Heart rate dynamics and asymmetry during sympathetic activity stimulation and post-stimulation recovery in ski mountaineers-a pilot exploratory study.

There is a lack of studies on non-linear heart rate (HR) variability in athletes. We aimed to assess the usefulness of short-term HR dynamics and asymmetry parameters to evaluate the neural modulation of cardiac activity based on non-stationary RR interval series by studying their changes during sympathetic nervous system activity stimulation (isometric handgrip test) and post-stimulation recovery in professional ski mountaineers. The correlation between the changes in the parameters and the respiratory rate (RespRate) and also the duration of the career was analyzed. Short-term (5 min) and ultra-short-term (1 min) rates of patterns with no variations (0V), number of acceleration runs of length 1 (AR1), and short-term Porta's Index were greater, whereas Guzik's Index (GI) was smaller during sympathetic stimulation compared to rest. GI increased and the number of AR1 decreased during recovery. Greater increases in GI and RMSSD were associated with greater decreases in RespRate during recovery. Greater increases in RespRate from rest to short-term sympathetic stimulation were associated with greater increases in 0V (Max-min method) and AR1 but also with greater decreases in decelerations of short-term variance and accelerations and decelerations of long-term variance. Greater increases in 0V (Max-min method) and number of AR1 during sympathetic stimulation were associated with a shorter career duration. Greater decreases in these parameters during recovery were associated with a longer career duration. Changes in measures of HR dynamics and asymmetry, calculated based on short-term non-stationary RRi time series induced by sympathetic stimulation and post-stimulation recovery, reflected sympathovagal shift and were associated with condition-related alterations in RespRate and career duration in athletes who practice ski mountaineering.

Prediction of peak oxygen consumption using cardiorespiratory parameters from warmup and submaximal stage of treadmill cardiopulmonary exercise test.

This study investigates the quality of peak oxygen consumption (VO2peak) prediction based on cardiac and respiratory parameters calculated from warmup and submaximal stages of treadmill cardiopulmonary exercise test (CPET) using machine learning (ML) techniques and assesses the importance of respiratory parameters for the prediction outcome. The database consists of the following parameters: heart rate (HR), respiratory rate (RespRate), pulmonary ventilation (VE), oxygen consumption (VO2) and carbon dioxide production (VCO2) obtained from 369 treadmill CPETs. Combinations of features calculated based on the HR, VE and RespRate time-series from different stages of CPET were used to create 11 datasets for VO2peak prediction. Thirteen ML algorithms were employed, and model performances were evaluated using cross-validation with mean absolute percentage error (MAPE), R2 score, mean absolute error (MAE), and root mean squared error (RMSE) calculated after each iteration of the validation. The results demonstrated that incorporating respiratory-based features improves the prediction of VO2peak. The best results in terms of R2 score (0.47) and RMSE (5.78) were obtained for the dataset which included both cardiac- and respiratory-based features from CPET up to 85% of age-predicted HRmax, while the best results in terms of MAPE (10.5%) and MAE (4.63) were obtained for the dataset containing cardiorespiratory features from the last 30 seconds of warmup. The study showed the potential of using ML models based on cardiorespiratory features from submaximal tests for prediction of VO2peak and highlights the importance of the monitoring of respiratory signals, enabling to include respiratory parameters into the analysis. Presented approach offers a feasible alternative to direct VO2peak measurement, especially when specialized equipment is limited or unavailable.

Evaluation of the performance of GPT-3.5 and GPT-4 on the Polish Medical Final Examination.

The study aimed to evaluate the performance of two Large Language Models (LLMs): ChatGPT (based on GPT-3.5) and GPT-4 with two temperature parameter values, on the Polish Medical Final Examination (MFE). The models were tested on three editions of the MFE from: Spring 2022, Autumn 2022, and Spring 2023 in two language versions-English and Polish. The accuracies of both models were compared and the relationships between the correctness of answers with the answer's metrics were investigated. The study demonstrated that GPT-4 outperformed GPT-3.5 in all three examinations regardless of the language used. GPT-4 achieved mean accuracies of 79.7% for both Polish and English versions, passing all MFE versions. GPT-3.5 had mean accuracies of 54.8% for Polish and 60.3% for English, passing none and 2 of 3 Polish versions for temperature parameter equal to 0 and 1 respectively while passing all English versions regardless of the temperature parameter value. GPT-4 score was mostly lower than the average score of a medical student. There was a statistically significant correlation between the correctness of the answers and the index of difficulty for both models. The overall accuracy of both models was still suboptimal and worse than the average for medical students. This emphasizes the need for further improvements in LLMs before they can be reliably deployed in medical settings. These findings suggest an increasing potential for the usage of LLMs in terms of medical education.

Validity of the Pneumonitor for RR intervals acquisition for short-term heart rate variability analysis extended with respiratory data in pediatric cardiac patients.

