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Biomedical subjects

L Glass

Publications and source records attributed to L Glass.

At least 19 recordsLinked to original sources

Apparent discontinuities in the phase-resetting response of cardiac pacemakers.

Injection of a brief stimulus pulse resets the spontaneous periodic activity of a sinoatrial node cell: a stimulus delivered early in the cycle generally delays the time of occurrence of the next action potential, while the same stimulus delivered later causes an advance. We investigate resetting in two models, one with a slow upstroke velocity and the other with a fast upstroke velocity, representing central and peripheral nodal cells, respectively. We first formulate each of these models as a classic Hodgkin-Huxley type of model and then as a model representing a population of single channels. In the Hodgkin-Huxley-type model of the slow-upstroke cell the transition from delay to advance is steep but continuous. In the corresponding single-channel model, due to the channel noise then present, repeated resetting runs at a fixed stimulus timing within the transitional range of coupling intervals lead to responses that span a range of advances and delays. In contrast, in the fast-upstroke model the transition from advance to delay is very abrupt in both classes of model, as it is in experiments on some cardiac preparations ("all-or-none" depolarization). We reduce the fast-upstroke model from the original seven-dimensional system to a three-dimensional system. The abrupt transition occurs in this reduced model when a stimulus transports the state point to one side or the other of the stable manifold of the trajectory corresponding to the eigendirection associated with the smaller of two positive eigenvalues. This stable manifold is close to the slow manifold, and so canard trajectories are seen. Our results demonstrate that the resetting response is fundamentally continuous, but extremely delicate, and thus suggest one way in which one can account for experimental discontinuities in the resetting response of a nonlinear oscillator.

Animals↗

Effect of misoprostol (PGE1) on glucose metabolism in type-2-diabetic and control subjects.

In vitro and in vivo studies have demonstrated that prostaglandins of the E series enhance muscle glucose uptake. We examined the effect of acute misoprostol (PGE1) administration on whole body insulin-mediated glucose disposal, as well as the major intracellular pathways of glucose metabolism in type 2 diabetic (n = 10) and non-diabetic (n = 4) subjects. Each subject received two 240-min euglycaemic insulin (40 mU/m2/min) clamp studies with tritiated glucose and indirect calorimetry. During one of the insulin clamp studies, 200 microg of misoprostol was ingested at 90 and 150 min after the start of the insulin infusion. Insulin-mediated total body glucose disposal, glycolysis, glycogenesis and glucose oxidation were similar during the insulin clamp studies performed without and with misoprostol in both the diabetic and non-diabetic groups. These results demonstrate that the acute administration of misoprostol does not enhance insulin-mediated glucose disposal in either type-2-diabetic or non-diabetic subjects.

Blood Glucose↗

Noise effects on the complex patterns of abnormal heartbeats.

Patients at high risk for sudden death often exhibit complex heart rhythms in which abnormal heartbeats are interspersed with normal heartbeats. We analyze such a complex rhythm in a single patient over a 12-h period and show that the rhythm can be described by a theoretical model consisting of two interacting oscillators with stochastic elements. By varying the magnitude of the noise, we show that for an intermediate level of noise, the model gives best agreement with key statistical features of the dynamics.

Arrhythmias, Cardiac↗

Synchronization and rhythmic processes in physiology.

Complex bodily rhythms are ubiquitous in living organisms. These rhythms arise from stochastic, nonlinear biological mechanisms interacting with a fluctuating environment. Disease often leads to alterations from normal to pathological rhythm. Fundamental questions concerning the dynamics of these rhythmic processes abound. For example, what is the origin of physiological rhythms? How do the rhythms interact with each other and the external environment? Can we decode the fluctuations in physiological rhythms to better diagnose human disease? And can we develop better methods to control pathological rhythms? Mathematical and physical techniques combined with physiological and medical studies are addressing these questions and are transforming our understanding of the rhythms of life.

Models, Biological↗

Automatic detection of atrial fibrillation using the coefficient of variation and density histograms of RR and deltaRR intervals.

