Lower Limb Pulse Rise Time as a Marker of Peripheral Arterial Disease.

OBJECTIVE: The aim of the study was to show if pulse rise times (PRTs) extracted from photoplethysmographic (PPG) pulse waves (PWs) have an association with peripheral arterial disease (PAD) or its endovascular treatment, percutanoeus transluminal angioplasty (PTA) of the superficial femoral artery. METHODS: Lower and upper limb PPG PWs were recorded and analyzed from 24 patients who suffered from PAD. The measurements were conducted before and after the treatment, and one month later by using transmission-mode PPG-probes placed in the index finger and second toe. Ankle-to-brachial pressure index and toe pressures were used as references in clinical patient measurements. PRTs, i.e., the time from the foot point to the peak point of the PW, were extracted from the PWs and compared bilaterally. The results from the PAD patients were also compared with 31 same-aged and 34 younger control subjects. RESULTS: Statistically significant differences were found between the pretreatment PRTs of the treated limb of the PAD patients and the same-aged control subjects ( , Mann-Whitney U-test). The changes in the PRT of the treated lower limb were observed immediately after the PTA ( , Student's t-test), and after one month ( ), whereas the PRTs of the non-treated lower limb and upper limb did not indicate changes between different examinations. CONCLUSION: Results show that a PRT greater than 240 ms indicates PAD-lesions in the lower limb. SIGNIFICANCE: This proof-of-concept study suggests that the PRT could be an effective and easy-to-use indicator for PAD and monitoring the effectiveness of its treatment.

Effects of Percutaneous Transluminal Angioplasty of Superficial Femoral Artery on Photoplethysmographic Pulse Transit Times.

We analyze the changes in upper and lower limb pulse transit times (PTT) caused by peripheral artery disease (PAD) and its treatment with percutaneous transluminal angioplasty (PTA) of the superficial femoral artery. PTTs were extracted from the photoplethysmograms (PPG) recorded from an index finger and 2nd toes. PTTs were defined between the R-peaks of the ECG and different reference points of the PPG: foot and peak points, maxima of 1st and 2nd derivative, and by means of intersecting tangents method. Also the PTTs between the toe and finger pulses were analyzed. Our sample consists of 24 subjects examined before and after the PTA and in 1-month follow-up visit. Also 28 older than 65 years controls having normal ankle-to-brachial pressure index (ABI) and no history in cardiovascular diseases as well as 21 younger subjects were examined. The differences between the groups and pre- and post-treatment phases were analyzed by means of non-parametric statistical tests. The changes in the PTTs of upper limb and non-treated lower limb were negligible. The agreement with the reference values, ABI and toe pressures, was studied by kappa-analysis, resulting in kappa-values of 0.33-0.91. Differences in PTTs were found between pre-treatment state of the treated limb, post-treatment state and the follow-up visit, as well as between the pre-treatment state and controls. If patients' age and systolic blood pressure were taken into consideration, the method of lower limb PTT calculation from the peak point turns out feasible in finding the markers of PAD and monitoring post-treatment vascular remodellation.

Tolerating the Intolerable: Flash Smelting of Copper and the Construction of Technological Constraints.

Material and energy constraints have had a major influence in the history of technology. However, prior research has surprisingly little to say about what these constraints actually are, how they emerge, and which are the mechanisms through which they influence technological change. This article studies a case where energy constraints were supposedly the source of a radical innovation in copper smelting in post-Second World War Finland. It finds that the constraints were significantly more ambiguous and socially constructed than the technologists themselves acknowledged, and highlights the context dependence of constraints and how technologists may perceive them. Technological feasibility influences the perception of constraints, and the perception of constraints influences what is found to be technologically feasible. This relationship is moderated by political power wielded by technologists.

The effect of percutaneous transluminal angioplasty of superficial femoral artery on pulse wave features.

We aimed to analyze the effects of percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) on arterial pulse waves (PWs). Altogether 24 subjects i.e. 48 lower limbs were examined including 26 treated lower limbs having abnormal ankle-to-brachial pressure index (ABI) (ABI<0.9 or ABI>1.3) and 22 non-treated lower limbs. The measurements were conducted in pre-, peri- and post-treatment phases as well as in follow-up visit after 1 month. Both ABI and toe pressures measured by standard equipment were used as reference values. PW-derived parameters include ratios of different peaks of the PW and time differences between them as well as aging index. Both treated and non-treated limbs were compared in pre- and post-treatment as well as follow-up visit conditions. The results were evaluated in terms of statistical tests, Bland-Altman-plots, free-marginal multirater κ-analysis and multiple linear regression analysis. PTA was found to cause small changes to the studied PW-derived parameters of the treated limb which were observed immediately after the treatment, but the changes were more pronounced in the follow-up visit. In addition, we observed that the endovascular instrumentation itself does not cause significant changes to the PW-derived parameters. The results show that PW-analysis could be a useful tool for monitoring the treatment-effect of the PTA. However, because the pre-treatment differences of the treated and non-treated limb were small, further studies with subjects having no arterial diseases are required. The study demonstrates the potential of the PW analysis in monitoring vascular abnormalities.

