This paper introduces a free and publicly open ICU database: multi-parameter intelligent monitoring in intensive care II: MIMIC-II, which has been built up and maintained by the laboratory of computational physiology at the Massachusetts Institute Technology, Beth Israel Deaconess Medical Center and Philips Healthcare over the past decade. This paper briefly introduces its infrastructure, implementation and applications in clinical studies. Clinical study pertaining to circadian variation in heart rate and blood pressure during sepsis is shown as a typical example of research performed with MIMIC-II. In this study, it was found there was significant difference in circadian variation in both heart rate and blood pressure between survival and non-survival groups in septic patients. This study tackled several important techniques necessary for the investigation of the circadian rhythm.
Blood Pressure ; Circadian Rhythm ; Critical Care ; Data Mining ; Databases, Factual ; Heart Rate ; Humans ; Medical Informatics

In comparison with the measurement of heart rate variability from ECG and from photoplethysmographic signal from 46 healthy adults in their spontaneous breathing state. The beat-to-beat intervals in ECG and pulse-to-pulse intervals in photoplethysmographic signal are extracted, and then the parameters of heart rate variability are calculated. Three kinds of algorithms are chosen to get the pulse-to-pulse intervals, which are the intervals of maximum of second derivative, the maximum of PPG signal and the tangent intersection. The results show that the correlation coefficients of the HRV parameters in the two calculation methods are highly correlated. The Bland-Altman scattered plots show the relative bias results from the algorithm of the maximum of PPG signal are smallest and singular points that deviate from the consistent limits are the least compared with the other two algorithms.
Adult ; Algorithms ; Electrocardiography ; Heart Rate ; Humans ; Photoplethysmography ; Reproducibility of Results

To investigate the effect of stepwise paced breathing (PB) on pulse transit time (PTT), we collected physiological signals of electrocardiogram (ECG), respiration and arterial pulse wave during a procedure of stepwise PB, which consists of 6 different breathing rates changing in a protocol of 14.0-12.5-11.0-9.5-8.0-7.0 breath per minute (BPM), with each breathing rate lasting 3 minutes. Twenty two healthy adults involved in this experiment and the change of PTT was analyzed during the stepwise PB procedure. In our study, the PTT was measured by calculating the time interval from the R-spike of the ECG to the peaks of the second derivative of the arterial pulse wave. Ensemble empirical mode decomposition (EEMD) was applied to PTT to decompose the signal into different intrinsic mode function, and respiratory oscillation and trend component (baseline) in PTT were further extracted. It was found that the respiratory oscillations in the PTT increased with decreasing of the PB rate, and many of the subjects (14 out of 22) showed the phenomena of PTT baseline increasing during the stepwise PB procedure. The results indicated that the stepwise PB procedure induced a high level of cardiovascular oscillation and produced an accumulative effect of PTT baseline increase. As PTT is capable of predicting changes in BP over a short period of time, increase of PTT baseline indicates the decrease of blood pressure. The experiments showed that the stepwise PB procedure could reduce blood pressure for most subjects. For future work, it is necessary to develop certain indices differentiating the effectiveness of the stepwise PB procedure on the PTT baseline change, and to test the effectiveness of this stepwise PB procedure on blood pressure reduction for patients with essential hypertension.
Adult ; Blood Pressure ; Blood Pressure Determination ; Electrocardiography ; Essential Hypertension ; Humans ; Hypertension ; Pulse Wave Analysis ; Respiration ; Respiratory Rate

Heart rate variability (HRV) analysis technology based on an autoregressive (AR) model is widely used in the assessment of autonomic nervous system function. The order of AR models has important influence on the accuracy of HRV analysis. This article presents a method to determine the optimum order of AR models. After acquiring the ECG signal of 46 healthy adults in their natural breathing state and extracting the beat-to-beat intervals (RRI) in the ECG, we used two criteria, i. e. final prediction error (FPE) criterion to estimate the optimum model order for AR models, and prediction error whiteness test to decide the reliability of the model. We compared the frequency domain parameters including total power, power in high frequency (HF), power in low frequency (LF), LF power in normalized units and ratio of LF/HF of our HRV analysis to the results of Kubios-HRV. The results showed that the correlation coefficients of the five parameters between our methods and Kubios-HRV were greater than 0.95, and the Bland-Altman plot of the parameters was in the consistent band. The results indicate that the optimization algorithm of HRV analysis based on AR models proposed in this paper can obtain accurate results, and the results of this algorithm has good coherence with those of the Kubios-HRV software in HRV analysis.
Adult ; Autonomic Nervous System ; Electrocardiography ; Heart Rate ; Humans ; Models, Cardiovascular ; Reproducibility of Results ; Software

