Unfamiliar waveforms spanning from the ST to TP segments only observed in certain limb leads of the standard 12-lead electrocardiogram due to Aslanger’ s sign

Aslanger’s sign,also known as the arterial pulse tapping artifact or electromechanical association artifact,is an electrocardiographic artifact caused by arterial pulsation at the site where the limb leads of the standard 12-lead electrocardiogram near the radial or posterior tibial arteries are positioned,particularly in hyperdynamic states.[1–8]It occurs in every cardiac cycle with a constant coupling interval between the QRS complex and artifact.This synchronization with the underlying heart rhythm makes it less likely to be recognized as an artifact compared to unsynchronized artifacts,such as those caused by limb movement and inadequate contact between the electrode and skin.[1,2,7,8]Almost all reported cases of Aslanger’s sign exhibit an unusual waveform morphology in all 12 leads except one of the standard 12-lead electrocardiogram.This sign is often confused with an electrocardiographic finding commonly observed during acute coronary events.

Intelligent Electrocardiogram Analysis in Medicine:Data,Methods,and Applications

Electrocardiogram(ECG)is a low-cost,simple,fast,and non-invasive test.It can reflect the heart’s electrical activity and provide valuable diagnostic clues about the health of the entire body.Therefore,ECG has been widely used in various biomedical applications such as arrhythmia detection,disease-specific detection,mortality prediction,and biometric recognition.In recent years,ECG-related studies have been carried out using a variety of publicly available datasets,with many differences in the datasets used,data preprocessing methods,targeted challenges,and modeling and analysis techniques.Here we systematically summarize and analyze the ECGbased automatic analysis methods and applications.Specifically,we first reviewed 22 commonly used ECG public datasets and provided an overview of data preprocessing processes.Then we described some of the most widely used applications of ECG signals and analyzed the advanced methods involved in these applications.Finally,we elucidated some of the challenges in ECG analysis and provided suggestions for further research.

Dipper Throated Algorithm for Feature Selection and Classification in Electrocardiogram

Arrhythmia has been classified using a variety of methods.Because of the dynamic nature of electrocardiogram(ECG)data,traditional handcrafted approaches are difficult to execute,making the machine learning(ML)solutions more appealing.Patients with cardiac arrhythmias can benefit from competent monitoring to save their lives.Cardiac arrhythmia classification and prediction have greatly improved in recent years.Arrhythmias are a category of conditions in which the heart's electrical activity is abnormally rapid or sluggish.Every year,it is one of the main reasons of mortality for both men and women,worldwide.For the classification of arrhythmias,this work proposes a novel technique based on optimized feature selection and optimized K-nearest neighbors(KNN)classifier.The proposed method makes advantage of the UCI repository,which has a 279-attribute high-dimensional cardiac arrhythmia dataset.The proposed approach is based on dividing cardiac arrhythmia patients into 16 groups based on the electrocardiography dataset’s features.The purpose is to design an efficient intelligent system employing the dipper throated optimization method to categorize cardiac arrhythmia patients.This method of comprehensive arrhythmia classification outperforms earlier methods presented in the literature.The achieved classification accuracy using the proposed approach is 99.8%.

Optimization of Electrocardiogram Classification Using Dipper Throated Algorithm and Differential Evolution

Electrocardiogram(ECG)signal is a measure of the heart’s electrical activity.Recently,ECG detection and classification have benefited from the use of computer-aided systems by cardiologists.The goal of this paper is to improve the accuracy of ECG classification by combining the Dipper Throated Optimization(DTO)and Differential Evolution Algorithm(DEA)into a unified algorithm to optimize the hyperparameters of neural network(NN)for boosting the ECG classification accuracy.In addition,we proposed a new feature selection method for selecting the significant feature that can improve the overall performance.To prove the superiority of the proposed approach,several experimentswere conducted to compare the results achieved by the proposed approach and other competing approaches.Moreover,statistical analysis is performed to study the significance and stability of the proposed approach using Wilcoxon and ANOVA tests.Experimental results confirmed the superiority and effectiveness of the proposed approach.The classification accuracy achieved by the proposed approach is(99.98%).

