Thesis (Ph. D.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "June 2008" Includes bibliographical references.

Myocardial injury is the leading cause of death in Europe following non-cardiac surgery. Its causes, diagnosis, and treatment are still under investigation by the scientific community. Some research groups have hypothesized a connection between myocardial injury and hypotension during surgery. This thesis investigated the development of a machine learning binary classifier to make a diagnosis of myocardial injury from a set of patients undergoing non-cardiac surgery. Furthermore, it aimed to clarify the potential of hypotension as a predictor of the pathology. After an evaluation of the requirements that the model had to meet, it was decided to use a decision tree. 4 features were selected combining ANOVA and the domain knowledge of the doctors. The classifier obtained a F1 macro-score of 0.68, showing to have potential in classifying patients as positive or negative. Among the selected features, hypotension obtained the lowest predictive power. Despite the performance of the model, further research is needed to validate the results across different populations and to investigate the use of hypotension as a predictor of myocardial injury. / Myokardiell skada är den främsta dödsorsaken i Europa efter icke-kardiell kirurgi. Dess orsaker, diagnos och behandling är fortfarande under utredning av vetenskapssamfundet. Vissa forskargrupper har hypotiserat om ett samband mellan myokardiell skada och hypotoni under operationen. Denna avhandling undersökte utvecklingen av en binär klassificerare med maskininlärning för att ställa diagnos på myokardiell skada hos en grupp patienter som genomgick icke-kardiell kirurgi. Dessutom syftade den till att klargöra hypotoniens potentiella betydelse som en prediktor för sjukdomen. Efter en utvärdering av modellens krav beslutades det att använda ett beslutsträd. Fyra egenskaper valdes ut genom att kombinera ANOVA och läkarnas domänkunskap. Klassificeraren uppnådde en F1-makropoäng på 0,68 och visade potential att klassificera patienter som positiva eller negativa. Bland de valda egenskaperna hade hypotension den lägsta prediktiva förmågan. Trots modellens prestanda behövs ytterligare forskning för att validera resultaten i olika populationer och undersöka användningen av hypotension som en prediktor för myokardiell skada.