Bacterial signatures in thrombus aspirates of patients with lower limb arterial and venous thrombosis.

OBJECTIVE: Increasing data supports the role of bacterial inflammation in adverse events of cardiovascular and cerebrovascular diseases. In our previous research, DNA of bacterial species found in coronary artery thrombus aspirates and ruptured cerebral aneurysms were mostly of endodontic and periodontal origin, where Streptococcus mitis group DNA was the most common. We hypothesized that the genomes of S mitis group could be identified in thrombus aspirates of patients with lower limb arterial and deep venous thrombosis. METHODS: Thrombus aspirates and control blood samples taken from 42 patients with acute or acute-on-chronic lower limb ischemia (Rutherford I-IIb) owing to arterial or graft thrombosis (n = 31) or lower limb deep venous thrombosis (n = 11) were examined using a quantitative real-time polymerase chain reaction to detect all possible bacterial DNA and DNA of S mitis group in particular. The samples were considered positive, if the amount of bacterial DNA in the thrombus aspirates was 2-fold or greater in comparison with control blood samples. RESULTS: In the positive samples the mean difference for the total bacterial DNA was 12.1-fold (median, 7.1), whereas the differences for S mitis group DNA were a mean of 29.1 and a median of 5.2-fold. Of the arterial thrombus aspirates, 57.9% were positive for bacterial DNA, whereas bacterial genomes were found in 75% of bypass graft thrombosis with 77.8% of the prosthetic grafts being positive. Of the deep vein thrombus aspirates, 45.5% contained bacterial genomes. Most (80%) of bacterial DNA-positive cases contained DNA from the S mitis group. Previous arterial interventions were significantly associated with the occurrence of S mitis group DNA (P = .049, Fisher's exact test). CONCLUSIONS: This is the first study to report the presence of bacterial DNA, predominantly of S mitis group origin, in the thrombus aspirates of surgical patients with lower limb arterial and deep venous thrombosis, suggesting their possible role in the pathogenesis of thrombotic events. Additional studies will, however, be needed to reach a final conclusion.

Fast motif matching revisited: high-order PWMs, SNPs and indels.

Motivation: While the position weight matrix (PWM) is the most popular model for sequence motifs, there is growing evidence of the usefulness of more advanced models such as first-order Markov representations, and such models are also becoming available in well-known motif databases. There has been lots of research of how to learn these models from training data but the problem of predicting putative sites of the learned motifs by matching the model against new sequences has been given less attention. Moreover, motif site analysis is often concerned about how different variants in the sequence affect the sites. So far, though, the corresponding efficient software tools for motif matching have been lacking. Results: We develop fast motif matching algorithms for the aforementioned tasks. First, we formalize a framework based on high-order position weight matrices for generic representation of motif models with dinucleotide or general q -mer dependencies, and adapt fast PWM matching algorithms to the high-order PWM framework. Second, we show how to incorporate different types of sequence variants , such as SNPs and indels, and their combined effects into efficient PWM matching workflows. Benchmark results show that our algorithms perform well in practice on genome-sized sequence sets and are for multiple motif search much faster than the basic sliding window algorithm. Availability and Implementation: Implementations are available as a part of the MOODS software package under the GNU General Public License v3.0 and the Biopython license ( http://www.cs.helsinki.fi/group/pssmfind ). Contact: janne.h.korhonen@gmail.com.

Separating OR, SUM, and XOR Circuits.

Given a boolean n × n matrix A we consider arithmetic circuits for computing the transformation x ↦ Ax over different semirings. Namely, we study three circuit models: monotone OR-circuits, monotone SUM-circuits (addition of non-negative integers), and non-monotone XOR-circuits (addition modulo 2). Our focus is on separating OR-circuits from the two other models in terms of circuit complexity: We show how to obtain matrices that admit OR-circuits of size O(n), but require SUM-circuits of size Ω(n3/2/log2n).We consider the task of rewriting a given OR-circuit as a XOR-circuit and prove that any subquadratic-time algorithm for this task violates the strong exponential time hypothesis.

Independent factors predicting early lower limb intra-arterial thrombolysis failure.