To investigate the effects of fluoride on the expression of thyroglobulin (TG),thyroid peroxidase(TPO),odium iodide symporter (NIS) genes in FRTL cells,FRTL cells cultured in vitro were treated in logarithmic phase with sodium fluoride at different concentration of 20.0,10.0,5.0,2.5,1.25 mg/L,respectively.After 72 h,the cells were collected and semi-quantitative RT-PCR for TG mRNA,TPO mRNA and NIS mRNA and β-actin was performed.The results showed that compared with the control cells,the expression levels of TG gene in FRTL cells treated with lower concentration of sodium fluoride increased compensatively,but decreased significantly (P<0.05) with higher concentration(>5.0 mg/L);the RT-PCR products of TPO and NIS in FRTL cells treated with all concentration of sodium fluoride reduced,some of them were significant (P<0.05).It is concluded that fluoride can reduce the expression of TG,TPO,NIS genes in thyroid cells,conseguently cause dysfunction" of thyroid in uptaking and unilizing of iodine,and synthesizing,storing,secreting of thyroid hormones.

Objective To investigate the effects of acupuncture rehabilitation techniques combined with Xingnaojing injection on functional recovery and the plasam level of glial fibrillary acidic protein (GFAP) in patients with severe traumatic brain injury (STBI).Methods Eighty-four patients with STBI admitted to Department of Neurosurgery in Jiuquan People's Hospital from October 2013 to December 2015 were enrolled,they were divided into observation group (44 cases) and control group (40 cases) by random number table,all patients received the routine basic treatment,such as decreasing intracranial pressure,anti-infection,neural nutrition therapy,etc.In addition,the observation group was treated with acupuncture rehabilitation training (each training 50 minutes,1-2 times a day,10 times as a course of treatment,a total of 5 courses) and Xingnaojing injection (in 0.9％ normal saline or 5％ glucose injection 250 mL intravenous infusion,one time a day,10 days as a course of treatment,a total of 3 courses).The evaluation score of Montreal cognitive assessment (MoCA),Modified Barthel index (MBI),Fugl-Meyer assessment (FMA) of motor function score and the plasma levels of GFAP and myelin basic protein (MBP) were measured before and after treatment in the two groups.Results After treatment,the MoCA,MBI and FMA scores were significantly higher in two groups than those before treatment (all P ＜ 0.05),the contents of MBP and GFAP were significantly lower than those before treatment,and the changes in observation group were more significant than those in control group [visual space and execution capability (score):4.99 ± 0.67 vs.3.42 ± 0.73,denomination capability (score):2.98 ± 0.77 vs.2.84 ± 0.47,delayed memory (score):5.76± 0.33 vs.3.87± 2.08,attention (score):6.17± 0.65 vs.4.75 ± 0.81,speech capability (score):3.51 ± 0.46 vs.2.04 ± 0.13,abstract thinking capability (score):2.94 ± 0.27 vs.1.58 ± 0.96,orientation force (score):6.02±0.65 vs.4.88±0.62,FMA score:68.71 ±34.17 vs.41.13 ± 14.82,MBI score:69.12± 10.45vs.37.63±6.11,MBP (μg/L):1.32±0.23 vs.5.31±0.79,GFAP (μg/L):0.19±0.08 vs.0.39±0.04,all P ＜0.05].Conclusions Acupuncture rehabilitation training combined with Xingnaojing injection may obviously improve the cognitive and motor functions in patients suffered from STBI,and clinically the combined treatment is worthwhile to be used extensively.

Objective:To investigate the whole genome characteristics of coxsackievirus A4 (CVA4) circulating in Qingdao city.Methods:Four CVA4 isolates circulating in Qingdao city during 2013 to 2015 were selected. Whole genome sequences of these strains were amplified by one-step reverse transcription-polymerase chain reaction (RT-PCR). Sequence alignment and phylogenetic analysis were performed using MEGA7.0 software package. Genetic recombination analysis was performed using similarity plots 3.5.1 software package.Results:Phylogenetic analysis showed that based on the sequences of the whole genome and P1, P2 and P3 regions, HS312/QD/CHN/2013 and HS605/QD/CHN/2014 strains together with the early domestic isolates belonged to the same clade, while FY218/QD/CHN/2015 strain and CV-A4/P1033/2013/China strain collected in Wenzhou in 2013 formed another clade in each phylogenetic tree. HS144/QD/CHN/2014 strain belonged to the same clade as HS312/QD/CHN/2014, HS605/QD/CHN/2014 and the early domestic CVA4 isolates in the phylogenetic tree based on the P1 region, but formed a separate clade in the phylogenetic trees based on the whole genome, P2 region and P3 region. Genetic recombination analysis revealed that there was genetic recombination between HS144/QD/CHN/2014 strain and the CVA2 strain of CV-A2/P373/2013/China isolated in mainland China in 2013 in the region of 2C-3D (5 081-7 301); FY218/QD/CHN/2015 and CV-A4/P1033/2013/China strains were highly homologous and recombination signal sequences were detected in the region of 2A-2B (3 821-4 161) between the two strains and the CVA2 strain of CV-A2/P373/2013/China.Conclusions:The CVA4 isolates circulating in Qingdao city presented obvious genetic diversity at the genome-wide level.