The paper describes a method for the automatic detection of atrial fibrillation, an abnormal heart rhythm, based on the sequence of intervals between heartbeats. The RR interval is the interbeat interval, and deltaRR is the difference between two successive RR intervals. Standard density histograms of the RR and deltaRR intervals were prepared as templates for atrial fibrillation detection. As the coefficients of variation of the RR and deltaRR intervals were approximately constant during atrial fibrillation, the coefficients of variation in the test data could be compared with the standard coefficients of variation (CV test). Further, the similarities between the density histograms of the test data and the standard density histograms were estimated using the Kolmogorov-Smirnov test. The CV test based on the RR intervals showed a sensitivity of 86.6% and a specificity of 84.3%. The CV test based on the deltaRR intervals showed that the sensitivity and the specificity are both approximately 84%. The Kolmogorov-Smirnov test based on the RR intervals did not improve on the result of the CV test. In contrast, the Kolmogorov-Smirnov test based on the ARR intervals showed a sensitivity of 94.4% and a specificity of 97.2%.

Atrial Fibrillation↗

Effect of rosiglitazone on glucose and non-esterified fatty acid metabolism in Type II diabetic patients.

AIMS/HYPOTHESIS: We aimed to examine the mechanisms by which rosiglitazone improves glycaemic control in Type II (non-insulin-dependent) diabetic patients. METHODS: Altogether 29 diet-treated diabetic patients were assigned at random to rosiglitazone, 8 mg/day (n = 15), or placebo (n = 14) for 12 weeks. Patients received 75 g OGTT and two-step euglycaemic insulin (40 and 160 mU/m(2)min) clamp with 3-(3)H-glucose, (14)C-palmitate and indirect calorimetry. RESULTS: After 12 weeks, rosiglitazone reduced fasting plasma glucose (195 +/- 11 to 150 +/- 7 mg/dl, p < 0.01), mean plasma glucose (PG) during OGTT (293 +/- 12 to 236 +/- 9 mg/dl, p < 0.01), and HbA1 c (8.7 +/- 0.4 to 7.4 +/- 0.3 %, p < 0.01) without changes in plasma insulin concentration. Basal endogenous glucose production (EGP) declined (3.3 +/- 0.1 to 2.9 +/- 0.1 mg/kg FFM. min, p < 0.05) and whole body glucose metabolic clearance rate increased after rosiglitazone (first clamp step: 2.8 +/- 0.2 to 3.5 +/- 0.2 ml/kg FFM. min, p < 0.01; second clamp step: 6.7 +/- 0.6 to 9.2 +/- 0.8, p < 0.05) despite increased body weight (86 +/- 4 to 90 +/- 4 kg, p < 0.01) and fat mass (33 +/- 3 to 37 +/- 3 kg, p < 0.01). Fasting plasma non-esterified fatty acid (NEFA) (735 +/- 52 to 579 +/- 49 microEq/l, p < 0.01), mean plasma NEFA during OGTT (561 +/- 33 to 424 +/- 35, p < 0.01), and basal NEFA turnover (18.3 +/- 1.5 to 15.5 +/- 1.2 microEq/kg FM. min, p < 0.05) decreased after rosiglitazone. Changes in EPG and mean plasma glucose (PG) during OGTT correlated with changes in basal EGP (r = 0.54; r = 0.58), first EGP (r = 0.36; r = 0.41), first MCR (r = -0.66; r = -0.68), second MCR (r = -0.49; r = -0.54), fasting plasma NEFA (r = 0.53; r = 0.49), and NEFA during OGTT (r = 0.66; r = 0.66). CONCLUSION/INTERPRETATION: Rosiglitazone increases hepatic and peripheral (muscle) tissue insulin sensitivity and reduces NEFA turnover despite increased total body fat mass. These results suggest that the beneficial effects of rosiglitazone on glycaemic control are mediated, in part, by the drug's effect on NEFA metabolism.

Adult↗

Improved glycemic control and enhanced insulin sensitivity in type 2 diabetic subjects treated with pioglitazone.

