Search Results (18)

Purpose: Post-COVID-19 syndrome (PCS) is characterized by low cardio-respiratory fitness (CRF). Recent research focuses on the role of autonomic nervous system dysfunction (AD) as a potential contributor to the diminished exercise performance. The aim is to determine the prevalence of AD—chronotropic insufficiency (CI) and abnormal heart rate recovery (HRR) in long-term PCS subjects and to analyse their association with exercise capacity. Patients and Methods: A total of 192 subjects with a history of SARS-CoV-2 infection were included. Chronic Fatigue Syndrome Questionnaire (CFSQ) was applied, and two symptomatic and asymptomatic emerged. Forty-seven had post-COVID complaints, persisting up to thirty months post-acute episode. CI and HRR were determined during the cardio-pulmonary exercise test (CPET). Results: Symptomatic subjects were divided into mild (20) and moderate-severe (27), depending on the CFSQ score; forty-eight PCS subjects without complaints served as a control group. Subjects with moderate-severe PCS showed lower peak VO2 (24.13 ± 6.1 mL/min/kg vs. 26.73 ± 5.9 mL/min/kg, vs. 27.01 ± 6.3 mL/min/kg), as compared to the mild/asymptomatic subjects. Diminished physical activity was established in 10 (37%) of the moderate-severe, 7 (35%) of the mildly symptomatic and 14 (29%) of the asymptomatic groups. The occurrence of AD in the mild/moderate-severe and control groups were, respectively, CI 35% vs. 81.5% vs. 12.5%. Abnormal HRR was, respectively, 20% vs. 33% vs. 8%. None of the subjects had depleted breathing reserve, dynamic hyperinflation, exercise bronchospasm or desaturation. Neither CI nor abnormal HRR correlated to peak O2. Conclusions: AD is present among long-term PCS subjects and may limit the cardio-respiratory response to exercise but is not independently associated with it. Assuming the multiorgan ANS innervation, it is highly probable that AD has diverse pathological pathways in the various PCS phenotypes and contributes differently by cerebral, cardiovascular, respiratory, peripheral or mixed pathways to the diminished neuro-cognitive and physical performance. Full article

Depression is a mood disorder that is highly prevalent and is characterized by cognitive, emotional, and physical symptoms. This study aimed to describe the physical health status of individuals with depressive symptoms in Qatar and examine the relationships between physical health indicators and depressive symptoms. A cross-sectional correlational design was used, and data were extracted from the Qatar Biobank. Depression was measured using the Patient Health Questionnaire (PHQ-9). The physical health measurements included heart rate, blood pressure, lung capacity, body mass index (BMI), waist-to-hip ratio, and a self-reported questionnaire. The sample included 687 participants with an average age of 35.39 ± 9.82 years old. The comorbidities reported by participants included diabetes, hypertension, and hypercholesterolemia, and their prevalence ranged from 10 to 26.2%. The BMI data revealed that 38.6% of the participants were either overweight or obese. Approximately 29% of females and 22% of males had an abnormally high waist-to-hip ratio. The percentage of individuals who complained of recurrent chest pain, headache/migraine, or body pain ranged between 12.2 and 43.2%. The mean score of the PHQ-9 was 10.07 ± 4.05, and 43.1% of the sample reported having moderate to severe depression. Several factors were significantly related to depression scores: heart rate, waist-to-hip ratio, headache/migraine, chest pain, body pain, and recent weight change. Healthcare professionals should screen individuals for both depressive symptoms and physical symptoms. This may help in the earlier detection of mental illness and/or physical disease, and thus may ensure better recovery or prognosis and may prevent serious complications. Full article