Effects of Antimicrobial Peptides on Production,Slaughter Performance and Blood Routine of Tan Sheep

[Objectives]This study was conducted to analyze effects of antimicrobial peptides added to the diet of Tan sheep on their production, slaughter performance and blood composition. [Methods] Ninety two four-month-old Tan sheep were randomly divided into two treatment groups according to their body weight, 46 in each group. The control check group(CK) was feed with conventional diet, and the experimental group was fed with the addition of antimicrobial peptide on the basis of the conventional diet, with the added amount of 2.5 g/sheep per day. The experimental period was 60 d. [Results] The incidence rate was 75.06% lower in the experimental group than in the CK. The average daily weight gain per sheep was 11.27% higher in the experimental group than in the CK(P<0.05). The feed conversion ratio was 8.45% lower in the experimental group than in the CK(P<0.05). The average daily gross profit per sheep was 12.12% higher in the experimental group than in the CK. For slaughter performance, the data difference of each item was not significant. The PH at 45 min and 24 h after slaughter was within the normal range of fresh mutton. The cooked meat percentage and water loss rate showed no significant differences(P>0.05). The marbling ranged from 2.45 to 2.50, indicating that the fat content was moderate, and the difference between groups was not significant(P>0.05). The flesh color ranged from 3.00 to 3.15, between light red and bright red, belonging to the normal color of mutton, and the difference between groups was not significant(P>0.05). The shear force was between 2.50 and 2.65, without a significant difference between groups(P>0.05). The white blood cells, lymphocytes and platelets in the experimental group were lower than those in the CK(P<0.01). The erythrocytes and hemoglobin in the erythrocyte group were higher than those in the CK(P<0.05). The neutrophils and monocytes in the experimental group were lower than those in the CK(P<0.05). [Conclusions] This study provides a technical basis for the rational use of antimicrobial peptides and their application in ruminants.

Microscopic Characteristics and Routine Detection of Hedyotis hedyotidea(DC.)Merr.

[Objectives]To study the microscopic characteristics and routine detection of Hedyotis hedyotidea(DC.)Merr.[Methods]The microscopic characteristics of the root,stem cross section and the whole plant powder of H.hedyotidea were studied by the methods of slide-shaft section,biological staining and microscopic imaging;the routine detection items such as moisture,ash,acid-insoluble ash and extract were detected and analyzed in accordance with the requirements of Chinese Pharmacopoeia.[Results]The microscopic characteristics of the root,the stem and the whole plant powder of H.hedyotidea were obtained.The moisture content of 10 batches of H.hedyotidea samples was in the range of 4.25%-7.90%,the water-soluble extract is in the range of 15.08%-22.52%,the total ash was in the scope of 8.27%-10.45%,and the acid-insoluble ash was in 0.13%-0.95%.The proposed water content of H.hedyotidea should not exceed 10.00%,the water-soluble extract should not be less than 12.00%,the total ash content should not exceed 13.00%,and the acid-insoluble ash content should not exceed 1.20%.[Conclusions]The results of this experiment can provide a reference for the quality control and quality standard of H.hedyotidea.

Analysis of Serum Cys-C,TBA,and Routine Blood Parameters of Patients with Hepatitis B-Related Decompensated Cirrhosis