Thesis (MScSportSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: There are extensive literature on the PEH response after acute and chronic aerobic and resistance exercise, as well as a few studies on concurrent and water exercise. However, there is comparatively little evidence that high intensity interval training (HIIT) elicits similar post exercise blood pressure reductions (PEH) compared to other types of exercise. Furthermore, it is difficult to quantify the magnitude of the hypotensive response following these exercises, due to variations in exercise protocols in terms of intensity and duration. Both these training variables are considered important determinants of the magnitude and duration of the PEH response. The current study determined the magnitude of the PEH response after an acute bout and six sessions of HIIT, and the effects after two weeks of detraining in overweight/obese young women. Twenty young women (aged 21 ± 2 years) volunteered for the study. All the subjects were normotensive (SBP: 119.2 ± 5.6 mmHg and DBP: 78.8 ± 4.1 mmHg). Subjects performed six sessions of HIIT within two weeks and detrained for two weeks. SBP, DBP, MAP and HR were monitored during seated recovery after exercise for 60 min to determine the change from resting values. The overall outcome showed that an acute HIIT session resulted in a reduction of 2.9 mmHg in SBP which approached near clinical significance, while six sessions of HIIT caused a clinically significant reduction of 5.3 mmHg; this response was almost totally reversed after detraining. There were no clinically significant reductions in DBP after the acute or six sessions of HIIT (1.7 and 2.7 mmHg, respectively). However, a clinically significant hypotensive response of 3.9 mmHg was sustained after detraining following the maximal exercise capacity test. MAP also reduced by a magnitude of 2.3 and 5.6 mmHg, respectively, after the acute bout and six sessions of HIIT, and detraining values were still 2.9 mmHg lower than resting values and approached near clinical significance. The results indicate that both an acute bout and six sessions of HIIT elicited a meaningful PEH response. However, the six sessions of HIIT caused a clinically significant reduction which was approximately twice the acute session. Likewise, detraining showed clinically significant effects in DBP and MAP, but SBP returned to near baseline values. This suggests that in only two weeks, the accumulated effects of six sessions of HIIT elicited a greater hypotensive response than after an acute session of HIIT. / AFRIKAANSE OPSOMMING: Daar is omvattende literatuur oor die post-oefening hipotensie (POH) na afloop van akute en kroniese aërobiese en weerstandsoefeninge, asook enkele studies oor gelyktydige krag- en uithouvermoë- en wateroefeninge. Daar is egter relatief min bewyse dat hoë intensiteit interval oefening (HIIO) soortgelyke post-oefening afnames in bloeddruk (POH) in vergelyking met ander tipes oefening veroorsaak. Voorts is dit moeilik om die omvang van die hipotensiewe respons na afloop van oefening te kwantifiseer, hoofsaaklik as gevolg van die variasies in oefeningprotokolle in terme van intensiteit en tydsduur. Beide hierdie inoefeningveranderlikes word as belangrike determinante van die omvang en die tydsduur van die POH respons beskou. Die huidige studie het die omvang van die POH respons na ʼn akute sessie en ses sessies HIIO, en die gevolge na afloop van twee weke se nie-inoefening (“detraining”) by oorgewig/vetsugtige jong dames, bepaal. Twintig jong dames (ouderdom 21 ± 2 jaar) het vrywillig ingestem om aan die studie deel te neem. Al die deelnemers was normotensief (SBD: 119.2 ± 5.6 mmHg en DBD: 78.8 ± 4.1 mmHg). Die deelnemers het ses sessies HIIO binne twee weke voltooi en het daarna vir twee weke geen inoefeningsessies gehad nie. SBD, DBD, GAD en HS is tydens ʼn sittende herstelfase vir 60 minute gemonitor om die verandering vanaf rustende waardes te bepaal. Die algehele uitkoms toon dat ʼn akute HIIO sessie ʼn afname van 2.9 mmHg in SBD tot gevolg gehad het wat aan kliniese betekenisvolheid grens, terwyl ses sessies van HIIO ʼn klinies betekenisvolle afname van 5.3 mmHg veroorsaak het; hierdie respons wat bykans volledige omgekeerd na die twee weke met geen inoefening. DBD het geen kliniese betekenisvolle afname na afloop van die akute of ses sessies van HIIO getoon nie (1.7 en 2.7 mmHg, respektiewelik). ʼn Klinies betekenisvolle hipotensiewe respons van 3.9 mmHg is egter gevind na die geen inoefeningsperiodes. GAD het ook met ʼn omvang van 2.3 en 5.6 mmHg, respektiewelik, verminder na afloop van die akute sessie en ses sessies van HIIO. Die geen inoefening waardes was steeds 2.9 mmHg laer as die rustende waardes en het aan kliniese betekenisvolheid gegrens. Die resultate toon dat beide ʼn akute sessie en ses sessies van HIIO ʼn betekenisvolle POH respons ontlok het. Ses sessies van HIIO het egter ʼn klinies betekenisvolle afname, wat ongeveer twee keer soveel as die afname van die akute sessie was, veroorsaak. In dieselde lig het ʼn twee weke geen inoefeningsperiode steeds klinies betekenisvolle veranderinge in DBD en GAD getoon, maar SBD het tot naby aan die basislyn waardes teruggekeer. Hierdie resultate suggereer dat in slegs twee weke die geakkumuleerde effekte van ses sessies van HIIO ʼn groter hipotensiewe respons as na ʼn akute sessie van HIIO ontlok het.

Equi-caloric bouts of interval (INT: 5x 2:2 min at 85 and 40% VO2max) and continuous (21 minutes at 60% VO2max) exercise were performed by 13 older prehypertensive males on separate days, at equivalent times of day, to assess the influence of exercise mode on post-exercise hypotension (PEH). Cardiovascular measures were collected for 30 min pre and 60 min post-exercise. PEH as measured by mean post-exercise systolic blood pressure (SBP) decrease, area under the SBP curve, and minimum SBP achieved, was equivalent after both conditions. SV was significantly reduced and HR was significantly elevated post-exercise after both conditions. No significant reductions in CO or TPR were observed. INT exercise provided a larger perturbation to the autonomic nervous system as measured by Baroreflex sensitivity and Heart Rate Variability. The responses elicited by acute INT exercise, with repeated exposure, may lead to greater improvements in blood pressure regulation than those associated with continuous aerobic training.