Botulinum neurotoxin (BoNT) intoxication is a rare but severe condition that is characterized by autonomic and neuromuscular dysfunction. This study aimed to evaluate autonomic impairment and blood pressure variability in patients with botulinum intoxication during an outbreak, compared to healthy controls, and to assess their progression over a six-month follow-up period. Methods: Twenty (n = 20) male patients diagnosed with BoNT intoxication and 34 age- and sex-matched healthy controls were enrolled. At baseline, all subjects underwent 24 h ambulatory blood pressure monitoring (ABPM), and clinostatic and orthostatic blood pressure measurements. Autonomic function parameters, including mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), SBP and DBP variability, SBP and DBP load, pulse pressure (PP), blood pressure variability ratio (BPVR), and morning surge, were analyzed. Follow-up assessments were conducted after six months. Results: Patients with botulinum intoxication exhibited significantly lower SBP, DBP, and blood pressure variability parameters compared to healthy controls. Orthostatic hypotension was present in 55% of patients at baseline, improving to 5% at follow-up. Respiratory failure occurred in 40% of cases, necessitating non-invasive ventilation in 35% and intubation in 20%. At six-month follow-up, mean SBP, DBP, heart rate, and blood pressure variability parameters increased significantly, indicating partial recovery of autonomic control. However, residual abnormalities in autonomic regulation persisted. Conclusions: BoNT intoxication leads to notable autonomic dysfunction, marked by impaired blood pressure regulation and a high prevalence of orthostatic hypotension. Although partial recovery occurs, long-term autonomic impairment persists, highlighting the necessity for ongoing cardiovascular monitoring and further research to accelerate autonomic recovery through targeted therapeutic interventions. Full article

Background: Heart rate turbulence (HRT) is a non-invasive technique that can be used to evaluate autonomic nervous system (ANS) function and cardiac arrhythmia. The objective of this study is to investigate whether COVID-19 can lead to long-term blunted HRT following recovery. Methods: This retrospective cohort study included 253 individuals with a confirmed history of COVID-19, referred to as the recovered COVID-19 group, along with 315 healthy participants who had no history of the virus. The recovered COVID-19 group was categorized into three subgroups based on their chest CT severity scores. The HRT analyses were obtained from a 24-h electrocardiography-Holter recording. Results: This study revealed that the HRT onset value was elevated in the recovered COVID-19 group, while the HRT slope value showed a significant decrease when compared to the control group. Correlation analyses indicated a positive relationship between the chest CT severity score and HRT onset, whereas a negative correlation was observed between the chest CT severity score and HRT slope. Regression analyses identified recovery from severe COVID-19, chest CT severity score, hypertension (HT), and smoking as independent predictors of both abnormal HRT onset and the existence of an abnormal HRT slope. Conclusions: Individuals who have recovered from severe COVID-19 are expected to encounter a permanent blunting of HRT, which is regarded as a significant indicator of an increased risk of ventricular arrhythmias and impaired autonomic nervous system (ANS) function. Recovered severe COVID-19 individuals should be carefully evaluated for HRT with 24-h ECG-Holter. Full article

Background/Objectives: The research addresses algorithmic bias in deep learning models for cardiovascular risk prediction, focusing on fairness across demographic and socioeconomic groups to mitigate health disparities. It integrates fairness-aware algorithms, susceptible carrier-infected-recovered (SCIR) models, and interpretability frameworks to combine fairness with actionable AI insights supported by robust segmentation and classification metrics. Methods: The research utilised quantitative 3D/4D heart magnetic resonance imaging and tabular datasets from the Cardiac Atlas Project’s (CAP) open challenges to explore AI-driven methodologies for mitigating algorithmic bias in cardiac imaging. The SCIR model, known for its robustness, was adapted with the Capuchin algorithm, adversarial debiasing, Fairlearn, and post-processing with equalised odds. The robustness of the SCIR model was further demonstrated in the fairness evaluation metrics, which included demographic parity, equal opportunity difference ($0.037$), equalised odds difference ($0.026$), disparate impact ($1.081$), and Theil Index ($0.249$). For interpretability, YOLOv5, Mask R-CNN, and ResNet18 were implemented with LIME and SHAP. Bias mitigation improved disparate impact ($0.80$ to $0.95$), reduced equal opportunity difference ($0.20$ to $0.05$), and decreased false favourable rates for males ($0.0059$ to $0.0033$) and females ($0.0096$ to $0.0064$) through balanced probability adjustment. Results: The SCIR model outperformed the SIR model (recovery rate: $1.38$ vs $0.83$) with a $-10\%$ transmission bias impact. Parameters ($\beta =0.5$, $\delta =0.2$, $\gamma =0.15$) reduced susceptible counts to $2.53\times {10}^{-12}$ and increased recovered counts to $9.98$ by $t=50$. YOLOv5 achieved high Intersection over Union (IoU) scores ($94.8\%$, $93.7\%$, $80.6\%$ for normal, severe, and abnormal cases). Mask R-CNN showed $82.5\%$ peak confidence, while ResNet demonstrated a $10.4\%$ accuracy drop under noise. Performance metrics (IoU: $0.91$–$0.96$, Dice: $0.941$–$0.980$, Kappa: $0.95$) highlighted strong predictive accuracy and reliability. Conclusions: The findings validate the effectiveness of fairness-aware algorithms in addressing cardiovascular predictive model biases. The integration of fairness and explainable AI not only promotes equitable diagnostic precision but also significantly reduces diagnostic disparities across vulnerable populations. This reduction in disparities is a key outcome of the research, enhancing clinical trust in AI-driven systems. The promising results of this study pave the way for future work that will explore scalability in real-world clinical settings and address limitations such as computational complexity in large-scale data processing. Full article