Objective:To study the levels of serum cystatin C(Cys-C),total bile acid(TBA),and other routine blood parameters on patients with decompensated hepatitis B cirrhosis.Methods:Study group 1 consisted of 30 patients with hepatitis B-related decompensated cirrhosis,and study group 2 consisted of 30 patients with hepatitis B;while the control group consisted of 30 healthy people who underwent physical examination.The blood parameters were used to evaluate the clinical treatment effect of patients.Results:The TBA,Cys-C,alanine transaminase(ALT),total bilirubin(TBIL),aspartate aminotransferase(AST),and international normalized ratio(INR)in study group 1 were significantly higher than those of study group 2 and the control group;while the platelet count(PLT),hemoglobin(Hb),albumin(ALB),and estimated glomerular filtration rate(eGFR)were significantly lower in the study group 1 compared to the control group and study group 2(P<0.05).The Cys-C,PLT,TBA,AST,TBIL,and INR of patients in study group 1 who were successfully treated were significantly lower than the patients who were not successfully treated(P<0.05).Conclusion:Serum Cys-C,TBA,and routine blood parameters are useful in predicting the condition and the prognosis of patients of hepatitis B-related decompensated cirrhosis.

Considerations for routine coagulation monitoring with rivaroxaban:A case report and review of the literature

BACKGROUND Rivaroxaban is a non-vitamin K antagonist oral anticoagulant that does not require coagulation monitoring based on current recommendations. Our goal is to explore whether routine coagulation monitoring should not be required for all patients receiving oral rivaroxaban, what relationship between routine coagulation abnormalities and bleeding, and how to deal with the above clinical situations through our case and review of the literature.CASE SUMMARY We report a 67-year-old woman with a history of atrial fibrillation who presented to the hospital with worsening dyspnea and cough. Based on electrocardiogram,venous compression ultrasonography, and computed tomography pulmonary angiography, the diagnosis of atrial fibrillation, deep venous thrombosis, and acute pulmonary embolism was confirmed. Her coagulation assays and renal function were normal on admission; she was not underweight, did not have a history of hemorrhagic disease, and her CHA2 DS2-VAS, HAS-BLED, and simplified Pulmonary Embolism Severity Index scores were 3, 0, and 0,respectively. Oral rivaroxaban(15 mg twice daily) was administered. The following day, she presented gastrointestinal and gum bleeding, combined with coagulation abnormalities. Following cessation of rivaroxaban, her bleeding stopped and tests improved over the next 2 d. Rivaroxaban was begun again 3 d after recovery. However, she again presented with gastrointestinal and gum bleeding and the abnormal tests, and the therapy was discontinued. At 30-d follow-up after discharge, she presented normal coagulation tests without bleeding.CONCLUSION Although current guidelines recommend that using non-vitamin K antagonist oral anticoagulants including rivaroxaban do not require coagulation monitoring,a small number of patients may develop routine coagulation test changes and bleeding during rivaroxaban therapy, especially in the elderly. Clinicians should pay attention to these patients and further obtain evidence in practice.

Brugada phenocopy: A new electrocardiogram phenomenon

Brugada phenocopies(BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome. BrP are characterized by type 1 or type 2 Brugada electrocardiogram(ECG) patterns in precordial leads V1-V3. However, BrP are elicited by various un-derlying clinical conditions such as myocardial ischemia, pulmonary embolism, electrolyte abnormalities, or poor ECG filters. Upon resolution of the inciting underlying pathological condition, the BrP ECG subsequently nor-malizes. To date, reports have documented BrP in the context of singular clinical events. More recently, recur-rent BrP has been demonstrated in the context of re-current hypokalemia. This demonstrates clinical repro-ducibility, thereby advancing the concept of this new ECG phenomenon. The key to further understanding the pathophysiological mechanisms behind BrP requires experimental model validation in which these phenom-ena are reproduced under strictly controlled environ-mental conditions. The development of these validation models will help us determine whether BrP are tran-sient alterations of sodium channels that are not repro-ducible with a sodium channel provocative test or al-ternatively, a malfunction of other ion channels. In this editorial, we discuss the conceptual emergence of BrP as a new ECG phenomenon, review the progress made to date and identify opportunities for further investiga-tion. In addition, we also encourage investigators that are currently reporting on these cases to use the term BrP in order to facilitate literature searches and to help establish this emerging concept.

