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Cells Mar 2023The nervous system is the primary target for lead exposure and the developing brain appears to be especially susceptible, namely the hippocampus. The mechanisms of lead...
The nervous system is the primary target for lead exposure and the developing brain appears to be especially susceptible, namely the hippocampus. The mechanisms of lead neurotoxicity remain unclear, but microgliosis and astrogliosis are potential candidates, leading to an inflammatory cascade and interrupting the pathways involved in hippocampal functions. Moreover, these molecular changes can be impactful as they may contribute to the pathophysiology of behavioral deficits and cardiovascular complications observed in chronic lead exposure. Nevertheless, the health effects and the underlying influence mechanism of intermittent lead exposure in the nervous and cardiovascular systems are still vague. Thus, we used a rat model of intermittent lead exposure to determine the systemic effects of lead and on microglial and astroglial activation in the hippocampal dentate gyrus throughout time. In this study, the intermittent group was exposed to lead from the fetal period until 12 weeks of age, no exposure (tap water) until 20 weeks, and a second exposure from 20 to 28 weeks of age. A control group (without lead exposure) matched in age and sex was used. At 12, 20 and 28 weeks of age, both groups were submitted to a physiological and behavioral evaluation. Behavioral tests were performed for the assessment of anxiety-like behavior and locomotor activity (open-field test), and memory (novel object recognition test). In the physiological evaluation, in an acute experiment, blood pressure, electrocardiogram, and heart and respiratory rates were recorded, and autonomic reflexes were evaluated. The expression of GFAP, Iba-1, NeuN and Synaptophysin in the hippocampal dentate gyrus was assessed. Intermittent lead exposure induced microgliosis and astrogliosis in the hippocampus of rats and changes in behavioral and cardiovascular function. We identified increases in GFAP and Iba1 markers together with presynaptic dysfunction in the hippocampus, concomitant with behavioral changes. This type of exposure produced significant long-term memory dysfunction. Regarding physiological changes, hypertension, tachypnea, baroreceptor reflex impairment and increased chemoreceptor reflex sensitivity were observed. In conclusion, the present study demonstrated the potential of lead intermittent exposure inducing reactive astrogliosis and microgliosis, along with a presynaptic loss that was accompanied by alterations of homeostatic mechanisms. This suggests that chronic neuroinflammation promoted by intermittent lead exposure since fetal period may increase the susceptibility to adverse events in individuals with pre-existing cardiovascular disease and/or in the elderly.
Topics: Rats; Animals; Lead; Neuroinflammatory Diseases; Gliosis; Hippocampus; Hypertension
PubMed: 36899953
DOI: 10.3390/cells12050818 -
Scientific Reports Jan 2021Electrocardiogram (ECG)-based intelligent screening for systolic heart failure (HF) is an emerging method that could become a low-cost and rapid screening tool for early...
Electrocardiogram (ECG)-based intelligent screening for systolic heart failure (HF) is an emerging method that could become a low-cost and rapid screening tool for early diagnosis of the disease before the comprehensive echocardiographic procedure. We collected 12-lead ECG signals from 900 systolic HF patients (ejection fraction, EF < 50%) and 900 individuals with normal EF in the absence of HF symptoms. The 12-lead ECG signals were converted by continuous wavelet transform (CWT) to 2D spectra and classified using a 2D convolutional neural network (CNN). The 2D CWT spectra of 12-lead ECG signals were trained separately in 12 identical 2D-CNN models. The 12-lead classification results of the 2D-CNN model revealed that Lead V6 had the highest accuracy (0.93), sensitivity (0.97), specificity (0.89), and f1 scores (0.94) in the testing dataset. We designed four comprehensive scoring methods to integrate the 12-lead classification results into a key diagnostic index. The highest quality result among these four methods was obtained when Leads V5 and V6 of the 12-lead ECG signals were combined. Our new 12-lead ECG signal-based intelligent screening method using straightforward combination of ECG leads provides a fast and accurate approach for pre-screening for systolic HF.
Topics: Algorithms; Electrocardiography; Heart Failure, Systolic; Humans; Neural Networks, Computer; Sensitivity and Specificity; Taiwan; Wavelet Analysis
PubMed: 33479367
DOI: 10.1038/s41598-021-81374-6 -
Journal of Interventional Cardiology Feb 2009The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since... (Review)
Review
The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory.
Topics: Cardiovascular Diseases; Catheter Ablation; Electrocardiography; Humans; Monitoring, Intraoperative; Myocardial Ischemia
PubMed: 19141091
DOI: 10.1111/j.1540-8183.2008.00419.x -
The Western Journal of Emergency... May 2018In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital... (Review)
Review
INTRODUCTION
In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.
METHODS
We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.
RESULTS
Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.
CONCLUSION
Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.