Cerebral palsy is a disorder of central motor and postural development, resulting in limited mobility. Cerebral palsy is often accompanied by cognitive impairment and abnormal behavior, significantly impacting individuals and society. Time, energy, and economic investment in the rehabilitation process is substantial, yet the rehabilitation outcomes often remain unsatisfactory. Additionally, some patients have limited sensory perception during rehabilitation training, making it challenging to effectively regulate exercise intensity. Traditional evaluation methods are mostly based on recovery performance, lack guidance at the neurophysiological level, and have an unequal distribution of medical rehabilitation resources, which pose great challenges to the rehabilitation of patients. Based on the issues mentioned above, this paper proposes a real-time cerebral signal monitoring system based on wearable devices. This system can monitor and store blood oxygen, heart rate, myoelectric, and EEG signals during cerebral palsy rehabilitation, and it can track and monitor signals during the rehabilitation treatment process. The system includes two parts: hardware design and software design. The hardware design includes a data signal acquisition module, a main control chip (ESP32), a muscle electrical sensor module, a brain electrical sensor module, a blood/heart rate acquisition module, etc. It is primarily for real-time signal data acquisition, processing, and uploading to the cloud server. The software design includes functions such as data receiving, data processing, data storage, network configuration, and remote communication and enables the visual monitoring of data signals. The system can achieve real-time monitoring of electromyography, electroencephalography, and blood oxygen levels, as well as the heart rate of patients with cerebral palsy, and adjust rehabilitation training in real-time during the rehabilitation process. At the same time, based on the real-time storage of the original electromyography and electroencephalography data, it can provide auxiliary guidance for later rehabilitation evaluation and effective data support for the entire rehabilitation treatment process. Full article

