacemaker follow-up procedures in the future.

Abiotic elicitation of indole phytoalexins and resistance to Leptosphaeria maculans within Brassiceae.

Forty three accessions of Brassica species and one each of Sinapis and Raphanus were assessed for (i) resistance to Leptosphaeria maculans according to a coty-ledon-inoculation test and (ii) indole phytoalexin accumulation following abiotic elicitation with CuCl2. Five indole phytoalexins were determined in the lines following elicitation. Brassilexin, cyclobrassinin and cyclobrassinin sulphoxide were found within at least some lines of all species, whereas brassinin was only detected in B. oleracea and B. napus and methoxybrassinin within these two species and B. rapa and B. carinata. None of the five indole phytoalexins could be found in Raphanus sativus or Sinapis alba. The accumulation of large amounts of specific phytoalexins could be correlated with the presence of the different Brassica genomes. Lines possessing the B genome (B. nigra, B. juncea and B. carinata) which accumulated high amounts of brassilexin, displayed a hypersensitive resistance to infection whereas the majority of lines of B. oleracea, B. napus and B. rapa which did not accumulate large amounts of brassilexin, were susceptible. However, a B. nigra and a B. rapa line which only accumulated low amounts of brassilexin were highly resistant to the pathogen. Neither the accumulation of the other phytoalexins nor the total accumulation of indole phytoalexins could be related to resistance to L. maculans.

Phomenoic acid and phomenolactone, antifungal substances from Phoma lingam (Tode) Desm.: kinetics of their biosynthesis, with an optimization of the isolation procedures.

Phomenoic acid and phomenolactone, previously isolated from the fungus Phoma lingam (Tode) Desm., have shown moderate antifungal and antibacterial properties in vitro. To rationalize the production of phomenoic acid, a kinetic study of its biosynthesis in the mycelium was performed. Phomenoic acid and phomenolactone appear in the mycelium after a prolonged incubation, a phenomenon which may be of particular interest for the production of these substances or in the study of the mechanism of their biosynthesis. The isolation procedure was optimized for phomenoic acid. Through a series of SiO2 column chromatographies, high-pressure liquid chromatography, and transformation of the mixture of phomenoic acid and phomenolactone into methyl phomenoate (BF3), the final yield of phomenoic acid reached 160 mg/liter of culture medium. An alternative method for the isolation of both phomenoic acid and phomenolactone is also reported in detail.