Detection and Analysis of Routine Blood Indexes in Guike Pig

[Objectives] In this study,routine blood indexes of Guike pig were detected to clarify quantity variation and morphology distribution of different functional cells（ red blood cells,white blood cells and platelets）,thus providing reference data for immunological evaluation and disease resistance research of Guike pig. [Methods] Blood samples were collected from forty-four 49-day-old healthy Guike pigs（ 22 males and 22 females） once a week for seven consecutive weeks to detect routine blood indexes,and the results were compared with routine blood indexes of Landrace pig and Enshi black pig. [Results]Among red blood cell indexes of Guike pig at different day ages,red blood cell count（ RBC） and hemoglobin count（ HGB） both reached the lowest levels（ 6. 85 × 10^12/L and 97. 1 g/L）at 70 days of age,which were significantly lower than the corresponding indexes at 49,56,63,84 and 91 days of age（ P 〈 0. 05,similarly hereinafter）; mean corpuscular hemoglobin（ MCH） and mean corpuscular hemoglobin concentration（ MCHC） demonstrated basically the same variation pattern,which both reached the lowest levels（ 15. 11 pg and 275. 70 g/L） at 70 days of age and reached the highest levels（ 16. 40 pg and 314. 30 g/L） at 91 days of age; hematocrit（ HCT）,mean corpuscular volume（ MCV） and red blood cell distribution width（ RDW） exhibited relatively stable changes with no significant differences among different day ages（ P 〉 0. 05,similarly hereinafter）. Among white blood cell indexes of Guike pig at different day ages,white blood cell count（ WBC） reached the lowest level（ 13. 71 × 10^9/L） at 63 days of age and reached the highest level（ 17. 52 × 10^9/L） at 84 days of age,with significant differences; neutrophil count（ NEUT）reached the lowest level（ 3. 61 × 10^9/L） at 70 days of age,which was significantly lower than that at 49,56 and 77 days of age; lymphocyte count（ LYMPH） exhibited relatively stable changes and was not significantly affected by the increase in day age. Among platelet indexes of Guike pig at different day ages,platelet count（ PLT）,thrombocytocrit（ PCT） and platelet volume distribution width（ PDW） exhibited relatively stable changes among different day ages,which were not significantly affected by the increase in day age. Compared to 35-day-old Landrace pig and 5-month-old Enshi black pig,most routine blood indexes of Guike pig were similar to or ranged between those of Landrace pig and Enshi black pig except HCT,mean platelet volume（ MPV）,PCT and PDW. [Conclusions]Guike pig has a certain uniqueness in routine blood indexes,which has developed a stable immune system at 49-91 days of age.

Early detection of sudden cardiac death by using classical linear techniques and time-frequency methods on electrocardiogram signals

Early detection of sudden cardiac death may be used for surviving the life of cardiac patients. In this paper we have investigated an algorithm to detect and predict sudden cardiac death, by processing of heart rate variability signal through the classical and time-frequency methods. At first, one minute of ECG signals, just before the cardiac death event are extracted and used to compute heart rate variability (HRV) signal. Five features in time domain and four features in frequency domain are extracted from the HRV signal and used as classical linear features. Then the Wigner Ville transform is applied to the HRV signal, and 11 extra features in the time-frequency (TF) domain are obtained. In order to improve the performance of classification, the principal component analysis (PCA) is applied to the obtained features vector. Finally a neural network classifier is applied to the reduced features. The obtained results show that the TF method can classify normal and SCD subjects, more efficiently than the classical methods. A MIT-BIH ECG database was used to evaluate the proposed method. The proposed method was implemented using MLP classifier and had 74.36% and 99.16% correct detection rate (accuracy) for classical features and TF method, respectively. Also, the accuracy of the KNN classifier were 73.87% and 96.04%.

