HBNET: A blended ensemble model for the detection of cardiovascular anomalies using phonocardiogram.

BACKGROUND: Cardiac diseases are highly detrimental illnesses, responsible for approximately 32% of global mortality [1]. Early diagnosis and prompt treatment can reduce deaths caused by cardiac diseases. In paediatric patients, it is challenging for paediatricians to identify functional murmurs and pathological murmurs from heart sounds. OBJECTIVE: The study intends to develop a novel blended ensemble model using hybrid deep learning models and softmax regression to classify adult, and paediatric heart sounds into five distinct classes, distinguishing itself as a groundbreaking work in this domain. Furthermore, the research aims to create a comprehensive 5-class paediatric phonocardiogram (PCG) dataset. The dataset includes two critical pathological classes, namely atrial septal defects and ventricular septal defects, along with functional murmurs, pathological and normal heart sounds. METHODS: The work proposes a blended ensemble model (HbNet-Heartbeat Network) comprising two hybrid models, CNN-BiLSTM and CNN-LSTM, as base models and Softmax regression as meta-learner. HbNet leverages the strengths of base models and improves the overall PCG classification accuracy. Mel Frequency Cepstral Coefficients (MFCC) capture the crucial audio signal characteristics relevant to the classification. The amalgamation of these two deep learning structures enhances the precision and reliability of PCG classification, leading to improved diagnostic results. RESULTS: The HbNet model exhibited excellent results with an average accuracy of 99.72% and sensitivity of 99.3% on an adult dataset, surpassing all the existing state-of-the-art works. The researchers have validated the reliability of the HbNet model by testing it on a real-time paediatric dataset. The paediatric model's accuracy is 86.5%. HbNet detected functional murmur with 100% precision. CONCLUSION: The results indicate that the HbNet model exhibits a high level of efficacy in the early detection of cardiac disorders. Results also imply that HbNet has the potential to serve as a valuable tool for the development of decision-support systems that aid medical practitioners in confirming their diagnoses. This method makes it easier for medical professionals to diagnose and initiate prompt treatment while performing preliminary auscultation and reduces unnecessary echocardiograms.

An update on understanding the pathophysiology in Kawasaki disease: Possible role of immune complexes in coronary artery lesion revisited.

Kawasaki disease (KD) is an acute self-limiting systemic vasculitis of unknown etiology affecting predominantly the coronary arteries. The role of circulating immune complexes (ICs) in the pathogenesis of KD has been studied using the sera of patients with KD. It has been proposed that ICs are triggered by single or multiple unknown causative agents as well as vasculitis. The outbreak of severe acute respiratory syndrome coronavirus 2 infections caused similar pathophysiology in producing vasculitis, and the RNA virus may have triggered signs and symptoms similar to KD. For clinicians and researchers alike, detecting the causative agents of KD remains a challenge. According to studies in animal models, type III hypersensitivity reactions caused by serum sickness are a prototype for IC vasculitis. The signs and symptoms of coronary artery dilation in swine are similar to those of KD. These models may be used to evaluate new pharmacological agents for KD. The pathogenesis of KD is complex and remains inadequately understood at present. However, circulating ICs may play a key role in the pathophysiology of KD and coronary artery vasculitis. Various therapeutic agents are being explored in the management of KD and these agents act at various stages of the production of pro-inflammatory cytokines and chemokines. In this review, we discuss recent developments in the pathogenesis of KD and provide insights into the innate immune response and mechanisms behind coronary artery damage in KD. We specifically explore the potential role of ICs in the pathogenesis of KD.

Analysis of Carbon Formation on Machined Leather Specimen Using FTIR Technique in Laser Diode Assisted Cutting Process.

The leather materials are used in a multitude of sectors, including footwear, apparel, handicrafts, and the automotive industry. Due to the radiant heat generated by a laser beam, the laser cutting of leather results in a carbonized cut edge. There is currently no technology available for measuring the carbonization along the contour edges of leather. The purpose of this experimental investigation was to determine the impact of power diode-based laser cutting on the carbonization of machined buffalo leather with the help of a digital microscope to improve the machining process. The ATR-FTIR spectrum was used to analyze the carbon-related functional group in the mid-IR spectrum of carbonized leather samples. It was found that the proposed method can measure the amount of carbon deposition in the cutting zone. The lower amplitude duty cycle with higher feed rate can reduce carbon formation owing to the lower thermal energy distribution. The amplitude (4.5 V), duty cycle (70%) and feed rate (90 mm/s) can produce optimal performance measures.

Role of Antioxidants in Horse Serum-mediated Vasculitis in Swine: Potential Relevance to Early Treatment in Mitigation of Coronary Arteritis in Kawasaki Disease.