Background: The prevalence of long-COVID (LC) presents a significant challenge to healthcare systems globally. There are still some discrepancies on the role of sex as an independent risk factor of LC complications. Thus, we aimed to determine the differences in clinical and cardiovascular complications between males and females without comorbidities after COVID-19. Methods: Clinical data on the course of the disease with the accompanying symptoms and post-COVID-19 symptoms were compiled from both male and female subjects with a minimum 12-week interval after COVID-19 recovery. Next, the patients were followed for 12 months. ECG, echocardiography, 24 h ECG monitoring, 24 h ambulatory blood pressure monitoring (ABPM), and selected biochemical tests were performed. LC was diagnosed based on the World Health Organization (WHO) definition. To reduce the impact of confounders, i.e., body mass index (BMI) and age, on the results of the study, the nearest neighbour (NN) propensity score matching (PSM) method with a 1:1 ratio was used. Results: The results were obtained following the removal of cases with comorbidities from the database consisting of 1237 males and 2192 females, and PSM of the new database included 886 cases (443 males and 443 females). At both the 3-month and 1-year post-recovery marks, females consistently reported a higher frequency of LC symptoms compared to males (p < 0.001 for both comparisons). Moreover, after 1 year of follow-up, females exhibited a higher prevalence of LC compared to males, with rates of 14% versus 8.3%, respectively (p = 0.013). The symptoms that significantly differed between females and males in the 12-month follow-up were hair loss (5.4 vs. 0.7%, p < 0.001), memory and concentration disturbances (8.4 vs. 4.3%, p = 0.013), and headaches (4.3 vs. 1.4%, p = 0.008). Females presented lower mean arterial pressure (MAP) [89 (83–95) mmHg versus (vs.) 94 (89–100); p < 0.001] and lower pulse pressure (PP) [46 (42–52) mmHg vs. 51 (48–57); p < 0.001] in 24 h ABPM and more elevated heart rates (HRs) in 24 h ECG monitoring as well as arrhythmia (p < 0.001 and p = 0.018, respectively). Males had a higher occurrence of ECG abnormalities such as QRS >= 120 ms, ST-T changes, T inversion, arrhythmia, and QRS fragmentation (27.3% vs. 19.2%; p = 0.004). No significant differences were observed between males and females concerning physical activity levels, stress, fatigue, alcohol consumption, and smoking habits. Conclusions: One year post-COVID-19 recovery, regardless of age and BMI, healthy females more often suffered from LC symptoms than males. They had lower MAP and PP in 24 h ABPM, more often had higher HRs and arrhythmia in 24 h ECG monitoring, and fewer ECG abnormalities than males. Full article

This study examined the post-surgery recovery of olive flounder (Paralichthys olivaceus) following tag insertion by analyzing behavior, heart rate, and wound healing. The experiments used 30 individuals (length: 38.67 ± 2.12 cm; weight: 742.48 ± 116.41 g). Heart rate was measured using a DST milli-HRT (Star-Oddi) bio-logger. To assess the influence of water temperature on the recovery process after surgical tag insertion, behavioral analyses, heart rate, and wound healing were conducted in two experimental groups: Experiment 1 (22 °C, optimal water temperature); Experiment 2 (28 °C, high water temperature); and control group (22 °C, non-operated fish). The experiment was repeated twice over a 7-day period for each experimental group. Compared to the non-operated fish, the operated fish exhibited stable levels after the 3rd to 4th day in Experiment 1. Statistical analyses based on heart rate in Experiment 1 indicated that the appropriate post-surgery recovery time point was approximately 3 days, representing the point at which behavioral fluctuations stabilized. In the case of Experiment 2, abnormal behavioral patterns (e.g., tilted swimming) and changes in average swimming time and daily heart rate were found to stabilize after 4 days post-surgery. Full article

In this work, we propose an algorithm for the detection, measurement and classification of discontinuities in signals captured with noise. Our approach is based on the Harten’s subcell-resolution approximation adapted to the presence of noise. This technique has several advantages over other algorithms. The first is that there is a theory that allows us to ensure that discontinuities will be detected as long as we choose a sufficiently small discretization parameter size. The second is that we can consider different types of discretizations such as point values or cell-averages. In this work, we will consider the latter, as it is better adapted to functions with small oscillations, such as those caused by noise, and also allows us to find not only the discontinuities of the function, jumps in functions or edges in images, but also those of the derivative, corners. This also constitutes an advantage over classical procedures that only focus on jumps or edges. We present an application related to heart rate measurements used in sport as a physical indicator. With our algorithm, we are able to identify the different phases of exercise (rest, activation, effort and recovery) based on heart rate measurements. This information can be used to determine the rotation timing of players during a game, identifying when they are in a rest phase. Moreover, over time, we can obtain information to monitor the athlete’s physical progression based on the slope size between zones. Finally, we should mention that regions where heart rate measurements are abnormal indicate a possible cardiac anomaly. Full article