Electrocardiogram manifestations in hyperkalemia

Hyperkalemia is defined as serum potassium level of more than 5 mmol/L. Prompt identification of hyper-kalemia and appropriate management are critical, since severe hyperkalemia can lead to lethal cardiac dysrhythmias. There is a wide range of electrocardiogram (EKG) changes associated with hyperkalemia. The sequence of EKG changes has been previously described with limited information to correlate the level of potassium to a particular change in the EKG. This study aims to describe a correlation between the level of potassium and EKG changes in the presence or absence of certain diagnoses, to determine which EKG finding in the context of level of hyperkalemia, should be considered life-threatening and prompt emergency intervention. If a relationship between serum levels of potassium and EKG changes is significant, clinicians may be able to better monitor and treat hyperkalemic patients. This paper reviews the literature on hyperkalemia, potassium homeostasis and EKG changes attributed to elevated potassium.

An Analysis on the Experience and Routines of Experimental Site of New-countryside Construction of Xianhong in Hubei

The paper tends to make an empirical analysis on the experimental site of new countryside construction of Xianhong in Hubei, pointing out that the inner and outer dependence on routines of experimental construction. The paper also puts forward the beneficial policies, focusing on the agricultural production and fostering professional farmers, to reduce much dependence on routines.

Is routine measurement of international normalized ratio necessary as part of the investigation of patients with cardiac-type chest pain?

Dear editor, Chest pain is a frequent complaint of patients presenting to the emergency department (ED), and many of them are referred to the cardiology service for further investigation. At the Charles V. Keating Emergency and Trauma Centre in Halifax, Nova Scotia, Canada, 4,800 (6.6%) of the approximately 73,000 patients per year register with a complaint of “chest pain”, and 20% of patients are referred to cardiology. Coagulation studies, specifi cally international normalized ratio (INR) frequently part of the “routine” panel of blood tests, are ordered for patients in the ED being investigated or treated for chest pain suspected to be cardiac in nature. Recent calls to examine how much of our practice is likely to benefit patients in any way have led us to question the clinical utility of routine use of these tests.

Preliminary abnormal electrocardiogram segment screening method for Holter data based on long short-term memory networks

Holter usually monitors electrocardiogram(ECG)signals for more than 24 hours to capture short-lived cardiac abnormalities.In view of the large amount of Holter data and the fact that the normal part accounts for the majority,it is reasonable to design an algorithm that can automatically eliminate normal data segments as much as possible without missing any abnormal data segments,and then take the left segments to the doctors or the computer programs for further diagnosis.In this paper,we propose a preliminary abnormal segment screening method for Holter data.Based on long short-term memory(LSTM)networks,the prediction model is established and trained with the normal data of a monitored object.Then,on the basis of kernel density estimation,we learn the distribution law of prediction errors after applying the trained LSTM model to the regular data.Based on these,the preliminary abnormal ECG segment screening analysis is carried out without R wave detection.Experiments on the MIT-BIH arrhythmia database show that,under the condition of ensuring that no abnormal point is missed,53.89% of normal segments can be effectively obviated.This work can greatly reduce the workload of subsequent further processing.

Preoperative ultrasound combined with routine blood tests in predicting the malignant risk of pancreatic cystic neoplasms

Objective:Accurate preoperative identification of benign or malignant pancreatic cystic neoplasms(PCN)may help clinicians make better intervention choices and will be essential for individualized treatment.Methods:Preoperative ultrasound and laboratory examination findings,and demographic characteristics were collected from patients.Multiple logistic regression was used to identify independent risk factors associated with malignant PCN,which were then included in the nomogram and validated with an external cohort.The Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI)were calculated to evaluate the improvement in the predictive power of the new model with respect to that of a combined imaging and tumor marker prediction model.Results:Malignant PCN were found in 83(40.7%)and 33(38.7%)of the model and validation cohorts,respectively.Multivariate analysis identified age,tumor location,imaging of tumor boundary,blood type,mean hemoglobin concentration,neutrophil-tolymphocyte ratio,carbohydrate antigen 19-9,and carcinoembryonic antigen as independent risk factors for malignant PCN.The calibration curve indicated that the predictions based on the nomogram were in excellent agreement with the actual observations.A nomogram score cutoff of 192.5 classified patients as having low vs.high risk of malignant PCN.The model achieved good C-statistics of 0.929(95%CI 0.890–0.968,P<0.05)and 0.951(95%CI 0.903–0.998,P<0.05)in predicting malignancy in the development and validation cohorts,respectively.NRI=0.268;IDI=0.271(P<0.001 for improvement).The DCA curve indicated that our model yielded greater clinical benefits than the comparator model.Conclusions:The nomogram showed excellent performance in predicting malignant PCN and may help surgeons select patients for detailed examination and surgery.The nomogram is freely available at https://wangjunjinnomogram.shinyapps.io/DynNomapp/.