BACKGROUND: Horse serum-induced immune complex coronary vasculitis in swine is the first experimental model to mimic most of the pictures of Kawasaki disease. Immune complex mechanism has been implicated as one of the possible mechanisms in the pathogenesis of vasculitis in Kawasaki disease. Antioxidants have a significant role in the reduction of cardiovascular diseases in both human and animal studies. We tried giving vitamins A, E, and C to treat immune complex vasculitis, in the hope of mitigating coronary vasculitis in Kawasaki disease. METHODS: Our study group consisted of 30 pure bred male piglets of 2-3 months of age, and they were divided into test and control groups. The test (AEC) group (n = 20) received two doses of horse serum, 10 mL (0.65 g protein)/kg body weight at 5-day intervals, and oral vitamins A, E, and C once daily for 14 days. The control group (n = 10) was further divided into the saline group (n = 3) receiving two doses of normal saline and the horse serum group (n = 7) receiving two doses of horse serum at 5-day intervals. Piglets were observed for the rashes and coronary artery dimensions. RESULTS: Both the AEC and the control horse serum group developed rashes after horse serum infusions, but the AEC group developed significantly fewer rashes, and no rashes were seen in the saline group. The control horse serum group (mean ± standard deviation = 2.13 ± 0.72) showed significant coronary artery dilatation, whereas there was no significant dilatation in the AEC group (mean ± standard deviation = 0.81 ± 0.58) or the control saline group (p = 0.002). CONCLUSION: Serum sickness is a prototype of immune complex vasculitis, and the severity can be ameliorated with antioxidants. A trial of therapeutic dosages of vitamins A, E, and C in acute phase of Kawasaki disease, may be effective in mitigation of coronary artery lesion in addition to intravenous immunoglobulin and aspirin.

Prenatal Diagnosis of Uhl Anomaly with Autopsy Correlation.

Uhl anomaly is a rare form of congenital hypoplasia of the right ventricular myocardium. Here, we report, a rare finding in fetal cardiac ultrasound in a 33-year-old woman who presented at 20 weeks' of gestation. A diagnosis of Uhl anomaly was made. An autopsy was performed at 23weeks gestation after obtaining permission for medicolegal termination of pregnancy. Histopathological examination confirmed the diagnosis. Diagnosing Uhl anomaly in fetal life is essential since mortality and survival mainly depend on the severity of right ventricle dysfunction related to, the either partial or complete absence of the myocardium. Hence, surviving cases need to be followed up carefully and counselled accordingly.

Histopathological evaluation of horse serum-induced immune complex vasculitis in swine: implication to coronary artery lesions in Kawasaki disease.

BACKGROUND: Immune complex (IC) vasculitis can be experimentally induced in animal models by intravenous injection of horse serum (HS), and the findings of HS-induced IC vasculitis in swine were very similar to that of Kawasaki disease (KD). The IC mechanism may be involved in the pathogenesis of vasculitis in KD. Here, we studied the two-dimensional (2D) echocardiographic and histopathological findings of acute, subacute, and healing phases of vasculitis induced by two different types of HS, and the reproducibility of IC vasculitis in swine. METHODS AND RESULTS: Our study group consisted of 24 pure-bred landrace male piglets of 1.5-3 months of age. They were divided into three HS groups (n = 17), namely, Group A (n = 8) receiving gamma globulin-free HS, and Group B (n = 6) receiving donor herd HS, three doses at 5-day intervals, and Group C (n = 3) that received only one dose of donor herd HS on Day 1, and the saline group (n = 7) that received three doses of intravenous normal saline (NS) at 5-day intervals. The 2D echocardiography was performed every 3-4 days, and all piglets were killed for histopathological studies at different dates from Days 2 to Day 60. All the HS groups developed rashes and demonstrated significant dilation (54-150%) of coronary arteries in Groups A and B; when compared (p < 0.02) with 9-53% dilation in Group C and the saline group. Histopathological changes of test groups were asymmetric coronary vasculitis in various stages, whereas none of the piglets in the control group developed vasculitis. No significant difference in the echocardiographic and histopathological findings was observed among the piglets that received two types of HS. CONCLUSION: HS can induce IC vasculitis in swine. The rashes and 2D echocardiographic and histopathological studies of the acute to healing phases showed close similarities with KD, and it is concluded that swine may serve as a unique experimental model for IC vasculitis and for various therapeutic trials.

Right ventricular exclusion and univentricular palliation for failed one and a half ventricle repair for Ebstein's anomaly.

A 20 year-old male was diagnosed to have Ebstein's anomaly with severe right ventricular dysfunction. He was taken up for 1.5 ventricle repair. Post procedure, there was difficulty in weaning from cardiopulmonary bypass due to progressive right ventricular dilatation compromising the systemic output. An atrial septectomy did not help. Progressive right ventricular dilatation compressing the left ventricle, demonstrated on transoesophageal echocardiogram, prompted us to perform a right ventricular exclusion and univentricular palliation. The patient was successfully weaned off cardiopulmonary bypass and had a smooth postoperative recovery. Judicious use of right ventricular exclusion and univentricular palliation could be an effective bailout strategy in difficult surgical scenarios in Ebstein's anomaly.

Left ventricular false tendons: echocardiographic, morphologic, and histopathologic studies and review of the literature.