OBJECTIVE: To elucidate the effects of pioglitazone treatment on glucose and lipid metabolism in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 23 diabetic patients (age 30-70 years BMI < 36 kg/m2) who being treated with a stable dose of sulfonylurea were randomly assigned to receive either placebo (n = 11) or pioglitazone (45 mg/day) (n = 12) for 16 weeks. Before and after 16 weeks of treatment, all subjects received a 75-g oral glucose tolerance test (OGTT) and hepatic peripheral insulin sensitivity was measured with a two-step euglycemic insulin (40 and 160 mU x min(-1) x m(-2) clamp performed with 3-[3H]glucose and indirect calorimetry HbA1c measured monthly throughout the study period. RESULTS: After 16 weeks of pioglitazone treatment, the fasting plasma glucose (FPG; 184 +/- 15 to 135 +/- 11 mg/dl, P < 0.01), mean plasma glucose during OGTT(293 +/- 12 to 225 +/- 14 mg/dl, P < 0.01), and HbA1c (8.9 +/- 0.3 to 7.2 +/- 0.5%, P < 0.01 ) decreased significantly without change in fasting or glucose-stimulated insulin/C-peptide concentrations. Fasting plasma free fatty acid (FFA; 647 +/- 39 to 478 +/- 49) microEq/l, P < 0.01) and mean plasma FFA during OGTT (485 +/- 30 to 347 +/- 33 microEq/l, P < 0.01) decreased significantly after pioglitazone treatment. Before and after pioglitazone treatment, basal endogenous glucose prodution (EGP) and FPG were strongly correlated (r = 0.67, P < 0.01). EGP during the first insulin clamp step was significantly decreased after pioglitazone treatment (P < 0.05) whereas insulin-stimulated total and nonoxidative glucose disposal during the second insulin clamp was increased (P < 0.01). The change in FPG was related to the change in basal EGP, EGP during the first insulin clamp step, and total glucose disposal during the second insulin clamp step. The change in mean plasma glucose concentration during the OGGTT was strongly related to the change in total body glucose disposl during the second insulin clamp step. CONCLUSIONS: These results suggest that pioglitazone therapy in type 2 diabetic patients decreases lasting and postprandial plasma glucose levels by improving hepatic and peripheral (muscle) tissue sensitivity to insulin.

Adipose Tissue↗

PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals.

The newly inaugurated Research Resource for Complex Physiologic Signals, which was created under the auspices of the National Center for Research Resources of the National Institutes of Health, is intended to stimulate current research and new investigations in the study of cardiovascular and other complex biomedical signals. The resource has 3 interdependent components. PhysioBank is a large and growing archive of well-characterized digital recordings of physiological signals and related data for use by the biomedical research community. It currently includes databases of multiparameter cardiopulmonary, neural, and other biomedical signals from healthy subjects and from patients with a variety of conditions with major public health implications, including life-threatening arrhythmias, congestive heart failure, sleep apnea, neurological disorders, and aging. PhysioToolkit is a library of open-source software for physiological signal processing and analysis, the detection of physiologically significant events using both classic techniques and novel methods based on statistical physics and nonlinear dynamics, the interactive display and characterization of signals, the creation of new databases, the simulation of physiological and other signals, the quantitative evaluation and comparison of analysis methods, and the analysis of nonstationary processes. PhysioNet is an on-line forum for the dissemination and exchange of recorded biomedical signals and open-source software for analyzing them. It provides facilities for the cooperative analysis of data and the evaluation of proposed new algorithms. In addition to providing free electronic access to PhysioBank data and PhysioToolkit software via the World Wide Web (http://www.physionet. org), PhysioNet offers services and training via on-line tutorials to assist users with varying levels of expertise.

Databases as Topic↗

Paroxysmal starting and stopping of circulating waves in excitable media.

Levels of intracellular Ca2+ were monitored using fluorescence from Ca2+-sensitive dyes in chick embryonic heart cells cultured in an annular geometry. There was spontaneous starting and stopping of reentrant waves of activity. The results are modeled using modified FitzHugh-Nagumo equations representing pacemakers embedded in a conducting medium. These results provide a potential mechanism for spontaneous abnormal cardiac rhythms in which there are rapid heart beats (tachycardias) that repetitively start and stop.

Algorithms↗

Evaluation of a manual wheelchair interface to computer games.