Differences in functional magnetic resonance imaging following cutaneous and routine acupuncture at different acupoints

Few studies have examined the effects of different stimuli at a single acupoint using functional magnetic resonance imaging.The present study applied acupuncture at the Neiguan（PC 6）,Waiguan（SJ 5）,Zhigou（SJ 6） and Yanglingquan（GB 34） acupoints in healthy volunteers.fMRI was used to examine the activation of brain areas in response to different types of acupuncture（cutaneous or routine acupuncture） at each acupoint.There were no significant differences in the distribution of activation in the regions of interest between cutaneous and routine acupuncture at the Neiguan,Waiguan,and Zhigou acupoints,but some differences were observed between the two methods of acupuncture at the Yanglingquan acupoint.There were no significant differences in the intensity of induced activation between cutaneous and routine acupuncture at the Neiguan,Zhigou and Yanglingquan acupoints,but the activation intensity in the right cerebellum induced by routine acupuncture at the Waiguan acupoint was greater than that induced by cutaneous acupuncture.Results confirmed that cutaneous and routine acupuncture at the Neiguan,Waiguan,Zhigou and Yanglingquan acupoints activated different functional brain areas,and caused activation of different intensities in some areas.

Can progesterone be a better alternative to dexamethasone for use in routine brain surgery?

Can progesterone be a better alternative to dexamethasone for use in routine brain surgery？ Surgical brain injury （SBI） is a form of brain trauma caused by various forms of neurosurgical interventions including brain tumor excision, evacuation of intracere- bral hemorrhage and brain lobectomv （e.g., in epililepsv surger）.

Electrocardiograms changes in children with functional gastrointestinal disorders on low dose amitriptyline

AIM: To study the effects of low dose amitriptyline on cardiac conduction in children.METHODS: Secondary analysis of data obtained from a double-blind, randomized placebo-controlled trial, evaluating low dose amitriptyline in children with a diagnosis of functional abdominal pain, functional dyspepsia, and irritable bowel syndrome according to the Rome II criteria. Children 8-17 years of age were recruited from the pediatric gastroenterology clinics of 6 tertiary care centers in the United States. The electrocardiograms(EKGs) done prior to initiation of amitrityline and 1 mo after initiation of amitriptyline were examined. The changes in cardiac conduction were evaluated in patients and controls. RESULTS: Thirty children were included in the study. There were 12 patients, ages 9-17 years of both genders, in the amitriptyline treatment group and 18 patients, ages 9-17 years of both genders, in the placebotreatment group. None of the patients had any baseline EKG abnormality. Amitriptyline use was associated with an increase in heart rate(P = 0.024) and QTc interval(P = 0.0107) as compared to pre-EKGs. Children in the placebo group were also noted to present a statistically significant increase in QTc interval(P = 0.0498). None of the patients developed borderline QTc prolongation or long-QT syndrome after they were started on amitriptyline.CONCLUSION: The study findings suggest that once patients with functional gastrointestinal disorders have been screened for prolonged QTc interval on baseline EKG, they probably do not need a second EKG for reevaluation of cardiac conduction after starting low dose amitriptyline.

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients

BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.