Topics: Blood Glucose; California; Electrocardiography; Emergency Medical Services; Evidence-Based Practice; Humans; Opioid-Related Disorders; Stroke
PubMed: 29760852
DOI: 10.5811/westjem.2018.1.36559 -
Biomedical Engineering Online Aug 2015During last decade the use of ECG recordings in biometric recognition studies has increased. ECG characteristics made it suitable for subject identification: it is... (Review)
Review
BACKGROUND
During last decade the use of ECG recordings in biometric recognition studies has increased. ECG characteristics made it suitable for subject identification: it is unique, present in all living individuals, and hard to forge. However, in spite of the great number of approaches found in literature, no agreement exists on the most appropriate methodology. This study aimed at providing a survey of the techniques used so far in ECG-based human identification. Specifically, a pattern recognition perspective is here proposed providing a unifying framework to appreciate previous studies and, hopefully, guide future research.
METHODS
We searched for papers on the subject from the earliest available date using relevant electronic databases (Medline, IEEEXplore, Scopus, and Web of Knowledge). The following terms were used in different combinations: electrocardiogram, ECG, human identification, biometric, authentication and individual variability. The electronic sources were last searched on 1st March 2015. In our selection we included published research on peer-reviewed journals, books chapters and conferences proceedings. The search was performed for English language documents.
RESULTS
100 pertinent papers were found. Number of subjects involved in the journal studies ranges from 10 to 502, age from 16 to 86, male and female subjects are generally present. Number of analysed leads varies as well as the recording conditions. Identification performance differs widely as well as verification rate. Many studies refer to publicly available databases (Physionet ECG databases repository) while others rely on proprietary recordings making difficult them to compare. As a measure of overall accuracy we computed a weighted average of the identification rate and equal error rate in authentication scenarios. Identification rate resulted equal to 94.95 % while the equal error rate equal to 0.92 %.
CONCLUSIONS
Biometric recognition is a mature field of research. Nevertheless, the use of physiological signals features, such as the ECG traits, needs further improvements. ECG features have the potential to be used in daily activities such as access control and patient handling as well as in wearable electronics applications. However, some barriers still limit its growth. Further analysis should be addressed on the use of single lead recordings and the study of features which are not dependent on the recording sites (e.g. fingers, hand palms). Moreover, it is expected that new techniques will be developed using fiducials and non-fiducial based features in order to catch the best of both approaches. ECG recognition in pathological subjects is also worth of additional investigations.
Topics: Biometric Identification; Electrocardiography; Humans; Signal Processing, Computer-Assisted; Statistics as Topic
PubMed: 26272456
DOI: 10.1186/s12938-015-0072-y -
Journal of the American College of... Aug 1987The three principal forms of medical electrocardiography are the standard 12 lead electrocardiogram (ECG), the exercise ECG and the long-term ambulatory ECG. The volume...
The three principal forms of medical electrocardiography are the standard 12 lead electrocardiogram (ECG), the exercise ECG and the long-term ambulatory ECG. The volume of use of the 12 lead ECG is 10 to 20 times greater than that of the exercise test or the ambulatory test, and it has received correspondingly more developmental and marketing attention. A great increase in the rate of adoption of computerized electrocardiography was brought about when large scale integration of computer hardware made it possible to place the entire computational package within a standard-sized ECG cart. Exercise ECG testing involves processing a data sample minutes in duration. Only a very few diagnostic possibilities are examined; emphasis is on measurements of the ST segment and on non-ECG observations. Ambulatory electrocardiography currently involves only one or two ECG leads and these are tested for only a few diagnostic possibilities; however, duration of the data sample is relatively long, usually 24 hours. Computer processing involves examination of about 100,000 cardiac cycles for RR interval, QRS shape and ST segment deviation.
Topics: Adult; Arrhythmias, Cardiac; Child; Diagnosis, Computer-Assisted; Electrocardiography; Exercise Test; Humans; Middle Aged; Monitoring, Physiologic; Quality Control
PubMed: 3298364
DOI: 10.1016/s0735-1097(87)80031-1 -
Scientific Reports Mar 2023Various efforts have been made to diagnose acute cardiovascular diseases (CVDs) early in patients. However, the sole option currently is symptom education. It may be...
Various efforts have been made to diagnose acute cardiovascular diseases (CVDs) early in patients. However, the sole option currently is symptom education. It may be possible for the patient to obtain an early 12-lead electrocardiogram (ECG) before the first medical contact (FMC), which could decrease the physical contact between patients and medical staff. Thus, we aimed to verify whether laypersons can obtain a 12-lead ECG in an off-site setting for clinical treatment and diagnosis using a patch-type wireless 12-lead ECG (PWECG). Participants who were ≥ 19 years old and under outpatient cardiology treatment were enrolled in this simulation-based one-arm interventional study. We confirmed that participants, regardless of age and education level, can use the PWECG on their own. The median age of the participants was 59 years (interquartile range [IQR] = 56-62 years), and the median duration to obtain a 12-lead ECG result was 179 s (IQR = 148-221 s). With appropriate education and guidance, it is possible for a layperson to obtain a 12-lead ECG, minimizing the contact with a healthcare provider. These results can be used subsequently for treatment.