BACKGROUND: Risk factors for early catheter-directed intra-arterial thrombolysis failure in acute lower limb ischemia remain unclear. METHODS: One hundred forty-nine limbs with acute artery or bypass graft thrombosis underwent catheter-directed thrombolysis (maximum of 48 hours). A retrospective data analysis was carried out to assess possible risk factors for early, 30-day treatment failure. RESULTS: Seventy-nine men (53%) and 70 women (47%) with a median age of 70 (range 32-93) years were treated. Treatment outcomes were determined as success (N = 115, 77%) or failure (N = 34, 23%). The failure criteria comprised rapid progression of ischemia (N = 4, 2.7%) and major bleeding complications (N = 2, 1.3%), both requiring thrombolysis termination and surgery. Inability to reopen native arteries/grafts (N = 10, 6.7%), run-off vessels (N = 10, 6.7%), in-hospital death (N = 4, 2.7%), the need for major amputation (N = 13, 8.7%), and reocclusions (N = 5, 3.4%) within the 30-day follow-up period were also considered as failures. Multivariate analysis of the risk factors' impact on the success of thrombolysis revealed such independent parameters as hypercholesterolemia (OR 0.16, 95% CI 0.06-0.42, P < 0.0001), previous bypass grafting of the ipsilateral limb (OR 0.18, 95% CI 0.06-0.53, P = 0.002), and duration of ischemia prior to the initiation of thrombolysis (OR 0.95, 95% CI 0.91-0.99, P = 0.009, per day). CONCLUSION: According to our results, factors independently predicting early failure include hypercholesterolemia, previous bypass grafting, and a delay in treatment initiation. Moreover, catheter-directed intra-arterial thrombolysis can be considered safe and effective in the treatment of acute lower limb ischemia.

[Obstetric and gynecologic embolizations]. / Obstetriset ja gynekologiset embolisaatiot: synnytyksenjälkeisen verenvuodon tukkimisesta myoomaembolisaatioon.

Postpartum embolization to decrease the maternal mortality rate and postpartum hysterectomies. An interventional radiologist performs the embolization at the obstetrician's request, when conventional means have failed to stop the bleeding. This will efficiently stop the bleeding. Fertility appears to remain normal after embolization. Embolization of uterine arteries is also utilized for the treatment of symptomatic myomas in patients, who do not wish to become pregnant. After the embolization the myomas will gradually shrink within months. The procedure has been found to be safe.

Effects of combined strength and endurance training on treadmill load carrying walking performance in aging men.

The present study examined the effects of twice weekly total body strength training (ST), endurance cycling (ET), and combined ST and ET (2+2 times a week) (SET) training on the load carrying walking test performance on the treadmill (TM) and changes in neuromuscular and endurance performance during a 21-week training period in aging men. Forty healthy men (54.8+/-8.0 years) were divided into 3 training groups (ET n=9, ST n=11, SET n=11) and a control group (C, n=9). Peak oxygen uptake (VO2peak), heart rate, and blood lactate concentration were measured before and after a 21-week training program using a graded TM and maximal incremental bicycle ergometer (BE) tests. Isometric forces, vertical jump, and electromyographic activity of leg extensor and/or forearm flexor (F) muscles were measured before and after training and the TM tests. Increases of 20-21% in strength and of 7-12% in cycling BE VO2peak occurred in the training groups, whereas the changes of C remained minor. VO2peak was associated, both before and after training, with TM exercise time in all groups (from r=0.65, p=0.030 to r=0.93, p<0.001). Only SET showed a significant training-induced increase (p=0.011) in exercise time of the TM walking with no significant increase in TM VO2peak. The present data suggest that in older men ET and SET induced specific increases in BE VO2peak and ST and SET in strength. However, only SET increased walking exercise time indicating improved load carrying walking performance because of large individual differences in the magnitude of the development of either strength or endurance capacities.

MOODS: fast search for position weight matrix matches in DNA sequences.

UNLABELLED: MOODS (MOtif Occurrence Detection Suite) is a software package for matching position weight matrices against DNA sequences. MOODS implements state-of-the-art online matching algorithms, achieving considerably faster scanning speed than with a simple brute-force search. MOODS is written in C++, with bindings for the popular BioPerl and Biopython toolkits. It can easily be adapted for different purposes and integrated into existing workflows. It can also be used as a C++ library. AVAILABILITY: The package with documentation and examples of usage is available at http://www.cs.helsinki.fi/group/pssmfind. The source code is also available under the terms of a GNU General Public License (GPL).

A new monitoring PAM fluorometer (MONI-PAM) to study the short- and long-term acclimation of photosystem II in field conditions.

We present and evaluate the performance of a new field monitoring PAM fluorometer (MONI-PAM) which is intended for short- and long-term monitoring of the acclimation of photosystem II (PSII). The instrument measures chlorophyll fluorescence, photosynthetic photon flux density (PPFD), and temperature in the field, and monitors exactly the same leaf area over prolonged periods of time, facilitating the estimation of both rapidly reversible and sustained non-photochemical quenching (NPQ). The MONI-PAM performance is evaluated in the lab and under natural conditions in a Scots pine canopy during spring recovery of photosynthesis. The instrument provides a new tool to study in detail the acclimation of PSII to the environment under natural field conditions.