Background and Objectives: Assessment of the prothrombotic, proinflammatory, and functional status of a cohort of COVID-19 patients at least two years after the acute infection to identify parameters with potential therapeutic and prognostic value. Materials and Methods: We conducted a retrospective, descriptive study that included 117 consecutive patients admitted to Iasi Pulmonary Rehabilitation Clinic for reassessment and a rehabilitation program at least two years after a COVID-19 infection. The cohort was divided into two groups based on the presence (n = 49) or absence (n = 68) of pulmonary fibrosis, documented through high-resolution computer tomography. Results: The cohort comprises 117 patients, 69.23% females, with a mean age of 65.74 ± 10.19 years and abnormal body mass index (31.42 ± 5.71 kg/m²). Patients with pulmonary fibrosis have significantly higher levels of C-reactive protein (CRP) (p < 0.05), WBC (7.45 ± 7.86/mm³ vs. 9.18 ± 17.24/mm³, p = 0.053), neutrophils (4.68 ± 7.88/mm³ vs. 9.07 ± 17.44/mm³, p < 0.05), mean platelet volume (MPV) (7.22 ± 0.93 vs. 10.25 ± 0.86 fL, p < 0.05), lactate dehydrogenase (p < 0.05), and D-dimers (p < 0.05), but not ferritin (p = 0.470), reflecting the chronic proinflammatory and prothrombotic status. Additionally, patients with associated pulmonary fibrosis had a higher mean heart rate (p < 0.05) and corrected QT interval (p < 0.05). D-dimers were strongly and negatively correlated with diffusion capacity corrected for hemoglobin (DLCO corr), and ROC analysis showed that the persistence of high D-dimers values is a predictor for low DLCO values (ROC analysis: area under the curve of 0.772, p < 0.001). The results of pulmonary function tests (spirometry, body plethysmography) and the 6-minute walk test demonstrated no significant difference between groups, without notable impairment within either group. Conclusions: Patients with COVID-19-related pulmonary fibrosis have a persistent long-term proinflammatory, prothrombotic status, despite the functional recovery. The persistence of elevated D-dimer levels could emerge as a predictive factor associated with impaired DLCO. Full article

(1) Background: The coronavirus disease 2019 (COVID-19) infection is often followed by various complications, which can cause disturbances in daily life after recovery from the infectious state, although etiological mechanisms are not fully elucidated. Previous studies have indicated that autonomic dysregulation is an underlying factor, and it is of interest to clarify whether autonomic dysregulation is also present in the asymptomatic subjects after COVID-19 infection (post-COVID-19) for early detection of post-COVID-19 complications. (2) Methods: In the present study, autonomic activity was assessed using heart rate variability (HRV) analysis in the workers who recovered from mild COVID-19 infection (n = 39). They took a leave of absence for an average of 11.9 days and returned to the original work without complications. HRV was measured after an average of 9.3 days from return. High-frequency (HF) and low-frequency (LF) HRV parameters and heart rate (HR) were recorded during a three-behavioral-state paradigm of approximately 5 min length composed of initial rest, task load, and post-task rest periods and were compared with the data of the workers without the history of COVID-19 infection (normal, n = 38). (3) Results: The HRV and HR scores at the initial rest in the post-COVID-19 subjects showed no difference from those in the control. It is found that the post-COVID-19 subjects exhibited an attenuation of LF/HF increment during the task load and an excessive increase of HF together with a decrease of LF, LF/HF and HR during the post-task rest period in comparison with the initial rest scores. (4) Conclusions: These abnormalities are evaluated as asymptomatic autonomic dysregulation in response to task load, are frequently present after COVID-19 infection, and could be related to the generation of complications. Full article

Autonomic nervous system (ANS) abnormalities are associated with major depressive disorder (MDD) already at adolescent age. The majority of studies so far evaluated parasympathetic and sympathetic branches of ANS individually, although composite indices including cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) seem to measure ANS functioning more comprehensively and thus could provide better psychopathologies’ predictors. We aimed to study CAB and CAR derived from high-frequency bands of heart rate variability and left ventricular ejection time during complex stress response (rest–Go/NoGo task–recovery) in MDD adolescents with respect to sex. We examined 85 MDD adolescents (52 girls, age: 15.7 ± 0.14 yrs.) and 80 age- and sex-matched controls. The MDD group showed significantly reduced CAB compared to controls at rest, in response to the Go/NoGo task, and in the recovery phase. Moreover, while depressed boys showed significantly lower CAB at rest and in response to the Go/NoGo task compared to control boys, depressed girls showed no significant differences in evaluated parameters compared to control girls. This study for the first time evaluated CAB and CAR indices in drug-naïve first-episode diagnosed MDD adolescents during complex stress responses, indicating an altered cardiac autonomic pattern (i.e., reciprocal sympathetic dominance associated with parasympathetic underactivity), which was predominant for depressed boys. Full article