The sedentary lifestyle of many people with spinal cord injury (SCI) has lead to cardiovascular diseases being a major health concern. A suitable exercise program may help improve the SCI individual's cardiovascular fitness level. GAMEWheels is an interface between a custom wheelchair roller system and a computer that enables an individual to control computer video games by driving his or her wheelchair. The purpose of Phase 1 was to evaluate the design of the GAMEWheels system and to determine the type of computer video game that is likely to motivate wheelchair users to exercise. Phase 2 included physiologic testing of wheelchair users and the GAMEWheels system to investigate whether the system elicits an exercise training response. Thirty-five subjects were recruited to evaluate the GAMEWheels by playing three commercial computer games (Phase 1) and to identify the computer game that they would prefer to use when exercising. The feedback from Phase 1 was used with test subjects to verify that the GAMEWheels system elicits an exercise training effect (Phase 2). Phase 2 included 10 subjects using the GAMEWheels system to play Need for Speed II. During game play, physiologic data were collected and the subjects' oxygen consumption and heart rate were analyzed. Analysis showed that the GAMEWheels system induced nine subjects to reach their training zone, defined as 50% and 60% of their maximum oxygen consumption and heart rate, respectively. This study demonstrates that the GAMEWheels system elicits an exercise training response.

Adult↗

Parkinsonian tremor and simplification in network dynamics.

We explore the behavior of richly connected inhibitory neural networks under parameter changes that correspond to weakening of synaptic efficacies between network units, and show that transitions from irregular to periodic dynamics are common in such systems. The weakening of these connections leads to a reduction in the number of units that effectively drive the dynamics and thus to simpler behavior. We hypothesize that the multiple interconnecting loops of the brain's motor circuitry, which involve many inhibitory connections, exhibit such transitions. Normal physiological tremor is irregular while other forms of tremor show more regular oscillations. Tremor in Parkinson's disease, for example, stems from weakened synaptic efficacies of dopaminergic neurons in the nigro-striatal pathway, as in our general model. The multiplicity of structures involved in the production of symptoms in Parkinson's disease and the reversibility of symptoms by pharmacological and surgical manipulation of connection parameters suggest that such a neural network model is appropriate. Furthermore, fixed points that can occur in the network models are suggestive of akinesia in Parkinson's disease. This model is consistent with the view that normal physiological systems can be regulated by robust and richly connected feedback networks with complex dynamics, and that loss of complexity in the feedback structure due to disease leads to more orderly behavior.

Humans↗

Locating ectopic foci.

INTRODUCTION: Successful radiofrequency ablation of an ectopic focus requires accurate localization of the region of enhanced automaticity. Present localization techniques require detailed electrical mapping that is time-consuming and involves much trial and error. Here, we propose two new localization techniques which were used to locate a pacemaker in a computer simulation. METHODS AND RESULTS: We suggest that an ectopic focus can be located by measuring the activation sequence of three or more intracardiac electrodes subsequent to an ectopic depolarization. Furthermore, the resetting response of an ectopic pacemaker can be used to estimate the distance from the stimulation electrode to the ectopic focus. We derive simple geometric localization strategies based on these ideas and examine the sensitivity of the strategies with respect to measurement uncertainties and electrode arrangements. Our localization strategies were tested using a numerical simulation of a pacemaker in a sheet of excitable media described by modified FitzHugh-Nagumo equations. The strategy based on electrode activation sequences located the pacemaker region in a homogeneous isotropic sheet after an average of 2.2 +/- 0.8 iterates in 10 out of 10 trials starting from random initial catheter positions. In the case of an inhomogeneous anisotropic sheet, the pacemaker was located after an average of 4 +/- 3 iterates in 9 out of 10 trials. The localization strategy based on resetting successfully found the pacemaker in a homogeneous isotropic sheet after an average of 1.2 +/- 0.4 iterates in 5 out of 5 trials and localized the pacemaker in an inhomogeneous anisotropic sheet after an average of 1.4 +/- 0.5 iterates in 5 out of 5 trials. CONCLUSIONS: Simple geometric strategies can be used to locate an ectopic focus. Although our basic localization strategies are sensitive to the electrode arrangement and measurement uncertainties, we show that iteration of our techniques quickly locates the pacemaker.

Cardiac Pacing, Artificial↗

Bursting calcium rotors in cultured cardiac myocyte monolayers.