Equi-caloric bouts of interval (INT: 5x 2:2 min at 85 and 40% VO2max) and continuous (21 minutes at 60% VO2max) exercise were performed by 13 older prehypertensive males on separate days, at equivalent times of day, to assess the influence of exercise mode on post-exercise hypotension (PEH). Cardiovascular measures were collected for 30 min pre and 60 min post-exercise. PEH as measured by mean post-exercise systolic blood pressure (SBP) decrease, area under the SBP curve, and minimum SBP achieved, was equivalent after both conditions. SV was significantly reduced and HR was significantly elevated post-exercise after both conditions. No significant reductions in CO or TPR were observed. INT exercise provided a larger perturbation to the autonomic nervous system as measured by Baroreflex sensitivity and Heart Rate Variability. The responses elicited by acute INT exercise, with repeated exposure, may lead to greater improvements in blood pressure regulation than those associated with continuous aerobic training.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Actuellement, l’étude du mouvement des tissus biologiques figure parmi les thématiques majeures dans le domaine de l’imagerie médicale, dont le challenge est d’apporter un complément d’information clinique et de permettre une aide au diagnostic. L’application récente de techniques d’élastographie ouvre de nouvelles perspectives de caractérisation biomécanique des tissus, et notamment du cerveau. Dans ce contexte, nous proposons une méthodologie innovante d’élastographie passive des propriétés mécaniques du tissu cérébral dont le but est de permettre à terme le diagnostic des maladies neurodégénératives. / The study of biological tissues movement is currently, one of the major thematics in the medical imaging field. The challenge is to provide additional clinical information and allow for diagnostic assistance. The recently introduced elastographic techniques, provide ample opportunities for biomechanical tissues characterization, particularly of cerebral tissues. An innovative passive-elastographic methodology for assessing mechanical properties of brain tissue is proposed. The eventual aim is to allow for the diagnosis of neurodegenerative diseases.

Perioperative hypotension corresponds to critically low blood pressure events during the pre, intra and postoperative periods. It is a common side effect of general anaesthesia and is strongly associated with an increased risk of postoperative complications, such as acute kidney injury, myocardial injury and in the worst case death. Early treatment of hypotension, preferably even before onset, is crucial in order to reduce the risk and severity of its associated complications. This work explores methods for predicting the onset of hypotension which could serve as a warning mechanism for clinicians managing the patient’s hemodynamics. More specifically, we present methods using only the arterial blood pressure curve to predict two different definitions of hypotension. The presented methods are based on a Convolutional Neural Network (CNN) trained on data from patients undergoing high-risk surgery. The experimental results show that our network can predict hypotension with 70% sensitivity and 80% specificity 5 minutes before onset. The prediction performance is then quickly reduced for longer prediction times, resulting in 60% sensitivity and 80% specificity 15 minutes before onset. / Perioperativ hypotension motsvarar perioder av kritiskt lågt blodtryck före, under och efter operation. Det är en vanlig bieffekt av generell anestesi och är starkt associerad med ökat risk av postoperativa komplikationer, så som akut leverskada, myokardskada och i värsta fall dödsfall. Tidig behandling av hypotension, helst innan perioden börjar, är avgörande för att minska risken och allvarlighetsgraden av postoperativa komplikationer. Det här arbetet utforskar metoder för att förutspå perioder av hypotension, vilket skulle kunna används för att varna vårdpersonal som ansvarar för patientens hemodynamiska övervakning. Mer specifikt så presenteras metoder som endast använder artärblodtryck för att förutspå två olika definitioner av hypotension. Metoderna som presenteras är baserade på ett Convolutional Neural Network (CNN) som tränats på data från patienter som genomgår högriskoperation. De experementella resultaten visar att våran modell kan förutspå hypotension med 70% sensitivitet och 80% specificitet 5 minuter i förväg. Förmågan att förutspå hypotension avtar sedan snabbt för längre prediktionstider, vilket resulterar i 60% sensitivitet och 80% specificitet 15 minuter i förväg.