BACKGROUND: Breathing pattern alterations change the variability and spectral content of the RR intervals (RRi) on electrocardiogram (ECG). However, there is no method to record and control participants' breathing without influencing its natural rate and depth in heart rate variability (HRV) studies. AIM: This study aimed to assess the validity of the Pneumonitor for acquisition of short-term (5 minutes) RRi in comparison to the reference ECG method for analysis of heart rate (HR) and HRV parameters in the group of pediatric patients with cardiac disease. METHODS: Nineteen patients of both sexes participated in the study. An ECG and Pneumonitor were used to record RRi in 5-minute static rest conditions, the latter also to measure the relative tidal volume and respiratory rate. The validation comprised Student's t-test, Bland-Altman analysis, intraclass correlation coefficient, and Lin's concordance correlation. The possible impact of respiratory activity on the agreement between ECG and the Pneumonitor was also assessed. RESULTS: An acceptable agreement for the number of RRi, mean RR, hazard ratio (HR), and HRV measures calculated based on RRi acquired using the ECG and Pneumonitor was presented. There was no association between the breathing pattern and RRi agreement between devices. CONCLUSIONS: The Pneumonitor might be considered appropriate for cardiorespiratory studies in the group of pediatric cardiac patients in rest condition.

Causality in cardiorespiratory signals in pediatric cardiac patients.

Four different Granger causality-based methods - one linear and three nonlinear (Granger Causality, Kernel Granger Causality, large-scale Nonlinear Granger Causality, and Neural Network Granger Causality) were used for assessment and causal-based quantification of the respiratory sinus arrythmia (RSA) in the group of pediatric cardiac patients, based on the single-lead ECG and impedance pneumography signals (the latter as the tidal volume curve equivalent). Each method was able to detect the dependency (in terms of causal inference) between respiratory and cardiac signals. The correlations between quantified RSA and the demographic parameters were also studied, but the results differ for each method. Clinical relevance- The presented methods (among which NNGC seems to be the most valid) allow for quantification of RSA and study of dependency between tidal volume and RR intervals which may help to better understand association between respiratory and cardiovascular systems in different populations.

Reliability of Symbolic Analysis of Heart Rate Variability and Its Changes During Sympathetic Stimulation in Elite Modern Pentathlon Athletes: A Pilot Study.

Background and Purpose: Most studies on heart rate variability (HRV) in professional athletes concerned linear, time-, and frequency-domain indices, and there is lack of studies on non-linear parameters in this group. The study aimed to determine the inter-day reliability, and group-related and individual changes of short-term symbolic dynamics (SymDyn) measures during sympathetic nervous system activity (SNSa) stimulation among elite modern pentathletes. Methods: Short-term electrocardiographic recordings were performed in stable measurement conditions with a 7-day interval between tests. SNSa stimulation via isometric handgrip strength test was conducted on the second day of study. The occurrence rate of patterns without variations (0V), with one variation (1V), two like (2LV), and two unlike variations (2UV) obtained using three approaches (the Max-min, the σ, and the Equal-probability methods) were analyzed. Relative and absolute reliability were evaluated. Results: All SymDyn indices obtained using the Max-min method, 0V, and 2UV obtained using the σ method, 2UV obtained using the Equal-probability method presented acceptable inter-day reliability (the intraclass correlation coefficient between .91 and .99, Cohen's d between -.08 and .10, the within-subject coefficient of variation between 4% and 22%). 2LV, 2UV, and 0V obtained using the Max-min and σ methods significantly decreased and increased, respectively, during SNSa stimulation-such changes were noted for all athletes. There was no significant association between differences in SymDyn parameters and respiratory rate in stable conditions and while comparing stable conditions and SNSa stimulation. Conclusion: SymDyn indices may be used as reliable non-respiratory-associated parameters in laboratory settings to detect autonomic nervous system (ANS) activity modulations in elite endurance athletes. These findings provide a potential solution for addressing the confounding influence of respiration frequency on HRV-derived inferences of cardiac autonomic function. For this reason, SymDyn may prove to be preferable for field-based monitoring where measurements are unsupervised.

Granger causality test with nonlinear neural-network-based methods: Python package and simulation study.

BACKGROUND AND OBJECTIVE: Causality defined by Granger in 1969 is a widely used concept, particularly in neuroscience and economics. As there is an increasing interest in nonlinear causality research, a Python package with a neural-network-based causality analysis approach was created. It allows performing causality tests using neural networks based on Long Short-Term Memory (LSTM), Gated Recurrent Unit (GRU), or Multilayer Perceptron (MLP). The aim of this paper is to present the nonlinear method for causality analysis and the created Python package. METHODS: The created functions with the autoregressive (AR) and Generalized Radial Basis Functions (GRBF) neural network models were tested on simulated signals in two cases: with nonlinear dependency and with absence of causality from Y to X signal. The train-test split (70/30) was used. Errors obtained on the test set were compared using the Wilcoxon signed-rank test to determine the presence of the causality. For the chosen model, the proposed method of study the change of causality over time was presented. RESULTS: In the case when X was a polynomial of Y, nonlinear methods were able to detect the causality, while the AR model did not manage to indicate it. The best results (in terms of the prediction accuracy) were obtained for the MLP for the lag of 150 (MSE equal to 0.011, compared to 0.041 and 0.036 for AR and GRBF, respectively). When there was no causality between the signals, none of the proposed and AR models did indicate false causality, while it was detected by GRBF models in one case. Only the proposed models gave the expected results in each of the tested scenarios. CONCLUSIONS: The proposed method appeared to be superior to the compared methods. They were able to detect non-linear causality, make accurate forecasting and not indicate false causality. The created package enables easy usage of neural networks to study the causal relationship between signals. The neural-networks-based approach is a suitable method that allows the detection of a nonlinear causal relationship, which cannot be detected by the classical Granger method. Unlike other similar tools, the package allows for the study of changes in causality over time.