BACKGROUND: Left ventricular false tendons (LVFTs) are fibrous or fibromuscular bands stretching across the left ventricle (LV) from the ventricular septum to the papillary muscle or LV free wall but not connecting, like the chordae tendinae, to the mitral leaflet. LVFTs have become the focus of studies and discussions since the advent of echocardiography. MATERIALS AND METHODS: We prospectively studied the prevalence of LVFTs by two-dimensional echocardiography in 476 infants and children referred to our institute for cardiac evaluation and cardiology workup. We also studied the morphology and histopathology of LVFTs in 68 congenital heart disease specimens and in 20 piglet hearts. The literature was reviewed and the clinical significance of LVFTs was discussed. RESULTS: LVFTs of varying size and different location were detected in 371 (77.9%) of 476 infants and children studied, in 42 (61.8%) of 68 congenital heart disease specimens, and in 19 (95.0%) of 20 piglet hearts. Of the 75 LVFTs from the congenital heart disease specimens, 33 (44.4%) were fibrous type, measuring less than 1.4mm; 38 (50.7%) were fibromuscular type, 1.5-2.4mm; and 4 (5.3%) were muscular type, 2.5mm or more in diameter. Of the 33 LVFTs from the piglet hearts, 23 (69.7%) and 10 (30.3%) were fibrous and fibromuscular, respectively, and none (0.0%) was muscular. CONCLUSIONS: LVFTs were detected partially or completely by modified two-dimensional echocardiography in both normal and abnormal hearts. LVFTs is a useful anatomical landmark of LV for the differentiation of morphological LV and right ventricle in segmental analysis of congenital heart disease. LVFTs are a cause of functional murmur. No pressure gradient was noted in the mid-LV or outflow tract. LVFTs could be a contributory factor in the generation of dysrhythmias during LV catheterization studies. LVFTs were more easily identifiable in neonates and young age patients because of a better delineation of images in echocardiography.

Surveillance of Kawasaki disease in Taiwan and review of the literature.

BACKGROUND: Kawasaki disease affects mainly children younger than five years, leading to coronary artery lesions, even to life-threatening myocardial infarctions. Since 1976, Kawasaki disease has occurred in thousands of children in Taiwan; some of them died. METHODS: Questionnaire forms for the survey of epidemiological features of Kawasaki disease were designed and sent to the hospitals of 100 or more beds in Taiwan, in 1987, 1992, 1994, and 2001, for retrospective reviews of their patients with Kawasaki disease encountered during 1976-2000. A school-based mass survey, on the prevalence of children with history of Kawasaki disease was conducted every year from 1990 to 2000. RESULTS: Since 1976, the number of Kawasaki disease patients increased, totaling to 8,267 patients in 2000. The ratio of the incidence increased by 1.15 times annually (Poisson regression), reaching the highest incidence of 54.9 per 100,000 children <5 years of age in 1998. Of them, 85.1% were under 5 years of age. The male-to-female ratio was 1.6. Coronary artery lesions were noted during acute, subacute and convalescent stages in 25.8% of the patients. The fatality rate decreased from 0.4% to 0.06%. There was no student with history of Kawasaki disease among students surveyed in 1990. Subsequent school surveys showed the prevalence was 24.6 in 1991, 74.6 in 1996, then reached to 103.9 per 100,000 school children in 2000, with an annual increase of 1.24 times (Poisson regression). CONCLUSIONS: In Taiwan, Kawasaki disease, first diagnosed in 1976, continued to occur with several outbreaks reaching to a peak incidence of 54.9 per 100,000 population less than 5 years of age in 1998. Epidemiological features of Kawasaki disease in Taiwan were similar to the Japanese experiences and the incidence was, next only to Japan, the second highest in the world.

A swine model of horse serum-induced coronary vasculitis: an implication for Kawasaki disease.

An attempt was made to induce immune complex vasculitis by horse serum (HS) infusions in piglets, hoping to produce experimental coronary artery lesions that mimic Kawasaki disease. A total of 21 purebred male piglets of 1.5, 2.5, and 3 mo were divided into HS (n = 14) and control, normal saline (NS; n = 7) groups. In seven piglets, 5 mL/kg of HS was infused, then repeated with 10 mL/kg 10 d later. In another seven piglets, 10 mL/kg of HS was infused three times at 5-d intervals. In three piglets in the control group, 5 and 10 mL/kg of NS was infused at 10-d intervals. In another four piglets of the control group, 10 mL/kg of NS was infused three times at 5-d intervals. Two-dimensional echocardiographic examinations for visualization and measurement of the coronary arteries were done before and after infusions at 4- to 5-d interval. Hematology examination showed that white blood cells and platelets decreased, then increased. The animals were killed at 14-60 d after the first infusion of HS or NS, for histopathologic and immunohistochemical studies. All HS groups developed skin rashes and echocardiographic evidence of coronary artery dilation and histopathologic changes of vasculitis. None in the NS group developed vasculitis. The main changes of the coronary vasculitis were intimal proliferation, smooth muscle cell necrosis, and vacuolization changes. Those that received three HS infusions developed more skin rashes than those that received two infusions. It is concluded that piglets may serve as an experimental model for immune complex vasculitis involving the coronary arteries with skin rashes mimicking Kawasaki disease.