Insulin increases microvascular perfusion and substrate exchange surface area in muscle, which is pivotal for hormone action and substrate exchange, by activating insulin signaling cascade in the endothelial cells to produce nitric oxide. This action of insulin is closely coupled with its metabolic action and type 2 diabetes is associated with both metabolic and microvascular insulin resistance. Muscle microvascular perfusion/volume can be assessed by 1-methylxanthine metabolism, contrast-enhanced ultrasound and positron emission tomography. In addition to insulin, several factors have been shown to recruit muscle microvasculature, including exercise or muscle contraction, mixed meals, glucagon-like peptide 1 and angiotensin II type 1 receptor (AT1R) blocker. On the other hand, factors that cause metabolic insulin resistance, such as inflammatory cytokines, free fatty acids, and selective activation of the AT1R, are capable of causing microvascular insulin resistance. Therapies targeting microvascular insulin resistance may help prevent or control diabetes and decrease the associated cardiovascular morbidity and mortality.
Cytokines ; Endothelial Cells ; Endothelium ; Fatty Acids, Nonesterified ; Glucagon-Like Peptide 1 ; Hand ; Insulin ; Insulin Resistance ; Meals ; Microcirculation ; Microvessels ; Muscle Contraction ; Muscles ; Nitric Oxide ; Perfusion ; Positron-Emission Tomography ; Receptor, Angiotensin, Type 1 ; Vasoconstriction ; Vasodilation ; Xanthines

OBJECTIVE To explore the significance of intraoperative auditory monitoring(IAMA) in surgery of acoustic neuroma and to compare the value of auditory brainstem response(ABR) and cochlear nerve action potential(CNAP) in auditory monitoring.METHODS Retrospective analysis of 12 cases of acoustic neuroma from January 2016 to December 2016 was performed.All patients have a practical hearing(AAO-HNS,grade class a,b),the ABR waveform can be elicited,wave v differentiation,All tumors were removed via posterior sigmoid sinus approach.RESULTS ABR waveform of all patients were prolonged with different degrees of change(0.68±0.41) ms compared with the preoperative data.Amplitude of CNAP diverse in different individuals,with an average prolong compared to the data before operation(0.25±0.16) ms.In all 12 cases,8 (66.7％) patients remained usable hearing after the operation,4 cases(33.3％) failed to have a usable hearing.Among these 4 patients,3 showed disappearance of wave v,1 patient showed wave v latency prolong in the ABR,meanwhile,2 patients showed P1 dissapear,2 patients showed P1 latency prolong in CNAP.The intraoperative auditory monitoring could play a role in preventing the hearing damage in the procedure.Drilling,noise,surgical nerve stretch or thermal injury may cause the hearing damage.A 5 minutes pause could get some degree of regain,with the amplitude rise again.CONCLUSION A combination use of the ABR and CNAP monitoring has a certain significance in surgery of acoustic neuroma.ABR waveform is stable and reliable,but costs longer time;CNAP stack quickly and improve monitoring sensitivity,but waveform varies.Vibration and noise caused by drilling,nerve stretch during operation and heat damage can be monitored timely.Combined use of ABR and CNAP monitoring can enhance the auditory preservation rate during acoustic neuroma surgery.

OBJECTIVE To evaluate the application ofretrolabyrinthine approach in cerebellopontine angel(CPA) region surgeries.METHODS A total of 42 patients underwent microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach were reviewed.They were hospitalized from January 1st 2011 to January 1st 2016 in our institution.The microscopic-endoscopic technique was applied in all surgeries.RESULTS Complete removal was obtained in all tumor resections and satisfactory symptom-relief was achieved in all microvascular decompressions and neurectomies.In cases with acoustic neuroma and cholesteatoma,useful hearing (AAO-HNS classes A,B and C) was obtained in 66.7％(6/9) patients.No facial paralysis and postoperative complications such as cerebrospinal fluid leakage occurred during follow-up.In cranial nerve rhizopathies cases,complete relief was achieved in all patients.No facial paralysis and other lower cranial nerve dysfunction occurred.CONCLUSION With the preservation of labyrinthine structures,the microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach could increase the hearing preservation level without facial nerve injury.Retrolabyrinthine approach is a good option for cranial nerve rhizopathies and tumors smaller than 15 mm in diameter without involvement of the fundus of internal auditory canal in the CPA region.