Intradialytic Hypotension (IDH) is the commonest complication of maintenance haemodialysis and is associated with increased morbidity and mortality. However, there is no standardised definition of IDH, making comparisons between studies difficult. This observational study with a total of 80 patients and over 600 dialysis sessions showed a poor correlation between symptoms and hypotension. Importantly, patients experienced low blood pressure without symptoms, so continuous intradialytic blood pressure monitoring is required to identify this asymptomatic group. In light of these findings, a revised definition of IDH is suggested. This study also aimed to identify predictors of IDH that could be detected in sufficient time to allow a mitigating intervention. A novel non-invasive alternative for continuous blood pressure monitoring is introduced which uses intra-fistula pressure data from the sensors sited in the extracorporeal circuit of the dialysis machine. Results show that in the majority of patients, changes in intra-fistula pressure correlate with blood pressure measurements obtained by a standard oscillometric device. To investigate whether IDH can be predicted, a photoplethysmogram (PPG) waveform was obtained from a pulse oximeter attached to the finger or ear. Continuous PPG monitoring of patients with IDH during dialysis demonstrated that some IDH episodes were predictable using the variation in the PPG baseline with respiration as a surrogate for low blood volume. Additionally, the area under the curve of the PPG waveform can be used as a surrogate for cardiac output and peripheral vascular tone, resulting in a reasonable predictor for potentially critical changes in blood pressure during dialysis. Individually, the novel metrics described here are limited in their identification of IDH in all patients affected, but in combination they may be used to develop a multi-parameter predictive model. The relative merits of personalised versus population-based models are explored and a conclusion is drawn that personalised multi-parameter data fusion modelling for haemodialysis patients would be an important area for future work.

Maintenance of stable arterial blood pressure during orthostatic challenges is a major problem after spinal cord injury (SCI). Since early participation in rehabilitation is critically important in reducing long term morbidity, recovering the ability to regulate blood pressure during therapy is essential for individuals with SCI. The objective of our study was to investigate short term cardiovascular function of able-bodied (AB), paraplegic (PARA) and tetraplegic (TETRA) subjects in response to head up tilt (HUT) as an early indicator of autonomic damage that might forewarn of future orthostatic regulatory problems. We acquired cardiovascular variables from able-bodied (AB; n=11), paraplegic (PARA; n=5) and tetraplegic (TETRA; n=5) subjects in response to HUT. The SCI patients in both groups were in their first two months post injury. Data were recorded at rest and during 7 min each at 20??, 40??, 60?? and 80?? HUT. Techniques used to estimate regulatory capability and reflex activity included: Mean values and spectral power of heart rate (HR) and arterial blood pressure (BP), baroreflex sequence measurements and cross correlation between HR and systolic blood pressure (SBP). An index of baroreflex sensitivity (BRS), baroreflex effectiveness index (BEI), and the percentage occurrence of systolic blood pressure (BP) ramps and baroreflex sequences were calculated from baroreflex sequence measurements. The spectral power of HR and BP, the cross correlation of systolic BP and heart rate (HR) were examined in low frequency (LF: 0.04-0.15 Hz) and high frequency (HF: 0.15-0.4 Hz) ranges. The BRS index was significantly (p andlt; 0.05) decreased from supine to 80o HUT in AB and TETRA. This index in PARA was the lowest at each tilt position in the three groups, and decreased with tilt. The percentage of heart beats involved in systolic BP ramps and in baroreflex sequences significantly (pandlt;0.05) rose from supine to 80o HUT in AB, was relatively unchanged in PARA and declined in TETRA. Both of these indexes were significantly (pandlt;0.05) lowerin the SCI than in the AB group at each tilt level. The BEI values were greatest in AB, and declined with tilt in all groups. Spinal cord injured patients had less power of BP and HR fluctuations than AB in both LF and HF regions. The LF spectral power of BP and HR increased with tilt in AB, remained unchanged in PARA and decreased in TETRA. The HF spectral power of HR decreased in all three groups. The peak HR / BP cross correlation in the LF region was greatest in AB, and significantly (pandlt;0.05) increased during HUT in AB, remained fairly constant in PARA, and declined in TETRA. The peak cross correlation in the HF region significantly (pandlt;0.05) decreased with tilt in all groups, and the SCI group had lower values than AB at each tilt level. We conclude that both PARA and TETRA had a smaller percentage of SBP ramps, BRS, and lower BEI than AB, likely indicating decreased stimulation of arterial baroreceptors, and less engagement of feedback control. The mixed sympathetic, parasympathetic innervations of paraplegics, or their elevated HR, may contribute to their significantly lower BRS. Our data indicate that the pathways utilized to evoke baroreflex regulation of HR are compromised by SCI and this loss may be a major contributor to the decrease in orthostatic tolerance following injury.