Muscle fatigue is a common symptom induced by exercise. A reversible loss of muscle force is observed with variable rates of recovery depending on the causes or underlying mechanisms. It can not only affect locomotion muscles, but can also affect the heart, in particular after intense prolonged exercise such as marathons and ultra-triathlons. The goal of our study was to explore the effect of four different natural extracts with recognized antioxidant properties on the contractile function of skeletal (locomotion) and cardiac muscles after a prolonged exhausting exercise. Male Wistar rats performed a bout of exhausting exercise on a treadmill for about 2.5 h and were compared to sedentary animals. Some rats received oral treatment of a natural extract (rosemary, buckwheat, Powergrape^®, or rapeseed) or the placebo 24 h and 1 h before exercise. Experiments were performed 30 min after the race and after 7 days of recovery. All natural extracts had protective effects both in cardiac and skeletal muscles. The extent of protection was different depending on muscle type and the duration post-exercise (just after and after one-week recovery), including antiarrhythmic effect and anti-diastolic dysfunction for the heart, and faster recovery of contractility for the skeletal muscles. Moreover, the muscular protective effect varied between natural extracts. Our study shows that an acute antioxidant supplementation can protect against acute abnormal endogenous ROS toxicity, induced here by prolonged exhausting exercise. Full article

Several reports have shown the impact of COVID-19 history on exercise capacity. This study compared the blood pressure (BP) response and oxygen pulse (O₂ pulse) characteristics in normotensive patients with and without a history of COVID-19 during the cardiopulmonary exercise test (CPET) and post-exercise recovery. This cross-sectional study involved 130 healthy Caucasian adult volunteers (71 participants with a history of COVID-19). All patients underwent the CPET with blood pressure measurements during exercise and post-exercise recovery. The post-COVID group had significantly higher systolic, diastolic, and mean blood pressure after 9 min of recovery and achieved a significantly lower max O₂ pulse (2.02 mL/beat on average) than the controls. It should be noted that the COVID group tended to have higher blood pressure values in all steps, with no differences in heart rate, pulse pressure, and saturation at any step. The COVID-19 outbreak was associated with a higher blood pressure response, significantly, in post-exercise recovery, a lower maximum O₂ pulse, and a lower maximum load achievement. Future studies are needed to determine if these abnormalities during the CPET and the blood pressure variation have prognostic value. Full article

CHARGE syndrome typically results from mutations in the gene encoding chromodomain helicase DNA-binding protein 7 (CHD7). CHD7 is involved in regulating neural crest development, which gives rise to tissues of the skull/face and the autonomic nervous system (ANS). Individuals with CHARGE syndrome are frequently born with anomalies requiring multiple surgeries and often experience adverse events post-anesthesia, including oxygen desaturations, decreased respiratory rates, and heart rate abnormalities. Central congenital hypoventilation syndrome (CCHS) affects ANS components that regulate breathing. Its hallmark feature is hypoventilation during sleep, clinically resembling observations in anesthetized CHARGE patients. Loss of PHOX2B (paired-like homeobox 2b) underlies CCHS. Employing a chd7-null zebrafish model, we investigated physiologic responses to anesthesia and compared these to loss of phox2b. Heart rates were lower in chd7 mutants compared to the wild-type. Exposure to tricaine, a zebrafish anesthetic/muscle relaxant, revealed that chd7 mutants took longer to become anesthetized, with higher respiratory rates during recovery. chd7 mutant larvae demonstrated unique phox2ba expression patterns. The knockdown of phox2ba reduced larval heart rates similar to chd7 mutants. chd7 mutant fish are a valuable preclinical model to investigate anesthesia in CHARGE syndrome and reveal a novel functional link between CHARGE syndrome and CCHS. Full article