Topics: Humans; Middle Aged; Young Adult; Adult; Feasibility Studies; Electrocardiography
PubMed: 36899040
DOI: 10.1038/s41598-023-31309-0 -
European Heart Journal. Acute... Mar 2014Currently, there are no specific diagnostic electrocardiogram (ECG) signs for Takotsubo syndrome (TTS) to differentiate it from acute coronary syndromes (ACS).... (Review)
Review
BACKGROUND AND OBJECTIVES
Currently, there are no specific diagnostic electrocardiogram (ECG) signs for Takotsubo syndrome (TTS) to differentiate it from acute coronary syndromes (ACS). Myocardial oedema has been detected by cardiac magnetic resonance imaging in patients with TTS. Recently it has been postulated that myocardial oedema may be the cause of low QRS voltage (LQRSV) in the admission ECG and attenuation of the amplitude of the QRS complexes (AAQRS) in serial ECGs, noted in a few published cases of patients with TTS. The objective of this study was to evaluate whether the admission ECG of patients with documented TTS reveals LQRSV and whether AAQRS is found when serial ECGs are compared in such patients.
METHODS
This study evaluated the prevalence of LQRSV in the admission ECG and AAQRS in serial ECGs in patients with TTS. ECGs of 368 patients with TTS from published reports in the international literature were evaluated for LQRSV (≤5 mm in limb leads and/or ≤10 mm in precordial leads) and AAQRS in serial ECGs.
RESULTS
LQRSV was seen in 91.5% of 200 patients with TTS and one ECG, with a distribution of 49.0, 42.8, 51.0, 52.0, and 46.9%, in lead aVR, and inferior, anterior, lateral, and high lateral ECG lead groups, respectively. AAQRS was seen in 93.5% of 168 patients with TTS and two or more ECGs, with a distribution of 78.3, 74.5, 60.1, 70.7, and 74.5% in lead aVR, and inferior, anterior, lateral, and high lateral ECG lead groups, respectively.
CONCLUSIONS
LQRSV and AAQRS are highly prevalent ECG signs in patients with TTS, and should be useful in aiding in its diagnosis and differentiation from ACS, on first contact with the patient on admission to the hospital, and the ensuing 24 hours, in conjunction with echocardiography and coronary arteriography.
Topics: Acute Coronary Syndrome; Diagnosis, Differential; Electrocardiography; Humans; Magnetic Resonance Imaging, Cine; Reproducibility of Results; Takotsubo Cardiomyopathy
PubMed: 24562801
DOI: 10.1177/2048872613504311 -
Annals of Noninvasive Electrocardiology... Jul 2011Lead aVR is the only lead in the surface ECG that does not face the "typically" relevant walls of the left ventricle. Historically, its value has been neglected most... (Review)
Review
Lead aVR is the only lead in the surface ECG that does not face the "typically" relevant walls of the left ventricle. Historically, its value has been neglected most likely due to its unusual configuration and direction, which appeared to have little correlation with other more congruous and easily diagnostic frontal leads. The isolation of the unipolar leads in the Standard surface ECG presentation may also have played an important role. Even with this "unfair" neglect, we know nowadays that it is very sensitive to locate obstructed epicardial coronary arteries. Besides helping distinguishing the culprit lesion of an infarct, lead aVR also helps recognizing other conditions that could be of clinical significance such as pericarditis, Brugada syndrome, fascicular blocks of the right branch, ectopic left atrial rhythms, etc. The purpose of this review is to revise the clinical value of lead aVR in the recognition of frequent and not so frequent clinical conditions.
Topics: Arm; Diagnosis, Differential; Electrocardiography; Heart Diseases; Humans
PubMed: 21762258
DOI: 10.1111/j.1542-474X.2011.00435.x -
Sensors (Basel, Switzerland) Feb 2023Smartwatches that support the recording of a single-lead electrocardiogram (ECG) are increasingly being used beyond the wrist, by placement on the ankle and on the...
Smartwatches that support the recording of a single-lead electrocardiogram (ECG) are increasingly being used beyond the wrist, by placement on the ankle and on the chest. However, the reliability of frontal and precordial ECGs other than lead I is unknown. This clinical validation study assessed the reliability of an Apple Watch (AW) to obtain conventional frontal and precordial leads as compared to standard 12-lead ECGs in both subjects without known cardiac anomalies and patients with underlying heart disease. In 200 subjects (67% with ECG anomalies), a standard 12-lead ECG was performed, followed by AW recordings of the standard Einthoven leads (leads I, II, and III) and precordial leads V1, V3, and V6. Seven parameters (P, QRS, ST, and T-wave amplitudes, PR, QRS, and QT intervals) were compared through a Bland-Altman analysis, including the bias, absolute offset, and 95% limits of agreement. AW-ECGs recorded on the wrist but also beyond the wrist had similar durations and amplitudes compared to standard 12-lead ECGs. Significantly greater amplitudes were measured by the AW for R-waves in precordial leads V1, V3, and V6 (+0.094 mV, +0.149 mV, +0.129 mV, respectively, all < 0.001), indicating a positive bias for the AW. AW can be used to record frontal, and precordial ECG leads, paving the way for broader clinical applications.
Topics: Humans; Reproducibility of Results; Electrocardiography; Arrhythmias, Cardiac; Heart Diseases; Thorax
PubMed: 36904759
DOI: 10.3390/s23052555