Rotating waves (rotors) of cellular activity were observed in nonconfluent cultures of embryonic chick heart cells by using a macroscopic imaging system that detected fluorescence from intracellular Ca2+. Unlike previous observations of rotors or spiral waves in other systems, the rotors did not persist but exhibited a repetitive pattern of spontaneous onset and offset leading to a bursting rhythm. Similar dynamics were observed in a cellular automaton model of excitable media that incorporates spontaneous initiation of activity, and a decrease of excitability as a consequence of rapid activity (fatigue). These results provide a mechanism for bursting dynamics in normal and pathological biological processes.

Animals↗

Reduced heat loss following sucrose ingestion in premature and normal human newborns.

To determine the energy savings caused by sucrose taste, we measured heat loss through direct calorimetry for 23 premature and normal term infants who were studied a total of 31 times. Following stabilization in the calorimeter, crying was induced by applying 1 ml cold water to the infant's foot. After 4 min, 0.1 or 0.2 ml sucrose were delivered intraorally through a remote syringe to arrest crying. Crying was accompanied by a 13.2% increase in metabolic rate that was quickly and completely reversed during crying cessation caused by sucrose taste. Heat loss was inversely and linearly related to infant body weight. The implications of these findings for minimizing crying and energy expenditure in normal newborns and especially in ill or small newborns are discussed.

Basal Metabolism↗

Bursting behavior during fixed-delay stimulation of spontaneously beating chick heart cell aggregates.

Spontaneously beating embryonic chick atrial heart cell aggregates were stimulated with depolarizing current pulses delivered at a fixed delay after each action potential. This preparation is an experimental model of a reentrant tachycardia. During fixed-delay stimulation, bursting behavior was typically observed for a wide range of delays. Episodes of bursting at a rate faster (slower) than control were followed by overdrive suppression (underdrive acceleration). We use a simple nonlinear model, based on the interaction between excitability and overdrive suppression, to describe these dynamics. A modified version of the Shrier-Clay ionic model of electrical activity of the embryonic chick heart cell aggregates that includes a simplified Na+ pump term is also presented. We show that the complex patterns during fixed-delay stimulation arise as a result of delicate interactions between overdrive suppression and phase resetting, which can be described in terms of the underlying ionic mechanisms. This study may provide a basis for understanding incessant tachycardias in the intact heart, as well as an alternative mechanism for the emergence of bursting activity in other biologic tissue.

Action Potentials↗

Entrainment and annihilation of reentrant excitation in a periodically stimulated ring of excitable media.

Excitable media, such as nerve, heart and the Belousov-Zhabotinsky reaction, exhibit a large excursion from equilibrium in response to a small but finite perturbation. Assuming a one-dimensional ring geometry of sufficient length, excitable media support a periodic wave of circulation. As in the periodic stimulation of oscillations in ordinary differential equations, the effects of periodic stimuli of the periodically circulating wave can be described by a one-dimensional Poincaré map. Depending on the period and intensity of the stimulus as well as its initial phase, either entrainment or termination of the original circulating wave is observed. These phenomena are directly related to clinical observations concerning periodic stimulation of a class of cardiac arrhythmias caused by reentrant wave propagation in the human heart.

Cardiac Pacing, Artificial↗

Counting and classifying attractors in high dimensional dynamical systems.

Randomly connected Boolean networks have been used as mathematical models of neural, genetic, and immune systems. A key quantity of such networks is the number of basins of attraction in the state space. The number of basins of attraction changes as a function of the size of the network, its connectivity and its transition rules. In discrete networks, a simple count of the number of attractors does not reveal the combinatorial structure of the attractors. These points are illustrated in a reexamination of dynamics in a class of random Boolean networks considered previously by Kauffman. We also consider comparisons between dynamics in discrete networks and continuous analogues. A continuous analogue of a discrete network may have a different number of attractors for many different reasons. Some attractors in discrete networks may be associated with unstable dynamics, and several different attractors in a discrete network may be associated with a single attractor in the continuous case. Special problems in determining attractors in continuous systems arise when there is aperiodic dynamics associated with quasiperiodicity of deterministic chaos.

Animals↗